Care Bill Allows ‘Aerial View’ Response To Provider Failure

Clauses 118 and 119 of the Care Bill will allow TSAs to take an ‘aerial view’ of the whole health economy and find the best way forward where communities are affected by change that extends beyond a provider in crisis, the NHS Confederation has said.

The organisation made the comments ahead of a vote on the clauses by MPs in the House of Commons on March 11th

Speaking ahead of the vote, NHS Confederation chief executive Rob Webster, said: “These clauses deal with a situation where there has been a catastrophic failure. This will be something that affects the whole health economy.

“We understand that the trust special administrator (TSA) will need to take a whole system view and the context in which a failing organisation operates and take a whole-system approach to developing a way forward.”

The NHS Confederation worked with the Foundation Trust Network and others to call for amendments to the Care Bill to require TSAs to consult with and consider the views of the organisations affected by any broader change the TSA recommends in the wider economy.

Mr Webster explained: “The debate has centred on these powers driving change across the NHS, with little regard to public consultation.

“We believe that this will not happen if radical change is planned and not crisis driven. This planned approach allows for effective consultation and works within the existing rules.

“What is essential is that, across England, politicians and the public understand the urgent need for change in order that the health service continues to remain sustainable,” he said.

“This is why our 2015 Challenge calls on both politicians to create the space for the change needed and local NHS organisations to be ready to make the essential changes.”

MPs debated the remaining stages of the Care Bill on 10 and 11 March. Ahead of the debate, the NHS Confederation put forward several recommendations to ensure the intentions behind the legislation become a reality.

In a briefing issued to parliamentarians last week, the Confederation agreed with the Care and Support Alliance that the objectives of the Care Bill and social care reform will not be met without sufficient funding.

With a funding gap between what the Dilnot reforms will provide and the resources needed in social care, the organisation urged for the shortfall to be addressed.

NHS Confederation members have told the organisation that when people’s needs are not met by the social care system, they turn to the NHS, resulting in an increased demand for emergency and unplanned work, and delays in discharging people from hospital.

This has had a big impact on the number of people admitted to hospital as emergencies, and delays in discharging patients, the Confederation said.

The organisation has long argued that a sustainable long-term funding settlement for social care that allows local authorities to spend money on all those who need care is crucial if current pressures on the NHS are to be relieved.

Social care plays a key role in preventing people from reaching crisis point when they need more intensive and costly treatment, and therefore needs to be funded to keep people as well as possible, for as long as possible.

Though the Better Care Fund (BCF) helps by providing a mechanism for pooling some resources across health and social care and using these where they will deliver the best outcomes for local populations, it must be made clear that the fund is not new money, and that delivering good care with limited resources will require tough choices, the Confederation said.

The briefing also emphasised the need for the health and care system as a whole to work together to reshape care in order to meet the needs of the high – and growing – number of people with long-term conditions and often complex needs.

The health service is still largely structured as it was decades ago, when the main expectation was the treatment of one-off episodes of illness.

The health service now needs to provide much more community-based care, and join NHS care seamlessly with social care, in order to keep people as well as possible for as long as possible, and prevent them reaching crisis point, the briefing argues.

The organisation cautioned that if a post-election drive for change in the way care is provided is not achieved, it is possible the current basis of the NHS, free for all at the point of need, will become unsustainable in the future.