The much talked-about Health and Social Care Bill has now returned to Parliament with some very significant government amendments after its two-month ‘pause’. The bill’s lasting impact on the NHS has been the subject of heated debate and disagreement and will doubtless continue to be throughout its passage through Parliament.
What matters most about the bill, though, has at times been obscured or at least debated only at the margins. Changes to the way the NHS works are not, and should never be, ends in themselves. They are the means by which taxpayers’ investment in our national health service achieves the greatest possible impact on our health, wellbeing and quality of life.
The NHS was created as a key component of the post-war welfare state. It was seen as an economic as well as social good; a way of achieving the best possible value for money in the way health care is paid for and organised. And it was inextricably linked to the other pillars of the Welfare State, such as housing, social security and National Assistance (the forerunner of social care).
The Health and Social Care Bill will likewise have a big impact not just on the NHS but on the lives of the people who rely on it. And it will affect a range of other public services: not just social care but also employment, housing and criminal justice among others.
The importance of integration was one of the central ideas of the Future Forum report. The government’s amendments to the bill thus seek to enhance integration in the new health system. But they do so as if health and social care exists in a bubble.
Integration within health and social care is of course vital. This is not just the case for older people and those with long-term conditions but for people who fall between service silos, such as those with a ‘dual diagnosis’ of mental health and substance use problems whose care is too often anything but integrated.
But integration can apply successfully beyond health and social care. Good, safe and if needs be supported housing is often the key to hospital discharges, for everyone from frail older people to patients in secure mental health wards. Links between housing and health are just as important as those with social care. Yet Health and Wellbeing Boards are in danger of being constituted without their active involvement.
Health and Wellbeing Boards have huge potential to act as the ‘glue’ to bring together a range of local agencies to promote good health and support the most vulnerable and disadvantaged. But without genuine cross-agency involvement they may find it hard to break down the silos that prevent services working together to meet commons goals.
As clinical commissioning groups begin to form and local authorities take on their extended roles in promoting public health, it is vital that they take the opportunity to build effective relationships with other public services. Tackling the determinants of ill health, intervening early when people become unwell and supporting those with the greatest needs remain big challenges for the health system. Yet they are also where it has the most potential to contribute towards the wellbeing of society as a whole: its fundamental purpose.
While the bill gets debated in Parliament and eventually implemented in the world outside, it is vital that we stay focused on ends, not means, and on how best the NHS and its many partners can make a difference to people’s lives.