Integration White Paper: BASW England initial response

The role of social workers as the main registered social care profession within integrated systems must be heard and represented within any new structures

BASW England welcomes the long-awaited integration white paper which was introduced by the Department for Health and Social Care on 9th February. This response comments on key themes and further analysis of the White Paper will follow.

The paper, titled Health and social care integration: joining up care for people, places and populations, seeks to bring together the NHS and local government more closely to “jointly deliver for local communities”.

The proposals are underpinned by experiences from the Covid-19 pandemic. In his oral statement introducing the paper, Minister of State for Health, Edward Argar MP said this period showed how “we were at our best when we were working across traditional boundaries towards a common goal."

The white paper sits alongside what they call “mutually reinforcing reforms”, including the Health and Care Bill as well as the Social Care white paper.

The paper focuses on the following key areas:

  • Delivering more integrated services for the 21st century: This section makes the case for further integration of services, reflecting on the power of collaboration as seen in the pandemic whilst exploring how they can “maximise the chances for health gain at every opportunity”.
  • Shared outcomes: Work with stakeholders will commence to pull together a framework that will set out national priorities for individual and public health wellbeing as well as how this can be delivered at a local level.
  • Leadership, accountability, and finance: The paper proposes there should be single leaders in local “places” or areas to focus on shared outcomes, who will work directly with local partners and be agreed by “the relevant authority or authorities and Integrated Care Board (ICB). This is intended to help provide clarity around decision-making.
  • Finance and integration: Government will work with partners to “develop guidance for local authorities and the NHS to support going further and faster on financial alignment and pooling”. How existing budgets are pooled across the NHS and local government will be considered to explore how shared outcomes can be achieved.
  • Digital and data: This section supports a centralised approach to data sharing with the hope of transparency being delivered through the digital and data transformation plans.
  • The health and care workforce and carers: Proposals build on those set out in the social care reform white paper, with a focus on improving initial training and ongoing learning and development opportunities for staff across health and care.

Whilst we support better integration to improve people’s experience and outcomes, we are aware that forms of integration and enabling legislation over three decades have not achieved sustained success. Reasons have included lack of parity (in funding and status) between health and social care, different practice, governance and legal frameworks and different workforce resourcing and employment arrangements.

The role of social workers as the main registered social care profession within integrated systems must be heard and represented within any new structures.  We will continue to advocate for the voice and requirements of social workers and for better whole system, interdisciplinary workforce plans and resourcing.

A new framework for integration must learn from what has and has not worked and resolve structural barriers to whole system working and leadership, as well as be ambitious for improvement.  We are pleased the paper does not call for an absorption of social care into health systems because we believe there is little evidence the principles and purpose of social care can be fully upheld in the culture and priorities of the NHS; we have raised concerns previously that government ambitions may head in this direction. We support clearer ‘place based’ integrated leadership but this must enable effective and empowered social care leadership and resourcing.

While integration may enable efficiencies and quality improvements, BASW England are clear that ambitions for better integration cannot deflect from the need for better funding of health and – specifically - social care services within integrated and aligned systems. This cannot be ignored, and major concerns remain about the effectiveness of the proposed health and social care funding reform formula. As the Health Foundation have said in their response, “Better integration between services is no replacement for properly funding them”.

We also support the call from ADASS call for “the ambitions, plans and timescales” that were set out to be “realistic and aligned with those in the Health and Care Bill and social care white paper with appropriate funding”.

A previous concern we raised centred on the make up and membership of ICBs (Integrated Care Boards).  Considering the role they will play working with the local “single leaders”, we await further information but we expect the leadership role and status of local authorities to be more strongly defined and we restate our opposition to the inclusion of corporate private providers having reserved spaces on such boards.

BASW England will continue to monitor the progress of this White Paper and stand ready to engage members and respond once the paper takes Bill form.