The ICS White Paper

Many existing statutory and non-statutory requirements underpin the work of Emergency Preparedness, Resilience and Response (EPRR) across the NHS in England. Primary drivers include the Civil Contingencies Act 2004 (CCA 2004) and supporting Contingency Planning Regulations 2005, the Health and Social Care Act 2012 (HSCA 2012), the NHS England EPRR Framework 2015 and the NHS Core Standards for EPRR. 

The CCA 2004 and its Regulations mandate a set of core duties for emergency preparedness and response upon Category 1 and Category 2 responders. However, the structure of the NHS is much changed since the CCA came to life in 2004. Supporting this challenge, the HSCA 2012, EPRR Framework 2015 and EPRR Core Standards take the CCA 2004 statutory requirements and translate them for the NHS, embedding a core set of requirements across all NHS-funded bodies.

The latest in the line of changes to the NHS structure is now nearly upon us. On the 11th February the Department of Health and Social Care (DHSC) published a white paper titled ‘Integration and Innovation: Working together to improve health and social care for all.‘ The core thrust of this document, the move towards models of Integrated Care Systems (ICSs) across all of England, is one that we have been on a pathway towards for some time and should come as no surprise. Government intends to legislate for every part of England to be covered by an ICS, made up of a statutory ICS NHS Body and a separate ICS Health and Social Care Partnership. This Partnership will bring together the NHS, local authorities and other partners to support integration and system planning.

These changes are underpinned by the introduction of a broad duty to collaborate across the health and care system, and a triple aim duty on health bodies: better health and wellbeing for everyone; better quality of health services for all individuals; and sustainable use of NHS resources.

The proposals include legislative change to enable NHS England (NHSE) to formally merge with NHS Improvement (NHSI, legally composed of two organisations: the Trust Development Authority and Monitor) under the simple future banner of ‘NHS England’. This should be a welcome change and one that cements the joint working programme that has seen NHSE and NHSI combine together in all but statute.

Furthermore, the pandemic has highlighted the need to balance national action with local autonomy. The evolution of the system in recent years has led to greater level of responsibility being held by NHS England and NHS Improvement. As Integrated Care Systems are established, we expect more of that responsibility to be held by ICSs themselves.

Department of Health and Social Care (2021)

The paper discusses the importance of a population health approach: preventing disease, protecting people from threats to health, and supporting individuals and communities to improve their health and resilience. However, the paper does not go as far as to introduce proposals on the future design of public health in the broadest sense, beyond a few specific items such as making it easier for the Secretary of State to direct NHSE to take on specific public health functions.

Other items of note include:

  • the introduction of a medical examiner system for the purpose of scrutinising all deaths that do not involve a coroner (amending the Coroners and Justice Act 2009 to allow for NHS bodies rather than Local Authorities to appoint Medical Examiners);
  • the introduction of The Health Service Safety Investigations Body (HSSIB) which will continue the work of the Healthcare Safety Investigations Branch and whose remit will be extended to cover healthcare provision within the independent sector;
  • and clarification to the scope of section 60 of the Health Act 1999 to include Senior NHS Managers and Leaders as professions who could be statutorily regulated, though the Department claims no intention to do this.

Of course, all of the above are only suggestions at this stage, but it’s hard to see a reality in which these proposals will not find Parliamentary support. Especially given many of them were generated through proposals from NHS England to the Department and have been subject to wide consultation.

What does this mean for EPRR?

One central theme through the ICS White Paper is the importance of place-based leadership. Within Civil Protection and Emergency Management exists already the important concept of subsidiarity, a central principle within the UK Government’s Concept of Operations for responding to emergencies. Namely, that decisions should be taken at the lowest appropriate level, with co-ordination at the highest necessary level. Local responders should be the building block of response for an emergency of any scale.  

Localised leadership and subsidiarity translate directly to and clearly support the needs of EPRR within the NHS. As the ICS NHS Body becomes the central leadership node within which a system around it is orientated and organised, mechanisms should be put in to place to ensure that EPRR joins this orbit. The ICS NHS Body is the natural leader for emergency preparedness and response at a local level.

There clearly remains a need for National and Regional leadership from NHS England, both from a programme of work perspective as well as in discharging duties around governance and assurance. There must also be an understanding on the role that EPRR regional and national teams play in ‘intensive support’ directed to systems that require it, for example if an ICS NHS Body were to poorly perform in the NHS Core Standards for EPRR assurance.

The White Paper will surely have generated discourse across the NHS at all levels, and I am sure response or positional papers discussing this further will soon begin to circulate. Until then, you can find the White Paper through the reference links below if you wish to find out more.

References

Cabinet Office. 2013. Responding to emergencies, the UK Central Government Response, Concept of Operations[Online]. London: The Stationary Office. [Accessed 24 February 2021]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/192425/CONOPs_incl_revised_chapter_24_Apr-13.pdf  

Civil Contingencies Act 2004. [Online]. London: The Stationary Office. [Accessed 24 February 2021]. Available from: https://www.legislation.gov.uk/ukpga/2004/36/contents  

Department of Health and Social Care. 2021. Integration and innovation: Working together to improve health and social care for all[Online]. London: The Stationary Office. [Accessed 24 February 2021]. Available from: https://www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all 

Health and Social Care Act 2012. (c 46). [Online]. London: The Stationary Office. [Accessed 24 February 2021]. Available from: https://www.legislation.gov.uk/ukpga/2012/7/part/1/crossheading/emergency-powers/enacted    

NHS England. 2015. NHS England Emergency Preparedness, Resilience and Response Framework[Online]. [Accessed 24 February 2021]. Available from: https://www.england.nhs.uk/wp-content/uploads/2015/11/eprr-framework.pdf 

NHS England. 2021. NHS England Core Standards for EPRR[Online]. [Accessed 24 February 2021]. Available from: https://www.england.nhs.uk/publication/nhs-england-core-standards-for-eprr/ 

UK Parliament. 2021.  Risk Assessment and Risk Planning Lords Select Committee. [Online]. [Accessed 24 February 2021]. Available from: https://committees.parliament.uk/committee/483/risk-assessment-and-risk-planning-committee/  

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