The Emerging Healthcare Landscape
Throughout 2021–22, LOCSU has supported LOCs in understanding ongoing health and care reform and considering how to offer solutions to national objectives and regional and local priorities. This support has taken the form of guidance, support meetings, optical lead support and engagement, as well as consultation and other engagement.
As the Long Term Plan 2019 (LTP) made clear, new models of health and social care are required to meet the population’s needs now and in future. England’s ageing population, the growth of chronic conditions and co-morbidities, and deployment of new technologies and treatments are all contributing factors to health care challenges, many of which are highly pertinent to eye health. To meet these challenges, the LTP stressed the need for greater preventative, integrated, collaborative, and out-of-hospital care, as tools for dissolving siloed thinking and provision and ensuring optimal patient outcomes.
To cement these methods in health and social care the LTP called for new legislation. As of March 2022, this legislation is close to receiving Royal Assent as the Health and Care Act 2022.
Some of the reforms this Act will introduce include:
- New bodies, including Integrated Care Systems, are expected to become legal entities from 1 July 2022: ICSs are large, holistic commissioning and provider bodies with much greater scope and size than CCGs. ICSs include acute hospital providers, local authorities, social care, voluntary, community, and primary care providers and services. ICSs will have much larger geographies, remits, and budgets than CCGs whose allocative functions ICSs will assume. Through ICSs, the present commissioner/provider split will be erased
- Triple Aim and Duty to Collaborate: There will be a new legal duty on health bodies to collaborate and implement the Triple Aim of better health and wellbeing for everyone (with a reduction in health inequalities); better quality of health services for all; and sustainable use of NHS resources
- Changes to procurement: The Competition and Markets Authority will no longer influence how the NHS ‘organises’ itself. This is a major move away from the ‘best value’ competitive procurement regime introduced by the Health and Social Care Act 2012. A new health services provider selection regime will be introduced. What this looks like is not presently confirmed
- Secretary of State for Health and Social Care new powers: Sec State will be granted many new powers, including legal power to:
- Create new trusts
- Intervene in local service reconfiguration changes
- Direct NHS England on public health
- Issue guidance on the Duty to Collaborate
When combining the proposals for legislation with other drivers of change such as the ongoing ophthalmology transformation project, England’s healthcare landscape will soon look significantly different. LOCs and the primary eyecare sector will see these changes first hand.
Likely affected areas relevant to LOCs will include:
- Place: Place-based commissioning will see barriers to commissioning removed and the introduction of a more flexible approach to meeting patient need. Place is not specifically defined but will likely be very local, meaning LOCs must play a key role. Place will also introduce a shift from activity-based funding towards outcome-based payments
- Extended primary care contracts: these will be more encompassing in scope, higher in value, and longer term. The erosion of the commissioner/provider split (through the roll-out of ICSs), and changes to procurement will have major impacts on service contracts across the system
- Primary Care Networks (PCNs): PCNs will have a prominent role in local decision-making and contractual requirements
- Engagement: New health bodies will cut across LOC boundaries. Larger LOCs will have several ICSs and many PCNs within their geographies
- Regional collaboration: LOCSU established regional forums in anticipation of these reforms. Regional forums are ideally suited to developing strategies based on shared learning across large geographies
Following the implementation of the Bill into law as an Act, LOCSU will continue to support LOCs in explaining both their own role as networks of eyecare leaders as well as the role of the primary eyecare sector in meeting key aims.
