[Feb, 2022. London, UK] On the 9th Feb 2022, the Department of Health & Social Care (DHSC) published a white paper, Health & Social Care Integration – Joining Up Care for People, Places and Populations that “sets out measures to make integrated health and social care a universal reality for everyone across England, regardless of their condition and of where they live.”
The paper seeks to put more meat on the bones of the Government’s 10-year vision for adult social care, People at the Heart of Care (01-Dec-21), which provided the first look at health & social care proposals that will be funded by the £1.8bn-per-year increase earmarked for social care from the imminent (01-Apr-22) 1.25% rise in NIC levy (£5.4bn total over three years).
We welcome several of the aims set out in the white paper, including:
We’re less sanguine about plans for single-local-leader accountability for delivery of shared outcomes at the “place” level within ICSs, and goals to “encourage” NHS and local authorities to do more to align and pool budgets (Section 3). Both of these ambitions are highly susceptible to a weakness highlighted in the white paper – past “[over]reliance on relationships and ‘soft’ levers, [which] can work well in areas where there are strong relationships, but are vulnerable to changes in leadership,” and are not back-stopped by structural accountabilities (p. 26). No alternatives or augmentations to address these vulnerabilities (outlined cogently by NHS Providers) are suggested – and, as the Health Foundation points out, “better integration between services is no replacement for properly funding them; the social care system in England is on its knees and central government funding over the coming years is barely enough to meet growing demand, let alone expand and improve the system.”
Most concerning of all, however, is the lack of detailed attention to the health and social care workforce (Section 5). There is a welcome show of support for training and development of staff (in social care), but no consideration of the broader panoply of workforce issues (vast vacancies, difficulty in recruiting/retaining staff, lack of incentives to choose health and social care as profession), as illustrated by a chorus of responses to the white paper:
Many would point out that integrating health and social care – both as a large-scale ambition and as an actual, on-the-ground occurrence in certain parts of the UK – is not new. And, indeed, the paper is shot through with examples of successful integration projects and programmes already underway. The rest of the paper sets out some admirable ambitions to promote closer integration of health and care, and rightly acknowledges that there is no single, one-size-fits-all approach. But again, as BHTA highlighted in our comment on the Government’s 10-year vision for adult social care, if the goal is to join up care across people, places and populations, a detailed, actionable plan is required – and this paper is still more “journey-planner” than an actual plan.
On this point we echo the sentiments of the NHS Confederation: “This is the latest in a long line of white papers over recent decades that have tried to better integrate services [and] the critical question, therefore, is ‘What will this white paper enable which cannot already be done?’ The answer to this appears to be ‘very little’.”
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Government white papers, announcements, and consultations increasingly refer to Integrated Care Systems (ICSs) and their component parts – Integrated Care Boards (ICBs) and Integrated Care Partnerships (ICPs) – which are set to replace Clinical Commissioning Groups (CCGs) in the Government’s reorganisation of the health and care system. BHTA has produced a guide to these groups and changes, including the Government’s most recent guidance (dated 15-Sep-21).
William Lee, Head of Policy and Compliance at the British Healthcare Trades Association
With over 25 years of policy and advocacy experience, William Lee has spent much of his working life championing the needs of vulnerable communities at US & UK NGOs and governments. He is responsible for the research, development and dissemination of policy, strategy, parliamentary and technical information to BHTA members, and supports with the association’s important stakeholder engagement.
About the BHTA: Representing over 400 companies in the healthcare and assistive technology industry, the British Healthcare Trades Association (BHTA) brings the industry together to help shape and improve the health and care of the nation. All BHTA members are committed to adhering to the Association’s Code of Practice – the only code in the industry approved by The Chartered Trading Standards Institute. https://www.bhta.com/what-we-do/
About the CTSI: The BHTA Code of Practice – the first for consumers in the healthcare industry – is approved under the Chartered Trading Standards Institute (CTSI)’s Consumer Codes Approval Scheme, ensuring all BHTA member companies trade ethically and professionally.
Contact email: marketing@bhta.com
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[Feb, 2022. London, UK] Following the Government’s decision to suspend its plans to introduce mandatory vaccination for frontline health and social care workers, William Lee, Policy and Parliamentary Executive of the British Healthcare Trades Association, highlights the challenges around clarity of guidance for businesses and the NHS that now must be addressed.
If a week is a long time in politics, what constitutes a long time in policy?
Eleven-and-a-bit weeks, apparently – that’s the elapsed time between the Government’s 09-Nov-21 decision that all frontline health & social care workers in England must (from 01-Apr-22) be fully vaccinated against COVID-19 as a condition of deployment (VCOD) and their 11th-hour reversal: the Department of Health & Social Care (DHSC) announced on Monday, 31-Jan-22 that the legal requirement for vaccination will be revoked (see also Sajid Javid’s statement to the House of Commons on the same day). This change will be subject to public consultation, the approval of Parliament, and – crucially – will require a change to the previous VCOD regulations already laid (more on this last point in a moment).
At the time of the Government’s original decision, we expressed conditional support – we understood the desire to take all necessary steps to protect healthcare workers and the public – but we stressed that mandatory vaccination was only 50% of the solution. BHTA outlined four key areas of support, from both the financial and policy perspectives, that Government needed to address to forestall potential economic fallout from the decision. And BHTA, its member companies, and other health & social care representatives highlighted to Government one of the most foreseeable negative effects: complex issues arising from workforce deployment.
The BHTA can’t but be pleased by the relief this reversal will bring to the health and social care sector. The NHS and its delivery-partner businesses (many of whom are BHTA members) were facing redundancies among those who remained unvaccinated, with dire personal consequences for employees and serious, costly workforce implications for employers. Now is not the time to lack for any frontline health & social care workers for any reason, nor to introduce more stress, complexity, and expense for those working so hard to deliver for patients in the third year of the pandemic. We do, however, note the frustration of nurses, NHS administrators, and businesses at the route that has led to this last-minute reversal, and we are very concerned about the risks that mixed messages present for BHTA members (businesses trying to provide the very best for patients as partners with the NHS across the health & social care landscape).
Most important now for the NHS and its delivery partners is immediate, clear, easy-to-follow guidance from the centre. Only this will allow the maximum number of health and social care workers back onto the frontline to serve patients, both COVID-19 patients and those affected by COVID-induced backlogs. Previous VCOD guidance on planning and deployment was both vague and lacking in detail – especially with regard to which categories of employees were and were not in scope for VCOD. As well, the guidance was a minimum standard, beyond which individual NHS Trusts were able to set their own rules and apply their own interpretations.
This was – and is – unhelpful. It creates too much opportunity for delay, confusion, and “one-size-fits-none” customisation-complexity for delivery partners who work with many NHS Trusts, and are faced with a different set of rules for each one. Now, after having pulled out all the stops in an effort to comply with the original, mandatory VCOD regulation, individual NHS Trusts are being told by Government in a 31-Jan-22 letter: “we’ve removed the legal requirement for vaccines, but you’re in a holding pattern when it comes to frontline staff deployment.”
And indeed, a legal change to the previously-laid VCOD regulations is a necessity – but NHS Trusts and their delivery partners need direction now on who can work on the health & social care frontline. Surely, with all else that has been possible during the pandemic, clear, detailed, centre-led guidance – equally applicable across the health & social care landscape, and flexible enough not to require interpretation on a Trust-by-Trust basis – is in the Government’s gift. At times “Levelling Across” (something that should be uniquely possible for Britain’s NHS) is as important as Levelling Up – and keeping the public happy with the care they receive from the NHS and its delivery partners has to be attractive to any Government.
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William Lee, Policy & Parliamentary Executive at the British Healthcare Trades Association
With over 25 years of policy and advocacy experience, William Lee has spent much of his working life championing the needs of vulnerable communities at US & UK NGOs and governments. He is responsible for the research, development and dissemination of policy, strategy, parliamentary and technical information to BHTA members, and supports with the association’s important stakeholder engagement.
About the BHTA: Representing over 400 companies in the healthcare and assistive technology industry, the British Healthcare Trades Association (BHTA) brings the industry together to help shape and improve the health and care of the nation. All BHTA members are committed to adhering to the Association’s Code of Practice – the only code in the industry approved by The Chartered Trading Standards Institute. https://www.bhta.com/what-we-do/
About the CTSI: The BHTA Code of Practice – the first for consumers in the healthcare industry – is approved under the Chartered Trading Standards Institute (CTSI)’s Consumer Codes Approval Scheme, ensuring all BHTA member companies trade ethically and professionally.
Contact email: marketing@bhta.com
[Dec, 2021. London, UK] On 01 December 2021, the Department of Health and Social Care (DHSC) published a white paper, People at the Heart of Care, that sets out its 10-year vision for adult social care, and provides information on proposals that will be funded by the £1.8bn-per-year increase earmarked for social care from the Government’s 1.25% rise in NIC levy (£5.4bn total over three years).
William Lee, Head of Policy and Compliance at the British Healthcare Trades Association, provides a whistle-stop tour of the social care reform journey, and explores some of the key points made in the document.
BHTA has commented previously on this funding increase (announced in Sep-21), and we are pleased to see the Government begin to flesh out its plans for social care. It is clear, however, that this white paper – as described by the Secretary of State in his Executive Summary – is really only a “journey-planner” for social care reform.
Disabled Facilities Grants (DFGs) – More of the same, more needed
We are pleased to note plans to continue DFG funding (see Chapter 4.18) at near its current rate (£573m/year 2021-22; £570m/year 2022-23 & 2024-25), not least since DFGs so often fund life-enhancing adjustments supplied by BHTA members (e.g. stairlifts, wet rooms, and other home modifications). As Care & Repair England points out, however, inflation and rising cost of materials and labour would have made a DFG funding increase more welcome, and we continue to wait for more detail on how new homes will be made more accessible, a decision that has again been delayed (see Chapter 4.24).
Digitisation and Caretech Innovation – The future is now?
An earmark of £50m/year over the next three years (£150m total) to drive digitisation across the social care sector and unlock the potential of caretech innovation that enables preventative care (e.g. measuring and monitoring devices) and independent living (e.g. tablets, e-readers) is a welcome development (see Chapter 4.28 ff). BHTA and its members agree with analysis from the Technology-Enabled Care Services Association (TSA) that indicates “digital tools can be used more proactively across adult social care, so that people can live healthier lives for longer, in their own homes.” We call on funders at all levels of Government – NHS, DHSC, Local Authority, etc. – to ensure that uptake of innovative products is as streamlined as possible, with focus on 360-degree positive effects of such innovation for patients and carers alike, rather than a narrow, cost-only view.
Social Care / Occupational Therapy Workforce – Who cares for the carers?
OTs and others in the social care workforce will welcome the announcement of £500m for a raft of planned workforce transformation measures (see Chapter 6.5 ff), including a Knowledge and Skills Framework and Continuous Professional Development, and it is gratifying to see OTs and others recognised for their outstanding work in helping people live richer, more independent lives. Concerns remain, however, about gaps in pay and working conditions for the social care workforce (see commentary from the Royal College of Occupational Therapists). We hope future efforts are in line more with the lofty aspirations of the white paper and less with the Government’s recent reticence to amend the Health and Care Bill 2021 to embed NHS and social care workforce planning/reporting in law.
Those Living with Dementia and Their Carers – Still waiting
The Government’s forthcoming standalone strategy on those living with dementia and their carers (See Chapter 1.15) is keenly awaited – some might say overdue – and it remains to be seen whether it will redress funding and support imbalances that mean dementia sufferers have access to fewer resources than those affected by other conditions.
Integration of Health and Care Services – Not quite yet
Perhaps the largest omission in the white paper is the lack of detail or colour around how health and care services will be integrated going forward, which has been relegated to another, future white paper (see Chapter 2, p. 30). Given the amount of integration “talk” from Government, the “walk” can’t come soon enough.
We applaud the aspirations outlined in the Government’s white paper, but much more detail is needed to understand how these aspirations – which, after all, do not address urgent social care needs right now – will translate to better social care in the future; in the words of the Association of Directors of Adult Social Services:
“There is much detail to fill in and much more funding to find . . . clearly the sums identified so far can be no more than pump-priming, [and] what we need now is a bridge to that brighter future, to address the immediate crisis and ensure that everyone gets the care and support they need.”
BHTA and its members look forward to working with DHSC and other delivery partners to ensure that the social care reform journey ends at its desired destination – where people have choice, control, independence, and quality & tailored social care that is fair and accessible.
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William Lee, Policy & Parliamentary Executive at the British Healthcare Trades Association
With over 25 years of policy and advocacy experience, William Lee has spent much of his working life championing the needs of vulnerable communities at US & UK NGOs and governments. He is responsible for the research, development and dissemination of policy, strategy, parliamentary and technical information to BHTA members, and supports with the association’s important stakeholder engagement.
About the BHTA: Representing over 400 companies in the healthcare and assistive technology industry, the British Healthcare Trades Association (BHTA) brings the industry together to help shape and improve the health and care of the nation. All BHTA members are committed to adhering to the Association’s Code of Practice – the only code in the industry approved by The Chartered Trading Standards Institute. https://www.bhta.com/what-we-do/
About the CTSI: The BHTA Code of Practice – the first for consumers in the healthcare industry – is approved under the Chartered Trading Standards Institute (CTSI)’s Consumer Codes Approval Scheme, ensuring all BHTA member companies trade ethically and professionally.
Contact email: marketing@bhta.com
• Government confirms vaccinations will be mandatory for all frontline workers in the health and social care sector as a condition of deployment (unless the individual is medically exempt).
• The BHTA calls on the government to address concerns over potential economic impact to health and social care providers
• Action to protect the health of the public and those working in the health and social care arena is welcome, but BHTA stresses a need for clarity on how its members will be supported to ensure they can continue to provide essential health and care equipment and services
[Nov, 2021. London, UK] On the 10th November 2021, the Department of Health and Social Care (DHSC) announced that – from 01 April 2022 – all frontline health and social care workers in England must be fully vaccinated against COVID-19 as a condition of deployment (unless medically exempt), after a consultation on the issue. This extends a similar decision to make COVID-19 vaccination mandatory for anyone working or volunteering in a care home (again, unless medically exempt) from 11 November 2021.
William Lee, Policy & Parliamentary Executive at the British Healthcare Trades Association (BHTA), details how the government must back up its decision to introduce mandatory vaccination with economic support for health and social care providers in the event of disruption, and clarify some essential points.
To say that mandatory vaccination divides opinion is an understatement, especially since the debate is typically framed as a conflict between individual freedoms (to accept or refuse the vaccine) and collective protection. The public, and the healthcare workers who protect them, are at the lowest risk of serious illness when as many people as possible are vaccinated.
This debate is important, indeed it even divides opinion among individual NHS workers; however, to echo a position outlined in a recent British Medical Journal opinion, it is a luxury we cannot afford right now “as this pandemic has shown, the problem with waiting for more information is that delaying action costs lives [and] there comes a time when a decision has to be made, even with imperfect or incomplete information.”
The BHTAunderstands the government’s decision to require mandatory vaccination, and we agree with the government’s desire to take all necessary steps to protect both healthcare workers and the public during this pandemic. However, the BHTA believes the government’s announcement only covers half the solution, and fails to address the important remaining half: support for any potential negative economic fallout as a result of the decision.
Luckily, the government does not have to look far for just such an example of a serious, sweeping, mandatory public health measure (lockdown) complemented by economic measures specifically designed to ensure its uptake/efficacy (the furlough scheme).
On behalf of all of our members in the health and social care sector, BHTA calls on the government to address the economic measures required and:
• Respond to industry concerns around complex legal issues arising from workforce deployment effects of mandatory COVID-19 vaccination
Employers in the health and social care arena (including BHTA in its response to the consultation above) have warned the government of serious legal concerns regarding existing employees who refuse the vaccine. Ranging from employee claims of unfair dismissal to compulsory re-deployment to companies’ inability to meet contractual obligations due to ex-post-facto application of vaccine rules, however, these concerns have, so far, not been addressed. Clarity and support from the government on legal issues would allow health and social care employers – already struggling with soaring operating costs, increased tax and payroll bills, and loss of staff to other, less stressful employment – to plan for and operate in a “new vaccine normal.”
• Commit to keeping COVID-19 vaccines free for as long they remain a condition of deployment in any setting/sector
Many employers are concerned that, in future, they will have to bear the cost of vaccinating employees against COVID-19, and keeping them up to date with any recommended boosters. If the government decides to stop funding free vaccines, there must be assurances provided that COVID-19 vaccines will remain free, and freely accessible to all employers whose staff are required to be vaccinated as a condition of frontline deployment.
• Establish – or extend – financial support for health and social care businesses to deal with the workforce effects of mandatory COVID-19 vaccination
There will doubtless be some employees – hopefully, a very small proportion – who refuse the vaccine but still have experience and skills valuable to businesses in particular, and the health and social care sector in general. Again, in the mould of previous programmes aimed at providing financial support for businesses affected by COVID-19, health and social care businesses could better help the vast majority of frontline workers decide to get the vaccine – and continue to provide the best quality and quantity of frontline support to patients – if they themselves are supported in retaining vaccine-hesitant workers who can still contribute positively. With estimates of NHS vacancies at 90,000 and social care vacancies at up to c. 100,000, targeted financial support for health and care sector businesses to aid employee retention is sorely needed.
• Set out clearly why the government has not considered – or considered and decided against – alternatives to mandatory vaccination
Many of those opposed to mandatory vaccination (see, e.g., the response of the Chartered Society of Physiotherapy) point to the existence of alternatives like daily lateral flow testing and ask why these are not deployed instead of mandatory vaccination. The government’s response to the consultation acknowledges these alternatives, but does not set out clearly why mandatory vaccination is the preferred option; doing so would clarify the choice for vaccination and further strengthen the argument for vaccine uptake that government is, in large measure, asking employers to make to employees on government’s behalf.
The BHTA and its members stand ready to support the government in its efforts to protect the public and frontline health and care workers. It is crucial that the government heeds, and addresses, the concerns raised to ensure that the impact of this decision does not hinder health and social care providers ability to deliver the best possible care to all.
William Lee, Policy & Parliamentary Executive at the British Healthcare Trades Association
With over 25 years of policy and advocacy experience, William Lee has spent much of his working life championing the needs of vulnerable communities at US & UK NGOs and governments. He is responsible for the research, development and dissemination of policy, strategy, parliamentary and technical information to BHTA members, and supports with the association’s important stakeholder engagement.
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• Government announces £12 billion per year for health and social care, funded by 1.25 per cent rise in NIC Levy
• The rise in tax comes amid growing price pressures on providers of essential healthcare and assistive technologies equipment and services, fuelled by continuing COVID-19 disruption and multiple supply chain challenges
• Action to improve the health and social care of the nation is welcome, but BHTA stresses a need for clarity on how funding will help consumers and providers of vital equipment and services
[Sept, 2021. London, UK] The British Healthcare Trades Association (BHTA)’s Chairman, Andrew Stevenson, notes that action to support the health and social care sector is welcome, but clarity is needed on how funding will positively impact consumers, patients, and providers of vital equipment and services.
It follows the introduction of the Health and Social Care Levy Bill, which will be funded by a UK-wide, 1.25 per cent increase in National Insurance Contributions, starting from April 2022. The tax is expected to raise approximately £12 billion to be injected into the health and social care system.
Additionally, there will also be a cap on social care costs, with a commitment that no one in England will now have to pay more than £86,000 in care costs over the course of their lifetime.
The announcement of the increase to NIC for providers of healthcare and assistive technologies equipment and services comes amid significant supply chain challenges for many, resulting in substantial price rises.
Andrew Stevenson, Chairman of the British Healthcare Trades Association:
“Any new funding is a welcome step in the right direction to address patient backlogs in the NHS, and to start to improve the position for social care. It remains to be seen, however, just how much of the income generated by the Government’s plan will be spent on social care, and what will be the net effects on the provision of social care products and services – for both consumers and providers.
“If all goes according to plan, 20 per cent of the new funding (£1.8bn/year) is earmarked for social care. While positive, this is far below the estimated £9.3bn/year required to maintain current levels of social care provision according to The Health Foundation, let alone provide for much-needed improvements. And there is reasonable anxiety that ever-growing NHS budgets could further reduce even the planned 20 per cent spend on social care: analysis from the Institute for Fiscal Studies shows that only twice in the last 40 years has NHS spend fallen at or below planned targets – in every other year, NHS spend increased. Indeed, in the words of the Resolution Foundation, “while billed as a social care announcement, in reality, social care played a minor role in a major tax-rise-funded increase in wider health funding, covering the NHS but also meeting ongoing pandemic costs.”
“BHTA and its members welcome any increase in money and resource for the NHS, particularly if it helps the NHS adopt innovative products and services, build resilient supply chains, and drive sustainability and net-zero goals. But – in the words of Conservative MP Anne-Marie Morris – “help for social care is needed now, not in three or four years’ time,” and the plan offers little clarity on how:
• Even with the £86k spending cap, consumers of social care products and services with modest homes and few financial assets can avoid the need to put a charge on their homes if they need significant in-home or residential care (especially since the cap excludes food and accommodation);
• Providers of social care products and services – already facing severe staff shortages; payroll pressures set to worsen as the furlough scheme ends in Sep-21; and skyrocketing 2021 shipping prices through spring, summer and into autumn – might cope with increased payroll costs associated with employers’ NIC rises (from which the NHS, the UK’s largest employer, is exempt);
“Although the relative focus on the NHS over social care means that the focus of what has been announced is on changing who pays for care, BHTA and its members remain committed to everyone having access to the best care so they can live healthier and more independent lives.”
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About the BHTA: Representing over 400 companies in the healthcare and assistive technology industry, the British Healthcare Trades Association (BHTA) brings the industry together to help shape and improve the health and care of the nation. All BHTA members are committed to adhering to the Association’s Code of Practice – the only code in the industry approved by The Chartered Trading Standards Institute. https://www.bhta.com/what-we-do/
About the CTSI: The BHTA Code of Practice – the first for consumers in the healthcare industry – is approved under the Chartered Trading Standards Institute (CTSI)’s Consumer Codes Approval Scheme, ensuring all BHTA member companies trade ethically and professionally.
Media contact: Calvin Barnett, Head of Marketing and Communications
Contact email: marketing@bhta.com