To have a voice in your local health and care system, you need to understand how it is governed and what services it is required to provide. This will help you identify:
what commissioners are looking for
how you can enhance the local offer.
To find out about the policy and guidance for palliative and end of life care in each nation, look at our overview.
To find out how to influence the decision makers in your local health and care system, have a look at our Local influencing resource.
Health and care policy frameworks in the UK
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In the UK, the devolved governments for each nation set the legislative framework for the national health services (NHS) and Local Authority social care. Acts of Parliament are implemented via policy, guidance and plans through the departments of health and social care in each nation.
Across the UK, the funding, planning and provision of healthcare is being further aligned with social care as we move towards more collaborative and integrated models of care.
Health and Social care
The Health and Care Act 2022 is the most recent amendment to the overall healthcare legislation in England. A key change is the establishment of Integrated Care Systems (ICS), joint health and care partnerships of commissioners and providers.
The Department for Health and Social Care has announced the development of a Major Conditions Strategy that will set out a shift to integrated, whole-person care, building on the measures in the NHS Long Term Plan.
Integrated Care Systems (ICS) are the structures introduced in 2022, through which health, social care and some of the wider determinants of health are to be coordinated and delivered. Health system responsibilities will be different between ICSs and national bodies such as NHS England, as set out in their operating framework.
Within each ICS, an Integrated Care Partnership (ICP) is responsible for co-producing an Integrated Care Strategy with local health and care partners. In August 2022, the Department of Health and Social Care (DHSC) produced statutory guidance on the preparation of integrated care strategies.
The Integrated Care Board (ICB) is the statutory NHS body responsible for developing a Five Year Joint Forward Plan. In the first year, ICBs have until June 2023 to consult on and finalise these. In December 2022, NHSE produced guidance on developing the joint forward plans.
NHS England has produced a suite of guidance for ICBs, including:
In Northern Ireland, the key legislation for the way the Health and Social Care (HSC) system is coordinated and delivered is the Health and Social Care (Reform) Act (Northern Ireland) 2009. The Department of Health, Social Services and Public Safety’s Framework Document (2011) describes the roles and functions of the various health and social care bodies and the systems that govern their relationships.
Health policy is guided by the Making Life Better framework for public health and the themes of health and wellbeing, and health inequalities, therein.
The implementation of the Integrated Care System is still under consultation. Within this, regional Area Integrated Partnership Boards (AIPB) will replace Local Commissioning Groups (LCG) and end the purchaser / provider split.
In 2011, the Scottish Government published its 2020 Vision for Health and Social Care. This set out the strategic vision for achieving sustainable quality in the delivery of healthcare services across Scotland. This has now been archived, but it set the vision for the national policies and plans that followed.
The National Health and Wellbeing Outcomes Framework sets the expectations against which Boards, Local Authorities and Partnerships write their strategic plans and report their annual performance.
The Health and Social Care Delivery Plan was published in December 2016 to implement the Healthcare Standards. This strengthened the role of Health and Social Care Partnerships to plan and deliver well-coordinated care that is timely and appropriate to people's needs. It also called for greater collaboration around and between NHS Boards.
The Scottish Government has introduced a Bill which aims to establish a National Care Service to sit alongside and mirror the National Health Service.
The key legislation for social care is the Social Services and Well-being (Wales) Act 2014. It established joint working between the NHS and Local Authorities in Regional Partnership Boards (RPB).
This legislation underpins the Welsh Government’s Programme for Government and the key health and social care plan: A Healthier Wales, which were published in 2021.
Although most health service guidance relates to contracting with NHS Trusts and hospitals, it is useful for hospices to know what the standard contracts are and what the contract uplifts are in any given year. This will help with contract negotiations.
The following information relates to contract uplifts for 2023/24.
The NHSE Payment Scheme annual inflation uplift factor minus efficiency factor currently stands at 3.4%. This was updated on 11th May 2023 to account for the 5% Agenda for Change pay award. The final figure is awaiting the medical pay award.
The payment scheme refers to aligned payment and incentive contracts, as promoted by the NHSE PEoLC funding approaches, but these would be based on palliative care and last year of life currencies with no national unit or guide prices.
The pay award guidance describes the additional uplift as being for providers and services ‘in scope’ of the NHS payment scheme. Where provider staff are not on Agenda for Change and local payment arrangements are in place, any changes to local prices will depend on the terms of the agreed contract or be by local agreement.
40% of English adult hospices received equivalent matching uplifts last year; this should set a precedent for all hospice contract negotiations.
In April 2023, the Department of Health described the budget allocation as a flat cash budget; essentially a cut in service funding.
The Scottish Government allocates funding for the health and social care budget. The Scottish resource allocation formula passes on 70% of the NHS budget to the 14 NHS Boards as target shares based on weighted capitation.
These take into account the Agenda for Change 7.5% pay award so as a minimum this should be passed on in all contracts.
The Welsh Government sets the funding for the Health Board revenue allocations. These equate to a 1.5% uplift in recurrent funding before the Agenda for Change pay award has been agreed.
Within this, Health Boards have a ring-fenced allocation for palliative care which has remained static at £5.339 million for the past five years. Separately, the national NHS Executive holds £2.2 million specifically to fund hospices.
In May 2023, the Minister for Health and Social Services committed in a letter to the Cross-Party Group (CPG) to working with Health Boards to embed inflationary uplifts into existing funding allocations and better contracts for hospices.
As a minimum, these should match the general 1.5% uplift.
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For more information and support, please contact Annette Alcock, Head of Health and Care System Relationships.
