Health and Care Act 2022 – What does it mean for you?

Health and Care Act 2022 (HCA) – What is it?

The Health and Care Act 2022 is a new piece of legislation published July 2021 and granted Royal Assent in April 2022. It is founded upon the many changes requested by NHS England and NHS Improvement (NHSEI). One key recommendation was the transformation of the NHS’ system architecture to increase coordination of services through creation of integrated care systems (ICS) – in simple terms, evolve the NHS to make collaborative working between Health and Care services easier, meeting the more numerous and complex needs of a longer living population.

What does it mean for Health and Care?

Big changes have and will continue to be made to the health and care system as part of the new Health and Care Act 2022 legislation:

• NHS England (NHSE) – the NHS Commissioning Board has now been renamed. The newly renamed NHSE has absorbed most NHS Improvement functions and responsibilities to form a singular regulatory body responsible for funding, planning, delivery, transformation, and performance/quality monitoring of healthcare across the UK.
• Mental Health Services – there will be greater focus on spending of mental health services, with the Secretary of State identifying before Parliament whether they expect an increase in expenditure/proportion of expenditure by NHSE and Integrated Care Boards (ICBs) in comparison to the previous financial year.
• Addressing/Reducing Inequalities in Care – the NHS Act 2006 has been amended regarding NHSE’s duties to reduce inequality between persons, specifically a person’s ability to access health services/patients with respect to outcomes of effectiveness, safety, and quality. ICBs will conduct more rigorous analysis of inequality of access to health services and of health outcomes.
• Environmental Responsibility – NHSE must regard and contribute towards compliance with section 1 of Climate Change Act 2008 (UK net zero emissions), section 5 of the Environment Act 2021 (environmental targets) and any current or predicted impacts of climate change under section 56 of the Climate Change Act.
• Involving Service Users – NHSE and ICBs must conduct more in-depth consultations with Service Users, carers, and representatives regarding planning and development of commissioning arrangements.
• Integrated care systems (ICSs), Integrated Care Boards (ICBs), and Integrated Care Partnerships (ICPs) – ICS have two statutory components: 
  • ICBs – currently around 40 ICBs across the UK will take on the commissioning functions of CCGs and are responsible for developing integration and collaboration, and for improving population health across the system. ICBs are accountable for NHS expenditure and performance within the system. They can exercise their functions through place-based arrangements.
  • ICPs – ICPs are statutory joint committees established by ICBs and their partner local authorities. ICPs utilise collaborative working between local system partners to develop an integrated care strategy to address the health, social care, and public health needs of the population. All ICPs must produce an integrated care strategy that identifies how the local ICB will assess and meet the needs of its area. Local Healthwatch must be involved in the strategy, as well as people who live or work in the area.
• Changes to Commissioning and Procurement Arrangements – the Act aims to reduce competition and improve collaboration across the NHS and local authorities through the revoking of Section 75 of the Health and Social Care Act, and NHS (Procurement, Patient Choice and Competition) Regulations 2013. The Secretary of State can now create regulations to implement a new provider selection regime, removing commissioning of NHS healthcare services from the scope of the Public Contracts Regulations 2015. The NHS (with local authorities on joint initiatives) will be able to directly award contracts to provides (e.g., if the current provider doing a good job and the service is not changing).
• Mandatory Information Standards – NHSE and the Secretary of State will produce mandatory information standards for technical information, data-related information, or relating to information governance. Some standards may only apply to public bodies and others may need to be extended to cover private organisations, such as interoperability standards. The Secretary of State may direct NHS Digital (previously known as the Health and Social Care Information Centre, and, with NHSX, merged into NHSEI) to collect this information.
• The Role of CQC – the CQC now has responsibilities regarding integrated care systems and local government adult social care. The CQC will review healthcare and adult social care in each ICB, with reviews covering partnership in the integrated care system. The Secretary of State will set priorities for reviews, including leadership, integration, quality, and safety. Reviews will assess “the provision of the NHS, public health and adult social care, the activities of the ICB, local authorities and provider in relation to the care and the function of the whole system including the ICP”.
• Financial Support – the Secretary of State can now provide financial assistance to providers of health and social care who operate for profit.
• Mandatory learning disability and autism training for health and social care provider staff – From 1 July 2022, CQC registered health and social care providers must ensure staff receive role appropriate learning disabilities and autism training.

What does this mean for Providers?

Providers will now have to conduct even more in-depth information recording and monitoring, which will be facilitated through newly designed/improved ECMs and care/support monitoring tools. Closer working with Service Users/carers/representatives, ICBs, local authorities, and Commissioners, especially more contract meetings discussing KPIs, will ensure information gathered is relayed throughout stakeholder channels and is utilised to improve integrated care strategies within the local area.

We have seen numerous tender questions regarding carbon reduction plans/net zero emissions, and this is something all providers will have to have in place to show compliance with new legislation.

The expansion of the CQC’s role will mean providers will potentially have to provide the CQC with proof of collaborative working/relationship with key stakeholders, which could be proved through stakeholder analysis plans for Service Users and providers as a whole.The ability to apply for further funding will be key to ensuring the unforeseen or developing needs of Service Users are met. How this funding will be applied for/distributed is currently unknown, but its availability to profit-based providers is big step forward to ensuring Service Users receive the care they need.

How to Prepare

To prepare for this legislation and the future impacts it is going to have, we suggest providers do the following:

• Assess internal quality monitoring and information recording processes and identify what further information would help identify Service User needs.
• Explore newly released care management systems for ECM purposes.
• Build a carbon reduction/net zero emissions plan that identifies how you will reduce your emissions to net zero, a time frame in which this will be done, and how this will be measured – the government’s carbon reduction plan template can be found here: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1053009/PPN-0621-Carbon-Reduction-Plan-Template-Jan22.odt. 
• Develop a stakeholder analysis chart and begin building/expanding local relationships with other providers, ICBs, local authorities, community groups, etc.

Useful links

For further information and a full overview of the legislation, visit: https://www.legislation.gov.uk/ukpga/2022/31/contents/enacted

For a quick breakdown and short video on the Health and Care Act 2022, visit: https://www.kingsfund.org.uk/projects/health-and-care-act-2022-make-sense-legislation or https://nhsproviders.org/a-guide-to-the-health-and-care-act-2022

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