The Government has set out plans for wide-ranging reforms to how health and social care services are commissioned in England, including CCG functions being taken over by integrated care systems (ICSs).
The white paper for a new Health and Care Bill, published today, said the Department of Health and Social Care will ‘bring forward measures for statutory Integrated Care Systems (ICSs)’.
Meanwhile, the NHS and local authorities ‘will be given a duty to collaborate with each other’ and the controversial section 75 of the Health and Social Care Act 2012 – which mandated for all NHS contracts to be put out to competitive tender – will be scrapped.
The Government said this will ‘remove much of the transactional bureaucracy that has made sensible decision-making harder’.
Under the plans, which ‘will start to be implemented in 2022’, CCGs will ‘become part of’ ICSs, with ICSs to take on their ‘allocative function’.
The white paper said: ‘A statutory ICS will be formed in each ICS area. These will be made up of a statutory ICS NHS body and a separate statutory ICS Health and Care Partnership, bringing together the NHS, local government and partners e.g. community health providers. We would expect the public name of each ICS NHS Body to reflect its geographical location – for example, NHS Nottinghamshire or NHS North West London.’
Although the reforms mark a departure from ‘GP-led’ commissioning, each ICS board will need to have ‘representatives’ from general practice, as well as NHS trusts and local authorities.
The paper added: ‘ICSs will also need to ensure they have appropriate clinical advice when making decisions.’
In a foreword, the Government said the proposals are aimed at ‘removing the barriers that stop the system from being truly integrated’.
It said that the Covid-19 pandemic had ‘accelerated’ at pace ‘collaboration across health and social care’ and argued this showed what can be achieved by working together ‘flexibly, adopting new technology focused on the needs of the patient’ while ‘bureaucratic rules’ are ‘set aside’.
Finally, the Government claimed it wants to make the system ‘more accountable and responsive to the people that work in it and the people that use it’.
To this effect, the proposed legislation will see the health secretary resuming some direct powers over NHS England – which in turn will be fully merged with NHS Improvement; as well as Monitor and the NHS Trust Development Authority.
The document said: ‘Our proposals will ensure NHS England, in a new combined form, is accountable to Government and the taxpayers that use it while maintaining its clinical and day-to-day operational independence.’
In a statement to the House of Commons this afternoon, where he laid out the proposals, health secretary Matt Hancock said: ‘The white paper provides a statutory basis for unified national leadership of the NHS, merging three different bodies that legally oversee the NHS into one – as NHS England.
‘NHS England will have clinical and day-to-day operational independence. But the Secretary of State will be empowered to set direction for the NHS and intervene where necessary.’
A Bill will be laid before Parliament to legislate on the reforms, which are based on proposals made in the NHS Long-term Plan, ‘later in the year’ when ‘time allows’, the DHSC said.
But health think tanks have warned that reforms could be ‘distracting’ and the BMA – which campaigned against the 2012 Health and Social Care Act – said that clinicians did not have the time during the middle of a pandemic to properly review proposals.
Previously, the BMA has said that NHS England proposals to abolish CCGs were of ‘significant concern’ for GPs and could cause ‘significant changes to their working lives’ if they go ahead.