Government set to announce NHS reforms tearing up Health and Social Care Act

The Government is set to announce NHS reforms today that are expected to hand more power to Integrated Care Systems (ICSs) and remove 2012 legislation mandating NHS contracts to be put out to tender.

The Department of Health and Social Care (DHSC) said it will publish its White Paper on reforms of the Health and Social Care Act today, with plans aiming to ‘join up’ health services and remove ‘unnecessary legislative bureaucracy’.

The ‘flexible’ proposals will ‘modernise’ the NHS’s legal framework and include moves to ‘make integrated care the default, reduce legal bureaucracy, and better support social care, public health and the NHS’, the DHSC said.

But health think tanks 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.

Plans for the reforms, which said CCGs could be replaced as commissioners by ICSs as part of new proposals for integration, were first revealed in November last year.

Trailing today’s publication, the DHSC said the reforms ‘will support local health and care systems to deliver higher quality care to their communities, in a way that is less legally bureaucratic, more accountable and more joined up, by bringing together the NHS, local Government and partners together to tackle the needs of their communities as a whole’.

‘Key’ measures include legally joining the NHS and local Government as part of ICSs to enable them to respond to local health needs, including ‘moving services out of hospitals and into the community’, the DHSC said.

The reforms will also tackle health inequalities through measures addressing obesity, patient choice and oral health, it added.

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’, according to the DHSC.

Announcing the White Paper, health secretary Matt Hancock said the proposals ‘build on what the NHS has called for’.

He added: ‘The NHS and local Government have long been calling for better integration and less burdensome bureaucracy and this virus has made clear the time for change is now.

‘These changes will allow us to bottle the innovation and ingenuity of our brilliant staff during the pandemic, where progress was made despite the legal framework, rather than because of it.’

NHS England chief executive Sir Simon Stevens said the legislation will build on ‘the flexible “can-do” spirit NHS staff have shown in spades throughout the pandemic’.

Professor Helen Stokes-Lampard, chair of the Academy of Medical Royal Colleges, said greater collaboration through ICSs that ‘go beyond the traditional NHS boundaries’ is ‘absolutely the right direction of travel’ for the NHS.

But the BMA warned that this was not the time for ‘sweeping reorganisation on such a scale’.

Council chair Dr Chaand Nagpaul said: ‘While the BMA supports greater collaboration within the NHS, our members and their colleagues need a real chance to assess these plans and their implications. On the back of a year in which doctors have gone above and beyond in responding to the greatest health crisis in a generation, they are now both physically and emotionally exhausted.’

He added: ‘Since 2012 the BMA has campaigned against wasteful and bureaucratic NHS procurement rules that require all contracts to be put out to competitive tender. While the White Paper proposes ending these competition rules, the BMA has previously expressed concerns that this could lead to awarding contracts without sufficient scrutiny to outsourced providers at huge expense to the taxpayer.

‘We have seen the devastating impact of this happening during the pandemic with both PPE and “NHS” Test and Trace. In contrast, where the NHS and clinicians were given the chance to lead, as in the vaccine programme, we have achieved far better progress, demonstrating why the BMA believes that the NHS should always be the preferred provider for NHS services. This is an opportunity to roll back on the expensive and inefficient use of the private sector, not increase it.’

And Independent think tank the Nuffield Trust warned that the shake up could take attention ‘away from patient care’ and bring a ‘clash of agendas’.

Nuffield Trust chief executive Nigel Edwards said: ‘Covid-19 has shown how crucial it is that health and social care services in England work well together, and provided brilliant examples at the front line that we need to build on. 

‘But we must be careful that in trying to boost cooperation, we don’t fall into the age-old traps of distracting, confusing reorganisation, or trying to run Europe’s biggest public service from Whitehall.’

He added: ‘The approach of having three overlapping boards locally for the NHS and social care risks confusion and a clash of agendas. Who holds the real power locally might be contested, especially as powerful independent Foundation Trusts remain.’

And he warned that new powers given to ministers could mean decisions made at the centre ‘miss the reality at the front line’.

Chief executive of the King’s Fund Richard Murray added that the Government and national NHS leaders should ‘step away from the damaging model of top-down command and control in the NHS’.

He said: ‘It is clear ministers intend to take greater control of national decisions about the NHS. 

‘The independence given to NHS England is seen as one of the successes of past reforms and whilst it is right to clarify who is accountable for the health service, the Government should protect the day-to-day clinical and operational independence of the NHS.’

He added: ‘There is much to welcome in the ambition of the White Paper, but the history of the NHS is littered with reform plans that overestimated benefits and underestimated disruption.’

The DHSC said the Government’s legislative proposals build on the ‘extensive consultation’ carried out by NHS England.

The proposals consulted on included two options – one CCG only per ICS with CCGs to ‘delegate’ population health roles to ‘providers’, or the ‘repurposing’ of CCGs with their statutory functions transferred to the ICS.