The Health and Social Care Select Committee shows NHS support in its proposals for legislative changes | Matthew Macnair-Smith

Houses of Parliament

As the drive to find our next prime minister looks set to rumble on for another month, it would be easy to believe legislation regarding the future of the NHS may fall by the wayside. Indeed, comments Matthew Macnair-Smith, membership and policy manager at the NHS Confederation, the only bill being debated by MPs at the moment concerns the fate of wild animals in UK circuses.

But there is good news - the Health and Social Care Select Committee has in fact delivered. The Committee, which was after all behind the push to draft legislation to overcome some of the legal barriers to integration, has been as swift as ever in examining the evidence.

In its report, it has put forward a set of recommendations based on input from stakeholders from across health and care, including the NHS Confederation, NHS Clinical Commissioners (NHSCC) and the Independent Healthcare Providers Network (IHPN), and broadly, the message seems to have been received, loud and clear.

In short, that message was to let the NHS get on with integrating and collaborating by removing the legal obstacles, without introducing new ones. We called on the government and national bodies not to indulge in a full-on, top-down re-organisation and to maintain the freedoms that health and care leaders have to set capital spending limits, and merge and reshape services around the needs of local populations.

Collaboration over competition

Our members have long told us that to overcome the challenges the health service now faces, collaboration is key. With this in mind, it is pleasing to see the strong support for repealing section 75 of the Health and Social Care Act 2012, with the intention of easing procurement rules, as NHSCC had highlighted to the Committee how existing procurement rules were often onerous, without adding much value.

How easy it will be to remove the NHS from the various legal frameworks that promote competition is another question. With European laws set to remain intact for the time being at least, it seems reasonable for the Committee to ask the government to assess whether the proposed legislation would have the effect of deregulating competition in the NHS. 

We agree that NHS England/NHS Improvement must consider very carefully what they replace these rules with. A ‘best value’ test may be one solution, but we need to understand how it would work in practice.

Collaboration must be wider than the NHS

We welcomed the emphasis on the role non-NHS bodies, across the voluntary, social enterprise and independent sector, should have in delivering services and supporting integration. It was also very positive that local government was recognised as a crucial partner.

The Committee is right to emphasise the need for collaboration to be wider than just the NHS. “Airless rooms” are not the desired outcome and we continue to support legal changes facilitating local authorities being part of joint committees alongside commissioners and providers. 

There is still a risk that some of the proposals will centralise powers

We were especially concerned by the proposals to allow NHS England/NHS Improvement to direct mergers or acquisitions involving NHS foundation trusts and to set annual capital spending limits for them as we feared it could lead to even greater intervention from national bodies in planning and decision making that is best led locally. We were glad the Committee did not support the proposals as originally drafted.

Of course, we know national intervention may sometimes be necessary to ensure individual local partners are not, unduly thwarting system-wide efforts and it is perhaps right that NHS England/NHS Improvement should have powers in reserve for such cases. But such powers should focus on removing barriers and encouraging local leaders to resolve disputes.

Next steps in uncertain times

Given the chaotic nature of UK politics at present, with the prospect of a new inhabitant of Number 10 and a likely new Secretary of State, these proposals may not be at the top of the political agenda. But it is important that we get this legislation right. The NHS Confederation will continue to engage on the proposals and any pre-legislative scrutiny on the horizon. We will also continue to try to address those vital areas that cannot be altered by tweaking legislation, such as leadership, relationships and culture.

Matthew Macnair-Smith is membership and policy manager at the NHS Confederation. Follow @nhsconfed


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