Legislating on the future of health and care in England

Healthcare leaders' views on the NHS reform white paper and implications for the forthcoming health and care bill.

31 March 2021

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In February 2021 the government published Integration and Innovation: Working Together to Improve Health and Social Care for All. The white paper sets out the key elements of a forthcoming health and care bill, the first piece of new primary legislation on health and care in England since the Health and Social Care Act 2012 (HSCA 2012).

This report outlines the views of healthcare leaders on the white paper, the implications for the forthcoming health and care bill and a set of recommendations to government as it develops the finer detail of the legislation.

Key points

  • Our members – spanning acute, mental health and community providers, as well as commissioners, primary care networks and integrated care systems – have strongly welcomed and endorsed the direction of travel set in the white paper. The experience of recent years, and especially the pandemic, have shown the very real benefits of collaboration within the NHS and also with other public services. Our members are clear that the complex challenges facing the health and care sector over the coming years will require ever-closer collaboration, risk-sharing and flexibility, which the proposed legislation will facilitate.
  • There is also a widespread view across the NHS that the forthcoming legislation should aim to be as permissive as possible. One of the most welcome features of the white paper is that it recognises the contribution that local leaders will make to addressing the specific needs of their communities. It is especially welcome, therefore, that the white paper provides scope for local flexibility. We urge the government and those that regulate and oversee the NHS to ensure that the bill, and especially the wider guidance to support its implementation, continues to embrace this principle.
  • There are, however, some concerns shared across our membership in four key areas that the government may wish to address in the bill:
  1. Increased powers for the Secretary of State over the NHS
  2. Governance and accountability
  3. The duty to collaborate
  4. Pace and timescales
  • It is hoped that the comments we outline will be helpful both for the Department of Health and Social Care and NHS England and NHS Improvement  as they develop the final wording of the health and care bill over the coming weeks. Our member networks, representing providers (including mental health), commissioners, integrated care systems  and primary care networks, will also be conveying more detailed concerns to government and NHSEI separately.