In February 2021, the Conservative government published Integration and Innovation: Working Together to Improve Health and Social Care for All. The white paper set out the key elements of a health and care bill, the most significant legislative reform to the NHS since the Coalition Government published the Health and Social Care Act 2012.
The government’s reforms outline a move away from key tenets of the Health and Social Care Act 2012, most notably reducing the emphasis on competitive tendering and outsourcing of healthcare services in favour of embracing collaboration and partnership working.
The Health and Care Act 2022 legally mandates partnerships called integrated care systems (ICSs) and allows health and care services to work together more seamlessly. In many ways, the NHS has already been working this way for a number of years given it was a key principle of the NHS Five Year Forward View and the NHS Long Term Plan.
As such, the reforms are broadly supported, but there were concerns about specific aspects, including proposed increased powers for the Secretary of State of Health and Social Care over the NHS.
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The direction of travel outlined by the Government in its white paper, Integration and Innovation: Working Together to Improve Health and Social Care for All, is broadly supported by our members.
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.
However, over the course of several member events and private discussions, our members have voiced concerns over four key issues – these are outlined below. Sitting above these specific concerns is a general view among our members that the forthcoming legislation should aim to be as permissive as possible.
- The increased powers for the Secretary of State for Health and Social Care over the NHS, including over service reconfigurations.
- Governance and accountability, including how putting integrated care systems on a statutory footing will impact on the statutory responsibilities of NHS trusts and foundation trusts.
- The duty to collaborate and how it will operate in practice.
- The pace and timescales of the reforms and their implementation, especially as the NHS attempts to recover from the Covid-19 pandemic.
We will continue to engage the Department of Health and Social Care, NHS England and NHS Improvement and other parts of government in order to ensure that our members concerns are addressed in the legislation.
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