A post-Covid overhaul of England’s NHS will undo key aspects of a controversial 2012 shake-up of the service, requiring different parts of the health and care system to work together and giving the health secretary more power to intervene in the running of the service.
The plan, leaked to a health news website, Health Policy Insight, and also reported by The Times, is due to come into effect from next year and will sharply reduce the role of competition in the health service.
The NHS is wary of huge shake-ups, to which it has often been subjected in recent decades, particularly as it seeks to cope with the current demands and long-term legacy of coronavirus.
However, the draft of the white paper says the aim is to “avoid a disruptive top down reorganisation” and adds that the majority of the proposals “either directly implement or build upon” NHS England’s own recommendations.
The NHS was given operational independence under 2012 reforms introduced by then-health secretary Andrew Lansley. The white paper suggests the health secretary will now be given “enhanced powers of direction” over NHS England and NHS Improvement which will formally merge.
A “clear line of accountability for service reconfigurations” will be introduced which could allow ministers to step in earlier over decisions about whether to close or downgrade a hospital, for example.
The Financial Times reported last year that Downing Street was seeking to tighten its grip, as it pressed for the delivery of general election promises, particularly a pledge to expand nurse numbers by 50,000 over the next five years. The independence of Simon Stevens, NHS England chief executive, and what some in government view as his intractability, has riled ministers in the past although on Saturday Whitehall officials played down the practical significance of enhanced oversight from the health department.
In recent years Stevens has encouraged the development of integrated care systems, through which health, local authorities and social care work together to improve the health of the local population, but they currently have no legal basis.
Under the white paper, the NHS and local authorities “will be given a duty to collaborate with each other underpinned by the inclusion of local authorities on the boards of integrated care systems”, the draft says — a change proposed in the NHS’s own long-term plan published two years ago.
The white paper also signals a change to rigid procurement rules set in place in the 2012 health and social care act, following which “retendering and re-procurement have become much more frequent to meet competition regulations, even when they are won repeatedly by the same organisation”, it says. It will legislate to make procurement “more flexible”, in order to help organisations retain staff and plan longer term.
The imminent closure of Public Health England has created uncertainty about where some key health responsibilities will lie in future. The white paper suggests that the health secretary will be able to direct NHS England “to take on specific public health functions”.
Danny Mortimer, chief executive of the NHS Confederation, which represents healthcare organisations, said the current legal framework “has held us back and new legislation is needed”.However he said the NHS had benefited over the past decade “from having more control over day-to-day operational matters delegated to it” and cautioned that the reforms needed “to better empower local NHS and care leaders to lead — they are best placed to run health and care services for their local communities,” he said.
The health department said: “From tackling bureaucracy to driving forward the integration of health and care services, we are rightly considering where changes need to be made to help us build back better. Full details will be set out in due course.”
The NHS said it had “come together to draw up practical proposals that will make it easier for those delivering health and care to work together to deliver the best possible care for patients, without some of the bureaucracy and fragmentation implicit in the 2012 Act.”