Lessons from the response of the National Health Service [NHS] to the covid pandemic, and frustration at the lack of central control over key policy levers are behind a coming major shake-up of the NHS, increases in the Health Secretary’s powers of intervention, and reform of the structure and responsibilities of arms length bodies, such as NHS England.
The wide-ranging proposals are revealed in a leaked copy of a forthcoming white paper which sets out in detail the government’s plans for new legislation to restructure the NHS in England and to give back to the Health Secretary central powers of intervention and control that were taken away by previous Conservative health reforms through the 2012 Health and Social Care Act promoted by then Health Secretary, Andrew Lansley, whose structural legacy has been widely considered wanting during the pandemic.
The full text of the leaked white paper can be found here:
- Integration and Innovation: working together to improve health and social care for all: The Department of Health and Social Care’s legislative proposals for a Health and Care Bill
Senior figures in government argue that the proposals will enable future Health Secretaries to be held personally and political accountable for the performance of the NHS in a way which has not been effective since 2012, when their responsibilities were reduced and some passed to NHS England, and other “arms length” bodies within the NHS.
Over the last two years, Integrated Care Systems [ICSs] have been formed across England. The Department for Health and Social care believes that through ICSs, NHS organisations, in partnership with local councils and others, are better able to take responsibility for managing resources, delivering NHS care, and improving the health of the population they serve. Integrated care systems, officials claim, have allowed organisations to work together and coordinate services more closely, to make real, practical improvements to people’s lives.
For NHS staff, the argument goes, improved collaboration can help to make it easier to work with colleagues from other organisations. And “systems can better understand data about local people’s health, allowing them to provide care that is tailored to individual needs”.
Improving patient outcomes
By working alongside councils, and drawing on the expertise of local charities and community groups, the NHS can help people to live healthier lives for longer, and to stay out of hospital when they do not need to be there….. at least, that’s the theory that lies behind the latest post-pandemic proposals.
Experience over recent decades would suggest that every time the Conservatives meddle with the NHS systems and structures, Labour cries “wolf” and warns of the Tories’ secret agenda to privatise the NHS. If that is Labour’s approach, and if Prime Minister Boris Johnson and Health Secretary Matt Hancock continue to deliver on the vaccination programme, things might be different this time.
Boris’s own covid health crisis last year, the world-leading development of vaccines in the United Kingdom, and the staggeringly successful roll-out of immunisation, against the background of a willingness to spend unrestricted money on the NHS and the vaccine programme during the pandemic could see that tired old argument made hard to stick.
Need for engagement
All who have an interest in shaping the future of the NHS in England need to engage with this policy development process, to identify their objectives and plan a route map for achieving them. Early engagement in a constructive dialogue with a wide range of government officials and politicians is the way to influence the future terrain of the NHS.
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