Government proposals for NHS reform are likely to go unchallenged

The NHS has faced, and is still facing, the most defining period in its history. Despite the successful vaccine rollout indicating that the pandemic might now be under control, the NHS will feel the effects of COVID-19 for many years.

The Government is now tasked with convincing Parliamentarians that the proposals set out in its White Paper: Working together to improve health and social care for all, will restore public confidence in the NHS, which, as Nigel Lawson once described, is “the closest thing the English people have to a religion”.

Unlike many of the legislative measures the Government has taken in the past couple of years, this shouldn’t be too tricky. When it comes to their plans for reform, the Government has the backing of the NHS itself, building on the NHS’s Long Term Plan proposals, as well as the recommendations set out by the NHS on legislating for Integrated Care Systems (ICSs). The Government is able to counter opposition to its proposals by arguing that they are delivering on exactly what the frontline staff, patient groups, and national experts are asking for.

The White Paper indicates a drastic shift away from the old legislative focus on competition between health care organisations towards a new model of collaboration, partnership, and integration, ditching the 2012 reforms introduced by the coalition government. The NHS and its partners would be given greater flexibility to deliver joined-up care, with local health and care leaders being given the freedom to make decisions based on the needs of their local population, sweeping away clunky competition and procurement rules. On the whole, the Government has realised the flaws in the current system from their perspective, and the White Paper symbolises a power grab back to the Government.

It is highly likely that the contents of the White Paper will lead to a ‘NHS Reform Bill’, due to be announced at the Queen’s Speech on 11 May. Despite having an 80-seat majority, we know that Tory backbenchers are capable of making things particularly difficult for the Government. Recently, we have seen rebels cause trouble for the whips on issues like China, free school meals, trade standards and covid restrictions. With any other Government Bill, one might expect large scale rebellions, and for the Bill to change drastically by the time it becomes law. But in this case, Conservative MPs are likely to vote in line with the whip.

As well as an 80-seat majority in the Commons, the Conservative Party are the largest party in the House of Lords, with 84 more seats than Labour. Despite this, the Government have faced major challenges in getting legislation through the upper house, with the Trade Bill and the Medicines and Medical Devices Bill being clear examples of this, demonstrating that Members of this House cannot be easily whipped. The latter of the two Bills picked up almost 50 pages of amendments in the Lords, and the wide range of healthcare experience amongst Peers indicates that they are likely to make more incremental changes to the Bill based on their more unique level of experience. Nonetheless, Peers would be wise not to disagree too strongly with the recommendations set out by NHS England.

You’d expect the Labour Party to have its own plans for NHS reform, and for them to be ready to pick apart every bit of detail on what the Government is proposing. Labour have had ample opportunities to capitalise on the widespread public solidarity with the NHS that the country has shown throughout the pandemic. The NHS has historically been a comfortable policy area for Labour, and they have had numerous open goals to highlight the already-made criticism of the Government’s failures throughout the pandemic.

However, it isn’t really in Labour’s interest to go down the road of blocking every measure the Government plans to introduce, as it is largely what the NHS itself is proposing should be implemented, leaving Keir Starmer in a tricky position. The NHS made specific recommendations to Government on the question of how to legislate to place ICSs on a statutory footing, and the Government has essentially played it safe by doing almost exactly what the arms-length body is proposing.

Regardless of your views on the White Paper, both Matt Hancock and Simon Stevens are determined about the significant role that ICS’s can play in the future of the UK’s healthcare system, and with those two on the same side, it would be unwise to bet against their inevitable inclusion as a key component of the future of the NHS.

Everything about the way in which health and social care is funded, delivered, and administered in the UK will be examined by Parliamentarians, Government officials, journalists, and other industry stakeholders. The next six months or so will prove to be an integral time for organisations to engage on the future of the UK’s health policy landscape.

The Whitehouse team are experts in providing public affairs advice and political analysis to a wide range of clients engaging with health and social care providers and policy makers, not only in the United Kingdom, but also across the member states of the European Union and beyond. For more information, please contact our Chair, Chris Whitehouse, at