NHS reform blueprint published

Today sees the publication of a government white paper on an NHS reform aimed at improving service integration. The proposals, if implemented, would put Integrated Care Systems (ICSs) on a legal footing. They would also enable NHS England to delegate or transfer the commissioning of certain specialised services to ICSs singly or jointly, or for NHS England to jointly commission these services with ICSs. A Bill is expected to be laid before parliament when parliamentary time allows.

Rolling back on Lansley reforms

Effectively rolling back the Lansley reforms of 2012, which mandated competition in the procurement of services, the proposals are intended to bring health and care services closer together.

The need for competition and competitive tendering in the NHS is removed, and Integrated Care Systems are put on a formal footing.

In addition, the reforms include measures to formally fold Monitor (NHS Improvement) into NHS England, and to hand the Secretary of State for Health and Social Care more control over both NHS England and NHS Trusts. They also set out proposals  for new national medicines registries to be created under the Medicines and Healthcare Regulatory Authority (MHRA). A forthcoming Data Strategy for Health and Care is foreshadowed too.

Role of the patient and voluntary sector could be strengthened

They also set out ambitions to create provisions relating to the formation and governance of joint committees and the decisions that could be appropriately delegated to them, and separately, allowing NHS providers to form their own joint committees. Both types of joint committees could include representation from other bodies, including the voluntary sector. The exact composition however is to be locally determined.

ICS’ will be comprised of an ICS Health and Care Partnership, bringing together the NHS, local government and partners, and an ICS NHS Body. The ICS NHS body will be responsible for the day to day running of the ICS, while the ICS Health and Care Partnership will bring together systems to support integration and develop a plan to address the systems’ health, public health, and social care needs. A key responsibility for these systems will be to support place-based joint working including with partners such as the voluntary and community sector.

Poor timing?

Similarly, the relative lack of proposals relating to social care reform – which was a manifesto commitment and which the sector believe is desperately needed – and the lack of workforce proposals, may undermine the efficacy of the reforms. The Government has stated that it intends to bring forward separate proposals on social care reform later this year.

The Neurological Alliance viewpoint

The timing of the proposed reform has been questioned. While the proposals were first mooted in the Long Term Plan for the NHS published in 2019 – and as such have been a long time in the making, the wisdom of reforming the NHS in a pandemic has been raised. However the government have robustly defended the plans, linking them to the need for a better, stronger NHS, post-pandemic.

Commenting on the proposals, Georgina Carr, Chief Executive of the Neurological Alliance, said:

“Given all we know about the need for better coordination between services to improve the experience people with neurological conditions have of health and care services, these reforms are welcome. However, while they remove barriers to better integration, they won’t make collaboration happen – much remains to be done on the ground to realise the potential in these reforms to improve the care people receive.

“Moreover, we remain to be convinced that these plans are being co-produced with patients, and that sufficient safeguards and lines of accountability are in place to ensure national standards are met when ICSs are given greater powers over commissioning – as we outline in our recent consultation response. These reforms constitute a substantial re-organisation and must be the best they can be, to make the difference needed to people with neurological conditions. We are seeking to join up with other VCSE organisations to influence the forthcoming legislation, to ensure this.”