Less 'Burdensome Bureaucracy' in NHS Changes for England

Nicky Broyd

February 11, 2021

The Government has confirmed leaked plans for changes to the NHS and social care in England in a white paper called 'Integration and Innovation: working together to improve health and social care for all'.

The "blueprint" rolls back many of the changes introduced in 2012 by former Prime Minister David Cameron and his Health Secretary Andrew Lansley.

The plans include:

  • The NHS and local government coming together legally to provide integrated health and care services and integrated care systems (ICS)

  • Data sharing across the health and care sectors

  • Removing the need to tender for all services

  • Putting the Healthcare Safety Investigations Branch permanently into law as a statutory body to help reduce risk and improve safety

  • Improved oversight and accountability in social care services with powers for the Secretary of State to directly make payments to adult social care providers if required

  • Tacking health inequalities and legislation for calorie labelling on food and drink packaging and banning junk food TV ads before the 9pm watershed

The current Health Secretary for England, Matt Hancock, said in a news release: "The NHS and local government have long been calling for better integration and less burdensome bureaucracy, and this virus has made clear the time for change is now."

NHS England Chief Executive, Sir Simon Stevens, added: "This legislation builds on the past 7 years of practical experience and experimentation across the health service and the flexible ‘can-do’ spirit NHS staff have shown in spades throughout the pandemic."

Separate proposals on social care reform are due later this year.

Plans 'Must Not Be Rushed Through'

Details were released to stakeholders in advance.

BMA Council Chair, Dr Chaand Nagpaul, welcomed greater collaboration within the NHS but said: "Proposals for sweeping reorganisation on such a scale will need greater time for consideration and must not be rushed through while doctors are still tackling the winter surge in infections, hospitalisations, and, tragically, deaths.

"The immediate and forthcoming challenge for the NHS will be addressing the greatest backlog of care our health service has ever faced, alongside the continued pressures of COVID-19. This requires significant new resources and an immediate action plan, rather than risk being diverted by a reorganisation of the health service in the midst of the pandemic.

"Since 2012 the BMA has campaigned against wasteful and bureaucratic NHS procurement rules that require all contracts to be put out to competitive tender. While the white paper proposes ending these competition rules, the BMA has previously expressed concerns that this could lead to awarding contracts without sufficient scrutiny to outsourced providers at huge expense to the taxpayer.

"We have seen the devastating impact of this happening during the pandemic with both PPE and 'NHS' Test and Trace. In contrast, where the NHS and clinicians were given the chance to lead, as in the vaccine programme, we have achieved far better progress, demonstrating why the BMA believes that the NHS should always be the preferred provider for NHS services."

Professor Helen Stokes-Lampard, chair of the Academy of Medical Royal Colleges, said: "We welcome the central proposals to drive integration and support greater collaboration through integrated care systems (ICS), that go beyond the traditional NHS boundaries. This is absolutely the right direction of travel for health and care more widely."

Professor Andrew Goddard, president of the Royal College of Physicians, said: "The shift from ‘competition’ to a focus on ‘collaboration’ in law will be welcomed by NHS clinicians. The recognition of the importance of workforce planning is also crucial – no long-term problem our health and care system faces will be solved until we tackle our workforce shortages.

"The implications of these proposals will be far reaching, so ongoing consultation with the health and care sector is key. It is essential that policymakers consider carefully how changes are communicated to NHS staff, many of whom are exhausted after the last 12 months and understandably wary of a major reorganisation."

Chief Executive of The King's Fund, Richard Murray, said: "By sweeping away clunky competition and procurement rules, these new plans could give the NHS and its partners greater flexibility to deliver joined-up care to the increasing numbers of people who rely on multiple different services."

Chief Executive of the Patients Association, Rachel Power, said: "Although the broad thrust of the proposals developed by NHS England, towards greater integration, was very welcome, the lack of a clear role for patients was a major weakness, and we will need to see this rectified in order to be able to support the planned legislation."

Politically Driven?

Chief Executive of NHS Providers, Chris Hopson, said: "These proposals provide an important opportunity to speed up the move to integrate health and care at a local level, replace competition with collaboration and reform an unnecessarily rigid NHS approach to procurement.

 "There is a lot of detail to get right in what is now a wide-ranging bill. We are keen to understand the Government's intentions on some of the new proposals it has added such as the new powers for the Secretary of State to direct NHS England, transfer powers between arms-length bodies and intervene in local reconfigurations."

Nuffield Trust Chief Executive Nigel Edwards said: "Ministers may come to regret all the new powers they are set to be granted over hospital closures and downgrades, directions to NHS England, and the responsibility to collaborate. The health service is so huge that decisions at the centre can easily miss the reality at the front line. And as earlier Governments learnt to their peril, centralising power means you centralise blame, and create more pressure to interfere."

Chief Executive of the Health Foundation, Dr Jennifer Dixon, said: "The proposals for more 'command and control’ over the NHS by the Secretary of State are politically driven. The Government’s handling of COVID-19 is no advert for more ministerial intervention in the health system. It is disappointing that political energy isn’t focused on fixing adult social care, one of the biggest policy failures in a generation, instead."

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