Protect the NHS, Press Pause on the White Paper for Health and Social care

I want the Government to press pause on implementation of this White Paper, which is being rushed through without adequate consultation with NHS frontline staff doing the work, local councils providing social care and the public using the services, when there are major concerns about proposals.

This White Paper has been rushed through during the Pandemic. It plans to completely restructure health and social care, but there are significant concerns with it. It will change the way the entire NHS budget is given to providers and could open up the way to NHS provision by large private companies, and reduce involvement of elected councils.

The Government has no plans to pause the proposals set out in our White Paper, “Integration and Innovation: working together to improve health and social care for all” (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/960548/integration-and-innovation-working-together-to-improve-health-and-social-care-for-all-web-version.pdf).

These proposals are now being delivered through the Health and Care Bill (https://bills.parliament.uk/bills/3022/publications), which was introduced in Parliament on 6 July. This Bill delivers on NHS England’s own proposals for reform, which were set out in its 2019 Long Term Plan (https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/) following an extensive engagement exercise. This involved NHS staff, patients and other health and care organisations which received over 190,000 individual responses. In developing the proposals, the Department for Health and Social Care has undertaken further extensive engagement with stakeholders, including approximately 100 organisations across the health and care system. These contributions have been invaluable to the development of our proposals. This includes leaders of existing Integrated Care Systems (ICSs) across the country, as well as representatives from local authorities and the Local Government Association.

Although this Bill captures learnings from the response to the pandemic and makes permanent some of the innovations we have seen in the system, it is also the result of long and careful consideration and engagement with NHS workers that precedes the pandemic. The introduction of the Bill at this time, to allow the system to make progress with integrating care in a way that will be crucial to the recovery from the pandemic, was supported by stakeholders including the Academy of Medical Royal Colleges, the NHS Confederation and NHS Providers.

This Bill builds on the work of existing ICSs by establishing new NHS bodies known as Integrated Care Boards alongside Integrated Care Partnerships in each local system area. Together they will empower local health and care leaders to join up planning and provision of services, both within the NHS and with local authorities, and help deliver more person-centred and preventative care. Integrated Care Boards will include representatives from local authorities, as well as from NHS trusts and general practice. Integrated Care Partnerships will bring together health, social care and public health (and potentially representatives from wider society where appropriate) and will be tasked with promoting partnership arrangements to enable more joined up planning and provision. Local authorities will have clearly defined roles within the structures of both Integrated Care Boards and Integrated Care Partnerships. This will reinforce the role of local authorities’ as system leaders and will give local government a greater voice in NHS decision making than ever before.

Integrated Care Boards will be public bodies and will be driven by health outcomes. Integrated Care Boards will take on the commissioning functions of the Clinical Commissioning Groups, as well as some of NHS England’s commissioning functions. They will be accountable for NHS spend and performance within the system. NHS England will have the power to set financial objectives for Integrated Care Boards and there will be a duty on Integrated Care Boards to meet these objectives. The allocation of resources to each Integrated Care Board will continue to be determined by NHS England, with the objective of ensuring equal access for equal need, building on the existing approach to setting allocations for Clinical Commissioning Groups and taking account of advice from the independent Advisory Committee on Resource Allocation. Integrated Care Boards will agree how the allocation will be used to perform its functions, in line with health and care priorities set at a local level. Money will flow from the Integrated Care Board to providers largely through contracts for services and outcomes, which may be managed by place-based partnerships or provider collaboratives.

Service provision by the independent sector has been an important and valuable feature of the system under successive governments, with decisions being taken by NHS commissioners. The overwhelming majority of services paid for by the NHS are provided by NHS bodies and this will continue to be the case. The Health and Care Bill had its Second Reading debate on 14 July and will enter Committee Stage from 7 September.

Department of Health and Social Care