NHS: What reforms does the government want to make?

Joined-up care and less bureaucracy are among the proposals by the government in a bid to reform the health and social care system in England.

A plan to build on work done during the coronavirus pandemic to create a “more integrated, more innovative and responsive” NHS has been set out by Health Secretary Matt Hancock.

However, many have questioned why these changes are being suggested while the NHS battles the Covid-19 crisis.

So, what exactly is being suggested?

What do the plans hope to achieve?

The Department of Health and Social Care (DHSC) said the proposals include improving care and tackling health inequalities through measures to address obesity, oral health and patient choice, the Department of Health said.

The measures effectively sweep away some of the bureaucracy and organisational changes introduced by then health secretary Andrew Lansley in the heavily criticised 2012 Health and Social Care Act which increased competition in the NHS.

The DHSC acknowledged that under the current system NHS staff waste a significant amount of time on unnecessary tendering processes for healthcare services.

The new proposals mean the NHS will only need to tender services when it has the potential to lead to better outcomes for patients.

What about social care?

The White Paper (the way the government sets out planned changes) promises better integration between the NHS and social care, which is usually funded privately or by local authorities.

Making it easier to treat people outside hospitals and making it safer and easier for medics to discharge patients into the community could ease pressure on the NHS while also improving care.

The government’s plans would allow the NHS and local government to come together legally as part of integrated care systems to plan services around their patients’ needs, including a greater focus on preventative healthcare outside hospitals.

Will ministers have a greater role?

Ministers will assume greater responsibility, although Mr Hancock has insisted the clinical and day-to-day operational independence of the NHS will be protected.

The reforms will give the health secretary “the right levers to ensure accountability back to Parliament and taxpayers”, DHSC officials said.

Anything else?

The coronavirus pandemic has starkly illustrated the dangers of an obese population and the White Paper includes new requirements about calorie labelling on food and drink packaging and the advertising of junk food before the 9pm watershed.

The White Paper also calls for the Healthcare Safety Investigations Branch to be made a statutory body and so able to enforce laws, and to reduce risk and improve safety.

What did the government say?

The proposed social care reform will “make the system work for those who work in the system”, Mr Hancock told the Commons.

“At its heart, this White Paper enables greater integration, reduces bureaucracy and supports the way that the NHS and social care work when they work at their best together," the health secretary said.

“It strengthens accountability to this House and, crucially, it takes the lessons we have learnt in this pandemic of how the system can rise to meet huge challenges and frames a legislative basis to support that effort."

Mr Hancock continued that “there is no better time than now” to carry out social care reform.

Answering critics who have asked “why now?” Mr Hancock told the Commons: “The response to Covid-19 has, in my view, accelerated the pace of collaboration across health and social care, showing what we can do when we work together flexibly, adopting new technology focused on the needs of the patient and setting aside bureaucratic rules...

“The pandemic has made the changes in this White Paper more not less urgent, and it is our role in Parliament to make the legislative changes that are needed."

What has Labour said?

Labour also questioned the timing of the suggestions, with shadow Health Secretary Jonathan Ashworth saying" “Staff on the front line are exhausted, underpaid. The Royal College of Nurses says the NHS is on its knees.

“Primary care and CCG staff are vaccinating and will be doing so for months ahead, including possibly delivering booster jabs in the autumn. And today we learn that 224,000 people are waiting over 12 months for treatment.

“And this secretary of State thinks this is the right moment for a structural reorganisation of the NHS.

“Now we will study the legislation carefully when published but the test of his reorganisation will be whether it brings waiting lists and times down, widens access, especially for mental health care, drives up cancer survival rates and improves population health.”

He added: “Fundamentally, how will this reorganisation and power grab improve patient care?

"He didn’t mention waiting times in his statement, it’s only mentioned once in the leaked White Paper.”

What have experts said?

Richard Murray, of the King’s Fund health think tank, said there was “much to welcome in the ambition of the White Paper, but the history of the NHS is littered with reform plans that overestimated benefits and underestimated disruption”.

He also questioned the timing of the proposed shake-up, with the health and care sectors still battling Covid-19.

Sir Simon Stevens, chief executive of the NHS, said: “Our legislative proposals go with the grain of what patients and staff across the health service all want to see – more joined-up care, less legal bureaucracy and a sharper focus on prevention, inequality and social care.”

Professor Helen Stokes-Lampard, chair of the Academy of Medical Royal Colleges welcomed the proposals “to drive integration and support greater collaboration through integrated care systems (ICS)”.

She said while legislation will not make collaboration happen, it can “remove barriers and facilitate the changes that the NHS really needs as we move into the post-pandemic recovery stage”.

NHS Providers chief executive Chris Hopson said there is “widespread agreement” across the NHS on many of the proposals in the White Paper based on a set of agreed legislative proposals in 2019.

He 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.”

But he said the organisation is “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”.

Dr Jennifer Dixon, chief executive of the Health Foundation, gave only a partial welcome.

She said: “One half of the proposals, to help local services collaborate better, could help improve care for patients and follows the direction NHS leaders are already taking.

“The other half, giving the Secretary of State more power over the NHS, is concerning, has no clear rationale and could take health care backwards.”

Ian Hudspeth, chairman of the Local Government Association’s community wellbeing board, said the paper “provides a promising base on which to build stronger working relationships between local government and the NHS”.

The British Medical Association’s council chair Dr Chaand Nagpaul warned against rushing reform when doctors are “now both physically and emotionally exhausted”.

He 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.”