A new government blueprint for NHS and social care reform has been cautiously welcomed by health experts who are warning against another top-down mandate.

Health and Social Care Secretary, Matt Hancock, has set out new proposals to build on the successful NHS response to the COVID-19 pandemic.

The proposals, set out in a white paper to be published on the government website, will bring health and care services closer together to ‘build back better’ by improving care and tackling health inequalities through measures to address obesity, oral health, and patient choice.

And the measures will modernise the legal framework to make the health and care system fit for the future and put in place targeted improvements for the delivery of public health and social care services.

The proposals build on the NHS’s recommendations for legislative change in the NHS Long Term Plan and come a decade on from the last major piece of health and care legislation.

They include proposals to make integrated care the default, reduce legal bureaucracy, and better support social care, public health and the NHS.

The reforms will also enable the health and care sector to use technology in a modern way, establishing it as a better platform to support staff and patient care, for example by improving the quality and availability of data across the health and care sector to enable systems to plan for the future care of their communities.

Time for change

Hancock said: “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.

“These changes will allow us to build back better and bottle the innovation and ingenuity of our brilliant staff during the pandemic, where progress was made despite the legal framework, rather than because of it.

“The proposals build on what the NHS has called for and will become the foundations for a health and care system which is more integrated, more innovative and responsive, and more ready to respond to the challenges of tomorrow, from health inequalities to our ageing population.

“By acting now, the Government can make permanent some of the beneficial changes where COVID-19 has catalysed new and better ways of working and clear the path for improvements into the next decade, such as delivering on manifesto commitments including 50,000 more nurses and 40 new hospitals.”

Professor Helen Stokes-Lampard, chairman of the Academy of Medical Royal Colleges, said of the announcement: “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.

“Legislation won’t make collaboration happen, but it can remove barriers and facilitate the changes that the NHS really needs as we move into the post-pandemic recovery stage.

“It is vital that we see genuine clinical engagement at every level of the operation of the ICS to drive collaboration.

“We will look forward to reviewing the full range of proposals and engaging in the development of the legislation.”

The legislation will fold Monitor and the NHS Trust Development Authority into NHS England, while maintaining the clinical and day-to-day operational independence of the NHS.

And corresponding reforms will ensure the Secretary of State for Health and Social Care has the right levers to ensure accountability back to Parliament and taxpayers.

The white paper sets out the Government’s proposals for legislation, building on the extensive consultation that has already been undertaken by NHS England; and a bill will be laid before Parliament later in the year.

The Government also intends to bring forward separate proposals on social care reform later this year.

But it is this confusion over whether local organisations, or government ministers, will have overall control, that is dividing critics.

Greater flexibility

Describing the white paper as ‘a decisive step away from the coalition Government’s 2012 reforms’, Richard Murray, chief executive of The King’s Fund health think tank, warned that the ‘NHS is littered with reform plans that overestimated benefits and underestimated disruption’.

He said: “Most important is the welcome shift away from the old legislative focus on competition between health care organisations towards a new model of collaboration, partnership and integration.

“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.”

And he highlighted a potential issue with the proposal to give ministers the power to intervene earlier in local decisions about the opening and closing of NHS services.

“The Government and national NHS leaders should be looking to step away from the damaging model of top-down command and control in the NHS,” he said.

“The independence given to NHS England is seen as one of the successes of past reforms, and while it is right to clarify who is accountable for the health service, the Government should protect the day-to-day clinical and operational independence of the NHS.”

He concluded: “These latest proposals add up to a major reform package and come at a time when the NHS, local authorities and charities are still battling COVID-19.

“In implementing these proposals, it will be essential to avoid distracting health and care services from dealing with the crisis at hand.

“Health and care services are facing chronic staff shortages, deep health inequalities laid bare by the pandemic, and an urgent need for long-term reform of social care. In addition to the structural reforms proposed, there is a pressing need for the Government to chart a way out of these deep-seated challenges.”

And Nick Sanderson, chief executive of care provider, Audley Group, said the joined-up health and social care plans did not go far enough.

“The UK’s fast-growing older population deserves better,” he adds.

“Yet again, the focus is on solving a problem already created, rather than preventing the problem from occurring in the first place.

Leaving a legacy

“The focus could, and should, have been on limiting the need for these services altogether, and numerous studies have shown us that housing is the answer.

“Enabling the provision of more-appropriate housing for older people, with care and wellbeing services attached, changes the focus entirely to keeping people healthy and secure in their own homes rather than needing hospital or residential care.

“If this government wants to leave a legacy to be proud of, that genuinely rips apart a broken system and builds it back better from the ground up, then housing policy MUST be joined up with health and social care.”