Reactions to white paper proposals for Health and Care Bill

Below are reactions from several organisations

Commenting on the release of today's ‘White Paper’ with legislative proposals for a Health and Care Bill, the chief executive of NHS Providers, Chris Hopson, said:

"There is widespread agreement across the NHS on many of the proposals in this paper thanks to the work done by NHS England and NHS Improvement and the Health and Social Care Committee to draw up a set of agreed legislative proposals in 2019, a process to which NHS Providers contributed extensively. We are pleased to see that this work forms the bedrock of what is now being proposed.

"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.

"It is also vital that the proposed new statutory powers for ICSs avoid overlap and duplication with the statutory powers of trusts and Foundation Trusts which the Government rightly says it will maintain as the key delivery mechanism for ambulance, community, hospital and mental health care services.

"We will also want to discuss how quickly these changes can be implemented given the operational pressures the NHS is currently facing.

"We look forward to working closely with the Government to get the detail of these proposals right and ensure they contribute to improvements in care for patients and service users".

Responding to the government ‘Integration and Innovation’ White Paper, Richard Murray, Chief Executive of The King’s Fund, said:

“Most important in these proposals is the welcome shift away from the old legislative focus on competition between healthcare organisations, towards a new model of collaboration, partnership and integration. The White Paper marks a decisive step away from the Coalition’s 2012 reforms.

“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.

“The thrust of these reforms is about giving local health and care leaders the freedom to make decisions based on the needs of their local population. Yet, running counter to that ambition, Ministers are also proposing they have 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.

“It is clear Ministers also intend to take greater control of national decisions about the NHS. The independence given to NHS England is seen as one of the successes of past reforms, and whilst it is right to clarify who is accountable for the health service, government should protect the day-to-day clinical and operational independence of the NHS.

“There is 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. 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 in this White Paper, there is a pressing need for government to chart a way out of these deep-seated challenges.”

Responding to the publication of the Government’s Health and Care white paper, Cllr Ian Hudspeth, Chairman of the Local Government Association’s Community Wellbeing Board, said:

“This white paper provides a promising base on which to build stronger working relationships between local government and the NHS, as equal partners, to address the wider determinants of health and deliver better and more coordinated health and care services. We will be working with councils, the Government and NHS England to better understand the full implications of these wide-ranging proposals.

“It is good there is renewed focus and commitment on existing local partnerships and accountability. We support placing Integrated Care Systems (ICSs) on a statutory footing and the addition of a truly joint Health and Care Partnership in every system alongside statutory NHS bodies. We will continue working with government to ensure clarity on their respective roles and responsibilities. Making decisions as close to the people they affect needs to be hardwired into the way we work together.

“We understand the desire for greater transparency in social care, but councils need to be an equal partner in the design of any national oversight. This must build on existing sector led improvement work, recognise local democratic accountability and give a voice to people who use and work in social care. It is helpful the white paper recognises the pressures facing social care and makes clear the Government remains committed to reform, but action is needed and proposals must be brought forward as a matter of urgency. These proposals do not address the need to put social care on a sustainable, long-term footing, nor the wider changes needed to ensure care and support can best enable people to live the lives they want to lead.

“Public health services run by councils have more than proven their worth through the pandemic, as part of the tremendous local response. Any centralisation of public health powers would be of clear concern and we hope that further government proposals to be brought forward will build on these strong local foundations.

“We also urge government to recognise and build on existing local democratic mechanisms, such as Health and Wellbeing Boards and health overview and scrutiny arrangements. We will be concerned if the powers of local Health Overview and Scrutiny Committees are undermined by giving greater powers to the Secretary of State.”

The Royal College of Physicians has welcomed the publication of government plans for new NHS legislation in England, which would begin to be implemented in 2022 if passed into law.

Commenting on the Health and Care White Paper, 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.

"Specific plans to tackle obesity through calorie labelling and restrictions on advertising are what we have been calling for through the Obesity Health Alliance. These positive measures however need to be part of a broader government strategy to address health inequalities.

"Legislation is only one part of the solution too. Much will as always come down to committed clinicians working in their local areas to deliver better care for their patients."

Jonathan Ashworth MP, Labour’s Shadow Health Secretary, responding to proposed reforms to the NHS and social care, said:

“Boris Johnson must explain why a reorganisation in the midst of the biggest crisis the NHS has ever faced is his pressing priority.

“With 192,000 patients now waiting over a year for treatment, our cancer survival rates shamefully low by European standards and mental health services stretched to the limits, Ministers need to outline how an NHS reorganisation at this point in time will deliver the standards of care patients deserve.”