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Some sensible proposals for reforming the health and care system in White Paper

By Sean O' Sullivan on 12 February 2021 NHS NHS England Health and social care Secretary of State for Health

Matt Hancock, the Health Secretary in England, yesterday (Thursday 11 February) launched a White Paper outlining proposals for the further integration of health and care services, the removal of bureaucratic rules and processes and the strengthening of accountability arrangements for the NHS in England.

The 80-page report is not the easiest of reads, packed full as it is of references to systems, structures, processes and legislative rules. I would not necessarily recommend this for anyone’s bedtime reading (other than insomniacs) but for anyone prepared to do some hard reading, there are some sensible proposals for reforming the health and care system. This is because the Government has wisely chosen to bring forward a range of ideas that many in the NHS, from Simon Stevens to health think tanks, Royal Colleges (including the RCM) and senior clinicians, have been calling for.

The promotion of greater integration - within the NHS and between NHS and local government – the scrapping of rules forcing services to be put out to tender and the promotion of collaboration over competition, are all steps in the right direction. We can certainly extend a cautious welcome to several the key recommendations, including:

  • A new duty on all health and care organisations to work collaboratively and with a common purpose of securing better health and wellbeing for everyone.
  • A requirement on NHS bodies to protect, promote and facilitate patient choice.
  • The ending of the presumption that competition is the only way to drive service improvement and the scrapping of rules around the compulsory tendering of services.
  • A new responsibility on the Secretary of State to publish a report setting out the workforce planning responsibilities of NHS bodies.
  • The strengthening of local public health systems and the role of ICSs in improving joint working on population health.
  • Further restrictions on the advertising of high fat, salt and sugar foods and new powers to strengthen food labelling requirements.

Many of these proposals are embryonic and, until they are fleshed out in the draft legislation, we may have to reserve further judgement. We will want to study in more detail other recommendations, such as the establishment of a Health Services Safety Investigations Body, which will to take over the work of HSIB. We will also want to get a better understanding of the implications for maternity services; for example, how will Local Maternity Systems (LMSs) work within ICSs?

Perhaps our biggest misgiving about the White Paper is the absence of any meaningful discussion about the NHS workforce, other than the duty on the Secretary of State to report on workforce planning responsibilities. At a time when so many staff are stretched to the limit and fearful for their wellbeing and that of their family and friends, is it asking too much of the Health Secretary to consider their wellbeing and what sort of NHS they would like to work in?

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