Government to introduce health and care bill in parliament

The government will present its health and care bill to parliament on 6 July setting out major NHS reforms that include scrapping CCGs, formalising the role of integrated care systems and increased powers for the health secretary.

Health and social care secretary Sajid Javid (Photo: Dan Kitwood/Getty Images)

The government said the bill would help the NHS and local government work together to plan health and care services and 'quickly implement innovative solutions to problems which would normally take years to fix', such as shifting services out of hospital.

It said a new NHS and public health procurement regime would 'reduce bureaucracy on commissioners and providers alike, and reduce the need for competitive tendering where it adds limited or no value'.

Measures will be set out in the bill to support social care alongside requirements on calorie labelling on food and drink packaging and the advertising of junk food.

Integrated care systems

Integrated care systems (ICSs) will become statutory organisations under the plans, taking on the commissioning powers of CCGs and moving some of NHS England's current powers to regional level.

NHS England said last year that 'it could be possible to allocate combined population-level primary care, community health services and specialised services population budgets to ICSs'.

Just one seat on each ICS board will represent general practice out of a mandatory 10 board posts in each of the organisations, officials have confirmed. 

BMA leaders have warned this must be considered the 'bare minimum' - and that the move away from CCGs must not see the 'strong clinical voice and local expertise' of general practice lost to health service management.

NHS reform

BMA leaders have said that 'ICSs should include formal roles for LMCs representing primary care, local negotiating committees for secondary care, and public health doctors'.

Other critics of the proposals have said that plans for ICSs have been developed 'undemocratically'.

Announcing plans to introduce the bill, health and social care secretary Sajid Javid said: 'The astonishing response of our health and care services to the COVID-19 pandemic has hit fast-forward on some of the bold changes the NHS set out to deliver in its Long-Term Plan and shone the spotlight on other areas that require change to achieve better care for our communities.

'To help meet demand, build a better health service and bust the backlog, we need to back the NHS, as it celebrates its 73rd birthday this week, and embed lessons learned from the pandemic. This will support our health and care services to be more integrated and innovative so the NHS can deliver for people in the decades to come.'

Health inequality

NHS chief executive Sir Simon Stevens said: 'This bill contains widely supported proposals for integrated care, which have been developed and consulted on over recent years by the NHS itself. They go with the grain of what our staff and patients can see is needed, by removing outdated and bureaucratic legal barriers to joined-up working between GPs, hospitals, and community services.

'In doing so, these pragmatic reforms build on the sensible and practical changes already well underway right across the NHS. And by enabling mutual support between different parts of the local health and care services they will undoubtedly both help tackle health inequalities and speed the recovery of care disrupted by the covid pandemic.'

However, the Doctors in Unite union backed a motion last year warning: 'ICSs have been introduced and developed undemocratically, without consultation and with a lack of transparency.

'Their aim is to impose "reduced per capita cost" control totals to force unproven and unsolicited innovation, including elements of privatisation and paid for care, in each system’s struggle to meet local population need.'

Doctors in Unite fears that each ICS will form an integrated care provider (ICP) that could ultimately run NHS services through a commercial contract - and has called for their replacement by health boards.

Doctors in Unite chair Dr Jackie Applebee told GPonline at the time: 'I think there are a number of risks to GPs with ICSs. Once we are in a formal system with controlled total budgets, funding for general practice could be squeezed even more than it is already.

'There is also the risk that the private sector might swoop in, promising to “provide” or “manage” the ICS for less than the current “NHS” managers can. This would really threaten the future of general practice.'

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