Nuffield Trust statement on Health and Care White Paper

Responding to the Health and Care White Paper, Nuffield Trust Chief Executive Nigel Edwards said:

“Covid-19 has shown how crucial it is that health and social care services in England work well together, and provided brilliant examples at the front line that we need to build on. But we must be careful that in trying to boost cooperation, we don’t fall into the age-old traps of distracting, confusing reorganisation, or trying to run Europe’s biggest public service from Whitehall.

“It’s good that the new model for local health services, based on ‘Integrated Care Systems’, will try to be flexible to the different needs of different places. But the approach of having three overlapping boards locally for the NHS and social care risks confusion and a clash of agendas. Who holds the real power locally might be contested, especially as powerful independent Foundation Trusts remain. 

“The NHS has seen so many restructures that it can shift easily into reorganisation mode, where attention is taken away from patient care to focus on who is on which committee and which lines are on the organogram.

“Ministers may come to regret all the new powers they are set to be granted over hospital closures and downgrades, directions to NHS England, and the responsibility to collaborate. The health service is so huge that decisions at the centre can easily miss the reality at the front line. And as earlier Governments learnt to their peril, centralising power means you centralise blame, and create more pressure to interfere.

“There is also a question of accountability here about major decisions. Should Ministers be able to open, close and transform NHS bodies without full legislation? MPs will want to think carefully about their ability to scrutinise changes to the service in future.”