The new Bill will change how England’s largest public service works locally, and how it relates to Parliament and the Government. This briefing, based on our research and analysis of emerging proposals over several years, presents the key points and issues on which we believe MPs should provide scrutiny.
- The new powers for the Secretary of State to direct the English NHS and to intervene in local service changes risk creating a health service where party political aims distort decisions or are perceived to. This could undermine trust and make for worse choices, as it has in the past.
- The Bill could see even minor local changes to NHS services anywhere in England sent to Whitehall for approval. This risks bogging down innovation and dragging ministers into decisions better left to local leaders.
- The changes to create a more cooperative NHS at a local level represent the right direction of travel. However, the local structures are complicated. There is a risk of gridlock where people do not cooperate well.
- By splitting the NHS into larger areas, the calculation that steers money to areas who need it more will be less precise. There is a risk that small areas with higher needs will lose out.
- The Bill does very little to address the severe and worsening crisis in social care. The admirable goal of the NHS working better with social care will not be achieved if the sector is failing to deliver basic support and protection, as is the case today.
- New Integrated Care Boards have many important powers to take on, and a complex structure. Putting them fully in charge over the next few months may be difficult during the ongoing pandemic.
- The requirement for the Secretary of State to describe who is in charge of the NHS workforce is not very helpful, and should be replaced by a duty to carry out independent calculations of whether policies will make enough key workers available or not.