The leaked NHS white paper

Friday 5 February saw the leaking of a white paper on health and social care reform. Usually, the Institute would wait until the official version was produced. Still, given the interest in the NHS and its future approach to systems working, some of the principles aired in the document may be of interest to governance professionals.

The move within the NHS to Integrated Care Systems (ICSs) has been broadcast widely and will not come as a surprise to NHS governance watchers. The NHS England in early January sought ways to make limited legislative changes to enable and support ICSs, but if the leaked document is the lodestar of future activity, the changes coming to the NHS in England will be far broader in scope. Leaving aside, whether now is the best time for a(nother) NHS top-down re-organisation, the changes are required if ICSs are to have the best environment and framework to succeed. And I think the majority of the public want the NHS to succeed. However, a multi-party partnership can be a governance challenge within the same sector, especially when working across sectors with different motivations and accountability frameworks.

The proposals mooted coalesce around four broad themes: working together and supporting integrations; stripping out needless bureaucracy; enhancing public confidence and accountability; and further support for social care, public health, quality and safety. Looking solely at the governance implications in the leaked document, the following will be of particular interest to members and others with interest in NHS governance:

Joint working and integration

1. The NHS and local authorities will be given a duty to collaborate with each other, underpinned by the presence of local authorities on the boards of ICSs. These will support ‘place-based’ aims to tackle local issues;
2. Using joint committees and joint appointments to support collaborative commissioning;
3. Better data sharing between NHS entities and place-based partners;

Bureaucracy

4. Reducing bureaucracy to promote innovation and support collaborative working in the achievement of joined-up, person-centred care, including by removing inflexible legislation and creating ‘New Trusts’;
5. Changing the application of competition and procurement legislation to NHS bodies;

Accountability

6. Improving public accountability, at the national and local level, including new powers for the Secretary of State to direct the revised NHS England, establish and abolish arm’s length bodies (ALBs), and service reconfigurations;
7. Merging NHS England, Monitor (formerly the regulator of NHS Foundation Trusts) and the NHS Trust Development Authority (the last two entities currently work together under the name of NHS Improvement) and clarifying the role of the Secretary of State, the Department for Health and Social Care, Government and Parliament;

Health and social care

8. Systems assurance and data measures to support social care commissioning; and
9. Other health promotion and prevention measures, such as advertising restrictions on certain foods.

The document might seek to ‘go with the grain’ of current NHS working arrangements, but some proposals are likely to have a profound effect on different parts of the health service and present some chewy governance challenges. Lessons from DevoManc, Local and Multi Strategic Partnerships and other cross-sectoral collaborations will be useful in identifying potential ways for the future NHS to be successful in working locally and in an integrated manner.

While it is not proposed that the white paper will be subject to public consultation, the Institute believes its experience of governance practices across all sectors would be invaluable in creating arrangements that deliver the future vision of the NHS and social care sector. As such, we will be organising a virtual working group to discuss the governance implications in the official white paper (once launched) and to present practical suggestions to improve the prospects for delivering better care, health and wellbeing while using NHS resources sustainably.

Louise Thomson FCG, Head of Policy (NFP), The Chartered Governance Institute UK & Ireland.

If you would like to get involved in the working group, please email Louise Thomson for further information in the first instance.

Find out more about our qualification in health service governance here.