Reforming the NHS Structure

Reforming the NHS structure again

Note: the NHS White Paper titled 'Integration and Innovation: working together to improve health and social care for all' was published on 11th February 2021.

Another major reorganisation of the NHS in England is under consideration by the government.

In November 2020, NHS England and NHS Improvement published proposals on integrating health and social care, with legislation to give effect to this by April 2022.

It is understood that this has now turned into a draft White Paper, likely to be published later this year, with very wide implications.

The Secretary of State for Health and Social Care has long wanted NHS England (NHSE) to be answerable directly to ministers rather than being semi-independent. This change is expected to be in the White Paper and means that decision-making will be more centralised, enhancing the role of ministers and officials within the Department of Health and Social Care (DHSC). Companies wanting to influence NHSE decisions would therefore have a new and important route through which to put forward their concerns.

Another change is expected to greatly reduce competitive tendering for NHS work, possibly abolishing it in some areas, although this should not affect medicines or medical devices.

However, by far the most major change will be the integration of health and social care, and the consequences which would follow from this.

The well-respected Health Foundation anticipates that England will be divided into 42 integrated care systems (ICSs), established as collaborations between NHS providers, commissioners and local authorities.

NHSE has set out two options for ICS structures – one is joint committees of existing statutory organisations and the other is having ICSs as new NHS bodies.

The latter is much preferred by NHSE. It would simplify the system, impose a degree of uniformity and be easier to set up (takeovers are invariably simpler that mergers). It also reinforces the case for placing a more powerful NHSE under direct ministerial control.

However, the consequences of adopting this second route would be profound. Clinical commissioning groups would be abolished, the position of primary care networks would be unclear and a new structure would be needed.

The last major reform, the Health and Social Care Act 2012, involved extensive time and resources, and diverted attention from current needs. This is particularly relevant today, with the NHS struggling to cope with COVID-19 and the backlog of normal cases.

For life science companies, the selling of authorised medicines under the new structure, still in the process of being organised, could become complicated and it is to be hoped that the lessons of 2012 will be remembered by DHSC and NHSE.

The 2012 legislation had to be paused in response to widespread opposition from the Royal Colleges and other health bodies, as well as by parliamentary concerns, particularly in the House of Lords. If this happens again, with the added intervention of local authority organisations, the start date of April 2022 may be seen as too optimistic.

MAP are monitoring developments and will update MAP Online as more information becomes available.

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Christopher Mockler

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