Letter to the new Secretary of State about the NHS bill

Dear Secretary of State,

First of all, we would like to congratulate you on your appointment as Secretary of State for Health and Social Care. We are committed to working with you and your team to address the major challenges that face our patients, staff and the wider health and care system.

We are the membership organisation that brings together, supports and speaks for the whole healthcare system in England, Wales and Northern Ireland. We are uniquely placed in that we have access to the views of leaders across all parts of the health system – from primary care providers, community services and mental health providers through to hospitals, ambulance services and the leaders of integrated care systems. We would welcome the opportunity to meet with you to discuss further how we can support you – our team is in contact with yours to see if we can find a date. We have enjoyed a close working relationship with your predecessors and look forward to continuing that with you.

In the meantime, we are writing to you with an urgent matter with regards to the publication of the NHS Bill. We understand that you will of course want to review the draft Bill and the legislative timetable before proceeding. With time running out before summer recess, we wanted to flag the concerns of our members about the potential implications of any delay.

Our starting point is one of support for the broad thrust of your Government’s reforms to the NHS. Seven in 10 of our members who responded to a survey we are due to publish shortly said they support the proposals outlined in the White Paper. There is much consensus that this is the right direction of travel. This has been bolstered by the pandemic which has showed the importance of integrating services and uniting in a common cause, including working together to tackle long-standing health inequalities. We can only do this by breaking down barriers between services and working in partnership across health and care services, and the planned legislation helpfully takes this one step further. In many ways, the legislation is catching up with the steps the NHS has been taking in recent years to integrate care following the vision outlined in the Five Year Forward View and the NHS Long Term Plan.

We are ready to take these reforms forward and removing the legislative barriers that currently hold back progress are a critical next step in the journey.

However, there is risk ahead if the timetable is delayed – we could lose the momentum that has been built up in recent months. NHS leaders are working hard to meet what is already a tight timetable and missing the opportunity to table this before summer recess risks making an already difficult task nigh on impossible.

For example, the chairs of the Integrated Care Systems that will become statutory bodies need to be appointed, and decisions are needed on those local systems that are likely to see changes to their boundaries. If we are to go live in April 2022, then these matters need to be resolved as soon as possible. We need this clarity to ensure that both your Government and NHS England and NHS Improvement can work effectively together with ICS and other NHS leaders to make this next stage of the reforms a success.

More generally, we have expressed concern over the potential for greater centralisation of power in these reforms, particularly when it comes to local service reconfigurations. We encourage you to look at this specific issue again. However, despite this we can only see risk in delaying the publication of the Bill as it will leave the system in flux at a pivotal moment.

As we have outlined, there is broad support for these proposals and any delay to the Bill will risk jeopardising what is already a very tight timetable. We recommend a pragmatic and realistic approach that enables us to keep moving forward with the reforms and which enables local leaders to make the necessary changes that they need to make ahead of the new structures being implemented.

You will no doubt have lots to contend with in your first few days in office, but we would welcome the opportunity to discuss this further with you.

Yours sincerely,

 Lord Victor Adebowale CBE, Chair

Matthew Taylor, Chief Executive