‘Integration and innovation’ white paper

On 11 February 2021, the Department of Health and Social Care published a white paper outlining its proposals for legislative changes to increase collaboration in health and social care. In this paper, the government stated that the plans aimed to ‘build on the incredible collaborations we have seen through COVID’.

‘Integration and innovation: working together to improve health and social care for all’

The government set out a series of proposals for a new health and care bill, with stated aims to integrate care, reduce bureaucracy and enhance public confidence and accountability.

Alongside other measures, the white paper included proposals to establish integrated care systems (ICSs – area-based partnerships of organisations tasked with improving health and care services and population health) as statutory bodies in all parts of England. Other proposals included: placing a ‘duty to collaborate’ on NHS organisations and local authorities; formally merging NHS England and NHS Improvement; and removing or changing ‘barriers’ to collaboration, such as competition law and the existing procurement system.

The white paper drew on proposals for legislative reform put forward by NHS England and Improvement in 2019 and 2020. But it also included additional changes. For example, it proposed increased powers for the secretary of state for health and social care, such as the ability to intervene directly to change local health service delivery.

The white paper also proposed a set of targeted changes related to public health, social care, and quality and safety. On public health, for example, the paper proposed a set of measures aimed at tackling obesity and related to the fluoridation of water. Proposals on social care included a new duty for the Care Quality Commission to assess how local authorities are meeting their adult social care duties, additional powers for the secretary of state to make payments directly to adult social care providers, and changes that aimed to improve data collection from social care providers.

Health and Social Care Committee inquiry

Stakeholders submitted oral and written evidence to the Health and Social Care Committee’s inquiry into the government’s proposals for reform. In its report on the proposals, the committee broadly welcomed the direction of reform. But it also raised concerns regarding their design and implementation: the committee highlighted the lack of clarity regarding the structure of ICSs; the risks of a large reorganisation of the system; and the lack of attention paid to systematic problems in the social care system.

Later developments

After the publication of the white paper, the government brought the Health and Care Bill for a first reading in parliament on 6 July 2021. Following parliamentary debate, several amendments were introduced and the Health and Care Act differed from the original proposals of the white paper. For example, the act included a duty for NHS England to publish guidance on collecting and analysing data on health inequalities. The bill received royal assent on 28 April 2022.