Unfortunately, your browser is too old to work on this website. Please upgrade your browser

NHS recommendations to government and parliament for an NHS bill

26 September 2019

Following the publication of the NHS Long Term Plan in January 2019, the prime minister asked NHS England and Improvement to design proposals for primary legislation to enable implementation of the plan and remove barriers to collaboration between NHS organisations and other parts of the health and care system. In February 2019, NHS England and Improvement launched a consultation on their initial proposals.


On 26 September 2019, NHS England and Improvement published their recommendations to government and parliament for an NHS bill, reflecting consultation responses and the findings of a Health and Social Care Select Committee inquiry into the initial proposals. It proposed a ‘highly targeted bill’ to reduce competition and procurement requirements and make it easier for health and care organisations to collaborate. It recommended against a complete reorganisation of the NHS, which would ‘distract from and slow down’ implementation of the Long Term Plan.

Key recommendations included:

  • The repeal of the Competition and Markets Authority’s roles in the NHS, as provided for by the Health and Social Care Act 2012.
  • A ‘triple aim’ of better health for the whole population, better quality care for all patients and financially sustainable services for the taxpayer.
  • Targeted measures to integrate commissioning, such as allowing groups of clinical commissioning groups (CCGs) to use joint or lead commissioner arrangements, and enabling NHS England to enter into formal joint commissioning arrangements with CCGs.
  • A formal merger of NHS England and NHS Improvement as a single organisation, rather than the existing arrangement of the two organisations working together where possible but retaining distinctive statutory responsibilities.
  • NHS commissioners and providers forming joint decision-making committees on a voluntary basis, rather than integrated care systems (ICSs – partnerships of organisations working to deliver health and care services in local areas) becoming statutory bodies.

Later developments

The COVID-19 pandemic delayed plans for legislative reform. In November 2020, NHS England and Improvement published updated proposals for reform. One of the key changes was a recommendation to enshrine ICSs in legislation. It outlined different options for ICSs becoming statutory bodies.

In February 2021, the Department of Health and Social Care published a white paper detailing the government’s legislative plans for a health and care bill, drawing on the NHS England and Improvement proposals. The white paper also included some additional proposals, including to increase the secretary of state’s powers to direct NHS England and ICSs. The subsequent Health and Care Bill received royal assent in April 2022.


NHS England.
NHS publishes response and recommendations on Long Term Plan legislative proposals.
NHS England; 2019.

UK Parliament.
NHS Long-term Plan: legislative proposals Contents [webpage].
UK Parliament; 2019.

NHS England.
Integrating care: Next steps to building strong and effective integrated care systems across England.
NHS England; 2020

UK Parliament.
Health and Care Act 2022 [webpage].
UK Parliament; 2022.