enable a greater range of delegation options for section 7A public health services, including the ability for onward delegation of the function into collaborative arrangements, such as a section 75 partnership arrangement We will take forward the NHS’s recommended approach by retaining existing patient choice rights and protections and bolstering the process for AQP arrangements. In addition, ICSs can be powerful drivers of patient centred approaches that provide greater choice and control to patients by transforming services around the specific needs of their populations. In line with NHS England’s recommendation, we are proposing to introduce a specific power to issue guidance on joint appointments between NHS Bodies; NHS Bodies and local authorities; and NHS Bodies and Combined Authorities. This will aid the development and delivery of integrated care and will ensure that there is a clear set of criteria for organisations to consider when making joint appointments.

The Work the System methodology itself is a system. It’s the controlling management tool used to analyze and maintain your personal systems. It’s the master control mechanism for organizing yourself into an efficient life: a life of serenity, prosperity, and contribution.”There is a direct connection between happiness and the amount of control we attain.” (Sam: Charles Duhigg discusses this at length in Smarter Faster Better .) introduce a power for the Secretary of State for Health and Social Care to mandate standards for how data is collected and stored, so that data flows through the system in a usable way, and that when it is accessed/provided (for whatever purpose), it is in a standard form, both readable by, and consistently meaningful to the user/recipient There is a big difference between the two phrases and their meanings, making them not interchangeable. What Does “In The System” Mean? Whether an outcome is to your liking or not, the underlying system is performing exactly as it was constructed.” Silent and invisible, your systems work without pause. Sometimes they work alone, but often they work together. They support and complement each other—and sometimes they fight each other.”

We know from the vanguard ICSs that taking a joined-up, population focused approach means you cannot see the people that services are meant for as just units within the system – their voice and sense of what matters to them becomes really central. That focus won’t come through structures alone of course but working with organisations such as Healthwatch there is a real chance to strengthen and assess patient voice at place and system levels, not just as a commentary on services but as a source of genuine co-production. These proposals focus on stripping out needless bureaucracy, turning effective innovations and bureaucracy busting into meaningful improvements for everyone, learning from the innovations during COVID-19. To further support integration, we propose to implement NHS England’s recommendation for a shared duty that requires NHS organisations that plan services across a system ( ICSs) and nationally (NHS England), and NHS providers of care (NHS Trusts and FTs) to have regard to the ‘triple aim’ of better health and wellbeing for everyone, better quality of health services for all individuals, and sustainable use of NHS resources. Following the publication of the Long Term Plan proposals for legislation, the NHS engaged with the public, patients, NHS staff and a broad range of representatives from across the health and social care sectors on possible legislative changes. There were more than 190,000 responses to this engagement exercise and in September 2019, NHS England published their final recommendations. A number of influential organisations and individuals wrote to the government in broad support. These recommendations were supported in a letter to government, including NHS Providers, Unison, the Local Government Association, the Academy of Medical Royal Colleges, National Voices and others.

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This will support NHS bodies to continue a culture of working together in the best interest of not only their immediate service users and organisations, but of the wider population, and for the ICS as a whole, working together strategically and through its ‘place’- based constituents. We hope that the triple aim will help align NHS bodies around a common set of objectives, thus supporting the shift towards integrated systems which have strong engagement with their communities. Reserve power over foundation trusts capital spend limit On safety and quality: we will bring forward measures to put the Healthcare Safety Investigation Branch (HSIB) on a statutory footing; to enable us to improve the current regulatory landscape for healthcare professionals as needed; to establish a statutory medical examiner system within the NHS for the purpose of scrutinising all deaths which do not involve a coroner and increase transparency for the bereaved, and to allow the Medicines and Healthcare products Regulatory Agency ( MHRA) to develop and maintain publicly funded and operated medicine registries so that we can provide patients and their prescribers, as well as regulators and the NHS, with the evidence they need to make evidence-based decisions. We will also be bringing forward measures to enable the Secretary of State to set requirements in relation to hospital food. And finally, we will take powers to implement comprehensive reciprocal healthcare agreements with countries outside the EEA and Switzerland (‘Rest of World countries’) – expanding our ability to support the health of our citizens when they travel abroad, subject to bilateral agreements. Delivering for patients, citizens and local populations – supporting implementation and innovation Many of the measures we are proposing have been under consideration for some time. In January 2019, the NHS published its Long Term Plan which set out the priorities for health and care over the next ten years. This plan, developed in partnership with those who know the NHS best – frontline health and social care staff, patients and their families and other experts – suggested targeted legislative proposals that would help to support the implementation of the objectives described in the Long Term Plan. But no one recognises more than does the government, and certainly no one recognises more than I do, that no legislation, however wisely conceived and however efficiently embodied in an Act of Parliament, can ever give the public a great health service unless the people who administer it want to do it and are enthusiastic in doing it.

The powers within the bill are intended to enable us to develop a new provider selection regime which will provide a framework for NHS bodies and local authorities to follow when deciding who should provide healthcare services. The provider selection regime will be informed by NHS England’s public consultation , and aims to enable collaboration and collective decision-making, recognising that competition is not the only way of driving service improvement, reduce bureaucracy on commissioners and providers alike, and eliminate the need for competitive tendering where it adds limited or no value. Commissioners will be under duties to act in the best interests of patients, taxpayers, and the local population when making decisions about arranging healthcare services. A primary thrust of the Work the System method is to generate extra time so you can better prepare.” This is no ordinary moment. We have seen collaboration across health and social care at a pace and scale unimaginable even a little over a year ago. The NHS and social care providers have delivered outstanding care to those in need while at the same time radically changing ways of working, reducing bureaucracy and becoming more integrated. New teams have been built, adoption of new technology has been accelerated, new working-cultures developed, and new approaches to solving difficult problems pursued. As a result, NHS capacity grew; new hospitals were built in just a matter of days; and new ways of treating patients have become the norm. As we look towards the future and to the recovery of our society, our health and care system will continue to be central to our national wellbeing and prosperity in the years ahead. Stop looking for a sudden hand-of-God solution to problems. Drop the idea that life is convoluted and mysterious, strip away the complexity, and get to work repairing the underlying inefficient mechanisms one by one.”COVID-19 response. As of 9 February 2021, the UK has vaccinated 12.6 million people. In the early stages of the response, the NHS COVID-19 Data Store was established, which safely brought together accurate, real-time information necessary to inform decisions in response to the current pandemic in England Joint appointments of executive directors can help to foster joint decision making, enhance local leadership and improve the delivery of integrated care. They can also help to reduce management costs and engender a culture of collective responsibility across organisations. remove NHS Improvement’s specific competition functions and its general duty to prevent anti-competitive behaviour The Strategic Objective is your Declaration of Independence, your mandate for a better future. The General Operating Principles document is your Constitution, a set of guidelines for future decision making. The Working Procedures are your laws, the rules of your game.”

In practice, we recognise that ICSs will have to develop effective and legitimate decision-making processes, and we are giving ICS NHS bodies and ICS Health and Care Partnership the flexibility to develop processes and structures which work most effectively for them. We also know that we need to support staff during organisational change by minimising uncertainty and limiting employment changes. We are therefore seeking to provide stability of employment and will work with NHSE and staff representatives to manage this process. COVID-19 has demonstrated the importance of different parts of the health and care system working together in the best interests of the public and patients. This has been something that organisations in the health and care system have been increasingly working towards over the past few years, despite the barriers in legislation which sometimes make it difficult to do so. We propose to implement NHS England’s recommendations and legislate to support integration, both within the health service, and between the health service and local government, with its statutory responsibilities for public health and social care. We anticipate that there will continue to be an important role for voluntary and independent sector providers, but we want to ensure that, where there is no value in running a competitive procurement process, services can be arranged with the most appropriate provider. The NHS will continue to be free at the point of care and our proposals seek to ensure that where a service can only be provided by an NHS provider – for example, A&E provision – that this process is as streamlined as possible.A growing and ageing population. Over the next 20 years the population in England is expected to grow by almost 10%. The number of people aged 75+ is expected to grow by almost 60% – an additional 2.7 million people Getting what you want—in life and work—lies in focusing on ‘working the systems’ that create the results. The Department of Health and Social Care’s paper, busting bureaucracy: empowering frontline staff by reducing excess bureaucracy in the health and care system in England, sets out the government’s strategy for reducing excess bureaucracy. These actions are being taken forward through a variety of different projects, some led by the department, some by regulators and some by other bodies across the health and care system. Whilst we can do a lot to reduce bureaucracy through changing processes and culture, the Department’s engagement demonstrated that a lot of bureaucracy is also generated by the legislation which in some places is no longer fit for purpose and we therefore want to use this opportunity to amend legislation to resolve these issues. allow ICSs to enter into collaborative arrangements for the exercise of functions that are delegated to them, enabling a ‘double-delegation’