In bringing forward these measures, we are determined to make the changes to legislation the NHS asked for and, given the government’s wider responsibilities for public health and social care, we intend to take forward a set of targeted legislative measures to support social care, public health and safety and quality. These proposals capture the initial learning from the experience of the health and care system in responding to the pandemic and make permanent some of the innovations where COVID-19 has accelerated new and better ways of working. They provide a framework which allows further evolution and will support, harness and sustain the collaboration and integration seen during COVID-19. This proposal will not impact on Parliament’s ability to scrutinise the mandate – each new mandate will continue to be laid in Parliament by the Secretary of State and will be published. NHS mandate requirements will also continue to be underpinned by negative resolution regulations, providing further opportunity for Parliament to engage with the content of the mandate. Furthermore, the existing duty for the Secretary of State to consult NHS England, Healthwatch England, and any other persons they consider appropriate before setting objectives in a mandate, will also remain in place. Healthwatch England’s involvement ensures that all NHS mandates are informed by the needs of patients and the public. Reconfigurations intervention power 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 Merging NHS England, Monitor and the NHS Trust Development Authority and Secretary of State powers of direction

NHS and local councils formed Sustainability and Transformation Partnerships covering all of England, to consider local health and care priorities and to plan services together The public largely see the NHS as a single organisation and as local health systems work more closely together, the same needs to happen at a national level. Recognising the evolution of NHS England, we are also bringing forward a complementary proposal to ensure the Secretary of State for Health and Social Care has appropriate intervention powers with respect to relevant functions of NHS England. This will support the Secretary of State, when appropriate, to make structured interventions to set clear direction, support system accountability and agility, and also enable the government to support NHS England to align its work effectively with wider priorities for health and social care. This will serve, in turn, to reinforce the accountability to Parliament of the Secretary of State and government for the NHS and the wider health and care system.

The Book in Three Sentences

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. High-performing teams and organisations have vibrant cultures that create the conditions for people to perform at their very best. They are collaborative and open organisations, people focussed with processes that support rather than suffocate the efforts of individuals to do good work. And so, this white paper sets out our proposals for legislation to support and enable the health and care workforce, organisations and wider system to work together to improve, integrate and innovate.

We will also work closely with the NHS to reduce the health inequalities currently experienced in the area of choice, by helping to increase clarity and awareness of patient choice rights within systems and of the range of choices available. Reducing bureaucracy proposals In this paper we refer to health and care partners for brevity’s sake, but to be clear, we believe that this means everyone who works tirelessly to deliver high-quality care and support to people all over the country, including NHS organisations, local authorities, voluntary partners and charities. Working together to integrate care introduce powers for the Secretary of State for Health and Social Care to require data from all registered adult social care providers about all services they provide, whether funded by local authorities or privately by individuals (discussed further in the adult social care proposals); and require data from private providers of health care

The Five Big Ideas

The legislative provisions that we propose for integrated care systems reflect NHS England’s recommendations for change following their recent engagement on ICSs, and are designed to provide a small set of consistent requirements for each system that the partners who make up that system can then supplement with further arrangements and agreements that suit them. The role of ICSs in supporting integration both within the NHS and between the NHS and its partners in local authorities along with further detail on the purpose and governance of integrated care systems is set out at annex B. In this section we set out the core functions of the ICS along with a number of other provisions designed to support integration across the health and care system. On current timeframes, and subject to Parliamentary business and successful passage, our plan is that these proposals for health and care reform will start to be implemented in 2022. We will continue to engage with stakeholders across the health and care systems, our arm’s length bodies and the devolved administrations on the detail of these proposals as they progress. We will also continue to work across government to ensure that the right systems and processes are in place that work for all, recognising the interdependencies between health and other social determinants. Annex A: Proposals for legislation Working together and supporting integration proposals

where NHS England specifies a service in the National Tariff, then the national price set for that service may be either a fixed amount or a price described as a formulagive NHS England the ability to joint commission its direct commissioning functions with more than one ICS Board, allowing services to be arranged for their combined populations NHS activity has grown every year since records began (at an average of 3.3% a year). Over the last 9 years (between 2009/10 and 2018/19) the number of attendances in A&E increased by 4.3 million; the number of GP appointments have risen from 222 million in 1995 to 308 million in 2018/19; and the number of outpatient attendances has increased by almost 36 million since 2009/10 The pandemic saw the suspension of certain data collection requests from government and national bodies such as NHS England, NHS Digital and the Care Quality Commission. Where data collection was vital to the pandemic response, existing powers were used to publish notices requiring health and care bodies to share data to help manage and control the spread of COVID-19 within local systems. We will build on this approach and make changes to the regulations governing the sharing of data to enable more effective use of data for the benefit of individuals and the health and care system as a whole.

NHS Long Term Plan confirmed that every area will be served by an integrated care system by 2021, with primary and community services funded to do more 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. areas refined initial proposals, drawing on conversations with frontline staff, local residents and others in the community The collaborative working between Health Education England ( HEE), NHS England and NHS Improvement and the Department on the development of the NHS People Plan has shown the need for a flexible and future-proofed regional workforce operating model. Whilst competition can drive service improvement, it has in some cases hindered integration between providers Currently, the Competition and Markets Authority ( CMA) has specific powers to review mergers involving foundation trusts ( FTs). It has become clear that the CMA is not the right body to review NHS mergers. In line with NHS England’s recommendations, we intend to remove these powers and allow NHS England, as overseer of the system, to ensure that decisions can always be made in the best interests of patients. The CMA’s jurisdiction over mergers is UK-wide, so we are working with the devolved administrations to ensure there would be no unintended consequences of these proposals.

The NHS has sent us a clear message that the current regime for arranging healthcare services is not working. It is confusing, overly bureaucratic and does not support the integration and efficient arrangement of services in the best interest of patients. NHS England will need to keep the guidance under review, and if substantial changes to it are considered, they will need to consult appropriate organisations before the revision is published. Data sharing The reforms within these legislative proposals will remove the current procurement rules which apply for NHS and public health commissioners when arranging healthcare services. They will do this by creating the powers to remove the commissioning of these services from the scope of the Public Contracts Regulations 2015, as well as repealing Section 75 of the Health and Social Care Act 2012 and the Procurement, Patient Choice and Competition Regulations 2013.