Ministers will take direct control of the NHS amid ongoing frustration at its performance during the pandemic, marking the biggest reform for the health service for a decade.
The plans are understood to have begun before the 2019 election, but have been accelerated amid mounting frustration from Number 10 over the state of the health service during the coronavirus crisis.
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A white paper will be published in the next few weeks to push through reforms by April 2022.
According to a leaked draft of the legislation seen by the Health Policy Insight website, ministers plan to take greater powers of direction over the day-to-day operations of NHS England.
The document states: “We are proposing to create a power of direction over NHS England that will provide clear lines of accountability by allowing the secretary of state for health and social care to direct NHS England in relation to relevant functions.
“We want to strengthen the secretary of state’s powers of intervention, oversight and direction. This will serve, in turn, to reinforce the accountability to Parliament of the secretary of state and government for the NHS.
“Covid has reinforced the importance of and increased need for clear and unified lines of accountability from the frontline to Parliament.”
The draft legislation also outlines plans for a more integrated healthcare service. Under current plans, clinical commissioning groups (CCGs) — which “buy” healthcare on behalf of patients — will be replaced by “integrated care systems” that will answer to the secretary of state.
CCGs currently control around £85bn of £201.7bn total annual spend by the NHS.
The draft white paper states: “The Covid pandemic demonstrated plainly that this broader approach to health and care is not only desirable but essential.”
The proposed legislation will also enhance the power of Whitehall to intervene in the provision of social care. The Care Quality Commission will be handed fresh powers to investigate local councils over their delivery of adult social care.
Health secretary Matt Hancock will also gain powers to block closures of hospitals, A&Es and maternity units under the new plans.
Hancock will also be able to add fluoride to water across the country and intervene on the quality of hospital food. However, he will not be able to formally direct a local hospital or to intervene in clinical decisions.
Currently, ministers are only able to intervene in reconfigurations if local councils make a formal objection or referral. Under the new legislation ministers would be able to intervene “at any point” in the process.
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Jonathan Ashworth, the shadow health secretary, said: “Ministers need to explain why reorganisation is the pressing priority when 190,000 people are waiting more than 12 months for treatment, and cancer survival rates need to be radically improved.”
An NHS spokesman said: “The NHS has come together to draw up practical proposals that will make it easier for those delivering health and care to work together . . . without some of the fragmentation implicit in the 2012 act.”