Time for Change

On 11 February 2021, the Department of Health and Social Care published the White Paper Integration and innovation: working together to improve health and social care for all, which sets out legislative proposals for a health and care Bill. The White Paper brings together proposals that build on the recommendations made by NHS England and NHS Improvement in Integrating care: next steps to building strong and effective Integrated care systems across England with additional recommendations relating to the Secretary of State’s powers over the system and targeted changes to public health, social care, and quality and safety matters.

The White Paper groups the proposals under the following themes:

  • working together and supporting integration
  • stripping out needless bureaucracy
  • enhancing public confidence and accountability
  • additional proposals to support public health, social care, and quality and safety.

The Kings Fund have provided a full summary to describe the main proposals under each theme and the rationale for each. It also provides an initial assessment of the proposals and their implications for the health and care system.


  • The proposals represent a marked shift away from the focus on competition that underpinned the coalition government’s 2012 reforms, towards a new model of collaboration, partnership and integration. At the same time, removing some of the competition and procurement rules could give the NHS and its partners greater flexibility to deliver joined-up care to the increasing number of people who rely on multiple services.
  • Unlike previous reforms, the proposed legislation aims to avoid a one-size-fits-all approach and leaves many decisions to local systems and leaders. This is appropriate given the great variation across England in terms of history, demography and local health challenges.
  • It is also important to recognise the limitations of what legislation can achieve. It is not possible to legislate for collaboration and co-ordination of local services. This requires changes to the behaviours, attitudes and relationships of staff and leaders right across the health and care system, including within the national bodies. This makes the implementation plan very important, especially as the legislation leaves so much to local (and national) discretion.
  • Some of the proposals seek to give ministers far greater powers over NHS England and other arm’s length bodies. While it is right to clarify who is accountable for the health service, the government should protect the day-to-day clinical and operational independence of the NHS. Similarly, the proposal to give ministers the power to intervene earlier in local decisions about the opening and closing of NHS services risks politicising local service decisions.
  • While legislative changes are needed to progress the integration agenda further and faster in the interests of improving care for patients, these proposals come at a time when the NHS, local authorities and voluntary sector organisations are still battling Covid-19. In implementing these proposals, health and care services must not be distracted from dealing with the crisis at hand.

Although this White Paper has the intention of creating a synergy between health and social care, each proposal is unfortunately very similar to the last with very few changes and minor tweaks.

While there are some things to welcome in the White Paper, the social care system faces many challenges that will not be fully addressed by these proposals, including chronic staff shortages, deep health inequalities and an urgent need for long-term reform of social care. There is a pressing need for the government to chart a way out of these deep-seated challenges.

This White Paper again falls short, and it feels like as a sector we are in a loop and constantly battling with the same issues. It is important however to keep raising these points to sector leaders and industry bodies, as the more we continue to challenge the government, the more likely it is that these issues will be addressed.

As a group we need to keep putting the pressure on, and by using the past 12 months to evidence how much social care delivers in our communities, this is now the best time to stand forward!

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