Ministers to use Covid as justification for taking more control over NHS England

Ministers are planning to use the coronavirus pandemic as a reason to erode the independence of NHS England including plans that would allow the health secretary to intervene in local reconfigurations of NHS services.

A leaked copy of the government’s planned legislative proposals for the NHS reveals it plans to give ministers greater powers of direction over the day to day operations of NHS England.

A copy of the Health and Care Bill proposals, first reported by Health Policy Insight, would also create new powers to allow the current structure of the NHS to be rewritten with the ability to set up new integrated care organisations covering local areas and allowing some contracts to be awarded without the need to put them out to tender.

The document says: “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.

It added: “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 health secretary will not be able to formally direct a local hospital nor will he have the power to intervene in clinical decisions.

Currently ministers can only intervene in reconfigurations if the proposals become controversial and local councils make a formal objection or referral. Under the new legislation ministers would be able to intervene “at any point” in the process.

The draft proposals said the existing system “can lead to difficult debates and lengthy processes, meaning a long and arduous journey to a decision being made and local areas and their democratic representatives left in limbo”.

It added: “We are therefore proposing to broaden the scope for potential ministerial intervention in reconfigurations, creating a clear line of accountability, by allowing ministers to intervene at any point of the reconfiguration process.”

The last major reform of the NHS in 2012, led by former health secretary Lord Lansley, has been widely criticised for its damaging effects on the health service. NHS England was given more independence from government along with the creation of more than 200 local clinical commissioning groups, which were responsible for commissioning and funding most local services, led by GPs.

The inability of ministers to reform the NHS since then has led to multiple workarounds with several half-mergers between NHS England and other national bodies.

Under the proposed legislation the health secretary would have the power to transfer functions from one arms length body to another – effectively allowing the government to reform the NHS without needing to bring full legislation to the House of Commons.

The plans also include a new focus on the NHS workforce with a duty placed on the health secretary to publish a document once during each Parliament setting out the workforce needs for the NHS and the plans in place to supply the staff required.

It also includes powers to make substantial changes to the professional regulators overseeing nurses, doctors and other clinicians. This will include the power to remove a profession from regulation, the power to abolish a regulatory body and opening the door to possible future regulation of NHS managers.

The Bill would also allow the health secretary to make direct payments to social care providers.

It also includes measure to ensure medical examiners review every death, and steps to bring the private sector under the remit of the independent Healthcare Safety Investigation Branch.

HSIB was setup in 2017 and was designed to be an independent body however the legislation would also give the health secretary the power to direct it to carry out investigations of certain incidents.

A Department of Health and Social Care spokesperson said: “We do not comment on leaks.”

They added: “From tackling bureaucracy to driving forward the integration of health and care services, we are rightly considering where changes need to be made to help us build back better.

“Full details will be set out in due course.”