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Former health ministers give warning that Health and Care Bill could lead to greater centralisation unless key principles embedded

21 June 2021

Five former health ministers, including Greater Manchester Mayor Andy Burnham and Rt Hon Norman Lamb, are calling on Government to “level up health” through its forthcoming Health and Care Bill.

The cross-party Health Devolution Commission, whose supporters include the LGA and the NHS Confederation, says the pandemic provides a unique opportunity to rethink as well as reorganise how health care is delivered.  However the Commission’s report ‘Levelling Up Health’ also warns that unless key principles included in its many recommendations are acted upon the Bill could lead to greater centralisation of NHS, social care and public health services.

‘Levelling Up Health’, makes 28 detailed recommendations to the Government’s Health and Care Bill including on the purpose of the reform and the future power relationship between the NHS, local government and other stakeholders including the VCSE and patient representative bodies. It says better – more personalised, local and integrated – NHS, social care and public health services and a relentless focus on addressing health inequalities should be at the heart of the Government’s reorganisation. 

The six most noteworthy recommendations are appended below.

Co-Chair of the Commission and former Health Minister during the Conservative-Liberal Democrat Coalition Government, Rt Hon Norman Lamb, said:

If the recommendations in this report are embraced by the Government and NHS England then there is a real opportunity to do health differently and in a way which has a genuinely positive impact on the health and prosperity of our local communities. There is, however, a danger that unless these changes are accommodated in the imminent Health and Care Bill the Government’s reforms could lead to greater centralisation not decentralisation of NHS, social care and public health services. 

“The White Paper offers the chance of using resources more effectively and of unleashing the power of local organisations and communities to improve health and prosperity but the proposals need strengthening in the way we have suggested in order to realise that vision.”

Co-chair of the Commission, the Mayor of Greater Manchester – which has been pioneering the Integrated Care System model that the Government plans to roll-out across England – and former Secretary of State for Health under the last Labour Government, Rt Hon Andy Burnham said: 

“The case for the long-overdue reform of health and social care in this country has never been stronger, but it has to be done right. This report sets out three core principles which must drive that reform if we are to create an effective integrated system fit for the future.

“The first must be establishing a genuine partnership of equals between the NHS and local government to deliver person-centred care. 

“The second is that real levelling up must underpin all of these reforms: levelling up between DHSC and local government, between NHS services and social care, between physical and mental health, and between treatment and prevention. All of this is crucial to redressing the stark health inequalities that still exist across the country.  

“The third is that there is a commitment to putting local expertise at the heart of these plans. It must be our local authorities with adult social care responsibilities, like those here in Greater Manchester, that are the building blocks of Integrated Care Systems. This is the starting point to take forward integration and delivery, and to ensure effective, place-based services for local communities.”

  1. Population health improvement and reducing health inequalities should be primary purposes of ICSs that are written on to the face of the Bill 
  1. ICSs should promote a ‘health in all policies’ approach and encourage greater action by other public, voluntary and private sector organisations 
  1. The Government should make a public commitment to parity of esteem between the NHS and Local Government
  1. The Government should publicly acknowledge that ‘place based partnerships’, based on the principle of subsidiarity and the footprints of councils with adult social care responsibilities, are the building blocks of the Integrated Care Systems and the principal level at which integration, and delivery, of services should be taken forward.
  1. The presumption should be that the ICS Partnership is chaired by a Local Government leader – or Metro Mayor if agreed by a relevant Combined Authority –  and include a range of members from the NHS, Local Government, Universities, LEP(s), the Voluntary, Community and Social Enterprise (VCSE) sector and patient representative bodies. 
  1. The ICS NHS Board should fulfil its mandate in ways that are compliant with the ICS Partnership’s Health and Wellbeing Plan. The Government should produce detailed statutory guidance on how the ICS NHS Board will have ‘due regard’ to the plan of the Partnership including a ‘comply or explain’ approach.

Read the full report here.