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Proposals set to limit health secretary interference with day-to-day NHS management

by Jess Hacker
19 November 2021

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Proposed amendments to the Health and Care Bill may limit ‘controversial’ powers for the health secretary to intervene in the day-to-day management of NHS services.

Amendments to the Bill – tabled yesterday (18 November) and to be discussed in Parliament next week – seek to curb suggested powers within the Bill that would grant the health secretary the power to intervene in local reconfigurations of NHS services.

The powers, outlined in the July version of the Bill, have been described by think tanks as ‘politically driven’, with important reforms ‘undermined by controversial plans for greater ministerial interference’.

Currently, the health secretary is only able to intervene with the approval of a local authority.

If passed, the new amendments would introduce several legal requirements the health secretary must comply with before intervening in local reconfigurations of NHS services.

They must:

  • Consider clinical advice about changes to clinical services
  • Consider the view of local health overview and scrutiny committees to ensure there is outward accountability
  • Publish a statement setting out why the intervention is in the public interest.

However, the King’s Fund told Management in Practice today that it believes the original proposal should be dropped entirely.

A spokesperson said that service reconfiguration decisions are ‘nothing if not based on operational and clinical considerations’ and that ‘by having the secretary of state involved earlier, that is bringing unhelpful politics into those decisions’.

They added that while these amendments go ‘some way’ to involving clinical consideration, they do not address the ‘decision-making logjam’ caused by a lack of definition over when an issue should be escalated to the health secretary.

Simialrly, the Health Foundation had previously called for the proposal to be dropped entirely, saying that they were ‘contentious’ and existed ‘to give his role more power over the day-to-day running of the NHS’.

The Bill

The Bill is set to enter its report stage from Monday (22 November), amid criticism over its decision to replace CCGs with integrated care systems (ICSs).

The campaign group Your NHS Needs You has claimed that the introduction of ICSs will lead to integrated care boards (ICBs) covering areas that are ‘too large’ to ensure local and public accountability, while also allowing private companies to ‘make decisions on allocating public expenditure’ through their ICB membership.

Its petition to scrap ICSs, which launched at the end of October, has now reached 90,000 signatures.

But the Government has said measures introduced under the Bill will reduce bureaucracy in the NHS.

Other proposed steps included assigning the NHS and local authorities a ‘duty to collaborate’, and scrapping section 75 of the Health and Social Care Act 2012 which mandated for all NHS contracts to be put out to competitive tender.

During its white paper phase, the Bill came under criticism for its lack of clarity around primary care’s involvement in ICSs.

In May, a survey revealed that half of primary care managers said they were ‘unclear’ or ‘very unclear’ about the role of primary care networks (PCNs) within ICSs.