Health bill delays create ‘risks’ for NHS facing covid and winter pressures, warn leaders

The NHS has been planning for the new bill to be enacted by April 2022, which gives it very little time to introduce the required changes. 

The bill, which will mean clinical commissioning groups being subsumed by statutory integrated care systems, had been expected to be published in late June. It was eventually published on 6 July, and will get its second reading in Parliament today.

The delays have raised concerns over whether the government can meet the tight legislative timetable. However, as great a worry for the service is the delay to NHS England guidance on how the new laws should be implemented. This guidance has had to be delayed or issued in outline form while the parliamentary process continues. 

A local board paper signed by two highly influential local NHS leaders – Dr Amanda Doyle and David Flory - cites concerns around the bill’s progress being delayed.

The paper, published by Lancashire and South Cumbria ICS on 7 July, says “ongoing delays” in the publication of national policy and guidance are “resulting in a prolonged period of uncertainly for our workforce”.

It adds: “Given the further delays to the progression of the bill through Parliament and the subsequent delays to the publication of national guidance, we consider that one of our key risks has now become an issue….

“Delay in bill having second reading in Parliament results in a further delay in the publication of national policy/guidance which risks a relatively short time frame for implementation in the second half of 2021/22, which will coincide with operational pressures related to winter and the potential further pressures related to the prevalence of covid-19.”

Dr Doyle is the chief officer of the ICS, but is set to become NHSE’s regional director for the North West next month. Mr Flory is chair of the ICS and a former chief executive of the provider regulator, the Trust Development Authority.

The paper added: “We continue to undertake significant work on the design and implementation of our system, place-based partnerships and provider collaboratives, noting the ‘permissive’ approach outlined by [NHS England] in relation to much of the development activities, particularly at place.

“However, it is now inevitable that a significant amount of change will need to take place during Q3 and Q4 which will be challenging for the [ICS], particularly for NHS partners who will need to manage the transition of large numbers of staff.”

Dame Gill Morgan, chair of the NHS Confederation’s advisory network on ICSs, said: “There is a real concern, and the timetable is very tight, but the majority view amongst our ICS network members is that we need to get on with it, including giving clarity as soon as possible to those ICSs affected by potential boundary changes.

“We have consistently said that the April 2022 start date is the beginning and not the end. It’s about giving ICSs statutory responsibilities safely so they can develop further from then on.

“Our members have welcomed the NHSE’s approach in involving them in the development of the guidance and continuing that engagement will be key. However, all the preparation that needs to happen, including transitioning staff and functions, will be set against the backdrop of a system which is once again battling covid-19, winter pressures, a huge waiting list backlog and still trying to deliver routine health care services.”

HSJ has asked the ICS if it wants to comment further.

A Department of Health and Social Care spokeswoman said: “We remain committed to the implementation of statutory integrated care systems across England by April 2022 and the second reading of the Bill on Wednesday 14 July is in line with that objective. We will continue work closely with NHS England to ensure legislative changes are aligned with operational changes.”

NHS England was also approached for comment.