• Government would make clear that “big private healthcare companies” won’t run integrated care
  • Health secretary hopes for “the buy in of the other parties”
  • Would have to drop bill if Parliament makes problem amendments
  • Open to giving NHS organisations stronger duties to integrate

The health secretary has told HSJ the government is “not going to hand [integrated care contracts] to the big private healthcare companies”, and would make this clear in Parliament when it presents new NHS legislation. 

Matt Hancock also said he was hoping for cross party “buy in” for changes to current NHS laws, and was “absolutely up for” seeking to agree proposals with the Labour party.

NHS England and Improvement are expected to propose changes to the Health Act 2012 later this year, in the NHS long-term plan, or early next year.

In a wide ranging interview, Mr Hancock said he “can see the advantages of some legislative changes” but does “not want a big legislative reorganisation or top down reorganisation of the NHS”.

HSJ asked whether he would be willing to include a clause saying that only NHS organisations can lead or control new integrated organisations, if that was the request from Labour in order to support legislation.

He said: “I am absolutely up for that sort of conversation… I am perfectly prepared to talk to the other political parties about what [legislation] might entail.”

But he warned: “Crucially… if we bring this bill forward and people add things to it that don’t work, or cost too much money, or are going to cause us problems, then we may have to drop the bill altogether. And it will be the people bringing forward additional baubles whose fault that would be, not mine.

“So I am perfectly prepared to go down this route but I am only prepared to go down this route being clear that we’ll come forward with a package proposed by the NHS, I hope with the buy in of the other parties, and what we’re presenting as the package would be the package we’re seeking to enact.”

About the prospect of private organisations running integrated care providers – which has been one fear expressed by critics on the left – Mr Hancock said: “There is no intention to have ICPs awarded to private healthcare providers.”

He stopped short of saying it could be ruled out in legislation, however, stating: “There’s a reason it’s complicated to draft who should be eligible, which is that I don’t want to rule out groups of GP practices coming forward and running integrated care, and GPs are largely private organisations.

“So… we’ll make clear in the passage when we present the legislation that we are not going to hand these to the big private healthcare companies.”

The area which is thought to be closest to awarding an ICP contract – Dudley in the West Midlands – is in discussions about whether it can create an NHS trust, or use the shell of an existing one, to host the organisation, which it wants to be led by primary care. Manchester Clinical Commissioning Group has also considered awarding a contract – there the leading contender appears to be Manchester University Foundation Trust.

Mr Hancock said he was “open minded” about giving NHS organisations stronger duties and responsibilities to integrate – which is one of the proposals being discussed – but was cautious about the prospect of a full merger of NHS England and NHSI.

He said his doing so would raise the difficult question of how independent from government the new organisation should be.

NHS England has substantial independence under the Health Act, he pointed out, while government has more power to direct NHSI, particularly in relation to non-foundation trusts.

“I am up for that [merger], but we then need a conversation about… where on the spectrum of independence do you lie?”

He added: “I wouldn’t want by accident to make the activities of NHSI which are currently directly under control of the department more independent, because that is not the direction anybody wants to go, and certainly I don’t.”

He said the balance of independence “in practice… works quite well at the moment, it just doesn’t work in theory”.

Hancock interview: ‘Big private health companies’ won’t run integrated care