• MPs support thrust of proposals
  • Raise questions and objections on several points
  • Next steps unclear with very weak government

The Commons health and social care committee has said it “welcomes” the thrust of NHS England’s proposals for legal change, but raised queries and objections on some important points. 

The cross-party committee held an inquiry into the proposals, which NHSE hopes will be the first stage of the Parliamentary process to them becoming law.

In its report published today it said the recommendations were “a pragmatic set of reforms, which remove barriers to integrated care” and generally supported many of the suggestions, including repealing “section 75” competition rules and regulations to “promote collaboration”.

However, the committee objected to several proposals and raised queries over others.

NHSE chief Simon Stevens said in response: “This is the first time in its 71-year history that the health service itself has been asked to make suggestions in this way, and it’ll be great if Parliament is now willing to act as the [committee is] recommending.”

The committee backed the decision not to create integrated care systems as “a separate legal entity” but said that to improve accountability ICSs should be holding “meetings in public and publishing board papers and minutes”. At present only some are doing this.

The committee also said: “We are concerned that the proposals are currently too NHS-centric. Integrated care systems must not repeat mistakes of the past and become unresponsive monopolies or ‘airless rooms’ where non-statutory alternatives are shut out.” It said local authorities “must be part of the decision-making process” and able to participate “as equal partners” in the joint committees.

It recommended legislation should rule out non-statutory providers being holders of “integrated care provider” contracts, and added that, since “legislation may not be brought before the House of Commons for some time… we strongly urge that ICP contracts should be piloted only in a small number of local areas and subject to careful evaluation”.

The MPs backed removing the Competition and Market Authority’s role in NHS providers but said “independent adjudication” of tariff challenges should be available. It said it was not clear what would be required to remove foundation trusts from CMA merger controls and that the government and NHS should also explore possible “difficulties” removing the NHS from public contract regulations.

The committee recommended an independent appeal mechanism be preserved for patients “who believe they have been denied choice”; and it objected to proposals to allow NHS Improvement to order mergers of NHS providers and control foundation trusts’ capital spending.

In relation to proposals for national bodies, the committee said it supported the proposal in principle to merge NHSE with NHS Improvement, but was “concerned about the degree of central control that would result from this merger”. It also asked for “more clarity” on the proposal to give the health and social care secretary extensive powers to move functions between different arm’s length bodies.

NHSE national director for strategy and innovation Ian Dodge said that along with responses to NHSE’s own consultation the MPs’ comments would “help improve our proposals and shape our final recommendations to government”.

The committee said it expected to review a draft bill in future.

HSJ understands the Department of Health and Social Care supports the legislation, but will only take it forward if it is not likely to be substantially amended by Labour MPs, so it can pass through Parliament without major dispute. This may be considered very unlikely in the current political climate.