NHS England and Improvement seek full merger

At a joint board meeting today, the pair revealed legislative proposals that would enable commissioners to work much more closely with each other, with providers, and with NHS England, as well as major changes to competition and procurement rules.

It also called for the health secretary to be given potentially contentious new powers to “transfer or require delegation” of functions from one arm’s-length body to another, or for new ALB functions to be created altogether.

Speaking at the board meeting, Ian Dodge, NHS England’s national director of strategy and innovation, said: “[This change would help] either the full merger of NHS England and NHS Improvement, or at the very least, more freedom to go further than is currently permissible.”

Board members indicated at their meeting today that their preference if and when legislation can be passed was for full merger of NHSE and NHSI, rather than only legal changes to allow them to work more closely together, and that they should make the case for this.

The two started integrating their national management structures last year, and began holding some joint board meetings, but have had to retain separate boards. 

The other new legislative asks include:

• Clinical commissioning groups and providers to be given “the ability to create… joint decision-making committees” between them.
• CCGs and providers to make joint roles and appointments across their organisations.
• Plans to repeal current procurement rules to “allow commissioners to choose either to award a contract directly to an NHS provider or to undertake a procurement process”.
• A “new shared duty” to be introduced so that all providers and CCGs in a local area must “promote the triple aim” of population health care, better care for all patients and efficient use of NHS resources.
• CCGs being given more responsibilities for specialised commissioning.
• The health secretary to be given powers to set up new integrated care trusts.
• Various new curbs on the freedom of foundation trusts, and proposed changes to national payments tariffs.

On contract regulations, Mr Dodge said the proposals included to “remove the NHS from public contract regulations so it is more free to decide the circumstances in which it goes out to procurement”.

The document said letting commissioners award contracts to existing providers will allow NHS organisations to develop new models of care, which current competition rules discourage, arguing this will be a more efficient use of financial resources.

The legal plans also said new standing rules will be set for commissioners to “strengthen” patient choice.

Responding to the proposals, David Hare, chief executive of the Independent Healthcare Providers Network, said: “We have serious concerns about the proposed reforms to commissioning and procurement which risk undermining accountability to taxpayers for how NHS resources are spent. [They] risk recreating the huge NHS monopolies of old.”

Bodies representing NHS organisations have broadly welcomed the proposals, although NHS Clinical Commissioners warned that joint appointments between providers and commissioners “could have significant issues for managing conflicts of interest and in taking decisions around procurement”.

Mr Dodge said at the meeting: “Even if the process were to move as rapidly as we could conceive… by the time we get to royal assent and then commencement it is quite hard to see how we can get provisions up and running before April 2022. This wouldn’t be arriving any day soon.

“We don’t need primary legislation to implement the long term plan but… it would help.”