The government’s health and care white paper “Integration and Innovation: working together to improve health and social care for all” was launched last week. It paves the way for a Health and Care Bill intended to increase collaboration and co-operation across the health and social care services.

The white paper largely builds on previous reforms and the strategies set out in the Five Year Forward view and Long Term Plan, a continuation of evolution rather than revolution. For example, the proposed legislative merger of NHS England and NHS Improvement (itself a non-statutory merger of Monitor and the Trust Development Authority) will simply reflect what has already taken place in practice.

Other proposed changes will be more significant. The measures outlined in the white paper document have the stated aim of making it easier for NHS organisations and their partners to work together. The intention is that the legislative proposals for health and care reform outlined in the white paper will begin to be implemented in 2022. From the white paper, a number of questions remain unanswered – although they may become clearer once the draft bill is published and guidance prepared.

Examples of the questions which immediately arise:

• Statutory ICSs – what will they look like and how will they function? Will the dual-body approach really reduce bureaucracy? How will the ICS exert influence without the power to direct?
• How will the twin goals of internal NHS collaboration (and accountability to parliament) and collaboration by the NHS with local authorities (and accountability to local electorates) be reflected in the legislation?
• How will the power to form committees and delegate (and double delegate) decision making between bodies be squared with the retention of individual provider responsibility for services?
• Reconfiguration – what will the new process look like and when can we expect “interventions”?
• How the proposals will replace or sit alongside existing collaborations and alliances?
• How will the “duty to collaborate” amend/change the existing duties to co-operate?
• The birth of “arrangement” of healthcare – how will the new provider selection regime work?
• Data – the white paper envisages a new age of shared healthcare data. What needs to change in order to enable this and what are the dangers?
• When will new trusts be appropriate for an ICS to deliver services? What form of consultation will be required, and how will the new trusts be financed?

The white paper sets out that the intention behind the proposed legislative changes are not intended to be a “one size fits all” approach. Although the devil will be in the detail, the proposals appear to envisage that there will still be a fair degree of freedom in how local systems are organised and take decisions. The white paper expressly notes the reality that collaboration and co-operation cannot be legislated into happening, this will still depend on local “buy in” to the new structures. This is reflected in the proposal that the new ICS Health and Care Partnerships will not be closely directed as to membership or role. How different Partnerships are structured across the country, and what role they will carry out when the intention is not to detail functions, could therefore see variation.

Following the success of our COVID-19 Portal, our Health and Care Bill Board will bring together published materials, articles and commentary on the latest developments on the white paper. This will develop over time and provide focused advice that you can use where it is relevant to your organisation. As answers to the questions become clearer, we will deliver guidance to you on what to expect as these proposals move towards becoming law.