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Joining up health and social care

On 11 February 2021, the government published a new white paper setting out a raft of proposed reforms to health and care. Many of the measures introduced under David Cameron’s government through the Health and Social Care Act 2012 are set to be abolished, with a broad move away from competition and internal markets and movement towards integration and collaboration between services.

There is now to be a new duty promoting collaboration across the healthcare, public health and social care system. This will apply to all partners within systems, including local authorities.

Failure of the existing legislative framework

Most observers believe the existing legislative framework created under the Health and Social Care Act 2012 has largely failed and that changes are needed. There has for some time existed a consensus that the future of health and care must be based on collaboration and partnership working. These reforms will provide the necessary updates to legislation to help make this happen, though legislative change alone will not be enough.

Welcome shift

According to the Kings Fund the most important reform in these proposals is the welcome shift away from the old legislative focus on competition between health care organisations towards a new model of collaboration, partnership and integration.

By sweeping away clunky competition and procurement rules, these new plans could give the NHS and its partners greater flexibility to deliver joined-up care to the increasing numbers of people who rely on multiple different services.

The thrust of these reforms is about giving local health and care leaders the freedom to make decisions based on the needs of their local population. Yet, running counter to that ambition, ministers are also proposing they have the power to intervene earlier in local decisions about the opening and closing of NHS services.

Greater control of government

The white Paper makes clear ministers intend to take greater control of national decisions about the NHS. The independence given to NHS England is seen as one of the successes of past reforms, and while it is right to clarify who is accountable for the health service, the government should protect the day-to-day clinical and operational independence of the NHS.

Litany of reform failure

While many of us will welcome the ambition of the White Paper. History tells us the NHS is littered with reform plans that overestimated benefits and underestimated disruption. These latest proposals add up to a major reform package and come at a time when the NHS, local authorities and charities are still battling Covid-19. In implementing these proposals, it will be essential to avoid distracting health and care services from dealing with the crisis at hand.

Health and care services are facing chronic staff shortages, deep health inequalities laid bare by the pandemic, and an urgent need for long-term reform of social care. In addition to the structural reforms proposed in this white paper, there is a pressing need for the government to chart a way out of these deep-seated challenges.

What is missed in the white paper

The white paper fails to address the key area that is paramount to all those who work in social care that is long overdue. The government says that reforms to social care and public health will be dealt with “later in 2021” outside the Health and Care Bill addressed in the white paper.


The white paper on reform to health and care is to be welcomed. Few would argue that the Health and Social Care Act 2012 has largely failed and that changes are needed. It would be hoped that this is not a false dawn and does not go the way of so much reform of the NHS in past decades.

In the world of social care much of our attention is focused on what the white paper has failed to address namely the reform of social care. This we are led to believe will occur later in the year. I wouldn’t hold your breath.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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