The measures outlined are designed to make it easier for NHS organisations and their partners to work together to tackle the issues that matter most.

A central theme is the importance of joint working with colleagues in local government and elsewhere.

Working together and supporting integration

  1. Integrated care systems
  2. Duty to collaborate
  3. Triple aim
  4. Foundation trusts capital spend limits
  5. Joint committees
  6. Collaborative commissioning
  7. Joint appointments
  8. Patient choice
  9. Data sharing

We are proposing to establish statutory ICSs, made up of an ICS NHS Body and an ICS Health and Care Partnership (together referred to as the ICS).  The ICS NHS body will be responsible for the day-to-day running of the ICS, while the ICS Health and Care Partnership will bring together systems to support integration and develop a plan to address the systems’ health, public health, and social care needs.  We will also legislate to ensure more effective data sharing across the health and care system.

The ICS NHS Body will be responsible for:

  • developing a plan to meet the health needs of their defined population
  • developing a capital plan for the NHS providers within their health geography
  • securing the provision of health services to meet the needs of the system population

The ICS NHS Body will

  • merge functions being fulfilled by non-statutory STPs/ICSs with the functions of a CCG
  • allocate and plan strategy
  • be able to delegate to place level and to provider collaboratives
  • establish an ICS Health and Care Partnership
  • need to align their allocation functions with place – this is for local determination.
  • meet the system financial objectives
  • be accountable for outcomes of the health of the population
  • explore ways to enhance the role of CQC in reviewing system working

NHS Trusts and Foundation Trusts (FTs) will remain separate statutory bodies with their functions and duties broadly as they are in the current legislation.

NHS providers within the ICS will retain their current organisational financial statutory duties.

Stripping out bureaucracy

  1. Competition
  2. Arranging healthcare services
  3. National tariff
  4. New trusts
  5. Removing local education training boards (LETBs)
  • Groups of ICSs could use joint and lead commissioner arrangements to make decisions and pool funds across all their functions.
  • NHS England could delegate, transfer or jointly commission certain specialised services to ICSs singly or jointly, allowing services to be arranged for combined populations.
  • The NHS will be free to make decisions on how it organises itself without the involvement of the Competition and Markets Authority (CMA).
  • A bespoke health services provider selection regime will be created to give commissioners greater flexibility in how they arrange services.
  • Where procurement processes can add value they will continue, but that will be a decision that the NHS will be able to make.
  • The division between funding decisions and the provision of care will be preserved.
  • Changes will be made to the tariff to enable it to be more flexible.
  • The Secretary of State will be given the power to create New Trusts within an ICS.
  • Local education training boards (LETBs) will be removed from the statute to give Health Education England (HEE) more flexibility.

Enhancing public confidence and accountability

  1. Merging NHS England, Monitor and the NHS Trust Development Authority and Secretary of State powers of direction
  2. The NHS mandate
  3. Reconfigurations intervention power
  4. Arm’s length bodies (ALBs) transfer of functions
  5. Removing special health authorities time limits
  6. Workforce accountability
  • We intend to formally bring together NHS England and NHS Improvement into a single legal organisation.
  • We are also bringing forward a proposal to ensure the Secretary of State for Health and Social Care has appropriate intervention powers with respect to relevant functions of NHS England


Additional proposals to support social care, public health, and quality and safety.

Additional proposals – social care:

  1. Assurance
  2. Data
  3. Direct payments to providers
  4. Discharge to assess
  5. A standalone power for the Better Care Fund

Additional proposals – public health:

  1. Public Health power of direction
  2. Obesity
  3. Fluoridation

Additional proposals – safety and quality:

  1. Health Services Safety Investigations Body (HSSIB)
  2. Professional Regulation
  3. Medical Examiners
  4. Medicines and Healthcare products Regulatory Agency (MHRA) new national (UK wide) medicines registries
  5. Hospital food standards
  6. Reciprocal healthcare agreements with Rest of World countries
  • A patient’s right to choose where and who will provide their health and care needs will be preserved and strengthened.
  • Repeal section 75 of the Health and Social Care Act 2012 Act including the Procurement, Patient Choice and Competition Regulations 2013. This will be replaced by a provider selection regime.
  • Remove the Competition and Markets Authority function to review mergers involving NHS foundation trusts.
  • Remove NHS Improvement’s competition functions and its duty to prevent anti-competitive behaviour
  • Remove the need for NHS England to refer contested licence conditions or National Tariff provisions to the Competition and Markets Authority
  • The procurement of non-clinical services will remain subject to Cabinet Office public procurement rules.
  • Remove the requirement for providers to apply to NHS Improvement for local modifications to tariff prices
  • The establishment of a the Health Services Safety Investigations Body (HSSIB) to investigate incidents which have or may have implications for the safety of patients in the NHS.