Leaked NHS Reform Plan Could See Reduced Role for Private Sector

Peter Russell

February 08, 2021

Editor's note, 12 February 2021: There's an update to this article here.

The Conservative Government is planning a major overhaul of the NHS by reversing some of the controversial privatisation plans introduced by the Tory-Lib Dem coalition, according to a leaked white paper.

The draft document suggested that Prime Minister Boris Johnson wants to reduce the role of the private sector in the NHS by reducing competition and competitive tendering and replacing it with collaboration between health providers.

It would also hand more powers to the Secretary of State for Health and Social Care to oversee the work of the NHS in England.

Undoing the Reforms of the Cameron and Lansley Era

The changes would effectively rollback some of the 2012 reforms of David Cameron's Government with his Health Secretary Andrew Lansley that saw the establishment of NHS England to run the health service as well as the creation of GP-led clinical commissioning groups to organise local services.

The leaked proposals, published by Health Policy Insight, acknowledged the "unprecedented test to health and care services" caused by the COVID-19 pandemic, along with the "urgent" need for a "broader approach to health and care".

As a result, the health and care systems have evolved with "creative workarounds and innovations", underlining the need to build on change and introduce flexibility, the document noted.

More Powers for the Health Secretary

It set out how England's Health Secretary would assume "enhanced powers of direction" over a newly merged NHS England and NHS Improvement, to set direction in a more "agile" way.

"The ability to provide a formal direction to NHS England in order to manage an emerging or difficult issue will sit alongside the strong and effective informal arrangements for working together that have evolved between the Department and NHS England in recent years," the document said.

NHS Trusts and Foundation Trusts would remain statutory bodies, but would see some of their independent powers eroded, with ministers able to limit their capital spending.

The proposals acknowledged that the NHS had sent the Government a clear message that current procurement arrangements for healthcare services were confusing, bureaucratic, and not working. Reform would mean that: "Where competitive processes can add value they should continue, but that will be a decision that the NHS will be able to make for itself."

Reform of Social Care?

The document repeatedly mentioned social care, saying that ministers "remain committed to wider social care reform, with proposals to be published this year".

Former Health Secretary Jeremy Hunt welcomed the proposed changes. He told BBC Breakfast that there was a need for "a lot more joined up care".

Mr Hunt, who now chairs the Commons Health and Social Care Committee, added: "The structures need to be improved to make that possible and I think that's what these reforms are intended to do, so I think they could be very positive."

Health bodies have not commented on the document. The Department of Health and Social Care said it did not comment on leaks.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.