1/17 We've highlighted, in a letter to @CommonsHealth, five areas of the forthcoming Bill that need particular scrutiny. Letter here: https://committees.parliament.uk/writtenevidence/25881/pdf/. @HSJnews blog here: https://www.hsj.co.uk/policy-and-regulation/five-priority-areas-for-scrutiny-in-the-forthcoming-health-bill/7029925.article. @HSJnews story here: https://www.hsj.co.uk/policy-and-regulation/health-secretary-could-prop-up-unsafe-services-with-new-power-say-nhs-leaders/7029873.article. Thread on issues below.

2/17 The five issues we've highlighted are new ministerial power of direction over NHS; new ministerial power over local reconfigurations; accountabilities and wider statutory set up of ICSs; workforce planning duties; and the power to set individual FT capital spending limits.

3/17 Issue 1. The proposed new power of Ministerial direction over NHS England must be framed in a way that maintains the NHS’s clinical and operational independence. The scope and areas of decision making/activity where the power is exercisable and cannot apply need defining…

4/17 …Any new Ministerial power of direction over the NHS must be exercised transparently and with appropriate consultation including publishing the views of the body being directed. Each use of the power needs to meet an objectively defined public interest test…

5/17 …Understand need for Ministers to sensibly move functions between arms length bodies. But it would be inappropriate for Ministers to abolish/neuter NHS England or Care Quality Commission via secondary legislation. Far reaching changes should require primary legislation.

6/17 Issue 2. Any exercise of the proposed new Ministerial power of intervention in local NHS reconfigurations must be fully transparent with the intervention made against set public criteria. Affected parties need the right to make appropriate representations...

7/17 …There should be a clear materiality threshold to pass before the Ministerial power can be used. There is an appropriate and important role for independent advice, as part of intervention, on issues such as the validity and importance of the clinical case for change…

8/17 ...Given the overwhelming importance of patient safety in these issues, there should be an explicit public test that use of power must maintain or improve patient safety before exercise. With relevant trusts and ICSs fully consulted on these patient safety issues.

9/17 Issue 3. In placing ICSs on a welcome statutory footing, the legislation, and the subsequent accompanying guidance, must be enabling and permissive. This will ensure that different systems can flexibly frame resulting arrangements to best suit their local needs…

10/17 ...ICSs need to be accountable not just to parliament through NHSE but also to the populations they serve and the health and care organisations within their footprint, including local government. ICS governance needs to reflect this three way accountability...

11/17 ...Given risk, resource and complexity managed by trusts, there must be complete clarity on how their accountabilities align with ICS accountabilities. We must avoid duplication, overlap or additional bureaucracy. We need to be clear how the financial flows will work.

12/17 Issue 4. Current duty on Ministers to set out workforce planning accountabilities is welcome but is clearly insufficient. Ministers should have an additional duty to publish regular, public, long term health and care workforce projections...

13/17 ...These should be produced at arms length from Ministers. They should draw on input from all relevant NHS arms length bodies, NHS frontline organisations such as ICSs and trusts and expert bodies such as think tanks. They need to set out the size and shape of workforce...

14/17 ...Needed to deliver safe, high quality, effective care. This should be costed. Ministers should then regularly update parliament on the government’s strategy to deliver those long term projections, including its approach to providing the required funding.

15/17 Issue 5. White Paper clear that FTs/trusts retain accountability for delivery of safe care. Right amount of capital spending central to this task. Proposal is for ICSs prioritise to capital with a reserve, backstop, power to set individual FT capital spending limits...

16/17 Vital that use of this power is carefully controlled to align with FT Board statutory accountabilities. NHS England’s 2019 legislative proposals contained a series of detailed safeguards that were agreed with NHS Providers. The White Paper omits many of these safeguards.

17/17 These included a commitment for NHSE to explain why the use of the power in each case is necessary, describe what steps it had taken to avoid requiring its use, and publish any representation from the NHS foundation trust affected. These safeguards must be explicit.