Healthcare structure: an important change

The health and care system has, in the last few years, been based on a competitive system led by the Clinical Commissioning Groups and was enacted by the 2012 Health and Social Care Act. There have been many statements decrying the competitive element, which has operated a quasi-market approach, and many providers of healthcare have found it to be anachronistic. The hoped for development in improvements of quality and efficiency have not really been delivered by this framework.  

The Health and Care Act 20221 seeks to enact a system that is now based on collaboration and is considered to be ‘enabling measures’. This new collaboration will occur between NHS organisations, commissioners, together with local authorities and voluntary sector partners, and has been already in place in some test sites in England since 2016. This was created by the development of integrated provider models, as set out in the Five Year Forward View2 and latterly through the Sustainability and Transformation Partnerships (STPs) and their evolution into non-statutory Integrated Care Systems (ICSs). 

These voluntary collaborative mechanisms have become ICSs and there is now one in all areas of England. Alongside the NHS measures, there are additional provisions to enable the Government to make targeted changes to support the social care system, improve quality and safety in the system, to grant the flexibility to take public health measures, and to implement worldwide reciprocal healthcare agreements. In addition, there are many small items of ‘tidying up’ following our departure from the European Union, as well as setting up the Health Services Safety Investigation Body to put it on a statutory footing. The formal merge of NHS England and NHS Improvement is also enacted.