Coinciding with the 70th anniversary of the creation of the NHS in 2018, the NHS in England was asked to produce a ten-year plan to improve access, care and outcomes for patients, in return for a five-year funding settlement. The resulting NHS Long Term Plan (January 2019) set out how the NHS should maximise the impact of extra funding. The Plan set objectives for improving public health and clinical outcomes, in areas such as preventing infant mortality, improving cancer survival rates, and better mental health services. To enable these changes, the Plan set out actions on workforce, technology, innovation and efficiency. It also proposed changes to the ‘system architecture’ of the NHS, to increase the coordination of services, with the creation of Integrated Care Systems (ICSs). This has been seen as a move away from some of the market-based reforms of the Health and Social Care Act 2012. In June 2019, NHS England and NHS Improvement (NHSEI) published an Implementation Framework, providing further detail on how the plan would be delivered. The coronavirus pandemic has had significant implications for the strategies developed as part of the Long Term Plan. Existing trends, such as closer working between local health and care providers, and the move to online working, have been accelerated by system-wide responses to Covid-19.

The NHS People Plan was published in July 2020 and sets out actions to expand the NHS workforce, strengthening recruitment and retention through improving staff health and wellbeing, equality diversity and inclusion and the NHS leadership culture. The People Plan acknowledged the impact of the coronavirus pandemic has had on staff and set out a support package for staff health and wellbeing. The Plan also committed to greater flexible working and action to improve the experience of NHS staff from BAME backgrounds.

In July 2021 the Government introduced a new Health and Care Bill, to enact policies set out in NHSEI’s recommendations for legislative reform, and the White Paper Integration and Innovation: working together to improve health and social care for all (February 2021). The Government says the Bill builds on the NHS’s own proposals for reform, aiming to make it less bureaucratic, more accountable, and more integrated, and that it incorporates lessons learnt from the pandemic. Several provisions in the Bill were originally proposed by NHSEI, such as establishing ICSs on a statutory footing, formally merging NHS England and NHS Improvement, and making changes to procurement and competition rules relating to health services. The latest proposals from NHSEI were set out in a consultation, Integrating care: next steps to building strong and effective integrated care systems across England, published in November 2020 (see also Legislating for Integrated Care Systems: five recommendations to Government and Parliament, published in February 2021).

The Bill also included proposals from the February 2021 White Paper to give the Secretary of State for Health and Social Care powers to direct NHS England (as the newly merged body would be known). It would also give the Secretary of State powers to transfer functions between some of the ‘Arm’s Length Bodies’ that lead, support and regulate healthcare services in England, and to intervene in proposed changes to the way health services are delivered. The Bill doesn’t cover wider reforms of the social care and public health systems, although it does provide for some changes in these areas (and ICSs are intended to improve coordination between the NHS and local authority services). The Health and Social Care Committee’s report on the White Paper proposals summarises a wide range of responses to the Government’s planned reforms. Overall, it supported the direction of travel set out in the White Paper. The Committee noted that the creation of ICSs could improve the delivery of care services for patients if proper accountability mechanisms are put in place, particularly relating to the safety and quality of care. However, the Committee also concluded that several areas in the White Paper required further clarity or revision, such as the addition of new powers for the Secretary of State.

On 19 July the Department of Health and Social Care published a series of factsheets on different aspects of the Bill. Having had its 2nd reading debate on 14 July 2021, the Health and Care Bill is currently in Committee for line by line scrutiny.

In a statement to the House on 7 September 2021 the Prime Minister announced an increase in national insurance for a ‘Health and Social Care Levy’. This will raise around £11.4 billion a year, with a further increase in the rates of income tax on dividends estimated to raise around £0.6 billion a year. Of the estimated total £12 billion a year, around £2.2 billion will go to Scotland, Wales and Northern Ireland, leaving just under £10 billion a year for England. Further information on the proposed Levy is available in the Library briefing: Health and Social Care Levy Bill 2021-22. Revenue from the Levy in England will initially be used to fund investment in health and social care set out in the Government policy paper: Build Back Better: Our plan for health and social care (September 2021). A chart from the Nuffield Trust breaks down the amounts allocated for different parts of health and social care over the next three years (Nuffield Trust, How will the health and social care levy be spent in England?, 10 September 2021).

The Health and Social Care Committee has launched an inquiry on clearing the backlog caused by the pandemic, to quantify the level of pent-up demand for key healthcare services; and to consider whether fundamental changes to the organisation and delivery of NHS services will be required to manage the backlog of cases caused by the pandemic. The Committee held an oral evidence session with patients, Royal Colleges and policy experts on 7 September 2021.

In July 2020, Health Education England published the Future Doctor report. This set out reforms in education and training to equip doctors with the skills that the future NHS needs, including generalist skills for doctors. HEE has also taken measure to support entry into psychiatry, general practice and other priority areas. NHSEI’s ‘growing for the future’ webpage provides further information on measures to support recruitment and retention. The Government has said it has taken a number of steps to help mitigate any staffing impacts of EU Exit, for instance by passing legislation that allows regulators to accept qualifications unilaterally from the EU. The Commons Library briefing Overseas health and social care workforce provides further background.

A wide range of groups representing NHS staff and organisations have called for the Health and Care Bill to include a requirement for a long-term workforce strategy. This has been backed by think tanks and the Health and Social Care Committee.

On 16 September 2021 the Secretary of State for Health and Social Care, Sajid Javid, gave a speech on the health inequalities highlighted by the pandemic. He announced that from 1 October 2021, public health work in England will be led by a new body called the Office for Health Improvement and Disparities.


The following is a selection of links relevant to this debate, including House of Commons Library briefings and Select Committee reports, as well as reports from health service bodies, think tanks and others. Please note the Library is not responsible for either the views or the accuracy of external content.

As health policy is a devolved matter these sources mostly relate to the future of health services in England.

House of Commons Library

House of Commons Library, Health and Care Bill 2021-22, 12 July 2021

House of Commons Library, The structure of the NHS in England, 02 June 2021

House of Commons Library, Mental health policy in England, 26 May 2021

Committee Reports

Workforce burnout and resilience in the NHS and social care

House of Commons Health and Social Care Committee

Second Report of Session 2021–22

18 May 2021

HC 22

Delivering core NHS and care services during the pandemic and beyond

House of Commons Health and Social Care Committee

Second Report of Session 2019–21

24 September 2020

HC 320

NHS nursing workforce

House of Commons Public Accounts Committee

Eighteenth Report of Session 2019–21

14 September 2020

HC 408

NHS capital expenditure and financial management

House of Commons Public Accounts Committee

Eighth Report of Session 2019–21

29 June 2020

HC 344

External Reports and Websites


Related posts