Parliamentary e-petition 598732 calls on the Government to renationalise the NHS, scrap Integrated Care Systems, and end PFI contracts.

The Government responded to the petition on 23 December 2021. The response stated that ‘The government has been steadfast in its commitment to the guiding principles of the NHS which mean the NHS is not and never will be for sale to the private sector.’ The full Government response can be viewed on the e-petition homepage.


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. The Bill is currently in Committee in the House of Lords.

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).

On 6 January 2022 the Health and Social Care Committee published its report on clearing the backlog caused by the pandemic. The Report concludes that tackling the wider backlog caused by the pandemic is a major and ‘unquantifiable’ challenge. It calls for a broad national health and care recovery plan to include mental health, primary care, community care, and social care as well as emergency care.  It highlights the need for better workforce planning to be a central part in recovery.

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.


Future of the National Health Service

22 Sep 2021 | House of Commons | 701 cc141-164


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

Office for Health Improvement and Disparities and Health Inequalities, 24 January 2021

Health and Care Bill: Committee stage report, 18 November 2021

Health and Care Bill 2021-22, 12 July 2021

The structure of the NHS in England, 02 June 2021

Mental health policy in England, 26 May 2021

Committee Reports

Clearing the backlog caused by the pandemic   

House of Commons Health and Social Care Committee

Ninth Report of Session 2021–22

7 December 2021

HC 599

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


The following is a selection of news and media articles relevant to this debate.

Please note: the Library is not responsible for either the views or the accuracy of external content.

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