Intended for healthcare professionals


NHS reforms: politicians will be back in the driving seat

BMJ 2021; 372 doi: (Published 19 February 2021) Cite this as: BMJ 2021;372:n481
  1. Richard Murray, chief executive
  1. King’s Fund, London, UK
  1. R.Murray{at}

England’s pandemic experience supports collaboration, not centralisation

Given its strapline—“Integration and Innovation”—it is no surprise that the Department of Health and Social Care’s new white paper aims to promote the longstanding integration agenda while downgrading competition as the organising principle for the NHS.1 Many have also noted that the proposals decisively tilt the balance of power back to the department and away from NHS England.23 The white paper contains a broad range of proposals and looking across the full set, the shift of power towards ministers and the department is a recurring theme.

NHS England is the most obvious loser in this general rearrangement. Since 2012, ministers have been able to formally instruct NHS England only once a year, in the NHS mandate, using a rather laborious process. The new proposals would give ministers greater power to direct NHS England on both NHS policy and the public health duties carried …

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