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Some observations on the White Paper (based on actually reading it) https://www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all
Claims that most legislative proposals come from NHS itself. Where that's true it's a huge change from 2010 when they published the legislation and then consulted during the "pause".
They claim broad support including from everyone who signed this letter https://www.aomrc.org.uk/wp-content/uploads/2019/09/190926_Support_letter_NHS_legislation_-proposals.pdf including @NVTweeting @NHSProviders @AoMRC etc.
But they admit they have added a few other points to join up national decision making and accountability. That gives those orgs who signed the letter some leverage in Committee evidence to say hang on, we supported *this* but not *that*.
Whilst claiming to reduce "bureaucracy" (just as Lansley did) this WP replaces CCGs with 2 new statutory bodies (ICS and ICS NHS body) on top of Health & Wellbeing Board. Feels messy. Opposition could cause damage with "alphabetti spaghetti" charge.
NHS execs could find themselves in a different statutory board meeting each day of the week, each with overlapping aims and duties to collaborate with each other.
Section 75 (the procurement stuff) will be replaced, not scrapped. Instead there will be a provider approval process, choice and AQP. Still quite competitiony.
The Govt argument for creating Monitor as a specialist market regulator, was that it would protect the NHS from general competition law bc FTs are considered "undertakings". Does that logic apply in reverse?
I don't think you'll be able to see these changes from space because they will be dwarfed by the volcanic operational challenge that was smoking pre-Covid and have since erupted like Vesuvius.
So, as in the 2010s, the redisorganisation will be a mere distraction from the firefighting on the ground. Some bits could help, others will be worked around. Let's not allow ourselves to be too distracted from the scrutiny and policy thinking that is really needed.
It still feels wrong timing - NHS England's proposals for legislation pre-date the pandemic and new challenges, so it would make sense to continue "muddling through" with the current law for a couple of years and then take stock after an Inquiry.
Oh and the reconfiguration intervention powers (a poisoned chalice) will completely undermine trust in service change proposals, and will massively increase bureaucracy. I did my Masters dissertation on this and wrote a report for @IPPR https://www.ippr.org/publications/the-future-hospital-the-politics-of-change
