We have an ageing population and rising numbers of people with long-term conditions like diabetes, arthritis and dementia.
For more and more people, healthcare is no longer about being patched up and sent home.
Instead, the reality for many is that they become unwell and stay unwell, requiring some form of help for the rest of their life.
This means we need a health service that provides seamless care to people as they move between different parts of the NHS, whether it’s general practice, hospitals or community services.
Many older people and younger ones with disabilities also rely on social care either in care homes or in their own home.
Many also look for help from charities and volunteer groups.
All of these services are organised separately and at the moment too many people fall through the cracks between them.
The government’s proposed reforms recognise this need for more joined-up services.
They mark a welcome step away from the last major NHS shake-up – the Coalition’s reforms of 2012 – and the Labour reforms that went before them.
Then the thinking was that making NHS and other organisations compete for business would drive up the standard of care.
In reality, it often led to a lot of red tape and stood in the way of working together.
Now, instead of making parts of the NHS compete against each other, these reforms aim to support collaboration and partnership between the different parts of the NHS, local government and charities.
The proposals do this by sweeping away clunky competition and procurement rules and will create new structures that try to bring together the different parts of the NHS with their key partners, particularly in local government.
However, although new legislation can remove unhelpful barriers and make it easier for different health and care organisations to work together, it can’t make this happen by itself. There will need to be a major implementation plan to help people work in a different way.
The reforms of 2012 also gave greater independence to NHS England, the body that runs the NHS. Many think this was one of the successes of those reforms as it removed Ministers from day to day interference in running NHS services.
The government now wants some of these powers back. In particular they want the power to intervene earlier in local decisions about the closing of NHS services and where money for new hospitals goes.
They also want to take back greater control of national decisions from the NHS. Of course, it is right to be crystal clear about who is responsible for the health service, but the day-to-day independence of the NHS should be protected.
And then there is the issue of timing. These proposals come at a time when our health and care services are still battling COVID-19 and are in the midst of the biggest vaccination programme in our history.
While these changes could make it easier to deliver good quality care in the long run, government needs to avoid distracting hard pressed staff from dealing with the crisis at hand.
Let’s not forget, health and care workers were already overstretched before the pandemic took hold with chronic staff shortages, deep health inequalities, and an urgent need for long term reform of social care.
Having the NHS, local councils and charities work together to make sure people get the health and care they need, when they need it, is one part of the solution to these challenges.
But on its own it will not be enough. In addition to the reforms proposed in this new White Paper, the government needs a credible plan to recruit and keep more staff, close the widening gap between those with the best and worst health, and finally come good on its promise to fix social care ‘once and for all’.