The Health and Care Act 2022 (the Act) contains the biggest reforms to the NHS in nearly a decade, laying the foundations to improve health outcomes by joining up NHS, social care and public health services at a local level and tackling growing health inequalities.

The majority of the Act is focused on developing system working with integrated care systems (ICSs) being put on a statutory footing through the creation of integrated care boards (ICBs). It also moves the NHS away from competitive retendering by default and towards collaborative delivery.

The Act formally merges NHS England and NHS Improvement and gives the secretary of state a range of powers of direction over the national NHS bodies and local systems and trusts. Other provisions include putting the Healthcare Safety Investigation Branch (HSIB) on a statutory footing; a new legal power to make payments directly to social care providers; the development of a new procurement regime for the NHS; and a new duty on the secretary of state to report on the system for assessing and meeting the workforce needs of the health service in England. The NHS will have to have regard to the wider effects of its decisions ('the triple aim duty'), and new duties will apply with regards to the environment. Regulations are planned to eradicate modern slavery and human trafficking from supply chains.

Provisions in the Act come into force at different times.

This guide provides a summary of the key parts of the Act for trusts and ICBs. It sets out:

  • the main provisions relevant to providers and systems
  • the secondary legislation that will flow from the Act
  • what you can expect in terms of guidance on the Act
  • the support NHS Providers will provide to you as the Act is implemented
  • how NHS Providers worked to shape provisions in the interests of our members and service users.


This document is intended to be a guide to the Act to help make it more readily accessible to NHS trusts and foundation trusts. It focuses on those sections we expect to be of most relevance and interest to trust leaders. For the full detail of provisions, please see the full text of the Health and Care Act 2022.

National context
Within the guide, text that sets out the national policy context or highlights guidance or regulations related to the Act is highlighted in bold.

NHS Providers view and activity

NHS Providers' activity to influence the legislation, and our view on the final proposals, is highlighted in bold and italics.