The most significant changes brought about by the Act are:

  • establishing ICBs and abolishing clinical commissioning groups (CCGs)
  • moving away from competitive retendering by default and towards collaborative delivery
  • formally merging NHS England and NHS Improvement.


  • an ICB and its partner trusts and foundation trusts must prepare a five-year forward plan to meet the local population's health needs and aim to break even financially each year.

Social care:

  • the Act establishes a cap on the amount that adults can be required to pay towards eligible care costs over their lifetime. This is expected to apply from October 2023.

The secretary of state's powers:

  • the secretary of state no longer has to set the mandate to NHS England and NHS Improvement for each financial year, and instead it can be set at any time and remain in force until is it replaced by a new mandate
  • the secretary of state gains a range of powers of direction, including intervention powers in relation to significant reconfiguration proposals
  • minimum standards for food and drink provided in hospitals can be set.

Regulatory powers and statutory bodies:

  • the national tariff is replaced with a new NHS payment scheme
  • NHS England and NHS Improvement has the power to apply a capital spending limit to a foundation trust for a single financial year
  • Care Quality Commission (CQC) will oversee and assess ICSs, and local authority adult social care duties
  • the Health Services Safety Investigations Body (HSSIB) is put on a statutory footing.

Statutory duties:

  • the 'triple aim' duty requires the NHS to have regard to the wider effect of decisions on health and wellbeing, the quality of services, and efficiency and sustainability
  • trusts and foundation trusts have duties regarding climate change and the environment and regulations are planned to eradicate slavery and human trafficking from supply chains.