The Health and Care Act 2022 – what does it mean for trusts and foundation trusts?

Finola Kelly profile picture

01 July 2022

Finola Kelly
Senior Inquiry and Legislation Manager


Today the Health and Care Act 2022 (the Act) initiates one of the biggest reforms to the NHS in nearly a decade.

The Act moves the 42 integrated care systems (ICSs) across England into a new form and onto a statutory footing from 1 July. ICSs brought together NHS trusts and foundation trusts, primary care, local authorities, and voluntary sector partners. Their goal was to remove barriers between organisations to deliver better, more joined up care for local communities and ultimately to improve population health. The successor statutory bodies – integrated care boards (ICBs) – will, from 1 July, continue to deliver on that ambition by embedding integration and collaboration across the system. We will support our members to navigate this evolving landscape through our trust in systems programme.

As part of the move away from the Lansley era reforms, the Act brings in a new provider selection regime, moving the NHS away from competitive retendering by default and towards an emphasis on collaboration. Clinical commissioning groups (CCGs) have been abolished, with ICBs taking on their functions as well as some of NHS England's commissioning functions. 

Collaboration is further strengthened by requiring each ICB and its partner local authorities to establish an integrated care partnership.

Finola Kelly    Senior Inquiry and Legislation Manager

Collaboration is further strengthened by requiring each ICB and its partner local authorities to establish an integrated care partnership (ICP). These ICPs will bring together health, social care, public health, and representatives from the wider public space and will be tasked with developing a strategy to address the health, social care, and public health needs of its system. The ICB and the local authority (or authorities) have to have regard to that plan when making decisions. To ensure that these new bodies discharge their functions effectively as a system, the Act gives CQC a duty to conduct reviews to assess the provision of NHS care, public health, and adult social care within the ICB area.

The Act also formally merges NHS England and NHS Improvement, mirroring at a national level the lessening of the commissioner-provider split at a local level. Recognising too their former roles of commissioning body and provider regulator respectively, the new NHS England has a duty to minimise and manage the risk of conflict between its regulatory and other functions.

In time, a number of other statutory bodies will come under NHS England's wing, including Health Education England, NHS Digital and NHSX. This growth in its scope is met by a number of new powers of direction for the secretary of state. This includes the power to direct NHS England in its exercise of its functions (with a limited set of exceptions), and the ability to set the mandate to NHS England at any time (rather than each financial year). The secretary of state will also set out each year the government's expectations for mental health spending.

Trusts and foundation trusts now have duties regarding climate change and the environment.

Finola Kelly    Senior Inquiry and Legislation Manager

While trusts and foundation trusts will see that their statutory underpinning is not changed, a number of changes expand their duties or otherwise directly affect them. This includes the secretary of state having the power to intervene in significant local service reconfiguration proposals. NHS England also has the power to set a capital spending limit for a named foundation trust in a given financial year. Trusts and foundation trusts now have duties regarding climate change and the environment and regulations are planned to eradicate slavery and human trafficking from supply chains. Minimum standards for food and drink provided in hospitals can also be set.

The Healthcare Safety Investigation Branch – which investigates safety concerns and makes recommendations to address system-wide causes of healthcare harm – is put on an independent statutory footing and will become the Health Services Safety Investigations Body. The 'triple aim' will now be a statutory duty requiring the NHS to have regard to the wider effect of decisions on health and wellbeing, the quality of services, and efficiency and sustainability. ICBs also have a duty to reduce inequalities in access and outcomes, and to have regard to the triple aim.

The Act provides welcome underpinning for closer collaboration in the NHS. NHS Providers' guide to the Act sets out these changes in more detail, as well as what guidance and regulations we can now expect. As these new structures and ways of working are established, it will be crucial to keep focus on the core purposes of system working: improving outcomes, tackling inequalities, enhancing productivity and value for money, and supporting broader social and economic development.  

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Finola Kelly profile picture

Finola Kelly
Senior Inquiry and Legislation Manager

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