Matthew Taylor is Chief Executive of the NHS Confederation

The Secretary of State for Health and Social Care Sajid Javid recently delivered an important speech on healthcare reform, setting out his vision for the future of England’s NHS. Some had expected a raft of new policy announcements, with an academy school style NHS revolution even being punted.

Instead, although the speech was labelled lacklustre by some, the Health Secretary largely reinforced the existing reform agenda set out in the Government’s Health and Care Bill and the integration white paper, building on the NHS Long Term Plan.

The last decade has seen healthcare leaders trying to work around the fragmentary nature of the 2012 Health and Social Care Act, and they are in strong agreement that the current direction of travel towards integration between health and care services is the right one.

There is now consensus across health and care that the biggest challenges facing the health and care sector – the elective care waiting list backlog, a changing demographic and ageing population and significant health inequalities – can only be addressed by bringing together local organisations as partners and planning collaboratively.

To do this effectively health and care organisations are set to partner locally in two ways. Firstly, through ‘place-based partnerships’ that will integrate local authorities and primary, secondary, community and voluntary providers of health and care. On top of that, they will do so through ‘provider collaboratives’ that will see integration between organisations offering similar or complementary services.

The Health Secretary has acknowledged both are fundamental to the Government’s reform agenda. He has also said he wants to see more of these partnerships for reform “so that teams and organisations with a track record of solving long-standing service issues can share learning across systems to bring improvements.”

Yet, despite the positive rhetoric on local empowerment, there remains a fundamental contradiction which concerns NHS leaders greatly. Some key aspects of the Health and Care Bill that, as they stand, will centralise, not devolve, decision making powers. The new powers being proposed by the Government run counter to its devolution agenda for the health service and will instead allow the Health Secretary to intervene at any stage of a proposal made by local health and care leaders to reconfigure services.

These powers of intervention will not only be possible for major changes like closing an A&E department, but, under the measures contained within the Bill, the Health Secretary will be able to reverse even minor alterations to services including boundary changes.

Decisions about local services can be politically sensitive. However, such decisions should usually be taken at a local level given they are often necessary to make improvements in care quality and the best use of NHS resources. In future, such decisions could be undermined at the intervention of the Secretary of State.

Local politicians, campaigning groups and members of the public alike are aware of this. They will know that referring local decisions directly to the Health Secretary and his department could scupper contentious plans, even before they have been properly consulted on locally. The process of open local consultation is an integral aspect of the existing decision-making process and allowing it to be bypassed may well prevent brave and necessary choices from being made.

Compromise, however, is still possible. On behalf of NHS leaders, the NHS Confederation has pressed for checks and balances to be applied to the new powers the Government seeks over local services. These would include a requirement for the Secretary of State to demonstrate that any intervention on a local service decision is to maximise patient safety, and that clinicians, Local Health Overview and Scrutiny Committees, and any relevant local NHS or partner organisations affected by the decision are fully consulted.

We have a golden opportunity to get the Health and Care Bill right if the NHS is to deliver top class services and value for money for patients. The Health Secretary himself recently invited us to listen to the “innovators already doing incredible things within the system”.

As the clock ticks on the passing of the Health and Care Bill, NHS leaders would urge the Government to cede some ground on these new powers. After all, history has frequently shown us that local NHS decisions are best left to the knowledge and expertise of those who are closest to their local communities.