It’s been a year now since the establishment of new powers for the Secretary of State for Health and Social Care in relation to major service change. The ‘call-in’ power was built into the Health and Care Act 2022 and, after some political ping pong and departmental development, was enacted in January 2024.

So how have systems, partners and stakeholders responded to this power in the first year of its existence? And how has it been exercised by the Secretary of State since?

While some expected this new power to be a significant risk to the effective and timely delivery of change programmes, the reality is that the power has barely been used.

In 2024, at least 30 call-in requests were made. So far, the power has not been used by the Secretary of State to direct a commissioner to take a course of action. Some call-in requests have been rejected because they do not meet the criteria for a viable call-in.

Since January 2024, however, systems have been required to notify the Secretary of State of proposals for major service change, and many of these proposals have been subject to the potential of a call-in.

Stakeholder understanding and utilisation of this power has been inconsistent across schemes. Though there were a few bumps in the transition from local authority scrutiny committees’ referral power into this new power, few authorities have made the request for a call-in. Whether they would have utilised their referral power for proposals they’ve chosen not to request a call-in for would be an interesting investigation.

We have seen single scrutiny committees make, re-make and restate the importance of their call-in request, but unlike the referral power there is no obligation for the Secretary of State to accept these requests. There is also the frustration that, once a request has been made, there is no timeframe with which the department must make a decision about it. This had led to lots of requests hanging in the ether, deprioritised in favour of other departmental decision making.

There is, however, a requirement that the Secretary of State make a decision within six months in relation to a call-in once it has been accepted. As we’re learning in real-time, though, the penalties for missing this deadline seem few and far between.

We have seen new developments through the establishment of this power. Individuals, campaigners and campaign groups now have an earlier route to indicate dissatisfaction prior to judicial review. The right for any individual to request that a scheme is called in has been used by these stakeholders already. This, though, has also happened in inconsistent ways. In some places, individuals have encouraged the local authority to exercise this power. In others, groups of individual campaigners have independently submitted call-in requests. This has led to some disarray in how call-in requests are managed and how they are assigned value.

We may see individuals use this power to request more frequently after the recent announcement by the government of changes to the judicial review process for national infrastructure projects. This is particularly pertinent to schemes in the New Hospital Programme, which now won’t be subject to the High Court appeals process if a judicial review is called.

I suspect that the original intention of the call-in power was to allow the Secretary of State to make significant asks of the commissioners of change, be it in the way they conducted an options appraisal or the way in which they worked with their local authorities, or perhaps even in the decisions that they make.

In practice, we’ve instead seen a year where the use of the power has been trialled, but tested very little. Without the outcome of a call-in on our hands it is hard to determine what the department considers an acceptable scope and scale for a legitimate call-in to be made, and changed, by the intervention of the Secretary of State.

This puts our friends and colleagues in NHS organisations in an interesting predicament, but one that nevertheless creates opportunity.

The power (and its associated statutory duties such as the notification duty and the as-yet enacted catalyst power) are likely to be reviewed in light of its use – or lack of – over the year.

This gives stakeholders of the department an opportunity to reflect on whether this enactment has brought programmes closer to the ambition of making timely, collective and collaborative decisions about major service change, or whether it has instead unintentionally impeded the progress of decision making.

If, as I suspect, the latter is more likely, this gives the department an opportunity to better engage with NHS organisations at the coalface of change programmes to understand how their original vision – of timely intervention, and quick resolution in areas of dispute – can be more effectively achieved. Whether or not this requires statutory intervention is a question best solved by meaningful involvement with those subject to that intervention.

For now, the call-in power remains in effect and the associated requirements of notification still apply to programmes of major service change. We’re excited to see whether the anniversary of this power inspires senior decision makers to better consider how they can effectively support organisations with delivering change at the pace the NHS needs to be able to thrive.

Blog by: Jonny Williams