Boris Johnson is planning a radical overhaul of NHS England, as he reverses controversial privatisation policies introduced by David Cameron, a leaked document suggests. According to the draft white paper, the government is planning to reduce the role of the private sector in NHS England and give the health secretary greater control. NHS commissioners would not be required to put contracts out to tender, which can draw competition from competing health groups. Instead, a new policy would leave the NHS and local authorities to run services and encourage them to work together more effectively. The health secretary would also take more direct control over NHS England, with the plans putting emphasis on reducing bureaucracy and improving integration between the different departments of the NHS. NHS Improvement, the health service’s spending watchdog, would also be scrapped and folded into NHS England. The plans would put an end to controversial changes introduced by Cameron’s administration in 2012, which were seen as a step towards the privatisation of the NHS. The 2012 model moved some power from the health secretary to NHS England, introduced clinical commissioning groups, which had control over local healthcare provisions, and built a greater role for the private sector in healthcare. The leaked document, published in Health Policy Insight, said these changes had “in some cases hindered integration between providers”, adding that “in practice, the NHS has not operated as the market intended by the 2012 Act”. The new plans say the private and voluntary sectors will continue to have an “important role” but that their influence will be limited. “Where competitive processes can add value they should continue, but that will be a decision that the NHS will be able to make for itself,” the document says. The plans also detail the need for greater focus on integrated healthcare with more emphasis on “healthy behaviour and prevention”. “The Covid pandemic demonstrated plainly that this broader approach to health and care is not only desirable, but essential. We have seen first-hand how different groups have been impacted in different ways by Covid-19, and how wider factors play a part in our health outcomes,” the document says. The plans have been welcomed by the former health secretary Jeremy Hunt, who said that they marked a “very big change”, but “the right change”. “The big difference between now and then is the growth in older people who need much more joined up care. Last year was the first year in history where, across the world, there were more over-65s than under-fives. Older people have much more complex needs … that need to be addressed with a programme of care not just a single visit to a hospital,” he told BBC Radio 4’s Today programme, adding that the plans should allow “the joining up of care between local authorities”. But he also said there needed to be greater scrutiny for private bodies working with the NHS. “If we are going to allow local monopolies to come back in the NHS, we need to make sure, in the details of these reforms, there’s a proper accountability mechanism,” he said, similar to Ofsted’s role in the education sector. The shadow health secretary, Jonathan Ashworth, said that reducing the role of privatisation in the NHS was very important, but that the reforms must also improve patient outcomes and reduce waiting times for treatment. “The Lansley changes were disastrous … and we pleaded with the government at the time not to do this, so it doesn’t surprise me that now they’ve now come along and said we recognise those changes were counterproductive,” he said. He questioned, however, whether now was the right moment to restructure the NHS as it grappled with unprecedented pressure from the coronavirus pandemic. “NHS staff are feeling ground down. Is this really the time for another structural reorganisation? And fundamentally what is the aim of these reforms?” he asked. “ This is a big task, and if government is going to embark upon this, it has to be clear what their destination is. Are these reforms going to improve outcomes for patients? That’s the standard by which they will be judged.” A spokesperson for the Department of Health and Social Care said it was “rightly considering where changes need to be made to help us build back better” and that the “full details will be set out in due course”.