Ministers are to press ahead with plans to assume more power over the NHS in England, amid growing speculation that the head of the health service will quit this year. The planned shake-up immediately prompted questions about why Boris Johnson has decided to trigger a potentially destabilising reorganisation of the NHS in the middle of the Covid pandemic. Matt Hancock, the health secretary, will on Thursday publish the first white paper on NHS reform since the coalition government’s hugely controversial health and social care bill in 2010. The proposals would hand the health secretary a sweeping new “general power to direct NHS England on its functions”, which would reduce the independence its powerful chief executive, Sir Simon Stevens, has built up and displayed during his seven years in the job. There has been tension between Hancock and Stevens, before and during the pandemic, including over worsening patient waiting times for NHS care and shortages of protective equipment for frontline staff. The Guardian revealed last July that Johnson was planning to take more control over NHS England in an attempt to regain powers the government ceded in the previous restructuring of the health service. The white paper also includes plans to give the health secretary more control over the NHS’s arm’s-length bodies, such as the Care Quality Commission and Health Education England, as well as the organisation led by Stevens, who advised Tony Blair when he was prime minister. But NHS bodies and health experts warned ministers the planned powergrab could backfire, distract staff from caring for patients and lead to the government being blamed by the public for any setback or controversy in the service, such as unpopular plans to downgrade a local hospital. Hancock said the forthcoming NHS reform bill would liberate the NHS from “burdensome bureaucracy” created by the shake-up in 2012 overseen by the then health secretary, Andrew Lansley, and lead to health and social care services working more closely together for the benefit of patients. It will build on improvements in the NHS seen during the pandemic, he believes. But Danny Mortimer, the chief executive of the NHS Confederation, which represents health service trusts, said: “There will be lessons to learn from the pandemic – for government and the NHS – but it would be wrong to conclude that greater ministerial control would have led to an improved response. “The NHS is already one of the most centralised health systems in the world and ministers must resist the temptation to centralise it further.” NHS England staff who work closely with Stevens expect him to stand down this year and it is thought he would not want to have his wings clipped in the way the government is proposing. One NHS insider said: “Under this new legislation the NHS’s remit would require someone with less power than Simon and someone who’s prepared to have less power. Simon quite enjoys his power.” Nigel Edwards, the chief executive of the Nuffield Trust health thinktank, said: “Ministers may come to regret all the new powers they are set to be granted over hospital closures and downgrades [and] directions to NHS England. “As earlier governments learned to their peril, centralising power means you centralise blame and create more pressure to interfere.” The timing of the shake-up has raised questions, given the NHS is still immersed in battling the pandemic and faces major challenges over holes in its workforce, delays in people accessing treatment and how it can halt the rise in diseases such as cancer, obesity and mental illness. “Boris Johnson must explain why a reorganisation in the midst of the biggest crisis the NHS has ever faced is his pressing priority,” said Jonathan Ashworth, the shadow health secretary. The proposal that NHS bodies no longer have to automatically tender contracts for services worth more than £615,000 – another Lansley legacy – will be warmly welcomed as rolling back the increasing privatisation of care seen in recent years. But Dr John Lister, secretary of the campaign group Keep Our NHS Public, said private health firms would still be able to bid for key contracts, including for providing data services. “There is no proposal to roll back the contracts of services already outsourced, or even terminate the contracts when they expire,” he said. Clinical commissioning groups, the local bodies which hold the NHS budget in an area, would be subsumed into 42 new legal entities called integrated care systems – groups of NHS bodies and local councils working together to integrate and improve health and social care. But Edwards warned of likely conflict between each ICS’s two distinct boards and the local health and wellbeing board, made up of elected members of the local council. The Department of Health and Social Care said: “By acting now, the government can make permanent some of the beneficial changes where Covid has catalysed new and better ways of working and clear the path for improvements into the next decade such as delivering on manifesto commitments including 50,000 more nurses and 40 new hospitals.”