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Evidence and consultations

Briefing on the Health and Care Bill: House of Lords Report stage

The Health and Care Bill (House of Lords Bill 2021–22) introduces new measures to promote and enable collaboration in health and care, building on earlier recommendations made by NHS England and NHS Improvement in 2019.

The Bill also contains new powers for the Secretary of State to intervene in the health and care system, and targeted changes to public health, social care, and the oversight of quality and safety.


The King’s Fund supports much of the Health and Care Bill, however there are four priority areas we believe require amendment.

  • Reconfiguration powers: Extensive new powers for the Secretary of State to intervene in local service reconfigurations bring the risk of a decision-making log jam and dragging national politics into local decisions over services. These powers should be removed from the Bill or, at the very least, safeguards should be added to limit the circumstances in which the Secretary of State can intervene, require appropriate consultation, and introduce a time limit on decision-making.

  • Powers to direct NHS England: To provide confidence in the operational and clinical independence of the NHS, parliament should seek further safeguards over the new powers for the Secretary of State to direct NHS England.

  • Workforce: The measures in the Bill to address chronic staff shortages remain weak. A new duty should be added to the Bill, requiring the regular publication of independently verified projections of the current and future workforce required to deliver care to the population in England.

  • Cap on social care costs: The change to the social care cap is regressive and will mean that the main beneficiaries of the government’s reforms will be people with higher assets, while the benefit to people with low to moderate assets will be marginal. To protect people with lower assets from catastrophic costs, the change to the care cap should be removed from the Bill.