Briefing on the Health and Care Bill: House of Lords second reading

This content relates to the following topics:

Part of The Health and Care Act 2022

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.

This briefing focuses on Parts 1 and 6 of the Bill, which deal with the NHS and its relationships to other parts of the system, including the powers of the Secretary of State, plus changes to the cap on social care costs.


  • This legislation will remove clunky competition rules and make it simpler for health and care organisations to work together to deliver more joined-up care to the increasing number of people who rely on support from multiple different services.
  • These reforms are complex and to help those who will implement them, the government should set out a clearer narrative as to how these changes will work in practice and make a positive difference to patients and service users.
  • The legislation is designed to be permissive and flexible to local circumstance. We encourage parliament to resist specifying in legislation granular detail about how improved collaboration should be achieved, as this would risk undermining the local flexibility that is critical for delivering integrated care.
  • 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 politicians into local decisions over services. We believe these clauses should be removed from the Bill or, at the very least, substantial safeguards added over their use.
  • Parliament should seek further clarification about the scope of the new powers conferred on the Secretary of State by the Bill, in particular those to direct NHS England, and ensure that there is adequate scrutiny of their use.
  • 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 projections of the current and future workforce required to deliver care to the population in England.
  • The Covid-19 pandemic has exposed deep and widening health inequalities. To ensure addressing this challenge is given sufficient priority, the new ‘triple aim,’ which is designed to create a common purpose across the NHS, should be amended to incorporate reducing health inequalities.
  • 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.


Aline Martin

Comment date
11 December 2021

We have one of the highest per capita death rates in the world from Covid.
Isn’t reorganising our healthcare system in the middle of a pandemic bound to make this worse?

Victor Standing

Retired pharmacist,
Northwest Regional HA
Comment date
03 December 2021

There is no reference in the White Paper to the proposed ‘housing disregard’, previously the subject of a BBC FactsCheck.

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