Briefing on the Health and Care Bill: House of Commons report stage and third reading

Health and Care Act 2022

Part of The Health and Care Act 2022

The Health and Care Bill (House of Commons 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, 2, and 3 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 proposed changes to information sharing across the health and care system.

Summary

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 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 political expediency trumping clinical judgement. We believe these clauses should be removed from the Bill.
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 and the workforce crisis has become a blind spot for the government. 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.

Comments

"Measures to deal with staff shortages are weak". Such measures are consistent with reducing beds (+ other facilities) to suit the staff available and to promote the growth of the private sector.

There should also be a means of knowing how 'future workforce requirements' are planned to be delivered.

Removing log-jams in decision-making by inhibiting political expediency over clinical judgement sounds fine.
However clinical judgements founded upon flawed data / inadequate consultations do need to be clarified properly and promptly - not just accepted in order to remove a log-jam in decision-making. It is easy to make a decision but to make a sustainable decision requires care over the quality of data and consultation. I know that Dorset CCG has fallen into the trap of believing that they are right and there are no options but the service reconfiguration they are currently supporting will cause harm to future 'severe trauma' patients who will not be able to gain hospital access in time, unless someone can audit the matter soon.