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

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Part of Our work on the legislative agenda for health and care reform

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. In addition to this document, we will issue separate briefings relevant to discrete aspects of the Bill where we have joined with partner organisations to suggest specific amendments.


  • 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 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, including which professionals should sit on which body, 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 politics into local decisions over services. 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. 
  • 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. 
  • 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.
  • 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.


Marcia Saunders

Retired social services and NHS manager,
Comment date
19 January 2022

Anyone who has doubts about the Health Care Bill’s intention to give unprecedented powers of direction to the Secretary of State can shed them now that the SoS has directed the NHS CEO to give £270m to private hospitals, as reported in The Guardian last week but not otherwise widely noticed.

The government's explanation that the purpose is to ‘create increased capacity and protect the NHS’ is disingenuous. It’s telling and to her credit that Amanda Pritchard, as CE and accountable officer, refused and had to be directed. Her reasons will not have been political. NHS capacity is determined by numbers of doctors, nurses and support staff in all of which there are currently huge shortages as a result of a decade of underfunding, pandemic exhaustion and Brexit. Whistling up a bunch of empty beds just doesn’t do it (c.f. Nightingales).
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