Briefing on the Health and Care Bill: House of Commons Second Reading

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

On Tuesday 6 July 2021, the government published the Health and Care Bill. The legislation introduces new measures to promote and enable collaboration in health and care, building on earlier recommendations made by NHS England and NHS Improvement. The Bill also contains new powers for the Secretary of State over the health and care system and targeted changes to public health, social care, and quality and safety matters.

This briefing has been produced to inform Second Reading of the Bill in the House of Commons on 14 July 2021. The briefing focuses on the main sections of the Bill, which deal with the NHS and its relationships to other parts of the system, including the Secretary of State.

Key messages

  • 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.
  • The success of these reforms will critically depend on how they are implemented locally. Ministers therefore need to do more to set out a compelling case for what the changes will achieve and the difference they will make to patients and service users.
  • The reforms to integrate health and care services build on the vision set out in the NHS Long Term Plan and are strongly supported by health and care stakeholders. Many of the changes have been requested by health and care leaders who currently face legislative barriers to joining up care.
  • While any reform brings the risk of disruption, not pressing ahead with these changes would potentially be more disruptive as preparations to implement them are well under way. It would also leave in place elements of the market-based approach to health and care that has led to today’s fragmented system.
  • Government and parliament should resist the urge to specify in legislation additional granular detail about how improved collaboration should be achieved at ‘place’ level. Local flexibility is critical for effective joint working.
  • Extensive new powers for the Secretary of State to intervene in local service reconfigurations bring the risk of political expediency trumping clinical judgement and a decision-making log jam – a far cry from the government’s stated ambition to reduce bureaucracy.
  • The Covid-19 pandemic has exposed deep and widening health inequalities. To ensure addressing this is given sufficient priority across the system, reducing health inequalities should be incorporated within the new ‘triple aim’.
  • The measures in the Bill to address chronic staff shortages remain weak. A new duty to publish regular workforce supply-and-demand projections should be added to the Bill.
  • Reforming health services while leaving the social care sector in crisis is a recipe for disaster. The government should come forward with its long-overdue plan to reform social care without further delay.

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