The National Health Service Bill 2015-16, also known as the “NHS Reinstatement Bill” is due to have its Second Reading debate on 11 March 2016. It is a Private Members Bill introduced by Caroline Lucas on 1 July 2015. The Bill seeks to make changes to a number of provisions in the Health and Social Care Act 2012, the National Health Service Act 2006 and other legislation. The Library has provided the following summary but further information about the aims and supporters of the Bill can be found on the website: www.nhsbill2015.org. The website states that the Bill aims to “fully restore the NHS as an accountable public service by reversing 25 years of marketization in the NHS, by abolishing the purchaser-provider split, ending contracting and re-establishing public bodies and public services accountable to local communities.”
Changes to administration and accountability
In summary the Bill aims to make the following changes to the administration and accountability of the NHS in England:
- re-establish the Secretary of State for Health’s duties in relation to the NHS in England that were in place until 2006 (as set out in s.1 of the NHS Act 1977), and to make provision about the other duties of the Secretary of State in that regard;
- abolish the NHS Commissioning Board, known as NHS England, and re-establish it as a Special Health Authority with regional committees;
- establish local Health Boards to plan and provide services, the Bill would give the Secretary of State a duty to approve schemes for the establishment of Health Boards by 1 January 2018;
- abolish clinical commissioning groups, NHS trusts and NHS foundation trusts, once Health Boards were approved (as part of measures to remove the split between commissioners and providers of services);
- to establish Community Health Councils (CHCs) (CHCs were established in 1974 to represent the patient interest and were abolished in 2003).
The website supporting the NHS Bill states that the Bill would permit flexibility in how it would be implemented, led by local authorities and NHS bodies. For example, it notes that local authorities would lead the process by which functions were transferred from existing NHS bodies to Health Boards, and that these Boards could cover more than one local authority area.
Competition and procurement rules:
In addition to the measures to remove the internal market in the NHS in England, the NHS Bill website states that the Bill includes the following provisions, which aim to prevent the application of competition law and procurement rules to the NHS:
- assert the competence of Parliament and the devolved bodies to legislate for the NHS without being over-ruled by EU competition law and the World Trade Organization’s General Agreement on Trade in Services;
- abolish Monitor, the “sector regulator” that licenses health service providers and oversees the operation of procurement, choice and competition rules in the health service;
- repeal of sections of the Health and Social Care Act 2012 relating to procurement, competition, tariff pricing, and health special administration;
- require the prior approval of Parliament and the devolved legislature for the agreement to the proposed Transatlantic Trade and Investment Partnership and other international treaties affecting the NHS;
- require government to report annually to Parliament on the effect of international treaties on the NHS.
Integration of health and social care:
The Bill would give the Secretary of State a duty to exercise his functions with a view to integrating the provision of health and social care services. The Bill would also require Health Boards to work with local authorities to integrate health and social care services.
The Bill would introduce a combined duty for the Secretary of State to protect and improve public health, and to reduce inequalities.
Other measures include:
- the transfer of financial obligations under NHS PFI agreements to the Treasury, which would also be required to assess and publish PFI obligations, and to explain to Parliament how it proposed to reduce them;
- the repeal sections 38 and 39 of the Immigration Act 2014, which concern the extension of NHS charges for certain non-EEA nationals (see for example the Library’s briefing on the Immigration Health Surcharge, which was introduced under s38 of the 2014 Act);
- a requirement for the use of national terms and conditions of employment for relevant NHS staff under the NHS Staff Council and Agenda for Change system.
Further information, including Explanatory Notes to a previous version of the Bill (NHS Bill 2014-15), is available from www.nhsbill2015.org. The website provides the following background on how the Bill has been developed:
“The first proposal for a Bill was made in August 2014 by Professor Allyson Pollock and barrister Peter Roderick.
The August 2014 proposal was put out for consultation, a process which ended in late December 2014.
Based on the consultation Peter Roderick and Allyson Pollock drafted another version, finalised on 21 February 2015.
February 2015 version of the proposed NHS Reinstatement Bill
Explanatory notes for the February 2015 proposed NHS Reinstatement Bill
Comparison between the August 2014 and February 2015 versions of the proposed Bill
On 11 March 2015, 12 MPs from five political parties tabled the first National Health Service Bill in the House of Commons, based on the second version of the proposed NHS Reinstatement Bill. The Bill ‘fell’ when Parliament ended before the May 2015 General Election, and was retabled in the current session of Parliament.”
While there was relative continuity in the structure of the NHS from 1948 to 1974, the NHS has subsequently undergone a number of major reforms, and particularly with the introduction of internal market reforms from 1991 onwards. The NHS and Community Care Act 1990 introduced the reforms set out in the Working for Patients White Paper, including the introduction of NHS trusts and the purchaser-provider split.
Although there was a shift away from internal market policies when Frank Dobson was Health Secretary, under the Labour government (and from 2000 in particular) there was a focus on commissioning, with patient choice policies also a feature of reforms during this period.
After the 2010 general election the Coalition Government introduced major structural reforms to the NHS. In June 2012 the NAO published Healthcare across the UK: A comparison of the NHS in England, Scotland, Wales and Northern Ireland. The NAO noted the increasing divergence in health services across the UK, in particularly the removal of the NHS internal market in Wales and Scotland and the increasing role of competition in England:
“In the last decade there has been notable divergence in policy and performance management between the nations, particularly in the use of competition between healthcare providers. Since devolution, the commissioners and providers of health services have been reintegrated in Scotland and Wales, thus removing the internal market. In contrast, the internal market remains in Northern Ireland and the role of competition has increased in England.”
Further information on the changes to the NHS in England introduced by the Health and Social Care Act 2012 can be found in the Library briefing The Structure of the NHS in England (CBP 7206).