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The Bill would enact policies set out in the NHS’s recommendations for legislative reform, following the NHS Long Term Plan (January 2019), and the White Paper, Integration and Innovation: working together to improve health and social care for all (February 2021).

The Government says the Bill builds on the NHS’s own proposals for reform, aiming to make it less bureaucratic, more accountable, and more integrated, and that it has incorporated lessons learnt from the pandemic.

What does the Bill do?

Several provisions in the Bill were originally proposed by NHS England, such as establishing existing Integrated Care Systems (ICSs) on a statutory footing, formally merging NHS England and NHS Improvement, and making changes to procurement and competition rules relating to health services.

The Bill also includes proposals from the February 2021 White Paper to give the Secretary of State for Health and Social Care powers to direct NHS England and to decide how some other health services are organised. It gives the Secretary of State powers to transfer functions between some of the ‘Arm’s Length Bodies’ that lead, support and regulate healthcare services in England, and to intervene in proposed changes to the way health services are delivered.

The Bill doesn’t cover wider reforms of the social care and public health systems, although it does provide for some changes in these areas (and ICSs are intended to improve coordination between the NHS and local authority services).

Social care and public health provisions

For social care, the Bill provides for the Care Quality Commission (CQC) to assess how local authorities deliver their adult social care functions and it aims to improve data sharing.

There are also measures to streamline how people with ongoing care needs are discharged from hospitals. Public health measures in the Bill relate to food advertising and water fluoridation.

Safety investigation and other measures

The Bill would establish the Healthcare Safety Investigation Branch as a statutory body, and make changes to the system of medical examiners.

These measures were previously introduced in the Health Services Safety Investigations Bill [HL Bill 4] in October 2019 and earlier draft legislation in 2017.

Other matters covered by the Bill include the regulation of health and care professionals, the collection and sharing of data (including measures to support the development of new medicine registries), international healthcare, and hospital food standards.

The Bill contains 135 clauses (grouped into six parts), with 16 Schedules, and makes changes to several existing Acts, most notably the National Health Service Act 2006 and the Health and Social Care Act 2012.

Reaction to the Bill

NHS England

The NHS England Chief Executive, Sir Simon Stevens, said the Bill’s proposals for integrated care were “widely supported”:

They go with the grain of what our staff and patients can see is needed, by removing outdated and bureaucratic legal barriers to joined-up working between GPs, hospitals, and community services.

The Chief Executive said the reforms would “undoubtedly both help tackle health inequalities and speed the recovery of care disrupted by the covid pandemic.”

The Health and Social Care Committee

The Health and Social Care Committee’s report on the White Paper proposals summarises a wide range of responses to the Government’s planned reforms. Overall, it supported the direction of travel set out in the White Paper.

The Committee noted that the creation of ICSs could improve the delivery of care services for patients if proper accountability mechanisms are put in place, particularly relating to the safety and quality of care. However, the Committee also concluded that several areas in the White Paper required further clarity or revision, such as the addition of new powers for the Secretary of State.

The new Secretary of State, Sajid Javid, has written the Health and Social Care Committee to explain how its report’s recommendations informed the drafting of the legislation.

More powers for the Secretary of State

While there has been widespread support for better integrated care, the proposals to extend the Secretary of State’s powers have been controversial.  Dr Jennifer Dixon, Chief Executive of the Health Foundation, said that the new powers are“ politically driven and risks taking healthcare backwards.”

NHS Providers has said it will seek appropriate safeguards to balance new ministerial powers. It also stresses that an excessively top-down approach to ICS structures could hinder effective local collaborative working.

While  noting its concerns about the additional powers for the Secretary of State, the NHS Confederation has said its membership of NHS organisations are relieved that the Bill has been brought forward before the summer recess. They describe the timetable for ensuring that ICSs can take on statutory responsibilities by April 2022 as “incredibly tight”.

Private sector involvement

There are mixed views about what changes to competition rules might mean for the level of private sector involvement in the NHS. The King’s Fund has welcomed the Bill’s removal of “cumbersome” competition rules under the Health and Social Care Act 2012. But the Labour party, the British Medical Association and anti-privatisation campaigners have warned that the Bill could allow contracts to be awarded to private healthcare providers without proper scrutiny.

What about other pressures on the NHS?

There are concerns that the Bill does not sufficiently address the greatest challenges facing the NHS, namely the impact of the pandemic on staff and patients, waiting lists for non-Covid treatment, wider reform of adult social care, and workforce pressures.

A wide range of groups representing NHS staff and organisations have called for the Bill to include further measures to require a long-term workforce strategy. This has been backed by think tanks and the Health and Social Care Committee.

The Shadow Health Secretary, Jonathan Ashworth, questioned the timing of the Bill, asking why the Government was embarking on reorganising the NHS rather than “…resourcing the NHS sufficiently to bring down the record waiting lists for surgery, mental health and cancer care or giving our NHS workers the proper pay rise they deserve.”

Other relevant Library papers

Death certification and medical examiners (CBP09197) – updated to include reference to the Bill.

Obesity (CBP09049) – updated to include reference to the Bill.


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