Documents to download

The Bill

The Health and Care Bill 2021-22 was presented in the House of Commons on 6 July 2021.

The Bill takes forward recommendations for legislative reform in the NHS Long Term Plan (January 2019) and the White Paper, Integration and Innovation: working together to improve health and social care for all (510KB, PDF), published in February 2021.

The Bill would develop the 42 existing Integrated Care Systems (ICSs) by creating an Integrated Care Board (ICB) and an Integrated Care Partnership (ICP) as statutory bodies in each ICS area. The ICB will lead on integration between NHS bodies and the ICP will focus on integration between the NHS, local government, and other providers.

The Bill formally merges NHS England and NHS Improvement, and makes changes to procurement and competition rules relating to health services.

The Bill also includes proposals to give the Secretary of State for Health and Social Care powers to direct NHS England and to decide how 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).

As it was originally presented to Parliament in July 2021 it had 135 substantive clauses and 16 Schedules [Bill 140, 6 July 2021 (928KB, PDF)]. The Government has produced a new version of the Bill reflecting the amendments made in the Public Bill Committee [Bill 183, 2 November 2021]. Including the four new clauses introduced at the Committee stage the Bill now has 139 clauses.

Committee stage

Committee stage began on 7 September 2021. It comprised four sessions of oral evidence and 20 sessions of line-by-line scrutiny over 10 days, concluding on 2 November 2021.

151 amendments and 70 new clauses (302KB, PDF) were tabled. Amendments 10 to 16, 117 to 121, and 147 to 148, and New Clauses 59 to 62 were all introduced by the Government and were subsequently added to the Bill.

While many Government amendments made technical changes, the new clauses would have the following effect:

  • To put a duty on the Care Quality Commission to carry out reviews and assessments into the overall provision of NHS care and adult social care services within each ICB area (New Clause 59);
  • To create a new power for the Secretary of State to intervene where local authorities are failing in the exercise of functions under Part 1 of the Care Act 2014 (adult social care) and make consequential amendments (New Clause 60);
  • To remove the Care Quality Commission’s power (under section 50 of the Health and Social Care Act 2008) to give an English local authority a notice of failure for not providing a service (New Clause 61); and
  • To provide for circumstances where community pharmacies and other dispensing services do not have to be paid to supply medicines because stocks have been centrally purchased by the NHS (community pharmacists and dispensing doctors are usually paid to cover the cost of purchasing the medicines they dispense) (New Clause 62).

Amendments and new clauses were tabled by the Opposition and other members of the Public Bill Committee on a wide range of issues, none of which were accepted.

Commitments to Government amendments at Report

At some points during the Committee stage, the Minister of State for Health, Edward Argar, committed to consider the issues raised further. In response to concerns about private sector involvement on ICBs, the Minister committed to bringing forward an amendment at Report, to prevent individuals with significant interests in private healthcare from sitting on ICBs.

The Minister confirmed plans to bring forward legislation to ban ‘virginity testing’ after this issue was debated in Public Bill Committee. On the 18 November 2021 several Government amendments were tabled for consideration on Report. These amendments seek to create a number of offences in relation to virginity testing (see Health and Care Bill: Notices of Amendments as at 18 November 2021 (287KB, PDF)).

On 17 November 2021, the Government published details of its plans to cap adult social care costs from October 2023 (see Gov.uk, Adult social care charging reform: further details). On 18 November the Government tabled a New Clause for consideration on Report which would amend the Care Act 2014 to implement these capping arrangements. This would mean the costs accruing towards the cap are costs incurred by an adult (at the local authority rate), rather than the combined costs incurred by both the adult and the local authority (for further background see section 3.6 of the Library briefing Proposed reforms to adult social care (including cap on care costs).

Further reading

Background to the Bill, commentary on its provisions and responses from the sector can be found in the Commons Library briefing on the Health and Care Bill 2021.

The following official documents provide more information about the Bill:

The King’s Fund and NHS Providers have published briefings on the Bill ahead of Report stage, which provide information and views on some of the proceedings in the Public Bill Committee:

The Commons Library briefing Death certification and medical examiners includes the Public Bill Committee consideration of the clause relating to medical examiners (Clause 124).

Information on legislative consent for the devolved legislatures can be found below:

Documents to download

Related posts