By Mike Birtwistle and Martha Burgess
On 19 January 2011 the Health and Social Care Bill was published. Today, 365 days later, it still has some way to go before it is enacted. As Rupert Gowrley noted on the day of publication, the Bill was either going to be a millstone or a milestone. In many ways it has been both.
Whatever you think about the reforms, the Bill has undoubtedly been a milestone, framing the subsequent debate in a way which few pieces of legislation do. Millstone? Well, no one in government (or opposition for that matter) would have envisaged that Parliament would still be considering the Bill a year later. Indeed, for many in the NHS the continuing uncertainty about the Bill is now hindering health service planning and delivery. Despite this, the extent of political feeling about the Bill can be seen by the RCN and RCM’s announcementof outright opposition to the Bill, a year after it was introduced (although in truth most people probably thought they opposed it already).
Much has been written, including on this blog, on the challenges that the Bill has faced so far. Over 70 Bill sessions have taken place, 28 of which were Committee sessions ahead of the now infamous pause to the process called by David Cameron in April. It is hard to believe that this Bill should take longer than its 1946 equivalent, which actually established the National Health Service.
The Bill has evolved as a result of that pause, and significant parliamentary scrutiny – what started as a Bill with 281 clauses now has 305. Yet it is hard to see either the legislative process or the pause as a success. As written before on this blog, that the pause was needed is hardly a ringing endorsement of the quality of scrutiny in the Commons. The fact that – nine months after the pause – we still have such opposition to the Bill shows that the Listening Exercise did not achieve its primary political objective: to defuse opposition to the Bill.
A year on, we are not there yet. The Bill still has a number of hurdles to pass before it reaches Royal Assent. And with the Queen’s Speech – and so the signal of a new parliamentary term – expected on 9 May, there is a clear deadline by which the remaining steps need to have been completed.
The remaining stages of the Bill will be about more than just passing parliamentary time. There are still substantive issues at stake. Hard as it is to believe, there is still no agreement on Part 1 of the Bill, which sets out the primary duties of the Secretary of State. As revealed in the HSJ this week, the Government is proposing a series of amendments aimed at reassuring peers about the accountability of the Secretary of State. Whether they lead to a permanent truce remains to be seen. Expect further rows about the private patient cap, private sector involvement and regulation, with critics using the PIP scandal to attack the premise of plurality of provision.
Report Stage is set to begin in the Lords on 8 February, with seven sessions planned in total. The recent debate over the Welfare Reform Bill has led many commentators to question whether the Lords are now in a fighting mood, ready to vote through significant changes to the Bill. This however is unlikely. For one thing, criticism of the two bills has been very different. While there are concrete changes that have been, and continue to be, called for on welfare reform, clarity in the changes wanted has been less forthcoming on NHS reform. Few organisations, or even politicians, have been able to point to specific amendments that they want to see made.
This is not to say that there will be no further changes to the Bill. Not only does it have to navigate the remaining sessions in the House of Lords, there will be a period of ping pong as the amendments made in the Lords are considered in the Commons and vice versa. Expect most further changes to be initiated by the Government.
As for timelines, these are far from certain (and experience tells us very open to change). For patients, healthcare professionals and many health watchers, the real action is happening outside of Parliament in the NHS. Whenever the Bill receives Royal Assent (and it will), the political implications of NHS reform have only just begun.
Happy anniversary Health and Social Care Bill.