Analysis

Bill Watch: The Health and Care Bill becomes law

Miles Watson

In a final flurry of parliamentary activity, the Government’s proposed reforms to the NHS in England passed through the House and is set to receive its Royal Assent. What should we look out for as we move from legislation to implementation?

And just like that it passed, hurried through the final stages of its 10-month legislative journey along with a range of other laws the Government wanted to clear from its books before the next Queen’s Speech. With final details related to NHS supply chain slavery and reconfiguration of services ironed out, the Health and Care Bill, the Government’s set-piece reform of the health system in England, becomes the Health and Care Act. Its passing cements a whole host of changes to the way healthcare is organised and delivered, from who gets to take part in local healthcare decisions to fluoridation of water supplies.

The entire process, bar a few parliamentary scuffles and an anti-privatisation social media campaign, has passed without much fanfare – certainly in comparison to Lansley reforms of a decade ago.  This was down, in large part, to NHS stakeholders which have long been primed and bought into the main change that this Act delivers – one of greater integration of healthcare-delivering services in large geographical footprints known as Integrated Care Systems (ICSs). The seeds were planted for this shift as far back as 2019’s Long Term Plan, if not before, and many providers have already set up their ICSs. This Act puts a legislative ‘rubber seal’ on all this. Just how successful they are in driving efficiencies and crucially, improving population health outcomes, remains to be seen.

In the final frantic week of legislative horse-trading known as ‘ping pong’, the Government quietly backed down from its ‘power grab’ which would have handed over greater controls of local NHS decision making to the Secretary of State, a move opposed by the likes of the NHS Confederation. As this was a move which Matt Hancock was a proponent of, his successor Sajid Javid, who was thought to be lukewarm on it, was happy to concede.

NHS workforce planning – a hot topic which is never far from the health (and national) pages – proved a sticking point, with MPs and peers wanting greater rigour in how workforce levels are reported and communicated. Has the perennial challenge of how to adequately recruit, resource and retain a workforce been solved by the Act?  The COVID-19 pandemic has highlighted longstanding systemic issues in the workforce, and the jury is out on whether the Act will be able to resolve these with the urgency that healthcare leaders have long been calling for.

Another serious issue brought into sharp relief by the pandemic – Healthcare Inequalities – has also been accounted for in the Act, including a suite of provisions which will aim to improve outreach and access to health services for ‘people’ (as distinct from ‘patients’), and strengthen data collection and publication on marginalised groups. This dovetails to the Government’s wider ‘levelling up’ agenda.  Again, only time – and robust implementation – will tell whether these will deliver a transformative improvement to the health of the country’s marginalised or deprived communities, or whether we will need to wait for more policy ideas as the Government continues this agenda.

What next?  As the Act is committed to vellum, health policy watchers and practitioners will be poring over the detail to understand how its provisions will change on-the-ground delivery of healthcare. Keep tuned to MHP Mischief for continued analysis as this process plays out over the weeks and months ahead.