Government hopes for clean Bill of health

By Joe Cooper

The government’s plans for healthcare reform have been back in the news this week with the announcement of a three percent pay rise for NHS staff yesterday, and the news that the anticipated proposals on social care have been delayed. However, flying somewhat under the radar has been the government’s flagship healthcare reform legislation – the Health and Care Bill.  

So what is in the Bill? 

In short, the Bill aims to deliver a more “integrated, efficient and accountable health and care system” by delivering the proposals outlined in the NHS Long Term Plan and making it easier for different parts of the health and care system to work together. As one would expect, the government is seeking to remove the ‘excess bureaucracy’ within the health and care systems, and tackling the wider issues relating to patient safety across the NHS. 

The Bill in its current form pieces together several different agendas into a single piece of legislation. For example, the Bill will also ensure that each part of England has an Integrated Care Board and Integrated Care Partnerships responsible for bringing together NHS and local government services. At the same time, the Bill will also introduce a ban of junk food adverts pre-watershed on TV and a total ban online in an attempt to tackle national obesity.  

The Bill will legislate for the creation of a new investigative body to investigate patient safety incidents occurring within NHS services which is an absorption of what had previously been the Healthcare Service Safety Investigations Bill going through Parliament prior to the 2019 General Election. Patient safety has been a particular priority for the government in the wake of high profile investigations such as the Paterson Inquiry and the Independent Medicines and Medical Devices Safety Review (known as the Cumberlege Review). These investigations followed high profile failures of patient safety, from procedural errors to wider cultural issues on the frontline. The Health and Care Bill will therefore see the Healthcare Safety Investigation Branch (HSIB) put on a statutory footing to deliver a fully independent national body to investigate healthcare incidents, while also creating a space in which honest, critical reflection can take place.  

Healthcare, particularly during a time when the value of the UK’s healthcare system has been thrust into national prominence, remains a contentious issue politically.  

Sir Simon Stevens, outgoing NHS England Chief Executive, welcomed the intention for greater integrated care across England, and said that the reforms “go with the grain of what our staff and patients can see is needed”.  

In many ways, the Bill’s attempts to join up NHS and local government services run contrary to previous Conservative governments’ attempts to reform healthcare. The Lansley Reforms to healthcare enshrined in the Health and Social Care Act 2012 represent perhaps the most clear example of an administration looking to move power away from centralised structures. This new Bill seeks to roll back on Section 75 of the 2012 Act, which was particularly controversial given its role in compelling NHS commissioning groups to put out to tender contracts worth more than £650,000 a year.  

Labour has been particularly critical of the way in which it argues the Bill could see NHS bodies award contracts to private providers without considering other bids. As part of the bid to reduce bureaucracy, the Bill includes plans for a “new procurement regime for the NHS and public health, informed by public consultation, and reducing the need for competitive tendering where it adds limited or no value”. Given Labour’s focus on deploying attack lines around private provision of services within the NHS we can expect this to continue to be the Party’s position as the Bill progresses through Parliament.  

The Bill completed its Second Reading last week and is now in Committee Stage. However with, Parliament rising for recess today the Committee Stage will not take place until the autumn. With the government’s social care plans now also expected in the autumn, the government will be spending the summer trying to cajole its own backbenchers, hesitant about the tax hikes floated to pay for the package, to fall in line.