The Bills announced in each session’s Queen’s Speech are the fulcrum of the Parliamentary year. But they are easily lost sight of, separately and wholly, as the political cycle moves – and a mass of other news and events crowd them out.
So during the coming months, ConservativeHome will run a brief guide, on most Sunday mornings, to each Bill from this year’s Speech: what it is, whether it’s new, its main strengths and weaknesses – and whether it’s expected sooner or later.
11. Health and Care Bill
This Bill proposes the first major NHS reorganisation since the Lansley reforms of the early Coalition years. It is divided into five main parts.
The first contains the organisational meat of the Bill – the clauses on integation and collaboration. Part Two covers health and adult social care information, and Part Three the Secretary of State’s powers. Part Four establishes a Health Services Safety Investigations Body. And Part Five covers miscellaneous provisions, including the advertising of “less healthy food and drink”.
The Department of Health and Social Care, so Sajid Javid is in the lead. And he indeed opened the debate on the Bill’s Second Reading during the summer.
Edward Argar, who wound up that debate and is still in place post-reshuffle, has been leading on the Bill in committee now that Parliament has resumed.
Carried over or a new Bill?
Currently under consideration.
The core of the Government’s case is that “the overwhelming majority of these proposals are changes that the health service has asked for”. These feature, broadly speaking, a tilt away from the competition principle furthered by the Lansley changes, and one back to the co-operation principle which has been stressed less since the Clarke/Milburn/Lansley reforms, carried out under both main parties.
Ministers argue that the Covid pandemic has shown up organisational problems within the provision of health and social care – such as the unnecessary retendering of contracts, data that can’t be shared between different NHS and social care providers, and above all the siloes that prevent patients being moved seamlessly from one part of the system to others.
A classic pincer movement could be made against this Bill. From the Right, it would be that the competition-based Clarke/Milburn/Lansley reforms have done much to improve choice, improve value for money and efficiency within the service, and that any shift away from the competititon principle risks creating cartels that cost more but deliver less value for patients.
From the Left, the case as made by Labour during the Second Reading debate welcomed the removal of the Lansley competition rules in Part One of the Bill; quarrelled with aspects of the new local health boards (including their boundaries, independent sector representation and composition) and objected to the new powers for the Secretary of State.
The context of Britain’s emergence from the pandemic, and the consequent challenges for the NHS and social care, is crucial to understanding the politics of the Bill. The Government must grapple with a backlog of treatments, the cutback in face-to-face GP appointments, reforming Mental Health provision – and, not least, the unresolved issue of improving social care.
Labour’s main attack, for all the above, has been about what isn’t in the Bill: mainly, yet more money and resources. The Opposition is preparing the ground for a political attack as queues for treatment grow. This is more important to it than the reorganisation itself, on which their attack has been headed off (since Simon Stevens, the outgoing NHS Chief Executive, was clearly a force behind it).
Controversy rating 4/10
We give this Bill a low score because the attack from the Right in Parliament hasn’t materialised (only three Conservative MPs opposed it at Second Reading), and because the thrust of the Left’s healthcare attack comes elsewhere. Javid’s hesitation about its timing hints at a bigger theme: this is scarcely the first NHS reorganisation, as those competition and co-operation principles clash, and it won’t be the last.