Health and Care Bill receives Royal Ascent: responses from health organisations

Health leaders and organisations have given a mixed response to the Health and Care Bill receiving Royal Assent this week meaning it has now become law.

The government says the Act introduces measures to tackle the Covid backlogs and rebuild health and social care services from the pandemic, backed by £36 billion over the next three years through the Health and Care Levy. It will also contain measures to tackle health disparities and create safer, more joined-up services that will put the health and care system on a more sustainable footing.

The Health and Care Act builds on the proposals for legislative change set out by NHS England in its Long Term Plan, while also incorporating valuable lessons learnt from the pandemic to benefit both staff and patients.

It also aims to tackle long waiting lists built up during the pandemic, and address some of the long-term challenges faced by the country including a growing and ageing population, chronic conditions and inequalities in health outcomes.

Health and Social Care Secretary Sajid Javid said: “The Health and Care Act is the most significant change to the healthcare system in a decade and will put it in the strongest possible position to rebuild from the pandemic, backed by our record funding.

“These measures have broad support and will harness the best ways of working to ensure people are receiving high quality, joined up care.”

Response from Royal College of Physicians

The Royal College of Physicians (RCP) said it has always supported the direction of travel set out in the Health and Care Bill as placing Integrated Care Systems (ICSs) on statutory footing will better enable integration at a local level to improve population health.

President Andrew Goddard said: “We welcome that government listened to sector organisations including the RCP and introduced key amendments to give ICSs new duties on health inequalities, clinical research and climate change. These changes will provide a good basis for action when the Act comes into force.

“The RCP was one of over 100 health and care organisations calling for the bill to include a duty for regular assessments of how many staff are needed now and in future to meet demand. It is disappointing and frustrating that government did not accept this amendment and that no compromise was reached. This is a significant missed opportunity to begin to solve the workforce crisis which remains the limiting factor in the government’s plans for health and social care.

“As we move to implementation, the RCP will be supporting its members to play their role locally. Integration will not happen without teams working differently, and we encourage physicians to be a part of this.”

Response from the British Medical Association

The BMA said the Health and Care Bill was the wrong bill at the wrong time, which completely fails to address the main problems the NHS and its members are facing: too few resources, a crisis in social care and crucially, a huge shortfall of staff.

BMA council deputy chair Dr David Wrigley said: “While we have seen some concessions from the Westminster Government – responding to our calls for greater protection from private providers influencing commissioning decisions via membership of NHS decision-making bodies, and safeguards to help prevent undue political interference in the running of local health and care services – we are utterly dismayed that ministers have ultimately failed to listen to frontline workers and demonstrate its commitment to safely staff the NHS and care services.

“More than 100 expert health and care organisations, Royal Colleges, charities and think tanks, as well as MPs and peers from across the political divide, supported amendments that would have held the Government legally accountable for providing regular assessments over the staffing numbers that we need now and in the future. The BMA estimates that England is already short of more than 45,000 doctors, and without a transparent, nationwide stocktake, it is impossible to plan for the future.”

He added that as the Bill now becomes an Act the BMA will continue to campaign for a publicly funded, publicly provided and publicly accountable NHS that gets the investment it needs, is properly staffed and protects the health and wellbeing of its workers so they are able to provide the high quality and timely care that patients deserve.

Response from the NHS Confederation

The NHS Confederation said its members – leaders across the NHS – have been clear that collaboration and partnership working at the local level must be the future of health and care. This legislation will help to facilitate that.

Matthew Taylor, chief executive, said: “We are pleased that government has heeded our calls to put safeguards on the new powers the legislation gives the Secretary of State for Health and Social Care over local service reconfigurations, which will let local leaders lead.

“We welcome the extent of engagement we and our members have had with the Department over the course of the Bill process.

“Our members working across Integrated Care Systems look forward to fulfilling their statutory responsibilities from July 1st, working to deliver the best possible care for the local communities they serve.”

Response from the King’s Fund

The King’s Fund said that the main thrust of this Act is a welcome shift away from the focus on competition between health care organisations towards a new model of collaboration, partnership and integrated care.

Richard Murray, Chief Executive, said: “The legislation gives the NHS and its partners greater flexibility to deliver joined-up care to the increasing numbers of people who rely on multiple different services. Now the hard work of implementation begins. Local health and care leaders will need support, endurance and commitment to turn the opportunity of this Act into a reality for local communities.

What will the Health and Care Act do?

The Act introduces measures that will:

• Level up health disparities in oral health and obesity through making it simpler to fluoride to water in more areas across England, and regulating unhealthy food and drink advertising;
• Make services safer by establishing the Health Services Safety Investigations Body, an independent public body which will investigate incidents that have implications for patient safety and help improve systems and practices;
• Crack down on the use of goods and services in the NHS tainted by modern slavery and human trafficking with a view to ensuring that the NHS is not buying or using goods or services produced by or involving any kind of slave labour;
• Ensure our health and social care workforce have the right skills and knowledge to provide informed care to autistic people and people with a learning disability by making specialised training (the Oliver McGowan Mandatory Training) mandatory by law;
• Support victims of abuse and respond to recent child safeguarding tragedies by committing to looking at information sharing in relation to the safeguarding of children, and requiring Integrated Care Boards to set out any proposed steps to address the particular needs of victims of abuse;
• Safeguarding women and girls by banning the harmful practices of virginity testing and hymenoplasty;
• Introduce regulation of non-surgical cosmetic procedures and improve the way we regulate medical professions;
• Address the barriers to joined up working, by supporting data sharing between health and social care and removing barriers in the hospital discharge process, reducing unnecessary delays for patients;
• Remove needless bureaucracy in the system, allowing staff to get on with their jobs providing the best possible treatment and care for their local populations. It also ensures that the NHS is fully accountable to parliament and the public, while maintaining the NHS’s clinical and day-to-day operational independence;
• Explicitly set out the parity of mental health and physical health and ensure transparency around the spending allocated to mental health support; and
• Support the government’s ambitious adult social care reforms, by creating the right framework for assuring, funding and sharing data on social care, to enable individuals to maintain their independence for longer.