Bill for More Integrated Healthcare System Introduced in Parliament

July 07, 2021

Proposals for a more integrated healthcare system in England have been welcomed but concerns were raised about politicians having more control over the running of the NHS.

The Health and Care Bill was introduced in Parliament on Tuesday.

It aims to make the health service less bureaucratic, more accountable and capable of providing joined-up care working alongside local authorities, according to the Department of Health and Social Care (DHSC).

Key measures include bringing the NHS and local government together to focus on patients' needs such as moving services out of hospitals and into the community, and on preventative healthcare, the department said.

In an attempt to reduce bureaucracy, another element would see the NHS only having to tender services when it can lead to better outcomes for patients – rather than current compulsory competitive tendering.

Levelling Up

The Bill will also support the introduction of new requirements about calorie labelling on food and drink packaging and the advertising of junk food before the 9pm watershed in a bid to "level up" health across the country.

As part of a package of measures aimed at improving oversight and accountability in the delivery of services in the social care sector, there would be improved powers for the Health Secretary to directly make payments to adult social care providers where required.

According to a White Paper published in February, the Health Secretary will have more power to set objectives for NHS England, and will be able to intervene when local services are being reconfigured, such as the closure of hospitals.

Sajid Javid, who took over the Health Secretary role from Matt Hancock last month, said: "To help meet demand, build a better health service and bust the backlog, we need to back the NHS, as it celebrates its 73rd birthday this week, and embed lessons learned from the pandemic.

"This will support our health and care services to be more integrated and innovative so the NHS can deliver for people in the decades to come."

NHS England Chief Executive, Lord Stevens, said the Bill "contains widely supported proposals for integrated care, which have been developed and consulted on over recent years by the NHS itself".

Reversing Lansley Changes

The shake-up will see the law changed to reverse reforms of the NHS in England introduced by former health secretary Andrew Lansley in 2012.

Lord Lansley branded it "a mistake" for ministers to be "trying to tell the NHS day-to-day what to do".

He told BBC Newsnight: "My main concern is that the Bill is designed to give the Secretary of State day to day control over the NHS. I don't think that's necessary. I don't think it's desirable. I think it's a strategic mistake."

British Medical Association Deputy Chair Dr David Wrigley said the organisation would be scrutinising the Bill and seeking to influence and amend it in key areas as it moves through parliament.

He said: “Whilst in the midst of a pandemic and facing the largest backlog on record, the BMA has consistently raised concerns whether now is the right time to introduce wholesale reforms."

He added: "The BMA has serious concerns that proposals for increased powers for the Secretary of State could result in undue political influence over the running of the NHS.

"Changes to legislation in this area cannot simply be a power grab for political gain."

Dr Jennifer Dixon, chief executive of the Health Foundation charity, welcomed aims to boost integrated care but urged Mr Javid to drop the proposal to increase powers for the Secretary of State.

She said: "The part of the Bill giving the Secretary of State more power over the NHS is politically driven, has no clear rationale and risks taking health care backwards.

"To ease the Bill's passing, the new Secretary of State for Health should now drop the contentious proposals to give his role more power over the day-to-day running of the NHS.

"He should add his own stamp to the Bill by adding simple but much-needed provisions to improve workforce planning across the NHS and social care.

"This would help to ensure that staffing shortages in the NHS, which are slowing progress on the backlog, are addressed."

Pat Cullen, acting general secretary of the Royal College of Nursing, said Mr Javid "will continue to grapple with vast staff shortages by failing to grip the issue of workforce accountability in today's Bill".

She said: "Ducking the question of workforce accountability will also make it even harder for government to deliver on the pledge of 50,000 more nurses – vital for the delivery of safe care to patients."


Ministers could end up feeling new powers under the Bill are a "millstone around their necks", warned Nigel Edwards, chief executive of the Nuffield Trust health think tank.

He said the parts of the Bill on increased collaboration are "bundled up with new powers for politicians to control the detail of how the health service runs".

He added: "The evidence of the past suggests this may lead to worse decisions, and they will come to regret it.

"Politicians should have the power to tell the NHS what to do, but they are not best placed to tell it exactly how to do it.

"The new role for the Secretary of State in intervening at any stage of changes to any service is a recipe for local decisions ending up in Whitehall and Westminster.

"It risks gridlock and a lack of innovation, and ministers themselves might come to feel it as a millstone around their necks."

This article contains information from PA Media.


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