The Health and Care Bill: Update
The Health and Care Bill has now been considered by both Houses of Parliament and the final stage is for the Commons to consider later this month the amendments which have been made in the Lords.
Q. What is the main aim of the Bill?
A. To integrate NHS healthcare and local government services in England.
The separation of the two has created real difficulties for patients and staff for decades. Under the Bill, England will be brought into line with the devolved UK governments which already have integrated services. Clinical Commissioning Groups, with which the life sciences industry is familiar, will be abolished and replaced by 42 new Integrated Care Boards (ICBs). These will be responsible for health and social care matters but will be NHS bodies and answerable to the Health Secretary.
The principle of integrated care has widespread support and will be implemented slightly later than expected in July 2022, rather than April (Source: NHS England, December 2021).
In February 2022, the government published a white paper giving broad guidance which included workforce integration, pooled budgets and digital capabilities (Health and social care integration: joining up care for people, places and populations).
Q. Are there any other areas relevant to the life-sciences industry?
A. Yes – in the following clauses:
- The Health Secretary will be able to commission certain specialised services and to disregard the financial implications for ICBs. They will be able to effectively overrule the National Institute for Health and Care Excellence (NICE) and NHS England. The Explanatory Notes to the Bill anticipate that this power will be used for patients with rare cancers, genetic disorders and complex medical or surgical conditions.
- The Health Secretary can set objectives for the NHS on cancer treatment as defined by outcomes (such as one-year or five-year survival rates) and would give these objectives priority over other objectives relating to cancer treatment.
- The Health Secretary will be required to publish and lay before Parliament, before the start of each financial year, a document setting out the government’s expectation on mental health spending for the year ahead.
- NHS Digital will be able to amass more information about the use of medicines and medical devices and their effect on patient safety. The Medicines and Healthcare products Regulatory Agency (MHRA) can use this information to establish and maintain comprehensive and centrally-held UK-wide medicines and medical device registries (where the MHRA’s independent advisory body so recommends) to improve market surveillance on the use of medicines and medical devices.
During a discussion on the pharmaceutical sector, the Minister acknowledged that “NICE’s consultation stated that there is an evidence-based case for changing the discount rate to 1.5%”, as MAP and many organisations have proposed, but regrettably he simply reiterated the view that further data needed to be collected on the likely effects of such a change (1 March 2022).
Q. What happened in the Lords?
A. The government was defeated on a number of issues, the three most important being:
- A clause introduced suddenly in the House of Commons at a very late stage, which capped the amount that anyone would be forced to spend on personal care costs in their lifetime to £86,000, was rejected. The points made were that the clause was not properly debated in the Commons, that those living in low valued properties would be penalised and that some kind of sliding scale might be needed.
- A proposed new power to require any NHS body to notify the Health Secretary of any reconfiguration of NHS services (or measures likely to result in reconfiguration) was also rejected. The point at issue was that any service change, large or small, would come before the Health Secretary and impose an administrative logjam, to the disadvantage of clinicians and patients.
- An amendment was carried, despite ministerial opposition, requiring the Health Secretary to lay a report before Parliament, at least once every two years, describing the system in place for assessing and meeting the workforce needs of the health, social care and public health services in England. The report must include an independently verified assessment of health, social care and public health workforce numbers, and the projected workforce supply for future years.
Q. What will happen next?
A. The Commons will decide in each case whether to accept, amend or reject the changes.
Much will depend on the attitudes of Conservative MPs and whether, given the crisis in the Ukraine, they will be more inclined to support the government.
There was a serious revolt against the cap on personal care costs in the Commons and similarly there has been support for the other two changes above made by the Lords, so some compromises may be made.
However, if the changes are rejected by the Commons, the Lords can stand firm and send the Bill in its amended form back to the Commons a second time. In Parliamentary terms, this is known as ping-pong.
However, by tradition, the Lords give way in the end to the elected Chamber on the grounds that the latter is the senior body and has being given chances to accept changes but has rejected them.
Q. Anything else of interest in the Bill?
A. Some further points are worth noting:
- The previous Health Secretary criticised the right of NHS England (NHSE) to be semi-independent, as set out in current legislation. Given that the NHS is funded almost entirely by central government and that ministers are answerable to Parliament for it, this arrangement was seen as anomalous. The Bill therefore gives the Health Secretary power to give directions to NHSE in relation to its functions.
- Compulsory competition in the NHS for hospital and community services will be abolished.
- The Health Secretary will appoint the Chief Executive Officers of ICBs.
- The government accepted that private commercial organisations should not be members of ICBs. An amendment was carried to bar them from any ICB sub-committee.
- Another amendment, again carried against the government, requires at least one ICB member to have expertise and knowledge of mental health.
MAP will continue to analyse the Bill and its implementation and is ready to advise clients on any areas of concern.