A more integrated and accountable NHS is crucial to tackle health inequalities
The Health and Care Bill is arguably the most significant piece of healthcare legislation in almost a decade. And perhaps uniquely, it is overwhelmingly made up of measures the NHS itself asked for.
The NHS published recommendations in 2019 which the former NHS Chief Executive and new Peer, Lord Simon Stevens, said make up about 85 per cent of the current Bill. Although its second in reading in Parliament took place recently on the 14th of July, the Bill itself has in fact been in the works since before the pandemic, and reflects extensive and broad collaboration and consultation with a huge range of stakeholders in recent months.
Covid-19 has reinforced the case for change, and has made the need to adapt the legal framework underpinning our NHS much more urgent, so the NHS and local government can continue providing excellent care and support for the people who need it in the years ahead. This reflects an evolution of our healthcare system to meet the needs of our population today, and in the future.
As we recover and tackle the backlogs of operations which have built up, the Bill will help usher in a less bureaucratic, more integrated and more accountable healthcare service, and now is exactly the right time to make these important changes.
The Bill will include new powers to improve democratic oversight of the NHS
Key to this more integrated NHS are the new Integrated Care Systems (ICSs) which now cover every area in England.
The Bill will allow for the establishment of Integrated Care Boards (ICBs) and Integrated Care Partnerships (ICPs) in law across England, to replace the current Clinical Commissioning Groups (CCGs). These two structures will provide the legal underpinning for the 42 ICSs which have been rolled out across the country since April.
Widely backed by the NHS, ICS’s will bring together the NHS, local government and potentially other organisations including the voluntary, community and social enterprise sectors to improve the health of their local population, prevent illness and tackle long term conditions and health inequalities.
We have listened to the health and care sector who have told us the new legislative framework must not be overly complex. So we’re respecting this, and giving local healthcare leaders the flexibility they need to innovate, creating a permissive rather than prescriptive approach.
Rob Webster, the Chief Executive of the West Yorkshire and Harrogate Health and Care Partnership – which is already working as a successful ICS – has welcomed what he calls, “the permissive nature of the legislation which allows for systems like ours to build on the progress we have made, and to drive delivery through partnerships in places and provider collaboratives”.
Addressing health inequalities is central to our levelling up agenda, and integrated care systems across the country are already making a difference to this. The pandemic has highlighted and exacerbated health inequalities across the world and I’m determined to do everything I can to ensure we tackle them.
Take homelessness for example. People living without fixed accommodation die 30 years earlier, on average, than the general population.
The Doncaster Complex Lives Alliance, an integrated health care partnership, have used monthly pop-up hubs to provide support for people affected by homelessness with an opportunity to reconnect with a range of health services. This means they can benefit from support and advice on their mental and physical health, as well as finance and housing, all in one place.
We can all agree integrating care is important for both patients and staff, and another important aspect of the Bill is accountability.
The Secretary of State for Health and Social Care is rightly responsible to Parliament for the NHS, which accounts for over £136 billion of public spending annually, excluding Covid-19 funding.
Many taxpayers, and voters, will be shocked to know there are currently limited legal routes of accountability between central NHS organisations, and the Health and Social Care Secretary.
For instance, if a local hospital is closing, the Secretary of State will only have a role in these local reconfigurations if they are referred to him by the local authority.
The Bill will therefore include new powers to improve democratic oversight of the NHS.
At a national level, it will also allow the Secretary of State to give directions to NHS England, if required, to ensure it is working effectively with other parts of the system including social care and public health, to support integration and progress broader priorities such as tackling health inequalities. To ensure full transparency, these directions have to be made in the public interest, in writing, and be published.
Accountability, flexibility and integration – three vital ways this Bill will improve our health service.
When Parliament returns from summer recess, this legislation will continue progressing through the House of Commons and I welcome informed debate on these issues in Committee.
We are determined to get this right and deliver reforms which reflect the health services’ own legislative proposals to ensure our NHS continues to be there for all of us and our loved ones in the years to come.
Edward Argar is the Conservative MP for Charnwood and the Minister for Health.
Get the inside track on what MPs and Peers are talking about. Sign up to The House's morning email for the latest insight and reaction from Parliamentarians, policy-makers and organisations.