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The Health and Care Bill: legislation struggling to catch up with reality

3 min read

The Health and Care Bill currently being debated in the Lords is a case of legislation struggling to catch up with a changed reality.

The Lords is debating dozens of amendments which raise the profile of mental health, give greater priority to tackling inequalities, confront the importance of tackling climate change, and recognise the central role of communities, place-based initiatives, arts activities, housing and planning in creating health. The amendments have come from all parties and the crossbenches.

Our health as individuals is intimately connected with the extent to which our communities flourish

This is all a very long way away from the 20th century model, where health was primarily seen as being about physical health and acute care, was NHS and profession-led, and was fundamentally about illness rather than health. This old-fashioned industrial age model is being rapidly replaced out there in the country by a model that recognises the full bio-psycho-social-environmental nature of health, is concerned with relationships and networks more than with systems and structures, and understands that all sectors of society – employers, schools, businesses, architects as well as families, voluntary organisations and communities – have a role to play and a responsibility to do so.

The Lords amendments taken together amount to a vision where our health as individuals is intimately connected with the extent to which our communities flourish, the inclusiveness of our society and the health of our planet. This is very much aligned with the vision for a “well-being society” advocated in the recently published ‘Geneva Charter for Well-being’.

These amendments reflect the profound changes underway across the country, which are being led by far-sighted and inspirational people. London has the long-established Bromley by Bow Centre which hosts numerous community activities, social enterprises and new businesses as well as a health centre; the City Mental Health Alliance which brings together international business seeking to create healthier practices and environments for their employees; and hundreds of other smaller scale schemes.

Similarly, the North has many health creators who through their energy and entrepreneurial activity have created activities such as Incredible Edible, started in Todmorden, West Yorkshire, which brings communities together around gardening and food and now has 150 groups country-wide; Greater Manchester’s Salford Dadz where unemployed men are improving their community; and The Sewing Rooms in Skelmersdale, Lancashire which brings together isolated women in a community business.

In the South there are programmes as varied as Growing Health Together in Horley, Surrey, created by pioneering GPs reaching out to local organisations; the TR14ers in Camborne in Cornwall, created by a police sergeant fed up with chasing young people for minor crimes and working with them to create a long-running dance club; and the many community activities based around Stroud in Gloucestershire.

MPs and peers can undoubtedly point to thousands more across the whole UK. I have described some in Health is made at Home, Hospitals are for Repairs – a title I borrowed with permission from Professor Francis Omaswa, the former head of the Ugandan health service.

I very much hope the government will listen to the many passionate and knowledgeable people in the Lords who are urging radical change to the bill and accept many of these amendments, perhaps even adding some of its own in order to accelerate the changes that are underway. There are forward-looking aspects to the bill, including, most obviously, the new Integrated Care Boards, but the overall framing of the legislation is still too narrowly institutional and dirigiste.

Even more importantly, the government needs to take decisive action to promote primary care, thriving communities and an inclusive society while creating a prospering and sustainable economy and environment.


Lord Crisp is a crossbench peer and former chief executive of NHS England. 

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Read the most recent article written by Lord Crisp - Radical long-term NHS reform is needed to fix the health and social care crisis