Health and Care Bill update
The Health and Care Bill is now making its way through Parliament. We are at the stage in the Commons where the real meat of scrutiny – committee stage. At a Public Bill Committee, MPs go through the Bill line by line, with the Minister present. Opposition MPs, and the Government, can suggest amendments. This happens more often than you would think – the detailed testing of the Bill’s contents at this stage will often lead the Government to make changes.
PBCs usually begin their work by taking oral evidence from a range of sources. We were very pleased to be invited to give evidence on 6 September, and used the opportunity to highlight with MPs the importance of health scrutiny. We were also able to raise our concerns about the removal of the power of referral to the Secretary of State where the health service proposes a substantial variation to local health services, and our worries about the logistics of setting up joint arrangements for scrutinising ICBs (integrated care boards) and ICPs (integrated care partnerships).
We’re co-ordinating with a range of other organisations to highlight these concerns with scrutiny, and have jointly put forward amendments which would tackle some of these issues. We’re currently working with the NHS Confederation, NHS Providers and the LGA to try to take this forward.
We are also engaging in further conversation about these issues with the DHSC Bill team. I should say that the Bill team have been excellent in engaging with us and others in the sector on our concerns and suggestions. In accountability terms, a big part of the Bill is the significant additional powers it gives to the Secretary of State to intervene in, and direct, the delivery of local health services. We think that these powers should be supported by strong local accountability, and the Bill team understand and accept that additional work needs to be done to flesh out what the relationship between the Secretary of State’s powers, and the ongoing role of health scrutiny, will be.
Originally the plan was that these issues would be dealt with in full in statutory guidance. In our view that won’t cut it. Scrutiny’s powers currently sit largely in a set of Regulations which will need to be amended in consequence of the Bill anyway, and we think that new arrangements for scrutiny’s role in reconfigurations, and on joint scrutiny of ICB/Ps, should be incorporated in these Regulations too. We think that this should be accompanied by a requirement, in primary legislation, for the Secretary of State to “consult” with local health scrutiny committees where he proposes to use his powers to intervene in respect of certain reconfigurations.
We’ve circulated a briefing to Parliamentarians on these points and we hope to see meaningful debate on the subject when MPs come to consider s38, and Schedule 6, of the Bill (currently expected to happen tomorrow, 21 September 2021). Even if changes are not made in Committee itself, we’re keen to see Government sponsored changes when the Bill comes back to the Commons chamber for its third reading – we’re also keen to see a Government commitment to the production of new Regulations on these subjects, rather than just statutory guidance.
I wanted to take this opportunity to thank those of you who have sent me your views on this so far; I have been able to feed these up to the Bill team and they have made our arguments on these matters stronger and more comprehensive. I’d encourage you to continue to send through your thoughts – and to discuss these issues yourselves, in committee or more informally.