Health Bill released: moving forward with NHS reform

Among a busy week in politics, plans for health system reform took a further step forward at the end of last week with the release of the Health Bill. This piece of legislation, now in draft before parliament, is intended to give effect to some key elements of the 10-Year Health Plan. It is accompanied by explanatory notes and an impact assessment, which provide a little more detail on what is intended.

As and when the Bill will be passed is ultimately subject to the will of parliament, the time allocated to it and the impact of debate over the more controversial elements. However previous indications have been that the abolition of NHS England and transfer of its functions elsewhere (most notably to the Department of Health and Social Care) will take two years. This would see legislation passed and in force by no later than April 2027 – a reasonably tight, but not impossible, timescale for provisions of this nature.

Over the coming weeks we will publish more detailed analysis of key areas of the legislation and its impact, together with discussion of what is expected in relation to elements of reform not covered in the Bill but flagged in the 10-Year Health Plan. In the meantime, below we have summarised some of the main points covered.

Structural reform – abolition of existing bodies

Most notably, if the Bill is passed, NHS England will be abolished. The draft legislation provides for this to happen, includes provision for transfer of key functions, duties, powers and liabilities to other bodies by order of the Secretary of State and makes a wide variety of amendments to existing legislation to account for this. Transfer powers are widely drafted, such that functions may move in a variety of ways, including to Integrated Care Boards, Trusts/ Foundation Trusts, Local Health Boards and ‘any other public body’.

Other bodies to be abolished according to the draft include Integrated Care Partnerships and the Health Services Safety Investigations Body (HSSIB), with its powers merged into the CQC. Healthwatch is also set to go.

Structural changes to reduce the overall number of ICBs have already taken place through existing powers. The Bill includes provision to change some elements of how ICBs are formed – including removing the requirement for them to have members nominated by local authorities, primary care providers and provider trusts, while adding a requirement for a member nominated by mayoral authorities.

Foundation Trusts

As expected, the Bill removes the requirement for Foundation Trusts to have governors. It introduces a range of proposed powers for the Secretary of State, including the ability to appoint foundation trust chairs and non-executives, powers of intervention where FTs are judged to be failing, and a ‘last resort’ option to de-authorise them. There are also powers included to limit spending.

What is not covered in this legislation, so would need to be provided for via an alternative route, is any mention of the creation of Advanced Foundation Trusts or Integrated Health Organisations.

ICBs – Health Secretary powers of direction

The Bill includes an extensive range of measures which the Secretary of State may take to intervene where an ICB is considered to be failing to move in a required direction. These include the power to take over functions or move them to an alternative public body to exercise.

Single Patient Record

In an area which is likely to prove controversial as the Bill passes through the Parliamentary process, one section makes provision for the creation of the Single Patient Record (SPR). The Secretary of State is given powers to make regulations for the purpose of ‘making patient information readily available’ both to (i) patients themselves and (ii) ‘people involved in the provision of patients’ health care or social care’.

The explanatory notes confirm that those within the scope of (ii) include those involved in direct care, including where these are private providers, although this access will, of course, be limited to information needed to undertake their role. Another provision enables regulations to be made to ‘lift the common law duty of confidentiality’ in relation to processing of certain information in some circumstances. There is also provision for some SPR data to be used for secondary purposes such as planning and research.

As noted, this area is likely to prove ripe for debate, and we will provide more detailed analysis in relation to the elements included in the Bill and the practical implications of these.

Neighbourhood health and system working

Elements of the Bill link into plans for more focus on neighbourhood health and ongoing effective cross-system working. Notably primary care commissioning would move formally to ICBs and there is a new requirement for neighbourhood health plans to be prepared by responsible local authorities and partner ICBs with reference to assessed local needs. This requirement responds to the repeal of the previously introduced requirement for ICBs to prepare integrated care strategies, a joint forward plan and a joint capital plan. System working, including population health planning approaches may be seen to be strengthened through amendments to the duties around health inequalities (explicitly referencing the need to ensure equality of outcomes) and patient involvement.

More detail to come

As noted above, this article summarises at high level only key headline elements of the draft legislation and there is much more detail to analyse in the coming weeks. Our Health and Social Care team will continue to track the progress of the bill, so keep an eye on our website for our views on these and the impact on wider elements of the proposed reforms. And if you’d like to discuss how these proposed changes may affect your organisation, please contact our team today.