The Health and Care Act

The Government has passed the Health and Care Act 2022 which proposes health reforms in England. We explain what it means for ICSs and commissioning in the NHS.

Location: England
Audience: All doctors
Updated: Monday 18 July 2022
NHS Structure Article Illustration

The Health and Care Act 2022 follows several years of informal changes to NHS structures and a growing consensus that the 2012 Health and Social Care Act is ill-suited to the needs of the health service.

The Act removes existing competition rules and formalises ICSs (integrated care systems) as commissioners of local NHS services. It also grants the health secretary authority over the health service.

Download the member briefing:

Summary of the Health and Care Act

Establish ICSs as statutory bodies

This makes the previously informal roles of ICSs formal, to help ensure they can be held accountable and empower them to govern NHS finances at a local level.

Specifically, the two component parts of an ICS – the ICB (integrated care board) and the ICP (integrated Care Partnership) will now have statutory status and will collectively hold the ICSs legal powers and responsibilities. ICBs will be responsible for the NHS functions of an ICS, while ICPs will oversee their wider public and population health efforts.

Transfer duties for commissioning services to ICSs

This means that CCGs will be absorbed into their local ICSs. Their commissioning powers and the majority of their staff will become part of the ICS body.

These powers will sit within the ICB, which will manage NHS commissioning and funding within ICSs.

Stop automatic tendering of NHS services

This will stop enforced competition, which has led to disruptive bureaucracy and fragmentation of services. It will repeal Section 75 of the Health and Social Care Act 2012 and replace it with a new system – the Provider Selection Regime – which will give NHS bodies a wider range of options when commissioning services.

Support integration

The Act aims to support the development of ICSs and integration by requiring all health bodies to abide by a triple aim, to cooperatively pursue:

  • better care for all patients
  • better health and wellbeing for everyone
  • sustainable use of NHS resources.

Expand the powers of the secretary of state for health

They will have increased power to direct the NHS, create new NHS trusts, intervene in local service reconfiguration and amend or abolish arm's length bodies.

Give the secretary of state workforce reporting duty

There will be a new duty for the secretary of state to publish a report at least once every five years on workforce planning. This would describe the system in place to for assessing and meeting workforce needs.

Introduces a cap on the cost of social care

The Act will introduce a new £86,000 cap on the amount anyone in England will need to spend on their personal care over their lifetime. Only personal contributions to the cost of care will count towards the cap. Means-tested payments made by the local authority will not be counted. 


BMA analysis

Although the BMA has called for some of the measures in the Act, such as the removal of Section 75 and enforced competition, we were opposed to the legislation, arguing it was the wrong Bill at the wrong time. We called for critical amendments to address the key issues in the Bill.

These included:

  • Increasing Government accountability for ensuring the health and care system has adequate numbers of staff to meet patient need, now and into the future, by requiring the Secretary of State to produce ongoing, accurate and transparent workforce assessments to directly inform recruitment needs.
  • Placing clinical leadership at the heart of the new Health and Care System by embedding clinical leadership and patient representation at every level of ICSs, including formalised roles for local medical committees, local negotiating committees and public health doctors.
  • Establishing the NHS established as the default option for providing NHS contracts to truly protect the NHS from costly procurement and fragmentation of services.
  • Ruling out private providers wielding influence over commissioning decisions by sitting as members of NHS decision-making bodies
  • Ensuring safeguards and limitations over the Secretary of State’s powers within the Bill to avoid unnecessary political influence in NHS decision-making

Our lobbying

Our lobbying and member-supported campaigns helped result in the Government bringing concessions to address some of our key concerns; as well as putting a spotlight on key issues, like unsafe staffing, throughout the parliamentary debates.

Concessions included greater protections over private providers influencing commissioning decisions via membership of NHS decision-making bodies and safeguards over undue political interference in decisions over local health and care services.

However, the Government ultimately failed to act on the concerns of frontline staff to address the main problems facing the NHS and our members: too few resources, a crisis in social care and, crucially, a huge shortfall of staff.

As the Act begins to be implemented, we will continue to campaign for a publicly funded, publicly provided and publicly accountable NHS that gets the investment it needs, is properly staffed and protects the health and wellbeing of its workers so they are able to provide the high quality and timely care that patients deserve.


BMA briefings, submissions and blogs

The BMA has been actively lobbying policy makers through direct meetings, consultation responses, parliamentary briefings and media work to take action to ensure the Bill addresses our key calls.

BMA press releases
BMA activism pack

Download our activism pack to get:

  • infographics to share on social media
  • a poster to spread the word
  • slides outlining what the Bill means and the BMA's position
  • a template letter to newspapers.

> Download activism pack

Watch webinar

In November 2021 we held a webinar on the Bill and what it means for you.

Sign in now, if you are not already, to reveal the link below.