The bill, which was introduced to the Commons yesterday, is regarded as the most significant piece of legislation concerning the NHS since the 2012 Health and Social Care Act and aims to promote greater collaboration and integration across different parts of the health service.
Planned provisions within the bill include establishing ICSs (integrated care systems) as statutory bodies and transferring to them the commissioning powers held by clinical commissioning groups.
The proposed legislation would also seek to end requirements around enforced competition through the automatic tendering of NHS services, as established by section 75 of the 2012 act, a move long called for by the BMA.
However, the Government has to go further if the NHS is going to be truly protected from unnecessary and costly private sector involvement, believes the BMA – and to ensure scrutiny and transparency over the awarding of contracts. The most effective way of doing that is to make the NHS the default option for NHS contracts and to tender competitively where this is not possible, says the association.
While welcoming aspects of the bill promoting integration and curbing competition, the BMA has warned that parts of the Government’s plans do not go far enough to protect patients and the NHS.
In particular, the association has voiced concern with plans contained in the bill that would, if passed, confer new and considerable powers on the secretary of state for health, such as the ability to amend or abolish existing arm’s length bodies, create new NHS trusts and to intervene in reconfigurations of the health service.
It has also expressed reservations over provisions that would give the health secretary and Department of Health more control over the collection and storage of patient data and has argued that the focus of the bill must be on increasing ministerial accountability, rather than power, in respect of the NHS.
Another proposal of the bill, which the BMA supports but believes should be further bolstered, is a requirement for the health secretary to publish a report detailing workforce planning every five years, with the association arguing that any staffing assessments must be ‘ongoing, accurate and transparent’ and for the purpose of informing recruitment needs.
Among the changes to the bill being called for by the BMA are:
- A requirement that the Government be accountable for ensuring adequate numbers of staff with regular workforce assessments to be delivered by the health secretary
- Ensuring that clinical leadership and patient representation are embedded across ICSs, including formalised roles for local medical committees, local negotiating committees and public health doctors
- The NHS to be made the default option for health service contracts
- Safeguards and limitations over the secretary of state’s powers within the bill to avoid unnecessary political influence in NHS decision-making.
Responding to the introduction of the bill, BMA council deputy chair David Wrigley said he welcomed certain elements of its contents, while stressing that there still remained many uncertain and concerning aspects of the prospective legislation that required further scrutiny.
He said: ‘The NHS since its inception has been subject to countless reorganisations, which never fully achieve what they set out to only have to go back to the drawing board. And now in 2021, the NHS finds itself in the most precarious position it has ever been in.
‘The BMA has serious concerns that proposals for increased powers for the secretary of state could result in undue political influence over the running of the NHS. Changes to legislation in this area cannot simply be a power grab for political gain.
‘The legislation also leaves open the possibility for corporate healthcare providers to gain seats on ICS boards which represents a clear conflict of interest affording them undue influence in decision-making which we believe should be left strictly to NHS and publicly accountable bodies.’
He added: ‘The BMA will now be scrutinising this bill closely as well as seeking to influence and amend the bill in these and other key areas as the bill now progresses through parliament.’