Current priority - Health and social care reform
The Government has introduced to the House of Commons a new Health and Care Bill that proposes health reforms in England.
The Government has stated that the Bill is intended to deliver on many of the proposals called for in the NHS England’s Long Term Plan, which focuses on improving integration and collaboration over competition.
However, the BMA has significant concerns about the Bill and does not believe it is the right bill at the right time. It is wrong to implement wholesale reform while the country is still fighting the COVID-19 pandemic. The NHS is facing a significant backlog of care, meaning doctors have had little time to scrutinise the details. The Bill doesn't address the significant pressures on the NHS in terms of waiting lists, resources and staff shortages.
An overview of the Bill and our key calls is set out in the following video. Our member briefing outlines the Bill proposals and BMA’s analysis of them in further detail.
What the Bill will do
Significant reforms include:
- establishing ICSs (Integrated Care Systems) as statutory bodies. This would make their currently informal roles formal, and ensure they can be held accountable – something which the BMA has called for throughout their development.
- transferring duties for commissioning services from CCGs (Clinical Commissioning Groups) to ICSs. This means that CCGs will be absorbed into their local ICSs, with their commissioning powers and the majority of their staff becoming part of the ICS NHS Body. The BMA has called for clarity on accountability structures and how clinicians will be involved at ICS and local level.
- stopping enforced competition by the automatic tendering of NHS services, which has led to disruptive bureaucracy and fragmentation of services, by repealing Section 75 of the Health and Social Care Act 2012
- supporting the development of ICSs and integration by requiring all health bodies to cooperatively pursue the aims of:
a. better care for all patients
b. better health and wellbeing for everyone
c. sustainable use of NHS resources.
- expanding the powers of the Secretary of State for Health, including increased power to direct NHSE/I, create new NHS Trusts, intervene in local service reconfiguration and amend or abolish Arms Length Bodies (ALBs)
- a new duty for the Secretary of State to publish a report every five years on workforce planning. This would set out who is responsible for workforce supply.
What the BMA is calling for
Although there are aspects of the Bill which the BMA agrees with, such as the removal of Section 75 and enforced competition, we believe that the Bill is likely to do more harm than good.
Without amendments, the BMA cannot support the Bill:
- Workforce: Government must be accountable for ensuring adequate numbers of staff. To do this, the Bill must include a responsibility for the Secretary of State to produce ongoing, accurate and transparent workforce assessments to directly inform recruitment needs.
- Clinical leadership: A truly collaborative and integrated healthcare system must have strong clinical leadership at its heart. To this end, clinical leadership and patient representation must be embedded at every level of ICSs, including formalised roles for local medical committees, local negotiating committees and public health doctors.
- Procurement and outsourcing: The Bill would replace the current competition and procurement rules for the NHS, scrapping Section 75 and automatic competitive tendering. However, to truly protect the NHS from costly procurement and fragmentation of services, the default option for NHS contracts must be the NHS. The threat of private health providers having a formal seat on new decision-making boards, and wielding influence over commissioning decisions, must be ruled out.
- Safeguards to curb political influence over NHS policy setting: The Secretary of State’s powers must be limited in the Bill to avoid unnecessary political influence in NHS decision-making.
BMA action so far
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 briefing - Health and Care Bill, Second reading
- Member briefing - Health and Care Bill
- BMA briefing - implications of the Health and Care Bill for general practice
- Member briefing - Government health White Paper
- Member briefing - NHS England's Integrated Care Systems design framework
We have privately written joint letters to the Secretary of State on the need for ongoing, transparent workforce assessments.