The 2021 Queen’s Speech lacks any details of the proposed ‘Health and Care Bill,’ which we might have expected to be based on the February White Paper “Integration and Innovation”.

Notes published in advance of the Speech by the House of Commons Library anticipated legislation along the lines of the White Paper, including proposals previously set out by NHS England:

  • “To establish Integrated Care Systems as statutory bodies and other measures to support integration of health and care
  • “To formally merge NHS England and NHS Improvement
  • “Changes to procurement and competition rules relating to health services,”

It also anticipated additional proposals that were included for the first time in the White Paper, to give additional powers for the Secretary of State “including powers over NHS England, Arm’s Length Bodies and health service reconfigurations, and powers to create new Trusts.”

Whether or not all or any of these will be included in the new Bill is now anyone’s guess, since the Queen’s Speech itself bears so little similarity to the expected content. On the NHS the relevant section said simply:

“My Ministers will bring forward legislation to empower the NHS to innovate and embrace technology. Patients will receive more tailored and preventative care, closer to home [Health and Care Bill]. Measures will be brought forward to support the health and wellbeing of the nation, including to tackle obesity and improve mental health.”

The accompanying Briefing Notes don’t add much, summing up the main elements of the Bill as:

  • “Driving integration of health and care through the delivery of an Integrated Care System in every part of the country.
  • “Ensuring NHS England, in a new combined form, is accountable to Government, Parliament and taxpayers while maintaining the NHS’s clinical and day-to-day operational independence.
  • “Banning junk food adverts pre-9pm watershed on TV and a total ban online.
  • “Putting the Healthcare Safety Investigation Branch on a statutory footing to deliver a fully independent national body to investigate healthcare incidents, with the right powers to investigate the most serious patient safety risks to support system learning.”

Missing completely from this bland summary is the much-vaunted proposal from NHS England, echoed in the White Paper, to scrap the controversial Section 75 of the 2012 Health and Social Care Act, and the associated regulations which effectively required Clinical Commissioning Groups to carve up an ever-increasing range of services into contracts and put them out to tender, inviting private as well as NHS providers.

When these proposals were included in a leaked version of the White paper, the story was spun by both the BBC and the Times to suggest the plans were a step to “scrap forced privatisation and competition within the NHS”.

This reading of the proposals was especially inappropriate after a year of pandemic measures had massively increased the level and proportion of health spending on private providers – with billions spent on privatised test and trace, huge sums spent on private management consultants, and billions more on the use of private hospitals to treat NHS patients, with plans to continue and increase this over the next four years at a cost of up to £10 billion.

Focusing on the tiny percentage of contracts subjected to competitive tender is also a misleading way of assessing the level of outsourcing of NHS services to private providers, since the bulk of this is now done through ‘framework contracts’ established by NHS England that list a range of pre-approved private and other providers, from which CCGs and trusts can choose without any competitive process.

And more recently NHS England itself is now promoting the idea of handing new contracts to run imaging networks in each Integrated Care System to commercial companies as one of two possible ways forward.

But if the Bill, now expected to be published next month and debated into the autumn, turns out to be as vacuous as the Speech and Briefing Notes suggest, then much of the debate over this aspect of the White Paper will turn out to have been misdirected.

However in preparation for the likelihood of the Bill being based more substantially on the White Paper, and given the Johnson government’s 80-strong majority, campaigners wanting to fight any of its damaging proposals will need to focus on issues and demands for amendments that might win broad enough popular support to split some Tory MPs and secure amendments.

Shadow Health Secretary Jonathan Ashworth MP told The Lowdown:

“We need to see what is included in the Bill. We obviously want to see genuine integrated, coordinated care for the patient, but that must be delivered by well-funded, publicly-provided, properly qualified primary care, working in partnership with community and secondary care.

“What is being proposed in the White Paper is a new confusing bureaucracy, with opaque decision making and little accountability to the public, allowing contracts to be handed out to private interests with no challenge. We’ve already seen what that means with a string of GP practices disgracefully handed to a US health insurance company. Labour will not be supporting anything that allows this or any other extension of private provision of the NHS.

“Moreover with waiting lists at record levels risking a middle class flight to the private sector the response must surely be a properly funded and staffed NHS with decent pay and conditions, not imposing financial straightjackets that can only lead to more rationing locally.

“Labour will be fighting in Parliament and the across the country for a publicly provided, fully funded comprehensive NHS.”

Demands for amendments which might draw wide support include:

  • Barring the new statutory Integrated Care Systems from including any private sector representatives on their Boards.  Instead independently appointed or elected representatives of public, patients and trade unions should have a place on every Board.
  • Requiring all ICS Boards to meet in public, offer online access, publish their minutes and Board papers and be subject to the Freedom of Information Act.
  • A clear and statutory requirement for accountability and scrutiny by local government at the most local “place” level within each ICS.
  • Maintaining the right of local authorities to refer controversial changes to the Secretary of State, and the Independent Reconfiguration Panel, which must be made more representative, not abolished.
  • Establishing NHS as the default provider when existing contracts expire. ICSs must be required to consult publicly before awarding a contract for any existing services to a private provider.
  • Requiring any ICS to publish fully without any claim to commercial confidentiality all proposals for contracts, the contracts themselves and the outcomes of regular contract monitoring.
  • No private provider should be approved for any NHS contract who does not pay staff at least the equivalent of NHS terms and conditions


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