By Guy Collis – UNISON Policy Officer
The government’s Health Bill resumes its Parliamentary journey in the House of Lords on 13 October.
As the first major piece of NHS-related legislation since the Health and Care Act in 2022, the new Bill is bound to face close scrutiny from peers. It will abolish NHS England, establish the Single Patient Record and introduce other controversial measures, including the abolition of the patients’ watchdog Healthwatch.
Each of these proposals attracted considerable attention during the Commons stages of the Bill. But potentially the most significant, and worrying, aspect of the legislation has so far received little attention.
Since former Conservative minister Andrew Lansley’s disastrous Health and Social Care Act in 2012, the NHS has been moving towards greater system working, in which the key players within the local NHS are encouraged to prioritise collaboration and service integration. It has meant moving away from market-focused reforms that fragmented service delivery, destabilised the workforce and cost billions.
Unfortunately, in seeking to implement key aspects of the NHS 10 Year Plan, the current Bill threatens to reverse this progress and return to a time of greater contestability, with Integrated Care Boards (ICBs) becoming “strategic commissioners”.
Most notably, Clause 22 of the Bill removes the requirement for ICBs to have at least one board member from a local NHS trust or foundation trust, reinforcing the split between those commissioning care and those providing it.
The government claims that strengthening this purchaser-provider split is necessary to enable ICBs to make commissioning decisions “in a forum that avoids conflicts of interest”.
But moving back to a more confrontational approach will not help the NHS tackle its most pressing challenges. As the Health Foundation has highlighted, “the big challenges facing health require a coordinated response” and the Bill “risks undermining the collaboration needed to address the challenges facing the health and care system”.
The government has presented no evidence that reinforcing the purchaser-provider split will deliver improvements – for the simple reason that none exists. The Health Committee attacked “20 years of costly failure” as far back as 2010.
As the Nuffield Trust told the same Committee earlier this year,
where you really shift resources or bring people together to transform a care pathway, it is not because of a strong commissioner gripping something and demanding something of providers… Where it works is where you have all parties together around a table with a shared endeavour, making decisions to do something different.
Elsewhere, the Bill sets out plans for new regulations to enforce patient choice, with Clause 16 giving the Secretary of State new powers to investigate ICBs that fail to comply with choice requirements.
Clause 10 is another oddity. It would allow the Secretary of State to vary the proportion of public and private provision of health services if they consider “that to do so is in the interests of the health service”. This would amend a section of the 2012 Act originally intended to address concerns about privatisation arising from Lansley’s NHS reforms.
MPs asked questions about this section of the Bill at both Second Reading and Report Stage in the Commons, but the government didn’t offer a response on either occasion. Concerns persist that such a clause could be abused by a future right-wing government intent on creating a much larger role for private healthcare delivery.
Taken together, these measures appear to run directly contrary to Prime Minister Andy Burnham’s analysis of the damage inflicted on public services by market pressures, and his stated desire to bring more essential services back into public control.
There is no need for the new Burnham-led administration to feel honour-bound to drive this Bill through Parliament in its current form. It originated under former health secretary Wes Streeting and most of its measures were absent from Labour’s 2024 election manifesto.
Instead, it bears many of the hallmarks of former secretary of state Alan Milburn, who returned to the Department of Health and Social Care in a non-executive role in 2024 and has spoken of healthcare in England needing to become “an ecosystem of very different providers”
New health secretary Yvette Cooper has already shown a willingness to move away from aspects of the Streeting-Milburn dogma by amending the Bill to restore a role for local authorities on ICBs.
Surely now is the time for the current health secretary to make a clearer break from previous NHS policy and ensure that the prime minister’s ambition for greater public control is not derailed when it comes to the country’s most popular public service.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
By Guy Collis – UNISON Policy Officer
The government’s Health Bill resumes its Parliamentary journey in the House of Lords on 13 October.
As the first major piece of NHS-related legislation since the Health and Care Act in 2022, the new Bill is bound to face close scrutiny from peers. It will abolish NHS England, establish the Single Patient Record and introduce other controversial measures, including the abolition of the patients’ watchdog Healthwatch.
Each of these proposals attracted considerable attention during the Commons stages of the Bill. But potentially the most significant, and worrying, aspect of the legislation has so far received little attention.
Since former Conservative minister Andrew Lansley’s disastrous Health and Social Care Act in 2012, the NHS has been moving towards greater system working, in which the key players within the local NHS are encouraged to prioritise collaboration and service integration. It has meant moving away from market-focused reforms that fragmented service delivery, destabilised the workforce and cost billions.
Unfortunately, in seeking to implement key aspects of the NHS 10 Year Plan, the current Bill threatens to reverse this progress and return to a time of greater contestability, with Integrated Care Boards (ICBs) becoming “strategic commissioners”.
Most notably, Clause 22 of the Bill removes the requirement for ICBs to have at least one board member from a local NHS trust or foundation trust, reinforcing the split between those commissioning care and those providing it.
The government claims that strengthening this purchaser-provider split is necessary to enable ICBs to make commissioning decisions “in a forum that avoids conflicts of interest”.
But moving back to a more confrontational approach will not help the NHS tackle its most pressing challenges. As the Health Foundation has highlighted, “the big challenges facing health require a coordinated response” and the Bill “risks undermining the collaboration needed to address the challenges facing the health and care system”.
The government has presented no evidence that reinforcing the purchaser-provider split will deliver improvements – for the simple reason that none exists. The Health Committee attacked “20 years of costly failure” as far back as 2010.
As the Nuffield Trust told the same Committee earlier this year,
Elsewhere, the Bill sets out plans for new regulations to enforce patient choice, with Clause 16 giving the Secretary of State new powers to investigate ICBs that fail to comply with choice requirements.
Clause 10 is another oddity. It would allow the Secretary of State to vary the proportion of public and private provision of health services if they consider “that to do so is in the interests of the health service”. This would amend a section of the 2012 Act originally intended to address concerns about privatisation arising from Lansley’s NHS reforms.
MPs asked questions about this section of the Bill at both Second Reading and Report Stage in the Commons, but the government didn’t offer a response on either occasion. Concerns persist that such a clause could be abused by a future right-wing government intent on creating a much larger role for private healthcare delivery.
Taken together, these measures appear to run directly contrary to Prime Minister Andy Burnham’s analysis of the damage inflicted on public services by market pressures, and his stated desire to bring more essential services back into public control.
There is no need for the new Burnham-led administration to feel honour-bound to drive this Bill through Parliament in its current form. It originated under former health secretary Wes Streeting and most of its measures were absent from Labour’s 2024 election manifesto.
Instead, it bears many of the hallmarks of former secretary of state Alan Milburn, who returned to the Department of Health and Social Care in a non-executive role in 2024 and has spoken of healthcare in England needing to become “an ecosystem of very different providers”
New health secretary Yvette Cooper has already shown a willingness to move away from aspects of the Streeting-Milburn dogma by amending the Bill to restore a role for local authorities on ICBs.
Surely now is the time for the current health secretary to make a clearer break from previous NHS policy and ensure that the prime minister’s ambition for greater public control is not derailed when it comes to the country’s most popular public service.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
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