Health and Care Bill 2021: new plans explained, how NHS will be affected, and what is the social care cap?

The Health and Care Bill has proved to be controversial, with some backing it while others have called for it to be scrapped

The Health and Care Bill 2021-22 was first introduced in the House of Commons in July, but what is it, what does it propose and why is it controversial?

Here’s what you need to know.

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What is the Health and Care Bill?

The Government said the Bill builds on the NHS’s own proposals for reform and aims to make it “less bureaucratic, more accountable, and more integrated”, with lessons learnt from the Covid pandemic incorporated in the documents.

The Bill will enact policies set out in the NHS’s recommendations for legislative reform following the NHS Long Term Plan (January 2019), and the White Paper, Integration and Innovation: working together to improve health and social care for all (February 2021).

Several provisions in the Bill were originally proposed by NHS England, including establishing existing Integrated Care Systems (ICSs) on a statutory basis, and formally merging NHS England and NHS Improvement.

The establishment of ICSs are also intended to improve coordination between the NHS and local authority services.

The Bill proposes to establish 42 independently run ICSs that cover the whole of England and are made up of GP surgeries, community and mental health trusts, hospitals and other primary care services, with local authorities and other care providers.

These ICSs would be run independently by boards made up of NHS trust representatives, finance, nursing and medical directors, as well as private companies.

The Bill proposes to establish ICSs as statutory bodies, which means they would have the power to authorise legislation.

The Bill also includes proposals from the February 2021 White Paper to give the Secretary of State for Health and Social Care - Sajid Javid - both powers to direct NHS England and to decide how some other health services are organised.

However, the Bill doesn’t cover wider reforms of the social care and public health systems, although it does provide for some changes in these areas.

In relation to social care, the Bill provides for the Care Quality Commission (CQC) in order to assess how local authorities deliver their adult social care functions, and it also aims to improve data sharing.

The Bill also includes measures to streamline how people with ongoing care needs are discharged from hospitals.

Why is it controversial?

The Bill has proved to be controversial, with some backing it while others have called for it to be scrapped.

Some are concerned that the Bill will lead to the privatisation of the NHS, with Labour MP Zarah Sultana writing on Twitter: “The Conservatives have never liked the idea of the NHS, truly free from the corrosive influence of private profit.

“They want to break it up, piece-by-piece, privatising it by stealth. That’s what the Health and Care Bill is designed to do. #ScrapNHSBill.”

Unite has also called for the Bill to be scrapped, as the union has voiced its concerns regarding the Bill’s impact on services, accountability, funding, privatisation, safety,  professional standards, and terms and conditions.

MP Kim Johnson wrote on Twitter: “Supporting the @unitetheunion campaign to #ScrapNHSBill and stop further sell-offs to the private sector. Our NHS, free at the point of need, not a cash cow for profiteers.”

However, the NHS England Chief Executive, Sir Simon Stevens, said the Bill’s proposals for integrated care were “widely supported”.

The Chief Executive said: “They go with the grain of what our staff and patients can see is needed, by removing outdated and bureaucratic legal barriers to joined-up working between GPs, hospitals, and community services.”

Sir Simon added that the reforms would “undoubtedly both help tackle health inequalities and speed the recovery of care disrupted by the covid pandemic.”

What is the social care cap?

On Monday evening (22 November), MPs backed an amendment to the Health and Care Bill required to implement the Government’s proposed social care cap by 272 votes to 246.

Nineteen Conservative MPs voted against the Government.

The Bill will now head to the House of Lords, where peers are widely expected to push for changes to the Government’s blueprint for how the social care cap will work.

The cap on care costs is the maximum contribution that anyone may need to make towards their care costs over their lifetime.

For those less able to afford this contribution, a means test is in place to ensure the state helps them so that they will not have to pay the full amount.

The cap on personal care costs is a central element of the Government’s plans to change how adult social care in England is funded, with the idea that from October 2023, no one will pay more than £86,000 over their lifetime for personal care, such as washing, dressing and eating.

Once people have reached this cap, ongoing costs for personal care will be paid for by local authorities.

Money spent on living costs, including food, energy bills and accommodation would not count towards the limit.

The threshold for getting some council support to pay for costs will also be made more generous, with people with assets up to £100,000 able to qualify instead of the current limit of £23,250.

The Government also published guidance confirming that only payments people make out of their own pocket will count.

The original plan was for the cap to include both care costs paid by individuals and contributions from councils, but the amendment to its plans last week said support payments from councils would not count towards the £86,000 limit on personal care costs, which means poorer pensioners could have to pay more before the Government steps in to help.