King’s Speech 2023: Health and social care

1. Government policy priorities

At the Conservative Party conference in October 2023, Prime Minister Rishi Sunak and Health Secretary Steve Barclay set out several health-related policy priorities which are expected to inform government policy in the months ahead.

1.1 Next steps on the NHS workforce plan

During his conference speech, Mr Sunak said his party’s “commitment to the principle of an NHS free at the point of use is immovable”.^[1] He added that as part of this commitment his government intended to “give the NHS the staff it needs” through the ‘NHS long-term workforce plan’, launched on 30 June 2023.^[2] The prime minister said the plan would double the number of students training to be doctors and nurses and was also a “reform plan for the NHS with new ways of training, new roles and new ways of working, all driving up productivity”.^[3]

The Labour Party had previously said it was “relieved” the government had introduced a workforce plan.^[4] During a statement on the plan in the House of Commons, the opposition alleged the government had essentially adopted an earlier Labour plan to train more doctors and nurses. However, it argued that a “serious strategy” on staff retention and a “proper plan” to end industrial action in the NHS were missing from the proposals.^[5]

The cited workforce plan included an undertaking to reform the system of regulation for healthcare professionals, intended to make it “faster, fairer, more flexible and less adversarial”.^[6] The plan proposed the following roadmap for these changes:

This modernised regulatory framework will be introduced first for anaesthesia associates and physician associates, who will be brought into regulation under the General Medical Council (GMC) by the end of 2024, before the reformed legislation is rolled out to doctors, and to the professions regulated by the Nursing and Midwifery Council and the Health and Care Professions Council over the following two years.

The Department of Health and Social Care ran a consultation on regulating healthcare professionals in 2021, and in its response said it would pursue reforms affecting nine regulatory bodies.^[7] In February 2023, the department consulted on a draft order that would enable the General Medical Council (GMC) to regulate anaesthesia associates and physician associates in the UK.^[8] The government is currently analysing feedback to this consultation before it introduces secondary legislation to effect the changes.

1.2 Creating a smoke-free generation

Mr Sunak also argued in his conference speech that his government “must tackle the single biggest entirely preventable cause of ill-health, disability, and death, and that is smoking”.^[9] He added:

In our country, smoking causes one in four cancer deaths. It kills 64,000 people a year and leads to almost one hospital admission every minute. It significantly increases the risk of strokes, heart disease, dementia, and stillbirth.

Mr Sunak proposed that his administration raise the smoking age “by one year, every year”. He observed this would mean a “14-year-old today will never legally be sold a cigarette, and that they—and their generation—can grow up smoke-free”. In making his case, Mr Sunak argued that measures to restrict consumer choice were not easy, but that his party should take an opportunity to cut cancer deaths by a quarter, ease pressure on the NHS and protect children’s health. Mr Sunak later said that there was “no safe level of smoking”, and that if Parliament agreed to approve the policy, with Conservative MPs expected to have a free vote, it would amount to the “biggest public health intervention in a generation”.^[10]

In a policy paper published on 4 October 2023, timed to coincide with Mr Sunak’s speech, the government confirmed that it intended to bring forward legislation to make it an offence for children born on or after 1 January 2009 to be sold tobacco products. The legislation would also make it an offence for anyone at or over the legal age to purchase tobacco products on behalf of someone born on or after 1 January 2009, referred to as ‘proxy purchasing’.^[11]

Reacting to the announcement, Sir Chris Whitty, the chief medical officer for England, said the “overwhelming majority of the medical profession, the nursing profession and all the health charities support this”. The NHS Confederation also praised the plan, although it warned that obesity was “fast overtaking smoking as the number one cause of preventable death in England”.^[12] Meanwhile, the Labour Party said it would “not play politics with public health” and indicated that it would support the measure in any parliamentary vote.

However, the Institute of Economic Affairs criticised the plan on the grounds it would discriminate against certain adults on the basis of age and could lead to a black market in cigarettes and missed tax revenues.^[13] In addition, Forest, a group that describes itself as representing adults who choose to smoke tobacco and non-smoking adults who are tolerant of smoking, accused Mr Sunak of taking a “wrecking ball to the principles of choice and personal responsibility”.^[14]

The New Zealand Parliament passed legislation in December 2022 implementing a similar annually rising legal smoking age policy, with restrictions due to come into effect from 1 January 2027.^[15] This follows a decade of measures aimed at reducing smoking rates, including increasing tobacco excise duty by inflation plus 10% each year, standardised packaging for tobacco products and stop smoking campaigns.^[16]

Alongside his proposal on limiting the sale of tobacco, Mr Sunak said his government would also bring forward measures to restrict the availability of vapes for children. Noting that one in five children had used vapes, he said these future measures would consider flavours, packaging and displays.^[17] The Department of Health and Social Care duly launched a consultation on 12 October 2023, in which it sought views on proposals to restrict child-friendly vape flavours and bright coloured packaging alongside views on the government’s plans to restrict the sale of tobacco for those born on or after 1 January 2009. The consultation follows an earlier call for evidence on youth vaping.^[18] It will close on 6 December 2023.^[19]

A government consultation on mandating quit-themed information messages and advice inside tobacco packets closed a week after Mr Sunak’s speech.^[20] The consultation, which was launched in August 2023, sought views on the introduction and design of tobacco so-called ‘pack inserts’. These are already in use in countries such as Canada and Israel, and Australia recently announced plans to introduce them. The government’s consultation document explained that current tobacco packaging regulations would need to be amended to allow for pack inserts in the UK.

1.3 NHS constitution update

During his conference speech, Mr Sunak also commented on biological sex in hospital settings. He said that patients “should know when hospitals are talking about men or women”.^[21] Health Secretary Steve Barclay had earlier announced that the government would change the NHS constitution following a consultation “later this year”. He said the aim of the change would be to “make sure we respect the privacy, dignity and safety of all patients, recognise the importance of different biological needs and protect the rights of women”.^[22]

On 3 October 2023, the same day as Mr Barclay’s speech, the Department of Health and Social Care published a press release confirming it would “consult on proposed updates to the NHS constitution to ensure the privacy, dignity and safety of all patients is respected”.^[23] It said the proposals would be brought forward later in 2023, ahead of the next routine update to the NHS constitution and its handbook in summer 2024. It said the government would “closely consider the latest advice from the Equality and Human Rights Commission on delicate issues of balancing the rights of different protected characteristics of patients in certain settings” as part of the exercise.

Reacting to the announcement, NHS Providers, the membership organisation for the NHS hospital, mental health, community and ambulance services, said that any proposed changes to the NHS constitution “should have improving inclusivity at the heart of what they do and be subject to wide conversations and consultation”.^[24] The trade union Unison was more critical. It said the government should be focused on tackling growing waiting lists, lengthening ambulance delays, worsening industrial relations and a “hopelessly adrift” social care system, rather than “trying to bar trans women from female-only wards”.^[25]

1.4 Investment in innovative technology

During his conference speech, Steve Barclay also announced a “new £30mn fund to speed up the adoption of tech in the NHS”.^[26] He said the fund would enable clinicians to adopt technology that could improve patient care, including tools to detect cancer sooner, help people receive treatment in their own home or increase productivity to help reduce waiting lists.

The Department of Health and Social Care later confirmed that integrated care systems in local areas could bid for funding to invest in medical technology. It said the new fund built on the February 2023 ‘Medical technology strategy’ and an earlier £21mn artificial intelligence diagnostics fund, which aimed to accelerate the adoption of promising AI imaging and decision support tools.^[27]

2. Reforming mental health legislation

In January 2021, the Department of Health and Social Care published a white paper on reforming the Mental Health Act 1983.^[28] The document set out the government’s proposals to reform mental health legislation following an independent review on the act published in late 2018.^[29] The white paper represented the government’s response to the independent review report, as well as setting out how the government intended to reform mental health policy and practice to improve patient experience.

A press release accompanying the white paper said the proposed changes would “deliver parity between mental and physical health services and put patients’ views at the centre of their care”.^[30] The measures would also seek to:

[…] tackle mental health inequalities including disproportionate detention of people from black, Asian and minority ethnic (BAME) communities, the use of the act to detain people with learning disabilities and autism and improve care for patients within the criminal justice system.

The government sought views on the implementation and impact of the proposed reforms during a consultation that ran until 21 April 2021.^[31] The government responded to the consultation in July 2021.^[32] It said that it “committed to legislate so that patients suffering from mental health conditions […] have greater control over their treatment and receive the dignity and respect they deserve”. The government added that it would bring forward a draft Mental Health Bill “when parliamentary time allow[ed]”.

On 27 June 2022, the government published a draft Mental Health Bill for pre-legislative scrutiny together with explanatory notes, an impact assessment and a delegated powers memorandum.^[33]

A joint committee of both Houses was established on 19 July 2022 to scrutinise the draft bill and published its final report on 19 January 2023.^[34] The committee, which was chaired by Baroness Buscombe (Conservative), urged the government to publish a “comprehensive implementation and workforce plan alongside the bill with clear actions and milestones”. It said there should be a statutory duty to report annually to Parliament on the progress against these milestones, including the number of detentions, lengths of stay and progress on reducing racial and ethnic inequalities. The committee also said that:^[35]

• a new statutory mental health commissioner post should be created
• the principles underpinning the 2018 review and respect for racial equality should be included in a future Mental Health Bill
• health organisations should appoint a responsible person to collect and monitor data on detentions under the Mental Health Act, broken down by ethnicity, with annual figures published by government, and to implement policies to reduce inequalities
• community treatment orders, which the committee said were used disproportionately for black and ethnic minority patients, should be abolished for the majority of patients, except those involved in criminal proceedings or under sentence where their continued use should be reviewed
• integrated care boards’ and local authorities’ duties should be strengthened to ensure an adequate supply of community services for people with learning disabilities and autistic people to avoid long-term detention
• patients detained or previously detained under the Mental Health Act should have a statutory right to request that an advance choice document, which allows a patient to state and record a range of preferences when they are well which they would like to be considered if they become ill, is drawn up

The government has yet to respond formally to the report.

However, in April 2022 the Department of Health and Social Care published a 12-week call for evidence for a new 10-year plan to improve mental health.^[36] The consultation ran until 7 July 2022 and the government published the results on 17 May 2023.^[37] The department said that when the call for evidence was first published, it intended that responses would inform both a mental health and wellbeing plan and a separate suicide prevention strategy. However, this had changed:

While we will publish a new suicide prevention strategy for England, the decision has since been taken to incorporate tackling mental ill health into a major conditions strategy, as announced on 24 January [2023]. This will ensure that mental ill health is considered alongside other physical health conditions and that the interactions between them are reflected in any resulting commitments. All responses received via the mental health and wellbeing call for evidence are being considered to inform the development of these two strategies.

As the response noted, the government had first set out this plan in January 2023.^[38] In August 2023 the government published an interim report setting out the case for change and a strategic framework for the final strategy.^[39] The following month it confirmed that the new major conditions strategy would be published in early 2024.^[40]

The ‘NHS long-term workforce plan’ published in June 2023 also included an ambition to increase the number of NHS staff working in mental health, including mental health nursing.^[41]

In August 2023, the Times newspaper reported that a new Mental Health Bill may not be included in the King’s Speech. Professor Sir Simon Wessely, who chaired the 2018 independent review on existing mental health legislation, was quoted as saying:

I would be very disappointed as we’re so close to the finishing line if [the bill] was delayed again […] My view is it is the kind of thing that governments should do. It is the right thing to do, and it needs to be done. Lots of people have put a lot of work into this. It’s not controversial. Nobody seems to disagree with what we’re trying to do.^[42]

However, the government later said it “remains committed to reforming mental health legislation in England and will introduce a Mental Health Bill when parliamentary time allows”.^[43]

3. Banning conversion therapy

A group of bodies, including NHS England and several professional medical associations, has described conversion therapy as:

[…] an umbrella term for a therapeutic approach, or any model or individual viewpoint that demonstrates an assumption that any sexual orientation or gender identity is inherently preferable to any other, and which attempts to bring about a change of sexual orientation or gender identity, or seeks to suppress an individual’s expression of sexual orientation or gender identity on that basis.^[44]

In the May 2021 Queen’s Speech, the government said that it would pursue a ban on conversion therapy.^[45] Characterising the practice as “abhorrent”, the then government added it was “determined” for the UK to continue as a “global leader in lesbian, gay, bisexual and transgender (LGBT) equality”. The May 2022 Queen’s Speech also included a commitment to bring forward a bill to ban the practice.^[46]

The government launched a consultation on banning conversion therapy in October 2021.^[47] It said that responses would inform draft legislation to be prepared by spring 2022, which would then be introduced “as soon as parliamentary time allow[ed]”. The government published three research reports on the subject alongside the consultation launch.^[48] It later pushed back the consultation closing date by eight weeks to “ensure the widest possible views are taken into account”.^[49] The consultation page notes that the government is currently analysing feedback and has not yet published a formal response.

On 31 March 2022 it was reported that ministers would explore non-legislative routes to stop conversion therapy instead of introducing a bill.^[50] However, the government was later reported to have said it would pursue a legislative ban as originally planned, following what was described as a “furious backlash” to the earlier reports. It added that such a ban would no longer cover the issue of gender identity.^[51]

In January 2023 the government announced that it had decided to publish a draft bill, which would “set out a proposed approach to ban conversion practices” and be designed to apply in England and Wales. The statement added that the bill would “protect everyone, including those targeted on the basis of their sexuality, or being transgender”, confirming the draft bill would cover the issue of gender identity. The statement also said the bill would be published “shortly” to allow for “pre-legislative scrutiny by a joint committee in this parliamentary session”.^[52]

During a debate in the House of Commons on 18 October 2023, the government said it remained committed to a ban on conversion therapy but did not recommit to publishing a draft bill in the current parliamentary session. Sarah Dines, parliamentary under secretary of state at the Home Office, also said:

The government have made it clear that conversion practices are abhorrent and have no place in our society. We are grateful to those who have responded to our consultation, which was very wide and well thought-out, and my ministerial colleagues will set out further details on that in due course. I cannot give a timeframe.^[53]

The Labour Party said in the same debate that it would introduce a “full and immediate trans-inclusive ban on conversion therapy, protecting legitimate talking therapies but closing any consent loopholes that are put in the statute book in the meantime”.

On the same date as the debate the Times reported that the government would include a draft Conversion Therapy Bill for pre-legislative scrutiny in the new parliamentary session, after previously having considered dropping the plan.^[54]

4. Other measures

The government has indicated it will pursue other health and social care-related measures in the new session.

4.1 Licensing non-surgical cosmetic procedures

In February 2022 the government announced its intention to introduce a licensing regime for non-surgical cosmetic procedures such as Botox and fillers.^[55]

On 2 September 2023 it launched a consultation, open until 28 October 2023, to seek views from industry and people who have undergone non-surgical cosmetic procedures on proposals including restricting who can perform certain high-risk procedures and age limits for patients. The new licensing regime is expected to be set out in regulations subject to legislative scrutiny through the affirmative procedure, meaning they will need to be approved by both Houses of Parliament before ministers can sign them into law.^[56]

4.2 Legal right for visits in hospitals, care homes and hospices

In June 2023 the government proposed new regulations to patients in hospitals and hospices and residents in care homes would be able to have visitors “in all circumstances”.^[57] It launched a consultation on the subject, which was open until mid-August. The government has said that responses to the consultation will inform its proposed development of secondary legislation to ensure the new rights.^[58]

4.3 Martha’s rule

In September 2023 the government said it was exploring introducing a new rule which would allow patients or their families to request a clinical review of their case from a doctor or nurse if their condition was deteriorating or not improving as expected.^[59] To be known as ‘Martha’s rule’ after the case of Martha Mills, who died of sepsis after clinicians dismissed extensive bleeding as a normal side effect of an infection, the rule would be similar to a system in Queensland, Australia, known as ‘Ryan’s rule’.^[60] The government said the rule had saved lives in Queensland, and the NHS was looking into whether similar measures could improve patient safety in the UK.

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Cover image by ar130405 on Pixabay.