What measures were announced in the December 2019 Queen’s Speech and not progressed?
In its 2019 manifesto, the Conservative Party pledged to “strengthen the NHS and social care”. The December 2019 Queen’s Speech subsequently included commitments in this area, including on bringing forward a bill on NHS funding and pursuing a cross-party consensus on adult social care reform in England.
The 2019–21 session saw government-sponsored primary legislation such as the NHS Funding Act 2020 and Medicines and Medical Devices Act 2021 receive royal assent. However, other health and social care measures that had been announced in the Queen’s Speech were delayed in view of the coronavirus pandemic. These included:
- Legislative changes in support of the NHS Long Term Plan.
- A Health Service Safety Investigations Bill to establish the Healthcare Safety Investigation Branch as an independent public body.
- Reform of the adult social care system.
- Modernisation of the Mental Health Act 1983.
The Government has indicated that it will progress these measures in the new session.
What government plans may be subject to future legislation?
Health and Care Bill: NHS proposals
In January 2019, the NHS in England published its Long Term Plan (LTP). This set out NHS England and NHS Improvement’s strategy for the next decade, building on a policy platform set out five years earlier. The document stated that implementation of the LTP was not dependent on changes to primary legislation. However, it added that changes to the statutory framework governing the NHS in England would support faster progress towards achieving the ambitions set out in the plan. In particular, “on service integration, on administrative efficiency, and on public accountability”.
After consultation, in September 2019 NHS England and NHS Improvement (NHSEI) made recommendations for provisions to be included in an NHS Bill. The proposals published for consultation had been widely welcomed, including by the House of Commons Health and Social Care Committee and a range of health and social care stakeholders.
Following its experience of the coronavirus pandemic, in November 2020 NHSEI made further proposals for legislative reform. These focused on options for putting integrated care systems (ICSs) on a firmer statutory footing than would have been the case under the earlier proposals. It asked for views. NHSEI then made specific recommendations on how best to legislate for ICSs in February 2021.
At the beginning of the 2019–21 session, the Government had said it was considering NHSEI’s recommendations and would “bring forward detailed proposals shortly”. It added this process would lead to “draft legislation that will accelerate the Long Term Plan for the NHS”.
In February 2021, on the same date as NHSEI published its recommendations on ICSs, the Department of Health and Social Care published a white paper setting out its proposals for a Health and Care Bill. It said the changes would build on the NHS’s own recommendations and modernise the legal framework for the health and care system, while taking account of experiences since the onset of the coronavirus pandemic. The proposals were grouped under three main headings:
- Working together and supporting integration: including introducing a duty on the NHS and local authorities to collaborate with each other and measures for statutory ICSs.
- Reducing bureaucracy: including making changes to competition and procurement elements in the Health and Social Care Act 2012 and removing the statutory requirement for Local Education and Training Boards.
- Enhancing public confidence and accountability: including putting the merger of NHS England and NHS Improvement on a statutory footing and enhancing powers of direction for the Government over the newly merged body, to be known as NHS England.
The Government added that any bill would also provide for additional measures in support of social care, public health and the NHS. These included:
- Giving the better care fund a standalone legal basis and enhancing assurance frameworks and data collection to improve accountability within the social care sector.
- Introducing further restrictions on junk food advertising; delegating powers to alter food labelling requirements; and moving responsibility for water fluoridation from local authorities to central government.
- Other measures such as putting the Healthcare Safety Investigation Branch on a statutory footing and establishing a statutory medical examiners system (both provided for in a separate government bill that failed to progress beyond first reading in the 2019–21 session); and allowing the Medicines and Healthcare products Regulatory Agency to set up national medicines registries.
The Government indicated that the Health and Care Bill would be prioritised in the new session, with a plan for changes to be “implemented in 2022”.
- Department of Health and Social Care, ‘Integration and Innovation: Working Together to Improve Health and Social Care for All’, 11 February 2021, CP 381
- Statement on the ‘Future of Health and Care’, HC Hansard, 11 February 2021, cols 505–22
- Statement on the ‘Future of Health and Care’, HL Hansard, 23 February 2021, cols 812–26
- House of Commons Health and Social Care Committee, ‘NHS Long Term Plan: Legislative Proposals’, 24 June 2019, HC 2000 of session 2017–19; and Academy of Medical Royal Colleges, Recommendations for an NHS Bill: Joint Letter, 26 September 2019
- House of Lords Library, ‘NHS Long Term Plan: Recent Developments’, 29 January 2020
Adult social care
In its February 2021 white paper on proposals for a Health and Care Bill, the Government said it remained “committed to the sustainable improvement of adult social care” and would bring forward proposals in 2021. The Government has previously indicated its intention to pursue reform of the adult social care system in England:
- In July 2019, in his first speech as Prime Minister, Boris Johnson said “we will fix the crisis in social care once and for all”. He said the vehicle for this would be a “clear plan we have prepared to give every older person the dignity and security they deserve”.
- The Conservative manifesto for the December 2019 general election included an undertaking to build a cross-party consensus on social care. It said a condition of any option would be that “nobody needing care should be forced to sell their home to pay for it”. The December 2019 Queen’s Speech reiterated this commitment.
- In January 2020, the Prime Minister said the Government would bring forward a plan on adult social care “this year” and would “get it done within this Parliament”. In March 2020, Secretary of State for Health and Social Care Matt Hancock wrote to all MPs and members of the House of Lords to initiate talks. He outlined that the Government intended to move to “structured talks on reform options in May”. However, Mr Hancock subsequently said the coronavirus pandemic had delayed progress.
- In June 2020, the Prime Minister said the Government was finalising plans to “solve social care”. The November 2020 spending review added that the Government was “committed to sustainable improvement of the adult social care system” and would bring forward proposals in 2021.
- In March 2021, the Prime Minister said he thought it was “highly likely” that social care would feature in the next Queen’s Speech.
- House of Commons Health and Social Care Committee, ‘Social Care: Funding and Workforce’, 22 October 2020, HC 206 of 2019–21; and Government Response, January 2021, CP 360
- House of Lords Economic Affairs Committee, ‘Social Care Funding: Time to End a National Scandal’, 4 July 2019, HL Paper 392 of 2017–19; and Debate on ‘Social Care Funding (EAC Report)’, HL Hansard, 28 January 2021, cols 235–80GC
In January 2021, the Department of Health and Social Care published a white paper on reforming the Mental Health Act 1983. The document set out the Government’s proposals to reform mental health legislation following Sir Simon Wessely’s independent review on the act published in late 2018. The paper represented the Government’s response to Sir Simon’s 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”. 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 week after publishing the white paper, the Government said it would publish a response to the consultation later in 2021. It added that it intended to publish a draft Mental Health Bill for pre‑legislative scrutiny in early 2022.
- Department of Health and Social Care, ‘Modernising the Mental Health Act: Increasing Choice, Reducing Compulsion—Final Report of the Independent Review of the Mental Health Act 1983’, December 2018
- Statement on ‘Mental Health Act Reform’, HC Hansard, 13 January 2021, cols 325–36
- Statement on ‘Mental Health Act Reform’, HL Hansard, 18 January 2021, cols 1013–26
In March 2021, the Department of Health and Social Care published its reform plans for the public health system. This followed an earlier overview of the Government’s plans published in September 2020.
The plans said that health would “no longer only be the business of the Department of Health and Social Care, but a core priority for the whole of government”. It added:
We will establish a new cross-government ministerial board on prevention, to drive forward and co-ordinate government action on the wider determinants of health. We will enable more joined‑up, sustained action by national and local government and our partners, working together in a coordinated way to create a step-change in public health.
The plans confirmed that the health protection capabilities of Public Health England (PHE) and NHS Test and Trace would combine into a new UK Health Security Agency. Meanwhile, the health improvement, prevention and healthcare public health functions of PHE would transfer to a new Office for Health Promotion that would be created in the Department of Health and Social Care. The plans added:
As national capability is only part of the story, we also need to strengthen our local response. This is vital, as so many of the conditions for good health and living well are determined locally. At the heart of our proposals in the forthcoming Health and Care Bill is the concept of population health: using the collective resources and strengths of the local system, the NHS, local authorities, the voluntary sector and others to improve the health of their area.
- David Buck, ‘Public health reform: a whole-government priority?’, King’s Fund, 1 April 2021
- British Medical Association, ‘Transforming the Public Health System: Reforming the Public Health System for the Challenges of Our Times’, 5 April 2021
Cover image by ar130405 from Pixabay.