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Health and Care Bill will have a ‘disruptive impact’, BMA says ahead of Commons debate


By Jess Hacker
23 November 2021

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MPs must make amendments to the Health and Care Bill to secure clinical leadership in Integrated Care Systems (ICSs), the BMA has said ahead of a debate over amendments to the Bill this evening.

Writing to MPs in the north east region – which will see the largest geographic ICS formed – the BMA regional council warned politicians over the Bill’s potentially ‘disruptive impact’ on patient care.

Dr George Rae, chair of the BMA’s North East Regional Council, flagged that the ICS has yet to develop a constitution, adding that it is ‘unclear’ at what level decision making will take place.

He added that the BMA is concerned how the interests of ‘all communities can be accommodated’, given the mixture of urban, rural and very remote areas covered by the ICS.

Describing the Bill, which entered its report stage yesterday (22 November), as the ‘wrong’ one ‘at the wrong time’, Dr Rae urged the MPs to support amendments that would ensure ‘independent’ leadership is embedded at every level of the ICS.

This should include formalised roles for local medical committees, local negotiating committees and public health doctors, he said.

MPs should also support further amendments which would:

  • Prevent private sector bodies sitting on Integrated Care Boards (ICBs) which will risk their influencing commissioning decisions,
  • Establish the NHS as the default option for NHS contracts to prevent them being outsources to private providers,
  • Ensure the health secretary regularly reports workforce numbers,
  • Ensure increased powers for the health secretary over the NHS are balanced with local health and social care needs.

The latter amendment – to curb suggested powers that would allow the secretary to intervene in local reconfigurations of NHS services – has sparked particular controversy.

Last week, the King’s Fund told Healthcare Leader that it believes the original proposal should be dropped entirely, arguing that ‘by having the secretary of state involved earlier, that is bringing unhelpful politics into those decisions’.

Vote on social care cap

It comes as MPs voted in favour of an amendment to change the capped-cost model for social care plans laid out in the Health and Care Bill last night.

In September, the prime minister announced that individual care costs would be capped at £86,000 from October 2023.

However, new details announced last week by the DHSC – and narrowly voted through last night at  272 to 246 – indicated that council contributions to care fees would not go towards this cap.

Critics have argued that this would mean people with assets valued under £100,000 who are eligible for means-tested support would end up paying the same as those who have assets over that amount.

Jonathon Holmes, policy advisor for the King’s Fund, told Healthcare Leader that while it is a ‘very technical change’, it is expected to have ‘quite serious implications for people with less wealth’.

The Bill and its amendments  will be discussed in parliament again this evening

Prior to this week there has been much criticism of the Bill, including a petition to scrap ICSs, which launched at the end of October and has now reached 90,000 signatures.

The campaign group behind the petition, Your NHS Needs You, has claimed that the introduction of ICSs will lead to integrated care boards (ICBs) covering areas that are ‘too large’ to ensure local and public accountability, while also allowing private companies to ‘make decisions on allocating public expenditure’ through their ICB membership.

However, the Government has defended the measures in the Bill, saying they will reduce bureaucracy in the NHS.

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