Thank you for contacting me about the Health and Care Bill.
I completely agree with you that the unprecedented threat of the COVID-19 pandemic reminded us how vital our health and care system is to all of us. I want to assure you that the NHS will always be free at the point of use, and any proposed reforms will aim to continue to improve the quality of these services and patient outcomes.
As we build back better from this pandemic, it is right and necessary that our health and care services are at the forefront. The pandemic underlined not only the dedication and skill of those in this sector, but also the necessity of a broader, more integrated health and care system. I welcome the intention to develop more joined up, integrated care between the NHS, Local Government and other partners including the voluntary and community sector, which will be vital in tackling the factors that affect the long-term sustainability of patient services. The Bill will make permanent some of the innovations we have seen as a result of the pandemic. I understand that these proposed reforms will also include proper accountability mechanisms, and give patients and the public the confidence that they are receiving the best care from their healthcare system.
The measures set out in the Health and Care Bill deliver on the NHS’s own proposals for reform in its Long Term Plan. I believe these proposals have been developed in consultation with key stakeholders in this sector, and I am encouraged by the preliminary positive feedback received. In particular, the comments from the former Chief Executive of NHS England, who has said that this Bill “will support our health and care services to be more integrated and innovative so the NHS can thrive in the decades to come”, are reassuring.
Alleged Privatisation of the NHS
The NHS is not being privatised or broken up. The independent and internationally respected thinktank The King’s Fund notes that in 2019/20 ‘the share of their [NHS commissioners’] total revenue budget that was spent on private providers remained relatively stable at 7.2 per cent.’ This rises to 10.8% if spending on services provided by charities, not-for-profits and local authorities is included. On the Health and Care Bill itself the King’s Fund states that ‘it is unlikely that the changes in the Bill will result in a substantial change in the private sector’s involvement in delivering NHS services.’ Such spending is driven solely by what is in the interests of patients.
On integrated provision the King’s Fund finds that ‘The new partnership structures in the Bill present an opportunity to improve the health of communities and individuals, with NHS organisations working closely with local authorities, VCS organisations and communities themselves.’
The independent Nuffield Trust says: 'There is nothing in the Bill that would change the NHS from being a publicly funded service, free at the point of use except for existing charges for services like dentistry.'
Social Care Cap (Charges and Means Test)
From October 2023, no eligible person starting adult social care will have to pay more than £86,000 for personal care over their lifetime. To be clear, the cap is not a target to be hit, but a backstop protection to ensure people have certainty and avoid catastrophic costs. The reformed means test, which is the best way to help make care affordable, will increase the threshold above which people must meet the full cost of their care to £100,000. This is more than four times the current limit of £23,250, and the number of people receiving state support in the social care system will increase from around half to two thirds.
In designing these reforms, the priority has been the creating a more generous means-testing system, which benefits those with low to moderate wealth. The nature of the means-test will dramatically reduce the amount that less well-off users will have to spend on care. For example, someone who has £100,000 of assets would need to draw on care and support in a residential home for about 10 years to spend the same amount as someone who entirely self-funds. Older adults have around a one-in-three chance of living in a residential home for three years and a one in 50 chance of doing so for 10 years.
Only the amount that an individual contributes towards their personal care will count towards the cap. This ensures that individuals living in different parts of the country, but contributing the same amount, do not progress towards the cap at different rates because of differences in amounts paid by their local authorities. It is right that less well-off people in different parts of the country benefit to the same extent and we do not see differences based simply on where someone lives.
The new social care reforms are clear, fair and reduce complexity. I am proud to support a Government that is tackling the issue of social care reform head on, significantly improving the sustainability and affordability of the provision of social care.
The NHS relies on effective workforce planning to ensure we can meet the health and care needs of local communities and I applaud the dedication of healthcare professionals across a range of professions.
Clause 35 of the Health and Care Bill would require the production of a workforce accountability report at least every five years. This report will increase transparency and accountability in the workforce planning process. For example, the report would set out the role and responsibilities of new Integrated Care Boards (ICBs) about how they would ensure the delivery of effective local and national workforce planning.
I recognise that people would like to go further, but there is common ground on the need to have effective workforce planning.
As my colleague Ed Argar - the Minister for Health - has stated, we cannot predict all future workforce needs, which is why the report is required to be published at a minimum of every five years.
This flexibility will allow an updated report to be provided earlier than the statutory required period to reflect any changes to roles and responsibilities .
I also recognise the level of support an amendment made to the Bill in the House of Lords has received from Peers, patient groups and professional bodies. I look forward to giving further consideration to workforce planning when the Bill returns to the House of Commons on Wednesday 30 March.
It should be kept in mind that in addition to Government measures in the Bill, the Department for Health and Social Care has already commissioned the development of a long-term 15-year strategic framework for the health and social care workforce. This is a welcome piece of work and I look forward to its publication, which I am told is expected later this year.
It is vital that workforce planning is closely integrated to the wider planning across health and social care. Two key NHS bodies will be merged to help put long-term planning and strategy for healthcare staff recruitment and retention at the forefront of the national NHS agenda.
The Government is delivering against its key pledges to increase the numbers of GPs and nurses - there are 1,200 more GPs and 27,000 more nurses compared to 2019.
I believe that the measures in the Health and Care Bill will help to clarify who is responsible for workforce planning and ensure NHS can provide the workforce needed to meet the health and care needs of the population.
Regulation of NHS Professions
Clause 157 of the Health and Care Bill is designed to provide more flexibility to the regulation of healthcare professionals so that it can change to better support patients, support our health and care services and help the workforce meet future challenges. Health and care professionals are regulated on a UK-wide basis and it is important that there are consistent standards to allow the flexibility for healthcare professionals to be able to work across the UK. The case for reforming professional regulation has long been acknowledged by bodies representing healthcare professionals. The existence of nine separate professional regulatory bodies is inefficient and confusing to patients. A consultation on the regulation of healthcare professionals is taking place and is due to conclude on 31 March 2022.
Government financial support
I am proud to support a Government that is providing historic investment in health and our NHS, and is committed to funding our health and public services properly. Following the 2021 Spending Review, NHS England’s day-to-day budget is set to grow by 3.8 per cent on average up to 2024/25, supporting the NHS to tackle the elective backlog, deliver its Long Term Plan and ensure it has the resources needed to fight COVID-19. Spending on health services will increase from £133 billion at the start of this Parliament, to over £177 billion by the end: an increase of over £44 billion. Despite difficult financial circumstances, NHS investment has increased every year since 2010.
Integrated Care Boards/Partnerships and privatisation
It is irresponsible scaremongering to suggest that Integrated Care Boards and Partnerships are being used to support privatisation, or cuts to NHS funding. The NHS will always be free at the point of use, and I believe these reforms will continue to improve the quality of NHS services and outcomes for patients. Ensuring every part of England is covered by an Integrated Care Board and Partnership is a key way of promoting local collaboration.
Private Providers (ICBs)
Service provision by the independent and voluntary sectors has been, and continues to be, an important and valuable feature of our healthcare system, which I fully support. That said, I do appreciate that there are concerns about private sector involvement in ICBs. It is important that people are assured that the work of ICBs will be driven by health outcomes, not by profits.
I know that the Bill does not allow private sector providers to influence, or to make, decisions on spending, but it is welcome that the Government has committed to putting that beyond doubt. They will bring forward an amendment at the next stage of the Bill’s passage through Parliament to protect the independence of ICBs by preventing individuals with significant interests in private healthcare from sitting on them
The Bill includes proposals to give local people, local clinicians and NHS organisations more control over the way health and care services are delivered. However, in a democracy, the public and Parliament, rightly, expect to be able to hold to account the decision makers who oversee the health system and the performance of the NHS, so I welcome measures in the Bill to allow for this. Importantly, I am assured that individual clinical decisions are explicitly exempt from the scope of the powers for the Secretary of State.
Timing of reform
The reforms set out in the Bill are vital to help our NHS build back better from the COVID-19 pandemic. Those in the system are telling Ministers that they are ready to implement the reforms and there should be no delay, and so, while I appreciate the concerns you have and will bear these in mind, I am satisfied that now is the right time to proceed.
I completely agree with you that NHS managers have played a vital role throughout this pandemic. I am pleased that Chris Hopson of NHS providers, which represents NHS managers, agrees that these reforms will end the “unnecessarily rigid NHS approach to procurement”. It is also welcome that the proposals enact the recommendations of the 2019 Kark Review for stronger measures to ensure that NHS senior managers have the right skills, behaviours and competencies. I understand that there are no plans at this stage to statutorily regulate senior NHS managers and leaders, and I will continue to monitor this closely. I will raise this issue with my ministerial colleagues.
Separately, I wholeheartedly support the Government's commitment to recruit 50,000 more nurses, 6,000 new GPs, and 6,000 more primary care professionals in addition to the 7,500 further nurse associates and 20,000 primary care professionals announced previously. These commitments are vital to ensuring our NHS is fit for the long term. Progress is already being made in this area, with more than 6,500 more doctors, almost 10,600 more nurses and over 18,700 more health support workers compared with a year ago.
I am happy to say that there are approximately 70,000 nurses and midwives in training, including 29,740 who began courses this academic year, an increase of 26 per cent on last year. The introduction of the new Nursing Degree Apprenticeship and nursing associate roles will significantly bolster the nursing workforce in the short term, as we continue to build an NHS workforce for the future.
Further, the NHS Long Term Plan focuses on retaining staff by ensuring that they are well supported and able to develop their own careers; this ethos will underpin all planning for the NHS workforce.
Alternative Provider Medical Service Contracts (APMS)
Primary care commissioners have long had the choice to commission services from a range of primary care providers. I believe it is crucial that local health commissioners have flexibility to commission partnerships, individuals and private and third sector organisations to deliver GP services to meet the specific healthcare needs of their local populations. Alternative Provider Medical Service Contracts (APMS) offer greater flexibility than national standard contracts, allowing commissioners to better meet local need and fill any gaps not covered by core general practice. Private and third sector providers play a vital role in the delivery of local services and must adhere to the same quality and safety standards as any other form of GP contractor. I am not in favour of proposed amendments to end APMS contracts, which I believe would undermine the important ability of commissioners to meet local need, particularly at a time when efforts are being made to build capacity in primary care and ensure commissioners go further in developing and designing high quality primary care services.
Thank you again for taking the time to contact me.
Craig Whittaker MP