Health and Care Bill - March 2022

Dear Constituent,

Thank you for contacting me about the Health and Care Bill.

As the Health Secretary has said during recent debates, the pandemic has tested our country, particularly in our health and care system. Everyone delivering health and social care in this country has risen to meet these tests in remarkable new ways. This has included bold new ways of working, of overcoming bureaucracy and of people working seamlessly across traditional boundaries. New teams were forged, new technologies adopted and new approaches found. There is no greater example of this than the extraordinary success of our vaccine roll-out, where health and care colleagues have been able to draw on the collective scale and strengths of our Union to deliver one vaccination programme for the whole of the United Kingdom, which has now seen it embark on the successful booster programme.

I am aware, however, that there are further challenges ahead which include an ageing population, an increase in people with multiple health conditions and, of course, the chance to embrace the full potential of data and technology. The measures in the Bill were consulted on over an extensive period and I hope that you were able to take part in that consultation which preceded this Bill.

The unprecedented threat of the 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. These proposed reforms will also include proper accountability mechanisms, and give patients and the public the confidence that they are receiving the best care. 

The measures set out in the Health and Care Bill deliver on the NHS’s own proposals for reform in its Long Term Plan. As the minister said in the recent debate, a two year consultation and engagement period enabled thousands of NHS staff to come forward and say what they think works and what they think needs to change. In the words of Lord Stevens, the former chief executive of NHS England, the overwhelming majority of these proposals are changes that the health service has asked for. The Bill supports improvements that are already under way in the NHS. It builds on the recommendations of the NHS’s own long-term plan. It is a product of the NHS, it is for the NHS, and it is supported by the NHS.

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 Lord Stevens, who earlier this year 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.

I appreciate that concerns have been raised that the establishment of Integrated Care Systems (ICS) will lead to a rationing of health care provision and a post code lottery. I was reassured by the NHS Confederation, NHS Providers and the Local Government Association’s statement that they “believe that the direction of travel set by the Bill is the right one”. Their statement notes that working in partnership at a local level is “the only way” we can address the challenges of our time. The chief executive of Age UK has said that ICSs are to be embraced and made as effective and inclusive as they can be, and the King’s Fund is calling for the Government to press ahead with these plans.

I have read suggestions that ICSs are being used for privatisation or to cut funding and in my view, those suggestions are scaremongering and I will respond to this in more detail below. 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 ICS is a key way of promoting local collaboration.

Integrated Care Boards are given a range of powers and duties under the Health and Care Bill, and will oversee the local NHS in their area. This will help to improve care and integration between health and social care locally. They are statutory bodies controlled by NHS England. I welcome the ability, set out in the Bill, of local NHS leaders to propose their own constitutions for choosing members of the Boards. This means that Boards could include companies that provide major local NHS services. Boards must also include NHS leaders, GPs, council leaders and independent non-executives. Meetings will be held in public and decisions must be transparent. Any conflicts of interest will have to be declared and managed. 

In relation to NHS professionals, I 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. 

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 and the announcement of a 3% increase in pay for most NHS staff, backdated to April, is welcome news.

With regard to suggestions of privatisation within the NHS, the Government has guaranteed that the NHS will always provide healthcare free at the point of delivery, regardless of ability to pay. The Government will not privatise the NHS.

The use of private providers and the voluntary sector in the delivery of NHS services is not a new concept, with the previous Government introducing the independent sector and competition into the NHS between 1997 and 2010. There has always been an element of private provision in healthcare services in this country, as the Nuffield Trust said in 2019: “The…evidence suggests the increase” in private provision “originally began under Labour governments before 2010” or as the independent and well regarded charity, King’s Fund concluded in their recent report,  “Overall, there is no evidence of a significant increase in spending on private providers  or widespread privatisation of services in recent years” - Is the NHS being privatised? | The King's Fund (

The NHS is something to be valued and protected which is why I support the commitment to properly fund the NHS. Since 2010 the NHS budget has increased every year, and I am happy to say that despite challenging financial circumstances, the annual budget of the NHS is being increased by £33.9 billion by 2023/24, which has been enshrined in law. 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. 

Competition in the NHS should act as a means to an end in improving services for patients, never as an end in itself.

In relation to the implementation of the Bill, the NHS itself wants, subject to legislation, to move at pace to implement statutory arrangements for ICSs by April 2022. That is why NHS England is beginning preparatory work, including publishing an ICS design framework. Further work, including on integrated care board design and consideration of appointments and staff from CCGs will take place.

The reforms set out in the Bill are vital to help our NHS build back better from the COVID-19 pandemic and there are no measures which will, as some have suggested, undermine the principles on which the NHS was funded. Those in the system are telling ministers that they are ready to implement the reforms and there should be no delay, and I am satisfied that now is the right time to proceed.

For all the reasons set out above, I support the Bill.

Finally, and in addition to the above specific issues, I have been asked by constituents to confirm my views on a range of other issues connected with the Bill, as follows:

i) Marie Curie's call to put end of life care at the heart of the Health and Care Bill. It is vital that every person can access high quality care at the end of life, and this was reflected in the Ambitions for Palliative and End of Life Care that were published by the National Palliative and End of Life Care Partnership in May 2021. These ambitions included ensuring care is coordinated and improving access to 24/7 expert palliative and end of life care services. The framework also included a goal to help people take control at the end of their life through personal budgets and other support.

In relation to the Health and Care Bill, I understand that an amendment was tabled to Clause 15 by Karin Smyth MP, which would place a requirement on Integrated Care Boards to commission palliative and end of life services.

Regarding patient choice, Clause 67 of the current Bill places a requirement on NHS England and Integrated Care Boards (ICBs) to outline how they will support patients to make choices about their care.

In addition, the Bill does not affect existing patient rights in the NHS Constitution, which includes the right for patients to be involving in planning and making decisions with care providers about end of life care.

ii) Workforce planning and staffing. My views are set out here: Health and Care Bill - workforce planning amendment: March 2022 | Richard Fuller

iii) Social care charging and the Bill.

I know that some people face real financial pressures each week or month after paying for their care. It is therefore welcome that, to allow people receiving means-tested support to keep more of their own income, the Government will unfreeze the Minimum Income Guarantee (MIG) for those receiving care in their own homes. From April 2022 this will rise in line with inflation.

From October 2023, anyone assessed by a local authority as having eligible care and support needs, either new entrants or existing social care users, will begin to progress towards the cap. Costs accrued before October 2023 will not count towards the cap. Before the cap comes into effect, local authorities will work to identify people who currently meet their care costs themselves, to ensure that they can begin progressing towards the cap from the point it comes into effect. 

The Government's plan for health and social care will tackle persistent unfairness in the social care system. Under the current system, people who fund their own care often pay more than people who are funded through their local authority for equivalent care. It is therefore encouraging that the Government will ensure that self-funders are able to ask their local authority to arrange their care for them so that they can find better value care. I welcome that this has been reiterated in the Government's Adult Social Care Reform White Paper and the Government, with the support of local authorities, care providers and the wider sector, will aim to ensure that self-funders can access the same rates for care costs in care homes that local authorities pay. 

As you may be aware, those receiving care themselves, or some else such as a relative, may choose to make additional payments for a preferred choice of accommodation or care arrangement. I am told that the Government intends to change the regulations to enable everyone receiving local authority financial support to fund such top-ups for their own care. These top-up payments, on top of the cost specified in someone’s personal budget or independent personal budget, will not count towards the cap and will still be payable by the person once the cap has been reached.

The new reforms to social care will complement the existing system whereby people in need of residential care can defer payment of care home fees so they do not face the added stress of rushing to sell their home. This system has been in place since 2015 and means that people have the flexibility to avoid selling their home within their lifetime. As part of the process to build on the announcements made, the Government will be working to review the existing scheme in order to provide more flexibility for people to defer their care payments and ensure more people do not have to sell their homes in their lifetime.

Of the £36 billion over the initial three years of the Health and Care Levy, £5.4 billion has been allocated to social care. My expectation is that, after the initial three years, more of the funding raised through the levy will shift naturally towards social care, with progress made on tackling the NHS backlog and as people begin to reach the new £86,000 care cap. The Levy will fully fund that cap in the future.

While I understand that the £86,000 cap does not apply to the cost of accommodation and food, known as daily living costs, I welcome that it will go a long way in helping with the general cost of care for those both in residential homes and in other care settings. Daily living costs are a notional amount to reflect that a proportion of residential care fees are not directly linked to personal care, like rent, food and utility bills and would have had to be paid wherever someone lives. For simplicity, daily living costs will be set at a national, notional amount of £200 per week. The Government has said that they will consult on the reforms to charges and I would encourage you to take part in this to ensure your views are heard.

Thank you again for taking the time to contact me



Richard Fuller MP