How could the Health and Care Bill strengthen action on health inequalities?
How could the Health and Care Bill strengthen action on health inequalities?
29 September 2021
About 10 mins to read
Key points
- Health inequalities in England are vast and growing. Government has committed to ‘levelling up’ the country as it recovers from the pandemic and is also embarking on major reforms to the NHS in England. The Health and Care Bill 2021–22 could be used to help strengthen action to reduce inequalities.
- The NHS has an important role to play in narrowing health inequalities, but progress has been slow in recent years and the pandemic has shown that more tangible action is needed. Yet the provisions outlined in the Bill amount to more of the same, transposing existing inequality duties onto the new NHS integrated care boards (ICBs). The duties placed on the health secretary and on NHS England are similarly unchanged.
- The core inequalities duty could be broadened to acknowledge the NHS’s role in influencing wider social and economic determinants of health, and health inequalities could be incorporated into the new ‘triple aim’ duty for the NHS. Other public services that are vital for enabling everyone to lead a healthy life, such as housing and social security, will also require investment if inequalities are to be narrowed.
Table 1: Comparing existing health system inequality duties and proposed changes
National Health Service Act 2006 (as amended by the Health and Social Care Act 2012) | Health and Care Bill 2021–22 (as introduced) | |
Legal duties on inequalities | The secretary of state must have regard to the need to reduce inequalities between the people of England with respect to the benefits people can obtain from the NHS [section 1C] | No change |
NHS England/CCGs must, in the exercise of its functions, have regard to the need to reduce inequalities between patients with respect to access to, and outcomes from, health services [sections 13G and 14T] | For CCG, read ICB – otherwise no change [new section 14Z35 inserted by clause 19] | |
Inequalities in other duties | Duty to promote integration: functions of NHS England/CCGs must be exercised with a view to health services, health-related services and social care services being provided in an integrated way where this would improve quality or reduce inequalities in access or outcomes [sections 13N and 14Z1] | For CCG, read ICB – otherwise no change [new section 14Z42 inserted by clause 19] |
Annual plans | NHS England’s business plan and CCG commissioning plans must explain how the duties to reduce inequalities are to be discharged [sections 13T and 14Z11] | For CCG commissioning plan, read ICB joint forward plan – otherwise no change [new section 14Z50 inserted by clause 19] |
Annual reports | NHS England and CCG annual reports must assess how effectively the duty to reduce inequalities was discharged [sections 13U and 14Z15] | For CCG, read ICB – otherwise no change [new section 14Z56 inserted by clause 19] |
Performance assessment | NHS England’s annual assessment of how well each CCG has performed must include an assessment of how effectively the CCG discharged its duty to reduce inequalities [section 14Z16] | For CCG, read ICB – otherwise no change [new section 14Z57 inserted by clause 19] |
Sources: National Health Service Act 2006 (as amended); Health and Care Bill 2021–22 (as introduced).
- Marmot, M et al. Health Equity in England: the Marmot Review 10 Years On. Institute of Health Equity (IHE); 2020 (www.health.org.uk/publications/reports/the-marmot-review-10-years-on) (p 13).
- Suleman M, Sonthalia S, Webb C, Tinson A, Kane M, Bunbury S, Finch D, Bibby J. Unequal pandemic, fairer recovery: The COVID-19 impact inquiry report. The Health Foundation; 2021 (https://doi.org/10.37829/HF-2021-HL12) (p 12).
- NHS England. Implementing phase 3 of the NHS response to the COVID-19 pandemic. NHS England; 7 August 2020 (https://www.england.nhs.uk/wp-content/uploads/2020/08/implementing-phase-3-of-the-nhs-response-to-covid-19.pdf) (p 2).
- Department for Business, Energy & Industrial Strategy. The Grand Challenges. Department for Business, Energy & Industrial Strategy; 2019 (https://www.gov.uk/government/publications/industrial-strategy-the-grand-challenges/industrial-strategy-the-grand-challenges).
- Rt Hon Sajid Javid MP. Key note speech by Secretary of State for Health and Social Care; 16 September 2021 (https://www.youtube.com/watch?v=ib-2T0hQSzE&ab_channel=TheCentreforSocialJustice).
- Alderwick H, Gardner T, May N. England’s new health and care bill. BMJ; 2021 (https://www.bmj.com/content/bmj/374/bmj.n1767.full.pdf) (p 1).
- UK government. Health and Care Bill introduced to Parliament. UK government; 2021 (https://www.gov.uk/government/news/health-and-care-bill-introduced-to-parliament).
- House of Commons. Health and Social Care Act 2012: Chapter 7 (https://www.legislation.gov.uk/ukpga/2012/7/pdfs/ukpga_20120007_en.pdf) (p 3).
- House of Commons. Health and Care Bill Part 1 — Health service in England: integration, collaboration and other changes; 2021 (https://publications.parliament.uk/pa/bills/cbill/58-02/0140/210140.pdf) (p 16).
- Ibid (p 17).
- Ibid (p 21).
- Ibid (p 46).
- Ibid (p 25).
- The King’s Fund. Briefing: Health and Care Bill House of Commons Second Reading. The King’s Fund; 2021 (https://www.kingsfund.org.uk/publications/health-care-bill-house-commons-second-reading-briefing) (p 6).
- Thorlby et al. The NHS Long Term Plan and COVID-19: Assessing progress and the pandemic’s impact. The Health Foundation; 2021 (https://doi.org/10.37829/HF-2021-P08) (p 20).
- The Health Foundation. Evidence hub: What drives health inequalities? The Health Foundation (https://www.health.org.uk/evidence-hub).
- Whitehead M, Dahlgren G. What can be done about inequalities in health? The Lancet. 1991; 26(338)8774: 1059–1063.
- Elwell-Sutton T et al. Creating healthy lives: A whole-government approach to long-term investment in the nation’s health. The Health Foundation; 2019 (https://www.health.org.uk/publications/reports/creating-healthy-lives).
- NHS England. Interim guidance on the functions and governance of the integrated care board. NHS England; 2021 (https://www.england.nhs.uk/wp-content/uploads/2021/06/B0886_Interim-guidance-on-the-functions-and-governance-of-the-integrated-care-board-August-2021.pdf) (p 11).
- NHS England. Integrated Care Systems: design framework. NHS England; 2021 (https://www.england.nhs.uk/wp-content/uploads/2021/06/B0642-ics-design-framework-june-2021.pdf) (p 8).
- Reed S, et al. Building healthier communities: the role of the NHS as an anchor institution. The Health Foundation; 2019 (www.health.org.uk/publications/reports/building-healthier-communities-role-of-nhs-as-anchor-institution).
- Allen M, Malhotra A M, Wood S, Allwood D. Anchors in a storm: Lessons from anchor action during COVID-19. The Health Foundation; 2021 (www.health.org.uk/publications/long-reads/anchors-in-a-storm).
- House of Commons. Health and Care Bill Explanatory Notes; 2021 (https://publications.parliament.uk/pa/bills/cbill/58-02/0140/en/210140en.pdf) (p 17).
- Alderwick H, Gottlieb L M. Meanings and misunderstandings: a social determinants of health lexicon for health care systems. Milbank Q. 2019 Jun;97(2):407-419 (doi: 10.1111/1468-0009.12390).
- NHS England. NHS oversight metrics for 2021/22. NHS England; 2021 (https://www.england.nhs.uk/wp-content/uploads/2021/06/B0693-nhs-oversight-metrics-for-2021-22.pdf).
- NHS England. Interim guidance on the functions and governance of the integrated care board. NHS England; 2021 (https://www.england.nhs.uk/wp-content/uploads/2021/06/B0886_Interim-guidance-on-the-functions-and-governance-of-the-integrated-care-board-August-2021.pdf) (p 11).
- Alderwick H, et al. Sustainability and transformation plans in the NHS: how are they being developed in practice? The King’s Fund; 2016 (https://www.kingsfund.org.uk/publications/stps-in-the-nhs).
- Briggs A, Göpfert A, Thorlby R, et al. Integrated health and care systems in England: can they help prevent disease? Integrated Healthcare Journal 2020;2:e000013 (doi: 10.1136/ihj-2019-000013).
- Alderwick H, Hutchings A, Briggs A, et al. The impacts of collaboration between local health care and non-health care organizations and factors shaping how they work: a systematic review of reviews. BMC Public Health 21, 753 (2021) (https://doi.org/10.1186/s12889-021-10630-1).
- Perkins N, et al. What counts is what works’? New Labour and partnerships in public health. Polit Policy 2010;38:101-17 (https://www.ingentaconnect.com/content/tpp/pap/2010/00000038/00000001/art00006).
- Thorlby et al. The NHS Long Term Plan and COVID-19: Assessing progress and the pandemic’s impact. The Health Foundation; 2021 (https://doi.org/10.37829/HF-2021-P08) (p 20).
- Ford J, et al. Transforming health systems to reduce inequalities. Future Healthc J Jul 2021, 8 (2) e204-e209; DOI: (10.7861/fhj.2021-0018) (p 204).
- Barr B, et al. The impact of NHS resource allocation policy on health inequalities in England 2001-11: longitudinal ecological study. BMJ 2014; 348 (https://doi.org/10.1136/bmj.g3231).
- Levene L S, et al. Socioeconomic deprivation scores as predictors of variations in NHS practice payments: a longitudinal study of English general practices 2013-2017. Br J Gen Pract. 2019 Aug;69(685):e546-e554 (https://pubmed.ncbi.nlm.nih.gov/31208972/).
- Fisher R. ‘Levelling up’ general practice in England: What should government prioritise? The Health Foundation; 2021 (www.health.org.uk/publications/long-reads/levelling-up-general-practice-in-england).
- Masters R, Anwar E, Collins B, Cookson R, Capewell S. Return on investment of public health interventions: a systematic review. J Epidemiol Community Health 2017; Mar 29. (https://jech.bmj.com/content/71/8/827).
- Owen L, Fisher A. The cost-effectiveness of public health interventions examined by the National Institute for Health and Care Excellence from 2005 to 2018. Public Health April 2019 169:151-162 (https://www.sciencedirect.com/science/article/abs/pii/S0033350619300356?via%3Dihub).
- The Health Foundation. Has government grasped the full enormity of the country’s public health challenges? [Press release]. The Health Foundation; 2021. (https://www.health.org.uk/news-and-comment/news/has-government-grasped-the-full-enormity-of-public-health-challenges).
- Dixon J, Everest G. The government’s levelling up agenda: An opportunity to improve health in England. The Health Foundation; 2021 (https://doi.org/10.37829/HF-2021-C07).
Further reading
How could the Health and Care Bill strengthen action on health inequalities?
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