The Health and Care Bill 2021/22 outlines major changes to NHS rules and structures in England. The Bill is the largest legislative shake-up of the NHS in a decade and undoes many of the changes introduced by the Coalition government in the last round of major NHS legislation back in 2012.

The Health Foundation has welcomed the Bill’s broad emphasis on increasing collaboration between different parts of the health and care system. Although the benefits of these changes should not be overstated, encouraging collaboration to improve care makes sense and goes with the grain of recent NHS policy. We also welcomed the government’s amendments to encourage a data driven approach to addressing health inequalities.

The House of Lords has repeatedly voted to amend the Bill in two critical areas:

  • Workforce planning – Peers have supported amendment 29B to clause 35, requiring the Secretary of State to publish independent assessments of current and future workforce numbers every three years. This is a compromise on a previous proposal.
  • The social care cap – Peers rejected the government’s amendments to the Care Act, which would put more people at risk of catastrophic care costs.

This briefing sets out why these decisions should be upheld as the Bill returns to the House of Commons. It also outlines our analysis of other key proposals within the Bill, including increased powers for the Secretary of State, the establishment of Integrated Care Systems (ICSs), action to address inequalities, and improved data sharing.

Further reading


Health and Care Bill


Our analysis of the key proposals in the Health and Care Bill 2021/22.

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