Snap guide to this session’s Government legislation 12) Health and Care Bill

26 Sep

The Bills announced in each session’s Queen’s Speech are the fulcrum of the Parliamentary year.  But they are easily lost sight of, separately and wholly, as the political cycle moves – and a mass of other news and events crowd them out.

So during the coming months, ConservativeHome will run a brief guide, on most Sunday mornings, to each Bill from this year’s Speech: what it is, whether it’s new, its main strengths and weaknesses – and whether it’s expected sooner or later.

11. Health and Care Bill

This Bill proposes the first major NHS reorganisation since the Lansley reforms of the early Coalition years.  It is divided into five main parts.

The first contains the organisational meat of the Bill – the clauses on integation and collaboration.  Part Two covers health and adult social care information, and Part Three the Secretary of State’s powers.  Part Four establishes a Health Services Safety Investigations Body.  And Part Five covers miscellaneous provisions, including the advertising of “less healthy food and drink”.

Responsible department

The Department of Health and Social Care, so Sajid Javid is in the lead.  And he indeed opened the debate on the Bill’s Second Reading during the summer.

Edward Argar, who wound up that debate and is still in place post-reshuffle, will presumably lead on the Bill in committee when it returns to the Commons.

Carried over or a new Bill?


Expected when?

Currently under consideration – it received its Second Reading in July.

Arguments for

The core of the Government’s case is that “the overwhelming majority of these proposals are changes that the health service has asked for”.  These feature, broadly speaking, a tilt away from the competition principle furthered by the Lansley changes, and one back to the co-operation principle which has been stressed less since the Clarke/Milburn/Lansley reforms, carried out under both main parties.

Ministers argue that the Covid pandemic has shown up organisational problems within the provision of health and social care – such as the unnecessary retendering of contracts, data that can’t be shared between different NHS and social care providers, and above all the siloes that prevent patients being moved seamlessly from one part of the system to others.

Arguments against

A classic pincer movement could be made against this Bill.  From the Right, it would be that the competition-based Clarke/Milburn/Lansley reforms have done much to improve choice, improve value for money and efficiency within the service, and that any shift away from the competititon principle risks creating cartels that cost more but deliver less value for patients.

From the Left, the case as made by Labour during the Second Reading debate welcomed the removal of the Lansley competition rules in Part One of the Bill; quarrelled with aspects of the new local health boards (including their boundaries, independent sector representation and composition) and objected to the new powers for the Secretary of State.


The context of Britain’s emergence from the pandemic, and the consequent challenges for the NHS and social care, is crucial to understanding the politics of the Bill.  The Government must grapple with a backlog of treatments, the cutback in face-to-face GP appointments, reforming Mental Health provision – and, not least, the unresolved issue of improving social care.

Labour’s main attack, for all the above, has been about what isn’t in the Bill: mainly, yet more money and resources.  The Opposition is preparing the ground for a political attack as queues for treatment grow.  This is more important to it than the reorganisation itself, on which their attack has been headed off (since Simon Stevens, the outgoing NHS Chief Executive, was clearly a force behind it).

Controversy rating 4/10

We give this Bill a low score because the attack from the Right in Parliament hasn’t materialised (only three Conservative MPs opposed it at Second Reading), and because the thrust of the Left’s healthcare attack comes elsewhere.  Javid’s hesitation about its timing hints at a bigger theme: this is scarcely the first NHS reorganisation, as those competition and co-operation principles clash, and it won’t be the last.

Ten questions for Johnson’s reshuffle

7 Sep

  • What does the Prime Minister do about economic policy?  His instinct is for government to spend a lot; Rishi Sunak’s is for it to spend less.  Boris Johnson would clearly be reckless to lose his second Chancellor in less than two years, and we don’t believe that he will try to move him. Furthermore, it isn’t at all clear who would play Anthony Barber to the Prime Minister’s Edward Heath.  But Sunak’s public pitch for loyalty over social care yesterday only confirmed the tensions between him and the Prime Minister. Johnson will be brooding over the future of the man who is favourite eventually to replace him.
  • Who runs Downing Street?  The Prime Minister frets about the unresponsiveness of the official machine.  He has lost Dominic Cummings.  He is installing a Delivery Unit.  He is beefing up his own political operation.  Does he take the radical option of creating a Prime Minister’s department?  Or the established one of relying on the Cabinet Office?  Either way, who does he put in charge?  Does he keep Michael Gove?  Move in Dominic Raab.  Or else send for Oliver Dowden – just as David Cameron’s former Deputy Chief of Staff is enjoying his own place in the sun in his own department (and perhaps eyeing Education)?
  • What about the Home Office and the Foreign Office?  Some in Number Ten share our panel’s lack of confidence in Priti Patel; Raab has been in place for almost two years.  Gove has been punted for both posts but, for all his talents, there is only one of him.  And if he moves out of the Cabinet Office, who will take the lead on Scotland?  Our bet for Foreign Secretary were the shuffle to come late would be Alok Sharma, now that he has globetrotting experience wearing his COP26 hat.  Will Johnson really promote the Cabinet League Table-topping Liz Truss, who he is bound to see as a potential rival?
  • Who does Johnson bring back and at what level?  John Whittingdale was brought back to support Dowden.  James Brokenshire was returned to help Patel.  When his illness worsened, another former Cabinet member, Damian Hinds, replaced him.  The message is: keep your nose clean, and there’s a way back.  But is the Prime Minister prepared to do the same at Cabinet level – summoning Liam Fox or Jeremy Hunt or Iain Duncan Smith or Geoffrey Cox or Robert Halfon or other members of the Alternative Cabinet?  For given the scale of the foreign and domestic policy challenges, there’s a lack of experience at the top.
  • Which women…?  The optics will be an inevitable feature of the shuffle, whenever it comes.  Johnson will want to increase the number of women at the top table.  Anne-Marie Trevelyan must be top of the list to return, but she only recently started her job as Energy Minister.  The Prime Minister will be keeping a watchful eye on the ambitious Penny Mordaunt.  Kemi Badenoch must be on any list for promotion, but is she ready to run a department?  Look out for Lucy Frazer, a potential future Justice Secretary; Chloe Smith if her health allows and, if media deployment is any guide, Helen Whateley. Will Tracey Crouch return?
  • …Ethnic minority members?… Nadhim Zahawi is being punted for co-Party Chairman, but he could also slot in at Education, where he has served as a junior Minister, or perhaps at Culture.  James Cleverly has been out of the domestic media eye at the Foreign Office and must be due to go back in it again.  Kwasi Kwarteng has only recently been appointed and will presumably stay where he is.  Lower down the ranks, Claire Courtino will go up sooner rather than later; then there is Ranil Jayawardena and, down in the Whips’ Office, Alan Mak.
  • …And Red Wallers…?  If promoting ethnic minority members is playing identity politics, so would be favouring white working class people.  MPs for the new Conservative northern and midlands seats aren’t necessarily working class – nor Red Wallers, strictly speaking – but they are yet another group that Johnson must consider.  Cabinet promotion from the 2019 intake would be drastic, and Johnson is more likely to turn to the trailblazers of 2017.  That might mean, say, Lee Rowley, the Tory Deputy Chairman, but the name most frequently raised is that of Simon Clarke, the former Business Minister.
  • P.S: what about appointment on merit?… Beware, Prime Minister, of the backlash from your average Conservative MP: male, white, and (in his view) overlooked because of political correctness.  “With one exception, those promoted in our intake have been women, ethnic minority members, or gay,” one 2019er complained to ConHome.  What about the Kit Malthouses and Edward Argars?  (The latter has had much to do as a Health Minister during the pandemic.)  Is there a quota on Old Etonians that keeps out Jesse Norman?  What about able backbenchers, such as Richard Fuller?
  • …And communicators?  The Government is short at the top of people who can get on the front foot on TV, if that’s quite the right way of putting it.  There’s Sunak, Gove, the Prime Minister himself, a more relaxed Grant Shapps, and Kwarteng.  And that’s about it.  Which is why Cleverly is due a return, and perhaps Brandon Lewis too.  He would fit in at Housing were Robert Jenrick to be moved, but on balance this is unlikely.  Jacob Rees-Mogg has been confined to the Commons as Leader of the House, and were he appointed Chief Secretary, he would be restricted to the Treasury.
  • What’s the least bad timing?  The infallible rule of reshuffles is that the anger of those sacked outweighs the gratitude of those promoted.  A shuffle this week would refresh the Cabinet before the conference season.  But one later would ease moving Raab, Ben Wallace or both: besides, it isn’t yet clear that Covid has run its course.  We assume when the shuffle comes Gavin Williamson will be moved, and at least two Cabinet members fired.  More, and Johnson will risk a “night of the long knives”.  Fewer, and what’s the point?  P.S: the promotion of the Johnsons’ old mucker Zac Goldsmith is a possibility.