Health and Care Bill

Written evidence on the Health and Care Bill submitted by the Health Devolution Commission.



The Health and Care Bill has the potential to transform the way that our health and social care system works to both improve the quality of NHS and social care services and to improve the health of the population and reduce health inequalities. However, the cross-party, cross-sector Health Devolution Commission - whilst broadly welcoming the legislation - stresses the need to embed in the legislation three key principles if the Bill is to be the much needed step forward in building a system-wide approach to addressing the challenges the nation’s health services face as we emerge from the Covid-19 pandemic.

These are:

· build a genuine partnership of equals between the NHS and local government to deliver person-centred care through place-based partnerships

· ensure genuine levelling up in the system : levelling up between DHSC and local government, between NHS services and social care, between physical and mental health, and between treatment and prevention.

· provide a genuine focus on reducing health inequalities in communities as well as delivering better, more integrated health and social care services.

The Health Devolution Commission – Co-chairs former Health Secretary Andy Burnham and former Health Minister Norman Lamb (see addendum for wider membership and partners) - has published a number of reports including most recently Levelling Up Health – also attached as a word document.

In brief the Commission believes there is a risk that the new legislation could lead to a more centralised NHS primarily focused on acute health care services and will fail to deliver its goal of system-wide health services transformation unless it includes a number of key checks and balances. These include mechanisms to ensure there is the correct balance of duties, resources and powers in decentralised ICSs between:

· improving health and care services for people, and improving the population’s health and reducing health inequalities;

· improving NHS services alone, and improving and integrating health and social care services;

· improving and integrating health and care services in the community, and improving institution-based acute services;

· freedom for local and accountable partners to work together to deliver an effective system, and national direction of local systems by central government.

The Commission is also deeply concerned that these proposals for better integration of health and care are being taken forward before proposals for reform and additional funding of social care have been agreed and published. The publication of these is now an urgent priority if the Bill is to achieve its aims.

We are also attaching a briefing by the Commission for MPs prior to the 2nd Reading Debate on the general principles of the Bill on the 14th of July. This highlighted seven key  issues that should be further examined in detail during the Bill’s Committee Stage in Parliament including:

1. The triple aim duty should be more specific than ‘consider the effects of their decisions’ or ‘have regard to the need to reduce inequalities between patients’ and include a specific duty to reduce health inequalities in the population as well as in the delivery and outcomes of health services.

2. The legislation should make clear that the NHS and Local Government are viewed as equal partners in integrated care systems, working together equally, as described in the NHSE ICS Design Framework, to produce both the Integrated Care NHS  Board forward plan and the Integrated Care Partnership health and wellbeing strategy.

3. The Bill should acknowledge that ‘place based partnerships’, based on the principle of subsidiarity and the footprints of councils with adult social care responsibilities, are the building blocks of the Integrated Care Systems and the principal level at which integration, and delivery, of services should be taken forward.

4. The presumption should be that the ICS Partnership is chaired by a Local Government leader - or Metro Mayor if agreed by a relevant Combined Authority -  and include a range of members from the NHS, Local Government, Universities, LEP(s), the Voluntary, Community and Social Enterprise (VCSE) sector and patient representative bodies.  A Local Government or Combined Authority leader should be a vice chair of the Integrated Care NHS  Board alongside an NHS nominee.

5. It should be clear what it means for ICBs to ‘have regard’ to the integrated care strategy. In the legislation for new standards on information sharing, the explanatory note says, that ‘providers of health or adult social care to whom such standards apply will have to comply with them, rather than merely having regard to them’ (our italics.) Similarly, the ICB should have to ‘comply’ with the ICP’s integrated care strategy rather than ‘merely’ have regard to it.

6. The Secretary of State should not have the power to intervene in any local decisions of an ICS unless there is a clear breach of the NHS mandate or constitution. The government should make clear its expectations on the accountability of place-based partnerships to the integrated care board and partnership in ways that respect the principle of decentralisation.

7. The development of the social care workforce should be included in the 5-year workforce plan to be published by the Government. This should be in the form of a Social Care People Plan and Promise that mirrors the NHS People Plan and Promise as proposed by the cross party, cross-sector Future Social Care Coalition. 

Phil Hope, former Minister for Care and lead author of the report, and myself as Director of the Health Devolution Commission as  well as Co-chairs Andy Burnham and Norman Lamb would be happy to be invited to give oral evidence to the Scrutiny Committee.

Best wishes




Director, Health Devolution Commission




What is the Health Devolution Commission?


The Health Devolution Commission advocates for a devolved approach to healthcare delivery and accountability. It has produced a number of reports over the past two years.  


The Commission brings together two former, Labour and Conservative, Secretary of States for Health, Andy Burnham and Stephen Dorrell, with three former Health Ministers including Norman Lamb, Alastair Burt and Phil Hope. They are joined by senior professional figures from the health, mental health, local government and third sectors.  


Who are members of the Commission :


Health Devolution Commissioners


· Rt Hon Andy Burnham, Mayor of Greater Manchester and former Secretary of State for Health (Co-chair)

· Rt Hon Sir Norman Lamb, former Minister for Community and Social Care (Co-chair)

· Rt Hon Alistair Burt, former Minister for Community and Social Care

· Rt Hon Stephen Dorrell, former Secretary of State for Health

· Phil Hope, former Minister of State for Care Services

· Dr Linda Patterson, former Medical Director of CHI and Vice President of RCP

· Peter Hay, former President ADASS


Advisory Commissioners


· Cllr Paulette Hamilton, Vice Chair, LGA Community Wellbeing Committee

· Sarah Walter and Michael Wood, NHS Confederation

· Dick Sorabji, Deputy Chief Executive, London Councils

· Professor Jo Pritchard and Dr Andrew Catto, Social Enterprise UK

· Steve Mulligan, Four Nations Lead, BACP

· David Weaver, President, BACP

· Seamus O’Neill, Chair, the Northern Health Science Alliance

· Rob Webster, Chief Executive, South West Yorkshire Partnership NHS Foundation Trust

· Jo Webster, Chief Officer, West Yorkshire and Harrogate Health and Care Partnership

· Sarah Price, Interim Chief Officer, Greater Manchester Health & Social Care Partnership

· Warren Heppolette , Executive Lead, Strategy & System Development, Greater Manchester Health & Social Care Partnership


Prepared 15th September 2021