Health And Social Care Act

The Government's Health and Social Care Bill has cleared its final hurdle and is now law, after receiving Royal Assent on 27 March 2012.

The legislation - first published as a white paper in July 2010 - is now known as the Health and Social Care Act (2012).

Timeline: The Health and Social Care Bill - From White Paper to Royal Assent

Health Secretary Andrew Lansley published the draft Health and Social Care Bill on 19 January 2011. The bill followed on from the publication of the NHS White Paper - Equity and Excellence: Liberating the NHS in July 2010.

Due to growing concern about the reforms, Prime Minister David Cameron, Deputy Prime Minister Nick Clegg, and Health Secretary Andrew Lansley launched the Government’s 'listening exercise' in early April 2011. The ‘NHS Future Forum’ was set up to review the Health Bill before it restarted its progress through Parliament.

The consultation ended on 31 May 2011 and the NHS Future Forum unveiled its recommendations on 13 June 2011. The Forum made 16 key recommendations, including:

the pace of the proposed changes should be varied so that the NHS implements them only where it is ready to do so
the Secretary of State for Health should remain ultimately accountable for the NHS
nurses, specialist doctors and other clinicians must be involved in making local decisions about the commissioning of care – not just GPs – but in doing this the NHS should avoid tokenism, or the creation of a new bureaucracy
competition should be used to secure greater choice and better value for patients – it should be used not as an end in itself, but to improve quality, promote integration and increase citizens’ rights
the drive for change in the NHS should not be based on Monitor’s duty to ‘promote’ competition, which should be removed, but on citizens’ power to challenge the local health service when they feel it does not offer meaningful choices or good quality
all organisations involved in NHS care and spending NHS money should be subject to the same high standards of public openness and accountability.

A day later, David Cameron agreed to accept all the changes suggested by the panel of experts, including more controls on competition and a slower pace of change.

Following parliament's summer recess, MPs debated the Health and Social Care Bill at its Commons Report Stage and Thrd Reading on 6 and 7 September 2011. The Government had tabled over 1000 amendments (approximately 700 of which replaced the word ‘consortia’ with ‘clinical commissioning group’), covering issues relating to competition, duties of the Secretary of State and the NHS Commissioning Board, amongst others. All the government amendments were passed and in a final vote on the Bill on 7 September, 316 MPs voted for the Bill, 251 against; with 4 Liberal Democrats out of a total of 57 voting against the Bill.

The Bill was debated again in the Lords on 11 October 2011, where it had its Second Reading. The House of Lords refused a motion calling for swathes of the Bill to face in-depth scrutiny. Despite widespread campaigning ahead of the vote, 354 peers voted against an amendment calling for the Bill to be scrapped, compared to 220 members in support of the amendment. A key vote on whether sections of the Bill around the health secretary’s powers and competition should face in-depth scrutiny in a select committee was also not backed by peers.

After this vote, the Health Bill continued through the normal parliamentary procedure, facing a committee stage in the House of Lords. On 25 October 2011, peers began forensic scrutiny of the Health and Social Care Bill in the first of a series of ‘Committee Stage’ debates. The Committee met twice a week throughout November and December but most of the amendments put forward by Peers were withdrawn following debate.

In February 2012, ministers revealed details of a series of amendments to the Health and Social Care Bill designed to placate the raft of concerns raised by the Lords.

The changes included a clearer directive to both CCGs and the health secretary to promote a ‘comprehensive health service', following fears that CCGs could initiate controversial rationing of some services. The Government also attempted to beef up safeguards against conflicts of interest in CCGs, and inserted clauses that will require the new GP-led bodies to give clearer evidence on how they are tackling health inequalities and promoting education and training. The Government also widened the scope for CCGs to examine potential conflicts of interest, by requiring them to consider not just the interests of board members, but of ‘all members of committees or sub-committees of either the group or its governing body.'

In March 2012, the Bill survived several eleventh hour attempts to postpone the Lords' final considerations and was passed on 20 March. The Queen signed the Bill and it returned to the Commons where it received Royal Assent on 27 March and became law.

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