The government’s Health Bill has been introduced to the House of Commons after being announced at this week’s King Speech.
Among its key elements, the Bill will cement the end of NHS England and begin another re-organisation of the health service.
Single patient healthcare records will also be introduced while patient advocacy group Healthwatch is set to be closed which could allow for “minsiters marking their own homework“.
Furthermore, there is nothing around prevention included within the Bill.
The government said the Bill aims to improve patient safety and experience through the new single patient record which would enable joined-up, proactive care and empowering patients.
It added abolishing NHS England would put power and resources in the hands of frontline NHS organisations.
Clarifying the role of local health bodies would aim to give them flexibility to design and deliver health services to best meet the needs of their local population.
Genuinely transformative
Sarah Woolnough, chief executive of The King’s Fund, called the Bill “genuinely transformative”.
“The creation of a single patient record, which if done well could help end fragmented care and significantly improve how patients and staff experience the NHS,” Woolnough said.
“But this opportunity comes with some risks, and against a backdrop of political instability.
“The Bill centralises more power in Whitehall and the hands of the Secretary of State, and may weaken independent patient voice by abolishing Healthwatch, at the very time ministers say they want to devolve more to local organisations and empower patients.
“Whether this Bill improves care will depend less on organisational reshuffling and more on whether patients ultimately see faster, better, more joined up care.”
Abolition of NHS England
On the abolition of NHS England and reducing bureaucracy, Woolnough maintained the transfer of the body’s functions to the Department of Health and Social Care (DHSC) and local Integrated Care Boards (ICBs) will fundamentally reshape how the NHS is run.
“These changes will also significantly impact how ICBs operate, from who sits around the table, to shifting who they are accountable to from NHS England directly to DHSC,” she continued.
“There are some welcome changes. Separating day-to-day performance management from ICBs’ strategic role as service commissioners is sensible, and involving mayors more closely could strengthen local accountability and community engagement.
“But there is a risk that power becomes increasingly concentrated in Whitehall. If every major change to services requires ministerial sign off, it could make clinically necessary reforms harder not easier.“
Woolnough added that while structures do matter to how a health service runs, ultimately they are not what patients care about.
“They are far more interested in the quality and speed of the care they receive,“ she continued.
“For those on the outside looking in, these technocratic restructures might look like rearranging deck chairs on the Titanic whilst many core problems around the nation’s health remain unresolved. And every minute spent navigating reorganisation is a minute not spent planning and delivering high-quality care.”
Single patient record
The single patient record represents the greatest opportunity to improve people’s experience of the NHS and their health contained within this legislation.
“On the NHS App, people would be able to see their primary, secondary and social care record all in one place, ending decades of frustrations around fragmented information and care,” Woolnough highlighted.
“There are concerns over who will ultimately be responsible for the data and ministers must ensure it is designed carefully to allay those fears. It is likely to be the most controversial element of the NHS Modernisation Bill but is worth making the argument for and one that we hope the government wins.”
Abolition of Healthwatch
On scrapping Healthwatch England and its local branches, Woolnough contended this would remove a mechanism for independently gathering rich and often unsolicited feedback of people’s experience using the health and social care system in England.
‘Earlier this year, The King’s Fund published research on the learnings from Healthwatch and what the future of the patient voice should look like,” she said.
“It concluded it should have independence at its heart and operate on a scale which supports both local and national insights.
“Without it, this Bill could leave the door open to the NHS and ministers ‘marking their own homework’ on patient experience by locating these functions in Whitehall and the local organisations that themselves commission services.”
Bill omissions
But aside from health secretary Wes Streeting’s resignation yesterday and the actual text of the Bill, Woolnough said perhaps the bigger story is what is not in the legislation.
“The lack of focus on prevention means opportunities are being missed on obesity, alcohol misuse, the promotion of clean air and generally shifting the balance of health spending away from hospitals,” she continued.
“To borrow the government’s phrase of going ‘further and faster’, without more announcements in this area, structural reform alone won’t be enough to make the NHS ‘fit for the future’ in a way that patients will feel.”