The Health Bill involves historic changes in how patient data is used at the front line, and the largest restructure of the English NHS since 2012. MPs should scrutinise these changes closely: health service reorganisations have often failed to deliver in the past. This briefing presents our understanding of the Bill and suggests questions and amendments we hope MPs will draw upon.
It builds on our original briefing published when the Health Bill was introduced to Parliament, and also when it entered Committee stage.
Key points
• The Single Patient Record is a laudable ambition. Patients and clinicians are let down by the lack of shared data across general practice, trusts, and other parts of the system. Shared data would also make research more accurate, showing which NHS initiatives really work and which do not.
• Public trust is critical to making this work. Many safeguards exist and will not change, but it would be helpful to have further details as to how the SPR will work, which bodies will be the data controller, and how it will relate to the separate Federated Data Platform initiative.
• MPs could increase the level of safeguards over patient data for the future by setting in law the general principle of patients being able to opt out of their data being shared for research, planning or other purposes outside direct patient care.
• The Bill creates new powers for the Secretary of State to intervene in NHS trusts and integrated care boards, well beyond what NHS England can currently do. These intensify the unusual centralisation of power in the English NHS, and would limit the scope for any real devolution.
• MPs should consider at least barring the Secretary of State from directing the relocation, opening, and closure of specific services, and providing for an independent commission to oversee the appointment of local NHS executives – or for combined authorities to play a role in doing so.
• The abolition of NHS England brings some opportunities, because unhelpful dysfunction and duplication did exist. It has not been handled smoothly, and disruption is inevitable. Ministers should give more clarity on how they will deliver the potential benefit of getting a grip on excessive, badly coordinated targets.
• The planned 50% DHSC job cut appears to require removing the large majority of central policy and analytical staff, or cutting operational staff. This risks having to rehire staff again or undermining new initiatives such as the Single Patient Record.
• The abolition of HSSIB and its merger into the CQC does not have a clear case behind it. It risks causing disruption and will certainly reduce independence, while not in itself reducing the number of different ways trusts are held accountable. Comparable bodies in other sectors and countries do not try to combine safety investigators with regulators.
• The abolition of local and national Healthwatches means an end to independent patient voice in the NHS. This may lose credibility, links to the community, and the ability to hold services to account. Local HealthWatches could be retained, or replaced by a new duty for independent patient voice bodies to be established by ICBs or combined authorities. It does not replace independent voice to have a function inside the ICBs.
• Several amendments proposed at Report Stage aim to broaden the scope of the Bill. The need to identify unpaid carers better, and the lack of transparency around trade agreements impacting the NHS, are pressing issues. However, statutory targets for general practice waiting times would be unhelpful.