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Health and social care bill: the issue explained
By: Patrick Butler
The Guardian, March 12, 2001
What is the health and social care bill?
Essentially, it is the legislative machinery that allows the government to take forward some of the reforms it outlined in the NHS plan published in July 2000 - a plan to
"modernise and rebuild" the health service and "reshape" the NHS from the patients' point of view.
What's in the bill?
A miscellaneous range of measures relating to primary care, long-term care of the elderly, local government scrutiny of the
NHS, patient advocacy, nurse prescribing, creation of care trusts, employment issues, and NHS drugs dispensing.
Doesn't sound wildly exciting..
Funnily enough, it is rumoured that the government - which announced the bill in the Queen's speech in December 2000, and published it shortly before the Christmas break - was expecting it to pass through parliament largely untroubled by controversy, mainly because of its unexciting technical nature.
Don't tell me - all hell broke loose
Well, it would be wrong to say it set the Commons ablaze, but it did cause a (partly successful) Labour backbench rebellion - over the abolition of community health councils
(CHCs) - and is likely to stumble in the Lords over widely disputed proposals to give the health secretary powers to disclose confidential patient information. Care trusts have also proved controversial, as have government plans to fund long term care of the elderly.
Tell me more about these controversial issues
• CHCs - local independent NHS consumer watchdog organisations - will be scrapped on the grounds that they are outdated and largely failed to act as patient advocates. Opponents have argued that this will dilute the democratic accountability of the NHS to local communities.
• The principle of patient confidentiality is a bedrock of medical practice, and clinicians must get consent from patients to use their medical files for research. The government wants to give the health secretary powers to disclose patient information where it is in the public interest, for example cancer research. Critics have dubbed it
"Orwellian" in scope.
• The government wants to pay for nursing care for elderly people in long term residential care - but it has disappointed critics by refusing to also pay for personal care, such as bathing and washing. During the passage of the bill, the Scottish Executive decided personal care would be available to patients in Scottish homes, piling further pressure on UK ministers to change tack. So far, however, they've not done so.
• Care trusts propose combining health and social services under one administrative roof to ensure "seamless delivery" of care. They will, however, be NHS bodies, and local authorities are concerned that this effectively represents a takeover of social services, which are democratically accountable to local authorities, by the
NHS, which is not accountable in the same way. Some critics would also argue that the Health Act 1999 allows everything that care trusts can do to be done anyway - without the alleged NHS takeover.
Have ministers backtracked on any part of the bill?
On the whole, no. The government had a loyal majority on the all-party group scrutinising the bill at committee stage, which nodded through all its clauses, and of course, a massive majority on the floor of the Commons to ease its passage through second and third reading. Rebel backbenchers did however force the government to compromise on the abolition of CHCs (though they couldn't prevent abolition) and there may be more ructions in the Lords. Not much will happen to change the original bill, however, unless the government decides it wants to change it. |
