The Amended Health and Care Bill is just as bad as the original version 

The amended Health and Care Bill will return to the House of Commons on 22nd and 23rd November for its Report and Third Reading.

It is in no better state than it was before the MPs in the Public Bill Committee debated amendments for two whole months, from 7 September to 2nd November.

None of the 161 Labour amendments (brought by Justin Madders or Margaret Greenwood) were agreed. They were all either:

  • withdrawn after debate
  • not called
  • not selected
  • voted down after division

A handful of Government amendments, brought by Health Minister Edward Argar, were agreed.

Plus one more that Argar has promised to present at the Report stage in the House of Commons on 22nd November, that will prevent private companies’ influence on Integrated Care Boards. But it is a dead cat.

Update 17.11.21: Here are the new amendments tabled for the Report stage .

And here is Argar’s promised Government amendment. It is pathetic.

Schedule 2, page 125, line 26, at end insert— “3A The [Integrated Care Board] constitution must prohibit a person from appointing someone as a member (“the candidate”) if they consider that the appointment could reasonably be regarded as undermining the independence of the health service because of the candidate’s involvement with the private healthcare sector or otherwise.”

As well as being singularly pathetic about private company members of the Integrated Care Board, this government amendment does nothing to prevent private companies’ membership of and decision making roles in Provider Collaboratives – which will control huge budgets and commissioning decisions delegated from Integrated Care Boards. (This is apparently enabled by Clause 60, which inserts new provisions into the NHS Act 2006 as a catch-all way to let Integrated Care Boards and just about anyone else delegate functions to, or exercise them jointly with, just about any body “at place and system level” that the Department of Health and Social Care may decide to make regulations about.)

The Health and Care Bill amendments have done nothing to make the Bill fit for the 21st century NHS

All the desperate flaws are still there, that are listed in the Don’t Blow It! letter that thousands of constituents have sent to around 400 MPs, asking them to vote against the Bill at its 3rd reading.

Unfortunately so far only 25 MPs have replied to constituents who sent them the Don’t Blow It! letter (and who gave around 100 MPs the Don’t Blow It! handkerchief as well.)

Nearly all of the MPs who’ve replied have just sent their standard Party response. We have thoroughly fact-checked the Conservative Party template and found it to be based on prejudice not evidence. (The fact check document is downloadable at the end of this blog post).

The standard Labour Party response also leaves much to be desired.

Only 2 MPs out of the 400+ who received the Don’t Blow It! letter from constituents have said they’ll vote against the Health and Care Bill at its 3rd reading.

Some Conservative MPs’ replies have been plain rude and ignorant. Epsom MP Chris Grayling told his constituents their letter was “complete nonsense…absolute rubbish.”

Other Conservative MPs accused their constituents of “irresponsible scaremongering” – a regrettable lapse into personal attack as a way of evading the facts.

You can read Chris Grayling’s reply to his constituents here, along with the Don’t Blow It! rebuttal:

The handful of Government amendments

Amendments 10, 11, 14 are finicky technical changes.

Amendments 12 and 13 reinstate the responsibility for Integrated Care Boards to commission secondary medical services (ie hospital services) and ophthalmic services.

Even so, Amendment 12 is not enough to make sure that the Bill upholds the government’s duty to provide an effective framework for protection of the right to life. Here is CK999’s full explanation of Amendment 12 and its weakness:

Amendments 15 and 16, respectively, require the Care Quality Commission to consult Integrated Care Boards before appointing a Trust Special Administrator, and require NHS England to consult ‘relevant Integrated Care Boards’ before exercising its discretion to make a trust special administration order for an NHS trust.

Amendments 117-121 are about Part 2 of the Health & Care Bill – the data bit: HEALTH AND ADULT SOCIAL CARE: INFORMATION.

117-120 amend Clause 79 Information Standards in order to:

  • Require providers to comply with information standards;
  • Allow for the application of mandatory information standards to private providers and to public bodies that exercise functions in connection with the provision of any health care in England – and not simply NHS services;
  • Make consequential amendments to clarify that information standards can be applied to healthcare information generated outside the NHS – by defining “health care” to include all forms of health care whether relating to physical or mental health and procedures that are similar to forms of medical or surgical care but are not provided in connection with a medical condition”;
  • Define “health services”: as services which must or may be provided as part of the health service in England, as in the National Health Service Act 2006 (see section 275(1) of that Act).”;

This basically means information standards are applied to healthcare data generated outside the NHS. (In the Amended Bill, what was Clause 79 in the original Bill is now Clause 81.)

Amendment 121 amends Clause 80 with regard to sharing anonymous health and social care information.

There has been no change or apparent opposition to Part 2 clauses on the Secretary of State’s powers to transfer or delegate functions. (The clauses were 86-87 in the original Bill and are 88-89 in the amended Bill.)

This leaves things wide open for NHS England to be awarded ‘COPI-like’ powers of data collection post-pandemic, for it to continue to feed patients’ data to Palantir – as per its ‘business as usual’ Planning and Population Health Management intentions.

(‘COPI’ is Control of Patient Information)

On 11 Dec 2020, the UK government quietly sealed a deal with Palantir, worth up to £23 million, to run its massive health datastore for two years. This was despite government assurances in legal correspondence with Foxglove that Palentir’s ‘COVID datastore’ would be unwound at the end of the pandemic and the data destroyed. The government also assured Foxglove that any extension would go out to public tender, in which taxpayers could see and debate the issues at stake.

Ignoring these commitments, the December 2020 contract paved the way for Palantir to play a major, long-term role in the NHS beyond COVID – as the NHS England/Improvement National Director for Data and Analytics announced a week after the contract award.

It’s not clear what precisely Palantir has been given access to: the list of NHS datasets that the firm will draw on have been redacted from the contract. Foxglove point out that what is clear, is that the government deliberately struck this deal on the quiet – knowing it would be controversial.

(Whether the Department of Health and Social Care itself takes such ‘Control of Patient Information’ powers to continue feeding its own BAE-built data platform remains to be seen. This is the Edge system to hold adult social care data. Lawyers acting on behalf of openDemocracy have written to the government demanding transparency about this system)

Amendments 147 and 148 are about a new clause 59—Care Quality Commission reviews etc of integrated care system.

This new clause imposes a duty on the Care Quality Commission to carry out reviews and assessments into the overall functioning of the system for the provision of NHS Care and adult social care services within the area of each integrated care board.

In the Amended Bill, these amendments seem to have been inserted as new clause 25 ‘Care Quality Commission reviews etc of integrated care system’, in the section, ‘Integrated care system: reviews and further amendments.’

These amendments seem to be a response to the Health and Social Care Select Committee response to the Bill when it was published in July:

“Rt Hon Jeremy Hunt MP, Chair of Health and Social Care Committee, said:

“While we welcome the direction of travel in health and care services outlined by the Bill, the proposals for Integrated Care Systems must be subject to transparent and independent Ofsted-style assessments on the quality and safety of care if improvements are to be delivered for patients.”

The Health and Care Bill is also amended by new clauses 60-62

New Clauses 60 and 61 seem to switch the power of intervention when a local authority is failing in their social care functions, from the Care Quality Commission to the Secretary of State.

New Clause 60 would create a new power for the Secretary of State to intervene where local authorities are failing in the exercise of functions under Part 1 of the Care Act 2014 (adult social care) and make consequential amendments

New Clause 61 would remove the power of the Care Quality Commission under section 50 of the Health and Social Care Act 2008 to give a notice of failure to an English local authority.

New Clause 62 Pharmaceutical Services: Remuneration In Respect Of Vaccines Etc. This new clause expands a power to make regulations under section 164 of the National Health Services Act 2006 (which, among other things, provides for circumstances in which no remuneration needs to be paid to persons who provide pharmaceutical services in respect of products because they are supplied by a health service body).

The reason for this is to allow further products to be centrally stocked and supplied free of charge to community pharmacies without the need for reimbursement under the standard NHS arrangements. The only products that it will cover are vaccines, pandemic treatments, and associated products such as diluents and syringes.

“There are various reasons why we may seek to procure centrally vaccines or products used to treat a pandemic, for example when the typical competitive supply chain and reimbursement arrangements cannot be relied on, because pressures from global demand mean that central purchasing and direct supply to community pharmacies is critical to maintaining continuity of supply for UK patients. In those circumstances, if centrally purchased products, rather than being supplied directly to pharmacies, were sold to wholesalers, that would risk wholesalers exporting or selling the stock at a much higher price than is usually paid, thereby playing the market. In this example, that would defeat the original purpose of the central stockpile.” (Public Bill Committee debates,

You can read the Amendments here (if you can bear it) https://publications.parliament.uk/pa/bills/cbill/58-02/0140/amend/health_rpro_pbc_1102.pdf

The Public Bill Committee debates are here:

The Don’t Blow It! Fact Check of the standard Conservative MPs’ response is here:

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