The Health and Care Bill proposes reforms to the health and care system in England. However, there are many things our members need changing in it.

As it is drafted, it doesn’t yet put sufficient legal requirements on the government to fix the nursing workforce crisis in England. 

With your help we can influence MPs and peers to vote for amendments to the bill to ensure the government is required to take explicit action in order to achieve safer staffing and protect patients.  

What’s a bill?

A bill is a proposal for a new law, or a proposal to change an existing law, that’s presented for debate before parliament. Bills are introduced in either the House of Commons or House of Lords for examination, discussion and amendment. 

What will the Health and Care Bill do? 

The Health and Care Bill sets out structural changes to the way that health and care services are delivered by trying to encourage greater collaboration between services. The previous Health and Social Care Act 2012 set competition as the main principle of delivering health services, and this is being reversed by the new bill. 

The bill also gives the Secretary of State for Health and Social Care a broad set of powers to direct how NHS services are delivered, including intervening in local reorganisations of services. Our members have raised concerns about these powers and we are actively lobbying for safeguards. 

While it is welcome that integrated care is being placed on a legal basis, the RCN is also raising significant concerns about what is missing from the bill. As it currently stands, the bill does nothing to require the government to tackle the chronic short staffing of health and care services.  

Without tackling the staffing crisis, we’re concerned that the aims of high-quality integrated care will not be achievable.  

How will this bill become law?

The proposals in this bill are still a long way from being finalised and need to be debated and voted on in parliament before they can become law. There are various stages to this, as explained on the UK Parliament website

What stage is the bill at now?

Thbill has completed its Commons stages – where MPs debated and voted on the bill – and is now being considered in detail by the House of Lords.

How are we trying to influence the bill?

Changes can be made to bills through a process of amendments. They must be proposed or “tabled” by MPs in the Commons or by peers in the House of Lords.  

RCN members are calling for changes to the bill which:

  • set out in the legislation that the Secretary of State for Health and Social Care has full accountability for the planning and supply of the health and care workforce
  • create a new duty on the Secretary of State to publish an assessment of workforce requirements based on population need  
  • include a role of executive nurse on integrated care boards
  • ensure that decisions about service reconfiguration are made in partnership with local communities and based on health expertise, safety and quality
  • guarantee consultation with relevant trade unions on any changes to the NHS payment scheme
  • provide professional bodies, such as the RCN, delegated standard setting functions
  • ensure a safe space for health and care staff to raise safety concerns 
  • recognise that within the current severe workforce crisis, the discharge to assess model cannot be implemented safely for patients or staff 
  • set out explicit duties for the government and NHS England to tackle health inequalities and for integrated care boards (ICBs) to report on the action they are taking to reduce health disparities. 

The bill is progressing through parliamentary stages and is currently in the House of Lords. We are working with peers to secure amendments to the bill and will be updating this page when Parliament reopens in early 2022.

What has the RCN done so far?

Over a long period of time members have been lobbying ministers and MPs to make the case for legislative change to ensure there are enough staff to deliver safe and effective care. It’s a crucial part of our staffing for safe and effective care campaign.  

When the bill was in the Commons, we encouraged members to email their MP asking them to vote in favour of the key amendments outlined above. More than 4,400 emails were sent to MPs reaching 525 of the 534 constituencies in England, meaning 98% of MPs were contacted. 

RCN General Secretary & Chief Executive Pat Cullen also gave evidence to the Health and Care Bill Committee in September 2021, and the RCN submitted written evidence. Pat told MPs that workforce measures in the bill must be strengthened, and the Health Secretary made legally accountable for health and care systems having enough nursing staff to deliver safe and effective care.  

Persistent, systemic workforce issues put nursing staff and patients at risk  

In September 2021, there were 39,813 full time equivalent registered nurse vacancies in the NHS in England, equating to a vacancy rate of 10.5%. It is not acceptable for nursing staff to be required to practise in this way or for patient safety to be compromised so severely.  

We have evidence of the unsustainable levels of pressure nursing staff are working under

Action must be taken to tackle serious staffing pressure, sickness, burnout and the growing backlog of undelivered care in the health and care environment. Look at and share with others the evidence in the Ten Unsustainable Pressures on the Health and Care System in England report.

Find out more

Read about our campaign for safe staffing in England and our policy briefing on the Health and Care Bill

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