Health and Care Act 2022

The Health and Care Act received Royal Assent on 28 April 2022. This represented the most significant health legislation in a decade and aimed to enable greater collaboration within the health and care system. It took forward NHS England’s recommendations for reform from the NHS Long Term Plan, published in January 2019, and built on proposals in the 2021 white paper on integration and innovation.  

The core measures removed previous legislative barriers to collaboration across the health and care system, aimed to simplify decision-making processes and gave the secretary of state for health and social care a range of new powers to direct national NHS bodies, local systems and trusts. The act also legislated for policies affecting social care and public health, as well as quality of care in the NHS. 

Integration 

The act primarily aimed to support collaboration within the health system, in contrast to other more market-based (or quasi-market) approaches dating back to the introduction of the NHS internal market in 1990. 

Integrated care systems (ICSs) brought together health and care organisations in local areas to provide more joined-up care, with a focus on improving outcomes, prevention and reducing health inequalities. The act put ICSs on a statutory footing through the creation of integrated care boards (ICBs) and integrated care partnership (ICPs) as statutory bodies in each ICS.  

ICBs were NHS organisations that planned health services for their local population. With ICBs established, clinical commissioning groups (CCGs) were abolished. The legislation established that the focus of ICBs would be integration between NHS bodies, and for ICPs, integration between the NHS, local government, and other providers. The legislation established new duties for the Care Quality Commission (CQC) to oversee and assess ICSs. 

The act also sought to promote greater local collaboration between commissioners and providers through changes to procurement and competition rules.  

The act formally merged NHS England and NHS Improvement, which from 2018 had announced plans to work closer together, integrating national programmes and activities where possible. It also put the Healthcare Safety Investigation Branch (HSIB) on a statutory footing and gave the NHS in England new duties around climate change and environmental sustainability. 

Public health 

The act provided for some changes to public health. This legislation sought to reduce health disparities in oral health and obesity. The measures introduced to do this were simplifying methods to add fluoride to water in more areas of England and regulating advertising of unhealthy food and drink. 

Adult social care 

The act also included several measures affecting adult social care. 

The government had announced that it would introduce a ‘cap’ on care costs faced by individuals over their lifetime, first legislated for in the Care Act 2014 but not yet implemented. The Health and Care Act 2022 amended the Care Act to change the way that costs were metered towards the cap. Under the previous legislation, people would hit the cap on care costs after the same length of time, regardless of income and wealth. But under the amendment, only people’s personal contributions to care costs would count towards the cap. This meant that it would take longer to hit the cap for less wealthy individuals receiving means-tested support to help meet their care costs. The introduction of the cap was later delayed again. 

The act also aimed to improve accountability and oversight of the adult social care market. It amended existing legislation to place new duties on the CQC to assess local authorities’ delivery of their adult social care functions and to enable the secretary of state to act when a local authority failed to carry out those functions. It also enabled the secretary of state to make payments to profit-making care providers.  

Accountability 

The act gave increased powers to the secretary of state for health and social care to direct NHS England and other arm’s length bodies, create new NHS trusts, and intervene in local service reorganisations. The act stipulated that the NHS’s operational independence would be unaffected on a day-to-day basis. It also gave the secretary of state the duty to report on the system for assessing and meeting the workforce needs of England’s health service. 

The Health and Care Act 2022 merged NHS Improvement, Health Education England, NHSX and NHS Digital into NHS England, becoming accountable to NHS England’s board via the Chief Executive. 

Net zero 

The Health and Care Act also embedded the NHS’s commitment to net zero in legislation, becoming the first health system in the world to do so. The act placed new duties on NHS England, all trusts, foundation trusts and ICBs to contribute towards statutory emissions and environmental targets. NHS England was also given the power to publish statutory guidance on net zero. 

Debates during the bill’s final stages 

The most significant debates during the final stages of the bill’s passage related to social care reform, workforce planning, early medical termination of pregnancy, and the secretary of state’s powers of intervention in decisions regarding local changes to health services. 

Despite opposition from the government, the House of Lords made amendments to legislation regarding the cap on social care costs and workforce planning. The House of Commons later removed these amendments. Attempts by the House of Lords to remove the secretary of state’s powers to reconfigure NHS services were also unsuccessful. 

Parliament held a ‘free vote’ on provisions relating to early medical termination of pregnancy. This led to an extension of provisions for home use, which had been first introduced during the COVID-19 pandemic.