Intended for healthcare professionals

Feature Briefing

Ten things you need to know about the Health and Care Bill

BMJ 2022; 376 doi: (Published 16 February 2022) Cite this as: BMJ 2022;376:o361
  1. Tom Moberly, UK editor
  1. The BMJ
  1. tmoberly{at}

It’s the first big overhaul of the NHS in England since 2012. Tom Moberly asks what doctors need to know

The clock is ticking

The new Health and Care Bill is the first major legislative reform of the NHS in England in a decade, and contains measures on the NHS, social care, and public health. The bill is scheduled to become law by April, although there are doubts this deadline will be met.

The proposed legislation is currently being examined by the House of Lords, and any amendments that are agreed then need to be taken to the House of Commons. The NHS’s latest planning guidance has pushed back the deadline for when the new NHS structures would be established on a legal basis by three months to July 2022.

It is a story of two halves

The bill consists of two big sets of legislative changes that are designed to perform two quite different functions but have been lumped together.

The first is largely to tidy up the mess left by Andrew Lansley’s Health and Social Care Act 2012—promoting integration and collaboration over competition, ending requirements around enforced competition, and introducing legal and organisational changes to close the gap between how the current system was set up and how it is now working. These changes will make it easier for local health commissioners to renew contracts with those existing providers that are seen to be doing a sufficiently good job, without having to go out to the market before awarding a contract.

The second is to enact a ministerial power grab, giving the secretary of state more control over local health services. This is thought to be a response to ministers’ frustration with the independence afforded to local health systems and their own relative lack of control over the delivery of their priorities for the NHS.

The bill also includes …

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