The Health and Social Care Bill needs a complete rethink

The Health and Social Care Bill 2021 is currently in the House of Lords and will shortly be returning to the House of Commons where it is likely to receive a mixed reception with some believing that it will lead to further privatisation and others opposed to the 1.25% precept on National Insurance.

In recent months the “cost of living” crisis has been added to that of health and social care.

Rising food and energy prices will hit those on low incomes disproportionately as they are essential items. The recent two-part BBC programme “The decade the rich won” highlighted the widening income inequality of the last decade. And according to a report by the Paris-based World Inequality Lab, 2020 saw the steepest increase in billionaires’ wealth on record.

Britain has one of the lowest state pensions in the western world with 2m older people living in poverty. There is a wealth of empirical evidence on the “social determinates of health” which has demonstrated the correlation between income and demand upon the NHS, so it is hardly surprising that 80% of the expenditure of the NHS goes on older people.

Unless Government does something to lift people out of poverty it will never keep pace with the increasing demand for health care. It is no use throwing more money at the first aid camp at the bottom of the cliff rather building a fence at the top. So, what would the outcome have been if the Government had used some of the additional £57.5b it has committed to health and social care to increase the basic state pension and lift older people out of poverty?

Over the past thirty years successive reorganisations have added to the cost and fragmentation of services, so there are now 551 organisations 24 County Councils, 181 District Councils and 58 Unitary Authorities in England and 22 County Councils in Wales, 223 NHS Trusts and 43 Police Authorities all serving different geographical areas, with different funding streams and different lines of accountability.

The proposed “Integrated Care Systems” and “Integrated Care Partnerships” will be very costly and appear more concerned with preserving the current configuration of local authorities and NHS Trusts and the purchaser / provider split and commissioning than they do the provision of integrated care. These 551 organisations could be merged into around 120 Unitary Authorities – based on the old County Council areas – returning the NHS and police to local democratic scrutiny within central government direction and, in many cases, taking out a tier of local government.

Regrettably the Health and Social Care Bill appears to be a quick fix component level response to a whole systems problem and will simply push the problem on a few years.

It needs a complete re-think.

* Chris Perry is a former Director of Social Services for South Glamorgan County Council, a former Management Consultant, a former Non-Executive Director of the Winchester and Eastleigh Healthcare NHS Trust, a former Director of Age Concern Hampshire and a former presenter of a weekly current affairs programme on Express FM. Now retired.

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This entry was posted in Op-eds.


  • David Garlick 14th Feb '22 - 3:54pm

    Sound article. Makes sense to those who have not. The ‘Haves’ don’t seem to agree.

  • katerina porter 14th Feb '22 - 9:46pm

    In a recent report (Alton?). says Britain is the 5th richest country in the world but has millions in poverty – and that is a political choice.

  • Chris Perry 15th Feb '22 - 1:13pm

    It is very encouraging to see so much support for a whole systems approach to these pressing problems. Not only can such an approach enhance the lives of many but also, in the longer term, prove less costly on the public purse reducing the tax burden on working people. It will take “Political Will” and “popular support” to get things moving.
    The 3.9m children being brought up in poverty, 2/3rds of whom have a parent in work, also needs urgent attention.

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