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• W3136756963 abstract "The UK Government has outlined its legislative proposals for a new Health and Care Bill.1Department of Health & Social CareIntegration and innovation: working together to improve health and social care for all.https://www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all/integration-and-innovation-working-together-to-improve-health-and-social-care-for-all-html-versionDate: Feb 11, 2021Date accessed: February 12, 2021Google Scholar The objectives, heavily aligned with the National Health Service (NHS) England Long Term Plan, include strengthening integration, reducing bureaucracy, and improving accountability. Although the timing is questionable, to the extent that these proposals aim to promote integration and cooperation, they should be welcomed. However, this legislation underpins another aim: to take back control of the NHS, with plans for the government to have enhanced powers of direction over a merged NHS England and NHS Improvement, and to transfer functions between health-related bodies, such as the Care Quality Commission, Health Education England, and the National Institute for Health and Care Excellence.1Department of Health & Social CareIntegration and innovation: working together to improve health and social care for all.https://www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all/integration-and-innovation-working-together-to-improve-health-and-social-care-for-all-html-versionDate: Feb 11, 2021Date accessed: February 12, 2021Google Scholar The rationale and policy evidence behind these proposed legislative changes are unclear. The last attempt by the current government to supposedly take back control, Brexit, has not inspired much confidence in the smooth running of policy. Ask the UK fishermen or just about anyone in Northern Ireland. Certainly, if NHS management is drawn into ministerial control, there is the risk that NHS objectives will conflict with other pressing government priorities, not least the various public finance issues that will continue past the lifetime of this government. In taking back control, reflection on how the UK Government has handled the ongoing pandemic is necessary. The UK has one of the highest COVID-19-associated death rates in the world.2Raleigh VS UK's record on pandemic deaths.BMJ. 2020; 370m3348Crossref PubMed Scopus (8) Google Scholar The early shortages in personal protective equipment delivery were scandalous. The track and trace system was not a world-beating system, as claimed. Conversely, aspects of the NHS response, particularly those not fully directed by the government, deserve recognition. In a matter of a few weeks, critical care capacity was massively expanded, many thousands of staff reallocated, and services reorganised to reduce transmission of COVID-19. The NHS has also established world-leading clinical trials on vaccines and treatments. As of March 14, 2021, the NHS has delivered the first of two vaccine doses to more than 24 million people in the UK. The main messages from these legislative proposals are improved integration and ministerial control. Note that most ministers for health will last less time than it takes to train a nurse or a doctor—hardly the sustainable outcome that would be wished for. Little is said on how the legislation will fund the delivery of any improvements. Surely further savings are not envisaged, given the frugal funding in the decade up until 2018. Our forthcoming London School of Economics and Lancet Commission on the future of the NHS,3Anderson M, Pitchforth E, Asaria M, et al. The LSE–Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service post COVID-19. Lancet (in press).Google Scholar in line with other bodies, calls for substantial increases in funding for the NHS, social care, and public health in the region of 4% per annum, in real terms, for each. We also recommend that long overdue reforms of the social care funding model are urgently implemented to improve financial protection. The obvious means of doing this for the NHS would be an increase in progressive taxation. Of course, there is some saving grace in this; most of these legislative proposals only relate to England. Scotland, Wales, and Northern Ireland have presumably to sort themselves out. We declare no competing interests." @default.
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• W3136756963 date "2021-04-01" @default.
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• W3136756963 title "The UK Health and Care Bill: failure to address fundamental issues of coverage and funding" @default.
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• W3136756963 doi "https://doi.org/10.1016/s0140-6736(21)00525-0" @default.
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