Boris Johnson's new policy to cap social care costs in England was narrowly voted into the new Health and Social Care bill on Monday evening but what is actually being proposed?

Salisbury MP John Glen was not present to vote on the Bill, although he welcomes the reforms, as he was in Madrid as part of his role as Treasury Minister.

The new bill made it to the House of Lords after 294 votes to 244 in the Commons where it has gone through a first reading and will receive further scrutiny in the second reading on December 7. 

What is the Bill proposing? 

The new plans have proven controversial.

Areas covered by the Bill include reforms to social care, a new obesity strategy, a new national medicines registry and extending the scope of the professions that can be regulated using powers from the Health Act 1999.

The full bill can be accessed on the parliament's website, but explained below are some of the key points as well as the proposed changes to social care.

Change to the calculation of the social care cap

Boris Johnson added a social care cap amendment to the Health and Care Bill through the Commons on Monday, November 23, despite significant rebellion from Tory backbenchers. 

The new cap of £86,000, which would come into effect in October 2023, would cover fees for personal care but not living costs.

This means:

  • People with assets of less than £20,000 – up from the current level of £14,250 – won't need to pay anything towards care fees although they might have to pay from their income  
  • People with more than £100,000 in assets won't get council financial support 
  • People with assets between £20,000 and £100,000 will qualify for council help, but will have to pay £86,000 out of their own pocket to reach the cap

A policy paper last week showed that only personal contributions will count towards that cap for people who receive financial support from a local authority for some of their care.

Experts said that means poorer individuals will reach the cap faster than those who are wealthier and will therefore see more of their assets eaten up by care costs.

The cap has been passed through the house of Commons, and now will need to be discussed by the Lords before it can be made into legislation.

More powers to the Health Secretary

If the new bill is approved, Health and Social Care Secretary, Sajid Javid, will be in charge of both NHS England and each Integrated Care System (IBCs) which are set to replace Clinical Comissioning Groups (CCGs).

This removes NHS Foundation Trusts’ independence, with Javid obtaining the power to create new trusts or abolish branches of the NHS (after formal consultation).

Reservations have been expressed over other powers too, such as the Department of Health and Social Care getting more control over collecting patient data. 

The Secretary of State will also be able to mandate water fluoridation and intervene on the quality of hospital food.

The British Medicial Association (BMA) commented: "The focus of the bill must be on increasing ministerial accountability, rather than power, in respect of the NHS."

Moving responsibilities from CCGs to ICBs

Clinical Comissioning Groups (CCGs) have been tasked with arranging provision of medical and other key services since the 2012 bill.

The new 2021 bill would pass this secondary care duty to Integrated Care Boards (ICBs) which involve local organisations and the NHS, except in the case of medical services or hospital care. 

The aim is for integration rather than competition but concerns have been raised about whether this change would pave the way for privatisation.

It is important to note that CCGs originally commisioned private companies for secondary care too, and there are rules in place for CCGs and ICBs in regards to conflicts of interest.

The change is that CCGs will be replaced by ICBs and will have the power to choose whether they arrange secondary medical services with NHS Trusts, NHS Foundation Trusts or private providers. They will no longer be acting under obligation.

The chair of the ICB will be approved by the Secretary of State.

An End to Public Tendering 

NHS services are automatically tendered, meaning they have to compete to be service providers.

The BMA has called for an end to this "enforced competition", but the bill aims to replace this with one that is less transparent.

It is possible under the new bill that private companies will be able to extend their contracts or be awarded new contracts without competition.

The BMA alternatively suggests the NHS should be the default option for NHS contracts, and competitive, transparent tender should be employed when there is not an NHS option.

Workforce proposal

A total of 18 Conservative MPs rebelled at the report stage of the Bill in the Commons in support of an amendment which seeks to introduce better workforce planning for care in England.

The BMA largely supports this aspect of the bill which would require the Health Secretary to publish a report detailing workforce planning every five years.

The association argued any staffing assessments must be "ongoing, accurate and transparent" and for the purpose of informing recruitment needs.

Yet, the BMA believes this should be further bolstered. 

What is missing from the Bill according to the BMA? 

The British Medical Association called for some changes to the Bill, which are listed below:

  • "A requirement that the Government be accountable for ensuring adequate numbers of staff with regular workforce assessments to be delivered by the health secretary"
  • "Ensuring that clinical leadership and patient representation are embedded across ICSs, including formalised roles for local medical committees, local negotiating committees and public health doctors"
  • "The NHS to be made the default option for health service contracts"
  • "Safeguards and limitations over the secretary of state’s powers within the bill to avoid unnecessary political influence in NHS decision-making."

What Salisbury MP has to say 

In his weekly column, Salisbury MP John Glen explained he did not vote on the Health and Social Care Bill as he spent 36 hours between November 21 and 22 in Madrid speaking on financial services.

But he says he has been "keeping a close eye on the reaction in my inbox". 

The Conservative MP wrote: "A few people have expressed disappointment that, as homeowners, they will be expected to contribute to their care costs, while others of lesser means will not.

"This leads me to wonder whether they are fully aware of the uncapped obligations that have fallen upon homeowners in the past.

"None of us know what needs we may have in our old age – nor whether we may be unfortunate enough to require long term residential care."

He highlighted that one in seven people can expect to accumulate care costs in excess of £100,000 and may face having to sell their homes, adding "But no more."

"We are putting an end to unpredictable and runaway care costs by ensuring that no-one will ever have to pay more than £86,000," the politician said.

"The bill also makes care more affordable by introducing a more generous means test and protects people’s assets with a daily cost of living limit.

"These reforms will mean that everyone is better off compared to the current system.

"It is high time that social care was fixed, and I am pleased that we have made this huge step forward."

Criticisms of the Health and Social Bill

Backbench Tory critics joined experts and Labour MPs in warning the move to count only individual payments towards the Social Care cap, and not local authority contributions, would cost poorer recipients more in assets than the wealthy.

Mr Johnson has defended the plans as “incredibly generous” and “much better than the existing system” during a speech at the CBI Conference on Monday.

The policy director at the King’s Fund health think tank, Sally Warren, criticised the change that was “sprung upon MPs with very little notice and with no impact assessment made available”.

“The change to the social care cap is a regressive step that will leave people with low levels of wealth still exposed to very high care costs,” she said.

“It is likely to mean that some people with moderate assets living in poorer areas will still be forced to sell their home to pay for their care, while wealthier people from richer parts of the country will be protected from this.”

Shadow social care minister Liz Kendall accused the Tories of having broken their electoral promise saying: “Instead they voted to tax ordinary working people, while the wealthiest in our country are unaffected.

“Once again Boris Johnson’s failures translate into working people paying the price.”

Sir Keir Starmer raised concerns over the policy at Prime Minister’s Questions yesterday, November 24.

He said of Mr Johnson in the Commons: “The only thing he is delivering is high taxes, high prices and low growth. I’m not sure the Prime Minister should be shouting about that.

“And it isn’t just broken promises, it’s also about fairness. Everyone needs protecting against massive health and care costs."

What do you think of the proposals for the new Health and Social Care Bill? Let us know in the comments. 

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