Parliament concludes scrutiny of Health and Care Bill

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The Health and Care Bill received Royal Assent and became an Act of Parliament on 28 April 2022.

During its passage through the House of Lords, members asked the government to think again on a number of topics, including:

safe discharge of hospital patients with care and support needs
organ trafficking
dispute resolution in children’s palliative care
learning disability and autism training
allowing pills for early medical abortions to be taken at home
eradicating modern slavery and human trafficking from the NHS supply chain.

What happened during House of Lords scrutiny of the draft law?

The bill was considered by the House of Lords between 7 December 2021 and 23 March 2022, before passing back to the House of Commons for consideration of Lords amendments.

Consideration of Commons amendments day two: Tuesday 26 April

Members have now considered the Commons response to Lords amendments (changes) for a second time.

Lords divisions

There were two votes (divisions) on proposed changes to bill. Members discussed the changes at length, but upon voting neither were agreed to.

The changes concerned:

Catch up

What's happened so far?

Consideration of Commons amendments day one: Tuesday 5 April

Members of the Lords considered Commons reasons for disagreeing to Lords amendments (changes) to the bill.

Lords divisions

There were five divisions (votes) on the proposed amendments to the bill.

Assessing and meeting workforce needs

The first vote was on Lords motion B1, which would require the Secretary of State, at least once every three years, to present a report to Parliament describing the system in place for assessing and meeting the workforce needs of health and social care services in England.

Members voted 187 in favour of the motion and 151 against, so the change was made.

NHS reconfiguration intervention powers

The second vote was on motion C1, which aims to ensure the Secretary of State's power to scrutinise and intervene in NHS reconfigurations can only be instigated if they have grounds to believe that the proposal for reconfiguration would be in the best interests of patients.

Members voted 169 in favour of the motion and 161 against, so the change was made.

Procurement and supply chains: modern slavery

The third vote was on motion D1, which would ensure that procurement of all goods and services for the health service in England avoids modern slavery.

Members voted 177 in favour of the motion and 135 against, so the change was made.

Cap on care costs for charging purposes

Vote four was on motion G1, which would require an impact assessment covering distribution, eligibility across regions, and the effect of the care cap on disabled adults under 40, before changes could be made to how 'costs accrued in meeting eligible needs' are determined.

Members voted 160 in favour of the motion and 151 against, so the change was made.

Smokefree 2030 consultations

The fifth vote was on motion J1, which would require the Secretary of State to consult on any recommendations of the independent review into tobacco control announced by the Secretary of State on 4 February 2022.

Members voted 130 in favour of the motion and 132 against, so the change was not made.

Government changes agreed following proposals by Lords members

Members also agreed to government amendments in response to proposals raised by the Lords at earlier stages. These relate to:

membership of integrated care boards and its committees
safe discharge of hospital patients with care and support needs
organ trafficking
dispute resolution in children’s palliative care
learning disability and autism training
allowing pills for early medical abortions to be taken at home.

Catch up

Lords third reading: Wednesday 23 March

Third reading is a chance for members to ‘tidy up' a bill, making any small changes to ensure it is effective.

Members speaking put forward technical amendments (changes) on subjects including a defective reference to caps on care costs and a repetition of a clause relating to the reconfiguration of NHS services.

Members also discussed the progress of the bill through the House at the conclusion of Lords stages.

Catch up

Report stage day four: Tuesday 16 March

Report stage is an extra chance for members to closely scrutinise elements of the bill and make changes.  

Members speaking on the final day of report stage put forward amendments  (changes) to the bill on topics including:

dispute resolution in children’s palliative care
publishing a national self care strategy for minor ailments
global health emergency international cooperation
mandatory training on learning disability and autism.

Lords divisions

There were six divisions (votes) on proposed changes to the bill.

Tobacco regulation

The first vote was on amendment 158, which requires the government to carry out a consultation for a regulation scheme for the prices and profits of tobacco manufacturers and importers.

Funds raised by the scheme would be used to pay for the cost of tobacco control measures to help deliver the government’s aim to make smoked tobacco obsolete by 2030.

Members voted 213 in favour and 154 against, so the change was made.

Organ trafficking

The second vote was on amendment 162, which ensures that in relation to organ tourism, there must be informed consent with no coercion or financial gain for the donation of organs.

This would therefore prevent organ tourism which involves either forced organ harvesting or black market organ trafficking.

Members voted 203 in favour and 159 against, so the change was made.

Assisted dying

The third vote was on amendment 170, which requires the government to present a new bill within one year of the Health and Care Bill's passing, which permits terminally ill, mentally competent adults to legally end their own lives with medical assistance.

Members voted 145 in favour and 179 against, so the change was not made.

Dispute resolution

The fourth vote was on amendment 172, which allows for dispute resolution between doctors and parents of a child in palliative care, by allowing parents access to evidence and opinion on alternative medical treatments.

Members voted 112 in favour and 107 against, so the change was made.

Global health emergency

The fifth vote was on amendment 174, which, in the event of an international public health emergency, requires the government to support domestic and international knowledge-sharing to help combat the emergency.

Members voted 82 in favour and 115, so the change was not made.

Termination of pregnancies

The final vote was on amendment 183, which allows for the medicines used for termination of pregancies to be taken in a pregnant woman's home, subsequent to a consultation with a registered medical practitioner,
nurse or midwife via video link, telephone conference or other electronic means.

Members voted 75 in favour and 35 against, so the change was made.

Catch up

Read the text of proposed changes (PDF)
Catch up on Parliament TV (part one and part two)
Read the Lords Hansard transcript (part one and part two).

Report stage day three: Monday 7 March

Members speaking on day three of report stage put forward amendments  (changes) to the bill on topics including:

the cap on care costs
safeguarding the right of unpaid carers in relation to hospital discharges
protecting patient data
establishing a licensing regime relating to non-surgical cosmetic procedures.

Lords divisions

There were six divisions (votes) on proposed changes to the bill.

Discharge of patients

The first vote was on amendment 113, which retains the duty on a NHS or independent hospital, to ensure a patient must be safe to discharge from hospital and mirrors carers’ rights, which were established in the Community Care (Delayed Discharges, etc) Act 2003.

Members voted 205 in favour and 155 against, so the change was made.

Holding of patient data

The second vote was on amendment 116, which seeks to keep statutory protections in place in regard to the safe haven for patient data across health and social care, required for national statistics, for commissioning, regulatory and research purposes. It also ensures that NHS England do not take on this responsibility because of a potential conflict of interest in their role.

Members voted 207 in favour and 169 against, so the change was made.

Disclosure of protected material

The third vote was on amendment 124, which removes the provision allowing coroners to require the disclosure of protected material from the proposed Health Service Safety Investigations Body.

Members voted 210 in favour and 169 against, so the change was made.

Care cap

The fourth vote was on amendment 141 which deletes clause 155, regarding the cap on care costs for charging purposes.

Members voted 198 in favour and 158 against, so the change was made and the clause deleted.

Commencment of Care Act 2014 provisions

The fifth vote was on amendment 144A, which inserts a new clause to ensure that all provisions under sections 15 and 16 of the Care Act 2014 have come into force before 1 April 2023.

Members voted 187 in favour and 143 against, so the change was made and the new clause inserted.

Advertising compliance

The final vote was on amendment 151A, which seeks to hold both advertisers and online platforms responsible in law for compliance with the online 'high in fat, sugar and salt' (HFSS) advertising restrictions in the bill, with meaningful sanctions for noncompliance.

Members voted 59 in favour and 99 against, so the change was not made.

Government changes agreed

Members also agreed to government changes establishing a licensing regime in connection with non-surgical cosmetic procedures.

Catch up

Read the text of proposed changes (PDF)
Catch up on Parliament TV (part one and part two)
Read the Lords Hansard transcript (part one and part two).

Report stage day two: Thursday 3 March

Members speaking on day one of report stage put forward amendments  (changes) to the bill on topics including:

role of Integrated Care Board, including steps to address needs of children and young people
mental health spending
dementia care
family help services
reporting of health, social care and public health workforce numbers.

Lords divisions

There were four divisions (votes) on proposed changes to the bill.

Workforce assessments

The first vote was on amendment 80, which requires the government to publish independently verified assessments every two years of current and future workforce numbers required to deliver care in England.

The assessments should take into account the economic projections made by the Office for Budget Responsibility, projected demographic changes, the prevalence of different health conditions and the likely impact of technology.

Members voted 171 in favour and 119 against, so the change was made.

Service reconfiguration

The second vote was on amendment 84, which removes a clause from the bill that enables the government to intervene in the reconfiguration of care services.

Members voted 145 in favour and 122 against, so the change was made and the clause was removed.

Supply chains

The third votes was on amendment 108, which ensures that the procurement of all goods and services from overseas for the health service in England is consistent with the UK's obligations under the Convention on the Prevention and Punishment of the Crime of Genocide.

Members voted 110 in favour and 91 against, so the change was made.

Sustainability

The final vote was on amendment 112, which sought to create an Office for Health and Care Sustainability, which operates separately to the government, to safeguard the longterm sustainability of an integrated health and adult social care system for England.

Members voted 80 in favour and 91 against, so the change was not made.

Catch up

Read the text of proposed changes (PDF)
Catch up on Parliament TV (part one and part two)
Read the Lords Hansard transcript (part one and part two).

Report stage day one: Tuesday 1 March

Members speaking on day one of report stage put forward amendments (changes) to the bill to be discussed on multiple topics, including:

renaming the National Health Service Commissioning Board ‘NHS England’
mental health spending
reduction of inequalities in access to health services to cover people before they are patients
requiring NHS England to have regard to certain matters relating to the environment, including climate change
membership and role of integrated care boards.

Lords divisions

There were  two divisions (votes) on proposed changes to the bill.

Conflict of interests

The first vote was on amendment 9, which ensures that conflict of interest rules that apply to an Integrated Care Board (ICB) also apply to commissioning sub-committees.

Members voted 174 in favour and 161 against, so the change was made.

ICB members

The second vote was on amendment 12, which ensures that at least one member of a local area's ICB has expertise and knowledge of mental health.

Members voted 162 in favour and 147 against, so the change was made.

Catch up

Read the text of proposed changes (PDF)
Catch up on Parliament TV (part one and part two)
Read the Lords Hansard transcript (part one and part two).

Committee stage

Committee stage, the first chance for line by line examination of the bill, took place over nine days between Tuesday 11 January and Wednesday 9 February 2022.