Health and Care Bill: Changing the shape of our health system


Today, MPs debate the principles of the Health and Care Bill in parliament. You may have heard on the news or seen in the papers that the government are putting through these reforms, but are not quite sure what this means in practice.

Our Policy Manager Lindsey Crawford sets out the main changes that this Bill will make, what this means for the support you receive, and what Rethink Mental Illness are doing to ensure that the Bill delivers the best possible outcomes for people severely affected by mental illness.

What is the Health and Care Bill?

The Health and Care Bill is attempting to change the shape of the health system, with the aim of bringing about more integrated care. In other words to ensure more joined up support between clinical and social care. At present, decisions about health and care services in your area are mostly made by Clinical Commissioning Groups (CCGs). There are just over 130 of those in England. Under the Bill, the CCGs will be scrapped and their responsibilities will now be delivered by Integrated Care Systems (ICSs), which cover a larger area. There are currently 29 ICSs in England.

Integrated Care Systems will be made up of an ICS board where decisions are made, and an ICS Partnership which will look at the health and care needs of the whole population in each ICS area. Both the ICS Board and ICS Partnership will include representatives from the NHS and the local authority, which is designed to bring about more joint decision-making between the NHS and local authorities.

How will this make a difference to the services I receive?

Rethink Mental Illness has welcomed the Bill as it has the potential to provide a better legal foundation for the NHS, which should make it easier for health and social care services to work in partnership.

People should be able to access high quality treatment in a timely manner. But, as stated in our Building Communities that Care report, this is only one vital part of what is needed to help people severely affected by mental illness keep well and thrive in their communities. Other factors, such as housing, jobs, your finances and support networks, are just as important.

The NHS and local authorities planning care and making decisions together should help to challenge the idea that mental health is only a matter for health services. We hope that this will mean that more people will benefit from health and social care services working collaboratively to provide support for the different needs that a person has. People with experience of mental health services will know that it is crucial to move away from a ‘one size fits all’ approach and focus on the individual needs of the person.

What is Rethink Mental Illness doing to influence the Bill?

While we were pleased to see the government publish this Bill, there are a number of areas where we think that the government needs to do more to make fully integrated care a reality.

Our biggest concern is that, even though government has brought forward the Health and Care Bill, it will not be possible for health and care services to work together to deliver better care if the social care system remains at breaking point. The government stated during the Queen’s Speech that it will bring forward it’s plan for social care this year, but we are disappointed that we haven’t heard any further detail about this.

Mental health social care is extremely important in supporting people living with severe mental illness to recover following hospital care, stay well and prevent further crises. That’s why we are currently lobbying the government to make sure that this at the centre of it’s plans for social care. In short, for this Bill to work effectively, we have to see mental health social care being appropriately funded.

We are also working with fellow charities and other important health organisations to try and bring about changes to the Health and Care Bill to ensure that the voices of those who most understand the needs of people severely affected by mental illness are at the heart of decision making and planning with ICSs. This includes giving a stronger voice to people with lived experience of mental illness, carers, VCSE organisations and NHS mental health providers.