For the first time since the 2013 Care Bill, the Government introduced new health legislation in the Queen’s Speech. Perhaps more symbolic than substantive, the NHS (Overseas Visitors Charging) Bill is expected to allow the NHS to charge non-EU migrants for a range of services, including diagnostic tests and scans, the use of ambulances, prescriptions, dental care, ophthalmic services and even emergency care.
Pre-briefing ahead of the Queen’s Speech suggested that the Government hoped to save up to £500 million a year through the new charges. But more significant than the possible economic impact (a drop in the ocean in terms of NHS finances) is the message behind the Bill: “the Government hears the public’s concerns over the impact of immigration on public services and is determined to create a fairer system (sub-text: this shows that we get immigration is an issue, now please vote to remain in the EU).”
Any new legislation creates an important opportunity in health, creating a vehicle for other measures that have been previously avoided. While Ministers will likely be keen to keep the Bill’s scope as narrow as possible, its passage through Parliament is the obvious opportunity to tweak existing law, codify some of the current anomalies across the system or respond to new challenges.
NHS watchers should have noticed that a significant rewiring of the system has taken place without any recourse to Parliament. Monitor and the NHS Trust Development Authority have been brought together to form NHS Improvement – an entirely new organisation in form and function, if not legality. The development of Sustainability and Transformation Plans areas effectively creates a new regional tier to the NHS, just without the legislation to underpin it. In public health, spending has been cut without any adjustment to the legal ring fence designed to prevent just that.
The political imperative to avoid legislation on these issues (and avoid another ‘top down’ reorganisation of the NHS) is clear, but events of the last year have also revealed the true power of decision-makers to act, unencumbered by legal constraints. Whether this circumnavigation of the 2012 Act can continue remains to be seen. Look out for ministers tacking on other measures to the Bill included in the Queen Speech if this proves to be necessary.
Sugar tax gets a formal go-ahead
Legislation to introduce a levy on sugary drinks, acting on the Chancellor’s announcement in the Budget, will please public health campaigners but is likely to attract controversy. Any attempt to formally hypothecate the income from this levy, enshrining the commitment to school sport in legislation, could create an interesting precedent.