King's Speech 2024: what you need to know

Political context 

On Thursday 4 July the country went to the polls, returning a Labour government with a majority of 174 (a working majority of 180 accounting for the Speaker, Deputy Speakers and Sinn Féin MPs who don’t take up their seat). While there is already analysis considering the resilience of the voting bloc that elected 411 Labour MPs (the party has started planning for fighting the next election), they have one of the biggest electoral mandates in the history of the House of Commons.  

The new government has used its mandate to announce its intention to introduce a wide range of legislation into parliament, with 35 bills covering many of the key issues it campaigned on including planning reform, workers’ rights, transport and green energy.  While there has been a flurry of government announcements in the lead up to the King’s Speech, this is the government’s first opportunity to set out the ‘how’ of its plan for change; the platform it sought to govern on.

The headline-grabbing announcements seek to communicate the messages the Labour Party has been keen to lodge in the minds of the electorate for a number of years – that it can be trusted with the economy and national security (issues that traditionally, Labour is perceived as being weaker on than the Conservatives). The speech has been briefed to media as ‘taking the brakes off Britain’, with the main focus on driving economic growth that will deliver ‘real and lasting change’ for people across the country and that as part of this, fundamentally change the way we ‘do’ government in the UK. 

What was announced

This was King Charles III’s second speech as monarch to signal the state opening of parliament and is the first King’s Speech since the 2024 general election. The speech sets out the government’s legislative plans for the session ahead.

The King delivered the stated aims of the government as ‘security, fairness, and opportunity for all’, with economic growth ‘a fundamental mission’.

Full details on the announcements can be found on the Gov.UK website. 

The most important proposed bills for the NHS are:

Tobacco and vapes bill: 

• This legislation will create a smoke-free generation by phasing out the ability to legally purchase tobacco products. 
• The bill will also restrict vape products, limiting children's ability to access them. 
• The previous Conservative government first introduced the legislation in the last parliament, but it was not given assent during the parliamentary wash-up. 
• Labour was the first party to propose a policy of phasing out smoking, and it backed the previous government’s tobacco and vapes bill when it was in opposition. It also committed itself to implementing the policy in its pre-election manifesto.

Mental health bill:  

• This new bill would reform the Mental Health Act 1983, which, among other things, has been criticised due to how it treats people with learning disabilities and autistic people.
• The 2024 Labour manifesto acknowledged the current Mental Health Act also discriminates against some ethnic minorities, particularly black people as they are far more likely to be detained than white people.
• Proposed reform would aim to improve autonomy, rights, and support for patients, emphasising ‘dignity and respect throughout treatment’.

Restrictions on junk food and energy drink advertising to children:

• No further detail was provided today. This will likely follow in secondary legislation.

Conversion practices bill

• This legislation will propose new offences to target acts of conversion practices towards the LGBTQ+ community that are not captured by existing legislation.

Other legislation announced not directly related to health but important for the NHS were:

Cyber security and resilience bill

• The bill will strengthen the UK’s cyber defences, ensuring that critical infrastructure and the digital services that companies rely on are secure.
• This will expand the remit of the existing regulation, putting regulators on a stronger footing and increasing reporting requirements to build a better picture in government of cyber threats.

English devolution bill

• This legislation seeks to devolve further powers to combined authorities and metro mayors.
• These powers cover skills, planning, energy, and transport, and to ‘support local growth plans that bring economic benefit to communities’.

‘Making work pay’

• Various relevant employment bills including:
  • a skills bill, which will abolish the apprenticeship levy and replace it with a new growth and skills levy
  • a race equality and disabled workers bill, which aims to enshrine the full right of equal pay in law
  • an employment rights bill (Labour’s New Deal for Working People), which that will update worker rights including banning zero-hour contracts and ensuring sick pay and parental leave are available from day one of employment.

The speech stated that other measures will be laid before parliament, allowing for further legislation during the session.

Analysis

The legislative agenda from the speech focused on economic growth, with less health focus than in recent years. However, the King stated the government’s intention to ‘reduce the waiting times, focus on prevention and improve mental health provision for young people’.

Tobacco and vapes bill

We are pleased to see a commitment to reducing rates of smoking, especially among children and young people, and to eventually phase out smoking.

We had welcomed the previous government’s intention to raise the age of sale for tobacco products and crack down on vaping. Smoking causes 76,000 deaths a year in the UK, and each month, 75,000 GP appointments could be attributed to smoking. Almost every minute of the day, someone is admitted to hospital because of smoking. Polling also indicates that the proposal has widespread support across British adults.

It is important to recognise the influence integrated care systems (ICSs) can have in their local areas in ensuring everyone has equal access to the resources they need to quit smoking and lead healthier, longer lives. Systems can also assist in engaging their communities in important conversations about health policy that can drive behaviour change. We hope that in implementing the bill that ICSs can provide guidance and support.

Mental health

The speech highlighted the government’s intention to give mental health ‘the same attention and focus as physical health’, especially focusing on the mental health of children and young people. The government’s manifesto commitments to ensure 100 per cent coverage of mental health support in schools and a network of Young Futures hubs across the country will be important pieces of the puzzle in improving children and young people’s mental health. They will also support the government’s bold aim of raising the ‘healthiest generation of children’ in history.

We welcome the government’s commitment to bring forward the new mental health bill, as parts of the existing legislation are over 40 years old. These reforms will help reduce detentions and unacceptable disparities in rates of detention for people from some ethnic minority backgrounds and improve recovery rates and outcomes. Reducing detentions under the Mental Health Act will also save money in the medium-to-long term, not just for the NHS but for the justice system and other public services.  

The reforms will remove the right to detain someone with a learning disability and autistic people without a co-occurring mental health condition for longer than 28 days. Linked to this is a new statutory duty on ICSs to supply an adequate amount of community services for this group. This will require substantial increase in community provision, which will need time to be built up. We have worked closely with the government over the last eight years to reflect member views during the process of reform, and we will continue to work with the government to support the successful implementation of this legislation.

Children’s wellbeing bill

The government has committed to bringing forward a children’s wellbeing bill, to ‘put children and their wellbeing at the centre of the education and children’s social care systems’. It includes measures such as free breakfasts in all primary schools and requiring schools to work more closely with local authorities around special educational needs and disabilities (SEND) inclusion. This was expected to be titled the ‘schools bill’, however given the drastic increases in demand for children and young people’s mental health services, we welcome this broader title for the bill and the potential to influence and strengthen the legislation around children’s wellbeing.

Regulation on junk food and energy drinks advertising

Obesity is one of the greatest long-term health challenges, with around two-thirds of adults above a healthy weight and one-in-three children leaving primary school already overweight or living with obesity.

A recent audit found significant variation in integrated care boards’ approach to tackling obesity. Obesity is a complex problem and is associated with difference in rates by socioeconomic status, income and ethnicity. ICSs, through their ability to take a whole population view, provide an opportunity to tackle the variations in service access, experience and outcomes.

Emerging evidence supports advertising restrictions as a policy tool to reduce purchase of foods high in fat, salt and sugar (HFSS). Given obesity is associated as a risk factor for a range of chronic diseases including cardiovascular disease, type 2 diabetes and some types of cancer, this legislation will improve the future resilience of the population by protecting children from unhealthy advertising and reduce obesity levels in the future.

We therefore support plans to further legislate and we will support the government in how to implement this most effectively.

Conversion therapy ban

We also welcome the proposed ban on conversion practices, which was included in the 2022 Queen’s Speech but omitted from the King’s Speech in 2023. This is in line with submissions we have made on behalf of our members advocating for a ban on these practices.

English devolution bill

We welcome the direction of the English devolution bill and the renewed approach to devolution as a means of supporting communities and driving economic growth. We also welcome the opportunity for the new government to place health at the heart of any future devolution deals, as we firmly believe that health is intrinsic to economic and social development and that health should form part of discussions.

As part of a commitment to a strategy for growth, the government should ensure health and care leaders are involved in local growth policy, programmes and funding infrastructure, maximising local impact and resourcing. To deliver this, the government should include a clear approach to understanding and unlocking the social and economic potential of the health sector in the proposed new industrial strategy.

Cyber security and resilience bill

We support the new moves and its pleasing to see steps being taken to protect the NHS and other public services from future disruption caused by cyber-attacks. Patient care should not be held to ransom by hackers, especially with health leaders and their teams working so hard to try to improve performance and tackle care backlogs. We await further detail around potential practical implications for our members
Skills England bill

NHS Employers has long argued for reform of the apprenticeship levy. These proposals are a positive step, and we will make the case for greater flexibility in the new levy to support health and care workers’ priorities and the delivery of the NHS Long Term Workforce Plan.

Economic growth and health

The government has set out that its core mission is growing the economy. While there was no NHS-specific focus it is crucial that ICSs, and specifically integrated care partnerships, have a key role in designing and delivering the new work, health and skill plans for the economically inactive that the government has recently announced. ICSs are driving forward work and health integration through their fourth purpose of supporting broader social and economic development and work and health programmes including WorkWell. 

Previous work and health interventions, such as Fit for Work service, have failed due to lack of integration with the health system and therefore low referrals from GPs. Increased devolution to local areas provides an opportunity to fully integrate work and health services and tackle rising economic inactivity due to ill health. 

How we will be supporting members
 

Mental health reform:

• The NHS Confederation’s Mental Health Network has worked closely with the Department of Health and Social Care over the last eight years to reflect member views during the process of reform, and we stand ready to work with the government to support the implementation of this important legislation. 

English devolution:

• The NHS Confederation’s Integrated Care Systems Network has relaunched the Place Forum to enhance support specifically for place leaders. Accountable officers at place can benefit from our closed community of practice, designed to maximise safe space and opportunities for peers to develop relationships and learn from one another. If you are a place leader, email helen.hunter@nhsconfed.org to receive meeting invitations, updates and resources
• Our health economic partnerships team works with government and public, private and third sector representative bodies to demonstrate and champion the NHS’s role in bringing greater regional economic prosperity and influencing future policy. Locally, the team directly supports individual NHS organisations and ICSs to link with their local economic leaders to understand, develop and build a common agenda, potentially bringing significant external revenues and benefits in local service design and delivery. Our new report Prevention, Population Health and Prosperity, explores the priorities, opportunities and challenges of bringing together health and local government devolution. 

Public health

• We will continue to engage with the new government on behalf of members to represent their views and advocate for changes required to promote prevention and impactful public health initiatives. This includes via our quarterly Public Health and ICS Forum, which invites systems to collaborate with national and local public health teams and is run jointly by the NHS Confederation, the Local Government Association, and the Association of Directors of Public Health. For more information contact office.icsnetwork@nhsconfed.org.