The Queen's Speech 2021

The parliamentary session normally lasts for around a year, bar the two-year 2017-19 session, and sets out the government’s priorities and bills to be brought forward. This briefing highlights key points from the Queen’s Speech, provides an analysis of bills that carry significant implications for health and care, and assesses what this means for our members.

Key points

• As expected, the Queen’s Speech sets out a bill to legislate for the government’s proposals in its earlier white paper on health and social care reform. These will take forward the biggest reforms to the NHS in a decade.
• The Queen’s Speech did not announce any new funding for the NHS, but reiterated funding announcements made at either the Spending Review 2020 or Budget 2021, such as funding for reducing the elective backlog and money for new diagnostics equipment.
• The government again failed to take the opportunity to publish its plans to reform social care. Instead, it announced that proposals ‘will be brought forward,’ but the government has not provided a timetable for reform or funding settlement, which is urgently needed.
• A key focus of the Queen’s Speech was on the government’s manifesto promise to ‘level up’ the United Kingdom. Health will have a vital part to play at the heart of levelling up and recovering from COVID-19.
• As part of the prevention agenda, the government has committed to introducing secondary legislation to require large out-of-home sector businesses with 250 or more employees to calorie-label the food they sell, and new air quality targets will be introduced through a planned environment bill.
• The proposals laid out today are to be welcomed and are a step in the right direction in helping to redress some of the damage that has been wrought not just on the health service, but on the whole population during COVID-19. We will await the detail of the additional investment that has been promised, as this will be crucial to aiding the recovery. We also welcome the NHS bill that will be published in this session, as this will be key to accelerating moves to integrate care. However, we believe the government’s failure to publish its social care reform proposals is yet another missed opportunity that leaves the social care sector facing an uncertain future.  

The full transcript of the speech and the supporting briefing notes are available on the gov.uk website.

Background

On Thursday 11 May 2021, the Queen set out her legislative agenda for the government.

The last parliamentary session had a heavy legislative focus on Brexit preparation, whereas the forthcoming agenda will be shaped by pandemic recovery. The government, following gains across the ‘red wall’ for the Conservatives during last week’s local elections in England, will seek to use the levelling-up agenda as a vehicle to embed changes to electoral dynamics escalated by Brexit.

The programme of 30 bills unveiled in today’s Queen’s Speech will now be debated through a motion on the Humble Address over six days and will likely shape the course of parliament for the next 14 months. Whilst the new legislative agenda focuses on levelling up, it fails to level with the electorate on social care reform. The promise of a forthcoming plan this calendar year falls short of a new bill on funding reform that is desperately required by health and care services. The health and care bill, however, represents the most significant NHS reform for a decade with a move towards integrated care and more powers of direction over the NHS for the Secretary of State. 

Beyond health, it’s worth noting the dissolution and calling of parliament bill, which will give the power back to the Prime Minister to call an early general election. The agenda set out today represents the last full legislative cycle, given an early general election is widely speculated for 2023.

What was announced on health and care?

Health and care bill

The Queen’s Speech sets out a bill to legislate for the government’s proposals in its earlier white paper, Integration and Innovation, aiming to enable the integration of services, collaboration with local authorities and addressing health inequalities. This includes the establishment of statutory integration care systems (ICSs) and the Healthcare Safety Investigation Branch (HSIB), removing legal requirements for mandatory tendering of NHS services, completing the merger of NHS England and NHS Improvement (NHSEI) and making the combined organisation more accountable to ministers, plus some public health measures like banning junk food adverts before 9pm.

As we set out in our report Legislating on the Future of Health and Care in England, the NHS Confederation has broadly welcomed proposals to establish statutory ICSs and empower them to plan and join-up care without costly mandatory tendering processes. The bill’s focus on health inequalities, bringing care closer to patients’ homes and improving prevention of ill health are in line with delivering existing policy. Our members are already driving this agenda forward at a local level and these reforms will remove bureaucratic obstacles.

However, some of our key concerns remain unaddressed in the government’s plans for the health and care bill. These include clear and robust checks and balances on ministers’ powers of direction over healthcare services, ensuring decisions are made in the best interests of patients on clinical, not political, grounds. Additionally, lay and clinical leadership should be guaranteed on ICS NHS bodies with clear accountability and balanced representation of care providers, such as mental health providers. We have said that the pace and timescales for the bill should move no faster than healthcare systems can keep up while still recovering from the COVID-19 pandemic. 

NHS catch up and recovery plan

Although no new funds were announced during the Queen’s Speech, the total package of additional funding allocated to the NHS for COVID-19 is now £92 billion, including £63 billion for this year and £29 billion for next year. This includes £325 million in capital spending for new investment in diagnostics equipment to improve clinical outcomes, to assist the NHS with recovery of non-urgent services and to address elective backlogs.

On top of previous investments of £450 million to upgrade accident and emergency facilities and £24 million to extend NHS 111 to become a single point of access for urgent care, the government plans to transform urgent and emergency care to prevent inappropriate attendance at emergency departments, improve timely admission to hospitals for patients in emergency departments, and reduce length of stay.

The government is proactively encouraging people to come forward in areas where late diagnosis worsens outcomes. This includes the Help Us, Help You advertising campaign. Such initiatives will support the continued return of urgent and cancer demand in primary care.

Social care reform

The speech announced that proposals on social care reform ‘will be brought forward.’ More concrete plans for change are urgently necessary, however we do welcome today’s proposals to understand the sector better in advance of the reform. Collecting data and evidence about the care being delivered and working with local and national partners to ensure reform is informed by diverse perspectives is important. In addition, the government’s recognition of the workforce’s key role in the system is paramount to sustaining the service and we endorse the plan for further engagement with staff groups on how to best support them.

Prevention

Following a green paper on prevention in 2019, the government used the Queen’s Speech to reiterate several, mostly non-legislative, policies to improve prevention of ill health. These are focused on reducing obesity, improving air quality, and reducing smoking and drugs use. For instance, delivering the government’s Healthy Weight Strategy, which it published in July 2020, and past spending commitments such as £100 million funding for healthy weight programmes. As had already been announced, a new Office for Health Promotion, sitting in the Department of Health and Social Care and led by the chief medical officer, will be responsible for delivering the parts of this agenda that do not sit with either NHSEI or the new UK Health Security Agency, following the closure of Public Health England.

However, there was some new prevention policy in the Queen’s Speech: the government committed to introducing secondary legislation to require large out-of-home sector businesses with 250 or more employees to calorie-label the food they sell. Meanwhile new air quality targets will be introduced through a planned environment bill. Overall, the speech’s prevention policies were largely neither new nor part of parliament’s legislative agenda. 

Mental Health Act reform

The Queen’s Speech made reference to measures that will be brought forward to support the mental health of the nation, building on the white paper on reforming the Mental Health Act published in January. We welcome the continued momentum behind the reform of the act, giving people greater control over their treatment and ensuring dignity and respect. As part of this we look forward to seeing the outcome of the consultation on the Reforming the Mental Health Act white paper and will continue to engage with the legislative process. We also support the government’s Mental Health Recovery Action Plan, which will help address the impact of the pandemic on the nation’s mental health and wellbeing.

Levelling up

A key focus of the Queen’s Speech was on the government’s manifesto promise to level up the United Kingdom. This seeks to support jobs, businesses and economic growth, and to address the impact of the pandemic on public services.

The government will publish a landmark levelling-up white paper later this year, building on actions the government is already taking to level up across the UK, and setting out new policy interventions to improve livelihoods and opportunity in all parts of the UK.

Various government funds and initiatives focus on local regeneration and town centre improvement, several of which were announced during the 2021 Budget. These include the £4.8 billion Levelling Up Fund, which will invest in infrastructure to improve everyday local life and boost growth and jobs; the £220 million UK Community Renewal Fund, which provides local areas with investment to level up and create employment opportunities in areas of the UK where they are most needed; and the £3.6 billion Towns Fund, which drives long-term, local economic and productivity growth in selected towns. The NHS Confederation will be publishing a briefing on the role of NHS organisations in unlocking these community funds imminently.

The government will seek to level up public services by investing £3.7 billion to build 40 hospitals and recruit 50,000 new nurses in England, to improve people’s access to public services, wherever they live.

As part of the £2.5 billion National Skills Fund, the government has introduced the Lifetime Skills Guarantee. Starting this year, 11 million adults are able to gain an A level-equivalent qualification for free. The devolved administrations will receive £500 million through Barnett consequentials as skills is devolved. This builds on the work the NHS Confederation has led with the Independent Commission on the College of the Future to support local working between NHS and further education.

The government will be investing £500 million a year in new prestigious technical qualifications featuring more workplace experience, known as T Levels.

Vaccination programme 

For phase 2 of the vaccination programme, the government is following JCVI advice to continue to offer the vaccination based on age, starting with the oldest remaining cohort (40-49 years old). 

The government is starting to plan for a potential booster campaign later this year. It is working with vaccine suppliers to work out which vaccines could be effective as a booster shot of a COVID-19 vaccine, and to design new vaccines specifically targeted at variants of concern. Over the longer term, regular boosters are likely to become a regular part of managing COVID-19. 

The NHS Confederation continues to send regular updates to NHSEI and government, setting out member concerns on vaccination delivery. The PCN Network is also in close contact with NHSEI to ensure that lessons from the vaccination programme so far are learned with the prospect of a booster campaign ahead.

Skills and post-16 education bill

The government is to legislate for reforms that will transform post-16 education and training, make skills more readily available and get more people into work, as set out in the government’s Skills for Jobs white paper. It is hoped this will enable people to access flexible funding for higher or further education, bringing universities and further education colleges closer together, and removing the bias against technical education.

It remains to be seen what the implications of this bill will be in relation to recruitment into the NHS. 

Environment bill

The government announced an initiative to improve air quality by requiring the Secretary of State to set at least two legally binding targets on air quality for PM2.5, the most harmful air pollutant. This will be of interest to NHS leaders when developing policies on sustainability, for example, by setting targets to reduce unnecessary travel by patients, visitors, and staff.

Conversion therapy

As an inclusive employer, the NHS Confederation welcomes the plan for much-needed progress on protecting LGBTQ+ people from conversion therapy. The government will launch a consultation before details of the ban are finalised, to hear from a wide range of voices on how best to protect people from conversion therapy. This must be done in a timely manner to ensure plans are not delayed.

NHS Confederation viewpoint

Overall

The proposals laid out today are to be welcomed and are a step in the right direction in helping to redress some of the damage that has been wrought not just on the health service, but on the whole population during the COVID-19 crisis. 

The NHS has faced an unprecedented battle over the past year and has at times come very close to breaking point, so the announcement of additional funding in March will go some way to addressing the impact of the pandemic. However, the detail of this investment will be crucial, and we will await further clarification in the coming months and as part of the forthcoming Comprehensive Spending Review. We have previously stated that the NHS will need a new multi-year settlement because of COVID-19, and we will continue to make the case to  government on this ahead of the Spending Review in the autumn.

The focus of the government on addressing elective recovery, primarily by freeing up urgent and emergency care for those who are most in need, echoes some of the concerns outlined in our recent briefing on elective recovery. However, the government will need to offer assurance to the healthcare sector that they will provide clear messaging to the public that the elective situation will not be resolved in 12 months, and that waiting times will be managed differently as the NHS recovers from the pandemic. We will be writing to the Secretary of State for Health and Social Care to outline the barriers to reducing the elective backlog over the summer, including quicker access to capital funds.

We also have more specific concerns on aspects of the Queen’s Speech and its supporting briefing notes, which are set out below. 

Legislative proposals

We welcome the government’s legislative proposals setting out plans for the health and care bill, as detailed in the white paper published earlier this year and further outlined today. 

These are the most significant set of reforms the health service has seen for a decade and there is broad support across our membership. We anticipate that the proposals on integration and collaboration will help frontline services and our members to move towards a model of fully joined-up patient care. Our view is that the legislation is in many respects playing catch up with the integrated ways of working we are already seeing across the country across and within ICSs, notably at place level.

That said, any reforms must not be subject to overly prescriptive guidance, should be delivered at a realistic pace and must enable decisions to be made at the most local level. Those in charge of running community-based health and care services are best placed to understand the needs of their communities.

There are many complex challenges facing health and care, which include tackling the waiting list backlog and the ongoing impact of the pandemic, bringing care closer to patients’ homes and tackling health inequalities, all of which will require even closer collaboration and integration over the months and years to come. There will be much to work through in the coming months, and we look forward to supporting the government as it develops the detail of forthcoming legislative changes.

Need for urgent social care reform 

It is disappointing and disheartening that the government has once again kicked the issue into the long grass, which means the very real risk that no real progress will now be made on this issue during this parliament.

As the NHS Confederation’s Health for Care campaign has repeatedly stated, the NHS and social care are sister services. If one suffers, so does the other and the COVID-19 pandemic has shown how fragile and in need of reform England’s social care system has become. A well-funded and good quality social care sector is vital to a healthy nation and a strong and well-performing NHS.

Social care reform is therefore urgently required and we need a timetable for reform now, not at some distant future point, and this must be coupled with significant long-term investment. 

Mental Health Act legislation

It has been clear for some time that the Mental Health Act desperately needs modernising. Today’s commitment by the government to bring forward that reform is to be welcomed and we look forward to continuing to support the process towards legislation.

Implementing the new legislation will have significant funding implications for the NHS, local authorities and the tribunal service. Our members look forward to implementing the legislation and wider commitments but will need the sufficient resource to do this successfully.

Simply, we must ensure that those who are in crisis receive appropriate and therapeutic care and that we are working towards eradicating gaps in mental health provision in terms of inequalities in access and outcomes.

Levelling up and training opportunities 

The pandemic has shown the urgent need for place-based approaches in rebuilding our local economies and communities and the government’s high-profile levelling up agenda will be an important mechanism through which local action will be targeted. While much of the detail of this will be revealed in the forthcoming white paper, including its definition of ‘levelling up,’ the Queen’s Speech briefing notes do reference the breadth of issues to be covered: 

‘It is about improving living standards and growing the private sector, particularly where it is weak. It is about increasing and spreading opportunity, because while talent is evenly distributed, opportunity is not. It is about improving health, education and policing, particularly where they are not good enough. It is also about strengthening community and local leadership, restoring pride in place, and improving quality of life in ways that are not just about the economy.’

Health will have a vital part to play at the heart of levelling up. This policy will be an important framing tool for place and system approaches to population health and for the strategies of our anchor institutions, such as hospitals, as they realise their role in local economic recovery, supporting communities to recover from COVID-19 and improving health and wealth in the longer term. The role of the NHS as an anchor has never been more important.

Increased investment in government-funded training for all adults will also be welcome news to employers. As the nation’s largest employer, the NHS recognises that it has a vital part to play in supporting the government’s focus on skills and broadening access to education. Our members look forward to working with the government and local colleges and universities to help the government realise its ambitions.

Providing more flexibility in training and education pathways will help prepare even more talented people for a career in the NHS.

Estates and workforce

While we have welcomed the government’s pledge to invest in 40 new hospitals, the government must also focus on supporting existing NHS buildings. In order to plan, commission and deliver services next winter, our members need quick access to capital for new equipment and to improve estates that are unsuitable for long term COVID-19-related infection prevention and control measures, especially with a potential autumn COVID-19 wave on the horizon. The investment in recruiting 50,000 new nurses is also welcome, but the existing NHS workforce must also be supported as NHS services remain under pressure due to the pandemic.

What's next?

• The NHS Confederation understands that we are unlikely to see the second reading of the forthcoming health and care bill until July 2021.
• Following our report Legislating on the Future of Health and Care, which set out our response to the integration proposals in the government’s white paper, the NHS Confederation will continue to engage with key stakeholders and policy makers over the coming months to relay member views on the proposed reforms. In recent weeks, the NHS Confederation has met with health ministers and the shadow health team and will shortly be conducting briefing sessions for parliamentarians.
• In parallel, the NHS Confederation continues to work closely with NHSEI and DHSC on the development of supporting guidance, including on issues such as provider collaboratives and place-based working.
• The NHS Confederation continues to convene the Health for Care coalition and to articulate a health sector view of what ‘good’ looks like for social care reform.