The Minister for Health (Stephen Hammond)
Although we oppose the motion, I welcome the opportunity to debate the regulations. The NHS long-term plan, which was published in January, set out a clear blueprint for fully integrated community health in the NHS for the first time in its history. The plan highlighted the intention to dissolve the historical distinction between primary and community health services and to break down the traditional barriers between care institutions, teams and funding streams, so as to support the increasing number of people with long-term health conditions, rather than viewing each encounter with the health service as a single unconnected episode of care.
NHS organisations will increasingly focus on population health by delivering the so-called triple integration of primary and specialist care, physical and mental health services, and health with social care, which is consistent with what doctors have consistently reported they need. I obviously welcome the commitment from the shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth), to integration. Today, the integration of services can take place through collaboration and co-operation, including some local alliance arrangements. However, in some areas, people working on the ground have told us that it would be better to have a lead provider to take responsibility for the integration of services for a population through an integrated care provider contract.
It is worth making the distinction between integrated care providers, which we are discussing tonight, and integrated care systems. An integrated care system growing out of the current network of sustainability and transformation partnerships will provide a platform on which commissioners can make shared decisions with providers about how to use resources, design services and improve population health. The long-term plan has set out an ambition for all STPs to evolve into ICSs. Integrated care providers, or ICPs, will be a new way of integrating health and care services so that people’s care is co-ordinated around them.
NHS England has developed the ICP contract to enable local areas to commission local health and care services, including primary medical services through a single contract. The intention is to establish the right organisational and financial incentives for providers to collaborate in order to deliver preventive, proactive and co-ordinated care. It is important to underline that ICPs are not new types of legal entity, but provider organisations that have been awarded ICP contracts. In the long-term plan, NHS England underlined that, when the contract is made available for use, it expects ICP contracts to be held by public statutory providers, and I want to discuss that a bit more in my remarks later.
Turning to the particular statutory instrument we are discussing tonight, we have identified a number of regulations that need to be amended to allow the first ICP contract to be awarded.
Thelma Walker (Colne Valley) (Lab)
In the last year, I have been on numerous Delegated Legislation Committees, and I have been shocked by the complex and far-reaching changes the Government have forced through without appropriate scrutiny. Can the Minister justify why substantive change to existing regulations should not be part of a Bill and subject to parliamentary scrutiny?
Stephen Hammond
As the hon. Lady knows, this has been subject to considerable scrutiny. It has been scrutinised by the Health and Social Care Committee, as she has already heard from its Chairman. She will also have heard that it has been subject to a number of other scrutiny processes, including judicial reviews.
Dr Paul Williams (Stockton South) (Lab)
The Minister is correct in saying that there has been some analysis of integrated care partnerships by the Health and Social Care Committee, but it has not scrutinised this statutory instrument. The Select Committee actually recommended very clearly that ACOs or ICPs should be NHS organisations. Will the Minister say why he should not accept the Committee’s recommendation?
Stephen Hammond
As the hon. Gentleman knows, the long-term plan has set out that the ICP contracts will be held by public statutory providers. That point has been made and reiterated several times not only in the Select Committee’s scrutiny, but in the remarks that the Committee and a number of people have made about privatisation. The Chairman of the Health and Social Care Committee has already intervened on the shadow Secretary of State, but she has said:
“The evidence to our inquiry was that ACOs, and other efforts to integrate health systems and social care, will not extend the scope of NHS privatisation and may effectively do the opposite.”
Dr Wollaston
Will the Minister assure the House that only public statutory providers will hold these contracts? That would be reassuring, as the language on this is not completely clear. Will he also give some assurance regarding the Select Committee’s other proposal, which is that the policy should be carefully piloted and evaluated? If it is done first in Dudley, followed by careful evaluation, I would be prepared to support it. If he cannot give reassurance on those points, it would be difficult for me to support the regulations.
Stephen Hammond
I can give the Chair of the Select Committee the assurance that the ICP contract will be made available in a controlled and incremental way, conditional on the successful completion of NHS England and NHS Improvement assurance through the integrated support and assurance process. That incremental process is, I think, in line with what she and her Committee recommended.
Jonathan Ashworth
Will the Minister confirm that, because of the competition and procurement rules and the regime brought in by the Andrew Lansley Act, he cannot rule out the possibility of an independent provider winning a contract? He might say it is unlikely, but he cannot rule out the possibility, so why does he not introduce a measure—a simple one-clause Bill, perhaps—to give the assurances that many campaigners want?
Stephen Hammond
The hon. Gentleman is right: it is highly unlikely. More than that, it is stated and restated in the long-term plan that NHS England has the clear expectation that the ICP contracts will be held by public statutory providers. He knows that, and others who have discussed this point have made it clear.
Justin Madders
I have a simple question and we would like a simple answer. Yes or no: do the Government intend to repeal section 75 of the Health and Social Care Act 2012?
Stephen Hammond
As the hon. Gentleman knows, the NHS has proposed in a recent legislative document that it looks at a number of issues. It is important that that round of engagements takes place, and the Government will consider what is said.
The majority of the amendments we propose simply ensure that the regulatory framework that applies to contractual arrangements for the provision of healthcare services continues to apply where services are provided under the new ICP contract and to those organisations that hold a contract. That is an important safeguard that, in simple terms, helps to ensure that care provided under an ICP contract is subject to all the same rules as care provided under existing and other NHS contracts, such as those governing the handling of complaints and the reimbursement of travel expenses.
The shadow Secretary of State has asked me to comment on the substantive change being proposed, underpinning the existing contractual arrangements for the provision of NHS GP services. The regulations will allow GPs who are currently providing services under existing contractual general medical services or personal medical services arrangements to suspend, rather than terminate, those arrangements in order to provide services under an ICP in what is known as a fully integrated arrangement. The British Medical Association has underlined that GPs should not be pressured into joining an ICP arrangement, and we want to make it clear to the House tonight that the participation of any individual GP practice is entirely voluntary. Any role in any ICP will be for them to decide. Allowing the suspension of GP contracts allows GPs to take part in an ICP arrangement but keeps the option available to them of returning to their previous contract.
The hon. Gentleman expressed a number of concerns about the ICPs. He implied that they had been brought in by stealth. In fact, the proposals have been subject to significant scrutiny by Parliament and the public, particularly in the past year. We have already discussed the examination of the evidence by the Health and Social Care Committee, which published a report last summer, which is, I believe, largely supportive of ICPs, recognises potential benefits and sets out helpful recommendations on introducing them in England. I have described the consultation processes previous iterations of the ICP contract and the regulations have gone through.
Moreover, as the Health and Social Care Committee was promised, NHS England has completed a full public consultation on the ICP contract and announced through the long-term plan that the ICP contract will be available for use. NHS England’s full response to the consultation was published on 15 March.
Various people have made points tonight about the privatisation of the NHS and said that ICPs are a route to privatising the NHS. They are clearly not.
Stephen Hammond
The NHS has stated clearly that NHS England’s expectation is that these contracts will be held by public statutory providers. The hon. Lady, who is making a number of points—[Interruption.] She says she is not making them, but shouting at me. Indeed, she is shouting at me.
Stephen Hammond
Oh, she is chuntering at me. While she is chuntering at me, she might like to consider what the King’s Fund has said about the claims of mass privatisation, which is that they are “hugely overstated”. I have already quoted the Chair of the Select Committee, who said that the evidence to its inquiry was that ICPs and
“other efforts to integrate health systems and social care, will not extend the scope of NHS privatisation and may effectively do the opposite.”
It is important to recognise that NHS England has taken measures to build a clearer narrative around integrated care. The long-term plan, which will be backed by £20.5 billion extra by 2023-24, will introduce integrated care for patients in England over the next decade.[Official Report, 19 March 2019, Vol. 656, c. 6MC.] Where local commissioners propose to use ICP contracts, they will have to ensure that it is an effective and beneficial option for the local area. The regulations will ensure that the healthcare of this country is improved by integrated care providers. I commend them to the House.