Health and Care Bill

(Limited Text - Ministerial Extracts only)

2nd reading
Wednesday 14th July 2021 Commons Chamber

[The Secretary of State for Health and Social Care (Sajid Javid)]

I beg to move, That the Bill be now read a Second time.

The covid-19 pandemic has tested our country like never before, and nowhere more has this been seen than in our health and care system. Everyone delivering health and social care in this country has risen to meet these tests in remarkable new ways. We have seen bold new ways of working, of overcoming bureaucracy and of people working seamlessly across traditional boundaries. New teams were forged, new technologies adopted and new approaches found.

There is no greater example of this than the extraordinary success of our vaccine roll-out, where health and care colleagues have been able to draw on the collective scale and strengths of our Union to deliver one vaccination programme for the whole of the United Kingdom. Today, I can confirm to the House that two thirds of adults have received both jabs against covid-19 one week earlier than planned. It is a remarkable achievement. Everyone working in the NHS and social care can be proud of what they have achieved, and we are all in this House very proud of them.

As we look to the post-pandemic world, we know there is still no shortage of challenges ahead—an ageing population, an increase in people with multiple health conditions and, of course, the chance to embrace the full potential of data and technology.

[Jim Shannon (Strangford) (DUP)]

Will the Secretary of State give way?

[Sajid Javid]

I will.

[Jim Shannon]

It is just, Secretary of State, because you mentioned the issue I wanted to bring up about people getting older. I spoke to your colleague, the Minister for Health, yesterday and I am appreciative of that—

[Jim Shannon]

Recent statistics show that over 40,000 people under 65 in the UK have dementia, and many more have not been diagnosed as of yet. It would seem that these figures are not addressed in the Health and Care Bill, so can I ask the Secretary of State what more will be done to offer support to those suffering with dementia and Alzheimer’s in the UK through this social services care Bill?

[Sajid Javid]

I am pleased that I gave way to the hon. Gentleman as he raises a very important issue. In this Bill, as I will come to, one of the central themes is integration. When I come to that, I hope he will see how that integration between NHS and social care will help to deliver a better service for those with dementia.

Everything I refer to—these challenges—are all in addition to the challenges of the pandemic that of course we still face and the elective backlog that we know is going to get worse before it gets better. Meeting the future with confidence relies on learning lessons from the pandemic—what worked and what did not work—and building on a decade of innovation in health and care.

Sometimes the best intentions of the past cannot stop what is right for the future. Bureaucracy can still make sensible decision making harder, silos can stifle work across boundaries and sometimes legislation can get in the way. We have seen how unnecessary rules have meant contracts have needed to be retendered even where high-quality services are being delivered, we have seen the complicated workarounds needed to help the NHS and local government to work together, and we have seen the uncertainty about how to share data across the health and care system. People working in health and social care want the very best for people in their care. That is what they have shown time and again, not least in the way they have embraced integration and innovation to save lives through this pandemic. They want to hold on to the remarkable spirit of integration and innovation, but they want to let go of everything that is holding them back and we want to help them to do it.

[Sir Edward Leigh (Gainsborough) (Con)]

On that point of bureaucracy, I recently saw the apotheosis of the NHS, where an Anglican church had draped an altar with a flag saying, “O Praise the NHS”. So when we have a new Secretary of State, can we have a really hard-hitting attitude to NHS bureaucracy? We all praise our doctors and nurses, but the fact is that, like any other bureaucracy, it is prone to underperformance, waste and incompetence. There is no harm, as long as we preserve the principle of being free at the point of delivery, in having innovative private sector solutions.

[Sajid Javid]

I hear what my right hon. Friend has said and I think that, as I progress through my opening remarks, he will like what I have to say about integration and cutting bureaucracy.

All these things that I refer to and all these changes we want to make are exactly what this Health and Care Bill will do. I want to thank the thousands of hard-working staff who, through two years of consultation and engagement, have come forward and told us what they think works and what they think needs to change. In the words of Lord Stevens, chief executive of the NHS, the overwhelming majority of these proposals are changes that the health service has asked for. The Bill supports improvements that are already under way in the NHS. It builds on the recommendations of the NHS’s own long-term plan. It is a product of the NHS, it is for the NHS, and it is supported by the NHS.

I am grateful to all the organisations that have helped to shape these important proposals—everyone from the NHS Confederation to the Local Government Association. I have spent many of my early days in this job talking to them, and they have all told me the same thing, which is that they are ready to take forward the reforms. I want to continue to work with them and to listen to their specific concerns, just as much as I want to listen to the concerns raised by hon. Members across the House and by Members in the other place.

[Munira Wilson (Twickenham) (LD)]

rose—

[Sajid Javid]

With that, I want to listen to this particular hon. Member.

[Munira Wilson]

The Secretary of State referred to Lord Stevens and what the NHS has asked for in trying to get rid of things that stand in its way. Something that it has not asked for is a massive power grab by the Secretary of State, which is in the Bill and will lead to political interference in day-to-day operational and reconfiguration decisions, which may not always be in the best interests of patients. Why does he think that that is a sensible way forward and something that the NHS wants?

[Sajid Javid]

Clinical decisions should always be made by those with clinical expertise—I think everyone in the House would agree on that—and that should be independent of any outside interference. The Bill does nothing to alter that. What it does is recognise that the NHS is one of the public’s top priorities. We spend over £140 billion of taxpayers’ money on the NHS, and it is right that there is proper accountability for that spending to Ministers and therefore to the House. I think that most people would welcome that.

[Rachael Maskell (York Central) (Lab/Co-op)]

The Secretary of State has talked about people he has consulted, so would he confirm that he has consulted the trade unions, particularly on schedule 2, which says that integrated care boards may appoint employees to address remuneration, pensions and terms and conditions. Can he confirm that that is a departure from Agenda for Change terms?

[Sajid Javid]

There have been wide-ranging consultations on the Bill, as I mentioned, which have taken place over the past two years. While I cannot say specifically which trade union or which particular organisation has been spoken to, as I was not in the Department at the time, I know that the conversations have been wide ranging.

The Bill is not the limit of our ambitions on the nation’s health. We are also transforming public health; we are bringing the Mental Health Act into the 21st century; and, by the end of this year, we will set out plans putting adult social care on a sustainable footing for the future.

We are also ambitious for our workforce. I have commissioned Health Education England to refresh its strategic framework for health and social care workforce planning. HEE will work in partnership across the sector and gather views from the widest possible range of stakeholders to help us to shape a workforce with the right skills, the right knowledge and the right values for the year ahead.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

My right hon. Friend has set out his plans to introduce a plan for social care by the end of the year, and I know that he is looking for a cross-party solution. In a joint inquiry by two Select Committees—the Housing, Communities and Local Government Committee and the Health and Social Care Committee—one of the recommendations was a system with a German-style social care premium. Would that potentially feature in his recommendations, and does he agree that that is a much fairer system than a Dilnot-style system that incentivises people to spend their assets or move them somewhere where they cannot be touched?

[Sajid Javid]

First, my hon. Friend is right to say that it would be great if all or most Members of this House, and certainly the different parties, could agree on a new system. I look forward to speaking to all hon. Members about what a future social care system could look like. In terms of the detail, I am afraid that he is just going to have to wait a moment longer, but I agree that the work by the Select Committees will, of course, inform our decisions.

I turn in a little more detail to the measures and themes that are captured in the Bill. The first is more integration. We know that different parts of the system want to work together to deliver joined-up services, and we know that, when they do that, it works. We have seen that with the non-statutory integrated care systems in the past few years. They have united hospitals and brought together communities, GPs, mental health services, local authority care and public health, and it works. We recognise that there are limits on how far this can go under the current law, so this Bill will build on the progress of integrated care systems by creating integrated care boards and integrated care partnerships as statutory bodies. England’s 42 ICSs will draw on the expertise of people who know their areas best. They will be able to create joint budgets to shape how we care for people and how we promote a healthy lifestyle. With respect to the specific geographies of the ICSs themselves, as I have said elsewhere, I am willing to listen.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

In passing, may I congratulate my right hon. Friend on his appointment? I also very much welcome part 4 of the Bill, which introduces the health services safety investigations body. This is a great innovation that was promoted by the Public Administration Committee and scrutinised by the Joint Committee that I chair. Can I just reinforce the points that I know he is now receiving from NHS England with a warning about changing the boundaries of the integrated care systems that are already operating? In Suffolk and north-east Essex, we have a very high-functioning de facto integrated care system operating already. Please will he not change it?

[Sajid Javid]

My hon. Friend has raised an important point, and this may be on the minds of other hon. Members as well. It is important to point out that several factors will be helpful in fostering stronger partnerships between the NHS and local authorities, including the alignment of boundaries. Earlier this year, the former Secretary of State asked NHS England to conduct a boundary review of integrated care systems, to understand the best way forward and the best alignment where local authorities currently have to work with more than one ICS. I have met my hon. Friend and other hon. Members, and I know that hon. Members may have made representations to my predecessor. I have been informed of those, and where the information might not be remembered easily, I am sure we can get hold of some video evidence. [Laughter.] I want to thank all hon. Members for their input into this, and I stress that no final decisions have yet been made on the boundary review.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Will the Secretary of State give way?

[Sajid Javid]

If it is on this issue, yes I will.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. Just a reminder that interventions need to be short and to the point, because there is a lot of pressure on time in this debate.

[Tim Farron]

My point is about boundaries. Lancashire and south Cumbria have a perfectly reasonable boundary, but does the Secretary of State agree that there is concern that, because most rural communities are attached to bigger, more populated urban ones, that can lead to an imbalance in decisions? One of the proposals that our community faces is that the Preston and Lancaster hospitals could be replaced by a single super-hospital somewhere in the middle. HIP2—the health infrastructure plan 2—is a good thing, but that would be very bad thing, because it would mean that people in south Cumbria could have a two-hour round trip just to get to A&E. Will he intervene and ensure that any proposals under HIP2 that undermine access to healthcare in rural communities are taken off the table?

[Sajid Javid]

I listened carefully to what the hon. Gentleman said. As I have said, no final decisions have been made, but if he would like a meeting with a Health Minister, we can arrange that so that the matter can be discussed further.

I am also very grateful to another of my predecessors, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), first for his leadership of the Health Committee, whose valuable report and recommendations we have taken on board, and secondly for his tireless dedication to the cause of patient safety, which sees its culmination in the Bill’s creation of the Health Services Safety Investigations Body. We must continue, in his words, that quiet revolution in patient safety. I have asked my officials to consider whether the Care Quality Commission could look broadly across the integrated care systems in reviewing the way in which local authorities and providers of health, public health and social care services are working together to deliver safe, high-quality integrated care to the public.

[Mr Kevan Jones (North Durham) (Lab)]

The Secretary of State talks of patient safety. May I ask him why the Bill contains none of Sir Bruce Keogh‘s recommendations on the cosmetic surgery industry, which are now 10 years old? In response to questions that I have asked, Ministers keep saying that the recommendations are going to be implemented. Could this not be an opportunity to improve patient safety in that area?

[Sajid Javid]

The right hon. Gentleman has raised an important matter. There are issues surrounding the cosmetic surgery industry, and I know that he has spoken eloquently about them in the House before. I do not necessarily agree that this Bill has to be the vehicle for any change, but if he wishes to discuss the matter further, I should be happy to meet him in due course, because it is important and it does require a fresh look.

Whenever the NHS is subject to change, it is tempting for some, who should actually know better, to claim that it is the beginning of the end of public provision. We know that that is complete nonsense, and they know it is nonsense, but they say it anyway. So let me very clear: our integrated care boards will be made up of public sector bodies and those with a social purpose. They will not be driven by any private interests, and will constantly make use of the most innovative potential of non-NHS bodies.

The spirit of this Bill is about holding on to what is best about the NHS and removing what is holding it back. That is something that we all want, and I am looking forward to a mature debate—[Laughter.] Perhaps that is too much to ask in this Chamber with this Opposition Front Bench, but I hope for, and I think the public expect, a mature debate on the Bill and on how we can achieve these sensible changes together.

In that spirit, the second theme of the Bill is cutting bureaucracy. As we have been tested during these past months, we have looked at the rules and regulations through new eyes. It has become increasingly clear which of them are the cornerstone of safe, high-quality care, and which are stifling innovation and damaging morale. It is that second group of rules and regulations that the Bill strips away, removing the existing procurement regime and improving the way in which healthcare services are arranged. Yes, this is about how we deliver better value for the taxpayer, but fundamentally it is about how we can free up NHS colleagues to deliver better care. We know that patients are better served when experts are free to innovate unencumbered by unnecessary bureaucratic processes. That is why the Bill will repeal section 75 of the Health and Social Care Act 2012, giving the NHS the flexibility for which it has been asking. I know that this is a point of agreement with the Labour party—

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

We said it 10 years ago.

[Sajid Javid]

The Labour party said it not just 10 years ago but in 2015, 2017 and 2019—in all those manifestos—so I am sure that its members agree with this direction. [Interruption.]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. If Members want to intervene, let me say to them that the Secretary of State has been very generous in giving way, but just shouting at him is not working.

[Sajid Javid]

They are excited, Mr Deputy Speaker, and I understand that. Let me excite them much more.

The third theme of the Bill is greater accountability. We have never seen so clearly as we have in the past 16 months how critical the health of our constituents is for the House. The Government of the day always work hand in hand with the NHS to deliver that priority. That is what people would expect from a responsible Government. People also rightly expect there to be clear lines of accountability for how this priority is delivered. Accountability is the foundation of our democracy, and on that I hope we all agree.

On the nation’s greatest priority, our health, this Bill sets out clear lines of accountability to the people we all serve. The Bill simplifies what has been a complex structure, bringing the three different bodies that oversee the NHS into just one, as NHS England. NHS England will continue to have clinical day-to-day operational independence, but it is right that the NHS must be accountable to Ministers, and Ministers must be accountable to Parliament, where we are all accountable to the people we serve.

Naturally, that accountability will extend to these integrated care systems. The right hon. Member for Leicester South (Jonathan Ashworth) is on the record, in an interview with the Health Service Journal in December 2019, as saying that he agrees with the principle of the legislative changes that had been put forward by the NHS for “democratically accountable” ICSs. He cannot have any objection to this point. We will see what he has to say from the Dispatch Box.

I hope we can all agree that this is a sensible and pragmatic step. Let me quote once more:

“We will reinstate the powers of the Secretary of State for Health to have overall responsibility for the NHS.”

Those are not my words but the words of the 2017 Labour manifesto. I look forward to working with the shadow Health Secretary on this and other aspects of the Bill, and I urge him to set aside petty party politics and point scoring and do what the NHS wants him to do, which is to back this Bill.

Before I finish my opening remarks, I turn to the reasoned amendment in the name of the Leader of the Opposition and other Opposition Members. What is claimed by the reasoned amendment is entirely wrong. This is exactly the right time for these reforms. The response to covid-19 has quickened the pace of collaboration across health and social care, showing what we can do when we all work together, when we adopt new technology and when we set aside bureaucratic rules. The pandemic has also brought home the importance of preventing ill health in the first place. The Bill lays the framework to achieve all that.

More than that, this Bill is what the NHS has been asking for. It builds on the NHS’s long-term plan and the work the NHS has already started to do voluntarily. We have invested record sums in the NHS, both before and, of course, during this pandemic, and we will continue to do so.

The systems are telling us that they are ready, that they want us to go ahead with this Bill. They do not want to see any delay, which is why this is important work for all of us. Hopefully Parliament can deliver what the NHS is asking for.

The unprecedented challenges of the pandemic have only deepened our affection for the NHS, and it has reinforced the noble idea that the NHS is there for all of us when we need it. I started learning about the NHS from a very early age when I used to go to check-ups with my mum and translate for her. It was there for her, it has been there for me, it has been there for my family, it has been there for my children and it has been there for all of us and our constituents.

Even in this fast-changing world, with the new and evolving threats to our health, the founding principles of the NHS are as true today as they ever were. It is our responsibility to build on this incredible inheritance. Our NHS is the envy of the world, so it is right that this Government should work across health and care to shape a system that is truly fit for the future. Our colleagues in health and social care have achieved extraordinary things in the most extraordinary times, and we in this place must give them the firm foundations they need to build back better in the years that lie ahead.

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[The Minister for Health (Edward Argar)]

Before winding up this important debate, I would like to put on the record, as I always do and as I know the shadow Minister does, our gratitude to all the staff in the NHS, social care and local government, and other key workers, for everything they have done in recent months. This Bill is evolution, not revolution. It supports improvements already under way in our NHS and it builds on the recommendations of the NHS’s own long-term plan, laying the foundations for our recovery from this pandemic. This Bill is backed by not only the NHS, but so many others working across health and care. A joint statement from the NHS Confederation, NHS Providers and the Local Government Association reads:

“we believe that the direction of travel set by the bill is the right one.”

It notes that working in partnership at a local level is “the only way” we can address the challenges of our time. The chief executive of Age UK has said that ICSs are to be embraced and made as effective and inclusive as they can be, and the King’s Fund is calling for us to press ahead. The list goes on; the NHS wants us to press ahead, and in the words of Lord Stevens, “The overwhelming majority of these proposals are changes the health service have asked for.” So it is vital that we in this House do right by them and by patients at this critical juncture. It is the right time for this Bill. We legislate, Opposition Members obfuscate. I remind the shadow Secretary of State of his 2017 manifesto, which stated:

“We will reinstate the powers of the Secretary of State for Health to have overall responsibility for the NHS.”

With this Bill, we put increased accountability for the Secretary of State at the heart of this, yet now the shadow Secretary of State no longer seems to agree with himself and characterises his own proposals as “meddling”. I know that he is dextrous in his politics and in his policy position, which is probably why he has survived under multiple Leaders of the Opposition, but this is stretching it a bit.

We have sought, in getting to this point, to work on a collaborative basis at every stage, and hon. Members can be reassured that we will continue to adopt that approach in the weeks ahead as we proceed with this Bill, when we hope it goes into Committee. My right hon. Friend the Secretary of State set out in his opening remarks his willingness to listen. In particular, he highlighted that in the case of ICS boundaries no decision has yet been made. As he set out, we are determined to embrace innovative potential wherever we find it. That is quite different from many of the accusations we have heard here today. I know it is tempting for some—even when they know better, and they do—to claim that it is the beginning of the end for public provision. It is not and they know it. They know it is scaremongering rather than reality. They know that there has always been an element of private provision in healthcare services in this country, and they should know that because, as the Nuffield Trust said in 2019:

“The…evidence suggests the increase”

in private provision

“originally began under Labour governments before 2010”.

The shadow Secretary of State should certainly know that because he was a special adviser in the Treasury and in No. 10 at that time.

With regard to the implementation of the Bill, the NHS itself wants, subject to legislation, to move at pace to implement statutory arrangements for ICSs by April 2022. That is why NHS England is beginning preparatory work, including publishing an ICS design framework. Further work, including on integrated care board design and consideration of appointments and staff from CCGs will take place, after Second Reading, of course; this is all subject to the passage of the Bill.

Let me turn to some of the specific points raised by hon. and right hon. Members. The hon. Member for York Central (Rachael Maskell) asked about “Agenda for Change”. I can reassure her that it is not the intention that ICBs depart from “Agenda for Change”. The Bill’s drafting and wording is in line with existing arrangements for other NHS bodies with regard to “Agenda for Change” and translates it into this context. However, I am always happy to discuss that with her further if she wishes. Her suggestion that this was conceived, as she put it, in a bunker is quite simply not the case. Indeed, all the stakeholders, including the NHS, have said that this is one of the most collaborative pieces of legislation development they have seen.

Turning to the workforce, as my hon. Friend the Member for Winchester (Steve Brine) said, we cannot legislate to address workforce challenges but we can and we will look very carefully at the recommendations of the Select Committee and of my right hon. Friend the Member for South West Surrey (Jeremy Hunt).

While we do not always agree on everything, the hon. Member for Twickenham (Munira Wilson) made sensible points, although I would slightly tease her that she argued against the principle of the Secretary of State taking powers in reconfiguration and shortly afterwards her hon. Friend, the hon. Member for Westmorland and Lonsdale (Tim Farron), intervened on him asking him to do exactly that.

[Munira Wilson]

I did point that out.

[Edward Argar]

She did.

In response to the hon. Member for Central Ayrshire (Dr Whitford), I am again grateful for her comments and happy to accept her kind invitation to join her on a visit to Scotland.

The right hon. Member for North Durham (Mr Jones) made a very important point. In doing so, he rightly paid tribute to the work in this space done by my hon. Friend the Member for Sevenoaks (Laura Trott) with her recent private Member’s Bill. As the Secretary of State said, either he, I or the relevant Minister will be happy to meet him to discuss it further. My hon. Friend the Member for Meriden (Saqib Bhatti) was right to talk about the need for local flexibility. That is what we are seeking to do.

The hon. Member for Eltham (Clive Efford) asked more broadly about public spending constraints after 2010. He is brave, perhaps, to mention that. I recall the legacy of the previous Labour Government, which the right hon. Member for Birmingham, Hodge Hill (Liam Byrne) summed up pretty effectively in saying,

“I’m afraid there is no money.”

On social care, which a number of hon. and right hon. Members mentioned, we will take no lessons from Labour. In 13 years, after two Green Papers, a royal commission and apparently making it a priority at the spending review of 2007, the net result was absolutely nothing—inaction throughout. We are committed to bringing forward proposals this year. Labour talks; we will act.

The NHS is the finest health service in the world. We knew that before the pandemic, and the last year and a half have only reinforced that. It is our collective duty to strengthen our health and care system for our times. I was shocked, although probably not surprised, that the Opposition recklessly and opportunistically intend to oppose the Bill—a Bill, as we have heard, that the NHS has asked for—once again putting political point scoring ahead of NHS and patient needs. For our part, we are determined to support our NHS, as this Bill does, to create an NHS that is fit for the future and to renew the gift left by generations before us and pass it on stronger to future generations. We are the party of the NHS and we are determined to give it what it needs, what it has asked for and what it deserves. I encourage hon. Members to reject the Opposition amendment, and I commend the Bill to the House.

[Mr Deputy Speaker (Mr Nigel Evans)]

I apologise to the 30 Members who did not get to speak in this important debate, some of whom are currently in the Chamber.

Question put, That the amendment be made.

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19:00

Division 55

Ayes: 218

Noes: 359

The list of Members currently certified as eligible for a proxy vote, and of the Members nominated as their proxy, is published at the end of today’s debates.

--- Later in debate ---

19:11

Division 56

Ayes: 356

Noes: 219

Bill read a Second time.