Building Safety Bill (First sitting)
(3 years, 3 months ago)
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The Chair
Before we begin, I have a couple of preliminary announcements. I encourage Members, if they are able, to wear a mask when they are not speaking, to try to accommodate the fact that we are quite a large number of people in this room. Please can you also give members of staff space when you are seated, and think about social distancing when you enter and leave the room? Hansard colleagues would always be grateful if Members could email their speaking notes, if they speak. Can you also all ensure that electronic devices are silent? Teas, coffees and food are not allowed during the sittings. Date Time Witness Thursday 9 September Until no later than 12.20pm Sir Ken Knight CBE QFSM, Independent Expert Advisory Panel; National Fire Chiefs’ Council Thursday 9 September Until no later than 1.00pm Construction Industry Council; Royal Institute of British Architects Thursday 9 September Until no later than 2.45pm Construction Products Association; The British Standards Institution Thursday 9 September Until no later than 3.30pm The National Housing Federation; Local Authority Building Control; Local Government Association Thursday 9 September Until no later than 4.15pm UK Cladding Action Group; End Our Cladding Scandal Thursday 9 September Until no later than 5.00pm Landmark Chambers; Anthony Gold Solicitors LLP Tuesday 14 September Until no later than 10.15am The Health and Safety Executive; Office for Product Safety and Standards Tuesday 14 September Until no later than 10.45am Long Harbour; Home Builders’ Federation Tuesday 14 September Until no later than 11.25am Councillor Jayne McCoy, Sutton Council; The Institute of Residential Property Management Tuesday 14 September Until no later than 2.45pm Leasehold Knowledge Partnership; Association of Residential Managing Agents Tuesday 14 September Until no later than 3.30pm BRE Global Limited; Association of British Insurers; National House Building Council Tuesday 14 September Until no later than 4pm Fire Brigades Union Tuesday 14 September Until no later than 4.30pm UK Finance Tuesday 14 September Until no later than 5.00pm Alison Hills; Stephen Day
Today, we will first consider the programme motion on the amendment paper. If you do not have a copy of that before you, please see one of our officials sitting at the side. Then we will consider a motion to enable the reporting of written evidence for publication, and a motion to allow us to deliberate in private about our questions before the oral evidence starts. In view of the time available, I hope that we can take those matters formally without debate. I call the Minister to move the programme motion standing in his name, which was discussed this morning by the Programming Sub-Committee for the Bill.
Ordered,
That—
(1) the Committee shall (in addition to its first meeting at 11.30 am on Thursday 9 September) meet—
(a) at 2.00 pm on Thursday 9 September;
(b) at 9.25 am and 2.00 pm on Tuesday 14 September;
(c) at 11.30 am and 2.00 pm on Thursday 16 September;
(d) at 9.25 am and 2.00 pm on Tuesday 21 September;
(e) at 11.30 am and 2.00 pm on Thursday 23 September;
(f) at 9.25 am and 2.00 pm on Tuesday 19 October;
(g) at 11.30 am and 2.00 pm on Thursday 21 October;
(h) at 9.25am and 2.00pm on Tuesday 26 October;
(2) the Committee shall hear oral evidence in accordance with the following Table;
(3) proceedings on consideration of the Bill in Committee shall be taken in the following order: Clauses 1 to 2; Schedule 1; Clauses 3 to 21; Schedule 2; Clauses 22 to 26; Schedule 3; Clauses 27 to 42; Schedule 4; Clauses 43 to 54; Schedule 5; Clause 55; Schedule 6; Clauses 56 to 120; Schedule 7; Clauses 121 to 128; Schedule 8; Clauses 129 to 133; Schedule 9; Clauses 134 to 147; new Clauses; new Schedules; remaining proceedings on the Bill;
(4) the proceedings shall (so far as not previously concluded) be brought to a conclusion at 5.00 pm on Tuesday 26 October.—(Christopher Pincher.)
Resolved,
That, subject to the discretion of the Chair, any written evidence received by the Committee shall be reported to the House for publication.—(Christopher Pincher.)
The Chair
Copies of written evidence that the Committee receives will be made available in the Committee Room and will be circulated to Members by email. I am sure that you have already received that initial email. Thanks to all the Clerks and all the staff, who are doing an amazing job on what is a lengthy and complex Bill.
Resolved,
That, at this and any subsequent meeting at which oral evidence is to be heard, the Committee shall sit in private until the witnesses are admitted.—(Christopher Pincher.)
The Chair
We are now sitting in public again and the proceedings are being broadcast. Before we start to hear from witnesses, I encourage Members who wish to make a declaration of interest in connection with the Bill to do so. First, I will put my own interests on the record. My husband is a partner in Kingsley Napley LLP, whose clients include those involved in the building industry.
Rachel Hopkins (Luton South) (Lab)
I am a vice-president of the Local Government Association.
Ian Byrne (Liverpool, West Derby) (Lab)
I am still a sitting councillor in Liverpool.
Daisy Cooper (St Albans) (LD)
I am also a vice-president of the Local Government Association.
The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Eddie Hughes)
I am a member of the Chartered Institute of Building.
Mike Amesbury (Weaver Vale) (Lab)
I am a vice-president of the Local Government Association.
The Chair
Thank you. I remind colleagues that if you feel there are things that you should register, you can talk to the Clerks during our proceedings.
We will now hear oral evidence from our first panel of witnesses: Sir Ken Knight, the independent panel expert, and Dan Daly, head of the protection policy and reform unit at the National Fire Chiefs Council. Before calling the first Member to ask a question, I remind all Members that questions should be limited to matters within the scope of the Bill and that we must stick to the timings on the programme motion that the Committee has agreed. For this session, we have until 12.20. Will the witnesses please introduce themselves for the record?
Sir Ken Knight: I am Sir Ken Knight. I currently chair the independent expert advisory panel at the Ministry of Housing, Communities and Local Government, which was formed immediately after Grenfell. My background—my DNA—is in fire. I was in the fire service for 40 years, after having been the chief fire officer in Dorset, then the west midlands, and then I was the London fire commissioner before becoming the Government’s chief fire and rescue adviser.
Dan Daly: My résumé is somewhat shorter than Sir Ken’s. I am currently a serving assistant commissioner in the London Fire Service. For the last 12 months I have been seconded to the NFCC to head up the protection policy and reform unit, working alongside government colleagues on new legislation.
Mike Amesbury
Q
Sir Ken Knight: First of all, I think it is a very robust Bill. It will not be a quick-fix Bill, but nor should it be. It is a generational change. It would be wrong to suggest that there is an instant solution. The whole notion of putting a Building Safety Regulator in place and in charge of these matters will take time to work through. I am not sure there is a quick fix. I think the challenge will be in enhancing capability and competence throughout the sector, because that is still lacking in all areas, whether it is in enforcement or the built environment. I would like to return to that, if I may, at the end because there is something—probably outside the remit of this Bill Committee—that needs to be thought through. We need to educate fire engineers in competency and not leave it to chance, because there are very few at the moment to take on the new roles.
Dan Daly: I welcome the Bill. It is an important step change in building safety legislation. If I were to look at one element, the scope is fairly narrow at the moment. I understand the need to build the role of the regulator and the extent of the Bill in a proportionate way, but as Dame Judith pointed out, it was a broken system that led us to where we are today. This is our opportunity to fix it once and for all. The history of fire safety legislation is littered with disasters that people have sought to fix, and the fix has applied to one particular area of the built environment. This is our opportunity to look at that scope and certainly build gateways into broadening the scope at an appropriate point to make sure it takes full account of the built environment and the issues that are definitely there in buildings other than high rise residential.
Daisy Cooper
Q
Dan Daly: There is a lot to be admired in what other countries have done, and certainly in that particular example, but you have to remember that they were some way ahead of where we are and where we started from. There was already a single regulator in place in Victoria that was able to be instructed to take on some of this work. The number of buildings and the scale of the issue were much smaller than where we are. I think in total there were around 2,300 buildings, looking at a much broader spectrum of buildings—healthcare buildings and schools above two floors, and all other buildings above three floors. We know that, when we are looking in this country at buildings above 18 metres, we are already talking about 12,000 buildings—that is just high-rise residential. When we talk about buildings above 11 metres, we are probably closer to 100,000. If you take on the full range of where they were in Australia, the numbers just keep increasing exponentially.
There is something to admire in where they were—certainly the fact that sprinklers and alarm systems were in much wider use in those buildings, so that, in the fires that they saw, nobody died. There were measures in the buildings to tackle those instances early, and equally to alert people to the fires. It is certainly something that we have been talking about and pushing for: the wider use of sprinklers and alarm systems. It is good to see that there has been some change and movement in that, as part of the work that we have gone through so far. You cannot discount what has gone on. We should always look to learn, but there is something about scale and scope here that is different.
Sir Ken Knight: Can I just add to that, Chair? I had the privilege to host both a political head and an official head from Victoria very early on after the tragedy at Grenfell. Remarkably or not, they were very complimentary about the work taking place in the building safety programme—as you will recall, the Victoria high-rise fires occurred several years before Grenfell itself. They were impressed, even though none of us is satisfied that the pace is enough on all of these things. Of course, they had the luxury that they had no fire deaths at all. It was a wake-up call for Victoria as well—to realise that they could not wait for the tragedy of the 72 fire deaths that we saw here to do things.
For all of us who have been in touch with other countries, there is lots to learn from them. However, it is also about the capacity: the numbers of buildings, and the significant number of high-rise buildings, that will be covered even in the first-stage proposal in scope in the Bill, compared with the total number in somewhere like Victoria.
Ms Marie Rimmer (St Helens South and Whiston) (Lab)
Q
Sir Ken Knight: It is quite a significant part of Dame Judith’s report, of course, and that mixed economy has come through into the Bill. It is actually something that I support, providing that there is a level playing field in the competency, ethics and assurance of those doing the work. That is covered in the Bill, in a great deal of how the Building Safety Regulator will need to bring that to bear. The Bill makes the point, though, that in those buildings of higher risk the Building Safety Regulator is the enforcing authority for building control purposes—not either of those two bodies. I think that that is right. However, it is about levelling up the playing field for the competencies and assurances that are in place with some bodies and not others at the moment. There is a bit to go, but I personally do not object to that outcome, providing that the private sector actors involved in that are not directly employed by those for whom they are doing the work in seeking the outcome for the approvals.
Dan Daly: I do not have much different to say. The inability to choose your own building control body is important, particularly for developers that have wrapped up a number of those services within their overarching companies. Having some independence of that is important. There needs to be some robust checking if there is private sector involvement; that is the important element, and hopefully that is part of the role that the Building Safety Regulator will be able to take on. I suppose that is something to come in the guidance that will follow this Bill. We have issues of competency and capacity across the sector, so we need to keep our mind open to all those avenues, but with the appropriate checks and balances in there and the appropriate safeguards to ensure there is no compromise on safety in favour of profit.
Ian Byrne
It is my Scouse accent. Is height the best measure of risk? If so, is the threshold in the Bill appropriate?
Sir Ken Knight: I promise you that it is my hearing. Height is pretty arbitrary in risk. I think any professional would say that; I am sure Mr Daly will comment from a national fire chief’s point of view. It is right that there is at least a point to start, and the threshold in the Bill of 18 metres or more than six floors is a place to start. I would not want to presume that that means that high-rise is necessarily high risk, because risk is a difficult equation with two axes—one is probability, and the other is the catastrophic outcome risk.
Dame Judith’s report, and indeed the Bill, are based on the idea that the more people who could be involved in a single fire, the greater the catastrophic risk. In reality, more deaths occur in the home in bungalows, but that is not about height; it is about the demographics of people living in bungalows and the effects of that. It was right to set the bar somewhere.
Helpfully, though, the Bill allows the Building Safety Regulator to look at that first flush of buildings in scope—that will result in something like 12,000 buildings, a significant capacity issue to deal with—and then to move on from that in a dynamic way to look at other risk features that are not necessarily height-related. One might want to include in the next stage care homes and hospitals that are not necessarily over 18 metres. However, as a first tranche, the place to start is right.
The Chair
Mr Daly, would you like to reply to that?
Dan Daly: The short answer from our perspective is no. We talked about broadening the scope, and that is a nod toward the fact that we recognise other premises as being high risk. Part of that risk is about not just the physical attributes of the building, but the people who live in, use and work in those places, particularly our most vulnerable people, and the reliance they may have, in terms of the evacuation strategies from those buildings, on the building’s performing in a way that allows time for horizontal evacuation or phased evacuation, supported by people who are there to enable them to escape from the building when they need to.
There are a number of factors that I do not think are yet covered here, and I would like to see the opportunity to broaden the scope at some appropriate point, but I understand the proportionate start in the way that Sir Ken has described.
Brendan Clarke-Smith (Bassetlaw) (Con)
Q
Sir Ken Knight: It is a very fair question. That is in the area of probability or likelihood of risk. Most of us do not run our lives in terms of anything other than likelihood, whether it is flying in an aeroplane or crossing a road. We do not tend to judge the catastrophic risk of those. There is a good deal of risk aversion at the moment, which is natural after the tragedy at Grenfell, but unfortunate, because, as you say, last year fire deaths in the home were at a 40-year low. If we think of the past year, where for the first time most people were in their homes and not in offices, that is quite a significant statistic.
Even in high-rise residential flats, most fires occur in the room and flat of origin and do not spread beyond the flat of origin, and most deaths do not occur outside the flat of origin either. That is not to make light of all the deaths that occur, of course. I think the question that you have asked is key for me in ensuring that we do not suggest there is no risk below 18 metres—going back to the previous height issue—nor is it all risk above 18 metres. It is a risk-based, proportionate approach, according to a competent risk assessor. What we have seen at the moment are both lenders and insurers moving that risk aversion to the point that people in their homes feel unsafe when they are not, are anxious about living where they are, and are finding the effect on the value of their flats very difficult. I think we have to bring the pendulum back to a proportionate approach, allowing competency and risk assessment, not a binary “is it safe or not safe?”
Dan Daly: What I would add to that is the fact that there have been some well-intentioned actions over time in order to keep people safe and try to build some reassurance back into the built environment. People have seen Grenfell, and they have since listened to the evidence at the inquiry. Quite understandably, public confidence is undermined, but what we are now seeing is undoubtedly that some of the measures, whereby those costs are being passed back to leaseholders, are causing actual harm. The effort to protect people from potential harm is now generating real harm to people’s mental health and wellbeing, so there needs to be a reaction in order to try to bring that back to the centre. Fires are mercifully rare, but as a professional fire officer, I can say that one fire is too many and one fire death is too many, wherever it occurs. I understand the need to bring the pendulum back, as Ken has described.
Daisy Cooper
Q
Dan Daly: Let me go back slightly to your first question, which was about what happened in Australia. I said that they were ahead of where we are because they knew where their buildings were, and they knew a lot more information about them. Right from the start, that has been an issue that has plagued efforts to understand the risk, where buildings are, what they are made of, and what are the other construction elements of their external envelope. That has been a difficult starting point. There is some work under way that the NFCC and fire and rescue services up and down the country are supporting through the building risk review, which is looking at high-rise residential buildings and trying to understand in more detail the exact condition and circumstances of the buildings. Given the focus of what brought us here today, I think that is the right place to start to try to rebuild that confidence.
For the future, we need the golden thread of information that we are talking about in the safety case regime. We need to start to understand more about the built environment completely, not just high-rise residential buildings, so that should we find ourselves here again—hopefully, we never will—we are in a better place to look at where the risk is, prioritise those buildings and maybe take some direct action in the first place. Unfortunately, we were just not in that place to start with.
Daisy Cooper
Q
Dan Daly: It depends on what the check is for the building and what the circumstances are. If you have the information, you can find what the appropriate intervention is. Realistically, when we talk about the numbers involved, where do you find the competency and capacity to do all buildings in an audit process? You have to find some risk-based approach.
Sir Ken Knight: Perhaps I could just add to Mr Daly’s point. The capacity and competency are important, because some of these are not just building checks. They are invasive and involve taking parts of buildings down and looking inside walls. It would be a very long process to do a whole system check on all buildings, which is why I think it was inevitable to take an 18-metre approach and talk about those buildings as higher risk in terms that I have described, rather than pause and do a whole system check on all the buildings. We would still be doing that some time ahead. The NFCC, for which Dan Daly is responsible, has done a great job in using fire and rescue services to check whether buildings are at risk or at multiple risks. It has had some very helpful results, because they have all been found to be risky buildings.
The Chair
Unless there are supplementary questions on that, I will bring in Siobhan Baillie.
Siobhan Baillie (Stroud) (Con)
Q
Dan Daly: Combining where we are now with the Bill and the secondary legislation to come along, I think the fire service has a role to play in helping to design that, to make sure that it is fit for purpose and that it complements what is coming through in the Fire Safety Act 2021, which will come out later this year. From what we have seen, there has been a clarification. The Bill does not mean any new powers for the fire and rescue service, but there is something in the information strands; this Bill will bring about a better knowledge of buildings. That is really important to the work of fire and rescue services in terms of targeting their regulatory role, adapting and making sure that their operational tactics are fit for purpose, and making sure that where we can target through our prevention activities, we are looking at the people who live and work in those buildings to make sure that the right prevention advice is provided to prevent fires in the first place.
Sir Ken Knight: I normally hesitate to comment on what fire and rescue services should do, having done it for 40 years and leaving it to professionals like Dan Daly and the NFCC, but I would just draw attention to the Fire Safety Act, which he referred to. The Fire Safety Act, of course, has recently passed through Parliament as an amendment. It does put, absolutely, enforcement authority with the fire and rescue authority, and that is the fire and rescue service. And it is much broader—this goes back to the height issue—because it is not just about height. It is about all those buildings where there are more than two occupancies, so it is a much broader piece of legislation, of which the enforcing authority is, effectively, the fire and rescue service. I think it will have a very close relationship both with local authorities and the Housing Act 2004 and with the Building Safety Regulator, because there is a wealth of knowledge in that background and experience and it is a key part of a modern fire and rescue service.
The Chair
I am going to bring in Ruth now, and I know that Mike and Marie have further questions that they want to ask.
Ruth Cadbury (Brentford and Isleworth) (Lab)
Q
Dan Daly: I think you are referring to Worcester Park.
Ruth Cadbury
Yes, Richmond House in Worcester Park.
Dan Daly: There are a couple of things that I think are useful here. One is the competency issue. I think we have maintained right from the start that everyone involved in the build process, right the way through and from maintenance through to occupation, needs to be competent in the role. That is the first part: how these buildings are constructed in the first place and the appropriate measures—barriers, fire-stopping arrangements and so on—being put in place.
There is also the work around product regulation, which I think is really important. We have all seen the evidence at the Grenfell inquiry that products not fit for purpose have been openly sold, knowingly sold. That needs to stop, so that people can build in confidence with the materials they have. I think those two things come together quite well to look at the issues. But there is something, again, about the scope of the Bill. It is starting where it needs to start. I can understand that the new regulator would want to start proportionately and get that right. But I think it is hugely important that we open up the pathways to extending that remit, to look at other types of building.
We have the issue of modern methods of construction. That can be any kind of new aspect of building. I think Worcester Park has an element of timber-frame construction. We are seeing lots of modular construction. We have the highest modular constructed building in Europe here in London. Those kinds of elements need to be looked at to ensure that competency goes right the way through, from the off-site manufacture and the materials used, to the on-site installation. Those are things for the future; that is a good place for us to be. My concern at the moment is this: what are we doing about the existing stock? I think that is part of your question. There is the issue about how we can reach back on building defects. I think there is a slight flaw in that.
There is a welcome extension to the timeframes on this, but the slight flaw is that it is to the date when the building was complete. We have already seen buildings for which even the 15 years proposed now would have elapsed. If it has not elapsed there certainly is not time between it coming in and the point in which it elapses for the legal action to kick in and take place. There needs to be something about whether it is from when the defect has occurred. The defect, if not picked up during the building stage, would then be beyond the vision and scope of the fire service as a regulator. The fire service does not dismantle buildings to understand what was not done properly through the building control process and construction processes. We need to get stronger on that issue as well. Those are the elements we can do more on in terms of reaching back.
There is an issue as well with buildings and planning. Some buildings will already have attained planning permission under the broken system, and they will be allowed to be built going forward, adding to the pile of issues we are trying to address now. Where is the hard stop on those buildings? They need to be reapplied for to make sure the standards are fit for purpose today. That is another important element we would like to see change to make sure we do not add to where we are.
Sir Ken Knight: Can I just add to that? I think that is why one of the important inherent, underpinning foundations of the Bill is that it enables legislation. It is such a large Bill and requires secondary legislation. I am sure there will be some who will sit here and suggest that it is not detailed enough. I do not hold that view; I think, by being enabling, it allows flexibility in the future for additions and to change some of those issues. It allows for the Building Safety Regulator to look at new methods of construction of buildings and make recommendations to the Secretary of State. That is probably where we came from. The Act it replaces is the Building Act 1984—some 37 years ago. That fixing in time of something that needs to be so dynamic according to risk and change enables this Bill to be that opportunity for the next generation.
The Chair
We have got just under 15 minutes, and there are three more questions to go through. Keep that in mind, if you could.
Ms Rimmer
Q
“must take all reasonable steps for… preventing a building safety risk materialising as regards the part of the building for they are responsible”.
The definition of the part for which they will be held responsible is to be defined in regulation. Should it not be defined within the Bill itself?
Sir Ken Knight: That is one of those examples where getting this huge piece of legislation through the Parliamentary process, which will itself be 12 months away, will it not, will allow that regulation to come swiftly afterwards. I am pretty relaxed, personally, that regulation and secondary legislation will follow and build up the basis of this very quickly indeed with the experience that needs to be held. I am not the expert in that area, but I am very convinced that going down this enabling route is the way forward.
Ms Rimmer
Q
Sir Ken Knight: No, there is not, but I think the Building Safety Regulator is already on the case. He has issued a document only this week about what safety cases will look like. He and his team will be having the same capacity issues as everyone else, but nevertheless I suspect he is not waiting for the Bill to happen. Nor are the major people out there responsible for buildings in the future, which is pleasing. They are already looking at what they need to do now to make people feel safe in their homes, rather than waiting for the Bill to pass through Parliament.
Dan Daly: I do not have much to add. The detail will come. I would like and welcome the opportunity for NFCC to be part of those discussions, as some other stakeholders are, to keep the promises that are made here. I do agree that there is an awful lot left to trust, and there needs to be some oversight to ensure that that trust is not betrayed and that, if the Bill is put through as an enabling piece, the guidance that follows is suitable to bridge the gaps in the information that is not there at the moment.
Mike Amesbury
Q
Sir Ken Knight: I can deal with some of that shopping list, which you are right to highlight. EWS1 has been one of those areas. The external wall system 1 form is the surveyor form for evaluations. I would argue that it has been misused on premises where it has added cost to the leaseholder. I have seen real examples where people trying to sell a bungalow have been required to have EWS1 for an external wall, which frankly is nonsense. Again, that is about the proportionality of lenders and insurers recognising that some of those building heights and risks do not need that.
The other reason for me saying that about EWS1 in principle is that I believe it will quickly be overtaken by the external wall assessment of the Fire Safety Act 2021, because everyone will require that. One of the advantages is that you will have one risk assessment for the whole building and not every leaseholder having to have an EWS1 form to satisfy their lender when they want to sell, adding to the cost for each leaseholder in turn. Will the Bill address that? I think the combination of those other things I have just mentioned will certainly assist that, but it does mean needing to get back to an approach that is both risk-based and risk-assessed, and people being competent, and the culture has to change. It is going to have to change very quickly because Dame Judith recognised that both culture and competence were key issues. I think they still are.
The Chair
Have you anything to add, Mr Daly?
Dan Daly: Just briefly, I think we have maintained the position for some time that leaseholders should not bear the costs of historic building defects. We welcome the extension of the period to look back at where issues have been found in buildings, but I think there is definitely more that could be done to give them that protection. Overarchingly, what is needed to give reassurance across a much wider sector—this is about lenders, insurers and constructors right the way through—is getting a regime in place as quickly as we can that supports and holds them to account in the right way.
I welcome the idea of industry leading the way to improve its own culture, but I actually want to see a regulator with some real teeth that can hold them to account as well, because that is what is going to be required. The Health and Safety Executive brought some real change in the construction industry, but that was because its attempts to change the industry were also supported by strong and robust enforcement that it was able to bring to that. Holding people to account and getting the regime in place that underpins the whole sector is something that will help with where we are.
Siobhan Baillie
Q
Dan Daly: It is very difficult in the context of Grenfell because that is obviously where people’s minds are focused, but in my professional experience you are generally at no greater risk in a high-rise building than you are elsewhere, and the figures bear that out. We see a number of deaths. My experience is in London and if you think about London, we see the commonality of people dying in fires is not where they live, but the circumstances of them, the vulnerabilities and the care they may be subject to, or the lack of care in some instances. That is what drives those deaths.
None the less, it is recognised that people will feel nervous in those homes. There is more that we can do and this regime helps with that. The work of fire and rescue services goes beyond response; we do much more than that. It is also about prevention and protection. The protection element is about looking at the buildings, and the prevention is about the advice we can bring to people in their own homes, and it all contributes to reducing that fire risk.
There is something here that people will recognise, which is that there is limited capability for fighting fires at height. We know that and have experienced that. That in itself will not help with public confidence, but the stats of the matter—this is an emotional argument, so stats are not always the best place to find ourselves—do not support the view that you are at any higher risk. However, we must address the fact that people have and should have the right to feel safe in their own homes. We are spending time on that, and I said I think it is the right place to focus the regime for now to build that confidence, but we must have the ability to extend the scope and make people safe wherever they live.
Sir Ken Knight: In the context of high-rise buildings, the differences are that it can be more dependent on the other measures in place to ensure that compartmentation is intact, such as fire doors, having self-closers fitted, ensuring that smoke ventilations are working—all of which, as we have heard in another place of inquiry, was woefully lacking. I think it is more dependent on that.
What is key is something Judith Hackitt picked up in this Bill: the residents’ voice as well as the residents’ responsibility. That is absolutely key to this as well. They need to be assured that they have the key information, but they also have to understand that they have a key responsibility to ensure that they and the others in the same building are safe as well. I think that combination makes high-rise different from a two-bedroom cottage somewhere, because it is more dependent on others and the compartmentation is more key. That is why I support starting at 18 metres in the Bill—starting at 18 metres for buildings in scope. That is the place to start, from our experience over the last few years.
Ruth Cadbury
Q
In terms of new build, building professionals have told me that in this country we have moved from designing and building for fire safety, as Brentford Towers were built, towards concerns about thermal insulation and energy saving, so have started to lose the focus on fire, whereas in other countries the two have gone together. Do the witnesses agree with that? If so, do they feel that the Bill addresses that challenge?
Sir Ken Knight: I have also heard it said—I have no evidence that it is correct—that the two sometimes seem to be movable objects in ensuring sufficient insulation, and indeed in making the homes and lives of residents much better and much less expensive because of heat loss and energy, and in meeting the very important net zero agendas as well. I think the Bill does address that. It makes it very clear that there are hard stops at each of those gateways that are put in place in the Bill, which the developer cannot pass until they have satisfied the Building Safety Regulator that they have met the fire safety requirements and the fire safety case. That has not ever been the case before. You could have a design and build that would move on and move on in process, and move beyond that gateway before being checked by the appropriate enforcing authority. I think the Bill has gone a long way towards addressing that very point—that fire and structural safety are not left as a second cousin.
Dan Daly: Absolutely. There is the ongoing role of the approved documents that sit behind the building regulations. That is an important part of what will support the endeavour of the Bill. We need to keep working on those. They have fallen woefully out of date with modern methods of construction. That is something that needs to be reviewed with the Building Safety Regulator going forward, and challenged to make sure that the appropriate documents are kept up to the date.
There is something about the competency of individuals as well, in reading those approved documents in tandem. There are documents that talk about how a building is structurally sound and how it is fire-safety sound, before it starts to talk about the thermal performance of the building, but the two should be read in conjunction. What we have seen is people not necessarily with the right competence adopting convenient interpretations of those documents rather than following what the documents are trying to say. That again points back to the competency issue and the oversight by the regulator, and hopefully the oversight of the gateway processes, to prevent those things happening again.
Ruth Cadbury
Q
The Chair
Just before you answer, I will point out that we have two minutes and then I will have to bring this to a close.
Dan Daly: That points back to the competency issue. We have the products stuff that will hopefully be regulated and perform better—people will know that what they are getting will do the job it says on the tin—and then the individuals who are employed to make the determination about what products are used on a building in certain circumstances having the right competency to interpret the building regulations and the approved documents to make sure they are using the right things in the right places.
Sir Ken Knight: The Bill, of course, includes the provision for a new construction products regulator, dealing with the products, which is really important in modern methods of construction. You are absolutely correct that modern methods of construction are important. Of course, modern methods of construction bring with them a precision in construction by pre-forming and pre-making, so modern methods have some advantage. We need to ensure that they have in-built fire safety elements when they are constructed and finished as buildings.
The Chair
I think that brings us to the end of questions for the first panel. I thank our witnesses for taking the time to be with us today, and for an incredibly useful set of answers. If I could ask you to exit through the doors, we will bring in our second panel of witnesses. Thank you very much.
Examination of Witnesses
Graham Watts OBE and Adrian Dobson gave evidence.
The Chair
Thank you for being with us today. Just before we start our questioning—Ruth Cadbury will kick it off—may I ask you both to introduce yourselves?
Adrian Dobson: Thank you very much. My name is Adrian Dobson. I am executive director of professional services at the Royal Institute of British Architects. That includes supporting our educational and practice standards, and our work in association with the Architects Registration Board.
Graham Watts: Hello. I am Graham Watts. I am chief executive of the Construction Industry Council. I am also chair of something called the competence steering group, which was set up after the Grenfell tragedy to improve competences across the industry. For full disclosure, I also co-chair the building safety workstream of the Construction Leadership Council and I am a director of Building a Safer Future Ltd, which is responsible for the building safety charter.
Ruth Cadbury
Q
Graham Watts: The Bill is very welcome. It is a step forward from the draft Bill that we saw last year. The clarification on scope has been very welcome, for example, but it is important to say that the Bill, or the Act in due course, will not be a panacea to ensure building safety. That is a really important point. The Bill is needed to support the paradigm shift that is needed in the culture change of the construction industry, and only that shift in the construction industry will ensure that we have safer buildings.
Adrian Dobson: I basically agree. It is important to say that it is just a piece in the jigsaw puzzle. It is very welcome that there will be a new regime for building regulations, and that the HSE will be placed with oversight of it. Basing it on the Construction (Design and Management) Regulations 2015, which have worked quite well in terms of looking after the safety of the people who construct buildings, is quite sensible. Without wishing to repeat what you have heard from previous witnesses, there are other pieces in the jigsaw. Inevitably, the industry relies on guidance. I think you have heard previously that the approved documents still need major review. Obviously there has been discussion about the buildings that are within the scope. You can imagine that other types of buildings may, in due course, need to come within scope, but it is sensible to start with what we know is at particularly high risk of catastrophic failure.
Eddie Hughes
Q
Graham Watts: As you know, Eddie, it is a massive industry—3 million people and several hundred thousand companies. Co-ordination, communication, leadership and challenge are the key factors that we in the CIC, and the bodies that support us, such as the RIBA and the Chartered Institute of Building, need to concentrate on. We really need to get away from a culture that is based on a race to the bottom, as a result of which companies that win work at very low profit margins do everything possible to prioritise the commercial side of things, avoid penalties and cut corners on quality in order to increase profit. That is the basic culture that we have to change. We have seen the evidence of that in the Grenfell inquiry. We do not need to see where the evidence is; it is there before our eyes.
Adrian Dobson: One thing to add is that, obviously, we are keen for things to move on at pace. What a number of the professional bodies, including the RIBA, are doing at the moment is working on our accreditation regimes for the new duty holders, because obviously we need to be in a position to accredit professionals to undertake the principal designer and principal contractor roles once the new regime comes into play. That is an important task for the professional bodies to be getting on with now.
Rachel Hopkins
Q
Adrian Dobson: There is a chicken-and-egg situation. I have been involved in a number of meetings on the competence standard, and obviously you can go off only what has been published so far. The publication of the draft regulations on the competencies and due diligence is quite helpful, although I hope that there may be a chance to talk about some concerns about those definitions. The more information that can come out, the better.
The Bill does explain the basic principles quite well, and I think everybody is supportive of that. There is complexity. One of the points that I would like to make, if I get the chance today, is that our view is that, if the principal designer is a key duty holder, they should be involved in gateway 1, which is when some quite key design decisions are made. It has been complicated to achieve that, because it has been achieved through a change to the town and country planning legislation. I can see that some of this is going to have to be sorted out once the system is in place; that is just inevitable, really.
Graham Watts: I tend to agree with the point that Ken Knight made in the previous session: the detail needs to be in secondary legislation, in the statutory instruments. Of course, that does mean that there needs to be adequate consultation and scrutiny of those statutory instruments. I have some experience of this from the industry perspective, as a designated body implementing aspects of the Building Act 1984. Too much of the detail was in the Act. It meant that there were unintended consequences down the line: things that needed to be changed could not easily be changed. That made my mind up on that issue.
Where there is a need for more detail on the face of the Bill is in those areas relating to the paradigm change in the industry that I spoke about earlier. That needs to be supported by the Bill, particularly in the area of competence, which actually underpins virtually everything that we are talking about. In the report that we produced at the end of last year, “Setting the Bar”, which sets out a new competence regime for occupations involved in high-rise buildings, we were hoping and expecting that there would be greater definition in the Bill.
For example, we thought that the requirement for independent third-party certification might be on the face of the Bill. It is absolutely essential, but it is not there. We think that there should be mandatory registration for those who have duty holder roles, and I am not just including principal designer, principal contractor and building safety manager. Also, for example, there is a need for independent construction assessment, and I am sure Adrian and I will talk about that a bit more later. It also seems to me an anachronism that we are defining the roles for principal designer and principal contractor but not for the building control profession.
Without having mandatory registration with the regulator—to say that Joe Bloggs or Freda Smith are qualified to be a principal designer—there is going to be a lot of confusion out there about who is qualified to hold those roles. I worry that the less scrupulous people within the industry will find ways around the requirements in order to prove, by some sort of desktop study, that they are actually qualified. There are also things like making sure that there is regular reassessment and mandatory continuing professional development. Although I appreciate that there are reasons why those details might not be in the Bill, we need them to be defined.
Daisy Cooper
Q
Adrian Dobson: Gosh. I am not so familiar with the workings of Parliament, but certainly I would make the point that those regulations will be very important. We have been poring over the competence regulations and the duty holder regulations; I know they are only in draft, to enable you to understand the Bill, but that level of secondary legislation and regulation will need proper parliamentary scrutiny.
There is also an important role for the industry, working with the HSE and the new authority, to ensure that the review of the guidance is done properly. With the best will in the world, I do not think this place or other similar bodies can do that detailed, rigorous interrogation of the guidance, and it is very important. It is the lack of guidance that has been causing some of the problems, particularly below the 18-metre threshold. We now have quite an ambiguous situation with those buildings, which is complicating the situation for leaseholders and so on.
Graham Watts: May I first of all say that I have been working in the industry for 42 years, liaising with Government on policy matters, and I do not think there has previously been a more exemplary case of consulting with industry, particularly on the draft Bill and more generally in the course of the Bill’s passage through Parliament? I would like to see the same process with the statutory instruments. We think there will be nine statutory instruments—we have seen two of them in draft already—but we need to continue that kind of early-warning consultation, avoiding unintended consequences, overlap and duplication and so on, with the draft secondary legislation, just as we have with the Bill itself.
Mike Amesbury
Q
Graham Watts: I think the answer to that is no, but the Bill does a bit more than the draft Bill did, particularly in the extension of the Defective Premises Act 1972. I am from the industry, and I have no doubt whatsoever that no leaseholder should have to pay for having been mis-sold a home that is not fit for purpose or safe. That should be axiomatic, and we should be exploring every opportunity. I know the housebuilders and developers have put up something like £500 million already, but in many cases they are not there any more—they have gone bankrupt, or it was a special purpose vehicle developer that does not exist any longer. I have no doubt that the Government must do more, but the industry must also do more, and I welcome the polluter pays principle of the developer tax.
Adrian Dobson: This Bill is a piece of the jigsaw; one problem is that this is predominantly a forward-looking piece of legislation, so it will address new projects and alterations to existing buildings, but it will not deal with the historical defects. That is a situation that will ultimately require the Government to engage with the insurance sector. We now have a situation where—to use the example of the EWS1 form, which I know you talked about earlier—because the insurance sector has pretty much excluded fire safety cover from many professionals, it is difficult to get professionals who can sign these forms, and they will now inevitably take a very precautionary approach, because they know that this insurance is difficult to get. There are some risks in thinking that the Bill itself will solve that; that historical liability is more complicated.
The Bill also raises the question of the insurability of the duty holder roles in the new regime; this illustrates why the interrogation of the regulations will be so important. The regulations as they are drafted at the moment mix words such as “take reasonable steps” with “ensure”, and they are very different. One is an absolute obligation and one is more like the CDM regulations. Will the insurers provide the insurance to underpin these roles? The insurance issue is where the problem lies, in my view.
Ian Byrne
Q
Graham Watts: I think the answer to that is yes, because competence is in the Bill and it underpins and supports all of the work that the industry has done over the last four years—some of the things that Adrian talked about earlier in the different sectors. As I said before, I would personally like the Bill to go further in defining the levels of competence and in making sure that the people who are registered actually have the competencies. I think that is absolutely necessary.
Adrian Dobson: I would tack slightly along the same line. I think the Bill is very good at trying to address the competence issue, although, for example, there are weaknesses in other areas of the industry. Procurement is complex in construction. I know that has been discussed in the Select Committee and various places. There is a duty on the principal designer to monitor design work for compliance, and a similar duty on the contractor. “Monitor” is quite a weak term. In design and build procurement there is no requirement for independent inspection, or no duty on the designers to return to the building and say, “Has this building been designed and constructed in accordance with that design intent?” So I think it is stronger on competence than it is on addressing some of the realities of the construction industry. Will the hard stop at gateway 2 really be a hard stop, because the commercial realities of the construction industry will tend to want to keep the project moving forward, and that is a risk? So it is good on competence and perhaps a bit weaker in other areas.
Ms Rimmer
Q
Graham Watts: We are obviously at an early stage in the development of the new powers for the product regulator. As we have discovered from the Grenfell evidence, it is an absolutely imperative aspect of the Bill, so I certainly welcome that side of it. The work that has been done in the industry to ensure integrity in the marketing information for construction products has been scandalously shocking in the past. As somebody from the industry, I am ashamed of the fact that we did not wake up to that, but I welcome a rigorous attention to the regulation of construction products and also the Government’s recent decision to postpone the implementation of the conformity assessed mark for a year, because that was causing huge problems in the construction sector. Personally, I think a year is not enough, but at least it is a step forward.
Adrian Dobson: My answer is probably similar to before. There is an inevitability that there will have to be secondary regulation. Maybe an area that it does not address is that once we get to the stage of developing revised guidance, we have some questions about how much different sectors of the industry have been able to influence the testing process. If you are going to rely on testing to give you confidence about the performance of products, that genuinely needs to be independent testing. I will be interested to see what the regulations say about that and how they keep that independence of the testing.
Shaun Bailey (West Bromwich West) (Con)
Q
Graham Watts: Both of those things are equally vital. I think the industry welcomed the decision to place the Building Safety Regulator within the HSE, because it is a well-respected agency and people take notice of its interventions. We understand that the regulator is likely to have somewhere in the region of 750 staff. It is not going to be an insubstantial body, and I am sure it will take effective enforcement action, but it needs buy-in from the industry. That comes back to my earlier point about a culture change within the industry, and not just in terms of the scope of the legislation—it must go beyond that. As people have said, the twin-track approach to regulations could be confusing and complex. We understand why there needs to be a limitation on the scope to begin with; otherwise, the system will not cope and will collapse. But there will be confusing areas at the margins, and it is essential that the industry adopts the same approach to its work on buildings that are not in scope and on buildings that are in scope. We cannot have a twin-track approach as far as safety is concerned.
Adrian Dobson: In fairness to the Government, it is difficult for the Government to regulate the competence and behaviours of the industry. Without the industry acting as a willing partner, it is virtually impossible, and the Bill tries very hard in that area. A more contentious issue is to what degree you have an element of prescription in what is done. We have had an element of prescription, and it was probably agreed that that was necessary because we had a stock of buildings that there were serious doubts about. I know that the Mayor of London has introduced an element that has been quite controversial, but I suspect that working out where the balance is will be quite difficult. When it comes to fundamental elements of fire and structural safety, I wonder whether you will inevitably end up with some firmer guidance. It might become prescriptive regulation or just clearer guidance on the basics of means of escape, compartmentation, alarms and sprinklers. Those are the fairly basic safety systems that buildings rely on.
Ruth Cadbury
Q
Graham Watts: I guess it is an unfair question for now, because the regulator does not exist yet. But I have been impressed by the way in which the HSE has set up interim arrangements. For example, the interim industry competence committee—there is a committee on industry competence on the face of the Bill—has already been set up, and I am already liaising with the chair of that committee to make sure that there is an appropriate transition from the work that we have been doing within the industry for the last four years, to the work that will be eventually housed within the regulator.
Clearly, the staff at the HSE are experts on health and safety, so Peter Baker has to build up his team. He is a long way from being able to do that at the moment, but I am hopeful that the same principles and protocols that have driven the HSE—certainly its ability to consult the industry through bodies such as the Construction Industry Advisory Committee, which has been significant—will be carried over into the new regulator when the legislation is enacted.
Adrian Dobson: At a very basic level, the fact that it will be within the HSE sends a useful signal, because it says that at the heart of the building regulatory process is the safety and welfare of people. It is a simplistic thing, but it is quite an important signal. It has probably been given to the HSE because of the relative success of the CDM regulations. I do not think anybody in the industry thinks the CDM regulations have been perfect, and it has taken quite a lot of iterations to get them to where they are today. There are some weaknesses, particularly in the handover of information at the end of the project. That will also be so important for the safety of buildings under the new Fire Safety Act. But I think HSE has a good track record, which is possibly what is giving people confidence about it.
The Chair
Q
Graham Watts: There are a couple of concerns that I wanted to get across, and I think Adrian certainly shares one of them. The first one is a worry about the unintended consequences of the Act, if they are not carefully thought through. I do have a real worry about the insurability of some of these roles. Adrian has already referred to the narrowing and hardening of the insurance market for anything to do with fire safety and cladding. That is significant. A lot of companies are pulling out of that work altogether, because either they cannot get the insurance or the insurance is too cost-prohibitive. There is an onerous set of requirements on the building safety manager, for example, that I think will make it potentially uninsurable.
There are things that can be done to help that. Clause 91 on residents’ engagement strategy qualifies the requirements by saying so far as “reasonably practicable”. I think we need that kind of codicil to the requirements on some of the roles within the Act; otherwise, they are going to be uninsurable. I was responsible for setting up the designated body for registering approved inspectors after the Building Act 1984, and that legislation was not implemented until 1997. It took 13 years for us to get over the problems—the unintended consequences of the Act—that meant it could not be implemented. One of those problems was the inability to get insurance for approved inspectors. I think that is a warning signal that needs to be taken care of.
Secondly, there is a need for independent scrutiny of construction work. Adrian and I both believe very strongly in that. It came over as a recommendation from the Chartered Institute of Building and others in the working groups within the Competence Steering Group. We have lost that. If we go back in time, it was traditional to have clerks of works independently scrutinising the work on site. It was traditional for architects and engineers to go on site and supervise to ensure that their design work was being correctly implemented. We have lost most of that—they are rarities now—and I think that the requirement to have that independent assessment of construction work is essential. Whether it could be on the face of the Bill is, I understand, a moot point, but it is something that we need to develop, and we do need Government support—particularly as a client, actually—to help ensure that that happens, because it is one way to make sure that the design intentions are properly constructed, and that we get the quality that was always intended.
The Chair
Mr Dobson, would you like to add any other thoughts?
Adrian Dobson: I would prefer to reinforce those three points. Whether it is a client’s duty to have some independent inspection or whether it encourages clients to have independent inspection through, perhaps, standards that can be developed for use by the duty holders, will be a key point. As Graham said, if we cannot get insurance for these duty holder roles, we risk to some degree repeating the EWS1 problem, where we create a system that then cannot do what it is meant to do.
Even with something like extending the Defective Premises Act, you can understand why it has been done, but it is yet another thing that will cool the appetite of the insurance market. That is why I think market engagement is so important. Graham has not said this, but I did mention earlier that we feel that once the HSE looks at this, it may wish to consider whether you should really have the principal designer involved in that planning application; because you are making decisions about how many means of escape there will be from a building, where you are going to site it on the site, and how you will get access for the fire brigade. You are making quite fundamental strategic decisions that go beyond just a fire statement, which is what the current regulations demand.
Mike Amesbury
Q
Graham Watts: We—by “we” I mean the Competence Steering Group rather than the Construction Industry Council—recommended that there should be an independent construction assessor on all projects in scope of the legislation. That obviously has not been taken forward, and I think I understand some of the reasons why, but I stress that whatever way that happens, it is essential to securing the culture change that I spoke about earlier.
Adrian Dobson: The Committee may wish to think about whether there should be duties on some of the designers as well. You can appreciate that when you are scrutinising construction work the architect may be able to look at some aspects. Some aspects very much need the structural engineer and the services engineer to be involved. So you might want some general inspectorate, as would be prepared by a clerk of works, that is on a more regular basis, but you will need some scrutiny from individual designers as well. There may need to be some duties around that, possibly.
Daisy Cooper
Q
Adrian Dobson: The most obvious person, given the way that the Bill is framed, is the client; but as you say, the client is rarely, in the construction process, the end user of the project. One of the areas—probably the most difficult to tackle—that has not been talked about a lot is how you raise the competence of clients. The Government themselves are a major procurer, as are local authorities. It is important that they set the example. At one time, local authorities would have employed clerks of works to go and look at projects, so it is quite interesting that they can act as a leading edge—but yes, it is a difficult one.
Graham Watts: For new build, obviously the sign-off at gateway 2 is from the principal contractor to the client. I think we are also talking here about a lot of refurbishment and renovation projects where the residents are in situ. There the responsibility needs to be to the building safety manager, and the building safety manager’s responsibility needs to be to the residents.
The Chair
If there are no further questions, I thank both our witnesses for a really excellent evidence session, and for taking the time to come before us today.
Ordered, That further consideration be now adjourned. —(Scott Mann.)
Health and Care Bill (Third sitting)
Thursday 9th September 2021
(3 years, 3 months ago)
Public Bill CommitteesRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 9 September 2021 - (9 Sep 2021)
The Chair
Before we begin, I have a few reminders. Please switch electronic devices to silent. Tea and coffee are not allowed during sittings of the Committee. I encourage Members to wear masks when they are not speaking, in line with the current Government guidance and that of the House of Commons Commission. Please also give each other and members of staff space when seated and when entering and leaving the room.
Members should send their speaking notes by email to hansardnotes@parliament.uk. Similarly, officials in the Gallery should communicate only electronically with Ministers. If everyone is agreed, we will go into private sitting to discuss lines of questioning.
The Chair
All our witnesses are appearing in person. It is helpful if Members direct their questions to specific witnesses.
Before calling the first panel of witnesses, I first remind all Members that questions should be limited to matters within the scope of the Bill and that we must stick to the timings in the programme order the Committee has agreed. For the first panel, we have until 12.15 pm.
Secondly, do any members of the Committee wish to declare any relevant interests in connection with the Bill?
Dr James Davies (Vale of Clwyd) (Con)
Chair, I am still a member of the British Medical Association.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I remain a member of the BMA.
The Chair
Welcome Sara and Chaand. Will you kindly introduce yourselves, please?
Sara Gorton: Good morning. I am Sara—it is pronounced as if it is spelled with an h at the end. I am head of health at the trade union Unison.
Dr Chaand Nagpaul: My name is Dr Chaand Nagpaul. I am a GP in north London. I have been a GP for more than 30 years. I am chair of the BMA UK council. We represent doctors across the UK—more than 160,000. I represent all doctors of all types, working in hospitals, public health, general practice—you name it.
Edward Timpson (Eddisbury) (Con)
Q
Sara Gorton: I hope you have had our Bill submission, which makes clear the areas where we feel the new Bill needs some amending. You are right that Unison was a signatory, along with the BMA and other colleagues, to the letter in 2019, so it is a matter of concern that, after all this time and with such broad consensus, we are still awaiting the legislation.
The Select Committee process that followed that letter clearly identified that the changes that have been added would be contentious, so that is adding further delay. There are a variety of elements that stray outside the clear consensus that was set out in the 2019 proposals. However, we are committed to seeing an end to a system that holds lots of unnecessary cost implications for the NHS. There is an urgent need to stabilise and give clarity of employment, particularly for the 27,000-plus people who are currently in a state of flux, moving between the clinical commissioning groups and the proposed new ICSs.
There are some clear areas where we would like to talk to you about amending, improving and strengthening what is in the legislation at the moment. There is very, very clear support for following through on the commitments in that 2019 letter, to strip away the unnecessary procurement and competition regime.
Dr Chaand Nagpaul: The BMA was very opposed, and I believe rightly so, to the changes in 2012. We felt they introduced unnecessary competition in the NHS that did not work, has not worked, was not good for the taxpayer, fragmented the service and increased private sector involvement, which we can talk about later. We were very supportive of any changes that would reverse that legislation and have a duty of collaboration. In fact, I led a piece of work at the BMA called “Caring, supportive, collaborative: a future vision for the NHS”, where we spelled out the sort of arrangements we believe would be right, in keeping with the principles of the national health service, and be right for patients, right for the workforce and right for the taxpayer.
In principle, the idea that the Government were relooking at or reversing the 2012 Act was something we supported. In one way, you could say that the repealing of section 75 is an element that we are supportive of. However, in doing so there are not sufficient safeguards and we believe there are many consequences that would actually do the reverse, in particular with regards to a lack of assuredness around national health service providers being supported, in terms of the continuation—we can talk about this later—of unequal arrangements for the private sector provision of care compared to the NHS, and in terms of the lack of clinical engagement that would ensue. Of course, we are getting rid of a whole tier of local commissioning organisations, CCGs, and moving them at a more distant level, called ICSs. We are very concerned about that.
We are also concerned about some of the Secretary of State’s powers and the balance between political accountability and political influence. There is a range of issues here that we think need to be addressed.
The other thing I should say is that we are in the midst of a pandemic. It is by no means over. It is hard to grasp the scale of the backlog of care. These changes have occurred when the profession has not been able to engage. I have not had the time to properly be involved in the input. With the BMA I have, but my colleagues have not. We believe that this is the wrong Bill at the wrong time. We should really address what the NHS needs and get the right Bill at the right time, in due course.
Edward Timpson
Q
Sara Gorton: When we set out our support along with other parties in 2019, we saw huge benefits from not wasting unnecessary time, process, money and oversight on unnecessary competition, particularly where no provider other than the NHS was capable of providing the service. We support the removal of the role, as set out in that consensus letter, and that has travelled through to the legislation.
Where we think this could be more robust is the so-called provider selection regime that backs up exactly how the process will be carried out. We think that needs to be extended to make it absolutely explicit that the NHS is the preferred provider where there is an NHS service, that there need to be limits placed on roll-over without scrutiny from external providers and that that provision should be extended to cover non-clinical services. I think that earlier in the week you heard from employers how important the whole-team—the one-team—approach had been during the pandemic and how crucial that had been to tackling the spread of the virus and the work that the NHS had done. We think that principle should be extended and placed in the provider selection regime as well.
Dr Chaand Nagpaul: We absolutely agree that repealing section 75 is something the BMA has called for since 2012. It has been a nonsense that every single contract up to this point has to be put out to tender: huge amounts of waste of taxpayers’ money and of time. As a GP, we were not even able to provide our own phlebotomy services without it going through a process, so in that sense, that is a good thing. However, just repealing section 75 without complementing it with the right tools to ensure collaboration will not work. In fact, the current arrangements repeal section 75 but do not provide any safeguards, or rather structural processes, that will, in our view, allow the NHS to work as a collaborative system.
The example I will give is that we believe the NHS should be the preferred provider of care wherever it is capable and wherever it is available to do so. There is so much evidence. People say: “Does it matter who provides?” Well, it does matter, and all the evidence in the last few years has shown repeated examples. Some of you will remember Circle taking over Hinchingbrooke Hospital. It is very easy for the private sector to say: “You know what? We will really run the NHS efficiently. We will use all the market skills we have.” The NHS does not work like that. We forget at our peril the added value, the accountability, the loyalty and the good will that the NHS provides. We really do.
We only have to look back at the last year. Compare the vaccination programme run by the NHS and delivered by NHS staff to Test and Trace. Even with Test and Trace, compare the £400 million that Public Health England had to the billions that went to the private sector, and local public health teams reached 97% of contacts compared to 60% for the others. I am saying that it does matter. Your local acute trust is not there on a 10-year contract, willing to walk away after two years. It is there for your population; it cannot walk away. I think that given those things, we need to make sure the NHS is the preferred provider.
The Chair
Could I just ask you to keep your answers to within the scope of the Bill, please? Also, I ask if we could perhaps have more succinct answers. I still have several people who want to ask questions and we do not have a lot of time to get them in. I intend to call the Front Bench spokespeople at about 10 minutes to 12. I now move to the hon. Member for Arfon (Hywel Williams), but if we could keep to the confines of the Bill, that would be good.
Hywel Williams (Arfon) (PC)
Q
Sara Gorton: This is a matter of no small significance to organisations such as my own that have membership across the UK. That ability to understand and translate the statistics that we get from one environment in the UK to another, and understand how that feeds through and get a whole picture of it, is really difficult at the moment. That is not just for the basic nuts and bolts of who is in the workforce at the moment, doing what job—the training plans, the workforce planning, and other aspects of workforce are really difficult to compare.
The short answer is that we would like to be involved in the interpretation, assuming that we do get that amendment through and the workforce reporting is on a more frequent basis than five years. We would like to be involved in the conversation about what that looks like, and how it can answer some of the issues that you have raised about feeding into a UK-wide perspective as well.
Hywel Williams
Q
Sara Gorton: That is not something we have considered in the passage of the legislation so far, but we are certainly willing to talk about it in future.
Hywel Williams
Q
Sara Gorton: There are all sorts of workforce aspects that are very relevant to the England and Wales environment. The joint systems we have for pay and pensions, and workforce planning as well, all need to be factored in, but lots of work on the detail of the workforce reporting is needed.
Dr James Davies
Q
Sara Gorton: That is not an area of the Bill that we focused on. Our main focus is on extending the provisions of the provider selection regime—the procurement. I can do some more work and send in something.
Dr Davies
Q
Dr Chaand Nagpaul: I can tell you, just from the personal experience of being a GP over 30 years and speaking to doctors and representing doctors, that clinical engagement is vital. None of us can have any workplace that functions well until those who work within it feel engaged—feel that their voice is heard and their experience is understood. One of my biggest concerns about the current arrangements is that at the moment, for example, we have clinical commissioning groups. We have had seven GPs in my local area representing me and my colleagues. That is going to whittle down to no one, except one primary care doctor—we think—on an ICS board, which will be more remote, so we are diluting that local accountability. We vote for those doctors who sit on the CCG boards; we will not have any voting, so you are reducing the numbers who are influencing.
The second point is that we believe that those who sit on ICS boards should be facing the reality of the clinicians they represent. In the medical profession, we have two statutory bodies—the local medical committees and the local negotiating committees—that represent hospital doctors and GPs, and we believe that they should be there because of their motive: they will be clinicians representing clinicians, as opposed to what sometimes happens, which is doctors becoming managers. We know that that just disconnects, and if you have a disconnect, you will not be able to deliver your aims as a health service.
The other notable omission in the Bill, we believe, is the lack of public health presence. There is no place for a public health doctor. Again, I know that it is not in the scope of the Bill, but I think we have to learn from the past year. Public health is vital.
The Chair
We should stick to within the scope of the Bill.
Dr Chaand Nagpaul: The scope of the Bill should include a public health doctor who is independent, who should be an advocate. Those of you who were present in the 1990s will know that is exactly what we had. An independent public health voice on ICS boards can provide proper independent advice on population health. These are meant to be population commissioning bodies, in the interests of the public. Those are the things that we think should be changed.
The Chair
Would anybody else like to ask a question from the Back Benches before I move to the Front-Bench spokespeople? Okay, that means that the SNP and Labour spokespeople have around 10 minutes. If they could keep it between nine and 10 minutes, that would be appreciated. I call Dr Philippa Whitford.
Dr Whitford
Q
I will ask each of you the same question. Obviously, the aim of the Committee is to improve the Bill and bring in voices. Sara, if you could amend only one part of the Bill, what would it be, and what change do you think would improve it to the greatest degree? I know that you may have three or four—your submissions are here—but what do you want us to do that would have the biggest impact in improving what actually happens to health and social care?
Sara Gorton: I am going to choose something that I think none of the other people you hear from, except staff representative bodies, will pick up on. We would like to see the principle set out in the NHS constitution: to involve staff in decision making about how the service that they work in is set up and run, and in decisions that could affect the way they work. That principle is very clear in the NHS constitution; at the moment, with the system set up the way it is, that is transacted through the relationships that staff have with their employers at a provider level. If the system proposed in the Bill comes in, one of the risks is that that may be undercut by decisions made at ICS level. I think trade unions and staff would feel as though they had a stake and would be reassured that they had involvement in future decisions with workforce implications made by those new bits of the system if that pledge were placed in the legislation and were the underpinning principle.
Dr Whitford
Thank you very much. Certainly, for some of the projects in Scotland around quality improvement or patient safety, the involvement of staff has actually made that work. Dr Nagpaul, I am pinning you down to one area and one change that you think will make a big difference.
Dr Chaand Nagpaul: The area would be around collaboration. We would want the section 75 regulations to be amended to make the NHS the preferred provider where it is able to do that. As part of that, there would be legislative changes on the duties of foundation trusts and other NHS providers to collaborate. We believe that at the moment, the changes for section 75 do not tally with any such duty, and we find that providers are focused on their own budgets and balance sheets, so you are talking about collaboration but not enabling it. We would want both those changes.
Dr Whitford
Q
Dr Chaand Nagpaul: Can I come back on that? At the moment, we are seeing foundation trusts thinking about their budgets, community providers thinking about theirs, and general practice as well. There is not even collaboration between the community and the hospital. No foundation trust currently has the ability to say, for example, “We will go beyond our budget and invest in the community—it may actually reduce our hospital admissions.” At the moment there is no structure of processes to enable collaboration even within the NHS.
Dr Whitford
Q
Dr Chaand Nagpaul: It is only looking at it—like sitting around the table. We have had a lot of these arrangements in the past. Until you actually change the duty of a foundation trust to collaborate, so that its board meetings are no longer focused purely on its own balance sheet but actually look at the good of the local community as a statutory change, we do not think this will work. It will just be aspirational.
Dr Whitford
Q
Dr Chaand Nagpaul: We are supportive of the concept of the HSIB. We know that the NHS is riddled with a fear culture and a targeting of individuals for systemic failures. Based upon the aviation industry, it is absolutely right to have arrangements whereby you can learn from serious incidents, and healthcare staff, doctors and patients have a safe place where they are free, without fear, to contribute and learn from such incidents.
What is important—this is something we learned from a previous episode involving a doctor called Doctor Bawa-Garba, where there were a lot of issues around her information being disclosed—is that safe places should be safe places. They should be legally privileged. That will allow us to make the NHS safer, because I think that openness will allow us to address the systemic issues that actually make up the majority of medical errors in our health service.
Dr Whitford
Q
Sara Gorton: The HSSIB is not an area that we have covered and focused on in our response, but like the BMA we are strongly supportive of attempts to drive a just and learning culture across the NHS. We have participated, through the social partnership forum in the NHS, in trying to spread that culture, and we are strongly supportive of the Freedom To Speak Up Guardian programme that is in operation in the NHS in England and its interaction with staff and their representative bodies.
Dr Whitford
Q
Sara Gorton: Yes, indeed—certainly no opposition to that.
Justin Madders (Ellesmere Port and Neston) (Lab)
Q
Dr Chaand Nagpaul: Yes. If you repeal section 75 but do not allow the NHS to be a preferred provider, we believe that opens the door for contracts to be handed out to the private sector and undermines the NHS.
Although it may fall out of scope, the point is that there is every reason for the NHS to be a preferred provider. The point I am making is that the NHS really is effective and cost-effective, and allows for a population approach from providers that have accountability to local populations.
The other problem we have at the moment, unless you put in legislation to make the NHS the preferred provider, is that at the moment a lot of contracts are going out to the private sector and are affecting workforce training. In some areas, cataract operations have been moved en bloc into the private sector, meaning that ophthalmology trainees are not even seeing them, and the providers that are providing cataract operations are being paid the same sum of money but not providing the full service.
Another problem we have at the moment is cherry-picking. It has been there since 2012 and nothing in this Bill is legislatively addressing that. It means that you pay the same amount to a hospital—I am a GP and there is a list of exclusion criteria for any patient who has co-morbidities or complex conditions, so I cannot refer them there—but when something goes wrong in the middle of the night or on a weekend, they end up in the A&E of our local hospital.
That is why we believe it is really important that the Bill is amended to make the NHS the preferred provider; that is what we are referring to. We believe it will allow for a much more co-ordinated, accountable, locally focused and population-approach health service.
Justin Madders
Q
Dr Chaand Nagpaul: If we have a Bill that is designed to support the NHS, we just feel that it does not make sense to then allow a private provider to sit on a commissioning board. We believe that there is an inherent conflict of interest. It is really important to understand that there is a difference between the private provider and the NHS. The private provider is ultimately driven by its financial motives, and to be sitting on a board influencing the spend of money where it may have an interest is a conflict of interest. That does not apply to the NHS. A doctor from a hospital does not have any financial gain to be made. I come back to the fact that we need to support the NHS, not as an ideological principle, but because it actually works.
Justin Madders
Q
Dr Chaand Nagpaul: No, I do not. If the NHS cannot provide a service—if it does not have the capacity—and there is a private sector contract, the private provider needs to be held to account to deliver. As I say, I think the same rules should be applied, so that if there is a complication, they need to be accountable for that complication, rather than the patient going back to the NHS, which picks up the pieces. There is a need to hold private providers to account where they are contracted to provide care, but we do not approve of them sitting on the commissioning board, which is about the use of public resources in the interests of local populations. That should be a commissioning decision, and commissioners who are accountable to the NHS and providers of the NHS should be sitting as part of that arrangement.
Justin Madders
Q
Dr Chaand Nagpaul: Sure. One is the NHS mandate, which spells out how the NHS functions. At the moment, the powers allow the Secretary of State to amend the mandate. We would like that to be affirmative. We would like it to be approved by Parliament, and therefore Parliament would vote to agree changes to the mandate. That is one area.
The other concern is about the local reconfigurations. We know how politically sensitive these things can be. We would not want the Secretary of State to have disproportionate powers in those arrangements, which will often be more susceptible to political influence. We think that those need to be safeguarded by mandated clinician involvement, so that we make the right decisions about local services. It is a counterbalance: we want a health service that has local clinician leadership, but on the other hand the Secretary of State can intervene. We think that is an amendment that needs to be made.
Justin Madders
Q
Sara Gorton: There are a couple of points to raise here. First, we would like to see in the legislation confirmation of what we have been given assurances of in guidance and conversation—that there is no intention for any new parts of the system to undermine the existing collective arrangements and that, for the workforce I represent, the collective agenda for change agreement would apply for their staff. There is a very clear amendment that could be supported to ensure the new bodies are listed as what are called annex 1 employers in the relevant terms and conditions documents. That is one aspect.
The other aspect is the role that the provider selection regime can play—sorry, not the provider selection regime; what are called the people responsibilities, which are set out in some of the guidance materials that have only been recently published to support the legislation. They set out 10 areas relating to workforce over which the new bodies may have scope. We would like to see those areas of scope clearly defined within the legislation. That is why what I said earlier about the commitment to involve staff through the constitution promise is so important. We want to ensure that, if decisions are made at system level that undercut the role that staff have in making decisions within providers—if there are overarching decisions made about workforce—staff have an opportunity, through their representatives, to understand what the impact might be and to influence that conversation.
Justin Madders
Q
Sara Gorton: We are supposed to stick to polite language in here, aren’t we? You can all probably imagine what most of our members feel. Sticking within the scope of the Bill, as we have been asked to, the relevant segue is to go back to the extension of the provider selection regime to the non-clinical services. We are strongly supportive of the measures that have been put in place to ensure that service sustainability and social value are taken into account. Clearly, however, extending those provisions to non-clinical services would create a culture of in-sourcing, of valuing all members of the healthcare team equally, and place those on an equal footing.
Justin Madders
Q
Sara Gorton: As you have hopefully seen in our briefing, we are calling for that to be either explained in much more detail in the guidance, or dropped from the legislation. We are already seeing concerns from regulated occupations that this could lead to a sort of “regulation-lite” scenario, and there are concerns that, without it being clear exactly what the proposals would entail, this could be a hostage to fortune. We would very much like to see some clarity on that, or have it taken out at this stage.
Justin Madders
Q
Sara Gorton: What we are more concerned about is the potential risk that, if involved in the ICBs and in the partnerships, they could exert influence over the exploratory stage of discussions, which could tilt the balance their way. That seems out of kilter when we do not have clarity that staff of the NHS will have the opportunity to be involved at the same sort of level. We are very keen to ensure that we support amendments making any of the processes, and the way that the boards meet, more transparent, and, clearly, subject to the freedom of information process.
Justin Madders
Q
Sara Gorton: At the moment, there is no explicit route through. What is set out in the published guidance documents is that the route for trade unions to be involved will be through the regional structures of NHS England and NHS Improvement. That is at a distance, and potentially after decisions have been made. Putting in a clear link, through that staff pledge in the NHS constitution and having that underpinning in the legislation, would really make clear the principle of staff involvement and engagement at the earliest stage of decisions.
The Minister for Health (Edward Argar)
Q
To both of you, do you think that now is the right time? I know that Chand has answered that, but this second part might apply to him: if it is not, when is the right time?
Sara Gorton: We were strong opponents of the 2012 legislation, so, in our view, the right time to do this would have been to not put that legislation through. However, we have been waiting for this batch of changes for some time. It has been evident, from 2013-14, and certainly since the “Five Year Forward View” was published, that what we were doing was having a structural workaround with people tacitly agreeing to almost ignore legislation. That is just not acceptable in the system.
Certainly, for my members who have been moved into new arm’s length bodies, moved around those bodies, and are now subject to another change, they want the security of knowing who is going to be employing them this time next year. In our view, the changes, both to the competition and procurement regime, and to clarifying how the new bodies will operate and what powers they will have, cannot wait. There are lots of other aspects that, as you can see from our briefing, we suggest could wait for future debate.
Dr Chaand Nagpaul: I want to be clear: we do not support the status quo. There is a pressing need to repeal much of the 2012 Act. However, I cannot overestimate how much the pandemic has affected us. We have not been able to be engaged, so it has to be asked: why do we need the Bill at this moment in time, when we are all absolutely overwhelmed? We know that any reorganisation of the health service means that people get distracted from their core work. The process of reorganisation takes human resource time. We have not been able to engage with this as we should, so we do not think that this is the right time.
The right time would be decided by two factors: first, when we are through the worst of what we are going through at the moment, and secondly, when the legitimate concerns we have are addressed, and there are the amendments that we would like to see. This Bill can shape the future of our health service. Get the right Bill, at the right time.
Edward Argar
Q
Dr Chaand Nagpaul: I am afraid I will have to let you know later, as I do not, off the top of my head, know exactly what those Bills contained.
Edward Argar
Q
Dr Chaand Nagpaul: First, the rules at the moment do not factor in that the NHS provides, in addition to the service, a complete, full body of care for patients. The same money would go on a hip replacement in the private sector. Secondly, there is the training element that I mentioned earlier. Thirdly, no acute NHS trust can walk away after two years—it is there to provide care to its population—but Serco was able to walk away after two years. We have many examples of private companies that have ended their GP contracts. Serco left an out-of-hours contract in Cornwall; that does not happen in the NHS. My local hospital has been there for as long as I can remember—it cannot walk away. The NHS provides accountability and duty, but more importantly, it is actually cost-effective. The staff have national terms and conditions; they provide huge amounts of good will and work above their contracts. It just makes sense to be resourcing our NHS.
Every time you take a contract away from the NHS, it is defunding the local system. We want taxpayers’ money to bolster an NHS that is co-ordinated, because we also want changes in the legislative requirements for foundation trusts and other NHS bodies to collaborate.
Edward Argar
Q
Sara Gorton: What the legislation sets out is a proposal for system working. Therefore, having something that disrupts that system is potentially counterproductive. I strongly support putting the NHS first—the NHS default—into the provider selection regime that is listed in clause 68.
Justin Madders
On a point of order, Mrs Murray. On the Minister’s question to the BMA witness about previous Acts that the BMA may have endorsed, that would clearly be out of scope as evidence. I would not want Dr Nagpaul to waste time researching an answer that the Committee could not take into account.
Edward Argar
Further to that point of order, Mrs Murray. Would it help if I set out the context in which I believe that question relates directly to the content of the Bill? Much of what is discussed in the Bill relates to previous legislation that has grown up over time; understanding which pieces of legislation the BMA supports will help us to better understand the evidence it has put forward on this legislation, and its context.
The Chair
Mr Madders, I think that the Minister has taken on board your point of order and paid attention to it. Thank you, Minister.
As there are no further questions, because we are out of time, I thank our witnesses very much for their evidence. We will move on to the next panel.
Examination of Witnesses
Professor Martin Marshall, Pat Cullen and Professor Helen Stokes-Lampard gave evidence.
The Chair
We will now hear from Professor Martin Marshall, the chair of the Council of the Royal College of General Practitioners; Pat Cullen, the general secretary and chief executive of the Royal College of Nursing; and Professor Helen Stokes-Lampard, the chair of the Academy of Medical Royal Colleges—all of whom are appearing in person. Starting with Pat Cullen, could I ask you to introduce yourselves for the record?
Pat Cullen: I am Pat Cullen. Thank you for inviting me along. I am the recently appointed chief executive and general secretary of the Royal College of Nursing. We are a trade union and a professional organisation, and we represent more than 480,000 nurses.
Professor Helen Stokes-Lampard: Hi! I am Professor Helen Stokes-Lampard, and I am chair of the Academy of Medical Royal Colleges. The Academy is the umbrella body for all the medical royal colleges in the UK and Ireland; we also cover the independent medical faculties.
Professor Martin Marshall: Good afternoon, everybody. I am Martin Marshall, chair of the Royal College of General Practitioners and a practising GP in Newham in east London.
The Chair
Thank you. We have until 1 pm for this session, so I propose the same timings as for the last one. I call on Back-Bench Members to indicate if they have any questions.
Dr James Davies
Q
Pat Cullen: We have yet to submit our evidence in relation to the Bill—we are currently doing that. It is very clear to us and our members that the Bill does not go far enough on accountability for the workforce. We are very clear that the workforce shortages in nursing are not addressed properly through the Bill.
The Chair
Could you speak up a little bit, please? We are finding it quite difficult to hear you.
Pat Cullen: That is not normal, mind you, for a woman from Northern Ireland! I will try again. Principally, our response to the Bill is that the accountability issues do not go far enough in the Bill. We are asking for the Secretary of State for Health and Social Care to not only clearly have full accountability and responsibility for the assessment of workforce planning, but ensure accountability for the delivery of the workforce. It is not just about the assessment. We are all clear about and know about—it has been played out well—the shortages of nursing staff. We had 40,000 vacancies heading into the pandemic. We make up 26% of the workforce. Everywhere you see a patient, you see a nurse, and we need nurses. That is the only way to provide the best care for our patients. We say that the legislator at the highest level must have that accountability and responsibility for the assessment and the delivery of the workforce shortages in nursing.
Professor Helen Stokes-Lampard: The Academy of Medical Royal Colleges has worked very closely with the Government on the development of the Bill, and we have been very grateful for the opportunity to collaborate so far. We have been largely supportive of the direction of travel, but the workforce, in clause 33 particularly, is the one area where we probably still have the greatest concern. We feel that it needs to go further. That builds on exactly what Pat has said. Along with other organisations such as the RCN, we have co-signed an amendment that goes further on that.
We feel that workforce planning needs to be very transparent and collaborative across multiple organisations and agencies, but ultimately owned by the Secretary of State for Health and Social Care. It needs to take on board both the projected supply of workforce already in the pipeline and projected demand. We anticipate that the line representing workforce supply going upwards, and the line representing the demand for need and care climbing even more steeply. There is a gap between them that, at the moment, we cannot quantify. It needs to be quantified and made transparent. Even if the state does not feel it can fund for that gap, we should not be afraid of knowledge. Without knowledge, we run into the risk of repeating historical cycles of boom and bust when it comes to workforce planning. That would be our big plea to you: try to strengthen that, and please do not fear knowledge—it will help us in the end.
Professor Martin Marshall: The Royal College of General Practitioners, as members of the Academy, are completely in line with Helen’s position. There is a marked workforce crisis relating to general practitioners and other health professionals who work in general practice. Without an adequate workforce, it will be very difficult to deliver any of the ambitions of the Bill, so we are absolutely in favour of a much stronger emphasis on workforce. I think workforce planning is an oxymoron and has been for many years in the NHS. This is an opportunity to do something about it.
Chris Skidmore (Kingswood) (Con)
Q
Professor Helen Stokes-Lampard: We have thought about this seriously—what would be a sensible interval? Having discussed this extensively with colleagues right across the health and care landscape, we have come to the conclusion that two-yearly feels about right. Annually just feels too intense, and it would be too labour-intensive to get meaningful data out in that period; you would run the risk of fatigue in the system. If we go much longer than two years, we run the risk of fundamental change coming into the system—another pandemic or some other national thing happening that needs to be factored in, and of which we need to be made aware. We have come down on two years, and that is the proposal that we put forward.
Every time, the work needs to look five, 10 and 20 years ahead. We need that longer-term projection. It takes so long to train doctors—that is the agency that I represent—from their entry to medical school to consultant independent practice that you need to have that time lag built into the system. That way, you can look at the totality of the workforce and ensure that you have the right interim solutions for the needs of the population.
Chris Skidmore
Q
Pat Cullen: Yes, we would certainly agree. We believe that annual plans are too short-term for the reasons that Helen has laid out—training nurses takes three years, and when you think about the added training for clinical specialist nurses and other advanced nurses in practice, it absolutely needs to be at least two years.
Professor Martin Marshall: We agree that two years is the right interval. I think the request of HEE to produce a high-level framework is a good start—that is correct—but it is just a start, and a high-level framework does not help workforce planning on the ground. It is right that most workforce planning should happen at a local level, but some elements need to be managed nationally. Basically, this is such an important issue for the NHS that it needs to be absolutely top priority in the Bill.
Professor Helen Stokes-Lampard: I am conscious that I did not answer the second part of your question about who should be involved. We propose that this be led by Health Education England, but it has to be done in collaboration with NHS England. We cannot look at the needs of the population without involving them. There are other bodies, too. For doctors in particular, we would argue that the Medical Schools Council and the GMC have to be involved. I am sure Pat will have similar views.
In terms of population needs, we need to look at the Office for Budget Responsibility and use the resources of the Office for National Statistics. We need to go widely on this; it is not about saying, “That is one person’s problem to sort, and then the Secretary of State signs it off.” This is a truly collaborative effort, and we need to legislate for and enable collaboration in the greatest possible sense.
Chris Skidmore
Q
Professor Martin Marshall: Universities have an enormous amount to offer. If we look at the way that universities have operated in academic health science networks in the current structures, in many parts they have played a really significant role. I absolutely think that ICSs give us an opportunity to bring universities into the debate.
Education is particularly important here. If the Bill is to achieve its potential of better population health, there are some massive training leads for all the workforce, and universities clearly need to be involved in that process.
Professor Helen Stokes-Lampard: To supplement what Martin has said, we have not criticised what the Bill says at the moment. For us, this is where the Bill is an enabler, and we hope it is a greater enabler that what we have currently. In that sense, the logical thing to do next is greater collaboration. The challenge with legislation is that although it can remove barriers and enable, it does not actually change culture. We need to engage with the individuals who are establishing this and ensure that the frontline educators and clinicians are on board with it to make it a reality.
Clearly, I support what Martin said about the vital need for education right across the piece. I think you will find that the universities are very much up for that and keen. It has been difficult to expand training places across nursing and medicine in short order, but it is something the universities are really stepping up to do. I think we would all argue that we want to go further and faster to deliver the best possible care for the public.
The Chair
Thank you very much. We have about 10 minutes, and three people have indicated that they want to ask questions, so if we could direct our questions to one person and keep questions and answers brief, that would be very helpful, because I would like to include everybody.
Hywel Williams
Q
Pat Cullen: We have had some thoughts about this across the countries—and we can learn from all of the countries, really. Of course, you will know from my accent that I come from Northern Ireland, and our regulator is a four-country regulator. In relation to the standards that are referred to within the Bill, I think our royal college will play an important role in terms of working with our regulator to look at some of the devolved responsibilities and the role that we can play in setting standards for our profession, and assisting and supporting our regulator in the setting of those standards right across the country, and obviously the other countries as well.
More recently, we have just brought out our nursing workforce standards, which apply across the four countries, and we had significant engagement in those right across the four countries. If you look at those standards being aligned in the new Bill and reading across to the new Bill, working across with our regulator and having more powers devolved to a royal college will enhance the regulator’s response to standards and the applicability of those standards, and their implementation across the countries.
Edward Timpson
Q
Professor Martin Marshall: We have pushed very hard for clinical representation on the board, and I think that the acknowledgement that a primary care representative is required is absolutely right. Of course, one representative is not going to change the world, but there is something symbolic about it, and there is something about having a primary care voice that is really important. The nature of that primary care voice is interesting, because of course, general practice is a multi-disciplinary specialty, and we work very closely with our nursing colleagues, our pharmacy colleagues and a whole range of different clinical disciplines. I think that in most localities, it is likely that a GP will be the representative of primary care, most obviously because general practice has a long track record of being involved in the management of the NHS, and the onus will then be on that general practitioner to represent all of the primary care voices. As a college, just last week we had a very productive workshop involving all the different specialties in primary care, and a strong sense of consensus that we must and will work together to drive this forward.
I have a particular focus on the primary care voice—I guess that is my job; Helen might refer to other clinical voices—but it is particularly important for primary care, for the simple reason that in primary care, we deal with about 90% of the presentations that come to the NHS every day. We live in, and are closest to, the communities that we serve. We are trained to address the broader determinants of health. We are trained as doctors, as GPs, for example, but we are trained to understand the social determinants of health and health inequalities. Everything that is important about this Bill is stuff that general practice is expert in, so we feel the general practice voice is really important.
One of our biggest concerns—not so much with the legislation, but the way that this is likely to play out on the ground—is that the general practice voice threatens to be diminished as a consequence of the change in legislation around CCGs. If you look at what the boards will look like, we know that the acute trusts will still have their governance arrangements and their budgets. CCGs are going to disappear. We are not necessarily saying that that is the wrong thing, but it means that a lot of the experienced clinical leaders in CCGs risk getting lost, and we know that that is not happening in some of the ICSs around the country, but it is happening in others. The CCG staff are just being transferred into the ICSs, but there is a real risk that the leaders who have been around for a decade or two decades, who understand the nature of organisational change and understand what the Bill is trying to achieve, will get lost. We know from the evidence that the most successful integrated care organisations around the world are the ones that are primary care led, so if primary care does not have a dominant voice, the ICSs are much less likely to achieve their potential.
Karin Smyth (Bristol South) (Lab)
Q
I would like to ask this to everybody. Personally, I think this issue of clinical representation is a backwards step in this Bill. You may or may not want to say whether you think that is true, but given that you have said that successful organisations are primary care-led, and none of these organisations will be clinically-led, let alone primary care-led, that is not rectifiable in the Bill through an amendment, I suspect. How will we ensure that these organisations are successful from a clinical leadership perspective, given the current state of the legislation, or would you be putting forward suggestions for amendments? I am sorry, but I do not think I have time to ask all three of you. Currently, CCGs are GP-led, so—
The Chair
We have about three minutes, so could you keep your answers to one minute each?
Professor Martin Marshall: I speak very rapidly.
“How?” is an interesting question. Can it be done in legislation? I think there have to be some legislative levers to ensure that this happens properly on the ground. There are some examples—one in Surrey and one in Gloucestershire—where there is already a very strong commitment to a robust primary care voice, so there is something about shining a light on those examples, which others can learn from. That is not a legislative responsibility, but it is a really important one. There is certainly something about holding localities to account and understanding what is happening on the ground at regular intervals, in terms of whether those voices are present and whether they are being heard.
Professor Helen Stokes-Lampard: I would strongly advocate that everyone takes a look at the very excellent document that NHS England put out just a few days ago, which is about implementation guidance for ICSs on clinical leadership. I have to say that whoever put it together absolutely nailed it, in terms of what to do and how. There is a how-to guide there. I had no input into it, so I feel I can shamelessly give you that, because there are a lot of answers in there.
The legislation as it stands on clinical leadership does not prevent any of those things, as I understand it. That goes back to my other point about ensuring that the legislation removes barriers and is a facilitative enabler of these things. Clearly, my colleagues have more specific things about it. I just want to draw to your attention to the fact that it says that clinicians who get involved in leadership need to be supported, protected and resourced to do so, because unfortunately clinician time is expensive. That comes back to the original conversation about workforce, but we have to factor it in. The evidence is quite clear that better clinical input in all disciplines helps systems run better and be safer. It is more cost-effective, but that needs support factored in from the outside.
Pat Cullen: You will not be surprised to hear me say that the Bill does not go far enough, and we will be looking for an amendment. There absolutely needs to be a director of nursing at the top table if you are to prevent what has happened and what has gone before, where the financial balancing of books significantly impacts the decisions of that table. The only way to ensure patient safety and quality of care, and that the workforce that we deserve and need for our patients are paramount and the centre of those discussions, is to have our clinical leaders at the top table. That must be a director of nursing, not only to bring evidence on the clinical care that needs to be delivered to the table to shape each strategic decision, but to hold that person to account for our workforce and ensure that the workforce is available to provide care for our patients.
The Chair
Thank you very much. We now turn to the SNP spokesperson, Dr Philippa Whitford. You have about seven minutes.
Dr Whitford
Q
Pat Cullen: No surprise, it is the accountability for workforce planning sitting and resting with the Secretary of State. I do not think any legislator or politician should have any issue with that. It is not about accountability being forced and pushed to the frontline. Of course, frontline clinical staff will have accountability and responsibility for the delivery of care, but that needs to be enshrined in legislation, and the Secretary of State needs to hold full accountability for workforce assessment and planning, and for ensuring that we have the workforce to deliver the best care for our patients. We owe that to every single nurse in the services today.
Dr Whitford
Q
Pat Cullen: Absolutely, and of course we look with envy at Wales and Scotland, although Scotland is lagging behind our Welsh colleagues in terms of safe staffing legislation. We will certainly push for safe staffing legislation to be brought forward in England as well. Of course, it is no surprise to anyone that our wonderful nurses moved to industrial action in Northern Ireland to push not for pay, but for safe nurse staffing legislation. That is what is important to every single nurse who is trying to care for their patients today.
Dr Whitford
Q
Professor Helen Stokes-Lampard: My one place is the same: the workforce issue and clause 33. It is about looking at both the supply of the workforce and the needs of the population—I think it has to be both those things. The responsibility rests with the Secretary of State.
Professor Martin Marshall: I have stated mine already: the strong general practice voice is what will make a difference. That is what will turn a currently fragmented service into an integrated one, and a service that is focused on treating diseases into one focused on preventing them.
Dr Whitford
Q
Professor Martin Marshall: Considerably tighter than it is at the moment. I am absolutely in support of safe spaces. A culture change needs to happen here, and legislation seems to be one of the ways of trying to promote that to get us into a much happier space than at the moment.
Dr Whitford
Q
Professor Martin Marshall: I am not sure I know enough about it to be able to answer that question, I am afraid.
Professor Helen Stokes-Lampard: The academy’s position is that we support the proposals as they are worded—we have not suggested any amendments to them. We certainly believe that putting HSIB on a more formal footing is the right thing to do. On what Martin said about safe spaces being the right thing going forward, there may be detail and finessing in the implementation of that, but no concerns have been raised with us as an organisation representing royal colleges.
The Chair
Pat, before you speak, could I ask you to swivel the microphone to your left towards you a bit? We are still having difficulty hearing you.
Pat Cullen: Can you hear me now? I do not know whether it is my accent or my voice.
It is no surprise to us that the Royal College of Nursing opposes—
Dr Whitford
Could you speak a wee bit louder? I am from Northern Ireland as well and we can definitely speak loudly when we want to.
Pat Cullen: We fundamentally oppose the power of the Secretary of State to authorise disclosure, and we will be looking for amendments. We believe that we must protect whistleblowers. They must come forward. That is the only way that we can learn lessons and make sure that our services are fit for purpose, and that we learn from that, so we will be looking for amendments.
Alex Norris (Nottingham North) (Lab/Co-op)
Q
Pat Cullen: Where do I start? They feel exhausted, demoralised; they are tired to say the least, and they are very concerned about the future. Why is that? Because they do not have the workforce to deliver.
The Chair
Could I just remind the shadow Minister to stick within the scope of the Bill, please?
Alex Norris
On a point of order, Mrs Murray. How our staff are at the moment is within the scope of a Bill about the NHS, I would have thought.
The Chair
Okay, but can we just make sure that we stay within the scope of the Bill?
Pat Cullen: I will try and answer in relation to the Bill. All the issues that I have just spoken about in relation to that exhaustion, the tiredness and the fact that they are not able to provide the care for their patients—there are opportunities in the Bill to correct some of those things. Again, going back—I hate to harp back to it in my Northern Ireland words—but the fact is that if we ensure that accountability sits with the legislator and with the Secretary of State, to ensure that we do not find ourselves back in this place again, with 40,000 vacancies going into a pandemic or at any other emergency situation we find our nurses in, that will absolutely assist and support. However, there are opportunities for the workforce in the Bill that we do not believe are being grasped at the minute, and that is further adding to the demoralisation that they are feeling.
Professor Helen Stokes-Lampard: I will keep it succinct. I completely agree that the clinical workforce—doctors—are demoralised, and I think anxiety would be the greatest feedback that we get: anxiety and fear of the amount of risk that is being held in the system at the moment. We are in the grip of a third wave of this pandemic, which many in the media seem to have completely forgotten about. People are dying by their hundreds on a daily basis still. This is a huge challenge. It goes back to exactly the point in the Bill about workforce planning for the future, so that we never find ourselves in a similar situation again. While we cannot predict when the next pandemic will hit, we can certainly be assured that another pandemic will come. The challenges around the climate and the global problems are going to impact on our health and wellbeing hugely, and we can plan for them now if we choose to. So, fearful and anxious, but we can do something about it. We have a unique moment in time to grasp this, and this legislation is one part of that unique moment in time.
Professor Martin Marshall: You will not be surprised to hear that morale in general practice is at rock bottom. We read about it in the newspapers every day. Surveys that we have conducted of our members suggest that 60% of GPs say that their mental health has deteriorated significantly over the last year. Anxiety, depression, suicide, ideation—33% of GPs say that at least once a week they find it almost impossible—
The Chair
Order. Could we keep to referring to what is in the Bill, please?
Professor Martin Marshall: Yes, and I am going to do so. The issue here is that if you speak to GPs, because of the stats that I have just described to you, nobody is talking about the Bill.
The Chair
But we are here to talk about the Bill.
Professor Martin Marshall: And almost nobody is talking about the implications of the Bill, because I guess our job is to engage clinicians with the potential of the Bill.
The Chair
I am just saying from the Chair that we are here to talk about what is in the Bill and to take evidence on the Bill, so we should stay within the confines of what is in the Bill.
Alex Norris
Q
Professor Martin Marshall: There could not be a worse time for general practice to introduce the Bill, but I do not think that means it should not happen. It has to happen now. The NHS is ready for it, so it has to happen. The fact that general practice does not have the capacity or capability to engage fully with the implications of the Bill will mean that the Bill will not realise its full potential.
Professor Helen Stokes-Lampard: From my point of view, there is never an ideal time to introduce legislation and, certainly, in the midst of a global pandemic is on nobody’s agenda as a good time to do anything legislatively. However, the consequences of not doing it are that the integrated care systems, which are in a really vital part of their evolution and formation, will stall and therefore are far more likely to fail. So my view and the view of the Academy of Medical Royal Colleges is that we absolutely must go ahead with this legislation in the timeframe. There is never a good time to have a baby or move house, but you still need to crack on and do these things at bad times.
Pat Cullen: Same here: never a right time. If you were to ask nurses on the ground today, carrying out patient care in frontline services, they would say that anything that might improve where things are at the minute will be a bonus. But the issue is how it plays out and whether we are listened to. The professional royal colleges do represent nurses. I am here representing 480,000 nurses today. It is really important that we get this right. There is never a right time, but it is actually a great time if we do get it right.
Alex Norris
Q
Professor Martin Marshall: I cited earlier the example in Gloucestershire. It has very purposefully built a primary care subgroup of the board in order to provide that clinical expertise and that clinical sounding board to everything that goes on at board level. That seems to me to be a really good way of moving on from a single GP on the board—which will be helpful but will have limited impact—to actually making a real difference on the ground. The real change, of course, will not happen at ICS level anyway. It will happen at local level; it will happen at the place level. That is where real change in integrated care, from the patient perspective, will be enacted and will be felt.
Professor Helen Stokes-Lampard: To build on what Martin has said, there are great examples of clinical panels, which is essentially what we will be talking about. That is a model that works extremely well and which can be broadly based and covering a huge range: primary and secondary care—the whole range of specialities. But in the same way, citizen panels have become something that can be hugely helpful as well. I am very anxious that we also hear the patient voice in the decision making at community level.
There has been a covid culture of creativity. When there was less top-down insistence on following direct process at the start of the pandemic, a lot of creativity was allowed to flourish. I feel we need to capitalise on that culture of creativity. These kinds of panels are exactly the sort of output that has come and they have been hugely beneficial. And, of course, the move to greater digital working has meant that we have been able to reach people that we have not otherwise been able to get. Clinicians leaving the clinical environment to participate has become easier when they can do so remotely. There is a dividend that we should build on.
Pat Cullen: To add to that, I fundamentally believe that the patient voice must be heard in those structures beneath the board. That is how we will really influence and move forward in terms of what is required, and those voices will feed into the population needs assessment at local level. But there needs to be a nurse involved in each one of those structures that feeds right in through to the director of nursing that sits on the board, and that is how you will hold the accountability line up and down.
Edward Argar
Q
Welcome and thank you very much for your evidence this morning and your frank answers to the questions posed. I want to ask a question in the context of what a number of you have raised about the different voices and the extent to which they need to be represented at the different decision-making levels of the new structure. We heard from previous witnesses, for example in the context of public health voices also, about the value that they add. The principle behind this legislation is that it is permissive rather than prescriptive. Therefore it is possible to have a lot more voices; there is only a de minimis level specified as prescribed. What is your view as to whether the appropriate balance between permissive and prescriptive has been struck in the Bill? If you think it has not been, where do you think the balance between permissive and prescriptive has been missed? Shall we start with Pat and then work our way along?
Pat Cullen: I have said very clearly that I believe the nurse needs to be represented at the board, and that needs to be an executive director of nursing. That needs to be prescriptive; it is not good enough to have it placed within mandatory guidance, it needs to be within the Bill. That is a red line for our nurses, and it will remain a red line, and we will be putting it forward as a red line.
Professor Helen Stokes-Lampard: I am going to be slightly subtler with what I say about this. I think the legislation, as drafted at the moment, is very enabling, and the implementation of it is where the great improvement in how we deliver care will come. I do think it is permissive, and I do think that it is enabling, and I completely understand my colleague’s desire to include specific words relating to nurses, GPs and whoever. What is vital for me is that the clinical voice is loud, clear, and can be influential. That is about implementation, culture and behaviour at a local level. Once we have the words for the final legislation, it is a question of how on earth we deliver it and support people to do it well, and how we learn from the best practice that is out there. That would be my—and our—view.
Professor Martin Marshall: In my 30 years as a GP, I cannot think of a single piece of legislation that has directly changed my practice on the ground. What I can see is the extent that legislation sets a tone and a culture within which clinical care is provided. I think this Bill is appropriately permissive, but, given the variation in all the challenges that we have identified, it needs to be permissive with really good oversight to ensure that the consequences of implementation do not lead to dramatic variation across the country.
Edward Argar
Q
Going back to Pat’s evidence, but also to all of you: we have heard in our evidence today, and we heard it on Tuesday, a lot of different, vital parts of the system arguing the case for why they should be represented in a prescriptive way. Equally, we will have others arguing that a committee beyond a certain size becomes less effective. In terms of numbers, we have set a minimum. You are entirely entitled to say that you do not have a view on this, but how would you see the balance being struck between different groups making the case for representation, but, equally, having an effectively sized decision-making body? We will start with Martin, and then work backwards.
Professor Martin Marshall: I am glad to say that I do not have a view, but I do think that the boards should be small in order to be effective. They need to listen to advisory groups and sub-boards below them; it is the structures below the board level that will really make the difference.
Professor Helen Stokes-Lampard: Formally, the Academy of Medical Royal Colleges does not have a view. Personally, I have chaired boards from as few as five people, through to boards of 70 people, all of which can be hugely effective if managed well. However, the larger the board gets, the tighter the management has to be, because it is harder to get voices heard and for everyone to feel represented. Essentially, I am saying the same as Martin: smaller boards are generally more effective at getting through the agenda, but there has to be a high degree of trust in those that are actually on the board, and strong lines to sub-groups, for them to function with maximum effectiveness.
Pat Cullen: The board needs to comprise the right people. It is not about numbers; it needs to have the right people with clinical focus and patient care driving the outcomes for patients, and it needs to make sure that it does not develop a financially focused agenda. As director of nursing I have been there too many times: the table loses focus on the patient’s voice and needs. There needs to be a clinical focus and the right people at the table.
The Chair
Thank you very much. As there are no further questions, I thank our witnesses for their evidence. That brings us to the end of our morning session. The Committee will meet again at 2 o’clock this afternoon to take further evidence.
Ordered, That further consideration be now adjourned. —(Maggie Throup.)
Health and Care Bill (Fourth sitting)
Thursday 9th September 2021
(3 years, 3 months ago)
Public Bill CommitteesRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 9 September 2021 - (9 Sep 2021)
The Chair
We are going to hear from Richard Murray, chief executive of the King’s Fund, Nick Timmins, senior fellow, policy, at the King’s Fund, and Nigel Edwards, chief executive of the Nuffield Trust. Thank you very much for coming. Could I ask each of you in turn to introduce yourself for the record?
Nigel Edwards: I am Nigel Edwards. As previously stated, I am the chief executive of the Nuffield Trust.
Nick Timmins: I am Nick Timmins, a senior fellow at the King’s Fund.
Richard Murray: I am Richard Murray, chief executive of the King’s Fund.
Edward Timpson (Eddisbury) (Con)
Q
Richard Murray: There is obviously a risk with any large-scale transformations, and particularly ones in the NHS, that they will cause too much disruption, and they distract people from the day job. I think that is the clear case against. If I may, I will just say a few words, though, on the case for. The existing system already causes disruption, so there are complicated workarounds; there are procurements being done that do not really need to be done. I would not underestimate the fact that there is a headwind in the system from trying to apply the 2012 legislation. There was a real head of steam, coming through covid, of people working together, trying to make this system work, still having to deal with some of those workarounds and still having to deal, sometimes, with doing things in an emergency that you probably would not be able to do in peacetime, so to speak.
The key thing is to try to keep the disruption to a minimum—wherever possible, and particularly for staff, to keep that degree of unnecessary churn down. I have to say, unfortunately, the NHS is quite good at doing large-scale churn without too much benefit. But I think on balance that as these changes are already under way and there are problems with the previous system, stopping now would be more disruptive than simply carrying on.
Nick Timmins: I do not want to take up a lot of time. I particularly agree with that last remark: stopping now would be worse than carrying on. A lot of this is already happening. We have been merging clinical commissioning groups ever since the new system came in in 2012. It is sort of completing a journey. You may not be entirely happy about all the arrangements around the different sorts of board and what have you, but to stop now, I think, would be not sensible.
Edward Timpson
Q
Nick Timmins: In large measure.
Nigel Edwards: I do not have anything to add, given the time. I agree with everything that has been said.
Mary Robinson (Cheadle) (Con)
Q
Richard Murray: I am afraid that is not an area we have focused on—sorry.
Nigel Edwards: Likewise.
Karin Smyth (Bristol South) (Lab)
Q
Secondly, there is the treatment of capital in the system and how local communities, healthcare systems and trusts will be able to develop estates and capital planning. The third obsession has completely eluded me for the moment. It is generally about the tariff—that may be your subject, Mr Edwards—and how the vague nod to a new tariff framework in the Bill is working out. You may be more privy than the Committee to the details on how that might work out; it is about the flow of money within the system. Would you like to start, Mr Edwards, on governance, tariff and capital?
Nigel Edwards: Richard may be able to give a more up-to-date account on capital. You will be aware that the mechanisms for the allocation of capital in the NHS are a little arcane and somewhat out of date. There have been various attempts to update the mechanisms. Richard has been looking at this and can perhaps tell us more, but my impression is that it will flow following the allocation formula for revenue. There will still need to be a tariff. Despite the fact that there is integration, a tariff allows you do to a number of useful things. Certainly, patients will flow between different ICSs, so there will need to be a mechanism to account for that. It is also quite a useful budgetary tool, so in terms of financial control, it is probably quite important that the tariff is maintained.
We have been promised guidance on the flow of funds more locally, but we have not yet seen it. My presumption is that there will be a negotiated process rather than just a straight use of the tariff in the way that we have seen up until now, with variations on block contracts, maybe using the tariff—or, more likely, the historical budgets—as the starting point. The business-as-usual capital, as opposed to major capital projects, remains as it always has been. Although it is subject to some review, at the moment I do not think a major change is proposed for it, but Richard probably knows better.
Nick Timmins: I have nothing particular to say about capital. I do think you need to retain a tariff—not for everything, because in some areas of healthcare it just does not work, but for electives and those sorts of procedures. That has two advantages: it means you need to understand your costs to construct the tariff in the first place so it is a driver of efficiency, and, equally importantly, it gives you a benchmark price with which to negotiate with the private sector whenever you do outsource some operations and procedures. You are able to say, “This is what is costs us, so this is what we’ll pay you.” If you do not have that, you are subject to a seller’s market and can be charged what you like because you do not know what your own costs are.
Richard Murray: On the flow of money, we are expecting revenue allocation to ICSs based on the current formula, trying to reflect need, inequalities, deprivation and age. The uncertainty is then how much those ICBs will allocate down to place level on a local government footprint. The expectation is that quite a large proportion of that funding—general practice, community services, quite a lot of mental health, and some acute services, too—will go down to that level, but none of that is in the Bill. The allocation to ICSs stops at that point, and as has been said, you need a payment mechanism to get the money off what are, effectively, commissioners and over into providers.
The changes to tariff are mostly about flexibility, so it should still be transparent; you should still be able to work out what people are being paid, which I think is important, and you should be able to benchmark between different providers, but instead of paying for each operation and each widget bit by bit, you can have formulas that try to reflect fixed costs. You can do it in a different way that adds some flexibility into the system, which I think is important when you are trying to bring providers and commissioners into common alignment over where the money is going. Tariffs had the problem of setting them at each other’s throats sometimes, because every time someone was admitted to a hospital you would get another payment, so commissioners wanted to keep it down and providers wanted to keep it up. There is the chance to try to align some of those incentives, but there is still a lot of gap around what actually will go down to place and what will determine it; of course, again, the budgets need to be equitable.
Nigel Edwards: Richard, if I may, I think a very important point that ought to be made here is that because the allocations will now shift from 100-plus clinical commissioning groups to 42 ICSs, the variations between them will be evened out. There will need to be some way of recognising the fact that within an ICS, you have very different patterns of need, which at the moment are recognised by the allocation formula, but in the future will not be. The money will be received by the ICS, so I think there is a question there. I know that local authorities—and, indeed, GPs and primary care networks—will want to say, “If we are in a particularly deprived area and we have historically had higher funding to recognise that, we would expect that to continue.” There ought to be a line of sight from the national allocation formula based on need to the money that is received by our locality.
Sorry, Richard. I thought you made a really good point.
Richard Murray: That is absolutely all right. On capital, the Bill does not really change the way that capital works in this system. The only difference is the ability of the Department, through NHS England, to cap the spending of foundation trusts, which they have not been able to do in the past. There are some limits around them being able to do that, but it gives an additional lever at national level. Having said that, the way that capital is working in the system has changed fundamentally already: some capital goes through an allocation system, a bit like the revenue funding, and I am leading a review for NHS England now on how that money flows.
The bit that I think is really uncertain is how the big hospital schemes get picked. That is the bit that looks very different. Obviously, there is a manifesto commitment. There used to be a process by which it was determined whether providers could afford to repay—if they could do it through loans, or if there was a need system. That is now going off in a completely different place, and I think that is the bit that is not quite clear. How does that work within this system? Who gets to choose how those projects get picked, so to speak? That is the big change but, again, it is not actually in the Bill; it is being done under the existing rules.
The Chair
I am really sorry, Karin, but I think we have to move on, because we have about seven minutes left for Back Benchers, and three indicating. Jo Gideon.
Jo Gideon (Stoke-on-Trent Central) (Con)
Q
Richard Murray: It will certainly make it easier. You remove some of the unnecessary impediments that have got in people’s way and pushed them into complex workarounds. It creates a structure through ICBs and integrated care providers to bring people together, so in that sense, it enables these things and makes them easier. However, if I am honest, you could still have NHS England and the Department deciding to run everything through ICBs and making them behave an awful lot like NHS bodies of the past. It enables those things, but the legislation by itself cannot prevent some of the older behaviours from living on. That is why implementation and what happens afterwards is critical, to try to ensure that it delivers on the things that I genuinely think it is trying to do. There is a heavy weight from the past of very centralised control that focuses very much on the independent republic of the NHS. That is the cultural issue that the people who will have to implement this will have to work against.
Jo Gideon
Q
Richard Murray: I would really ensure that local government is part of this. It is an independent voice, and has already been a useful counterweight to some of those centralising forces, as local government comes closer to the NHS. Ensure that people from the voluntary sector are there. They do not follow the orders that come out of NHS England, so you are putting people directly into the system who carry some of that independence and are looking out fundamentally to their local communities. That really is the strength of some of the ICP structures—that you have those people round the table and, indeed, some of them on the ICB itself. Really invest in that place-level work. That is where a lot of the excitement will come from working with local government, and again with the voluntary sector and primary care. Do not get too focused on the ICS as this interim middle step, because it is quite distant from where a lot of the action goes on.
Nigel Edwards: It is not just upper tier local authorities that have an important voice in this. I think that Richard is right: a lot of the most interesting and bigger changes are likely to happen at the place level. It is probably the case that quite a lot of legislation has not really affected how patients are cared for or how professionals work. In some senses, that is not a bad thing. I think this does remove some of the behavioural oddities of the hybrid market and other systems that we had.
It will introduce some other hazards, in particular—Richard sort of referred to this—the slight danger of ICSs becoming inward looking, and some organisations, and the independent and voluntary sector, being excluded and not feeling that they have a voice. The challenge that local authorities can bring to that will be important, as will behavioural change from NHS England and some of the regulatory machinery, but you cannot legislate for that. That is a cultural change that is probably beyond the scope even of legislators.
Nick Timmins: Yes, and you can see that in evidence that you have already heard about the construction of the board and the partnership. It seems clear to me—you have heard from the Local Government Association—that some local authorities were happy to join a single board and others felt that that was too much of a loss of sovereignty, which is why we have ended up with this slightly complicated system of an NHS board and a partnership board. Probably, in an ideal world, it would have been better if it was one, but you have to live with what people are prepared to do.
Dr James Davies (Vale of Clwyd) (Con)
Q
Nigel Edwards: The current system dates back to Andrew Lansley, who set up four tests. Do not ask me what they are. I can look them up, but I cannot remember them. However, they were good. They involved local people and clinical support. You had to make an evidence-based case. Then there was a process that involves local stakeholders, and then there was the opportunity for review by the Secretary of State and referral by local authorities and the independent reconfiguration panel, which has been a remarkably longstanding innovation, given the way that NHS organisations are formed and then abolished. It has done, I think, a very good job.
The current system seems to me to work quite well. The Secretary of State still has a say, particularly around controversial decisions, but they do not get sucked into every small reconfiguration and change. You also do not have a point where there is an opportunity for local participants to say, “I’m not going to contribute to this conversation any more. I’m going straight to the top,” and undermine people working together locally. I am of the view that the current system works quite well. I think we said to the previous Secretary of State, “You need to be really careful what you wish for. You may think that your intervention is going to help to move things along and improve innovation. It’s quite likely, from both previous experience and experience in other similar types of systems, to have the opposite effect.”
Richard Murray: I would not disagree with anything that Nigel said. Also, the clauses in the Bill as they stand at the moment are really, really unhelpful. There may be things you could do to make reconfiguration easier, but I think they would be working around the margins of what Nigel said. It would not be wholescale intervention without limit by Ministers in local decisions—that would mean any change, of any service, could go up to the Secretary of State. Also, if you need to make an emergency move for an operational reason, you would need to write to the Secretary of State in advance—you kind of think the clue is in the fact that it is an operational crisis. I think that the legislation as drafted would not give Ministers what they want, so I really think it is not helpful at all.
Nick Timmins: Can I just add to that? I think it is really dangerous for both Ministers and the NHS. Not many people know about the Independent Reconfiguration Panel. It has worked very well. It has dealt with about 80 controversial cases. It quite often suggests some amendment, and the Secretary of State does not have to take its advice, but the Secretary of State almost invariably does take its advice. I think that if we end up with lots and lots of reconfigurations hitting Ministers’ desks, Ministers will come to regret that. If you listen to the views of previous Secretaries of State, they almost always say, “It’s ludicrous we ended up having to make a decision about what was going to happen”—in Nether Wallop or wherever—which was the case before the Independent Reconfiguration Panel was around.
Chris Skidmore (Kingswood) (Con)
Q
Richard Murray: There are a couple of things around competition. Probably the most obvious one is that it never really worked. A lot of care, particularly urgent or emergency care, is not an area for choice in the first place, so you are already dealing with a fairly specific part of the health service and drawing an awful lot of attention into that one element of the service when a lot of the interest is in care for people with long-term conditions and how you stop overuse of A&E and emergency services. There are lots of examples of things, particularly uncertainty around competitive procurement. Commissioners were anxious about where they stood in law so they used, and probably overused, competitive procurement.
I know from speaking to some commissioners that they sometimes felt slightly powerless to influence the provider side so they would put it out to procurement instead. There was very little sign that all the effort and bureaucracy that went into that really did any good at all. Let us step away from that and enable more co-operative working, to try to get the kind of change that we need for long-term conditions, for the real health conditions that this country faces. I should say that a lot of the academic evidence has found no benefits of competition, so not only was it not a helpful thing, it just did not seem to work—probably reflecting the fact that we have such shortages in this country. Competition works only when there is a meaningful choice.
On the triple aim, you would not want the system to get tied up in a new round of bureaucracy, form filling and ticking boxes, to show that it has duly considered the triple aim. I think it is also important to make sure you do not lose the issue of inequalities from the triple aim. I would not want to exaggerate: does legislating a grand vision make people do things differently on the ground? I think it is helpful to remind NHS providers and others that absolutely they should be thinking about the quality of care; absolutely they should be thinking about value for money and making sure they are efficient. But they also have a duty to the health of the wider population. You can then, through that triple aim, bring the different parties in this system closer together, and I think that for some non-executive directors and for governors, it is quite helpful to know that they are all working in the same direction. So I would not exaggerate the kind of change it would bring, but I think it is a move in the right direction.
Nigel Edwards: Can we just nuance the competition point? Actually, there were two elements to the competition regime. One was the very formal going out to tender and big, bureaucratic procurements—often resulting in the reappointment of the previous provider at significant expense. But the other component was patient choice—for diagnostics, for maternity and for elective surgery. I think that dynamic has benefits. One of the slightly worrying things in some of the plans produced by the ICSs’ predecessors—the STPs or strategic transformation partnerships—was a wish to “repatriate” work, as they called it, which meant to bring work back from providers outside their patch into their own. That was not necessarily a good thing; patients should have the opportunity to have a choice of provider and, particularly in the case of specialised services, one would be concerned about people saying, “Let’s grow our own services locally,” rather than, “Let’s use centres of excellence.”
The maintenance of patient choice, and ensuring that ICSs do not act to limit patient choice, particularly for those patients living on their margins, is quite an important dynamic; almost all ICSs have borders with someone else, and patients naturally flow across them. People want to be able to make choices, because they have an existing relationship with a provider or because they have a relative who lives nearby and could care for them while they are there. There is international evidence that that dynamic has a beneficial effect on providers’ behaviour.
Dr Philippa Whitford (Central Ayrshire) (SNP)
Q
Richard Murray: That is a very fair point; it did create that tension within the system, because more activity was what made you successful and gave you your bank balance. The flexibilities that the Bill gives to step away from those more mechanistic tariffs that pay for activity should enable that, with two caveats. First, much of this will come in guidance from NHS England about exactly how this will work; there is clearly not enough detail in the Bill to do that, and why would there be? That still needs to be worked through.
Secondly, it is quite complicated to get right; this is a very difficult thing to do, and one of the pointers we see in some other countries, such as New Zealand, is a focus on everybody working together and not getting too caught up in trying to divide up the pie between competing parties. Again, that is where things such as the triple aim may help to keep people’s minds focused on the purpose, which is good quality care, value for money and a healthy population. There are more flexibilities in this system to do that, so that we do not get the kind of perverse incentives we have seen in the past.
Dr Whitford
Q
Richard Murray: I think there will need to be a change in culture here; it is almost inevitable that if you look within different ICSs, you will find extremely financially successful institutions next door to some that are deeply troubled and that are facing problems in community services, general practices and other services. There will be a need for a culture change, but one that does not lose sight of the fact that you want organisations to be well run. You do not want to end up with some of the weaker organisations thinking, “I shall now pass this problem on to my big brother down the road who has very deep pockets.”
You need to try to maintain the right incentives and support for institutions to run themselves well, to keep the value-for-money element of the triple aim, while also being able to move money around the system without getting caught in silos such that the acute trust has all the money and mental health does not. We need to be able to begin to move money across those different boundaries, which the old financial system did not help us to do.
Dr Whitford
Q
Richard Murray: You would hope that the ICBs would have that power and the ICPs would try to set the direction. For many of the really tricky pieces between community services, general practice and social care, it is probably more at place; the ICBs are often so big that they are unlikely to get directly involved in those decisions. They can set the framework and try to ensure that in some sense it is working as a whole, but many of those decisions will come down at place level.
Dr Whitford
Q
Nick Timmins: I have little to add. This is really an issue of behaviour, culture and financial flows. It is not something that the Bill can lay down or dictate.
Dr Whitford
Q
Nick Timmins: The tariffs definitely caused some problems. Changing the way the tariff is used is very important, but that does not mean that you should get rid of it entirely.
Dr Whitford
Nigel?
Nigel Edwards: I agree with all of that. This gives a vehicle that will allow many of those perverse incentives to be removed. People found ways of working round them previously, but this simplifies things. Richard made the point that it is definitely the case that some trusts, particularly acute trusts, have done very well out of the tariff. They will find it quite painful to make the adjustment, but that is not a reason for not making the change.
Dr Whitford
Q
Nigel Edwards: I have sat with a number of different geographies and tried to work that out, and it is probably going to be different in different places. Some of the ICSs are quite geographically coherent and have a lot to do with each other. For others, such as Cheshire and Merseyside or BOB—Buckinghamshire, Oxfordshire and Berkshire West—there is less in common at the strategic level. It will be quite different in different places, particularly where there are powerful upper-tier local authorities within ICSs. They will want to have a strong voice at the place level.
One of the virtues of the legislation as currently formulated is that it allows some flexibility, and it allows people to tailor some of those relationships to fit their local geographies. But I would see the partnership part of this having a very important role in shaping the overall strategy. For quite a lot of people, the risk is having too many meetings and too many partnerships. It is very important that the partnership board sets the agenda and then the places and the ICB get on with it.
Dr Whitford
Q
Nigel Edwards: Yes. The NHS has always had a bit of an obsession with neatness and uniformity. If there is one thing that I have learned from working with these different ICSs, it is that they are very different in terms of their physical, political and psychological geography. Trying to fit a standard model of governance to them would be a mistake. We need to hold them to account for how well they are implementing their plans and how far they are improving outcomes for their population. We need to know whether they are making the best of the money that we are giving them, rather than whether they are conforming to a centrally designed governance model that will work on average, and that will therefore work nowhere.
Justin Madders (Ellesmere Port and Neston) (Lab)
Q
Nigel Edwards: This took us all somewhat by surprise, I think it is fair to say. Richard may have had a different briefing from the Department of Health and Social Care on yesterday’s announcement. I picked it up on reading the document; it was not pointed out to me. I think I read it slightly differently. It seemed to me that the plan was likely to be a formalisation of all the activities that are currently going on, rather than a new direction of policy, but I am probably the wrong person to be asking about that. If it is not that, it would not be very helpful.
Richard Murray: One of the things the documentation speaks about is the planning of the health and social care workforce. You asked where I think the Bill is deficient. One example is its inability to help with the very poor track record, over quite a long time, in planning the health and social care workforce—hence all the problems that we have with the workforce right now. There is a nod in the White Paper to that. It may only be that the crossover between those two workforces is not the fundamentals of the numbers that go through them.
Otherwise, I really hope that the White Paper is not about further legislative change. It might be about setting out, for example, the outcome measures that would really work for an ICS, meaning that it will cover both critical issues for the NHS and critical issues for health, public health and social care, to make sure that you have that rounded and meaningful measure so you know who is doing well. If it is another round of legislation, I must admit that I would pause before saying whether that is a good idea, with the exception of the workforce issue, which remains the critical factor here.
Justin Madders
Anything to add, Nick?
Nick Timmins: The workforce does need to be tackled—it is just a glaring hole in all this. The NHS has plenty of policy at the moment; it has had an eight-year drive towards better integrated care—that is what the Bill is focused on—and a lot of that will not come through legislation, beyond what is in the Bill.
Justin Madders
Q
Nigel Edwards: Each ICS is supposed to have a chief finance officer—a director of finance—and an accountable officer. That is the starting point. I think the question to ask them would be to what extent they are spending money in a way that reduces health inequalities and improves outcomes in an equitable fashion—I think they would want to do that. One of the things that has very much struck me in my conversations with ICSs—this is very much influenced by local government, which will be a powerful advocate for this, as will primary care networks—is that quite a lot of people will be scrutinising this. The person to ask who is clearly accountable for answering that question is the accountable officer of the ICS.
Of course, ICSs do not have a legal obligation to distribute money below place level. You might not want to do that, because there is a need to be flexible, and sometimes you might want to spend more in a particular area if there is a sudden strategic priority, but over the long term, the expectation is that those accountable officers should be able to demonstrate that they are spending money in ways that relate to the objectively assessed needs of their populations.
Justin Madders
Q
Nick Timmins: I think that is exactly the right question to ask. What have Ministers not been able to get the NHS to do without the powers of direction that he is seeking? When they were presented, it was as though the NHS was somehow unaccountable when, as I am sure you all know, Ministers can tell the NHS what to do through the mandate. The difference in the current system is that NHS England has to agree that what it is being asked to do is reasonable. If NHS England does not think it is reasonable, resourceful or doable, it can object, and the Minister then has to come to Parliament and explain why he is, in effect, instructing the NHS to do something. A measure comes before you and is subject to a negative resolution. If someone rejects it, it can be debated, so there is a perfectly good mechanism there right now. I think the really, really important question is: what are Ministers not able to get the NHS to do that means that they now feel the need for new powers of direction?
Justin Madders
Does anyone wish to add to that?
Nigel Edwards: I have no answer to that question.
Richard Murray: If the reason is not made clear, you end up starting to get worried and suspicious: “Are they trying to direct money towards one part of the country rather than another and overturning the allocation mechanism? Do they want powers to intervene in procurements?” Those are all the things that you would not want them to do which, to be honest, health Ministers generally have not done anyway. Even when they had the powers, they tried desperately not to get involved, because it is extremely poor governance and extremely poor value for money. However, without that explanation of why they want it, the temptation is to start worrying about what they want the power for.
Some of the behaviours could be governed through the framework agreement, or they should be able to be. You have the mandate that sets direction over the short to medium term, but the framework agreement also sets out the way NHS England should work with other parts of the system, so there are other things that you can use within this system. As it stands, and if it stays as it is now, to provide comfort to people, the temptation is to start listing the things that Secretaries of State should not direct—they should not direct allocations to individual parts of the country; they should not interfere in procurement decisions. You end up with quite a long negative list, but I would probably rather have a negative list than no list.
Nigel Edwards: The problem with negative lists, of course, is that you will forget something.
The Minister for Health (Edward Argar)
Q
Nigel Edwards: I think we have shared our anxieties about the reconfiguration and direction powers. In terms of what this does to the organisational architecture, it seems to me to strike the right balance between permissive and directive.
Nick Timmins: I would echo that. I have major reservations about the new powers of direction and, I think, major reservations if you build in reconfiguration service changes. The good thing about this—it has been the good thing about the development of the integrated care system so far—is that it is quite flexible. That is unusual in the NHS’s history: we tend to come up with very prescriptive solutions for what the system should look like everywhere, when in practice the circumstances are different, so I think the balance is pretty good.
Richard Murray: You could easily criticise the degree of permissiveness; you could criticise the degree of direction in there. The question should be, “Can anyone come up with a better one?” We have not been able to do so, so I think it is a balance well drawn. Of course, a lot will then rest on the behaviours that are shown after the Bill is through—whether people live up to that kind of core belief around that permissiveness and the freedoms that have been given.
The Chair
We have time to squeeze in one very quick one, if anyone has something else to ask.
Justin Madders
Q
Richard Murray: I think a longer-term mandate is a better thing. The idea that each year, sometime between December and March, you can set a different expectation on the NHS is operationally unreal for the system. They cannot do it, so I think we want to get back to something where you set out a clearer medium-term objective for the things you want the NHS to achieve, whether that is reduced waiting times or better health, and allow them to try and work towards it.
Budgets on that basis would also be incredibly helpful—if you are working in the service not knowing what capital you might have two years down the line and what revenue you might have. I think there is a real chance to do that in the spending review. That is a move in the right direction; we just have to make sure that if the budgets are still set on an annual basis, you do not get a diversion between what it is you have been asked and the budget then being suddenly moved on that annual basis. I would strongly encourage the Government to also try and set multi-year settlements for the NHS, as used to be done, so that people can plan at local level.
Nick Timmins: If memory serves me right, the original idea of the mandate was a rolling three-year mandate. You set the objectives of the NHS and what you want it to achieve, and you can have a little review of it each year, but it is clear. I probably should have said that if the money was also planned on the same basis, that would help no end.
The Chair
That brings us to the end of our time. I thank our witnesses very much.
Examination of Witnesses
Dame Gill Morgan and Louise Patten gave evidence.
The Chair
Q
Dame Gill Morgan: I am Dame Gill Morgan. I am chair-designate of Gloucestershire ICS, but I have been involved there for over two years, so I have seen the development of this movement. I am now the elected chair of the terribly titled NHS Confederation advisorate. What is important about that is that it includes all the ICS chairs that have been and all the ICS people who have been acting in as accountable officers for the work that has developed thus far, so I think I bring a perspective on the reality of what people worry about.
I have been involved with health service Bills for well over 20 years. This one is an exemplar of how people can work with a service to develop a Bill that largely has the support of the system. People have engaged, listened, changed things and taken the frontline views seriously into account. We do not agree with everything, but you asked our think-tank group of people about some of the issues and changes and the permissive approach, and all those things are truly endorsed. For me, it has been the best experience in 25 years of involvement in healthcare. I want to have that noted because people worked really hard to do that.
In contextual terms, you have to realise that this is the first time the NHS has tried to do something fundamentally different. We always legislate for things that look the same—they quack the same, they walk the same, they waddle the same—yet systems and communities are fundamentally different. My ICS, which I am proud to be part of, has a population of about 600,000, and 15 other ICSs have populations of under 1 million. They have our characteristics of closeness of community and long-standing trust. On the other hand, there are some very big ICSs. What the Bill has done well thus far is to create a permissive environment that allows us to see how we can flourish as well as the big places. If you try to define it—
The Chair
I am sorry to interrupt you. This session is intended for Members to ask you questions rather than for you to make a statement. I would prefer to move to Louise Patten and ask her to introduce herself so that we can get on with the questions.
Louise Patten: Good afternoon everyone. My name is Louise Patten. I head up the ICS network and NHS clinical commissioners at the NHS Confederation. I am also a clinician.
Karin Smyth
Q
Dame Gill Morgan: What is different about this Bill is that it is the first time that local government will be very actively involved in those decisions. It has always been involved in scrutiny and big changes, but it will be heavily represented on our partnership board. We have four local government people, including two elected members on our ICB—integrated care board—so we are bringing in the local government elected people.
We intend our partnership board to meet in public and we are looking at exactly how many of our meetings of the ICB should be in public. Clearly, when talking about quality and clinical stuff, the actual deliberations need a private bit—[Interruption.] When talking about named individuals, yes, they do; but when talking about the quality of the service in general, that is something that needs to be clear and in the public domain. We need to get the balance right between what we need to do publicly and what we need to do privately—as we will, because we will have so much local government involvement, with elected members, as well as Healthwatch and other people like that. They are all intrinsic parts, in a way that they have never been before. It has never felt as engaging to me as it does now, certainly in my patch.
Louise Patten: From my point of view, having experienced health overview and scrutiny committees as an accountable officer, the patients and public certainly feel that there is the voice of that local place. It is important to NHS leaders that that continues—that ability to have local scrutiny at local level, which is very much where patients and service users feel is the right place to do it.
At the strategic level, we must not forget that ICSs comprise both the integrated care board and the partnership. This is a real opportunity to tether the NHS to always thinking about the wider determinants of health, social value, public health and, again, patient experience.
Edward Timpson
Q
Dame Gill Morgan: Our big learning about all of this is that, at the end of the day, many of the structures do not matter; what matters is people being in the same room, having the conversation about common purpose, and getting to know and trust each other. The reflection on that has been why we now have such an emphasis on place. If you have a really large ICS and you are trying to do it all, you are so distant from patients, citizens and clinicians that you will never have the contact. Place, in those bigger systems, has to be where you begin to pull those things together, by getting the right people to engage and developing the right level of trust.
As far as clinical engagement is concerned, the ICS is about three things—the triple aim, which is, basically, how do we get better health services today, which are responsive, high-quality and all those things we want; how in the long term do we create populations that are healthier than they are today, which means thinking about employment and all those bigger things; and, in the middle, how do we take services that we deliver today and transform them to be more community-orientated, better for citizens and delivered where people want them? In each of those three boxes, clinicians are absolutely fundamental.
A lot of our effort—in particular around covid and some of the successes—has been in getting that synergy, with clinicians in the transformation box feeling that they can not only write on what the hospital does, but define what the community does and what the GPs do, because they are all working collectively. That has been transformational. Certainly, we would not have managed covid as effectively as we have without those sorts of relationships running all the way through the system as a thread.
Louise Patten: The clinical leadership has to be multi-layered, right the way through from the strategic level to place. We have to have clinical advice and we must heed it when we are talking about planning clinical services. That is fundamental. I think it will involve different groups of people. If it is a care pathway about cardio-vascular disease or a professional pathway about social care, we must heed clinical and professional advice when we are planning these services, so it is multi-layered.
Edward Timpson
Q
Louise Patten: From strategy right the way down to grassroots implementation.
Dr Whitford
Q
Dame Gill Morgan: It is about multi-layering of advice. We will have a primary care sub-committee partly because managing primary care, and all the things that come through GMS and the opportunities, is expert; we do not want it to be subsumed by a generalist groups. We want it to have proper focus, because if our vision of the future is right, we need better and more engaged primary care at local level that can link its services more effectively with support in the hospital and the community. That is the objective, so we will have that.
We will also have an ICB. GPs will have different views. That is one view, which is about me as a jobbing GP. I go in in the morning, and I do my work and all of those things. I need to be supported to do that, but I also need GPs in the system who are engaged in management. We are very proud of our primary care networks, which are beginning to pull together around our localities, because we are smaller and it is not a big place.
There are models where they are working with second tier local government, where they are beginning to think about housing, and they are working with the voluntary sector, so when they are talking about frailty, it is not a GP or a hospital conversation; it is a system conversation in this place. All of a sudden there are things that can be unlocked. If we leave it in any one box, as we have always done in the past—there is a box for acute, for this and for that—we do not get this. Our task is to make those boundaries semi-permeable, with the expectation that we look at the patient flowing through all those boundaries, rather than pretending that patients sit in an individual box, because they do not.
Louise Patten: Frankly, stakeholders who are anxious about whether they have a place on the partnership board or the integrated care board need support in being helped to co-ordinate their response, so they have a collective voice. The variations for ICSs are huge, from a population of 600,000 right the way through to just upwards of 3 million. Supporting those stakeholders to have a united voice and providing assistance will be really helpful.
Alex Norris (Nottingham North) (Lab/Co-op)
Q
Dame Gill Morgan: The first thing is that you would try to make sure that you have developed a mechanism for engagement and trust, so that you do not get into those sorts of disagreements. If you get into those disagreements while you are sat around the board, you have failed to do the task of integration and partnership. That is what happens in the conversations about how we solve it. If we ever got into that sort of difficulty, it would have to be resolved at the integrated care board, and we will have local government, public health and social care on our board as full and equal partners.
Alex Norris
Q
Dame Gill Morgan: The more you try to write in legislation, the more it becomes the lowest common denominator and the less you unleash the innovation that you want. I would do something quite different. I would probably write something that requires the different models of ICSs to be formally evaluated over a period of time, so for the first time we could look to structural change and say, “This is what it has demonstrated, not just against the outcome measures measured by the Department of Health and suchlike, but this has been a structural change that has added benefit, or not.” If you are going to do that, it must be done from day one. I think that is more important than trying to put something about solving problems in the Bill. You will never hit the particular strange circumstances of a locality that has problems, because they are always serendipitous.
Alex Norris
Q
Louise Patten: The selection process for chairs and the executive team has got to be about what this integrated care system requires, what sort of leadership, and what are the partners that we have got. No two ICSs are the same. In order to achieve that, it needs to be a local discussion about what it is that this system needs to make sure it has the best leadership to take it forward. That will involve discussion with local people, local stakeholders and potentially the public to sort that, because the leadership will be different in different ICSs.
Alex Norris
Q
Louise Patten: The two will have a very good idea collectively about what leadership is required: one from experience of leaders and the other very much from the grassroots level of, “If this is our system, this is what we need.” It is a combination of the two.
Alex Norris
Q
Louise Patten: It is both/and.
Edward Argar
Q
Dame Gill Morgan: Yes, I think you have got the balance, and that is the joy of working with a Bill team. I think the balance is right. You have tried not to be prescriptive and tie our hands, but you have been clear in the sense of setting a direction and focus that we will all take into account, so you do not have to tell us things to make the NHS do it. We do it because we pick up the runes.
On the issues that we would be more concerned about, I personally am concerned about the ability of the Secretary of State to call in changes. In part that is because the one thing I think the NHS has learnt in the time that I was out and came back is how to do relatively good consultations. We have just finished a massive consultation. Patients have gone with us. The local communities have gone with us, mostly. We have had citizens juries and all sorts of things to reach a consensus about the direction of travel. The worst thing in the world would be that people say, “There is no point in engaging in those mechanisms locally because, at the end of the day, we will just complain to the Secretary of State and it will not happen.” If that becomes the way people manage that part of the Bill, it will take us backwards, not forwards, in terms of proper citizen engagement.
Louise Patten: On balance, it is about the Secretary of State’s powers of reconfiguration, and NHS leaders in general are concerned about that. It is not so much about the Secretary of State having an early understanding of the reconfigurations or the intent, but about the fact that that decision could be taken at a point where all the evidence is not ready to be properly considered.
Building on Gill’s point, patients and the public would be very frustrated if they felt that they had not had an opportunity to be answered, so we are asking, if not for the clause to be removed, for at least the clinical case for change to be considered from the ICB. Coming back to clinical decisions about clinical services, we want that accountability to local communities, not just up to Whitehall, and some transparency about why the decision was made, and on what basis and information it was taken.
Edward Argar
Q
Dame Gill Morgan: I think you are absolutely right: de minimis. What I have argued throughout is that if the centre, if you and then NHS England, which issues guidance, are clear about the principle that we have a proper engagement mechanism with our local authorities and citizens, they need to ask us how we are doing that, and to ensure that our constitution meets that. There are plenty of checks to ensure that it happens without you telling us that we have to have this, this and this.
In our case, we will have mental health and social care around the table, not because we are told to but because we could not imagine how we could do our work at a local level without having those people feeling that they are full partners and sitting around the table. There is a set of concerns about having local government involved in making decisions about the expenditure of large amounts of NHS money. I do not care; they are the local people who need to be involved in the decision making. Actually, if they see the deliberations and challenge first hand we will get better-aligned budgets. At the end of the day, that is to everybody’s benefit.
Louise Patten: There are already five mandated board positions in the legislation. A further five will be in the mandated guidance from NHS England. We are up to 10 already. I think the most important thing here is: where do you stop? There is a risk that there is a perception of two tiers—that those who have a mandated position on the board are of more importance than others. That flies in the face of partnership working.
Edward Argar
Q
Dame Gill Morgan: My view is that we are where we are and we need to progress. Going backwards would be a problem, but actually I am a bit more positive than that. Covid has demonstrated to people that if they think innovatively, out of the box and in partnership ways they can get solutions that are quicker than they would have been before, so in the system as a whole there is a recognition that partnership has offered more. We will all retrench as the world moves on from where we are, but there is real learning from covid on which we can capitalise. Many systems have done reviews of what worked and why, looking for the silver linings in that learning. I think the Bill goes with the analyses that have come out.
Louise Patten: At the NHS Confederation, we have that sort of umbrella view. We must not forget that, on collaboration and integration, people have been working to this for some time. There are some great examples of it, and this legislation moves that opportunity to really accelerate it. People recognise that it is a tight timescale, but they are absolutely committed to doing it.
Dr Whitford
Q
Dame Gill Morgan: There are a couple of statutory sub-groups that we are going to require, like accounts, audit and remuneration. More importantly, over the last few years, systems like ours have developed ways of handling finance and quality that have been about a partnership approach, so you do not have a head of quality covering all the organisations, but you have the heads of quality from all the organisations coming together to problem-solve. The heads of finance come together to work out how to allocate the money. That is a very, very effective way of doing it. It teases out the tensions and gets people who are expert in delivery in those conversations. We will have a number of committees like that. The question is: which ones of those become statutory? Which ones do you do through officers? Where do you build people in? All of them will have primary care build-in, because you cannot do service otherwise.
On the partnership forum, which is a different sort of animal, we had already got into the vehicle whereby the full ICB board took cognisance twice a year, because these outcome measures do not change very rapidly. All we do is talk about those longer-term agendas, so it is not just us saying, “Here’s our plan, over to you.” It is about saying, “What really worries you? How can we help? What is important? How do we do it?” We had a wonderful session on apprenticeships. NHS apprenticeship levy money is being used to support some of the stuff that county councils want to do. That would have never happened in the old days because we were not sat in a room with mutual trust and a single purpose.
At the heart of this, every ICB and every partnership board will have to define, “What’s my purpose? What’s your purpose? What’s our shared purpose?” That managerial trust-developing, partnership-developing work is what will make this a success. I started, and I was rapped across my knuckles by Mr McCabe for saying too much—quite appropriately. At the end of the day, you are not going to get that through legislation. You are going to get it by creating an environment and properly holding us to account for what we are doing in these boxes.
Dr Whitford
Q
Dame Gill Morgan: Indeed. This is guidance, not legislation, so we have to develop a constitution of what we are doing, and we are committed to reviewing it. If today we think that we know what we will need in three years’ time, we are not asking ourselves the right questions, so we need to be reviewing constantly. That is one of the things that we have historically been very bad at in the NHS. We do something, we enshrine it, and then a few years later we throw it all away and start with a new thing. How do we evaluate it? How do we say, “This has been brill, this has been flaky. Let’s get rid of the flaky, and let’s put more of the brill in”? It is that sort of managerial question with us, rather than the very flat, “How do you hit this today?”
Dr Whitford
Q
Dame Gill Morgan: I personally think that we have to be very careful. I do not know if this is a role for legislation. A joke in the NHS is that pilots are phase 1 implementation. That is an old joke. It is not this Government; it is every Government. We have always said that. We have to be really careful that we build in evaluation across the piece and do not pick two or three metrics that look as if they have gone the bad way to prove what we wanted to argue before. That is done both in favour of things and against things, and we end up with this sort of noise in the system. Let us plan now and get a proper, effective academic unit to build in some evaluation at the end of this time, and then let us all take stock in two and a half years and say, “Hasn’t this been brilliant”—in my opinion, it will be brilliant—or, “It won’t do any harm, but it’ll be nothing”. We have got to do better than nothing.
You will gather that I am in favour of ICSs. [Laughter.]
The Chair
I think we drew that conclusion from your evidence—absolutely.
May I just thank you both very much for giving evidence today? I am sorry that I had to interrupt you, but I am an obsessive timekeeper. Such is life. Thank you very much.
Examination of Witnesses
Ed Hammond and Andy Bell gave evidence.
The Chair
Q
Good afternoon, both. Can you both introduce yourself for the record, starting with Ed?
Ed Hammond: My name is Ed Hammond and I am the deputy chief executive at the Centre for Governance and Scrutiny.
Andy Bell: I am Andy Bell and I am also a deputy chief executive, but at the Centre for Mental Health.
Dr James Davies
Q
Andy Bell: It is a really good question and I think that, on its own, the legislation certainly has some potential to assist with that. Of course, there also need to be a number of other things and I can talk about those if that would be helpful.
The first positive thing to say about this legislation is that the idea of integrated care—the practice of providing care that actually links across between mental and physical health, NHS and social care, and prevention and treatment—undoubtedly is the way to go. I think we have a number of areas within the system where we know that people at the moment get very poor support for their mental and physical health, as a result of the lack of integration in the system.
Examples would be people who have both alcohol and mental health difficulties at the same time; people living with long-term physical illnesses, such as diabetes or kidney disease, who get really inadequate and often very poor emotional support, if indeed they have any emotional support at all; and, indeed, people living with long-term mental health conditions, whose physical health is very often very badly neglected, and they have very little support. Integrating care—actually doing that on the ground—and achieving a real change in the way that services are organised around people’s needs would undoubtedly make quite a significant difference and reduce some of those inequalities.
I think the way that the Bill and the various bits of guidance are written gives us some hope that that may happen; it certainly does not answer all of our questions about it. In and of itself, I think it is potentially a step in the right direction, but we need to give some thought to a number of caveats around that.
Dr Davies
Q
Andy Bell: Yes, sure. Again, “integrated care”—we like the words; they are good—but the difficulty in a way is, first of all, the fact that this is very much an NHS-dominated set of proposals. It was written by NHS England for NHS England. I think that if we have a genuinely integrated system, where people will get support across the whole range of services, we need this to be an equal partnership between the NHS, local government, and voluntary and community organisations.
If you look at the proposals, in a sense what they are doing is taking decision making and power within the health and social care system further away from local communities into what are effectively sub-regional groupings. There is not anything very local about integrated care systems in many places, and that gives us some pause for thought. It is very much NHS dominated. If we look at the current health and care system, public health and social care are often the less well-funded and less well-resourced parts of the system. From what we see from the spending plans, it looks like that will become even more the case if you have legislation that, in a sense, reinforces the power of the NHS over other partners. I worry we are not going to get that real shift.
Dr Davies
Q
Ed Hammond: In terms of scrutiny generally, it is a challenging picture, as Andy said. There is a challenge around the need for effective local accountability. That scrutiny is best exerted at a local level. Local scrutiny is much more able to assess and make accurate conclusions about what outcomes have been reached. We do a lot of work as an organisation supporting local councils in their formal health scrutiny functions. The past 20 years of that has demonstrated a significant degree of success in local government being able to lead with local healthwatch in, alongside and on behalf of local people, seeking to understand how local health services design and deliver effective outcomes, challenging, where necessary, through the referral power for substantial variations.
My worries echo Andy’s in that the Bill as it stands moves a lot of decision making, commissioning and direction activity up to system level. Depending on the character, relationships and personalities of the key individuals involved, there is a risk that decision making therefore becomes remote from local accountability, making effective scrutiny of outcomes more challenging to achieve.
Karin Smyth
Q
Ed Hammond: In answer to your first point, I think it is clear. As we become more familiar with what is a complex system—and health governance is complex—some of this confusion will dissipate. As we start to operate practically within these systems, familiarity will breed a degree of confidence in understanding whose roles relate to what. As with all complex systems, it is vital that everybody understands their individual and collective responsibility for governance within those systems and accountability.
It is great when you have a partnership-led framework, in which everybody in the system is working together, and everybody has some stake in the system and in decision making. It is not a hierarchical, dictatorial system; it is one based, hopefully, on dialogue and, to an extent, consensus. The risk of that is that it necessarily dilutes accountability. Where everybody has a stake in decision making, you need some kind of external source of local accountability. That leads on to a second question. I think there is a need for a distinct and separate form of local accountability within these new arrangements at system, place and neighbourhood level. That role is currently performed at a local level in two main places: through local Healthwatch, from whom you will be hearing later, and through local health overview and scrutiny committees.
For me, the risk of these new arrangements is that, first, the removal of the power of referral to the Secretary of State by health overview and scrutiny committees on matters of concern relating to substantial variation of local health services is a worry for us, as it is for NHS colleagues. Also, the focus on system-level decision making will, by definition, make it more challenging for local health overview and scrutiny committees to co-ordinate to form, where necessary, joint committees to effectively oversee, scrutinise and hold to account ICS, ICB and ICP activity at system level.
The Chair
Do you want to add anything to that, Andy?
Andy Bell: Yes. It is a really important question. From the perspective of mental health, we have seen an enormous amount of progress in recent years from local Government really embracing the mental health agenda in many areas and becoming both a partner but also a scrutineer of the NHS through scrutiny committees and through the role of health and wellbeing boards too. The importance of that natural connection through, between the health and wellbeing board with the ICP in particular, the partnership bid, feels like there needs to be a very clear and close relationship and, again, where possible, decisions being made at place level—in the new language—feels really important to allow for that kind of relationship to build and actually become a really positive relationship, because so much of this does come down to relationships. However, clearly, the need for some kind of external scrutiny is incredibly important.
When we think about it from the mental health perspective, where systems or governing bodies—be it the integrated care board or anything else—are allowing mental health to slip through or particular groups of people are being poorly catered for by the system, some kind of external scrutiny and clear accountability is incredibly important. One thing we have said we would like to see in the Bill is an extended and expanded role for the Care Quality Commission to really scrutinise the degree to which integrated care boards and the decisions they are making—and, indeed, partnerships in their strategies—are looking across the board at health inequalities.
At the moment, the Care Quality Commission is very good at inspecting services for whether they are working appropriately with individuals they are seeing, but it has no powers to scrutinise whether the health system as a whole is working fairly and appropriately across all different groups of people. Unfortunately, that means, certainly from what we see in the mental health world, that there are a number of groups of people who get very poor support for their mental health—actually, very little help at all—and there is no current means in the system to address that.
Mary Kelly Foy (City of Durham) (Lab)
Q
Andy Bell: It is difficult to tell; the Bill is largely silent on mental health. If we had a system where there was genuinely equal regard for both mental and physical health, we would not have to worry about that, because we would know that the system would treat mental health fairly and equally, and there would be no disparity in the way it was thought about. Unfortunately, all our experience tells us that that is not what happens within many health systems at different levels, from very local to national, so we would like to see some assurances in the Bill.
From our point of view, that could happen in one of two ways. Legislation only gets you so far, but it could place specific duties on both NHS England and integrated care boards—I am being very careful in specifying integrated care boards here—that they must take action to ensure that mental and physical health are given equal regard in their decision making, particularly on resource allocation. We feel strongly that there needs to be a voice for mental health within integrated care boards. That is highly likely to happen within integrated care partnerships, but within integrated care boards we do not have confidence that mental health will be properly represented at the top table where important decisions about resource allocation are made.
We think that would help. There are no 100% safeguards in legislation, but one positive thing we have seen with the 2012 Act is that a clause at the very top of the Act talked about mental and physical health as one of the key purposes of the NHS, and that has been used positively and helpfully to make the case for parity in health systems up and down the country. A few simple words can sometimes make quite a big difference.
Edward Timpson
Q
Ed Hammond: For me it starts with an understanding of what decisions are best made at system level and what decisions are best made at place level. Certainly, I would imagine one of the first things that ICBs and ICPs would need to do, once established, would be to determine how to set up a system-wide framework for ensuring equality and equity in terms of how its health and care service is delivered, and then determine how and where it is most appropriate that more detailed decisions come to be made at place level. Otherwise, the system simply becomes too unwieldy.
There are risks that those partners sitting at that system level will draw decision making into those spaces, rather than pushing it back out to localities, because it is the simplest, in many ways the most efficient and apparently the most co-ordinated way of doing it, but in practice it will not serve the interests of local accountability or better outcomes. That raises the prospect of certain services being delivered in different ways in different localities, depending on the political priorities of different councils, but that is local democracy—that is local government bringing its understanding of the demographics of the populations it serves into the conversation.
I think this can all be made to work if there is sufficient transparency in the system, so that those within and those outside it understand how decisions are being made, on what subjects, and by whom. When you have that clarity, it becomes easier to unpick what is happening at place level. Are decisions being made at system level that would be more appropriately made at a lower level? Is there consistency across the entire system? What does the geography mean for decision making and commissioning, and these kinds of things? It provides assurance, and it provides everybody with more confidence that decisions are being made properly in the interests of local people.
Going back to the point I made before, that is also why some external local accountability is so important, because effective local external accountability can challenge the system on whether the right decisions are being made at the right level, and whether they reflect and are responsive to what the local needs are. Local scrutiny committees are, at the moment, anchored at place level within local authorities. They are well able to publicly draw in the voice and concerns of the public about those kinds of issues, and transmit them to health and care partners so that there is a clear way for those concerns and issues to be responded to.
Dr Whitford
Q
Ed Hammond: That is a challenge, because it brings into focus the role that different accountability partners play in the system. We have already heard a little about the CQC and the work it does in assessing and monitoring clinical outcomes. Of course, within ICBs and ICPs there will come to be—one would hope—robust and effective performance management arrangements. Certainly, looking at the Secretary of State’s expectations around the exercise of new powers, one would expect that, for the Secretary of State to understand where he chooses to intervene and direct services, that would be on the basis of evidence that would need to be collected in a consistent and systematic way across England, but also within individual ICBs. Presumably, we can expect some kind of performance framework to be established nationally to provide evidence to support the Secretary of State in the exercise of their powers.
Then at local level, you have, as I mentioned before, local Healthwatch and local health scrutiny communities. Now, local scrutiny committees obviously cannot bring the clinical expertise to bear on issues of concern; the CQC naturally leads on many of those issues. I think what those local partners in local Healthwatch and scrutiny committees can do is understand where there are gaps in the system; where there are concerns about aspects of performance that others have perhaps not picked up on; where there are concerns emerging from conversations within local communities that councillors are hearing about day to day, because they have direct contact with local people; and those concerns that might not otherwise find their way on to a performance scorecard, but might relate to things that are not being monitored, measured or managed particularly well. That local connection is a vital part of what makes health scrutiny work.
Dr Whitford
Q
Ed Hammond: Yes. Where ICBs and ICPs are putting those monitoring arrangements in place, I would certainly expect local clinicians to have a role in assessing, evaluating and analysing that data and evidence. As I have said, committees of local councillors would also be able to do that. I think we have a resource challenge in how that local government scrutiny operates, but as a matter of principle local councillors are increasingly adept at that data analysis, despite the fact that they may not be clinical experts. They are able to carry out some form of analysis. Collectively, we can see that, together, those partners can bring to bear a form of local accountability, primarily at system and place level.
Dr Whitford
Q
Andy Bell: We have hugely underinvested in it, and indeed very poorly appreciated it. What we have seen in recent years, which we hugely welcome, is huge progress on mental health awareness and understanding. That was not there 10 or 15 years ago. It has not been that long since in a debate in the House of Commons the first Member stood up and spoke about their own experience of mental illness; that was hugely powerful, and began quite a significant social movement. However, we do not yet have literacy around that issue, or indeed a real understanding about what we can do to promote the public’s mental health. With the creation of the new Office for Health Improvement and Disparities—I must remember to get the name right—there is an opportunity to make public mental health as important as public physical health. How we translate that to local areas will be really interesting.
When I talk to people working in local public health departments, I see a huge enthusiasm for and interest in how they can better support mental support in the communities they serve. We have seen incredibly creative work from around the country, such as in Leeds and Bristol, from public health teams that are leading the way who understand that the things that determine our mental health are very much about the society and environments we live in—the families we come from, the schools we go to, the amount of income we have, and the homes and neighbourhoods that we live in. There is a growing understanding of that. However, we have not yet put that into practice on a large scale, and indeed the resources available to public health departments to do that are very threadbare. Many have to be very creative in how they do that.
We very much welcomed the promotion and prevention fund set up recently by the Government, which gave funding to local authorities in the 40 most deprived local areas in England for mental health promotion activities. We are really looking forward to seeing what that money is used for, and we very much hope that it will be the beginning of something much bigger. Our worry, in relation to the Bill in particular, is the understanding of prevention, and indeed the understanding of prevention that I read in yesterday’s Command Paper on the health and social care plan. It is still based on physical health, and the idea that public health is about telling people how to live their lives and how they should behave, rather than what really determines our mental health: how much money we have coming into our home, how safe we feel, and our position in society. It is really clear that very often the way that economic and social inequalities affect our mental health also affects our physical health. Very often it is poor psychological wellbeing that leads to later physical health problems, so we really have to start taking public mental health as seriously as any other part of public health.
Justin Madders
Q
Ed Hammond: The obvious mechanism is the Secretary of State’s power of intervention. It is all about that referral upwards really to the Secretary of State to act. Ideally, these kinds of things can and should be resolved through dialogue, because the Secretary of State can intervene only so much. One of my worries about the focus in certain elements of the Bill on the new and enhanced powers of the Secretary of State is that it sort of assumes that the Secretary of State will need to have fingers in lots of pies to be aware of where these issues are occurring across England, and be prepared to step in where they are happening, which requires the exercise of a significant watching brief across a wide range of areas in a way that does not currently happen.
Ideally, these kinds of things can and should be thrashed out by the people involved at local level. The Secretary of State can intervene but does that intervention persist if relationships have effectively broken down? What do you do then? You cannot run everything from Whitehall; there has to be some kind of mechanism to rebuild relationships and trust. One would hope that it would not get that bad, but I know of past tensions. There are divergent priorities between local authorities, NHS partners and other partners in respect of health and care issues. The logic of ICPs is that you are aligning those priorities better, but that is not guaranteed.
That is one of the reasons we consider that there should be a role sitting with local health scrutiny committees to escalate matters of particular concern to the Secretary of State, so there is not this assumption that the Secretary of State is exercising a continual watching brief over everything that is going on. There is that formal power of escalation from an external body holding the system to account that can, before that escalation, exert some kind of influence at local level to try to knock heads together and bring some form of agreement in place, so that you are not in a situation where you have a persistent assumption that Whitehall will need to step in in every case where these kinds of issues occur.
Justin Madders
Q
Andy Bell: At the moment, it is really impossible to say. I would like to see the Bill achieving parity of esteem for mental health. As I say, the principles of integrated care could certainly enable that to happen, if combined with a lot of other very significant and important activity to shift the culture in the health service, apart from anything else. The lack of specific provisions in the Bill to ensure that parity is taken seriously is a real worry. I think there are still gaps in the Bill that could be very simply addressed and would help to ensure that system leaders, wherever they are—whether they are on integrated care boards or any other three-letter acronym that gets created—realise that their personal responsibility is to bring about parity for mental health.
I think we are at a point now where there is some recognition in most parts of the system that mental health is important, but very often, outside specific mental health services, there is still an assumption that mental health is something other people and other organisations do, and there is not that shared responsibility for it in quite the way that we think would help to move us forward.
Justin Madders
Q
Andy Bell: This is incredibly difficult. We have some very ambitious plans now—the NHS long-term plan ambitions for mental health. There is, quite rightly, an awful lot of money going into that, because we have a very big gap in our ability to meet people’s needs. The only way that is going to succeed is if we have a very significant expansion in the mental health workforce.
We need to remember that that workforce is not just what people think it is. It is obviously nursing and obviously psychiatry, but it is also social work—a lot of really important mental health provision is in local government under social care. We need to think about the importance of advocacy and the importance of peer support, the importance of employment and housing rights workers, who we know make a big difference to people’s lives. There is also the key role of the voluntary sector in providing forms of support that may not come under traditional clinical headings, but none the less make a huge impact in people’s lives. We need to build the workforce.
The Bill gives some steps forward and summary assurances. In some ways, it is not quite the right place to be dealing with this. This is about whether the various parts of the system—the health education system, the NHS itself and its partners in local government—have the resources and the right ways to encourage people to come and work in mental health. It would be great to see the kind of recruitment campaigns we have had for the NHS as a whole to really help bridge that very big gap in the mental health workforce. At the moment, I think the Bill is probably neutral on it. It would be good to see some stronger assurances, at the very least holding the Secretary of State to account for how they are achieving the workforce ambitions set out in the long-term plan and future policies that will have to come.
Edward Argar
Q
Building on what you have already said about the legislation, what would you identify as the opportunities of the legislation, if properly implemented or interpreted in the right way, for furthering that linkage and that joined-up mental health provision? Obviously, that goes beyond local council services and the NHS. There are a whole wraparound series of services that impact on someone’s mental health. What do you see as the opportunities in the legislation that we either need to draw out further or at least not lose sight of?
Andy Bell: This is about building real, sustainable, long-term partnerships. One of the things I know colleagues in the NHS and local government find very frustrating is that they just find a way of working with each other and then the legislation changes again and they have to start all over, so it is about having a system that actually works and stays working, that builds on the best of what is there already. I think there is some frustration in places where they spent a long time building relationships between clinical commissioning groups and local authority colleagues, sometimes with jointly employed staff, and now they have to start all over again because we are moving to a different thing. That will be immensely frustrating for many folk.
If we take the principle that this is about integrating care and equal partnerships between different players, including the voluntary and community sector, and if we give that time to work, we will enable partnerships to form with a clear voice for people—for example, in the case of mental health, for people living with mental health difficulties—so that decisions are being made with and in partnership with the people who use them rather than remotely by professional experts on their own.
Collaboration is incredibly important too. One thing we really welcome about the Bill is that it is moving us away from a system of competing providers to providers working collaboratively—literally, in providing collaboratives. There is a slight risk that all the power will be vested in one organisation and there will not be that check and balance between commissioner and provider. But some of the early provider collaboratives working in children’s mental health services that we have looked at have made really huge strides really quickly to reduce, for example, the number of children forced to go to hospital outside their local area in a mental health crisis. They have come together, looked at what support is needed for children in a crisis and put community services, in particular, in place to achieve that.
One further thing that will be important is that there is some positive provision in the Bill to ensure that ICBs—I think it is ICBs, yes, it is—have to take into account inequalities in access and outcomes. That is great, but there is not that requirement to pay attention to inequalities in health and to go out and identify which groups of people are experiencing health inequalities and what the system can do to deal with that upstream rather than waiting for people to need formal healthcare. That would be the other part that would really help in the Bill—to build on some of the positive noises and moves in the right direction in collaborating at the level of prevention and on the things that determine our health as well as in the provision of services when things have reached a point where people need care.
Edward Argar
Q
Ed Hammond: Broadly speaking, yes, that is fair. My central point would be that those structures and the opportunity that local government has through this Bill for more direct and active involvement in health and care decision making are good, but there still needs to be that separate independent source of accountability that we feel sits properly at a local level with democratically elected local councillors who have powers through health scrutiny committees to talk to local people about their needs. That needs to be there and needs to be strengthened. In respect of the Secretary of State powers I was talking about, my worry would be that we would see ICBs and ICPs looking over their shoulder at what the Secretary of State might want to do rather than looking down to local communities to understand where local need lies, with decision making being led somewhat by what people think national priorities should be.
Part of the solution to that problem is the things we have proposed around, for example, requiring the Secretary of State to consult with local scrutiny committees before exercising those powers, having the powers for local scrutiny committees formally to escalate things to the Secretary of State to act on, and what we have suggested for more effective joint scrutiny by multiple councils of the ICB at system level as well. Those are all part of that strength and accountability framework. It is about saying, “Okay, we have involved local government in decision making through the ICPs and through continuing the health and wellbeing process, but in doing so we also have to enhance and build on our existing health scrutiny arrangements.” As things stand, the Bill removes elements of those by removing the power of referral. It is about having a balance of accountability arrangements and ensuring that that strong external accountability continues.
The Chair
We had better leave it there. We are out of time. I thank you, Andy and Ed, for your evidence today.
Examination of Witness
Sir Robert Francis QC gave evidence.
The Chair
Welcome, Sir Robert. Could I ask you to introduce yourself for the record, please?
Sir Robert Francis: I am Sir Robert Francis. I am chair of Healthwatch England.
The Chair
Thank you very much. We have until 4.30 pm for this session. I call Mary Robinson.
Mary Robinson
Q
Sir Robert Francis: That rather depends on what arrangements are made in the new system. I have seen no guidance issued yet as to how this should work, and I am not surprised at that, because until you know precisely what the structures are and what the accountability and information flows are, it is quite difficult to do that. But I would agree that it is vital in the ICB and the ICP world that sufficient provisions are made for people who have concerns—whether they be staff, patients or the public—to make those concerns known safely to those responsible for doing something about them. In terms of this new world, that means that the ICB and, I suspect, the ICP need to have people who are directly responsible for that. Unless that happens, whistleblowers are going to find themselves in an even more parlous and uncertain place than they are at the moment.
Mary Robinson
Q
Sir Robert Francis: Unless there is certainty on guidance, policies and guardians, of which I am a great supporter, people do not know where to go. Clearly, where things are going right in terms of an open culture, there are many people whom others will go to as a matter of ordinary business. But if we are talking about places where, unfortunately, that is not the case—I think they do exist—people do not know who to go to for help. They need to know that they have protection to go to places to provide information of concern, and they need to know that they are going to get support. If there is no guidance and no clear framework, none of that will happen, and secrets will remain at provider level, when they should be sent elsewhere. Existing mechanisms, such as going to the CQC and your local Freedom to Speak Up guardian in your trust, will still exist—I see no reason why those should not—but I suspect there will be areas and subjects where that will not necessarily be the answer to the question the individual wishes to pose.
Jo Gideon
Q
Sir Robert Francis: Healthwatch England welcomes the requirement for Healthwatch and representatives of the public to be “involved”—that is the word—in the strategy, but we would like to see that enhanced, as I am sure many people would, and we just heard that expressed very articulately. In order for these new reforms to work, it is absolutely essential that the public whom the system serves are able to engage with it and participate in the design of the services that they are going to receive. In order to do that, in our view, they need a visible presence on the ICB board and the ICB partnership. Although that can of course be done by local discretion and local arrangement, we think it would be a powerful boost to the importance given to the people’s voice if there was a representative on the ICB—not as a voting member but, in NHS England’s parlance, as a “participant”. It would be a requirement that one of the participants be such a representative, and you will not be surprised to know that we would advocate that person being a representative of Healthwatch.
That can be done through a coalition of local healthwatches—in many places there will be more than one—so that they have a presence on the board and are able to raise things. It is not just a question of the ICS deciding what to ask people about; they need to have a flow of intelligence coming in about what people are actually concerned about, and those two things are often different. It should be someone who is able to question what is happening in a constructive way.
Of course, part of that is done by local government representatives, and this is not a substitute for local democracy, but we consider that Healthwatch has a local and national ability to reach out to groups who do not often get considered, for instance, and that is particularly relevant if you are seeking to tackle health inequalities. Through the relationships that a good local healthwatch has with groups who feel—rightly or wrongly—that they have often been ignored, the questions that they pose can be put and the answers given back to them. That is a two-way process; you need someone who is independent from the system but in the room, and they also need to be able to transmit into the room information from patient services and the public, and transmit information back. They are part of the mechanism for explaining to the world at large this extremely complicated new concept—namely, a system of which the public has no understanding at all at the moment. A lot of professionals do not either.
Edward Timpson
Q
Sir Robert Francis: Clearly, patient choice and view include information about people’s experience of the service they have had, where they think the gaps are, and their needs. The less you have a competitive exercise with different organisations coming in and saying, “We can provide this better than X or Y,” the more you need to know what people think about what you are proposing, or indeed the more you need to know to inspire creative thought about how you meet the needs that people are telling you they have.
Our view is that while we actually welcome the removal of the requirement for tendering and all the bureaucracy that, quite often in our healthwatches’ experience, interferes with and delays getting solutions to things, that should not mean that we do not have a concentrated effort to involve patient services and the public in the design of what they are being provided with. In effect, that would include how you commission the service that they are going to be provided with. You then need a constant flow of information and dialogue about whether that is working. Frankly, I do not see a great deal of clarity in the Bill about how performance will be monitored after having commissioned services and worked out your strategy and so on.
Edward Timpson
Q
Sir Robert Francis: Definitely, and it would be quite wrong to think that children and young people cannot be fully involved and consulted in the design of the services that are required for their benefit. Many local healthwatches have been very good at doing just that.
Dr James Davies
Q
Sir Robert Francis: I do not think it prevents it, but the extent to which it allows for it will depend, as I understand it, on the strategic decisions being made locally within the system. The answer is that I am not quite sure.
Karin Smyth
Q
Sir Robert Francis: First, there is no ideal person to do the job. I think that past iterations of what is now Healthwatch may have been slightly too full of people who were more interested in constitutional matters than the actual provision of health services. That was the impression I formed during the Stafford inquiry, but I think that is not true of Healthwatch. The presence of a Healthwatch person—by the way, this requires a new level of Healthwatch collaboration and function, but that is not difficult to provide in the Bill—will not produce, in itself, the culture that you talk of. The health service is still an organisation that, in the jargon, is top-down and is delivering things to people, rather than getting their ideas and responding to them. But the presence of the Healthwatch person, or some independent person, is at least a symbol of the need to have such a culture and to develop it. It will be someone whose principal task may be to question whether that culture is being led and developed.
If you have that person, you can back it up if you need to—in regulatory terms—with whatever form of systemic review the Care Quality Commission is tasked with doing. Its reports could certainly be a very valuable tool in relation to this, but you need a channel of communication between the ICB, if that is to be the centre of all this, and the wider world within its constituency. Unless there is someone whose independent role is to oversee whether that is happening, I am not sure it will. All organisations currently in the NHS have directors of engagement and communication. I suspect that, with the best will in the world, most of them see it as their job to defend the organisation. This is not about defending an organisation; it is about welcoming constructive comment from the public and responding to the needs that people communicate to them.
Dr Whitford
Q
Sir Robert Francis: What I am about to say in answer to your question is my personal view. Healthwatch England, for reasons you will understand, does not have a view on that—apart from welcoming the existence of this body and the fact it has a statutory function. I confess to some concern about the safe place provisions, and I said this in part to a parliamentary Committee before. On the one hand, I fully endorse the need to protect people who come forward to give information—sometimes potentially damaging to themselves—so we can learn the relevant lessons of safety. Therefore, I absolutely support the idea that anything said in these circumstances cannot of itself be used to prosecute or discipline them, or indeed be used in civil proceedings.
On that point, as a lawyer, I would be very hesitant on the advice I would give to someone on the basis of the Bill as it stands, because there is no certainty that what goes into the safe space stays there. It is all a matter of discretion, albeit a High Court judge’s discretion or sometimes a coroner’s discretion. That would have to be worked out. It is probably difficult to reinforce more, but if it could be it should be.
However, I think that is different from denying bereaved families and victims of an incident, if they are still alive, knowledge of what has been said to the investigation board. At the very minimum, I would like to see there be discretion to share that information with families. I can see there may be circumstances in which that is not possible, and I can see that it might be necessary for there to be quite stringent conditions around what they personally can do with the information they are given. What worries me about the position at the moment is that it starts from a presumption of dividing the staff from the patient from the families, and you get straight into, I presume, an adversarial situation. That is not necessary the case, and if we work the system and the learning culture properly, everyone will be trying to contribute to learning rather than blaming each other. You are not going to get that if you are denying one half of the incident the information that the other half has.
Dr Whitford
Q
Sir Robert Francis: Yes, or something closer to it. After all, it is rather artificial. The family will often know the people involved in the treatment of their loved one. Where there is already likely to have been a breakdown of trust and confidence, this would be perpetuated and possibly increased if they are not given access to information that it is possible to share responsibly with them. I can see circumstances in which that would not be the case—that is why it would have to be discretionary—but I think many concerns of people I know who would have possibly been settled if only they had seen something more than they get in the report.
Dr Whitford
Q
Sir Robert Francis: Often, if I may say so, things that patients and their relatives have seen for themselves. If I were a relative of someone who died in hospital and I was being told, “This is due to a systematic fault. It was not down to the nurse or the doctor,” I would want to know a bit more about that. I would want, if I could, to talk to those individuals so that they could perhaps learn a little more from the impact of all this on people. I am not saying that it should happen in all circumstances, but in order for the family to have a true understanding of it. It does not necessarily mean they need to know the names in that sort of case that you mentioned, but I do not think it should be automatically assumed that they will be excluded from that information.
Alex Norris
Q
We have spoken quite a bit in these proceedings about the relationship between the integrated care board and the integrated care partnership, the fact that the board has to pay “due regard” to the integrated partnership’s plan, and what that due regard means. You talked about that in your written evidence, and you suggested mechanisms for resolving the situation—or at least making account for a situation where the board sets aside the ICP’s plan. Could you talk a little more about that?
Sir Robert Francis: The first requirement is that there needs to be clarity about what happens in those circumstances, which I am not sure we see in the current legislation or in the guidance that NHS England has produced, which I briefly read. Our suggestion is that there should be a provision inserted into the Bill that, if there is a disagreement, and the board decides to do something that is contrary to the views put forward by the partnership, it should then be obliged to set out their reasons for that. In other words, there should be transparency, which enables accountability, if it is necessary, to be more easily handled.
That would be the major thing we would require, but there also needs to be a better understanding, as far as the public is concerned, about the relationship between the two. I have heard what has been said today, and I must say that I am not clear that the partnership is a sub-committee of the board. That is because the Bill explicitly says that the creation of the partnership is a joint matter between the board—I think, or the NHS—and the local authority. It strikes me that that is not clear.
That is important because, if there is a disagreement, local people are entitled to know why. It would be good if they could also be persuaded that whatever is happening is actually the right thing for them, but they are certainly entitled to be part of the discussion. For that to happen, there need to be reasons given. Another thing that might send a shiver through some spines is that if there is an obligation to give reasons, it might be easier for those who object to the course being taken to challenge it.
Alex Norris
Q
Sir Robert Francis: Yes.
Alex Norris
Q
We will move on to something else that you said in your written evidence. On Tuesday, we had a very good conversation about data, but the whole thing was about quantitative data. In your written evidence, you talk about qualitative data, and it is very easy for us, as Members of Parliament, to conceive of the importance of that, as it is something that we routinely draw on. With your insight from leading Healthwatch, how can we develop systems that properly trap that, use that and prioritise that just as much as the quantitative data?
Sir Robert Francis: Technically, these days, that is no problem at all. You will not expect me to explain that to you, but the qualitative data—comments from the friends and family test, or similar things—is easily mined these days. You can develop a view of the sentiment that comes through it, and you can then dig down more closely into specifics if you need to. That information is extremely valuable to Healthwatch in determining what people think about a particular subject or services, and we feel that there should be a recognition that that data, in that form, should be capable of being shared with a statutory body like Healthwatch, and possibly others.
We also think that—I am sure others might agree—while quantitative data is extremely important, it is informed by qualitative data. The personal impact—good or bad—of things that happen in the service are best described by the people who have received that service. If you just look at figures—I am afraid that this was a problem at Mid Staffs—you lose a great deal, and the trigger for change and improvement is lost.
Edward Argar
Q
We sought with this Bill to be permissive rather than prescriptive; behaviours, and how things work on the ground, are often as, if not more, important than the framework. Notwithstanding your on-the-record comments about Healthwatch participation in ICB levels as a formal member, what else would you draw out as opportunities within the framework to build on patient participation and accountability to those who pay for, and use, the service? Are there other opportunities, that, with a small tweak either in guidance or in the Bill, we could seize more effectively?
Sir Robert Francis: I suspect that there is something around reporting, particularly with the oversight of quality, inequalities and matters of that nature, which would be of assistance. I agree that flexibility of engagement is really important, and Healthwatch claims no monopoly over this. I see it taking place in guidance. If the emphasis is to change culture to one where the service is being responsive to people’s needs, as opposed to providing them with what the service thinks they need, there could be greater emphasis in the Bill on ensuring there is a strategic plan for engagement. There could be more emphasis on how the ICS is going to engage with local people and communities, and an actual requirement that it provides comprehensible information to the community about how people should be able to communicate with it. I know they sound like matters of detail, but if there is an obligation to make such things clear, it does not prevent flexibility, but it does oblige organisations to actually do it—and mean it. There will be lots of other ideas, I am sure.
Edward Argar
Q
Sir Robert Francis: In relation to a decision of whether information should be capable of being used in legal proceedings, there is no better qualified person than a High Court judge—so, absolutely. My advocating that there should be some qualification in relation to the family does not mean, in any way, that I suggest they should then be able to use that for litigation or other purposes. Indeed, some of the conditions you might impose on them in order for them to get the information are that they do not do those sort of things. There will be areas where it can be said that it is too sensitive for that. Of course, there may need to be a balancing of people’s rights of privacy. It is really about ensuring that families feel that they are not being excluded or that something is being hidden from them. We need to build trust. I do not think that that decision needs to be taken by a High Court judge, because it is not about legal proceedings; it is about something really quite private.
The Chair
Thank you, Sir Robert.
Examination of Witnesses
Stephen Chandler and Gerry Nosowska gave evidence.
The Chair
Q
Stephen Chandler: Good afternoon, everyone. I am Stephen Chandler. As you said, I am currently the president of the Association of Directors of Adult Social Services. ADASS is a small charity that represents directors such as myself. My day job is director of adult services in Oxfordshire—up and down the country. It is probably important to say by way of context that I have only worked in the public sector. I left school and started my training as a nurse. The first 20 years of my career were in the NHS. I reached trust board level via a route of joint commissioning. The second half of my career is in local government, so in a way I am living proof of integration, if there was one.
Gerry Nosowska: I am Gerry Nosowska, and I am the chair of the British Association of Social Workers, which is the professional body for social work in the United Kingdom. We have around 22,000 members. I am here to represent the voice of social work, and our experts by experience who have worked with us.
Edward Timpson
Q
Stephen Chandler: It is a really good question. We see the importance of bringing that collective data together in one place at every level in the stratified system. If you take the integrated care system, at the macro level it is really important for population-based planning. My local integrated care system covers Buckinghamshire, Oxfordshire and Berkshire—colloquially, BOB—and for some conditions dealing with it at that footprint is really important. Having data, for example, around cancer care and some of the specialist mental health services is really important.
The first thing that I did this morning was to chair a call looking at urgent care activity in our local system, and it was really important for the staff from the community trust and social care, as well as the acute staff, to be looking at a single view of the citizen—the patient—in that instance. We have done a lot of work to get there already. Again, this is about building on some good foundations, but it is critical for practitioners to do their job to have that data there, flowing readily, as well as for us in the planning and commissioning sense.
Edward Timpson
Q
Gerry Nosowska: Yes, please. The link between health and social care data is obviously essential, because health care impacts on people’s lives and social lives, and social determinants impact on health. Joining those things up will help us to have a much more holistic picture, which is what social workers are interested in. For social workers, what we really want to understand are the trends, the gaps, and the barriers to wellbeing. In practice, having that data and that understanding—ideally a really local understanding—is important.
We would want to see social workers and experts by experience input into the kind of data that is collected, with an understanding in particular of under-met or unmet need, so that we can become more preventative, which is another aim of integration, and we have information about people who might fall outside of statutory responsibilities—self-funders, for example. We know that there is a real need to understand much more about the pressures on carers. This is an opportunity to think about how we can build more fairness locally through understanding the inconsistencies in people’s experiences and outcomes. We also have a need to understand the impact of digital developments on people—how to ensure equity as we move into a wider range of working. Another hope would be that, ultimately, our health and social care leaders will be able to be more proactive using the data, because very often it feels like we are on the back foot.
Karin Smyth
Q
Every project that I have seen or witnessed on integration—joint commissioning; joint collaboration—has fallen apart in the end because of accountability for the money. A finance director in a local authority has to account for its budgets, and the finance director and accountable officer of a health authority ultimately has to account for their budgets. If agreement cannot be held at that point, those projects fall apart.
We heard earlier that we still do not know any detail on the tariff or money flows as a result of changes in the Bill—changes that will come into place in April. We also have the better care fund outwith the Bill, and this week’s announcement of a major change in funding is also outwith it. I wonder, with your ADASS hat on, how can you now help the Government to get around the problem for organisations regarding accountability for the money so that they do not fail?
Stephen Chandler: Again, that is a really good question. To be honest, a real challenge for those of us working in both health and social care is that uncertainty and delay in knowing the financial envelope we are working with. The announcements this week help to provide some clarity of what the future funding arrangement is likely to look like but, of course—from a local government point of view—until the spending review confirms the final settlement later this year, we will not know.
Some practical examples of how to mitigate or manage some of that uncertainty clearly come down to how much you are able to put together—and feel confident to put together. I suspect it was probably there in your day in Oxfordshire, but Oxfordshire has a large pooled budget arrangement—some of it completely risk-shared, but some of it not. That reflects the confidence and experience we have in using that money together. If I were not here providing testimony to you, I would be chairing a joint commissioning executive. In Oxfordshire, across health and social care, we have responsibility for more than £500 million in health and social care expenditure.
We are talking about continuing to build on some really good relationships and experiences that have existed but, rather than allowing them to evolve because individuals—either at a system level or a personal level—believe it is the right thing, it becomes policy and direction. I think that the success for us has to be looking at where systems have been able to resolve some of those challenges. I am still working with my CCG colleagues in Oxfordshire around what we believe the better care fund will look like, having signed the agreement at the beginning of the year. That is about us becoming much more involved and therefore much more confident in each other.
You will appreciate that ADASS members are constantly providing reassurance and at times caution to our elected members on how far we could and should go in relation to sharing and using our resources. Some of the developments in the Bill around the establishment of integrated care partnerships fully provide a vehicle for some of that greater transparency and greater opportunity to look at the problem, the challenge and the opportunity from a place, and then from a system, point of view.
Karin Smyth
Q
Stephen Chandler: Yes, indeed. Without giving away too much personal information, my wife and I have a joint account. We each have our own accounts. She is not here, so I will say that I think I have the authority on the joint account, but if she was here she would probably say that she has.
The point I am trying to make is that a lot of this works on the formal agreement, but as much of it also works on the trust and confidence you build in those relationships. However, you cannot take away the facts, as you said. Equally, my elected members are very clear with me that I am responsible for ensuring that Oxfordshire County Council’s resources are being managed and used in the way that they have approved.
Dr James Davies
Q
Stephen Chandler: The principles that underpin successful discharge are, quite simply, a person-centred, strength-based approach to enabling that individual to get back, preferably and ideally, to their own home, in a timely manner, with the level of support that they need to continue the recovery that will have started in the hospital but will not have finished in the hospital.
Where we have got that process right—I think the discharge to assess arrangements have really helped us in this—is by clarifying that the destination for discharge, for the majority of patients, has to be home. It is pathway 1—“Home First”, as it is often described—with the appropriate reablement support to maximise the recovery. That is good for the patient; it is good for us in local government, because it reduces the level of ongoing care needs in many cases; and it is good for the NHS, in that it frees up acute hospital beds. Those are the principles.
The way you successfully do that is by ensuring that the focus is on the patient and getting the patient—the citizen—to their home, not on the organisational form and who is responsible for it; in fairness, we all are. Discharge to assess has helped us to clarify “Home First” or pathway 1, and it has provided for some of those systems where one of the stumbling blocks was the resources to make that happen.
The challenge we have, though, is that we have introduced “Home First” at a system level nationally at a time when demand, linked to covid and the unintended consequences of covid, has really impacted. I reference my first meeting this morning, looking at acute pressures in Oxfordshire. We pride ourselves on getting people home, and “Home First”, but when I was chairing that call I heard myself saying, “We need to move people into some interim beds”, because I needed to create capacity in the acute system. I am hearing that coming through from director colleagues up and down the country; we are making less than ideal decisions for people because of just how much demand there is in the system. Let us be very clear: good discharge is discharge home, to your bed, with the support to enable you to maximise your recovery.
Dr Davies
Q
Gerry Nosowska: Yes, please. I completely agree with Stephen on the principles behind discharge to assess, and we have good experience within social work of it working when there is clear shared responsibility and the person is kept at the centre of it. We also have evidence from our members of the potential for rapid discharge to assess, without real advocacy and potentially without the involvement of social work, to lead to some undermining of people’s rights around potentially being placed in a more restrictive environment and potentially struggling to have access to their family. It is partly about resourcing, but it is also about the ethos of human rights and people’s right to be heard and to have choice, and then having the practical backing to follow things up well.
I think that people with experience of social care and health want to have a really clear and transparent process. For that to happen well, we still need some safeguards around that transition. It is a complex moment in people’s lives, and I would want to see social work involvement in the guidance around that. But we also need to be thinking, if we want people to have more of their care closer to home, about how we rebalance resources—this relates to the previous question—by making sure that there are incentives for the resource to be put into community and local support and not just into the most urgent matters.
Stephen Chandler: Could I come back in? One thing that I omitted—it was remiss of me—was that we also need to never forget the importance of the support for carers, particularly around hospital discharge. All too often we are focusing on the individual in the hospital bed and the need to get them out, but we also need to ensure that we are not overlooking or not giving due regard to the role of the carer in that. If I could ask you to do anything, it would be this. Can you just ensure that the emphasis on the role of carers and how all of this is going to help the role of carers is brought through? Without carers, the health and care system would disintegrate rapidly.
Chris Skidmore
Q
Stephen Chandler: You are right: discharge to assess and, indeed, the “Home First” model of three pathways is not new. It has been around and used up and down the country for a decade or so now, so there are some well established services that you can draw some really good data from. Before I was in Oxfordshire, I was in Somerset, and we did a lot of work in the Somerset system to develop “Home First”, because our delays were really poor. We saw significant improvement in the outcomes for patients in the first instance. We then saw significant improvements in the flow from the acute hospitals, and I would say we also saw some significant benefits to the local authority in relation to the commitment it had to individuals on an ongoing basis.
I have been out of that system for over two years, but the work that it has done since then to take that even further is phenomenal, and I would encourage you to talk to some of the health and social care professionals in that system. One of the hallmarks of the system is that it does not rely solely on health and social care professionals. It has brought what it refers to as community agents and village agents into the hospital to help with discharge. It has got the voluntary sector as an equal partner. It is helping the individuals beyond the health and care needs that they have in leaving hospital.
I personally believe that discharge to assess is a robust and positive model, and I am hearing nothing to the contrary from director colleagues. What I am hearing from director colleagues, though, is real anxiety about conclusions that might be being drawn from the very point you made, which is that we have tried to evaluate discharge to assess in a very short period of time, and at a time when demand and pressure on the service has been at its most acute. Remember that it is not just the physical demand on those services that we have been experiencing; we have been working on an assumption that there is likely, at any point, to be an immediate surge in the demand for acute services, so we have been working to try to ensure that there is always capacity behind us should a further wave—either a local or a national wave—occur. We have been, up and down the country, operating systems at a pace that I have never seen before, as a result of covid. I would be cautious about drawing out any strong opinions around discharge to assess from an evaluation that was done during that covid period. For me, it is the only model that really helps people leave hospital in a timely manner.
I do not know about any of you, but as I get older and hospital admission becomes more likely, I want that hospital admission to deal with the acute need that requires it, but I want to go back home as quickly as I possibly can and to be able to continue to regain the independence I had. I do not want to become reliant on the local authority for all my support, which is why that reablement support at discharge is so critical.
Gerry probably wants to add to this, but the multidisciplinary approach that has a social worker and the local authority at its heart, building upon not just the professional expertise we bring but the relationships with our communities, our voluntary sector and our social care providers, is critical to that success.
The Chair
Do you want to add anything, Ms Nosowska?
Gerry Nosowska: Yes, please. The issue with getting out of hospital is not about getting out of hospital; it is about getting your life back and getting back to your normal life. We know that reablement can be a really important part of that. The persistence, co-ordination and attention to the impact of a transition from hospital to home is something that social workers can really help with, and I do not think we should underestimate how potentially complex that can be. It is not just a question of somebody going back home and picking up where they left off.
Having really good support rapidly following up is absolutely essential. We have concerns about evidence of either inappropriate support or lack of support, support that has not been there or follow-up that has not happened. I would want us to be careful about checks and balances here.
Dr Whitford
Q
Gerry Nosowska: I think that this can achieve some strengthening of integration if it is not just a reorganisation that sucks in energy and resource, but a change that is absolutely about relationship, trust and understanding of local services, and it leads to a flow of resources and attention to that idea of home and community. There is potential, absolutely, but we have seen efforts to build integration before. What makes them work, certainly from a frontline point of view, is parity of esteem, trust, understanding and recognition of expertise, and relational time together.
One question I have is about how the integrated care partnership and the board have the appropriate input, the right people in there and the right people engaged, so that those relationships can really build, bearing in mind that we might be talking about quite a large area. We also have to make sure that from the point of view of the person who needs help or care, it is about their local community and neighbourhood. If I were going to change something, I would want to make sure that there was lived experience and social work expertise at the heart of those integrated structures.
Dr Whitford
Q
May I ask you the same questions, Stephen? Do you think it will improve integration? What is the one thing you would change?
Stephen Chandler: I do believe that it will improve integration. As I said earlier, anything that helps those people who have yet to be convinced that integration is a good thing or provides them with some of the roadmaps for putting integration into place is great. From a local government point of view, strengthening the role that local government has in relation to the health and wellbeing of its citizens in the way that this does is good. I look forward to the refined guidance around the roles that health and wellbeing boards will have, because when I talk to my leader, I emphasise to her the importance that that gives her, as an elected member who chairs that board.
On whether I would change anything, we risk focusing a lot on either people who are acutely unwell or the elderly. From a local government and social care point of view, we work with people across their life course, including working-age adults, many of whom often have very complex underlying health and care needs. Recognising the need to ensure that health and care systems work well for a 25-year-old with learning disabilities who is trying to achieve his potential, or to help somebody with a severe and enduring mental illness to maintain their employment and therefore their accommodation, is really important.
Unfortunately, those voices are not always as obvious in what we are doing, but they are so important. I have been quoting this a lot of late, but each and every one of us is just one accident or life-changing illness away from needing that. We all recognise that we may need healthcare to deal with it, but very few of us think that we may then need and want the support of social care. In my case, if I had an accident or a significant stroke on the way home, I would need help maintaining my family. All the things we take for granted are only possible for a lot of people through the help that local government and social care provide, but doing that together with our health colleagues offers even greater opportunities.
Dr Whitford
Q
Stephen Chandler: It absolutely is. If you think of a young person with a complex health need associated with a learning disability, we need to work together to ensure that we are allowing them to maximise their potential while managing the risk associated with their health needs. For somebody who is coming out of the criminal justice system, maximising their potential to reintegrate into society, get a job and get a house is only possible if we work together. That is why integration must be much more than just a focus on the frail elderly.
Dr Whitford
Q
Stephen Chandler: I will come back to you on that. I cannot immediately think of a part.
Justin Madders
Q
Gerry Nosowska: It is a genuine concern, yes—partly because, as Stephen was saying, it was rolled out very rapidly, at scale, during an unusual and very pressured time. Social workers have often been involved in those transitions, and very well, to advocate and to ensure that the person’s voice is heard and that people do not get lost somewhere in the system or forgotten, but the concerns are around the potential weakening of that social work role.
Not everybody will need that, but I advocate for a social worker being available to anybody who might need that kind of co-ordination, therapeutic support and advocacy at the point of such a major life transition. We want a review of the model, but we also have concerns about just taking out wholesale all the elements around notification of social care and everything that was in the care Act. A lot will hinge on what the statutory guidance says about this. We must make sure we do not lose people in the system, because there is always an incentive to free up a valuable resource in hospital, but our statutory job is to promote wellbeing.
Justin Madders
Q
Gerry Nosowska: My understanding was that the discharge to assess was due to be reviewed, but I do not know why there has been a delay on that.
Justin Madders
Q
Gerry Nosowska: I am not aware of a large-scale, formal review of it, no.
Justin Madders
Thank you. That is all I have, Chair.
Stephen Chandler: If I could help, I am aware that the Department of Health and Social Care has undertaken a review of some discharge to assess arrangements. It is not a national review, but I think about eight separate systems have been subject to a review. I have not seen the outcome of it, but a review of a limited capacity has taken place.
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
No, my question was covered earlier. I had assumed that I would be called as a Back Bencher, if you see what I mean, as I am not the lead Minister on this Committee.
The Chair
I apologise for that, but I understood that we had decided to share the time between Back Benchers and Front Benchers, and I counted you among the Front Benchers. There we go. Never mind.
Jo Churchill
Q
Stephen Chandler: The Bill reaffirms and formalises the requirement to plan very carefully for the population at a place level first, and then at a system level. In doing so, it sets up an integrated care partnership with a clear set of objectives, based on the population. Of course, it emphasises the importance of prevention as a way of helping people remain healthy and well for longer.
In Oxfordshire, we have set up our shadow partnership, and one of the areas we are looking at is our out-of-hospital support—particularly how we can avoid the need for hospital admissions. Again—this goes back to a point I made earlier—in doing so, we are looking at how we as a system can contribute individually, and therefore collectively, to reducing crisis and therefore the need for hospital admission. It has changed the tone of the discussion from, “Isn’t that an NHS responsibility, whether primary care or secondary care?” to, “How can we do better for our population?”.
You might say, “Well, hold on. That sounds like a very subtle change.” Let me be clear: some of these subtle changes really do make an impact. Coming back to an earlier question about resources, this also enables us to have the conversation around the prioritisation and impact of those resources. Instead of saying, “Here is the county council’s budget plan and here is the NHS’s”, we can ask how we make best use of that collective resource. The Bill helps by formalising that and providing some additional structures and focus on that.
The Bill is helpful, but it will be interesting to see how it works where, perhaps, systems have not had positive relationships or have had a more adversarial approach. I was really lucky in Somerset, because the emerging ICS there was coterminous with the local authority. It was a single provider. It was perfect in a way. I am in an ICS now where there are three different population groups. We know some ICSs have significantly more.
The opportunity is there to be grasped. This provides a fantastic focus if it can be ensured. In fairness to colleagues, the focus seems to be “start at place and work upwards”, rather than “start at system and work downwards”, in order to make really good differences to people, particularly around hospital admission avoidance. It also gives me, from a local authority point of view, greater leverage to challenge my NHS colleagues around their investment in secondary care and community care resources, because that area has, unfortunately, seen significant reductions over the years.
Jo Churchill
Q
Stephen Chandler: Absolutely.
Jo Churchill
Q
Gerry Nosowska: Prevention is always undermined by the resources moving into urgent and acute needs. In practice, social workers are not able to do therapeutic, restorative support work that they would be able to if they had the time to spend with people who need that. There is a fundamental resource issue that the Bill does not address directly, but it may help with the potential for pooling resources. Again, people in the community do not care whether it is a health or social care resource. If there is a need emerging that can be responded to, and preventive work can be done, it should happen without health and social care arguing about exactly whose purse it comes out of.
There are some really successful examples of reablement and preventing avoidable hospital admissions. We know it is possible. Scarcity does breed competition rather than collaboration, so that is something to think about. As for what the Bill might also do, the partnership strategy ought to have a very strong preventive element to it, and that needs to be dug down into locally—into particular communities, neighbourhoods and streets. That is where you really need lived experiences. I have a question about the regard that the integrated care board would have to that, and the potential for a wonderful, collaborative partnership strategy around prevention to be disregarded because of an acute need. I was listening to Robert Francis, and I think his suggestion that there be a written explanation to a local community if that happens is very good.
Edward Argar
Q
I will turn to Stephen first and then to Gerry. We have sought to be permissive rather than prescriptive in this Bill. Have we struck broadly the right balance, or are there areas where it might need to be tweaked, either in legislation or in guidance?
Stephen Chandler: Your director colleague was absolutely right. I think that you have got the balance right in relation to permissiveness. I worry that the guidance does not prescribe directly how we should develop that culture, but having worked as long as I have, I realise that you cannot prescribe how relationships are formed and how cultures work. You have to create the conditions for success. Some of those conditions are in the Bill. I have talked about some of them in relation to the pooling, the boards and the assurance methodology. What has to be absolutely clear—and I am hearing it clearly, so it is not that I have not heard it—is the importance of seeing this as a vehicle for meaningful change to people’s lives, not a restructuring of health and social care. Rather, this is a vehicle for improving the lives of people in communities and systems, and for allowing health and social care professionals to maximise their individual abilities for that collective good. In a way, there is a duty on me as a leader in the system to create that culture and environment.
You have not gone into the area of assurance, but for me it is really important that when assurance looks at a system, it looks at the leadership and how that leadership translates the freedom, the permissiveness, but also the accountability, clearly. The feedback I am hearing from our members is, “We favour the permissive approach that is taken in this.” We would not say that the tolerance should be changed one way or the other.
Edward Argar
Gerry?
Gerry Nosowska: Apologies, I think I lost my connection for a moment, so I might repeat some of the things that Stephen said. On the balance between permissive and rigid, we have an interest in the consistency of opportunity and outcomes for members of the population. Areas face different challenges, so it is important that locally there is flexibility around how those challenges are met. What will hold those models together are the principles of ensuring transparency around decision making; the involvement of lived experience and clinical expertise in both social care and health; and real local accountability. Certainly, more local community decision making, planning and work, and less centralisation, is much more in tune with responding to the lived needs of people and their day-to-day priorities.
Edward Argar
Thank you, Gerry and Stephen. I have no further questions, Mr McCabe.
The Chair
May I thank our witnesses for their evidence? That brings today’s oral evidence sessions to a close. The Committee will meet again on Tuesday in Committee Room 14, with Mr Peter Bone in the Chair.
Ordered, That further consideration be now adjourned. —(Maggie Throup.)
Building Safety Bill (Second sitting)
(3 years, 3 months ago)
Public Bill CommitteesRead Full debate Read Hansard Text
The Chair
Before we start the next four evidence sessions that we will have before 5 o’clock, Theo Clarke wants to update the Committee.
Theo Clarke (Stafford) (Con)
Thank you, Chair. I would like to draw attention to a possible interest: my husband is an estate agent at Hayman-Joyce.
The Chair
Thank you very much. To remind colleagues, if you have any interests, you can talk to the Clerks and they will ensure that they are properly declared.
Examination of Witnesses
Peter Caplehorn and Dr Scott Steedman gave evidence.
The Chair
Q
Peter Caplehorn: Good afternoon, everybody. I am delighted to be part of this session. I am Peter Caplehorn, the chief exec of the Construction Products Association. I have held that role for the past two years. I have been with the CPA for seven years, and prior to that I spent 38 years in practice as a commercial architect, involved in technical matters and regulations, and involved with British standards and a lot of building regulation development. I hope that that is of help.
Dr Steedman: Good afternoon, ladies and gentlemen. I am Scott Steedman, director general of standards at the BSI, which incorporates the director of standards role. In my early career, I was an academic in civil engineering. I then spent around 20 years in industry on major building projects. Since 2012, I have been in the role of director of standards at the BSI, so I am responsible for the national standards body and all British standards.
Ms Marie Rimmer (St Helens South and Whiston) (Lab)
Excuse me, Mrs Miller, but a number of us are having difficulty hearing on this side.
The Chair
Yes—when I chaired a Select Committee, I always used to remind everybody that these microphones are purely ornamental. They do not really amplify very much, so projection is always good at these events. I thank our witnesses for being with us today. Obviously we are hybrid. We have Peter online and Scott here in the room, so bear with me. Perhaps we will take this slightly slower to ensure that we include Peter in our conversation. Please just shout at me, Peter, if I have not quite seen that you want to intervene.
Daisy Cooper (St Albans) (LD)
Q
I noted that in your evidence you urged us to
“resist the consequent serious danger of disproportionate reaction.”
I was very struck by that because it was a very different piece of evidence than we received from almost every other actor in the sector. I would be grateful if you could set out whether you believe that those voluntary forms of regulation are sufficient, and what a disproportionate reaction would look like in relation to your part of the industry.
Peter Caplehorn: What I was trying to do was to set the scene. We fully appreciate and support all the statutory moves that are being made. Equally, I wanted to emphasise that industry and a lot of organisations across construction have also been working in the same direction. Perhaps I did not express the point clearly. It was not a case of saying that the other non-statutory initiatives are more important; it is simply the fact that this body of work is going on. I think that that is really important because the objective is to reform, enhance and have culture change across the whole industry. That is brought about by having good statutory powers, and by having the attention of industry and making it move of its own accord.
On the point about overreaction, I wanted to keep my evidence fairly succinct, to be honest, but I was referring to the issues in the industry with insurance. All of us will be concerned about the various reports in the media about insurance issues, and the impact of those. This has to do with the analysis of buildings. Some are clearly in need of remediation, but a lot have been given that label because the industry has overreacted to things that have been going on with regard to safety.
We need regulation; it is crucial. Way back when we started, there was a strong deregulatory movement, and that was unfortunate; it led us to this position. We need good, proportionate regulation, but there should be an equal measure of activity and seriousness from the industry to ensure that its morals, obligations and ethics are in tune with what we all want. I hope that sets the scene for you.
Dr Steedman: I support Peter warmly. It is all about standards, including the regulations. We are looking to achieve a generational change in the culture of an industry, and that will be quite a long process. I applaud the work of the Department and the Ministers here, and their engagement that has brought the Bill to this stage, but we are designing a new structure of powers, which will include standards set out in regulation, standards set out in statutory guidance, supporting regulations, standards that will come from industry, and codes of practice used at an operational level. All of those need to be integrated so that they work together as a full ecosystem.
However, in the end, as Peter says—I totally support his point—you need the industry to want to do this. It needs to want to improve. You cannot police it on every nut and bolt; we know of countries where that happens, and it just does not work. If you want to achieve industry transformation, you need the industry to aspire to become better. We have seen that in important areas, including health and safety, where a change in approach has led to significant improvement in the health and safety of operatives on construction sites. This is an even greater task, in a sense. It is all about creating a system of standards, including higher-level regulatory powers and voluntary standards, that lead to the outcome that we want as a country.
Daisy Cooper
Q
Dr Steedman: My immediate reaction is that I think the Bill is proportionate, but there is a lot more work to do, and we look forward to working with the Department and industry on the supporting regulations and statutory guidance. They really ought to come along together—that would be very useful—but in so far as we are seeing the approach today, it is proportionate, and I welcome that. I do not think that it goes too far.
Peter Caplehorn: I absolutely support Scott in his analysis, which is exactly right. I add that it is important that industry sees that the Government are moving the agenda forward. I can point to several programmes in the past—nothing to do with building safety, of course—where the Government have announced a programme, industry has invested heavily, and then the programme has faltered. I think that is a shame. Many people with a memory of those circumstances will now see the Bill laid out in the way that it is, with all the elements to it.
Again, I reiterate that I do not think it is disproportionate; I think it sets the scene extremely well, and we can all see how we can work from it going forward. In fact, many people have already taken that up, but it is important that this is now a key moment, so that all the energy and effort from industry really get pushed forward. That is crucial.
Mike Amesbury (Weaver Vale) (Lab)
Q
Dr Steedman: There are some points that I think are missing. The regulator role is complex. I think we need a new regulator. In the work that we have done recently on competence standards, it is very clear that there needs to be a regulator. I think that the Health and Safety Executive is the right place to put the Building Safety Regulator. However, this goes beyond a regulator role; it turns into an enforcer role. Part of the complexity of this subject is the risk of creating a two-tier structure where you have structures that are in scope and structures that are out of scope, and a regulator that is regulator and enforcer for some buildings but just an ordinary regulator for other buildings.
I appreciate that building control is supporting this, but on the relationship between the Department and the regulator, in its role as regulator and enforcer for the buildings in scope and ordinary regulator for the buildings not in scope, and where determination will lie if someone is disputing the regulator’s role as an enforcer, that kind of complexity will not help the industry. It needs to happen and we need to work it out, which will take time, but the role as specified is extremely important and well defined, and I think it is being taken up very earnestly. The people involved are extremely excellent. Peter Baker is a well-respected individual, and I think we are in good hands with him.
Peter Caplehorn: Again, I support entirely what Scott has just said. To contextualise this a little, one of the issues that has been upon us for at least the last 20 years is the lack of oversight and sanction that Dame Judith Hackitt pointed out clearly in her review, to such an extent that I think the generality of customer practice across the industry was that regulation can be treated with a certain degree of lip service—that we do not really need to focus on the essence of a lot of regulation, simply because nobody will pick up on it and there will be no real sanction.
This is a key turning point in where we need to go, because the industry needs to recapture a respect for regulation and for compliance. The regulatory situation that is mapped out in the Bill starts to address that, but I share the concerns that Scott has expressed over the complexity. We have to start somewhere. To me, there is a bigger question here about how we reform the whole industry and the mechanisms that come into play. At the moment, that is set out in terms of a definition of higher-risk buildings, with different implications for other buildings. We have to look forward to the prospect of a regime that would be the same in addressing all buildings. That would start to simplify some of the current complexity, but we have to start somewhere.
The Chair
Dr Steedman, do you want to come back in before I bring in the next question?
Dr Steedman: Mike asked other questions about the Bill itself and improvements or missing pieces, so I do not know whether you want me to take that now, Chair.
The Chair
Please do, and then I will bring in others.
Dr Steedman: I have four suggestions of areas for improvement. One is a technical matter, but it is extremely important. It is probably an accident, but the definition of designated standards is inconsistent with other statutory instruments. The definition of designation, which is the process whereby a Secretary of State designates a standard to support industry in demonstrating or claiming compliance, has been created since EU exit to reflect the history of the way we do things in the UK. It used to be called citation. The definition of what a designated standard is and the Secretary of State’s ability to designate a standard from a defined body is incorrectly described in the document today, so I would encourage some work on that.
You will see it in schedule 9, which relates to clause 133, on page 198 of the Bill, and the definition there needs to be improved. It talks, for example, about “EU harmonised standards”, but there is no such thing—it does not exist. It is a harmonised European standard, not an EU standard, because the standards written by industry are not written by EU organisations. As it stands, there is no provision at all in the Bill that would allow the Secretary of State to request or designate a British standard from the BSI—the national standards body.
That is just an error or oversight, because if you look at other instruments, such as those relating to product safety and metrology, the definition is carefully written out. I encourage the officials in MHCLG to refer to the Department for Business, Energy and Industrial Strategy because the text is available. That would be an important clarification and alignment.
We have discussed the point about things being in scope or out of scope. That is something that we will have to work on, because creating a narrative for industry that is consistent and clear will require clarity in that, and we have discussed some of the complexities. However, I am not convinced that you actually can solve it now. We will have to move all these pieces forward together, including industry, so that we can achieve that learning. There are some excellent examples from industry of organisations that are really trying extremely hard, but there is a very long tail as well.
I have also hinted that it is not clear who will do what between the Department and the new Building Safety Regulator. For example, who will oversee secondary legislation, approved documents and changes? Is that the regulator and enforcer, or is it the Department? We need some support perhaps on who the regulator is. The Bill helpfully states that the Building Advisory Committee will report to the regulator, but does the Department need its own independent advisory committee? I am not clear about that.
Those are the four points I want to stress, but the most important one, technically, is the designation definition. We could provide texts, if that would be helpful.
The Chair
Peter, was there anything you wanted to add? I could see you nodding.
Peter Caplehorn: Nodding in agreement, Chair. I would just like to mention two areas. When we start to talk about the new duty holders—principal designer, principal contractor and the building safety manager—there are obviously publicly available specification standards being produced to amplify those roles, and that is important. The origination of the principal designer and principal contractor come from the Construction (Design and Management) Regulations 2015, which have been in place for some time and effectively try to ensure risk is managed during the design and construction process, including maintenance, which is often forgotten.
That is an existing set of criteria and duties. They are now going to be amalgamated with the new duties of the same name. I am slightly concerned that that means that individuals and individual organisations will have two distinct requirements placed upon them. What I would not want to see is an undermining of the health and safety issues in place of individuals and organisations focusing on building safety in the round. I think that that is something that needs some work as we go forward and develop the new regime.
The other area that I would like to mention is the establishment of the new gateway system. Again, that is fairly well defined and fairly easily laid out, but we must be aware that every building project that starts from an initial idea and moves through to completion has an inherent natural chronology. It is so often overlooked that the process will follow a natural sequence of events. A couple of times in the current proposals it is as if one thing will always follow directly after another, but sometimes that does not happen. You will get a scheme with planning consent, and then there might be quite a pause before work continues. You might get other intervals in the process. It will none the less still follow the same sequence, but just not as a smooth operation. Again, we need to ensure that the new proposals reflect how those processes go forward.
Dr Steedman: Peter is absolutely right. That is the reality of the construction sector. Perhaps to the earlier point about disproportionality, trying to prescribe things at this level in rigorous a way is not going to reflect the reality on the ground, and then people start doing their own thing.
To the point about principal designer, principal contractor and building safety manager, we have thought long and hard about that—when I say “we”, I mean with the industry group—and the point was to try to avoid creating new roles and new titles and yet more division among who is actually accountable and responsible for safety through life and in the design and construction. My own recommendation was to stick with principal designer and principal contractor, even though the terms were originally used in the context of health and safety in construction, and in a sense to augment those roles to say that if individuals fulfilling the roles were working on higher-risk buildings, they should have these additional skills and competencies. In a sense, it was not about trying to bang two things together, but saying that someone may be an ordinary principal designer or a principal designer qualified to work on high-risk buildings. Therefore, you have one person and one title, but you may have a different gradation of qualification. That is where it came from, and I do not think Peter is disagreeing with the title.
Peter Caplehorn indicated assent.
Siobhan Baillie (Stroud) (Con)
Q
Peter Caplehorn: The issue there is that we fully recognise that this legislation is needed and fully support it, but there is an ongoing conversation to be had with regard to the definitions. We have looked at how you would define a safe product and, indeed, a safety-critical product, and there is quite a bit of work to be done to balance out the needs of the regulations with the practicalities.
To give the Committee an example, if we were to take a sheet of plasterboard, it can be used in many different applications. If it is just used as a finishing element, I would suggest that it is not anywhere near a safety-critical item in most cases. Whereas when that same sheet of plasterboard is used in a compartment wall that is used to fire separate two areas of a building, then it very much is a safety-critical product, so there is that diversity within the product sector.
Equally, some products are clearly safety critical and should be strictly controlled and monitored. We need an ongoing conversation as the team develops the regulations, to ensure that the guidance and, eventually, the list of safety-critical products are clearly usable in a practical sense, and also so that there is complete clarity as we go forward.
Dr Steedman: It is an excellent question. We have to think of products as forming a system, and sometimes products that are completely safe in one system might be completely unsafe in another. Electrical cabling, for example, might be suitable in one jurisdiction, in one country, but if you mixed it up with electrical systems in the UK you would have a disaster on your hands. So this concept of safe products is very difficult to define, because products really have to be seen in context.
The onus should perhaps be on performance-based criteria, so we look to specify the performance of a product and them to demonstrate that that performance has been achieved, and not just by the class of product but by the actual individual product placed in the structure, ensuring that compliance is rigorous. This concept of shaping performance requirements and then allowing industry to innovate in order to achieve those requirements is very important. If you prescribe every detail—the diameter of everything, the thickness of this and that—rather than making things safe, you actually lead yourself down the path of blocking innovation and stifling progress.
We want to balance all of that out, and the best way of doing that is through performance regulations, with standards managed independently, that are required to be used in safety-critical situations to demonstrate that the products will actually do the job that the designer wants to achieve.
Siobhan Baillie
Q
Peter Caplehorn: I think there is a lot of work to be done in this area. We have been working closely with the MHCLG team as this has developed, but I still think that we probably need to map out a number of practical examples so that when the regulations eventually emerge we have the right practical answers. That might be in the form of guidance, but it certainly needs a little more development before we have a system that I could vouch for to deliver the outcomes needed.
Dr Steedman: There are interesting lessons from other sectors. The medical devices industry, for example, faces those challenges the entire time. Whether it is a sticking plaster or a heart device, there is a whole difference in the level of risk, so the way in which that type of product is regulated and the standard developed is another place to look. I agree with Peter that we need to take our time. The architecture of the Bill is there to do this, but there is a lot of work to do in developing the guidance and secondary legislation.
Ruth Cadbury (Brentford and Isleworth) (Lab)
Q
Peter Caplehorn: Thank you for that question, because it is of concern and it has been historically, as you said. The Bill as set out does start off in the right place. We have the structure to pursue those issues. In parallel, a lot of work is being done on the quality of testing and on verification of product quality. We are starting a new road that will start to address some of that, but equally, I would raise the move towards greater competence across the industry. Clearly, some product combinations will cause trouble and they can be seen by somebody fairly early on in the process who is competent in analysing those criteria. I would put designers and engineers firmly in that spot.
Some more difficult inherent problems that occur over time are in the province of the testing and research and development areas of product manufacturers themselves. They do a lot on research and development on products because, clearly, it is in nobody’s interest for things to emerge later on that will cause problems. None the less, we do see them.
Back to our central subject of the Bill, it does set out the framework, and I believe that with the secondary legislation coming along behind it, it will give us more opportunity to ensure that products are fully tested in combinations, to ensure that we reduce the prospect of any failure like that happening in future. None the less, it is a challenging arena.
Dr Steedman: It is important to remember that we are focusing on safety here, and that means human safety affected by a physical object, and not necessarily quality. The Bill will not necessarily transform the quality of the industry—that is a different thing all together. You are absolutely right that if you look at historical failures of engineered structures, in many cases it is to do with communication between different parties involved in a very complex industry and the long chain that Peter described. The failure to understand the consequences of the assumptions of the person who did that piece of work leads to an issue in years to come that people cannot diagnose. There are some very famous examples of that.
Perhaps one of the additional points worth making is on the digital information. New standards are being developed today on digital management of fire safety information, for example, and new tools—there is a BSI identifier tool to allow a persistent and enduring identifier to be applied to individual products, so that downstream, you could walk around a building in years’ time and identify precisely what that was, and if an issue had arisen you would be able to trace it back.
Dame Judith Hackitt’s recommendation on the “golden thread”, the digital trail of construction products and how they are assembled, and the ownership of the building through life management are a vital part of the culture change that will enable a much easier identification of problems in future. As Peter says, the physics is relatively well understood; if people do the right tests, they will find the problem, but sometimes things surface many years on and we want to catch that at the earliest possible stage, to make sure we avoid safety issues.
Ms Rimmer
Q
Dr Steedman: I am very sorry, but I cannot really address any questions about the funds. I am not an expert.
The Chair
I would even go so far as to say that the funds are slightly outwith the Bill, so it is slightly out of scope. Was there something else?
Ms Rimmer
For tenure. If you own a property or if you are a social tenant, it is not available for your home.
Dr Steedman: I would anticipate that the building is designed, constructed and managed regardless of who the occupants are, or how the occupancy is structured. I would sincerely hope that the outcome of this Bill will be to achieve a building that meets our national expectations for public safety, regardless of who is in it or the ownership structure of the apartments inside. It would be entirely wrong if the Bill were to somehow separate out buildings on those grounds, and I would be very disappointed. I have not seen any evidence of that in this Bill, which is focusing very much on the technical aspects of safety, not on the occupants.
Ms Rimmer
It is about building safety systems, the priorities, and if the owners of properties just put in for any grants that they are eligible for—they are, for instance, eligible to claim from the building safety fund—they are not allocated according to risk. It is allocated based on eligibility, or is available according to eligibility, not risk.
Dr Steedman: It is an interesting point.
The Chair
Yes, it is an interesting point, but we are drawing Dr Steedman into things that are probably outwith the Bill.
Dr Steedman: It is outwith the Bill, I am afraid.
Ian Byrne (Liverpool, West Derby) (Lab)
Q
Dr Steedman: This Bill gives us the architecture, ultimately—it will take time—to change and improve the culture of the construction industry. The construction industry in the UK dates from around the Napoleonic times: the structures, the people, and the professions that work in the industry date from hundreds of years ago. I do not want to comment on the history or any assertions about the culture, but I am very confident that the structure of this Bill—the way it is laid out, with the supporting statutory guidance—will effect change. However, in the end, it has to be the industry that makes the change, and the industry needs to lead that process. It is no good simply writing it all in a Bill and expecting some magic wand to make it happen. In the end, the industry has to step up.
Ian Byrne
Q
Dr Steedman: The outcome of the regulation, including the vast scope of industry standards, will together deliver the culture change, but regulation alone cannot deliver culture change, because you cannot regulate everything. In the end, you have to have a combination of carrot and stick that encourages people to realise that in order for companies and industries to become more successful and have more satisfied clients, they need to behave better, and they need to recognise the importance of safety in their work and the impact of their work on others.
A lot of the work that we have done on the competence standards development—the framework of new competence standards, the PAS standards that Peter referred to earlier for principal designer, principal contractor and building safety manager, and possibly for building control—is about recognising the importance of your work impacting others. Lots of people can do their work, but you can still have an unsafe situation. People need to realise that the impact of your work on others is where a lot of the big risk comes from, so that requires people to think wider than their own profession. This Bill will help us get there.
The Chair
I can feel Peter listening patiently online. Would you like to add to those comments?
Peter Caplehorn: Chair, I am grateful. I was absolutely going along with what Scott was saying. I would just like to add something, though. If I can take everybody back to the John Prescott summit in 2001 on health and safety in construction, he made the very clear point that the industry needed to change. That was primarily driven by the industry understanding the message and getting on with it. Of course, regulation came along later in the shape of the early Construction (Design And Management) Regulations, but it was very much about the industry understanding the message and dealing with it. Again, I come back to what Scott has just said. This Bill sets out a very good framework and it marks a point of confidence that everybody should be marching in the same direction, but it will require the industry to do a lot of the heavy lifting as well.
I would like to highlight two points that I think have yet to be addressed and are fundamental in our steps to make sure that we get rid of the industry that we have had up until recent times. One is a reform of procurement processes, and the other is a change to the standard contracts that are used to procure buildings across the industry. Dame Judith Hackitt, in her report, identified both as seeding some of the bad behaviours that we have seen, and I think both are in need of work. In fact, that work has started, but it is outside the regulatory framework.
Dr Steedman: Just to close on that remark about procurement, I would warmly support it. We have not really grappled with procurement as a tool and yet we have standards that go back to 2011 on construction procurement policies, so the issue of procurement and how it is done is a very strong lever to drive behaviours in the right direction.
The Chair
This will probably have to be our last question to you and is from Ruth Cadbury.
Ruth Cadbury
Q
Dr Steedman: I made a few comments earlier about the complexity of the scope and the risk of a two-tier system. Peter and I both commented that you have to start somewhere; and it is a very high-risk place where you have members of the public living in buildings in multiple forms of ownership. It is a very complex and highly sensitive issue. I think, in terms of somewhere to start, that higher-risk residential buildings are the right place to start, but I have no doubt that over the years ahead the principles laid out in the Bill will enable us to approach other higher-risk buildings and assets and eventually to encompass much more of the built environment.
Peter Caplehorn: Absolutely. There is danger in complexity, and we do have to start somewhere, but I see the Bill also laying out reform in the whole of the construction sector. The focus is on buildings in scope, but there are quite a few provisions in the Bill about changing a lot of other aspects of the regulatory framework, and that is really important. I would like to see us moving forward as quickly as possible, actually ditching the higher-risk category and using the momentum, using all the issues that we have discussed in this session, to push forward so that everybody can be clear that all buildings are addressed to the same technical standard, all buildings are safe and all buildings will be proven to deliver the performance.
Can I just add another point? While this is absolutely about safety and, in particular—as Scott said—structure and fire, we have a big problem in terms of climate change and reducing carbon. Buildings in future must also take into account those issues. With all the groundwork we are now putting in place, I would hope that people will be equally—
The Chair
Order. I am afraid I am going to have to draw your comments to a close there, Peter. I am so sorry to interrupt you; we are strictly governed by the rules here. Thank you so much for the point you were making.
We have come to the end of the time allotted for this panel. I thank the witnesses, who have spent such a good deal of time with us today, providing such incredibly useful information—a huge thank you to both of you. That closes the third of our panels. Thank you very much.
Examination of witnesses
Victoria Moffett, Kate Henderson, Martin Taylor and Councillor David Renard gave evidence.
The Chair
Good afternoon to the four witnesses on our next panel, who are going to introduce themselves. Kate, can I ask you to start?
Kate Henderson: Good afternoon. I am Kate Henderson, chief executive of the National Housing Federation. We represent housing associations in England, which are not-for-profit providers of more than 2.5 million homes to around 6 million people. Our members reinvest all their surpluses back into building more affordable homes and supporting residents.
By way of introduction, housing associations vary in size. They also vary in the profile of the buildings that they own and manage and in terms of the residents and communities they exist to serve. So, while many of our members provide general needs rented accommodation for people on lower incomes, they also provide specialist and supported housing, and with that come safety requirements. Across the board, the safety of residents is our No. 1 priority. We are really grateful to be able to give evidence to the Committee.
The Chair
That is brilliant—thank you. Victoria, and then I will ask Martin and David, who are joining us online, to introduce themselves as well.
Victoria Moffett: I am Victoria Moffett. I am the head of building and fire safety programmes at the National Housing Federation.
Martin Taylor: I am Martin Taylor, the executive director at Local Authority Building Control. We are a membership organisation for building control team members within local authorities across England and Wales and—
The Chair
Order. I am going to ask our technical people here if we can increase your volume. It is a little bit difficult to hear you. [Interruption.] The technical feedback is to ask you to stand nearer to the microphone, Martin. Is that possible?
Martin Taylor: Yes, Chair. Is that any better?
The Chair
It is, though please be aware that it is a little difficult for us to hear you. Great. Could you just say again which organisation you are from?
Martin Taylor: I am from Local Authority Building Control. I lead the technical operations within that organisation, which supports local authorities across England and Wales.
The Chair
Fantastic. David, could you introduce yourself, please? [Interruption.] We have no sound from David at the moment. [Interruption.] Are your headphones connected to your audio device? That is as much technical information as I can give. [Interruption.] We have lost David at this point. If you can hear me, David, can you make sure that your headphones are selected on the device you are trying to broadcast from? Hopefully, you will rejoin us shortly.
There are a number of questions we want to ask this panel. With four people on the panel, I am keen to ensure that we get cracking, as we only have until 3.30 pm for this session and then I will have to bring it to an end. If it is all right with colleagues, we will crack on, even though we are currently missing one of our witnesses. Mike Amesbury will kick off the questions and others can follow.
The Chair
David, you are back—hooray! It is lovely to see you. Can we check your audio?
Councillor Renard: Can you hear me?
The Chair
Yes. That is fantastic, David, thank you so much. Can you introduce yourself?
Councillor Renard: I am Councillor David Renard. I am the leader of Swindon Council, but I am speaking today on behalf of the Local Government Association, which represents most councils in England.
The Chair
That is fantastic. I will now hand over to Mike, who will ask the first question.
Mike Amesbury
Q
The Chair
Who would like to kick off with that? Kate, go for it, and then I will bring in David.
Kate Henderson: We absolutely welcome the introduction of a fit-for-purpose regulatory system on building safety. This Bill is a really important starting point in ensuring that we have a safety system that protects residents.
One thing that the Bill does not attempt to address is the funding for remediation. Within the Bill, there are some financial protections for leaseholders in terms of extended liabilities. That is welcome, in that it assumes that developers are liable for poor workmanship, but it does not necessarily solve the problem for leaseholders. That is because leaseholders may still be facing building safety costs. They would have to pay for legal advice to go through this process, with no guarantee of outcome. We would suggest, as we have suggested throughout, that the Government provide the upfront cost for all remediation work, and that that is then recouped down the line from those responsible. We think that is missing from the Bill.
In terms of the new Building Safety Regulator and its role, as the Bill comes through we would like to see detail on transition. There is going to be a huge amount of change. While we welcome the regulation coming in, it needs to be risk based, as does funding. At the moment, it is very welcome to have the building safety fund, but it is based on tenure and on access for leaseholders in buildings over a certain height. It is not based on risk. We would like to see this based on risk and, similarly, as the regulation comes in, for that to be based on risk, and for us to have transition arrangements in place, prioritising the highest risk buildings.
My third point, before I stop and let others come in, is about access. There are provisions in the Bill for access to properties. We know from our members that they engage with their residents in many different ways around building safety checks, communication and access. The majority of the time, where a check needs to take place, access is provided by the residents through this dialogue. But there are circumstances in which access is difficult to attain, perhaps because the resident has multiple vulnerabilities, is concerned and does not want to allow access, perhaps because they are refusing or perhaps because the building is leasehold and the resident is not there.
We absolutely believe that residents should have the right to privacy, a quiet life and quiet enjoyment of their property, but we want to see good provisions for right to access, and at the moment the way the Bill is structured, in terms of going through the courts, gives us some concern. At best, it could take two months, but at worst we know from members at the moment that securing access can take up to a year. We absolutely want to be fully compliant as this comes in, but right to access is an area that we would like the Bill to pay some further attention to.
The Chair
Councillor David Renard indicated that he wanted to come in next.
Councillor Renard: The LGA also welcomes the Bill. We feel that it will strengthen the building safety system in England, particularly in relation to new buildings, but we have some concerns about the lack of focus on some buildings, particularly those converted under permitted development rights. However, overall we think the Bill is a step in the right direction.
On the scope of the Bill, it seems to us that it focuses very much on buildings over 18 metres, and we would also like to see a risk-based approach to buildings. It is quite possible that a building under 18 metres can be much higher risk than one that is over 18 metres. Therefore, we would much rather see a risk-based approach, which also included care homes and hospitals that fit into that risk profile. We also believe that the Bill does not do enough to protect leaseholders and social landlords from the costs that have resulted from developer failings.
We believe that the requirements around accountable persons need to be much clearer and that the Bill should end competition in building control, because otherwise we will end up with a two-tier system when it comes to safety.
The Chair
Martin Taylor has been indicating that he wants to come in.
Martin Taylor: In respect of what is welcome, we very much welcome the appointment of the HSE; we very much look forward to the gateway points; and, importantly, we welcome the way in which ownership has been introduced into the Bill. People will actually own responsibility for compliance, which we think will significantly change culture within the industry.
We feel that the unintended consequences of the Bill are that it will intensify competition in building control for buildings that sit outside the scope of the new regime. So, although there will be no competition for in-scope buildings, that will then intensify the competition for out-of-scope buildings.
We feel that what is missing in the Bill is that there should no longer be a position or a place for a duty-holder to be able to choose who regulates them. We think that the extension of duty-holder choice should extend across to all buildings and that people should no longer have the option to choose who regulates them through the building control process.
The Chair
That is really helpful. Thank you. Victoria, can I bring you in as well?
Victoria Moffett: Of course. Naturally, I agree with all the points that Kate made. However, specifically to answer the question about what is missing from the Bill, there is a lot of detail missing; we know that that detail will come later in secondary legislation. And there has been a huge amount of work to prepare for the recommendations that Dame Judith Hackitt made, in the last three years, since she made them.
However, to continue progressing with the preparations, just those final bits of clarity would really give people the confidence they need to see that they are going in the right direction. We represent not-for-profit housing associations that are regulated on value-for-money standards; they need to be absolutely certain that what they are doing is the right thing. There is so far you can go, and we will keep going in that direction, but to get it over the line we need that detail as well.
The Chair
That is brilliant; thank you. This is working well so far, with hybrid technology; thank you to our witnesses.
I will bring in Ruth Cadbury now.
Ruth Cadbury
Q
Martin Taylor: It is an excellent question. Yes, we have long maintained that there should not be competition in building control. In case members of the Committee are not aware, anyone who procures building work can choose who regulates them through the building control process. It could be a local authority building control team or a private sector approved inspector. As far as we are aware, that is the only regulatory function where you can actually choose who regulates you. It is a bit like marking your own homework at school. That means local authorities have to compete against the approved inspectors in respect of their big project. Those approved inspectors submit quotations of how much they think it will cost them to deliver that building control service. It goes without saying that anyone procuring building work will look to go with the lowest cost provider of that building control service.
Local authorities do not enjoy the facility of being able to offer a quotation. Their charge can only be based on what it costs them to deliver those services. Local authorities have to compete with the private sector, but they do not have a level playing field. We fundamentally disagree with that, but you could say we are bound to, because we represent local authorities rather than approved inspectors.
On the second part of your question about whether the Bill addresses this issue, it will very much address it, but only in respect of high-risk buildings. Local authorities will support the regulator in the delivery of building control services in respect of high-risk buildings. That will then intensify the competition for buildings that fall out of scope. The first intention of the Bill is that approved inspectors will not be able to support the regulator unless local authorities do not have the capacity, but that will intensify the competition for these lower-rise, smaller buildings and further intensify the problem. It will address it in respect of high-risk buildings, but not all risky buildings are over 18 meters—look at low-rise care homes and hospitals. I think I have answered your question. It will help, but only in respect of high-risk buildings.
The Chair
Witnesses should not feel compelled to speak to every question. That was a relatively specific one. Unless anyone has anything else to add, I will move on to Daisy’s questions.
Daisy Cooper
Q
Turning to my second question, we have heard a lot from industry players today who talk about long-term change. I have noticed that although we recognise that long-term change is needed, that is very different from the sense of crisis and urgency that we hear from our constituents who are affected. I want to hear from any of you where you feel this is on that spectrum of emergency, urgency and long-term change.
Kate Henderson: We welcome the considerable funding in the building safety fund. That is a huge commitment from the Government, and recognition of the scale of this challenge. The cost of remediation will far exceed the £5 billion that has been put forward, but it is a welcome contribution. However, that money is available based not on the highest risk but on tenure. It is absolutely right that there be support for leaseholders—we do not think leaseholders should have to pay—but we also do not think social tenants should have to pay. There will be consequences to the fact that this funding is not available to social tenants and social landlords.
Our response to your first question is that we believe that the Government should provide the up-front costs for remediation based on a risk-based approach, with the highest-risk buildings remediated first, and then recoup them. No matter who has done the work, it is about how we expedite this based on risk. That is about prioritising safety and minimising the impact on leaseholders and social residents. The consequence of not having funding for social residents and landlords—this is non-negotiable; the work has to take place—is that money is diverted away from building much-needed affordable homes and investment in existing homes and communities.
This is absolutely a crisis. It is not a crisis of our making; it is a crisis that has been made over the last 30 years. It is a failure of regulation and of construction, development and workmanship. We are going at the fastest pace we possibly can to put it right, but there are huge uncertainties and complexities. One thing I have found incredibly useful is going out on site and seeing buildings that are going through this process with residents living there, and the time it takes to get that through. We absolutely think that this is a crisis, and that work needs to take place as quickly as possible, but the complexities of access to funding and establishing liabilities means that work is not taking place as quickly as it could. The building safety fund is hugely welcome. A number of our members have bids in with the building safety fund, and some have been successful—
The Chair
Order. The Bill does not include the building safety fund, so could we perhaps not focus on that too much? I am trying to draw the parameters tightly. Is that all right?
Kate Henderson: That is absolutely fine. My broader point is that we are waiting for some Government timelines. Yes, there is a crisis, but the speed at which we can work is also dependent on access to some of that funding.
The Chair
I will bring in David, who indicated that he would like to make a contribution.
Councillor Renard: The Local Government Association has similar views. We are extremely concerned about the impact that this could have on leaseholders, so we very much take the view that the Government should pay the up-front remediation costs and seek to claim back as much as possible from those directly responsible. The failure to protect leaseholders will leave councils to pick up the pieces if householders subsequently become homeless, and then the responsibility falls on to local councils to fund rehoming them.
We also take the view that any remediation that applies to social housing providers should also apply to local authority tenants; otherwise, money may be diverted away from repairs and maintenance and towards other costs, and that would just store up a problem for the future.
Victoria Moffett: The funding is obviously a really important point. The Government funding means that all the barriers to remediation can be overcome from a financial perspective. In support of that, you also need Government to co-ordinate the limited resources to carry out remediation works and prioritise the buildings that present the greatest risk. That is the best way to address risk across the board overall. We are not seeing that happening, and that is very much part of the same argument.
Ian Byrne
Q
The Chair
Who would like to tackle that one?
Victoria Moffett: As far as I am aware, there is not anything in this Bill specifically about people with disabilities. The Fire Safety Act 2021, in making changes to the Regulatory Reform (Fire Safety) Order 2005, is the place where that would be appropriate from a legislative perspective. You probably know that the Government have recently consulted on a requirement for a personal emergency evacuation plan for anybody who might need one. Without a doubt it is key that people who have disabilities or mobility issues feel safe in their property.
We made the point in the consultation that we want a discussion about the questions that would arise if that were made a requirement. There might be questions specifically about a person’s plan. For example, I think the Government talked about times when it could be appropriate for somebody to gain support from friends or family, and that might be right, but not in all cases. Those are the questions we need to find an answer to, but the premise of ensuring that people with disabilities or mobility issues are safe in their homes is absolutely non-negotiable.
Rachel Hopkins (Luton South) (Lab)
Q
Kate Henderson: We welcome the emphasis from Government on ensuring the costs associated with building safety through the building safety charge are proportionate and kept as low as possible for residents. We are very committed to that. At this stage, it is quite hard to know what those costs are going to be without knowing the specific competencies of the building safety manager, the skills base and what that will cost.
On your question about protections for leaseholders, I must first say that as housing associations, we want to see all our residents sustain their homes, so we will do everything we can to support them with remediation costs—in pursuing funding from Government, pursuing developers or pursuing warranties. We will absolutely do that. On the building safety charge, the Bill suggests that it is separate from a service charge, and that you pay it within 28 days. Having looked at that, we think it places more vulnerabilities on leaseholders. With a service charge, there is case law, so you can hold your landlord to account, and that is an important point to address. If the building safety charge was transparently and openly included within the service charge, the leaseholder would have a right to redress through case law under service charges.
The other point here is that, if the building safety charge is within the service charge, it can be paid not within 28 days, but on a monthly basis. It would be estimated for the year ahead and then divided up by 12 months, as with service charges. You would then get to the point in the year when you compared budget with actuals and readjusted, and if that cost were to go up and your leaseholders were unable to pay it, you would work out an affordable repayment plan. Our recommendation is that there should not be 28 days. The charge should be included as a provision within the service charge, but in an open, accountable and transparent way, so that the leaseholder has not only a right to redress, but a more manageable payment plan.
Ruth Cadbury
Q
Victoria Moffett: To be honest with you, that is an arrangement that we have not considered at all. Rather than answering on the hoof, we might have to go back and give that some thought. We can certainly do that and write to the Committee.
Councillor Renard: We will also provide a written answer to that. It is a really good question, and we will give it some thought and respond to the Committee.
Shaun Bailey (West Bromwich West) (Con)
Q
The Chair
Right, a little package of questions there from our colleague. David, do you want to start? Then I will bring in others.
Councillor Renard: I will address a couple of those. We believe the Bill has some shortcomings when it comes to the issue of accountable persons, and we feel that the Government need to be very clear about where that accountability sits. If there is an arm’s length management organisation, it needs to be clear in the guidance, so we need to have some regulatory guidance. We also think that the regulator needs to give accountable persons adequate time to implement the new system and provide the appropriate guidance. Of course, there is the need to ensure that there are enough accountable people with the right qualifications across the country, so thought needs to be given to whether there are enough skills and how long it will take to get them in place.
The Chair
Martin, do you want to add anything else on Shaun’s question about taking reasonable steps and the duty to co-operate?
Martin Taylor: I think the key here will be the detail in the guidance that needs to come out for accountable persons. It is critical that people take accountability of the risk, which is what the Bill attempts to set out. One final thing I would add is that the risk in not just limited to fire, so it will be key that the guidance comes out. I know the guidance is being planned from the work that we are doing on the Joint Regulators Group.
The Chair
And our two witnesses appearing physically—would you like to jump in at this stage?
Kate Henderson: Sure. The duty to co-operate is very welcome, but there is still the potential for some issues to arise. The example that we have just heard is not uncommon. We can have buildings that are owned by freeholders that are shell companies, and sometimes those companies then demise the internal parts of the building to a long-term leaseholder. They can also discharge their management duties to a managing agent. Sometimes the long-term leaseholder and the managing agent might be the same entity, but they might not be. In that scenario, we understand that the principal accountable person would still be the freeholder, even though they have appointed a managing agent and have a long leaseholder. Our members have told us that it can be really difficult to engage with the freeholder in this sort of set-up, especially when they need to do things such as assess external wall materials or identify what needs to be remediated. We would want some reassurance that the duty to co-operate has been really thought through for the most challenging of these buildings, in terms of absent freeholders.
A particular challenge is where the freeholder is overseas, potentially in the Isle of Man or Gibraltar. The entity might be outside UK jurisdiction, so I think we would like—we are seeking legal advice at the moment, which of course we will share with the Committee when we have it—an assurance from Government that we are working through the detail of this rather complicated situation. That is not just about us as social landlords; it is about the access that the new Building Safety Regulator can have to that freeholder, and it is about communication for residents. There is some really welcome content in the Bill on good communication with residents—we absolutely support that—but in that type of arrangement, how do we get the right information? If a housing association has a few properties in a wider block with an absent overseas freeholder, it is about making sure that we can reassure those residents and get them the information they require. It is those interrelationships that we still need to work through, and I am not sure that the duty to co-operate at this stage solves that, although we would like it to.
Victoria Moffett: On the question about reasonable steps, I agree with David and Martin about the need for guidance. I suggest that that guidance needs to be focused on what the risks are and what is appropriate to reduce those risks, as well as what outcomes in that building we want to achieve.
Daisy Cooper
Q
Victoria Moffett: That sounds like an interesting concept. We would want to have further discussion of it. It is an interesting comparison. Some of our members have raised the fact that the presumption of access for broadband could minimise the compartmentation that is there to contain a fire to a flat of origin, but the presumption for access in this scenario could be quite a helpful thing.
The Chair
I was going to say that we had ended our questions, but Mike, please, come in.
Mike Amesbury
Q
Kate Henderson: Thank you for highlighting the campaign, which is specifically around damp, mould and disrepair in homes. There have been some really unacceptable examples, which are being put right. It is absolutely incumbent on anyone, whether they are a social landlord or a private landlord, to ensure that residents have safe and secure homes.
On that and specifically on damp and mould—I know that is not what this Bill is about—context is important in terms of there being a consistent improvement in the quality of homes. Around 5% of housing association properties have some kind of damp or mould. It is higher in the private rented sector, but is still not good enough and we are working on it. Two per cent. is structural—that is a separate conversation about regeneration—and 3% is about things like condensation. Again, it is never the resident’s fault, but there is more we can do to support that.
In addition to the question of the physical buildings, that investigation perhaps raises the issue of how residents are treated and rights to redress, transparency and accountability. There is some welcome provision here about communication, with resident engagement as part of the Building Safety Bill, but the consumer regulation that will come through the Social Housing White Paper is the really important place for ensuring that we get the right regulatory framework. It is interlinked with this regulatory framework, but it will also come through the regulator of social housing with new consumer regulation. On that front, there is an absolute commitment from us about being open, accountable and transparent, and wanting to have a really strong and positive relationship with residents in the social housing sector.
The Chair
Q
Councillor Renard: I have a quick comment on the last point. When it comes to building safety and other issues, local councils with responsibility for housing, housing stock and tenants have been very quick to respond to the needs of those tenants, as a general rule. Obviously, there may be some examples of where that has not been the case, but by and large local authorities have been very positive and proactive in responding to the building safety issues. I wanted to put that on the record.
The Chair
Q
Martin Taylor: Just one thing. We stand ready, as an organisation, to build the competency in building control. I know that there has been much discussion around competency across the wider industry. As an organisation we have established a competency foundation to build the competency of building control surveyors. We stand ready with a suite of qualifications and accredited learning, all ready to roll out to the industry. We just need to establish the burdens funding that we have applied for. Then we can assure you that we can deliver that competence across local authority building control.
The Chair
Q
Victoria Moffett: Just a final point. Housing associations are absolutely committed to the safety of their residents. We think that it is really important that we move over to this new system as quickly as we can, but also diligently. Doing that on a risk basis is key, and we are really happy to work with the Government and the HSE to define what that looks like.
Kate Henderson: I echo what Victoria just said. We really welcome the legislation coming forward. It is really important that this legislation dovetails with the legislation in the Fire Safety Act. We have concerns about the capacity to implement, and we want to work on that transition with Government and the Building Safety Regulator, and to work with Government to ensure that this is about not just funding, but about co-ordination and ensuring that we prioritise highest-risk buildings first. I reassure the Committee that the safety of residents is our absolute top priority.
The Chair
If there are no more questions from colleagues, on behalf of the whole Committee I thank all our physically present and online witnesses for your time, and your answers to all the questions. Thank you very much.
Examination of Witnesses
Liam Spender and Giles Grover gave evidence.
The Chair
Q
Liam Spender: I am Liam Spender, representing the UK Cladding Action Group, and I am a leaseholder affected by cladding issues.
The Chair
Liam, we can hear you loud and clear. That is fabulous.
Giles Grover: Good afternoon. My name is Giles Grover. I am here on behalf of the End Our Cladding Scandal campaign team. I am an affected leaseholder as well; I have been affected for four years now, with no end in sight, unfortunately. I am here to represent the 20 or so resident groups across the United Kingdom.
The Chair
That is fantastic. We can hear you loud and clear as well. I remind colleagues that this session lasts until quarter past four.
Rachel Hopkins
Q
Liam Spender: Thank you for the question. As you have picked up on, we set out in our written evidence quite a lot of detail about the flaws we saw in the Bill. The fundamental issue is the one that you have identified: we were promised a solution that has not materialised in the Bill. In many ways, the Bill makes things worse. The key way it makes things worse is that it removes any legal doubt that leaseholders and residents of those buildings, who had no part in their design, regulation or construction, will be held responsible for past, present and future costs when things go wrong. That is an appalling failure of public policy.
The panel before ours touched on all the difficulties with the complicated machine that is being set in motion, with building safety charges, accountable persons and building safety managers. I fear that we are heading for a situation where the Building Safety Bill will become a jobsworths charter, and leaseholders will be seen as one giant blank cheque.
Giles Grover: I will not take too long, because a lot of this is about the history since the catastrophic events at Grenfell, after which we had many years of Government—Prime Ministers and Ministers—saying that we must be protected from all those costs, which we played no part in creating, as Liam said. Those promises carried on for a couple of years, but it is kind of clear that as the scale of the issue has widened and more buildings have become trapped in it because they have been built so unsafely, the Government have rowed back on that.
In 2020, that promise was changed to “unaffordable costs”. Before a Select Committee in November of last year, Lord Greenhalgh, the building safety Minister, could not really give an answer on what affordability meant; it was a case of, “Hopefully, people won’t go bankrupt.” Sadly, that has already happened to a number of people, who have lost their homes or had to sell at a massive discount. The really frustrating thing, and what has really shocked us—perhaps we should not be so surprised—is the number of promises that were made during the Fire Safety Act ping-pong process. A number of Ministers—including Lord Greenhalgh again, and Kit Malthouse in February—kept saying that leaseholders should be protected, but that the Fire Safety Bill was not the correct legislation and that the Building Safety Bill would address that.
Despite many months of promises and many months of Ministers telling potential rebel Conservative MPs that they would address the problem of historical costs in the Building Safety Bill, the Bill is here and does nothing to address that problem. There is a little bit of tinkering, and something positive for the future of the Defective Premises Act 1972, but we will still have to pay tens of thousands of pounds in costs—sometimes hundreds of thousands—for issues that go far beyond cladding, as the Government and the Secretary of State have known for a couple of years, if not longer. I could go on, but I will leave it there for now.
The Chair
Rachel has a supplementary. I commend Rachel for the way that she phrased her question so that it was entirely in order, because she was referring not to the building safety fund but to the affordability of repayments. That is entirely in order.
Rachel Hopkins
Q
Giles Grover: The one thing is for the Government to hold true to their word over the years and legislate to ensure that we are protected from historical remediation costs. The intention to protect us was in the draft Bill and in the impact assessment, but it has now been taken out, with the aim of transparency for the building safety charge, and there is still nothing to help people across the country who are being forced to pay bills for tens of thousands of pounds that are landing on our doorsteps daily. We need legislation that finally protects us. I am sure Liam can go into the McPartland-Smith amendments that will do just that.
Liam Spender: I think what is missing from the Bill is everything that is set out in the McPartland-Smith amendments. In particular, the Bill makes it very clear what the legal responsibilities of leaseholders are—the people living in these buildings—but does nothing to make clear what the responsibilities are of the people who put these buildings up and designed them. A critical part of what McPartland-Smith does, as well as providing money for current faults, is to provide a clear legal remedy if buildings are not built properly in the future. I think that is something that stands out like a sore thumb in the current draft of the Bill. That is what is missing, and that is what I would like to see added.
Daisy Cooper
Q
Liam Spender: You are quite right that the situation is worsening by the day. People are facing existential questions—do they carry on with their property or not? They are facing unpalatable choices. I think one of the ways that the Bill makes things worse is in relation to works that are required to remove building safety risks, an example of which could be cladding. The Bill makes clear that they are all recoverable through the ordinary service charge mechanism, so it removes any doubt that leaseholders have to pay for other people’s misdeeds and mistakes.
We are already seeing the consequences with cladding, so imagine what it will be like with the next thing that comes down the road. You have seen the stories in the newspaper and on “Newsnight” last week that people are already facing six-figure bills, some people have committed suicide and others are declaring bankruptcy. There is a pall hanging over these people and it is a blight on the housing market, which the Bill does nothing to address. I will let Giles add more colour to that answer.
Giles Grover: Again, everything is a long story. A lot of us have been trapped since very soon after the events at Grenfell when buildings were assessed for ACM, and everything has just snowballed and got a lot worse. Every so often, there are incremental positive steps in terms of funding, but you have to fight tooth and nail for those. As Liam said, and as you said in your question, Daisy, it is families, first-time buyers, pensioners—people from all walks of life who just wanted to fulfil that very British dream of being a homeowner or a flat leaseholder; a leaseholder is not necessarily a homeowner. Just the other day, someone told me that because she is so worried and because there is no detail about the loan scheme, she has accepted an offer that is £35,000—it will not pay off the mortgage—on an under-18m building just to be able to move out. She has a little child as well. That is just in Manchester, but it is happening across the country.
As Liam said, there have been suicides, for a mixture of reasons as well, but people just feel helpless. We are currently trapped. You start off being financially trapped, and everyone focuses on the finances. But then, especially during the pandemic, for a year and a half you are sat in your flat looking at the walls and not able to sleep at night from thinking, “What happens if there is a fire?”
This is people in buildings of all heights and all tenures, with defects of all types. As much as it started as a cladding scandal—we are called End Our Cladding Scandal—it has become a building safety crisis. It is not just cladding; it may be balconies, internal compartmentation or lack of fire protection for steelwork. With all these issues, once they are identified and once you have a proper fire risk assessment—a type 4 intrusive one—you start uncovering the lack of regulations, the lack of oversight and the poor development practice, but we are still being made to pay for it. We are still the ones on the hook for it, despite it being none of our fault. It is an absolute disgrace, and it is unfathomable that it is still happening. Government have done something, but not enough to solve this issue once and for all, to provide that certainty to leaseholders and the housing market, and to help us move on with our lives.
Mike Amesbury
Q
Liam Spender: No. The same builders that have put up buildings with the horrific array of defects that we are seeing are still perfectly entitled to draw on the Help to Buy scheme and the recently announced subsidies for affordable housing. There has been no accountability or payment from the polluter. All that has been offered, which is not in the Bill, is the residential property developer tax, which we do not know the details of. But it is wholly inadequate that it will recover only 13% of the estimated £15 billion cost. The bulk of the cost of the current crisis and/or future crises is being dumped on leaseholders, which is what this Bill does.
Giles Grover: I agree with Liam. It is not holding them to account at all. The latest figures are approaching £15 billion, and developments have made £2 billion since the catastrophic events at Grenfell. Government have supported them through the Help to Buy scheme and through instantly having a stamp duty land tax relief, and there is a mortgage guarantee scheme for first-time buyers that is open to everyone. The figure that always bothers me more than anything is the amount of money that the Exchequer loses every year—billions of pounds—to the zero rating of VAT on construction.
A lot of those things have laudable aims, but do they actually help the supply side? They do not; they are all about demand. Government are happy to praise the economic effects—the jobs, the flow of taxpayer money—and it certainly pans out to support the construction industry. The collective state of industry failure is affecting hundreds of thousands, if not millions, of people. It has taken two and a half years of kicking and screaming to get a bit of money out the Government every so often. Every year there is a little bit more. They keep telling us, “We’re not going to give you any more; we aren’t going to help you out”, but then we get further. There will be a point next year, hopefully, when the Government will say, “Here’s a little bit more”, but everything is a little bit here and little bit there. We are not being helped.
Why are we being forced into a planning tax loan scheme? Why are the Government not forcing the developers to pay that? The simple point goes back to: it was never our fault, it was never anything we did. The regulations are terrible, weak and inadequate. A lot of people knew that for years; the Government were advised of that for years. Builders were allowed to do whatever they wanted and to cut corners. Dame Judith Hackitt says there is a race to the bottom, focusing on profits over safety. But now, we are the ones on the hook to make that right. I do not get how that is at all fair. We need more funding from Government, we probably need more funding from the developers, and we need more funding from the product manufacturers as well. Leaseholders should finally be protected.
Kate Osborne (Jarrow) (Lab)
Q
Liam Spender: I think the whole responsible person regime has not been properly thought out. You cannot see, as parliamentarians, the full detail—that is being developed behind closed doors with industry. You are being asked to put this through without seeing how that very important relationship will work. The fundamental issue with the accountable person and building safety manager is that you would expect to find that regime in a petrochemical refinery, not in a residential building. It is totally unsuited to what needs to be done, massively over engineered, and the cost of it will fall on residents. The Government need to go back to the drawing board and come up with a much more tightly defined set of duties for these people, in order to avoid a situation where we end up with the advice notes, on steroids—which is a real risk.
Giles Grover: I would echo those comments. The difficulty is, again, that the legislation and the guidance are still not really there to help us understand how it will work. There are potentially moral hazards between the roles of those accountable persons—the building safety managers—in terms of how they will coalesce. There might be different accountable persons, or responsible persons, depending on the building. It still feels like there is no effective control. I do not think anybody wants to be an accountable person right now; the competencies required are a pretty wide skill set, and I fear that they will not be able to get insurance. I think we need a lot more work on how the accountable person will interact with the responsible person.
Shaun Bailey
Q
Liam Spender: Thank you for that excellent question. There are three critical things to address. First, there need to be leaseholder resident representatives on the rule-making bodies. This avoids a situation where industry and Government make rules that suit them, and pass the bill on to leaseholders who are left with the inadequate tool of challenges to the building safety charge and service charge, to contest bills that have already been paid. Secondly, the Government are trying to perform some sort of Frankenstein operation, with the Building Safety Bill, on a system that has had its day—namely, leasehold. There is a fundamental imbalance of power in the leasehold system in favour of landlords. Until you address that, you will not solve the problem of rules being made to suit landlords and bills being passed on to residents with no oversight, and no control. Thirdly, Dame Judith Hackitt identified in her report the culture of box ticking in the industry, the race to the bottom and value engineering—all that sort of stuff. Until that changes, nothing changes; buildings will continue to be built that are not fit for occupation and we will end up repeating the cycle at some point in the future. Those are the three things that need to be changed. I think that the McPartland-Smith amendments go a long way towards changing them, by introducing clear, legal routes to recovery against builders if they do not do their jobs properly.
Giles Grover: I will just echo the comments on the fact that the whole leaseholder structure means that you are still at the bottom of the food chain. There is all this talk about the building safety charge, but, as Liam said, ultimately it is about leasehold law—despite the Government thinking there might be protections in landlord and tenant law, we have seen that there are not the supposed protections there should be, because all the cases are based on the terms of the lease, which are always written against us. There needs to be an overarching look at the fact that it is not just the building safety charge, it is about service charges and how they are levied. There needs to be a bit more control over that, so that there is the actual ability to challenge it, rather than saying, “You can potentially go to the tribunal.” Ultimately, the cases we have seen do that just end up being rebuffed.
I am still concerned about the insurance issues we are facing now. There does not seem to be enough control. We have seen buildings insurance soaring by hundreds of per cent. I am not sure what protections there are against that happening. We have tried to report it to the FCA and the CMA, but are simply told that the responses are not as constructive or helpful as they could be.
Everything needs to be looked at again—even the building safety charge itself. When it was first drafted, I remember a meeting with one of the deputy directors of MHCLG where they said they did not really know much it was going to be. It was an academic exercise. Even the numbers in the current impact assessment say it will be £16 a month. It might be £42 or £26 a month. For existing buildings it should be more. No one really knows. As some industry figures have started to look at it, it might well be hundreds of pounds a month. There needs to be an overarching, holistic look at service charges and building safety charges. That would be the first thing.
To go back to Liam’s point about the McPartland-Smith amendment, that is what we are hoping the Conservatives will look at and realise that, yes, residents must be protected now, because they are the innocent people.
Ian Byrne
Q
Giles Grover: Thank you for the question, Ian. Resident engagement is key. As we saw last night—those of you who watched “Grenfell: The Untold Story”—if there had been sufficient resident engagement in 2015 and 2016, would the events of June 2017 have happened? I do not think they would have. It is important to have resident engagement, but, as we have seen, as lot of these things are very much tick-box exercises. Recently—or not so recently—the National Fire Chiefs’ Council updated its guidance on simultaneous evacuation and interim measures such as waking watch to say that residents should be consulted and cost-benefit options should be explored. That never happens in practice.
What is there actually to make it happen? The Government do not want to legislate for a resident group in each building. I can understand the reasons for that, but what is to stop the responsible person, the council entities, from just saying, “We have tried to engage residents. We put a few flyers up and gave a form out.” There needs to be a more positive obligation on them to actually engage residents than there seems to be now.
Liam Spender: I wholeheartedly endorse all of that. The answer to Ian’s question is that the residents engagement strategy in the Bill is not up to scratch. The problem is that the rules are being made now by statutory instruments in close consultation with industry. There is no amount of resident engagement strategy or vision that can overcome that issue. Once the regulations are made, there will be limited room for manoeuvre. I think there needs to be resident representation on the rule-making bodies to ensure we actually have a genuine residents’ voice, rather than a couple of cul-de-sacs that freeholders, managing agents, responsible persons—whatever title they are being given in the Bill—can lead residents down without there being any meaningful input.
Ruth Cadbury
Q
Liam Spender: Yes, is the simple answer. The building safety indemnity scheme would be one way of creating a pot of money into which all stakeholders would pay to ensure there was money available to fix buildings with issues, in whichever sector they are in—private, public—and whatever tenure they are in, whether they are rented or held on long leases. That would seem to be an equitable way of doing it. It is one implementation of the idea that the polluter should pay and that there should be a social insurance scheme in the same way that there is for uninsured drivers. I will let Giles add to that answer.
Giles Grover: I have nothing to add to the specific point on that amendment. I have tried to read the Building Safety Bill, the impact assessment and the explanatory notes many times, but I have not managed to make it right through to the end. Having read the amendments and interrogated those, the McPartland-Smith amendment is one that helps us. The simple point is about better protection for current and future leaseholders by ensuring that the limitation periods are extended, by using legislation such as the Housing Act 1985. That would help us.
The simple amendment, the one that I really want to see, and which I think should be a no-brainer, is the one about VAT. I cannot remember which one it was—I am sure Liam will—but it says that the VAT that we have been forced to pay on works and on fire safety interim measures, for the last five years, should be refunded. It should mean that we are treated the same as the developers and the building owners that can apply for zero-rating. They have been told that exceptional health and safety reasons apply, so they can be classed as “person constructing” status.
Would it not be a good start to put us on that same deal and to say, “Actually, here you go—the money you have spent already, that 20% that has been added on, you can have that back”? For future cases—in instances where future remediations are funded—at the very least, that should be taxed at 0%. The Treasury has profited from VAT and from insurance premium tax. Agreeing to that amendment would be one way of showing they want to help the leaseholders who have been forced to pay these costs with the additional costs added on.
The Chair
Thank you, Giles. I think you were referring to new clause 1. Ruth, did you have a second question?
Ruth Cadbury
Q
That clearly raises a challenge for your members, whether the building manager or owner is a resident management organisation or housing association or private sector freeholder or leaseholder. How do you respond to what the federation says, and presumably other building owners and managers say as well?
Liam Spender: Yes, I did hear that evidence. From a residents’ point of view, we would have concerns about making it too easy to gain access into people’s homes, potentially for spurious reasons. You may have seen in the written evidence that we have submitted that we suggest there needs to be a very tough statutory code of practice, to make it clear when powers of entry should be used, whether or not that is accompanied with tweaks to the drafting of those clauses; that is a possibility. However, the key point is that we have a very clear set of rules saying when people can enter private property for safety issues.
After we have finished with this panel, you will hear from two eminent housing lawyers, who will probably have much more to say on this topic and will probably say it far more eloquently than I can.
I will let Giles chip in with anything he wants to add.
Giles Grover: I am not sure that I can be more eloquent than you, Liam, but I will do my best.
Having been a property manager for a year and a half—for my sins—I understand the actual difficulty of entering a property. I think that the point is that, as Liam said in our submission, there is a lease generally of quiet enjoyment. However, leases also say that for good estate management generally you can enter a building within 48 hours.
It does not feel like there are enough protections essentially to stop accountable persons who want to mitigate their own liability from abusing these powers. I do not know how every single electrical point in every single flat will be checked, as well; I defer to Liam and the lawyers you will have before you later.
Shaun Bailey
Q
May I just ask you both: where should the driver be to ensure that tenant representation is effective? Should it be prescribed from national Government, in the context of this Bill? Should there be a mix? We have so many different types of ownership and of tenant model; I have three that are utilised in my own local authority alone. How do we ensure that every single person who needs that representation actually gets it, and where should the prescription for that come from—from national Government downwards, or from local government upwards? How do we do that? As you said in response to me before, the core of this is the importance of ensuring that those communities are accurately represented. So I am interested to hear from you both your thoughts on that.
Liam Spender: Thank you for the question and for engaging with the detail on this; as you say, it is vital. There is no one better placed than the people living in buildings to have a view on what is safe and what they think needs to be done to make those buildings safe.
I think there needs to be clearer language in the Bill about taking into account the resident’s voice, because at the moment a lot of the language in the Bill is passive; it is about residents being given information and not particularly good rights of consultation. There needs to be something in the Bill that creates a genuine partnership between the managers and the people living in the buildings.
To reiterate the point that I made in previous responses, residents need a voice on the groups and committees that make the rules, so that from the ground up and from the get-go the rules are shaped by that voice as they are being made, rather than just presented at the other end.
The last point I will make is that there needs to be better and more readily accessible advice for leaseholders and tenants. Perhaps specific programmes can be set up to provide that advice, so that people know where to go to get help when things are not working, and we do not end up with relationships breaking down, and so that we can have a genuine partnership. I think that would be a helpful addition.
I will let Giles add anything that he wants to add.
Giles Grover: I echo all those comments. Again, I have seen for myself the difficulty of engaging all residents; there is the turnover of residents as well, and you might have absent leaseholders. I appreciate that it might be difficult to do it on a statutory basis, but a lot more guidance and help could be provided to those responsible persons. In general, whether at this point there is that engagement with residents, or whether it is about tackling the issues that we are still facing, in terms of fire safety in our buildings, there probably needs to be a lot more partnership with local government and central Government. Local government—local authorities—and the fire service are able to be more reactive. They are on the ground and already have that relationship with the responsible persons and the managing agencies. That whole approach of saying, “Okay, this is what central Government are doing and this is what local government is doing, supported by the fire services,” could actually help drive a lot of it forward. Councillors have that local knowledge, as they are the ones residents turn to directly, as well as their MPs. Engagement with all stakeholders could be a lot better than it seems currently designed to be.
Kate Osborne
Q
Liam Spender: I think the simplest answer to the question is that we can expect the cost of living in higher-risk buildings, however defined, to be significantly higher in the future than it is today. We cannot really give any credence to the Government’s estimates that it will be between £9 and £26 a month. If you read the press articles, some of which quote industry figures you will be talking to next week, they are already talking about £500 a year extra just to pay the administrative costs of the new regime. That might not sound like a lot of money, but for some people—particularly shared owners who struggle to get on the ladder—it is make-or-break money. It is a lot of money if you have not got it—that is one way of describing it.
If that sort of burden were being imposed on a company, there would be uproar about it and there would be a great deal more scrutiny of it, but billions of pounds of costs are being loaded on to leaseholders as a result of the new regulatory regime, and the question that needs to be asked is whether we really need to spend that money. Do we really need to spend other people’s money—people who may struggle to pay—on this particular issue? I will hand over to Giles and let him add anything he wants to add.
Giles Grover: It is difficult to consider it, because last year it slightly changed. Last year, it included the historical remediation costs, and there were some vague, wide-ranging, heavily caveated figures about what it might be. Those figures are still heavily caveated. I suppose the difficulty I have is thinking about the future building safety charge when I have to pay a lot more already. A lot of people are already paying hundreds of pounds, so it is hard to have this conceptual thought about what may be put in place when they are already facing hundreds of pounds a month. Until there is more clarity about what it actually is, until there is more control over the building safety charge, and until the problems I am facing right now and the thousands of pounds I have to pay right now are resolved, I will not really consider it fully.
The Chair
Q
Liam Spender: The one thing we would like to have spoken about, but we have not had the questions to do it, is how the Bill affects the housing market. In addition to the cost that is being loaded on to leaseholders, does it affect the functioning of the market? We already know—we made references to this in our written evidence—that banks are starting to make extra provision in their books because they think mortgages are worth less as a result of their exposure to cladding. If you ask me, that is shades of 2008, when we had an enormous banking crash. I suppose the issue for Parliament to consider, when considering this legislation, is what the effect on the economy of not putting up enough money—not by a long shot—to fix the current cladding issues and then creating this enormously complex machine, which may not be suited to the task. I do not think it is and I do not think many people think it is. What is the effect of that on the housing market and, in turn, what is the effect of that on the wider economy? And does Parliament really want to make that choice without knowing and considering that impact? I will hand over to Giles to add anything he wants to add.
Giles Grover: Thank you, Liam. On that point, I think it was in November 2020, before the Chancellor’s spending review, when we wrote to make exactly that point. The shades of the 2007-08 financial crisis were starting to become clear: the impact on regulatory capital of the banks with mortgages being valued at zero, and the increasing number of forfeitures. We saw reporting earlier this year about the impact on flat sales transactions. I think they were halved in September 2020. So, as Liam says, there is the effect on property prices, especially in the north—I am from Manchester. The property prices would be lower, but that means that the actual remediation costs are much larger. I think that has not really been considered.
There is the loan scheme as well. It might not be part of the Building Safety Bill, but we still have no idea how it is going to work and how it will not materially impact property prices.
The other thing I will just pick up on, which is in the Building Safety Bill, is the measurement of height and height being the determinant of risk. I think it was Sir Ken Knight who said earlier that height was a crude threshold. Robert Jenrick also said on 20 January 2020 that it was an arbitrary threshold; it might be important, but there are other factors. There is talk of PAS 9980, which will help with that, but, as was mentioned earlier today, the fire at Richmond House, Worcester Park, was in a building that was under 11 metres and it was completely destroyed in 10 minutes. Okay, there is the issue of higher buildings; I understand you might have to phase the scheme in, but we need a solution for all buildings. We need proper risk matrices that actually look at building risk holistically—that look at occupancy and means of escape and do not just say, “Okay, you’ve got cladding here.” What about the internal issues? What about the cavity barriers? What about the lack of sprinklers? One example of what could be done, which we have suggested before, is this. Rather than forcing people in buildings under 18 metres or between 11 and 18 metres to pay a cladding tax, why not ensure that you have sprinklers in those buildings? That is now part of Approved Document B, because Government have realised the clear safety principles of it. That would actually go a long way towards helping many of the people in the under 18-metre or 11 to 18-metre buildings. One final point is that we need to ensure that all buildings, not just those over 18 metres and from 11 to 18 metres, are safe, because those under 11 metres are still potentially very unsafe.
The Chair
If there are no further questions from members, let me, on behalf of the whole Committee, thank you, Liam and Giles, both for taking the time to join us this afternoon and for your incredibly comprehensive and thorough answers to the questions posed. We are very grateful for your first-hand insight. I will let you get on with the rest of your afternoon. Thank you for joining us. That brings to a close the fifth panel of witnesses, and we will now turn to our final panel of witnesses, who have just been referred to by Liam and Giles.
Examination of Witnesses
Justin Bates and Giles Peaker gave evidence.
The Chair
This is the sixth panel of witnesses before us today. We will now hear from Justin Bates and Giles Peaker. Before we start the questioning, could I ask you to introduce yourselves and the organisations that you are representing?
Giles Peaker: I am Giles Peaker. I am a partner in the property disputes team at Anthony Gold Solicitors.
Justin Bates: I am Justin Bates. I am a barrister at Landmark Chambers and I am the editor of the “Encyclopedia of Housing Law and Practice”.
Ian Byrne
Q
The Chair
So just a small question to start with.
Giles Peaker: The immediate impact on building practices is not clear. One would hope that, under the new regime, buildings might become, and be kept, safer. The immediate impact on building premises that we know have not been great is hard to see. Frankly, without stronger liability for the building sector, that is unlikely to change.
The Chair
Giles, could I ask for a favour? Please move your iPad slightly. The microphones are a tiny bit directional, so that helps pick up the sound. Justin?
Justin Bates: Not immediately is the answer, for two reasons. One is that there is so much to be fleshed out in SIs that it is pretty hard to know where this will ultimately go. Until you see the SIs and, in some cases, the guidance, it is quite a nice framework, but it does not matter until you get the secondary legislation.
The other reason why things are unlikely to change immediately is that the focus of the new regime is primarily tall buildings—18 metres-plus—and, as you can all appreciate, there are lots of buildings, both new and existing, that are under 18 metres. While I anticipate that, over time, they will be brought within scope of the regime, that is not the starting point, so nothing much will change for them immediately.
To be frank, I am not sure that legislation can change culture. You can legislate for all the things you want, but if people build on the cheap because there is no real comeback on them, that is the position. For example, you cannot sue building control, regardless of whether it is local authority or private, if they sign off rubbish buildings. If you want to make building control a lot more effective, let people sue them when they get things wrong. We will talk about this later, but one of the flagships in the Bill is extending the limitation period in the Defective Premises Act 1972. You can have the longest limitation period you want, but if all the building is done by SPVs—special purpose vehicles—worth £1, which are wound up the minute they are built, the law does not help you at all. There is a limit to what you can do via legislation, and the Bill is a pretty modest start, even at that.
Daisy Cooper
Q
Justin Bates: There is probably no way of doing this without significant SIs, because to legislate at the level of detail that you probably need, you would have a 10,000-page Bill—you guys would still be in Committee at Christmas. There is also a value to doing it by SI for an element of future-proofing, because it will be easier to update it as things change. I do not see why you could not have at least a draft of the SIs to accompany the Bill, to be considered as part of the scrutiny. One assumes that the thinking as to what will be in the SIs must be reasonably advanced. The moment you have them, this Committee or some other Committee is as well placed as anyone else to do that kind of scrutiny and to bring in the leaseholder and external voices. At the risk of sounding like a typical lawyer, I suspect I am sitting somewhere in the middle.
Giles Peaker: I think I would agree. There are very significant operational elements of this Bill that will be done by statutory instrument, so we are largely in the dark about the way in which it will play out and operate, inasmuch as we have no idea what will be in the SIs. The difficulty with scrutiny of SIs is, I suppose, a parliamentary problem rather than a legal one, but I support Justin’s suggestion that at least drafts, indications or outlines of where the SIs will be going would be significant at this point.
Shaun Bailey
Q
Giles Peaker: I suspect that would be a matter for guidance; guidance would not necessarily avoid the risk of litigation on the issue, but it would mitigate it. The risk for all involved, particularly those who will end up paying for it, is that “reasonable steps” will be seen to be taken as doing every single thing possible to avoid any prospect of being sued or losing one’s insurance, and with that sort of risk avoidance there is a clear risk, particularly when you are looking at potential criminal liability in some aspects. We need some sort of clear guidance on the extent of “reasonable steps”. The difficulty is, of course, that you are looking at a wide range of potential safety issues, and I do not think you could draw a bright line under every single one. Inevitably, without something beyond clause 84, the accountable person will be running scared of what the potential consequences for them will be, if they do not do literally everything.
Justin Bates: The phrase “reasonable steps” is one that the draftsman of this Bill really likes, because it crops up in quite a few places. Contrast clause 84 with clause 124, inserting proposed new section 20D(9) into the Landlord and Tenant Act 1985. That is the one about how you regulate service charges, and in that one the Secretary of State is giving himself a power expressly to issue guidance about what will be reasonable steps. I cannot see that he has done the same in clause 84. He is making the accountable person go back to the prescribed principles, but prescribed principles are not the same thing as guidance. I do not see why you could not add a new subsection (6) to clause 84, stating that the Secretary of State may issue guidance from time to time about what constitutes a reasonable step for these purposes. That would be quite useful—and if you wanted to make him lay it before the House before it takes effect, you could even scrutinise it.
Brendan Clarke-Smith (Bassetlaw) (Con)
Q
Giles Peaker: It will partly depend on who you act for.
Justin Bates: It will depend on who you act for and what you do. For both of us, our primary focus is on residential property law—leasehold, freehold, tenants and so on—so I am really interested in from about clause 120 onwards, the service charge and the building safety charges. Those are all my Christmases come at once, in terms of the amount of litigation you are creating for me, which is probably not what you intended. I want to come back to who you act for. If you act for a developer, one of the things that will worry you is the extension of limitation periods under the Defective Premises Act 1972. At the moment, it is six years from building control sign-off and, in practice, very few people know enough about the problem within that timeframe. 15 years is obviously better than six. If you have developer clients, you will advise them to do as much building as possible through SPVs and then wind them up, once finished, because your exposure after the Bill will be much more significant. That is even more true for refurbs, because you are extending the Defective Premises Act to include refurbishments, not just new builds. That is an aspect that will very much interest the legal profession.
I think there is a lot here that will end up in litigation, and there is not a lot you can be done about that because this is a pretty significant change to the structure of how buildings are regulated, and to the structure of the landlord-tenant relationship. You cannot lawyer-proof this, but you might not need to be quite as generous to lawyers as you are being. In a moment, we will come on to where you could be more exacting with your wording, to be clearer about what you want.
The Chair
Giles, do you want to add anything to that?
Giles Peaker: I think that is right. In some ways, the Bill is actually inviting more litigation through the extension of limitation. To be honest, that is probably the one thing that will not happen, for reasons we will probably get on to—or it might happen, but to a very small degree. I have no doubt that there will be considerable tribunal activity over the new requirements in clause 124, from a leaseholder perspective. The advice to developers might be quite expensive, but it will be very short and sweet: “Limit your liability in any way you can”. SPVs will be the way they do that.
Mike Amesbury
Q
Giles Peaker: The extension of limitation is a start. The problem with suing developers and builders has always been twofold; limitation is one, because problems usually do not manifest themselves within the first six years. The other problem is finding somebody worth suing, and that is the big problem. I get a lot of inquiries about potential new build cases. Most of them are out of time, but most of them also do not have anybody they can actually sue, because developers have liquidated or wound up. One thing that could be considered—although it is difficult and goes against some fundamental tenets of English company law—is to allow tracing profits, to make parent companies liable for special purpose vehicles. That would be one way to cut out the simple “take the profits and run” approach. Justin suggested properly enabling the suing of building control; that is currently off the table, but it might improve the attention to detail, although the professional insurers are already going bust.
Justin Bates: Again, if you are feeling adventurous, you could make directors liable for the acts of their companies—make them personally liable for any building defects. That is not as radical as it sounds—you did that to directors of rogue landlord companies in the Housing Act 2004 and the Housing and Planning Act 2016. I appreciate that every company director hearing this is having a wince and every company lawyer is pulling their hair out, but you have done it twice in relation to rogue landlords, so it is not that big a stretch to go to rogue developers.
There is a danger in asking litigation lawyers for policy advice because every problem that I see involves suing people. That is what I do for a living, so take everything I am about to say with a large pinch of salt. Fundamentally, Parliament has to decide what is the nature of the current building safety crisis that it is dealing with. Is it one that requires a collective response or an individual response in individual buildings? The Bill is about individual buildings. If you are lucky enough to be a leaseholder or freeholder who benefits from the Defective Premises Act 1972 extension and you can find someone worth suing, there is some good stuff for you in here. I personally think that would be, at most, 15% of affected buildings at the moment, and you have got the June 2020 National Audit Office report if you want to see MHCLG’s response to that. It thinks that even that would be a higher figure.
Likewise in clause 120 and the restrictions on when you can pass service charges on. There will be some buildings that benefit from that, but it is all happenstance. You are not solving the collective problem. You are creating some remedies for some buildings. If you think this is a collective problem, the only way is for some collective body to take control of it, such as central Government, to fund works, at least up-front—that would be one solution—and then recoup.
You could have a scheme, which I understand is a variant of what is in Australia, whereby central Government fund works on affected properties but a condition of the funding is that it requires all affected parties to assign their rights to central Government, who then get round to suing when they feel like it, because central Government do not really care if their litigation takes five years to work through. Central Government will still be here in five years’ time, whereas individual leaseholders do not have five years to wait for cases to pan out. There is lots you could do if you want to adopt a more collective approach, but you need to be clear that this is a very individualistic response here. That will help some people, but probably not many.
Selaine Saxby (North Devon) (Con)
Q
Justin Bates: If the Bill works in the way it is envisaged, you should at the end of the construction stage of the building be able to go to one place and have all the documents relevant to that building. You should have the plans, the design and so on. One problem that you have seen coming out of the Grenfell inquiry, for example, is that no one had all of the plans for the building. Firefighters went in and discovered there were two floors that did not exist on the plan that they had. If this works, this will be better for pulling together a centralised and collective set of records, which will help. That is the obvious one that I can think of, comparing it with a problem that we know exists. Can you think of any others?
Giles Peaker: There will be more accountability via the accountable person, certainly from the point at which the building is occupied. I am not clear how far that accountability will transfer back to the people actually responsible for the problems, if there are problems. The basic idea of having a person accountable for the building’s safety is in itself a good idea, but the complexities that follow on are immense. I am not sure that the issue of establishing who is the accountable person, particularly in properties where there might be multiple people who would be candidates or would fall under the list of who would be an accountable person, has been adequately solved.
How can I put it? I am fine on the principle; I am less certain about the practice, particularly as we are still waiting for statutory instruments—quite a lot of them—on how the accountability will be seen through. A lot of it will be down to the approach taken by the regulator. As we have seen with the regulator of social housing and so on, that can be quite a variable approach.
Selaine Saxby
Q
Justin Bates: Until we see all the secondary legislation, you cannot start to work out where all the problems will be. You have Dame Judith Hackitt’s report in the background. Dame Judith effectively concludes in her interim report that we have a building industry that cuts corners and throws up the cheapest buildings it can, to sell for the most profit as quickly as it can. That is the cultural problem. If you have still got that culture, people are going to find a way to get around the law. That is what they do. If you are really worried about building standards, you have to address that cultural bit first.
I am not saying that I have any answers to that, which was one of the earlier questions. Legislation by itself cannot make people be morally good, but you can impose enormous and painful penalties on people who do bad things. For example, building control is liable to pay damages if it turns out it was negligent in some respect. That will focus a lot of minds. It will end the practice that is rumoured to exist of some building control being very keen to say yes, because it does not want to get the reputation of being the person who says no, because then they do not get any other work.
Giles Peaker: There is indeed case law on building control signing off on non-existent flats without having seen them. Despite being clearly negligent, and potentially fraudulent, no liability was found. Yes, there is certainly a case for focusing building control’s minds on what it is they are doing.
Daisy Cooper
Q
Giles Peaker: The current position on leaseholders potentially having to pay for building defects is somewhat hotch-potch. By and large, for the huge majority of leases, they will have to, because it will be under the lease. There will be some leases where that is less than clear and some where they may not have to. So far, there have been no such successful cases at the first-tier tribunal or the upper tribunal, but it is theoretically possible—I am not ruling it out.
The Bill certainly takes as read that the cost of remedial works will pass under the service charge. There is no envisaging otherwise; it is simply the case, as far as the Bill goes. In terms of inserting, for instance, a direction by the regulator, it makes it 99.9% certain that the costs will indeed pass under the service charge. Not so much by specifying but by presenting the framework by which the remedial works will be assessed under the serviced charge, yes, it does enshrine that principle.
Justin Bates: Clause 124 is the critical one for this. Clause 124 assumes that the leaseholder is going to have a contractual liability under the lease, and it is right to make that assumption. In 99.9% of leases the starting point position will be that the leaseholder pays. By one route or another, there will be a clause in the lease that could be used. I agree it is theoretically possible that you have a lease that does not allow for that. I do not think it is very likely.
Clause 124 does not actually do anything to stop that. It takes the contractual position—that the leaseholder pays—and says, “We are going to ameliorate that in a relatively limited way.” First off, it only applies to a particular type of work, which is going to be specified by the Secretary of State in regulations. We do not actually know what kind of work it will apply to yet. I know it is not just cladding we are talking about here, but for simplicity’s sake let us say the Secretary of State passes an SI that says it applies to cladding replacement. In those circumstances, the Bill puts the freeholder under an obligation to look at alternative sources of funding. He has to go and look at granting funding—building safety fund money would be an obvious example. He has to look at insurance funding that might be available. He has to look at any other third parties that might have to pay because the developer could sue them, and he has to look at anything else the Secretary of State specifies, which is why it would be useful to know what the Secretary of State intends to specify. But it is only a duty to take reasonable steps to see whether any of those parties can pay up. What will reasonable steps mean in these circumstances? Once the building safety fund is exhausted, there is no publicly announced plan for any further grant funding. You know the building safety fund will get exhausted, because the Select Committee has done the work on that.
On insurance, it is good to have it enshrined in law that you should be looking to your insurers to pay up—frankly, case law has got there already, so it is not much of a development but it is always useful to have it confirmed in one place. The one that troubles me is the idea that the freeholder has to take reasonable steps possibly to sue third parties. What will reasonable steps mean here? Presumably, the freeholder will go and get legal advice from someone, and lawyers being what they are, they will say the prospects of success are somewhere between x and y. If he says there is a 51% chance of success, does the freeholder have to do it? Bear in mind that the legal costs of a failed claim will almost be certainly be a service chargeable cost. If he says it is 70%, does the freeholder have to do it?
If he does have to bring litigation, in the meantime, what will you do about the actual work on the building, because suing someone does not get a building made safe? In the meantime, all the leaseholders—your constituents who write to you about waking watches and higher insurance premiums—will keep paying that while the freeholder and the developers have a fight about who should pay the ultimate work.
I understand what it is trying to do: it is trying to give freeholders a meaningful kick to make sure they exhaust other sources of funding before they go to leaseholders. I just see this generating a lot of litigation to achieve very little.
Giles Peaker: To follow that through, clause 124 appears to make it an obligation for the accountable person to actually carry out works in the meantime while searching for the other sources of funding. Where is that money coming from? It is not going to happen. There will be no money, unless they charge the leaseholders in the meantime and then refund them, but they cannot do that.
If you are looking at potential litigation by the freeholder, I do that kind of work—you are looking at two or three years before there is an outcome, whether successful or not. Costs of failed litigation could be immense and will go through the service charge—that is entirely right under this Bill. But if the accountable person does not bring litigation, you are looking at the leaseholders prospectively bringing a challenge in the tribunal that they do not have to pay the remedial costs, whatever they are, as specified in the statutory instrument, because the accountable person has not complied with the relevant section of 20D. You are then asking the first-tier tribunal to reach a finding on what the landlord’s reasonable prospects of success would have been had they pursued a claim against the developer, as a condition of whether the charge has to be paid. That is a huge stretch for the FTT. How do you evidence that? The leaseholders bring along someone like me who says, “I put it at 70%.” The freeholder brings along their solicitor who advised them and said, “It’s a 40% chance.” What is the FTT to do? I cannot see that working. It is years and years of litigation one way or another.
Daisy Cooper
Q
Giles Peaker: Immense.
Daisy Cooper
Immense—there you go. I was almost there. They are facing immense costs on top of that. Am I right in saying that those are the choices you have just outlined facing leaseholders under this Bill?
Justin Bates: All of those scenarios are plausible on clause 124 as drafted, yes.
Ruth Cadbury
Q
Justin Bates: Oh, yes.
Ruth Cadbury
Q
“moral hazard between the roles of the accountable person and the building safety manager”,
particularly the use and misuse of concerns about fire safety to do works that are not about fire safety, and may not even be necessary. I think I was reading that they feel this legislation could be used for work that is not the intention of this Bill. Do you recognise that, and is that an issue?
Giles Peaker: I am not entirely sure that is a different position to the current one. There is the eternal struggle between freeholders and leaseholders as to what works are necessary and what works are recoverable under the lease. Again, we are not sure what would count as remedial work, so that would be specified, but undoubtedly, yes, there will be attempts to smuggle in other kinds of works that could not otherwise be charged for. I am not saying that this is right: this is just what happens, and there will doubtless be tribunal disputes as to whether that is correct. That would require leaseholders to take it to the tribunal, so I am not sure there is a great difference with the current situation on that, but the current situation is hardly great.
Ruth Cadbury
Q
Giles Peaker: No, I would not say so.
Justin Bates: It is important to remember that this Bill is not only about fire safety. We are all talking about that because that is the current crisis, but clause 59 says that a building safety risk is:
“(a) the spread of fire;
(b) structural failure;
(c) any other prescribed matter.”
That is what this Bill is concerned about. It is not limited to fire safety. Suppose you had this Bill 60 years ago: it might have been the vehicle you used to deal with asbestos, for example. You could have prescribed asbestos as one of the other matters there. As I understand it—this is where the SIs would be a legitimate tool—this is intended to be a structure that you do not have to come back to for 50 years. That is why having it beyond fire makes sense, because there will inevitably be another problem that we discover in years to come. Yes, focus on fire at the moment because that is your immediate concern, but this is not a Bill limited to fire safety.
Rachel Hopkins
Q
Giles Peaker: I suppose that it would be straightforward in a number of situations, because the building safety manager would, in effect, be appointing the person to carry out the fire risk assessments and would effectively work as the responsible person. However, there is obviously the potential for adding yet more people with yet more responsibilities in relation to the building.
Justin Bates: I am not sure that is a question for a lawyer, because a lot of it depends on the personalities involved. Joint working can work: think of the GLA’s taskforce, for example, which is doing good work on fire safety at the moment. They have local authorities and the fire brigade working together. There is no inherent, logical reason why joint working is bad. Much of it depends on the personalities involved and the political will behind each organisation to make it work. I am afraid that I am probably not the person to help you with that question.
Mike Amesbury
Q
Giles Peaker: We have been wracking our brains about this one. I know the clause that you are referring to. We are not entirely sure why it is there. I think it is probably just to avoid there actually then being a human rights challenge to BSA on whatever relatively spurious basis. I cannot see a valid human rights challenge, and certainly not in terms of the removal of the six-year limitation. A limitation defence is not a property for the purposes of article 1 of protocol 1; they could not pull an article 1 complaint.
I do not think that there are any article 6 issues, because limitation does not stop you being liable; it just stops you being sued. You are still responsible for the problems. If the period for which you can be sued is extended, where is the article 6 problem? You will still get your fair trial in court. After wrestling with it, I cannot see one.
Justin Bates: What has almost certainly happened is that because we are designing for legislation with retrospective effect, the draftsman of this has realised that retrospective law is something that does flag up human rights concerns. You can do it—your Parliament is sovereign; you can do whatever you want—but it does flag up human rights concerns. Rather than having a fight about whether there is a human rights defence or not, the draftsman has said, “If anyone ever manages to succeed in one, this will be the outcome”.
These words could be hostage to fortune, but I suspect that it is a clause that will not go very far because you would see more litigation about whether the defence was available at all. This assumes that the defence is available, and it has decided what the outcome will be. I can understand why it has been put in there, because if it is not in there and a developer brings a human rights defence and wins, what happens is that the developer is still liable in damages, but a declaration of incompatibility is made, and you then have to deal with your incompatible legislation. I can see why the possibility of that has been headed off at the beginning, but I do not think it will go anywhere. I know that Giles takes a slightly different view.
Giles Peaker: I do take a slightly different view. I have a horrible feeling that that clause will invite people to try, which would inevitably mean at least three to five years of litigation on that issue, but we will see.
Daisy Cooper
Q
My question, to follow up on Rachel’s point, is this. Based on what is currently published in this Bill, are you able to ascertain whether or not there is a situation in which the two roles that Rachel mentioned—the responsible and accountable people—might be diametrically opposed in what they are legally obliged to do, or are you simply of the view that not enough has been published to ascertain that?
Justin Bates: At the moment, I would lean towards the latter. I do not think the planning analogy is a good one, because this is not like two elected bodies, each with their own political concerns, fighting over where the houses should be; it is between two supposedly neutral public authorities. I see the co-operation duty as closer to the duties that exist under the Housing Act 2004, whereby local authorities and fire brigades have to work together when they are doing certain kinds of inspection.
I am not for a second pretending that you do not get areas of conflict. In pure housing law disputes between district councils and county councils about homeless children, you get enormous fights—a very common fight is about whether it concerns housing or social services—so I am not saying that there are no fights to be had. As far as I am aware, that problem does not come up under the Housing Act. That is probably the closest analogy. Can I think about it and send something in afterwards if I think of any particular problems?
The Chair
If there are no further questions, I will draw this evidence session to a close. I thank our witnesses for their time. We are really grateful to them for bringing their expertise to the Committee.
Ordered, That further consideration be now adjourned. —(Scott Mann.)