Integrated Care Boards: Budgets
(1 month, 1 week ago)
Lords ChamberRead Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Scriven
To ask His Majesty’s Government whether they intend to mandate a statutory minimum ring-fenced allocation within Integrated Care Board budgets for community-based transformation.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, integrated care boards are responsible for commissioning health services to meet local need. We do not intend to mandate a statutory minimum ring-fence for community-based transformation. Through the medium-term planning framework and the neighbourhood health framework we are requiring systems to set out how they will shift activity from hospital to community. They need to provide clarity and consistency in order that we scale neighbourhood services and teams and develop locally led neighbourhood health plans.
Lord Scriven (LD)
My Lords, that is all well and good, but financial transparency is the bedrock of accountability. Yet in the answer to a recent FoI request, 80% of ICBs indicated that they could not identify their spending on learning disability services. Will the Minister acknowledge that without the basic financial data, the current system provides a perfect screen for ICBs to quietly raid learning disability budgets to cover acute deficits?
Baroness Merron (Lab)
The noble Lord raises a good point about data. Indeed, one of the pieces of work we are doing with ICBs on how they commission services is requiring better data and data analysis. I hope the noble Lord will see the improvements, but I very much take to heart the point he makes.
Lord Blunkett (Lab)
My Lords, I hope my noble friend will forgive me for concentrating on the South Yorkshire ICB because of the considerable difficulties that have been experienced locally. I know that she cannot give me a clear answer this afternoon, but given that the previous Health Secretary is no longer in post, and therefore the meeting that Clive Betts MP and I had with him has been somewhat overtaken, will she go back to the department and take a look at the withdrawal of resources from neighbourhood and place, which she quite rightly mentioned, to sustain the bureaucracy rather than the delivery?
Baroness Merron (Lab)
No ICB should be taking that line. My noble friend is aware that in line with the 10-year plan, NHS England has asked integrated care boards to reduce their running costs. I emphasise running costs, which are not the front-line costs. On the meeting with the former Secretary of State, I can assure my noble friend that the information and views given will of course be brought to the attention of the current Secretary of State. NHS England is the body responsible for dealing with ICBs, their performance and their ways of meeting what is required of them.
Lord Bellingham (Con)
My Lords, the new Norfolk and Suffolk ICB was officially launched on 1 April this year, formed by merging the Norfolk and Waveney ICB with Suffolk. The Minister stated at the time that the streamlining process would reduce running costs by 50%. Can she give a timeline for these savings? Will those figures will be impacted by the inevitable cost of the restructuring?
Baroness Merron (Lab)
To develop further the reply I gave to my noble friend, ICBs have been asked to reduce their running cost allowance to a cap of £19.40 per head of weighted population for the financial year 2026-27, which the noble Lord was asking about. I have to emphasise that by focusing on 36 ICBs and building them around nine clusters, people in ICBs will be able to pool budgets, cut their running costs and be more efficient. I think that is very welcome.
Baroness Gerada (CB)
Can the Minister comment on whether the mental health investment standard introduced in the Health and Care Act 2022, which requires the Secretary of State to report annually to Parliament on the share of NHS funding for mental health, will be replicated for primary care?
Baroness Merron (Lab)
I understand why the noble Baroness is asking that question. I cannot confirm that that is the case, but I will gladly raise that point with my colleague the Minister for Care.
Lord Kamall (Con)
My Lords, I will follow up on the question asked by the noble Baroness, Lady Gerada, on the Health and Care Act 2022. I remember that during the debates on the Bill there were calls for many specialisms to be represented on integrated care boards. In order to avoid unwieldy boards, we compromised on the phrase, I think, “with regard to”. With hindsight, we see that that did not always happen. We also find that ICBs are often dominated by large trusts, something that might be made worse by the forthcoming NHSE abolition Bill. Given these two factors, what is the Minister’s department saying to ICBs to make sure that there is an emphasis on community-led provision of health and care services?
Baroness Merron (Lab)
The noble Lord actually outlines our entire focus. In March this year, we published the neighbourhood health framework that will empower local leaders to develop and scale neighbourhood health. It is important to recognise that this is not just more of the same; this is actually a change. It is a major shift, as outlined in the 10-year health plan on the back of the independent review by the noble Lord, Lord Darzi, that will mean that we can deliver what noble Lords rightly press me for: better patient-focused care, closer to home and with lower waiting times. That is the entire focus of the new arrangements. All the guidance and the targets that are set focus on that, which has not been the case previously.
Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)
We will hear from the Lib Dem Benches.
Baroness Pidgeon (LD)
My Lords, since last year the number of patients waiting more than a year for basic community health services has shot up by a staggering 32%. What specific actions will the Government take to ensure that patients receive timely community health services?
Baroness Merron (Lab)
In February 2025 we published an overview of core community health services, Standardising Community Health Services, in order that ICBs should not just bear it in mind but act on it when planning for their local populations. I know that noble Lords are aware of this, but I often remind myself that ICBs are the best place to ensure that local health services meet the needs of local people. To assist the noble Baroness, we have also set very clear ambitions in our medium-term planning framework that mean that, by 2028-29, at least 80% of community health service activity should take place within 18 weeks, which would bring it in line with targets for elective care.
Lord Patel of Bradford (Non-Afl)
My Lords, Sir Chris Whitty produced a report on coastal health that exposed deep and persistent health inequalities in many of our coastal communities. Coastal communities, about 55 towns, make up nearly 20% of the UK population. Five years later, can the Minister tell the House what has changed as a result of that report? How will integrated care boards be encouraged to invest in prevention and community-based services in those areas? They are big enough to have problems but not big enough to have the infrastructure surrounding them.
Baroness Merron (Lab)
I take the noble Lord’s point, but allocations take account of factors such as rurality and the different costs of providing care. For example, the formula says that reflecting longer travel times in sparsely populated areas for emergency ambulances, which would make the costs higher, is permitted; travel time for community services also reflects that additional time. The financial allocations are far more sensitive to the needs of local areas than they have been.
Baroness McIntosh of Pickering (Con)
My Lords, the Government have identified that NHS England staffing and administration costs have risen to £2 billion, with significant duplication between NHS England and the department. Have the Government identified savings that can be made that could, for example, be used to deliver healthcare in rural areas where it is more expensive to access the service?
Baroness Merron (Lab)
That is the very reason why the allocations currently take account of the special needs of areas such as rural areas. In the NHS Bill, we will bring NHSE into the department and will reduce the duplication and costs.
Baroness Blackwood of North Oxford (Con)
My Lords, virtual wards are an aspect of community transformation that has been scaling fast. Safety and outcomes will be maintained only with an appropriate workforce plan to meet that demand. Can the Minister say what plans are in place to address that workforce need?
Baroness Merron (Lab)
It is indeed the case that, as we move our services to the community and build around the patient, changes and improvements to staffing will be needed. The NHS workforce plan should be available and will be published in the not too distant future.