NHS Integrated Care System Boundaries

Debate between Bernard Jenkin and Peter Aldous

Tuesday 29th June 2021 Commons Chamber

[Sir Bernard Jenkin]

My hon. Friend anticipates what I might say later.

The foundation trust for the Ipswich and Colchester hospitals will have two different commissioners, or Suffolk will have to take over the commissioning role for Colchester Hospital, leaving north-east Essex GPs, mental health services and so on with a different commissioning authority from that of the local hospital. NHS England told the MPs:

“We still do not know how the funds will flow”.

We certainly will not have all the partners sitting around a single table. The constituency of my hon. Friend the Member for Waveney (Peter Aldous) will be reabsorbed into Suffolk, even though it is half of the wider Great Yarmouth and Waveney place.

[Peter Aldous (Waveney) (Con)]

My hon. Friend is making a very good point. The Waveney area of Suffolk has been in a health administrative area with neighbouring Great Yarmouth for a very long time, and with the rest of Norfolk for a reasonable time as well. Any change would be highly disruptive, a distraction and demotivating for hard-working staff. I have written three long letters to the Department of Health and Social Care and have had a meeting with the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), but does my hon. Friend the Member for Harwich and North Essex share my concern that there is a perception among those working in health and care in the local area and East Anglia that changing the boundaries is a done deal? Can the Minister confirm in his response that that is not the case?

[Sir Bernard Jenkin]

I very much hope that my right hon. Friend the Minister will confirm the latter; I have been assured that it is not the former, which is why I thought it was worth having this debate. The problem that my hon. Friend the Member for Waveney has is that the local population will continue to have acute services commissioned and provided from Norfolk. The imposition of separate Norfolk and Suffolk ICSs would compromise place-level integration for that population.

The west Essex population, which may be close to your heart, Madam Deputy Speaker, has acute services commissioned and provided predominantly from Hertfordshire, London or Cambridgeshire, and very little from the rest of Essex. That means west Essex will become part of an Essex ICS when it does not even include many of the key partners responsible for delivery of acute services to that population, and of course there is to be a new hospital, which may well be outside the Essex border. The proposed county-based arrangements would fragment NHS commissioning for places in north-east Essex, Waveney and west Essex. There might be different commissioners for acute, community and primary care. These places can only fully realise the benefits of integration if they have the flexibility to align all NHS commissioning. Other parts of the country will be similarly affected.

The idea of coterminosity for the administrative convenience of county councils is, I am afraid, a bit like the tail wagging the dog. In 2018, across the UK as a whole, we spent £149 billion on the NHS, but only £22 billion on social care. How can it make sense to align NHS commissioning with social care boundaries? That is not integration with social care; it is disintegration of NHS commissioning, and why do it now, of all times? We would be destabilising our health and care infrastructure while we are not yet out of the pandemic, let alone free of the aftermath.

The focus needs to be on the recovery of services. Elective treatment waiting lists increased to 5.12 million in April—a record high. There are other options for Essex and Suffolk, and I dare say in other parts of the country as well, such as a two-county proposal, as many Essex and Suffolk MPs set out in our letter to the Secretary of State two weeks ago.

In conclusion—I want to give time for others to contribute—the new legislation could provide the opportunity for ICSs to build on their successes, but that will be impossible with the level of disruption that a change of boundaries would bring about. Conservatives should have learned the lesson that NHS reorganisations usually fail to deliver the benefits promised. That will be especially true if reforms are rushed through again, tearing up what has been so recently established. Boundaries are the contentious part of the reforms. It would be better to allow the current ICSs to implement the new legislation and then look at whether boundary changes are necessary, rather than trying to do both at the same time.

So often I have seen it happen: structural and organisational reform is imposed from above as a substitute for a full understanding of what is really going wrong and why. It is always hard to improve leadership and to promote the right attitudes and behaviours in large and complicated organisations, particularly the NHS, but the slowest way to achieve this is to have another structural organisation. Everyone stops thinking about the job they are doing and thinks only about what new job they are applying for. After the reorganisation everyone has to re-learn how their job works and to re-establish new relationships, but nobody has challenged the attitudes and behaviours, which are still holding the organisation back. So often the problems are about poor leadership, poor employee engagement and lack of stability, which yet more structural change just makes worse. I therefore urge my right hon. Friend to delay the decision concerning future ICS boundaries until after the pandemic, and to consult and explore alternative boundary proposals after the legislation has settled down.