Health and Care Bill

Debate between Lord Beamish and Jonathan Ashworth

2nd reading
Wednesday 14th July 2021 Commons Chamber

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

I beg to move an amendment, to leave out from “That” to the end of the Question and add:

“this House declines to give a Second Reading to the Health and Care Bill, notwithstanding the need for a plan for greater integration between health services and social care services and for restrictions on junk food advertising to improve population health outcomes, because the Bill represents a top down reorganisation in a pandemic leading to a loss of local accountability, fails to reform social care, allows further outsourcing permitting the private sector to sit on local boards and fails to reinstate the NHS as the default provider, fails to introduce a plan to bring down waiting lists for routine NHS treatment or tackle the growing backlog of care, fails to put forward plans to increase the size of the NHS workforce and see them better supported, and fails to put forward a plan that would give the NHS the resources it needs to invest in modern equipment, repair the crumbling NHS estate or ensure comprehensive, quality healthcare.”

Well, the Secretary of State talked a lot, but he did not say very much. Look at the context of where we are. Yesterday, we recorded 36,000 covid infections. Hospital admissions have increased to over 500 a day, up 50% in a week. Waiting lists are at the highest level on record, currently at 5.3 million. Some 336,733 people have been waiting over a year for treatment, over 76,583 people are waiting over 18 months, and over 7,000 people are waiting over two years. Some 25,889 people are waiting more than two weeks from urgent referral to a first consultant appointment for cancer. Emergency care is grappling with some of the highest summer demands ever seen. Two hundred and fifty thousand people are waiting for social care. NHS staff are exhausted, facing burnout. We went into this pandemic with 100,000 vacancies across the NHS and a further 112,000 vacancies across social care.

The answer from the Secretary of State is to embark on a top-down reorganisation when we are not even through the pandemic—a reorganisation that will not deliver the integration needed, because reforms to social care are delayed again; a reorganisation that will not deliver more care but in fact, in periods of stretched health funding, could well deliver less care; and a reorganisation that is, in effect, a Trojan horse to hide a power grab by the Secretary of State.

Let us be clear why this reorganisation is taking place. The Government have come forward with this Bill because of the mess of the last reorganisation—the mess that the Secretary of State supported and voted for, and the mess that he spoke out for in this House, saying that it would modernise the NHS and that the

“concept of GP commissioning has been widely supported by politicians from all parties for many years. May I urge my right hon. Friend to keep putting patients first by increasing GP involvement in the NHS?”—[Official Report, 4 April 2011; Vol. 526, c. 773.]

Why, if he believed that then, has he U-turned now? And it was a mess that we warned of. My hon. Friend the Member for Leicester West (Liz Kendall), who opposed that Bill in this House, warned the Government that it would increase bureaucracy and increase the fragmentation that the Secretary of State has just complained about from the Dispatch Box.

Ministers said that that reorganisation under Lord Lansley would reduce bureaucracy, and Back Benchers told us that it would reduce bureaucracy, but what ended up happening? Billions were wasted and thousands of NHS staff were made redundant. That was the Government’s priority then, and now they are asking us to clean up their mess today. They also told us that that reorganisation would improve cancer survival rates, and where are we today? We are still lagging behind other countries on cancer survival rates. Perhaps the Secretary of State could have come to the Dispatch Box and apologised for that Lansley reorganisation and 10 wasted years.

The Secretary of State talked about NHS leaders, but the truth is that NHS leaders asked for a simple Bill to get rid of the worst of the Lansley restructuring and instead re-embed a sense of equity, collaboration and social justice in our NHS structures. That is not what this Bill is. Of course, the Secretary of State secretly agrees with me. According to The Times, he wrote to the Prime Minister saying that there were “significant areas of contention” that were yet to be resolved with the Bill, and that he wanted to delay it. The Secretary of State was only back five minutes and already Downing Street was overruling him. When it overrules him on his choice of spin doctors, he walks; when it overrules him on the future of the NHS, he puts his career first and stays in the Cabinet.

I listened carefully to the case made by the Secretary of State. He talked of the need for greater integration between health and social care and the need to provide better co-ordinated care, and he referred to an ageing population.

To be frank, that was a speech that Health Secretaries and their predecessor Social Services Secretaries have been making more or less since 1968, when Richard Crossman proposed the first set of NHS reorganisations. Indeed, there were echoes of the Secretary of State’s speech in that made by his predecessor Keith Joseph, when he came to this House in 1972 to set up the area health authorities, bringing together hospitals and community care and working more closely with local authorities because we needed seamless care. Those authorities were of such a size that, within a year, they were rearranged again into district health authorities. Given the size of some of the integrated care systems that the Secretary of State is proposing, I suspect that the seeds of the next reorganisation are being sown today.

Yesterday, the Secretary of State told the House that his

“three pressing priorities for these critical…months”

were

“getting us…out of this pandemic…busting the backlog”

of non-covid care, and

“putting social care on a sustainable footing for the future.”—[Official Report, 13 July 2021; Vol. 699, c. 163.]

But absent from his speech was any credible explanation of how this reorganisation will meet his objectives that he outlined to the House yesterday. In fact, in the last 30 years, we have seen around 20 reorganisations of the NHS. Have any of them delivered the outcomes that Health Secretaries have promised from the Dispatch Box? Well, not according to analysis in The BMJ, which observes:

“Past reorganisations have delivered little benefit”.

Why should this one be any different?

The question for me is: how will the 85-year-old with multiple care needs experience better whole-person care as a result of the restructuring that the Secretary of State is embarking upon? How will waiting times for elective surgery for cancer and mental health be improved by this reorganisation? How will health inequalities that have widened and life expectancy advances that have stalled be corrected by this reorganisation? To those questions, the Secretary of State had no answer today: the Bill fails those tests because it is a badly drafted Bill and could in fact even worsen health outcomes.

Let me outline our specific concerns. On the proposed integrated care boards, the Bill collapses the remaining 100 or so clinical commissioning groups into 32 integrated care systems differing in geographical size and with some covering populations up to 3 million or 4 million. In some parts of the country, the ICSs are not based on the NHS agreed boundaries, but currently on centrally drawn-up boundaries for political reasons. We know that Cheshire will be combined with Merseyside. Glossop is cut off from Greater Manchester and allocated to Derbyshire. Frimley is split up, leading the former Prime Minister, the right hon. Member for Maidenhead (Mrs May), to complain in an Adjournment debate recently:

“Do not break up Frimley ICS. Just for once, let common sense prevail.”—[Official Report, 29 June 2021; Vol. 698, c. 238.]

These boundaries and the way in which they were proposed by the previous Secretary of State, the right hon. Member for West Suffolk (Matt Hancock), prompted NHS Providers to warn that the disruption could lead to

“a worsening of patient care”.

And then, of course, we have the design of the integrated care system, split across two committees—a partnership board containing people from local authorities, the third sector and others, and then an NHS board responsible for spending the money, for commissioning. The Secretary of State has moved away from GP commissioning, of course; he wants the NHS board to commission now. Those two boards will probably have different chairs, but the NHS board only has to have “regard” to the partnership board strategy. Nor is it clear how local authority seats—the one local authority seat—will be decided when they cover more than one council and possibly even councils of different political persuasions, so we will see how a consensus can be built then.

Other important voices are left out. Mental illness accounts for roughly a quarter of the total burden of illness, yet there is no guarantee that mental health providers will get the seats on these boards, when we know that mental health services are under pressure and the Secretary of State tells us that the mental health backlog is one of his personal priorities. The pandemic has also reminded us that the health and wellbeing of our community is not just in the hands of large hospitals or general practice. It is also in the hands of our directors of public health, who have shown exceptional local leadership throughout this crisis, standing on the shoulders of their forebears, who in the past confronted diseases such as cholera, smallpox and diphtheria. Test and Trace would have been far safer in their hands from the outset, by the way, and what is their reward? They are sidelined. Public health, again, should be properly represented on the NHS boards and we will table amendments to that effect.

[Mr Kevan Jones]

Does my right hon. Friend agree that it is not just about their being sidelined; it is actually about the budgets for public health, which have been pushed off into the autumn? If the consultation paper that went out last year is anything to go by, County Durham would lose 19% of its budget. How can we effect these changes without its being divorced from what will be provided in terms of cash?

[Jonathan Ashworth]

My right hon. Friend is absolutely right. I will come to the financial flows in a few moments. But how on earth can we have a triple aim of trying to improve health outcomes for a population and not even give public health a voice and a seat on the decision-making body that decides health plans for an area?

The Secretary of State talks about integrating health and social care. There is no seat for directors of adult social services on these committees, either. And what about patients? Patients were not mentioned very often by the Secretary of State in his speech. Patients will always come first for the Opposition. They have no mandated institutional representation, either—no guaranteed patient voice—so we have yet another reorganisation of the NHS whereby patients are treated like ghosts in the machine. It is utterly unacceptable. This is fragmentation, not integration, with a continued sidelining of social care.

There is a loss of local accountability as well, because there is no explicit requirement that the boards meet in public or publish their board papers. Although NHS England has stated that that is its preference, it is not required; nor is there any commitment, despite the wide geographical spread of some ICSs, for meetings to be made accessible online. But, of course, the White Paper did indicate that the independent sector could have a seat on an ICS, and the explanatory notes to the Bill state that

“local areas will have the flexibility to determine any further representation.”