Queen’s Speech

Lord Adebowale Excerpts

Wednesday 12th May 2021 Lords Chamber

[Lord Adebowale (CB)]

My Lords, in commenting on the gracious Speech, I will limit my remarks to matters relating to health and social care and the proposed Bill that will come before this House in due course. I declare my interest as chair of the NHS Confederation, which represents the leaders in health and social care across the country—the people who will be running the integrated care systems, the primary care networks, the acute trusts, the mental health trusts and the community trusts. It was in talking to my members that these remarks were formulated.

There is general welcome for the direction of the proposed health and social care Bill. The principles that have been set out in the gracious Speech in reference to this Bill—the notion of population health and of reducing both the inequality and the inequity gap that currently exist in our health and social care provision—are most welcome. It cannot be right that the active life expectancy—the expectancy of when your body and functions will start to break down—of a woman in Barking and Dagenham is 55 but in Richmond upon Thames is over 70. We must address that; it is both immoral and a poor use of public money.

My colleagues in the confederation welcome this Bill generally. However, given the warm words, there are four things that I wish to draw the House’s attention to, in the hope that, when the Bill comes to the House, we can take a deep dive into these issues to improve it and ensure that the intentions in the Bill are brought to fruition. I will say a bit about each of the issues, which are: the powers of the Secretary of State; the time for scrutiny; inclusion, about which I might not say what noble Lords think I will; and social care.

The first issue is the powers of the Secretary of State, which appear to be increased in their presence in the Bill and which are comprehensive in their ability to intervene in a way that flies in the face of the very principles of local flexibility that are required to improve health outcomes and address the health inequalities that we all want to resolve. The fact of the matter is that statutory allowances and accountability to Ministers in the current framework allow for many of the issues that need to be resolved in the reconfiguration of health and social care to be dealt with locally, and we cannot understand how the powers of the Secretary of State will add any value. There is indeed a risk that such powers will undermine the very intentions of the Bill, and that the priorities and powers of the statutory integrated care systems will be undermined by central intervention, especially where these interventions are on service changes that those very ICSs should be making. We have one of the most centralised health systems in the world, and we would urge Ministers not to legislate to further centralise it. In short, let local leaders lead.

Let us be clear about the interventions from the Department of Health and Social Care, NHS England and NHS Improvement. These interventions should be only when strictly necessary, and we should have transparency around how they occur. It would be useful to understand, perhaps through examples, where and when the Department of Health and Social Care or the Secretary of State believe intervention might be necessary. Just to be clear, we currently have independent reconfiguration panels that, following local authority referral, provide clear mechanisms for resolving disputes around local service reconfigurations. Let us have some clarity around the Secretary of State’s interventions. A requirement to make a public direction in writing, with a public interest test, might be something that the House wishes to discuss.

There is also some confusion around appointments to the powerful bodies that will be in the new health and social care structures. The Secretary of State will, I am sure, want to avoid these key posts being in any way politicised, and to confirm that local NHS organisations already have clear processes for the appointment of senior leaders, supported by good governance and, of course, the Nolan principles. Within the new powers, the Secretary of State can change the breadth of the powers of the arm’s-length bodies. I accept that the Secretary of State may need to change these powers, but we need to do so with transparency and with clear explanation, not through secondary legislation. Surely they should be discussed in this place and the other place.

The second point is about time. While the Bill is generally welcome, it needs sufficient parliamentary scrutiny. Judging by the number of emails I have had from the public, this Bill is of great public interest and should be given proper scrutiny. The time given for ICSs to be ready—by April 2022—is incredibly tight. There is understandable concern about aligning boundaries with uppity local authorities, for instance. According to clinical commissioning group leaders, given the time allowed, we would need to start appointing critical executive positions in these new bodies in September 2021.

Thirdly, on inclusion, it is critical that we include the voluntary community and social enterprise sector in the new structures, as 38% of community services are delivered by the social enterprises and the voluntary sector.

Fourthly and finally, I echo the concern and disappointment expressed at the total lack of mention of social care restructuring. We will shackle the future of the NHS and the great hopes for this Bill that are held across the health and social care sector unless we reform and properly fund social care. We need to do so in order to pay tribute to the leadership and hard work of my colleagues across the NHS and social care system. Let us not shackle this Bill; let us free it to do what the public and my colleagues want it to do.