Health and Care Bill

Lord Bradley Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Bradley (Lab)]

My Lords, I declare my health interests in the register. I am pleased to speak in this debate and add my congratulations to the noble Lord, Lord Stevens of Birmingham, on his excellent maiden speech.

The Government set out their laudable intentions to integrate health and social care some years ago. In 2018, they changed the name of the Department of Health to the Department of Health and Social Care. I believe that that was a step in the right direction but progress since then has been woefully slow. Recent initiatives have tended to reinforce the separation of the two services rather than their integration, and have not led to the development of seamless pathways of care centred on the needs of the individual. With this Bill strangely pre-empting a further integration White Paper, the Government seem more concerned with the architecture of the NHS, recentralising powers and decision-making to the Secretary of State than with having a genuine ambition to devolve powers to local communities to deliver efficient and effective integrated services.

Belatedly and controversially, a new clause was introduced in the Commons to set up a new funding stream for social care, but it was not clearly ring-fenced for the purpose, with most of the money initially going to support the NHS further. While that money is much needed by the NHS to tackle appalling backlogs of care, it ensures that the current crisis in social care is not addressed—particularly, as we have heard, the dire workforce situation and the failure to address funding for local authorities, where the demand on them for social care provision also remains critical.

Despite these reservations, I am sure we all want to see a system develop that genuinely addresses proper health and care integration. So much work will be done during Committee and beyond to try to improve and shape that ambition, including full scrutiny of the social care funding clauses. As a starting point today, I want briefly to raise two issues.

The first is clarity about service planning at local place level. Local services such as primary, community and many secondary care services require planning, oversight and management at local level. This Bill allows ICSs to delegate resources and responsibility to place-level entities, but there is no statutory framework for the form of local commissioning bodies or their governance and relative accountability relationships. With the abolition of clinical commissioning groups, it is unclear to me how this important function will be fulfilled in the future. I hope the Minister will be able to clarify that point later this evening.

The second issue is the structure and governance of ICSs. A dual structure is planned for ICSs, with the integrated care board and a partnership board. There is obviously a risk that ICBs will be dominated by acute trusts, with other services being relegated to the partnership board. In my view, it is essential that if, for example, parity of esteem between mental and physical health is to mean more than words, mental health trusts are recognised in statute to sit on the ICB. Similarly, it is essential that allied health professionals such as speech and language therapists and the voluntary sector are at the ICB table to ensure their voices are heard loudly and locally. Finally, how will the public voice be heard, to ensure that the best interests of the health of local populations are duly considered? I would welcome the Minister’s views on this when he winds up.

I hope the Government will listen carefully to the concerns and issues raised in our debates on the Bill in order to ensure that this is not another missed opportunity to make a proper step forward, not only in the integration of health and social care but towards early intervention and prevention programmes which tackle the root causes and determinants of ill health and health inequality, as was brilliantly articulated recently by Professor Sir Michael Marmot and his team in my home area of Greater Manchester. As Archbishop Desmond Tutu famously said:

“There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.”


That should be the guiding principle during our deliberations on this Bill.