Building an NHS Fit for the Future

Paula Barker Excerpts

Monday 13th November 2023 Commons Chamber

[Paula Barker (Liverpool, Wavertree) (Lab)]

The most Gracious Speech summed up the agenda, or lack thereof, of a tired Government: one who have run out of steam after inflicting considerable damage to our country over 13 long years and are intent on whipping up hate, manufacturing culture wars and sowing division, instead of a Government concerned with the bread and butter issues that matter to working people the length and breadth of Britain.

The Gracious Speech could have—should have—included significant measures to improve our public services and rescue our public sector from the state of permanent decline that those on the Government Benches have put it in. The NHS is on life support and so, too, are the Tory Government. Waiting lists are now approaching 8 million and NHS staff are forced to use outdated, creaking equipment, making their jobs harder. Meanwhile, those on the Tory Benches preoccupy themselves with minimum service levels and trade union bashing, rather than tackling the root causes of the recruitment and retention crisis gripping our health service. Those on the Tory Benches say that they want minimum service levels on strike days, but what is the Conservative plan to provide minimum levels of service on non-strike days?

As the Prime Minister brings back one of his predecessors to the heart of Government, let us not forget that it is the 13 years of public sector pay policy first initiated by the new unelected Foreign Secretary as Prime Minister that has led us to this point. Only yesterday, the General Medical Council warned the Government that a record number of doctors plan to leave the profession due to burn-out and dissatisfaction. It states that the long-term workforce plan has come too late. Indeed, many would say it represents too little, such is the scale of the problems that are now endemic in the NHS.

There was never a better time in recent history for the Gracious Speech to include the Government’s long-promised mental health Bill. Instead, the reform of the Mental Health Act 1983 has been shelved by the Government. The charity Mind is right when it proclaims that the Government have failed to prioritise mental health as well as broken their promise to thousands of people. Despite the Government promising to deliver 6,000 extra NHS GP appointments, patients are finding it impossible to see a GP because there are simply not enough GPs to meet the demand for care. Some of my constituents are being forced to perform DIY dentistry, because they are facing two-year waits for check-ups and some cannot even access an NHS dentist.

If we look at adult social care, we see that thousands of people are stuck in hospital beds who are medically fit to leave but unable to do so because the care they need in the community simply is not there. I am sure that all Members remember only too well the former Prime Minister—for the avoidance of doubt, let me remind them that this was three Prime Ministers ago—telling us that he would fix the broken social care system within the first 100 days of office. Nowadays, many Ministers do not even reach the heady heights of 100 days in office—just ask the lettuce.

Once again, the Gracious Speech contained nothing for renters, NHS staff or working people. The Government are again reaffirming their intent to turn their back on the most vulnerable in our society. The scars left by the pandemic, the volatility of the labour market and the cost of living crisis weigh heavily on millions upon millions of people in this country—on workers in the public and private sectors, and on those who cannot work.

The Government’s programme of austerity hit the very poorest in their first five years. Electorally, the Government were shielded from their own policies because—as he has now admitted—the then Chancellor, now the Prime Minister, changed the funding formulas to take money from deprived urban areas and give it to other parts of the country such as the leafy shires. However, now the chickens are coming home to roost, and it appears that no one is safe from the Government’s economic dogma, aside from their mates in the 1%—not homeowners, and not those on wages larger than the national average. Indeed, many are carrying the significant economic burden of our times, for themselves and their families.

When we have the highest tax burden since the second world war and the largest squeeze on wages in 200 years, the word “economy” featured just once in the King’s Speech. If anyone was in any doubt about the lack of a long-term plan from this Government, they should be in no doubt now. The Government do not have one. They are out of ideas, out of Ministers, and out of time. Last week’s King’s Speech was one of the last big moments that the Government had to turn the tide and come to the aid of our citizens in their time of need. Instead, they have signalled their intent to fill the vacuum left by a threadbare agenda with politicking, and with division rather than governing. The best thing they can do now for the British people is call a general election, and give Britain its future back.

Oral Answers to Questions

Paula Barker Excerpts

Tuesday 17th October 2023 Commons Chamber

[Steve Barclay]

Yes I will. I pay tribute to my hon. Friend for the way he has championed this issue. I have visited the hospital; I have seen it for myself. As he will be aware, the full business case was received by the Department this morning. While the cost has increased, it is still within the wider funding envelope for the scheme on that site and I will do everything I can to expedite the process as he asks.

[Paula Barker (Liverpool, Wavertree) (Lab)]

In recent months, there was a concerted campaign from the public to prevent the closure of Park View Medical Centre in Liverpool, which was subsequently closed by the Merseyside and Cheshire integrated care board. Not long after the conclusion of the campaign, during which members of the public were turning up to board meetings, the ICB announced that 50% of its meetings would now be held exclusively in private. I for one do not believe that that is a coincidence. What would the Secretary of State’s advice be to Merseyside and Cheshire ICB on transparency and accountability, and is it not time we looked at strengthening the guidance?

[Steve Barclay]

The hon. Lady raises an important point. I was not aware of that decision by the local ICB. As a principle, I think we can agree across the House that greater transparency on such meetings is important, so I will follow up on that. The Government are making significant investment into Merseyside; both Alder Hey Children’s Hospital and the Royal Liverpool University Hospital have been rebuilt at significant cost as part of this Government’s commitment to investing in the NHS estate in that area.

NHS Winter Pressures

Paula Barker Excerpts

Monday 9th January 2023 Commons Chamber

[Steve Barclay]

The measures announced today speak to the heart of that issue: by putting in more capacity to decompress emergency departments, we allow, in particular, more same-day emergency care, where patients can be rapidly assessed, diagnosed and treated without being admitted to a ward. By unblocking capacity on wards, we enable emergency departments to release patients, which in turn creates the capacity for ambulances to hand over patients. The delay in handovers from ambulances is caused where the emergency department is already at capacity and there is an understandable reluctance from clinicians for additional patients to come in. Freeing up capacity within the emergency department is therefore about the operation of same-day emergency care at the front door of the hospital as well as what is happening at the back door with delayed discharge.

[Paula Barker (Liverpool, Wavertree) (Lab)]

The Secretary of State has said that the Government will now block-book residential homes for hospital discharges, but social care is in crisis and has been for many, many years. Care workers are leaving the profession in droves, because of low pay and poor conditions. To prevent care workers from leaving to work for supermarkets or Amazon, what will he do to recognise their incredibly highly skilled work and pay them what they deserve? Unless we retain existing staff, the international recruitment drive is meaningless.

[Steve Barclay]

We need to both maximise international recruitment and retain existing staff. That is why the Chancellor, in the autumn statement, with all the other competing pressures that he faced, prioritised putting £7.5 billion into social care over the next two years—the biggest ever increase, under any Government. Alongside the announcement of a further £6.6 billion investment in the NHS over the next two years, that was about recognising the centrality of social care in the wider pressures on the NHS.

Access to GP Services and NHS Dentistry

Paula Barker Excerpts

Tuesday 21st June 2022 Commons Chamber

[Paula Barker (Liverpool, Wavertree) (Lab)]

I put on record that my husband is a senior manager in the NHS.

Dr Claire Fuller was commissioned by the Government to lead a national review of primary care. In her introduction to that review, she says that

“there are real signs of…discontent with”

general practice,

“both from the public who use it and the professionals who work within it.”

Every day, more than 1 million people benefit from primary care professionals and, by Dr Fuller’s own admission, primary care teams are over-stretched “beyond capacity”. Sadly, we have not heard anything today from the Secretary of State to address that issue.

GPs have been working in local communities for over 100 years. The concept has not changed: GPs are still based in their local community, with the only difference being that the buildings they work in are much more modern. GPs have now moved to a triage system, creating the perception that it is difficult to get a face-to-face appointment, and for some of my constituents that perception is reality. Bookable appointments have now moved to a longer lead-in time, from three to four weeks in advance to seven to nine weeks in advance. Nationally, there were half a million more appointments in January this year than in January 2020, but the number of GPs is roughly the same, despite the Government’s promise in February 2020 that they would recruit 6,000 more GPs by 2024. More than two years down the line, we are simply no further on.

People are frustrated and angry that they are being contacted by GP surgeries to book in for a health check, yet cannot get to see their GP when they feel unwell. While it is undoubtedly important for GPs to carry out health checks, which can enable interventions, that cannot be at the expense of routine appointments. Those health checks are on an enhanced service contract, meaning that the GP is paid for every patient who takes them up. That is in addition to their normal contractual obligations, so it is no wonder that patients are frustrated. At the NHS Confederation last week—the gathering of more than 5,000 senior NHS managers and staff—which the Secretary of State said he attended, the single biggest area of concern was workforce.

We must ask ourselves why the guidance from NHS England predominantly concentrates on emergency care, rather than urgent care. It talks about how many people are waiting in accident and emergency, how many ambulances are delayed, and how many people cannot be discharged on time. Those are all important subjects, but that emphasis diverts people’s attention from the important point that the part of the NHS that deals with 90% of patient needs, GPs, only receives the crumbs off the table: 9% of the budget. It is time for the Government to deliver on their promises to recruit more GPs. The biggest threat to the NHS is crippling workforce shortages. If those shortages are not resolved, the Government will eventually start saying, “The NHS is failing.” That will, in turn, lead to the hedge funders coming in and taking over.

Our NHS staff are underpaid, undervalued and under-resourced, and are then blamed by this Government—this Government who have been in power for 12 years. Meanwhile, patients are struggling to get GP appointments and, often, when they call 111, they are advised to present themselves at A&E. This Government are hellbent on turning the NHS into the national hospital service, rather than the national health service. The model of primary care must change, and change for the better, to enable our constituents to access GP services in a timely and appropriate manner. Quite frankly, nothing less is good enough.

Vaccination: Condition of Deployment

Paula Barker Excerpts

Monday 31st January 2022 Commons Chamber

[Sajid Javid]

I understand my hon. Friend’s question. When the evidence changes—or, in this case, the change in the variant from delta to omicron—Ministers receive different advice. That advice always comes with up-to-date legal analysis as well, and that legal analysis is certainly taken into account when making a decision.

[Paula Barker (Liverpool, Wavertree) (Lab)]

Like the hon. Member for Broxbourne (Sir Charles Walker), I too am angry. I am angry because, in December last year, I twice asked the Secretary of State to pause and let us do this via consensus, rather than by making it mandatory. The language we use in this place is extremely important, and the Secretary of State has spoken this evening about care workers and their “choice” to be sacked. What I say is that they did not choose to be sacked. This Government chose not to give them appropriate personal protective equipment at the height of the pandemic. This Government chose to discharge elderly patients into care homes at the height of the pandemic. That is the real choice that this Government have made. Will the Secretary of State re-evaluate? Will he go back and apologise to those care workers, some of the lowest paid in our labour market, and ensure that they have continuity of service and of pension contributions?

[Sajid Javid]

Where the hon. Lady and I will absolutely agree is on the service that we have seen as a country from care home workers and domiciliary care workers over the pandemic. It has been the test of a lifetime for anyone working in that sector and each and every one of those people has risen to that challenge and provided the best care that they could in the most difficult circumstances. As the hon. Lady will know, there is an inquiry into the pandemic, where I am sure that many of the issues will be looked at, such as whether better support could have been provided under the circumstances. Looking ahead, however, it is important that we continue to do everything we can to continue to support that vital sector.

Public Health

Paula Barker Excerpts

Tuesday 14th December 2021 Commons Chamber

[Paula Barker (Liverpool, Wavertree) (Lab)]

Given time, I will concentrate my comments on mandatory vaccinations for NHS staff. I find myself really torn on this emotive subject, and I also find myself trying to apply logic to what is quickly becoming an illogical argument from the Government Benches. If it is really about patient safety, the Government should already have identified workers in the NHS who are still unvaccinated and have been working with them to alleviate fears and concerns and remove barriers. The Secretary of State should explain to the House why it is acceptable for those in the NHS who remain unvaccinated to work on the frontline to assist with the omicron crisis but, come 1 April, to be dismissed. Quite frankly, it makes no sense.

Comparisons have been drawn with the requirement for NHS staff to be vaccinated against hepatitis B. The reality is that chapter 12 of the Public Health England Green Book, which provides the latest information on vaccines and vaccinations, states:

“Hepatitis B vaccination is recommended for healthcare workers who may have direct contact with patients’ blood or blood-stained body fluids.”

It is not the law. The Government proposal will see these workers work around the clock during the next few weeks and months, only to be dismissed on 1 April if they do not succumb to mandatory vaccination.

[Andy McDonald]

Does my hon. Friend agree that if these measures will come into force at the beginning of April and the parties concerned are to participate in a framework agreement for their roll-out, there is an ideal opportunity for those parties to work through how they may be implemented? By rushing the measures today, we are being robbed of that opportunity, despite the noises from the British Medical Association, the unions and the royal colleges.

[Paula Barker]

I thank my hon. Friend for that excellent point, which I agree with wholeheartedly.

The workers I am talking about are the workers who worked around the clock at the start of the pandemic, despite having inadequate personal protective equipment, because they were putting the nation first. They are the workers who will continue to work around the clock over Christmas and the new year. In an institution that is built on consent between patient and clinician, the Government are ripping up the rulebook to suit their own ends, while at the same time we are seeing the 17th reorganisation of the NHS since 1993.

We clapped for our care workers and NHS staff on a Thursday, and they will get us through the latest crisis over Christmas and the new year. But now the Government, who ripped up the rulebook last Christmas while the rest of us obeyed the rules, sacrificing seeing our loved ones—some in their final moments—are going to dismiss workers in April. And all this while No. 10 and the Department for Education not only had Christmas parties but told this House and the nation that they did not. The message is inconsistent and makes no sense.

We are told to trust the Government, but it is increasingly concerning that they are reviewing the Human Rights Act and want to replace it. We should be very afraid, because this could be a sign of things to come from a Government and a Prime Minister who believe they are above the law. Even worse, if they do not like the law and it does not serve their purpose any more, they will rip it up and start again until they get the policy or the outcome they want, irrespective of civil liberties or economic damage.

The right to choose, particularly when it comes to our own bodies, is something we should all take very seriously. I implore everyone to get vaccinated and boosted to protect themselves and others, but the Government have set a precedent that should worry every citizen. For the first time ever, we have seen the profession of care workers singled out; they have had conditions attached to their employment status that were never there to begin with.

There is so much that the Government could do in the weeks and months ahead, from constructive negotiations with the trade unions, which remain opposed to mandatory vaccinations, to ensuring that local authorities and health services have the resources and capacity required to deliver the ambitious daily targets for boosters, and that statutory sick pay is set at the Living Wage Foundation rate. Most importantly, they could follow the rules themselves, to give the public confidence that any measures introduced are proportionate and necessary.

Before entering this place, I represented care workers, NHS staff and public servants, many of whom are now my constituents. I take very seriously my responsibility to ensure that their voices are heard, while trying to balance that with the unprecedented situation before us and the importance of public health. I think we can do just that by consensus rather than compulsion.

I implore the Government to pause on the issue of mandatory vaccinations, withdraw the relevant statutory instrument and work on the issue with the trade unions, the Labour party and all those in the House who offer cross-party support. The Secretary of State himself has said that we have seen an increase in vaccination rates since the start of the consultation. Please, remove the SI and let us work together to get the country vaccinated.

Covid-19 Update

Paula Barker Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

I welcome that question from my right hon. Friend. What I would say to her is that with the risk we see from omicron at this point in time—the rise in infections, the increased risk of hospitalisation and the information we have on vaccines—we think we have taken the appropriate response. It is a balanced and measured response. It is designed to protect so much of what we love in our country, especially the interests of our children. The most important thing to focus on now is the booster programme.

[Paula Barker (Liverpool, Wavertree) (Lab)]

First of all, I encourage everybody to be vaccinated and to have the booster jab. I am delighted that the Secretary of State has moved away from passports to people having an LFT if they cannot show their covid pass. I thank Labour Front Benchers for the work they have done, too. The Secretary of State talks about the incredible work the NHS is doing and what it will do over the next few weeks, but will he pause his plans for mandatory vaccination of all NHS workers, have conversations with the trade unions and come up with a plan for it to be by consent, rather than mandatory?

[Sajid Javid]

First, I agree with the objection I think the hon. Lady had to vaccine passports as a requirement for people to be vaccinated to enter a high-risk venue. It is important that we focus on a test requirement with an exemption if one happens to have the right level of vaccination. On her question about mandatory NHS vaccination, however, I am afraid I have to tell her we will not pause what we have already announced, not least because—this is the view of the NHS leadership as well—omicron has made it even more urgent that we continue with it.

Health and Care Bill

Paula Barker Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Mary Kelly Foy]

I thank my hon. Friend for that intervention. A theme throughout these new clauses is that most people start smoking when they are children or when they are young, and most of them say that they wish they had never started. The new clauses would tackle young people’s access to tobacco-related products.

[Paula Barker (Liverpool, Wavertree) (Lab)]

It is often vulnerable children, and often those in care, who start smoking early, so does my hon. Friend agree that it is incredible that the Government have so far said that they will not support these new clauses?

[Mary Kelly Foy]

Yes, it is absolutely incredible. We have heard that a tobacco plan might be on its way, but every day that goes by without our putting these recommendations in place is another day on which someone dies of tobacco harm, and on which more young people become addicted to nicotine products.

Discussions with the Treasury on the “polluter pays” levy would not be necessary. The Food and Drug Administration administers the user fee in the United States, and the Department of Health and Social Care could and should administer such a scheme here.

New clause 11 has been revised in the light of the Government’s response to our proposal in the Committee, in which they cited the need to

“review the evidence base of increasing the age of sale to 21 in more detail”.––[Official Report, Health and Care Public Bill Committee, 28 October 2021; c. 816.]

They also stated the need for a public consultation. I agree that a consultation is the appropriate next step, so the new clause has been revised to require the Government to consult on raising the age of sale for tobacco from 18 to 21 within three months of the passage of this legislation.

To sum up, my new clauses address loopholes in the law. They would take incremental and obvious next steps to strengthen tobacco regulation still further, and they would provide the funding that is desperately needed to deliver the Government’s smoke-free 2030 ambition—funding that the spending review failed to deliver. When I was chair of the Gateshead tobacco control alliance, I saw the damage that smoking can do. It shortens life expectancy, increases the pressure on our health services, drives down productivity and drains wealth from our poorest communities—and for one in every two smokers, it will kill them. Eventually, the Government will have to accept that the measures proposed are necessary. The only question is how long they will wait, and how many lives will be ruined by tobacco in the meantime. I urge the Government to accept these new clauses in full.

--- Later in debate ---

[Edward Argar]

I have already given way to the hon. Lady, so I will not do so again.

I thank the hon. Member for Bristol South for her words, but the situation is not as she characterises it with my having been dealt a difficult or challenging hand this evening. I am proud to stand here and defend this Government as the first Government to make changes to tackle the social care challenges that this country faces.

[Paula Barker (Liverpool, Wavertree) (Lab)]

Will the Minister give way?

[Edward Argar]

I have given way a number of times and I want to make some progress. I will be winding up the debate, so hon. Members will have the opportunity to come back in then.

--- Later in debate ---

Let me turn to the amendments that the Government are introducing on the membership of integrated care boards. Government amendments 26 to 28 are minor and technical, and simply make it clear that the constitution of an ICB may provide for more than one member to be nominated by NHS trusts and NHS foundation trusts, primary medical service providers or local authorities. The proposed legislation sets out the minimum membership of the integrated care board, which needs to include members nominated by those bodies. However, local areas can go beyond the legislative minimum requirements in order to address their local needs. We want to make it clear that that includes being able to nominate more than one member from those sectors to sit on the board, if that is what is best for the local system.

[Paula Barker]

Will the Minister give way?

[Edward Argar]

On ICBs, but not on new clause 49. We have moved on and I need to make some progress, because I know that many Members want to speak.

[Paula Barker]

I thank the Minister for giving way; he has been very generous with his time. Does he agree that if true integration and genuine parity of esteem are to be achieved, it should be written into law that local authorities should have a seat on the ICB?

[Edward Argar]

Local authorities will have a seat on ICBs and on ICPs. The approach set out in the legislation is appropriate. We have sought throughout for it to be permissive, not prescriptive, and that remains the right approach.

Menopause (Support and Services) Bill

Paula Barker Excerpts

2nd reading
Friday 29th October 2021 Commons Chamber

[Paula Barker (Liverpool, Wavertree) (Lab)]

I start by reflecting on the importance of these sitting Fridays. They are full of noble pursuits, with hon. Members trying their utmost to leave their small stamp on the world.

To my hon. Friend the Member for Swansea East (Carolyn Harris), whether it is this Bill today, or measures on gambling machines, school holiday hunger and child funeral costs, she always champions the right and just causes, using her voice in this place to elevate the voices of those who feel that they have been long forgotten. I congratulate her and thank her for the support that she has always given me.

Madam Deputy Speaker, perhaps this will come as a surprise to you, as it will, I hope, to everyone in this place today, that I, too, am a woman of a certain age. The challenges that women face in this place are great. Many women may be starting families or raising young families and I can only imagine how difficult that must be.

I was first elected in December 2019, not long ago, and my two sons were of high school age. I had avoided such challenges, but new ones presented themselves. I want to briefly share a little of my personal experience. A number of years ago, I had a blood test and went to get my results. I was told by the GP quite incredulously, “You are in your 40s and peri-menopausal.” A few weeks ago, I contacted the GP to ask for a referral to the women’s hospital in Liverpool to go to the menopause clinic. He asked me why. I said that I wanted to discuss HRT. He said, “We can prescribe HRT.” I replied, “I was told I had to discuss that with the nurse, and last time I discussed my symptoms with her, she prescribed anti-depressants to me when I wasn’t depressed. I also asked her how long I needed to take the medication for. She told me, ‘Forever’.”

That story is not unique; it is the story of so many women. Whether it is brain fog or migraines, whether it is hot flashes—which I have suffered incredibly from all morning—weight gain or overwhelming tiredness, as a perimenopausal women, I know all these signs and symptoms to be true and real, and I appreciate the toll that it can take on physical and mental health.

Despite my challenges, I know how lucky we in this place are. The challenges that perimenopausal and menopausal women must negotiate in the workplace are many and sometimes complex. Many co-workers simply do not understand bosses and shift managers concerned at the drop in productivity, the changes in mood and the need for time off, given the irregular periods, bladder problems and much else besides. There are no warning signs, and no timeframe is set out by our bodies, which are all unique and respond very differently.

As my hon. Friend the Member for Swansea East set out so eloquently with her Bill, we should abolish prescription charges for HRT right away, and what is so evidently lacking is a national conversation on the menopause. That is why clause 2 is so important.

[Gerald Jones (Merthyr Tydfil and Rhymney) (Lab)]

I congratulate my hon. Friend the Member for Swansea East (Carolyn Harris) on her campaign, which she has delivered in her inimitable and passionate style, which we know and love. As well as awareness in medical school and in the workplace, does my hon. Friend the Member for Liverpool, Wavertree (Paula Barker) agree that it is hugely important that we have awareness across society? Until this campaign, my awareness of menopause was shockingly bad and awareness in society, particularly among men, is really important.

[Paula Barker]

I thank my hon. Friend for his intervention. I was going to say that education and awareness for those of school age right through to GP practices should form the backbone of a new dawn for women, who so often feel alone and frustrated that men around them just do not get it.

Finally, I say to my hon. Friend the Member for Swansea East: “From one sister to another, I stand with you today and with every woman out there who needs to know that someone, somewhere has got their back.”

Future of the National Health Service

Paula Barker Excerpts

Wednesday 22nd September 2021 Westminster Hall

[Paula Barker (Liverpool, Wavertree) (Lab)]

It is a pleasure to serve under your chairship, Ms Bardell. I thank my hon. Friend the Member for Leeds East (Richard Burgon) for securing this important debate. I know that 83 of my own constituents signed the petition, and many more have emailed me expressing concerns about the Government’s Health and Care Bill. I concur with those concerns.

Over the last 18 months, billions have been wasted on failed track and trace systems and failed personal protective equipment contracts that have been awarded to mates down the pub, while our amazing NHS workers have not received the pay rise that they deserve. Of course, we want to see greater collaboration between health and social care services, especially on the back of the ongoing pandemic and the lessons that we have drawn from it. No longer can health and social care services work in silos. We saw how social care, particularly residential care, played second fiddle to the NHS in the early part of the pandemic. That is superbly illustrated by the Channel 4 drama “Help”, based in my city of Liverpool. However, I am resolute that the Health and Care Bill must be paused, as too many questions remain unanswered. I will try to outline some of those questions.

We can expect integrated care boards to spring into life in the new year. They will, certainly in a governance sense, vary from area to area. While having a place-based strategy that is responsive to local health needs and inequalities is welcome, we cannot be subject to a postcode lottery, with the influence of private providers greater in some areas because they have been awarded places on the boards and others have not. Nothing in the draft legislation prohibits such a conflict of interest, nor is it clear anywhere that the NHS is the preferred provider for medical and clinical services. The potential for interference from the Secretary of State for Health is a major cause for concern when it comes to awarding contracts, particularly given the Government’s own support for privatisation.

On the integration of health and social care services, I remain a sceptic, even if the intentions are sound. I fear that there is a real risk that adult social care will be the poor relation to a resource-hungry NHS, especially with a huge elective care backlog. That is the only conclusion we can draw from the Prime Minister’s announcement of extra spending on health services and the non-plan for social care. Out of £36 billion, £5.4 billion over three years to be put aside for social care is not enough and will not make an tangible difference for local authorities, as the primary commissioners of adult services.

Locally pooled NHS and local government adult care budgets—if that is to be the direction of travel—could well enhance the provision of adult social services, but equally the reverse could be true. That is why, through integrated care partnerships, the importance of place and locality is emphasised as part of every established integrated care board. Accountability must float sideways, down and up. It is essential that integrated care boards must be held accountable by ICPs and vice versa, right through to smaller partnerships working at local level. Local government needs to be front and centre of the development of any integration strategy, as the custodians of adult social care.

The draft legislation should mandate ICBs to develop comprehensive workforce strategies in their localities. Labour councils in my own north-west region, alongside Unison North West, are already engaged in such work, but are coming up against an unforgiving social care market, with too many providers refusing—yes, refusing—money to increase the wages of their staff. Many of the Labour amendments and others will significantly improve the Bill and answer many of the questions I have raised. Sadly, I suspect the Government will not give them a fair hearing.