Health and Care Bill

Baroness Bennett of Manor Castle Excerpts

Lords Hansard - Part 1 & Report stage
Tuesday 1st March 2022 Lords Chamber

[Baroness Young of Old Scone (Lab)]

My Lords, the noble Baroness may wish not to be churlish, but I would regret it if I could not be a little churlish. I declare an interest as chairman of the Woodland Trust and vice-president of a range of environmental and conservation organisations. I thank the Government and the Minister for the assurances given. I also thank the noble Lord, Lord Stevens of Birmingham, for his shuttle diplomacy between the churlish and the less churlish in achieving these very welcome amendments.

I will press the Minister a little further on what she said, just to make sure that we are completely clear. The guidance will be crucial, and I am glad to see that it will be issued initially within 12 months of Royal Assent. I just want the Minister to clarify that the guidance on procurement will cover the need not just to reduce emissions through the NHS supply chain but to secure the other environmental targets, such as those set by the Environment Act. The preamble says that, but I want to make sure there is clarity in Hansard that the guidance will ask for procurement to do not just the climate change job but the other job.

Although the duties on the trusts, ICBs and NHS England include climate change, adaptation to climate change and improving the natural environment, most of the examples the Minister gave revert back just to climate change. The proposed new section in the amendment is headed up:

“Duties as to climate change etc”.


It is the “etc” that I am rather interested in. I think we should spell out more clearly what that is.

Can the Minister assure the House that the guidance will include performance in all three areas—climate change, adaptation and the wider environmental objectives set by the Environment Act and in other places? Because of the massive threat that climate change represents, it is very easy—we all fall into this trap—to squeeze out focus on the other, equally vital environmental areas. We have to remember that if we want to defeat climate change, we also have to defeat biodiversity decline and a range of other environmental factors. I hope the Minister can give these assurances to the more churlish among us.

[Baroness Bennett of Manor Castle (GP)]

My Lords, my speech follows rather neatly from that of the noble Baroness, Lady Young of Old Scone. I will begin not by being churlish but by turning this around the other way and declaring my position as a member of Peers for the Planet and paying great tribute to the noble Baroness, Lady Hayman, who has so led the Government in the right direction on this Bill—as on the Financial Services Act, to think of a recent one before this. I would like to think that maybe it has got a little easier this time than it was on the Financial Services Act, so maybe we are progressing to the point where a Bill will arrive in your Lordships’ House with climate and environment already there, and we can just focus on trying to strengthen and improve it.

--- Later in debate ---

[Baroness Bennett of Manor Castle (GP)]

My Lords, I am delighted to contribute to this rich and important debate, and particularly to speak to Amendments 10 and 13 in my name.

Commenting on the words of the noble Baroness, Lady Meacher, about the importance of public health, I would stretch that much more broadly than the examples that she gave. It really ties to the previous group, where we were talking about how climate change and the nature of the environment are related to health. A public health approach really is talking about ensuring that we have a healthy environment, that we prevent illness and malfunction. If we do not have that approach in the ICBs, that is a real problem.

I agree with the noble Lord, Lord Bradley, that government Amendment 31 is useful but not sufficient to deal with the issues that are raised by this group of amendments. The Green group very much agrees with Amendments 9 and 12 and will support them should we get to that point.

I declare my interest as a vice-president of the LGA and the NALC, which may be relevant here. In speaking to Amendments 10 and 13, I declare exactly where I come from. It was the Royal College of Nursing that persuaded me that these amendments should be here. It is very much the college’s case that I now present.

To begin with a little bit of history, as part of the statutory regulations of the Health and Social Care Act 2012, it was mandated that registered nurses would be part of the governing body of clinical commissioning groups. If we look at Regulation 11 of the National Health Service (Clinical Commissioning Groups) Regulations 2012, we see that a CCG governing body must have at least one registered nurse within its membership. This will be lost if it is not required within the leadership of the integrated care boards.

This ties to a point made by the noble Lord, Lord Bradley, that sometimes there are very powerful forces in medicine. It also relates to the points made by the noble Baronesses, Lady Thornton and Lady Brinton, about the powerful force of private interests in medicine. Other truly important voices often get swept aside. It is worth noting that in the NHS in England, registered nurses are more than 49% of all professionally qualified clinical staff. They have a unique relationship with patients and clients which gives them a different insight to other professionals on how the service works, and in ensuring that measurement of performance reflects the interests of patients and clients.

In representative volume terms alone, the case here is very clear. Registered nurses lead, innovate, and deliver the largest proportion of care, and their leadership brings critical expertise, advice and challenge into boards. Without this clinical leadership, there is a risk that service design and delivery become a matter of financial accounting, without proper attention being given to quality and outcomes for patients and clients, or that there is a focus on the heroic interventions rather than on day-to-day care or on the importance of rehabilitation, on which we heard a lot of debate in Committee and which is an area to which our registered nurses bring particular skills.

It is not my intention to move these amendments, but I hope that the Government will listen to the case being put by what is a hugely important professional body and a hugely important body of professionals, and that we see action taken after this debate to make sure that registered nurses are represented.

[Baroness Watkins of Tavistock (CB)]

My Lords, I rise to speak to the amendments in my name and to support those of the noble Baroness, Lady Hollins, who earlier described the need to standardise the knowledge and experience of commissioners, given the potential significance of their decisions.

The Government rightly suggest that there must be some flexibility so that integrated care board membership best reflects the competences needed to commission for local populations. However, unless regulations stipulate essential criteria for members’ collective skills, knowledge and experience, we risk falling into old habits of medical paternalism. That will undermine efforts towards more integrated, holistic care and mental health needs may be given cursory regard. The voices of nurses—as so ably outlined by the noble Baroness, Lady Bennett of Manor Castle—and other professionals will not be heard.

I would like to share with the House a well-known quote in organisational management: “Every system is perfectly designed to get the result it gets”. We now have the opportunity to safeguard the diversity of experience in each integrated care board by establishing a minimum standard, imposed either by regulation or by statutory guidance, to ensure the system gets the result that best meets commissioners’ needs for local patients and populations across the country.

--- Later in debate ---

[Lord Kamall (Con)]

I wish my noble friend had stood up the moment I mentioned Amendment 10A. I can only apologise. I have received advice to agree with what my noble friend said. I shall very quickly move on and I thank him for his vast experience of this.

Let me move on to a couple of issues raised about mental health. We expect mental health trusts to play a critical role in ICBs and ICPs. The Bill sets out a minimum requirement. It does not specify what sort of care NHS trusts or NHS foundation trusts deliver. As we said earlier in the debate, we hope that ICBs by local agreement go beyond the minimum requirements. We clearly want to see parity of esteem between mental health and physical health.

Noble Lords mentioned public health. The department and NHS Improvement publications have stated an expectation of an official role for directors of public health in ICBs and ICPs. This recognises the vital advisory and leadership roles of directors of public health in the system-wide effort across all domains of public health, which is amplified by the shift to a more preventive, collaborative and integrated systems focus on improving population health. We are working very closely with stakeholders to shape this official role in relation to ICBs.

Can I just check that we talked about Amendments 14 and 32? Yes, we did. This is a more interactive session than many noble Lords would have expected. Perhaps it will do as a sort of novelty. I believe that Amendments 14 and 32 are aligned closely with the skills mix amendment, and I hope that will go some way to satisfying concerns.

On guidance, I am able to reassure your Lordship’s House that NHS England’s regional teams are having ongoing discussions with CCGs and will deal with ICB leaders about the potential membership of the ICB board on establishment. These discussions are focused on ensuring that the board will be effective in discharging the statutory duties of the ICB. Looking beyond this, NHS England is able to issue guidance to ICBs and will engage with them—to understand what issues are emerging during the initial period of operation —and their committees and how they are working with stakeholders. In some areas, NHS England is already developing draft guidance. For example, the proposal is that each ICB will be expected to have a named lead with responsibility for commissioning for learning disability and autism.

On regulations, we think the rules as currently set out in the Bill, and with the addition of the new skills mix amendment, are sufficient and will give ICBs the space they need to develop effective systems in their area. The Bill already includes a regulation-making power that covers any provision related to ICBs’ constitutions, including ICB membership. Therefore, if we deem it necessary in future to be more specific about ICBs’ membership requirements, we retain the ability to do so through regulations. I hope I have been able to provide some assurance—sufficient assurance—to noble Lords and that they will not move their amendments when they are reached.

[Baroness Bennett of Manor Castle (GP)]

I do not believe that the Minister has directly addressed Amendments 10 and 13. I am aware of the time, so perhaps he will agree to write to me about them.

[Lord Kamall (Con)]

That is a very wise suggestion by the noble Baroness, and I will acquiesce to it.