NHS: Independent Investigation

Bernard Jenkin Excerpts

Thursday 12th September 2024 Commons Chamber

[Wes Streeting]

My hon. Friend, who I am delighted to see representing Bassetlaw, is already showing herself to be an outstanding champion for her community. She raises a really good challenge that we all face as constituency MPs: the public recognise that change takes time and that we cannot fix more than a decade of problems in the immediate future, but they want to know that at least we are hitting the ground running and getting the job done.

I can reassure my hon. Friend’s constituents in Bassetlaw that within our first couple of months, this Government employed 1,000 more GPs on the frontline who had been left unemployed by the previous Conservative Government. We did that pretty much immediately. We have settled—I hope; we await the outcome of the ballot—the junior doctors’ dispute, so we can remove the cost of disruption and industrial action and start work on getting the waiting lists down. We will be working at pace to deliver 40,000 more appointments every week so that we can cut waiting lists, and 700,000 urgent emergency dentistry appointments so that we can ensure that people get the care they need. Every single promise in our manifesto, notwithstanding the challenges in the public finances, was a fully costed, fully funded promise that we will keep and that the country can afford.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

May I urge the Secretary of State to learn from what is working well in the NHS, as well as from what has gone wrong? In reference to the Health and Care Act 2022, paragraph 14 on page 121 of the report states:

“The result is that the basic structure of a headquarters, regions, and integrated care boards (ICBs) is fit for purpose.”

I draw the Secretary of State’s attention to the Suffolk and North East Essex ICB, which is one of the most successful in the country. Can we learn from that success, and build it into other areas?

[Wes Streeting]

I thank the hon. Gentleman for his constructive approach. The tragedy of the Health and Care Act 2022 was that a large part of its focus was on trying to correct the enormous damage done by Lord Lansley through a top-down reorganisation that nobody wanted and that the country could not afford. That is why I have said very clearly that we will not repeat the mistakes of top-down reorganisation. With the architecture of the system, we will take an approach of evolution rather than counter-revolution.

On the hon. Gentleman’s point about learning from what is working well in the NHS, what gives me great hope for the future of our national health service is that every day there are amazing people providing great-quality care, reforming, innovating and showing us what the future looks like. It is the responsibility of this Government to take the best of the NHS to the rest of the NHS. That is exactly what we will do.

Government Policy on Health

Bernard Jenkin Excerpts

Monday 9th September 2024 Commons Chamber

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. Let the record reflect that, when he was raising the crisis that is leaving people in Hartlepool without access to NHS dentistry, Conservative Members were shouting, “What about Alan Milburn?” That says everything about their priorities, everything about their lack of remorse and contrition, and everything about why they should stay in opposition for a very long time while we sort out the state of NHS dentistry in Hartlepool and across the country.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

How legitimate is it for the House of Commons to ask about external people coming into Departments and potential conflicts of interest? In cases like Alan Milburn’s, or that of a former Conservative Secretary of State, how does the Department identify and manage conflicts of interest?

[Wes Streeting]

It is entirely legitimate to ask questions, and it is also entirely legitimate for Government Departments to invite people with a wide range of experience and insight to advise on policy debates and discussions. That happens all the time. Where do we draw the line? Do we have to send compliance forms to Cancer Research UK before it comes in to talk about how we tackle cancer? Do we have to send declaration of interest forms to patients who want to discuss awful cases they have experienced?

Frankly, I find this pantomime astonishing. I am surprised that the shadow Secretary of State thinks this is such a priority that she should raise it on the Floor of the House rather than NHS waiting lists, ambulance response times, GP access or the state of social care. It is clear that the Conservatives have not learned why they are in opposition.

Pharmacy First

Bernard Jenkin Excerpts

Wednesday 31st January 2024 Commons Chamber

[Dame Andrea Leadsom]

I am always happy to speak to colleagues on both sides of the House about their ideas for new dental and pharmacy schools. It is an ongoing interest.

England is, in fact, blessed with huge numbers of community pharmacies—well over 10,000—and four in five of us are able to walk to a community pharmacy within 20 minutes. The number of pharmacies in more deprived areas is double the number in more well-off areas. We are very well served by our brilliant pharmacies, and I hope the Pharmacy First programme will improve their footfall and their value in each of our communities.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I very much welcome this initiative to encourage our pharmacies to provide more frontline healthcare. People need to know about this, because they often do not think of going to the pharmacy. What work are the Government doing in larger population centres such as Harwich and Dovercourt, which has over 20,000 people but no out-of-hours pharmacy cover? People have to make a round trip of more than 40 miles to collect a prescription on a Sunday, for example. Are the Government doing any work on 24/7 pharmacy coverage for larger population areas?

[Dame Andrea Leadsom]

My hon. Friend raises an important point. Pharmacists will keep their community pharmacy open for up to 72 hours a week in most cases, and up to 100 hours in some cases, which means there is weekend accessibility. We keep this under review, but the availability is very good.

Recovering Access to Primary Care

Bernard Jenkin Excerpts

Tuesday 9th May 2023 Commons Chamber

[Steve Barclay]

I agree and thank the hon. Member, who is absolutely right to recognise the huge amount of work done by GPs and their staff, including receptionists. That is why the recovery plan is very much targeted at recognising the workload. I flagged in my statement the additional volume of patients that a typical GP surgery is seeing and that reflects the huge amount of work that is done. I think pensions were a factor, certainly in the feedback from the profession. The issue was raised. The changes the Chancellor announced take 9,000 GPs out of the tax changes, but the hon. Gentleman is right—that was not the only factor; the workload was another. The recovery plan looks to cut bureaucracy and, as I say, reduces the targets to five. It also looks at areas where there are appointments that we do not feel are necessary—so it looks at how secondary care can do fit notes, for example, rather than someone needing to go to the GP to get one. There are areas where we can streamline GPs’ workload and that is what the recovery plan does. On the workforce plan, we have said on a number of occasions that, post purdah, we would set that out very shortly. We will have more to say on that in due course.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I join the hon. Member for Sheffield South East (Mr Betts) in inviting the Secretary of State to thank all our GPs for their incredible work. I very much welcome his statement. Will the Pharmacy First plan enable places such as Harwich and Dovercourt in my constituency to increase the out-of-hours cover that pharmacies provide? Otherwise people will have to travel miles just to get a prescription. Also, where are all these new GP staff going to be put? Most GPs have very cramped premises. West Mersea surgery in my constituency has been trying to develop new premises for a long time, unsuccessfully because the GPs’ partners will not take the risk. At the Mayflower surgery in Harwich, there is empty space in the building rented by the NHS from a failed Labour private finance initiative project, but the GPs cannot afford to pay the rent, so the space sits empty, although it is still paid for by the taxpayer. What are we going to do about that?

[Steve Barclay]

First, I join my hon. Friend in paying tribute to the work that GPs do in his constituency, as they do elsewhere. On pharmacies, part of the reason for the investment is to support pharmacy, including in rural settings. The more funding going in, the more they can prescribe. The more things they are able to do, the better the business model. There are more pharmacists and more pharmacy shops than there were in 2010, but it is important we make the business model more viable and that is what the announcement does. On estates planning, that is an issue for each integrated care board to consider. He mentions a specific issue locally with a former PFI and how it is being used. That is not a new issue. I sat on the Public Accounts Committee when it was chaired by the right hon. Member for Barking (Dame Margaret Hodge) and I remember looking at many a Labour PFI. The regional fire control centres were a case in point; the estate could no longer be afforded and the space was empty. If there is an issue like that, I will be happy to look at it in due course.

Covid-19 Update

Bernard Jenkin Excerpts

Wednesday 8th December 2021 Commons Chamber

[Sajid Javid]

We work very closely across the UK, and the positive output from that work has been evident throughout the pandemic, especially on vaccinations and antivirals. We will continue to work together and provide whatever support is needed.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

My right hon. Friend obviously understands that these measures will try the patience of the British people. Will he look at the other measures that can suppress the virus, particularly the booster rate? Does he agree that the rate of booster vaccinations is constrained not by supply or demand, but by the capacity of the health service to deliver the vaccines? Will he also, therefore, support integrated care systems that call on military assistance or local authority assistance and want to reopen the mass vaccine sites to accelerate the vaccine programme?

Health and Social Care

Bernard Jenkin Excerpts

Friday 3rd December 2021 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I thank the Minister for his undertaking about brief answers, and I urge Members to ask brief questions as well. Otherwise we will not get everyone in, because we do need to return to the private Member’s Bills.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I thank my hon. Friend for his statement. Can he confirm that it is the Government’s policy to encourage the reopening of mass vaccination centres to get through the bulge of booster jabs that we need? In that regard, will he congratulate the South Suffolk & North East Essex integrated care system, which has once again secured facilities at Harwich international port, and will he thank the port for offering those facilities again? We are hoping for a mass vaccination session on 19 and 20 December, and further sessions in January. Is that not the way to take the pressure off GPs?

[Edward Argar]

Of course I join my hon. Friend in paying tribute not just to Harwich port but to his local healthcare system, about which he and I have spoken on many occasions. It does an amazing job: its willingness to find innovative solutions to boost our booster rates is exactly what we need to see. I commend everything that his local trusts are doing.

Covid-19 Update

Bernard Jenkin Excerpts

Thursday 21st October 2021 Commons Chamber

[Maggie Throup]

I reassure the hon. Lady that we look regularly at all the data, particularly the covid data. If we feel it is necessary, we put enhanced measures in place. A number of colleagues in the House will have experienced that. It works really well. Obviously, we have the Budget and the spending review coming up shortly, and I am sure she eagerly awaits what will be in them.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

On the devolution point, let us remember it is a two-way street. There may well be things that we can learn from the Scottish Government that they have done better and differently from the United Kingdom Government, and we should not be shy about that, but we should also point out that Scotland would not have had many vaccines had they not been part of the United Kingdom.

I just point out to my hon. Friend—I hope she will take this back to the Department—that it is dead easy to get the public engaged on this subject: the Prime Minister holds a press conference with the chief medical officer and the chief scientific adviser and starts to explain in harsh terms what will happen if people do not carry on being vaccinated. That is the way to communicate, and we should do that. Can she also explain why we have given the booster vaccine to the GPs? They have enough to do. My integrated care system area is taking it away from the GPs and reopening the vaccine centres so that the GPs can get on with treating their patients, because there are not enough of them to do that job as it is. The pharmacies and the vaccine centres will take over the booster jabs.

[Maggie Throup]

I reassure my hon. Friend that there are numerous ways in which people can get a jab; it is not just at general practices.

Covid-19 Update

Bernard Jenkin Excerpts

Monday 19th July 2021 Commons Chamber

[Nadhim Zahawi]

I thank the hon. Member for that thoughtful question. He is absolutely right: there are about 5.3 million people waiting for treatment. He is also right that we have to make sure that the NHS has the resources to do it, which is why two things have happened: the Secretary of State has made it a priority to deal with the pandemic, and he has made it an equal priority to deal with the backlog. He has made £1 billion available for the NHS to do that work.

[Sir Bernard Jenkin (Harwich and North Essex) (Con) [V]]

I thank my hon. Friend for his statement, but I confess to some disappointment that the daily vaccination rate is not being sustained at a higher level. What is the constraint? Is it supply, is it logistics or is it that the hard-to-reach groups are slower in coming forward? What consideration are the Government giving to what is happening in other countries such as the United States, where people are being offered some kind of reward for coming forward and accepting a vaccination?

[Nadhim Zahawi]

I am grateful to my hon. Friend for his question. The vaccination rates in the United Kingdom have been incredibly high. We are at 88% with the first dose and 68% with double doses. On double doses, we are actually ahead of the United States of America. That does not mean we become complacent, however. We are doing everything we can to ensure that every cohort, and every ethnicity has the ability to access the vaccine.

Let me give him an example of some great work in the London Borough of Newham. Last week it had 23 different vaccination sites in pop-ups, in mosques, in GPs and in community pharmacies across the borough. Young people were literally tripping over a vaccine site. Part of it is access. Part of it is taking the vaccine to those communities. I am working with a number of colleagues to make sure we get into rural communities, for example with vaccine buses, and in community centres where people feel safe and comfortable to have the vaccine. The work does not end today. We continue to double down on our effort to continue vaccination. Again, I want to place on record my thanks to the metro Mayors for the work they do with us to make sure that happens as well.

Health and Care Bill

Bernard Jenkin Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Sajid Javid]

First, my hon. Friend is right to say that it would be great if all or most Members of this House, and certainly the different parties, could agree on a new system. I look forward to speaking to all hon. Members about what a future social care system could look like. In terms of the detail, I am afraid that he is just going to have to wait a moment longer, but I agree that the work by the Select Committees will, of course, inform our decisions.

I turn in a little more detail to the measures and themes that are captured in the Bill. The first is more integration. We know that different parts of the system want to work together to deliver joined-up services, and we know that, when they do that, it works. We have seen that with the non-statutory integrated care systems in the past few years. They have united hospitals and brought together communities, GPs, mental health services, local authority care and public health, and it works. We recognise that there are limits on how far this can go under the current law, so this Bill will build on the progress of integrated care systems by creating integrated care boards and integrated care partnerships as statutory bodies. England’s 42 ICSs will draw on the expertise of people who know their areas best. They will be able to create joint budgets to shape how we care for people and how we promote a healthy lifestyle. With respect to the specific geographies of the ICSs themselves, as I have said elsewhere, I am willing to listen.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

In passing, may I congratulate my right hon. Friend on his appointment? I also very much welcome part 4 of the Bill, which introduces the health services safety investigations body. This is a great innovation that was promoted by the Public Administration Committee and scrutinised by the Joint Committee that I chair. Can I just reinforce the points that I know he is now receiving from NHS England with a warning about changing the boundaries of the integrated care systems that are already operating? In Suffolk and north-east Essex, we have a very high-functioning de facto integrated care system operating already. Please will he not change it?

[Sajid Javid]

My hon. Friend has raised an important point, and this may be on the minds of other hon. Members as well. It is important to point out that several factors will be helpful in fostering stronger partnerships between the NHS and local authorities, including the alignment of boundaries. Earlier this year, the former Secretary of State asked NHS England to conduct a boundary review of integrated care systems, to understand the best way forward and the best alignment where local authorities currently have to work with more than one ICS. I have met my hon. Friend and other hon. Members, and I know that hon. Members may have made representations to my predecessor. I have been informed of those, and where the information might not be remembered easily, I am sure we can get hold of some video evidence. [Laughter.] I want to thank all hon. Members for their input into this, and I stress that no final decisions have yet been made on the boundary review.

NHS Integrated Care System Boundaries

Bernard Jenkin Excerpts

Tuesday 29th June 2021 Commons Chamber

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I am sorry that this debate is unlikely to be the penalty shoot-out that some people may have been looking for.

We know that the Government are about to publish a new Bill on the NHS, but it is not widely known or understood that the NHS in England is being prepared for a major reorganisation. The clinical commissioning groups established by the Lansley reforms have gradually been subsumed into groups called integrated care systems. These ICSs are not legal entities, but single executive teams that have effectively merged the CCGs. Their boundaries are established according to the local health economies. For example, the North East Essex CCG has been merged with two Suffolk CCGs to form the Suffolk and North East Essex ICS, which commissions all NHS services across the whole area. This enabled Ipswich Hospital NHS Trust and Colchester Hospital University NHS Foundation Trust to be merged. I have to say that this is highly effective. In my nearly 30 years as a Member of Parliament, I can honestly say that the NHS in our area has never been better led.

[Sir David Amess (Southend West) (Con)]

I know that my hon. Friend will agree that we have had a fabulous football result this evening.

Going back to the days when my hon. Friend’s father was a Health Minister, when the noble Lord Fowler was Secretary of State and when the late Lord Moore was Secretary of State, would he agree that we have had far, far too many of these reorganisations, and that we need to halt the process in our area at the moment?

[Sir Bernard Jenkin]

I will come to that point later; I shall not want to repeat myself.

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

I congratulate the hon. Member on having secured the debate on changes to the NHS integrated care system boundaries on the night that England have beaten Germany and qualified for the quarter finals of Euro 2020. Does he agree that although these plans may satisfy the political ambitions of some, they do not deliver the best outcomes for our constituents, including my Slough constituents, who are already well served by the successful Frimley ICS, which should not be broken up? If something is not broke, why needlessly try to fix it?

[Sir Bernard Jenkin]

I was anxious to give way to the hon. Gentleman to show that there is cross-party concern about this matter; I am sure that his point will be enlarged upon by my right hon. Friend the Member for Maidenhead (Mrs May).

All this is being put at risk at a time when the NHS is still reeling from the impact of covid-19. The new Bill will place ICSs on a statutory footing, which is a good thing, but there is also a proposal that the ICS boundaries should be redrawn to be coterminous with upper-tier local authority social care boundaries, and that is what we are questioning.

I am most grateful for the way my right hon. Friend at the Dispatch Box has listened recently to MPs affected by these proposed changes and has consulted us. He therefore already understands why I and others remain so concerned, but I must put it on the record that the rest of the consultation process has been not just inadequate but in defiance of proper transparency and accountability.

[Sir David Amess]

Absolutely outrageous!

[Sir Bernard Jenkin]

My hon. Friend says that is outrageous.

A firm of organisational consultants, Tricordant, was instructed by NHS England and NHS Improvement East of England to host roundtables in recent months with all the stakeholders in and around the NHS in the east of England. For some reason, it was told to exclude the MPs. Tricordant has produced several drafts of its report, which have been shared among existing ICS leaderships, NHS providers and tier 1 local authorities, but not with MPs. A few of us were eventually briefed by NHS England at the Minister’s behest, but I am mystified as to why we were not positively engaged at the outset.

The White Paper produced in February 2020—incidentally, just as we perhaps should have been anticipating the pandemic, instead of planning an upheaval of the NHS—talks about this coterminosity of boundaries, but it also has a whole section on the primacy of place. I will explain this, but those two objectives are fundamentally incompatible. The consultation exercise then appears to have been driven by that dogmatic insistence on coterminosity, and has been further confused by a lack of clarity about the problem that actually needs to be solved.

In Essex and Suffolk, areas larger than single counties were ruled out so Ministers will be presented only with a choice between the boundaries as they are and two county ICS areas—one for Essex and one for Suffolk. Discussions concerning the future of the Suffolk and North East Essex ICS have been strongly weighted towards the county councillors and their officers. Not all relevant NHS stakeholders have been consulted, which is why NHS Providers, which represents NHS leaders across the country, has spoken out on their behalf. Individual NHS leaders are understandably reluctant to criticise proposals in public, but they are known to be against the change, including the leaderships of the acute trusts across the east of England.

I understand why the county councils want this change, and I completely respect their ambition. Essex has made clear to me its frustration at making time for meetings with three different ICSs. I can also see that the new boundaries are superficially attractive, because they align NHS commissioning with the boundaries for the health and wellbeing board and other statutory public services, such as the Essex police and the local resilience forum. Essex County Council acknowledges the extremely successful place-based working implemented by Suffolk and North East Essex ICS, which incidentally has been complimented by the Care Quality Commission, the King’s Fund and the National Audit Office.

The new legislation is intended to extend place-based working to all areas. None the less, the Tricordant report would be misleading if it did not express the clear preference of NHS leaders in Essex to retain the existing ICS boundaries, primarily in recognition of the long history of operating as a single health economy, the significant flow of patients across the county border, the strength of existing relationships in the system, and the progress that has been made locally in integrating health and care services.

There are practical difficulties with the changes for Harwich and North Essex, which are replicated in other parts of England. Enablers of effective place-based working—the leadership, the philosophy and having all the partners sitting around one table—are essential to build effectiveness. A place—I use that term advisedly—that has thrived as part of one system will not necessarily thrive as part of another. Superb progress has been made in north-east Essex in recent years and, more recently, in mid and south Essex. These systems are now working not just because commissioning reflects what is called place but because people have grown into their roles and developed relationships of trust across different organisations. All that will be discarded by the wholesale changes to NHS commissioning by imposing coterminosity.

[James Sunderland (Bracknell) (Con)]

Does my hon. Friend agree that, because Members of Parliament in Nottinghamshire, Berkshire, Hampshire, Suffolk, Essex and beyond have not been adequately consulted on these proposals, we should pause any decision with a view to looking more objectively at what is on the table?

[Sir Bernard Jenkin]

My hon. Friend anticipates what I might say later.

The foundation trust for the Ipswich and Colchester hospitals will have two different commissioners, or Suffolk will have to take over the commissioning role for Colchester Hospital, leaving north-east Essex GPs, mental health services and so on with a different commissioning authority from that of the local hospital. NHS England told the MPs:

“We still do not know how the funds will flow”.

We certainly will not have all the partners sitting around a single table. The constituency of my hon. Friend the Member for Waveney (Peter Aldous) will be reabsorbed into Suffolk, even though it is half of the wider Great Yarmouth and Waveney place.

[Peter Aldous (Waveney) (Con)]

My hon. Friend is making a very good point. The Waveney area of Suffolk has been in a health administrative area with neighbouring Great Yarmouth for a very long time, and with the rest of Norfolk for a reasonable time as well. Any change would be highly disruptive, a distraction and demotivating for hard-working staff. I have written three long letters to the Department of Health and Social Care and have had a meeting with the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), but does my hon. Friend the Member for Harwich and North Essex share my concern that there is a perception among those working in health and care in the local area and East Anglia that changing the boundaries is a done deal? Can the Minister confirm in his response that that is not the case?

[Sir Bernard Jenkin]

I very much hope that my right hon. Friend the Minister will confirm the latter; I have been assured that it is not the former, which is why I thought it was worth having this debate. The problem that my hon. Friend the Member for Waveney has is that the local population will continue to have acute services commissioned and provided from Norfolk. The imposition of separate Norfolk and Suffolk ICSs would compromise place-level integration for that population.

The west Essex population, which may be close to your heart, Madam Deputy Speaker, has acute services commissioned and provided predominantly from Hertfordshire, London or Cambridgeshire, and very little from the rest of Essex. That means west Essex will become part of an Essex ICS when it does not even include many of the key partners responsible for delivery of acute services to that population, and of course there is to be a new hospital, which may well be outside the Essex border. The proposed county-based arrangements would fragment NHS commissioning for places in north-east Essex, Waveney and west Essex. There might be different commissioners for acute, community and primary care. These places can only fully realise the benefits of integration if they have the flexibility to align all NHS commissioning. Other parts of the country will be similarly affected.

The idea of coterminosity for the administrative convenience of county councils is, I am afraid, a bit like the tail wagging the dog. In 2018, across the UK as a whole, we spent £149 billion on the NHS, but only £22 billion on social care. How can it make sense to align NHS commissioning with social care boundaries? That is not integration with social care; it is disintegration of NHS commissioning, and why do it now, of all times? We would be destabilising our health and care infrastructure while we are not yet out of the pandemic, let alone free of the aftermath.

The focus needs to be on the recovery of services. Elective treatment waiting lists increased to 5.12 million in April—a record high. There are other options for Essex and Suffolk, and I dare say in other parts of the country as well, such as a two-county proposal, as many Essex and Suffolk MPs set out in our letter to the Secretary of State two weeks ago.

In conclusion—I want to give time for others to contribute—the new legislation could provide the opportunity for ICSs to build on their successes, but that will be impossible with the level of disruption that a change of boundaries would bring about. Conservatives should have learned the lesson that NHS reorganisations usually fail to deliver the benefits promised. That will be especially true if reforms are rushed through again, tearing up what has been so recently established. Boundaries are the contentious part of the reforms. It would be better to allow the current ICSs to implement the new legislation and then look at whether boundary changes are necessary, rather than trying to do both at the same time.

So often I have seen it happen: structural and organisational reform is imposed from above as a substitute for a full understanding of what is really going wrong and why. It is always hard to improve leadership and to promote the right attitudes and behaviours in large and complicated organisations, particularly the NHS, but the slowest way to achieve this is to have another structural organisation. Everyone stops thinking about the job they are doing and thinks only about what new job they are applying for. After the reorganisation everyone has to re-learn how their job works and to re-establish new relationships, but nobody has challenged the attitudes and behaviours, which are still holding the organisation back. So often the problems are about poor leadership, poor employee engagement and lack of stability, which yet more structural change just makes worse. I therefore urge my right hon. Friend to delay the decision concerning future ICS boundaries until after the pandemic, and to consult and explore alternative boundary proposals after the legislation has settled down.

--- Later in debate ---

[The Minister for Health (Edward Argar)]

I congratulate my hon. Friend the Member for Harwich and North Essex (Sir Bernard Jenkin) on securing this timely debate about potential changes to ICS boundaries—and indeed on elevating me to the Privy Council, for which I am grateful. He and I have known each other for a long time and I always listen carefully to what he says. When there was the prospect of extra time, our friendship might have been in doubt had I been in here and unable to see the final result, but we got the result we all wanted just in time, so it is a pleasure to be here today.

The subject is important, not only for my hon. Friend, who works tirelessly for his constituents, but for all hon. Members who have spoken. The provision of healthcare goes to the heart of what many of our constituents care passionately about.

In his remarks, my hon. Friend expressed his concerns about the future of Suffolk and North East Essex ICS as one of the areas included in the NHS England ICS boundary review. I am grateful that he has called the debate, not only to allow fellow parliamentarians to express their views before any decision might be made on the Floor of the House, but to let me listen once again to them. I am equally grateful to my right hon. Friend the Member for Maidenhead (Mrs May). She and I have known each other a very long time and she knows that I have huge respect for her opinions. When she speaks, I always listen carefully.

As has been said, in the recent White Paper, we set out proposals to place integrated care systems in statute. We are working with NHS England and the Local Government Association to deliver and develop those proposals. At the outset, it is important that I highlight a key point. Members alluded in their remarks to the feeling that something here is predetermined. If there is such a feeling, that is a challenge for us to overcome because I want to reassure hon. Members that nothing is predetermined in any of the specific situations that they have outlined.

As has been set out, ICSs aim to strengthen partnerships and joined-up working between the NHS and local authorities. Local authorities therefore have a key role in ICSs. We know that coterminous boundaries can support more joined-up working between the NHS and local government, but I take on board entirely from my time as a local councillor—indeed, as a cabinet member for health and adult social care—the point that my right hon. Friend the Member for Maidenhead made that sometimes natural geographies of place can mean a lot more to our constituents than administrative boundaries to which we as politicians might pay a lot of attention.

For the reasons I have given, earlier this year the former Secretary of State, my right hon. Friend the Member for West Suffolk (Matt Hancock), asked NHS England to conduct a boundary review to understand what the options—I emphasise options—were to achieve alignment in the small number of areas where coterminosity was not already in place. He set out to do that in two stages: NHS England and its regional teams have led on the review at a local level, engaging with local NHS and local authority stakeholders to determine options for alignment, local views and concerns, and to put forward a fair reflection of what they had heard, while in parallel I, as a Minister of the Crown, have held multiple meetings with parliamentary colleagues. I think I have met well over a dozen colleagues in person or virtually—in this day and age—and held almost 10 different meetings.

I thank NHS England for all its engagement and work on the review. As I say, over the past six months its regional teams have worked closely with local NHS and local government stakeholders to consider, with an open mind, the options available for the areas identified in the review.

As right hon. and hon. Members have made clear, it is important to recognise where things are working well irrespective of coterminosity and serving Members’ constituents well. As I say, the review is without prejudgment and I would not wish to pre-empt what may be either recommended or even just set out as options. In that context, keeping the current arrangements would of course be an option to consider. I reassure Members that the Secretary of State and I do have at the forefront of our minds the need primarily to ensure the best health outcomes for local people when any decision is taken. I hope that my hon. Friend the Member for Harwich and North Essex will recognise the sincerity with which I say that.

Before I conclude, let me turn to a couple of specific points that my hon. Friend mentioned. I wish to clarify that were any changes made to ICS boundaries as a result of the review, they would not impact on the patient’s right to choose or use services outside of their ICS or current patient pathway flows.

On funding, I wish to try to reassure my hon. Friend a little more than perhaps he was reassured in the meeting to which he alluded. Once ICSs are placed on a statutory footing, the allocation of resources to each integrated care board will be determined by NHS England based on the long-standing principles of ensuring equal opportunity of access for equal need and reflecting the considerations that currently inform how moneys flow to areas when following the patient.

[Sir Bernard Jenkin]

Will my hon. Friend allow me to intervene on one point?

[Edward Argar]

Briefly, because I want to give my hon. Friend the reassurance that he seeks before the time runs out.

[Sir Bernard Jenkin]

What my hon. Friend has said does not address how Suffolk would be funded to commission services for Essex patients at an Essex hospital, and it does not address what will happen to the distribution of deficits, which is uneven across the existing ICSs.

[Edward Argar]

I would try to address that point briefly, but I think my hon. Friend would rather have the reassurance that I can give him. Perhaps I can pick up that point separately with him, because I do not want to run out of time.

Finally, and most importantly, I reassure my hon. Friend and other Members that no decisions have yet been made regarding the outcome of the ICS boundary review. As he would expect, the newly appointed Secretary of State will want to consider carefully the background to this issue, the options before him and, indeed, the views of right hon. and hon. Members before any decision is made. I have discussed this matter with the new Secretary of State and wish to extend his clear commitment to meet my hon. Friend, my right hon. Friend the Member for Maidenhead and other Members before he makes any decision and decides how to proceed in this matter.

My hon. Friend knows me well, and my preference is generally for evolution, not revolution. I hope that, him knowing me well and in the light of what I have said today, he will recognise the sincerity of what I say. I also hope it is helpful that I have put on record, once again, that no decisions have been made and that Members will be consulted and have the opportunity to speak to the Secretary of State. I hope that commitment reassures my hon. Friend, at least in the short term, that nothing will happen without him and other Members having their say clearly on the record.