NHS Integrated Care System Boundaries

Edward Argar Excerpts

Tuesday 29th June 2021 Commons Chamber

[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.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I normally thank the Minister politely at this point in the day, but I really do thank the Minister for what he has just said on this particular occasion.