Health and Care Bill

Jeremy Hunt Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. It will be obvious to Members that a large number of colleagues want to contribute to the debate. I urge brevity, so that others can participate. I call the Chair of the Health and Social Care Committee, Jeremy Hunt.

[Jeremy Hunt (South West Surrey) (Con)]

Madam Deputy Speaker, I think on this occasion I can oblige you, because I will be very brief. I wish to speak to amendment 114, which may seem a rather technical amendment—as is evidenced by the fact that, out of 650 colleagues, only one has actually signed it, and that is me—but it makes up in quality for what it does not have in quantity. It is about making sure that the new integrated care boards focus their energy on the safety and quality of care of patients. That is very important, because the new integrated care boards will have enormous power. In effect, they will be the local governing bodies of our NHS.

Although the statutory structures matter, what the people running those care boards focus their attention on is incredibly important to all our constituents. The amendment will make sure that when care boards consider their priorities, the things that matter to patients—the safety and quality of care—are put at the very top of their list. We know the way the NHS works. It is the fifth-largest bureaucracy in the world, and there is a plethora of internal NHS—

[Edward Argar]

rose—

[Jeremy Hunt]

I see the Minister wants me to give way. May I make my argument for one moment, and then give way?

There is a plethora of internal NHS targets, there are operational targets and there are financial targets. They often have an excellent purpose, but, as in the case of Mid Staffs and other cases where things went badly wrong, being under a lot of pressure to meet those targets means corners can be cut, and the quality of care experienced by patients can be really damaged. The amendment would make sure that there was discipline in the system, so that whatever pressure NHS managers were under, they were always focused on safety and quality of care.

[John Redwood]

I pay tribute to my right hon. Friend for what he did as Secretary of State to stress the importance of this crucial work, and he is not on his own: I support him.

--- Later in debate ---

[Jeremy Hunt]

Before I come to the Minister, I want to say—and I am very grateful to my right hon. Friend the Member for Wokingham (John Redwood), who gave me consistent support on this agenda when I was Health Secretary—that, in the public sector, the one system that has seemed to make sure we focus public bodies on our constituents’ priorities is the Ofsted system in schools. We have rolled that out, I think reasonably successfully, to hospitals, GP surgeries and care homes, and this amendment makes that possible for the new integrated care boards. I want to give the Minister a chance to intervene to tell us his reflections on whether this system could work.

[Edward Argar]

I am grateful to my right hon. Friend. It is not just my right hon. Friend the Member for Wokingham (John Redwood) who supports him on this; I and the Government do, and we are delighted to accept his amendment.

[Jeremy Hunt]

I am most grateful to my hon. Friend, and I am also grateful to the Opposition, who have indicated that they will not oppose the amendment.

[Kevin Hollinrake]

Now that that one is sorted, would my right hon. Friend offer the House his views on new clause 49?

[Jeremy Hunt]

I am happy to do that, because I know my hon. Friend has a great interest in social care issues. I feel conflicted by new clause 49. I think that what we will end up with after this measure will be a whole lot better for people on low incomes than what we had, because the means-test threshold will be raised from £23,000 to £100,000, and that is a very significant improvement. However, I have to be honest and say that it is nothing like as progressive as we had hoped, but it is a step forward. My concern when it comes to social care is that our entire debate is focusing on what does and does not contribute to the cap, when the fundamental problem in social care is the core funding to local authorities; that, though not a matter for this Bill, has a direct impact on the care received by our constituents.

I conclude by thanking the Government for their support for amendment 114. I will move it formally later, but I am not expecting to divide the House on it.

[Dr Whitford]

I initially want to touch on new clause 49. Like other members of the Bill Committee, I sat through hours and hours from September to November, and the Government have suddenly pounced on us with this at the last minute. It is such a complicated new clause, but it has not been interrogated.

It is quite clear that the Government’s original spin that no one would pay more than £86,000 for social care and no one would have to sell their house is completely misleading. All the accommodation costs are on top of this. As has been highlighted in the media and by Members in the Chamber, those with assets of about £100,000 will not see any real gain from this policy, while those sitting on assets of £500,000 or more will keep a lot of their wealth. That means it exacerbates the differences, and penalises those in the north of England and areas where house values are not so high. Basically, it is feeding the frenzy down here of people sitting on over-inflated house prices. As has been said, this is not levelling up, just doubling down.

The cap applies only to personal care, which means things like washing and dressing. That has been provided free in Scotland both within the care home and in home care since 2002. It was expanded in 2011 to provide more hours so that people with greater need could stay at home longer, and it was extended to those under 65 with care needs in April 2019. Scotland is the only UK nation that provides free personal care, and we see it as an investment. It is an investment that we spend 43% more per head on social care in Scotland, but it is an investment in people’s independence and their inclusion in society. The problem is that we spend far too much time talking about social care just as a burden, instead of actually seeing it from the point of view of the user.

The Scottish Government have already added an extra penny on taxation for medium and high earners to cover things such as our wellbeing policies, health or social care, but this Government’s plan to increase national insurance contributions will disproportionately hit low-paid workers and young workers. I would say that the biggest weakness of all, as we know from the original debate on the national insurance change, is that the funding is not going to go to social care initially; it is going to go to the NHS, yet it is social care that is in crisis. This is what is causing the pressure in accident and emergency, because people who are ready to be discharged simply cannot be, as the care support is not there. I do not think that this fixes the problem. There will actually be very little money, because a lot of it is going to go on capping the overall payment. I do not see social care benefiting from this at all, yet it is social care that needs investment more than anything else.

Turning to the main substance of the Bill, which is meant to some extent to unpick the damage and fragmentation of the Health and Social Care Act less than a decade on, I wish to express support for amendments 9 and 72. Many in the NHS, including me, will be glad to see the back of section 75 enforced tendering. Others in the Chamber know that it was the Health and Social Care Act that brought me into politics, as I just could not believe anybody thought what they were doing was a good idea. It is still clear from the pandemic that this Government are absolutely wedded to outsourcing services to private companies, and to the flawed notion that financial competition somehow drives up clinical quality. I am sorry, but that simply is not the case. As the Chair of the Health and Social Care Committee has highlighted, we have to focus on safety, on clinical audit, and on peer review if we want to drive up care quality for patients, not just on the money in the system.

The Government appear to have conceded that integrated care boards should be statutory bodies, as health boards have always been in Scotland, but partnership boards can include private providers, such as with Virgin Care in Bath. As the partnership boards will be involved in devising the local strategy for health services, that is likely to lead to a blatant conflict of interest, and I do not see a resolution to that. The NHS simply should be the presumed provider of health services. That is not just, as the shadow Health Minister said, because the NHS is in it for the long term, or for a quick contract, but because the NHS provides the training to nurses and doctors who are the vital workforce of the future. Private providers do not do that; private providers largely live off the NHS. As well as not training staff, where there are major problems or complications, patients inevitably end up in the intensive care unit of an NHS hospital.

In conclusion, for all the size of the Bill, and the scale that the reorganisation will involve for staff in the NHS, who we all know are frankly exhausted, the Government have failed to take the opportunity to repair fully the damage of the Health and Social Care Act 2012, and to recreate in England a unified public health system, such as the one we are lucky enough still to have in Scotland.