Health and Care Bill

Justin Madders Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

In today’s debate we have heard from 37 hon. and right hon. Members, as well as the Member for Delyn (Rob Roberts), and another 29 hon. Members registered an interest to speak but were not called. A huge range of topics has been covered, some of which I hope to address briefly. I hope Members will forgive me if I cannot mention each contribution individually.

Many Members have talked about the particular geographic configuration of their ICS, and it is clear that there is lots of unhappiness about that in certain parts of the country. That is hardly surprising, given that has been done without any parliamentary oversight so far. It seems that, under the Bill, Parliament will not even get to approve where the boundaries lie.

There has been no attempt at public consultation or discussion about where these boundaries sit, and that is a theme throughout the Bill. Decisions, money and power move further away from the public and closer to the Secretary of State. He is certainly taking back control but, at the same time, he is silencing the patient voice.

In the Bill, the Secretary of State has a veto on who leads the integrated care systems, and he can stop foundation trusts borrowing money that they desperately need to tackle the £9 billion maintenance backlog. He even has the power to decide whether to instigate the closure of local services.

By contrast, when the 2012 Act was going through Parliament, Lord Lansley, who was then Secretary of State, told the Chamber:

“We want clinicians and their patients to lead the NHS, but they cannot do this while they sit under a vast hierarchy of regional and local organisations, all reporting to Whitehall. Everyone agrees that top-down command and control gets in the way of clinicians doing their job”.—[Official Report, 31 January 2011; Vol. 522, c. 613.]

The Bill supercharges command and control, so it is little wonder that even the British Medical Association has come out against it. It creates a vast web of new organisations, but very few of them will make decisions. It is pretty clear that the integrated care partnerships in particular will be little more than bystanders when it comes to the crunch, and that the boards will have all the power. That is a huge democratic deficit that must not be allowed to go unchallenged. When we hear about companies such as Virgin already having a seat on one of the ICS boards in the south-west we know that the power lies in totally the wrong place. The Bill needs to make it crystal clear that private companies should be a million miles from making decisions about how the NHS is run.

At the same time, the Bill does not legislate for boards to include a representative from a mental health organisation, for example. How will that encourage integration, let alone parity of esteem? There are plenty of others who are not guaranteed a seat at the table but who ought to be in the vanguard of integration: directors of adult social care, directors of public health, carers and, most of all, patients, who seem to have been completely forgotten in all this. How will decisions be made by the boards? Will there be transparency about where the money is spent in those areas which, we should not forget, are much larger than clinical commissioning groups. How can we be sure that the money will go to those parts of the ICS with the most need, and how can that be challenged if it does not?

We have seen the blatant abuse of the levelling-up fund, and party political considerations seep into every decision made by the Government. Will it now be patients who pay the price for that? How will the combined trust deficits of £910 million be met? The danger is that the Bill will force ICSs to close small local services to bail out the bigger trusts.

While we welcome an end to section 75 provision, I wonder exactly how much money has been wasted in convoluted procurement processes and legal challenges. Is it £3 billion, £4 billion or £5 billion? Whatever the final figure, there is no doubt that that money could be better spent on frontline services. While moving away from that monumental mistake is a good thing, it seems as if we are going from one extreme to the other, with the removal of any safeguards at all on who contracts can be awarded to. The Government are legislating for cronyism. I am sure that pub landlords and pest control companies will be delighted, but we cannot give the Secretary of State the blank cheque that the Bill allows.

There is a huge blank sheet of paper where the plan to tackle the workforce crisis ought to be. The Secretary of State will produce a report once every five years, but that is not a serious commitment to the workforce. Indeed, it is not a serious commitment to Parliament either, and the social care workforce is not even mentioned. Let us not forget that we have 122,000 vacancies in that workforce. The Select Committee has set out the kind of people whom we really ought to aim to employ, with annual, independently audited reports that cover the NHS and social care. In the words of the Select Committee:

“The way that the NHS does workforce planning is at best opaque and at worst responsible for the unacceptable pressure on the current workforce which existed even before the pandemic.”

The Bill will only reinforce that position, rather than reverse it.

In the introduction that the Secretary of State gave to the Bill today, it sounded very much as if he thought that it was the panacea that we have all been waiting for, but many more experienced Members could be forgiven for having a sense of déjà vu. Let us remind ourselves of what Lord Lansley told the House about the 2012 reforms:

“Previous changes have tinkered with one piece of the NHS or another, when what was needed was comprehensive modernisation to create an NHS fit for the demands of the 21st century. That is precisely what this Health and Social Care Bill will deliver.”—[Official Report, 31 January 2011; Vol. 522, c. 616.]

The Health and Social Care Bill provided for the constitution and structure of the NHS to work for the long term. How has that worked out? There are record waiting lists and staff vacancies; billions diverted into the private sector away from the NHS; life expectancy has stalled; and A&E targets have been missed five years in a row. The NHS was trying to unpick the last disastrous reorganisation before the ink was even dry on the Royal Assent, so why is this set of reforms going to be any more successful than the last? How is one line of this Bill going to tackle the operation backlog? Is not the truth that without a proper sustained funding settlement to meet the demand in both health and social care, this latest set of reforms is merely another rearrangement of the deckchairs? Why, oh why, is so much time and resource being focused on a wasteful, top-down reorganisation, in the middle of the pandemic? Even the Prime Minister told us on Monday that we are not out of it yet. Only today, planned operations have been cancelled in Newcastle because of a surge in covid cases. Is it not the case that every meeting called, every document written, every minute spent on this top-down reorganisation is less time spent on fighting the increase in covid cases we currently see, bringing down waiting lists, tackling the increase in mental health conditions, solving the workforce crisis and actually delivering the reform to social care that the Prime Minister promised nearly two years ago?

This Bill is the equivalent of someone reorganising the whole interior of their house, spending fortunes on new furniture and decorations, but finding it is all ruined within months because they forgot to put a roof over their head; we cannot fix the NHS if we do not fix social care. We know that, everybody knows that. The Government say they have a plan, but we still do not know what it is. Crucially, for the purposes of today’s debate, we do not know whether it will fit in with what is in this Bill. So are we going to have yet another reorganisation next year because there was no forward thinking? What about learning the lessons from covid? The inquiry is not even going to start until next year, so are we going to see yet another reorganisation when we have learned the lessons from that? The only thing guaranteed from this reorganisation is that another one will surely follow shortly afterwards. So let us reject this Bill, go back to the drawing board and come up with a plan that actually deals with the challenges that we have to face.