Integration White Paper

Karin Smyth Excerpts

Wednesday 9th February 2022 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

I thank the Minister for advance sight of his statement, which I got about 30 minutes ago, but I confess that I read most of it some 30 years ago when I was developing joint services. After waiting an eternity for the Department of Health and Social Care White Paper, the Government are spoiling us with their third paper of the year. All these papers are necessary to try to remedy the disastrous Lansley Act—the Health and Social Care Act 2012.

We acknowledge that reversing that Act and the integration of health and social care, however it is defined, is extremely difficult, but this integration will not be delivered by the White Paper and it is certainly not well defined. It is not clear how this fits with the Health and Care Bill, which is currently in the Lords. Even the experts involved in the Committee and elsewhere are repeatedly tripping over crucial issues such as the relationship between integrated care boards, integrated care partnerships and integrated care systems. How do they work with health and wellbeing boards? Where is the clinical leadership? Where is the accountability to local people? I banged on a lot about accountability in the Bill Committee so I am glad that somebody was at least listening and that we seem to have a bit of progress, but where are the voices of local people who are increasingly being asked to pay more for less?

Like a house made of crepe paper, this gossamer-thin White Paper collapses with the faintest breeze of scrutiny. Let us be clear: it is not a plan, nor is it even a starting strategy. It is just a series of woolly claims about how things could be better, unsupported by any evidence or analysis of the resources and organisational and funding flow changes that will obviously be necessary. It could have been written at any time over the past 30 years. It contains little that is new and nothing to illustrate new thinking or new attitudes. It relies on the bogus assumption that because something may work for a while on a small scale, it will obviously work everywhere. It is not any kind of plan for integrated care that people will recognise; these are just aspirations about integrated systems.

There is little to explain how a joined-up system would be managed, how it would be accountable to the public, patients and service-users, how the funding will be allocated and shared or how performance would be assessed and weaknesses addressed. Nothing in the White Paper addresses the key issue of balancing what is locally determined against national standards and national entitlements.

Crucially, there is nothing to address the key barrier to integration—that social care and the NHS are in different empires with no level playing field. One is means-tested and one is not. One has national criteria for entitlement and one does not. The way in which they are governed and funded is totally different and they are kept going by two separate workforces with no aligned terms and conditions.

I welcome the announcement of a skills passport and we will certainly look at the detail of that. However, unless there is pooled funding on a major scale—out-of-hospital funding—there will be no system drivers to really improve integration. This White Paper is again about simply encouraging, but we have had 30 years of that.

The reality is that the White Paper is remarkable for what it does not do. It does not seem to help children and young people. It does not address the challenge of how to care for and support working-age adults with a disability. It does not really value or assist the informal workforce or carers.

Our NHS and care system is under enormous pressure after years of austerity funding made incalculably worse by the impact of the covid pandemic, but the challenges that it faces are manifest, from a legacy of a “hospital first” approach to a decades-long failure to share care records. That runs alongside chronic underfunding and devaluing of public health, huge gaps in the workforce and wholly inadequate social care provision, with more than 500,000 people waiting for assessment and hundreds of thousands more denied access to care of any kind because the barrier for access is far too high.

This is a will-o’-the-wisp White Paper: one minute it is there before us only to vanish at a glance. The truth is that there does not seem to be anything of note that cannot already be done. Fundamentally, what is the point of it? As things stand, the number of patients waiting for care will continue to rise for the next two years, and there is no plan—not even the ambition—to get waiting times and waiting lists down to the record lows seen under the last Labour Government.

Worse still, these proposals will see patients paying more in tax but waiting longer for care. The Government are blaming covid, but will the Minister tell us when the target for NHS patients in England to be treated within 18 weeks was last met? If he cannot remember, it was in fact in 2016, four years before the pandemic. It is clear from the announcement yesterday and here today—just as it is from the decade of Tory mismanagement that left the NHS ill-equipped to cope with covid—that the longer we give the Conservatives in office, the longer patients will wait. Their time really is up.

Today is not a serious endeavour; it is a greatest hits of soundbites and buzzwords, randomly assembled to make a decent press release and get an outing on the evening bulletins. It is a desperate desire to own the news cycle and calm Tory Back Benchers’ nerves. It really is disappointing and it is simply not good enough.

[Edward Argar]

It is a pleasure to see the shadow Minister in her place—she will know that I genuinely mean that, because she and I spent many happy days upstairs in Committee debating exactly these issues. This White Paper sets out clearly the next steps and builds on the strong foundations of integration that that legislation put forward, with the integrated care boards, integrated care providers and integrated care systems, which our deliberations in Committee and in this House demonstrated were clear, understandable and effective in providing locally based governance; bringing together at an ICB level NHS services within a locality, and within an ICP broader ranges of services, including housing providers and others. This has been bringing together the national health service we have with the localised delivery we all seek.

That is one of the key points of the White Paper: the next steps in how to deliver place-based solutions and allow the system to continue to evolve organically through that permissive approach that characterises the legislation we are putting through Parliament, rather than the prescriptive approach that the Labour party at times appears to prefer. The White Paper contains new thinking on new ways forward, drawing on not just the lessons of the pandemic but much longer-standing arrangements within localities, recognising best practice for integration between health and social care, and reflecting that organic development that occurs within a place as local leaders, local communities and those using the services work together to deliver services that work best for them.

The hon. Lady touched on how some of this might work in practice and talked about funding and budgets. We have made it clear—I used to use this when I was a local councillor—that section 75 of the National Health Service Act 2006, on the ability to pool budgets, has been effective, but it is time to go further and explore whether that remains the most effective vehicle by which that sharing of budgets can be undertaken, so it is right that we look at this.

The hon. Lady touched more broadly on social care and the NHS. I have to say to her that we announced our White Paper for social care last September. She mentioned the plethora of White Papers. We rightly recognise the different parts of the health and social care system and have clear plans for each of them. Those different White Papers together form a coherent whole, putting forward reform proposals that will make a difference for patients and others alike. I have to say to the Opposition that, much as they may gently chide us on this, in 13 years in government they had two Green Papers, one royal commission and one spending review priority, but still no reforms to improve social care provision in this country. This Government have seized the nettle and brought forward proposals that will genuinely move us forward.

Finally, on the hon. Lady’s points about yesterday’s announcement on NHS waiting lists, this Government have been transparent with the British people about the challenge ahead of us and about our plan to meet that challenge. Our approach, which combines ambition with realism, has been welcomed by stakeholders across the health and social care space. Ours is the party of the NHS. We are the party that has put the resources into that NHS, with £33.9 billion put into law at the start of 2020, and then record funding through the health and care levy, which the Labour party voted against.