Draft National Health Service (NHS Payment Scheme - Consultation) (No. 2) Regulations 2022

Karin Smyth Excerpts

Monday 9th January 2023 General Committees

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under you, Sir Graham. I am always concerned when a Minister brings forward something that is seen as an administrative process; indeed, we should all be concerned when that happens.

As my hon. Friend the Member for Enfield North said, this matter is very important. I have a couple of questions. As my Front-Bench colleague said, PBR was introduced as part of a quality drive to incentivise the system—to make the system operate in certain ways. I served on the Committee that considered the Health and Care Bill as it progressed through this place last year. I asked the then Minister, the right hon. Member for Charnwood (Edward Argar), several times what system would replace PBR to incentivise the operators in the systems, or the trusts and so on, but no answer came forward. It would be helpful to hear from this Minister, in his wrapping up on the admin process as part of the consultation—we know that was launched on 23 December, at the same time as planning guidance for the NHS, not giving the NHS managers, and so on, much time for a Christmas break—what the Government are thinking in terms of a system that will still incentivise quality of service and efficiency of taxpayers’ money. So far, we do not know what that will be.

PBR ignored the operation, particularly, of community mental health services and primary care—it never operated for those. Not many mental health services, in particular, asked to be inside the tariff, in order to maximise their own income. Therefore, what in the system will support community, primary and mental health services to drive up quality and ensure that we have efficient use of money?

On the 66% threshold for consultation—I would recommend that figure for many referendums and consultations—will the Minister provide clarity about this point? If, for example, in my area of Bristol, North Somerset and South Gloucestershire, the providers disagreed with the proposals, but the ICB decided otherwise, would the providers make up the 66% differently from the ICBs? That was not clear in the Minister’s comments. Trusts and trust chief executives, particularly, should be free to make a judgment on what works best for them. However, the drive of the 2022 Act—which I support—is about making the whole system use its money more efficiently, and that is where the Government now are, so can trusts in local ICB areas disagree with the recommendations of the ICBs? How is the 66% being calculated?

[Will Quince]

I thank the hon. Member for Enfield North for her constructive comments and broad support. Several of the issues raised did not actually relate specifically to this debate. We are of course here to discuss the objection percentages. I am conscious that she would like to push further on items including payment by results, but I will just say—not wanting to test your patience, Sir Graham, given the strict parameters of this statutory instrument—that I would be very happy to write to her. Alternatively, there are health oral questions coming up. I stress that if there are proposals that relevant commissioners disagree with, I encourage them to make representations as part of the consultation, which is open until 27 January.

Let me turn specifically to why I believe the 66% is proportionate—I covered that in my opening speech. The 66% is made up of either integrated care boards or providers, and I will happily write to the hon. Member for Bristol South on that. I think the point that she was making was whether there is weighting towards an ICB versus a provider. Is that right?

[Karin Smyth]

To be clear, the two or three trusts in my patch could all object, but the ICB could support this. Do the trusts have to come within the totality, or will the trusts be counted separately, without getting too mathematical about it? Every trust in the country could oppose this, but the 44 ICBs could support it, for example, in extremis.

[Will Quince]

I thank the hon. Lady for clearing that up. I think the answer to the question is that if an integrated care board or a provider hits the 66%, that threshold is triggered.

Perhaps it would be helpful if I set out what would happen if the threshold is triggered. Unlike the previous scheme, where the Competition and Markets Authority would be involved, under the new proposals, if the objection threshold is reached, NHS England must discuss the objections with representatives of all organisations that objected. It is in the interests of both them and NHS England to reach a conclusion that is workable for both.

Following the discussion, NHS England must decide whether to amend the proposed payment scheme and reconsult on the amended payment scheme, or to proceed with the scheme, as published, that was consulted on. If it decides to proceed with publication, it must also publish a notice explaining its reasons for doing so and send a copy explaining with the notice to all organisations that objected and therefore met the threshold.

I thank Committee members for their contributions to today’s debate, and I would be very happy to write to or meet any hon. Member who has further questions. I genuinely believe that the objection percentages that we have discussed strike the right balance in allowing real collaboration between NHS England and those that it is consulting on. I commend the regulations to the Committee.

Question put and agreed to.