Integrated Care Regulations

Kevin Hollinrake Excerpts

Monday 18th March 2019 Commons Chamber

[Jonathan Ashworth]

We keep being told by Ministers, by those who are favour of integrated care and by various interested stakeholders that Labour Members are scaremongering and that we have nothing to worry about—that it is all going to be fine and all going to be in the public sector—yet at the same time we are seeing controversial privatisation after privatisation all across the country, of which the one in Oxford is just the latest example. This has happened since the Secretary of State went to the Select Committee and said that there would be no privatisation on his watch.

In south-east London, private companies are in a three-way fight for the biggest-ever NHS pathology contract—a £2.2 billion contract for 10 years. If the Secretary of State was sincere in his commitment to no privatisation on his watch, he would bring forward legislation to ensure that ICPs are statutory public bodies that are publicly accountable. He would first take the advice of the NHS itself, as embodied in the long-term plan and the subsequent proposals for legislative change, and rid our NHS of the morass of competition law and economic regulation that was brought in by the Health and Social Care Act 2012. Everyone agrees that this particular aberration has had its time.

While the NHS proposals do not yet go as far as Labour Members would want and would not resolve all the problems of the internal market and private sector involvement that our NHS struggles with, they would remove the default assumption for competitive tendering that would currently make many ICSs feel obliged to put contracts for ICPs out to tender for fear of falling foul of the competition rules. Overall, they provide a far preferable base from which to pursue integrated care than the maze of contradictions and obstacles that Andrew Lansley’s Act forced on them. Rather than this regulated change, why is the Minister not bringing forward the legislation that NHS England has called for?

I have two other quick points for the Minister. The new secondary legislation seeks to substantially change the regulations underpinning the existing contractual arrangements for the provision of NHS GP services. We should remember that general practice is already hard to recruit for and we are already losing GP numbers, yet the proposal to incorporate GP practices into ICPs appears to cut across the idea of GPs beginning to work in wider networks covering 30,000 to 50,000 patients, retaining their GP contracts but sharing common resources. That was highlighted as a direction of travel to be celebrated by the Prime Minister when launching the long-term plan.

GP practices can already network and collaborate without this new contract. The contract will offer a sweetener to GPs of new money if a GP practice signs up to the new contract, but the proposals have been opposed by the BMA. Dr Richard Vautrey has said:

“We have repeatedly expressed our serious concerns about ICP contracts which leads to practices giving up part or all of their General Medical Services contract as a result. Practices should not feel pressured into entering an ICP contract as to do so could leave their patients worse off.”

Perhaps the Minister can explain why he is correct and Dr Vautrey is wrong.

I want to make a quick point about the pooling of budgets with respect to universal free-at-the-point-of-use NHS and means-tested social care. If the boundaries between health and social care are dissolved, will the Minister mandate ICPs and clearly specify that which is considered healthcare and that which is considered social care? I raise that because we are already seeing CCGs across the country cutting back on their responsibilities to provide continuing healthcare for some of the most vulnerable people. Can he guarantee that some services currently provided free on the NHS—whether rehabilitation care or nursing care provided by district nurses, such as wound care or continence care—will not suddenly be designated as social care, so that charging creeps into the system?

[Kevin Hollinrake (Thirsk and Malton) (Con)]

The hon. Gentleman talked about the funding of social care. One of the recommendations made by the Health and Social Care Committee, in concert with the Housing, Communities and Local Government Committee, as a solution to adult social care funding, was a system of social insurance. Would he support that on a cross-party basis?

[Jonathan Ashworth]

The hon. Gentleman is a passionate campaigner for his social insurance proposal, and I have heard him make that point many times. I say to him gently that when the Government bring forward their Green Paper—I emphasise the word “when”—we will engage fully in the debate, and I am sure he will make that point then, whether the debate happens this year, next year or the year after; we will wait and see.

There is a problem with the dissolving of boundaries between health and social care and what that could mean, with charges creeping into the system for some services that were previously considered NHS services but are now designated as social care services. Is the Minister prepared to mandate ICPs, so that we have clear guidelines about that? Finally, where is the patient voice in any of this? Where are the guarantees that decisions will be made not only in public but with the public involved in the decisions that affect them locally?

We on the Opposition Benches support integration; we have long called for it. We support greater collaboration. We support the planning of health and social care delivery in local areas. We support restoring local area-based health bodies delivering care, rather than the fragmented mess we have today. We have, of course, had such bodies before—we used to have district health authorities and strategic health authorities, and some have suggested rather mischievously that we seem to be going back to what we used to have in the past.

Until the default assumptions of tendering and wasteful procurement exercises are removed from primary legislation, such secondary legislation will always create further dangers of private operators gaining control of NHS services. Until that is done, Ministers will have no one to blame but themselves if the spectre of privatisation continues to haunt their ICP plans. We oppose NHS privatisation. We oppose NHS cuts. We oppose anything that undermines the fabric of a public national health service. We oppose these regulations. We seek to annul them, and I commend our motion to the House.