Health and Care Bill

Kevin Hollinrake Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Sajid Javid]

There have been wide-ranging consultations on the Bill, as I mentioned, which have taken place over the past two years. While I cannot say specifically which trade union or which particular organisation has been spoken to, as I was not in the Department at the time, I know that the conversations have been wide ranging.

The Bill is not the limit of our ambitions on the nation’s health. We are also transforming public health; we are bringing the Mental Health Act into the 21st century; and, by the end of this year, we will set out plans putting adult social care on a sustainable footing for the future.

We are also ambitious for our workforce. I have commissioned Health Education England to refresh its strategic framework for health and social care workforce planning. HEE will work in partnership across the sector and gather views from the widest possible range of stakeholders to help us to shape a workforce with the right skills, the right knowledge and the right values for the year ahead.

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

My right hon. Friend has set out his plans to introduce a plan for social care by the end of the year, and I know that he is looking for a cross-party solution. In a joint inquiry by two Select Committees—the Housing, Communities and Local Government Committee and the Health and Social Care Committee—one of the recommendations was a system with a German-style social care premium. Would that potentially feature in his recommendations, and does he agree that that is a much fairer system than a Dilnot-style system that incentivises people to spend their assets or move them somewhere where they cannot be touched?

[Sajid Javid]

First, my hon. Friend is right to say that it would be great if all or most Members of this House, and certainly the different parties, could agree on a new system. I look forward to speaking to all hon. Members about what a future social care system could look like. In terms of the detail, I am afraid that he is just going to have to wait a moment longer, but I agree that the work by the Select Committees will, of course, inform our decisions.

I turn in a little more detail to the measures and themes that are captured in the Bill. The first is more integration. We know that different parts of the system want to work together to deliver joined-up services, and we know that, when they do that, it works. We have seen that with the non-statutory integrated care systems in the past few years. They have united hospitals and brought together communities, GPs, mental health services, local authority care and public health, and it works. We recognise that there are limits on how far this can go under the current law, so this Bill will build on the progress of integrated care systems by creating integrated care boards and integrated care partnerships as statutory bodies. England’s 42 ICSs will draw on the expertise of people who know their areas best. They will be able to create joint budgets to shape how we care for people and how we promote a healthy lifestyle. With respect to the specific geographies of the ICSs themselves, as I have said elsewhere, I am willing to listen.

--- Later in debate ---

[Jonathan Ashworth]

My right hon. Friend is absolutely right. I will come to the financial flows in a few moments. But how on earth can we have a triple aim of trying to improve health outcomes for a population and not even give public health a voice and a seat on the decision-making body that decides health plans for an area?

The Secretary of State talks about integrating health and social care. There is no seat for directors of adult social services on these committees, either. And what about patients? Patients were not mentioned very often by the Secretary of State in his speech. Patients will always come first for the Opposition. They have no mandated institutional representation, either—no guaranteed patient voice—so we have yet another reorganisation of the NHS whereby patients are treated like ghosts in the machine. It is utterly unacceptable. This is fragmentation, not integration, with a continued sidelining of social care.

There is a loss of local accountability as well, because there is no explicit requirement that the boards meet in public or publish their board papers. Although NHS England has stated that that is its preference, it is not required; nor is there any commitment, despite the wide geographical spread of some ICSs, for meetings to be made accessible online. But, of course, the White Paper did indicate that the independent sector could have a seat on an ICS, and the explanatory notes to the Bill state that

“local areas will have the flexibility to determine any further representation.”

[Kevin Hollinrake]

The right hon. Gentleman talks about solutions to social care. Will he come on to his own solutions to social care? Will they potentially include the recommendations of the Select Committees about that German-style social care premium—recommendations made by members of his own party who were elected by his party to serve on those Committees? Is that something that he is now willing to explore? He has ruled it out time and again on the Floor of the House.

[Jonathan Ashworth]

I have. The hon. Gentleman is a dogged advocate for that proposal for social care, and he is quite right: he always raises it with me. I am unpersuaded but I am more than happy to sit down with the Secretary of State and with my hon. Friend the Member for Leicester West to discuss a solution to social care. We keep being told that there are going to be cross-party talks, but I think I missed the Zoom link, because they have not happened so far.

As I was saying, these committees do permit a seat, if the committees want it, for the independent sector. In Bath, in Somerset, we have seen Virgin Care get a seat on the shadow ICS. The Opposition think that is unacceptable and we shall table amendments to prohibit it.

I welcome the removal of the section 75 competition and procurement rules, finally scraping the remnants of the Lansley competition rules off the boots of the NHS. We did warn him and others that this compulsory competitive tendering would lead to billions going to the private sector, would be wasteful and bureaucratic, and would be distracting—and it even led to the NHS getting sued by Virgin Care when it did not win a contract. But this is not the end of contracting with the private sector. Without clauses to make the NHS the default provider, it would be possible for ICBs to award and extend contracts for healthcare services of unlimited value without advertising, including to private companies. Given the past year, when huge multibillion-pound contracts have been handed out for duff personal protective equipment and testing, we naturally have concerns about that and will seek safeguards in Committee. We are worried about further cronyism.

We are particularly concerned about the Bill because of the power grab clauses for the Secretary of State. He is creating 138 new powers, including seven allowing him in effect to rewrite the law through secondary legislation, to transfer functions between arm’s length bodies without any proper scrutiny. He has not explained why he needs these powers or given any guidance on how he expects to use them. These powers also include a requirement that Ministers be informed of every single service change, every single reconfiguration, and the Secretary of State will then decide whether or not to call them in for ministerial decision. Are you sure you want that power, Secretary of State?

The Government have gone from wanting to liberate the NHS under Lansley to now listening out for the clang of every dropped bedpan echoing through Whitehall. This is not a plan for service modernisation; it is a “Back to the Future” plan and it will mean more inertia. Instead of powers to interfere at every level, resetting the mandate for the NHS within years, we instead would want the duties on the Health Secretary, and therefore on the 42 ICSs to which he delegates those responsibilities, to continue the promotion in England of a comprehensive health service, as per the National Health Service Act 2006, to be fully reinstated and made explicit.