Queen’s Speech

Lord Hunt of Kings Heath Excerpts

Wednesday 12th May 2021 Lords Chamber

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, the Queen’s Speech promised yet another major structural change in the NHS. Well, it is no surprise that the Government want to do away with the wretched Health and Social Care Act 2012, which cost billions and wasted years, but I question their timing. Right now, the NHS, local authorities and the voluntary sector are still battling Covid-19. In implementing these proposals, the risk is that health and care services will be distracted from dealing with the crisis at hand and the tremendous backlog of patients who need urgent treatment.

Nothing in the legislation will address the chronic staff shortages, deep health inequalities and urgent need for long-term reform of social care. The proposals represent a marked shift away from the focus on enforced competition that underpinned the coalition Government’s 2012 changes. That is welcome. At the heart of the changes is the proposal to establish integrated care systems—ICSs—as statutory bodies made up of two parts: an ICS NHS body and an ICS health and care partnership. The ICS NHS body will be responsible for NHS strategic planning and financial allocation decisions. What is not clear, as NHS Providers has reported, is how the accountabilities of all parts of the local health system will align without duplication, overlap or additional bureaucracy.

It is even less clear when it comes to the ICS health and care partnership, which will be responsible for developing a plan to address the system’s health, public health and social care needs. It appears to have no authority, with the ICS NHS body and local authorities required merely to “have regard to” what this new body says. Why has local government not been brought more into the core of decision-making and accountability? Why are the largely ineffective health and well-being boards to continue to operate separately?

NHS Providers has also spoken of its concern that the Government’s planned powers of direction for the Secretary of State are too far-reaching. Many of the proposals give Ministers far greater powers over NHS England and other arm’s-length bodies, including the power to intervene earlier in local decisions about the opening and closure of NHS services.

I certainly worry that the forthcoming Bill gives too many powers to Ministers through secondary legislation. The White Paper argues that these are needed to enable the Secretary of State to respond more flexibly to rapidly changing circumstances, such as those seen during the pandemic. Yes, but those powers are not needed outside the pandemic, and it is not clear why reducing parliamentary involvement in this way is merited. If Ministers insist on seeking direct control of NHS England, that means they can no longer hide behind the decisions of a quango and will have to report and account to Parliament on many more detailed issues than now. I hope they realise that.

The proposals predominantly aim to reform the NHS. However, the NHS does not work in isolation—public health, social care and the NHS are closely connected. There is clearly a risk that, in setting out fixed plans for the NHS, the options for public health and social care reform become limited.

What about the needs of non-acute services? It is noticeable that the White Paper has not made it mandatory to have representatives of mental health and community trusts represented on each ICS board. Why not? What about community pharmacy, optometry and dental services?

It is also clear that the restructuring has little to say about the real challenges facing the NHS and social care. On social care, we are told virtually nothing. After decades of reviews and failed reforms, the level of unmet need rises, the pressure on unpaid carers grows, the supply of care providers diminishes and the strain on the undervalued care workforce ever increases. Social care remains severely underfunded, with the most deprived areas being worst hit. More than a million adults who need social care are not receiving it—the system is riddled with unfairness. There is no confidence that the Government will come up with anything near a coherent and funded plan. Until they do so, the promised NHS Bill can be only a pale shadow of what is required.