Health and Care Bill

Lord Hunt of Wirral Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is my pleasure to support all the amendments in this group, so ably introduced by the noble Baroness, Lady Thornton. I thank her for tabling this amendment and Amendment 28, to which I was pleased to attach my name.

I agree with pretty well everything that has been said but want particularly to highlight the contribution of the noble Baroness, Lady Hollins. As she was talking, I was thinking about testimony that I heard earlier this week at the All-Party Parliamentary Group for Art, Craft and Design in Education. A teacher was saying that if their educational provision caters to the most vulnerable and disadvantaged pupil in their school, that means that it is catering the best for everyone. It might be thought that having a representative for the interests of those with autism and learning difficulties will affect the care that they receive but it would actually greatly improve the care that everyone would receive. That is not often adequately understood.

As the noble Baroness, Lady Thornton, said in her introduction, there are really two sub-groups here. Going from consideration of Amendment 18 to Amendment 30, we are essentially talking about, as the noble Baroness, Lady Bakewell, was saying, the need to avoid corporate capture of our NHS, although the corporate sector has already won many battles and taken over a great deal of the NHS. If the need for profit is the way in which things are being run, care must suffer. Care is the second priority and that is an unavoidable fact. When one considers privatisation—I have later amendments that will address the care sector in particular—we see where this has been allowed to extend to extremes, whereby the private equity sector has taken over our care system at enormous cost to the quality of care for public and private pockets. The system is in a state of near-continual collapse. We have to make sure that ICBs do not go down the route that our care sector has already gone down.

I am thinking about this matter for Report. There is also a further issue whereby although these amendments address people’s current employment and roles, we also need to think about the revolving door situation, about which, I see from social media, the public are increasingly concerned. We see people flipping between the private and public sectors and taking the interests, direction of travel and thinking of one to the other—and not for positive purposes.

I am aware of the hour but I am looking at the second sub-group of amendments, Amendments 37 to 41, and at who should be there. The issue relates to my comments on the previous group. We cannot just say, in terms of managing the NHS, “Just leave it to the doctors and the experts. They know about care.” Of course they do in terms of running services but in making choices and allocations and in ensuring that the ICB meets the needs of its community, it is the community that knows what the needs are and should tell the medical people what needs to be delivered, and the shape of that delivery. The technical details will come down to the medical people.

It is therefore crucial that we do not see the ICBs as technocratic places for people with MBAs and doctors but that we should include trade unionists, patients and carers. Carers are particularly important because our current system does so poorly in meeting their needs and supporting them. We need bodies that truly serve to represent the community.

[Lord Hunt of Wirral (Con)]

My Lords, in declaring my interests as set out in the register, I want to press my noble friend the Minister on conflicts of interest.

Paragraph 8 of Schedule 2 to the Bill provides that local NHS trusts and GPs are to appoint members of the integrated care board. Organisations that provide the bulk of NHS services will therefore be co-opted into the work of commissioning. It is currently the work of commissioners to hold providers to account, objectively determining whether they are best placed to provide a service and assessing their performance. The new integrated care boards must continue to perform that role.

Clause 14 introduces into the 2006 Act new Section 14Z30, subsection (4) of which provides, rightly:

“Each integrated care board must make arrangements for managing conflicts and potential conflicts of interest in such a way as to ensure that they do not, and do not appear to, affect the integrity of the board’s decision-making processes.”


Reference has already been made to amendments that seek to exclude individuals involved with independent healthcare provision from joining the ICBs. Does my noble friend the Minister agree that the membership of provider appointees on integrated care boards may at least risk creating a perception of a conflict of interest between the roles of those individuals on the board and any roles they may hold with provider organisations? How can the benefit of provider input into the work of an ICB be reconciled with the task of objectively assessing both the suitability and performance of providers? I believe that greater clarity from the very outset on the extent of the role that provider appointees will be expected to play will surely assist ICBs in developing robust governance arrangements, which would then enjoy public confidence.

[Baroness Meacher (CB)]

My Lords, I support Amendment 37. In so doing, I add my strong support to the comments of the noble Baronesses, Lady Bakewell and Lady Bennett.

Of course, the ICBs will be central to ensuring adequate funding and support, not only for the powerful acute health trusts and primary care but for the services that are historically underfunded. It is for these services that this amendment is particularly important. Before discussing these specific gaps in the Government’s vision for the new system, I want to stress that I am very concerned that we should not lose vital clinical leadership along with patient representation, which were the hallmarks of the CCG system. Of course, we want worker and carer representation but, in my experience, top medics are actually rather good at deciding how money should be allocated across services.

In my view, the absence of a public health representative from the shortlist of necessary ICB members in the Bill is an extraordinary oversight. This amendment seeks to put that right. ICSs are already in the process of developing their draft constitutions, which, while dependent on the final content of the Bill, provide a clear indication of their intent regarding clinical membership. It is particularly concerning that several ICSs have failed to include any role on their ICB for public health experts in their draft constitutions, with some failing to make any reference to public health at all. As the BMA points out in its briefing, this poses a significant risk to the role and prominence of public health within the work of those ICBs.

In relation to the importance of public health representation on ICBs, noble Lords should be aware of the impact of this on the vexed issue of drug addiction. Police services up and down the country are recognising that criminalisation and imprisonment are entirely counterproductive in this field. These responses only limit the young person’s education and employment options and tie them into a life of drugs and crime, with appalling consequences for them but also for their communities. Police services are increasingly adopting diversion to treatment as a preferable response when an individual is found in possession of drugs, but drug treatment services have been cut over the past 10 years. ICBs will need to tackle this situation as a matter of urgency if the police are to be able to stem the tide of county lines and other highly damaging consequences of our counterproductive and, in my view, idiotic drug policies and failure to treat addiction as a mental health problem, which, of course, it is. These urgent issues will not be confronted unless public health is strongly represented on ICBs and other boards and committees in the new structure.

Another cri de coeur is for mental health, as others have said. Having chaired a mental health trust for many years, I am acutely conscious of the impact of bed shortages on very sick people and their families and of the very high threshold for child mental health services. There is no doubt that if we do not treat children with mental health problems, we will have adults with these kinds of problems throughout their lives. The country cannot afford to continue neglecting this important field. I support the other amendments in this group. The NHS has major long-term workforce shortages and other problems. If they are to be addressed adequately, the staff need representation, along with patients and carers.

I end with a plea to ensure, through membership of ICBs, ICSs and ICPs, that clinical leadership is retained within the NHS. On ICBs, this must include at least two primary care members, at least one clinical representative of secondary care, acute care and mental health and at least one qualified and registered public health consultant. I hope the Minister will tell the Committee whether he agrees with this approach to ICB membership.