Health and Care Bill

Lord Prior of Brampton Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Prior of Brampton (Non-Afl)]

My Lords, I should first refer to my declaration of interest—in particular, that I am currently chairman of NHS England. Looking down at the noble Lord, Lord Stevens, and also seeing the noble Lord, Lord Adebowale, and the noble Baroness, Lady Harding, I could almost believe we were back at a board meeting at NHS England. I will give the House an idea of the kind of chief executive the noble Lord, Lord Stevens, was. At the beginning of a board meeting he would tell us what he thought, and then, to avoid any unpleasantness, at the end of the meeting he would tell us what we thought, so we all went away perfectly happily. It was a very good arrangement. It is wonderful to see him here in this House, and he will make a huge contribution, I am sure, in the years to come.

The phrase “another NHS reorganisation” is designed to send a chill through the sturdiest of hearts of all of us who have worked in the NHS for many years, so why do I actually think that the Bill is the right thing at this time? First, there is a pragmatic reason: it has very wide support from within the NHS; it goes with the grain of NHS culture; it is a Bill to be delivered bottom-up. Secondly, there is another pragmatic reason: it is already happening on the ground. NHS England and NHS Improvement already operate as one organisation, and locally integrated care systems have been and are being created. Thirdly, this is not some new-fangled ideological concept dreamt up by an ambitious Secretary of State. The process towards integration was launched some seven years ago by my former colleague and noble friend Lord Stevens. Then, it was called the five-year forward view. The underlying philosophy of the Bill has been road-tested in numerous places across England for seven years.

Fourthly, the fundamental basis of the Bill is, I think, unanswerable. I quote something verbatim from the NHS Five Year Forward View written seven years ago which is still true today:

“The traditional divide between primary care, community services, and hospitals—largely unaltered since the birth of the NHS—is increasingly a barrier to the personalised and coordinated health services patients need. And just as GPs and hospitals tend to be rigidly demarcated, so too are social care and mental health services even though people increasingly need all three.”


Finally and fifthly, the ICS structure will enable the NHS more effectively to deliver population health and, in particular, to address the growing and unacceptable levels of health inequality that disfigure our society.

For all those reasons, I support the Bill. I hope, however, that the Government will recognise that the improved accountability and transparency that resulted from the purchaser-provider split, the productivity gains that came from the incentives built into payment by results, and the innovation value driven by competition should still be kept as drivers of improvement and change within the ICS structure. I also hope—this will not be popular on all sides of the House, although it used to be popular on the other side—that this Government will publicly recognise the very important contribution that the private sector can make to delivering high-value care. I hope these issues will be debated fully in Committee.

The Bill, in whatever shape it finally takes, will not on its own mend a healthcare system that is extremely fragile, as many healthcare systems are in the developed world. Most health systems in the developed world are not, in reality, health systems; they are late-stage sickness and emergency care systems. By using digital technologies and predictive AI, by incorporating genomics, by focusing on population health, out-of-hospital care and self-care, and by investing in precision, personalised public health, we have a chance of changing what has now become an outdated model.

There are four particular issues I will leave with the Minister. The first is the workforce. I commend the amendment put forward by Jeremy Hunt in the other House. Long-term workforce planning is essential to the future of the NHS. The second is mental health. We have made huge progress but we are not there yet; there is no real parity of esteem in the provision of services and funding for mental health. Thirdly, I would like to see the ICBs committed to achieving net-zero carbon emissions, which the NHS as a whole is now committed to. Finally, on social care, I thought the contribution by the noble Lord, Lord Kerr, was pertinent. He is absolutely right: we are at the beginning of reforming social care, not the end.