Health and Care Bill

Nigel Evans Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Munira Wilson (Twickenham) (LD)]

I would like to make it clear that the Liberal Democrats have long supported the aim of integration between health and social care, and the far greater involvement of local authorities in the planning, commissioning and delivery of services. We recognise that the pandemic has forced many of these bodies to work closely together in a much more collaborative way, and that is welcome. However, the Bill pays lip service to social care. It is largely a Bill about NHS reform, with yet another acronym-laden reorganisation that seeks to provide the legislative basis to integrate NHS services, currently in crisis mode, with a broken, underfunded and fragmented social care system. It is a massive power grab by the Secretary of State for political interference in operational and local service reconfiguration decisions and in who runs integrated care boards. The Bill is woefully inadequate in ensuring that the plans and resources are in place to ensure that we have sufficient doctors, nurses and other healthcare professionals and carers to deliver care, both now and in the future. This is all against a backdrop of record waiting lists and staff who are burnt out, stressed and struggling to cope with the third wave of the pandemic while dealing with surging A&E visitors and tackling the enormous backlog of care.

Without meaningful social care reform, this Bill cannot realise its aim of providing citizens with better joined-up care. With over 100,000 vacancies in the workforce, 1.5 million people are currently missing out on the care they need, putting additional burdens on the NHS and, importantly, on 9 million unpaid carers. The Government have promised—at the moment I take them at their word, though they have broken it many times—that they will bring forward social care reforms later this year. So why not delay the Bill for a few months and take account of the new model of social care, rather than doing a half-baked job now?

It really beggars belief when we look back over the past 16 months of the pandemic that the right hon. Member for West Suffolk (Matt Hancock), who was the architect of the proposals, seriously thought that granting himself more powers over the day-to-day running of the NHS was a good idea. We only need to look at the PPE fiasco and the failures of test and trace, both of which were run centrally, to see that handing back power to the Secretary of State is the very opposite of what we need. Allowing him or her to meddle in the day-to-day running of our NHS seems to fly in the face of the desire for more local and regional decision making.

I fully support and endorse the proposals of the right hon. Member for South West Surrey (Jeremy Hunt) on the health and care workforce independent planning proposals. They need to be properly resourced and annually reported to Parliament. Without a workforce plan, without wholesale reform of social care and while waiting lists are skyrocketing and the Health Secretary is embarking on a power grab that is his predecessor’s vanity project, this Bill will fail in its fundamental aim, shared by most Members of this House and health and care leaders—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. The hon. Lady’s time has run out.

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[Debbie Abrahams (Oldham East and Saddleworth) (Lab) [V]]

This is the wrong Bill at the wrong time. To introduce a Bill like this when the covid pandemic is far from over and staff are on their knees shows a lack of understanding of what is needed.

I am concerned that this reorganisation of the NHS is being used as an opportunity to extend the involvement of UK and international private healthcare companies. The Bill proposes that private healthcare companies can become members of the integrated care boards, potentially meaning they will be able to procure health services from their own companies. Under the Bill, ICBs will have only a “core responsibility” for a “group of people”, in accordance with enrolment rules made by NHS England. There are concerns that this evokes the US definition of a health maintenance organisation, which provides

“basic and supplemental health services to its members”.

What is included in the core responsibilities?

Why is there no longer a duty but only a power for ICBs to provide hospital services? What does that mean for the thousands waiting for elective surgery? What about those waiting for cancer and other therapies? For those who say, “What does it matter who provides our healthcare as long as it meets the NHS principles of being universal, comprehensive and free at the point of need?” I say that not only is the Bill a clear risk to those founding NHS principles but there is strong evidence that equity in access to healthcare, equity in health outcomes and healthcare quality are all compromised in health systems that are either privatised or marketised, as the NHS has increasingly become.

That brings me to my third area of concern: health inequalities. It is notable that the Bill places the duties for the reduction of health inequalities with ICBs. The 2012 duty on the Secretary of State and NHS England to reduce inequalities is repealed, showing the clear lack of commitment to levelling up and the reduction of the structural inequalities that have been laid bare by this pandemic and contributed to the UK’s high and unequal covid death toll. With this change, the Secretary of State is ignoring not only decades of overwhelming evidence that clearly shows that health inequalities are driven at national policy level, but the Prime Minister’s commitment to implement the recommendations that Professor Sir Michael Marmot made in his covid review last December to tackle inequalities and build back fairer.

My final point is on social care. As chair of the all-party parliamentary group on dementia, I express my profound disappointment that, 19 months since the Prime Minister pledged to fix the broken care system, it still has not been fixed. The Bill is a missed opportunity to set out the framework for social care reform in the context of an integrated health and social care system. For people with dementia and their family carers, who have suffered disproportionately from covid, this is a real blow. They deserve better. For me, the principle of health and social care—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sorry, but we have to go on.

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[Philip Dunne (Ludlow) (Con) [V]]

I am pleased to support the Bill. It is the first significant reorganisation of healthcare in recent years, and only the second since the Conservatives came into office following 13 years of Labour Administrations who reorganised the health services nine times, so we should not be taking lessons from the Opposition on the timing or the fact of putting things right.

The Bill is very substantial legislation that learns lessons from the way in which the NHS has had to work during the covid pandemic. In particular, the flow-through of patients discharged out of the acute sector as a result of much closer working with social care and local authorities is an integral part of creating the new integrated care boards. I very much welcome the fact that they are being established on a statutory footing and that there will be representation from local authorities and a role for health and wellbeing boards to provide local oversight. That is an essential step to allow the healthcare economy across our communities to collaborate effectively, and to remove some of the artificial barriers.

I will touch briefly on three other points. On the measures proposed for reconfiguration, we in Shropshire have been at the wrong end of a protracted reconfiguration process for our acute hospitals. Streamlining the process by which decisions are made will benefit patients. In Shropshire, it has taken several years to reach the point at which decisions can be made, and at every stage obstacles are put in place that add to delay and uncertainty. As a consequence of that, it is hard to attract staff to a system not working as well as it should, and the system has gone into special measures. The provisions to streamline difficult decisions are therefore very welcome.

Secondly, as my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee, said, the Bill is somewhat light on workforce, but it does include key measures to speed up the ability of physicians trained in other systems to be welcomed into the NHS or to return to the NHS and if they have retired. I urge Ministers in Committee to look carefully at what can be done—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I am afraid we are under huge time constraints.

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[Bell Ribeiro-Addy (Streatham) (Lab) [V]]

This month we marked the 73rd birthday of the NHS, and instead of celebrating it and giving it the homage that it deserves—the NHS, one of the very best things about our country—the Government have introduced a Bill that looks set to ramp up their long-standing attempts to continue to privatise it. I was proud to add my name to the reasoned amendment in the name of my hon. Friend the Member for Coventry South (Zarah Sultana) because we do not need private healthcare companies to sit on boards deciding how NHS funding is spent, further outsourcing of contracts without proper scrutiny, transparency and accountability, or the introduction of a model of healthcare that incentivises cuts and the closure of services.

Forcing NHS staff to implement yet another top-down Conservative reorganisation would take people away from the task of tackling growing treatment lists and coping with rapidly rising covid cases. We need to fill our 84,000 vacancies, and we need a 15% pay rise across the board for our NHS staff. It is hard to see how ordering a reorganisation such as this while ignoring calls for increased funding and a plan for social care could be anything other than disastrous.

This corporate takeover Bill—which is exactly what it is—will put private companies at the heart of the NHS and pave the way to sell off our confidential health data to multinational corporations. Nobody wants that. It will normalise the corrupt contracting that we have seen during the pandemic. The money that we spend on our healthcare should go to the services that we need, not to the pockets of Conservative party donors or corporate shareholders. Over the path of the pandemic, we have seen what this outsourcing and privatisation has meant in practice. Contract after contract awarded without competitive process. People being failed. Failing contracts. Delivery failed on again and again. Now the Government want to open up new ways for that to happen, just as they have done throughout the pandemic.

Let us consider what happened with Track and Trace, which was a complete disaster in the hands of Serco. The system has been so ineffective that, recently, MPs concluded that it had ”no clear impact”—a £37 billion system with no clear impact. After a decade of cuts, it was our NHS and its staff and volunteers who led the vaccination roll-out. That was a success, but it was their success, not the Government’s success. That is a lesson that we can learn about exactly what happens when we give the NHS the funding it needs, but the Bill does nothing to do that. We do not need more overpaid consultants involved the NHS; we need to value the staff we already have, and put in the investment that made the vaccination programme a massive success. We must be clear—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. We must move on to the next speaker.

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[Several hon. Members rose—]

[Mr Deputy Speaker (Mr Nigel Evans)]

The wind-ups begin at 6.44 pm.

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[Edward Argar]

She did.

In response to the hon. Member for Central Ayrshire (Dr Whitford), I am again grateful for her comments and happy to accept her kind invitation to join her on a visit to Scotland.

The right hon. Member for North Durham (Mr Jones) made a very important point. In doing so, he rightly paid tribute to the work in this space done by my hon. Friend the Member for Sevenoaks (Laura Trott) with her recent private Member’s Bill. As the Secretary of State said, either he, I or the relevant Minister will be happy to meet him to discuss it further. My hon. Friend the Member for Meriden (Saqib Bhatti) was right to talk about the need for local flexibility. That is what we are seeking to do.

The hon. Member for Eltham (Clive Efford) asked more broadly about public spending constraints after 2010. He is brave, perhaps, to mention that. I recall the legacy of the previous Labour Government, which the right hon. Member for Birmingham, Hodge Hill (Liam Byrne) summed up pretty effectively in saying,

“I’m afraid there is no money.”

On social care, which a number of hon. and right hon. Members mentioned, we will take no lessons from Labour. In 13 years, after two Green Papers, a royal commission and apparently making it a priority at the spending review of 2007, the net result was absolutely nothing—inaction throughout. We are committed to bringing forward proposals this year. Labour talks; we will act.

The NHS is the finest health service in the world. We knew that before the pandemic, and the last year and a half have only reinforced that. It is our collective duty to strengthen our health and care system for our times. I was shocked, although probably not surprised, that the Opposition recklessly and opportunistically intend to oppose the Bill—a Bill, as we have heard, that the NHS has asked for—once again putting political point scoring ahead of NHS and patient needs. For our part, we are determined to support our NHS, as this Bill does, to create an NHS that is fit for the future and to renew the gift left by generations before us and pass it on stronger to future generations. We are the party of the NHS and we are determined to give it what it needs, what it has asked for and what it deserves. I encourage hon. Members to reject the Opposition amendment, and I commend the Bill to the House.

[Mr Deputy Speaker (Mr Nigel Evans)]

I apologise to the 30 Members who did not get to speak in this important debate, some of whom are currently in the Chamber.

Question put, That the amendment be made.