Future of the National Health Service

Paula Barker Excerpts

Wednesday 22nd September 2021 Westminster Hall

[Paula Barker (Liverpool, Wavertree) (Lab)]

It is a pleasure to serve under your chairship, Ms Bardell. I thank my hon. Friend the Member for Leeds East (Richard Burgon) for securing this important debate. I know that 83 of my own constituents signed the petition, and many more have emailed me expressing concerns about the Government’s Health and Care Bill. I concur with those concerns.

Over the last 18 months, billions have been wasted on failed track and trace systems and failed personal protective equipment contracts that have been awarded to mates down the pub, while our amazing NHS workers have not received the pay rise that they deserve. Of course, we want to see greater collaboration between health and social care services, especially on the back of the ongoing pandemic and the lessons that we have drawn from it. No longer can health and social care services work in silos. We saw how social care, particularly residential care, played second fiddle to the NHS in the early part of the pandemic. That is superbly illustrated by the Channel 4 drama “Help”, based in my city of Liverpool. However, I am resolute that the Health and Care Bill must be paused, as too many questions remain unanswered. I will try to outline some of those questions.

We can expect integrated care boards to spring into life in the new year. They will, certainly in a governance sense, vary from area to area. While having a place-based strategy that is responsive to local health needs and inequalities is welcome, we cannot be subject to a postcode lottery, with the influence of private providers greater in some areas because they have been awarded places on the boards and others have not. Nothing in the draft legislation prohibits such a conflict of interest, nor is it clear anywhere that the NHS is the preferred provider for medical and clinical services. The potential for interference from the Secretary of State for Health is a major cause for concern when it comes to awarding contracts, particularly given the Government’s own support for privatisation.

On the integration of health and social care services, I remain a sceptic, even if the intentions are sound. I fear that there is a real risk that adult social care will be the poor relation to a resource-hungry NHS, especially with a huge elective care backlog. That is the only conclusion we can draw from the Prime Minister’s announcement of extra spending on health services and the non-plan for social care. Out of £36 billion, £5.4 billion over three years to be put aside for social care is not enough and will not make an tangible difference for local authorities, as the primary commissioners of adult services.

Locally pooled NHS and local government adult care budgets—if that is to be the direction of travel—could well enhance the provision of adult social services, but equally the reverse could be true. That is why, through integrated care partnerships, the importance of place and locality is emphasised as part of every established integrated care board. Accountability must float sideways, down and up. It is essential that integrated care boards must be held accountable by ICPs and vice versa, right through to smaller partnerships working at local level. Local government needs to be front and centre of the development of any integration strategy, as the custodians of adult social care.

The draft legislation should mandate ICBs to develop comprehensive workforce strategies in their localities. Labour councils in my own north-west region, alongside Unison North West, are already engaged in such work, but are coming up against an unforgiving social care market, with too many providers refusing—yes, refusing—money to increase the wages of their staff. Many of the Labour amendments and others will significantly improve the Bill and answer many of the questions I have raised. Sadly, I suspect the Government will not give them a fair hearing.