Future of Health and Care

Philippa Whitford Excerpts

Thursday 11th February 2021 Commons Chamber

[Matt Hancock]

I pay tribute to my predecessor’s work setting up integrated care systems in the first place. In a way, this legislation builds on the foundations that he laid when he was in my job, and I look forward to working with the Health and Social Care Committee on the legislation as it proceeds. We have already had discussions, and I am grateful for the Select Committee’s work so far and the insights it has provided.

The question my right hon. Friend raises about the accountability of ICSs is absolutely central, not just to accountability for the use of taxpayers’ money, but to driving up both the quality of care for patients and the health of the population the ICSs serve. It is critical that we ensure the correct combination of high levels of transparency, the role of the CQC as inspector, and accountability up from the ICS, through NHS England, to Ministers and therefore Parliament, and through our democratic processes to taxpayers. The White Paper sets out at high levels how that accountability will work. The details will be a matter for the Bill. The combination of transparency and clear lines of accountability are vital to make sure that while we use the integration provided for in the Bill to empower frontline staff to deliver care better, they are held to account for the delivery of that care and, critically, the outcomes for the population as a whole whom we serve.

[Dr Philippa Whitford (Central Ayrshire) (SNP) [V]]

Health and social care staff always do their best for their patients and residents, regardless of legislative systems, but I welcome the Government’s recognition of the damage caused to the NHS in England by the Health and Social Care Act 2012, and the proposal to reverse some of its most obstructive and expensive aspects, particularly section 75, which forced the outsourcing of services, promoted competition instead of collaboration, and made pathways more disjointed and confusing for patients, especially those with complex conditions. The devil, however, will indeed be in the detail.

Which model of integrated care is the Secretary of State proposing? Will he merge organisations, including commissioning groups, or, as the NHS would prefer, create new public NHS bodies, similar to the health boards we have in Scotland? When sustainability and transformation partnerships were created, their transformation budgets were quickly used up in covering debts caused by the bureaucracy of the healthcare market, so what additional funding is he committing to bring about this reorganisation? Given the pressure of covid, the backlog of urgent cases, and extensive staff vacancies, how does he plan to create the capacity for staff to carry out such service change? Covid has highlighted the vulnerability of the care system, so what plans are there to integrate health and social care?

Finally, the Secretary of State has highlighted health inequalities, but poverty is the biggest driver of ill health. What discussions has he had with the Secretary of State for Work and Pensions and other Cabinet colleagues about promoting the prioritisation of health in all policy decisions?

[Matt Hancock]

Of course health is an important consideration in all policy decisions. The overall response to the pandemic has demonstrated that.

The hon. Lady is right to raise the issue of integration and to ask what plans there are for the integration of health and social care. Indeed, that is at the core of the proposals, as I set out clearly in my statement, and at the core of the White Paper. The integration of health and social care has improved significantly this year as a result of people having to work together in the pandemic. Fundamentally, social care is accountable to local authorities, which pay for it, and therefore to the local taxpayer, whereas the NHS is accountable to Ministers and central Government. The combination of these two vital public services is a challenge that I think can be addressed through the integrated care systems. We have been working very closely with the Local Government Association in England and the NHS to try to effect that integration as much as possible.

The hon. Lady raises the issue of funding. Of course, the NHS has record funding right now, and rightly so, but these reforms are about spending that money better to improve the health of the population, to allow new technology to be embraced, and to remove bureaucracy. It is not about having to spend more money on a reform; it is about reforming in order to spend money as well as possible.