Health and Care Bill

Steve Brine Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Jonathan Ashworth]

I have. The hon. Gentleman is a dogged advocate for that proposal for social care, and he is quite right: he always raises it with me. I am unpersuaded but I am more than happy to sit down with the Secretary of State and with my hon. Friend the Member for Leicester West to discuss a solution to social care. We keep being told that there are going to be cross-party talks, but I think I missed the Zoom link, because they have not happened so far.

As I was saying, these committees do permit a seat, if the committees want it, for the independent sector. In Bath, in Somerset, we have seen Virgin Care get a seat on the shadow ICS. The Opposition think that is unacceptable and we shall table amendments to prohibit it.

I welcome the removal of the section 75 competition and procurement rules, finally scraping the remnants of the Lansley competition rules off the boots of the NHS. We did warn him and others that this compulsory competitive tendering would lead to billions going to the private sector, would be wasteful and bureaucratic, and would be distracting—and it even led to the NHS getting sued by Virgin Care when it did not win a contract. But this is not the end of contracting with the private sector. Without clauses to make the NHS the default provider, it would be possible for ICBs to award and extend contracts for healthcare services of unlimited value without advertising, including to private companies. Given the past year, when huge multibillion-pound contracts have been handed out for duff personal protective equipment and testing, we naturally have concerns about that and will seek safeguards in Committee. We are worried about further cronyism.

We are particularly concerned about the Bill because of the power grab clauses for the Secretary of State. He is creating 138 new powers, including seven allowing him in effect to rewrite the law through secondary legislation, to transfer functions between arm’s length bodies without any proper scrutiny. He has not explained why he needs these powers or given any guidance on how he expects to use them. These powers also include a requirement that Ministers be informed of every single service change, every single reconfiguration, and the Secretary of State will then decide whether or not to call them in for ministerial decision. Are you sure you want that power, Secretary of State?

The Government have gone from wanting to liberate the NHS under Lansley to now listening out for the clang of every dropped bedpan echoing through Whitehall. This is not a plan for service modernisation; it is a “Back to the Future” plan and it will mean more inertia. Instead of powers to interfere at every level, resetting the mandate for the NHS within years, we instead would want the duties on the Health Secretary, and therefore on the 42 ICSs to which he delegates those responsibilities, to continue the promotion in England of a comprehensive health service, as per the National Health Service Act 2006, to be fully reinstated and made explicit.

[Steve Brine (Winchester) (Con)]

As ever, I have listened carefully to the right hon. Gentleman. If this is the “Back to the Future” Bill, presumably it puts right what once went wrong. Does he support the clauses on foods that are high in fat, salt and sugar, and the watershed proposals for advertising?

[Jonathan Ashworth]

Yes, although I am disappointed that they are in this particular Bill. I think they should be part of a stand-alone Bill. In my concluding remarks, I will make a point or two about other public health interventions, which I imagine and hope that the hon. Member, as a great champion of public health, would support.

It is crucial that the Secretary of State’s duty to provide comprehensive healthcare is reinstated, rather than the duty to meddle in the NHS at any time he wants, because there is a lack of clarity about how the funding flows work in this system. The talk is of moving to capitated budgets for an area to provide holistic care to meet the complicated care needs of individual. But when waiting lists are increasing at the current rate, and when cancer waits and mental health referrals are going up, how is an area going to fund the episodic care for each unit of extra care that is needed—often care that is expensive and more complicated because it needs to be done in the acute sector?

We have worries. Clauses 21 to 24 on the financial duties on ICS boards, NHS trusts and NHS foundation trusts are alarming, because they put in place a duty to ensure financial balance across the ICS area, but there is no clarification of how that balance should be achieved and enforced. Local health budgets have been stretched to breaking point after years of underfunding, so what does this duty mean for existing deficits? At the moment, trusts have a combined deficit of £910 million. King’s has a deficit of £111 million. Worcestershire has a deficit of £81 million. University Hospitals of Leicester NHS Trust has a deficit of £80 million. Will the ICBs need to fill this £900 million black hole before they are even up and running How exactly will trust and ICS board deficits be dealt with at the end of each financial year?

This could well be a return to the days that we saw in the ’80s, which some Members in the House may recall, when health authorities would close beds and put off paying bills from January onwards in order to hit financial balance. If health authorities have to hit this financial balance year by year, will it result in a postcode lottery of more rationing and an even longer list of treatments being removed from the NHS through the decisions of ICBs because they have to hit balance, effectively forcing patients either to go private or go without? I hope that the Minister, in summing up, can clarify what the situation will be.

If a set of providers, trusts and an ICB feel that the financial settlement they have been given by NHS England will not allow them to deliver the levels of care to bring down the waiting lists, which the Secretary of State said is one of his top priorities, or to improve mental health outcomes, which he has also said is one of his top priorities, what is their appeal process? How will the arbitration process work on an area’s financial settlement under the current plans to bring together NHS England and NHS Improvement, not split them out?

The Bill is spun as an attempt to integrate health and social care, but there is nothing in it actually to integrate health and social care, because there is nothing in it to fix social care. If it is about integrating health and social care, where is the long-promised Bill to reform social care? The Bill will repeal provisions in the Care Act 2014 that require patients to be assessed for their social care needs before they are discharged from hospital. Without long-term funding in place, that could mean a patient being sent home, left out without support and waiting for an assessment. Will the Secretary of State, or the Minister who responds to the debate, guarantee that that will not be the case? Will they put in place the necessary funding alongside the Bill?

A number of royal colleges and health bodies have said today that the biggest challenge facing the NHS is workforce. The Bill proposes a duty on the Secretary of State to report on workforce once every five years. That is simply not good enough. We need a solution to workforce now; we need a solution to recruitment now; staff need a fair pay rise now; we need more investment in training and professional development budgets now; and we need safe staffing legislation now. We will therefore look to amend the Bill, hopefully on a cross-party basis and perhaps working with others who put forward proposals to improve the workforce sections of the Bill.

As my hon. Friend the Member for York Central (Rachael Maskell) asked the Secretary of State, what does the Bill mean for “Agenda for Change”? The Bill suggests that an integrated care system will be able to change “Agenda for Change” terms; we disagree with that.

Finally, on public health, the Bill introduces restrictions on the advertising of less healthy food and drink. We welcome this step—it, too, was in our 2017 manifesto, which the Secretary of State has been reading—but we would go further. Why can we not have more restrictions on the advertising of unhealthy food around schools? Our public health crisis is about not just obesity but smoking and alcohol, so why are there no provisions in the Bill on smoking services and to ensure alcohol calorie labelling? We will table amendments on those issues in Committee.

This is the wrong Bill at the wrong time. Will the person with learning difficulties or the older person who needs social care experience improved care? No. Will social care be brought back in from the wilderness? No. Will the cancer backlog be tackled more effectively? No. Will health inequalities be narrowed? No. Will parity of esteem for mental health be delivered? No.

Instead of this being a simple Bill to end competition and foster local collaboration, NHS staff will be left trying to second-guess where the Secretary of State will interfere next in the safe running of their local NHS with his in-year changing mandate. The rules on funding could result in more rationing and cuts, so we cannot possibly support the Bill. We have championed integrated care for many years, but the Bill does not deliver it and we urge the House to accept our reasoned amendment.

--- Later in debate ---

[Steve Brine]

It is unquestionable that we have a challenge with the GP workforce. It is about numbers, yes, but does my right hon. Friend agree that constituents have a big challenge with access to general practice? We currently do not have the right balance between telemedicine and in-person medicine.

[Jeremy Hunt]

There is a big issue, and my hon. Friend is aware from his time at the Department of Health that its root cause is capacity in the system. These capacity issues taken together are why the Health Foundation says that, in just over a decade, we risk a workforce gap in the NHS of about half a million people. That is why this is such a big issue. I urge the Secretary of State to think about that during the Bill’s passage.

--- Later in debate ---

[Steve Brine (Winchester) (Con)]

Health Bills, rightly, do not come around too often, so when they do there needs to be good reason. My conclusion, from the necessary establishment of integrated care systems to the so-called triple aim, the removal of the competition aspect and the new power of direction, is that there is good reason for legislation at this time. This is obviously a vast Bill, but because Health Bills do not come around very often, it is understandable that colleagues and officials will use the opportunity to give legislative cover to things that they have been working on for a long time. The Healthcare Safety Investigation Branch is a very welcome example of that.

I want to focus on workforce and then on primary care, and in doing so I refer the House to my entries in the Register of Members’ Financial Interests. On workforce, I remember publishing the cancer strategy in 2018. The issue then was not our ambition but having the cancer workforce to meet it. Obviously, the chances of surviving cancer have improved significantly in recent years. There are many reasons for that, but detecting 75% of cancers at stage 1 or early stage, which must happen, needs the radiographers in post and demands an endoscopy workforce that can properly execute the FIT screening for the bowel cancer programme, as one example.

[Christine Jardine (Edinburgh West) (LD)]

The hon. Gentleman is making an excellent point about the necessary workforce in the NHS. Does he agree that if we were perhaps to offer indefinite leave to remain to the many thousands of frontline NHS workers in all departments who are here on visas and have worked hard through this pandemic, we would help to fill the gap that so desperately needs closing?

[Steve Brine]

The hon. Lady makes a sensible point. There is obviously a process in place whereby that can happen, but if she is asking whether I agree with a liberal immigration policy to help our health service, then absolutely, yes I do. Addressing the cancer workforce and the wider NHS staffing picture is not an omission from the Bill—we cannot legislate staff shortages out of existence—but if we do not address that issue and face up to our long-term structural gaps, many of the reforms around tackling the backlog and building back better will not amount to a row of beans.

[Jeremy Hunt]

I congratulate my hon. Friend on the extraordinary work he did when he was a Minister on early diagnosis of cancer. Is he aware that the Health and Social Care Committee has just opened an inquiry—we had our opening session yesterday—into that issue, and into how we can get the right workforce in place to deal with those important matters?

[Steve Brine]

I was aware of that, and I am pleased to hear it. The Select Committee will soon have Cally Palmer before it—she is the national cancer director and one of the best in the business—and I look forward to following what she says. In advance of the comprehensive spending review, the Bill should include a requirement on the Government to publish modelling of the future supply of the entire healthcare workforce.

On primary care, I welcome the formal creation of integrated care systems, but we need them to realise their potential, and to do so fast. If they are going to work, general practice needs to embrace the wider primary care family, which means finally to recognise the potential of community pharmacy, ophthalmology and dental services as vehicles of prevention as much as of treatment.

Finally, if we move upstream of the Bill, what we do must be about prevention. We hear talk this weekend of a waiting list touching 13 million people. Let us tackle that for sure, but let us also get behind the food and drink clauses in part 5, and think about the future and our children as much as about the present. Several years ago I was fortunate to write up the high fat, sugar and/or salt proposals as part of chapter 2 of the child obesity plan, and I am pleased that the 9 pm watershed is legislated for in the Bill. I pay tribute to Jamie Oliver and his Bite Back 2030 campaign, and the young people involved with that, as well as to Cancer Research UK for its support. I realise that not everyone on these Benches, or perhaps outside, supports that move, and I agree that it will have little impact if that is its grand sum. Ministers need to take the tackling obesity strategy that was published last year, implement it all, and then go again.

I welcome the clauses on the fluoridation of water supplies. Let us stop debating whether we do that and —to borrow a phrase—follow the science.

In conclusion, the Bill is worthy of support on Second Reading. There will be an awful lot of work to do in Committee and the other place, but I will certainly support it this evening.