Health and Care Bill

Baroness Thornton Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, first, I declare my interest as a non-executive member of a hospital trust in London; indeed, my chair is in the Chamber. I was also on a CCG for three years and it got absorbed into its local ICS, so I have lived this story, too.

I thank noble Lords for a debate that has done as much justice to this Bill as time has allowed. I congratulate the noble Lord, Lord Stevens, who is much too young to be a national treasure, if he does not mind me saying so. I also thank the outside organisations and the Library for the many briefs. Patient groups, royal colleges, regulators, trade unions, the EHRC, health charities, campaigns, and even a chocolate manufacturer, on behalf of the confectionery industry, and a large optician chain have a close interest in the Bill and have troubled to tell us so, and I thank them very much.

I particularly enjoyed the contribution from my noble friend Lord Howarth, linking, as he did, the arts and health and well-being. All I can say to my noble friend Lord Rooker is that I would not mind being on the prosecco experiment myself, particularly at this time of night. For my part, I intend to focus on the core of the Bill, the NHS reorganisation. The key questions about the Bill are surely these. What does it do for patients? How does it address health inequalities and the NHS workforce? Does it make things better or worse, or is it silent, and what can we do in this House to improve it to tackle those challenges? That is surely our job.

On the workforce, for example, my noble friend Lord Turnberg, the noble Lords, Lord Stevens, Lord Kakkar and Lord Patel, the noble Baroness, Lady Watkins, and many others pointed to the fact that, without a plan and a comprehensive strategy that covers all the health and social care workforce, it is not possible to deliver better care for patients to address health inequalities, which is why amendments about the workforce will receive significant attention as we move forward.

Many of us were in the House during the passage of the Health and Social Care Act 2012, which was never fully implemented because it was a bit of a mess, if I may say so. I remember the tangled spaghetti of organograms resulting from the 2012 reforms. If the noble Lord, Lord Stevens, thinks that this one is worse, I dread to think what that would look like. Of course, we will have to untangle that.

As my noble friend Lady Merron said in her opening remarks, we are not convinced that this is the Bill that the NHS and social care need at this time. In 2017, the Government should have prepared a Bill that simply implemented changes to reverse the worst of the 2012 Act, stop the pointless bureaucracy and ease the implementation of the NHS long-term plans. However, we are no longer in 2017: we have been through the biggest public health disaster of modern times. We can be grateful for the huge strengths of our NHS, but the pandemic has also amplified the inequalities and serious flaws that need addressing.

I will give three examples of what we have to address in the Bill. We all understand that primary care provides the vast majority of NHS care and will play a more significant role in prevention, tackling health inequalities and supporting capacity issues in the hospital sector under the NHS Long-Term Plan. Therefore, it is vital that primary care has an input into the new integrated care partnerships, which will advise the integrated care boards, which are usually much smaller. The key point is that working towards genuinely integrated health and social care, focused on the needs of individuals, is not recognised in the Bill as it stands. For example, where is the role of health and well-being boards? They are stuck in some kind of floating structure, as the noble Lord, Lord Lansley, pointed out.

I turn to the second thing that is missing. We know that social enterprises and charities are vital in the delivery of health services. Social enterprises, for example, are delivering one-third of all community health services and two-thirds of all out-of-hours health services. They deliver care services, dentistry, mental health services, addiction treatment and many more services. They are a serious and significant part of local health systems. These organisations should not be left out of the decision-making processes.

My point is that we must find a way to do two things. We must ensure that these excellent providers of services are involved in the planning of services at ICS level. We must also ensure that the issue of social value is recognised. The NHS is committed to using social value within commissioning and procurement decisions. Unfortunately, the Bill does not include any reference to social value, which means that the new procurement system for the NHS may go against the grain of the rest of the public sector.

The third issue to address is integration and social care. While the Bill was in Committee in the Commons, we learned that, at some point, there is to be an integration White Paper, which certainly was not in the disappointing document that was launched last week. There is still no overall strategy or plan to address the immediate scandal of inadequate social care. Many in government do not appear to understand that social care is about not just the old and care homes but children and young people with disabilities, as the noble Baroness, Lady Campbell, explained to us.

There is a 10-year vision in the paper launched last week, but it has no milestones, no targets, no strategy and not much funding. It has vague promises, and waters down the Care Act 2014, so we on these Benches will look carefully and critically at that part of the Bill. Let us not pretend: this is an NHS Bill and not yet a health and social care Bill. Surely our job is to make it into that.

Of the many briefings we received on the issue of health inequality, to which the Bill refers, I was struck by the one from the EHRC, which suggested that integrated care partnerships’ strategies should

“include an explicit focus on addressing inequalities in access to and outcomes from services, and that groups sharing protected characteristics”

should be

“fully consulted on their development … Integrated Care Partnerships are required to include representatives from social care and mental health to ensure parity of esteem and a genuine ‘whole system’ approach.”

My noble friend Lord Bradley, the noble Baroness, Lady Bull, and others have said this today.

In the Commons, the Government levelled criticism at my colleagues over their desire to put safeguards into the Bill and the Government’s desire to leave maximum latitude for local solutions. There is an irony here. The Government want to control appointments. They want to agree all the so-called flexibilities and not leave them to local planning at the moment. The Bill is far more top-down system management of the old school, so the Minister can expect some discussion around reconfiguration.

There are concerns about how the new bodies will be accountable. I join my noble friend Lady Morgan in a plea for clarity about this. How are the new bodies accountable and to whom? There is also nothing in the Bill at the moment about accountability to the public and patients.

We need to address issues about who can and should sit on boards that allocate the billions; about restrictions on deals with private providers, on which I am sure that my noble friends Lady Bakewell and Lady Chakrabarti will hold our feet to the flames; about making sure that procurement is done properly; about the new bodies being far more open and transparent than current ones; about respecting the whole NHS and social care workforce, not just doctors and nurses; about including children and safeguarding; about removing fragmentation between different flavours of provider bodies; about a genuine and active role for local authorities in preparation for real integration; and more. I fear we may be here for some time.

We on these Benches absolutely want the Bill to be amended to achieve the outcomes we all agree about—for example, the plea from the noble Baroness, Lady Blackwood, about innovation, and workforce rights, dealing with inequality, transparency, local design and population health. We want to work with our colleagues across the House to ensure that the Bill reflects all those things that we agree about.

The Commons had 21 sittings in Committee and did not even scrutinise the social care cap amendment and other government amendments inserted on Report and at Third Reading. We will have to do that too. I congratulate your Lordships’ House on giving the Minister a clear insight into the scrutiny we believe the Bill now deserves and will receive in the coming weeks. I congratulate him and the Bill team in anticipation of the efforts they will have to put into that. I look forward to the Delegated Powers Committee’s report. I also ask him to ensure that the House is given sufficient time in Committee and at the other stages to give the Bill the scrutiny and thought that our NHS and social care system deserve.