A wide range of issues that are part of this group of amendments demonstrate the cold reality of this Bill. It is a jumble sale of bits and pieces. Of course a Bill can be wide-ranging, but having breadth is not the same as having coherence, or indeed clarity. Such are the issues within scope in this grouping that I will not comment directly on every new clause and amendment but hope to have time to say at least a few words on those emanating from the Opposition Front-Bench team, as well as on any Government new clauses or amendments that we oppose. Some amendments refer to matters that have been dealt with in Committee where we have expressed our views and put forward amendments that failed to persuade the Government. Sadly, we have insufficient time to go over the same ground again, particularly given the rapid shifting of the goalposts we have seen in the past week.
I turn first to integrated care boards, or ICBs, and, more widely, the issue of governance. The question of governance and accountability remains an important matter to us and needs greater clarity than currently appears in the Bill. For Members who may not be familiar with the detail, the Bill proposes yet another reorganisation of the NHS, creating 42 new integrated care systems where decisions on how NHS and care spending will be made. The decision-making bodies within these systems are the ICBs, replacing the CCGs,
which fall away into the annals of history alongside the primary care groups, the primary care trusts and all the other permutations that we have seen.
Our discussions on these matters in Committee showed that our disagreements tended to centre around an intention by Government to limit what is in statute and to leave maximum flexibility at local level, as opposed to our desire to ensure that safeguards and protections were in place for those matters we felt were too important to be left out. It is wholly ironic, therefore, that the Bill proclaims, on the one hand, local freedoms and flexibilities, yet on the other proposes sweeping top-down powers for NHS England and the Secretary of State. Our view remains that some flexibility is fine to allow shaping to local needs, but that some key principles need to be put into the Bill to ensure that there are no misunderstandings or unintended consequences.
We know that the genesis of this Bill has been the realisation that increasingly large parts of the NHS were ignoring the 2012 Lansley Act. Along with changes to procurement and pricing, this grouping deals with the main elements of reversing parts of that Act. We could spend all our time referring to what we said 10 years ago, and how the Health and Social Care Act 2012 has proved to be the disaster that we said it would be, but we will spare the Government the “We told you so” lectures, because even those on the Government Benches are now aware that the 2012 Act has been among the worst policy mistakes in the history of the NHS. Whether that damage was worse than the damage done by a decade of austerity remains to be seen, but repairing the damage done by austerity is not for today, as there is little in the Bill to address the ongoing consequences of a decade of underfunding, particularly the wholly appalling waiting times that we now see across the board.
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What became clear in Committee was that the Bill is an NHS reorganisation with little to say on social care. In fact, until last week at least, just two clauses out of 135 related to social care. We get one system of procurement replaced by another that resembles Swiss cheese, and we get nothing at all in the Bill on funding flows and pricing. We were originally told that this was a Bill for integration, but halfway through its consideration, we were told there would be a White Paper along shortly to deal with integration. At least that means there is recognition that the Bill will not deliver the promised land of integration—if, indeed, it is the promised land—but in the meantime, the Government will expect people to crack on with this reorganisation, taking them away from the day job.
On Second Reading, we said that the Bill was
“the wrong Bill at the wrong time.”—[Official Report, 14 July 2021; Vol. 699, c. 438.]
It does not address any of the vital issues facing the NHS. Since then, on every metric, the NHS is performing worse. The challenges have got greater ahead of what is widely expected to be the most difficult winter in the NHS’s history. The NHS does not need yet another reorganisation when the fundamental challenges it faces remain untouched. The explanatory notes and impact assessment for the Bill are both sketchy at best. For example, we do not know what this reorganisation
will cost the NHS, and there is certainly nothing in the Bill about social care caps, but we will return to that later.
Then there is the justifiable fear about private sector providers being given a seat on the ICB, although, as the Minister has said, there does appear to be general agreement that something should be done about that, so this debate is more about the how than the why. I appreciate the efforts made by the Minister with amendment 25 in trying to find an accommodation with us, and his birthday wishes. He is absolutely right; there is no place I would rather be than in this Chamber discussing health and care integration. I am afraid we will not be able to support Government amendment 25, because it does not go far enough in our opinion. It adds unnecessary subjectivity into matters and it is not comprehensive in its coverage.
Amendments 76, 77 and 78 deal with the issue and would limit the possibility for influence by vested interests, especially those of the private, for-profit sector. Crucially, they close the door on the possibility, left open by the Government’s amendment, of private providers sitting on sub-committees or place-based bodies of ICBs. Incidentally, that problem is of the Government’s own making by virtue of them leaving the level of direction for place-based Government arrangements deliberately vague in the Bill.