My Lords, I declare my interest as a vice-president of the Local Government Association. I welcome the noble Lord, Lord Stevens of Birmingham, to his place and look forward to hearing his maiden speech. I also offer my thanks to everyone who has briefed us. We, too, regret that the advisory speaking time is five minutes on a long and complex Bill, with many expert speakers whom I am sure the House will want to hear. We note that this time is advisory.
In principle, we have long argued for true integration of health and social care, and reforms are long overdue. The coalition Government created the better care fund, which has set a standard for integrated care in a number of places such as Torbay, but our social care system has needed reform for decades. The increasing workforce crisis and cuts to publicly funded patients, with private patients having to subsidise them, is scandalous. Covid, including the omicron variant as well as the severe winter crisis already with us, makes it much harder for substantial reforms to be in place for the end of March. I echo the comments of the noble Baroness, Lady Merron, about it being the wrong Bill at the wrong time.
The long-awaited adult social care reform White Paper, People at the Heart of Care, was essential for delivering true integration. Despite the Prime Minister’s promise on the steps of No. 10 Downing Street two and a half years ago, I am afraid that the White Paper is deeply disappointing, not least on how integration will work in practice. Perhaps it is not surprising that Ministers have already announced another social care integration White Paper for next year. We still need to see it before the passage of this Bill. I fear that we will not. We believe that these changes will not work without the reform of workforce planning, and we will seek to strengthen the long-term planning arrangements, especially for social care, where progressive career pathways and proper skilled rates of pay are long overdue.
We too regret the powers being given to the Secretary of State. The reforms under the coalition Government by the then Secretary of State, the noble Lord, Lord Lansley, to remove them from operational decisions was the right one. Despite some of Ministers’ words in briefings, we need to be convinced that this is the right move. Ministers tampering with reconfigurations, capital grants or even contracts have already led the Johnson Government into serious difficulties. Worse, giving powers to the Secretary of State to transfer or delegate powers or functions without a clear rubric about how sparsely this must be used, and in what circumstances, is also dangerous. Through some of these provisions, Parliament is once again excluded from scrutinising Ministers’ actions.
We are concerned about the membership of ICBs. With the increased commissioning duties on local authorities, it is important that they have a voice at the table. More than one local authority in an ICB area gives us a problem. The same is true for NGOs, charities and local enterprises that are involved in the delivery of local social care. Much of the reforms, for both ICPs and the levy, are based on older people’s social care. We think it is wrong that disabled younger adults and children who need social care have been squeezed into inappropriate arrangements once again. Unpaid carers are still evidently meant to pick up much of the burden of care, especially with the new emphasis on getting people home from hospital, sometimes before assessment. It is time that the Government truly recognised the commitment and the cost of these unpaid carers and rewarded them.
Part 2 sets out the new information and data requirements for health and social care, especially the latter. We seek assurances that patient and client data will not only be protected and anonymised but cannot be sold on to commercial parties. We are concerned about the power of the Secretary of State to decide what is and is not commercially confidential. We believe that the Health Services Safety Investigations Body is long overdue, but we will seek confirmation that it is to be truly independent from Ministers. In Part 5, we welcome the proposed ban on virginity testing but also seek a ban on hymenoplasty.
International healthcare arrangements in Part 6 must protect the NHS from this Government’s former aims to give countries the right to bid for NHS contracts as part of economic treaties in the Healthcare (International Arrangements) Bill of 2019. We will seek to ensure that nothing like this creeps in again.
A few weeks ago, the Government rushed the Health and Social Care Levy Act 2021 through Parliament in just a few days. It was clear to us then that the creation of a new tax mechanism deserved careful scrutiny, but this was denied to Parliament, not least because of the lack of detail in how it would work. The Minister said that the new cap arrangements are fair; they are not. They let down exactly the group of people that this Government claim they want to help: those who live outside the greater south-east, with property worth over £100,000.
There is irony in the Government saying in their document:
“It is important that the new reforms are clear and reduce complexity”
before setting out a complex structure of disregards and benefits and the bombshell that neither local authority contributions nor personal care, nor what are sometimes known as hotel costs will count towards the cap. We will oppose this.
My colleagues will cover the clauses on food and drink and the fluoridation of water supplies. We also regret the limited public health reforms to tackle inequalities.
We have argued for years that we need a comprehensive integrated health and social care system, alongside a modernised and effective NHS, managed by its leaders without ministerial interference. Our broken care system, where staff and providers have battled valiantly against all the odds, desperately needs real reform.
This Bill has some of the right ideas, but it is already clear that there are many worrying elements which will not deliver the reform or funding needed. Health and social care providers, all the wonderful staff across both sectors and the public who use and rely on our NHS and social care systems, need that reform. From these Benches, we will aim to persuade the Government to improve this Bill.
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