My Lords, it is a privilege to follow the noble Baroness, Lady Campbell. I want to congratulate the noble Lord, Lord Stevens, on his quite outstanding maiden speech.
Overall, I welcome the shift away from competition to greater collaboration and integration in our complex health and social care sector that this Bill signals, but, like others, I am very concerned about the timing of this legislation. The health and social care systems currently face extreme challenges, workforce shortages and burnout, a resurgence of Covid with a new, more transmissible variant, a huge pandemic-induced backlog of treatment, winter pressures and social care in crisis. Now does not feel like the right time for a structural reorganisation which will inevitably divert scarce clinical and management attention from front-line delivery. So my first question to the Minister is: why now?
Secondly, the fundamental problem that the NHS is confronting is a lack of capacity and resilience, particularly the lack of spare capacity in the system, meaning that it is continuously running at an unsustainable “hot” level of bed occupancy. The UK has 2.7 hospital beds per 1,000 of population compared to an EU average of 5.2 and significantly fewer doctors and nurses per head of population. So my next question to the Minister is: what plans do the Government have urgently to increase capacity and deal with workforce shortages, and how does this Bill help? Like others, I strongly support the calls for Clause 35 to be amended so that the Secretary of State must publish independently verified assessments of current and future workforce numbers every two years.
I wish to focus briefly on three issues that I shall pursue in the Bill. First, the Bill reads as if it is written by adults for adults. Babies, children and young people make up 30% of the population. They have their own distinct workforce, a distinct legal framework and distinct services. More needs to be done to ensure that the benefits of integration apply equally to the children’s system, and this should be made explicit in the Bill.
It is vital that children are prioritised in the new integrated care systems and that a national accountability framework supports them to deliver improvements in health and social care outcomes for children. There must be a plan to set out clearly how existing duties, including leadership of local safeguarding arrangements, will be transferred from CCGs to integrated care boards without endangering the safety of children or impacting on the provision of services. Following the heartbreaking and horrific murder of Arthur Labinjo-Hughes, the Bill should be used as an opportunity to strengthen leadership within these safeguarding partnerships, to improve independent scrutiny of the arrangements, and to ensure that action is taken in response to the lessons learned.
Secondly, as highlighted in a recent report on child vulnerability by the Lords Public Services Committee, there needs to be improved data sharing to allow better joint working across health, education, and children’s social care. As the noble Lord, Lord Bichard, pointed out, data sharing in the Bill currently applies only to the adult system, for reasons I do not understand. The Bill must surely be amended to make it clear that the benefits of better information and data sharing apply equally to children and that agencies can and should share data where it is in the best interests of children to do so.
Mental illness represents up to 23% of the total burden of ill health in the UK but only 11% of NHS England’s budget. At present, there is no assurance in the Bill that mental health will be given equal precedence with physical health in integrated care systems or by NHS England. This is disappointing after the hard-fought and successful battle, which many noble Lords were involved in, to amend the 2012 Act to make it clear that the Secretary of State must prioritise mental health as much as physical health. While the new Bill does not remove this duty from the Secretary of State, it fails to replicate it in the new triple aim. Like the noble Baroness, Lady Morgan, I want mental health to be mentioned explicitly in the NHS’s triple aim and in relevant parts throughout the Bill to specify that NHS England, ICBs and ICPs are expected to pursue “parity” between mental and physical health in all their functions and to report publicly on their outcomes.
Finally, on health inequalities, there is clearly scope for the Bill to be strengthened, as the noble Lord, Lord Patel, made clear. The pandemic has cruelly exposed and exacerbated health inequalities that have long existed in our society. I was going to set out various places where that could be done, but the noble Lord did it so comprehensively and clearly that I shall not repeat it.
If levelling up is to mean anything, the triple aim should be amended explicitly to reference health inequalities, thereby sending a clear signal to all parts of the new healthcare system that this is a priority at all levels.
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