My Lords, I declare my interests as in the register, specifically as chair of University College London Hospitals NHS Foundation Trust and of Whittington Health NHS Trust, and as vice-chair of the UCL provider alliance. I am grateful to the King’s Fund and others for their briefings, and declare a further interest as a former chief executive of the King’s Fund. I add my congratulations to the noble Lord, Lord Stevens of Birmingham, on his superb maiden speech and share his concern that there is not a greater focus on mental health in this Bill, and indeed on the determinants of health and public health in general.
We have so little time to speak that I will simply support what many noble Lords have already said in asking for further assurances around workforce planning and education and training, given that we have an absolutely exhausted workforce and we face tough recruitment issues. If it is bad in health, it is completely dire in social care. I also echo what other noble Lords said about the Secretary of State’s new powers and the effect on the poorest of the way the £86,000 social care cap is designed.
I will focus on three specific things. The first is capital spending limits for NHS foundation trusts, because the present drafting differs significantly from what was set out in the NHS’s 2019 legislative proposals.
I hope we can go back to those proposals, which were a sensible compromise between system and organisation. That is particularly important for specialised commissioning, given that ICBs are set up largely to be accountable to their local populations. In north-central London, only a third of our provider income and asset base relates to north-central London residents, so safe- guards are essential to ensure that ICBs have a statutory responsibility to maintain and develop specialised service assets, as well as those serving their populations.
The Bill appears to say that NHS England can pass many of its commissioning activities but not its responsibilities to the integrated care boards. Delegating complex commissioning arrangements for those specialised services where there is no evidence base for joining up pathways of local care will lead simply to a fragmented approach. Providers such as my own, UCLH, Great Ormond Street and others providing regional or national specialist services face the prospect of agreeing contracts with 42 ICBs rather than a single commissioner, adding significant bureaucracy and transaction costs. I wonder whether that can be sensible.
I am absolutely delighted that the membership of the ICBs will include, among others, representatives from local authorities. The guidance from NHS England states that it is expected that the local authority representative
“will often be the chief executive”.
This wording implies some flexibility, but there is a very strong case to be made for the local authority representative being one of the local council leaders, who are, after all, the elected representatives responsible for running local services, including children’s and adult services—precisely those services where we need improved integration with health, as many noble Lords have said. I hope the Minister can give us an assurance that each ICB will have the freedom and flexibility to reach this decision locally.
Lastly, most of us will warmly welcome the Health Service Safety Investigations Body. The Bill makes provision for creating a safe space within investigations to enable clinicians and others to provide information without the fear that that will be disclosed or used for disciplinary purposes. That is understandable, but the clause as drafted seems to cut across the unique constitutional role of the Parliamentary and Health Service Ombudsman to investigate complaints about the NHS and other public services.
The Bill prohibits the national ombudsman from accessing information held in the HSSIB safe space without seeking permission from the High Court. Schedule 14 appears to strip the ombudsman of long-held constitutional powers by being excluded from the safe space while the same exclusion does not apply to coroners. This would be the first restriction on the ombudsman’s powers since it was established back in 1967. It contravenes international standards set out in the Council of Europe’s Venice principles and the United Nations resolution on the role of the ombudsman, which was co-sponsored by the UK Government, and it will undermine public confidence in the administrative justice system, with patients feeling that they have less access to justice and public accountability when failed by NHS services—because we do not always get it
right, as the noble Baroness, Lady Cumberlege, has made abundantly clear. I welcome the broad thrust of the Bill, but there is still much to clarify and change.
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