My Lords, I support the demand of the noble Baroness, Lady Thornton, for an impact assessment and look forward to having the many hours it will take to read and thoroughly digest. As she said, this is a Bill of 244 pages with 155 substantive provisions and 156 delegated powers, over half of which allow no parliamentary scrutiny. Although the general thrust of it, in relation to easing the transition to more integrated and collaborative working, is welcomed and indeed demanded by the sector, that same sector is now very hesitant about its introduction at this time. As I prepared this speech, there were 122,000 absences in the NHS due to Covid and 200 members of the Armed Forces were being drafted in to help; 24 hospital trusts had declared a crisis situation, 20% of beds are occupied by Covid patients in 16 hospital trusts, and discharge targets are not being met.
So, despite the many preparations for this structural change to the NHS, many in the sector have welcomed the short delay in implementation that is being proposed. The Government have said that they want the Bill to be permissive, but the question is, permissive to whom? It is a skeleton Bill that gives a wide range of powers to the new ICSs to commission services in the way they think fit, but it also gives the Government unprecedented powers to use regulations, guidance and even published documents to specify what should be done in future. It gives the Secretary of State considerable new powers.
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Rarely have I read such a scathing report from the Delegated Powers and Regulatory Reform Committee as its 15th report. Like the noble Baroness, Lady Thornton, I am a great fan of this authoritative committee. In a previous report, Democracy Denied?, it pointed this out:
“The Health and Care Bill is a clear and disturbing illustration of how much disguised legislation a Bill can contain and offends against the democratic principles of parliamentary scrutiny.”
Therefore, the least we could ask for was an assessment of the first measure: turning the NHS Commissioning Board into NHS England, with its new scope and new powers. It is a disgrace that this was put before us only this morning on the first day of Committee. Yes, we already had a 178-page memorandum explaining what is in the Bill, but we do not know what is not in the Bill because the Government plan to give us all that at a later stage through the numerous Henry VIII powers that they plan to take, most of which allow for scant parliamentary scrutiny.
Therefore, it is up to this Committee of the whole House to demand as much information about the Government’s intentions as we can get through the use of exploratory amendments over the next few weeks. The Minister can be assured that we will do so; I look forward to his response and having time to read the impact assessment.