My Lords, these are important amendments and I am grateful to all the noble Lords who tabled them. Perhaps I could start with the amendments relating to waiting times, before going on to those about ICB functions.
Beginning at the end, as it were, Amendment 215 would legislate for an additional duty for the Secretary of State to publish a report annually on waiting times for treatment in England, disparities in waiting times for treatment and the steps being taken to ensure that patients can access services within maximum waiting times, in accordance with their rights in the NHS constitution.
I entirely understand the intention behind the proposed new clause. It is important that patients can access healthcare within reasonable waiting times and it is important for all of us to have visibility of the waiting list size, as well as waiting times, in England. Your Lordships will understand that the Covid-19 pandemic has caused an unprecedented strain on the NHS, bring about significant disruption. It has shone a light on disparities and led to the largest NHS waiting list on record. It is a priority of this Government to reduce waiting times, tackle disparities and provide access to healthcare as quickly as possible to patients.
Although the situation is difficult, I think I can give reassurance on three grounds. First, the NHS already has waiting time standards. Some are enshrined in legislation and some are operational standards, but all are described in the NHS constitution and the accompanying handbook. Since March 2007 the NHS has published monthly official statistics on waiting times. This includes consultant-led referral-to-treatment waiting times, which monitor the length of time from referral through to elective treatment. It also includes the number of patients who began cancer treatment and waited longer than 62 days for cancer treatment. NHS England also publishes monthly management data on the number of people currently waiting longer than 62 days for diagnosis or treatment.
Secondly, the department already submits information on waiting times to Parliament as part of its annual report. Much of this data is very similar to that asked for in this amendment.
Thirdly, as I speak, extensive work is already being undertaken by the NHS so that patients can access services within maximum waiting times. The funding we have announced for elective recovery, including cancer services—with £2 billion this year through the elective recovery fund and £8 billion over the next three years through the health and social care levy—will increase activity, reduce waiting times and deliver millions more checks, scans, procedures and treatments. We also announced £5.9 billion of capital funding at the October 2021 spending review to support elective recovery, diagnostics and technology over the next three years, which will further reduce patient waiting times.
Fourthly and finally, we will set out in the elective recovery delivery plan how the NHS will deliver increased elective capacity and reduced patient waiting times for elective services, including for cancer patients. I hope that provides a degree of reassurance that we approach reducing waiting times seriously and that the data is available to hold us and the NHS to account for progress.
I now turn to Amendment 6 tabled by the noble Baroness, Lady Wheeler, and the noble Lord, Lord Sharkey, which would require the mandate to specify
maximum waiting times that NHS England should ensure the NHS meets. This would include the current 18-week referral-to-treatment waiting time standard as well as waiting times for diagnosis of rare and less common diseases.
The Government should always consider whether the mandate to NHS England should set expectations on waiting times. I do not think the mandate has ever been silent on waiting time standards, and nor would I expect it to be. I firmly believe, though, in the principle that the Government of the day should be free to set a mandate based on the priorities that they have been democratically elected to deliver. These will inevitably change over time in light of improvements in services and technology, as well as evolving patient need.
However, requiring the mandate to continuously include waiting time standards is unnecessary because important waiting times set out in legislation or NHS operating standards are reflected in the NHS constitution, as I mentioned. NHS England and other organisations that commission or provide NHS services have a long-standing duty to have regard to the constitution, in addition to NHS England’s duties in respect of the mandate.
I now turn to the amendments relating to ICB functions. I again thank noble Lords for bringing these matters to the Committee today. Amendment 19, tabled by the noble Baroness, Lady Wheeler, and the noble Lord, Lord Sharkey, seeks to amend Clause 8, which ensures that NHS England is able to direct integrated care boards to take on responsibility for the commissioning of specialised services on its behalf. The noble Lord, Lord Sharkey, asked me a series of detailed questions on that theme. If he will allow, I will write to him on those that I am unable to deal with in the remarks that follow.
The first thing to say here is that NHS England does not propose to use Clause 8 initially. The intention is that any delegation is agreed with ICBs. Delegating some direct and specialised commissioning to ICBs makes sense, because it is likely to be an enabler for integrating care and improving population health. It gives the flexibility to join up key pathways of care, leading to better outcomes and experiences for patients and less bureaucracy and duplication for clinicians and other staff.
My concern about the amendment is that it would add to the bureaucratic burden rather than reduce it. It would create an unnecessary set of regulations as well as duplicative reporting mechanisms, as regulations made under Section 13YB(3) can already be used to impose conditions, which could include creating national standards. Furthermore, Section 14Z50(7) already puts a duty on NHS England to undertake yearly performance assessments of each ICB. These are focused on how each ICB has performed its function through the year, including the commissioning of specialised services that may have been delegated.
I say to the noble Lord, Lord Sharkey, that we fully recognise that Covid has significantly impacted on waiting lists, including for specialised services. The investment that we have announced to reduce waiting times should also impact on waiting times for specialised
services. NHS England is keen to see progress in that area as much as in any other. We will hold it to account for that progress.
My noble friend Lord Lansley and the noble Lord, Lord Warner, expressed concerns about the risk of growing disparities and inconsistency in the quality of specialised healthcare around the country. The key point that I would emphasise is that NHS England will retain responsibility for setting national standards as well as service specifications and access policies. These will apply to all prescribed specialised services, whether they are retained for commissioning by NHS England or become the responsibility of ICBs to commission. It may be a single ICB, but it may be a group of ICBs commissioning; it will depend on the type of service and the size of the ICB.
NHS England will therefore remain the accountable commissioner for all specialised services and will ensure that the appropriate safeguards are put in place for those services that may be delegated to ICBs or groups of ICBs. Only services that are considered appropriate for more integrated commissioning would be delegated; that is, those services that are suitable and ready. There will be services that are not appropriate, and these will be retained for commissioning by NHS England. As I am sure the noble Lord, Lord Warner, well knows, we need to remember that the list of prescribed specialised services contains very highly specialised services such as hand transplants and much more routine services such as dialysis. Whereas those on the upper end of the scale will always need to be commissioned nationally —I cannot see any alternative there—it is right that those more common services can be commissioned more locally.
I turn next to Amendment 21, which I am grateful to the noble Lord, Lord Davies, for bringing forward. I do not in the least dismiss the issues that he has raised. I understand the spirit in which the amendment was brought and hope that I can give some reassurance on two counts: first, that it is not our intention for ICB functions to be delegated to private entities, and, secondly, that safeguards are already in place.
It is perhaps also worth drawing the Committee’s attention to the narrowness that this amendment would impose on the delegation of functions. It would prevent delegation of functions to other statutory public bodies such as local authorities. As the noble Lord will appreciate, this would run counter to our desire to support further integration and to allow the pooling of budgets and functions between the NHS and local authorities. This has been a fairly long established practice and has worked well to support joint commissioning, service improvements and more seamless services for patients.
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The power to delegate functions is crucial to unlocking the innovation and integration that the Bill is aiming for. Different areas will have different circumstances, and it is important that they have the flexibility to build arrangements that work best for them, their patients and the public. However, I understand the concern that functions could be delegated to private companies; I assure the Committee that this is not the intention and we do not expect it to happen.
Private providers are not included in the specific list of bodies which an ICB can arrange for functions to be exercised by or jointly with in the Bill. Furthermore, NHS England may issue statutory guidance on delegation and joint committees, which we expect it to do. This is likely to include scenarios, case studies and model delegation agreements. ICBs will have to have regard to this guidance.
Crucially, regardless of whether or not a function is delegated, the ICB will always remain ultimately responsible for it and will continue to be assessed and overseen by NHS England on how well it is discharging its functions. The key point here is that delegation is not a means to avoid accountability. Neither we nor NHS England will allow it to become so.
On the integrated care provider contract, I assure the Committee that it continues to be our intention that it should be awarded only to statutory bodies. The published draft integrated care provider contract is suitable for entering into only with statutory bodies. This was based on the recommendation from the Health and Social Care Committee.
Finally, Amendment 60, in the name of the noble Baroness, Lady Thornton, would place a duty on ICBs to promote and share best practice and work to remove barriers to achieving this. I am very sympathetic to her concerns to ensure that our health service is effectively integrated and that innovations are shared throughout the system. I am glad to reassure her that this sort of integration is a core part of the Bill and will already be delivered by existing proposals in Clause 20.
I remind the Committee of the proposed duty for ICBs to promote innovation. This would include ensuring that new innovations and best practices are spread freely to ensure that the whole system works efficiently. Secondly, I remind the Committee of ICBs’ duty to promote integration. This requires ICBs to ensure that health services are delivered in an integrated way where they consider that this would improve the quality of services and reduce inequalities of access or outcome. In combination, these duties require ICBs to work to ensure that different elements of the health service effectively communicate with one another to implement innovations and share best practices.
The work to share best practice is already well established. NHS England currently collates and shares best practice case studies of how non-statutory ICSs are supporting innovation and research through its funding of the academic health science networks— 15 regional bodies set up to support the identification, adoption and spread of innovation. The work of AHSNs, which are commissioned by the Accelerated Access Collaborative to spread proven innovation at pace and scale, is a key lever in all this. The national network of AHSNs provides a critical interface between national and local systems in the identification, adoption, spread and scale of innovation. AHSNs drive both the generation of demonstrably useful, evidence-based innovations and their adoption and spread. This includes thousands of innovations supported in the last year, covering millions of patients.
I hope that I have given a measure of reassurance on these matters and that, in consequence, the noble Baroness, Lady Wheeler, will feel able to withdraw her Amendment 6.