My Lords, this is an assortment of amendments that are all linked to the core of the Bill, which is about integration. The issues, as ever, are about whether it is appropriate to place such a detailed level of specification in the Bill, and where.
Amendment 50 seeks equity of access for fracture liaison services. In many ways the amendment by the noble Lord, Lord Black, supported by my noble friend Lord Hunt and others, is about the balance between a national mandate and local delivery in order to ensure that there is equity of access—in this case, for fracture liaison services. I would be interested to learn how the Minister believes such a thing could be implemented and assured, and in how we can best express that in the Bill.
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Amendment 51A briefly touches on the well-trodden ground of the 2012 Act and the differences in the famous Sections 1 and 3 of the National Health Service Act 2006, which varied the wording around the duties of the Secretary of State. Some saw that as a device to try to exclude patients or treatment as a cost-cutting measure; others saw it as simply tidying up the wording to meet reality. In fact, experience since 2012 indicates that fears were indeed overstated at that time. However, as the noble Baroness, Lady McIntosh of Pickering, said:
“Surely, this should be rolled out nationally”,
and that is the aspect that we are discussing here.
The amendment seeks to ensure that emergency care cannot be refused when it is needed just because a patient is not resident in the ICB area. We touched on that last week—or perhaps it was earlier this week; I cannot remember—but, frankly, if you break your leg in Blackpool but live in Bolton, the ambulance will still come for you. As far as I know, there is no mechanism for checking where you live or even whether you are ordinarily resident in an area in the case of non-emergency hospital in-patients. We all know that infectious diseases and emergency care can and should be properly protected.
Amendment 57 from the noble Lord, Lord Farmer, is very much in line with Labour’s policy of promoting care close to home, with a focus on prevention, but achieving that probably goes beyond what the Bill says it will do. It will take a change of attitude and culture throughout government. For example, in Wales, the focus on well-being and adequate funding getting to the right places in the NHS and beyond is about tackling the determinants of poor health. That policy
was put in place at least five years ago and is now beginning to have effects, so this is a long-term change of culture and attitude.
Amendment 100 in the name of the noble Baroness, Lady Finlay, is about rehabilitation and patient support. I fully support the aim that this serves and how it highlights, as have other amendments, the fragmentation of sources of support.
Amendment 110 would require ICBs to publish a strategy on support for victims of domestic abuse. Again, I agree with that, but we have to work out how best to deal with it, because such a strategy would require agreement across a much wider range of stakeholders, which is exactly as it should be.
Amendment 101B, in the name of my noble friend Lord Layard, addresses parity of esteem, an issue that many noble Lords have addressed. We know that two things appear to work in the NHS, and the Minister, as a distinguished economist, knows this: money and targets. So we hope that the amendment in the name of the noble Lord, Lord Stevens, and that of my noble friend Lord Layard, could, as it were, work together across the House to produce an amendment that addressed those issues: the targets, progress and resourcing to deliver parity of esteem. We on these Benches are certainly very keen to see that happen and to be part of the process that will take us there.
Through the important discussion that we have had today, perhaps we can see that something needs to be done and will, I hope, work towards those things. I was struck by the remarks of the noble Baroness, Lady Barker, about HIV, which highlighted three matters: inequalities, innovation and fragmentation. It is unacceptable that we are having to look at an area where there is great innovation and scope for great improvement but where there are huge inequalities and huge fragmentation. That underlines the issue of the lack of integration and the case for public health to be at the core of prevention and integration. I look forward to the Minister’s response to this debate, because I hope we are on the cusp of making some improvements to the Bill that will actually take us forward.