I do not think that is a reasonable ask by the noble Baroness, if I may say so. I am trying to describe a structure that should deliver what I am sure she wants to see—safeguards and good pointers for ICBs to make their own decisions, while also ensuring that some of the pitfalls mentioned in the debate are not fallen into. If I can let her see the work in progress, I shall certainly be glad to do so—I do not have a problem with that—but I suggest that it is not necessary for her to do that to accept the proposition that I am trying to put forward.
As I have mentioned, the Bill requires an ICB to set out in its constitution how its functions will be discharged, including any arrangements to delegate functions to provider collaboratives. Furthermore, as an additional safeguard, the Secretary of State may impose conditions on the exercise of the power through regulations.
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I wholeheartedly agree with the noble Lord on the need for transparency and accountability, but—he partly forecast my reply here—we are giving the NHS the flexibility to determine the structures that work best for individual areas. That is not something we are foisting upon the NHS; I draw the Committee’s attention to the NHS Confederation’s urging to
“embrace a flexible and permissive approach that considers a range of models that will work in varied geographies and contexts.”
We therefore come to the issue of accountability that the noble Lord rightly raised. Where NHS England or an ICB delegates a function as part of a collaborative arrangement, it will be expected to take appropriate steps to ensure that the function is being effectively carried out on its behalf. That will include the power to set the terms of delegation agreements, which can impose terms as to how the delegation powers can be exercised. The Bill includes a number of safeguards; for example, as I have mentioned, NHS England will have a power to issue statutory guidance in relation to delegated functions and joint working arrangements, and there will be transparency through the constitutions.
My noble friend Lord Lansley understandably raised the issue of the purchaser-provider split. As he knows, the Bill does not abolish that split, but I understand the point of his question. I think I can best answer it by saying that ICBs or NHS England will still bear ultimate responsibility for protecting the interests of patients and taxpayers, and will be able to oversee providers’ exercise of delegated functions through the terms of the delegation agreement and the performance assessment functions. Providers can be given greater flexibility to design services around their understanding of patient needs. That will happen only where ICBs are satisfied that quality standards continue to be met and the function is being effectively carried out.
My noble friend also suggested that we might consider keeping CCGs to enable the local assessment of patient need and the services that are required to be retained in the commissioning arrangements. Instead of that, we need to go back to the functions of the health and well-being boards and the ICPs. The system will enable the kinds of granular insights, described earlier by the noble Lord, Lord Mawson, that will inform strategies for the whole population.
We come to the question that noble Lords asked earlier: why do we have health and well-being boards and ICPs? The best answer is that they perform complementary functions. The ICP will be responsible for developing an integrated care strategy for the whole population within the geographical footprint of its relevant ICB, but that strategy should be informed by local assessments of needs developed by health and well-being boards at the local level so that the system plans reflect the needs of every community within the area. That is how the circle is intended to be squared.
Not all of my reassurances today have landed well, but I hope I have provided reassurance to the Committee that place-based commissioning structures are already an intention and sufficiently catered for in the current provisions, and that the noble Lord, Lord Hunt, will feel able to withdraw his amendment.