My Lords, I will speak to Amendment 179 and the other amendments in my name. I thank the noble Lords who put their names to these amendments: the noble Lords, Lord Shipley, Lord Hunt of Kings Heath and Lord Patel. We are told that the driving force of the Bill is to ensure that health and care services are delivered at place; and to empower local leaders—leaders who know what their local communities’ needs are and who will make decisions about how care is delivered. I am sure that is music to the ears of my noble friend Lord Mawson.
We are told that the integrated care systems—the ICSs—will be given the flexibility to plan, to commission and to provide services according to the specific needs of their population. This principle is undermined by the unchecked power that the Bill gives the Secretary of State over local configuration of services. I am pleased to tell your Lordships—particularly my noble friend Lord Howe, who is on the Front Bench for this item—that Amendments 179 to 183 have the support of a number of influential voices. These are voices from the health and local government sectors, the NHS Confederation, the King’s Fund, NHS Providers, the LGA, the BMA, National Voices and the Centre for Governance and Scrutiny. These organisations cover NHS leaders, local authorities, clinicians and patients. It is significant that they are united in their deep concern about the powers that the Secretary of State would have over local reconfigurations as the Bill currently stands.
Of course, there is an existing system for local reconfiguration and it works very well. It is overseen by the Independent—that word is very important—Reconfiguration Panel, the IRP. This has helped take politics out of the difficult decisions surrounding services. Crucially, the current process for service reconfiguration starts with local consultation and consideration of clinical advice. These elements are fundamental, and they must be maintained in a future process. In short, the Secretary of State should be able to intervene in a decision about local services only once local people have had their say on the proposed changes, and once clinical advice has been considered. It will be to the detriment of patient safety if it has not. Under the existing arrangements, when the process takes too long, it has often not been about the IRP but about the Secretary of State’s failure to reach a decision, yet the Government state that the new powers are needed to speed up the process.
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Just before Christmas, for instance, the Secretary of State finally made a decision on the reconfiguration of local stroke services in Kent and Medway—a decision that had been on his desk for two years. That was not because the Secretary of State disagreed with the panel’s findings; on the contrary, he accepted the recommendations in full and has always done so.
I know that we need to speak at speed and get through our business so I will resist telling the Committee of the shattering case of Epsom and St Helier University Hospitals, where the politics got involved. A proper process was followed and took a year. Even today they are only starting to build what was decided 16 years ago. It has taken that long to get to this position. The detail is fascinating but I will not go into it because it is quite lengthy.
Amendment 179 addresses the scope of reconfiguration in the current form. Currently the Bill allows the Secretary of State to intervene in any number of local service reconfigurations. This would include decisions about an individual GP or dental surgery, for example—very local issues. We could well see a world in which the DHSC is snowed under with such decisions to intervene. These are local decisions but still are very real to local communities. In turn, this would increase the costs for the department and reduce the time that its civil servants had to spend on national policy matters. The amendment would mean that any intervention from the Secretary of State could be made only on complex and significant decisions.
Amendment 180 concerns transparency and clinical oversight. The noble Lord, Lord Hunt, talked about that earlier today. We agree that decisions on local service reconfigurations should be based on clinical advice. That is the way in which services should be delivered to ensure patient safety and quality of care. The amendment would require the Secretary of State to consult all relevant organisations delivering the NHS services under consideration, to obtain the clinical advice of the integrated care board, and to publish those submissions. This will ensure that changes to clinical services are based primarily on clinical, not political, pressures.
Of course we should put patient safety and health first but the amendment would also require the Secretary of State to consult the health and overview scrutiny committees. They scrutinise local service reconfigurations and ensure accountability to local communities where a service spans more than one local authority area. Again, I hope noble Lords will agree that patients and citizens have the right to scrutinise and to have a say in how the services that they pay for through their taxes are delivered.
Amendment 181 is important. It seeks to ensure that decisions on local reconfigurations are not delayed over months. For example, it could be politically expedient for a Secretary of State to delay a decision because of a pending election, either local or national. Limiting the period to three months would mean that the Secretary of State had to provide certainty to local service managers for planning purposes and reduce any delays to accessing care.
Amendment 182 would ensure that changes are in the public interest. At Second Reading, the Minister said that the new powers for the Secretary of State were about ensuring accountability. Surely it follows that he must set out why he is intervening in a configuration process and why it is the public interest for him to do so. The amendment would require him to publish a statement demonstrating that any decision he has made on a reconfiguration proposal is in the
public interest and that it has been taken with consideration of its positive impact on patient safety. Again, this will provide a safeguard against any decisions being made for politically expedient reasons.
Amendment 183 addresses the ability of the Secretary of State to act as a catalyst in reconfigurations. I hope noble Lords will agree that local service reconfigurations should be based on clinical considerations. In its current form, the Bill would allow the Secretary of State to be the instigator of local reconfigurations, even if there were no appetite locally. This is a significant overreach of powers. How can the Secretary of State know what is best for patient safety in any one of the 42 ICS areas? The amendment removes the Secretary of State’s power to act as the catalyst for reconfiguration.
In closing, I hope that the Minister, my noble friend Lord Howe, will view these amendments in the spirit in which they have been drafted. I have sought a compromise to ensure that clinical checks and balances on the new powers of the Secretary of State are reasonable and acceptable. After all, they are intended to protect the Secretary of State and his department as well as patients, clinicians and service managers. If I have been unconvincing, I hope that my noble friend will be persuaded by the succinct letter in today’s Times signed by Richard Murray, the chief executive of the King’s Fund, Chris Hopson, chief executive of NHS Providers, and Matthew Taylor, chief executive of the NHS Confederation—all of them and their organisations have been very helpful in advising me on this issue.
I hope also that Ministers will recognise the breadth and depth of support from the health and local government sectors for these amendments. They will know that bringing together so many organisations with varying roles and priorities is very difficult. The fact that so many are singing the same song is a triumph and I am sure that my noble friends on the Front Bench will consider these views and give pause for thought. I am sure that they will not be dismissive. That is not in either of their natures, as we have witnessed on other matters. However, I want some reassurance that these amendments are not totally negative and are not to be totally dismissed. I hope that my noble friends will seek to work towards some of these amendments because they are really important. Those of us who have been through the whole process of reconfigurations in a position of authority—not as a Minister, as the noble Lord, Lord Warner, was, but as junior Ministers—know how fraught reconfigurations are. I therefore hope that these amendments will find some favour with my noble friends on the Front Bench.