My Lords, I rise to move Amendment 225ZA and will also speak to Amendment 285. I thank the clerks for their help in
devising Amendment 225ZA, which enables us to discuss Amendment 285, which I regard as important, today. Amendment 285 is the substantive amendment I shall address.
The amendment is important because it places in legislation recommendations from the 2017 report by this House’s Select Committee on the Long-term Sustainability of the NHS and Adult Social Care. I am delighted to see two members of that Select Committee, the noble Lords, Lord Ribeiro and Lord Scriven, here this evening. Unfortunately, the Select Committee’s chairman, my noble friend Lord Patel, who did an extremely good job, is unable to be here, but I believe he will join my noble friend Lord Kakkar to discuss a less detailed amendment, Amendment 286, which tries to achieve the same objectives as Amendment 285. For the record, the two Select Committee recommendations which are germane to this amendment are recommendations 33 and 34, found on page 98 of our report. In the interests of time, I will not spell these out, because they are effectively set out in Amendment 285, but I will draw the Committee’s attention to some of the evidence which caused us to make these recommendations.
On page 84 of the report there is a section on:
“A culture of short-termism”.
This starts at paragraph 322 with the sentence:
“Our inquiry uncovered endemic short-termism in almost every area of policy making.”
We made it clear on that occasion that the noble Lord, Lord Stevens—then plain Simon Stevens, the chief executive of NHS England—was “the most notable exception” with his Five Year Forward View.
The committee was very concerned about the approach of what was then the Department of Health, particularly the evidence given to it by its Permanent Secretary, now Sir Chris Wormald, who remains in post today. I draw the Committee’s attention to paragraph 324 of our report, which sets out what the Select Committee made of the Permanent Secretary’s evidence:
“Although we questioned him at length on the work taking place in his department on the long-term future of the NHS, revealingly, we were not provided with any concrete examples. Moreover, he questioned whether this was work that should even be taking place in his department”.
We concluded at the end of paragraph 324:
“We were unconvinced by the answers he provided and we are left with no choice but to conclude that the Department of Health is failing to plan for the future”.
I have been in this place for 22 years. This was a pretty damning conclusion for a cross-party committee of this House to come to. The Permanent Secretary of the government department with the biggest budget after cash benefits, and which would be spent on the biggest public or private workforce in the country, was saying that it was not the department’s job to do long-term planning. This seemed to have been left to NHS England’s chief executive, who had been given no responsibility for securing the workforce he needed or settling the pay and conditions of service for that workforce—matters determined by the government department, whose boss thought it was not his job to do any long-term planning. The Select Committee was rather stunned by this view of what the job of a government department was.
Is it any surprise that your Lordships’ Select Committee made the recommendations it did? I see no evidence that much has changed for the better since the Select Committee’s report. When the noble Lord, Lord Stevens, spoke in the debate on the amendment on the workforce tabled by the noble Baroness, Lady Cumberlege, he seemed to confirm, if one looks back at Hansard, that this was the case, with his account of endless delays before any kind of workforce future plan saw the light of day.
The workforce amendment tabled by the noble Baroness, Lady Cumberlege, has much to commend it, as I said when we debated it. It is certainly a big improvement on the current situation and puts statutory pressure on the Secretary of State to produce regular workforce plans. My worry is that the plan that that amendment would produce may not be long term enough or closely tied to funding streams. Moreover, any planning done under the noble Baroness’s amendment would still be subject to Whitehall negotiation and Treasury and No. 10 interference if it had data or messages that were politically uncomfortable at the time of publication. I had serious doubts about the wisdom of leaving health and care workforce planning totally in the hands of elected politicians and their civil servants. I say that having been a senior civil servant and a Minister.
Two recent stories in the Times have reinforced my view. When we discussed my Amendment 72 on 24 January, I raised the matter of the front page headline in the Times of 18 January: “Javid plans NHS revolution modelled on academy schools”. I thought this was odd, given that we have not completed the legislation on this NHS reorganisation. The noble Baroness, Lady Chisholm of Owlpen, did not totally reassure me when she said in response:
“No further plans have been agreed.”—[Official Report, 24/1/22; col. 37.]
I therefore assumed something odd was going on.
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I was not surprised, therefore, to see the very large spread on page 4 of the Times last Saturday, 29 January, again with the headline:
“GPs nationalised in Javid plan to reduce hospital admissions”.
The journalist—a highly reputable one, in my experience —quotes from a letter sent from the Health Secretary to the Prime Minister this month, telling him that he had
“an ambitious agenda that has the potential to be a central plank of your domestic policy legacy.”
The Prime Minister needs all the help he can get, at the moment.
I cite this information not just because I am curious about what is going on at 39 Victoria Street and the implications for this Bill. Although this issue seems above the Minister’s pay grade, he might wish to venture some explanation. More specifically on my amendment, these Times stories rather make the case for not putting longer-term health and care workforce planning in the hands of Ministers and their civil servants. If the criterion for NHS reform is to be the Prime Minister’s policy legacy, I am unconvinced that the NHS and its staff will end up in a good place.
Amendment 285 places the job of looking ahead and planning in a body independent of government. This body must be set up within six months of the Bill becoming law. The functions of the body are to be exercised on behalf of the Crown as though it were a public department. It has three main functions: monitoring and publishing data relating to demographic trends, disease profiles and the likely pace of change affecting future service demands; assessing the workforce and skills mix required to respond to those changes and publishing regular reports on these matters; and to consider the stability of health and adult social care funding relative to changing demographic and disease trends. In other words, it tries to stop what we had in the past, moving with the NHS budget from feast to famine and back again.
This new office should look five, 10 and 15 years ahead, and publish regular reports laid before both Houses of Parliament. It must produce an initial baseline report within a year of its establishment. It would have an executive chair and five members. The chair and two members would be appointed by the Health Secretary, but only with the consent of the Public Accounts and Health Select Committees of the House of Commons. The remaining two members would be chosen by the office itself. The initial term of office would be five years, and no one could serve more than two terms.
The workings of this new body are largely copied from the legislation setting up the Office for Budget Responsibility in 2011. That innovation seems to have worked well and was the model that this House’s Select Committee had in mind. However, I am not a proud author and I am open to alternative drafting, providing it does not weaken the independence of the body.
Even Jeremy Hunt, who, as far as I can see, ignored this recommendation when he was Secretary of State, seems to have changed his mind. In an interview to the Times last October, he regarded this kind of approach as likely to keep Governments honest.
I hope this House gives serious consideration to this amendment. The stories in the Times about considering further NHS reforms are disturbing and have serious implications for this Bill on Report. They should give the House pause for thought in giving the Secretary of State the powers of direction being sought. If another NHS reform is being cooked up in Victoria Street, it raises the question of why Parliament is labouring so long on this Bill.