My Lords, I rise to speak to this group of amendments, but particularly to move at the appropriate time my Amendment 12. Again, I declare my health interests in the register, especially as a trustee of the Centre for Mental Health and an honorary fellow of the Royal College of Speech and Language Therapists.
As we have heard, we had considerable discussion about membership of ICBs in Committee. I argued in an amendment that membership of ICBs should include a representative of a mental health trust. I also supported amendments stating that allied health professionals—who make up about a third of the health and social care workforce, within which speech and language therapists are a crucial service—should also have membership on the board. However, as we heard, the Government rejected the arguments, principally on the grounds that they made membership too prescriptive and inflexible.
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The Minister, with strong support from the noble Baroness, Lady Walmsley, which I welcome, has instead brought forward Amendment 31, which addresses, among other things, the need for an ICB to
“review the skills, knowledge and experience”
of board members and to
“take such steps as it considers necessary to address or mitigate that shortcoming.”
This is clearly very important, and I do not oppose Amendment 31. I certainly hope that, as the Minister indicated, allied health professionals such as speech and language therapists will be part of that review and of the board. But the amendment does not ensure that critical areas of healthcare, particularly mental health, are at the table when the ICBs are established.
Government Amendment 31 is retrospective, looking backward at a possible lack of knowledge and expertise after the event, while ICBs are the crucial forum where decisions will be made about millions of pounds of NHS funding, as well as choices about priorities and system changes. Membership of ICBs really matters from day one. It cannot be left to chance or adjusted inconsistently over subsequent years. Further, I remain concerned that if the voice of mental health is not in the room from the inception of ICBs, there is a danger that the very powerful interests of acute trusts will dominate the agenda, which could lead to undermining the not inconsiderable progress towards parity of esteem between mental and physical health, as we have already heard.
My amendment, on mental health representation, tries to overcome the Government’s criticism of overprescription and inflexibility by proposing that at least one member of the ICB should have expertise and knowledge of mental health in each ICB area. The Centre for Mental Health and the Mental Health Foundation support the view that this has the advantage of not being prescriptive and of not specifying that mental health representation should have a clinical focus or involve the nominee of a particular mental health trust. This could help to contribute to a more rounded conception of mental health, including public mental health representation, user-led representation or community organisation being placed on the board as the advocates for mental health services in their local area. This would help to ensure that integrated care systems do not become remote from their local communities and that the issues that really matter to the people are addressed from day one as the ICB plans its services.
Amendment 31, which would require ICBs to have a balance of skills and knowledge, is certainly a huge step in the right direction. I again commend the noble Baroness, Lady Walmsley, for the work she undertook on this amendment, but it should go one step further and guarantee that none of the 42 ICBs can leave mental health out of the room when crucial decisions are made. My amendment would not constrain ICBs by specifying who can or cannot bring mental health on to the board, but it would ensure that that voice is there and in the room. In doing so, it would benefit everyone’s health and well-being, helping to create a more balanced and effective health and care system in every area, and for all of us.
As the Minister said he would listen to the arguments, I hope he will accept this and, if not, clearly explain why. I will not move my amendment now but certainly will at some point.