My Lords, Amendments 61, 95 and 96, which are all in my name, are to two separate issues. Amendment 61 relates to an issue we debated a number of times in Committee, when, if I may presume, there was a degree of support among noble Lords for the proposition that integrated care partnerships, in so far as they have to produce a strategy for a needs assessment for their area, have a very complementary—indeed, one might say overlapping—responsibility with health and well-being boards established in local authorities.
I will not go into the detail of how this works, and nor do I rest on the construction of Amendment 61. I freely acknowledge that this is a tricky thing to do. There will be circumstances where one ICS, one ICB or one ICP covers a lot of local authorities and others where it covers only one or two. In the latter case, it is
pretty straightforward to integrate health and well-being boards and integrated care partnerships. In other cases, the membership and construction may be more complicated.
1 pm
Essentially, I want to ask my noble friend a very simple question. We hope it may be possible for integrated care partnerships and health and well-being boards to work together. In certain circumstances, it might also be concluded that they should essentially be the same organisation, since they do the same or similar jobs. How does the legislation permit this to happen?
Previously, we said that the link between this and Amendments 95 and 96 was that, for a number of years, the NHS has engaged in activities and has been structured and organised in ways which it says are not supported by legislation. We do not have to debate whether or not this is so. The point is that the structure of this Bill was intended to enable the NHS to have legislation that directly supports the way in which it proposes to work organisationally in future.
Ten days ago, the Government published a further integration White Paper. As noble Lords will recall, among other things it said that there should be a single person accountable for shared outcomes in each place. It said:
“Our focus in this document is at place level.”
It went on:
“Success will depend on making rapid progress towards clarity of governance and clarity of scope in place-based arrangements.”
Amendments 95 and 96 are about where that place structure is. If the Government are looking to create legislation which reflects future ways of working, where is the place board?
Amendments 95 and 96 relate to Clause 62, which is about the process of delegating functions from NHS bodies to other bodies. In future, one of the essential delegations will be from integrated care boards to their place boards. Would it not make sense for Clause 62 to include place boards? Amendment 95 adds them to the list of relevant bodies, and Amendment 96 simply says what a place board is. The description is more or less non-controversial, although I do not rest on its drafting. Logic says that, if the Government are intending that place boards should exercise a significant function which will be delegated to them by local authorities and/or integrated care boards—potentially both—why not put them in the clause which arranges the delegation of functions? Otherwise, in a year or two, we may end up in exactly the position about which the NHS complained in 2016: that, in integrated care systems, something had been created which the legislation did not support. In a way, place boards reflect the structure of clinical commissioning groups, which have been established over a number of years and are now to be abolished. I am very worried that we will again end up in a situation where place boards are important, yet the legislation will not create a structure to allow this to happen.
I hope that my noble friend will be able to offer encouraging words about how this is to be achieved. It needs to be in the legislation to enable future arrangements to be supported. I beg to move.