Future of Health and Care — House of Lords, 2021-02-23
Topic: Health
James Bethell (Conservative, Centre-right): My Lords, I thank the two noble Baronesses enormously for those thoughtful and helpful questions. We are at a very early stage in the process of this important legislation, and the questions from both the noble Baronesses, Lady Brinton and Lady Thornton, are extremely helpful and make a good challenge. I will attempt to answer them as best as I can I reassure the noble Baroness, Lady Thornton, that we have all read the debates around the Lansley Bill carefully and learned an enormous amount from them. We greatly look forward to reminiscences from all those who were there in those days. There are some things that the Lansley Bill did that left an important and lasting legacy, and it would be wrong to overlook those. The establishment of Healthwatch and a focus on outcomes was a cultural inflection point in the history of the NHS. The overall importance of commissioning will not be lost in any changes introduced by this Bill. Lastly, this Bill massively builds on the establishment of NHS England in its measures. These are some examples of where the Lansley reforms made huge advances However, as the noble Baroness, Lady Thornton, rightly pointed out, some of those reforms have had their day and it is now important to move on to the next round, building on those reforms while fine-tuning some of them. One of the most important areas of development is around collaboration. By that, I mean that the challenge of modern healthcare is to bring a huge amount of expertise and extremely complex resource to bear on individual patient challenges. The sheer complexity of some of the treatments and therapeutics that can benefit the patient requires not just simple clinical analysis by an individual but teams across many disciplines, sites and, sometimes, institutions. It is the bringing together of that huge amount of collaboration that the Bill focuses on The noble Baroness is right that we face massive challenges in the period ahead. The vaccination programme is absorbing a huge amount of resource. There is a tremendous backlog in almost every area of the NHS and getting through it is a great challenge. NHS staff themselves are tired and exhausted; they deserve a break. This should not hold us back from doing exactly what the NHS had planned to do before the Covid epidemic, what stakeholders in the NHS repeatedly tell us that they want to do and what the huge amount of engagement that we have done tells us is right to do. I remind her that the core of the White Paper is the proposals made by the NHS to the Government in September 2019 to help the NHS deliver its long-term plan NHS England and NHS Improvement carried out a huge engagement process before making those recommendations. That exercise had over 190,000 written responses from individuals and organisations representing different parts of the health and social care system. Those recommendations were supported and endorsed by key leaders across that system, including NHS Providers, UNISON, Healthwatch, the Local Government Association, the Royal College of Nursing and many others. The recommendations made by NHSEI also built on recommendations made by the Health and Social Care Select Committee in June 2019. The Bill will have been thought about and prepared for over many years. It is the thoughtful application of important reforms and therefore deserves the close analysis and support of noble Lords. There are tremendous benefits to patients. The noble Baroness, Lady Thornton, specifically asked what the tangible benefits are, and I will pull out three in particular First, there are some specific public health measures in the Bill. As the noble Baroness, Lady Brinton, rightly raised—I will come back to it, in a moment—public health is central to the outcomes of the Bill. Fluoridation is the iconic measure, but a thick red thread of public health runs throughout the Bill. Secondly, the constitution of the Healthcare Safety Investigation Branch—HSIB—will, with statutory muscle, bring about the important investigatory element to promote the patient safety agenda, which my noble friend Lady Cumberlege wrote about in her report. Thirdly, the bringing together of GP and social care services into integrated care systems will bring much closer the decisions about patients which often cross barriers that, I am afraid, are huge obstacles to effective care today I will address the question of social care directly because the noble Baronesses, Lady Brinton and Lady Thornton, challenged me on this point: why have we not in the Bill brought about a wholesale financial rebooting of adult social care? The measures on adult social care in the Bill are just one aspect of a wider reform agenda. Our wider objectives for social care are to enable an affordable, high-quality and sustainable adult social care system that meets people’s needs while, supporting health and care in joined-up services around people. The Prime Minister has been crystal clear about his agenda for reform. A broad range of options are being explored on how best to accomplish these reforms and we want to ensure we get that reform right. Engagement with the sector and the public will be an important part of that We are still considering a number of funding reform options. However, the leading options, such as a cap and floor, are already provisions in the Care Act so they require only secondary legislation to enact. For this reason, we do not require anything on charging reform to be included in the Bill. However, the Bill should be considered as an important paving stone to wholesale social care reform I entirely agree with the noble Baroness, Lady Brinton, that culture is important. We are absolutely committed to putting social care in exactly the same hierarchy as the NHS. We believe that local authorities have a central role in the provision of social care; that is envisaged to remain the same. The noble Baroness, Lady Thornton, asked specifically: who will sit on the boards? That is exactly the kind of question that I look forward to debating here in the House and engaging on with noble Lords The noble Baroness, Lady Thornton, asked about competition, and she and the noble Baroness, Lady Brinton, raised deep-seated and heartfelt concerns about cronyism and corruption. I take those concerns very seriously. Huge amounts of taxpayers’ and voters’ money have been employed during the pandemic in the fight against Covid, and very large sums of money were spent on PPE in circumstances where there was a huge rush and difficult arrangements were being put in place. However, I remind both noble Baronesses that when they attack the Government and make accusations of cronyism, chumocracy and corruption but have no foundation for those attacks, they are interpreted as attacks on the very NHS and social care staff who have worked extremely hard to procure the right services and products, who have the interests of patients in mind, and who are working so hard to save lives. Attacks on the integrity of the system are extremely damaging to their morale and the integrity of that system. I kindly ask the noble Baronesses, Lady Thornton and Lady Brinton, who have made these attacks repeatedly over the last few months, to think very carefully about the way in which they make these accusations In particular, I will address the question raised by the noble Baroness, Lady Brinton, of PPE being taken from lorries that was destined for social care and sent instead to the NHS. If she indeed has evidence that such a thing happened, I would be very grateful if she would write to me. But if she does not, I would be extremely grateful if she did not raise this anecdote again, because it is a damaging image which hurts very much those who work in social care and the NHS, and is not necessarily fit for a debate such as today’s In terms of the PPE contracts that were the subject of a recent action in the law courts, I will repeat the sentiments expressed by my right honourable friend the Secretary of State for Health. Every waking moment of every day for everyone involved in the procurement of PPE was dedicated to getting the right kit to people on the front line to save their lives. If the paperwork was done two weeks late, that is an entirely proportionate and reasonable consequence of a very difficult situation, and seeking to make political capital out of an administrative oversight does not seem at all proportionate to the situation This is an extremely exciting Bill we have before us. I very much look forward to debating it in this Chamber. I am extremely grateful to the noble Baronesses, Lady Brinton and Lady Thornton, for their questions.