NHS Funding Bill (Money Bill) — House of Lords, 2020-02-26
Topic: Health
Ajay Kakkar (Crossbench, Unknown): My Lords, I join in congratulating the Minister on the way in which he has introduced this Second Reading. Clearly it is to be welcomed that there is clarity on the financial settlement attending the delivery of the NHS in England over the years remaining in this Parliament. I declare my interest as chairman of UCLPartners and chairman of the King’s Fund This is not the first time that a Government have committed substantial additional funding for the delivery of the NHS. On previous occasions when these commitments have been made, the regrettable fact has been that the performance associated with the additional funding has been uneven. This demonstrates that additional funding in itself is not the absolute answer to all the issues that face the long-term sustainability of the NHS Clearly, additional funding is critical; as we have already heard in this debate, the funding that has currently been guaranteed will play an important role in ensuring the medium-term sustainability of the delivery of important services. However, the reality is that one must be certain that the environment—the structural solution for the NHS to which this additional funding is going to be delivered—is entirely appropriate. The noble Lord, Lord Hunt of Kings Heath, has identified that the long-term plan in itself identifies a number of opportunities by which sustainability for the NHS can be achieved Much of the long-term plan is predicated on the concept that integrated care is now essential if the delivery of health services is to be sustainable. The NHS long-term plan identifies three important integrations: between primary and secondary care; between physical and mental healthcare; and between healthcare and social care. In providing the long-term plan, the NHS has also made suggestions with regard to legislative change that might be required to ensure that the disposition of the additional funding, and indeed the delivery of the plan itself, is going to be improved. I know the Government have received those legislative suggestions, but they have yet to respond to them. In opening the debate, the Minister made reference to that and to the fact that further legislation may come before your Lordships’ House in due course in this Parliament to deal with those questions One important suggestion is of course a merger of NHS England and NHS Improvement. I wonder whether Her Majesty’s Government have found themselves in a position to take a view on that matter. Clearly it is at the heart of whether the system for the delivery of healthcare is as effectively constructed as it needs to be to ensure that this vital additional funding is applied in the most effective and efficient fashion Additionally, suggestions have been made that commissioners and providers may come together in joint decision-making committees such that, at a local level, the disposition of this additional funding is applied in such a way that the integration of services is achieved effectively and that this funding provides maximum benefit, both in individual patient care and the management of local populations. Do Her Majesty’s Government believe that joint decision-making committees, created on a voluntary basis, will have sufficient influence and power at a local level to drive forward the appropriate integration of services such that the delivery of care achieves the benefits that we very much hope will be available to patients and to local populations The noble Lord, Lord Hunt of Kings Heath, made another very important observation earlier, which relates to the report on the long-term sustainability of health and social care from your Lordships’ ad hoc committee chaired by my noble friend Lord Patel. It is a very important observation that this Bill, which is laying out in statute guaranteed funding for the NHS over multiple years for the first time, could form the basis—the foundation—for a first step towards that broader, long-term sustainability for the NHS. Your Lordships’ committee report made a number of important recommendations. Some of those have already been adopted by Her Majesty’s Government in a number of different ways, so clearly that report has had impact and is influential in the debate with regard to the long-term sustainability of the NHS. It should be taken as a very important observation that the presentation to this Parliament of this Bill in itself is important but could provide for a longer-term approach to the sustainability of the NHS, dealing not only with financial questions, as this Bill does, but with the important structural issues that will need to be addressed if repeated increases in funding can be applied in the most effective fashion to achieve the goals and objectives that we all strongly support.