Health and Care Bill — House of Commons, 2021-07-14
Topic: Health
Jonathan Michael Graham Ashworth (Labour, Centre-left): Yes, although I am disappointed that they are in this particular Bill. I think they should be part of a stand-alone Bill. In my concluding remarks, I will make a point or two about other public health interventions, which I imagine and hope that the hon. Member, as a great champion of public health, would support. It is crucial that the Secretary of State’s duty to provide comprehensive healthcare is reinstated, rather than the duty to meddle in the NHS at any time he wants, because there is a lack of clarity about how the funding flows work in this system. The talk is of moving to capitated budgets for an area to provide holistic care to meet the complicated care needs of individual. But when waiting lists are increasing at the current rate, and when cancer waits and mental health referrals are going up, how is an area going to fund the episodic care for each unit of extra care that is needed—often care that is expensive and more complicated because it needs to be done in the acute sector We have worries. Clauses 21 to 24 on the financial duties on ICS boards, NHS trusts and NHS foundation trusts are alarming, because they put in place a duty to ensure financial balance across the ICS area, but there is no clarification of how that balance should be achieved and enforced. Local health budgets have been stretched to breaking point after years of underfunding, so what does this duty mean for existing deficits? At the moment, trusts have a combined deficit of £910 million. King’s has a deficit of £111 million. Worcestershire has a deficit of £81 million. University Hospitals of Leicester NHS Trust has a deficit of £80 million. Will the ICBs need to fill this £900 million black hole before they are even up and running How exactly will trust and ICS board deficits be dealt with at the end of each financial year This could well be a return to the days that we saw in the ’80s, which some Members in the House may recall, when health authorities would close beds and put off paying bills from January onwards in order to hit financial balance. If health authorities have to hit this financial balance year by year, will it result in a postcode lottery of more rationing and an even longer list of treatments being removed from the NHS through the decisions of ICBs because they have to hit balance, effectively forcing patients either to go private or go without? I hope that the Minister, in summing up, can clarify what the situation will be If a set of providers, trusts and an ICB feel that the financial settlement they have been given by NHS England will not allow them to deliver the levels of care to bring down the waiting lists, which the Secretary of State said is one of his top priorities, or to improve mental health outcomes, which he has also said is one of his top priorities, what is their appeal process? How will the arbitration process work on an area’s financial settlement under the current plans to bring together NHS England and NHS Improvement, not split them out The Bill is spun as an attempt to integrate health and social care, but there is nothing in it actually to integrate health and social care, because there is nothing in it to fix social care. If it is about integrating health and social care, where is the long-promised Bill to reform social care? The Bill will repeal provisions in the Care Act 2014 that require patients to be assessed for their social care needs before they are discharged from hospital. Without long-term funding in place, that could mean a patient being sent home, left out without support and waiting for an assessment. Will the Secretary of State, or the Minister who responds to the debate, guarantee that that will not be the case? Will they put in place the necessary funding alongside the Bill? A number of royal colleges and health bodies have said today that the biggest challenge facing the NHS is workforce. The Bill proposes a duty on the Secretary of State to report on workforce once every five years. That is simply not good enough. We need a solution to workforce now; we need a solution to recruitment now; staff need a fair pay rise now; we need more investment in training and professional development budgets now; and we need safe staffing legislation now. We will therefore look to amend the Bill, hopefully on a cross-party basis and perhaps working with others who put forward proposals to improve the workforce sections of the Bill As my hon. Friend the Member for York Central (Rachael Maskell) asked the Secretary of State, what does the Bill mean for "Agenda for Change"? The Bill suggests that an integrated care system will be able to change "Agenda for Change" terms; we disagree with that Finally, on public health, the Bill introduces restrictions on the advertising of less healthy food and drink. We welcome this step—it, too, was in our 2017 manifesto, which the Secretary of State has been reading—but we would go further. Why can we not have more restrictions on the advertising of unhealthy food around schools? Our public health crisis is about not just obesity but smoking and alcohol, so why are there no provisions in the Bill on smoking services and to ensure alcohol calorie labelling? We will table amendments on those issues in Committee This is the wrong Bill at the wrong time. Will the person with learning difficulties or the older person who needs social care experience improved care? No. Will social care be brought back in from the wilderness? No. Will the cancer backlog be tackled more effectively? No. Will health inequalities be narrowed? No. Will parity of esteem for mental health be delivered? No Instead of this being a simple Bill to end competition and foster local collaboration, NHS staff will be left trying to second-guess where the Secretary of State will interfere next in the safe running of their local NHS with his in-year changing mandate. The rules on funding could result in more rationing and cuts, so we cannot possibly support the Bill. We have championed integrated care for many years, but the Bill does not deliver it and we urge the House to accept our reasoned amendment.