Health and Care Bill — House of Lords, 2021-12-07
Topic: Health
Syed Kamall (Conservative, Centre-right): My Lords, over the pandemic the NHS has worked wonders. Throughout the greatest challenge that our health and care system has ever faced, the extraordinary dedication, care and skill of the people who work in our communities and hospitals have been unwavering, and I am sure that the whole House would want to put on record our thanks and admiration for staff across the health and care system The Government believe that part of that thanks must be in the form of giving the NHS the Bill that it wants, the Bill that it has asked for and the Bill that it needs to take better care of all of us. Some may say that this is the wrong time for this legislation. The Government and, more importantly, the NHS disagree. The Bill builds on the progress that the NHS made during the pandemic. Under crisis conditions, the NHS evolved, finding new reserves of incredible creativity, innovation and collaboration. It rolled out an extraordinarily successful vaccine programme, it drew on our collective strengths to deliver a programme reaching every corner of the United Kingdom and it has continued to deliver But the NHS has told us that the current legislation contains barriers to innovation that the Government feel duty-bound to remove. The NHS has asked for more flexibility to enable local leaders to try out new things—not as a free for all but in ways that best suit local needs and ensure that the system can evolve. The NHS has asked us to protect and nurture the innovation and hard-won lessons of the pandemic, as we begin to build back better Much of the Bill is not new: it builds on years of work on the ground to integrate care, on the work outlined in the NHS Long Term Plan and on years of experience, effort and learning, and of the system pushing the legislation to its limits to do what is best. It also builds on the Integration and Innovation White Paper that we published in February 2021, and on the many consultations that we have held on different aspects of the Bill. The NHS asked for legislation to make it fit for the future, and we are delivering. The Government believe that this is the right Bill at the right time, with wide support for the principles of embedding integration, cutting bureaucracy and boosting accountability. I am sure that noble Lords will agree that one of the biggest challenges facing the NHS is the workforce. The Bill proposes a duty on the Secretary of State to report on the workforce "once every five years". The Government are asking the NHS to develop a 15-year strategic framework for workforce planning, and we are looking to merge NHS England and Health Education England to deliver this. We are on track to deliver on our promise of 50,000 more nurses by March 2024 The Government believe that this Bill will also help to deliver adult social care reform. In September, we announced plans to invest an additional £5.4 billion to begin a comprehensive programme of reform. Last week, we published our reform White Paper, People at the Heart of Care. This sets out our vision for adult social care and our priorities for investment, with measures including a new £300 million investment in housing and a £500 million investment in the workforce, to bring tangible benefits to people’s lives The Government recognise that their amendment to the adult social care charging system was considered controversial. However, it is necessary, fair and responsible. Everybody, no matter where they live in the country, no matter their level of starting wealth, will have the contribution they have to make to the cost of their care capped at £86,000. Those with lower levels of wealth will be far less likely to have to spend this amount, thanks to a far more generous means-testing regime that we will introduce. To be clear, the Government believe that nobody will be worse off in any circumstances than they are in the current system, and many people will be better off Furthermore, without this change, two people with the same level of wealth, contributing the same amount towards the cost of their care, could reach the cap at very different times. This is not considered fair. A fairer system is to have the same cap for everybody, and then provide additional means-tested support so that people with less are unlikely ever to spend that amount At its heart, this Bill is about integration. It builds on the lessons of the pandemic, when the NHS and local authorities came together as one system and not as individual organisations. New integrated care boards and integrated care partnerships will build on the progress made so far to plan, to join up services and to deliver integrated care. We are grateful for the work done to develop these clauses by both the NHS and the Local Government Association We have listened throughout the Bill’s passage in the Commons to concerns that we are enabling privatisation. Nothing could be further from the truth. To put this beyond doubt, we amended the Bill in the other place to make it clear that that no one may be appointed to an ICB who would undermine the independence of the NHS, either as a result of their interests in the private healthcare sector or otherwise Many noble Lords will be aware of the integration White Paper announced in September and currently in development. I can assure the House that this will build on the integration measures in the Bill, to go further and faster and to deliver person-centred care. We expect to publish it in early 2022 As I have mentioned, a key aspect of this Bill is removing bureaucracy where it gets in the way. While bureaucracy often ensures that there are processes and procedures in place, we all know how excessive bureaucracy can make sensible decision-making harder. We believe that health and care staff are able to deliver better when they are trusted and given space to innovate, with barriers removed. Every NHS reform has claimed to reduce bureaucracy, with varied degrees of success, but such reforms have often been top-down. These reforms come not from the top down but from the bottom up, giving the NHS what it has asked for. This includes introducing a new, more flexible provider selection regime that balances transparency, reducing bureaucracy and fair and open decision-making It is right that the day-to-day decisions about how the NHS is run, both locally and nationally, are free from political interference. However, it is also right that there is democratic oversight and strong accountability in a national health system that receives £140 billion of taxpayers’ money every year. The public deserve to know how their local health system is being run. Integrated care boards will hold meetings publicly and transparently, and the Care Quality Commission will have a role in reviewing integrated care systems The Bill also ensures greater accountability from healthcare services to government, to Parliament and, ultimately, to the public. Through new powers of direction, the Government will be able to hold NHS England to account for its performance and take action to ensure that the public receive high-quality services and value for taxpayer money. Equally, we must ensure that there are safeguards and transparency mechanisms in place. That is why the Bill is clear that the new power of direction cannot be used to intervene in individual clinical decisions or appointments. The public also expect Ministers to ensure that the system conducts reconfiguration processes effectively and in the interests of the NHS and, where necessary, to intervene. In such instances, the Bill provides a mechanism for the Secretary of State to intervene, subject to the advice of the independent reconfiguration panel As we all know, the health challenges that we face are not static, so the NHS must continue to be dynamic. As the noble Lord, Lord Darzi, once said: "To believe in the NHS is to believe in its reform".—[Official Report, 11/10/11; col. 1492.] The Government believe that this Bill allows the NHS to meet the challenges of today and adapt to those of tomorrow. With this Bill, we can look beyond treating disease and focus on prevention with measures to promote good health, such as tackling obesity and stopping the advertising of less healthy products to children. This Bill includes a range of important additional measures, including the establishment of the Health Services Safety Investigations Body, or HSSIB—a world-leading innovation in patient safety—and legislation to ban virginity testing to fulfil the Government’s commitment to the most vulnerable The Government believe that the founding principles of the NHS—taxpayer-funded healthcare available to all, cradle to grave and free at the point of delivery—remain as relevant now as they were in 1948. To protect these values, we must back those who make them a reality every day of their lives by building and constantly renewing a culture of co-operation and collaboration. I commend this Bill to the House.