Glenys Thornton on the challenges facing ministers once peers get into the finer detail of the Health and Care Bill
The Health and Care Bill is in some respects a worthwhile piece of legislation. But it is also going through Parliament at the wrong time, and fails to deal with the issues deeply affecting our health and care system, including increased inequality, long waits, workforce shortages, weak and underfunded public health, and wholly inadequate levels of provision and funding.
The bill began as a legislative response to the NHS leadership wanting to reverse key aspects of the Health and Social Care Act 2012 deemed incompatible with the development of their Long Term Plan. These included ending compulsory competitive tendering for certain services and allowing greater cooperation and joint working among various bodies. In addition, informal organisational arrangements that the NHS had developed in Sustainability and Transformation Partnerships, were to be put onto a statutory basis – and these are reflected in the proposed 42 Integrated Care Systems.
Legislation expected in 2017 emerged in 2021, with the addition of a raft of new powers (and some new functions) for the Health Secretary – including direct involvement in service reconfigurations, the transfer and delegation of various functions in relation to arms-length bodies, professional regulation, and reporting on workforce needs. Labour considers all of these to be unnecessary, as they compromise the separation of political and operational responsibilities that were one of the few 2012 changes that appeared to add value.
The bill also includes proposals around information standards and information sharing, setting up the Health Service Safety Investigations Body, and given CQC powers to investigate adult social care; as well as medical examiners, where some serious questions have been raised over the impact. Plus, there are some genuine health matters relating to food advertising, fluoridation, and virginity testing. And, of course, the highly contentious new clause concerning the social care costs cap – something the Government introduce only once the bill had gone through Commons Committee stage.
Labour has broadly supported the proposals that remove the worst of the 2012 Act but will seek to add safeguards to ensure proper governance and accountability, and to prevent new arrangements being open to abuse. Appointments to key positions must be made properly not just awarded. Services should ideally stay within the NHS – but contracts made with the private sector must be subject to a proper procurement regime. All new bodies must be completely open and transparent, and not pretend to be businesses with secrets to hide.
Amendments relating to yet another NHS reorganisation are clearly going to be of major importance when we reach the later stage of the bill; as will those relating to the new Integrated Care Boards which will have responsibility for billions of pounds of public money. These boards will be crucial in working towards a more integrated care system, involving local authorities, voluntary organisations, and others. It is vital that yet another attempt to try to resolve how NHS services are commissioned will learn from the earlier CCGs, PCGs, and PCTs.
Labour Peers will be looking to put checks on the new powers of the Secretary of State, ensure effective workforce planning across the whole of the care sector, and tackle the attempt to reduce the value of the care costs cap. Doing so, however, is going to involve the building up of a wide coalition of interest both within and beyond Parliament – and we especially look forward to parliamentarians on the government’s own benches doing the right thing.
Baroness Glenys Thornton is Shadow Health Minister in the House of Lords. She tweets @GlenysThornton
Published 7th December 2021