Health and Care Bill
Public Bill Committee, 7 September 2021.
Sheryll Murray (Conservative, South East Cornwall)
I have a few preliminary announcements. Please switch off all electrical devices or turn them to silent. Tea and coffee are not allowed during sittings of this Committee. I encourage Members to wear masks when they are not speaking; this is in line with Government guidance, and that of the House of Commons Commission. Please also give each other and members of staff space, both when seated and when entering and leaving the room. Members should send their speaking notes by email to hansardnotes@parliament.uk, and when officials in the Gallery communicate with Ministers, they should do so electronically.
We will consider first the programme motion on the amendment paper, then a motion enabling the reporting of written evidence for publication, and then a motion allowing us to deliberate in private about our questions before the oral evidence sessions. In view of the time available, I hope those matters can be decided without debate.
I call the Minister to move the programme motion, which was discussed yesterday by the Bill’s Programming Sub-Committee.
Sheryll Murray (Conservative, South East Cornwall)
Copies of written evidence received by the Committee will be circulated to its members by email and made available in the Committee Room.
Sheryll Murray (Conservative, South East Cornwall)
If everyone is agreed, we will go into private session to discuss lines of questioning.
Examination of Witnesses
Sheryll Murray (Conservative, South East Cornwall)
Some of our witnesses will be giving evidence today by video link, while others will appear in person. It is helpful, particularly when witnesses are giving evidence by video link, if Members could direct their questions to specific witnesses. Before calling the first panel of witnesses, I remind all Members that questions should be limited to matters within the scope of the Bill and that we must stick to the timings in the programme motion that the Committee has agreed. We have until 10.30 for our first panel. Do Members wish to declare any relevant interests in connection with the Bill?
Jo Churchill (Conservative, Bury St Edmunds)
I have no relevant interest to declare, but we are unable to see a screen. Would it be possible to erect a screen so that we can see those giving evidence?
Sheryll Murray (Conservative, South East Cornwall)
Yes, we can do that. As there are no witnesses giving evidence in person, it would be okay for Members to sit at the witness table, if that would be better.
Jo Churchill (Conservative, Bury St Edmunds)
That would be great.
Philippa Whitford (Scottish National Party, Central Ayrshire)
I want to declare an interest as a medical practitioner, although not commonly practising, and as a member of the British Medical Association.
James Davies (Conservative, Vale of Clwyd)
Likewise, I declare an interest as a serving general practitioner in the NHS, a member of the BMA and as a member of the Royal College of General Practitioners.
Sheryll Murray (Conservative, South East Cornwall)
Thank you. I am very keen that we continue this session as quickly as possible. We will now go to our witnesses. Good morning and on behalf of the Committee, thank you very much for agreeing to give evidence. Please introduce yourselves for the record.
Sheryll Murray (Conservative, South East Cornwall)
I think that would be good; ladies first.
Sheryll Murray (Conservative, South East Cornwall)
Thank you very much. Members who wish to ask questions should please indicate that.
Edward Timpson (Conservative, Eddisbury)
Good morning to you both. Having taken big Bills through Parliament before, I am aware that a lot of scrutiny goes into the detail on the statute book, for obvious reasons, but sometimes we also need to reflect on the implementation and how we can make the legislation turn into a reality. Q Based on the proposals in the Bill, what role do you think you can play to bring about that reality through the development of the workforce to meet the demands on the healthcare system that the Bill is trying to improve the prospects of meeting?
Edward Timpson (Conservative, Eddisbury)
Q Do you see the principles set out in this Bill, along with the details in each of the relevant clauses, around integration and collaboration as a natural progression from a lot of the work that has already been undertaken by yourselves and others working in the healthcare system?
Edward Timpson (Conservative, Eddisbury)
Thank you.
Sheryll Murray (Conservative, South East Cornwall)
I now call Mary Robinson.
Mary Robinson (Conservative, Cheadle)
It is really interesting to hear—I have seen it, as I am sure you all have—how partnerships have been built through covid. There has been a huge amount of joint working and integration. Have you been able to pick out any specific areas of learning over the past year and a half that we would hope to see as we go forward and which would be really useful as we build this integrated networkQ ?
Mary Robinson (Conservative, Cheadle)
Thank you.
Sheryll Murray (Conservative, South East Cornwall)
I call Dr James Davies.
James Davies (Conservative, Vale of Clwyd)
Q I am interested to hear your views on the adequacy of the requirements for workforce projections within the legislation as it stands, in relation to both the NHS workforce and social care, potentially, and how you think the devolved Administrations should be brought in. Dr Navina first, please.
James Davies (Conservative, Vale of Clwyd)
Thank you.
Sheryll Murray (Conservative, South East Cornwall)
Thank you. I call Karin Smyth.
Karin Smyth (Labour, Bristol South)
I appreciate that people working together and perhaps substantiating some of those informal arrangements might, in theory, do some of what you hope. However, the employers remain the institutions that make up the integrated care boards—that is the effect of the Bill. You have started to talk about the process. Could you perhaps talk a bit more about how that is enforced, what that means in practical terms for employers and how employers might behave? I am partly thinking of one of the trusts in my area, which, a number of years ago, set up a wholly owned subsidiary company, with the benefit for them of different terms and conditions for staff as a way of saving money. That was obviously detrimental to the healthcare system generally because you are competing for the same sorts of staff. We made the trust stop doing that because we wanted the staff to be treated the same. My point is: the employers, the terms and conditions, the benefits and the way that they will attract staff remain the same. The Bill does not make the ICB the employer or the way to deliver those terms and conditions or ways of recruitment. I think it is a theory. Can you convince us otherwise and show how in practical terms the Bill solves some of those problemsQ ?
Chris Skidmore (Conservative, Kingswood)
I want to return to the issue of workforce planning, which obviously is integral to both of your organisations. You have discussed the strategic framework you have been working on, and hopefully that will evolve into a workforce strategy, which is addressed in clause 33 of the Bill. I have tabled an amendment to clause 33 which is to make the workforce report annual rather than once every five years. I think that the pandemic has demonstrated the futile nature of trying to produce a report once every five years, when we know that the nature of the workforce could change radically during that period. Would your organisations agree that it would be better for that report to be produced on an annual basis? Clause 33 states that NHS England and Health Education EnglandQ
“must assist in the preparation…in this section,”
but only
“if requested to do so by the Secretary of State.”
You have talked about locally led decision making and planning. Do you both agree that we need better co-creation? My amendment covers the fact that a plan should be developed and agreed by stakeholders in particular. Would your organisations welcome this amendment, which would result in an annual workforce strategy and require it to be developed by all other healthcare organisations working in this sphere?
Hywel Williams (Plaid Cymru, Arfon)
Good morning. This Bill is mainly about services in England, apart from the part about the health services safety investigations body and clause 112 on Welsh health bodies requesting help. However, there is significant traffic from Wales to England, and a certain amount in the other direction, to access health and care services. This might impact on services in the north-west of England and along the Welsh border. This is a very broad and quick question: in what ways do you see yourselves and other health bodies in England taking account of the priorities and needs of the Welsh Government and of the Welsh population to access health services in England?Q
Hywel Williams (Plaid Cymru, Arfon)
Q I am very glad to hear what you have said. Professional staff are notoriously footloose, as far as Wales is concerned, so there is a certain issue about workforce planning. In my own area, I used to teach in social work education. We have a nursing school at Bangor University, which is a very valuable provision, but I am not sure how many are retained in the health service in Wales—or the other way around, of course.
There is one other point I would make, and this is more philosophical than practical. The Welsh Government’s approach to health is based on a wellbeing model. It is much more proactive than other models. I hope that, philosophically, that sort of approach is useful and interesting for you, and that you will be taking full notice of it.
Hywel Williams (Plaid Cymru, Arfon)
Thank you.
Justin Madders (Labour, Ellesmere Port and Neston)
Good morning. Thank you for coming. I am sure that you will be aware that everyone in the country, and the Q whole Committee, is very grateful for the work done by frontline health and social care staff, not only over the past 18 months, but over many years. The consequences of that work have been starkly drawn to everyone’s attention by the Health Committee report on staff burnout. What in the Bill will address the issues raised in the report?
Sheryll Murray (Conservative, South East Cornwall)
Thank you. I intend to move to the SNP spokesperson at 10.15 am, and to the Minister at 10.25; the session ends at 10.30. If we can keep questions and answers succinct, that would be appreciated.
Justin Madders (Labour, Ellesmere Port and Neston)
Q You were very clear in your view of what was needed to make clause 33 more effective. In your opinion, would the clause also require some funding requirements to meet the demand?
Justin Madders (Labour, Ellesmere Port and Neston)
Q Thank you. I have a quick question for Dr Evans, and then one more question for you both. You have mentioned the commission that you have been asked to form to draw up that strategy. When is that expected to be published?
Justin Madders (Labour, Ellesmere Port and Neston)
Q May I ask you both whether you have given any thought to, or been able to quantify, the amount of staff and management time that will be taken on implementing the Bill?
Justin Madders (Labour, Ellesmere Port and Neston)
Thank you. For the last minute, I am going to hand over to my colleague.
Alex Norris (Labour/Co-operative, Nottingham North)
I have a very quick question for Danny Mortimer. You have the unenviable task of negotiating with the staff and their representative unions on all sorts of issues—pay, terms and conditions, safety. When you have such negotiations, how high up on the list does a commissioning restructure come in terms of the things that our front-line staff are really after?Q
Sheryll Murray (Conservative, South East Cornwall)
I call Dr Phillipa Whitford, the SNP spokesperson.
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Thank you very much, Mrs Murray. Dr Evans, we have talked quite a lot about workforce and highlighted the fact that the workforce move around the UK, and therefore work in the four different nations. Registration of nurses and doctors is UK-wide, although only Scotland has registration for care staff. Do you not think that that needs to be recognised to some extent in clause 33, so that we do not end up having Peter robbing Paul? This year, we have seen a shortage of foundation places. Although all four nations have increased medical student places, a young doctor cannot practise unless they get their two years at foundation level. Do we not need to be consulting specifically with the other health Ministers and looking at the workforce in general? I do not mean transferring control of that workforce, but recognising, for the next five, 10 or 20 years, the needs and the strategies of the different nations so that we do not end up stealing from each other.
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Sorry to interrupt, Dr Evans, but this year the foundation places are managed on a UK basis, and this year, at the beginning of the summer, there were several hundred graduates who did not have a foundation place—I hope they have all got one now. That can mean people literally being sent to a different part of the UK, away from their family and their support mechanisms, and we all know how tough these years are. This is being managed at a UK level, and yet the three devolved nations are also trying to tackle workforce issues. If they are not included in this, or at least consulted, do you not see that as a weakness?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Thank you. Danny Mortimer, we have talked about the change that is coming, and a lot of it is to enable the innovation that has come through the pandemic. I was back in the NHS in Scotland in the first wave, and I saw that creativity. How do you think it can be done without consuming a lot of the bandwidth of frontline staff? You talked to the shadow Minister about management, but it often takes up frontline staff. Would you see a gradual change? Are you concerned that the footprints of some of the ICSs that have already evolved are apparently going to change? Is that not going to add new upheaval in certain geographical areas?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Yes, I totally recognise that. In Scotland, we reintegrated primary and secondary health back in 2004, and in comparison with the last seven years of trying to integrate health and social care, that was a walk in the park. It is much more challenging, but equally it is where we are all trying to get to. If I can ask you, on a different subject—
Sheryll Murray (Conservative, South East Cornwall)
I think we are getting close to the last question.
Philippa Whitford (Scottish National Party, Central Ayrshire)
This is the last question.
On the health services safety investigations body, I was on the pre-legislative Committee, where there was an aim of protecting the safe space disclosures quite thoroughly to ensure staff had the confidence to discuss very sensitive issues. In the version that is in this Bill, much more is covered by safe space protection, but then there are exemptions such as the coroner. Although staff can be summoned and made to give evidence, if they feel that that will end up being shared through a lot of disclosure exemptions, do you think they will really believe that that space is protected, in the way it is in the airline sector?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Thank you.
Sheryll Murray (Conservative, South East Cornwall)
Thank you. I call the Minister.
Edward Argar (Conservative, Charnwood)
Q Thank you, Mrs Murray. I will try to be brief, with just two questions. Morning, Danny; morning, Navina. My first question is this: what do you see as the potential role of legislation in addressing future workforce needs— both the limitations of legislation in doing it and the opportunities?
Edward Argar (Conservative, Charnwood)
Q Thank you. One final question from me, if I may, Mrs Murray. I think it was Dr Mortimer who touched on a couple of points in his comments. One was that the way it is envisaged that this will be implemented would minimise any impact or burden, as it were, on the system, and I think that both witnesses touched on the learnings from the pandemic—the opportunity to build on what was done during that. To what extent, or not, would the witnesses consider that this is the right time to be doing this?
Edward Argar (Conservative, Charnwood)
Thank you both. Thank you, Mrs Murray.
Sheryll Murray (Conservative, South East Cornwall)
Thank you, Minister. As there are no further questions from Members, I thank the witnesses for their evidence. We will now move on to the next panel.
Sheryll Murray (Conservative, South East Cornwall)
We will now hear from Amanda Pritchard, the chief executive of NHS England, and Mark Cubbon, the chief operating officer of NHS England and NHS Improvement. Both witnesses are appearing via Zoom, and we will run this session until 11.25 am. Could the witnesses please introduce themselves for the record?
Sheryll Murray (Conservative, South East Cornwall)
Thank you very much.
Karin Smyth (Labour, Bristol South)
Q Welcome to our witnesses. Ms Pritchard, welcome to your new role.
We have just heard some interesting evidence, and I want us to be very specific about our terminology when we refer to integrated care systems, integrated care partnerships and the integrated care board. In your view, who is accountable for the spending in my local area under the new arrangements? Approximately £1.5 billion is spent in the local area. In the new system, who is accountable for that spend?
Karin Smyth (Labour, Bristol South)
Q That is really helpful and very clear. The chief executive and the finance director of the integrated care board are clearly accountable. To whom are they accountable?
Karin Smyth (Labour, Bristol South)
Q So when I have an issue that I want to bring to my local integrated care board’s finance director and chief executive, I will take it through to NHS England and then back to Parliament, of which I am obviously a Member. At what stage does the Secretary of State get involved with my issue?
Karin Smyth (Labour, Bristol South)
Can I ask about clause 20, which is about externally financed development agreements? In your view, is there a role in that clause to develop primary care and community estate? I am particularly interested in whether that provides the ability to continue the LIFT arrangements that were undertaken by primary care trusts but not by CCGs.Q
Karin Smyth (Labour, Bristol South)
So how do we, in the system, ensure the development of primary and community estate? Are we in the queue with the Treasury, behind the 40 or whatever hospitals? Is there any way in which we can develop primary and community estate within the scope of the Bill? If we cannot do that through the Bill, how do we do it?Q
Karin Smyth (Labour, Bristol South)
Q Just to be clear, where would this capital come into the system? Presumably it would come to the ICB, as the accountable body. Where would the capital separately come from?
Sheryll Murray (Conservative, South East Cornwall)
Thank you. We now go to Jo Gideon.
Jo Gideon (Conservative, Stoke-on-Trent Central)
Thank you, Chair. I would like to expand on the previous questions. It is my understanding that the integrated cared boards are the accountable bodies when the funds come in. But is the spending—the actual allocation funds—to be delegated down to integrated care partnerships, or is that at the discretion of individual integrated care boards?Q
Jo Gideon (Conservative, Stoke-on-Trent Central)
Q If I understand you correctly, place sits within the partnership rather than the board? I know the design has been about flexibility for each local board and partnership, to involve as many people as is relevant for local priorities. Do you think there is a tension about who sits on which, and what level of clinical representation do you think should be specified on boards?
Sheryll Murray (Conservative, South East Cornwall)
Thank you. I call Dr James Davies.
James Davies (Conservative, Vale of Clwyd)
Q Thank you, Mrs Murray. To follow on from the discussion about special interest groups and particular clinicians on the ICS boards, are you saying, therefore, that you do not think the legislation should specify, for instance, that there is a representative for mental health in relation to children, or in relation to social care? How do we explain to the representatives of those very important subject areas that it is down to local flexibility? What happens if local flexibility results in a lack of attention to those issues?
James Davies (Conservative, Vale of Clwyd)
Thank you.
Sheryll Murray (Conservative, South East Cornwall)
Thank you. I believe Mr Edward Timpson indicated that he wanted to ask a question.
Edward Timpson (Conservative, Eddisbury)
Q I did; thank you, Mrs Murray. I want to ask a brief question, if I may, about the proposed merger of NHS England and NHS Improvement. I assume, although I do not know, that this is part of the long-term plan that was set out by NHS England, but I hope it is a direction of travel that you are both comfortable with. Could you explain what you see as the practical benefits of the merger, in terms of both the working behind the scenes to ensure that we keep quality high in the health service and the experience of patients, who will be on the receiving end of those services?
Edward Timpson (Conservative, Eddisbury)
Thank you.
Sheryll Murray (Conservative, South East Cornwall)
Thank you. Now we will hear from Mr Chris Skidmore.
Chris Skidmore (Conservative, Kingswood)
Q I know we have spoken about the need for flexibility in the composition of ICBs and also their related duties. I wanted to ask, though, whether it would be helpful if there were greater clarity in the Bill on the role of universities when it comes to training and education. I would think I am the only person in Parliament who has been both a Health Minister and Universities Minister, and it was very clear to me, when dealing with healthcare education, that there was not the integration around higher education and health in the way ideally we should have set it out. The Bill provides an opportunity to perhaps rectify this.
Also, I wanted to ask for your views on the duties for the ICBs, particularly around research and innovation. It may be a terminology issue, but the duty to promote innovation and to promote research, through the ICBs, is only
“on matters relevant to the health service”
or
“in the provision of health services”.
It does not cover the care system. I would have thought that when we look at the very definition of an integrated care board, it should actually be promoting research and also innovation when it comes to the care system, as well as health services. I would greatly appreciate your thoughts on that.
Sheryll Murray (Conservative, South East Cornwall)
Thank you. We now move to the shadow Minister, Mr Justin Madders, and Mr Alex Norris.
Justin Madders (Labour, Ellesmere Port and Neston)
Q Good morning and congratulations on your appointment, Ms Pritchard. Obviously, the NHS has got lots of challenges. Covid is still very much in play, and there are the waiting lists and the workforce crisis. To your mind, which is the biggest challenge that the NHS faces and how will it be addressed by this Bill?
Justin Madders (Labour, Ellesmere Port and Neston)
Q You touched on funding. You will obviously be aware of what NHS Providers and the NHS Confederation said last week about what might be required to address the operation backlog. Do you think that figure is about right?
Sheryll Murray (Conservative, South East Cornwall)
Thank you for that, but I just remind the shadow Minister to keep within the scope of the Bill.
Justin Madders (Labour, Ellesmere Port and Neston)
Q Of course. I was merely responding to the answer that was given. In terms of how the Bill is implemented, what would you say success will look like in five years’ time?
Justin Madders (Labour, Ellesmere Port and Neston)
Q Could you just turn that around to the patient’s experience? I know that there are so many different variables in this, but from a patient’s perspective, how will the Bill improve their experience?
Justin Madders (Labour, Ellesmere Port and Neston)
Is there time for a quick question?
Sheryll Murray (Conservative, South East Cornwall)
Absolutely.
Justin Madders (Labour, Ellesmere Port and Neston)
Q In terms of the reorganisation, we know that they always come with a price tag. Do you have a figure for how much the reorganisation that will follow, which is being undertaken as a result of the Bill, will cost the NHS?
Justin Madders (Labour, Ellesmere Port and Neston)
Q Sorry to cut across you, Mark, but I am running up against time and do not want to upset the Chair. I was just looking for a figure. Do you have a figure for how much this is all costing?
Justin Madders (Labour, Ellesmere Port and Neston)
Thank you.
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Following on from Dr Davies’s comments about the structure of the ICS board and the representation of some of the sectors, such as mental health, we have not talked much about the partnerships this morning, so could you explain what you think their role is? I know there are concerns about who will be represented on them, potential conflicts of interest—obviously, particularly around the lack of financial transparency if private providers are used—and some of the sectors, such as dentistry, community pharmacy, end of life and palliative care. People on the ground, at the frontline, are not sure who will represent them in either of those structures to ensure that that service is available for every community and that we do not end up with postcode prescribing. Will there be some guidance? How do you think that will work? I will start with Mark and then go to Amanda, because this is nuts and bolts.
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Obviously, there is quite a different balance, in both power and accountability, between the two organisations. Do you think there is an advantage in there being a split, or had you expected there to be a single body for each area making the decisions? That surprised some people when the Bill was published. Could you give just a brief answer on what you think about whether having one board or these two boards is an advantage or disadvantage? Amanda, you look like you want to come in on that.
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q The ICS board is very NHS, so how do we ensure that attention is paid to the strategy or the findings of the partnership, so that we do not end up with a very health model, when you are trying to get to a wellbeing model?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q And you think “with regard to” is sufficiently strong to ensure that that happens?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Okay. That’s fine. In one of your earlier answers, you talked about improving clinical quality, which obviously goes along with patient safety, both of which were my background when I was in the NHS. But that is still going to involve procurement and a degree of financial competition. Something that has disappeared in England over the past decade is peer-reviewed audit of clinical quality outcomes, which is the outcome for patients. With the title NHS Improvement—and it did surprise me when I came to this place that that is not what it is about—how do you think that will come back, because it should not just be about money; it has to be about achieving better clinical outcomes? I understand that the report on breast cancer, “Getting it Right First Time”, has still not been published, even though it was ready in December 2019. Having led on this kind of thing in Scotland, how are you going to drive clinical quality for patients? I will start with you, Amanda, and then go to Mark quickly.
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Just before we go to Mark, would you see a re-emergence of national quality audits such as for certain cancers, which have been largely lost in England over the past 10 years? Would you hope that they would return?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Mark, do you have anything to add very briefly?
Sheryll Murray (Conservative, South East Cornwall)
Before I call the Minister, I remind Members that there will be a hard stop at 11.25 am. If witnesses could keep their answers as brief as possible, it would be much appreciated.
Edward Argar (Conservative, Charnwood)
Q Thank you, Mrs Murray. I will try to rattle through three quick questions. I think this is my first public opportunity to put on record, as the shadow Minister did, my congratulations to you, Amanda, on your appointment.
If I recall correctly, your predecessor, now Lord Stevens, says that about 85% of provisions in the Bill were things that the NHS asked for in its 2019 consultation. Do you recognise that figure, and how would you characterise the approach that has been adopted to the development of the Bill?
Edward Argar (Conservative, Charnwood)
Q I will confine myself to one more question, Mrs Murray, to make sure that we do not run up against the time limit. This question has been asked of other witnesses, and I suspect it will be asked of others. To what extent is this the right time to make these changes?
Edward Argar (Conservative, Charnwood)
Q Mark, in the minute or so before Mrs Murray closes the proceedings, is there anything you want to add on those two questions?
Sheryll Murray (Conservative, South East Cornwall)
As there are no further questions, I thank the witnesses for their evidence. That brings us to the end of our morning sitting. The Committee will meet again at 2 pm in this room to take further evidence.
Examination of Witness
Steve McCabe (Labour, Birmingham, Selly Oak)
This is the third panel. We will now hear from Simon Madden, the director of data policy at NHSX, who is appearing in person. We have until 2.30 pm for this session. Good afternoon, Mr Madden. Could I ask you to introduce yourself for the record?
Alex Norris (Labour/Co-operative, Nottingham North)
Thank you, Simon Madden, for your attendance this afternoon. I think it would be safe to say that the roll-out of the general practice data for planning and research scheme did not go as planned earlier this year. It was remarkable that despite the limited engagement, well over 1 million people opted out. What learning do you think we can take from that exercise for the data provisions contained in part 2 of the BillQ46 ?
Alex Norris (Labour/Co-operative, Nottingham North)
Q Do you see the process enabled by the Bill running alongside a future resumption of the GPDPR process—or a conditions-based continuation, as you put it—or would they remain two separate things that overlap?
Alex Norris (Labour/Co-operative, Nottingham North)
Building on that point—
Steve McCabe (Labour, Birmingham, Selly Oak)
Hang on a second. I had better give somebody from another party a chance.
Karin Smyth (Labour, Bristol South)
Chair, I have another question.
Steve McCabe (Labour, Birmingham, Selly Oak)
I will come to you in a second, Karin. I am just trying to balance it between the respective parties.
Philippa Whitford (Scottish National Party, Central Ayrshire)
Obviously, a lot of the detail will only be there when the regulations are laid, but there has been a lot of concern in England about the talk of data being provided in a pseudonymised form to commercial companies. Is this not a repeat of the care.data issue, which lost public trust? A lot in these clauses could apply to Scotland. We have real issues in Scotland, where we have a lot of data sharing and analysis, and suddenly this gives NHS Digital to demand data, whether for a registry or for something else. It is about the commercial side; I do not think patients have an issue with Public Health England, universities or whoever learning from their data. The public concern is about the idea of pseudonymised data ending up with commercial companies.Q
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q But the public are not comfortable with that.
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q That is the public concern. My concern is that the data in Scotland lives within NHS Scotland. It is not under this Parliament or anything else, and yet there is no mention of Scottish Ministers being able to say, “We will share it in an anonymous form. We will be able to break that code if there is a safety issue on a medicines registry or if a piece of research needs to be traced back to a patient.” You can set filters within your trusted environment without handing over pseudonymised data to a commercial pharmaceutical company.
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q But by whom? That is the public concern. They have no issue with a public body. They are anxious and it goes right back to care.data. The danger is that it will set back your whole digital agenda if you get hundreds of thousands of the public all opting to not take part.
Karin Smyth (Labour, Bristol South)
Q I hope that this is in scope, Mr McCabe. I have just come from the Chamber, where the Prime Minister is still on his feet. He talked about integrated care records, but I am not quite sure if we are discussing the same thing. This may not be news to you, Mr Madden, but could you clarify whether we are all talking about the same thing? I appreciate that you were not there to hear the Prime Minister, but is it your understanding that what we are hearing today about social care is the same as the conversation we have been having about integrated care records, personal care records and so on?
Edward Argar (Conservative, Charnwood)
I will ask a couple of questions, if I may, Mr McCabe, and then perhaps the hon. Member for Nottingham North can come back in if we have time. Moving away from what has been explored by colleagues so far on the extremely important protections around data sharing and data use, can you set out how the changes set out in the Bill relate to and will help you deliver the data strategy that you have in place?
Edward Argar (Conservative, Charnwood)
Q To what extent would you consider it a fair characterisation that this is, in a sense, evolutionary, and that, actually, to a large extent, the provisions related to data—to go back to what you said—add greater transparency and legal clarity around some things that may have had to happen during the pandemic, and give them a longer-term basis in statute, as debated by this place? Do feel entirely free to disagree with that characterisation, I hasten to add. I am not leading you in any way, but to what extent would you consider that to be a fair reflection of these provisions?
Alex Norris (Labour/Co-operative, Nottingham North)
Q I will ask two questions in finishing, if I may, Mr McCabe. The first is a final one on the GPDPR promise. Mr Madden, you said that that is a separate process to the one in part 2 of the Bill—which I completely agree with—but that in the public’s mind, the two are likely to be conflated, and that now would be a good moment to reset the relationship between people and their data. Again, I completely agree with that. Is there any technical reason why we could not run those two processes not as two but as one?
Alex Norris (Labour/Co-operative, Nottingham North)
Q Finally, I remember from my time in local government that we would talk about the desire in social care to share data with the health service. We talked about, obviously, regulatory barriers that stopped us and we would welcome provisions that removed that, but a very practical obstacle on our list of things in the way was that the systems did not necessarily speak to each other. Do you think that health service systems and social care systems are ready to speak to each other now, or will there need to be, across all integrated care systems, a whole new provider brought in?
Jo Churchill (Conservative, Bury St Edmunds)
Q Mr Madden, I would like to know specifically how the strategy will help us to deliver integrated care within the confines of the Bill, so that we can give better patient outcomes, because ultimately that is what I have assumed the Bill is striving for. You did allude to how that interoperability gives us greater vision into the system. I wonder whether you could help us by bringing that to life. Thank you.
Steve McCabe (Labour, Birmingham, Selly Oak)
Anyone else? I will assume there are no more questions. Mr Madden, I thank you very much for your evidence.
Examination of Witnesses
Steve McCabe (Labour, Birmingham, Selly Oak)
This panel is mixed. We have Saffron Cordery, the deputy chief executive of NHS Providers, who is joining us remotely via a video link, and Matthew Taylor, the chief executive of the NHS Confederation, who is appearing in person. Can you hear us okay, Saffron?
Steve McCabe (Labour, Birmingham, Selly Oak)
In that case, Saffron first, then Mr Taylor, can you introduce yourselves for the record, please?
Karin Smyth (Labour, Bristol South)
Good to see you both. Thank you for coming. I want to talk about accountability. I asked NHS England this morning about how accountability works in the new system and it was clear that local accountability lies with the integrated care board—the chief executive and the finance director, in the first instance. We were then taken through the system up to NHS England and Ms Pritchard then said “through Parliament”, which she corrected to “through the Secretary of State through Parliament”. I asked at what stage the Secretary of State becomes involved in the accountability, a question that she did not answer and which I would like you both to answer for me.
We have also heard that the Bill is something the NHS asked for. I have not met a single person working at any level in the NHS who says that the powers given to the Secretary of State directly, added to the Bill after conversations with the NHS, are a good thing and are clearly workable. That is my pretext.
Perhaps I can give the example of a constituent who came to me about ear wax removal, which was a subject that concerned him greatly. Will I write to the Secretary of State as a Member of Parliament to ask him about the lack of ear wax removal services in my integrated care board area, or will the chief executive be the final arbiter of such decisions? Mr Taylor, do you want to go first on behalf of the confederation?
Karin Smyth (Labour, Bristol South)
Chair, can I come back?
Steve McCabe (Labour, Birmingham, Selly Oak)
I will come to you if there is time, but I want to move on. Dr Davies.
James Davies (Conservative, Vale of Clwyd)
Thank you. I have a general question about the key feature of the Bill: integration of services. What is the experience of your members with regard to that and have those views changed thanks to the pandemic? Perhaps we can hear from Saffron firstQ .
Edward Timpson (Conservative, Eddisbury)
I want to build on that point about permissiveness and take it a step further in terms of the specification in the Bill around ICBs and ICPs—the boards and partnerships. A lot of us on the Committee have been requested to look carefully at individual parts of the healthcare system. That does have a generality to it, covering mental health, children, palliative care and so on, and their representation is very clear within partnerships and boards. Based on your views around permissiveness and flexibility and the different paces ICSs are currently at, how do you see this? How do we reassure people that their views and the particular parts of the health system they represent will get a fair hearing and that the accountability structures will be in place to make sure they are able to come back if they feel they are not being addressed properlyQ ?
Chris Skidmore (Conservative, Kingswood)
I wanted to turn to workforce planning and your views on clause 33. The NHS Confederation, in its written evidence, has suggested that the five-year period for a strategic review on workforce planning is too long. That mirrors my amendment, which has a crack at this. I have suggested an annual review. It was suggested this morning that two years might be the right time length. I see that the NHS Confederation has suggested three years. I want to get your organisations’ views on what a strategic review should look like, but also on the format and how a strategic review should be undertaken so that it actually works as an act of co-creation, rather than being directed centrally by the Secretary of State on to Health Education England.Q
Karin Smyth (Labour, Bristol South)
Q If I may, I will return to the permissiveness and place conversation. I agree with the Bill’s direction of travel around place. I do not like the word “permissiveness”, because we have essentially a local cartel of healthcare providers deciding on resources and their allocation, and that locks out local communities. I am a bit suspicious of the NHS being given permission to do as it sees fit. That is why I put forward the example about ear wax removal—because that matters to local people, as we all know; that is what some of these things come down to.
The Bill falls apart because of the governance arrangements and the accountability, which does not follow the logic of place-based commissioning. My solution for the Government, should they wish to take it, is something around a good governance commission, based on the previous appointments commission-type process. It would bring in skilled people, with clear role descriptions, clear skills and a degree of independence. It would have the trust of local people, and would bring these very powerful chief executives together with local leaders to explain why, in Bristol, you cannot have ear wax removal, or why you are closing certain provision and opening it in Derbyshire or wherever. Have you had an opportunity to look at my proposal for a good governance commission and locally accountable chairs—perhaps elected, or appointed? What do you think of that as a solution that would bring power and accountability closer to local people?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Matthew, you mentioned that the degree of local integration varies, and that it is impacted by things such as boundaries—particularly the relationship between NHS and local government boundaries in the shift to a wider view of wellbeing. How much of a problem is it that the number and the footprints of the ICSs are different from those of the proposed sustainability and transformation plans? Are people who were growing together suddenly finding that they are no longer working together, and that they will have to start working with someone else? Do you not see that as something that will hold things back?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Is it a necessary challenge?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Obviously, the delivery will be different, but the aim will be the same. What mechanism do you see evolving to allow the sharing of good practice? The integration of health and social care has been going ahead for seven years in Scotland, and we know how difficult it is. It is exactly as you say: some areas have made amazing innovations, and others are struggling. In what forum do you see one place being able to learn from another’s experience?
Philippa Whitford (Scottish National Party, Central Ayrshire)
But how do you—
Steve McCabe (Labour, Birmingham, Selly Oak)
I am wondering if we should hear from our other witness.
Philippa Whitford (Scottish National Party, Central Ayrshire)
I was going to ask Matthew all my questions, and then go to Saffron with them all.
Steve McCabe (Labour, Birmingham, Selly Oak)
Well, you only have about two minutes.
Philippa Whitford (Scottish National Party, Central Ayrshire)
Saffron?
Steve McCabe (Labour, Birmingham, Selly Oak)
We had better move on.
Justin Madders (Labour, Ellesmere Port and Neston)
Good afternoon. Obviously, you have the ICB and the ICP both within an ICS. If there is a disagreement between them about the direction of travel on a particular policy issue, who arbitrates? In your opinion, who is likely to be sided with in such a dispute?Q
Justin Madders (Labour, Ellesmere Port and Neston)
Q On the Secretary of State’s powers of intervention on reconfigurations, is it your understanding that a local system could agree across the board that particular changes were necessary and actually that it was important for reasons of patient safety that those changes were made but that the Secretary of State could intervene at any time to stop them?
Edward Argar (Conservative, Charnwood)
Q I have just a couple of questions, because a lot of the issues have been explored. My first one is something that we have not touched on yet in our questioning of witnesses. I welcome both your thoughts on the proposals in the Bill to delete and replace section 75 of the 2012 legislation, around procurement, and your reflections on the opportunities or challenges that that presents.
Edward Argar (Conservative, Charnwood)
Matthew?
Edward Argar (Conservative, Charnwood)
Q My second question—I think this has come through in what both of you have said, but feel free to challenge it when you answer if I have misrepresented what you have said—involves one of the key things I have detected, which is that we must be careful not to forget that no one size fits all in this context. Back in the dim and distant past when I was a councillor, I sat on a primary care trust board as a local authority representative, and I found that joint working could be highly effective, so what is the right balance? You have touched on this in some of your previous answers. Recognising that it is sometimes as much about relationships as about formal structures, what do you think is the right balance between permissive and prescriptive in what we are trying to do here? How do we strike that balance appropriately, and have we struck it appropriately?
Edward Argar (Conservative, Charnwood)
Thank you. Saffron?
Steve McCabe (Labour, Birmingham, Selly Oak)
Given the time, we will leave it there. I thank our witnesses, Saffron Cordery and Matthew Taylor.
Steve McCabe (Labour, Birmingham, Selly Oak)
We will now hear from Ian Trenholm, the chief executive of the Care Quality Commission, and Keith Conradi, the chief investigator at the Healthcare Safety Investigation Branch, both of whom are appearing in person. We have until 4 o’clock for this session. May I ask you both to introduce yourselves for the record?
Jo Gideon (Conservative, Stoke-on-Trent Central)
Thank you for attending. Can you characterise the contribution this Bill will make, in your opinion, to patient safety and quality of careQ ?
Jo Gideon (Conservative, Stoke-on-Trent Central)
Can I ask just one more question, Chair?
Steve McCabe (Labour, Birmingham, Selly Oak)
I am not being flooded with a whole array of hands, so why not? On you go. I will come to you in a second, Edward.
Jo Gideon (Conservative, Stoke-on-Trent Central)
Q I just want to come back on the hospital food standards. I know that malnutrition is an issue that has been raised within the hospital setting. Would you be able to set parameters for what the reporting requirement is in order to measure standards in that regard, for instance?
Jo Gideon (Conservative, Stoke-on-Trent Central)
Yes. Well, it was more from a medical point of view than from a vending machine point of view. That is absolutely helpful. Thank you.
Steve McCabe (Labour, Birmingham, Selly Oak)
Do you have anything to add to that, Mr Conradi?
Edward Timpson (Conservative, Eddisbury)
Q Just to follow up on the answers that we had about the healthcare safety investigations branch and putting it on a statutory footing, I am speaking as someone who chaired the first national child safeguarding panel, which was looking at investigating what were then called serious case reviews and trying to understand how you get to the bottom of the why question, as opposed to simply what happened. In fact, we used the air accident investigation branch as an exemplar of that. It would be helpful to understand how you think these new powers, and the statutory footing that you will have, will help enhance your ability to answer those all-important why questions within the health system, and get away from the potential for it to become a finger-pointing exercise that does not necessarily improve the outcome for patients.
Steve McCabe (Labour, Birmingham, Selly Oak)
Do you want to add anything to that, Mr Trenholm?
Mary Robinson (Conservative, Cheadle)
I declare an interest as chair of the all-party parliamentary group for whistleblowing. I am interested in the powers that you are going to be taking on—how those will enhance your work—and also in what you said about properly Q protecting information. Of course, part of this is about properly protecting the person or individual who provides that information in very many cases. I am wondering whether this is going to enhance the ability to whistleblow and to highlight these issues, and whether there is more to be done legislatively and whether you see this as being a forerunner to it.
Could I also ask about the regulatory role? With regard to whistleblowers who raise these issues—we are talking about safety and the best interests of patients here—will this enhance the powers and abilities that you have, or is more needed still.
Karin Smyth (Labour, Bristol South)
Q Mr Conradi, could you talk a little about what the branch will be doing in relation to maternity cases and how that is seen to be investigated? You have talked about systems, but will there be a look at all maternity cases in a system? Could you elaborate a little on that? If I may have a second bite, you could also talk a little about discussions now as to where we think the relationship lies with the health service ombudsman and being clear on the roles within this Bill and how that might look in the future.
James Davies (Conservative, Vale of Clwyd)
Q Mr Trenholm, you referred to the fact that the CQC will be assessing ICSs in future, which was a recommendation of the Health and Social Care Committee. You also referred to oversight of social care provision. Can you clarify whether that is by virtue of your assessment of the ICSs as a whole, or is it through a local authority-targeted assessment that the Health and Social Care Committee has also called for in an Ofsted-style rating?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Mr Conradi, you have talked about this coming from Air Accidents Investigation Branch, where the safe space is very tightly protected. That is very much as has been put forward. The key concern is the fact that coroners are listed in the Bill. The ombudsman is already lobbying and many of us are being lobbied to get access to safe space testimony. The Campaign for Freedom of Information is also lobbying for that. Will that not just kill it dead, in that you can compel people to come and give you testimony, but you cannot compel them to talk about all the soft weaknesses within a system that contributed to that tragedy or failure? Should it not be that maybe we need to define more tightly what is protected? All these bodies should be able to investigate as they do now. They are not losing anything because you would have safe space.
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q I was on the pre-legislative scrutiny Committee and we spent a lot of our time debating this. It can be very easy as MPs to say, “Everything should be available to everyone.” In actual fact, we need to learn rather than blame. Obviously you do not want it to be with coroners, but do you think there needs to be redefinition within the Bill to make it clear that it is only the testimony and documents that you are holding? You are not stopping anyone else getting medical records, calling witnesses and doing what they should be doing now. The Bill almost gives the impression that you will squash other investigations.
Philippa Whitford (Scottish National Party, Central Ayrshire)
Thank you. In the interests of time, I am happy with that.
Justin Madders (Labour, Ellesmere Port and Neston)
Q I have a couple of questions for Mr Trenholm. You mentioned the importance of co-operation with other agencies. At the moment, are there barriers that the Bill could help with in terms of identifying people who may provide inadequate care under the guise of a company and then dissolve it, move on and create another? Is there anything in the Bill that will help you to track those people?
Justin Madders (Labour, Ellesmere Port and Neston)
Q In terms of what you are required to do under the Bill, have you made an assessment of what additional resources you will need to deliver that?
Justin Madders (Labour, Ellesmere Port and Neston)
Q Mr Conradi, in your submission to the Committee you mentioned a concern about the powers of the Secretary of State to order investigations. You used the term “undue political influence”. I wonder whether you could expand on what you mean by that exactly, and what your concerns are.
Justin Madders (Labour, Ellesmere Port and Neston)
Q In terms of recommendations, how are they monitored to ensure that they are actually implemented?
Justin Madders (Labour, Ellesmere Port and Neston)
Q So in terms of what NHSI do at the moment, presumably you are interested in their investigations and ongoing work, but there is no formal method by which they can report back to you so that you can be satisfied that things are progressing?
Steve McCabe (Labour, Birmingham, Selly Oak)
Do have anything further you want to add? No. Minister.
Edward Argar (Conservative, Charnwood)
Q Thank you both for your evidence. I have one question for Mr Trenholm, two for Mr Conradi and then one for both of you, if I may, time permitting, Mr McCabe.
You will have heard in the evidence just before, Mr Trenholm, the comments by Matthew Taylor about the difference between assessing a system versus a provision. How do you see how the CQC would square that circle, because he highlighted the very different approaches and his reservations about some of that? How do you see that issue being resolved, or what would you like to see in that space?
Edward Argar (Conservative, Charnwood)
Q Thank you. Mr Conradi, the first question is probably a relatively quick and simple one, but I will not prejudge your response. Given that the HSSIB aspects have been in preparation for quite some time—I am alluding to the work that Dr Whitford and other colleagues did some time ago—what would your view be on the appropriateness of getting this done and the timeliness of bringing these measures forward? I am asking a number of witnesses whether this is the right time to be doing what we are proposing. In the case of HSSIB, is it the right time?
Edward Argar (Conservative, Charnwood)
Q I suspected that might be the answer, but I did not want to prejudge. My second question goes to a slightly knottier area, and one that you have already alluded to. I think you have said—by all means correct me if at any point I misinterpret what you have said—that ideally you would prefer the safe space to be as absolute as possible, given the nature of what you are seeking to do. There is, as we recognise in the Bill, a challenge about the specific statutory rights of coroners as members of the judiciary; I note what you have said about that. Would it be fair to say, first, that notwithstanding that, you would not want that safe space to be eroded further for other groups? I think you have been clear that you would prefer it not to be eroded at all, but you would not want its erosion to go further. The second element is this. Although you would prefer it to be preserved intact, do you think that if there is going to be that exception in the case of coroners, for example, the High Court is the right level of arbitration in something like that? I know you suggested that it might be.
Edward Argar (Conservative, Charnwood)
Q Thank you. My final question is to both of you. Your organisations are separate but key elements focused on patient safety and the safety of outcomes for individual patients. How do you see the work of your two organisations fitting together and complementing each other, while recognising that they are both very distinct?
Edward Argar (Conservative, Charnwood)
Thank you very much.
Steve McCabe (Labour, Birmingham, Selly Oak)
Mary, did I see you trying to come in with another point?
Mary Robinson (Conservative, Cheadle)
Q Thank you so much, Mr McCabe; that is very kind of you. I have just a very short question. How does any of this relate to the Public Interest Disclosure Act 1998 and the way you are required to protect the disclosures given by individuals, in terms of the issues that you have already raised?
Steve McCabe (Labour, Birmingham, Selly Oak)
Anyone else? It does not look like it. I thank both our witnesses for their evidence.
Steve McCabe (Labour, Birmingham, Selly Oak)
We now move on to our sixth panel of witnesses. We will hear from Councillor James Jamieson, chair of the Local Government Association and Professor Maggie Rae, president of the Faculty of Public Health, both of whom are joining us remotely. Could both witnesses introduce themselves for the record, please?
Steve McCabe (Labour, Birmingham, Selly Oak)
Thank you.
James Davies (Conservative, Vale of Clwyd)
First to Councillor Jamieson on the changed procedures during the pandemic for the discharge of patients into social care, do you welcome the embedding of those changes into legislation for the futureQ ?
James Davies (Conservative, Vale of Clwyd)
Q Very good. Thank you. As a follow-up question to both panellists, could you comment on the benefits arising from the preventive measures in the Bill on the fluoridation of tap water and obesity?
Mary Foy (Labour, City of Durham)
One of our earlier witnesses touched on the social determinants of health—housing, green spaces, good jobs—being the greatest factor in a person’s healthy life and life expectancy. Q I am disappointed that there is nothing in the Bill that addresses those fundamental issues. Do you think that there is scope for them to be touched on, as well as in working with local authorities?
Even more remarkable as regards reducing health inequalities is the absence of any detail, duty or provision to tackle alcohol harm and tobacco control, which of course are the greatest factor in determining a person’s life expectancy—and further down the line they have the greatest impact on local authorities’ social care bills. Do you think they should be included in more detail in the Bill, with a duty to reduce health inequalities rather than just having “regard” to reducing them?
Steve McCabe (Labour, Birmingham, Selly Oak)
Please do.
Edward Timpson (Conservative, Eddisbury)
Q This is principally for Councillor Jamieson, if I may, in relation to the role of local government in the new integrated care structure. As you will be aware, there was initially a one-part structure, and partly through the input of the LGA, I think, we have ended up in the Bill with a two-part structure, with both the board and the partnership. For the first time, in many respects, that puts local government very much at the heart of NHS decision making. How do you think that that will assist in addressing both health inequalities within the local area and—I note your point about the flexibility of the board and the partnership—what barriers do you think it will help remove, so that we get a truly integrated system and service that the local government level will have a positive influence on?
Karin Smyth (Labour, Bristol South)
Q Following up on that point, I do not know whether our witnesses heard our earlier session, but I asked them about this very issue of decision making, governance and accountability. Professor, I hear what you are saying and I understand that you had lots of discussions with the Bill team, but I am not entirely clear what your ask is for the legislation. It would be very helpful if you could spell out what could be added into the Bill to achieve the outcome that you are seeking and the assurance that the drive and logic of the Bill around place-based commissioning, which I support, are made reality somehow.
My point to Councillor Jamieson, which I made to earlier witnesses, is about the integrated care boards, which are the decision-making and accountability bodies locally—the ICPs are essentially a committee of these boards. The accountability, responsibility and decision making lie very clearly with the integrated care boards, which are essentially, as I have called them, a cartel of local healthcare providers—largely the acute sector trusts, which are responsible for vast sums of money. Councillor Jamieson, you have gone to the effort of putting your name on a ballot paper and persuading local people to put their cross by your name. Should you fall foul of them, or make decisions that they do not agree with, you will soon no longer be Councillor Jamieson. That is very clear accountability. With that hat on, can you talk us through your understanding of the role of local government status wise—beyond “Let’s all work together in partnership”—when we reach that real decision-making, push-comes-to-shove crunch about where accountability to local people could lie for decisions if we improve this Bill?
Karin Smyth (Labour, Bristol South)
Can I just clarify—
Steve McCabe (Labour, Birmingham, Selly Oak)
Actually, in view of the time, I am going to ask you not to, Karin. I am sorry, but if we are going to hear from Professor Rae and give Chris Skidmore a chance, we had better just move on.
Chris Skidmore (Conservative, Kingswood)
Q This is a question to Professor Rae about research. I am sure you will agree that research is vital when it comes to demonstrating the changing nature of health care inequalities and potential solutions. Clause 19 places a duty on ICBs to promote research. Is that enough, or would you agree with new clause 9, which I have tabled, which would place a duty on the Secretary of State to promote research? You can promote research, but there is still a need to protect the budget, especially of the National Institute for Health Research. Should that be ring-fenced, so that integrated care boards have the opportunity to finance research, let alone promote it?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Obviously the pandemic has highlighted the impact of health inequalities and social and economic inequalities across the UK. Tackling them would be critical to improving population health, but how do you think the local systems will manage to balance need versus demand? Often we have the loudest voices expressing demand and the people with the greatest need are either silent or simply not listened to, so how will these changes help to get their voices listened to?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Councillor Jamieson, this talks about a shift, which we have seen some of the devolved nations also following, from treating illness to trying to promote wellbeing in a holistic sense. A lot of that, as we have already touched on in this session, falls under local government. There is no budgetary discussion in this, but how much will that be impacted by the ability of local government to tackle the poverty and deprivation that are among the biggest drivers of ill health? As you say, housing, active travel, pollution and so on are your brief, but we know that local governments have been on a very tight financial leash for quite a long time.
Philippa Whitford (Scottish National Party, Central Ayrshire)
You mentioned there—
Steve McCabe (Labour, Birmingham, Selly Oak)
I am really sorry, but we had better move on to Alex Norris.
Alex Norris (Labour/Co-operative, Nottingham North)
Q Thank you, Chair, and good afternoon to the panellists. Councillor Jamieson, I will start with you, if I may. You have mentioned on a number of occasions that you see this as enabling legislation and that, rather than prescribing to your community or the community of your members what model they should pursue, it leaves you the space to do that. I have some enthusiasm for that, but one area where that is not the case is schedule 2 to the Bill, which sets out, in schedule 1B to the National Health Service Act 2006, that the chair of the integrated care board must be
“appointed by NHS England, with the approval of the Secretary of State”.
Under paragraph 5, only NHS England can remove a chair if they are unpopular and not doing the job, and there is nothing that you can write into your local decision making to get around that. Are you comfortable with not having any say over your chair when they are appointed or whether they carry on in the job?
Alex Norris (Labour/Co-operative, Nottingham North)
Q Thank you. Professor Rae, you have talked a lot about the challenges to the nation’s health at the moment and the negative direction of travel in recent years. The King’s Fund estimates that, entering the pandemic, the value of the public health grant was 15% less than in 2013. Is that a characterisation that you recognise? What does that mean we do less of than we did seven or eight years ago?
Alex Norris (Labour/Co-operative, Nottingham North)
Q I have a question on fluoridation. At the moment, there is broad agreement that the system does not work: local communities, through their local authorities, can try to lead the process and take it through. I know from my time on my local authority, where I was very keen to do that, that it was very, very hard to do, although not impossible. We are taking away that grassroots, ground-level approach and replacing it with a top-down, Secretary of State-led approach. That has many attractions, in the sense that it takes away from some of the parochial concerns and planning concerns about where you have pour the stuff in to make it work. At the moment, we are going from one to the other. Would you have any anxieties if, rather than moving from one to the other, we kept what we currently had and added the new model to it, so that rather than either/or, it is both?
Steve McCabe (Labour, Birmingham, Selly Oak)
I am going to go to the Minister now because of time.
Edward Argar (Conservative, Charnwood)
Q Good afternoon, Councillor and Professor. I have two or three questions; we will see how we do on time. I will get through as many as I can, and if I do not get through them all, I do not get through them all.
Back in the day, I served as a councillor and cabinet member for public health, adult social care and health, and worked very closely with my then local PCT, which probably shows you my vintage. One of the things that I found was that the structures were important, but the relationships and how it worked on the ground, and the ability to be flexible and build up the trust between the two organisations was more effective in getting better outcomes. We have heard from previous witnesses about the importance of local flexibility to adapt to local work arrangements and conditions. Do you think we are striking the right balance between being permissive in allowing that flexibility and not being too prescriptive, or do we need to go a little more in a different direction?
Edward Argar (Conservative, Charnwood)
Q Thank you. Councillor Jamieson, I have seen that councils can often be at the forefront of leading innovation and driving change in a dynamic way. From the LGA’s perspective, do you think that we are striking the right balance between permissive and prescriptive, and is the approach to the ICP board and ICB an appropriate balance?
Edward Argar (Conservative, Charnwood)
Thank you, both. Mr McCabe, I am conscious of time and our programme motion, so I will pause there.
Steve McCabe (Labour, Birmingham, Selly Oak)
Thank you, Minister. I thank both our witnesses for their evidence.
Steve McCabe (Labour, Birmingham, Selly Oak)
We will now hear from Eluned Morgan, who is the Minister for Health and Social Services in the Welsh Government. I hope that I have pronounced your name properly. We will also hear from Lyn Summers, head of health and social services central legislation team, and Mari Williams, senior lawyer (health)—both from the Welsh Government. All witnesses are remote, and we have until 5.15 pm for the session.
James Davies (Conservative, Vale of Clwyd)
Minister, would you outline your understanding of how the Bill will impact the people of Wales? I believe the areas to be the UK-wide medicines information system and social care discharge to assess measures, which may well be relevant in border areas, but there may be other pointsQ .
James Davies (Conservative, Vale of Clwyd)
Q Is it a fundamental objection to the content of those elements of the Bill or is it a procedural matter?
James Davies (Conservative, Vale of Clwyd)
Can I have one further question?
Steve McCabe (Labour, Birmingham, Selly Oak)
Why not?
James Davies (Conservative, Vale of Clwyd)
Q Thank you very much. Minister, we met recently about the NHS in north Wales and you very kindly sent a detailed response. I am very appreciative of that. One of the things we discussed was interoperability —the fact that the health service in a lot of Wales interacts with that in neighbouring parts of England. We have talked today about data sharing in general, and I wonder what your thoughts are about the importance of comparable and interoperable data between England and Wales.
James Davies (Conservative, Vale of Clwyd)
Thank you.
Steve McCabe (Labour, Birmingham, Selly Oak)
Before I move on, do Ms Williams or Ms Summers want to add anything to the questions that have been asked so far?
Steve McCabe (Labour, Birmingham, Selly Oak)
I thought Lyn Summers was indicating that she had. Okay—anyone else?
Karin Smyth (Labour, Bristol South)
Q The bulk of the Bill is about us in England looking at integrated care systems. Obviously, you operate according to a unitary provision already. I am not sure who is best placed to answer this question, but could you share with us any evidence, which might help inform our deliberations as we move to a different system, that the unitary integrated system provides better patient outcomes?
Steve McCabe (Labour, Birmingham, Selly Oak)
Thank you. Do either of you wish to add anything to that?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q Obviously, as a Scottish MP, I echo the same concerns from the Scottish Government about these areas. Although it is largely billed as legislation for England, quite a lot of clauses extend further, yet there is often no mention even of consultation, let alone of consent. Certainly, one matter than concerns me is medical information, so what consultation did the Welsh Government have? Unlike Scotland, Wales is mentioned in the extent of the Bill, so how early were the Welsh Government consulted when it was being put together before its launch at the end of July, which is pretty much when the Scottish Government got to see it?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q We obviously heard in the Prime Minister’s statement today talk about spending directly in health and social care despite its being devolved.
May I ask you a short, specific question? The healthcare services safety investigation body is England-only at the moment, but it is described that investigations could be requested in Welsh cases due to people coming over the border. Is that something that the Welsh Government are considering? At what level would such a decision be made? Would that be a local request, or would it go up through your central structures?
Philippa Whitford (Scottish National Party, Central Ayrshire)
Q And that would apply also to things like sharing patient information of a certain type, and whether it was anonymised or pseudo-anonymised and so on? That would be a concern for you?
Alex Norris (Labour/Co-operative, Nottingham North)
Q I thank you, Minister, and your officials for your time this afternoon. You mentioned correspondence with Ministers in the UK Government. Is that correspondence publicly available, or is it something you are willing to make publicly available?
Alex Norris (Labour/Co-operative, Nottingham North)
Q In your conversations, have Ministers shared with you an impact assessment for the Health and Care Bill?