Health and Care Bill

Public Bill Committee, 9 September 2021.

Sheryll Murray (Conservative, South East Cornwall)

Before we begin, I have a few reminders. Please switch electronic devices to silent. Tea and coffee are not allowed during sittings of the Committee. I encourage Members to wear masks when they are not speaking, in line with the current Government guidance and that of the House of Commons Commission. Please also give each other and members of staff space when seated and when entering and leaving the room.

Members should send their speaking notes by email to hansardnotes@parliament.uk. Similarly, officials in the Gallery should communicate only electronically with Ministers. If everyone is agreed, we will go into private sitting to discuss lines of questioning.

Examination of Witnesses

Sheryll Murray (Conservative, South East Cornwall)

All our witnesses are appearing in person. It is helpful if Members direct their questions to specific witnesses.

Before calling the first panel of witnesses, I first 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 order the Committee has agreed. For the first panel, we have until 12.15 pm.

Secondly, do any members of the Committee wish to declare any relevant interests in connection with the Bill?

James Davies (Conservative, Vale of Clwyd)

Chair, I am still a member of the British Medical Association.

Philippa Whitford (Scottish National Party, Central Ayrshire)

I remain a member of the BMA.

Mary Foy (Labour, City of Durham)

I am a member of Unison.

Sheryll Murray (Conservative, South East Cornwall)

Welcome Sara and Chaand. Will you kindly introduce yourselves, please?

Sheryll Murray (Conservative, South East Cornwall)

Thank you. Will Members indicate whether they have any questions?

Edward Timpson (Conservative, Eddisbury)

Good morning, both. My name is Edward Timpson. I am the Member of Parliament for Eddisbury in Cheshire. This question is for both of you, but I will start with Sara. You were a signatory who supported NHS England’s original proposals for legislative change back in 2019, I think. How much in the Bill before us reflects what you signed? What do the changes proposed bring for your members and to the health and care system, based on the proposals that you were in favour of back in 2019? That is probably something you will be able to answer as well, Dr Chaand Nagpaul, but Sara firstQ112 .

Edward Timpson (Conservative, Eddisbury)

Q May I have one follow-up question, Mrs Murray? Picking up on your answers and accepting that you will have some aspects of the Bill that you will want to challenge and some amendments that you will want to put forward, the general thrust of the Bill, which is moving from a competition to a collaboration approach, is one that you both welcome. In that endeavour, and touching on some of the issues around procurement and the section 75 regulations governing NHS procurement, what benefits do you see in the changes to the role of the Competition and Markets Authority, which will change the current procurement regime? You touched on some of your concerns, but what are some of the potential benefits?

Sheryll Murray (Conservative, South East Cornwall)

Could I just ask you to keep your answers to within the scope of the Bill, please? Also, I ask if we could perhaps have more succinct answers. I still have several people who want to ask questions and we do not have a lot of time to get them in. I intend to call the Front Bench spokespeople at about 10 minutes to 12. I now move to the hon. Member for Arfon (Hywel Williams), but if we could keep to the confines of the Bill, that would be good.

Hywel Williams (Plaid Cymru, Arfon)

This question is specifically for Sara. You said in your response to the Bill that you agree with the Select Committee recommendation for an annual report on workforce shortages. The workforce move, specifically between England and Wales, very freely and the Governments of Wales, Scotland and Northern Ireland have their own appreciation of workforce shortages and how to respond. For example, after a long campaign, we now have a medical school being set up in Bangor in my constituency. Anyway, the point of my question is how do you see the Governments in those parts of the United Kingdom being able to feed into the process without ceding their power to decide for themselves? How do you see it going?Q

Hywel Williams (Plaid Cymru, Arfon)

Q You see that in Wales, acting through the Welsh Government, so would you be seeking direct access regarding Welsh issues to the Government here in Westminster?

Hywel Williams (Plaid Cymru, Arfon)

Q Lastly—if I may, Chair, very briefly—a great number of people from Wales receive treatment in England, mainly from north Wales. They go to Merseyside and Manchester, and sometimes to London as well, so I am sure you would be in favour of the health bodies in those areas taking due regard of not only the health needs of their own population, but those of the population that comes in from Wales.

Hywel Williams (Plaid Cymru, Arfon)

Thank you.

James Davies (Conservative, Vale of Clwyd)

Q I am interested in Unison’s position on the social care aspects of the Bill, and in particular the CQC inspection that is proposed, and also the data collection powers, please.

James Davies (Conservative, Vale of Clwyd)

Q That is fine. In that case, I will turn to Dr Chaand about a fit and proper persons register for those on NHS boards, or wishing to be on NHS boards. Do you have any views on that, and how legislation might expand?

Sheryll Murray (Conservative, South East Cornwall)

We should stick to within the scope of the Bill.

James Davies (Conservative, Vale of Clwyd)

Thank you.

Sheryll Murray (Conservative, South East Cornwall)

Would anybody else like to ask a question from the Back Benches before I move to the Front-Bench spokespeople? Okay, that means that the SNP and Labour spokespeople have around 10 minutes. If they could keep it between nine and 10 minutes, that would be appreciated. I call Dr Philippa Whitford.

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q Thank you very much, Mrs Murray.

I will ask each of you the same question. Obviously, the aim of the Committee is to improve the Bill and bring in voices. Sara, if you could amend only one part of the Bill, what would it be, and what change do you think would improve it to the greatest degree? I know that you may have three or four—your submissions are here—but what do you want us to do that would have the biggest impact in improving what actually happens to health and social care?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Thank you very much. Certainly, for some of the projects in Scotland around quality improvement or patient safety, the involvement of staff has actually made that work. Dr Nagpaul, I am pinning you down to one area and one change that you think will make a big difference.

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q Obviously, because of the duty of balancing budgets, one of the frictions within the system is going to be where an area that is managing its budget has to collaborate with a service—perhaps in social care—that is not. Clearly, the aim of the Bill is to bring about integration.

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q Do you not think that creating the overarching ICB is meant to look at that budget in a more holistic way?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q My second and final question to you both is about the healthcare safety investigations body. I was on the pre-legislative scrutiny Committee for it and I know there will be a lot of support for it across the House. However, on Tuesday we heard Keith Conradi’s concerns about disclosure of safe space material. As a representative of the BMA, what is your view about that part of the Bill—part 4—and the degree to which it protects or weakens safe space, and how do you think it will affect staff engagement with the process?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q And yourself, Sara?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q But you would support, as Dr Nagpaul says, the idea that safe space should be protected?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Thank you very much.

Sheryll Murray (Conservative, South East Cornwall)

Thank you very much. I now turn to Justin Madders, the shadow spokesman.

Justin Madders (Labour, Ellesmere Port and Neston)

Thank you, Mrs Murray. Good morning to the witnesses and thank you for coming today. Dr Nagpaul, you talked earlier about unequal arrangements for private sector provision. Could you expand a little on what you mean by that?Q

Justin Madders (Labour, Ellesmere Port and Neston)

Q We will see what we can do about that. In your written submission, you raised concerns about private providers sitting on ICS boards. Could you just say a little more about what your concerns are there?

Justin Madders (Labour, Ellesmere Port and Neston)

That is very clear, thank you. To play devil’s advocate, can you think of any positive reason why there would be a need for private companies?Q

Justin Madders (Labour, Ellesmere Port and Neston)

Thank you. In your submission, you also referred to concerns about some of the Secretary of State’s powers proposed in the Bill. Could you say a little more about what those concerns are, please?Q

Justin Madders (Labour, Ellesmere Port and Neston)

Thank you. Ms Gorton, good afternoon—it is afternoon now. You obviously represent a huge range of employees within the NHS. What role do you see ICBs having in direct negotiations and consultation with the workforceQ ?

Justin Madders (Labour, Ellesmere Port and Neston)

Thank you. That is very helpful. You have probably seen quite a lot of media coverage today about the possible salaries of the chief executives of the ICBs—up to £270,000. What do your members, who have had 10 years of pay restraint, feel about those kind of figures being bandied aboutQ ?

Justin Madders (Labour, Ellesmere Port and Neston)

Q Moving on to the proposals in the Bill regarding professional regulation, do you see any risk or have any concerns about that, as it is set out?

Justin Madders (Labour, Ellesmere Port and Neston)

Q I will ask the same question that I asked Dr Nagpaul about the involvement of private providers on ICBs. Is there, in your mind, any possible argument as to why it might be a good idea?

Justin Madders (Labour, Ellesmere Port and Neston)

Q Just one final question: at the moment, do you feel that there are enough avenues for trade union staff representation to feed into the boards?

Justin Madders (Labour, Ellesmere Port and Neston)

Thank you very much.

Edward Argar (Conservative, Charnwood)

Q Sara and Chand, welcome. I will try to get through three questions, but, if I run out of time, I will settle for two. We heard from a significant number of witnesses on Tuesday; you will have seen or read what they said. The overwhelming majority said that now was the right time to do this. Sara, I noticed that, in your evidence, notwithstanding the challenges you posed about some of the content that you would disagree with, you highlighted that this was due in 2019, on the basis of the original consultation, and asked why it had taken so long.

To both of you, do you think that now is the right time? I know that Chand has answered that, but this second part might apply to him: if it is not, when is the right time?

Edward Argar (Conservative, Charnwood)

Q I have read your evidence very carefully, and your views on the 2012 Act are clear. To put in context what sort of changes—not withstanding your evidence—the BMA is and is not supportive of, which of the 1999, 2001, 2003, and 2006 Acts did the BMA come out fully in support of?

Edward Argar (Conservative, Charnwood)

Q Thank you. Feel free to write to the Committee. This is my final question, so that we finish on time. This relates directly to the BMA’s evidence, but Sarah may want to come in on this afterwards. You both touched on the procurement regulations in section 75 of the 2012 legislation; why are saying that NHS, or public sector, provision should be the default, rather than whatever provision provides the best outcome for patients? You highlighted the very clear view that NHS and public sector provision is the most cost-effective and the most clinically effective; it would therefore succeed anyway if the question is what delivers the best outcomes. Why preset that default?

Edward Argar (Conservative, Charnwood)

Q In the minute left, Sarah, is there anything you wanted to add?

Sheryll Murray (Conservative, South East Cornwall)

Thank you very much. We are making excellent time.

Justin Madders (Labour, Ellesmere Port and Neston)

On a point of order, Mrs Murray. On the Minister’s question to the BMA witness about previous Acts that the BMA may have endorsed, that would clearly be out of scope as evidence. I would not want Dr Nagpaul to waste time researching an answer that the Committee could not take into account.

Edward Argar (Conservative, Charnwood)

Further to that point of order, Mrs Murray. Would it help if I set out the context in which I believe that question relates directly to the content of the Bill? Much of what is discussed in the Bill relates to previous legislation that has grown up over time; understanding which pieces of legislation the BMA supports will help us to better understand the evidence it has put forward on this legislation, and its context.

Sheryll Murray (Conservative, South East Cornwall)

Mr Madders, I think that the Minister has taken on board your point of order and paid attention to it. Thank you, Minister.

As there are no further questions, because we are out of time, I thank our witnesses very much for their evidence. We will move on to the next panel.

Sheryll Murray (Conservative, South East Cornwall)

We will now hear from Professor Martin Marshall, the chair of the Council of the Royal College of General Practitioners; Pat Cullen, the general secretary and chief executive of the Royal College of Nursing; and Professor Helen Stokes-Lampard, the chair of the Academy of Medical Royal Colleges—all of whom are appearing in person. Starting with Pat Cullen, could I ask you to introduce yourselves for the record?

Sheryll Murray (Conservative, South East Cornwall)

Thank you. We have until 1 pm for this session, so I propose the same timings as for the last one. I call on Back-Bench Members to indicate if they have any questions.

James Davies (Conservative, Vale of Clwyd)

Q Good afternoon and welcome. I would like to ask all three panellists about the workforce projection elements of the Bill and the adequacy of those, starting with Pat.

Sheryll Murray (Conservative, South East Cornwall)

Could you speak up a little bit, please? We are finding it quite difficult to hear you.

Chris Skidmore (Conservative, Kingswood)

I have two questions. On clause 33, which we have just spoken about, what would be the best compromise when it comes to planning for a workforce strategy? The Bill suggests five years, and that the Secretary of State should direct Health Education England and NHS England to produce this report. Would you suggest a more frequent process? If so, how frequent should it be? What organisations should be involved with workforce planning, and how would you see that operatingQ ?

Chris Skidmore (Conservative, Kingswood)

Q Do the other organisations agree with that assessment?

Chris Skidmore (Conservative, Kingswood)

Q On clause 19 and the duties on the ICBs and ICSs, particularly, in your case, around education, training and research, do you have any thoughts about who might be able to help those ICCs with their duties, and about the role of universities, which are not mentioned in the Bill? How can we integrate not just health and social care, which are the focus of the Bill, but education and training, and what needs to take place for that integration to happen?

Sheryll Murray (Conservative, South East Cornwall)

Thank you very much. We have about 10 minutes, and three people have indicated that they want to ask questions, so if we could direct our questions to one person and keep questions and answers brief, that would be very helpful, because I would like to include everybody.

Hywel Williams (Plaid Cymru, Arfon)

Q I have a question for Pat. You have indicated some concern about the new powers regarding professional regulators and the fact that there may be changes, including the dismissal of regulators and that sort of thing, through secondary legislation. Given that those bodies are UK-wide, do you think that the Senedd, the Welsh Government in Cardiff, and the other Governments should have some input into those sorts of decisions about professional regulators?

Sheryll Murray (Conservative, South East Cornwall)

Thank you very much, Mr Williams. I now turn to Edward Timpson.

Edward Timpson (Conservative, Eddisbury)

Q Thank you very much, Mrs Murray. This is directed to Martin. Perhaps unsurprisingly, there is a lot of demand on representation or membership of the integrated care boards, and I think we heard evidence earlier that in my own area of Cheshire and Merseyside, if everyone who wanted to sit around the table was sitting around the table, there would have to be 63 seats, which is clearly unwieldy and unworkable. Specifically thinking about the organisations that you represent, when it comes to clinical representation, moving from the CCGs to the ICS, what do you think should be specified about clinical representation on these new ICBs?

Sheryll Murray (Conservative, South East Cornwall)

Thank you.

Karin Smyth (Labour, Bristol South)

It is as though we have rehearsed, because that was my question. I was a GP manager leader in my area before coming to Parliament, and GPs have been at the forefront of developing CCGs, as you said, which followed on from the great desire of Governments to move the gatekeeper up the food chain, shall we say, in order to provide clinical leadership and—to be crude—control costs.Q

I would like to ask this to everybody. Personally, I think this issue of clinical representation is a backwards step in this Bill. You may or may not want to say whether you think that is true, but given that you have said that successful organisations are primary care-led, and none of these organisations will be clinically-led, let alone primary care-led, that is not rectifiable in the Bill through an amendment, I suspect. How will we ensure that these organisations are successful from a clinical leadership perspective, given the current state of the legislation, or would you be putting forward suggestions for amendments? I am sorry, but I do not think I have time to ask all three of you. Currently, CCGs are GP-led, so—

Sheryll Murray (Conservative, South East Cornwall)

We have about three minutes, so could you keep your answers to one minute each?

Sheryll Murray (Conservative, South East Cornwall)

Thank you very much. We now turn to the SNP spokesperson, Dr Philippa Whitford. You have about seven minutes.

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q Thank you very much, Ms Murray. I hope to try to do two questions, so can you focus your answers? If you heard the earlier session, you will know what the first one is. If there is one part of the Bill that you could change, what would it be and what would the change be? Our job over the next couple of months is to improve the Bill, so what would get the biggest bang for our buck?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q Obviously, Wales and Scotland brought in safe staffing legislation, which does not yet exist in England. Of course, workforces move around, so although this is very much a plan for the workforce in England, we do not want to get into robbing Peter to pay Paul. Do you feel that the consultation around that needs to be strengthened—things such as the foundation places for junior doctors might relate more to Helen and Martin—to ensure that the Bill actually takes account of different strategies?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q Thanks very much. Helen, what would you pick as your one place?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q This is also, hopefully, a very short, specific one—I will start with you, Martin—on the Healthcare Safety Investigation Body, and the issue of safe space disclosure and discussion after an incident. In the Bill, coroners have access, for example, and others are lobbying for access. What is your view of how tight the safe space should actually be to get staff to really engage with it?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q Do you think there is a misunderstanding of what would be covered by “safe space”, in that it should really apply only to the evidence that HSIB gathers? It does not stop other bodies having access to medical records or doing their own investigations, which they do now.

Philippa Whitford (Scottish National Party, Central Ayrshire)

And Pat?

Sheryll Murray (Conservative, South East Cornwall)

Pat, before you speak, could I ask you to swivel the microphone to your left towards you a bit? We are still having difficulty hearing you.

Philippa Whitford (Scottish National Party, Central Ayrshire)

Could you speak a wee bit louder? I am from Northern Ireland as well and we can definitely speak loudly when we want to.

Philippa Whitford (Scottish National Party, Central Ayrshire)

Thank you very much. Thank you, Chair.

Sheryll Murray (Conservative, South East Cornwall)

Thank you. I now turn to the shadow Minister, Alex Norris.

Alex Norris (Labour/Co-operative, Nottingham North)

Thank you, Chair. Thank you to all three of you for joining us this afternoon, and thank you for everything Q your members have done for us in such difficult times in recent months. Collectively, you speak for tens of thousands of NHS staff and allied professionals, so a simple first question from me. Pat, you might go first: how do staff feel at the moment?

Sheryll Murray (Conservative, South East Cornwall)

Could I just remind the shadow Minister to stick within the scope of the Bill, please?

Alex Norris (Labour/Co-operative, Nottingham North)

On a point of order, Mrs Murray. How our staff are at the moment is within the scope of a Bill about the NHS, I would have thought.

Sheryll Murray (Conservative, South East Cornwall)

Okay, but can we just make sure that we stay within the scope of the Bill?

Sheryll Murray (Conservative, South East Cornwall)

Order. Could we keep to referring to what is in the Bill, please?

Sheryll Murray (Conservative, South East Cornwall)

But we are here to talk about the Bill.

Sheryll Murray (Conservative, South East Cornwall)

I am just saying from the Chair that we are here to talk about what is in the Bill and to take evidence on the Bill, so we should stay within the confines of what is in the Bill.

Alex Norris (Labour/Co-operative, Nottingham North)

With that in mind, given the quite challenging picture that all three of you describe there, do you have any anxieties that this is not the right time to have the Bill and that, with staff anxious, demoralised and tired, a reorganisation might add to those anxieties and concerns for the future?Q

Alex Norris (Labour/Co-operative, Nottingham North)

Q I will just ask a final question in my last couple of minutes. Martin, notwithstanding what you said about a greater GP voice on boards, and similarly Pat regarding directors of nursing on integrated care boards, what else could we do to get the voice of the staff really heard in the plans generated by the integrated care partnerships and then executed by the boards? What mechanisms do you think are effective ways of hearing from the frontline what is happening day in, day out? Perhaps, Martin, you could go first.

Alex Norris (Labour/Co-operative, Nottingham North)

Thanks, all three of you.

Sheryll Murray (Conservative, South East Cornwall)

Thank you. We now go to Minister Argar.

Edward Argar (Conservative, Charnwood)

Q Thank you, Mrs Murray. I will endeavour to be relatively brief, as I am conscious of time.

Welcome and thank you very much for your evidence this morning and your frank answers to the questions posed. I want to ask a question in the context of what a number of you have raised about the different voices and the extent to which they need to be represented at the different decision-making levels of the new structure. We heard from previous witnesses, for example in the context of public health voices also, about the value that they add. The principle behind this legislation is that it is permissive rather than prescriptive. Therefore it is possible to have a lot more voices; there is only a de minimis level specified as prescribed. What is your view as to whether the appropriate balance between permissive and prescriptive has been struck in the Bill? If you think it has not been, where do you think the balance between permissive and prescriptive has been missed? Shall we start with Pat and then work our way along?

Edward Argar (Conservative, Charnwood)

Q Thank you. I have three minutes left, so I may try a follow up. That is really helpful, and thank you again for the candour of your answers. Much as it may sometimes pain us in this place, we do recognise that legislation can be an enabler, but we cannot sit here and solve problems on the ground simply by legislation. I sat on a PCT board many years ago, and the culture and the working relationships were almost more valuable than the framework that sat around them.

Going back to Pat’s evidence, but also to all of you: we have heard in our evidence today, and we heard it on Tuesday, a lot of different, vital parts of the system arguing the case for why they should be represented in a prescriptive way. Equally, we will have others arguing that a committee beyond a certain size becomes less effective. In terms of numbers, we have set a minimum. You are entirely entitled to say that you do not have a view on this, but how would you see the balance being struck between different groups making the case for representation, but, equally, having an effectively sized decision-making body? We will start with Martin, and then work backwards.

Edward Argar (Conservative, Charnwood)

Thank you all very much, I have no more questions.

Sheryll Murray (Conservative, South East Cornwall)

Thank you very much. As there are no further questions, I thank our witnesses for their evidence. That brings us to the end of our morning session. The Committee will meet again at 2 o’clock this afternoon to take further evidence.

Steve McCabe (Labour, Birmingham, Selly Oak)

We are going to hear from Richard Murray, chief executive of the King’s Fund, Nick Timmins, senior fellow, policy, at the King’s Fund, and Nigel Edwards, chief executive of the Nuffield Trust. Thank you very much for coming. Could I ask each of you in turn to introduce yourself for the record?

Edward Timpson (Conservative, Eddisbury)

Good afternoon, Mr McCabe, and good afternoon to each of our witnesses. I am Edward Timpson, the MP for Eddisbury, in Cheshire. I want to start by contextualising the discussion about the Bill, particularly off the back of the pandemic and with regard to the timing of the Bill and the issues that it is trying to resolve, which perhaps have been highlighted even more by the demands and pressures that have come through over the last 18 months. Do you think that this is the right time to be taking forward the principal measures in the Bill, particularly around moving from competition to a more collaborative approach and the integration that it is looking to achieve through many of the measures that we have seen with the integrated care system, board, partnership and so on? I will start with you, Richard, and then we will move alongQ155 the panel.

Edward Timpson (Conservative, Eddisbury)

Q So it is a natural progression from what is happening practically.

Mary Robinson (Conservative, Cheadle)

Do you have any thoughts on the new HSSIB and its powers, which are set out in the Bill? I know that you are likely to be probed further on this later, but do you have any thoughts on how it will be implemented, the investigatory powers it will have and the safe spaces and protections it can give? Do you have a view on how it will sit with existing legislation on the protection of whistleblowersQ ?

Mary Robinson (Conservative, Cheadle)

Nice and easy—thank you.

Karin Smyth (Labour, Bristol South)

I have three obsessions with the Bill, some of which I have shared with you. First, on local governance and accountability, I have tabled an amendment to follow the logic of the Bill and make accountability local rather than going via some obscure route to the Secretary of State.Q

Secondly, there is the treatment of capital in the system and how local communities, healthcare systems and trusts will be able to develop estates and capital planning. The third obsession has completely eluded me for the moment. It is generally about the tariff—that may be your subject, Mr Edwards—and how the vague nod to a new tariff framework in the Bill is working out. You may be more privy than the Committee to the details on how that might work out; it is about the flow of money within the system. Would you like to start, Mr Edwards, on governance, tariff and capital?

Karin Smyth (Labour, Bristol South)

But it all has to be in place by April.

Steve McCabe (Labour, Birmingham, Selly Oak)

I am really sorry, Karin, but I think we have to move on, because we have about seven minutes left for Back Benchers, and three indicating. Jo Gideon.

Jo Gideon (Conservative, Stoke-on-Trent Central)

WeQ have had a pretty large consensus across a large number of organisations that the Bill is welcome as an enabler. Also, earlier this morning, we had a comment that no Bill has ever changed people’s behaviour. To what extent do you think the Bill will enable people’s behaviour to change, in terms of how partners work together at a local level?

Jo Gideon (Conservative, Stoke-on-Trent Central)

Q How might we implement the changes that you suggest?

James Davies (Conservative, Vale of Clwyd)

Nigel Edwards, you mentioned the word “reconfiguration” earlier. In an ideal situation, from your point of view, Q how would you see a reconfiguration decision being reached, and how do you balance that with the need and expectation for ministerial accountability?

Chris Skidmore (Conservative, Kingswood)

I want to touch on the King’s Fund’s comments in its own white paper in which it welcomed the Bill’s removal of the “cumbersome competition rules” that were introduced in the 2012 Act; and to discuss some of the consequences Q of competition and why it is welcome that we remove that; and to ask this question. Are there are any unintended consequences from also introducing the duty on the triple aim in commissioning decisions?

Steve McCabe (Labour, Birmingham, Selly Oak)

I think we had better move on. Dr Whitford?

Philippa Whitford (Scottish National Party, Central Ayrshire)

I will start with you, Richard, on tariffs. I have a background in the NHS. I and colleagues south of the border know of people doing outreach work from a hospital trust into a community. They developed services that were successful in reducing admissions, but sometimes the service was shut down precisely because the hospital’s income disappeared. I will come to your colleagues, but are you comfortable that the funding going into the ICB will give that integrated vision of how money is spent, to ensure that people who can be supported or treated by a community project do not end up in hospital just because that is the way the ICB generates moneyQ ?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q Do you think there will be a friction where, say, a foundation trust has had good financial management and a budget that is not too bad is asked to work with one that has been struggling—particularly in social care, where we are looking for integration?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q Obviously, the idea is that the ICBs would have that vision and power.

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q Nick?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q But obviously the tariffs created some problems.

Philippa Whitford (Scottish National Party, Central Ayrshire)

Nigel?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q Perhaps I can start with you on this question. We obviously hear about the ICB, which appears to be the power base, and the ICP, which is more flexible and will put forward an agenda and an idea. How do you think the power balance or imbalance between those two is going to work?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q So the challenge you see is more about things like footprints and boundaries making it clunky in some areas. It is about trying to get that right.

Steve McCabe (Labour, Birmingham, Selly Oak)

I think we had better move on now. I call Justin Madders.

Justin Madders (Labour, Ellesmere Port and Neston)

Good afternoon, and thank you for coming today. You will have heard the Prime Minister’s statement on Tuesday. He referred to a White Paper on integration. As the Bill is primarily concerned with integration, perhaps you could save him some time by pointing out the deficiencies in the Bill—in terms of integration—that need to be included.Q

Justin Madders (Labour, Ellesmere Port and Neston)

Anything to add, Nick?

Justin Madders (Labour, Ellesmere Port and Neston)

Q Nigel, can I ask you a specific question about tracking where the money is distributed within an ICS, which you referred to earlier? You have already mentioned the Cheshire and Merseyside ICS, which my constituency falls within—what was 12 CCGs moved not so long ago into one massive beast, for want of a better description. If I wanted to hold someone to account on whether the money was distributed on a fair and equal basis consistent with historical distributions, who would I speak to and who would be responsible for that?

Justin Madders (Labour, Ellesmere Port and Neston)

Q Thank you. I have a question for all three of you. The Secretary of State is seeking some quite broad powers of direction. What problem do you think he is trying to fix by giving himself those powers?

Justin Madders (Labour, Ellesmere Port and Neston)

Does anyone wish to add to that?

Steve McCabe (Labour, Birmingham, Selly Oak)

I had better move on at this stage. I am really sorry, Nigel. Minister?

Edward Argar (Conservative, Charnwood)

Q Thank you, Mr McCabe. I will only ask the one question, because I am conscious of time and keen that Opposition Front Benchers have their time. My question goes to the heart of this, and I am afraid it is a subjective question, but with all your expertise in this space, your answers will be instructive. In framing this legislation, we sought for it to be both evolutionary in reflecting the changes that are already under way, and permissive rather than prescriptive. Do you feel we have struck the right balance in terms of permissive versus prescriptive? If not, where is that balance missing? Shall we start with Nigel, and then work along?

Edward Argar (Conservative, Charnwood)

Thank you all very much. No more questions, Mr McCabe.

Steve McCabe (Labour, Birmingham, Selly Oak)

We have time to squeeze in one very quick one, if anyone has something else to ask.

Justin Madders (Labour, Ellesmere Port and Neston)

Q Thank you, Chair. Do you see any risks attached to the flexibility the Secretary of State has given himself with the mandates?

Steve McCabe (Labour, Birmingham, Selly Oak)

That brings us to the end of our time. I thank our witnesses very much.

Steve McCabe (Labour, Birmingham, Selly Oak)

Q We will now hear from Dame Gill Morgan, the chair of Gloucestershire integrated care system and the NHS Confederation’s ICS network advisorate, and Louise Patten, the ICS network lead for the NHS Confederation’s ICS network advisorate. Thank you very much for coming. We have until 3.15 for this session. May I ask you both to introduce yourself for the record?

Steve McCabe (Labour, Birmingham, Selly Oak)

I am sorry to interrupt you. This session is intended for Members to ask you questions rather than for you to make a statement. I would prefer to move to Louise Patten and ask her to introduce herself so that we can get on with the questions.

Steve McCabe (Labour, Birmingham, Selly Oak)

Thank you very much. I call Karin Smyth.

Karin Smyth (Labour, Bristol South)

Q I broadly agree with the direction towards permissiveness and the logical direction of the Bill. I am profoundly disturbed, and most of the NHS representatives are making me feel more disturbed, about the lack of local accountability and scrutiny that local people will have of the power that we are giving, with due respect, to people such as you, designated within and by the local health service to police and manage itself. In your drive for permissiveness and power within the system locally, how does a local patient hold you to account for, in my area’s case, the £1.5 billion-worth of decisions that you are going to be making? How do we break the national power and make the local power better?

Edward Timpson (Conservative, Eddisbury)

Q I am Edward Timpson, the MP for Eddisbury in Cheshire, so coming into the Cheshire and Merseyside ICS, which is a very different proposition from Gloucestershire’s. In that context—it is encouraging to hear how engaged you feel in the process to date, so reflecting on that engagement—what do you think you have discovered already from the preliminary work in Gloucestershire? You have used that example in our evidence sessions. How has that helped to inform the way in which collaboration can best work, bearing in mind that there will be different political, social and economic geographies in each area? In doing so, where do you think clinical representation needs to fit within an ICS, or even within the ICP or the ICB, to ensure that the decisions made are the best for patients and their outcomes?

Edward Timpson (Conservative, Eddisbury)

Q All the way up to the board?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q In the morning sitting we heard from Professor Marshall, who was talking about your own ICS. I asked about the problem of the power imbalance between the partnership and the board, and he mentioned that you have a primary care sub-group. We have had a lot of discussion about how we gather the voices and ensure everyone is there. What led Gloucestershire to develop that? How do you feel it is working? Do you think that is a good model? How do you ensure the board listen to what the partnership come up with?

Alex Norris (Labour/Co-operative, Nottingham North)

Thank you both for coming this afternoon. Dame Gill or Ms Patten—it is fairer to ask the question more generally—suppose the integrated care partnership itself put forward plans for the footprint. The integrated care board, under this draft legislation, has to pay due regard to that. If you disagreed with that as a board, how would you manage that? How would that be resolved? How would that manifest locallyQ ?

Alex Norris (Labour/Co-operative, Nottingham North)

Q That is a very helpful answer, thank you. Obviously there would be old informal mechanism. From my time as chair of health and wellbeing in Nottingham, I remember that the best thing you could ever do was just phone someone up and talk about it. Beyond that, for systems that may not be advanced or relationships that may not yet be embedded, is there a good formal mechanism that we could be writing in to ensure that that existed?

Alex Norris (Labour/Co-operative, Nottingham North)

Q Louise, with your broader advisorate hat on, what do you feel about the selection of chairs and how we could get local voices into both the selection and—hopefully never needed—removal of chairs?

Alex Norris (Labour/Co-operative, Nottingham North)

Q You said, “What does the area require?”, so you would say that local people would have as good or a better understanding of that than, say, NHS England at the centre in Whitehall.

Alex Norris (Labour/Co-operative, Nottingham North)

Q So in your modelling it would be a partnership of the two.

Edward Argar (Conservative, Charnwood)

Q I only have a couple of questions, Mr McCabe. I welcome the witnesses and thank them for their evidence so far. One question will be one that I have asked witnesses in previous sessions. We are seeking with this legislation to recognise the existing evolution of the system and the limitations of legislation in driving implementation and behaviours on the ground, as opposed to people finding their own ways of working within a framework. We have therefore focused on a permissive as opposed to a prescriptive approach. Do you believe that we have got the balance right in seeking a permissive framework rather than a prescriptive one? Are there any examples that you would add to what you have already said to illustrate your perspective on that?

Edward Argar (Conservative, Charnwood)

Q Thank you. My next question follows on from that, acknowledging that point about reconfiguration powers, and builds on your clear answer to Karin that you think that what is framed here strengthens local accountability and engagement, and relates to something that you may have mentioned earlier, Gill, in some of your answers. Do you think that it is the right approach, in terms of ICB membership and others, to set a de minimis core membership and then allow that local flexibility to reflect local needs, local accountability and local engagement, to expand it as the local system and local people feel appropriate? Do you think that strikes the right balance?

Edward Argar (Conservative, Charnwood)

Q A final question, if time allows. I entirely take on board your point about the aim, the underlying point about implementation being key here—almost more so than the legislative framework—and the point about a single pot and sense of ownership. I remember the old section 75 of the National Health Service Act 2006, rather than the Health and Social Care Act 2012, being the mechanism that I used when I was a councillor to work with the primary care trust. It worked, but it was a bit clunky at times. My question is one that I have asked other witnesses, so I suspect that it will not come as a surprise to you. Do you think that this is the right time to be introducing these changes and legislation and, if not, when would be?

Edward Argar (Conservative, Charnwood)

Thank you both very much. No more questions, Mr McCabe.

Steve McCabe (Labour, Birmingham, Selly Oak)

Dr Whitford, did you have anything else?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q It was really just about other groups. You talked about having a primary care sub-group, and there has been a lot of discussion about how to harvest voices up. Could you expand a little on how your sub-group is working and what other sub-groups you would have? How do you make sure the ICB pays attention to what the partnership comes up with? For me, from outside, it seems like it is the board that has the power in the end. Therefore, how do you ensure that? I understand the need for relationships, but what voices other than primary care are you bringing forward with sub-groups or other ways of working?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q Obviously, we have heard a lot of discussion about voices that are missing or not listened to, so a sub-group approach might actually be a model for other areas to think about harvesting ideas up towards the partnership and the board.

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q Do you feel that there will be enough evaluation of what works and what has not worked within the structures that are being proposed through audit and formal evaluation?

Steve McCabe (Labour, Birmingham, Selly Oak)

I think we drew that conclusion from your evidence—absolutely.

May I just thank you both very much for giving evidence today? I am sorry that I had to interrupt you, but I am an obsessive timekeeper. Such is life. Thank you very much.

Steve McCabe (Labour, Birmingham, Selly Oak)

Q We will hear next from Ed Hammond, who is the deputy chief executive at the Centre for Governance and Scrutiny, who is appearing in person, and from Andy Bell, who is the deputy chief executive at the Centre for Mental Health, who is appearing remotely. I will just remind Members: if you are directing your question at Andy, can you make that clear, so that he is aware of it?

Good afternoon, both. Can you both introduce yourself for the record, starting with Ed?

James Davies (Conservative, Vale of Clwyd)

Q Andy Bell, how do you think this legislation can help to address current mental and physical health inequalities in this country?

James Davies (Conservative, Vale of Clwyd)

Q That is very promising. Can you just give an indication of those caveats, if that is possible?

James Davies (Conservative, Vale of Clwyd)

Q Ed Hammond, on the same agenda of scrutiny of outcomes, how do you think those are best measured, and how does the Bill assist with that?

Karin Smyth (Labour, Bristol South)

Q That leads neatly on to my point. We have just heard a great defence of ICSs as the system of accountability, and you have said that system level is where decision making is happening. The chief executive told us very clearly on Tuesday that accountability for decision making was clearly located in the ICB. The ICP—the partnership—is formally a committee of the ICB. I think each of our witnesses—very experienced people—have actually confused those three acronyms. They have also confused the accountability, which NHS England has told us is very clearly in the ICB. The finance director, the accountable officer at the ICB, carries the can. The other person will ultimately be fired, should the accounts not balance and there be some sort of health and safety patient scandal. I think that is clear. First, do you think that is clear? Secondly, how can we encode the good direction of travel in the Bill around local accountability to somebody who could oversee it in a more independent way and better hold that accountability locally?

Steve McCabe (Labour, Birmingham, Selly Oak)

Do you want to add anything to that, Andy?

Steve McCabe (Labour, Birmingham, Selly Oak)

Thank you. Mary Kelly Foy.

Mary Foy (Labour, City of Durham)

This is for Andy. It is noted that mental health provision has for far too long been seen as the Cinderella service of the health system. Indeed, there is very little in the Bill specifically around mental health. Given the growing number of people suffering with mental ill health and the shortage of services, is there enough in this Bill to satisfy you that mental health will be given parity of esteem alongside physical healthQ ?

Edward Timpson (Conservative, Eddisbury)

Q This is a question for Ed, building on the fact that you have, I think, fairly extensive experience of working with local authorities and supporting them on governance and scrutiny. Having direct involvement in NHS decision making on funding and so on is a fairly new role for local authorities, and different ICSs will have different sizes and geography; for instance, mine is Cheshire and Merseyside, which is one of the largest—I think it is three or four times the size of some other ICSs. Over and above being involved in the board, for local authorities in larger ICSs, where the emphasis on place could be lost if they are not more fused into the system, how do you think the Bill could help to ensure that that is the case, so that we get the right balance between their involvement in the decisions, based on their knowledge of their own population, and the wider regional decisions?

Steve McCabe (Labour, Birmingham, Selly Oak)

Thank you. Dr Whitford.

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q Could I ask you a question, Ed? Obviously, you talked there about better outcomes. Regardless of who is judging it, you need evidence for that, and there are two aspects here to help to know what success looks like. From the perspective of local scrutiny of health improvement—improvement of health and wellbeing at a local population level—how do you see that being done? Obviously, that is what the ICB and ICP are being challenged with. Coming from a breast cancer background, where obviously you have specialist teams that need to be judged, what about the scrutiny of healthcare through quality improvement clinical outcome standards, which require audit and benchmarking against ICSs elsewhere in England, so that you do not have postcode variation in survival, treatment, or anything else? How do you see those two scrutinies working?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q But you do think there would be a role for analysing data? My background is breast cancer. You know that what chemo you use and what surgery you did is going to affect the outcome for that woman in 10 years’ time, so in Scotland we have that in clinical standards. Those kinds of metrics would not necessarily go to the Secretary of State initially, but local teams want to improve and clinicians want to drive quality performance. Would that be something that you would be involved in developing; or who would be doing that?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q A brief question to Andy: there has been discussion over recent years about the need for greater preventative public health. Do you think there is enough discussion or enabling of that approach in mental health? Although we may not do it, we all know what we should do to be physically fitter and healthier—how good we are is up to us. But many of the public have no idea how to protect their mental health. Do you think there is enough population and preventative mental health work? And are there ways of strengthening that in the Bill?

Justin Madders (Labour, Ellesmere Port and Neston)

Q I have just one question for you, Mr Hammond. You obviously have the ICB decisions being made. What, in your understanding of the Bill, would happen if—hopefully this will not happen, but we have to look at every possibility—the chief executive of the ICB was making decisions that the ICP and other partners were not in agreement with, and they effectively lost confidence in him? Is there any mechanism that would be able to deal with that situation?

Justin Madders (Labour, Ellesmere Port and Neston)

Q Thank you. Mr Bell, do you see this Bill helping to achieve parity of esteem for mental health?

Justin Madders (Labour, Ellesmere Port and Neston)

Q I have one more question, Mr McCabe. One of the consistent points we have heard from witnesses is that they are not convinced that the provisions in the Bill on workforce are sufficient to deal with the workforce challenges that the NHS faces. Would that be something that you feel is also the case for mental health professionals?

Edward Argar (Conservative, Charnwood)

Q Good afternoon, Ed and Andy. Andy, in my first question, can I pick up on something you said there, before I broaden out to a question to you both? You talked there, quite rightly, about the importance of parity of esteem for mental health. As a local councillor years ago, I saw how important local councils and the NHS working hand in glove on mental health provision is, because if we get one half right but not the other half, it just does not work.

Building on what you have already said about the legislation, what would you identify as the opportunities of the legislation, if properly implemented or interpreted in the right way, for furthering that linkage and that joined-up mental health provision? Obviously, that goes beyond local council services and the NHS. There are a whole wraparound series of services that impact on someone’s mental health. What do you see as the opportunities in the legislation that we either need to draw out further or at least not lose sight of?

Edward Argar (Conservative, Charnwood)

Q In the two and a bit minutes I have, in order not to get cut off by Mr McCabe, I will direct my question to Ed and will bring you in, Andy, if I have time. We have heard about how what is proposed in many ways enhances local accountability and local authority involvement in decision making, but to go back to your earlier comments, would it be fair—you are entirely entitled to say that it would be unfair, and that I am misinterpreting—to say that alongside that your request was a request that in enhancing that we should not lose the local accountability mechanisms and processes that have already grown up over the years in local authorities, be that health and wellbeing boards, joint overview and scrutiny committees, or whatever? Is that a fair characterisation? Feel free to correct it.

Edward Argar (Conservative, Charnwood)

Thank you.

Steve McCabe (Labour, Birmingham, Selly Oak)

We had better leave it there. We are out of time. I thank you, Andy and Ed, for your evidence today.

Examination of Witness

Steve McCabe (Labour, Birmingham, Selly Oak)

Welcome, Sir Robert. Could I ask you to introduce yourself for the record, please?

Steve McCabe (Labour, Birmingham, Selly Oak)

Thank you very much. We have until 4.30 pm for this session. I call Mary Robinson.

Mary Robinson (Conservative, Cheadle)

Q Welcome and thank you for coming along, Sir Robert. I am Mary Robinson, MP for Cheadle and, with another hat on, the chair of the all-party parliamentary group for whistleblowing, so I obviously know about the reports you have conducted into these issues and about the Freedom to Speak Up review in particular. How will the Bill’s provisions on the HSSIB further the ability of people in the NHS to come forward and speak up in a safe space?

Mary Robinson (Conservative, Cheadle)

Q Could you expand on that? Why would they be in a more uncertain place?

Mary Robinson (Conservative, Cheadle)

Sorry, just to—

Steve McCabe (Labour, Birmingham, Selly Oak)

I think I am going to move on. Jo Gideon.

Jo Gideon (Conservative, Stoke-on-Trent Central)

Q Thank you, Mr McCabe. How do you think the public voice should be represented across the integrated care system at board and partnership level?

Edward Timpson (Conservative, Eddisbury)

Q Sir Robert, a shift away from competition towards collaboration and integration is very much at the heart of the Bill. We heard earlier that competition is not just about the constant tendering for services but also has the element of patient choice. From the evidence you have gathered from your local healthwatches and more generally across the country, where do you think patient choice needs to sit within these reforms? I am particularly interested in children and young people from the ages of nought to 25, because we are talking about all our health system’s service users.

Edward Timpson (Conservative, Eddisbury)

Q Is my point about children and young people one that you look at and factor in?

Steve McCabe (Labour, Birmingham, Selly Oak)

Dr Davies.

James Davies (Conservative, Vale of Clwyd)

Q My point is also about patient choice. I work as a GP in England and know that many patients enjoy being able to access secondary and tertiary care throughout England, if they wish to do so—something that my constituents in Wales do not generally have the opportunity to do. Are you satisfied that the Bill protects that opportunity to its maximum?

Steve McCabe (Labour, Birmingham, Selly Oak)

Karin Smyth.

Karin Smyth (Labour, Bristol South)

Q May I take you back to the ideal person or Healthwatch person on the ICB? In my early days in management, in the 1990s, the community health council secretary and chair—I realise the situation was varied across the country—were important people locally. They had access culturally, and any changes to the system were expected to work with them. They had much access, regardless of their position on bodies. In my view, what has come since healthwatches were abolished—I will not say by who—has never really replicated that cultural relationship. You might wish to comment on that. Were you saying that having a person on the ICB would help with this situation, or is there another way in which we can embed a culture that recognises the importance of some sort of patient voice outwith the system?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q I want to look at the Health Services Safety Investigations Body, which is discussed in part 4 of the Bill. Obviously, you have been involved in the past with whistleblowers, Mid Staffs and so forth. We have talked a lot in recent years about learning, not blaming. What is your view on that part of the Bill? How do we protect what is given within the safe space, paralleling Air Accidents Investigation Branch, but give the public the confidence through Healthwatch that this is not stopping any other investigation happening now, and that taking that approach can get under the bonnet of real issues that have led to tragedy?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q When we took evidence from Keith Conradi, he said that obviously the learning from the safe space is in the reports, so there is discussion. Obviously there is no naming of people. Are you talking about the family or the patient having access to the raw data?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q HSSIB does not remove the duty of candour or the need for a local trust or hospital to investigate. It should not remove the need for significant adverse event inquiries and discussion—the families not having been involved as an external on those. Often the family simply want to know what happened and that it will not happen again. However, we often talk about failures as system failure and that can be down to personality. It is not necessarily the case that staff are giving evidence that conflicts with the patient, but often it is quite sensitive things about poor personal relationships within a hospital or team that have had an impact, or a lack of something.

Philippa Whitford (Scottish National Party, Central Ayrshire)

But in what way—

Steve McCabe (Labour, Birmingham, Selly Oak)

I know it is fascinating, but we had better go to Mr Norris.

Alex Norris (Labour/Co-operative, Nottingham North)

Q Thank you, Chair, and good afternoon, Sir Robert.

We have spoken quite a bit in these proceedings about the relationship between the integrated care board and the integrated care partnership, the fact that the board has to pay “due regard” to the integrated partnership’s plan, and what that due regard means. You talked about that in your written evidence, and you suggested mechanisms for resolving the situation—or at least making account for a situation where the board sets aside the ICP’s plan. Could you talk a little more about that?

Alex Norris (Labour/Co-operative, Nottingham North)

Q Do you envisage, when setting out those reasons for disagreement, that they would be publicly available?

Alex Norris (Labour/Co-operative, Nottingham North)

Q Thank you.

We will move on to something else that you said in your written evidence. On Tuesday, we had a very good conversation about data, but the whole thing was about quantitative data. In your written evidence, you talk about qualitative data, and it is very easy for us, as Members of Parliament, to conceive of the importance of that, as it is something that we routinely draw on. With your insight from leading Healthwatch, how can we develop systems that properly trap that, use that and prioritise that just as much as the quantitative data?

Edward Argar (Conservative, Charnwood)

Q I will try to be brief in the five minutes that we have left. Sir Robert, I have two questions: one with your Healthwatch hat on; and one in your personal capacity—and also as an eminent lawyer.

We sought with this Bill to be permissive rather than prescriptive; behaviours, and how things work on the ground, are often as, if not more, important than the framework. Notwithstanding your on-the-record comments about Healthwatch participation in ICB levels as a formal member, what else would you draw out as opportunities within the framework to build on patient participation and accountability to those who pay for, and use, the service? Are there other opportunities, that, with a small tweak either in guidance or in the Bill, we could seize more effectively?

Edward Argar (Conservative, Charnwood)

Q That is useful, and builds on your written evidence. What do you think in a personal capacity? This builds on Dr Whitford’s questions and acknowledges Keith Conradi’s preference that the safe space be not qualified. If one accepts that it is qualified in respect of aspects of the judiciary—he acknowledged in those circumstances that he would accept that—would you consider that a High Court judge is probably the most appropriate person to make such a judgement on whether something should be taken out of the safe space and made available to a coroner?

Edward Argar (Conservative, Charnwood)

That is extremely helpful, thank you very much.

Steve McCabe (Labour, Birmingham, Selly Oak)

Thank you, Sir Robert.

Examination of Witnesses

Steve McCabe (Labour, Birmingham, Selly Oak)

Q We now come to our final witness session of the day. We will be joined by Stephen Chandler, who is the president of the Association of Directors of Adult Social Services. We will also be joined remotely by Gerry Nosowska, who is the chair of the British Association of Social Workers. We have until 5.15 pm for this session. I remind Members, because one of our witnesses is joining remotely, to be clear about who they are directing their questions to. May I ask both witnesses to introduce themselves for the record?

Edward Timpson (Conservative, Eddisbury)

Q May I start with you, Stephen? This may start to build on your dual professional career in both local government and the national health service. The Bill tries to ensure that much of the important data that flows between the two, and other services within the health and social care system, is more effectively and efficiently used for the benefit of patients and their outcomes, so how could a new provider dataset best meet the needs of local authorities in particular in meeting their Care Act duties?

Edward Timpson (Conservative, Eddisbury)

Q Gerry, I do not know whether that is something that you, from a social work perspective, would like to comment on.

Karin Smyth (Labour, Bristol South)

Q I, too, did joint commissioning roles in Oxfordshire at one point—so, only the best.

Every project that I have seen or witnessed on integration—joint commissioning; joint collaboration—has fallen apart in the end because of accountability for the money. A finance director in a local authority has to account for its budgets, and the finance director and accountable officer of a health authority ultimately has to account for their budgets. If agreement cannot be held at that point, those projects fall apart.

We heard earlier that we still do not know any detail on the tariff or money flows as a result of changes in the Bill—changes that will come into place in April. We also have the better care fund outwith the Bill, and this week’s announcement of a major change in funding is also outwith it. I wonder, with your ADASS hat on, how can you now help the Government to get around the problem for organisations regarding accountability for the money so that they do not fail?

Karin Smyth (Labour, Bristol South)

Q But, clearly, accountability is with the ICB and not with the partnership. We have heard that very clearly from NHS England.

James Davies (Conservative, Vale of Clwyd)

Q Stephen Chandler, what are the principles that underlie the successful discharge of a patient from hospital, and does this Bill support that?

James Davies (Conservative, Vale of Clwyd)

Q Gerry, do you have any comments to add?

Chris Skidmore (Conservative, Kingswood)

Q What confidence do you have in the discharge to assess model? Obviously, there have been pilots since 2016, but a lot of this was accelerated through the pandemic. That may be a good thing, but it might also be a bad thing, in that we have now to look at data in a very short timeframe. I served on the Health Committee over a decade ago, and during those discussions around tables like this, we used to talk about the Liverpool care pathway and how that was a good model to be following, until it unwound spectacularly and its local delivery was not as was thought in Committees like this. I wanted to ask what your view is on discharge to assess. You have mentioned carers and ensuring that we take into account the need for carers to be able to cope with any rapid discharges. Are there any other concerns that you might have about the model that should be taken into account?

Chris Skidmore (Conservative, Kingswood)

Thank you.

Steve McCabe (Labour, Birmingham, Selly Oak)

Do you want to add anything, Ms Nosowska?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q May I start with you, Gerry? Do you think the provisions in the Bill will bring about genuine integration of health and social care, which is something that has been talked about through quite a lot of my lifetime in the NHS? If you could only change one thing in the Bill to get the best outcome from it, what would it be?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q A common theme that we have heard throughout both days of discussion is about how to capture the voices and the understanding from such a broad landscape within health and social care. In Scotland, we have been working on integration since about 2013. It is clear that in some areas it is massively successful and in other areas it is struggling. A lot of it comes down to relationships, understanding and willingness to step forward together.

May I ask you the same questions, Stephen? Do you think it will improve integration? What is the one thing you would change?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q As you say, we often think of the frail elderly when we think of social care, but is it not the case that the need for social care among working-age and younger people—you talked about learning difficulties and disability—is a growing and under-serviced area?

Philippa Whitford (Scottish National Party, Central Ayrshire)

Q So is there a bit of the Bill you would want to change? If we let you write an amendment, what would you write?

Justin Madders (Labour, Ellesmere Port and Neston)

Q I have a couple of questions for Gerry. Your briefing made it clear that your members had a concern about discharge to assess; a clear majority said they did not support it, although the numbers are quite small. Would you say that is an accurate reflection of your overall membership?

The rest of the debate is in Hansard.