Before winding up this important debate, I would like to put on the record, as I always do and as I know the shadow Minister does, our gratitude to all the staff in the NHS, social care and local government, and other key workers, for everything they have done in recent months. This Bill is evolution, not revolution. It supports improvements already under way in our NHS and it builds on the recommendations of the NHS’s own long-term plan, laying the foundations for our recovery from this pandemic. This Bill is backed by not only the NHS, but so many others working across health and care. A joint statement from the NHS Confederation, NHS Providers and the Local Government Association reads:
“we believe that the direction of travel set by the bill is the right one.”
It notes that working in partnership at a local level is “the only way” we can address the challenges of our time. The chief executive of Age UK has said that ICSs are to be embraced and made as effective and inclusive as they can be, and the King’s Fund is calling for us to
press ahead. The list goes on; the NHS wants us to press ahead, and in the words of Lord Stevens, “The overwhelming majority of these proposals are changes the health service have asked for.” So it is vital that we in this House do right by them and by patients at this critical juncture. It is the right time for this Bill. We legislate, Opposition Members obfuscate. I remind the shadow Secretary of State of his 2017 manifesto, which stated:
“We will reinstate the powers of the Secretary of State for Health to have overall responsibility for the NHS.”
With this Bill, we put increased accountability for the Secretary of State at the heart of this, yet now the shadow Secretary of State no longer seems to agree with himself and characterises his own proposals as “meddling”. I know that he is dextrous in his politics and in his policy position, which is probably why he has survived under multiple Leaders of the Opposition, but this is stretching it a bit.
We have sought, in getting to this point, to work on a collaborative basis at every stage, and hon. Members can be reassured that we will continue to adopt that approach in the weeks ahead as we proceed with this Bill, when we hope it goes into Committee. My right hon. Friend the Secretary of State set out in his opening remarks his willingness to listen. In particular, he highlighted that in the case of ICS boundaries no decision has yet been made. As he set out, we are determined to embrace innovative potential wherever we find it. That is quite different from many of the accusations we have heard here today. I know it is tempting for some—even when they know better, and they do—to claim that it is the beginning of the end for public provision. It is not and they know it. They know it is scaremongering rather than reality. They know that there has always been an element of private provision in healthcare services in this country, and they should know that because, as the Nuffield Trust said in 2019:
“The…evidence suggests the increase”
in private provision
“originally began under Labour governments before 2010”.
The shadow Secretary of State should certainly know that because he was a special adviser in the Treasury and in No. 10 at that time.
With regard to the implementation of the Bill, the NHS itself wants, subject to legislation, to move at pace to implement statutory arrangements for ICSs by April 2022. That is why NHS England is beginning preparatory work, including publishing an ICS design framework. Further work, including on integrated care board design and consideration of appointments and staff from CCGs will take place, after Second Reading, of course; this is all subject to the passage of the Bill.
Let me turn to some of the specific points raised by hon. and right hon. Members. The hon. Member for York Central (Rachael Maskell) asked about “Agenda for Change”. I can reassure her that it is not the intention that ICBs depart from “Agenda for Change”. The Bill’s drafting and wording is in line with existing arrangements for other NHS bodies with regard to “Agenda for Change” and translates it into this context. However, I am always happy to discuss that with her further if she wishes. Her suggestion that this was conceived, as she put it, in a bunker is quite simply not the case. Indeed, all the stakeholders, including the NHS, have said that this is one of the most collaborative pieces of legislation development they have seen.
Turning to the workforce, as my hon. Friend the Member for Winchester (Steve Brine) said, we cannot legislate to address workforce challenges but we can and we will look very carefully at the recommendations of the Select Committee and of my right hon. Friend the Member for South West Surrey (Jeremy Hunt).
While we do not always agree on everything, the hon. Member for Twickenham (Munira Wilson) made sensible points, although I would slightly tease her that she argued against the principle of the Secretary of State taking powers in reconfiguration and shortly afterwards her hon. Friend, the hon. Member for Westmorland and Lonsdale (Tim Farron), intervened on him asking him to do exactly that.