My Lords, I welcome much in this Bill, especially the provisions on childhood obesity, and I welcome the end to the 2012 Act clauses which obstructed collaboration between primary and secondary care and community services. I congratulate the noble Lord, Lord Stevens of Birmingham, on the work that he did to formulate so much of what is in this Bill and on his maiden speech.
However, as we scrutinise the Bill, there are a number of things that we should look at. The noble Lord, Lord Lansley, will be surprised that I am going to agree with him on something for once, but I wonder what the philosophy is that is going to drive up standards of patient care. Competition in the form we used it did not work for the reasons discussed, but the danger of the new ICS structure is that we could create local monopolies and will not be focused enough on what really matters, which is driving up patient care. We need to think about how we define what we mean by success for the ICS and how we define failure. That failure regime is not clearly enough set out in the Bill. I also think that FTs should keep their independence, which Clause 54 would seek to remove.
Essentially—the noble Lord, Lord Mawson, made this point eloquently—we have best practice all over the place in this country. We have wonderful people doing wonderful things in the NHS and social care. Everywhere you look, you can find somebody brilliant, often working against the system, who is getting it right. Our problem is that we never seem to be able to spread that best practice to anywhere. The argument for ICSs is that they are bigger, they will contain more
ambition within them, and so we will be able to drive their ambition in that way and bring the laggards with us. I think that will be largely true, but we need to make them entrepreneurial. A number of noble Lords in this debate have proposed all sorts of extra people who might sit on these boards. I would only warn that talking shops really do not get things done; we have far too many of them already and I hope that we will be able to keep these things relatively slimline.
As many speakers have said, the biggest limiting factor in the NHS and care at the moment is staff. I would support a new amendment to Clause 35. I suggest that we consider removing the reference to the OBR which Jeremy Hunt made in his amendment; that would make a big difference. I do not think that it is necessary for the workforce strategy to be consistent with fiscal projections, and I hope that might be considered by the Minister.
As the noble Baroness, Lady Harding, and others have said, we also urgently need to retain staff. We need to train them; yes, HEE needs a bigger budget, but we need to retain the wonderful people that we have. If there is any chance within the structure of this Bill to remove every impediment possible to resolve the pension issues for GPs and to reduce paperwork wherever we can, I urge that we should take it.
We need much better data sharing, but when I was working as a temporary adviser to the DHSC last year, I had a worrying conversation with a wonderful receptionist in a care home. She said to me, “I haven’t been able to talk to a single family today; I’ve got grieving families trying to get through to me on the phone. They can’t get through because it is clogged up with people from local authorities, people from the Department of Health, people from Public Health England, who are calling me to find out the data.” That was a major failing in the pandemic, and we are in danger of making the same mistake again. We must commission for outcomes, but we must find ways to measure them which do not mean multiple agencies—I should have added the CQC, on which I used to sit, to that list—ringing up front-line staff, who have better things to do. We would raise the morale of front-line staff if we stopped asking them to input data into systems again and again.
I want to make two further points. First, if we are serious about parity between mental and physical health, I suggest that we use that phrase to replace “health” in the Bill wherever we can. Finally, Covid-19 has of course exposed what we have long known about health inequalities in this country. I urge the Minister to consider whether the triple aim could be expanded more explicitly to focus on health inequalities.
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