Health Bill (Seventh sitting)
House of Commons · Public Bill Committees · 25 Jun 2026 · 129 speeches · Official Report
The Committee consisted of the following Members:
Chairs: Sir Roger Gale, † Dr Rupa Huq, Emma Lewell, Sir Jeremy Wright
† Argar, Edward (Melton and Syston) (Con)
Brackenridge, Sureena (Wolverhampton North East) (Lab)
† Chambers, Dr Danny (Winchester) (LD)
Daby, Janet (Lewisham East) (Lab)
† Foody, Emma (Cramlington and Killingworth) (Lab/Co-op)
† Irons, Natasha (Croydon East) (Lab)
† Johnson, Dr Caroline (Sleaford and North Hykeham) (Con)
† Joseph, Sojan (Ashford) (Lab)
† Kyrke-Smith, Laura (Aylesbury) (Lab)
† Morgan, Helen (North Shropshire) (LD)
† Prinsley, Dr Peter (Bury St Edmunds and Stowmarket) (Lab)
† Robertson, Dave (Lichfield) (Lab)
Robertson, Joe (Isle of Wight East) (Con)
† Smyth, Karin (Minister for Secondary Care)
† Stafford, Gregory (Farnham and Bordon) (Con)
† Twist, Liz (Blaydon and Consett) (Lab)
† White, Jo (Bassetlaw) (Lab)
Sanjana Balakrishnan, Rob Cope, Committee Clerks
† attended the Committee
Public Bill Committee
Thursday 25 June 2026
(Afternoon)
[Dr Rupa Huq in the Chair ]
Health Bill
The Chair
Before we begin, I remind Members to switch electronic devices to silent. Tea and coffee are not allowed during sittings, but there are copious amounts of water-blue is still and silver is fizzy. Clause 15 Public involvement in commissioning by Secretary of State
I beg to move amendment 28, in clause 15, page 11, line 26, at end insert- “(d) in the design of service and arrangement for service delivery (co-production).” The amendment would explicitly require the Secretary of State to make arrangements for the co-production of any health service commissioned by the Secretary of State.
The Chair
With this it will be convenient to discuss clause stand part.
It is a pleasure to serve with you in the Chair, Dr Huq. I am moving this amendment on behalf of my hon. Friend the Member for Oxford West and Abingdon (Layla Moran), who is the Chair of the Health and Social Care Committee. She designed the amendment to explicitly require the Secretary of State to make arrangements for the co-production of any health service commissioned by the Secretary of State. The Liberal Democrats support clause 15 more broadly, and particularly the plans to involve affected patients, carers and representatives in planning and commissioning arrangements. Carers are a priority for our party, so it is really important to us that they have a meaningful say in the design and delivery of their care. I would be grateful if the Minister could elaborate on what that might look like in practice. The amendment would tighten up the clause to make some of its provisions more explicit, so that we can be confident that anyone involved in an individual’s care has the ability to influence it in an appropriate way.
It is a pleasure to serve under your chairmanship, Dr Huq. I will speak briefly about clause 15 and amendment 28, tabled in the name of the hon. Member for Oxford West and Abingdon, the Chair of the Health and Social Care Committee, of which I am a member. The amendment is clearly positively intended. We all want the co-production of services, and we have discussed it quite a lot on the Health and Social Care Committee. A number of amendments were tabled in the name of the hon. Member for Oxford West and Abingdon but were agreed on by the Select Committee. I think it is fair to say that there are a number of areas that the Committee could not agree on and that are obviously not in front of it, given its political make-up, but we all agreed on the ones she has tabled. That being said, cross-party agreement often necessitates fairly non-partisan and perhaps non-specific wording, so while I agree with the intention behind the amendment, and while it is clearly important to have co-production when designing services, I am not entirely comfortable with the way the amendment has been drafted. This goes back to comments I made on the Liberal Democrat new clause 2 about how the requirement would operate in practice or how such an approach would be applied consistently across different commissioning functions. Although I am very keen on the principle, I am concerned about the intention.
I will not detain the Committee for long, and I will speak primarily to clause 15. I am broadly supportive of what the Minister seeks to achieve, as I understand it, with the clause. It is absolutely right that service users and communities are engaged by their integrated care boards-those commissioning services-in the design of services as well in individual care. As I alluded to before we adjourned for lunch, however diligent an ICB may be in doing formal consultations or conducting surveys, it is all too easy for that to appear to the actual users of the service as a box-ticking exercise, with the board none the less determined to follow through with the strategic plan that it conceived and consulted on in the first place. We have seen that challenge on a number of occasions in my Melton and Syston constituency, with the recent closure of St Mary’s birth centre in Melton Mowbray. There was a consultation and engagement with the public, but we always feared that, ultimately, a decision to close was what the ICB wanted and, lo and behold, that is what happened. Similarly, the ICB decided to pull away from accepting the need for a second GP practice or enhanced GP services in Melton Mowbray. There was a consultation and discussion, but ultimately the conclusion that we feared at the outset of the process was indeed what was reached at the end of it. The clause will not necessarily address all that, but it is a step forward in putting pressure on an ICB, or on those...
My right hon. Friend is making an absolutely correct point, which I made when we were talking about the Secretary of State’s ability to remove, by sacking or otherwise, the chief executives of ICBs. There is a tension between us as Members of Parliament trying to lobby the Secretary of State for changes in our constituencies when he currently has no power to actually make those changes. The clause will potentially give him the power to make those changes, but being able to sack a chief executive is probably a step too far. How does my right hon. Friend see the powers in the clause, which are probably correct, balancing with the local decision-making process and clinical expertise? There will clearly be a tension between the two.
My hon. Friend comes to this with significant knowledge from his work on the Health and Social Care Committee. He is absolutely right, but that is a tension and a balance that I fear runs as a thread throughout this legislation, between local decision making and tailoring and the genuine need for a Secretary of State to have effective powers. We lobby Secretaries of State; on occasion I have lobbied the Minister, and she has always been very responsive-she does not always agree with me, but she has always been very responsive to me. As Members of Parliament, we do that on behalf of our communities. My argument is that ICBs need to be more responsive, even when they do consult, to make it clear that the decision is not predetermined by the board and that they are going through the process. In the context of this clause, that also needs to be true of the Secretary of State: it needs to be not simply a formulaic approach but a genuine engagement and consultation. My question for the Minister, in that context, is about how we make sure of what she is seeking to do in the clause. The Secretary of State or those undertaking commissioning on their behalf must pay heed to something, but how do we make sure that that consultation, engagement and feedback genuinely have some teeth in what emerges in the final decision?
My right hon. Friend the Member for Melton and Syston and my hon. Friend the Member for Farnham and Bordon have covered my points so effectively that I will be very brief indeed. How do we ensure that the consultation is not just well meaning and ticking the legal boxes, but actually listened to, so that people’s voices are incorporated into the plans? Also, I appreciate that amendment 28 is a well-meaning intervention, but how do we ensure that all voices are heard in a co-production, not just those who are the most articulate or the most able to engage with a process that they see online?
Patients and the public have a critical role in shaping our health services. I am grateful to the hon. Member for Oxford West and Abingdon for tabling the amendment, as moved by the hon. Member for North Shropshire. I will discuss the amendment with the wider question of whether the clause should stand part of the Bill. To be clear, the Government are committed to engaging with patients and the public about the services they use. Services shaped together with the people who rely on them are better services. We want to see deep and collaborative ways of working between patients, public and the NHS. Across the country, there are good examples of that from which we want to learn. That is why the clause requires the Secretary of State to involve patients and the public in the planning of commissioning arrangements, the development and consideration of proposals for service change, and decisions that may affect how services are delivered or the range of services available. The clause is intended to encourage early engagement and meaningful involvement in service change, thereby helping to build legitimacy, trust and better-informed commissioning decisions. As a duty, it covers the entire end-to-end commissioning cycle. I have been a commissioner myself, so although I will not detain the Committee too much on that, it is indeed part of the job of a commissioner to do that at a very early stage. I also draw attention to the fact that the clause places a statutory duty on the...
I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn . Clause 15 ordered to stand part of the Bill . Clause 16 Regulations about commissioning by integrated care boards
I beg to move amendment 51, in clause 16, page 12, line 10, at end insert- “(3) The regulations must ensure that integrated care boards may not impose operational policies requiring patients to wait a minimum number of weeks before they may access treatment.” This amendment would prevent minimum waiting times for NHS treatment.
The Chair
With this it will be convenient to discuss the following: Amendment 35, in clause 16, page 12, line 10, at end insert- “(3) Regulations under this section must make provision requiring integrated care boards to make arrangements which ensure that community equipment and wheelchair services are provided within 18 weeks of the date on which a person is assessed as requiring such equipment or services. (4) For the purposes of subsection (3)- ‘community equipment and wheelchair services’ means equipment, aids, home adaptations or appliances provided to support a person’s independence, safety, care or daily living at home or in the community, including hoists, hospital beds, pressure-relieving mattresses, commodes, shower chairs, walking frames, grab rails, ramps, specialist seating, postural support equipment, associated mobility equipment, and wheelchairs.” This amendment would require the Secretary of State to make regulations which would require integrated care boards to ensure that community equipment and wheelchair services are provided within 18 weeks of the date on which a person is assessed as requiring such equipment or services. Amendment 63, in clause 16, page 12, line 10, at end insert- “(2A) Regulations under subsection (2) must make provision requiring integrated care boards to- (a) assess whether sufficient capacity exists to meet current and projected patient demand for cancer treatment, including radiotherapy treatment, (b) maintain plans to ensure that...
The Government say they are firmly committed to cutting waiting times and meeting the NHS’ 18-week target. It seems odd that, despite that, it is necessary for me to table an amendment to prevent systems from forcing patients to wait artificially longer for their care through the imposition of minimum waiting times. Last year, The Times reported that at least eight local ICBs had introduced policies to pay healthcare providers for treatments only once patients have waited 12 weeks or more. I cannot think of any clinical reason why someone should wait for 12 weeks before having any treatment. At the time, the Minister said that while there was “no formal national policy supporting minimum waits”, local areas may “choose to include minimum waiting times in Activity Planning Assumptions to ensure delivery of targets within agreed financial allocations…to support commissioners in managing activity to ensure they can sustainably manage within their budgets”. I do not understand why we would want to make people wait longer than necessary. The Royal College of Surgeons has expressed concerns and made clear that minimum waits prolong “pain and anxiety” for those made to wait longer, saying that it is “counterintuitive…to give commissioners the green light to impose 18-week waits, while simultaneously working to ensure patients begin treatment within 18 weeks.” Age UK deemed it a “rationing approach” that is “potentially harmful to the health and wellbeing of older people.” NHS...
I want to speak to amendment 63, tabled by my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron). As hon. Members know, he has campaigned passionately and for a long time on the provision of radiotherapy. His amendment seeks to ensure that there is sufficient and equitable access to radiotherapy. Radiotherapy is required by half of all cancer patients, and it is incredibly cost-effective, but England has fewer radiotherapy machines than comparable European countries, and thousands of people have to travel long distances and over 45 minutes for their treatment, particularly in my hon. Friend’s Cumbria constituency, as he has noted on many occasions. The Darzi review noted that radiotherapy services are on their knees. They have some of the longest waiting times for treatment and vast parts of the country are classed as radiotherapy deserts, because of lack of accessibility. Radiotherapy currently has the worst 62-day performance of all main cancer treatments, and if we are serious about ensuring that all cancer targets are met by 2029, then we need the infrastructure, people and equipment to deliver them. Cancer cases are expected to rise 30% by 2040, meaning that radiotherapy centres must be able to keep pace. Importantly, radiotherapy can also be used at an earlier stage in treatment, potentially saving lives, saving money and meeting important waiting time targets. We really ought to be leading the way on this and keeping pace with our European counterparts...
Amendment 35 has not been moved, but it is very similar to new clause 35, which may be moved and concerns equipment. I will address both together. I think all in this Committee would agree that ensuring timely access to community equipment and wheelchair services is vital for patient independence, dignity and recovery. I have a number of constituents who believe that they are not getting access to that equipment in the time they would expect. We also need to ensure that we give proper consideration to the efficiency and management of resources. In particular, we should look more closely at what happens after that equipment has been distributed. Too often, items such as crutches, wheelchairs or Zimmer frames are not reviewed after issue or returned when they are no longer needed. We are already seeing a massive financial consequence of that. It was reported last year that the Royal Berkshire NHS foundation trust is losing around £70,000 a year due to patients retaining unused mobility equipment. That might seem like a drop in the ocean for the NHS, but £70,000 could fund another nurse, if we include the on-costs. These things do have consequences. Despite distributing thousands of items, only 38% of crutches and just 15% of Zimmer frames were returned in 2024. That represents a significant loss of reusable equipment and considerable pressure on NHS resources. It also gets into the mindset of how patients use and value those pieces of equipment and how NHS users think about...
I should say that I am on a waiting list for treatment myself. The validation process seems to involve phoning people to check if they still need treatment, which after a long period is perhaps not an unreasonable thing to do. However, if they then say yes, they are phoned again a few weeks later; and if they say yes again, they are again phoned a few weeks after that. That puts pressure on people to say, “Okay”. If they are then asked, for example: “Would you be happy to see the consultant so that he can check that you are still listed for the right procedure, given that your condition may have changed and you may want to do something else?” it feels entirely unreasonable to say anything other than “Yes” to that. Would my hon. Friend be surprised to hear that when some people do that they find that they do indeed need the same procedure, but that their waiting time has now gone back down to zero?
My hon. Friend makes two important points. First, of course there has to be a validation process. There has been for a long time, and I do not think that anyone is objecting to that. However, it is a question of how it is being articulated and the people it is focused on. It is being focused on vulnerable people. I have anecdotal evidence from conversations with a significant number of people since I posted that social media video that they feel pressured into coming off the lists. It does not help that trusts have financial incentives to take people off lists. Earlier this month, the Health Service Journal said that three trusts are earning more than £1 million in having people taken off lists. There is no problem with giving trusts a financial reward to do due diligence and validate the lists, but there is potentially a perverse incentive for trusts to try to knock people off them.
I am not entirely clear why there is a problem with the financial incentive. People coming off lists that they have been on for a long, long time may well have a clinical condition that is changing. In my practice, I deal with the management of children with glue ear, who need to have grommets. From time to time, the condition fluctuates and the glue ear goes away. Equally, the reason that we do a tonsillectomy is that people get recurrent acute tonsilitis, but it is actually quite a good idea for people to wait some time because often the recurrent acute tonsilitis simply settles down and they do not need their operation. Sometimes, when a patient comes into hospital for an operation on their tonsils and I ask them, “When did you last have an attack of tonsilitis?” they say, “I can’t remember.” We have to take account of the fact that the condition of the patient may fluctuate.
The hon. Gentleman is entirely correct, and I think I said some moments ago that I am not against a validation of the list-I think I even said that I am not against some sort of financial incentive to clear the list. My concern is the extraordinary jump in the baseline in the last month or so: 351,000 people have been removed from the list for no apparent reason. While I have been having anecdotal discussions with patients, my hon. Friend the Member for Sleaford and North Hykeham has been doing something a little more robust. It would be interesting to see the outcome of her endeavours and researches and to find out exactly what is happening in those areas. Anyone with a modicum of inquiry and common sense would say that the significant jump that we have seen in a single month deserves at least a level of interrogation, which the hon. Member for Bury St Edmunds and Stowmarket is not allowing in his comments.
Does my hon. Friend agree that when somebody-particularly a vulnerable person-receives a call asking them whether they would be prepared to see a consultant to see whether they still need treatment, they are aware of all the noise in the media? They are aware that other people are waiting. People do not want to waste NHS resources. The first time, they may think it is a routine process but, when they receive the second or third call, they may start to think to themselves, “They are trying to tell me that they want to do something else. Maybe I don’t need it as much as other people.” They feel obliged and pressurised into saying they do not need the procedure when they do.
My hon. Friend is absolutely right. The danger in this process-especially the multiple instances of chasing within a period of weeks, which sometimes happens-is that pressure is put on patients. Again, I know anecdotally from patients who have been speaking to me that those who are most compliant-if I can put it like that-and do not want to make a fuss are generally older and vulnerable people, who feel that they are perhaps causing an inconvenience to the system. They see people with, in their view, more serious conditions or a greater need. We need to be very careful about creating perverse incentives, financial or otherwise, to try to take some of those people off the list. As I say, the significant jump that we have seen deserves more scrutiny and inquiry, and that is why I am very supportive of my hon. Friend’s amendment. We need to understand whether patients are being removed because they no longer require treatment, as the hon. Member for Bury St Edmunds and Stowmarket said-which is, of course, entirely appropriate-or just to improve targets, present an improved picture of waiting lists, and unlock the financial benefits tied to performance metrics. There is a troubling echo here. We saw similar practices in the 2000s when patients were removed or reclassified in ways that reduced waiting list numbers without genuinely improving access to care; it damaged confidence in the system then and it risks doing so now. What concerns me most is that we may be repeating that...
We are in 2026. Social media and the media scrutinise everything that we do. Will the hon. Member confirm if there has been any report in the media that somebody, anywhere in the country, has had their condition made worse, or died, or did not get treatment?
There have been a number of reports of situations where people have not received care and have died because of that, so I do not see the hon. Member’s point. I think that, with amendment 52, my hon. Friend the Member for Sleaford and North Hykeham is trying to ensure that when the statistics are published, we can scrutinise the reasons behind them. The hon. Member for Ashford may be entirely right; let us imagine that is the case, and there is no gamifying or pressure going on. Why not allow the public to see that? Why not put to bed the HSJ stories that say there is something fishy going on? He should welcome that level of transparency and scrutiny to back up his argument if he is correct.
The hon. Member for Ashford talks about social media and social media comments. I wonder if, where the DHSC or the Government have put that waiting lists are falling, my hon. Friend has read any of the comments that come in from the general public below such proclamations.
My hon. Friend tempts me to be political; I will rise to that briefly. Yes, I have seen them and she is right. There is a clear concern that when the Government make all these proclamations about how brilliant the NHS has suddenly become, the reality on the ground does not meet that for many patients. However-I am being gentle now-that is probably not exclusively a problem with this Government. My right hon. Friend the Member for Melton and Syston might kill me, but I am sure other Governments have done something similar. I will go back to amendment 52 because I think it is really important. Let me be clear: it would not prevent people being removed where appropriate; it would simply require the Government to be honest about why. It requires the Secretary of State to publish the number of patients removed from waiting lists each month and, crucially, the reasons why. If everything is being done properly there should be nothing to fear from such transparency, but if there are problems, sunlight is the best disinfectant and the amendment is exactly what we need. We owe it to our constituents and to every patient in the country to ensure that waiting lists are not improved just on paper, or in a press release, or in a social media tweet, or at the expense of the care of real people but actually improved. If we are to strengthen patient choice, particularly in relation to community services that substitute for or prevent hospital admission and treatment, there are some good...
There are a number of amendments in the group. Amendment 35 was not moved but as the hon. Member for Farnham and Bordon spoke to it, I will comment on that amendment, which is in the name of my hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis). Community equipment and wheelchair services are really important to us and-to allay the concerns of the hon. Member for Farnham and Bordon-that is why the medium-term planning framework requires that, from this year, all ICBs and community health services must actively manage and reduce waits over 18 weeks and develop a plan to eliminate all 52-week waits. I assure the Committee that we will hold the ICBs for their performance. The community health services situation report has a specific monitoring line, covering children and young people and covering adults, for the wheelchair, orthotics, prosthetics and equipment category. We intend to continue that work following NHS England’s abolition. Consistent national standards will help us to identify the best and the weakest-performing areas, to identify what improvements need to be made and to tackle the longest waits. Amendment 52 was tabled by the hon. Member for Sleaford and North Hykeham. We are committed to ensuring that all patients receive the NHS care they need in a timely manner, and I recognise the importance that Committee members have placed on that matter. The NHS constitution sets out that patients should start consultant-led treatment within 18 weeks of...
Will the Minister give way?
I will move on. It is absolutely right that integrated care boards, as local commissioners, retain the ability to manage their services and waiting lists effectively, given the shocking numbers that they have inherited. This is complicated, difficult work: commissioners have to balance demand, capacity and clinical need, and a prohibition such as the one set out in the amendment would threaten to remove legitimate flexibilities that are required at the local level to ensure that services are delivered safely and efficiently. We are clear that systems should not be setting minimum wait times that exceed the 18-week constitutional standard, but hon. Members will appreciate that not all elements of waiting are inappropriate. In many cases, they reflect clinical pathways, sequencing of care or the need to prioritise the most urgent patients. It is imperative that clinical judgment and urgency remain the key drivers of prioritisation, which is something the amendment threatens to remove. Turning to amendment 52, I recognise that Members across the House are committed to ensuring that all patients receive the NHS care they need in a timely manner. Validation is a routine and long-standing part of waiting list management by providers. It ensures that patient records are accurate, that patients are on the best pathway to meet their needs and that they still need their appointments. Routinely validated waiting lists will support a return to the 18-week NHS constitutional standard....
I am interested to hear what the Minister has to say, but does she agree that this is yet another reason why we must go full speed ahead to get the single patient record sorted out?
Once again, my hon. Friend is absolutely right. He is expert on this issue and has outlined to us some excellent clinical examples. I look forward to debating the single patient record further in Committee. Importantly, any patient removed from a waiting list should be notified alongside their GP. Data on the total number of removals from waiting lists is published by NHS England. That data includes, but cannot separately identify, patient pathways removed as a result of validation. The Department remains committed to the transparent publication of official waiting list statistics following the abolition of NHS England, although there are no plans to publish more detailed breakdowns. NHS staff are delivering record levels of elective activity, which has enabled us to meet our interim target of 65% of patients being seen within 18 weeks.
If a person has been waiting more than 18 weeks, the trust calls them and asks them to see a consultant to check whether they still need the appointment or whether they need a different treatment. If, after having that appointment, they are told that they still need the treatment, that same day they go back on the waiting list as if it were day one. Therefore, they have not waited less than 18 weeks, even though the Minister’s statistics might suggest they have. Does she accept that?
The hon. Lady outlines a particular case, and if she wants to raise that separately, I am happy to come back to her with a fuller answer. As she knows, and as the hon. Member for Farnham and Bordon also knows from his work with Getting It Right First Time, there are complications in some of this. I do not accept the hon. Lady’s point, but if there are particular or anecdotal examples of what she referred to, I am absolutely prepared to look at them. Patients, with their GP, need to understand what is happening. That is a key part of our elective reform plan. If patients are on the list for a long time, they should be told why, and what alternative provision can be made for them. We are taking an active approach to supporting and empowering patients with information and knowledge, and being transparent about how we get down the shocking lists that the Conservatives left us, which stood at 4 million people before the pandemic.
Amendment 63 was tabled by the hon. Member for Westmorland and Lonsdale and spoken to by the hon. Member for North Shropshire. Improving timely access to cancer treatment including radiotherapy is a firm priority for the Government. That is why we published the national cancer plan in February this year. The plan is driven by evidence and shaped by the voices of more than 11,000 patients, charities and professionals who responded to the call for evidence. I am very grateful to them for their contribution.
The plan makes specific commitments to improve radiotherapy services’ productivity, including by using artificial intelligence to streamline treatment planning. We have allocated £70 million of funding for state-of-the-art radiotherapy machines and to streamline, improve and incentivise the use of the latest treatments. Both of those commitments are due to be delivered in 2027. The plan also commits to delivering 5,000 learning opportunities each year and rebalancing cancer training places to remote, rural and coastal regions to address inequalities in cancer care. I know that the hon. Member for North Shropshire works very hard on that. We continue to recruit in priority medical specialties, including clinical oncologists, medical oncologists and clinical radiologists. We are reforming training to support rapid development for radiologists. We are also tackling poor performance and serious variation through the Getting It Right First Time programme and national interventions to address these issues at local level.
We are well aware that radiotherapy performance is below that of other treatment types. There is much work to do, and we are committed to it, but I hope that the hon. Member agrees that it is important not to duplicate efforts already in train to improve oversight of cancer treatment and radiotherapy services. I hope that gives the hon. Member for Sleaford and North Hykeham the reassurance she seeks.
Before I finish, I draw the attention of the Committee to other aspects of clause 16 and associated schedule 2. Clause 16 allows the Secretary of State to make regulations to inform the commissioning activities of ICBs. Those regulations can cover matters relating to waiting times, patient choice arrangements, the enforcement of patient choice regulations and the appeals process against the individual commissioning decisions of ICBs.
New section 14Z45A of the National Health Service Act 2006 will allow the Secretary of State to continue to set regulations to impose duties on ICBs in relation to waiting times for the treatment or other services that they arrange as part of their commissioning functions. That provides a clear statutory mechanism to set and maintain waiting time expectations, helping to ensure that patients receive timely care. The regulations may also require ICBs to put arrangements in place to address cases where a specified treatment or service is not provided within a specified period. That helps to ensure that delays to patient care are identified and managed consistently, and that patients receive appropriate follow up and support.
New section 14Z45B requires regulations to be made for the arrangements that ICBs must make when exercising their commissioning functions to enable people to make choices in relation to specified treatments or services. The regulations may make other provisions for ICBs to protect and promote patient choice rights, including rights created by the regulations themselves and rights described in the NHS constitution. That provides a clear signal that patient choice must continue to be delivered within the integrated care system.
New section 14Z45C makes provision for the enforcement of patient choice requirements. It enables the Secretary of State to investigate whether an ICB has failed or is likely to fail to comply with regulations made under section 14Z45B. It also enables the Secretary of State to accept an undertaking from the ICB to take specified steps to prevent, mitigate or remedy any failures. With supporting schedule 2, it sets out the procedure for undertakings. The Secretary of State’s powers of direction over ICBs are set out in sections 14Z61 and 14Z62A of the 2006 Act. The new measures retain the patient choice enforcement powers of that Act, ensuring that accountability for patient choice is maintained.
New section 14Z45D allows the Secretary of State to continue to set regulations creating a formal appeals process, so that patients can contest decisions about their care made by their ICBs. It enables the creation of independent panels to review cases, sets rules for how appeals work, including timelines and the power of panels, and makes provision for administrative support for the process. That power allows clear, consistent rules for appeals to ensure that all patients are heard.
Taken together, these four powers provide the basis for a number of key regulations underpinning the operation of ICBs, and as such I commend the clause and schedule 2 to the Committee.
Question put, That the amendment be made.
Amendment proposed : 52, in clause 16, page 12, line 10, at end insert-
“(3) The regulations must include a requirement for the Secretary of State to publish the number of patients validated off of treatment waiting lists each month, and the reason for which they have been removed.”- (Dr Caroline Johnson.)
This amendment would require publication of the number of patients validated off waiting lists each month and the reason for their removal.
Question put, That the amendment be made.
Clause 16 ordered to stand part of the Bill.
Schedule 2 agreed to.
Clause 17
Duty to have regard to impact on services in border areas
Question proposed , That the clause stand part of the Bill.
We know that in some areas of Scotland and Wales that are near the border with England, the way that health services are planned and commissioned in England can have implications for the people who live in Scotland or Wales. That is why clause 17 inserts new section 14Z45E into the 2006 Act, to place a duty on integrated care boards, when exercising their commissioning functions, to “have regard to the likely impact of those decisions on the provision of health services” to persons in Scotland and Wales living near the English border. I assure the Committee that the clause will operate solely in relation to the exercise of ICB commissioning functions in England. It will neither confer functions on ICBs in relation to the commissioning or provision of services outside England, nor affect the responsibilities of devolved Administrations for the organisation and delivery of health services in Wales and Scotland. I commend the clause to the Committee.
I want to draw the Minister’s attention to some of the difficulties relating to cross-border healthcare in a border area. I represent an area on a border. North Shropshire has a very wiggly, for want of a better word, border with Wales, which means that some English constituents are registered with a GP surgery in Wales but receive their secondary care in England. That causes significant difficulties for them because of the lack of joined-up communication between the two Administrations. I seek assurance from the Minister that as ICBs in England will have to pay regard to people who live near the border in Wales, conversations are going on with the commissioners in Wales to ensure that that process is as smooth as possible.
The hon. Member for North Shropshire makes the point very well. Back when I was a Minister, and subsequently shadow Secretary of State, she raised that point with me. The clause is sensible. The Minister articulated concisely and reasonably why it is necessary. It is the nature of any devolution arrangements that a little bit of cross-border co-operation is required along the border to make sure that services work effectively for people. This may have changed, but in my experience the majority of those crossing the border were people from Wales coming for secondary care services in a hospital on the English side of the border, so I think the clause is entirely reasonable. I echo the hon. Lady’s request: I would be grateful if the Minister updated the Committee on what conversations she has had, particularly with the Welsh Government, but also with the Scottish Government, to ensure that there is reciprocity and that they will put an equivalent provision into their laws to ensure that patients in England are taken into consideration in their healthcare planning.
The clause imposes a duty on ICBs to have regard to the likely impact of their commissioning decisions on areas of Wales and Scotland close to the border. In some respects, this is like other parts of the Bill-a statement of the obvious regarding a person’s job. Are we suggesting that the Secretary of State, and in particular ICBs, would not consider the effect of their decisions? I hope that they would, but, given that the clause is there, what teeth does it have? What if they do not? Is there any consequence in the Bill if they do not? As others have said, will the Minister confirm whether there is a reciprocal agreement with Wales and Scotland? If there is not, what negotiations has she entered into and what progress are they making?
As an MP in Bristol, which is not quite on the border, but is pretty close, I absolutely understand. We have relationships with our Welsh colleagues and I have been involved in debates on this matter. The clause ensures that, with the abolition of NHS England, regard is had to to arrangements with our colleagues across the border. We all understand that devolution means that different arrangements will be made in the constituent parts of the United Kingdom. It is not for the UK Government to determine what those are, because they are devolved. However, I assure members of the Committee that across the piece in the Department, and indeed across the Government, regular meetings and conversations on these and other matters with regard to the devolved functions are a regular part of the work that we do. Question put and agreed to . Clause 17 accordingly ordered to stand part of the Bill. Clause 18 Transfer schemes in connection with integrated care boards Question proposed, That the clause stand part of the Bill.
The clause gives the Secretary of State the powers to make transfer schemes where an ICB is being abolished or established, or where the area covered by an ICB is being amended. A transfer scheme ensures that all the staff, property rights, responsibilities and liabilities, other than criminal liabilities, of the ICB being abolished are transferred to another ICB. That ensures that the ICB taking over has the appropriate information and resources to continue to arrange healthcare services for their population. In the past, that has been used to support the restructuring of ICBs to achieve geographical boundary alignment with strategic authorities, as set out in the 10-year health plan. The power also allows transfers to the Secretary of State and, when a new ICB is established, allows the transfer of staff from an NHS trust or foundation trust or from a special health authority. Following the abolition of NHS England, we expect that Ministers will continue to need to be able to make transfers between ICBs. The clause allows that as needed. I therefore commend the clause to the Committee.
I have one question for the Minister. Which ICBs does she envisage being abolished, or is this just a precaution for the future?
It is precautionary to give the power in the event-future-proofing the Bill. Question put and agreed to. Clause 18 accordingly ordered to stand part of the Bill . Clause 19 Integrated care boards: power to provide assistance Question proposed, That the clause stand part of the Bill.
The clause relates to the power for integrated care boards to provide assistance and support in relation to the health service. It replaces section 14Z48 and, in part, section 12ZA of the National Health Service Act 2006 with a clearer and more flexible power. At present, the various ICB assistance powers are narrower and more confusing. Section 12ZA provides for certain forms of practical assistance in connection with ICBs’ commissioning functions, while section 14Z48 provides a more limited power to make grants or loans. Other specific assistance powers sit elsewhere in the legislation, including in sections 96, 112, 124 and 147, which allow assistance and support for primary medical services, dental, ophthalmic and pharmaceutical services. Clause 19 replaces all those separate powers with a general power for ICBs to provide assistance or support. The clause will make it clearer when an ICB may support providers, prospective providers or other activity connected with the health service. It will allow an ICB to provide assistance or support to a person who is providing or proposing to provide services as part of the health service. It will also enable an ICB to support a person who is carrying out or proposing to carry out activities that the ICB considers to be conducive to the health service. The assistance may include financial assistance, making available the services of ICB staff, or making available any other ICB resources. The clause also allows assistance to be...
The Government’s explanatory notes state that the clause is intended to give ICBs the ability to provide a broad range of support to those involved in providing or administering the health service. The flexibility there aligns with the Government’s stated vision for more autonomy across the system. I have a couple of questions. If the ICB were to provide support in a way that was out of line with good practice or what is expected by the Department, what would be the recourse? Where will it be possible for right hon. and hon. Members to see the financial expenditure that ICBs make in any such circumstance?
I thank the shadow Minister for her questions. ICBs are part of the accountability outcomes framework, so they will be monitored in the usual way, and any expenditure by the ICB-and, indeed, by the Department-is recorded in the departmental accounts. Question put and agreed to. Clause 19 accordingly ordered to stand part of the Bill. Clause 20 Performance assessments of integrated care boards Question proposed, That the clause stand part of the Bill.
The clause transfers the requirement to conduct annual assessments of integrated care boards from NHS England to the Secretary of State and focuses the assessment on the statutory functions of the organisations. To do that, it removes a prescriptive list of duties to be assessed that was inserted by the Health and Care Act 2022. ICBs are essential to delivering our health mission. They are responsible not only for arranging healthcare services, but for planning how those services will focus more on prevention, digital innovation and delivery in the community. It is therefore entirely appropriate that the Secretary of State should hold ICBs to account and undertake a meaningful assessment of their performance. Currently, NHS England assesses the performance of ICBs annually, reviewing how well they have performed against a list of duties prescribed by the current legislation. The process for those assessments is set out in guidance each year and is driven by both publicly available performance data and local insight. The results are published online and form part of the ongoing performance conversation between NHS England and each ICB. Although NHS England can choose to assess more than those statutory duties as part of that process, the duties form a static list of requirements that are already expected as part of the ICBs’ statutory functions. Having such a list may inadvertently skew attention away from other priorities in the 10-year health plan and our mission. As we...
The Minister has saved me from having to give a speech on this clause, so I will ask her a couple of questions instead. Does the Secretary of State intend to publish the list of criteria against which he will require assessment to take place, so that it is transparent what is being considered? Notwithstanding the Minister’s point about the 2022 legislation, the Secretary of State will define the list, so will he publish those criteria? Within what period following the end of the financial year will the Secretary of State commit that the results will be published?
I recognise the right hon. Gentleman’s expertise as a former Minister in this role. I do not want to mislead him, so I will come back to him in writing on both those points, if that is acceptable. He tempts me to be more prescriptive than I think we intend to be at this point, but I will ensure that he gets a proper answer to both questions. I commend the clause to the Committee.
As has been said, the clause replaces the part of the NHS Act that requires NHS England to carry out performance assessments of the ICBs and rewrites it so that the Secretary of State has to carry out those assessments. That makes some sense, but, as the Minister said, it takes out the criteria against which the ICBs will be assessed. I accept what the Minister says-she wants those criteria to be set out more flexibly than can be done in primary legislation-but it is not reasonable or fair to assess people against criteria that they do not know in advance. It will be important, will it not, that ICBs know in advance what those criteria will be? Given what she said to my right hon. Friend the Member for Melton and Syston about writing to him, will she commit to writing to us to say not only what the criteria will be at the moment, but how far in advance ICBs can expect to receive them before they are expected to work to them and then be assessed against them? Will variation be a factor in whether an ICB is deemed to have been performing well or not? We know that there is a tension in the Bill between the Secretary of State’s need to equalise provision and the ICBs’ desire and intention to vary it and innovate. Given that the Secretary of State is a political individual, how will the assessment process be conducted in a way that gives ICBs and their leaders confidence that there will not be political interference in it?
Of course ICBs will know how they are going to be assessed; that will be in guidance in the usual way. In the last two years, in planning terms, we have brought forward all that work for the system-including on the finances-in order that the system works more efficiently, and we will continue to seek to do that. The hon. Member, as she has several times in the Committee, returned to the question of variation. When there is devolution and local systems are different, there will be a degree of variation, as I have said. In performance management terms, where there is unwarranted variation, we will seek justification and understanding of that. Sometimes, there is variation for geographical reasons. There may also be historical structural reasons in a local system, or temporary reasons why performance is variable. We would look at that as part of that general work. Question put and agreed to. Clause 20 accordingly ordered to stand part of the Bill. Clause 21 Membership of integrated care boards
I beg to move amendment 46, in clause 21, page 15, leave out from line 33 to line 6 on page 16 and insert- “(2) The constitution must provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include- (a) at least one person nominated by one or more NHS trusts or NHS foundation trusts which provide services under arrangements made by the integrated care board, in accordance with regulations made under sub-paragraph (2A); (b) at least one person nominated by a body representative of providers of primary medical services whose area falls wholly or mainly within the area of the integrated care board, in accordance with regulations made under sub-paragraph (2A); (c) at least one person appointed by a local authority whose area falls wholly or partly within the area of the integrated care board; and (d) at least one member nominated by the mayor of each mayoral strategic authority whose area coincides with, or includes the whole or any part of, the integrated care board's area (if any). (2A) The Secretary of State may by regulations make provision about the nomination of ordinary members under sub-paragraph (2)(a) and (b), including provision about which NHS trusts, NHS foundation trusts or representative bodies are entitled to make nominations. (3) The constitution must set out the process for making nominations under sub-paragraph (2). (4) A person making a nomination under sub-paragraph (2) must have regard to any guidance published by the Secretary of...
The Chair
With this it will be convenient to discuss the following: Amendment 25 in clause 21, page 15, line 38, at end insert- “(2A) The constitution must also provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include at least one member nominated jointly by the local authorities whose areas coincide with, or include the whole or any part of, the integrated care board's area.” This amendment would require integrated care boards to have a member jointly nominated by local authorities from within the board's area, as is currently the case but would otherwise be removed by clause 21. Amendment 45, in clause 21, page 15, line 38, at end insert- “(2A) The constitution must provide for the ordinary members as mentioned in sub-paragraph (1)(b) to include at least one member nominated by local primary care providers.” This amendment would ensure that ICBs have to have representation from primary care providers. Amendment 26, in clause 21, page 16, line 3, leave out from “mayor” to “sub-paragraph (2)” on line 4 and insert “or local authority nominating an ordinary member as mentioned in sub-paragraphs (2) and (2A).”. This amendment is consequential on amendment 25 and would require a local authority involved in nominating a member of an integrated care board to have regard to guidance published by the Secretary of State. Amendment 27, in clause 21, page 16, line 9, at end insert- “‘local authority’ has the meaning given by section 2B(5);”. This amendment is...
At present, integrated care boards will have a chair, a chief executive and at least three further ordinary members. Those three ordinary members will include a representative of the NHS trusts and NHS foundation trusts in the area, someone from the primary medical services in the area and someone nominated by the local authority areas within the ICB area. Under the clause, the requirement for those individuals is replaced with a requirement to have someone from each of the mayoral authorities. Because of the order in which the Government have done this-removing half the budget from the ICBs, which has caused them to merge in a way that is not coherent with the Government’s not-yet-complete local government reorganisation-we have a situation where representation is not even. For example, in my ICB area the Mayor of Greater Lincolnshire and the Mayor of the East Midlands will each be able to choose someone to represent them on the board, but the proportions of the population are not even. Lincolnshire will be over-represented, which is not an issue for my constituents, but it may be for those from Nottinghamshire and Derbyshire. Likewise, the northern part of Greater Lincolnshire, which is in a different region, has a small population relative to its ICB. Some mayors will therefore have representation that is not proportionate to their population size. There is surely a risk that the next step will be for the Government to say they want to make things more even, with ICBs...
In essence, our amendments 45 and 46 would reinstitute representation on the ICB, so that the people can work together and understand each other’s roles more effectively. We could then get an integrated and joined-up system, rather than a system where the social care people talk to the local authority, which talks to a health and wellbeing board, which passes a message on to the ICB, which makes a decision-perhaps with the approval of the mayor, who might not have any health responsibility-and that decision then goes back down. We all know about Chinese whispers-we all played the game as children-and passing message after message is not as effective as having direct representation on the board. Social care has been put on the back burner by this Government. I do not want to make this a political point, particularly, but we have seen the report taking a long time, and nothing really happening in the meantime. That is very much this Government: they are writing plans, reviews and glossy brochures, but what people need is delivery.
Others will have a lot to say, so I shall take no more time, other than to commend amendments 45 and 46 to the Committee. They would ensure that we have good representation on the ICB, particularly of social care, and that we get a co-ordinated, joined-up and well delivered commissioning process.
We have a few concerns about the clause in general, especially about the removal of local authority and primary care representation on the ICB. Some ICBs are already stepping back from joint commissioning arrangements with social care and the health and wellbeing boards, and it is vital that social care has a seat at the table. We have talked about this extensively in many Committees and in the Chamber, but the Liberal Democrats have been emphatic that we cannot solve any of the problems in the NHS without solving social care. At any given point, our hospital in Winchester certainly has 160 people in it who are well enough or would be better cared for in the community with a social care package; instead, they are stuck in a hospital, obviously affecting flow through the whole hospital and even affecting A&E waiting times. Combined with the changes to the pooled budgets that will affect the better care fund, we are seriously concerned that the Bill is increasingly separating the NHS and social care just at a time when the service and experts are screaming out for greater integration and collaborative working. We discussed GPs this morning. They have long-standing concerns about getting their voice heard, given their unique place in the health system. They are the front gate to the NHS and they have the most patient contact of any NHS service. Removing the duty seems to be a step in the wrong direction in that regard. Finally, the change will leave in limbo areas such as...
The clause will replace the constitutional requirements contained in paragraph 8(2) to (4) of schedule 1B to the 2006 Act so that “ordinary members” must now include at least one member nominated by the mayor of each mayoral strategic authority whose area coincides with or includes the whole or any part of the ICB’s area. The ICB’s constitution must set out a process for making such a nomination, and a mayor nominating an ordinary member must have regard to any guidance published by the Secretary of State, following the abolition of NHS England, as to the selection of candidates. The definition of a local authority in paragraph 8(7) of schedule 1B to the 2006 Act will be replaced with the definition of a mayoral strategic authority. Sub-paragraph (1), outlining the process to determine the appointment of an ordinary member, and sub-paragraph (6), specifying that one ordinary member must have knowledge and experience in mental health services, are both retained. The clause therefore represents a clear shift in the structure of integrated care boards and, in my view, an unwelcome one, by removing the requirement for representation of GPs, local authorities and NHS trusts, while introducing a requirement for representation from mayoral authorities. Those are not minor features of the system. The inclusion of local authorities in particular was designed to ensure that decision making reflected local needs and supported genuine integration between health and social care. For as...
Where a mayor is from one political party and local authorities are run by different political parties, the mayor, as part of the ICB, will be able to make decisions about spending done by authorities that are run by different parties. That will surely create a political conflict, or at least the potential for one.
My hon. Friend makes an interesting point that I had not considered before, but she is absolutely right. The upper-tier authorities and strategic mayors might be from different parties, and, where the mayor does not have an actual responsibility for health, there essentially could be democratic deficit there that I had not thought about. My hon. Friend makes an interesting point. That democratic deficit will potentially be exacerbated in the other half of my constituency, which is in Surrey. As I have already alluded to, the Surrey ICB has taken on Frimley but is also now merging with Sussex. As far as I can tell, the Government have absolutely no plans to introduce a mayoral authority in Surrey; however, my quick googling suggests that there will be a mayoral authority in Sussex in 2028, so the mayor of Sussex could be sitting on a board where there is no representation from the Surrey side. That is a complete democratic deficit. There would be the Surrey and Sussex ICB, with representatives for the people of Sussex but not for the people of Surrey. That must be an unfairness. I hope the Minister, if she cannot answer now, will at least go away and think about how that democratic deficit will be avoided. I suggest that she dumps the whole idea and goes back to having the people who actually run health and social care in our country on the board. That is why I am very supportive of amendments 45 and 46, tabled by my hon. Friend the Member for Sleaford and North Hykeham....
I agree entirely with my hon. Friend the Member for Farnham and Bordon. At risk to my political career, such as it is, I also agree entirely with the hon. Member for Winchester, who made a very good point in drawing the Committee’s attention to something that should not need to be said, which is that the provision of healthcare and social care go hand in hand, and if either part of that equation does not function, the other part will not. He highlighted a good example, and I visited Winchester hospital when I was a Minister. If we do not have a functioning social care system, or a social care system that is closely integrated in and working closely with the NHS, we see the knock-on effects pretty swiftly in terms of the large numbers of people medically fit for discharge who are unable to be discharged, which then impacts on the flow through an acute hospital setting. That is one of the big factors we see in A&E backing up, because people cannot be discharged, people cannot get into beds because the beds are full and then the ambulances are queuing up outside. The hon. Gentleman illustrated that point extremely well.
On the economics, it costs around £850 a night to keep someone in a hospital bed and a fraction of that for a social care package. This is an absolute false economy, even if we ignore patient experience and patient recovery.
The hon. Gentleman is absolutely right from the financial perspective. As he mentioned, there is, of course, the human perspective and the impact on someone’s recovery and their health, as well as their psychological health, if they are in hospital when they simply want to get home, because they have no medical need to be in hospital. My worry about clause 21 is that it essentially seeks to undermine the whole concept that ICBs rest upon. ICBs were conceived to bring together all the NHS services in a particular area, but also, as my hon. Friend the Member for Farnham and Bordon highlighted, to make sure that the NHS footprint mapped on to the geographical footprint of the upper-tier local authority delivering social care, so that the ICB is looking at the same geographical area for the two key parts of the system and they neatly map on to one another. With changes, mergers and acquisitions-as well as a whole range of other changes-that link is already breaking and weakening, as ICBs start covering larger areas and look in different directions. As my hon. Friend the Member for Farnham and Bordon set out, and as I think the hon. Member for Winchester highlighted in an earlier sitting, because we do not know what local government reorganisation will look like in the years to come, we increasingly run the risk of creating something that again will not map on to a geographical footprint and may have to change. In a number of areas-take my area, Leicestershire-we do not have a...
The risk with the changes is, first, that we lose the local authority representation, that link with social care and that voice. As my hon. Friend the Member for Farnham and Bordon, from the Health and Social Care Committee, highlighted, we also lose the voice of those who are actually delivering care in our communities, who are at the coalface and who bring valuable insight to the workings of an integrated care board. The risk that we run, which we sought to mitigate in how the system was originally conceived, is that, once again, an integrated care board becomes essentially a board of NHS management, that looks at things dispassionately but is without that frontline voice-that grit in the oyster, that voice of social care to challenge the decision making within the board. That risks creating a system that moves away from being focused on integration and on those who provide the service and what they see at the frontline, and back towards simply being an internal board of the NHS. There was always going to be an element of the latter, because it is an internal accounting and decision-making mechanism of the NHS, but we felt it was important that there was that alternative voice or voices within it to ensure that it was not simply an echo chamber.
My genuine fear-quite apart from local government reorganisation, the lack of mayoral authorities in some areas and the risk, highlighted by my hon. Friend, that a mayor coming from one part of the system but not reflecting the views of another part of the geography could be the representative-is that we lose the central link between health and social care on a local footprint.
I am listening carefully to what the right hon. Member has to say. I wonder whether he could present us with a concrete example of where precisely elected local government involvement in the commissioning of services in ICBs has been essential, because it seems to me that what an ICB needs is expertise in commissioning. We need people who know how to commission services. Although I understand the importance of representation, I think that what we really need is expertise in commissioning.
I take the hon. Gentleman’s point to a degree, but I would refute a chunk of it. We need within the organisation people who have those technical skills and know how to commission, draw up a specification, put it out to tender, or work out what is needed and ensure that what is delivered reflects what was commissioned and that the performance is what is sought to meet the needs of the local area. At board level, we need representation from local authorities and others, because it sets the strategic direction. The board members are not the people who are going to sit there and write the commissioning document. They will probably approve it, but they are not the experts who will be drafting it. We are talking about two different functions, and I argue that when a board-level decision is being made, we want those voices in the room to ensure that those different perspectives are reflected and there is that critical challenge to what is proposed by the executive directors. We essentially have non-executive directors who are there to challenge, to question-perhaps to agree, but perhaps to push back on things. That is how many boards operate. In what is proposed, we lose some powerful voices from round the table. They may not carry the day, but those voices should be heard. Having sat where the Minister is sitting now, I appreciate that she may not be willing or in a position to accept the amendments, but I hope that she will take away and reflect further on the challenges of...
I absolutely recognise that this is an area of huge interest to hon. Members across the piece. I assure colleagues that officials and I have been working with representatives of the Local Government Association and mayors throughout the development of the Bill and the future architecture, and we will continue to do so. We will continue to have discussions and to make sure we get this right, because it is complex and complicated. Given that we are all politicians, we understand. Many of us have been councillors and local representatives, and have spent a lot of our time-sadly, for officials-knocking on doors, going out and persuading individuals to vote for these people. We understand that it is quite personal and we want to get it right. If I may, I will not take any interventions so that I can address the amendments and our approach to ICB membership. As my hon. Friend the Member for Bury St Edmunds and Stowmarket said, ICBs are commissioners. This is a fundamental shift, which I will come on to, and it is different from the 2022 work. I now want to outline the board membership set out in clause 21, but I think we will be discussing this for some time. Lord Darzi’s review found inconsistency in the roles being undertaken by ICBs and concluded that the health and care system would work better if each organisation had greater clarity and focus on its particular role. That is our starting point, and we set out to do that in the 10-year health plan. In future, all ICBs will...
Amendment proposed : 25, in clause 21, page 15, line 38, at end insert-
“(2A) The constitution must also provide for the ordinary members appointed as mentioned in sub-paragraph (1)(b) to include at least one member nominated jointly by the local authorities whose areas coincide with, or include the whole or any part of, the integrated care board's area.”- (Helen Morgan.)
This amendment would require integrated care boards to have a member jointly nominated by local authorities from within the board's area, as is currently the case but would otherwise be removed by clause 21.
Question put, That the amendment be made.
Amendment proposed : 45, in clause 21, page 15, line 38, at end insert-
“(2A) The constitution must provide for the ordinary members as mentioned in sub-paragraph (1)(b) to include at least one member nominated by local primary care providers.”- (Dr Caroline Johnson.)
This amendment would ensure that ICBs have to have representation from primary care providers.
Question put, That the amendment be made.
Clause 21 ordered to stand part of the Bill.
Ordered, That further consideration be now adjourned. -(Emma Foody.)
Adjourned till Tuesday 30 June at twenty-five minutes past Nine o’clock.
Written evidence reported to the House
HB79 Angela Moreton, Founder, The Full Impact
HB80 Glaukos UK
HB81 National Data Guardian (supplementary)
HB82 Carers UK (supplementary)
HB83 Adam Cooper
HB84 Dr Stephen Watkins