Health and Care Bill, Report Stage, House of Lords, March 2022

• The LGA broadly supports the Bill’s focus on improving the health and wellbeing of the population through greater integration between NHS organisations and between the NHS and local government. We also support the duty on the integrated care board (ICB) and all local authorities within the integrated care system (ICS) to have regard to the integrated care strategy in making decisions.
• We are strongly in favour of the duty to engage with patients, carers and representatives. We have committed to work with the Government, NHS, local government and patient and public voice organisations, to produce clear guidance to support local health and care systems to work in partnership with their communities.
• The LGA strongly supports the requirement for ICBs and local authorities to establish an integrated care partnership (ICP) with responsibility for convening a broad partnership and producing an integrated care strategy. It is good to see recognition of the importance of Health and Wellbeing Boards (HWBs) and the health and wellbeing strategies and joint strategic needs assessment they produce.
• We support the intention of the legislation to give local systems the flexibility to make their own arrangements for joining up services, and setting their own strategies for improving population health, but this means that there is relatively little on the face of the Bill and more emphasis will be on statutory guidance to accompany the legislation. We have already been working with the Government and the NHS on co-branded pieces of guidance, including the Thriving Places pre-implementation guidance for ICSs on working at place level, and the engagement document on establishing ICPs. We are looking forward to continuing to work on joint guidance.
• We support the repeal of legislation related to delayed discharges. This paves the way for the continuation of discharge arrangements which have worked well during the pandemic. The emerging evidence is that going home straight from hospital is what people want. However, the policy is not fully implemented by the NHS and local government because of the ongoing pressures of Covid and the uncertainty over funding. We also need a flexible joint workforce working across health and social care to ensure that people get holistic and person-centred support to regain their independence.
• The provisions for assuring local authorities’ adult social care functions set out a new role for the CQC and the Secretary of State in the review and performance assessment of councils. We are working closely with the CQC, DHSC and other partners to ensure the assurance process is proportionate, includes a clear and continuous role for existing sector-led improvement work, and takes account of the significant financial pressures facing adult social care in their assessments.
• We are concerned that the increase in powers of the Secretary of State to intervene at an earlier stage in NHS reconfiguration proposals will undermine existing local authority health overview and scrutiny powers and corrode local accountability. We are seeking amendments which relate to Schedule 6 of the Bill. These amendments would require the Secretary of State to consult with relevant health overview and scrutiny committees in exercising this power. We’ve defined relevant HOSCs as (a) in relation to an area that coincides with the area of a health overview and scrutiny committee; (b) in relation to an area that may be the whole or part of the area of more than one health overview and scrutiny committee.
• Many provisions in the Bill relate to the practical steps the NHS must take to reorganise governance, staff and budgets. However, it is vital that clinical, professional, political and community leaders at local, system and national level stay focused on the broader and more challenging ambition to work together to improve health and wellbeing and reduce health inequalities, which have widened further during the pandemic.

• The LGA, NHS Confederation, NHS Providers, the King’s Fund and the Centre for Governance and Scrutiny supported an amendment regarding the increased powers for the Secretary of State to intervene earlier in NHS reconfigurations. The amendment proposed that the Secretary of State be required to consult the relevant health overview and scrutiny committees and all relevant NHS organisations in exercising this power. The amendment was tabled by Baroness Cumberlege (Conservative) in the Lords Committee Stage on 26 January but was withdrawn after discussion in which Lord Stevens (Crossbench), Lord Howarth (Labour) and Lord Shipley (Liberal Democrat), Lord Patel (Crossbench), Baroness Walmsley (Liberal Democrat) and Baroness Thornton (Labour) all spoke in favour of the amendment.
• Lord Kamall, Parliamentary Under-Secretary of State for the Department of Health and Social Care, gave the following commitment with regard to the amendments: “I have heard what a number of noble Lords have said, especially former Ministers, Secretaries of State and others involved in the system, and it is quite clear that I need to go back and consult further. In that spirit, I ask that noble Lords do not move their amendments, and hope that I have explained the reasons why.” We are continuing to seek support for this amendment at the Report Stage in the House of Lords.

Laura Johnson, Public Affairs and Campaigns Adviser

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