Health and Care Bill, Committee Stage, House of Lords, 11 January 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. As such, we support amendments 179, 180, 181, 182 and 183, tabled by Baroness Cumberlege (Conservative), 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.

Amendments 179, 180, 181, 182 and 183, tabled by Baroness Cumberlege (Conservative) would require the Secretary of State to consult with relevant health overview and scrutiny committees when exercising the power of intervening at an earlier stage in NHS reconfiguration proposals. Relevant HOSCs are defined as (a) in relation to an area that coincides with the area of a Health Overview & Scrutiny Committee; (b) in relation to an area that may be the whole or part of the area of more than one Health Overview & Scrutiny Committee.

LGA view

• The LGA supports this amendment as it reflects our concerns that the increase in powers of the Secretary of State to call in NHS reconfiguration proposals will undermine existing local authority health overview and scrutiny powers and corrode local accountability.

• There is already a clear process for reviewing proposals for NHS reconfigurations, which is routed in local accountability, through health overview and scrutiny processes to assess whether proposals are in the best interests of local communities. Moreover, they operate these powers in consultation with local people. Local authorities are able to refer such cases to the Secretary of State, but the best option is for cases to be resolved as close as possible to the communities they represent.

• There has been no strong call to enable the Secretary of State to intervene earlier in the process. As highlighted above, the current legislation already has a clear role for the Secretary of State in cases that are referred.  Short-circuiting this process risks bypassing the existing local process.

• A key objective of the Health and Care Bill is to increase transparency and accountability. We support this aim but it does not align with the Government’s approach to accountability. Almost all the measures in the Bill to improve accountability focus on accountability upwards through Parliament and the Government. While accountability to the Government and to Parliament is important, so is local accountability to local communities and their elected representatives in local councils. There is a risk that in operating this new power, the Secretary of State, will reduce rather than increase local accountability.

Amendment 98 tabled by Baroness Tyler of Enfield (Liberal Democrat) would require the Secretary of State to lay regulations before Parliament which provide formal guidance on how the Integrated Care Board must perform its existing duty as a statutory safeguarding partner, building on statutory guidance in Working together to safeguard children (2018).

LGA view

• The LGA supports this amendment.

• New multi-agency safeguarding arrangements for children were introduced by the Children and Social Work Act 2017, which abolished local safeguarding children boards (LSCBs) and introduced the concept of three statutory safeguarding partners – local government, the police and health services.
• In Sir Alan Wood’s review of the implementation of these arrangements, published in May 2021, Sir Alan commented on the challenge posed by the reorganisation of Clinical Commissioning Groups (CCGs) into Integrated Care Services (ICS) and argued “It will be essential for clear guidance to be given to ICS about the role of the safeguarding partner and the ICS role in local safeguarding partnerships.”

• This recommendation built on concerns raised by councils around issues such as data sharing and representation of partner agencies on multi-agency safeguarding arrangements in some areas. For example, in some areas, concerns have been raised about the seniority of health and police representatives and therefore their authority to take decisions on behalf of their organisations.

• This proposed amendment to the Bill will help to deliver Sir Alan’s recommendation. This is particularly important given that ICSs and ICBs will cover a larger geographical area – and therefore likely more safeguarding arrangements - than CCGs; it will need to be clear how the lead safeguarding partner role will be delegated effectively to ensure appropriate engagement in multi-agency safeguarding arrangements.

Amendment 151 tabled by Baroness Tyler of Enfield (Liberal Democrat) would require an integrated care partnership to specifically consider the needs of babies, children and young people when developing its strategy.

LGA view

• The LGA supports this amendment. There are currently some significant challenges in the area of children’s health, for example significant waiting lists for children’s mental health services, and councils are concerned that without dedicated children’s representatives on Integrated Care Boards, such challenges may not be given the priority they require.
• There are some examples of good practice emerging, which is positive. However this amendment would helpfully ensure that the specific needs of babies, children and young people are explicitly considered by all integrated care partnerships.

Amendment 269 tabled by Lord Young of Cookham (Conservative) aims to ensure that before a patient is discharged from hospital into the care of a young person, the relevant local authority ensures that this is appropriate.

LGA view

• The LGA supports this amendment. Young carers do an amazing job but it is vital we do not ask them to provide a level of support that impinges on their wellbeing or is beyond their capability. It is also vital that the presence of a young carer does not limit access to services a patient may otherwise be entitled to.

The LGA has repeatedly raised concerns about the financial challenges facing children’s social care, with cost pressures of £0.6 billion each year on top of existing pressures worth £1 billion. If this amendment were passed, it is vital that children’s social care departments are adequately funded to fulfil this responsibility and provide the support that young carers need.

Amendment 174 by Baroness Hollins (Crossbench) would require the Secretary of State to publish, at least once annually, a report describing the system in place, and progress made, to bring about parity in pay between the health and social care workforces.

LGA view

• While much of the recent white paper’s ambition for the care workforce is to be welcomed, it will not hang together cohesively without proper action on pay. The white paper’s reference to the National Living Wage does not answer the pay question because it will not allow the sector to become competitive with the NHS and other key employers. Indeed, it could exacerbate existing difficulties with recruitment and retention.

• Without meaningful transformation on pay, many of the ideas put forward in the white paper (such as the knowledge and skills framework) will be hard to deliver because people will have no guarantee of increased pay and reward for their increased skills and may therefore continue to use social care as a stepping-stone to the NHS or other opportunities outside of the sector.

• We have long argued that the social care workforce must be developed in a manner equivalent to the NHS as part of a stable, sustainable solution to long-term funding problems and that this must involve parity of esteem for social care staff with their NHS colleagues. Any changes to pay and reward must be fully funded by central government as there is no resource in the sector to meet the demands of this challenge. It would be important to assess the best form of comparison with the NHS on basic pay and resulting costs as overall costs could be in the region of £1 billion to £2 billion.