Health and Care Bill, Consideration of Lords amendments, House of Commons, 30 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.


Key messages

  • 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 therefore urge the Government to ensure the statutory guidance on Secretary of State powers includes the requirement that the Secretary of State should carry out these powers in consultation with all relevant local authorities and health bodies affected by the reconfiguration proposal. We also call on the Government to work closely with the LGA, organisations representing the NHS and the Centre for Governance and Scrutiny in drafting the statutory guidance to support the legislation to ensure that the Secretary of State undertakes this new power in consultation with local government and NHS leaders.
  • 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.

Further information

Amendment statements

Removal of Secretary of State powers to intervene in on NHS reconfiguration

Amendment 108, to leave out Schedule 6. The Government disagrees with the Lords in their Amendment.

LGA view

  • We are concerned 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.
     
  • At Committee Stage in the House of Lords, Lord Kamall, Parliamentary Under-Secretary of State for the Department of Health and Social Care, gave reassurances regarding the Secretary of State’s powers in regards to NHS reconfiguration. The Minister said “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 urge the Government to ensure the statutory guidance on Secretary of State powers includes the requirement that the Secretary of State should carry out these powers in consultation with all relevant local authorities and health bodies affected by the reconfiguration proposal.
     
  • We also call on the Government to work closely with the LGA, organisations representing the NHS and the Centre for Governance and Scrutiny in drafting the statutory guidance to support the legislation to ensure that the Secretary of State undertakes this new power in consultation with local government and NHS leaders.

Needs of children and ICPs

Amendment 22 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.

Licensing of cosmetic procedures

Amendment 84, on the licensing of cosmetic procedures.

LGA view

  • The LGA agrees that cosmetic procedures should be undertaken by trained professionals in appropriately regulated premises. A licensing regime is one way of achieving this, however, we would like to see consideration of how a licensing regime would intersect with existing frameworks that already oversee medical professionals who may be undertaking these procedures and who the appropriate organisation to oversee them is.
     
  • It is also important to recognise the significant capacity issues within local regulatory services, and the existing challenges they face in meeting current statutory duties. If councils are given responsibility for a new licensing regime any new burdens would need to be fully funded and authorities supported to implement the new regime, particularly given the potentially specialist nature of cosmetic procedure licensing. This would need to include upfront funding to set up the new scheme, fully funded training for inspectors and guidance on inspections, as well as measures to ensure there is sufficient professional capacity to oversee this licensing regime.
     
  • Given these issues, it is important that councils are consulted on any regulations associated with this amendment.

Care worker pay

Amendment 29 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.
     
  • The Association of Directors of Adult Social Services (ADASS), Care Provider Alliance (CPA), Care and Support Alliance (CSA), Local Government Association (LGA), Skills for Care, Social Care Institute for Excellence (SCIE) and Think Local Act Personal (TLAP) recently published a report calling for a co-produced, national workforce strategy alongside action to improve terms and conditions.