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Health and Social Care Act 2012

Volume 792: debated on Thursday 5 July 2018


Asked by

To ask Her Majesty’s Government, in the light of the Prime Minister’s criticism of the regulatory framework established under the Health and Social Care Act 2012, what plans they have, if any, to bring forward measures to amend or repeal that Act.

My Lords, the Government have announced a five-year funding settlement, and we have asked the NHS to develop a 10-year plan to transform health and care. As my right honourable friend the Prime Minister said, as it develops its plan we will listen to the NHS about whether there are any barriers created by legislation. We will consider, after that, what changes may be needed.

My Lords, in her speech on 18 June the Prime Minister referred to chief executives of NHS organisations having to make so many reports to different regulators that they have no time to improve their own organisation, and to a typical clinical commissioning group having to agree 200 contracts with other parts of the NHS. Is not the answer to the first question from the noble Lord, Lord Hamilton, that the NHS, employing 1.3 million, is not hard to manage, but the fact is that the Government have bequeathed to it an organisational structure that is dysfunctional and costs billions of pounds? If he really wants to help the NHS, will the Minister not come forward with a Bill to repeal the Health and Care Act 2012?

My Lords, since the 2012 Act was passed, there have been some significant improvements in NHS performance, not least in cancer outcomes, for example. There are also around 42,000 more staff since 2010. So improvements have clearly been able to happen within the legal framework set by Parliament in 2012. Nevertheless, we recognise that as the service is required to become more integrated and people across different care functions are required to work together, we need to look at the structure. There is already joint working, for example, between NHS England and NHS Improvement at the regional level. But if the NHS identifies any barriers, we will look at those.

My Lords, when we are looking at the structure, which is clearly important, can we also look at priorities within the National Health Service? I heard this morning that certain treatments and unnecessary medicines are to be ruled out. Can we have a comprehensive list of those? It is not right that dandruff shampoo should be on prescription. It is not right that we should be looking at funding the treatment of gaming machine addiction. Can we have a real look at the priorities?

My noble friend makes a very important point, which is that as we move ahead, even with the funding settlement, it is essential that the NHS becomes more productive. That means looking at whether there are medicines or treatments that are no longer producing the outcomes it was suggested that they would and taking those out of service. It is very important to state that this has to be a clinically led process. We have already begun that with certain low-value prescriptions. NHS England is now leading that process—as I say, it is clinically led—to look at whether there are other treatments that could be discontinued.

My Lords, what does the Minister make of the poll that showed that 66% of British people would be prepared to pay more for the provision of the National Health Service? What is his view on a hypothecated tax to meet those needs?

I am sure that the Chancellor will have taken that view on board and he will reveal his decisions in the Budget.

My Lords, have the Government made any estimates of the cost of the extensive and in some cases overintrusive regulatory system? The Minister has rightly said that the Government are looking for savings in the NHS. Surely this is an area where savings can be made, as well as that of questionable surgical procedures.

That is one of the areas we need to look at to make sure that there is proper regulatory reform. It does not necessarily require legislation, primary or secondary. There are actually fewer managers in the NHS today than in 2010. We have tried to transfer responsibility to clinical staff. But if the NHS identifies any barriers, we are committed to looking at them.

My Lords, the Minister has referred to the NHS five-year plan, but does he agree that that plan is worthless without a clear proposal for social care funding in the future, including on how the NHS and social care can fully integrate?

I absolutely agree with the noble Baroness that they have to go hand in glove. That is why the Green Paper has been delayed, so that it can co-ordinate properly with the NHS plan. It is also important to point out that the Prime Minister was very clear in her announcement that, as a result of the settlement on social care, there would be no further pressures on the NHS.

As we are looking for savings in the National Health Service, perhaps my noble friend can explain why the National Health Service does not reclaim crutches, Zimmer frames, moon boots, et cetera. Even wheelchairs are found in the attics of deceased former patients. There must be quite a reserve in your Lordships’ attics, which would be very helpful.

I could not possibly comment on the latter point. My noble friend makes an important point. Of course it is right to be judicious with the use of these kinds of products. However, they are sometimes damaged in use and are not always reliable, which is one reason they cannot always be reclaimed and reused.

My Lords, we should first congratulate and celebrate the establishment of the first NHS hospital at Park Hospital, now Trafford General Hospital, in Greater Manchester. But we should also have concern that the devolution deal for health and social care for Greater Manchester is being impeded because of the Health and Social Care Act. What changes would the Minister recommend to ensure that the ambitions of the devolution deal to integrate health and social care and physical and mental health are progressed as rapidly as possible?

I join the noble Lord in congratulating Trafford General Hospital. I think that one of my colleagues is there today, unveiling a plaque. I am grateful to him also for raising the devo deal for Greater Manchester. It is a very important deal that goes further than any other in the area of health and social care. If it is the case that it is impeded by the Act—and I do not think that that is necessarily a given—I would say that the changes that need to be made ought to be promoted and proposed by Greater Manchester and by the clinicians themselves. That is exactly the sort of thing that the Prime Minister has asked for.

My Lords, perhaps I may pursue the question asked by the noble Baroness, Lady Blackstone, to which the Minister responded, “Yes, we need to look at regulation”. The Minister knows that GPs are leaving the service at an unprecedented rate, and a large part of the reason for that is the regulatory burden. Will he make a commitment to undertake a full investigation of the regulatory burden on NHS staff, with the terms of reference being to reduce that burden?

I agree with the noble Baroness about the importance of bolstering our GP workforce—that is one thing we are absolutely focused on. It is part of the five-year forward view and clearly of the long-term plan as well. I will identify one area where we are trying to make a big difference, which is indemnity insurance. We know that this has been a financial burden on GPs and we are looking at creating a state-funded scheme to provide reassurance. This is just one way in which GPs are looking for support from government.