Contribution
It is a real pleasure to follow the hon. Member for Glasgow South West (Dr Ahmed). I did not agree with everything in his speech, but I know of his passion for NHS services and I am grateful for the work that he did as a Minister, particularly in helping me to advocate for my constituents, which I will come to in the main part of my speech. I should start with the standard declarations: I am a former NHS doctor and my wife is a current NHS doctor.
There is a lot of good and very reasonable stuff in this Bill. I very much support the abolition of NHS England and I am glad that is being taken forward. The single care record makes complete sense. It is pretty crazy that we do not already have a national system in place. I think there will be some speed bumps in terms of administration, and the question I have is this: how is it going to encode sex data? What data is the record going to use as sex data, given the problems and the discussion that we had just before this debate?
For me, the problem is about accountability. I have a local integrated care board. I also have NHS trusts, one of which is Surrey and Borders, which has been failing to deliver rapid, timely autism spectrum disorder and attention deficit hyperactivity disorder assessments for children. Frankly, that failure to provide a speedy assessment for ASD or ADHD locally is a disgrace. I have been putting pressure on my local trust to try to change that. My constituents expect me to do that. Some of my constituents expect me, as an MP, to be able to click my fingers to make this happen, but of course I cannot do that because this is the NHS trust, the chief executive and the ICB.
I raised this issue in Parliament with the then Secretary of State, asking him to investigate my local mental health trust and look at the failings, and I am grateful that the then Minister, the hon. Member for Glasgow South West, responded to me and wrote to my ICB. The response I got was that this was within the ICB’s framework, and that what ICBs do is essentially up to them. My ability to go about changing this is therefore very limited.
I get the point about clause 11 and the Secretary of State taking a few more powers to direct ICBs, but that is a very blunt tool. In reality, it will not be accountability. I cannot quite believe that it will work in such a way that, if I raise something in Parliament, a directive will force my ICB to deliver better for my patients. I cannot quite see that that will happen in reality—or perhaps I am wrong and it will. In that case, Parliament will essentially become a forum for MPs—all of whose constituents will expect them to be able to give directives to our NHS trusts and ICBs—to raise these issues so that the Secretary of State can take forward a directive.
It would be far better if ICBs were directly accountable to local politicians. I heard the response that the plan is for ICBs to be accountable to mayors, but we do not have a mayor in Surrey and, even though many of us have been calling for a mayor, there is no timescale for getting one. ICBs need to be directly accountable to locally elected representatives in some way, shape or form, and the logical group is Members of Parliament, because that is what the public believe and expect. I hope that, as the Bill goes through, we will investigate the local accountability of ICBs in the NHS and that perception.
One of the biggest dangers is the sense that we, as MPs, can deliver direct changes in day-to-day clinical commissioning, from which, of course, we have a degree of distance. I reiterate that, at the moment, the public perspective and public belief is that that is what we are empowered to do. We therefore have to be empowered to do that, or we have to have mechanisms to make it clear to people that local NHS care is not in the direct control of myself or anyone else here, apart from Ministers on the Front Bench.
Patient groups are an important mechanism, but they are also important in terms of consultation. I worry about what will happen when ICBs consult on plans. What is the number? What is the survey? What is the metric? Who is appointing the ICB chair? Who is appointing the NHS foundation trust chair? Who is appointing the members of all these quangos? Where do democratically elected representatives sit in these appointment decisions?
Given the time limit, I will finish on this point. Accountability is critical in getting this right. Care models need accountability. I have raised this matter in Parliament for many years now. I hope that we can use the Bill as an opportunity to give our constituents the accountability they need and deserve in the delivery of local health care.