Rachael Maskell

The national must determine the “what”, and bringing NHS England into the Department is therefore the right decision. However, as many Members have said today, it is the “how”—how we do this at a local level—that determines the outcomes we see. Given the huge inequalities in our constituencies, which we have all spoken about today, the question of how we deliver, in particular, the third shift to prevention, is really important. The right integration, the right systems and the right focus will bring our health service together at a local level. I agree that the accountability processes are not in the right place under the Bill, and I agree with the hon. Member for Runnymede and Weybridge (Dr Spencer) about the need to ensure that we in this place have that connection to the national and the local, while also integrating with those held publicly accountable in our councils and combined authorities. But the focus also needs to be there. It is because there is no coterminosity between commissioners and providers that people are looking in both directions in trying to bring about a system that cannot have the capacity to deliver in such ways. We need to see that bringing together of services to focus on a “population health” approach, but the Bill does not do that. We need to think about what the outcomes that we want to see. I have lived through so many reorganisations, and I know that it is not reorganisations that ever deliver the satisfaction outcome. Given that ICBs have now been stripped back to such an extent—unable to communicate with us, as MPs, and not having the resources to make decisions—I fear that that delivering the “how” will become harder under this model. However, we also need to ensure that local accountability comes from our communities—and that leads me to the issue of healthwatch. What we called community health councils were abolished in 2003. We replaced them with public and patient involvement forums, and replaced those with local involvement networks and then with healthwatch, which is soon to be scrapped. If it did not exist, we would invent it, because it has the independence that the new structures do not have, giving patients and people confidence in a system that enables them to raise their voices, and to be sure that their voices will be heard and systems will be held to account. I therefore oppose clauses 64 and 65, with the respective schedules 9 and 10, and ask the Government to reconsider and also to take on board the questions that have been raised about the systems that make it possible to hold investigations. HSSIB has done that well, and I think that its role should continue. Given what has happened over a decade of raising concern in the House, I welcome the commitment of the former Secretary of State, my right hon. Friend the Member for Ilford North (Wes Streeting), to a public inquiry, but we do not have a chair and we do not have terms of reference. It is therefore really important that we put in place the right structures to hold the system to account.