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Health and Social Care Bill - Schedule 4 - Integrated Care System: Minor and Consequential Amendments
22 November 2021
Lead MP
Mary Foy
Debate Type
Bill Debate
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Other Contributors: 92
At a Glance
Mary Foy raised concerns about health and social care bill - schedule 4 - integrated care system: minor and consequential amendments in the House of Commons. Other MPs contributed to the debate.
How the Debate Unfolded
MPs spoke in turn to share their views and ask questions. Here's what each person said:
Lead Contributor
Opened the debate
I beg to move, That the clause be read a Second time. This amendment aims to make minor and consequential changes to the Integrated Care System provisions in the Health and Social Care Bill to ensure they are workable and effective. It includes adjustments that will clarify roles and responsibilities within the integrated care system, ensuring better collaboration between health and social care providers.
Mary Foy
Lab
City of Durham
The amendment is necessary to address gaps in the current provisions that may hinder the effective implementation of integrated care systems. It includes measures such as updating definitions and clarifying inter-agency responsibilities.
Catherine West
Lab
Hornsey and Friern Barnet
Asked if spending 0.5% of GDP on health inequalities aligns with Professor Marmot’s work, indicating support for addressing social and health inequalities.
Agreed that stopping younger generations from taking up smoking is key. Believes proposals will help achieve this strategic aim.
Acknowledged measures apply to England but noted they will have an effect throughout the UK, including helping towards a smoke-free Wales goal.
Called this one of the most important new clauses and highlighted tobacco companies' recruitment tactics for younger smokers as indefensible.
Jim Shannon
DUP
Strangford
Supported with statistics showing two-thirds of smokers start before 18, over a third under 16. Emphasised need for legislation and punishment to address this.
Janet Daby
Lab
Lewisham East
Agreed that prevention is better than cure, citing the difficulty many adult smokers face when trying to quit.
Paula Barker
Lab
Liverpool Wavertree
Pointed out that vulnerable children and those in care often start smoking early, questioning why the Government opposes supporting these measures.
Greg Smith
Con
Mid Buckinghamshire
The amendments in my name seek to rectify an unfairness by ensuring broadcasters are treated the same as online platforms. Broadcasters will have to pre-clear any advertising that is put on their platform and face harsh penalties, including revocation of broadcast licence. By contrast, although the Bill puts significant restrictions on online platforms, they are not subject to the same stringent requirements. This is important because recent evidence shows that online influencers flout rules, and regulators appear powerless to hold them accountable as they would for traditional media.
Barry Gardiner
Lab
Brent West
He supports the argument made by Greg Smith that there is a disparity between online advertisers and broadcaster advertisers. He suggests that if restrictions on broadcasting advertisements to children are implemented, similar restrictions should also apply to online advertisements.
Alun Cairns
Con
Bristol North West
He supports the argument presented by Greg Smith and suggests that while there is a genuine obesity crisis among young people, the focus should be on evidence-based approaches rather than high-profile publicity efforts.
Karen Bradley
Con
Staffordshire Moorlands
She agrees with Greg Smith's points and emphasises that responsible broadcasters should not be penalised when they are doing the right thing. She recognises the need for cross-Government approaches to manage issues in the online space.
Asked about private companies' involvement in integrated care organisations under the Bill.
Barry Gardiner
Lab
Brent West
Confirmed that approximately 5.6 million people are on NHS waiting lists and questioned what measures in the Bill could help this situation.
Suggested that the shadow minister should be even more concerned about longer waiting times for his Welsh constituents compared to those in England.
Bury South
Agreed that alcoholic drinks lack important health information and suggested that the amendment could address this disparity with energy drink labelling.
Highlighted the issue of added sugars in processed foods and proposed a tax on such products to reduce waiting times and improve public health.
Jim Shannon
DUP
Strangford
Suggested that taxing added sugar could help control the rise in type 2 diabetes cases observed during the pandemic.
Catherine West
Lab
Hornsey and Friern Barnet
Argued for a holistic approach to health, including prescribing exercise such as swimming to improve national health outcomes.
Richard Fuller
Con
North Bedfordshire
Asked the shadow minister if he would be willing to support his new clause in case of a vote.
Central Ayrshire
Intervened to point out that brands cannot be separated from the products they advertise, particularly in promoting certain types of food and drink.
Jim Shannon
DUP
Strangford
Asked whether new clause 14 can address the rising numbers of diabetics and children with obesity. Suggested that further measures might be needed to tackle these issues.
Central Ayrshire
She supports new clauses 2 to 4, which aim to strengthen health warnings on tobacco products; new clauses 6 to 10, which seek regulation of tobacco pricing; and new clause 15, which would mandate clearer labelling of alcohol units. She also supports the inclusion of alcohol as a less healthy food under advertising regulations (amendments 11 to 13). Her arguments include the need for public health measures to prevent disease and reduce healthcare costs, citing statistics on smoking-related diseases such as chronic obstructive airway disease, vascular dementia, strokes, heart attacks, and various cancers. She emphasises that stopping smoking is beneficial but many people require support from smoking cessation services which have been cut due to austerity measures. Additionally, she supports new clause 17 for minimum unit pricing of alcohol based on the success seen in Scotland where alcohol sales fell by over 7% compared with a continued rise in England and Wales.
Barry Gardiner
Lab
Brent West
Committed to the hon. Lady's comments, highlighting the diminishing success of smoking cessation services due to austerity measures which have reduced funding for these critical public health initiatives.
Bury South
Agrees that alcohol dependency should be seen as a medical issue rather than a personal choice and advocates for national conversations to destigmatize addiction.
Catherine West
Lab
Hornsey and Friern Barnet
Supports the hon. Lady's comments on new clause 30, emphasising that cuts to local government funding have led to increased alcohol-related deaths post-covid.
Arfon
Expresses hope for discussion on new clause 30, stressing that drug abuse is an illness and a social ill that requires harm reduction strategies.
Bob Blackman
Con
Harrow East
Suggests a polluter pays levy as a new source of funding, estimating it could raise £700 million in the first year alone. Emphasises that not only can measures be implemented but they must also be funded. Mentions the need to consider raising the age of sale and tougher regulation to address issues such as smoking among young adults and women during pregnancy.
Peter Dowd
Lab
Bootle
Responds to Bob Blackman's speech by highlighting that in 2015, the cost to the NHS of smoking was £2.6 billion, emphasising that investing in smoking cessation is money well spent.
Agrees with Bob Blackman's argument and suggests an interrelationship between alcohol dependency and smoking, stating that reducing people’s inhibitions through alcohol makes it more likely they will smoke. Proposes a culture of moderation in alcohol to improve the situation.
Geraint Davies
Lab
Carmarthen West and South Pembrokeshire
Davies emphasises the critical public health issue of air pollution, contributing to thousands of deaths annually. He supports a ban on wood-burning stoves, which significantly contribute to PM2.5 emissions. Davies also criticises advertising for its persuasive power over consumer choices and highlights the link between reduced government funding and increased consumption of alcohol and smoking. He advocates for better farming practices that enhance the nutritional value of foods and raises awareness about the high cost of diabetes related to added sugar.
Bury South
Wakeford supports amendments 11, 12, 13 and new clauses 15 and 16. He argues that alcohol is a silent killer causing significant harm to individuals, families, and wider society. He highlights the lack of restrictions on alcohol advertising compared to less healthy products and calls for clearer labelling and better treatment services for those with alcohol dependence.
John Stevenson
Con
Carlisle
Supports the proposed amendments, stating they would ensure a level playing field for competition between retailers’ and manufacturers’ products. Argues that the current criteria based on UK employee numbers could be unfair to UK businesses, potentially leading them to divert manufacturing abroad. Proposes using turnover as an additional criterion for exemptions.
Catherine West
Lab
Hornsey and Friern Barnet
Questions whether the Bill addresses exercise prescriptions alongside dietary measures. Expresses concern about declining rates of children's swimming skills, suggesting that a comprehensive approach to childhood obesity should include both diet and physical activity.
John Stevenson
Con
Carlisle
Acknowledges the Government’s measures but seeks reassurance regarding the definition of small and medium-sized enterprises exempt from advertising restrictions. Supports the principle that regulations should be proportionate to the scale of the problem.
Richard Fuller
Con
North East Bedfordshire
Views the proposed legislation as an overreach by the state into personal and family choices. Argues that such measures should be debated more thoroughly before implementation, drawing comparisons to other contentious issues like water fluoridation.
Julian Lewis
Con
New Forest East
Questions the appropriateness of introducing significant changes towards the end of a lengthy bill. Suggests that controversial measures should be debated more openly and comprehensively before legislative enactment.
John Hayes
Con
South Holland and The Deepings
Critiques what he perceives as the paradox of excessive state intervention in minor lifestyle choices while allowing broader societal issues to go unchecked, suggesting inconsistency between regulatory approaches.
Highlights potential inconsistencies between television and online advertising regulations. Urges for a consistent approach that could be refined during the bill’s passage through Parliament, maintaining an open mind to improvements.
Greg Smith
Con
Mid Buckinghamshire
Commits to further consideration of his amendments on liability for online advertisements. Encourages thorough consultation with broadcasters and industry experts to address potential loopholes in the legislation.
Richard Fuller
Con
North Bedfordshire
Requests a meeting to continue discussing improvements that could be made to the bill, particularly focusing on industry-led alternatives to state intervention.
Bury South
Advocates for treating alcohol addiction as a mental health issue and seeks commitment from the Minister to address mental health funding to support such an approach.
Mary Foy
Lab
City of Durham
Begged to ask leave to withdraw the clause, indicating opposition to it.
Edward Argar
Con
Melton and Syston
Moved that the clause be read a Second time, indicating support for its inclusion in the bill.
Damian Green
Con
Ashford
Mr Green intervened to ask for an impact assessment detailing figures related to possible losses and gains, highlighting the importance of addressing distributional issues.
John Baron
Con
Not specified
Expressed concern about the distribution of relative losses affecting those who are less well off.
Barbara Keeley
Lab
Worsley and Eccles South
Criticised the proposal for disproportionately benefiting those with greater assets and questioned its fairness. Also raised concerns about local government financing impacts.
Catherine West
Lab
Hornsey and Friern Barnet
Asked why the Government was moving away from previous recommendations of Mr Dilnot, highlighting a lack of adherence to independent assessments.
John Redwood
Con
Wokingham
Defended the proposal as making up only a small minority of total costs and raised concerns about hotel costs not being addressed in current proposals.
Bob Neill
Con
Croydon South
Asked for assurances regarding local government financing impacts and requested an impact assessment before finalising the Bill.
Jon Ashworth
Lab
Delyn
Called for clarification on changes from previous positions, highlighting inconsistencies with earlier documents and questioning fairness of the proposal.
Matthew Hancock
Con
West Suffolk
Defended the new package as fairer and more comprehensive than previous proposals, including costs for domiciliary care which were not previously included.
Karin Smyth
Lab
Bristol South
Expressed dissatisfaction with lack of mention in Committee stages and questioned timing and thoroughness of legislative process.
Paul Bristow
Con
Not specified
Defended the proposal as part of a journey to tackle social care issues, acknowledging it may not be perfect but is a significant step forward.
Philip Dunne
Con
West Worcestershire
Clarified that domiciliary care costs were included under new proposals which was previously absent from Dilnot’s original recommendation.
Kevin Hollinrake
Con
Thirsk and Malton
Questioned fairness of the proposal, particularly for those with modest assets who would never reach the cap under new proposals.
Mel Stride
Con
Central Devon
Asked specific questions regarding benefits and fairness under proposed changes.
Paula Barker
Lab
Liverpool Wavertree
Called for local authorities to have seats on Integrated Care Boards (ICBs).
Liz Kendall
Lab
Leicester West
Questioned fairness and benefits of proposed changes, particularly for those with modest assets.
Charles Walker
Con
Broxbourne
Proposed changing references to 'health' in the Bill to 'physical and mental health'.
No extracted contribution text available for this contributor yet.
Mike Amesbury
Lab
Weaver Vale
Criticised the proposal as 'Robin Hood in reverse' and urged Conservative MPs to vote against it.
Barbara Keeley
Lab
Worsley and Eccles South
Described the social care cap amendment as grossly unfair, highlighting that 34% of people with dementia would reach the cap under Sir Andrew Dilnot’s original proposals but only 15% would do so now. Emphasised the exclusion of working-age adults and those with disabilities from protection.
Alison McGovern
Lab
Birkenhead
Compared the proposal to a tax exacerbating regional inequalities rather than addressing them, particularly affecting constituencies where house prices have not risen as rapidly as in wealthier areas.
Barry Gardiner
Lab
Brent North
Asked Madders whether the Prime Minister is being dishonest about his promise to prevent people from having to sell their homes for care costs, given the current proposal.
John Redwood
Con
Wokingham
Expresses support for Jeremy Hunt's amendment, acknowledging his previous work as Secretary of State to emphasise the importance of this issue.
Edward Argar
Con
Melton and Syston
Gratefully acknowledges the support from John Redwood and confirms that the Government is also in agreement with Jeremy Hunt's amendment, indicating their intention to accept it.
Kevin Hollinrake
Con
Thirsk and Malton
Invites Jeremy Hunt to share his views on new clause 49 after the acceptance of amendment 114, showing interest in further discussions.
Raises concerns about new clause 49's complexity and the Government's last-minute introduction. Criticises the social care policy for exacerbating wealth disparities, particularly affecting areas with lower house values. Emphasises the Scottish model of free personal care as an investment in people’s independence. Argues that funding from increased national insurance contributions will disproportionately affect low-paid workers and should be directed towards social care, not just the NHS.
Newton Abbot
Proposes new clause 33 and amendments to address domestic abuse, mental health parity, access to approved medicines, and research. Argues that without proactive strategies by ICBs, domestic abuse will continue to go unnoticed for years despite multiple visits to healthcare providers. Emphasises the need for detailed measures to compare physical and mental health inputs and outputs to achieve parity of esteem. Proposes amendments to ensure equitable access to NICE-approved medicines across different formularies. Also advocates for research infrastructure within ICBs and hospital trusts to accelerate clinical trials.
Jon Ashworth
Lab
Leicester South
Expresses support for Anne Marie Morris's proposals, particularly highlighting the importance of ensuring domestic abuse victims receive the necessary support through proactive strategies by ICBs.
Rob Roberts
Lab
Dulwich and West Norwood
Supports the proposal to include an obligation for research in healthcare institutions. Declares a personal interest as his partner is a clinical research nurse, understanding the challenges faced in finding patients for studies. Argues that Anne Marie Morris's amendment 17 could revolutionise medical research by making patient recruitment more efficient.
Wirral West
Ms Margaret Greenwood is concerned about the influence of private companies in NHS decision-making processes and proposes amendments to ensure that integrated care boards are made up only of public sector representatives. She also raises concerns about the Bill's provisions for procurement reforms, which she believes facilitate privatization without proper oversight.
Diane Abbott
Ind
Hackney North and Stoke Newington
Ms Diane Abbott agrees with Ms Margaret Greenwood that the Health and Care Bill is akin to an NHS corporate takeover, with concerns over contracts being awarded to private companies through a 'VIP lane' and the potential for private corporations to sit on local health boards.
Peter Dowd
Lab
Bootle
Mr. Dowd supports his amendments to ensure that everyday wellbeing, self-care for minor ailments, and the management of long-term conditions are integrated into local health systems. He emphasises the importance of community pharmacists in providing advice on treatments and self-care techniques, advocating for a more structured approach to self-care after the pandemic.
Gosport
She supports the clause as it increases the threshold above which people must meet the full cost of their care from £23,000 to £100,000 and includes domiciliary care. She acknowledges financial and geographical inequalities but believes that this measure will protect more people compared to previous systems.
Daisy Cooper
Lib Dem
St Albans
The speaker opposes the clause, arguing it does not integrate health and social care services properly. She criticises the timing of its introduction during a controversy period and highlights the lack of attention to unpaid carers and NHS/Social Care workforce issues.
The speaker supports her amendment 102 which requires integrated care boards to address the needs of victims of domestic abuse. She believes it will ensure every part of the state is pulling in the same direction on such issues.
Clapham and Brixton Hill
Raises concerns about the privatisation of NHS, waiting lists doubling since 2010, health inequalities widening over time. Supports data collection on health inequalities to drive policy changes.
Charles Walker
Con
unknown constituency
Tabled a series of amendments asking the Government to change general references to 'health' to 'mental health and physical health'. Argues this is important for recruitment of mental health nurses, psychiatrists, and overall healthcare policy.
Karin Smyth
Lab
Bristol South
Supports the banishment of competition as an organising principle in NHS. Tables two amendments focusing on palliative care and local improvement finance trusts, urging for a good governance commission to avoid cronyism.
David Simmonds
Con
Ruislip, Northwood and Pinner
Supports new clause 49 as it reforms adult social care charging policies for sustainability. Also supports new clause 55 to ensure rigour and accountability in ICS provision for children's services.
Richard Burgon
Lab
Leeds East
Critiques the Health and Care Bill, arguing it facilitates privatisation of NHS by allowing private corporations to sit on health boards. Tables amendment 9 to establish NHS as default provider, opposing Government's amendment 25.
Mel Stride
Con
Central Devon
Expresses concerns over lack of time and appropriate information for new clause 49. Questions impact assessments and highlights potential negative effects on less well-off individuals.
Alison McGovern
Lab
Birkenhead
Intervenes to question whether people will get what they were promised under new clause 49, expressing concerns about the actual benefits for constituents.
I oppose amendments to this Bill, except those tabled by the Government. I argue that NHS funding is at record levels under this Conservative government and it was Labour who pushed competition and private sector involvement in healthcare. The provisions on integrated care systems (ICSs) enjoy support from within the NHS and are intended to make the system less bureaucratic and more accountable.
Apsana Begum
Lab
Poplar and Limehouse
I support new clause 57, which sets out a requirement for NHS England to publish guidance on health inequalities. My amendment 99 aims to reduce inequalities between non-migrant and migrant users of health services by ensuring automatic access to healthcare without fear of detention or deportation.
I support new clause 55, amendments 91 and 92, and amendment 102. These call for guidance on meeting the needs specifically of babies, parity of esteem between mental and physical health, and clarity about plans to tackle domestic violence.
Jess Phillips
Lab
Birmingham Yardley
I argue that the situation where my constituents will subsidise the care of individuals like my father, who owns a house worth £700,000, is unacceptable. I believe it is unfair for those living in council houses to be left with nothing while others benefit from significant property wealth.
Edward Argar
Con
Melton and Syston
Argues that the Bill supports NHS priorities, maintains the NHS's public nature despite claims to the contrary, and strengthens provisions regarding conflicts of interest. Highlights the flexibility given to local systems within a national framework for better service delivery. Acknowledges support for amendments 102 and 114, and appreciates work done by colleagues on new clause 49.
Kevin Hollinrake
Con
Thirsk and Malton
[INTERVENTION] Asks the Minister to give way but it is unclear if he is for or against any specific amendment.
Matt Western
Lab
Warwick and Leamington
[INTERVENTION] Asks the Minister to give way multiple times, indicating potential concerns or further questions about the amendments or Bill clauses.
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