PARLIAMENTARY DEBATE
Draft National Health Service (Integrated Care Boards: Exceptions to Core Responsibility) Regulations 2022 - 15 June 2022 (Commons/General Committees)

I beg to move,

That the Committee has considered the draft National Health Service (Integrated Care Boards: Exceptions to Core Responsibility) Regulations 2022.

As always, Ms Nokes, it is a pleasure to serve under your chairmanship. I will endeavour to be brisk in my remarks this morning. The purpose of the regulations is to ensure operational continuity as the changes from the Health and Care Act 2022 are implemented following Royal Assent in May. That Act strips out needless bureaucracy, improves accountability and enhances integration. It forms the bedrock for the NHS to build on in years to come, which is why I am delighted to be here to debate the regulations that will facilitate its implementation.

The regulations relate specifically to the transfer of functions from clinical commissioning groups, which were abolished by the 2022 Act, to newly established statutory integrated care boards. Under the National Health Service Act 2006, which was amended by the 2022 Act, NHS England may set rules so that integrated care boards have “core responsibility” for every person who is provided with NHS primary medical services through registration with a GP practice in their area of England, and for every person resident in the ICB’s area who is not registered with a GP practice. That means that when a person sees a GP in an area, the relevant ICB is responsible for arranging the provision of secondary health services that that person may need.

This instrument provides an exception to that obligation for individuals who are usually resident in Scotland, Wales or Northern Ireland but are registered with a provider of NHS primary medical services in England. The regulations do not prevent those who are resident in Scotland, Wales and Northern Ireland from accessing health services in England; instead, they simply make clear where the commissioning responsibility sits for those patients. They promote autonomy for devolved Governments to commission secondary care services for their residents, while still allowing patients to access secondary healthcare services in England. In essence, it is about which authority commissions and pays for a patient’s care, not the patient’s right to access care. The regulations are vital to give clarity and ensure consistency among authorities in England and those in Scotland, Wales or Northern Ireland in respect of who commissions and pays for a patient’s secondary care.

To conclude, it is important to be clear that this instrument does not change existing cross-border commissioning arrangements. Health is a devolved matter, and the instrument simply transfers an existing commissioning exception from clinical commissioning groups to integrated care boards, to reflect the changes in the nomenclature in the new legislation. The arrangements are a continuation of the approach to devolved health policy that was introduced in the National Health Service (Clinical Commissioning Groups—Disapplication of Responsibility) Regulations 2013, which are to be revoked as a consequence of the 2022 Act.

The regulations before us will ensure operational continuity of services for patients as the English health system implements integrated care boards, they are supported by the devolved Governments and they provide clarity on the role of integrated care boards within the existing cross-border arrangements. I commend the regulations to the Committee.

It is a pleasure to serve under your chairmanship, Ms Nokes.

The Minister and I first discussed the Health and Care Bill that became the 2022 Act in February last year. That Bill was finally introduced in July that year, so there was plenty of time to prepare it and to get us all lined up for it, and the NHS was already asking for legislation. We then spent six weeks in the Bill Committee, there were some delays, and the legislation spent extensive time in the Lords, et cetera. We now find ourselves back discussing consequentials. A simple tidying-up exercise for the health service does not mean that, does it? It means months and months of bureaucracy, time and effort for Clerks and so on, and changes to the law, while the system has to try to cope with it.

We support the regulations; I accept that they are consequential and do not actually change services for people. Will the Minister say how many many more consequential statutory instruments we are to expect as part of the tidying-up exercise? Given the largest waiting lists and waiting times the NHS is currently having to manage, it is important that system managers understand what is coming down the tracks. It is currently the middle of June and the regulations have to be in place for 1 July so that people have certainty about what they need to put in place. Patients also need to be assured that they will have a seamless service wherever in the United Kingdom they live, reside or visit friends and family. It would be helpful to have an idea of whether there will be similar consequentials, if the Minister can tell us this morning.

Other than that, we hope that the regulations will go through and make things easier, and that the NHS and the Government can get on with trying to improve the health service for the benefit of all our constituents.

I am grateful to the shadow Minister for her remarks and for her support for this instrument. It was a pleasure to serve opposite her for, as she alluded to, many months in the the Health and Care Bill Committee, before she was shadow Minister. She is right to talk about the length of time that that legislation spent going through Parliament before it received Royal Assent; of course, we could not introduce these regulations until Royal Assent was granted in the middle of May, although we did secure the early commencement of the 2022 Act’s provisions in order to be able to bring forward the relevant consequential regulations as swiftly as possible.

The shadow Minister asked how many more consequential regulations we anticipate—I think she was referring specially to those that relate to the implementation of ICBs and integrated care systems by 1 July on a statutory footing. To date, I think I have seen, commented on and approved a further five instruments. They are overwhelmingly technical in nature, and replicate existing arrangements but change the language and nomenclature used. Of course, one of those sets of regulations will formally, legally commence these provisions from 1 July—that has to be done through regulations.

We would of course have liked to have seen Royal Assent earlier than we did, but a considerable number of amendments were tabled, both in our House and in the other place, so it took a considerable amount of time to navigate through the parliamentary process. However, we got there and received Royal Assent for a piece of legislation that will go a long way towards building on the success we have seen so far in improving health outcomes in this country, and that will enable the NHS to go forward with a strong base on which to build and from which to evolve. I again commend the regulations to the Committee.

Question put and agreed to.