Speeches by Coleman.

“Will you check whether they are doing that properly?”

“What will you change in the way that the NHS thinks and behaves when it comes to local authorities to enable palliative care—or whatever area—to become better?”

“You do not see at the top of the NHS an intellectual challenge in respecting local authorities and working with them on a genuine partnership basis, as opposed to, “We have to get them in line as well as everybody else”? It is about how you start thinking about a problem and who your partners really are, and whether th…”

“I understand that, and it is all on paper. In practice, the NHS tends to say what needs to happen in a quite unpartnership-focused, if I can use horrible jargon, or—in normal language—dictatorial way. Are you aware of that?”

“I am a little lost. Are you saying they do not know what to do because they are not properly trained?”

“But the ICB itself is so often the problem, because it is the NHS. There is one, or maybe two or three, but that is going to change. As I say, the 10-year plan wants to reduce the already rather small presence of local authorities on ICBs. The ICBs are effectively NHS organisations that tell local authorities what to d…”

“That is very helpful, and I completely agree with you. As a conceptual approach, I very much support that. There were some very interesting comments about your experience of coming in as a Health Minister and dealing with the situation and the system as you found it. How keen are you to overcome the blockage in the rel…”

“The problem is not the system approach, which is really effective and also happens in hospitals local to me, but the funding that local authorities know they can rely on and plan ahead for. The problem there is that the NHS has a different timetable for its funding. Its budget has different start and end points. As so …”

“That is brilliant.”

“And they are on board with this?”

“Absolutely. Prevention is obviously one of the three drivers, and it works much better. My experience of the Better Care Fund—I have only been a Member of Parliament since July 2024, so I appreciate that things may have moved on—is that the NHS dictates to local authorities what is going to happen. There is a sort of n…”

“The 10-year plan talks about strategic authority mayors, rather than local councils, sitting on ICBs. We do not have a strategic authority mayor in London who does that, and there are other parts of the country where it might not be appropriate. I think one of the weaknesses of what is otherwise a very impressive 10-ye…”

“A paper that the Committee discussed before Christmas, the name of which escapes me, says that only mayors will be on ICBs. At the moment, you have three councils sitting on the North West London ICB, which is unusual—we had to fight for it, and we got it—and in other places it is one or two. You are merging ICBs—obvio…”

“It is good to see you all today. Thank you for coming. May I ask a bit about ICBs? To pick up the point that you were talking about with the Chair, if you want local authorities to be more involved in developing palliative care services and other services, why is the Government planning to reduce the number of local au…”

“I am going to stop you. Forgive me.”

“No, I am just focusing on the problems that you—”

“Are there other problems that you have come across? I think you have left something significant out, but I do not want to lead you. I just want to get your view on what else has been a big problem. Samantha, I can see that you want to come in.”

“I am going to stop you right there, because I thought you would say that. I am not going to ask you about the model; I would like to go one step back. What were the problems that you found with PFI that the new model is trying to address? If you could start with the problems, and then we could talk about how the new mo…”

“I would like to move on to a different area, which is mostly going to involve questions for Sir Jim and Samantha, to give Wes a break. It will be about PFI and public-private partnerships. The plan is to build 250 neighbourhood health centres, with 120 operational by 2030, the vast majority via a new PPP model and cost…”

“Are the PPPs going to be negotiated and managed by ICBs? If so, will they be trained?”