Health and Care Bill

Lords Hansard - Part 2 & Report stage
Thursday 3rd March 2022 Lords Chamber

Report (2nd Day) (Continued)

16:03

Clause 39: General power to direct NHS England

Amendment 83

Moved by

[Lord Lansley]

83: Clause 39, page 47, line 37, at end insert—
“(4) A direction under section 13ZC may not be given in relation to a decision about the relative allocation of resources to integrated care boards.(5) A direction under section 13ZC may not be given in relation to a decision about the results of a procurement of goods or services provided for the purposes of the NHS in England.”

[Lord Lansley (Con)]

My Lords, noble Lords will recall from Committee some substantial discussion about whether it was wise for the Secretary of State to take additional powers of direction in relation to NHS England. I suppose I should declare an interest since I gave the NHS commissioning board, or NHS England, the freedoms it currently enjoys. I am probably the person least likely to be persuaded that it is a very good idea to take all that away. After our debate in Committee, I thought it was probably sensible, rather than to seek to remove the powers of direction that the Secretary of State is given under Clause 39, to look at the exceptions to that power in new Section 13ZD and ask: are these all the exceptions that we should have?

On Amendment 83, the conclusion I reached was that there were at least two specific areas which are not mentioned in new Section 13ZD but should be; namely, limitations on the use of this power on the part of the Secretary of State. First, the local allocation of resources to integrated care boards—and the difficult decisions of trying to remedy the inequalities in access to healthcare services through the resource allocation process—is not something which any of us want the Secretary of State to interfere with; otherwise, it is sure to be regarded as being done for a political purpose, even if it might be done for another.

Secondly, there is the question of

“procurement of goods or services”.

After all the experience we have had over recent months, the last thing any of us wants is to go too far in the direction of the Secretary of State having a power in relation to procurement when that can perfectly well be given as a responsibility to NHS England. This is Amendment 83, and I hope that my noble friend, if he cannot accept the amendments, will give us some specific assurances in relation to the Secretary of State not using those powers.

In this group, I also put my name to Amendment 84, which would remove Clause 40—and, by extension, Schedule 6—from the Bill. This is about the Secretary of State coming in and acquiring more powers than was formerly the case. I was shadow Secretary of State for six years or so. During that time, I would have loved it if the then Secretary of State had all these powers to intervene in every reconfiguration, because I went around the country—as people are fond of reminding me—mobilising opposition to some of the ways in which the health service, led by the then Government, was trying to reconfigure services. This is not something that the Secretary of State or the current Government should wish for themselves or for their successors in office. I will not go back into all the arguments, but there are plenty of good examples of where, if the Secretary of State had this power, people would press the Secretary of State to use it—and it would be deeply unwise for a Secretary of State to get involved.

The justification on the part of the Government is that it stops this going on for ever. But there is a reason that these things go on for a long time—because they are intensely difficult, and the balances are very difficult to strike. Sometimes, the processes of consultation and public engagement take a long time. If the Government’s argument is that they are going leap in, intervene and settle it all quickly, both sides will yell when they do that. We can be absolutely certain of this. No one will be happy, and everyone will blame the Secretary of State. This is very firmly in the “be careful what you wish for” category. We would do the Government a great service by deleting Clause 40 from the Bill. If the noble Baroness, Lady Thornton, pursues that, I will certainly support her. I beg to move Amendment 83.

[Baroness Thornton (Lab)]

With the leave of the House, I thought it might be useful if I used my slot to speak right now on leaving out Clause 40. First, I thank the noble Lords, Lord Patel and Lord Lansley, and the noble Baroness, Lady Walmsley, for putting their names to this amendment. The noble Lord, Lord Patel—with whom I spoke this morning, and who is definitely on the mend, so I hope we will see him next week—said how strongly he supports the amendment. I will speak very briefly because we have already said much of what needs to be said about saving the Secretary of State from himself—as the noble Lord, Lord Lansley, said, I think. This is what this amendment is about.

Clearly, this is not what the NHS asked for in the Bill. It did not ask for this power. It has been added to the Bill—by a previous Secretary of State, I suspect—and I hear rumours that even the current Secretary of State is not a great fan. Why would any Secretary of State want to have this power—to be lobbied and drawn into any minor local dispute, particularly as we head towards a general election?

I have a small anecdote. A small coastal town had a small hospital with an accident and emergency department. It could not be properly staffed, it regularly closed for random periods, and far too often patients arrived there only to be moved to the larger A&E 20 miles down the road. Proposals were made to close it—and of course, outrage ensued. “Save our A&E”, people said, even though it was unsafe. Local politics were poisonous, and the blame for the closure was thrown on opponents, whichever side they were on.

However, over time, good communications, clinical leadership and, eventually, bringing local people into the team, got the proposal moving. People understood what was needed and why, and the reconfiguration process went through its stages, with external reviews and analysis by the national clinical advisory team, which all gave reassurance. The clincher came when a distinguished clinician leading the review told a meeting that he would personally go and paint over the road signs for the A&E, because it was so unsuitable. It shut, which probably means that lives were saved.

The process of rational argument and proper analysis works, and on this occasion we should not just leave it to local politics to decide what reconfiguration means. The Secretary of State has enough powers to direct the whole NHS in its fullness, but should not be involved in what may be very small reconfigurations indeed. We agree, and many people in the NHS and its organisations agree, that this clause should be removed from the Bill.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have no doubt that when the Minister responds he will say that the Secretary of State is likely to use this power very rarely. The point is that the moment the health service knows the Secretary of State has such a power, that will immediately influence its behaviour in relation to any improvements or major changes of services likely to lead to opposition from the local Member of Parliament. I think that the Minister is responsible for innovation in the health service, and this will put the kibosh on innovation and service changes.

Written on my heart is Kidderminster General Hospital. The Minister may not recall this, because it is a long time ago now, but Worcestershire Health Authority made proposals to reconfigure A&E services and close Kidderminster General Hospital. The then Member of Parliament, David Lock, who was a loyal member of the Government, bravely defended that decision. He lost his seat in 2001, and it has been written on the hearts of many MPs since then that they do not defend that type of change, because they might lose their seats.

I cannot believe that the Government wish to give the Secretary of State the nightmare of that kind of lobbying—I am trying to tempt the noble and learned Lord, Lord Clarke, to intervene here, because he knows what MPs do. What we have at the moment is a very good system, at arm’s length, and it beats me why on earth the Government want to do this. We need to do the business and get rid of the clause. I suspect that we shall not see it back again.

[Baroness Walmsley (LD)]

My Lords, Amendment 84 is intended to remove the powers of the Secretary of State, in Clause 40, to intervene in decisions on reconfigurations of health services. I said in Committee, and I say again, that those powers are very dangerous. We have recently seen how the Government’s powers to provide or withdraw funding for a proposal to, say, build a new school or improve infrastructure in a particular constituency have got them into trouble. Political considerations have trumped public interest. In the media they call that pork barrel politics—not a very complimentary phrase, I am afraid.

16:15

All politicians know that the provision of a new hospital or clinic, or the closing of a healthcare setting or a rural school, are very sensitive considerations in elections. All parties pay close attention to such things at election time and between elections. The Prime Minister knows this—why else would he put such emphasis on the promise of 40 so-called new hospitals by 2030? He knows that it makes a good headline.

The powers of reconfiguration being sought by the Secretary of State in Clause 40 would enable this Government to change the decisions of those put in place locally, who are well qualified to make those decisions in a non-partisan and needs-based way, and thus allow the Government to wield unwarranted political power and take it from the competent people they have put in place to take those decisions. I do not trust this Government, who are currently trying to use the Elections Bill to ensure that they continue in power, to resist using these Secretary of State powers in this Bill for political purposes. It is incumbent on all parties to stop them, and to stop any future Government doing this, by removing Clause 40.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

I thank noble Lords for bringing this debate to the House today. I am sure that the Secretary of State will be grateful for the desire to save him from himself and his powers. Let me read out the following quote:

“If we went out to Parliament Square now and straw-polled people walking by, asking them who they thought was responsible for the NHS in England at a national level, I think we would wait a very long time before anyone gave any answer other than the Government and, by extension, the Secretary of State”.—[Official Report, Commons, Health and Care Bill Committee, 21/9/21; col. 393.]


These are not my words, but those of the Opposition spokesman during Committee in the other place.

One of the core pillars of the Bill is to ensure appropriate accountability for the NHS. This is of the utmost importance as we invest further in local service decision-making and delivery. It is critical that, in line with the aims of the Bill to empower local systems, the Secretary of State has the appropriate levers to meet the public expectation for ministerial accountability.

There has been some confusion about what the powers in the Bill will do, and if noble Lords will allow me, I will spend a moment on this to add clarity. Clause 39 will simply allow the Secretary of State to direct NHS England—and only NHS England—on matters where it already has functions. This is not a power over local bodies. Clause 40 and Schedule 6 will allow the Secretary of State to call in and decide on reconfiguration decisions. They do not remove any of the existing safeguards, including the requirement to consult or the role of the Independent Reconfigurations Panel in providing advice to the Secretary of State.

I understand the arguments put forward in Amendment 83, and I will take procurement first. We agree that it is inappropriate for the Secretary of State to be involved in individual procurement decisions. That is not the motive behind this power, and it is not the way it would be used. The regulation-making power inserted by Clause 70 prevents the Secretary of State being able to use this direction-making power to direct NHS England—

[Baroness Thornton (Lab)]

The Minister said that this was not the motive behind the power, but motive is not the point here. I am sure that the Secretary of State has the best of motives, as does the Minister, but the point is the effect of what the Bill says.

[Lord Kamall (Con)]

I thank the noble Baroness for clarifying that. Of course, we completely understand the concerns that have been raised. The Secretary of State must use regulation-making powers where they exist, rather than using the power of direction to achieve what could be achieved under regulations.

Turning to the allocation of resources to the ICBs, the Government have no ambition to use this power to interfere with individual allocations of money to the system. It will not be used to interfere with the independent Advisory Committee on Resource Allocation. NHS England will continue to make funding allocations to ICBs to support them to deliver functions via the target formula, in order to reduce inequalities between patients. We have attached safeguards to this power to make sure it is not misused. Any exercise of this power must be done transparently: it must be made in writing, be published and be made in the public interest. This will enable Parliament to challenge Ministers and hold them to account.

Turning to Amendment 84, Clause 40 and Schedule 6 will allow the Secretary of State to better support effective change and respond to stakeholder concerns, including views from the public, health oversight and scrutiny committees and parliamentarians, in a more timely way. The clause and schedule will ensure that key decisions made about how services are delivered are subject to democratic oversight.

It is a misapprehension that the Secretary of State currently has no role in the decision-making process for reconfigurations. He does and without these provisions that role will continue. However, currently, referrals usually come at a very late stage in the process, which represents neither good value for the taxpayer nor good outcomes for patients.

I understand the concerns from noble Lords, including former Ministers, about how these powers might be used. But I have been asked to make clear that we expect the vast majority of reconfiguration decisions to continue to be managed by the local system—

[Lord Hunt of Kings Heath (Lab)]

I am sorry to interrupt, but does the Minister not take my point that it is not that Ministers will have to use those powers; it is that they have powers that will change behaviour immediately in the health service? That is the issue.

[Baroness Walmsley (LD)]

Before the Minister answers that question, I wonder if he would be kind enough to answer two from me. He just gave a list of what the powers will not be used for, but could he tell us what sort of thing the powers will be used for and under what circumstances? Can he also say why previous Secretaries of State—some of whom are not very far from where I am standing now—did not feel the need for those powers and still felt themselves accountable for the health service?

[Lord Kamall (Con)]

I thank noble Lords for those interventions. If they will allow me, I will come to answer them in my remarks.

We understand the concerns about how these powers will be used. It is in the interests of nobody, least of all the Secretary of State, to be making every decision in the system, and stakeholders will be encouraged to continue to resolve matters locally where possible. Duties for those responsible for reconfigurations to involve patients and consult the local authority will continue. Nevertheless, the Secretary of State is ultimately accountable for all changes to the health service. Therefore, it is entirely consistent with democratic principles that he or she should have the ability to intervene where it is deemed to be in the interests of the public.

We recognise that, in exercising these powers in this clause and schedule, it will be vital that the Secretary of State receives expert and clinical advice. That is why the Independent Reconfiguration Panel will continue to provide independent advice to the Secretary of State, allowing them to benefit from its many years of experience. This will mean that the Secretary of State will have independent advice that will include the views of both overview and scrutiny committees and patients, and the clinical case for change—

[Baroness Cumberlege (Con)]

I thank my noble friend. On this clinical advice, he is aware of the enormous changes that were made to stroke services in London. In the reconfiguration that took place, many lives were saved. But when it came to east Kent, the reconfiguration request, which was to do with stroke services, sat on the Secretary of State’s desk for two years. I just wonder how many people died for that delay.

When I put forward an amendment in Committee, I said that a decision must be made within three months by the Secretary of State if it is before his view, on his desk. Delay costs lives. It is absolutely critical that decisions are made fast in these reconfigurations, because we will lose lives.

[Lord Kamall (Con)]

Indeed, sometimes it is absolutely critical that decisions are made quickly. Where there are concerns about the speed of those decisions, the Secretary of State may ultimately decide to intervene, subject to advice from the Independent Reconfiguration Panel, overview and scrutiny committees, and patients, and based on the clinical case, should he or she decide to exercise powers under this clause.

I understand the concerns raised in this House and have heard the arguments presented today and in Committee. However, I think it would help if I reminded noble Lords that the Secretary of State’s powers included in the Bill are to ensure accountability. The public rightly want to hold the Government to account for the health service, and these powers allow that to happen effectively. The other place acknowledged that approach and supported it—

[Baroness Walmsley (LD)]

I cannot believe that the Minister meant to imply that all the structures being set up in this Bill are not accountable, because there are a whole lot of accountability measures in this Bill which will hold to account the people making these decisions without the Secretary of State. One might think from what he just said that the powers are very narrow.

But I draw his attention to page 206 of the Bill. In proposed new Section 68A(4)(3)(a), it just says that the Secretary of State can decide whether a proposal goes through or not, but in proposed new Section 68A(4)(3)(b) it says that the Secretary of State can intervene in the “particular results” that have to be achieved. In proposed new Section 68A(4)(3)(c) he can decide the procedure and other steps that should be taken in relation to the proposal. In proposed new Section 68A(4)(3)(d) there is the

“power to retake any decision previously taken by the NHS commissioning body”.

These seem to be very broad powers; they are not just small intervention powers by the Secretary of State.

[Lord Kamall (Con)]

The noble Baroness raises some important points, but I remind her that, alongside those, she should consider safeguards and limitations that are being put in place to address these concerns and the importance of ensuring due accountability for health service delivery. I understand the strong feeling among noble Lords and have tried to go as far as I can in addressing those concerns. I once again, perhaps in vain, ask noble Lords to think about the assurances that have been given and not to move their amendments when they are reached.

[Lord Lansley (Con)]

My Lords, I am grateful to my noble friend. In particular I am grateful for his specific assurances on the powers of procurement and the question of resource allocation. We can be pretty confident that the Secretary of State would not interfere with the Advisory Committee on Resource Allocation or the NHS England response to it. If the Secretary of State were to start messing with the formula, we would get into a very difficult place.

I am still of the view that there was a very good reason we gave NHS England greater freedoms. I think it would not have been possible for NHS England to have published its Five Year Forward View in 2014 or even more so the Long Term Plan in 2019, in circumstances where it had occupied the same relationship with the Secretary of State as it did in the past.

This is taking NHS England from its current degree of independence to something that it was not in the past, but is a little more ambiguous. It will be difficult, for precisely the reasons the noble Lord, Lord Hunt of Kings Heath, explained, for the NHS to feel that, when the successor to the long-term plan is published by the successor to the noble Lord, Lord Stevens of Birmingham, it is the NHS’s own plan. That has been very important; Ministers have said it a thousand times. Why do we not let that happen? The measures in Clause 39 take a real risk of infringing on the idea that it is the NHS’s own plan.

It does not mean that the Secretary of State is not accountable, but that they are accountable in ways that they can legitimately control: the resource allocation and an expectation of the priorities and outcomes. That is where the Secretary of State should be putting the weight of the Government, not in trying to decide how outcomes in the NHS are best achieved. I do not agree in principle with what is proposed in Clause 39, but I am not going to press that point.

I will, however, if the noble Baroness, Lady Thornton, pushes it, support her on Clause 40. I say to my noble friend: look at Schedule 6. The structure of it does not even mention the Independent Reconfiguration Panel. As soon as there is a proposal for a reconfiguration from any of the NHS bodies, it quite clearly places in the hands of the Secretary of State the responsibility to decide whether to go ahead with it or not. That will be exactly the moment when the Secretary of State is drawn in and is not able to be extricated from it.

My noble friend has simply to look at the example of the reconfiguration of congenital paediatric cardiac services to realise that no sensible Minister would have been drawn into that debate at an early stage with any confidence of being able to make a decision that would have been accepted by any of the parties to that debate.

[Lord Stevens of Birmingham (CB)]

The noble Lord raises the congenital paediatric cardiac case, and the noble Baroness, Lady Cumberlege, raised the Kent stroke question. On that question, the estimate was that 40 to 50 people will have died or lost their ability to live independently as a result of that two-year delay. Is it not the case that, for the very reasons that the noble Lord, Lord Lansley, has just set out, those kinds of delays will now be invisible to the naked eye because these proposals will never get off the ground due to the self-censoring of necessary clinical change that would save lives, precisely as the noble Lord, Lord Hunt of Kings Heath described?

[Lord Lansley (Con)]

We all know that when these proposals come forward, there is a lot of local pressure. In many cases, it will be local pressure that is transmitted to the Secretary of State by Members of Parliament who are—

[Baroness Penn (Con)]

My Lords, it might be worth reminding noble Lords that on Report, noble Lords only speak twice for short questions of elucidation.

[Lord Lansley (Con)]

I am responding to the debate, am I not?

[Noble Lords]

You are.

[Lord Lansley (Con)]

The noble Lord was elucidating something to which I was responding. That is my view. Anyway, I was not planning to go on at any length. My point is very straightforward. As the noble Lord, Lord Hunt, said, that will be transmitted to the Secretary of State at an early stage, before the point where the Secretary of State can, in any practical way, distance himself or herself from the decision by giving it to the independent reconfiguration panel. There is a process out there. I am a Conservative, and we do not change things that are not broken. This is not yet broken. It is a system that has been used tolerably well and we should stick with it, so I support leaving out Clause 40. However, I beg leave to withdraw Amendment 83.

Amendment 83 withdrawn.

16:33

Division 2

Ayes: 145

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Labour: 64
Liberal Democrat: 49
Crossbench: 21
Independent: 7
Conservative: 3
Green Party: 1

Noes: 122

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Conservative: 115
Independent: 3
Crossbench: 2
Democratic Unionist Party: 1
Ulster Unionist Party: 1

Clause 45: NHS trusts: wider effect of decisions

Amendments 85 to 87

Moved by

[Lord Kamall]

85: Clause 45, page 50, line 6, leave out “The reference in subsection (1)” and insert “In subsection (1)—
(a) the reference”Member’s explanatory statement
This amendment is consequential on another amendment which provides that references in new section 26A of the NHS Act 2006 to effects of a decision in relation to certain matters include its effects in relation to inequalities with respect to those matters.

86: Clause 45, page 50, line 9, at end insert—
“(b) the reference to effects of a decision in relation to the health and well-being of the people of England includes a reference to its effects in relation to inequalities between the people of England with respect to their health and well-being;(c) the reference to effects of a decision in relation to the quality of services provided to individuals includes a reference to its effects in relation to inequalities between individuals with respect to the benefits that they can obtain from those services.”Member’s explanatory statement
This amendment provides that references in new section 26A of the NHS Act 2006 to effects of a decision in relation to certain matters include its effects in relation to inequalities with respect to those matters.

87: After Clause 45, insert the following new Clause—
“NHS trusts: duties in relation to climate change
After section 26A of the National Health Service Act 2006 (inserted by section 45 of this Act) insert—“26B Duties in relation to climate change etc(1) An NHS trust established under section 25 must, in the exercise of its functions, have regard to the need to—(a) contribute towards compliance with— (i) section 1 of the Climate Change Act 2008 (UK net zero emissions target), and(ii) section 5 of the Environment Act 2021 (environmental targets), and(b) adapt to any current or predicted impacts of climate change identified in the most recent report under section 56 of the Climate Change Act 2008.(2) In discharging the duty under this section, NHS trusts must have regard to guidance published by NHS England under section 13ND.””Member’s explanatory statement
The new Clause would require NHS trusts, in exercising their functions, to have regard to certain matters relating to the environment, including climate change.

Amendments 85 to 87 agreed.

Clause 54: Capital spending limits for NHS foundation trusts

Amendments 88 to 91

Moved by

[Lord Kamall]

88: Clause 54, page 53, line 16, at end insert “in respect of a single financial year”
Member’s explanatory statement
This amendment means that any order imposing a limit on the capital expenditure of an NHS foundation trust may only relate to a single financial year (rather than spanning more than one financial year).

89: Clause 54, page 53, line 20, leave out “period” and insert “financial year”
Member’s explanatory statement
This amendment is consequential on the amendment requiring an order under new section 42B(1) of the National Health Service Act 2006 to relate to a single financial year.

90: Clause 54, page 53, line 22, at end insert—
“(4A) An order under this section may be made at any time during or before the financial year to which it relates.”Member’s explanatory statement
This amendment is consequential on the amendment requiring an order imposing a limit on the capital expenditure of a foundation trust to relate to a single financial year. It clarifies that although the limit must relate to the whole financial year, the order imposing it may be made part-way through that year.

91: Clause 54, page 53, line 24, leave out “period” and insert “financial year”
Member’s explanatory statement
This amendment is consequential on the amendment requiring an order under new section 42B(1) of the National Health Service Act 2006 to relate to a single financial year.

Amendments 88 to 91 agreed.

Clause 59: NHS foundation trusts: wider effect of decisions

Amendments 92 to 94

Moved by

[Lord Kamall]

92: Clause 59, page 55, line 37, leave out “The reference in subsection (1)” and insert “In subsection (1)—
(a) the reference” Member’s explanatory statement
This amendment is consequential on another amendment which provides that references in new section 63A of the NHS Act 2006 to effects of a decision in relation to certain matters include its effects in relation to inequalities with respect to those matters.

93: Clause 59, page 55, line 40, at end insert—
“(b) the reference to effects of a decision in relation to the health and well-being of the people of England includes a reference to its effects in relation to inequalities between the people of England with respect to their health and well-being;(c) the reference to effects of a decision in relation to the quality of services provided to individuals includes a reference to its effects in relation to inequalities between individuals with respect to the benefits that they can obtain from those services.”Member’s explanatory statement
This amendment provides that references in new section 63A of the NHS Act 2006 to effects of a decision in relation to certain matters include its effects in relation to inequalities with respect to those matters.

94: After Clause 59, insert the following new Clause—
“NHS foundation trusts: duties in relation to climate change
After section 63A of the National Health Service Act 2006 (inserted by section 59 of this Act) insert—“63B Duties in relation to climate change etc(1) An NHS foundation trust must, in the exercise of its functions, have regard to the need to—(a) contribute towards compliance with—(i) section 1 of the Climate Change Act 2008 (UK net zero emissions target), and(ii) section 5 of the Environment Act 2021 (environmental targets), and(b) adapt to any current or predicted impacts of climate change identified in the most recent report under section 56 of the Climate Change Act 2008.(2) In discharging the duty under this section, NHS foundation trusts must have regard to guidance published by NHS England under section 13ND.””Member’s explanatory statement
The new Clause would require NHS foundation trusts, in exercising their functions, to have regard to certain matters relating to the environment, including climate change.

Amendments 92 to 94 agreed.

Clause 62: Joint working and delegation arrangements

Amendments 95 and 96 not moved.

Clause 67: Wider effect of decisions: licensing of health care providers

Amendment 97

Moved by

[Lord Kamall]

97: Clause 67, page 61, line 42, at end insert—
“(2AA) For the purposes of subsection (2)(da) (as read with subsection (2A))—(a) a reference to the effects of decisions in relation to the health and well-being of the people of England includes a reference to the effects of the decisions in relation to inequalities between the people of England with respect to their health and well-being; (b) a reference to effects of decisions in relation to the quality of services provided to individuals includes a reference to the effects of the decisions in relation to inequalities between individuals with respect to the benefits that they can obtain from those services.”Member’s explanatory statement
This amendment provides that references in new subsection (2)(da) of section 96 of the Health and Social Care Act 2012 to effects of a decision in relation to certain matters include its effects in relation to inequalities with respect to those matters.

Amendment 97 agreed.

Schedule 10: The NHS Payment Scheme

Amendment 98

Moved by

[Lord Lansley]

98: Schedule 10, page 223, line 21, at end insert—
“(5A) Rules under subsection (1) may not be framed by reference to whether the provider is in the public or, as the case may be, private sector.”

[Lord Lansley (Con)]

My Lords, I will not go on at great length because noble Lords have heard more than sufficient from me today, but this group brings us to what is known in the trade as the provider selection regime: that is, how the NHS goes about the process of commissioning services from a range of providers and the relationship between that and the choice that is available to patients. I am going to refer to my amendments, Amendments 98 and 99, and, without going on about it, I commend Amendment 80 in the name of the noble Lord, Lord Warner. Finding out whether people have actually experienced choice and whether that is helpful to them is a useful thing to do, and I am not sure whether it features in the current electronic referral system. It would be useful to add it in.

The words of Amendment 98 are in fact already in the regulations that the NHS currently lives by because, born of the previous experience when there were discriminatory payment arrangements for private sector providers relative to public sector providers—ie, more advantageous payment arrangements for the private sector than the public sector—in the 2012 legislation we legislated to prevent that happening in the future. The current Bill removes said prohibition on discrimination on the basis of the ownership, public or private ownership, of a provider.

Noble Lords might think, “Ah, this is trying to avoid us discriminating against the private sector.” This was actually included in order to prevent the Government or the NHS discriminating in favour of the private sector. There may be arguments for it in certain circumstances because NHS bodies often have, as it were, fully depreciated assets and to create additional capacity the private sector very often has to invest capital and has to meet the costs of capital as well as the revenue costs of providing services. None the less, we addressed all that and took the view that we did not want any discrimination: we wanted no competition on price, but we wanted competition on quality. That is why, to be perfectly frank, I am testing the Government’s intentions in omitting something that was a central plank of policy for the 2012 legislation.

On Amendment 99, if I recall there is language in the original White Paper from last year, which set the provisions for the Bill, which referred to “any qualified provider” and made it clear that it was the Government’s intention to maintain the existing choice arrangements and access to any qualified provider. Indeed, I think it said that it would “bolster” the system, although I am not sure whether that is happening anywhere. The amendment is really intended to test a particular issue that arose. I am a very sad person, and I was looking at the service conditions for the NHS standard contract; the noble Lord, Lord Stevens of Birmingham, will know them intimately. There is a point at which commissioners who are presented with people who wish to access other providers, who have a contract with another commissioner, are not required to extend that service to them. The way in which it was written in the standard contract was to talk about circumstances where the originating contract does not refer to the address—I think it said the postal address—included in the originating contract. My point to the Government is that this is absurd. There can be geographic limitations, but we should aim not to make them as limiting as the reference to a postal address in the originating contract would have made them.

The wider point is that, if one looks at the new provider selection regime, one sees that there is a process by which commissioners—the decision-making bodies commissioning services—go through a process of saying, “What are the circumstances of commissioning providers?” They ask whether it is circumstance 1, extending the existing arrangement; circumstance 2, going to a different provider; or circumstance 3, going to competition. The language of circumstance 2 is:

“where the decision-making body wants to use a different provider and the decision-making body considers it can identify a suitable provider without running a competitive procurement process”.

This is something that it will be readily able to do in many cases. A commissioner can say, “This is the circumstance. We want to go to a different provider and we know who we want to go to—that’s fine, we’ll give them the contract.”

Circumstance 3 is

“where the decision-making body cannot identify a single provider or group of providers that is most suitable without running a competitive process; or to test the market”.

The body could choose to test the market, but of course more than subtly. Whereas, in the past, the NHS tended to think that it needed to test the market in circumstances in which the legislation did not actually require it to, there is no such thing as compulsory competitive tendering in the 2012 legislation, or the regulations made under it. But now it has shifted completely the other way, and NHS bodies will be able broadly speaking to choose not to use competition at all. The question is whether that will really be sustainable. In the short run, access to the private sector may well be quite widespread, and there may well be a significant element of choice available to patients through the electronic referral service, but that may be closed down in years ahead, if these provisions are implemented in the way in which they are set out.

I issue a further warning to my noble friends. If you are a provider of services to the NHS and you believe that a decision has been made unfairly or inappropriately by the NHS, there is a standstill on the contract, you have 30 days, and you can send in a complaint, in effect, to the decision-making body, which then decides whether it has done the right thing. There is no independent process whatever, so it seems that the chances of providers resorting to law to challenge what they regard as unfair decisions on the part of decision-making bodies in the NHS rise dramatically with the implementation of these processes.

All that said, I hope what I can hear from my noble friends on the Front Bench is that what they said in the White Paper a year ago in February 2021 remains true: that they are going to sustain patient choice, that they will use the resources of NHS providers and beyond to enable us to fulfil our very demanding recovery programme, that they will think hard about whether the precise language in some of the respects that I have outlined is fair to providers, and that commissioners in the NHS will use their procurement capabilities to deliver best value for patients. I beg to move Amendment 98.

[The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)]

The noble Baroness, Lady Brinton, is contributing remotely.

[Baroness Brinton (LD) [V]]

My Lords, I start by commending Amendment 100 tabled by the noble Lord, Lord Warner, and I look forward to hearing him speak on it. It is an excellent idea to ask people how much choice they have actually had when offered treatment. I also thank the noble Lord, Lord Lansley, for explaining his two amendments, and I would like to say to him that he is not sad for carrying out his role in your Lordships’ House with interest and care. His expertise in matters that may leave others cold should be celebrated. The amendments of the noble Lord, Lord Hendy, ask that trade unions should be part of consultations on private providers, and that seems sensible.

I wish to focus, albeit briefly, on Amendment 106A, which proposes that Clause 70 be left out, and which will be spoken to later by the noble Baroness, Lady Thornton; I apologise to her that under the remote rules I have to speak first. I will confine my remarks to the views of the Delegated Powers and Regulatory Reform Committee’s 15th report, in which paragraphs 17 and 18 make plain its views about these proposed procurement arrangements and regulations. The first point that it notes is that the memorandum, at paragraph 481, says that

“full analysis has not been completed and there has not been time to produce a more developed proposal.”

Why on earth do the Government wish to bring into force legislation that they admit they have not had time to analyse, let alone produce a more developed proposal for? We from our Benches, along with other noble Lords, have repeatedly said that the Cabinet Office procurement Bill is likely to overtake the needs for NHS-specific procurement regulations.

Paragraph 17 of the DPRRC Report gets straight to the heart of the issue and provides a response to the amendments that the noble Lord, Lord Kamall, has tabled, starting with Amendment 101 in this group. It says:

“We do not accept that the inclusion of regulation-making powers should be a cover for inadequately developed policy.”


It is therefore more than a little surprising to see a slew of government amendments on this issue that, in the group under discussion, strengthen the powers under regulation.

Paragraph 18 of the Delegated Powers Committee report states that:

“Ministers would not ordinarily propose clauses in one Bill possibly requiring imminent amendment in a subsequent Bill without expecting to face questions. The House may wish to seek further and better particulars from the Minister concerning the possible effect of any Cabinet Office procurement Bill on the Health and Care Bill, and … to press the Minister on why it was necessary to include provision, based on inadequately developed policy, in the Health and Care Bill when the Government intend to introduce a procurement Bill.”


Not only have we tried this at an earlier stage, but there have been meetings between Committee and Report, and it appears that the Government are determined to press on. I know that the noble Baroness, Lady Thornton, has concerns about the Government’s intentions on the clause and its amendment; if she chooses to call a Division on stand part, we from these Benches will support her.

[Lord Hendy (Lab)]

My Lords, I support Amendments 98A, 98B and 98C. Among other things, the Bill is designed to facilitate the outsourcing to private contractors of NHS services currently carried out in-house. That is the Government’s policy for the NHS, although it is firmly opposed by most of the citizens of this island.

17:00

These are topical amendments, since it has been announced today that 1,800 Serco workers will be brought in-house at Barts Hospital and put on NHS terms and conditions. The amendments would protect NHS workers from the consequences of the policy of outsourcing. Usually when public services are outsourced, the contractor makes a profit by reducing the number of staff performing the work formerly done in-house and by cutting staff wages, terms and conditions. The Transfer of Undertakings (Protection of Employment)—TUPE—Regulations mitigate that process but usually only by delaying it. TUPE also fails to protect when contractors subcontract parts of the operation or hire new staff on new terms and conditions.

Amendment 98A would prevent cuts to the wages, terms and conditions of NHS staff who are outsourced and prevent contractors hiring staff on worse terms, thereby undercutting in-house staff. It does so by requiring that the pricing rules for paying contractors must preserve, then and for the future, the going NHS staff rates, terms and conditions, as negotiated from time to time between the NHS unions and NHS Employers. Payment of those prices would be dependent on honouring those terms.

In Committee, the Minister rejected the need to protect NHS staff in this way, saying that the NHS remained committed to Agenda for Change, which is the name given to the current collective agreement, but he further stated:

“Independent providers will remain free to develop and adopt the terms and conditions of employment, including pay, that best help them attract and keep the staff they need”;

in other words, nationally negotiated terms and conditions for NHS staff which have applied since the founding of the NHS are to be abandoned. Those who work in the outsourced parts of the NHS are to be thrown to the wolves.

It is not just national terms and conditions that are to be jettisoned for those NHS staff but their ability to be collectively represented at all. Let us not be in doubt that their terms and conditions will be fixed unilaterally by the new provider on a take it or leave it basis. Their collective voice will be silenced. The Minister acknowledged that when he went on to say:

“However, we expect that good employers would set wage rates that reflected the skills of their staff”;—[Official Report, 26/1/22; col. 402.]

in other words, each employer will set the rates unilaterally in accordance with market forces at the lowest possible level that the staff will tolerate. There will be no trade union representation. Of course, the undercut rates for the outsourced staff will be used to resist higher wages for those lucky enough to be retained in-house. This is a lose-lose situation for the staff, although no doubt the privateers will make their profit. Our NHS, already sustained on cheap labour and the good will of its heroic staff, will become an even greater exploiter of labour. This will be a disaster for patients too.

The fact is that NHS staff are grossly underpaid, and the real value of their wages is falling. After years of pay freeze, last year’s miserable 3% increase is being destroyed by an inflation rate of 6% this year. The inadequacy of their terms and conditions is the prime reason for the extraordinarily high level of vacancies—93,000 at the end of last year—which increases as more work is done by fewer hands. A catastrophe looms.

Briefly, Amendments 98B and 98C are intended to ensure that the unions are among the consultees on the likely impact of payment schemes. I am grateful to the noble Baroness, Lady Brinton, for her support for that proposal. The Minister sees no place for unions in setting the terms and conditions of external providers, so it is even more vital that trade union consultation is made an explicit requirement of the pricing process. This is particularly so given that the providers themselves are to be consulted on the prices they are to be offered—in stark contrast to the workers, under the current draft. I hope the Minister will agree to modify these provisions accordingly.

[Lord Warner (CB)]

My Lords, my Amendment 100 requires NHS England to

“conduct a public survey of whether patients have been offered choices about where they obtain treatment and must report to the Secretary of State what action they will take as a result of the survey.”

I am grateful for the support of the noble Lords, Lord Hunt and Lord Lansley, and the noble Baronesses, Lady Cumberlege and Lady Brinton.

Currently, there is no regular survey of whether patients are aware of their right to choose or of how many have exercised it. The last NHS England official survey of whether patients were aware of their choices was in 2015, when just 47% of those questioned said they were aware.

Waiting times vary enormously by geography. Knowing about the right to choose could mean a significant cut in the waiting time for treatment. For example, waiting times for orthopaedic care vary from 89 weeks in Bedfordshire Hospitals NHS Foundation Trust to 25 weeks in the relatively nearby Milton Keynes trust. Recent polling by the Royal College of Surgeons showed that 73% of patients questioned would willingly travel to a surgical hub which was not their local hospital if they could be treated more quickly.

There is no system for monitoring whether patient choice is working. Amendment 100 fills this gap and restores the situation to where it was before 2015. I hope the Minister will accept this simple amendment in the interests of patients.

[Baroness Jones of Moulsecoomb (GP)]

My Lords, I am implacably opposed to privatisation of the NHS—not for ideological reasons, although the Green Party is strongly opposed as well. I think it is inefficient. Privatisation has not worked. It has failed to deliver on promises to increase quality, decrease cost and help patients. Rather than save money through reduced bureaucracy, the main cost savings of privatisation seem to be in cutting the terms and conditions—chiefly the pay and pensions—of staff. If private companies can compete for public services, let them compete on a level playing field, rather than simply capturing staff and paying them less.

I am pleased that the noble Lord, Lord Lansley, explained his Amendment 98 because I had understood it completely the other way around—that he was protecting private services. I was going to have a word with him afterwards about it, but there is now no need.

As the noble Lord, Lord Hendy, just said, most people in Britain do not want a privatised NHS. They want a public service because that is what will give them the best results.

[Baroness Thornton (Lab)]

My Lords, this group contains a number of helpful amendments. I welcome the amendments that the Government have tabled in response to the many and varied discussions we have had. I am grateful for this positive and constructive approach, which proposes transparency at the heart of procurement.

We have discussed with the Government at some length why the NHS has to have its own bespoke procurement regime, which the Bill paves the way for. We have seen two consultation documents about the scope, scale and nature of this bespoke regime. Although they seem quite sensible, we have been assured that the Government feel that the regulations will be based on a sound foundation.

The noble Lord, Lord Warner, is quite right about patients not knowing their right to choose. It is a hole in the provision. The right to choose is very important. People absolutely do not know that they have it.

While not being explicit, the new providers’ selection regime will actually get us to where Labour tried to get in 2010 with the NHS as the preferred provider, at least as far as the many complex and expensive services provided by NHS trusts, FTs and other core patient-facing services are concerned. Therefore, the principle is fine. The problem is that it does not extend across everything that the NHS procures, and that is partly the nub of what my noble friend said in his amendments, which I will return to in a moment.

Our view is that in any circumstances where competitive procurement is to be used, the national rules apply, so why does the NHS need a bespoke system for all non-clinical stuff? We have never actually had an answer to that, except that the NHS comes up with wider regulations, and we feel that that it is a waste of time and effort. However, we have had ample assurances from the Government that the NHS bespoke regime will be properly documented and all the rules set out, with some route to enforcement and challenge. We are assured that there will be no award of contract without applying the process that is set out—no back doors and no flexibility when contracting with private companies. With those assurances in mind and the knowledge that campaigners and trade unions will be vigilant and might even stump up for judicial review, and because of the ICB amendments agreed earlier in the week, we will get more or less what we wanted and we will not try to remove Clause 70 from the Bill.

I turn to the remarks of my noble friend Lord Hendy, who has our sympathy and approval. Had we been discussing this at a different time of day, we may have sought to support some of his amendments, and certainly the spirit of them. He has posed a legitimate question to the Minister: why do the Government not insist on good employment of staff as a criterion for their procurement regime?

We on this side of the House remain opposed to the outsourcing of NHS-funded services such as cleaning, catering and many others because we can see that it has led to staff being transferred into the private sector, corners being cut and standards dropping. It has been a symptom of chronic underfunding and it is a terrible long-term strategy. It has of course been completely counterproductive because it has sometimes meant that our hospitals have not necessarily been cleaned, serviced or looked after as we might have wished them to be. We have tried at various stages to introduce safeguards and to outlaw altogether the NHS’s tax-dodging habit of setting up SubCos, but those are probably matters for another day.

I would say to my noble friend that I am not sure that changing the procurement regime is the best way forward for this issue, although he has our support in the politics and context in which he introduced his amendments.

[Earl Howe (Con)]

My Lords, before addressing the amendments in the name of my noble friend Lord Lansley and the noble Lords, Lord Hendy and Lord Warner, it may be helpful if I speak to the six government amendments in this group: Amendments 101 to 104, 106 and 107. The first five of these amendments would amend Clause 70, which inserts a new regulation-making power in relation to the procurement of healthcare services, Section 12ZB, into the NHS Act 2006. They amend the clause so that regulations, when they are made under this power, will have to include provision for procurement processes and objectives, for steps to be taken when competitively tendering and for transparency, fairness, verifying compliance and the management of conflicts of interest. Amendment 106 also requires NHS England to issue guidance on the regulations.

17:15

It was always our intention for the regulations made under the power inserted by Clause 70 to include these vital aspects of the new provider selection regime. However, we have listened to the concerns of the House and hope that these amendments, alongside the information we have provided through the consultation we launched on 21 February, provide noble Lords with reassurance as to the intended contents of those regulations. Secondly, Amendment 107 makes the regulations subject to the affirmative procedure. We are grateful for the input of the Delegated Powers and Regulatory Reform Committee in advising us on this. In summary, these regulations will allow the NHS to procure healthcare services in a way that reflects the reality of those services without unnecessary bureaucracy and with the ultimate goal of providing value for patients, taxpayers and the population in the vital health services they need.

I respond to the noble Baroness, Lady Brinton, by saying that we intend to remove the procurement of healthcare services from the scope of the Public Contracts Regulations 2015. The future government procurement reforms will not overtake the provider selection regime made under powers in this Bill. Any amendments made as a result of the Cabinet Office regime will be minor ones to ensure alignment between the regimes. The PSR will not be replaced when the Cabinet Office regime come into force.

I turn now to my noble friend Lord Lansley’s Amendment 105, which is aimed at setting some general objectives for procurement. We agree that services should always strive to meet the needs of service users and it is our intention that the regulations made under Clause 70 will set out general objectives to ensure that procurements are carried out in a way which promotes the interests of patients, the taxpayer and the population, and supply the services that patients need.

NHS England consulted in 2021 on proposed key criteria for decision-makers, with agreement or strong agreement from around 80% of respondents that these key criteria were appropriate considerations. These include quality and innovation; value; integration; collaboration and service sustainability; social value; and opportunities to increase access to healthcare, reduce health inequalities and disparities, and promote patient choice. However, decision-makers should have flexibility to weight the criteria according to the needs of their population. I say to my noble friend that including four of these objectives in the Bill risks the appearance of prioritising them above all others, which I am sure is not his intention. He will know the trap that exists in legislation in having a list that is not exclusive.

I hope that my noble friend is also reassured by the government amendments in relation to fairness in procurements. It is intended that this will include applying the regime to different types of provider equally and being able to clearly justify procurement decisions by reference to the objectives and key criteria.

I turn next to Amendment 98. The NHS payment scheme will set rules about how commissioners pay providers for services and will apply to all providers of procurements: that means NHS trusts, foundation trusts, the voluntary sector and the independent sector. NHS England and NHS Improvement, which set the current tariff, are moving away from payment by activity to a population-based payment model with a mix of fixed and variable payments. Individual prices may still be used for smaller contracts or as the basis for setting fixed or variable payments.

There may be scenarios where it is appropriate to have different pricing rules for individual providers, to take account of cost variations. But I can assure my noble friend that this would not be solely on the basis of whether they were an NHS or an independent provider. When setting any prices, as required in the Bill, NHS England will aim to ensure that the prices payable represent a fair level of pay for the providers of those services, as well as fair pay between providers of similar services.

Turning now to Amendment 98A, I want to restate that the department and NHS England remain committed to Agenda for Change. As part of the process of setting the rules for the payment scheme, NHS England will, of course, want commissioners to consider staff pay, pensions and terms and conditions. Similarly, NHS England will continue to take account of cost growth arising from uplifts to Agenda for Change. Independent providers will remain free to develop and adopt the terms and conditions of employment, including pay. However, we expect that good employers will set wage rates that reflect the skills and experience of their staff.

I turn next to the question of consultation, as mentioned in Amendments 98B and 98C. New Section 114C makes it clear that, before publishing the payment scheme, NHS England must consult any person it thinks appropriate. In practice, we expect this to include trade unions and staff representative bodies such as the Social Partnership Forum, NHS Providers, the Healthcare Financial Management Association and all the royal colleges. NHS England must also provide an impact assessment of the impact of the proposed scheme.

I now turn to Amendments 99 and 100, which are about patient choice. First, I begin with Amendment 100. As a point of principle, we believe in giving people choice, in terms of GPs, elective care and, where possible, personalisation. This Bill builds on and strengthens that principle. I can understand the desire of the noble Lord, Lord Warner, to ensure that patients are offered meaningful choices, but I hope I can reassure him that the mechanisms for this are already in place. NHS Digital already has a patient survey process in place to see whether patients were aware of the choices they could make and were offered those choices. The NHS e-Referral Service tracks referrals to secondary care, which are an indication of where choice has been offered. There is also a national e-RS pop-up survey for patients, which collects data on whether choice has been offered by primary care for elective referrals. Results of the patient survey are published by NHS Digital on a quarterly basis. So this amendment would require NHS England to duplicate functions of an existing process, and I suggest to the noble Lord that that would not be a profitable route to go down.

I move to Amendment 99. My noble friend Lord Lansley has highlighted a part of the standard contract which relates to patient choice. I hope that I can give him some comfort. Yesterday, NHS England published its response to the consultation on the 2022-23 standard contract. It includes clarifications to ensure that current rules in relation to the legal right of choice of provider are properly applied in situations where the provider does not have a contract with the responsible commissioner of the patient being referred. Where providers are able to offer new, clinically appropriate elective services—or existing services from new locations —we want to see them properly and swiftly accredited by local commissioners. Where providers meet local criteria for those services—which must be transparent, proportionate and non-discriminatory—providers should be awarded NHS standard contracts for those services without delay. Patients would then be able to choose services through the NHS e-Referral Service.

I hope that my responses have served to reassure the noble Lords, Lord Hendy and Lord Warner, and my noble friend Lord Lansley, that the Government are very much in tune with their thinking on these matters and that the points they have sensibly raised through the amendments have been addressed in one way or another. I hope, too, that the Government’s amendments, to which I have spoken, will have allayed the specific concerns voiced at earlier stages about the regulation-making power in Clause 70. Accordingly, I would invite my noble friend to withdraw his Amendment 98.

[Lord Lansley (Con)]

My Lords, I am most grateful to my noble friend, in particular for the helpful explanation of the impact of the response to the consultation published yesterday, which I think moves us in the right direction on the service conditions in the standard contract on that point. I am grateful for my noble friend’s assurance on Amendment 98 as well. Clearly the power is available in the regulations to make sure that the non-discriminatory element of the procurement regulations can be brought forward in due course, so it need not be in the Bill. I beg leave to withdraw Amendment 98.

Amendment 98 withdrawn.

Amendments 98A to 98C not moved.

Clause 69: Regulations as to patient choice

Amendment 99 not moved.

Amendment 100

Tabled by

[Lord Warner]

100: Clause 69, page 63, line 21, at end insert—
“6H Survey relating to patient choiceNHS England must annually conduct a public survey of whether patients have been offered choices about where they obtain treatment and must report to the Secretary of State what action they will take as a result of the survey.”

[Lord Warner (CB)]

I am grateful to the Minister for his reassurances on the issue of patient choice. I suggest that the arrangements that he outlined in his response to my amendment are not well known, even to those such as the Independent Healthcare Providers Network, so I wonder whether he might look at the arrangements for publicising that information. In the meantime, I shall not move my amendment.

Amendment 100 not moved.

Clause 70: Procurement regulations

Amendments 101 to 104

Moved by

[Earl Howe]

101: Clause 70, page 63, line 35, leave out “procurement by relevant authorities” and insert “processes to be followed and objectives to be pursued by relevant authorities in the procurement”
Member’s explanatory statement
This amendment changes the principal regulation-making power in relation to procurement so that regulations under the power will have to include provision for procurement processes and objectives.

102: Clause 70, page 63, line 40, at end insert—
“(1A) Regulations under subsection (1) must include provision specifying steps to be taken when following a competitive tendering process.”Member’s explanatory statement
This amendment requires procurement regulations to include provision specifying steps to be taken when following a competitive tendering process.

103: Clause 70, page 63, line 41, leave out from beginning to end of line 1 on page 64
Member’s explanatory statement
This amendment is consequential on the changes made by another amendment to the principal regulation-making power in relation to procurement.

104: Clause 70, page 64, leave out lines 2 to 6 and insert—
“(3) Regulations under subsection (1) must, in relation to the procurement of all health care services to which they apply, make provision for the purposes of—(a) ensuring transparency;(b) ensuring fairness;(c) ensuring that compliance can be verified;(d) managing conflicts of interest.”Member’s explanatory statement
This amendment requires procurement regulations to make provision, in relation to all health care services to which they apply, for the purposes of ensuring transparency and fairness and that compliance can be verified and managing conflicts of interest.

Amendments 101 to 104 agreed.

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

I shall not call Amendment 105, as it has been pre-empted by Amendment 103.

Amendment 105 not moved.

Amendment 106

Moved by

[Earl Howe]

106: Clause 70, page 64, leave out lines 7 and 8 and insert—
“(4) NHS England must publish such guidance as it considers appropriate about compliance with the regulations.” Member’s explanatory statement
This amendment requires NHS England to publish guidance about compliance with any procurement regulations that are made.

Amendment 106 agreed.

Amendment 106A not moved.

Clause 71: Procurement and patient choice: consequential amendments etc

Amendment 107

Moved by

[Earl Howe]

107: Clause 71, page 64, line 31, at end insert—
“(b) in section 272 (orders, regulations, rules and directions), in subsection (6), after paragraph (zzd), insert—“(zze) regulations under section 12ZB,”.”Member’s explanatory statement
This amendment means that regulations made under new section 12ZB of the National Health Service Act 2006 (as inserted by Clause 70 of the Bill) will be subject to the affirmative procedure rather than the negative procedure.

Amendment 107 agreed.

Amendment 108

Moved by

[Lord Alton of Liverpool]

108: After Clause 71, insert the following new Clause—
“Health service procurement and supply chains: genocide convention obligations
(1) The Secretary of State must by regulations make provision for the purposes of ensuring that procurement of all goods and services for the purposes of the health service in England is consistent with the United Kingdom's obligations under the Convention on the Prevention and Punishment of the Crime of Genocide.(2) For the purposes of subsection (1), procurement is not consistent if a Minister of the Crown has assessed that there is a serious risk of genocide in the sourcing region.(3) A Minister of the Crown must make an assessment as to whether there is serious risk if the chair of a relevant select committee of either House of Parliament requests one, and must complete such assessment within two months.”

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

I should note, for the convenience of the House, that the noble Baroness, Lady Brinton, will be taking part in this debate remotely.

[Lord Alton of Liverpool (CB)]

My Lords, as we move to Amendment 108, I should declare my interests as set out in the register: my involvement in a number of all-party parliamentary groups, and the fact that I am patron of the Coalition for Genocide Response. I should also declare my support for the other two amendments in the group, Amendments 162 and 173, which will be spoken to by the noble Lord, Lord Hunt, who has trenchantly and consistently pursued the arguments around forced organ harvesting and the public exhibition of anonymous cadavers from Chinese jails. I have spoken in favour of those amendments previously and will not repeat my arguments today.

Like those two amendments, Amendment 108 is an all-party amendment, which was tabled in Committee by the noble Lord, Lord Blencathra, by the noble Baronesses, Lady Hodgson of Abinger and Lady Kennedy of The Shaws, and by myself, and supported by the noble Baroness, Lady Brinton, who is a sponsor today. It would have been moved by the noble Lord, Lord Blencathra, but he has had to self-isolate in Cumbria with Covid, and we all wish him a speedy return to his place.

Yesterday the noble Lord, Lord Blencathra, was able to attend an online meeting with the noble Earl, Lord Howe, and the noble Lord, Lord Kamall, and he asked me to move the amendment in his place. I thank both Ministers for their constructive engagement, and perhaps I might pursue further with them some of the arguments and issues raised yesterday. During our discussion the department told me that it had found no evidence of child labour, forced labour or unethical behaviour. Indeed, that was a repeat of a statement made to me in a parliamentary reply by the noble Lord, Lord Bethell, when he was a Minister.

17:30

How does that square with reports to the contrary in the public domain? On what basis was a c grade given to the companies which have been buying merchandise from China? Who went into the Xinjiang factories and forced labour camps? I should say that today at 4.34 pm I was sent a letter from the department saying that 13 performance areas were asked about according to something called amfori BSCI monitoring —it is not explained in the letter what that is and perhaps the noble Earl will be able to tell us—and that they had reached “an acceptable level of maturity.” What does that mean? What is an acceptable level of maturity and how does that square with the so-called c grade that these 13 performance areas had previously been given? Were these in Xinjiang? What were these performance areas? Where were they? Did we look at forced labour camps and what did we see? How was the judgment arrived at? I asked about this in Committee and again during yesterday’s meeting. This is an issue that should go on the public record, and I hope the noble Earl will agree to put the letter that I was sent just before today’s proceedings into the Library of your Lordships’ House so that everyone will be able to study it.

The issues underlining the amendment tabled by the noble Lord, Lord Blencathra, were aired at length in Committee, building on his consistent complaint that we are insufficiently self-reliant and have become too dependent on goods made by slave labour which by their very definition will always be cheaper and therefore destroy competitiveness both here and elsewhere.

In Committee I asked specifically about a Guardian report concerning MedPro. All I have received are coveralls about commercial sensitivity and mediation processes, and that is reiterated in the letter today. That does not give enough information for the House about vast sums of public money and even more importantly about where the goods originated.

To avoid repetition of all the arguments, the signatories of this amendment have circulated an article on yesterday’s edition of PoliticsHome setting out the arguments in favour of the amendment. In summary, the amendment is about the procurement of merchandise for the National Health Service from states credibly accused of genocide. Why is it needed? It is because of the possibility that perpetrators of this crime above all crimes are benefitting from procurement by the UK Government and because spending taxpayers’ money on the proceeds of genocide and slave labour is unacceptable and should be unconscionable.

Although the amendment is generic and does not name any country, the noble Lord, Lord Blencathra, made it clear in Committee that this would have a significant effect on the procurement of goods from Xinjiang, where both the Foreign Secretary and the House of Commons after a vote declared that a genocide is under way. For the avoidance of doubt, the Department for Health and Social Care’s records show that over the course of the pandemic the department generated orders for 36.9 billion items of personal protective equipment and that of these, 24.1 billion items have a country of origin recorded as China, including 10.7 billion gloves.

In a reply I received last year I was told that we had bought 1 billion lateral flow tests from China. Curiously, the letter I have received today—perhaps again the noble Earl will be able to amplify this—on one hand says it would be commercially sensitive to tell me what has been spent on these items of PPE and specifically on lateral flow tests, but elsewhere tells me that £4.8 billion has been spent. So, it is either commercially sensitive or it is not, and I do not understand what the figure therefore relates to.

So how does the amendment address this? What is its purpose? In the light of reports of slave labour-made PPE entering our supply chains, it meets the clear and urgent need to address health procurement. Recall that Dominic Raab rightly described the industrialisation of more than 1 million incarcerated Uighurs in Xinjiang. The amendment requires the Government to address our heavy dependence upon regions which, in whole or part, produce slave-made PPE and which too often goes unaddressed. This House is being consistent with its earlier decisions in urging the Government to come forward with a comprehensive policy on genocide which is long overdue.

As the noble Lord, Lord Blencathra, said in Committee, in comparison with the bipartisan legislation in the United States, with its rebuttable presumption on all trade with China, this amendment is modest. In a proportionate and balanced way, it does not circumnavigate the Government’s position that a determination of genocide is for competent courts only. It only requires a response where serious risk of genocide is said to occur. If the Foreign Secretary is right, how can we justify spending billions of pounds on billions of items made by slave labour in a state that she has accused of genocide? The amendment lays a duty on a Minister of the Crown to assess whether there is a risk of genocide in the sourcing region if the chair of a relevant Select Committee of either House requests such an assessment to be made.

It is worth reminding the House that the list of those supporting the amendment includes the British Medical Association, Accountability Unit, atrocity prevention organisations such as the World Uyghur Congress and many others. I also drew the attention of the seminar about this amendment held in your Lordships’ House two days ago to the valued support of my noble friend Lord Stevens of Birmingham, the former chief executive of the National Health Service.

Why would anyone want to oppose this? The department tells us that it is not appropriate to address genocide in a health Bill. However, not only is there a specific and huge issue centred on National Health Service procurement—very much a Department of Health and Social Care issue—but genocide is not a narrow departmental matter. It is something which, under the 1948 convention on the crime of genocide, we are all required to address, in whatever capacity and right across government. The department is also bound by the law. The requirements are set out in Theresa May’s landmark legislation, the Modern Slavery Act, which I gave my total support to when it passed through your Lordships’ House in 2015. There are legal duties here.

I also take this opportunity respectfully to suggest to the noble Earl that we must not make sweeping claims about the good state of our health supply chains. There is much more to this than the Telegraph report which linked £150 million of PPE directly to Xinjiang. I mentioned to the noble Earl in conversation that Professor Laura Murphy’s seminal report In Broad Daylight details various NHS providers who are heavily implicated in China’s labour transfer schemes, which are widely acknowledged to be involuntary work schemes targeted at ethnic minorities.

I am also aware that analyses are under way of NHS-procured PPE, which is highly likely to show that many constituents originate in Xinjiang. I particularly draw the attention of the House to the extraordinary and remarkable speech the noble Lord, Lord Rooker, made in Committee, where he talked about the work of Oritain and how it can determine right down to the last shred the origins of cotton. That is obviously very significant in this context, and I was grateful that the final paragraph of the letter I have referred to says that the department’s officials will be happy to meet Oritain. That is extremely welcome.

While I am at it, I also refer the noble Earl to the House of Commons Business, Energy and Industrial Strategy Committee’s fifth report of Session 2019-21, which said:

“We were disappointed by the Government’s statement, as it introduced no significant new measures to prohibit UK businesses from profiting from the forced labour of Uyghurs in Xinjiang and other parts of China. We are also deeply concerned about reports that the Government procured personal protective equipment from factories in Xinjiang and other parts of China implicated in modern slavery during the early part of the Covid-19 pandemic.”

So, this is not scaremongering on the part of noble Lords or people who are perceived to be hostile to the Chinese Communist Party. This is a reputable report from a House of Commons Select Committee for people of high academic distinction. The noble Earl will perhaps want to study it in more detail.

The department tells us it is not appropriate to address genocide in a health Bill, but not only is there a specific and huge issue centred on NHS procurement—very much a health department issue—but genocide is not a narrow departmental matter: it is, as I said, something that every department in government needs to address, and the House needs to reach decisions on this and on the other two amendments in this group.

I end by simply citing public support: two-thirds of those polled, some 65%, say they would support preventing the Government from procuring health equipment for the National Health Service from regions where they believe there is a serious risk of genocide. So there is widespread public support for what the promoters of this all-party amendment are asking the House to do. The House should seize this opportunity to ensure that our National Health Service is free from slave labour and, on behalf of the noble Lord, Lord Blencathra, I beg to move.

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

I now call the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, I am sorry to hear that the noble Lord, Lord Blencathra, is unwell, and I thank the noble Lord, Lord Alton, for his excellent introduction to Amendment 108, to which I have added my name. I also support the other two amendments in this group, which are in the name of the noble Lord, Lord Hunt, who I commend for his consistent campaign on these issues over the years. His Amendment 162 would ensure that there must be informed consent, with no coercion or financial gain, when organs are donated or when UK citizens go abroad for transplants. Amendment 173 would ensure that cadavers would no longer be used for public display unless it is the body of a person which is at least 100 years old, because, as with Amendments 108 and 162, there is real concern that people have been forced to have organs removed, or their bodies have been used after their death—sometimes murder, sometimes execution—but without their consent.

Returning to Amendment 108, it has two clear objectives: the first is to prevent the Government procuring health service goods produced in regions where there is a serious risk of genocide. While the Government say there is no evidence, a New York Times investigation found that PPE made through the Xinjiang labour transfer programme was present in US and international healthcare systems. As we have heard from the noble Lord, Lord Alton, there is increasing evidence that the NHS has procured such items already.

The second objective is to create a process through which the UK Government can be required to assess regions for serious risk of genocide and publish their assessment. This is necessary because the UK Government have given out PPE contracts worth almost £150 million to Chinese firms with links to forced labour abuses in the Uyghur region.

The Government have said that genocide amendments are not appropriate in the Bill and that the Modern Slavery Act 2015 offers protection, but the reality is that the UK is not leading the world here. The US Uyghur Forced Labor Prevention Act creates a “rebuttable presumption” banning all goods sourced in whole or in part from the Xinjiang region of China, unless clear and persuasive evidence can be provided to the contrary; and the European Union is now considering bringing forward new legislation to ban products made with forced labour from entering the European market. The UK’s Modern Slavery Act does not go nearly as far as either of these proposals, merely requiring that companies publish—but not that they act upon—modern slavery statements. People’s lives and human rights are at stake here. Frankly, it is time the UK followed suit with stronger legislation. This amendment would be a strong and careful start that means government and Parliament cannot look away. I look forward to the Minister’s response.

[Baroness Kennedy of The Shaws (Lab)]

I shall speak very briefly, because I am conscious of the time and that we have a lot of business to do. This amendment seeks nothing more than to create another human rights threshold for health procurement, adding to those that are already in place, which seek to address slavery but have major shortcomings, as the noble Baroness, Lady Brinton, has just described. I keep hearing it being said that a health Bill is not the proper place for an amendment concerning genocide. Well, I am afraid that I do not agree. This is an appropriate place.

We are not asking the Government or the Department of Health to decide whether there is a genocide taking place; we are asking the Minister to take on the duty to assess whether the source of instruments, test kits, protective equipment or whatever may be from forced labour and a situation of slavery. Xinjiang province is the obvious place for us to be concerned about, but there are other places—for example, in India—that we should be concerned about too, and I think that placing that duty on the shoulders of the Minister is a way of concentrating minds. That is why I really press this amendment and I pay tribute to the way the noble Lord, Lord Alton, has so assiduously pursued this. That is all I wanted to say, but I will support this amendment and I urge the House to support it too.

17:45

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great honour for my two amendments to be grouped with that in the names of the noble Lords, Lord Alton and Lord Blencathra. As the noble Lord has discussed the supply chain, I should declare my interest as president of the Health Care Supply Association, although I am not speaking on its behalf when it comes to my strongly supporting his amendment, which sets the context for my own two amendments.

We debated this issue very fully in Committee. I think that the House believes strongly that the commercial exploitation of body parts in all forms is unethical and unsavoury. When it is combined with mass killing by an authoritarian state, we cannot stand by and do nothing. In 2019, the China Tribunal, led by Sir Geoffrey Nice QC, stated:

“The Tribunal’s members are certain—unanimously, and sure beyond reasonable doubt—that in China forced organ harvesting from prisoners of conscience has been practiced for a substantial period of time involving a very substantial number of victims.”


In June this year, 12 UN special procedure experts raised the issue of forced organ harvesting with the Chinese Government in response to credible information that Falun Gong practitioners, Uighurs, Tibetans, Muslims and Christians had been killed for their organs in China.

Currently, human tissue legislation covers organ transplantation within the UK, where we have a very ethical approach, but it does not cover British citizens travelling abroad for transplants, and British taxpayers’ money will pay for anti-rejection medication regardless of where the organ was sourced or whether it was forcibly harvested from prisoners of conscience.

I shall not repeat all that I said in Committee, but I have had a helpful meeting with Ministers for which I thank them. In that meeting and in subsequent meetings, the Minister was concerned that my amendment in relation to organ tourism would penalise vulnerable people seeking to pay for a transplant. I have thought about that carefully, but, in the end—and the noble Baroness, Lady Kennedy, expressed so well why this Bill is highly appropriate for these kind of amendments—we have to draw a line in the sand. That is particularly so today, in the horrific circumstances that we meet. We have to draw a line in the sand and send out a powerful message globally that we will not support these abhorrent practices in any way.

My Amendment 162 comes later, but I shall seek the opinion of the House at that time.

[Baroness Northover (LD)]

The noble Lord, Lord Hunt, has very effectively introduced the amendments to which I have put my name, Amendments 162 and 173, and I wish briefly to express the support of these Benches for those. We also support Amendment 108, to which my noble friend Lady Brinton has put her name.

As noble Lords know, we have been inching forward on these matters with Ministers, and I welcome that forward movement. I note, however, recent warnings from Ministers that, for example, there are “opportunity costs” in implementing these measures, as ensuring that proper standards are enforced requires effort and potential cost. I understand that. Nevertheless, we cannot allow ourselves to become complicit in any way in organ tourism where the source of those organs is forced or where selling the organ is to address appalling poverty.

Some say that this trade may be declining in and from China. If so, that is welcome and might reflect international pressure, not least on the Chinese medical profession. It is not clear that those involved in the China Tribunal and the Uyghur Tribunal would agree that it is declining.

Even if we were to accept that, and Ministers seemed to indicate that they thought that might be the case, we are also hearing now of an increase in the selling of organs in Afghanistan because of the dire situation there. There have been recent reports of journalists seeing the scars of those who have sold their kidneys. That is a terrible indictment of our walking away from Afghanistan and failing to address the appalling conditions that we have left there. How can we regard such potential “donors” as being anything other than the most extremely vulnerable? How can you put that up against the vulnerable who may need to have donations?

As for the bodies exhibitions, we have discussed before how distasteful they are—but then we realise with horror exactly where these bodies seem to have been sourced: among other things, from Chinese prisons. We should never have condoned that, turning a blind eye. I agree with the noble Baroness, Lady Thornton, who argued in Committee that they should simply be banned. There is no reason whatever to agree to their continuation.

I now hear that the Government may argue—and this is incredibly familiar—that these amendments are flawed. As the noble Earl knows, often Ministers are given briefs that say, “This is a flawed amendment, so turn it back.” I am very familiar with them. In those circumstances, the best thing is for your Lordships to pass these amendments, because Ministers know, or should know, that the essence is extremely clear, and with government lawyers we can work out how best to sort out any unintended consequences. I hope that I do not hear anything about these amendments being flawed—and I say that to the Box. I therefore commend them to your Lordships.

[Baroness Finlay of Llandaff (CB)]

My Lords, I support all the amendments in this group, and I shall speak specifically and briefly to Amendments 162 and 173.

These amendments are updates to the Human Tissue Act, which was born out of public outrage following the Alder Hey scandal, when over 100,000 organs, body parts and entire bodies of foetuses and stillborn babies were stored in NHS facilities. The body parts of dead patients, including children, were removed without consent. Today, the Human Tissue Authority’s guiding principles, as set out in its code of practice, are consent, dignity, quality, honesty and openness. These principles should not only reflect how human tissue sourced from within our own nation is treated, we must treat human tissue and organs with the same principles when sourced overseas.

In China, as has been said, there is substantial evidence of Falun Gong practitioners and Uighurs—as well as some evidence of Tibetans and house Christians—being killed on demand for their organs. Blood is taken off them for tissue-typing at the time when they were taken into custody, often with no idea why they were taken into custody at all, other than that they belong to one of those groups. There is no consent, no dignity and no transparency.

On 7 December last year, the British Medical Association released a statement on the abuse of Uighurs in China, expressing

“grave concern regarding the situation in China and the continuing abuse of the Uyghur population of the country as well as other minorities.”

It went on to state:

“We are particularly alarmed by the reports of organ harvesting, forced birth prevention, and the use of genomics data for racial profiling.”


It urged

“the UK government and international actors to exert pressure on the Chinese government to cease its inhumane actions towards the Uyghurs”.

If we do not pass amendments as laid before the House today, we will be complicit with these practices, because we will be looking at them with Nelson’s eye, with all the evidence that we have that they are going on.

On Amendment 173, on the exhibition of whole bodies using a plastinated technique, I suggest that there is no transparency whatever. Any attempt to claim that there has been consent is extremely suspect, because consent is very easily falsified. I went to one of these exhibitions because I thought you ought to go and see what you are criticising. This was not an anatomical, educational experience but a visual display of plastinated bodies in all kinds of different poses. But the one that horrified me the most was a pregnant woman, quite advanced in her pregnancy and with the foetus in her womb, which had been plastinated. I do not believe that that woman would have given consent for plastination. That raised real questions as to why such an advanced foetus was in the womb of a dead woman without something there explaining the nature of her death, the cause of death and the circumstances in which she had decided to consent to such a procedure.

[Baroness Smith of Newnham (LD)]

My Lords, I will speak to Amendment 108, while supporting the other two amendments introduced so powerfully by the noble Lord, Lord Hunt, and my noble friend Lady Northover, and to which the noble Baroness, Lady Finlay, spoke so eloquently.

I am completely in support of those amendments, but I wish to speak briefly to the genocide amendment today. On various occasions during the Covid pandemic questions were asked of the then Health Minister about the procurement of PPE. He was not able to give me a straight answer to say, “We can guarantee that no PPE procured could have had anything to do with slave labour or could have come from Xinjiang.”

The NHS seeks to be world leading. We all support it and want it to be able to deliver for every citizen in this country. But that should not be at the expense of the lives of those in other parts of the world. It is not good enough to say that we have the Modern Slavery Act if that will not lead to a change in practices. It is absolutely essential that our supply chains do not include anything that comes from forced labour.

If one looks at what is going on in Xinjiang, it is possible to barter to get numbers of people, just as it was 200 years ago during the slave trade. That is not acceptable. It may be the case that, as the noble Baroness, Lady Kennedy of The Shaws, pointed out, we will be told, “This is not the right piece of legislation.” If it is not, what will the Government bring forward that will mean that every point of our supply chain—every part of government procurement—ensures that we are not procuring things that have been made using slave labour?

We must not be complicit. This House should support the amendments, and if the Minister is not able to support the amendment, perhaps he could come back with a revised and better version of the amendment that will do what we all seek to achieve.

[Lord Moylan (Con)]

My Lords, I will speak briefly only to Amendment 108, which I understand the Government are likely to resist when my noble friend the Minister comes to speak. I say simply, very briefly, that to be persuasive, my noble friend has to explain how through administrative measures the National Health Service will achieve the effects of this amendment. He has to explain that in a credible way and that the effects will be rapid and comprehensive. Any idea that this will be kicked into a long review that ambles on and may or may not produce the effects required by at least the first two proposed new subsections of the amendment will lack credibility; I am less concerned about the chairman of the Select Committee part that comes in the third one. I would like my noble friend to know before he speaks that that is what I think we all want to hear.

18:00

[Baroness Walmsley (LD)]

My Lords, China has been found out. Thanks to surveillance and other types of technology, and courageous on-the-ground reporting, it is clear that China does use slave labour. As we know, the UK has a duty under the genocide convention, and there is strong evidence that much of the material produced by slave labour, even possibly by genocide, is being used by NHS staff—and even by noble Lords ourselves when we use lateral flow tests, since we are not confident about where they came from. They come from areas where there is serious risk of genocide and as the noble Baroness, Lady Kennedy, said, it is not necessary to determine genocide in order to be obliged to do a risk assessment and take action; and we are not doing enough of that. Over half of these products come from places where there is no conflict, so action against conflict is not adequate. More needs to be done. We must not fail to do it because it is more convenient to buy products to keep us safe without investigating how they are produced. Our safety must not be on the backs of people whose rights, and even their lives, are being taken from them.

The same applies to organ-harvesting from unwilling donors. There is incontrovertible evidence that it is not just happening but happening increasingly, and it absolutely has to stop. My noble friend Baroness Northover made a strong case that the exhibiting of cadavers should not happen in a civilised society, and I hope that the Minister is going to tell us how the Government are going to stop it.

[Lord Eatwell (Lab)]

My Lords, I rise to give my strong support to Amendment 108, and I do so because of the terms of the genocide convention to which this Government are committed and are obligated to support. It is important for the House to note that genocide is not defined solely as mass killing. It is also defined as

“causing serious bodily or mental harm … deliberately inflicting … conditions of life calculated to”

destroy the protected group

“in whole or in part … imposing measures intended to prevent births”,

and

“forcibly transferring the children of the group to another group.”

The Government are a signatory to the genocide convention, and I think the noble Earl, Lord Howe, is obligated by that signature to support this amendment.

[Baroness Merron (Lab)]

My Lords, it is impossible to turn away from the connection between procurement of products and services and the message and support that such procurement may give to those who seek to exploit, oppress, damage and murder.

I thank the noble Lord, Lord Alton, for introducing this amendment, in the name of the noble Lord, Lord Blencathra, who we wish well. Genocide and the abuse of human rights do not respect the imposed boundaries of government departments, and that is why it is appropriate that these amendments, which have extensive support both inside and outside your Lordships’ House, have been tabled today. Amendment 108 has cross-party support and if the will of the House is tested, we on these Benches will support it.

The NHS is the biggest single procurer of medical products in the world. It has a huge amount of leverage to be a force for good or otherwise when it comes to ethical procurement. It can starve abusive regions of resources. It can also remove a veneer of acceptability from those regions.

If we are serious about being global Britain and a force for good in the world, we need to act as such. It is surely wrong that, for example, we are using bandages which have been produced by forced labour. We must hold the Government to their commitment to provide guidance and support to UK government bodies to use public procurement rules to exclude suppliers where there is sufficient evidence of human rights violations in any of their supply chains. As expressed by my noble friend Lady Kennedy, this is about giving the Minister the opportunity to act. It is about focusing minds. I hope that the amendment will find favour with the noble Earl.

In Committee, my noble friend Lord Collins spoke of the need not to be tied down by a very strict legal definition of genocide. He also emphasised that we must focus on broader human rights issues. As the noble Lord, Lord Alton, said, we need to take a comprehensive, joined-up approach. Amendment 108 gives us this opportunity.

I thank my noble friend Lord Hunt for continuing to press home the need for action, as outlined in Amendments 162 and 173. We heard explicitly and movingly about the realities of how this affects people’s bodies, alive and dead, and the distaste and abuse related to it. It is surely right that UK citizens are safeguarded against complicity in forced organ harvesting as the result of genocide. Countries such as Spain, Italy, Belgium, Norway and Israel, among several others, have already taken action to prevent organ tourism in respect of China. We have the opportunity to do so today.

I hope that the noble Earl will feel able to accept these amendments. I am grateful to the noble Lord and his officials for the opportunity to discuss these matters. I hope only that your Lordships’ House can assist in improving this aspect of the Bill by taking action, as we should, about genocide and the abuse of human rights.

[Earl Howe (Con)]

My Lords, the amendments in this group bring us to three discrete topics which are nevertheless linked by a common thread—that of human rights. Because they engage us in issues of great sensitivity, I begin by saying something that may sound unusual. There is probably no one in this Chamber who is not instinctively drawn towards these amendments. All three are honourably motivated. In pointing out any shortcomings, I would not want noble Lords to think that the Government did not understand or sympathise with why they have been tabled.

I will start with the issue of organ tourism. Like the noble Lord, Lord Hunt, I find it abhorrent that individuals exist who are in the business—often the lucrative business—of sourcing human organs from provenances that are both illegal and supremely unethical. They then entice desperate and seriously ill people to go to a foreign country to have such organs transplanted within them. This idea is unconscionable. As far as we can, we should have no truck with it. The Human Tissue Act already prohibits the giving of

“a reward for the supply of, or for an offer to supply any controlled material”

in any circumstance where a substantial part of the illicit transaction takes place in England, Wales or Northern Ireland.

The Modern Slavery Act makes it an offence to arrange or facilitate another person’s travel, including travel outside the UK, for the purposes of their exploitation, which includes the supply of organs for reward in any part of the world. The law as it stands addresses a substantial element of potential criminality. How widespread is this criminality? What do we know about the scale of organ tourism as it relates to UK residents? I have obtained some figures from the department. In 2019-20, the last reporting year before international travel was curtailed by the pandemic, a total of 4,820 organ transplants took place in this country. At the same time, NHS Blood and Transplant data shows that only seven UK residents received a transplant abroad, many if not all legitimately, and had follow-up treatment in the UK.

Therefore I am thankful to say that the scale of the problem of illicit organ tourism, as it relates to UK residents, is small. If the noble Lord, Lord Hunt, were to say to me that one such case is one too many, I would agree, but the House should not support this amendment, because it is not right to support an amendment that could cause vulnerable transplant patients who receive a legitimate transplant overseas to face imprisonment because they may not have the right documentation. That is what the amendment could lead to. Checking such documentation and creating individually identifiable records for every UK patient who has received a transplant overseas would put healthcare professionals in an invidious and inappropriate position by blurring the line between medic and criminal investigator.

More to the point, it could also prevent those who legitimately receive an organ transplant abroad—particularly those from minority-ethnic backgrounds—from seeking follow-up treatment, for fear of being treated as a criminal suspect. Following that thought through, I say that the effect that this amendment could have in exacerbating health inequalities is likely to be far greater than its effect in deterring transplant tourism, especially, as I have emphasised, because there are already legal provisions in place covering most cases of organ tourism.

I listened with care to the noble Baroness, Lady Finlay, particularly regarding her examples of the exhibition that she went to. I join her in being somewhat incredulous that there could be consent to some of the exhibits that she witnessed. However, where consent has been obtained, it must be unequivocal. As I emphasised, the law as it stands now prohibits the exhibition of bodies or body parts where express consent cannot be fully demonstrated. I undertake to speak to the Human Tissue Authority, to see that, should there be another exhibition of this kind proposed, there is full transparency in the form of labels under each exhibit making clear how consent was obtained and what it consisted of.

Targeting those who receive an organ, rather than the traffickers and their customers who initiate or negotiate the arrangements, risks imprisoning vulnerable patients who may have been misled as to the provenance of their organ. That would be disproportionate. The Government’s view remains that the best approach is to continue targeting traffickers and their customers, while doing all that we can to help UK residents who are in need of an organ by focusing our efforts on improving the rates and outcomes of legitimate donations.

18:15

I turn to Amendment 173 relating to the public display of cadavers. Again, this is an issue of great sensitivity about which we all have personal views. I am sorry that I read out the wrong reply to the noble Baroness, Lady Finlay, just now. The noble Lord, Lord Hunt, has been assiduous in pursuing the case for a complete ban on these displays and we have heard the powerful case that he and others put in support of such a ban. But once again I will say why I think the amendment should not be supported.

The law already prevents new public displays of bodies and body parts where the donor has not given their express consent, and that is as it should be. The question we now need to answer is whether the law should also prevent the display of bodies and body parts where such express consent has been given. This is where I return to the points I made about the speech of the noble Baroness, Lady Finlay. There may well be individuals who express their desire to donate their bodies after death for the purpose of an exhibition devoted to the display of the human anatomy. Some people sincerely feel that such exhibitions have educational and artistic merit on the grounds that they provoke interest in the inner workings of the human body. Some of us may find the idea of such exhibitions distasteful, but I say gently to noble Lords that in a liberal and free society such as ours it is not the role of government or, I suggest, this House to be the arbiter of taste. We should respect the principle that we have always championed in our debates concerning human tissue, which is that of informed consent. I suggest that this case is no different.

In turning to Amendment 108, I recognise the enormous strength of feeling in the House on the human rights violations that we hear from many sources are being perpetrated in Xinjiang. I also acknowledge the concerns raised by several noble Lords that items procured by the NHS may be sourced from regions where forced labour or other serious violations of human rights are occurring. As we have heard, this is a complex issue—complex because supply chains are complex—and I do not wish to sound complacent or uncaring if I say that there are no easy answers. But I reassure the House that the Government are resolutely committed to taking robust action to tackle this challenge, not just in the NHS but across all our supply chains. I will demonstrate to the House exactly how we are doing that, both currently and prospectively.

Over the past year, we have introduced a number of robust, evidence-based measures to help ensure that no UK organisation, public or private, is complicit in the human rights violations occurring in Xinjiang. Those measures include new guidance for UK businesses on the risks of doing business in Xinjiang, the announcement of enhanced export controls and commitments to introduce financial penalties for non-compliance with Section 54 of the UK’s Modern Slavery Act, as well as new procurement guidance to help exclude companies linked to modern slavery violations.

We are also working closely with international partners to ensure a co-ordinated approach to supply chains. Under our G7 presidency last year, G7 leaders committed to working together to ensure that global supply chains are free from the use of forced labour. That effort is government-wide and across all sectors of business.

Within the NHS specifically, we have taken and continue to take action in line with procurement and modern slavery law. Since 2020, NHS Supply Chain has utilised the UK Government’s portal, the Supplier Registration Service, to undertake assessments of both modern slavery and labour standards where, through risk assessment, a contract is deemed high-risk. We fully recognise, however, that further work is needed across government to meet the scale of the challenge. That is why the Government have announced a comprehensive review of their 2014 modern slavery strategy, with a new strategy due to be published this spring. This is a major undertaking, including a thorough review of all aspects of our approach to tackling modern slavery. We are also looking at introducing further measures through the upcoming procurement Bill. Those measures would be in addition to new legislation to strengthen further and future-proof the transparency and supply chain provisions of the Modern Slavery Act, when parliamentary time allows.

This ongoing work does, I trust, demonstrate the Government’s commitment to taking a robust, holistic and co-ordinated approach to meet the complex challenge posed by the risk of human-rights violations in global supply chains. That is why, despite our having no doubt as to the honourable intentions behind this amendment, we do not believe that building it into the Health and Care Bill would further our efforts in taking robust action to address human rights violations, wherever they may take place.

The UK is strongly committed to early and effective action to prevent all mass atrocities—whether that is genocide, war crimes, crimes against humanity, or ethnic cleansing—and we will do this through a variety of means: early-warning tools, diplomacy, development and programmatic support, human rights monitoring, and coercive measures such as sanctions and defence tools. Our work in this area is long-standing, both in terms of preventing atrocities and in securing accountability and justice for atrocities committed. The issues and concerns raised today by the noble Lord, Lord Alton, and other noble Lords require a comprehensive and carefully considered response befitting both their gravity and complexity. We do not, however, consider this Bill to be an appropriate instrument through which to tackle this issue.

That said, I acknowledge the strength of feeling in this House relating to the NHS, specifically about ensuring that no part of the NHS is inadvertently complicit in human rights violations, where they exist in supply chains. Therefore, in addition to the range of measures we are already taking, I am pleased to make a commitment that the department will undertake a new, focused internal review of NHS supply chains to address the concerns that have been expressed with regard to the risk of exposure. In conducting this review, the Government would welcome further engagement with the noble Lord, Lord Alton, my noble friend Lord Blencathra, and, indeed, all noble Lords who have spoken in this debate. Your Lordships’ insights will, I have no doubt, be greatly valued as we take forward this important work. I was grateful to the noble Lord, Lord Alton, for the references and pointers that he mentioned in his speech.

I hope that this provides noble Lords with further reassurance about the Government’s approach but, more than that, I hope that the undertaking I have just given, combined with the statements I have made to the House about the extensive work now in train across government to bear down as hard as we can on modern slavery and the abuse of human rights across the world, may persuade the noble Lord, Lord Alton, to withdraw Amendment 108.

[Baroness Finlay of Llandaff (CB)]

Before the noble Earl sits down, may I apologise to the House? I should have declared that I am the UK chair of Commonwealth Tribute to Life, which aims to establish a memorandum of understanding across the Commonwealth over ethical transplantation.

The Minister, in his reply, spoke of seven patients who are known to have travelled abroad for organs. Most of those were legally arranged, so the numbers are very small; yet the clinical services in the UK are not aware that it is illegal to arrange to purchase an organ abroad if most of that transaction happens in the UK, or to procure the travel to go. I wonder whether the Minister would be able to undertake to work with us in NHSBT to ensure that all the clinicians working in the field are aware of this and can brief patients appropriately at the time they sign up to be on the transplant list, so that they understand that, although they are eligible for a transplant, they should not be seeking transplants in other countries, even when tempted to do so. It can look quite alluring, and I am concerned that, within the profession itself, there might be some misunderstanding. I realise this is a difficult question and the Minister might prefer not to answer it now; it might be something we could discuss later.

[Earl Howe (Con)]

My Lords, that is a perfectly valid question from the noble Baroness, and I would be happy to take that back to those in the Department of Health and Social Care who have direct responsibility in this area.

[Lord Alton of Liverpool (CB)]

My Lords, I know that this is a complex and long Bill, and that the House will want to move quite quickly to the next business. I will end by simply thanking every noble Lord who has participated in today’s debate, especially the noble Baronesses, Lady Walmsley and Lady Merron, from the opposition Front Benches, and the noble Lords on the Government Benches who have supported the noble Lord, Lord Blencathra, and the noble Baroness, Lady Hodgson, at every stage of the progress of this amendment.

I know that when the noble Earl, Lord Howe, said that he was instinctively drawn to these amendments, and that he found many of these practices abhorrent, he was speaking as he feels. I am grateful to him, not only for the meeting that we had yesterday with the noble Lord, Lord Kamall, but for his promise to look at this further. Among those to whom I would like to introduce him is a Uighur surgeon I have met, who has given evidence here in the House about being forced to remove organs and to kill the patient in the course of that. This is the ethical issue here. If people profit from that in any way whatever, even if inadvertently, we must not be complicit.

A year ago, we were promised that there would be an urgent review of exports to Xinjiang and fines for businesses which failed to comply with the Modern Slavery Act, when parliamentary time allowed. Those things have not happened. The urgent review has just been completed, but it ended up dealing only with military exports and there have been no fines applied one year later. It is never the right Bill or the right time. The noble Lord, Lord Forsyth, and I were told this on the telecommunications Bill, we were told it again on the then Trade Bill. We are told it on every Bill. That is why it is inevitable that we come back with amendments like this until the comprehensive plan, to which the noble Earl referred, actually happens.

The House really needs to send this amendment further. We have had between Committee and now for the Government to help us redraw it, if there are any defects or flaws. I am unaware of what they may be; they have never been pointed out to us. The noble Earl also knows that the Government could say to us, “Bring this back at Third Reading and we will help to draw up such an amendment.” However, I am told that this is not possible either. Therefore, the only way for us to ensure that this amendment can proceed and be perfected is to send it to another place. I am glad to be able to tell the House that a former leader of the Conservative Party, Sir Iain Duncan Smith, has agreed that he will personally promote this amendment if it is passed in your Lordships’ House today and take it further there. He says that he is with us 100%. I would like to seek the opinion of the House.

18:27

Division 3

Ayes: 110

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Labour: 43
Liberal Democrat: 35
Crossbench: 20
Conservative: 5
Independent: 5
Democratic Unionist Party: 1
Green Party: 1

Noes: 91

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Conservative: 88
Crossbench: 2
Independent: 1

18:40

Amendment 109

Moved by

[Lord Kamall]

109: After Clause 77, insert the following new Clause—
“Meaning of “health” in NHS Act 2006
In section 275(1) of the National Health Service Act 2006 (interpretation), at the appropriate place insert—““health” includes mental health;”.”Member’s explanatory statement
This new Clause clarifies that in the NHS Act 2006 “health” includes mental health (unless the context otherwise requires). Although the natural meaning of health is capable of including “mental health” the existing provisions of the Act are inconsistent about whether they mention mental health expressly which could cause confusion.

Amendment 109 agreed.

Clause 79: Abolition of Local Education and Training Boards.

Amendment 110

Moved by

[Lord Kamall]

110: Clause 79, page 69, line 42, at end insert “and the “and” before it”
Member’s explanatory statement
This amendment is consequential on Clause 79(3) of the Bill, which omits paragraph (c) of section 100(4) of the Care Act 2014.

Amendment 110 agreed.

Amendment 111 not moved.

Amendment 112

Moved by

[Lord Warner )]

112: After Clause 80, insert the following new Clause—
“PART 1AHEALTH AND CARE SUSTAINABILITYOffice for Health and Care Sustainability
(1) There is to be a body corporate, independent of the Government, called the Office for Health and Care Sustainability (“the Office”) to safeguard the long-term sustainability of an integrated health and adult social care system for England. (2) The Office must be established within six months of the passing of this Act and must publish a report of its initial findings relating to its main functions within a year of its establishment.(3) The role of the Office is to continually assess the outlook for the health and care system over the coming five, 10 and 15 years.(4) The Office has no function in operational or service delivery aspects of the health and care system.(5) The Office must—(a) monitor and publish data relating to demographic trends, disease profiles and the likely pace of change relating to future service demands,(b) assess the workforce and skills mix required to respond to those changes and publish regular reports on those matters, and(c) consider the stability of health and adult social care funding relative to changing demographic and disease trends, including the alignment between health and adult social care funding, and publish regular reports.(6) The functions of the Office are to be exercised on behalf of the Crown as if it was a public department.(7) The Office is to consist of—(a) an executive chair appointed by the Secretary of State with the consent of the Public Accounts and Health Select Committees of the House of Commons,(b) two other members appointed by the Secretary of State with the consent of the Public Accounts and Health Select Committees of the House of Commons, and(c) two other members nominated by the Office and appointed by the Secretary of State.(8) The initial appointments under subsection (7) are for a term of five years and no more than two terms may be served.(9) The remuneration of the executive chair is to be agreed by the Secretary of State but may not be less than that paid to the Permanent Secretary of the Department of Health and Social Care; and all other salaries and gratuities for members may be agreed by the Office with the consent of the Secretary of State for Health and Social Care.(10) The Office may employ staff on terms and remuneration consistent with that of the civil service.(11) The Office may—(a) establish such committees and sub-committees as it deems necessary,(b) determine its own procedures and those of its committees and sub-committees, and(c) do anything calculated to facilitate, or conducive or incidental to, the carrying out of any of its functions.(12) The annual budget of the Office is to be provided by the Secretary of State after consultation with the Public Accounts Committee of the House of Commons.(13) The Office must keep proper accounts and records in relation to its accounts, and must prepare and publish each year an audited statement of accounts.(14) The Office must prepare an initial report on its work within one year of its establishment, and thereafter annually, and may at any time publish a report on its functions when it considers that this assists safeguarding the long-term sustainability of an integrated health and adult social care system in England.(15) The Secretary of State must lay any report prepared by the Office before both Houses of Parliament.”Member’s explanatory statement
This amendment implements recommendations 33 and 34 of the 2017 report by the House of Lords Select Committee on the Long-term Sustainability of the NHS and Adult Social Care. It draws on the legislation setting up the Office for Budget Responsibility.

[Lord Warner (CB)]

My Lords, Amendment 112 is my name and the names of the noble Lords, Lord Hunt, Lord Scriven and Lord Kakkar. I am grateful for their support. This amendment goes much wider in terms of independence from the Secretary of State than Amendment 80, moved so convincingly by the noble Baroness, Lady Cumberlege, earlier today.

Amendment 112 establishes a new body to help to secure the long-term sustainability of our health and care system. That body is an independent office for health and care sustainability as recommended by this House’s Select Committee on the Long-term Sustainability of the NHS and adult social care. This new body is based on the model of the Office for Budget Responsibility. That body is widely accepted as having worked well over a number of years. My amendment draws heavily on the 2011 legislation setting up the OBR.

The new office of health and care sustainability has three main functions which are set out clearly in the amendment, so in the interests of time I will not repeat them. The new body would look five to 10 to 15 years ahead and publish regular reports which would be laid before both Houses of Parliament. It would produce an initial baseline report within a year of its establishment. Like the OBR, the new body would have an executive chair and five members. The chair and two members would be appointed by the Health Secretary but—and this is a very big but—with the consent of the House of Commons’ Public Accounts Committee and Health and Social Care Committee. The remaining two members would be chosen by the office itself. Like the OBR, the new body would not have a membership controlled by Ministers.

The new office of health and care sustainability would be much more independent of the Secretary of State than is provided for in Amendment 80. It would have a much wider remit in terms of improving the balance between the NHS and social care, on both staffing and funding. The greater long-term independence seems essential given that the Department of Health—now the Department of Health and Social Care—has a political and official track record which was revealed to the Lords Select Committee as pretty unsatisfactory.

The Department of Health has been failing to plan for the future for a very long time. The evidence given by its Permanent Secretary totally failed to convince the Select Committee that it took long-term planning seriously. That Permanent Secretary is still in place. I do not like personal attacks, but in evidence to the Select Committee this person actually said that he did not see long-term planning as part of his job description. So we have a situation where the long-term planning of the NHS and social care is simply not on the agenda of the government department responsible for it.

With this track record and the Covid recovery programme that the Department of Health and Social Care now faces, it seems to me a triumph of optimism over reality to rely on that department and its harassed political head to undertake long-term planning. I say that despite the House passing Amendment 80. We are looking for a situation in which there is more independence of the Secretary of State and, indeed, more independence in the collection of information, the sifting of that information, and the analysis that that information shows—and that covers funding as well as workforce issues.

18:45

I am pleased to say, however, about the report that was presented to the then Health Secretary, Jeremy Hunt, although it seemed at the time not to get much support from him, that he seems to have had a Damascene conversion since taking up the job of chair of the Health Select Committee. In an interview that he gave to the Times last year, he is quoted as saying that

“he wants an Office for Budget Responsibility-style body to keep his successors ‘honest’ by spelling out how many doctors and nurses are needed.”

The only problem with that conversion is that it fails to consider all the other types of staff that a sustainable health and care system needs, but it is better that he has moved some way towards accepting that there is a need for a body of this kind.

If we want a sustainable health and care system in the decades ahead, we need an independent office of health and care sustainability to do the long-term planning. History has shown that we cannot rely on the departments and their political heads, who are busy doing the day-to-day stuff, to take the time to plan for the future far ahead to sustain our health, our NHS and our adult social care system. I beg to move.

[Lord Kakkar (CB)]

My Lords, I declare an interest as a member of your Lordships’ ad hoc Select Committee on the Long-term Sustainability of the NHS. My noble friend Lord Warner has very clearly introduced the arguments summarised at that time, when your Lordships’ committee made its report, strongly supporting the establishment of an independent office for the sustainability of health and care, and I shall not repeat those arguments.

What was striking was Her Majesty’s Government’s response to that report and, indeed, to recommendations 32 to 34 in that report, which dealt with that specific question. To summarise, Her Majesty’s Government felt that that office was unnecessary and that the Office for National Statistics had much of the data publicly available to assist in this long-term planning activity. Clearly, that is not the case; it has not happened, and it is unlikely to happen.

It is essential, as we have heard, that such an office is established not only to deal with questions of workforce—my noble friend has identified the interview given by the right honourable Jeremy Hunt on the question of an independent office for questions of workforce—as sustainability of health and care goes far beyond workforce. A very careful and appropriately defined methodology and expertise needs to be brought together to ensure that we can plan on a definite basis and achieve the sustainability that every Member of your Lordships’ House clearly regards to be essential. I therefore hope that Her Majesty’s Government accept this amendment.

[Baroness Merron (Lab)]

My Lords, five years have passed since the ad hoc Select Committee on the Long-term Sustainability of the NHS, under the chairpersonship of the noble Lord, Lord Patel, recommended an office for health and care sustainability. I thank the noble Lord, Lord Warner, for bringing this amendment before your Lordships’ House. This is a clear direction to put sustainability at the heart of planning and is long overdue. So we on these Benches support the amendment, and I hope the Minister will accept this amendment as a way forward.

[Baroness Penn (Con)]

My Lords, I thank noble Lords for bringing this debate before the House today. As mentioned in the debate in Committee, the specific functions described in Amendment 112 are crucial functions that the Government are committed to ensuring are discharged. This commitment is underlined by the fact that there are already bodies and mechanisms in place to fulfil these functions. These are core components of the Government’s commitment to evidence-based health provision. This commitment has been made clear in many of the Bill’s provisions, in our wider programme of public health reform and in the proposals set out in the Government’s plan for health and care.

The amendment makes recommendations on both appraisal and scrutiny of funding and of social and demographic trends. With regard to the monitoring of trends, the department already publishes data relating to disease profiles, which incorporates demographic trends where relevant. This is supported by independent academic modelling from the Care Policy Evaluation Centre, CPEC, to produce projections of the long-term demand on adult social care services. As for funding, noble Lords will also be aware that successive Governments have used the well-established spending review process to set public service budgets. This takes into account the needs of service users, but crucially also considers the fiscal context and how healthcare expenditure balances with the range of priorities across government.

As noble Lords have noted, aligned to those spending decisions, the Office for Budget Responsibility already scrutinises the Government’s fiscal approach and our management of fiscal risks. For example, in October 2021 the OBR provided an independent analysis of the Government’s reform to the funding of adult social care in England and has announced that it will provide more analysis of the long-term implications in its next fiscal sustainability report. There is also, as noble Lords will know, a wide range of highly influential non-governmental bodies dedicated to the kinds of functions proposed for this new body—the King’s Fund, the Health Foundation and the Nuffield Trust to name just three. All of these contribute richly to the public debate on financial sustainability and on the size and composition of the workforce, as well as other related issues, and to the ability of this House to scrutinise government decisions on spending and policy.

The Government therefore do not think that the creation of a further body would add value. At this crucial time for the health and care system, we must proceed with the reforms we have outlined. For these reasons I hope that the noble Lord, Lord Warner, will feel able to withdraw his amendment.

[Lord Warner (CB)]

My Lords, no chance. I wish to test the opinion of the House.

18:53

Division 4

Ayes: 80

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Labour: 35
Liberal Democrat: 25
Crossbench: 17
Independent: 3

Noes: 91

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Conservative: 88
Democratic Unionist Party: 1
Independent: 1
Crossbench: 1

Consideration on Report adjourned.

House adjourned at 7.05 pm.