Health and Care Bill

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

Consideration of Lords amendments

[Madam Deputy Speaker (Dame Eleanor Laing)]

I must draw the House’s attention to the fact that financial privilege is engaged by Lords amendments 34 to 37, 52 to 54, 80, 81, 84, 86 to 88, 91, 93, 94, 96, 97 and 129. If they are agreed to, I will cause the customary entry waiving Commons financial privilege to be entered in the Journal.

After Clause 148

Mandatory training on learning disability and autism

15:11

[The Minister for Health (Edward Argar)]

I beg to move Government amendment (a) to Lords amendment 91.

[Madam Deputy Speaker]

With this it will be convenient to discuss the following:

Lords amendment 91.

Lords amendment 85, and Government motion to disagree.

Lords amendment 86, and Government motion to disagree.

Lords amendment 87, and Government motion to disagree.

Lords amendment 88, and Government motion to disagree.

Lords amendment 92, Government motion to disagree, and Government amendment (a) in lieu.

Lords amendment 95, Government motion to disagree, and Government amendment (a) in lieu.

Lords amendments 52 to 54, 66 to 79, 82, 84, 93, 94, 96 to 101 and 109 to 122.

Lords amendment 123, and amendment (a) thereto.

Lords amendment 124, and amendment (a) thereto.

Lords amendment 125, and amendment (a) thereto.

Lords amendment 126, and amendment (a) thereto.

Lords amendment 127, and amendment (a) thereto.

Lords amendments 128 and 129.

[Edward Argar]

It is a pleasure to debate their lordships’ amendments and to serve opposite the hon. Member for Tooting (Dr Allin-Khan) for our consideration of this group of amendments—I do not usually do so as our portfolios do not always overlap. The amendments in the group all relate to questions of patient safety, patient engagement, public health and building a learning culture in the NHS.

First, may I put on record how proud I am that the Government are protecting the safety of women and girls through the hymenoplasty amendment, which I know has cross-party agreement? I will run through the amendments and concessions that the Government have made on a number of aspects of the Bill before turning to the perhaps more contentious areas in the group. We have tabled amendments to ban the carrying out, offering and aiding and abetting of hymenoplasty in the United Kingdom. We have accepted all the recommendations of the expert panel on hymenoplasty and agree that the procedure is inextricably linked to virginity testing and violence and that it has no place in our society. I offer my gratitude to all the members of that expert panel, to those who have campaigned so long and so hard on the issue and to my hon. Friend the Member for North West Durham (Mr Holden) for his continued hard work to protect vulnerable women and girls.

I urge the House to support amendments 84, 96 and 129, which create a licensing regime for non-surgical cosmetic procedures.

[Mr John Baron (Basildon and Billericay) (Con)]

In the spirit of accepting amendments and suggestions, may I thank the Minister, his officials and his special advisers for accepting the amendment in this place on prioritising cancer outcomes as a means of encouraging earlier diagnosis? That really will drive survival rates up. I also thank the nearly 100 colleagues here and in the other place who helped and supported the campaign. In that spirit, I assure the Minister that we will do what we can to help the Government in ensuring that the legislation prioritising cancer outcomes will have its desired effect at the frontline.

[Edward Argar]

I am grateful to my hon. Friend. Again, I think that I speak for both sides of the House on a cross-party basis in saying that we were pleased to be able to accept his amendment, on which he campaigned hard, in this place. I think that will lead to further improvements in cancer treatment and cancer care outcomes for many people in our country.

I return to the amendments relating to cosmetic regulation. I thank the hon. Members for Member for Swansea East (Carolyn Harris) and for Bradford South (Judith Cummins) and the right hon. Member for North Durham (Mr Jones) on the Opposition Benches as well as my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) and my hon. Friends the Members for Sevenoaks (Laura Trott) and for Thurrock (Jackie Doyle-Price) for their hugely important work in driving forward the agenda. While the amendment is broad, the Government will of course work with stakeholders, including Members of this House, to develop regulations to set out the specific cosmetic treatments that will be subject to licensing and the detailed conditions and training requirements that individuals will have to meet.

[Mr Richard Holden (North West Durham) (Con)]

I thank the Minister for his comments about virginity testing and hymenoplasty and the work done by other hon. Members on parts of the legislation that affect women and girls. One issue with virginity testing and hymenoplasty relates to the family procedure rules—I know that they fall outside his Department—which still permit spouses to apply for a so-called virginity test on the grounds that a marriage is not consummated. Will he speak to his colleagues and perhaps suggest a meeting with me and other campaigners in the area to see if we can remove from legislation some of those issues affecting women and girls?

[Edward Argar]

My hon. Friend makes an important and highly relevant point. I will certainly pass his request on to colleagues in the Ministry of Justice and the Attorney General’s Office to look at that and, hopefully, meet him to discuss it further.

We are accepting amendments in a number of other areas to improve the quality of services that the NHS provides. First, we are tabling amendments to ensure the full operability of the noble Baroness Hollins’s amendment—Lords amendment 91—on mandatory training on learning disabilities and autism. We have discussed and agreed the changes with her and are content that her amendment, along with our Government amendment, will legislate that all health and social care providers who carry out regulated activities ensure that their staff receive specific training on learning disabilities and autism.

[Dame Caroline Dinenage (Gosport) (Con)]

On that amendment, will my hon. Friend join me in paying tribute to the many people who have campaigned for learning disability and autism training for health and care professionals? I think specifically of Paula McGowan—the training will be named after her son, Oliver McGowan. Training frontline health and care professionals to have a better understanding of learning disability and autism will certainly improve people’s interactions with our health and care services, and it will save lives.

[Edward Argar]

I am happy to join my hon. Friend in paying tribute to Paula McGowan and all those who have campaigned for this and other amendments that the Government have been able to accept to the Bill. It is often easier to pay tribute to right hon. and hon. Members who have championed issues in this House, but often they are merely mouthpieces for those campaigners who have done so much to raise the profile of such issues.

The Government have also taken steps to extend the storage limits for embryos and gametes, removing an existing unfairness. Currently, legislation discriminates between those who have a medical need to freeze their materials and those who do not. Amendments 82, 98, 100 and 122 remove that distinction by introducing a new scheme consisting of 10-year renewable storage periods up to a maximum of 55 years for everyone regardless of medical need. Our proposals were welcomed unreservedly in the other place, and I hope that they will receive a similar reception in this House.

The Government have also tabled a number of amendments in the other place on transparency of payments made and other benefits given to the healthcare sector. Lords amendments 52 to 54, 93, 94 and 97 all deliver on a recommendation from Baroness Cumberlege’s independent medicines and medical devices safety review. They will enable the Secretary of State to make regulations requiring companies to report information about payments or other benefits that they have provided to the healthcare sector.

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

I thank my hon. Friend for what he said, which, with the Cumberlege review, is very important. I urge him again to go further on that review.

[Edward Argar]

I hear my right hon. Friend’s gentle but firm urgings, and I hope that he will welcome the progress that we have made.

[Sir Mike Penning (Hemel Hempstead) (Con)]

The Cumberlege report was fantastic. The Minister accepted some of what it said but not in relation to Primodos, especially in the area of compensation. Can we look at that again?

[Edward Argar]

I am always happy—or the relevant Minister is always happy—to meet my right hon. Friend on any matter relating to the Department’s work.

Turning to the Health Services Safety Investigations Body—HSSIB—and patient safety, we intend to support the development of a learning culture across the NHS. With that in mind, I would like to turn to Lords amendments 66 and 109. The related clauses concern how we balance the need for those who speak to the HSSIB to feel safe to speak openly and candidly to HSSIB staff, while ensuring that coroners can fulfil their judicial functions. This has been, throughout the passage of the Bill, a difficult balancing act with no perfect answer, which has been given much thought and attention, and on which reasonable people can come to equally valid but different views. However, I have concluded that there is significant strength of feeling in both this House and the other place on whether coroners should have access to protected material held by the HSSIB.

I am grateful to my colleagues in the Ministry of Justice, in particular the Under-Secretary of State for Justice, my hon. Friend the Member for Corby (Tom Pursglove), and to the Chief Coroner for considering the different views judiciously. Recognising that, the Government have decided to accept their lordships’ amendment, which removes the ability of senior coroners to access protected material held by HSSIB through relying on certain powers under the Coroners and Justice Act 2009. We hope that will give reassurance and strengthen the ability of the HSSIB to deliver what we all want across this House, which is to support an open learning culture across the NHS.

This group of amendments also includes a substantial number of amendments to improve public health. In the other place, we brought forward amendments to enable the smooth and effective implementation of restrictions on the advertising of less healthy food and drink. I urge the House to accept Lords amendments 101, and 123 to 128, which allow the necessary preparatory work to take place before the restrictions are due to come into force on 1 January 2023. They also introduce the ability to delay that implementation date via secondary legislation, should that be deemed necessary.

[John Redwood (Wokingham) (Con)]

I welcome very much what the Minister said on the previous Lords amendment concerning safety culture. Can he tell us a little more about what other actions will be taken in lieu of legislation, which is not always the best answer, to encourage the learning, safety and quality culture which is so vital to a great service?

[Edward Argar]

I am grateful to my right hon. Friend, who is absolutely right. We heard in this House, a little earlier this afternoon, the Secretary of State for Health and Social Care present a statement on the Ockenden review. The review has a number of—not recommendations specifically, but urgent action points. Donna Ockenden was very clear on that and my right hon. Friend accepted all of them. One of the themes that came out in that context is people’s fear of speaking up. We believe that the HSSIB will play an important part in stimulating that culture of openness and transparency, and people coming forward without fear. That is why we reflected very carefully and accepted their lordships’ amendment.

[Sir Peter Bottomley (Worthing West) (Con)]

I want to re-emphasise to the Minister and to others the injustice when Dr Hadiza Bawa-Garba, at an inquest three years after an event, led the police to get her prosecuted for gross negligent manslaughter and then the other actions, which I will not rehearse now. If we are going to have doctors as good as Dr Bawa-Garba and others learning from events, we will do better than the previous system. I am glad the Government are accepting the Lords amendment.

[Edward Argar]

I am grateful to the Father of the House, who I believe, in the course of our discussions about whether to accept the Lords amendment, wrote to me, along with other right hon. and hon. Members highlighting that particular case in the context of an open and transparent learning culture.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I thank the Government for accepting the amendment. I raised the issue on Second Reading and I can see the Minister smiling at how many times we have talked about it in Committee and in the prelegislative Committee. It is critical that the safe space is safe. Systems make errors or do not prevent errors, so we need people to be candid. I pay tribute to the Government for accepting that, because it allows HSSIB to have a decent start and a decent chance.

[Edward Argar]

I am grateful to the hon. Lady not only for her comments just now, but for her work on this agenda and on HSSIB over many years on various incarnations of this legislation. She has a right to gently tweak my tail that I could have listened to her in Committee and got here faster, but as she will know, occasionally it takes a little time in Government to be able to move to the compromise that often we all seek.

Turning back to the advertising restrictions, the overall policy direction has been set out effectively through last year’s Government consultation response, this proposed legislation and the debate that has taken place in both Houses.

[Alun Cairns (Vale of Glamorgan) (Con)]

Will the Minister give way?

[Edward Argar]

If I may just finish this point. I suspect my right hon. Friend may speak later on the amendments tabled by my hon. Friend the Member for Buckingham (Greg Smith).

A consultation on secondary legislation will be launched shortly and consultations on the wider guidance to the restrictions, which will support industry and provide further clarity on what to expect, are anticipated later in the year. Therefore, we do not believe there is a need to incorporate a requirement in primary legislation to specify a gap between the date of publication of guidance and implementation of the restrictions, as proposed by my hon. Friend, but I look forward to hearing his speech later. I reassure him that the Government will of course continue to work closely with industry and with him to ensure that the transition is as smooth as possible.

[Alun Cairns]

I am grateful to my hon. Friend for giving way and he pre-empts some of my comments. Does he recognise the significance of the change to the broadcasting and advertising industries? It seems to me that the amendment tabled by my hon. Friend the Member for Buckingham (Greg Smith) is very reasonable in giving 12 months minimum for the industry to prepare for such significant changes.

[Edward Argar]

I am grateful to my right hon. Friend. I know him well but I was not sure if would be able to predict exactly what he was going to say, so I am pleased that I have managed, to a degree, to pre-empt him. I recognise the impact, and that is why we believe we have struck the appropriate balance, both in terms of the time for preparation and implementation, but I will of course listen to what my hon. Friend the Member for Buckingham says when he speaks to his amendments.

Finally, amendment 79 relates to the international healthcare arrangements clause, which amends the Healthcare (European Economic Area and Switzerland Arrangements) Act 2019 to enable the Government to implement comprehensive reciprocal healthcare agreements with countries outside the EEA and Switzerland. The clause will give the devolved Governments a power to make regulations giving effect to such agreements in devolved areas of competence. This minor and technical amendment to the definition of devolved competence and the consent requirement in new section 2B(2) reflects the fact that the consent of the Secretary of State under section 8 of the Northern Ireland Act 1998 is given in relation to an Assembly Bill, rather than an Assembly Act. It has no impact on the policy intention of the clause and I hope that hon. Members on both sides of the House will be content to pass the amendment.

On Report in the other place, the Government committed to accept in principle Lords amendment 95 to change the process for regulations that give effect to healthcare agreements, so they are subject to the affirmative resolution procedure. While we continue to support the intention of the amendment, I move that this House disagrees with Lords amendment 95 and moves an amendment in lieu, Government amendment (a). This amendment achieves the same objectives, but amends the international healthcare agreements clause rather than the regulations clause for the Bill to ensure that all regulations made under the soon-to-be-named healthcare international arrangements legislation are subject to the affirmative procedure. This includes any regulations made by the devolved Governments and achieves the objectives of the Lords amendment. This conclusion has been reached following constructive engagement with noble Lords for which the Government are extremely grateful.

In addition, to make parliamentary scrutiny of our healthcare agreements even more robust, we will set out a forward look in annual reports produced under section 6 of the 2019 Act, highlighting any agreements with other countries that are under consideration. We will publish all non-legally binding agreements and their associated impact assessments. I urge the House to accept all those Lords amendments as beneficial to the public and the NHS.

Although I have sought to compromise and reach agreement on many areas, I am afraid that there are a number of Lords amendments that we urge the House to reject. First, let me deal with Lords amendments 85 to 88. I pay tribute to the work of my hon. Friend the Member for Harrow East (Bob Blackman), the chair of the all-party group on smoking and health, for its proposals to help the Government to achieve a smoke-free country by 2030. However, the Government cannot accept these Lords amendments, because the proposals would be very complex to implement, take several years to materialise and risk directing a lot of Government resource into something that we do not see as a sustainable or workable way to fund public health. This would also rightly be a matter for Her Majesty’s Treasury.

The Javed Khan review is under way and I encourage colleagues to wait patiently for that and to be guided by what emerges from it.

[Bob Blackman]

rose—

[Edward Argar]

If I can just finish this point, I will give way to my hon. Friend. Our preference is to continue with a proven and effective model of encouraging tobacco cessation. Ultimately, given the review that is under way and the forthcoming tobacco control plan, which will be published later this year, we do not believe that this Bill is the right place for the proposals.

I will give way to my hon. Friend, but then I wish to turn to the final, important set of Lords amendments on abortion.

15:30

[Bob Blackman]

I thank my hon. Friend for giving way and for what he is saying about tobacco control. The recommendations are due to come out next month and most of those—indeed, most of these Lords amendments—refer to carrying out consultations without decisions actually being made. Does he not accept the point about having a consultation, taking people’s views and then deciding what to do?

[Edward Argar]

To a degree, that is why I mentioned the Javed Khan review. We are undertaking a lot of work and let us see what emerges from that, as well as from consultations and other pieces of work, and draw it all together. I can see where my hon. Friend is coming from, but I think that the Government have set out the right approach, so I encourage right hon. and hon. Members to reject their lordships’ amendments.

[Steve Brine (Winchester) (Con)]

Will my hon. Friend give way?

[Edward Argar]

I will if my hon. Friend is brief, but I know that a lot of colleagues wish to speak on the abortion amendment and I want to give them enough time to do so.

[Steve Brine]

Further to the intervention from my hon. Friend the Member for Harrow East, when I published the tobacco control plan in 2019, with the smoke-free ambition for 2030, we in the Government promised to consider the “polluter pays” approach to raising funds for tobacco control and smoking cessation services. The Lords amendments just require the Government to fulfil that commitment, which was barely three years ago, and to consult. I press the Minister on that again because we as a Government committed to doing this less than three years ago.

[Edward Argar]

My understanding—although my recollection may fail me, so I caveat my comment with that—is that this was initially looked at that stage, but was not proceeded with. I know that my hon. Friend will continue to press that point and I pay tribute to him for being the policy Minister at the time and for making huge progress on this agenda. I suspect that we will return to this matter subsequently, and I look forward to the comments of the shadow Minister, the hon. Member for Tooting, in due course.

[Liz Twist (Blaydon) (Lab)]

Will the Minister give way?

[Edward Argar]

I will not now, but I may during my wind-up speech, if I have time. I want to conclude my remarks so that colleagues can make their contributions on the matters that I have referred to, but if there is time, I commit to taking an intervention from the hon. Lady at the end of our consideration of this set of Lords amendments.

We come, finally, to Lords amendment 92 and the amendment offered in lieu relating to abortion. I am aware of strong and sincerely and genuinely held views from Members on all sides of this debate and this issue, and I respect the integrity of their views. Although I will set out why the Government took the action that they did and the procedure that is in place, I emphasise at the outset that, given that this matter is before the House because of an amendment by their lordships, it is right that this is properly considered and that this will be—in line with how we normally treat these matters—a free vote, in which how individual Members vote will be a matter of conscience.

In response to the covid pandemic, an approval was issued in accordance with the Abortion Act 1967 that allowed women to take both pills for early medical abortion at home. That temporary measure addressed a specific and acute medical need, reducing the risk of covid-19 transmission and ensuring continued access to abortion services. My right hon. Friend the Secretary of State announced last month that the approval will end at midnight on 29 August 2022.

[Tonia Antoniazzi (Gower) (Lab)]

Does the Minister acknowledge that, in Wales—[Interruption.]—and in Scotland, telemedical abortion will continue to be available to all women after the covid-19 pandemic has finished? To be honest with the Minister, that needs to follow suit in England.

[Edward Argar]

I would not suggest for a moment that Wales or Scotland should follow England or that England should follow Scotland and Wales. They are devolved competences. Each devolved Administration will rightly form their own view of the balance of benefits, the pros and cons, and that is right. That is what our devolution settlement is for. This House is considering the amendment that was brought here from the Lords and this is an opportunity for Members to express their view on what should happen in this country.

The Government remain of the view that the provision of early medical abortion should return to pre-covid arrangements, and face-to-face services should resume, given that the temporary change was based on a specific set of emergency circumstances. However, we recognise that their lordships have made an amendment in that respect and it is therefore right that this House considers it.

In normal times, we prefer and believe that decisions about the provision of health services are more appropriately dealt with through the usual processes, rather than through primary legislation. We have a number of concerns about the approach taken in the amendment. Parliament has already given the Secretary of State a power to issue approvals under the Abortion Act. That allows the Secretary of State flexibility to make decisions about how healthcare in this area is provided, which can be adapted quickly and easily to respond to changes in service provision or other external circumstances, as was the case with the temporary approval in response to concern about the risk to services from covid-19.

From a process perspective, it is not appropriate, in our view, to insert into primary legislation the intended detail regarding home use of both pills. That would mean that should any issues arise, there would no longer be scope to react quickly, as the Secretary of State did during the pandemic. However, we recognise that that is now a matter for debate and decision by this House.

In addition, Lords amendment 92, as drafted by my noble Friend Baroness Sugg, would not have the intended effect. If agreed to, it would create legal uncertainty for women and medical professionals by including wording on the statute book that does not, in fact, change the law in the way it appears to. On a procedural point, we therefore urge all right hon. and hon. Members to disagree with the Lords in their amendment.

All Members have the opportunity, however, to vote on our amendment (a) in lieu, which we have drafted to ensure, irrespective of colleagues’ views, that the provision does the job it was intended to do. We all agree that it is crucial that the law is clear in this area and does not create any uncertainty for those who rely on it. That is why we have tabled our legally robust amendment in lieu, which stands in my name and which would achieve the intended purpose of Baroness Sugg’s amendment.

It is for right hon. and hon. Members, in a free vote, to judge how they wish to vote on the amendment in lieu. I encourage them to reflect and make their decision when the amendment is pressed to a Division.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

The Opposition congratulate the Lords on their hard work on the Bill, which is much improved from when it left the Commons. We support the Lords amendments, which are sensible and proportionate and will go some way to tackling health inequalities that are still sadly far too prevalent.

Over the past two years, we have seen the very best of our NHS. Publicly owned and free at the point of use, it is the best of us and has protected our families for generations; I hope it will continue to do so for many years to come. Unfortunately, the Government are set on a power grab, and refuse to act to tackle workforce shortages and ever-growing waiting lists. Waiting times for cancer care are now the longest on record, patients with serious mental illnesses are being sent hundreds of miles away for treatment, and one in four mental health beds have been cut since 2010. We deserve better. Our NHS deserves better.

We can all agree that the amendments in this group are wide-ranging, so I will be covering a range of subjects. A number of amendments in the group speak to women’s health. We have seen time and again that the Government are dismissive of women’s health and have ignored the needs of half the population. In its original form, the Bill was far too scant on tackling health inequalities; it is only because of colleagues in the other place and Labour votes that we are making ground on tackling them at all.

Along with the rest of our health team, I am proud to support the continued provision of telemedical abortion services in England. Maintaining the existing provision of at-home early medical abortion following a telephone or video consultation with a clinician is crucial for women’s healthcare. Not only did that preserve access to a vital service during the pandemic; it enabled thousands of women to gain access to urgently needed care more quickly, more safely and more effectively. Women’s healthcare must reflect the needs of those whom it serves. Scrapping telemedical abortion services would drastically reduce access to that vital service, and would simply serve to increase the number of later-term abortions. Everyone should have access to safe and timely healthcare. I say to Ministers: please do not ignore clinical best practice and the expert opinions of organisations and royal colleges.

We welcome provisions to ban hymenoplasty, and the power to create a licensing regime for non-surgical cosmetic procedures. Those too were a result of Labour votes, because the original Bill did not even mention them. Ministers must stop treating women as an afterthought in healthcare provision. However, we are glad to see that the Government have accepted the Lords amendment to remove coroners’ access to material held by the Health Service Safety Investigations Body.

On the NHS frontlines, I see at first hand the pressure placed on staff. Staff must feel protected, and must be encouraged to come forward. It is crucial for the Bill to promote a learning culture, so that any investigation can establish what training and procedures need to change in order to prevent any future mistakes. Only by enshrining that culture can we ensure that staff will feel comfortable about coming forward.

We welcome Baroness Hollins’s amendment to introduce mandatory training on learning disabilities and autism for all regulated health and care staff, and we are pleased to see that the Government support it. Everyone deserves access to safe, informed, individual care, and hopefully the amendment will go some way towards reducing health inequalities that are faced all too regularly by people with learning disabilities and autism.

[Barry Gardiner (Brent North) (Lab)]

I agree with much of what my hon. Friend is saying. For instance, I too believe that it is a woman’s right to choose. One of the features of a physical consultation was that it gave the woman an opportunity to do so in a free environment. Does my hon. Friend share the concern that I know exists among many of our constituents that if the consultation is done by telephone, it is possible that a woman who is being coerced will not be understood to be being coerced by the consultant who is dealing with her? It is important that, in preserving the right to choose for the woman, we do not allow a situation in which that woman could be coerced, by a coercive partner, into making a choice that is not her own.

[Dr Allin-Khan]

I thank my hon. Friend for his intervention. There are widely held variations in views across the House, but I stand by the principle that everyone should have access to safe and timely healthcare, and that scrapping telemedical abortion services would drastically reduce access to a service that is incredibly important for women, and, as I have said, would simply increase the number of later-term abortions, which can have physical and mental impacts on the mother herself.

As for Lords amendments 85 to 88, it is disappointing to see the Government going against their own ambitions and targets. The consultation referred to in Lords amendment 83 would be on a statutory “polluter pays” scheme to make tobacco manufacturers fund measures to reduce smoking prevalence and improve public health. Smoking is responsible for half the difference in life expectancy between the richest and the poorest in society. Will the Minister please explain why we are still waiting to see the Government’s tobacco control plan, which we were promised by the end of 2021? The Government need to stop kicking public health matters into the long grass. They say that they recognise the stark health inequalities associated with tobacco use, but delays will do nothing to level the playing field and eradicate health disparities.

Ministers need to make sure they listen to the Lords, whose amendments go a long way towards eradicating the vast health inequalities that exist across society today. Rather than wasting time trying to overturn the changes, Ministers should now focus relentlessly on bringing waiting times down.

[Fiona Bruce (Congleton) (Con)]

I rise to speak to Lords amendment 92 and the Government motion to disagree, and to the amendment in lieu. A few months ago, in my role as the co-chair of the all-party parliamentary pro-life group, I wrote to the Health Secretary, supported by more than 60 parliamentarians—not an insignificant number—urging him to discontinue the temporary provision to allow for the taking of both sets of abortion pills at home. We said that we were deeply concerned about reports that taking both sets of abortion pills at home without direct medical supervision had led to a number of deeply concerning, unacceptable health and safety risks to women and girls in this country. These included a lack of basic checks by abortion providers before sending abortion pills, and the occurrence of severe complications and later-term abortions due to the lack of in-person assessment. We were also, notably, concerned about the greater risk of coercion by a partner or family member where the doctor does not see the woman in person.

15:45

[Jess Phillips (Birmingham, Yardley) (Lab)]

Will the hon. Lady give way?

[Fiona Bruce]

Please let me continue. I am sure the hon. Lady will have put in to speak. I thank Health Ministers for listening, and for recently cancelling this temporary emergency provision from August, fully in accordance with the Government’s intention at the outset of the covid pandemic, which was that the measure would be temporary. To delve a little deeper into the issues and concerns, having no in-clinic assessment means that gestational age is, and can only be, an estimate. Many women cannot be sure that they are within the legal—and, I presume, safe—limit of nine weeks and six days for taking such pills. Indeed, several women who have needed hospital treatment after taking an at-home abortion pill were clearly many weeks over that limit.

[Alec Shelbrooke]

Will my hon. Friend give way?

[Fiona Bruce]

I feel that I must be fair, and I have said that I will not take interventions—

[Alec Shelbrooke]

Just on this point?

[Fiona Bruce]

All right.

[Alec Shelbrooke]

I am genuinely grateful to my hon. Friend, and I am not intending to speak in the debate. I know that she has deeply held beliefs, which I respect very much. She is giving examples and details. Can she give data referring to the examples she is giving? I have been struck by the fact that in this debate, I have heard a lot of anecdotal evidence that has not been backed up by any reference to data, and I think that data is important for this debate.

[Fiona Bruce]

Yes; the organisation Right to Life, which is the secretariat to the all-party parliamentary pro-life group, has collated such data. Freedom of information data analysis also shows that one in 17 women taking abortion pills requires hospital treatment. That means that more than 14,000 women have been treated in hospital following the approval of pills-by-post abortion. A similar study of FOI data in February 2021 showed that every month, 495 women attended hospital with complications arising from abortion pills, and that 365 of them required hospital treatment. Thirty-six women every month are making 999 calls—that is more than one a day—seeking medical assistance because they are concerned about complications arising from taking abortion pills.

Women, especially vulnerable women, deserve the care and attention given in an in-person meeting with an experienced clinician before making such an important decision. Indeed, 74% of GPs have indicated concerns about women finding it distressing to terminate a pregnancy themselves at home. More than 600 medics signed an open letter to the Prime Minister in May 2021 calling for an end to pills-by-post abortion, and a clear majority—70%—of the respondents to the Government’s consultation on this subject said that the temporary measure of pills-by-post abortion should end.

However, whatever one’s views on abortion, the Government very recently made a decision to cease the authorisation of these pills from August this year, due to this being a temporary covid provision that was never intended to outlast the covid pandemic period. The Government—our Health Ministers—have made an informed, carefully considered, evidence-based decision. We should respect that, but once more, those pressing for an even more easily available abortion regime in this country are not willing to accept it. Instead, they are seeking to make a serious change to the law through an amendment, as is frequently their practice. That gives us far too little time to debate such fundamental issues. There is too little opportunity for us parliamentarians to scrutinise this serious issue, which is literally a matter of life and death. Whatever our views on abortion, that is simply wrong. I urge colleagues to vote against this proposal to make at-home abortion pills permanently available.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I come to this Bill rather late, so I pay tribute to my hon. Friend the Member for Central Ayrshire (Dr Whitford), who did most of the heavy lifting on it for the SNP. I have turned up for the fag end of the process. I hope the House will oblige me by listening to a few general comments before I address the Lords amendments.

Overall, this Bill is a missed opportunity for England to go back to a unified service, similar to the one we have in Scotland. Whatever system we have, I am sure each of us on these islands would wish to extend our gratitude and thanks to the staff who delivered such a focused patient care service in difficult times, throughout the pandemic. I also acknowledge the Government’s progress on recognising the need for consent from the devolved nations; that should have been included in the Bill from the get-go. Still, better late than never.

As we know, health is mainly a devolved matter. Following discussions with the UK Government, the Scottish Government were able to bring forward a legislative consent motion in December, further to which, in the light of securing acceptable amendments, the Scottish Government recommended consent to the Secretary of State’s power to transfer or delegate functions under clauses 88 to 94.

The UK Government made amendments to introduce two new clauses to the Bill—on hymenoplasty offences in Scotland, and on information about payments, et cetera, to persons in the healthcare sector—that also require legislative consent. The Scottish Government are content to recommend that the Scottish Parliament grants that consent.

In summary, the SNP supports Lords amendments 66 and 109 on the Health Services Safety Investigations Body to protect safe spaces and reduce any future harm to patients. These amendments largely rehash some of the amendments we tabled at previous stages, and I welcome the Government’s acceptance of the Lords amendment to remove coroners’ access in this regard.

A key health driver on which we can make a big difference is encouraging people to stop smoking, which is one of the best things people can do at any time of life. We support Lords amendments 85 to 88 on a tobacco products statutory scheme for the regulation of the prices and profits of tobacco manufacturers and importers, and they would require the Secretary of State to carry out a consultation on the scheme.

Although I understand that the Minister does not wish to prejudge the options for England’s tobacco control plan, we should remember that these would be UK-wide measures, and public health and smoking cessation are devolved to Scotland. The Scottish Government’s programme for government committed to a refreshed tobacco action plan built on the pillars of prevention, protection and cessation to achieve their target of lowering Scotland’s smoking rate to 5% or lower by 2034, which would put tobacco out of sight and out of mind for future generations. These Lords amendments, particularly on the “polluter pays” charge, would be beneficial in that regard, and Scotland’s progress should not be held back by decisions in this place.

In conclusion, I draw Members’ attention to the Cancer Research briefing:

“Implementing a ‘Smokefree Fund’ would require tobacco manufacturers to pay for the harm caused by tobacco but without letting them influence how the money is spent. It would provide much-needed investment in evidence-based measures such as public education campaigns and Stop Smoking Services, without further squeezing the public purse.”

Who could argue with that?

[Several hon. Members rose—]

[Mr Deputy Speaker (Mr Nigel Evans)]

A lot of people want to contribute to this debate, and this first group must come to an end at 10 minutes past 5. Those who make long contributions really are doing other people out of an opportunity to speak.

[Greg Smith (Buckingham) (Con)]

I will be as quick as I can, Mr Deputy Speaker. The point underlying my amendments to Lords amendments 123 to 127 is relatively straightforward and simple. I heard what the Minister said in his opening remarks, but I feel that if we act in a way that impacts an industry—in this case, UK broadcasters—as severely as the advertising restrictions will, and we are talking about a £200 million a year loss to our great British broadcasters, it is a matter of fairness and equity that we should give them enough of a lead-in time, enough notice and enough ability to adapt, remodel their services and find a way of surviving, to put it bluntly.

I have spoken before in the House about the fact that I do not agree with the nanny state and telling advertisers what they can and cannot advertise. The Lords amendments that we are considering, and my amendments to them, are very much about the implementation of a policy, and about giving British broadcasters—public service and fully commercial ones alike—a fighting chance. It would be much fairer to give broadcasters at least a year to comply from the point at which Ofcom publishes its guidance and puts it in the public domain. Broadcasters and advertisers will have to go through a lot of processes once this Bill receives Royal Assent, and that cuts the time that they have to put in place new policies, compliance checks and mechanisms to comply with the legislation. Two months on from Royal Assent, Ofcom will not even have got its statutory powers in this regard, and so will not even be able to start work with the Advertising Standards Authority and other bodies on the detail, and the ways and means of implementation.

[Alun Cairns]

I strongly support the amendments that my hon. Friend has tabled. Does he agree that the definition of some of the products, and the work that needs to be done, needs to undergo significant consultation, because of the way in which the efficacy, strength and merits of the policy will be judged?

[Greg Smith]

I am grateful to my right hon. Friend for that point, as the argument that I am making is very much that these things take time. Two months on from Royal Assent, Ofcom gets its statutory powers. Only then can it start the consultation, and the work of defining the restrictions on advertising that come under the broad categories in the Bill. Let us assume that two months on from Royal Assent is some time in the next couple of months. There would then be 10-week or perhaps three-month consultations to get the detail right, for a go-live date of 1 January 2023. That does not give our broadcasters sufficient time to put in place their processes, remodel their whole service, and find a way of working when they are so many hundreds of millions of pounds down on their operating models.

[Steve Brine]

I am listening carefully to my hon. Friend. I joined the Department of Health and Social Care in 2017 and we made it very clear that this was our direction of travel. Our child obesity plan part 2 made it very clear that this was our intention. The truth is that broadcasters have known for a long time that this is the Government’s intention. My fear is that what lies behind what he is proposing is not questions of practical implementation, but argument with the principle.

[Greg Smith]

I make no secret of the fact that I am against the principle of these restrictions. The Government’s own data shows that the restrictions will save only 1.74 calories a day, which is less than what is in a Tic Tac. However, that is not the place we find ourselves in today; these amendments are specifically about implementation. Given that it is clearly the will of this House and the other place to push the legislation through, I want us to give our broadcasters a fighting chance to survive, adapt and continue being successful, great broadcasters.

15:59

[Jess Phillips]

I had not intended to be here at all today. Sadly, my mother-in-law died of a heart attack very suddenly on Friday, so women’s health and how we treat it is at the very top of how I am feeling at the moment. My mother-in-law, much like my own mother, who sadly died as well, sent her children to women’s liberation playgroup. She would not have forgiven me for not turning up for the opportunity of a free vote, so here I stand. Her name was Diana, and I feel that days like this are often dedicated to the Dianas of this world.

I want to respond to some of what has been said about coercion and control. I respect the hon. Member for Congleton (Fiona Bruce) and her firmly held views, and I would go down fighting for her right to hold those views. Had she allowed me to intervene on her earlier, I would have asked her whether she could tell me which expert agency that deals with violence against women and girls agrees with her. I represent the entirely alternative view. Maybe she and I could just both be honest and say that, largely, the detail in front of us does not necessarily matter: she thinks one way and I think another, and we should just be honest about the reality of that situation.

There is no evidence that coercion will be a concern any more than it already is. That is not my experience, from years of working with victims of sexual violence, sexual exploitation and abuse. The problem is not usually that they are forced to have abortions but the alternative: they are forced to go to term. They are scared. I worked with a beautiful woman called Natasha who was killed when her violent ex-partner found out that she had had an abortion. He murdered her. That is the normal pattern.

[Sir Peter Bottomley]

The evidence that has been given to me is that virtually every group concerned with violence against women and girls supports the use of telemedicine, as do Dame Clare Gerada and Dame Lesley Regan, who are leading doctors, gynaecologists and obstetricians. Lastly, with telemedicine consultations, the period of time before an abortion has been halved, not increased.

[Jess Phillips]

I agree 100% with every word that the Father of the House has just said. There is no expert opinion group that agrees with the view put forward by the hon. Member for Congleton, who cited the secretariat of a pro-life group. By the way, I am pro-life: I am pro the people who live being able to make choices. I am incredibly pro-life—I am just also pro-choice. I hate the terminology that suggests somehow one side is pro-life; what is the alternative?

[Alec Shelbrooke]

First, may I offer my condolences for what must be a very difficult time for the hon. Lady and her family?

There has been a lot of conversation in which people have said, “You’ve got no way of knowing that it is going to be less than nine weeks and six days.” Will the hon. Lady address that particular point, which is very important to how people have been trying to frame the debate?

[Jess Phillips]

I have heard similar framing, with some saying people will take the pills after 10 weeks. If we look at the actual data, we see it shows that the change increased from 25% to 40% the proportion of abortions happening before six weeks. Telemedicine has dramatically reduced the gestational period, making it much less. I am afraid to say that these are not a good faith arguments. They are based not on fact, but on the idea that women will lie. Women are concerned about their health. They are frightened about their health. We do not make decisions about our health in the hope that we will be harmed; we do what is best. We should not be treated like children; we should be treated like adults.

[Mrs Maria Miller (Basingstoke) (Con)]

I thank the hon. Lady for giving way and add my condolences to those of others for her sad loss.

The hon. Lady is right when she says that these issues can be entrenched and people have entrenched points of view. When we have that situation as a House, we look at the facts and at what the experts say. The experts who support Government amendment (a) in lieu of Baroness Sugg’s Lords amendment 92 include the vast majority of professionals: the Royal College of General Practitioners, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the British Medical Association; and the Academy of Medical Royal Colleges. Does the hon. Lady agree that, when it comes to trying to find a way forward through entrenched views, we should look at the experts, and the experts are giving us a very clear way forward, followed by my hon. Friend the Minister?

[Jess Phillips]

I absolutely agree. It is difficult to be dispassionate. I have never been accused of being dispassionate about anything. I am passionate about what I eat for my breakfast. I am just not a dispassionate sort, but the right hon. Lady is absolutely right that we must look at column A and column B in this instance. Column A is full of experts—medical experts, women’s rights experts, and women themselves—and a huge amount of evidence.

[Dame Diana Johnson (Kingston upon Hull North) (Lab)]

I just wanted to add to the list that the right hon. Member for Basingstoke (Mrs Miller) just read out the World Health Organisation, which also says that telemedicine is safe, and the National Institute for Health and Care Excellence, based in the United Kingdom, which made a recommendation in 2019 about the safety of telemedicine for abortion.

[Jess Phillips]

I totally agree with my right hon. Friend. Actually, if people are against telemedicine for abortion, they might have very strongly held views about not liking telemedicine for anything. By that virtue, they should be against it for everything. For all the people who are desperately worried about vulnerable women—victims of domestic abuse and victims of sexual violence—not being able to access healthcare, I say come on and join me. They are absolutely right: there is zero availability of most mental health support. There is zero chance of getting a GP appointment any time soon, but somehow, people are against telemedicine only on this issue.

Often in debates, we do not stand up to seek to convince others. That only happens when there is a free vote—when actually the debate is really important. To people who are unsure, I say that I understand it—I totally get it—especially if they do not necessarily have so much skin in the game have but a huge load of emails in their inbox. The reality is that if they are not sure, they should either try to be convinced by the debate and the evidence, or they should simply abstain on the issue.

This is not particularly difficult for me. As I have said, I am not a dispassionate sort. I have stood in this House before and said that I have had an abortion. I do not feel devastated by that fact. I think we need to be clear about this. In this place, we only deal in hard cases, because they tell the argument much better. One thing I would say about when I had an abortion is that the worst process of having an abortion is the waiting. I had made the decision about what I was going to do with my body. I had made it the second that I saw I was pregnant on a pregnancy test, because I am an adult woman, completely capable of handling my own body and knowing my own mind, and that is how we should treat every woman in this country.

[Fiona Bruce]

On that point about adult women, and the point about the number of professional organisations that have been quoted, as if there were universal support for the continuation of telemedicine, I will mention two organisations, with particular reference to young people. The National Network of Designated Healthcare Professionals for Children, NHS doctors and nurses who work in the area of children’s safeguarding, has welcomed the Government’s decision to end the provision, and the Royal College of Paediatrics and Child Health recently released a statement:

“Children and young people under the age of 18 and Looked after Children up to the age of 25 must be offered and actively encouraged to take up a face-to-face appointment to assess gestation, support their holistic needs and assess any safeguarding issues as part of the pathway for early medical abortions.”

[Jess Phillips]

I could not agree more. People should absolutely be able to access a face-to-face appointment where they want and need one, and there is not a single thing in the legislation that would prevent that. I go back to this idea: “If you don’t like abortion, don’t have one. No one’s forcing you.” This is exactly the same. No one is forcing anybody to take through the procedure at home; it is a choice that we should allow adult women to make.

When I made that choice, after I made it I had to wait another eight weeks. It was some time ago, long before the pill was even necessarily widely available. I had made the decision, and I did not feel sad about it. I did not feel bad about it. I had made the decision on behalf of my son, who had only just been born—although, actually, I do not even need an excuse. I did not want to have a baby, having just had one, and it is perfectly well within my gift to make that decision. The argument is often made about all the children who have been lost because of women like me, but my younger son, Danny, would not exist if that baby had been born, so we end up equal, and he is a cracker of a kid.

The reality is that I had to wait, and I started to feel pregnant. I started to feel unwell, I started to feel tired and it started to affect my work. That was horrendous for me, knowing that I was not going to go ahead with it—not horrendous because of guilt, but because it made me feel sick and it made me feel that people had expectations of me. I had to hide it. I could not tell people I was pregnant; I had to hide that fact from people at work and other places, because I had to wait. Had I been able, at the four-week point when I found out I was pregnant, to just stay in my house and ring up, it would have been a far better situation for me.

People do not want to think about me, but rather obsess about the difficult cases, not the vast majority who are adult women and should be trusted to take medication in their own homes. We are treating those women as if they are going to get a methadone allowance from a surgery, as if they cannot be trusted when they say, “Actually, I’d prefer to stay at home and not maybe have a miscarriage on the bus on the way home because I live in a rural community.”

If people want to hear about the hard cases, I am currently handling one. It is the case of a young woman who has been sexually exploited since she was 13 years old. She is 23 now. She has had 10 years of being raped repeatedly, pretty much every weekend of her life, by multiple men, and it continues. Obviously, she falls pregnant—well, she does not fall pregnant; she is raped and then she gets pregnant. She has very little trust in agencies and in the police, and she is right to have so little trust. She has been failed time and again. Without the opportunity of telemedical abortion, I have no idea how she would cope. It is a vital service for people who really need it.

I ask hon. Members to vote Aye on Government amendment (a) in lieu of Lords amendment 92, or, if they are not sure, to abstain. Adult women can be trusted to decide what they want to do with their health, and any other vote would suggest otherwise.

16:15

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I would like to draw Members’ attention to my entry in the Register of Members’ Financial International, and particularly, since these organisations have been mentioned, to state that I am a member of the British Medical Association and the Royal College of Paediatrics and Child Health.

The measure relating to amendment 92 was introduced in the context of the pandemic. The reason that the rules were brought in the first place was to protect women from coronavirus and to reduce its spread within society at a time when we did not have a vaccine. For me, this debate is not about ideology at all—it is not about the rights or wrongs of abortion, whether women should or should not be able to have abortions, whether or not life begins at birth, or anything of that nature. Society and Parliament have decreed that abortions may take place and that women should have the right to choose, and I support that. For me, this is a debate about women’s safety, particularly the safety of the most vulnerable and marginalised women and girls.

Previously, women would have attended a clinic and been given a tablet and another tablet to take a day or so later, and usually the bleeding would begin in the hours after the second tablet is taken. Under the new process, a woman or girl can speak to somebody on the telephone to arrange for the tablets to be delivered to her, or to be collected by her, and then take the tablets at home. It is very difficult for a clinician to tell whether the woman they are speaking to on the telephone is indeed pregnant. There are not necessarily visible signs of pregnancy below 10 weeks, and palpation of the abdomen would not be expected, so it is not clear to the clinician on the phone whether the woman is pregnant. Clearly, someone believes a woman when she says she is pregnant, but there is no way to be certain. In particular, there is no way to be certain of gestation. Although a woman may know when she has had sex and when her last period was, quite a number of women will bleed in the early stages of pregnancy, and some women mistake those early bleeds for a period, which means that women may believe that they are less pregnant than they are. If they go to a clinic, that can be determined, whereas over the telephone it cannot.

The NNDHP, which my hon. Friend the Member for Congleton (Fiona Bruce) mentioned, has found a number of examples since March 2020 of women who have had babies delivered quite significantly later in gestation; they had mid-term to late-term abortions believing that they were early in pregnancy when they were not. The examples included 12 babies who were born with signs of life, so the pregnancy would have been quite advanced. The women thought that they were at less than 10 weeks, or told the doctor that they were at less than 10 weeks, but they were not. In six of those cases, the woman giving birth was herself a child. One can only imagine the distress felt by these women and children when they take an abortion pill to deliver what they believe to be a foetus of less than 10 weeks and out comes a baby of up to 30 weeks’ gestation who may at that point have been alive. It is not rare to have side effects from these tablets. One in 17 women have to attend hospital and 36 women call 999 each month because of complications of taking these medicines at home.

If this measure had been introduced in a proper fashion rather than as part of the coronavirus regulations, we would have discussed it quite thoroughly and made it very clear that it should not apply to children. I do not think that many people in this House would think that a 14-year-old girl should be ringing up and receiving abortion medicines over the telephone, but that is indeed what the legislation allows. People may say that doctors would not do that, but we know that six of the children who delivered babies that they thought were at a much earlier stage were themselves under the age of 18.

[Steve Brine]

Surely the point is that this measure was brought in hastily in a pandemic. Therefore, if Members are not sure today, far from abstain, they should be returning to the status quo pre-pandemic. Then this Government can should consider the issue properly and seriously on its own and ask the House to make a decision.

[Dr Johnson]

I can only absolutely agree with my hon. Friend’s intervention.

I also want to talk about coercion, because we know that some women may be coerced into having an abortion.

[Dame Diana Johnson]

Before the hon. Lady moves on, I want to raise something with her. Obviously she has a clinical background, and she will know jolly well about the range of safeguarding measures that all clinicians, the royal colleges and all those involved in abortion care have to follow. She makes it sound as though no safeguards are in place. For instance, if a 14-year-old telephoned a clinician to seek advice around abortion, that clinician may well say, “I want to see you face to face.” There is nothing to stop that happening, and that may well be a proper safeguard that would carry on, irrespective of whether telemedicine carries on today.

[Dr Johnson]

With respect, the right hon. Lady makes my point for me, because that is right: there is nothing to stop that happening, and it may be that the doctor would say that they wanted to see the patient, but they do not have to do so. We know that abortions are being prescribed by telemedicine to children under the age of 18. If this measure had been looked at properly by the House as a single issue, rather than as this amendment to something else, we would have stipulated that children under the age of 18 should not be receiving abortions over the telephone without proper appointments, as I think they should and as the right hon. Lady, if I understand her correctly, also seems to be saying that they should.

We know that sometimes women and girls can be coerced into having abortions that they do not want, perhaps because the baby is of a gender or sex that the father does not want, perhaps because they are being abused, or perhaps they are being trafficked or sexually assaulted. It is very difficult for a woman to tell someone about that over the telephone, whereas if a woman is seen in clinic, she has that one-to-one opportunity.

[Jess Phillips]

Will the hon. Lady give way?

[Dr Johnson]

I am going to finish my point. In person, the woman has a one-to-one opportunity with that clinician and a chance to say, “Please can you help me?” Clinicians are alert to that opportunity to provide that help. It is true that if the woman receives the abortion by post, the problem of her being pregnant is solved, but the problem of her being abused is not. That is what can continue.

[Jess Phillips]

Will the hon. Lady give way?

[Dr Johnson]

No, I am going to continue. The other problem with giving tablets—[Interruption.] The hon. Lady spoke for 16 minutes, which is considerably more than a fair share, given the number of Members who want to speak, so I will keep going.

The other problem is who will take the tablets. If someone is prescribed something of such severity over the telephone, the clinician does not know who will take the tablets. Will they be taken by the woman speaking to the clinician on the telephone? Will they be given to somebody else? Are they going to be sold to somebody else? Is somebody else going to be forced to take them? The reality is that we do not know and we cannot know, and that is another safety issue.

I will summarise my concern by saying, as a woman— I have not had an abortion, but I guess in the future I could become pregnant and not want to be—if I were having an abortion, I would rather have the inconvenience of having to go to a clinic than the worry of knowing that some women are having abortions without going to a clinic. Essentially, for me this is an issue of whether we want to make things more convenient for the majority of women, or we want to protect the women who are the most vulnerable, the most marginalised and the most at risk.

[Mr Deputy Speaker (Mr Nigel Evans)]

I intend to call the Minister at 5 o’clock to give him 10 minutes to wind up. We have not got long, so will Members please keep their contributions as short as they can?

[Jim Shannon (Strangford) (DUP)]

Thank you for calling me, Mr Deputy Speaker, to speak in this debate. I am pleased to follow the hon. Members for Sleaford and North Hykeham (Dr Johnson) and for Congleton (Fiona Bruce). I thank them both for the contributions.

It will be no surprise to the House that I am here because I abide by the absolute view that both lives matter—the unborn child and the mother. I know that many people believe that if someone is anti-abortion, they are anti-woman. I am not—I never have been, never will be and it is not the case. I believe in life and helping people. My career and all my life have been based around that, and I will continue as long as God grants me the strength to do so.

The Minister referred in his introduction to the fact that the regional devolved Administrations will make their own decisions. They can make that decision in Scotland and Wales, but we cannot make that decision in Northern Ireland, because the Government made it here. They took that decision away from us, and I am particularly concerned about that.

I have several concerns about the approach adopted during the pandemic in relation to so-called telemedicine to access abortion, which was recognised at the time as short-term. Without a face-to-face appointment, there is no confirmation of how many weeks pregnant a woman is, which makes a difference to the experience of an abortion at home. As reported in the summary of consultation responses, women who had experienced an abortion said that information should be provided on

“how inaccurate dating of pregnancy may mean increased pain and bleeding”.

A woman whose pregnancy is later than 10 weeks could find herself unexpectedly passing a mature baby at home, which could lead to significantly more complications. I understand that those advocating for the Lords amendment argue that complications have decreased since the pandemic, but I question the evidence, given that the Government and the Minister’s Department say that

“data on complications is incomplete”

and they are working on reviewing the system of recording abortion complications.

I am also persuaded by the concerns about the increased possibility of a woman finding herself pressurised at home to have an abortion that she does not want, as other hon. Members have said. There is a well-known link between abortion and domestic violence. Indeed, the BBC published a survey a few weeks ago reporting that 15% of those surveyed said they had felt pressured into ending a pregnancy. How are we protecting those women? How can doctors know that they are really speaking to a woman who is voluntarily calling about an abortion, or even that they are speaking to the right person at the other end of the phone?

There are many differing and strong views on this subject on both sides of the House, but I question whether the women who find themselves coerced into an abortion from their home, or who have found themselves bleeding unexpectedly at home or having an abortion much later in their pregnancy than they expected, would agree that telemedicine abortion is a positive step in women’s health. I doubt that they would.

I have recently been vocal regarding the need for face-to-face GP appointments. I have been inundated by constituents who simply have no confidence that a diagnosis by picture or telephone call is safe. I have constituents whose cancer has been undiagnosed because the GP was unable to see first hand what would have been clear in a face-to-face appointment. I believe that face-to-face appointments should be available.

I find it difficult to understand how pills to end life—to take away life—in a painful manner for the mother can be given without seeing someone to assess what cannot be seen on the phone. The signs and movements that an experienced GP can see that point to a deeper problem cannot be discussed in the two minutes allocated to such phone calls and I am fearful that the duty of care that we are obliged to discharge will continue to be missed. I am diametrically and honestly opposed to this legislation, because as I said at the outset, both lives matter. Lives could have been saved if abortion had not been available on demand.

I will vote against the permanent extension of this ill-advised scheme today and urge hon. Members on both sides of the Chamber to join me. It is a step backwards rather than forwards in providing adequate support and care for women, and it further normalises the practice of abortion as a phone call away rather than as a counselled decision under medical care, which is what it deserves to be. I, my constituents and my party are clear that this is a massive issue. I fully and absolutely oppose the Government in what they are putting forward today, for the safety of both mothers and the babies, because I am about saving lives, not destroying lives.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I rise to speak on the subject of the health services safety investigations body and on abortions. I begin by making a couple of declarations: I am a now non-practising doctor, my wife works as a doctor, and I am a member of the Royal College of Physicians and the Royal College of Psychiatrists.

On the HSSIB, I will keep it brief. I hugely thank the Minister for supporting the Lords amendment and ensuring that we have those safe spaces for doctors. That is critical for the body to work and for us to learn from it. Hopefully, we can undo some of the harms of previous atrocities and what has happened to previous doctors, as has been referred to.

On abortion, it is important to say that I wholeheartedly support and believe that women should have access to safe and legal abortion services, but the regulatory framework around them is complex and it is a sensitive area. As is clear from the powerful speeches that I have heard from both sides of the House, it is also sensitive for hon. Members. Many of my constituents—on both sides of the debate—care deeply and correspond regularly with me about it; I care deeply about it too. I have looked after women who are contemplating having an abortion and I have looked after women who have had abortions, so although I have never carried out one myself—I am a mental health doctor—I have seen it from both ends.

16:30

I am concerned that, having brought in temporary measures, we should have the space to consider and debate this properly, and I do wonder how much of what has been said is ideology and how much is critical appraisal of the evidence. I have to say that I am unclear about whether we really have positive data to support saying that telemedicine abortions are safe. Is it not more a case of the absence of negative data? So what sort of things do we need to look at to understand this better? I would really welcome the Government bringing forward substantive legislation so that we can properly consider, debate and investigate this and other areas of abortion legislation in the UK, and following consultation with my constituents on such proposals, I might support them.

[Dame Diana Johnson]

I rise to speak to amendment (a) tabled by the Government in lieu of Baroness Sugg’s amendment—Lords amendment 92—which would continue the telemedicine service for early medical abortion that was introduced during the covid pandemic. First, I pay tribute to the noble Baroness Sugg for her persistence and her work in the other place.

This is about how we best provide essential healthcare to women, and remember that one in three women will have an abortion during their lifetime. It is about making access as straightforward and women-centred as possible. The Secretary of State recently made a pledge in his speech to the Royal College of Physicians when he talked about the need to

“empower patients and fulfil the promise of the technological leaps we’ve seen throughout the pandemic.”

Scrapping telemedicine abortion at this stage goes completely against what the Secretary of State was talking about. This is also about trusting women, as the Chair of the Women and Equalities Committee, the right hon. Member for Romsey and Southampton North (Caroline Nokes), has talked about and as my hon. Friend the Member for Birmingham, Yardley (Jess Phillips) has said today.

Such is the strength of the evidence that the Welsh Government recently announced that they will be making telemedicine for abortion permanently available. This sends a clear message that, while women in Wales can be trusted to use a healthcare service in a way that meets their needs, women in England cannot. Not only will there be unequal abortion access between the devolved nations, but this decision will lead to health inequalities within England for the most vulnerable and marginalised. I struggle to see how the decision to bring this service to an end after August is in line with the Government’s commitment to put women at the centre of their own healthcare, as detailed in the vision for the women’s health strategy.

Telemedicine has already enabled an estimated 150,000 women to access abortion care at home. Its removal means that every woman, regardless of her personal circumstances and health needs, will be forced to attend a clinic. Lords amendment 92 would ensure that women can continue to access a consultation with a clinician by telephone. To make it crystal clear to everybody, very importantly, face-to-face consultations will still be available. We have heard concerns about younger people, and face-to-face consultations will be available—

[Nick Fletcher (Don Valley) (Con)]

Will the right hon. Lady give way?

[Dame Diana Johnson]

I am going to carry on because I know time is short.

Those consultations will be available if the clinician feels that that is appropriate or the woman wants to see somebody face to face. Let us all be clear: this is about choice. The continuation of telemedicine means that a woman would not have to travel long distances to attend a clinic if, for example, she lived in a remote area or had to make arrangements—

[Nick Fletcher]

Will the right hon. Lady give way?

[Dame Diana Johnson]

I am talking about women’s experience, so I will continue, if the hon. Gentleman does not mind.

The woman may have to make arrangements if she has childcare or caring responsibilities, or she may have to take time off work. In the case of a coercive and controlling relationship, she would have to explain where she is going to a perpetrator, such as the Mumsnet user who said she had to visit a hospital to access abortion care and was “terrified” of her abusive ex-partner finding out where she was. She spoke of having to construct “various lies” about where she was that day and why she had to have someone look after her children.

I referred to NICE and the World Health Organisation in an intervention, but we should be aware that since telemedicine was introduced the risk of complications related to abortion has reduced, as women are able to access care much earlier in their pregnancy. I will rehearse the long list of supporters of the measure continuing: The Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the Royal College of General Practitioners, the British Medical Association, the Royal Pharmaceutical Society, the Faculty of Sexual and Reproductive Health, the TUC, Women’s Aid, Rape Crisis, Karma Nirvana, the Terrence Higgins Trust, End Violence Against Women, Mumsnet, and many others. What I find most disappointing is that the Government are going against a wealth of robust and widely accepted peer-reviewed evidence from medical professionals and women’s charities, and appear to give greater weight to anecdote, erroneous opinion and misinformation focused on campaign groups with extreme views who bombarded a consultation. Sadly, that further emphasises that this is not an evidence-based policy decision.

[Caroline Nokes (Romsey and Southampton North) (Con)]

Will the hon. Lady give way?

[Dame Diana Johnson]

I want to address the issue of safeguarding. Let me be clear: creating more barriers to access does not help women; it helps abusers. The End Violence Against Women coalition and other major VAWG organisations reject the claim that telemedical abortions put women at greater risk of coercive abortions. The fact is that coercive pregnancies are far more common than coercive abortions, and since the introduction of telemedical abortions providers have seen a rise—a rise—in safeguarding disclosures, highlighting that the system provides a safe space for women to come forward if they are being coerced. Nurses are highly trained to assess safeguarding issues, and if concerned they will ask the women to come to the clinic for face-to-face assessment.

Finally and crucially, women themselves strongly favour keeping telemedicine for early medical abortion. A clear majority want it to continue.

As a country, we have an opportunity to be seen to be a shining light for women’s reproductive rights around the globe at a time when those rights are being rolled back elsewhere. The weight of the evidence in favour of maintaining this essential women’s healthcare pathway is overwhelming. I ask Members to support the amendment in lieu.

[Mrs Miller]

First, I apologise for being late to the debate, Mr Deputy Speaker. I appreciate your calling me to speak, and I will be brief.

Amendment (a) in lieu of Lords amendment 92 is all about increasing women’s choice, not about taking choice away from anyone. The basis on which the amendment can be judged is the evidence we have gathered, not in a short period of time, but during two years in which 150,000 women have used telemedical abortion care. Judge the amendment against that backdrop; it is done not on a whim or a fancy, but after two years of intensive analysis.

While I might want to agree with those of my right hon. and hon. Friends who are calling for a reasoned debate in the House of Commons on the broader issues of abortion, the truth is that we do not have those debates because the Government talk about changes to abortion provision coming from Back Benchers when that provision is now so out of date in our country that we need the Government to look at it more broadly. I will support the amendment because it is the right thing to do. The amendment is backed by a huge range of organisations and a significant body of evidence, and it requires the Government to look more broadly at abortion—to take this as a responsibility and to stop shoving it back on to the Back Benches.

Continuing telemedical abortions will be supported and regulated in exactly the same way as face-to-face abortion care, and to suggest otherwise is to be factually incorrect. Members really need to think about the evidence showing that online sales of abortion pills from unregulated providers have decreased since telemedical abortion was made legally available. Rather than push people back into an unregulated market, let us keep what we have, which has worked for 150,000 women over the past two years. But please, please, Minister, let us have a reasoned look at abortion more broadly. Stop saying that this is an issue for Back Benchers. It is not.

[Alex Cunningham (Stockton North) (Lab)]

I will speak specifically to Lords amendments 85 to 88 on tobacco control. First, I pay tribute to my hon. Friend the Member for City of Durham (Mary Kelly Foy) who put so much work into tobacco control amendments in Committee but is unable to be here. Like her, I am an officer of the all-party parliamentary group on smoking and health, and I strongly support amendments 85 to 88 on the “polluter pays” levy on tobacco manufacturers. I heard what the Minister said about a levy being complicated and how it might take years to implement, but a way must be found to make big tobacco pay for the crisis that it sustains every day that it remains in business.

Like my hon. Friend the Member for City of Durham, I represent a constituency in north-east England, which is the most deprived region of the country and has high rates of smoking. We have reduced smoking significantly in recent years, but, despite that progress, it is still the leading cause of premature death, killing more than 400 of my constituents a year. In my constituency, smoking costs society more than £62 million, which is money that our community can ill afford. I also worry that nearly 15% of local pregnant women are still smoking at the time of delivery, which is 50% higher than the national average. We all know that smoking in pregnancy significantly increases the risks of miscarriage, stillbirth, sudden infant death syndrome and foetal growth retardation. The levy would raise vitally needed money for investment in deprived areas such as ours in the north-east to break the cycle of addiction, disease and premature death. At current rates of decline, Cancer Research UK has calculated that the smokefree 2030 ambition will not be achieved for our most disadvantaged communities until 2047.

[Steve Brine]

This is such an important subject, so it is good that we are discussing it as part of the Bill. I am so puzzled by the Government’s approach because money is clearly short in the Treasury and the levy would be a new source of income that could help with a public health aim and save millions in the long run. The reason for it was summed up beautifully by the chief medical officer when he said that

“a small number of companies make profits from the people who they have addicted in young ages…to something which they know will kill them.”

We have an opportunity to do something about that at no cost to the Exchequer.

[Alex Cunningham]

It is exactly that; I could not agree more. I am sure that Ministers will work hard to try to find ways in which we can make the polluter pay—that is a polluter who pollutes the bodies of our people.

Achieving the smokefree 2030 ambition is the most effective way to achieve the health missions in the Government’s levelling-up White Paper to reduce the gap in healthy life expectancy between top performing and other areas by 2030 and to increase healthy life expectancy by five years by 2035. Becoming smokefree will also improve my constituents’ employability by reducing levels of sickness, disease and disability.

I am pleased that tobacco control is not a party political issue, and I am pleased to work closely on it with the hon. Member for Harrow East (Bob Blackman). We have very different political views on many things—he has heard me say this—but we are as one on this issue. It was a Conservative Government who committed to making England smokefree by 2030, but that ambition is shared by all political parties in Parliament. It is also supported by the public, but, like the all-party parliamentary group, they recognise that this ambition needs substantial funding to be delivered.

A survey of 13,000 people carried out last month for Action on Smoking and Health found that making tobacco manufacturers pay for measures to end smoking was supported by more than three quarters of the public, with little opposition—I think that 6% of people were opposed. Let us remember that, over the last 50 years, smoking has killed an average of 400 people a day year in, year out, which is far more than covid has or will. It is only right that big tobacco, which has lined its pockets from the human misery caused by polluting the bodies of our people, is forced to pay the price of ending this lethal epidemic. I urge the Government to accept the amendments as a step on the track to achieving the smokefree 2030 ambition that we all share.

[Laura Trott (Sevenoaks) (Con)]

It is a pleasure to follow the hon. Member for Stockton North (Alex Cunningham). I will speak briefly to Lords amendment 84 and to the Government amendment in lieu of Lords amendment 92.

On Lords amendment 84, on the licensing of cosmetic procedures, I just want to thank the Government for putting this in. Non-surgical cosmetic interventions such as Botox and fillers are the wild west of the healthcare world. We do not expect something that we can easily and legally get done in the safety of our own home to be able to blind us, but that is the case. It is high time that this was sorted and it is a huge step forward for women’s health, so I thank the Government very much.

16:45

On the Government amendment (a) in lieu of Lords amendment 92, I fully respect that this is something a lot of hon. Members feel very, very strongly about. I want to read a quote:

“Telemedicine for early medical abortion has been a success story of the pandemic and the removal of this service would be an infringement on women’s rights to access the healthcare they deserve.”

That is from Dr Edward Morris, chair of the Royal College of Obstetricians and Gynaecologists. I agree. Keeping the option of this service is supported by all women’s groups working with vulnerable people, including: End Violence Against Women Coalition, Women’s Aid and Rape Crisis. They all say it is a lifeline for women in vulnerable situations and that taking it away will put them at risk. Some 86% of women who experience rape or assault by penetration know the perpetrator. Privacy and flexibility in accessing services in relation to sexual violence is crucial for women’s safety.

I want to make a point about the dignity of women going through this process. I have a close family member who had an abortion. There is a reason why the first pill is known as “abortion on the bus”. One goes to get the pill and the effects can happen very quickly. She was driving home and had to pull over at Sainsbury’s, where she vomited in a toilet. She had severe diarrhoea and she was bleeding very heavily. That was forced on her because of an artificial constraint that we put on how women can access abortion. That is not right. The safety concerns are just not there. It has been proven to be safer since we have allowed telemedicine during this period. It is what women want.

I understand that people feel strongly about this issue, but honestly, this is a matter of human dignity, of women’s dignity. I urge hon. Members to think very carefully when this is put forward today, because it really will make a huge difference to a huge number of women.

[Carla Lockhart (Upper Bann) (DUP)]

I speak today in opposition to the amendment which aims to make the provision of home abortion pills a permanent part of the law. When the decision was taken to allow women to carry out their own abortions at home for the first time, we were told it was a purely time-limited emergency approval, similar to all other emergency approvals. Two years on, the Government have lifted remaining pandemic restrictions, including the temporary at-home abortion policies, specifically by allowing six months for providers to prepare. It is sad and concerning that the other place has amended the Bill to frustrate the Government’s decision and so seek to block the revocation of the temporary change. The changes to allow abortions at home were introduced without parliamentary scrutiny or public consultation. Now that we have evidence about how it works in practice, we know the policy presents huge risks to women’s health and safety.

Since the policy has been in place, the media have reported several heartbreaking stories of women who were traumatised by their experience of at-home abortion. Sadly, we learned of another just this morning. As reported by the BBC today, 16-year-old Savannah received abortion pills far beyond the safe and legal 10-week gestational limit. She disclosed that during her phone consultation the abortion provider calculated she was less than eight weeks pregnant, so she went to a British Pregnancy Advisory Service clinic to collect abortion pills. She was not scanned or examined. As the BBC reports, on taking the second pill she began to experience, in her words, “really bad” pain. She shared:

“My relative called another ambulance, because when I was pushing my boyfriend could see feet.”

Members, this baby was born with a heartbeat. They were both taken to hospital, where Savannah was found to have been between 20 and 21 weeks pregnant. Unsurprisingly, she said she had been left traumatised and that if she had been scanned to determine her gestation, she “would have had him”.

Savannah’s story should make us all pause and consider what this policy actually means. Perhaps it would be different if her story was an anomaly, but it is not. Tragically, delivery of near-viable or viable infants from a failed medical abortion is more common than abortion advocates would care to admit. Early on in the pandemic, just weeks after this policy was approved, a leaked “urgent” email sent by an NHS regional chief midwife quoted the “escalating risk” around at-home abortions and cited

“the delivery of infants up to 30 weeks gestation.”

Similar reports have been made by the body that comprises all senior NHS doctors and nurses who fulfil statutory child safeguarding functions in the NHS, the National Network of Designated Health Care Professionals for Children. Specifically, it has recorded 47 cases of early medical abortions that resulted in mid-to-late pregnancy terminations, across all ages, since the start of the pandemic in March 2020. Six involved girls and in half those cases, and 12 instances in total, there had been signs of life.

I find it very interesting that, as reported by the BBC, those in favour of at-home abortions—such as abortion provider the British Pregnancy Advisory Service, which is usually all too ready to comment on abortion—could not comment on these cases, perhaps because they know that individual cases matter and that there is truly no excuse for allowing these tragedies to occur.

Women and girls deserve better. We have the opportunity today to champion women and girls everywhere and to ensure that these scenarios, which are so easy to avoid, are prevented. Women simply need to be seen in person prior to receiving abortion pills, especially young people and vulnerable women up to 25.

As it stands, abortion providers are unable to guarantee that they know who takes the pills, when or where they are taken or whether an adult is present, given the risk of complications, such as the delivery of live babies. A Sky News documentary found that 96 women every week—14 each day—who have at-home abortions will suffer from complications that may need follow-up treatment or surgery.

We owe Savannah and her child, and indeed, all women and girls, better than this. Abortion harms the voiceless, the most vulnerable in our society, and it harms women and girls. The Government have rightly prioritised the safety of women and girls. I therefore urge hon. Members to look at the risks posed from continuing this policy and to do the right thing by voting to end at-home abortions.

[Several hon. Members rose—]

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Three Members are standing and I want to get you all in, so we will have a four-minute time limit.

[Sir Edward Leigh (Gainsborough) (Con)]

Obviously, abortion is a deeply emotional issue and we probably all know where we stand, but this is not a debate about abortion. At-home abortions were brought in as a purely temporary measure to defend women’s health. It was always the understanding that the measure would continue just as long as the pandemic continued.

There are many different arguments about this issue. I could go through the statistics that have been given to me that some people might deny, but it is undoubtedly the case that more than 10,000 women who took at least one abortion pill at home provided by the NHS in 2020 needed hospital treatment. There is therefore an issue around safety and women’s health and we need a proper debate. This amendment was brought in in the House of Lords at night-time. Barely a seventh of the Members of the House of Lords actually took part in the Division. We need a proper, evidenced debate on this issue. There is nothing more important when a human life is at risk.

Of course, we all support telemedicine; I chaired a meeting yesterday on atopic eczema and we are making wonderful steps, but as important as curing atopic eczema is, it is nowhere near as important as a situation where a life is at stake. I know that there are different views about coercion, but surely the whole point of the Abortion Act, for those who supported it, was to get abortions into a safe medical location and to get them away from the backstreets. People surely did not want them to be done at home, where there is risk. The hon. Member for Upper Bann (Carla Lockhart) spoke about the case of the 16-year-old girl who delivered a foetus who, apparently, was 20 weeks old. That is why, as my hon. Friend the Member for Congleton (Fiona Bruce) said, the National Network of Designated Healthcare Professionals for Children welcomes the Government’s stance, and why children and young people will be provided with protections.

I urge hon. Members, whatever their view, to think, to consider the evidence and not to rush in. The amendment goes completely against the whole spirit of the Abortion Act. Whatever we think of that Act, the amendment would be a huge new step that I believe would put more women’s health at risk and possibly lead to coercion—we need more evidence on that. I therefore support what the Government are doing today.

[Matt Warman (Boston and Skegness) (Con)]

I rather think that men should enter the debate on abortion with a degree of trepidation and humility. In that spirit, I will make three simple points.

First, it strikes me as absolutely right that parliamentarians in this place and in the other place should seek to use every vehicle before them to enact the improvements in our constituents’ lives that we all want. It is right and fair to say that the measures were temporary and were brought in only for a certain purpose, but it cannot be right to say that now that we have done that extraordinary experiment, seen how many women have benefited from the change in telemedicine and got the data, we cannot let the vehicle of the Bill pass us by without trying to make this improvement.

Secondly, the reason that all the expert bodies—including the Royal College of Obstetricians and Gynaecologists, Women’s Aid and the Academy of Medical Royal Colleges, where I have to declare that my wife works—support this approach is that they have seen the evidence. They look at that evidence as organisations that have the safeguarding of their patients absolutely at the heart of every single thing they do. They have looked at what we have done and the evidence we have gathered, and they say it is right to continue with the measures brought in for the pandemic. That is why Wales and Scotland have continued them.

We have to trust the evidence; we have to trust the science. We have to understand that we are in the position that we are in as a result of the covid vaccine programme because we trusted the science. Today, we have an opportunity to trust the science yet again. That seems to me an incredibly powerful argument.

We are not making telemedicine compulsory; we are making it a choice. Yes, we are putting a huge burden on doctors to say that the person on the other side of the screen is not someone who should have pills by post, so to speak. We are saying that they should make that calculated judgment. We ask the professionals, be they in charities or in hospitals, to make those judgments every day. We do so because they are the experts.

I say simply to hon. Members that there are issues on which we profoundly disagree—of course there are; these are fundamentally ethical issues—but if we are in favour of abortion, we should be in favour of the choice that is provided by the very safest options. We can see today from the evidence of the past couple of years that it is safer for women who are at their most vulnerable to have the option that we are talking about today. It is not compulsory; it is an option. For me, supporting that today is the definition of being pro-choice.

[Bob Blackman]

I have had more correspondence on Lords amendment 92 than on any other in the past 12 years. I shall vote accordingly, against Baroness Sugg’s amendment and against the Government’s amendment in lieu.

As chairman of the all-party parliamentary group on smoking and health, I support Lords amendments 85 to 88, which require the Government to have a consultation on the polluter pays levy on tobacco manufacturers. The levy was the central plank of our recommendations to the Government to deliver their smoke-free 2030 ambition. We had other recommendations, but that was the central one because funding for smoking cessation and tobacco control has been reduced every year since 2015 and has not been reinstated in the spending review or the recent spring statement.

Additional funding is vital to reducing smoking rates among the most disadvantaged in society and particularly among pregnant women. The current target to reduce the national prevalence of smoking in pregnancy to 6% by 2022 will be missed, and I think we should be clear about that. Last year alone more than 50,000 women smoked during pregnancy, which caused damage to them and to their unborn children. If we want to create a smoke-free society for the next generation, we must step up our efforts now.

17:01

The APPG’s recommendation for a levy was strongly supported in the other House, which is why we are discussing it today. We are discussing a number of amendments today, but the Government received its heaviest defeat on these amendments. They were backed by 213 votes to 154, and those voting for them included two former Health Ministers and two former chief executives of the NHS, one of whom was also a former permanent secretary to the Department of Health. Lord Naseby spoke against, using a quote from the Exchequer Secretary about the Treasury’s 2015 consultation, when she said it had concluded that a levy would

“add complexity and additional costs, while the amount of revenue it could raise is uncertain.”––[Official Report, Finance (No. 2) Public Bill Committee, 5 January 2022; c. 77.]

That may have been true in 2015, but it is not the case today. In 2015 we could not prevent tobacco manufacturers from passing the cost on to consumers because we were in the European Union. One of the benefits of Brexit is that, now we are out of the EU, we can. Lord Young of Cookham said in the other place that the levy would allow the Government to

“put the financial burden firmly where it belongs, on the polluter”.—[Official Report, House of Lords, 6 March 2022; Vol. 820, c. 290.]

We should not forget that tobacco manufacturers have the highest profit margins of any consumer companies in the world. Imperial Tobacco, for example, which sells about four in 20 of the cigarettes smoked in the UK, makes £71 in profit for every £100 in sales, far more than the average for consumer businesses, which is £12 to £20. Big Tobacco can afford to pay to fix the damage that it does. The Government first promised to consider a “polluter pays” levy three years ago, in the 2019 prevention Green Paper, but they have failed to do so. Economists from the University of Bath have estimated that if the levy were introduced, we could raise £700 million a year. At a time when the public purse is depleted, that is not to be sneezed at.

As I said on Report, the Government

“may resist these measures”

—and they may resist them today—

“but we on the Back Benches who are determined to improve the health of this country will continue to press on with them, and we will win eventually.”—[Official Report, 22 November 2021; Vol. 704, c. 74.]

I know for a fact that when Javed Khan produces his recommendations, he will recommend even more stringent measures that the Government will need to introduce.

[Edward Argar]

Given that I spoke at length in my opening remarks, I will endeavour to use the few minutes remaining to me to cover some of the key points made in the debate. First, I should have said in my opening remarks, and say now to the hon. Member for Linlithgow and East Falkirk (Martyn Day), that I am grateful to the devolved Administrations for the constructive manner in which they have engaged with me and with my Department. I hope that that process has been collegiate and satisfactory from their perspective as well.

Let me clarify my response to a point made by the hon. Member for Gower (Tonia Antoniazzi). Health is, of course, devolved in Wales and Scotland. Were the Government’s amendment in lieu in respect of abortion to be passed, it would apply to England and Wales, but it would simply do what the Welsh Government are already doing.

We have called for Members to reject Lords amendments 85 to 88, in respect of tobacco. We heard from the hon. Member for Stockton North (Alex Cunningham), who rightly cited the hon. Member for City of Durham (Mary Kelly Foy). I am sorry that she could not be here today, but in Committee she took a close and well-informed interest in these issues. We have also just heard from my hon. Friend the Member for Harrow East (Bob Blackman).

[Liz Twist]

Will the Minister give way?

[Edward Argar]

I did promise not to take interventions, given the time, but I will take one from the hon. Lady, because I was not able to do so during my opening remarks.

[Liz Twist]

May I add my backing to the call for support for Lords amendment 85? Yesterday many of us attended a reception organised by Cancer Research UK, which has highlighted this issue. Will the Government please bite the bullet and support the amendment?

[Edward Argar]

Before responding to the hon. Lady, I must correct myself. I should have said “With the leave of the House” before starting my wind-up remarks.

I am grateful to the hon. Lady for her work on this issue. Although this does not normally fall within my ministerial portfolio, she and I have debated this issue across the Floor of the House, and I know her interest and her passion for this issue, and the hard work that she has done on it. While I recognise that, I believe that the Government’s approach of resisting the Lords amendments in this space is the correct one, and I therefore fear I may disappoint her. We will see whether the House divides on this matter; I suspect it will, but that will be up to shadow Ministers and other Members. I welcome the debate, and I suspect it is a debate we will continue to have.

I have listened extremely carefully to my hon. Friend the Member for Buckingham (Greg Smith), as he would expect. I would encourage him not to press the point further at this stage, and I will of course continue to reflect carefully on the points he has made. They are important points about the impact on industry and on the broadcasting industry, and I will consider carefully what he said, but we believe that we have struck the appropriate balance in the legislation as it stands. I am grateful to him for his intervention in this debate and his comments.

It was perhaps predictable when looking at the nature of the amendments in this group that Lords amendment 92 and amendment (a) in lieu would inform the bulk of the contributions across the House. This is an issue that Members quite rightly hold strong views on, and there are sincerely held and informed views on both sides of the debate. It is important that this debate is well informed. We heard from my hon. Friends the Members for Runnymede and Weybridge (Dr Spencer), for Congleton (Fiona Bruce) and for Sleaford and North Hykeham (Dr Johnson), and the hon. Member for Strangford (Jim Shannon), the right hon. Member for Kingston upon Hull North (Dame Diana Johnson) and the hon. Member for Birmingham, Yardley (Jess Phillips). May I offer my condolences to the hon. Member for Birmingham, Yardley and her family on the loss of her mother-in-law, Diana, on Friday?

We also heard from my right hon. Friend the Member for Basingstoke (Mrs Miller), my hon. Friend the Member for Sevenoaks (Laura Trott) and my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), as well as from my hon. Friend the Member for Boston and Skegness (Matt Warman), who gave a typically powerful speech on the subject. We also heard from the hon. Member for Upper Bann (Carla Lockhart).

I have made it clear throughout the debate that this is a free vote, but I would urge Members, in reaching their decisions, to be cautious about some of the figures that have been used in support of some of the arguments today. We do not have all the detailed figures, and I understand that some of them may be based upon extrapolations from freedom of information requests conducted in this respect. I am not drawing any conclusions beyond that, but I would urge caution among Members in how they use those figures.

It is absolutely right that this issue, having been inserted into the Bill by the noble Baroness Sugg, should have been carefully considered by this House. The volume of contributions reflects the importance attached to it by Members. The Government have been clear that these were temporary provisions put in place to reflect an extraordinary set of circumstances, and my right hon. Friend the Secretary of State has been clear that, as we move out of the pandemic, such temporary pandemic-related measures should cease. However, the House has had the opportunity to debate this matter today, and the views expressed on both sides are important for the House to hear.

As I have said, I hope that Members will be clear about the process that we will follow. We hope that, on the voices, the House will reject the Lords amendment tabled in Baroness Sugg’s name purely on the basis that it is legally defective and will not do the job that was intended for it in policy terms by the noble Baroness. We have therefore tabled what we believe is a legally effective amendment in lieu of that amendment. Uncertainty in this area of policy and of law does no one any favours, and we would not wish uncertainty for anyone in this space. That is why we were unable to accept the noble Baroness’s amendment and why we are asking the House to reject it, but we have come up with something that we believe provides clarity and is legally effective in what it does. As I say, it is for hon. Members to consider their own position on this matter of conscience, which is of import to our constituents up and down the country, and I suspect they, too, will have strong views either in favour or against. It is right that the House brings such matters to a debate and a vote.

17:11

Two hours having elapsed since the commencement of proceedings on consideration of Lords amendments, the debate was interrupted (Programme Order, this day).

The Deputy Speaker put forthwith the Question already proposed from the Chair (Standing Order No. 83F), That amendment (a) to Lords amendment 91 be made.

Question agreed to.

Amendment (a) accordingly made to Lords amendment 91.

The Deputy Speaker then put forthwith the Questions necessary for the disposal of the business to be concluded at that time (Standing Order No. 83F).

Lords amendment 91, as amended, agreed to.

After Clause 148

Tobacco products statutory scheme: consultation

Motion made, and Question put, That this House disagrees with Lords amendment 85.—(Edward Argar.)

17:11

Division 236

Ayes: 275

---

Conservative: 266
Democratic Unionist Party: 7

Noes: 183

---

Labour: 138
Scottish National Party: 21
Liberal Democrat: 12
Plaid Cymru: 3
Conservative: 2
Independent: 2
Social Democratic & Labour Party: 1
Alliance: 1
Alba Party: 1
Green Party: 1

Lords amendment 85 disagreed to.

Lords amendments 86 to 88 disagreed to.

After Clause 148

Permitted Locations for Abortion Treatment

Lords amendment 92 disagreed to.

Amendment (a) proposed in lieu of Lords amendment 92. —(Edward Argar.)

Question put, That the amendment be made.

17:26

Division 237

Ayes: 215

---

Labour: 126
Conservative: 72
Liberal Democrat: 10
Plaid Cymru: 3
Independent: 2
Social Democratic & Labour Party: 1
Alliance: 1
Green Party: 1

Noes: 188

---

Conservative: 175
Democratic Unionist Party: 7
Labour: 4
Liberal Democrat: 1

Amendment (a) made in lieu of Lords amendment 92.

Lords amendment 95 disagreed to.

Government amendment (a) made in lieu of Lords amendment 95.

Lords amendments 52 to 54, 66 to 79, 82, 84, 93, 94, 96 to 101 and 109 to 129 agreed to, with Commons financial privileges waived in respect of Lords amendments 52 to 54, 84, 93, 94, 96, 97 and 129.

Clause 35

Report on assessing and meeting workforce needs

[Edward Argar]

I beg to move, that this House disagrees with Lords amendment 29.

[Madam Deputy Speaker (Dame Eleanor Laing)]

With this it will be convenient to discuss the following:

Lords amendment 30, and Government motion to disagree.

Lords amendment 48, Government motion to disagree, Government amendment (a) in lieu, and amendment (b) in lieu.

Lords amendment 57, and Government motion to disagree.

Lords amendment 89, Government motion to disagree, and Government amendment (a) in lieu.

Lords amendment 108, and Government motion to disagree.

Lords amendments 42 to 47, 55, 56 and 58 to 64.

[Edward Argar]

It is a pleasure in discussing this set of amendments to be facing the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting), although I might not say that after he has made his contribution or challenged me. I am grateful for the opportunity to speak to this important set of amendments, and I again put on record my gratitude to their lordships for the work they have done in scrutinising this Bill. This group is about accountability and makes it clearer that the Government are committed to ensuring that the NHS is transparent, accountable and effective.

Lords amendments 42 to 47 ensure that the procurement regulations will have to include provision for procurement processes and objectives; for steps to be taken when competitively tendering; and for transparency, fairness, the verification of compliance and the management of conflicts of interest. They also require NHS England to issue guidance on the regulations. It behoves me to pay tribute to the shadow Minister, the hon. Member for Bristol South (Karin Smyth), who served on the Bill Committee throughout. Although we did not always agree, she brought her expertise and forensic skills with issues such as this to that Committee. Even if she did not always agree with the conclusions, she made sure we were well informed in the conclusions we reached.

We recognise those key aspects as vital. While it was always our intention to include them in the new provider selection regime, the amendments add clarity and clearly signal our intentions. Furthermore, Lords amendment 47 makes the regulations subject to the affirmative procedure. We are grateful for the input of the Delegated Powers and Regulatory Reform Committee in advising that, and we have listened.

Lords amendment 55, supported by the Scottish Government, makes it clear that any powers or duties conferred on Scottish Ministers in relation to their role in collecting information for medicine information systems can be treated in the same way as other NHS powers or duties in Scotland and be delegated to health boards in Scotland.

Lords amendments 56 and 58 to 64 relate to the power to transfer the functions of arm’s length bodies. Following constructive engagement with the devolved Governments, these amendments enable us to proceed on a UK-wide basis. Lords amendment 56 clarifies that the powers in part 3 of the Bill in respect of special health authorities apply in relation only to England and cross-border special health authorities, and not Wales-only special health authorities. Lords amendments 58 and 59 remove devolved Ministers and Welsh NHS trusts from the list of appropriate persons to whom property, rights and liabilities can be transferred through a transfer scheme following a transfer of functions.

Lords amendment 60 creates a requirement for the Government to obtain the consent of the devolved Governments for any transfer of functions within the competence of their legislatures or which modify functions exercised by the Welsh Ministers, Scottish Ministers or a Northern Ireland Department. Finally, Lords amendments 61 to 64 are consequential upon the changes made by Lords amendment 60.

I am also asking the House to disagree with several amendments made in the other place. First, Lords amendment 29 relates to the workforce, and I reassure the House that the Government are committed to improving workforce planning. We recognise the importance of having a properly trained workforce in sufficient numbers and in the right places. We are already taking the steps we need to ensure we have record numbers of staff working in the NHS. While we recognise the strength of feeling behind the amendment, we simply do not think it is necessary in its current form, and we urge the House to reject it.

[Peter Aldous (Waveney) (Con)]

I am aware that the Government have put in place their own plans for NHS workforce planning, but can my hon. Friend address the concerns that framework 15 has inadequacies in terms of data collection, does not provide an assessment of workforce numbers and is not responsive to societal shifts?

17:45

[Edward Argar]

My hon. Friend puts his finger on a key issue, which is the dynamic nature of workforce trends, whether in terms of demand or supply, which is one of the challenges of a long-term projection—it would need to be a dynamic process. That is why we believe that the right approach is the one set out by my right hon. Friend the Secretary of State. His predecessor commissioned that framework review from Health Education England in July last year, and the Secretary of State has subsequently asked for further work to be done in a further commission that looks at a workforce framework over 15 years. That is the first time that has been done, as I heard him say at the Dispatch Box earlier today when talking about the Ockenden review, and it will be a hugely valuable tool for the NHS and for us when we make decisions in this place about priorities and prioritisation in healthcare. As always, I am grateful to my hon. Friend the Member for Waveney (Peter Aldous).

Before I go into more detail, I will make a point on which I suspect the shadow Secretary of State and I are in complete agreement. Although there may not be many things in this group of amendments that we agree on, I am sure that he will join me in recognising the amazing work done by our health and care workforce over the past two years, and not just in the past two years, which were exceptional circumstances, but every day of the year—day in, day out—whichever year it is. I put that on record because it is important.

[Wes Streeting (Ilford North) (Lab)]

indicated assent.

[Edward Argar]

The hon. Gentleman nods; as I say, I suspect that may be a rare moment of agreement on this group of amendments.

We continue to be committed to growing and investing in the workforce. This year we have seen record numbers of staff working in NHS trusts and clinical commissioning groups, including record numbers of doctors and nurses. The monthly workforce statistics for December 2021 show that there are more than 1.2 million full-time equivalent staff. Those workforce numbers come on the back of our record investment in the NHS, which is helping to deliver our manifesto commitments, including to have 50,000 more nurses by the end of the Parliament. We are currently on target to meet that manifesto commitment, as the number of nurses was a little over 27,000 higher in December 2021 than in September 2019.

The spending review settlement will also underpin funding the training of some of the biggest undergraduate intakes of medical students and nurses ever. In that context, I highlight the decision made, I believe, under one of my predecessors to expand the number of medical school places from 6,000 to 7,500, which has come on stream. Of course there is a lead time before those going through medical schools will be active in the workforce, but it is an important step forward.

[Janet Daby (Lewisham East) (Lab)]

I draw the Minister’s attention to the 2 million Uyghurs who have been detained in concentration camps. They are making slave-made goods that have infiltrated our NHS, which puts health workers at risk of wearing products made by modern slavery. Will he recognise the importance of accepting Lords amendment 48 so that the NHS is not dependent on slave-made goods?

[Edward Argar]

I hope the hon. Lady will forgive me, because I will finish discussing the workforce amendments before I turn to the so-called genocide amendments and the organ sales amendments. I will come to her point, but I hope she will allow me to do it in that way; I have heard what she has said.

[Rachael Maskell (York Central) (Lab/Co-op)]

Will the Minister give way?

[Edward Argar]

I will make a little progress, then I will give way to the hon. Lady, as I tend to do. She is a regular participant in health debates.

We are already committed to improving workforce planning. In July 2021, as I said, we commissioned that important work with partners to review long-term strategic trends. It is also important to note in that context that my right hon. Friend the Secretary of State announced that we are merging NHS England and Health Education England, which is a hugely important move that brings together the workforce planning and the provision of places and of new members of the workforce with the funding available for that and the understanding of what is needed in the workforce. It brings supply and demand considerations together.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Will the Minister give way?

[Edward Argar]

I will make a little more progress, then I will give way to the hon. Member for York Central (Rachael Maskell) and then, if I have time, I will give way to her. I want to address the points of the hon. Member for Lewisham East (Janet Daby) in good time and I am conscious that the votes took up a chunk of the time allowed for this group of amendments.

We are also committed to increasing transparency and accountability. The unamended clause already increases transparency and accountability on the roles of the various actors within the NHS workforce planning system.

[Rachael Maskell]

When looking at workforce planning, it is really important not only that the Government depend on NHS professionals trained overseas, but that they look at commissioning more training places here. In particular, I would point to the dentistry profession, as the Government are currently waiting for 700 dentists to pass their exams. It really does highlight the shortage of training for our own dentists when one in three dentists practising has trained overseas. Will the Government look at the commissioning of more training places so that we can grow our own workforce?

[Edward Argar]

The hon. Lady will be pleased to know, or will I hope be reassured to a degree to know, that underpinning our strategy to grow the workforce—for example, the nursing workforce or other specialisms—is the fact that we have multiple strands to the strategy. Those coming from overseas who wish to work in the NHS are always going to be an important and valued part of our NHS workforce, but of course we are also committed to growing the number, for want of a better way of putting it, that we grow at home through training places and medical schools. Crucially, however, a key element here is retention of our existing staff, so that we are not simply recruiting and training lots more staff to replace those who are leaving. All of those factors are important.

[Debbie Abrahams]

Does the Minister want to comment on the fact that 100-plus organisations—and not just those 100 organisations, including the BMA, but former chief executives of NHS England—are still very concerned that the Government’s measures on workforce planning do not go far enough?

[Edward Argar]

I am grateful to the hon. Lady, and she and I have worked together on a number of issues in the past. We always engage—and the since the inception of the Bill and throughout its passage, we have engaged collaboratively—with a whole range of organisations, such as professional bodies and trade unions, including some of those she mentioned. We believe that the approach we have adopted in the commissions from the Secretary of State, coupled with the merger with Health Education England, will be a significant step forward, and we believe it is the right approach to take. I suspect that the hon. Lady may disagree, and I always respect her opinion, although I may not always agree with it.

[Jeremy Hunt (South West Surrey) (Con)]

Will the Minister give way?

[Edward Argar]

I wanted to make a little progress, but I will give way to the Chair of the Select Committee.

[Jeremy Hunt]

Could the Minister possibly just tell me whether there is a single NHS organisation that is not supporting Lords amendment 29, which the Government are planning to reject?

[Edward Argar]

I may regret giving way to my right hon. Friend. I do not often say that, but perhaps I do now. I believe that this is about striking an appropriate balance in workforce planning and understanding supply and demand. I believe that the approach we have adopted as a Government, with the commission and the subsequent commission from the Secretary of State, is the right one. We are working closely with all NHS organisations from NHS England down, and I am sure that we will continue that collaborative work and that they will recognise the value being added by these commissions.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Will the Minister give way?

[Edward Argar]

I will make a little progress if I may, but if the hon. Gentleman can shoehorn his way in a little later, I will, assuming I am making good progress, try to find a way to come back to that point for him.

On Lords amendments 30 and 108, while we recognise the concerns of the other place, we think it is important to enable the Secretary of State to intervene in reconfigurations with greater flexibility where such an intervention is warranted. While the Secretary of State already has powers over reconfigurations, our proposals will allow them to better support effective change and respond in a more timely way to the views of the public, health oversight and scrutiny committees and, indeed, parliamentarians in this House. It will reduce wasted time and effort, and it will allow Ministers to become involved at the right stage, not simply at the end stage of the process. For that reason, we urge the House to reinstate clause 40 and schedule 6.

[Tim Farron]

rose—

[Edward Argar]

I think the hon. Gentleman is seeking to intervene. I find it difficult to say no to him, so I will give way.

[Tim Farron]

The Minister is a thoroughly good man, and I am very grateful. He will be aware of the National Audit Office’s projection that there are probably 100,000 undiagnosed cancer cases since the pandemic. Tragically, clinicians reckon that probably 20,000 of those people have already passed away. Will he agree and commit to a specific workforce strand when it comes to cancer? We desperately need cancer specialists, nurses, oncologists, radiotherapists and so on if we are going to be able to tackle this problem, but also make sure that we are not overburdened in the future, so that we can save lives?

[Edward Argar]

I am pleased I took the hon. Gentleman’s intervention on an issue that I know he has long taken an interest in. As well as the overall macro-trends of supply and demand, I expect the work being undertaken to look at the specialisms sitting beneath. He and I have discussed the significant increase in percentage terms in the number of radiographers, radiologists and others since 2010, but I acknowledge his underlying point that there is more to do if we are to achieve the ambitions set out in our consultation on the 10-year cancer plan and our broader ambitions for cancer care and treatment. We continue to look at that, and those specialisms will form a part of that work.

The hon. Member for Lewisham East raised a subject that I suspect will come up in contributions to the debate, including from my right hon. Friend the Member for South West Surrey (Jeremy Hunt). Regarding Lords amendment 48, we have heard the strength of feeling in the other place about the gravity of this issue, and I know that no one in this House would support the use of forced labour in creating NHS goods or their coming from areas where genocide may be taking place. We are fully committed to ensuring that that does not happen and we are now proposing further measures to tackle the use of forced labour, but we do not believe that this is the right legislative vehicle for introducing those changes, especially those made in the other place relating to genocide.

The Government will bring forward new rules for transforming public procurement in the forthcoming procurement Bill, which will cover all Government procurement and further strengthen the ability of public sector bodies to exclude from bidding for contracts suppliers that have a history of misconduct, including forced labour. We believe that that is the right vehicle for such provisions. The review of the 2014 modern slavery strategy will be published in spring this year, and will provide an opportunity to build on the progress we have made and to adapt our approach to take account of the evolving nature of these terrible crimes. We know that the NHS is one of the biggest procurers in this country, and it is for that reason that we are introducing measures in this Bill to ensure that NHS procurement works for the good of all.

NHS England and NHS Improvement agreed a new slavery and human trafficking statement for 2022-23 on 24 March, with new modern slavery countermeasures in the NHS supplier road map, updates to the NHS standard contracts to strengthen our position on modern slavery, and the development of a new strategy to eradicate modern slavery across the NHS supply chain. We are going to go further than that, though. In amendment (a) in lieu of amendment 48, we propose to introduce a duty on the Secretary of State to carry out a review into the risk of slavery and human trafficking taking place in NHS supply chains, and to lay before Parliament a report on its outcomes. That review will focus on Supply Chain Coordination Ltd, which manages the sourcing, delivery and supply of healthcare products, service and food for NHS trusts and healthcare organisations across England. As well as supporting the NHS to identify and mitigate risk with a view to resolving issues, the review will send a signal to suppliers that the NHS will not tolerate human rights abuses in its supply chains and will create a significant incentive for suppliers to revise their practices. I will listen to my right hon. Friend the Member for South West Surrey when he makes his contribution and endeavour to respond when I wind up this debate. I know he has strong views on this subject, as do other hon. Members

[Janet Daby]

I thank the Minister for his response. My concern is the level of urgency. If the Government allow the problem to continue in the NHS, they are inadvertently allowing slavery to continue, which is not helpful.

[Edward Argar]

As ever, the hon. Lady makes her point courteously but clearly. As I said, depending on the time available at the end of the debate, I will endeavour to respond more fully to the points that she and my right hon. Friend make.

[Sir Iain Duncan Smith (Chingford and Woodford Green) (Con)]

I hope to speak on this subject if I catch your eye, Madam Deputy Speaker, but I want to make the point that right now, even though it is not meant to be allowed, the NHS is using products made by slave labour. Only two days ago, The Spectator demonstrated that products being used in King’s College Hospital actually came from providers in Xinjiang, so it is happening now. Like the hon. Member for Lewisham East, I want to emphasise the urgency of this issue, so I intend to bring it up with my hon. Friend the Minister during the debate.

[Edward Argar]

I should say at this point that I was grateful for the opportunity to talk to my right hon. Friend about this subject a week or two ago, and I suspect that our conversations will continue.

I want to cover the rest of this group of amendments. Lords amendment 57 would exclude statutory functions of NHS Digital from the transfer of powers in the Bill. I urge the House to reject that amendment. I have assured Members of this House and in the other place that the proposed transfer of functions of NHS Digital to NHS England would not in any way weaken the safeguards we have in place for the safe and appropriate use of patient data. NHS Digital’s current obligations in terms of its data functions, and particularly the safeguards that apply to patient data, will become obligations on NHS England. The merger, which has been announced as Government policy, is in response to the recommendation of the Wade-Gery review. It is essential to simplify a complex picture of national responsibilities for digital and data services in the NHS, bringing them together in a single organisation that leads on delivery and the data needed to support it.

18:00

Finally, I turn to amendment 89, on organ tourism. While the Government are sympathetic to its aim of ensuring that the law would capture anyone with a close connection to this country who purchases an organ overseas, we have significant concerns about the adverse impact that such an approach could have on transplant patients and NHS staff. We therefore tabled an amendment in lieu, which would achieve a similar effect without creating a disproportionate impact on vulnerable recipients and NHS staff. In effect, it would mean that wherever in the world their actions take place, most UK nationals—and all residents of England, Wales and Scotland—could be prosecuted for existing offences that cover the trade in human organs. The amendment would encompass paying for the supply of an organ, seeking to find someone willing to supply an organ for payment or initiating or negotiating any commercial arrangement for an organ to be supplied. Such things are already illegal, and we are extending the territoriality of that for English, Welsh and Scottish residents.

The Government’s amendments strengthen account-ability and improve the Bill. However, several of the amendments from the other place are either unnecessary or have unintended consequences, so we ask the House to reject them.

[Wes Streeting]

It was a great pleasure to see the Minister at the Dispatch Box, but I must warn him and the Minister for Care and Mental Health, the hon. Member for Chichester (Gillian Keegan), that the Government will not convince us that their position on workforce is right even by sending out the most charming members of their Health team. I will go into the reasons for that. I start with enormous thanks to Members of the House of Lords for the enormous amount of work that they put into making the Bill much better than it was when it left the House of Commons. In particular, I thank my noble Friends Baroness Thornton, Baroness Merron and Baroness Wheeler who showed great wisdom and stamina in forging huge alliances in the other place to get the consensus needed to make the improvements that we are discussing. I also thank Liz Cronin and Richard Bourne for supporting the shadow Lords team.

The NHS is facing the greatest crisis in its history. Covid has not gone away, and the covid pressures on the NHS certainly have not gone away. Instead, it is in the unenviable position of having to deal with those ongoing challenges at the same time as trying to address the significant backlog that existed before we went into the pandemic, when a record 4.5 million people were already on NHS waiting lists.

Today, we see that there is a staff shortage of 110,000 across the NHS as well as 105,000 vacancies in social care. Six million people are now waiting for NHS treatment—the longest waiting lists on record—and they are waiting longer than ever before. Cancer patients are not being seen by specialists on time; they are waiting too long for diagnosis when every day matters. Stroke victims are being left to wait hours for an ambulance—except in the north-east, where over the winter heart attack patients were told to phone a friend or call a cab. It is therefore no surprise to learn today that public satisfaction with the NHS is at its lowest level in 25 years, since 1997. Of course, that was the year when Tony Blair led Labour to victory at the general election and delivered shorter waiting times and the highest patient satisfaction in the history of the NHS. The Government could do a great deal of good by learning from the example left by the last Labour Government and trying to rebuild the legacy that they have trashed over the last 12 years.

It is not just patients who are dissatisfied with the NHS. I know from speaking to frontline staff and NHS leaders across the country that they are exhausted after their heroic efforts of the past two years. They are burned out, they are overstretched, and there are simply not enough of them. They are proud of the NHS and proud to work for the NHS, but, in too many cases, people are going home at the end of a long shift and agonising about whether they did the right thing, agonising about whether they made the right decisions for their patients and agonising about whether they had forgotten a crucial detail. It is getting worse, not better. Some 27,000 NHS workers voluntarily left the health service in just three months last year, the highest on record. The Health Secretary has admitted that the Government will not meet their manifesto commitment to recruit the 6,000 GPs we need to get people seen on time and we know that many cases will simply present in overstretched accident and emergency departments. Today, we heard about the consequences of the failure to safely staff our health service.

On that note, I want to place on record my thanks to the Secretary of State for Health for his response to the Ockenden review—and to his predecessor, the Chairman of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt) for commissioning the review in the first place—and the commitment to implement in full not its recommendations, because Donna Ockenden has not made recommendations, but the must-dos she has set out. I cannot imagine the trauma of losing a child and we owe it to mothers who have been through that suffering to ensure that they are never let down again. This is not a party political point. The review spans two decades under Labour and Conservative Governments. I want to acknowledge that and be honest about that. The clear finding is that we must safely staff our maternity wards. Today, midwives are leaving the NHS in greater numbers than it is able to recruit them. That is just one of the reasons why we need a workforce plan for the NHS.

[Geraint Davies (Swansea West) (Lab/Co-op)]

I have just returned from Lithuania, where I was speaking to the head of migration in a refugee centre who said that they are welcoming their neighbours not just because they should but because they are providing a very valuable addition to their workforce. They are taking tens of thousands of people. Given that 1.4 million EU citizens who are registered to work in Britain have decided to stay in Europe, should we not be opening our hearts and homes and recognise the benefits some of them would bring by working in the NHS?

[Wes Streeting]

I thank my hon. Friend for his intervention. It is certainly the case that refugees fleeing Ukraine—indeed, other conflict zones around the world—bring enormous skills to our country. For as long as they are here and living with us, we should enable them to make whatever contribution they wish. If some of the people from Ukraine or elsewhere want to work in the NHS, we should absolutely welcome them with open arms.

[Rachael Maskell]

I am grateful to my hon. Friend, who is making an excellent speech. This debate is concentrated on physical health, but if we look at workforce planning on mental health we know we are at a significant deficit. If we are talking about parity of esteem, surely Lords amendment 29 is absolutely imperative, so that we can start investing in the future of our mental health services?

[Wes Streeting]

My hon. Friend is absolutely right and she will know of our party’s ambitious commitments, outlined by my hon. Friend the Member for Tooting (Dr Allin-Khan), to ensure that patients receive guaranteed mental health treatment within a month. That would be revolutionary. It will require investment and require recruiting the people we need to help provide that care, but this country is living through a mental health crisis on top of everything else. This has been a deeply difficult two years for our country during the pandemic. Many people bear not just the physical scars and ongoing physical health consequences of long covid, but the grief, the loss and the injury to their mental health and wellbeing caused by this deadly pandemic. Many of those people who are suffering mental health crises are the very people who are still turning up for their shifts in the hospitals, still turning up for their shifts in the GP surgeries, and still turning up at work to help care for others even though they are in need of care themselves.

Lords amendment 29 does not commit the Government to hire thousands more doctors and nurses, although they should. It does not commit to new funding for the NHS, although it desperately needs that. It does not even commit the Government to finally publish the workforce strategy the NHS is crying out for, despite the fact that the NHS has not had a comprehensive workforce strategy since the Labour Government’s plan was published in 2003. All we are talking about today is an independent review of how many doctors, nurses and other staff the NHS needs for the future. That is not just a view put across by Labour Members: it is supported by many Members right across the House, including the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey, who is a former Health Secretary. It is not the first time that he has helped to unite the sector, although I remember the days when it was sometimes united in opposition to, rather than in support of, his proposals.

I will say this, actually: when the right hon. Member for South West Surrey took over as Chair of the Health and Social Care Committee, I was really nervous about the prospect of a former Health Secretary effectively marking his own homework, but on this issue, he has shown a degree of honest reflection and has genuinely contributed his experience to the debate about the future of health and social care in this country. Not only has he been honest about where he fell short, and where other Conservative Ministers may have fallen short, but he is determined to make sure that we improve the quality of the health and social care debate in this House. I very much welcome his contribution to the debate about the NHS workforce challenge.

[Jim Shannon]

Will the hon. Member give way?

[Wes Streeting]

How can I resist?

[Jim Shannon]

The shadow Minister is always kind in giving way. I want to back up his comments about the right hon. Member for South West Surrey (Jeremy Hunt). On Lords amendment 29, does the shadow Minister acknowledge that Macmillan Cancer Support said that it needs an additional 3,371 cancer nurse specialists? That would double the nurses by 2030, and it gives us a reason why we need to support Lords amendment 29 and why workforce safety is critical.

[Wes Streeting]

The hon. Gentleman is absolutely right. If I am honest, I suspect that the Minister and the Secretary of State for Health and Social Care also agree that Lords amendment 29 is needed. I suspect the truth is that they are not the ones blocking it. They are in a Treasury-imposed straitjacket from the Chancellor, preventing them from doing what they know to be necessary for the NHS, because the Treasury would rather stick its head in the sand and not acknowledge the scale of the challenge or the reality of the cost. It hopes that ignorance is bliss and that we can carry on as we are, and perhaps nobody will notice—even the 6 million people on NHS waiting lists.

[Matt Rodda (Reading East) (Lab)]

I wholeheartedly agree with my hon. Friend’s speech; he is addressing absolutely the issues that the sector faces. All of us support the NHS and want to see it thriving. Does he agree, however, that the challenge is about the Treasury and the Prime Minister and the lack of support and understanding from the Prime Minister and the Chancellor at this crucial time, when the NHS has gone through such a difficult period?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. To be honest, I do not know whether No. 10 or No. 11 is running the show. We hear that the Chancellor also blocks the Prime Minister from time to time. I can think of a few occasions during lockdown where that would have been good, if the Chancellor had bolted the door to the back garden, but we will not dwell on that now, Madam Deputy Speaker, because you will tick me off—

[Madam Deputy Speaker (Dame Eleanor Laing)]

No, we will not.

[Wes Streeting]

As you already are, Madam Deputy Speaker, but I could not resist.

The problem is that unless we face up to the scale of the workforce challenge, the Government simply will not deliver the shorter waiting times that patients need until they break out of their straitjacket. They should start today; otherwise, patients will be left wondering why they are paying more in taxes but waiting longer for care.

Government Members may argue that we do not need Lords amendment 29, because there is a planned update to “Framework 15”, Health Education England’s 15-year strategic framework for workforce planning—[Interruption.] My hon. Friend the Member for Bristol South (Karin Smyth) cannot wait; she is watching her inbox daily, waiting for it to arrive. The truth is that this is inadequate. Previous iterations of the framework have not quantified the staffing numbers needed. The Secretary of State was recently unable to confirm when he appeared before the Health and Social Care Committee that the revised framework will set out the required numbers of staff. The truth is that the recent past is littered with promises of workforce strategies and frameworks that have either not materialised or failed to deliver the action needed.

Let me turn to the Minister’s claim that we have record numbers of doctors and nurses—it is today’s equivalent of, “You’ve never had it so good.” We all know—he knows this very well—that the population is growing and ageing, and as it does so, we need the numbers of nurses, doctors and carers to keep up. This is a question not just of recruitment, but of retention. When I ask frontline staff, “What would make the single biggest difference to your morale? What would be the thing that keeps you going even though you are exhausted, stressed and burned out?”, their answer is very simple: they just want to know that the cavalry is coming and that significant numbers of staff will be recruited to help provide the support they need. Their greatest fear is that the people who have slogged their guts out to get us through the pandemic will be left alone as they try to help the NHS to recover from the pandemic and from the problems that existed before it. If we are not careful, we will risk losing those staff, creating even greater pressures—a greater cost to patient care, a greater cost to patient safety and a greater cost in recruiting and training new doctors and nurses. With the best will in the world, and with the best training available at our brilliant medical schools, doctors and nurses take years to develop the skills and experience to make them outstanding clinicians. Those are the people we risk losing at this very moment.





While I have the opportunity, may I say to the Minister that I cannot understand why there are 791 medical school graduates who still do not have a junior doctor post? These people are qualified, they are ready and there is a shortage—get them to work!

18:14

Lords amendment 30 is a power grab, pure and simple. Does the Secretary of State really believe that he knows better than those who are working on the ground in our NHS? The Bill includes a requirement that Ministers be informed of every single service change and every single reconfiguration, and the Secretary of State will then decide whether each should go ahead. They should be careful what they wish for.

As the right hon. Member for South West Surrey knows, when I was first elected to this House and he was Secretary of State, I would not stop badgering him about the future of King George A&E. Every time I did, he batted it back to the local NHS trust and said that it was a local decision driven by clinical need. In the end, we won and we did not need him, but imagine the political pain that I would have inflicted on him if I had known that he was the one who held the pen and held the power. I say to the current Secretary of State: be very careful what you wish for.

The new powers, I am afraid, are part of a theme running through the Bill of more powers being placed in the hands of Government—a theme that the Delegated Powers and Regulatory Reform Committee has described as “disturbing”. The Government have gone from wanting to be the great liberators of the NHS under the right hon. Lord Lansley—who has gone through a rather entertaining damascene conversion in the other place—to wanting to rule with an iron fist under Comrades Javid and Argar.

The powers are completely unnecessary. They risk causing a decision-making logjam and dragging national politics into local decisions about services. For reforms intended to reduce bureaucracy, they could create a significant new bureaucratic burden.

[Katherine Fletcher (South Ribble) (Con)]

Along with Mr Speaker and Mr Deputy Speaker, I have been in a similar position in Lancashire with the A&E unit under threat at Chorley and South Ribble Hospital. Contrary to the hon. Gentleman’s point, I have found that even with a meeting with the Speaker and Deputy Speaker of the House and the Health Secretary, and with a very compelling case as to why the local trust has made the wrong decision, there is nothing in law to allow them to do anything about it. I therefore very much welcome the amendments to ensure that local bureaucrats are not too tied in.

[Wes Streeting]

I really do understand the hon. Member’s point. She would like to be able to save her services and lobby her colleagues in Government to make those decisions, but—speaking from experience—saving our accident and emergency department was not about using politics or political pressure to change the decision. Public support was really important and we did our fair share of parliamentary petitions, marches and everything we could to keep the pressure up, but in the end it was about the evidence base that we put together to save the department.

When it comes to matters of clinical provision and of providing the best services for patients, clinical factors have to be paramount. I worry about how decisions turn into a political football either side of a general election and become a party political knockabout, when the primary consideration should be patients’ safety and concerns. Although I have cited an example in which saving our A&E was the right decision, I can think of cases right across the country in which communities feel very strongly, and we understand why, but passion, emotion and sentimental attachment to particular services do not always align with the clinical interests of local populations. Patient safety and evidence must come first. I really worry about the introduction of a party political knockabout in that context.

Ministers have argued that the new powers are necessary to ensure democratic oversight of health service decisions, but the existing system allows appropriate democratic oversight and allows contentious service change decisions to be resolved. I do not believe that the wholesale upheaval of the system and the introduction of sweeping new powers for the Secretary of State are justified.

Let me now deal with some of the other amendments— very briefly, as I am conscious of time. We support Lords amendment 48, which requires the Secretary of State to ensure that health service procurement does not violate the UK’s international genocide obligations. The amendment is consistent with the UK’s obligations under the convention on the prevention and punishment of the crime of genocide.

Lords amendment 89 deals with a related issue, prohibiting organ tourism involving both forced organ harvesting and black market organ trafficking. We welcome this change in the Bill, which amends the Human Tissue Act 2004 to prohibit UK citizens from travelling to countries such as China—although the wording of the amendment is not country-specific—for the purpose of organ transplantation. The restrictions are based on ensuring that there is appropriate consent, no coercion, and no financial gain. In some parts of the world, organs are not given freely but are taken by force, and we must bear that in mind in the drafting our legislation.

Lords amendment 57 is intended to retain the current safe haven for patient data

within NHS Digital, and to prevent NHS England from taking on responsibility for it. Keeping patient data safe is important. It can be powerful when it is used well, and has enormous potential for better population health and better clinical outcomes in individual cases, if data is used wisely, safely and ethically. The amendment will keep statutory protections in place for a patient data “safe haven” across health and social care, required for national statistics and for commissioning, regulatory and research purposes. It also ensures that NHS England does not take on this responsibility, because of a potential conflict of interest in its role.

Lords amendments 42 to 46 deal with procurement. We welcome these changes. The years of the pandemic have also been years of crony contracting. After the scandal of billions in taxpayers’ money being handed out to mates for duff PPE and testing contracts, and PPE literally going up in smoke—along with taxpayers’ money—we hope that this is the start of Ministers’ looking again at where they went wrong during the pandemic.

This afternoon the House faces a simple choice. We must decide whether we are going to be honest with ourselves, with the NHS and with the country about the genuine staffing challenge in health and social care—and whether we are going to have a more responsible and grown-up political debate about how we meet that challenge—or whether we prefer to be the ostriches of the Treasury, with our head in the sand, pretending that these issues will go away, hoping for the best, hoping to squeeze a bit more efficiency out of the NHS through new efficiency targets. That really will not cut it. The recruitment of staff already announced by the Government really will not cut it.

For as long as we allow this situation to continue, patients will wait longer. They wait in agony. Their health outcomes are worse, and they lose confidence in the national health service. It is the greatest institution that this country has ever built, and it is going through the greatest crisis in our history. Let us be honest about that—with ourselves, with the NHS, and with the country—and support their lordships in their amendment.

[Sir Iain Duncan Smith]

I shall try to be brief. I rise to speak to amendments (a) and (b) in lieu of Lords amendment 48, which refers to genocide. Along with 19 colleagues, some of whom are present, I tabled amendment (b) to recognise first a problem for the Government, and secondly an absolute imperative for all of us here.

The problem for the Government with Lords amendment 48 is, I understand, the inclusion of genocide. There is a reason for that. I disagree with the Government about this, but that is where they are. The Government talk of a “competent court” having to decide questions of genocide. We have been through this again and again recently, but the fact is that we will never get a decision from a competent court when it comes to countries of the scale and dimension of China, either because they veto it in the Permanent Assembly or because they are not members of the International Criminal Court, so we cannot get them that way.

I recognise that the purpose of this is really more to do—quite rightly—with slave labour, so the title of my amendment alludes to slave labour. That is much more focused, and makes clear what I should like to think we are all after. I abhor the genocide that I absolutely believe to be taking place in Xinjiang, and I think we need to take much greater action on that, but in the context of the Bill, the purpose of the amendment was to make clear to the Government that a significant number of Members—and more would have signed it had I bothered to ask them—are very keen to see such a measure included. I say those words carefully, because I have read what the Government have written down and I have discussed this at length with the Minister and the Secretary of State, and I fully accept what they are trying to do here with this amendment on review, but that amendment on review cannot tighten up the time because it can only be post hoc, as it were, after the Bill goes through. My determination is that, by the time this Bill comes back from the Lords, we will have an amendment specific to modern slavery in it.

The reason I say that is that this is clear, with a reference even in the last two days to the use of equipment made by slave labour in Xinjiang in at least one of our hospitals. That equipment has been tested, so there is no excuse for not knowing. There is a company called Oritain—there are others—that now has the digital and genetic fingerprints of all the products from these areas. It has spent 10 years getting this information, and it can test a product and tell us not only where in rough terms it comes from but even which factory made it. There is no excuse now. This is being used in the United States, which has declared genocide, for testing these products.

The NHS is a phenomenal purchaser and has huge capability to change people’s direction. I say to the Minister that I understand that behind closed doors—if any closed doors exist in Government generally, but these ones—some members of the Government have asked the Secretary of State to do an impact assessment. We love impact assessments in Government. Most times they mean absolutely nothing because they tell us what happened before, but not what will happen in the future. That is because almost every time the Government try to forecast the future, we get it wrong. Even the Office for Budget Responsibility manages that quite regularly.

What difference would an impact assessment make to this amendment in my name and that of 19 other Members? For example, an impact assessment might tell us that we should no longer buy from a particular area because we are certain it provides through slave labour, but that the procurement would be, say, £20 million more expensive as a result. Does that impact assessment then mean we cannot do that because we do not want to lose £20 million—or £20 billion or whatever it happens to be—because that is too expensive, and that we will on balance therefore purchase from a known slave labour provider? Is that what we are saying? Is that what the impact assessment will say to us? I say to those who call for an impact assessment: be careful what you call for. There is a simple impact here: are we to purchase equipment made by slave labour?

I have also heard that someone else in the Government has said that the balance is between provision for those who need it here in the UK and our use of a product that comes from a place using slave labour. I say: be careful of that comment. It is not a choice we have to make. Our choice is to care for those here in the UK, but also to care for those who are being brutalised and beaten into product production and often losing their lives; we have to have a care for them as well. There is no choice here. It is simple: do we or do we not wish to have products in circulation in our NHS, of which we are all very proud, that were made by slave labour? This is the single point.

I understand the problem with Lords amendment 48; it is that the Government will never recognise genocide, so that amendment would never have a bearing or an effect because they would simply say, “We do not recognise that genocide has taken place in that area and therefore we are let out.” It is let-out for them. This amendment of ours is very specific. It deals with slave labour, and we can prove slave labour. So I say to my hon. and right hon. Friends: this unites the whole House. If this comes back amended either by the Government or by somebody in the House of Lords, I give a little warning—not a threat—to my Government that the choice when this comes back will be: do you support the use of slave labour or do you not support the use of slave labour? There is no other choice. It is not a moderated choice. It is very simple for us. I will vote against slave labour for an amendment coming back from House of Lords, and I believe that many of my colleagues here—all of them, I hope—will do the same. I am certain that that will be the case for those on the Opposition Benches.

I have huge regard for my hon. Friend the Minister, and very much so for the Secretary of State. I have spoken to them at length, and I believe them to be completely onside with my argument. I ask a wider group in the Government to stop it. This is more important than moderated impact assessments, which mean nothing; this is about human lives. When it comes to human lives, the best impact we can have is ending brutality, intolerance and slave labour. If we can bring that to an end, it would be the biggest impact we ever have, and we could be proud of it.

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. It has only just become obvious to me that so many people wish to speak on this group of amendments. I will have to set an immediate time limit of four minutes, which might be reduced to three minutes. People who intervened on the Front Benchers will be considered to have already made their contribution.

18:30

[Geraint Davies]

It is, of course, 125 years since the birth of Aneurin Bevan, who famously said:

“Illness is…a misfortune the cost of which should be shared by the community”.

That cost, as the right hon. Member for Chingford and Woodford Green (Sir Iain Duncan Smith) said, should not be borne by the victims of genocide, abuse or slavery, so I support amendment 48 and, indeed, amendments (a) and (b).

I am the trade rapporteur of the Council of Europe in respect of safeguarding human rights, democracy and the rule of law. I very much hope that where there is abuse or slave labour, we pursue filtering out such imports from procurement in general. Curing illness should not be at the cost of creating illness and harm abroad.

Obviously we need security of supply. We have seen China use embargoes and trade sanctions against Australian wine and Lithuanian products, or whatever, so we need a safe supply, much of it home-grown, for when we face such a problem or a pandemic. I put it to the Minister that we need to look much more at generating production and procurement in the public sector. It is no good going to the pub landlord of the right hon. Member for West Suffolk (Matt Hancock) to get expensive PPE. We need both value for money and ethical sourcing.

Some of the proposals for integrated care boards involve corporations that have a vested interest. If we remove competitive tendering, waiting lists and costs would both go up. It is critical that we get value for money.

Looking at what happened in Wales during the pandemic, we find that the cost of PPE was, in fact, half the cost of PPE in England. The £1.1 billion given to Wales for test and trace was a Barnett consequential, but we spent only half of that, £533 million, because we used public sector procurement and production effectively.

Through a combination of ethical procurement and public sector provision, we can keep the light of the health service shining, we can keep the faith and we can build a stronger, more successful and cost-effective health service.

[Jeremy Hunt]

Like the shadow Health Secretary, I rise to speak in support of amendment 29, which the Government plan to vote down. This wholly innocuous amendment simply asks them to publish, every two years, independent projections of the number of doctors and nurses we should be training. The Government are rejecting the amendment because they think it would compel them to train more doctors, which is true, but it ignores the fact that this is the best way to reduce the £6.2 billion locum bill that is currently devastating the NHS budget.

The shadow Health Secretary was very generous to me, and I return the compliment by saying that I think he is doing an excellent job. I hope he remains shadow Health Secretary for many years.

I ask the House, in the nicest possible way, to reject the compromises proposed by the excellent Minister. The Government are publishing a 15-year framework, but he knows and we know that it will simply detail the number of doctors that the Government think they can afford, not the number of doctors we actually need. In the past—even last year—when the NHS has tried to publish the number of doctors it thinks it needs, it has been stopped by the Government. Why is there this reluctance to publish the number of doctors we are going to need in 15 years’ time, given that 97% of hospital bosses say that staff shortages are having an impact on the quality of care they are giving and there are 110,000 vacancies? The answer is simple: it is because the Government know we are not training enough right now. What message does it send to young doctors, newly qualified midwives and newly qualified nurses, who are incredibly stressed and pressured by the situation on the frontline, if we are saying to them, “Look, it is really tough now, but we are not even prepared to train enough doctors, nurses and midwives for the future to relieve that stress and pressure later on in your career”?

[Steve Brine]

I will support my right hon. Friend in standing up for Lords amendment 29, because when I look back to our time together at the Department, when we published the long-term plan and when I published the cancer plan, I know that the thing that undermined us most of all was when the stakeholders came back and said, “Where’s the people plan that goes alongside it?” Because we could not answer that, we were always playing catch-up. This Lords amendment sets that train back on the right track.

[Jeremy Hunt]

I thank my hon. Friend for that comment. He was an excellent cancer Minister. In our time, the biggest pressure was funding, but now people say that the biggest pressure is workforce. It is devastating for morale to refuse to address this issue at a time such as this. Any Government who care about the long-term future of the NHS have an absolute responsibility to make sure that we are training enough doctors and nurses for the future. Any Government who care about value for money for taxpayers should welcome a measure that will help us control a locum and agency budget that has got massively out of control. That is why opposing Lords amendment 29 makes no sense either for the Department of Health and Social Care or for the Treasury. This is why it is supported by more than 100 health organisations; every royal college and every health think tank; people in all parts of this House; many peers in the other place, including Lord Stevens, who used to run the NHS; and—this is the point I wish to conclude with—by thousands of thousands of doctors and nurses on the frontline.

[Sir Roger Gale (North Thanet) (Con)]

Is it not the case that what my right hon. Friend is proposing is custom and practice in very many developed countries already?

[Jeremy Hunt]

It is absolutely the case. We need something like this because, as I know—I will do my self-reflection now—when a Health Secretary negotiates a spending settlement with the Chancellor, the number of doctors they are going to have in 10 or 15 years’ time is quite low down their list of priorities because they are thinking about immediate pressures. So we need something that deals with that market failure. I did set up five new medical schools and was proud to do so, but I do not know whether that was enough. That is why we need something to make sure that we never have to worry, whoever the Government and the Health Secretary are, that this fundamental thing that is vital for the future of the NHS for all of us is always properly looked after.

Let me conclude by remembering what we were discussing this morning in the Ockenden review. We talked about the agonies faced by families. We did not talk enough about the agonies faced by doctors, midwives and nurses who find themselves responsible for the death of a child—it is psychologically incredibly devastating for them. We need to be able to look them in the eye and say, “The No. 1 thing in the Ockenden review that came out was that staffing shortfalls can make a difference. We understand that.” They know and we know that there is no silver bullet; this cannot be solved overnight. It takes seven years to train a doctor, 10 years to train a GP and three or four years to train a nurse or a midwife. No one is expecting a solution tomorrow, but we do at least have a responsibility to look each and every one of those people, who worked so hard for us in the pandemic, in the eye and say, “We do not have a solution right away but we really and truly are training enough for the future.”

[Daisy Cooper (St Albans) (LD)]

The Minister made a valiant effort to dissuade some of us from supporting Lords amendment 29—the workforce amendment—but I suspect he knows he is not kidding anybody.

We have learned today that public satisfaction with the NHS is at its lowest level since 1997. We should not underestimate the blow that that news will deliver to the health and care workers who turn up, do an amazing job, and go above and beyond every single day. To say that that news is dispiriting is an understatement. It is important that those workers know that the public, and every Member of this House, loves our NHS; it is just that we want it to work a bit better. It is hardly surprising that people’s biggest frustrations are waiting times, a lack of proper funding and staff shortages. Those things are the fault not of health and care workers but of this Tory Government, who are driving our health and care services into the ground.

Cancer Research UK says that without the workforce amendment the Bill will fail to address the biggest barrier to the achievement of world-class cancer outcomes in the UK: the staffing shortages and pressures. The King’s Fund has said that the health and care workforce crisis will be the key rate-limiting factor in the reduction of the NHS elective care backlog. The workforce amendment may not be a silver bullet, but it is the closest thing to one, which makes it all the more frustrating that the Government will not accept it. As I suspect the Minister knows, the Government’s objections just do not stand up to scrutiny.

As the right hon. Member for South West Surrey (Jeremy Hunt) said, framework 15 simply sets out the number of staff the Government think they can afford, rather than the number of staff we actually need. I urge the Minister to think about what message that sends to my constituent, who is a newly qualified midwife. She wrote to me just a couple of months ago and said:

“I am extremely concerned about the crisis in maternity care. This isn’t caused by Covid-19—the systemic failings have been crippling the service for a generation—but the pandemic has made a bad situation worse.”

She said:

“I am being harmed, my clients are being harmed. Staff are being harmed. For every 30 newly qualified midwives, 29 are leaving. Parents are reporting bullying and coercion. Threats are being used to ensure compliance. Unnecessary medical interventions are at epidemic levels. Trauma—amongst parents and midwives—is rife.”

She said that “concerns are being missed” and interventions “made too late”, and that the reason was “staffing problems.” If that is not a wake-up call, I do not know what is.

I wish briefly to express my concern about the powers the Bill will give the Secretary of State. At best, the change will create a bureaucratic nightmare; at worst, it will lead to meddling and the politicisation of the day-to-day running of the NHS. The Government have tried to argue that the pandemic showed the need for Ministers to have more powers, but we know that during the pandemic the Secretary of State had powers over PPE and test and trace, both of which issues were handled extremely badly. The NHS’s operational independence is critical, but it will be undone by the introduction of the Henry VIII powers in the Bill, so Liberal Democrats will oppose them.

Finally, I congratulate the right hon. Member for Chingford and Woodford Green (Sir Iain Duncan Smith) on his impassioned speech. I agree with him wholeheartedly that we have a duty as a nation and as a society to ensure that the goods used in our publicly owned NHS are not tainted by modern slavery or linked to the behaviours that may lead to genocide.

[Derek Thomas (St Ives) (Con)]

I rise to speak in support of Lords amendment 29, in the context of those who suffer brain tumours. I wish to take a moment to reflect on the fact that Tom Parker, a member of The Wanted who had done so much work to raise awareness of brain tumours and who worked with the all-party parliamentary group on brain tumours, which I chair, died today of his brain tumour. I wish to take a moment to remember him, his family and the two young ones he has left behind.

As I say, I chair the APPG on brain tumours, so I wish to discuss the need for Lords amendment 29 in that context. As we have heard, there is currently no data on how many healthcare staff the country needs, but we know that staff are overstretched. As we heard from my right hon. Friend the Member for South West Surrey (Jeremy Hunt), £6.2 billion was spent on locums in the financial year 2019-20 to plug the gaps. The NHS and social care will never be able to keep up with demand without regular assessment of the numbers needed. As we know, the Government have so far dismissed this workforce planning amendment on the basis that the Department of Health and Social Care has commissioned a long-term strategic framework. We have heard already this evening why that is not good enough, although I am extremely aware of how much the Minister is engaged in, and concerned about, this workforce subject, and he has been generous with his time in talking to colleagues about what the Government hope to do.

18:45

Lords amendment 29 puts measures to adopt a sustainable long-term approach to workforce planning on a statutory footing. Regular, independent public workforce projection data will not solve the workforce crisis. However, a collective national picture of the health and care staff numbers needed now and in future to meet demand will provide the strongest foundations for taking long-term strategic decisions about funding, regional and specialty shortages, and skill mix. The regionality issue is very important for an MP who represents west Cornwall and the Isles of Scilly, as we have enormous problems in getting the skills that we need.

Let me turn to the issue of brain tumours. The National Institute for Health and Care Excellence recommends that both cancer and brain tumour sufferers have access to a clinical nurse specialist. A CNS plays a vital role in providing high-quality cancer care, and in supporting people diagnosed with a brain tumour, including by requesting scans, accompanying patients to clinics, co-ordinating their care, and signposting to available support services. For those diagnosed with a brain tumour, access to a clinical nurse specialist is crucial due to the challenges associated with co-ordinating their care. There are often multiple clinical professionals involved in their care, making the role that the CNS plays as an anchor and a central point of call for the patient incredibly important. That is why every brain tumour patient, whether living with a high or low-grade brain tumour, should have access to a CNS or a keyworker, as recommended by NICE. However, the workforce is incredibly stretched, and despite doing everything possible to deliver high-quality care, there are not enough staff to give every patient the support they need.

In a survey run by the Brain Tumour Charity, nearly one in six respondents with a brain tumour said that they were not given any access to a clinical nurse specialist, and 59% of respondents were able to speak to a keyworker, but that was all. In addition, the 10-year plan recommended holistic needs assessment provision, but for that, time and staff are needed. Ultimately, this challenge comes down to the NHS workforce. In the 2021 spending review, the Government announced funding specifically for the NHS workforce, but we recognise this afternoon that Lords amendment 21 is the only way for the independent assessments to deliver current and future workforce needs.

[Peter Dowd (Bootle) (Lab)]

I concur with the comments made by every hon. and right hon. Member today, with the exception of the Minister. There is no question but that the NHS workforce is in crisis; that is what so many organisations say. The Government response has been limited to stopgap measures, so I am grateful to the Lords for their hard work on this Bill, which has been much improved since it left the Commons. The Lords are clearly on the side of the NHS. I hope that, even at this late stage, the Government will recognise that Lords amendment 29, which I support, is perfectly reasonable, and will welcome it with open arms. If they do not, the question is: why not?

I have had many emails from nurses and other healthcare professionals who are calling for such a measure to be supported. The amendment refers to a report on workforce needs, and says that it must include independently verified assessments of current and future workforce numbers required to deliver care to the population of England. What is wrong with that? It seems perfectly sensible. Planning the NHS workforce is central to the smooth operation of the service. The Lords amendment seeks to ensure that.

In north-west England, NHS vacancy rates have increased over the past year; they are reaching 13,500. That puts huge strain on the remaining workforce. There is a chronic workforce shortage in the NHS, driven by years of insufficient investment, and that needs to change. Mental health issues, alongside covid-related absences, are having a lasting effect on the mental health of NHS staff. British Medical Association surveys have consistently shown that the pandemic has, since its start, left staff reeling, and they are increasingly burned out as a result of the lack of support.

The number of people in the general practice workforce has lagged behind demand in recent years, as people have said time after time, and the pressure is becoming unsustainable. It is driving GPs out of the workforce and threatening to destabilise general practice. That is also the case for many other allied professionals across the whole spectrum. To address that, it is vital that the Government develop and implement a detailed plan to fill workforce shortages, but they have not yet seized that opportunity. The granularity of the assessment of the workforce situation sets the scene for the bigger picture. The chronic lack of resources and support has been keenly felt in the Liverpool city region. Hospital trusts in Liverpool plan to reintroduce car parking charges for NHS workers from 1 April. After everything those workers have done during the pandemic, it is dreadful that, in the midst of a cost of living crisis, they are being asked to cough up substantial resources just to get to work.

Workers are working two, three or four extra shifts per week. That is dangerous. NHS healthcare workers in Southport and Ormskirk Hospital NHS Trust and St Helens and Knowsley NHS Trust are campaigning to be re-banded because they are doing work that they should not have to do, and that they are not necessarily trained for. That is why I support Lords amendment 29, which is sensible and proportionate. As for the Chair of the Health and Social Care Committee, I say: there are 100 healthcare and related organisations saying, “This amendment is the right thing to do.” If those on the frontline think it is the right thing to do, why do the Government not also think it is the best thing to do?

[Mike Wood (Dudley South) (Con)]

At its best, our national health service provides truly world-class care. That is down to the skill, passion and professionalism of its workforce. As hon. Members will know, I have personal reason to forever be grateful to the NHS, and particularly the staff at Russells Hall Hospital in Dudley. While new hospitals, equipment and technology are all crucial, they are nothing without the health and social care staff who are the beating heart of our health service.

However, I am concerned that Lords amendment 29 does little more than add to an already onerous level of bureaucracy in our NHS. Providing a report every two years instead of every five does not improve the record number of doctors and nurses. The Government are already committed to reviewing the long-term strategic trends in the health and social care workforce, and to developing a workforce strategy, and clause 35 of the Bill already commits to a workforce review every five years. That in itself will be quite an arduous task.

Huge steps have been taken in investing in the future of the NHS workforce, including by funding a 25% increase in places since 2016-17. That means 7,500 more medical schools training places in England over the past six years. The shadow Health Secretary is obviously right to say that the population has grown in recent decades, but I think it has grown by 8% since 2010, while the number of doctors working in our NHS is up by about one third. Clause 35 allows for medium and long-term workforce plans, and offers a sensible balance between the need for such work and the need to minimise unnecessary bureaucracy. That is why I will not support the amendment.

Turning to Lords amendment 30, while I recognise the arguments made by Opposition Members, I do not agree with them or believe that clause 40 should be removed from the Bill. I believe it contains sensible powers. We expect the Secretary of State to be responsible for our national health service—for the services provided in every part of the country. There was much opposition and controversy when provisions reducing that responsibility were introduced in previous legislation. If he is to exercise that responsibility, he must have the powers to do so.

Voters and Members of Parliament expect the Secretary of State to be able to take action where health services have been reduced. On 11 November, a few weeks before the by-election in North Shropshire, the leader of the Liberal Democrats, the right hon. Member for Kingston and Surbiton (Ed Davey), questioned the Prime Minister at Prime Minister’s questions about the closure of Oswestry ambulance service. If we are to question the Prime Minister or the Health Secretary on the closure of services such as ambulance stations or hospitals, then it is only right that the Secretary of State should, in extreme circumstances, have the power prevent those closures. Our voters expect that, and frankly so do the Opposition.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I wish to speak to Lords amendment 29 on the workforce. The most important thing I learned during my five years as a shadow Health Minister is that everything comes back to the workforce. We can have the grandest plans, strategy documents, reorganisations, integrations and configurations—all of which are probably in this Bill, in various forms—but it will all count for very little if the fundamental cog in the machine, the workforce, is not a central part of those plans. The consistent failure to invest in, and provide a plan for, the workforce, so that it can meet demand over a sustained period is at the root of the challenges that the NHS and social care face today. We now have a chance to correct that.

Let us look at some of the challenges. There are 93,000 NHS staff vacancies; £6 billion-plus has been spent on temporary staff to fill gaps; and more than half of staff are working unpaid extra hours each week, with 44% saying that they have felt ill with work-related issues—little wonder, given that retention remains a huge issue. We need a plan, and we need to give staff some semblance of hope that we are listening—that the claps on a Thursday were not just an empty gesture; that the tributes that we rightly pay here to their dedication are not meaningless platitudes; and that there is a determination to do something about the persistent rota gaps that mean that staff are both exhausted and demoralised.

The Health and Social Care Committee report on staff burnout says:

“It is clear that workforce planning has been led by the funding envelope available to health and social care rather than by demand and the capacity required to service that demand.”

That is rather the nub of it. Health and social care are both demand-led systems, yet the funding and therefore the workforce capacity are not linked to demand. Until that central issue is addressed, we will keep coming back to the many varied and unfortunate consequences of an overstretched and under-resourced workforce.

I suspect that the Minister—who I have a lot of time for, even though he is often wrong on these things—might privately think that a long-term workforce plan might be a good idea, not just to ensure that the NHS can plan properly and to move forward on a sustainable footing, but because that might help his Department when it goes into negotiations on the spending round with the Treasury, as it will be able to point to an independently verified assessment of workforce need. If the amendment has a weakness, it is that it does not ensure that any plan is actually feasible, because there is no requirement in it that any plan be fully funded. However, a plan that shows, for all the world to see, a clear funding gap would be helpful to the Minister, because it would allow him to go to the Treasury with a clear and objective demand. As he knows, I like to be helpful to him, so I hope that on this occasion he can support the amendment.

This debate is timely because it comes on a day when two surveys have been released that lay bare the crisis that we face. One survey shows that public satisfaction ratings with the NHS are reported to be at a 25-year low—a quarter of a century of surveys there—and another shows that the number of NHS staff who would recommend their trust as a place to work has plummeted. Those two facts are intertwined and symptomatic of the workforce crisis that the amendment is trying to address.

The question we must ask ourselves, if we choose not to support the Lords amendment, is whether the Government’s existing plans create sufficient accountability and rigour to deliver the transformative approach that the amendment would. In my view, it introduces a level of robustness to workforce planning that is currently missing. For the reasons I have set out, we owe it to the workforce, to patients and to those in receipt of social care to put workforce planning on the strong footing that the amendment would deliver.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I am surprised that the hon. Member for Strangford (Jim Shannon) does not wish to speak. [Interruption.] Oh, he does. I hope he will be brief, so that the Minister will have time to answer the debate.

[Jim Shannon]

I certainly will make my points quickly. My first is on the organ transplant amendment, to which the Minister referred. I fully support the measure and have been asking for it for a number of years in the House, so I am pleased to see it moved tonight. Secondly, I am not sure whether the right hon. Member for Chingford and Woodford Green (Sir Iain Duncan Smith) is going to push his amendment to a vote—[Interruption.] He is not, but if he did, he would have my support and probably that of my party, too.

Thirdly, I am pleased to lend my support to Lords amendment 29. It would create a national independent view of how many health, social care and public health staff are needed to keep pace with projected patient demand over the next five, 10 and 20 years. I wholeheartedly agree with Macmillan Cancer Support that the Bill will fail to address the biggest challenge facing the NHS and social care right now: staffing shortages and pressures. The Government need to take Lords amendment 29 seriously. The hon. Member for Ellesmere Port and Neston (Justin Madders) referred to it, too. We recognise that we need to address staff shortages as soon as possible. I have referred to Macmillan and their request for an additional 3,371 cancer nurse specialists to help address that issue.

I will conclude with this point. I understand that the Government may come back with all the justifications as to why this is not the right amendment—the Minister is a real good man; we all know that, and he responds well to all our requests—but I am content that it would begin to address the issue that our NHS workforce is disintegrating. One of my constituents is in a prestigious medical school here on the mainland. She went to do her rotation with a GP as part of the work she does. He told her, “Do any job but this.” I thought that was disappointing. He said, “It will consume your life. You will work long hospital shifts and you will not have a personal life.” This is a seasoned GP who simply cannot cope, so we must do something, and this amendment is a way forward. I therefore will support it whenever it comes to a vote.

19:00

[Edward Argar]

As ever, I thank hon. and right hon. Members from all parts of the House for all their contributions to this important debate on an important set of amendments. Even if I do not always agree with everything he says, I welcome in particular the contribution from the hon. Member for Ellesmere Port and Neston (Justin Madders). He and I spent a productive period—I was going to say happy—sitting opposite one another for two days a week over many weeks in Bill Committee, taking this legislation through. While I miss him from his previous role as effectively my shadow, I wish him well in his current shadow ministerial role. I also put on record my gratitude, although he cannot be here today, to the hon. Member for Nottingham North (Alex Norris) for his work on the Bill.

I gently tease, and this is no reflection on the current shadow Minister, that in Committee it took two shadow Ministers to try to keep me on my toes. It appears today that it takes three, but in saying that I cast no aspersions on the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting), who I am fond of, even when he is gently or less so gently pushing me on certain issues.

I turn first to the organ tourism amendment, and I am grateful to the shadow Secretary of State for his approach on this issue. We have a shared objective here, and I assure Members that our approach would target not only transplant tourists, but anyone involved in making the arrangements for the purchase of the organ who may be a British national. The Government amendment, paired with our commitment to work with NHS Blood and Transplant to make more patients aware of the legal, health, and ethical ramifications of purchasing an organ, will send an unambiguous signal that complicity in the abuses associated with the overseas organ trade will not be tolerated.

Turning to reconfigurations, I strongly believe that the public rightly expect Ministers to be accountable for the health service, which includes the reconfigurations of NHS services. This House rightly voted to retain these clauses on Report. The reconfiguration power will ensure that decisions made in the NHS that affect all our constituents are subject to democratic oversight. Without it, the Secretary of State’s ability to intervene and take decisions will remain limited, and usually be at a very late stage in the process. Although I hear what hon. Members have said, I note that many hon. Members from both sides of the House none the less seek to persuade the Secretary of State and seek to raise issues relating to their local services with the Secretary of State with a particular outcome in mind.

As now, the Secretary of State would not be alerted to a potential change in services until the change had become a relevant issue and would not be able to intervene without that formal referral. We have retained the independent reconfiguration panel. The shadow Secretary of State raised the issue of the clinical appropriateness of the changes. Nothing that is proposed here alters the fact that clinical appropriateness and clinical and patient safety remain central to any decisions and remain an obligation on the Secretary of State in any decisions that he or she makes in that context.

Briefly, on the remarks of the shadow Secretary of State about waiting lists, he will be aware that we published a comprehensive and ambitious but realistic elective recovery plan that is backed by record funding and resources for the NHS to tackle those waiting lists, which have grown as a result of the pandemic. I am straight enough with him to recognise that there were waiting lists before the pandemic. He always makes that point and I highlight that we have a plan to fix that, which is exactly what we are doing.

The shadow Secretary of State also highlighted several other factors relating to the workforce and the workforce clause, as did my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the shadow Secretary of State—sorry, the Chair of the Health and Social Care Committee; I do not think we will be fielding shadow Secretaries of State from the Conservative Benches for some time yet. I entirely understand where my right hon. Friend is coming from on this issue, but I believe the approach that the Government have adopted, with the framework 15 commission and review and the broader commission that the Secretary of State has set out to look at drivers of workforce supply and demand, absolutely reflects our recognition of the centrality and importance of the workforce, and the right workforce, to the delivery of all our ambitions for constituents and for recovering waiting lists and waiting times.

We have not waited for any projections to get on with that; we are already investing in increasing our workforce and we are seeing record numbers of people working in our NHS. I have already highlighted that we are well on target to meet the commitment of 50,000 more nurses, with a current increase in the number of nurses of 27,000. The hon. Member for St Albans (Daisy Cooper) highlighted the same issues in her remarks.

I am particularly grateful to my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith) for his contribution on a challenging issue. There is a considerable degree of consensus on both sides of the House about the abhorrence of modern slavery, slavery or anything linked to it. We remain of the view that this is not the right legislation for the proposed changes.

As I set out in my previous remarks, new rules for transforming public procurement will further strengthen the ability of public sector bodies to exclude suppliers from bidding for contracts where they have a history of misconduct—or extreme misconduct in the case of slavery, forced labour or similar. In developing the modern slavery strategy review, it will continue to be important to engage across Government and civil society, nationally and internationally, to collect the necessary evidence to agree an ambitious set of objectives. It is right that the Government take action on the crime of modern slavery and it is right that the NHS is in step with all public bodies in doing so.

From listening to my right hon. Friend, I expect the issue to reappear when their lordships consider our amendments. In that context, I hope that he and other hon. Members are willing to continue to engage with the Government and my Department on this hugely important issue. As he rightly said, it is important not just in this House but outside this House to those we represent. I look forward to continued engagement with him.

[Sir Iain Duncan Smith]

Will the Minister give way?

[Edward Argar]

I have literally 30 seconds left, so if my right hon. Friend’s intervention can be in five seconds, I will give way.

[Sir Iain Duncan Smith]

Can the Minister tell his colleagues in the Government that there is never a good time? Now is the right time, and let us get on with it.

[Edward Argar]

I think that was exactly five seconds, and I am grateful to my right hon. Friend. I suspect that colleagues across Government will have heard what he said and will pay very careful attention to it, as I know Ministers across Government do to all that my right hon. Friend says in this House.

With that in mind, I ask the House to accept the motions in my name on the amendment paper.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I congratulate the Minister on his perfect timing. That is very rarely done with such precision.

Question put, That this House disagrees with Lords amendment 29.

19:10

Division 238

Ayes: 249

---

Conservative: 243

Noes: 167

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Labour: 136
Liberal Democrat: 11
Conservative: 10
Democratic Unionist Party: 3
Independent: 2
Plaid Cymru: 2
Social Democratic & Labour Party: 1
Green Party: 1

Lords amendment 29 disagreed to.

19:25

More than four hours having elapsed since the commencement of proceedings on Lords amendments, the debate was interrupted (Programme Order, this day).

The Deputy Speaker then put forthwith the Questions necessary for the disposal of the business to be concluded at that time (Standing Order No. 83F).

Clause 40

Reconfiguration of services: intervention powers

Motion made, and Question put, That this House disagrees with Lords amendment 30.—(Edward Argar.)

19:25

Division 239

Ayes: 265

---

Conservative: 258
Democratic Unionist Party: 3

Noes: 156

---

Labour: 136
Liberal Democrat: 11
Plaid Cymru: 3
Independent: 2
Conservative: 2
Social Democratic & Labour Party: 1
Green Party: 1

Lords amendment 30 disagreed to.

Lords amendment 48 disagreed to.

Government amendment (a) made in lieu of Lords amendment 48.

Lords amendment 57 disagreed to.

Lords amendment 89 disagreed to.

Government amendment (a) made in lieu of Lords amendment 89.

Lords amendment 108 disagreed to.

Lords amendments 42 to 47, 55, 56 and 58 to 64 agreed to.

Clause 14

Establishment of integrated care boards

[Edward Argar]

I beg to move, That this House disagrees with Lords amendment 11.

[Mr Deputy Speaker (Mr Nigel Evans)]

With this it will be convenient to discuss the following:

Government amendment (a) in lieu of Lords amendment 11.

Lords amendment 51, Government motion to disagree, and Government amendment (a) in lieu.

Lords amendment 80, Government motion to disagree, and Government amendments (a) to (n) in lieu.

Lords amendment 81, and Government motion to disagree.

Lords amendment 90, Government motion to disagree, and Government amendment (a) in lieu.

Lords amendment 105, Government motion to disagree, and Government amendment (a) in lieu.

Lords amendments 1 to 10, 12 to 28, 31 to 41, 49, 50, 65, 83, 102 to 104, 106 and 107.

[Edward Argar]

Let me repeat, quite legitimately, what I said in opening the debate on the previous group of amendments. It is a pleasure to serve opposite the shadow Minister, the hon. Member for Bristol South. It was also a pleasure to serve opposite her in the Bill Committee. She was not the shadow Minister then, but she brought her expertise and, as I said earlier, her forensic knowledge of these areas of the Bill—occasionally to my slight discomfort—and, overall, a degree of informed deliberation to our proceedings.

The amendments in this group relate to integration, commissioning and adult social care. The Government’s amendments strengthen our expectations of commissioners, especially in relation to mental health, cancer, palliative care, inequalities and children. Lords amendments 1, 25, 27 and 49 strengthen our approach to mental health. Amendment 49 makes it clear that “health” refers to both physical and mental health in the National Health Service Act 2006.

[Sir Charles Walker (Broxbourne) (Con)]

Will my hon. Friend give way?

[Edward Argar]

Of course I will. I cannot say no to my hon. Friend.

[Sir Charles Walker]

I want to thank my hon. Friend for making that clear, because there was some concern that the Bill broke with parity of esteem by not recognising that mental health was as important as physical health. A number of Members raised concerns about that, and I want to thank my hon. Friend and his team for getting it right. They should be congratulated.

[Edward Argar]

I am very grateful to my hon. Friend. He has come in at just the right time, because I was about to thank and pay tribute to him and, indeed, to my right hon. Friend the Member for Maidenhead (Mrs May). Both of them have, in their typically determined and persistent but very courteous way, pressed this issue and highlighted the need for it to be explicit in the legislation. I think we have made the Bill stronger and clearer through Lords amendment 49, and I pay tribute to my hon. Friend for that.

Lords amendments 1, 25 and 27 also require the Secretary of State to publish, and lay before Parliament, a document setting out the Government’s expectations for mental health spending for the financial year ahead. Lords amendment 105 requires a member with experience of mental health to sit on each integrated care board. Although we have adopted a permissive rather than a prescriptive approach throughout, we are persuaded of the need and the benefits—given the parity of esteem—of having that experience on the ICBs, and, while we are proposing some changes in the drafting, we agree with the principle. I hope that the shadow Minister shares that view.

I pay tribute to my hon. Friend the Member for Basildon and Billericay (Mr Baron), and to Members of the other place, for their engagement and continued support in relation to Lords amendments 2, 3 and 4, which relate to cancer objectives in the NHS mandate. The amendments change the focus of the cancer outcomes objectives so that they capture all cancer interventions. Those objectives will have priority over any other objectives relating to cancer, not just those relating specifically to “treatment”. I also pay tribute to Baroness Finlay, who has long campaigned to add explicit reference to palliative care services to the list of services that an integrated care board must commission. That is why we are accepting Lords amendment 12.

Lords amendments 22, 83, 102, 103 focus on addressing the needs of babies, children and young people. Lords amendment 22 would require the ICB to set out any steps it proposed to take to address the particular needs of children and young people, while Lords amendments 83, 102 and 103 specify that the Government must publish a report describing the Government’s policy on information sharing by or with public authorities in relation to children’s health and social care and the safeguarding of children. I pay tribute in that context to my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who has long taken a keen interest in these issues.

19:45

There are also a number Lords amendments relating to how an ICB must discharge its functions. As the House knows, this Government are committed to tackling health inequalities, and Lords amendments 5, 7, 8, 10, 13, 14, 16, 17, 24, 31, 32, 38, 39 and 41 take us further in tackling disparities and levelling up opportunity and outcomes across the country. These amendments received cross-party support in the other place and I am sure that they will be welcomed here too.

[Alicia Kearns (Rutland and Melton) (Con)]

I thank my hon. Friend and neighbour for giving way. On the duties of integrated care boards, he knows that one of my grave concerns about health inequalities relates to rural settings. In Rutland, our citizens receive care in Peterborough, Stamford, Kettering, Corby, Leicester and sometimes even beyond. The big problem at the moment is that their health records are not shared across those different clinical commissioning groups, leading to big problems with them getting the care and support they need. Will ICBs be able to help us to overcome these issues? I have been lobbying the Department of Health and Social Care for months to help us sort out this problem.

[Edward Argar]

I can reassure my hon. Friend that under the changes we are putting in place through the integrated care systems, ICBs will continue to be able to commission services and to send patients to hospitals outside the ICS area. They will also be obliged to co-operate and work with other organisations in the patient’s best interests. We are setting this alongside the broader work that we are doing in the Department on the interoperability of data. I hope that that has reassured her to a degree.

We are also committed to supporting research, and I ask the House to agree to Lords amendments 6, 15, 26 and 28, which further embed research and provide increased clarity, transparency and oversight in respect of ICBs, NHS England and the Secretary of State’s research duties.

[Debbie Abrahams]

I want to ask the Minister about two matters. First, why are health inequalities not explicitly mentioned among the triple aims of the Bill? Secondly, on the membership of ICBs, I am sorry if I misheard, but I did not hear him discuss the amendment on how to avoid any conflict of interest involving private providers on those boards.

[Edward Argar]

The reason for that is that an amendment was brought forward on Report, and the matter was settled at that stage; things have not changed since. In lieu of what had been tabled, we tabled our own amendment on Report, which—even though in our view it was unnecessary—we felt further clarified how to avoid conflicts of interest. In the previous group of amendments, we tabled an amendment to extend that conflict of interest policy and approach to the sub-committees of the boards, in order to ensure that it is explicit that the policy applies to both. It is essentially the same principle, but widened out to the sub-committees to avoid them being inadvertently left out of the legislation.

[Craig Tracey (North Warwickshire) (Con)]

I really welcome Lords amendment 12 on palliative care. Can the Minister give us any more information about whether statutory guidance will be given to the ICBs? It is important that they get proper guidance on what is expected of them. Can he also reassure us that palliative care will be a priority objective for the trusts?

[Edward Argar]

I can give my hon. Friend an assurance that we expect that to be the case. I will turn to palliative care in the context of other amendments shortly, and I might address some of his points then.

We are also committed to tackling climate change. Lords amendments 9, 18, 33 and 40 place duties on NHS trusts, foundation trusts, ICBs and NHS England to have regard to the Government’s key ambitions on climate change and the natural environment in everything they do. The amendments include a guidance-making power for NHS England that will assist in the discharge of these duties by different bodies.

There are also a number of amendments relating to how integrated care boards should operate as statutory bodies. Amendments 19 to 21 and 23 require an ICB to consider the skills, knowledge and experience it needs to discharge its functions and, where there are gaps, to consider what steps it can take to mitigate them. The amendments also require the forward plan to include detail on how the ICB intends to arrange for the provision of health services, as well as its duties under sections 14Z34 to 14Z45. The annual report must also include an explanation of how it has discharged these duties.

The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) mentioned conflicts of interest. We amended the Bill in this place, and the Lords amended it further with Lords amendment 11. We understand the motivation, but the drafting does not fulfil the stated aim, which is why we tabled an alternative amendment in lieu of that amendment.

[Debbie Abrahams]

Will the Minister give way?

[Edward Argar]

I want to make a little progress. If I make good time, I may be able to give way, but I am conscious of the need to give the shadow Minister and other colleagues plenty of time to speak—about, I suspect, one aspect of this group of amendments in particular, but we will see.

We commend a number of additional amendments to the House. Lords amendments 34 to 37 limit the powers to set capital expenditure limits for NHS foundation trusts, so that they cannot apply for periods longer than a financial year. I reaffirm my commitment to ensuring that these powers on expenditure limits are used only as a last resort, as NHS England agreed with NHS Providers. I also ask the House to accept Lords amendments 50, 65, 104, 106 and 107, which are minor and technical changes required to ensure that the Bill functions as intended.

Although we have made progress on a number of amendments, we urge the House to disagree with the other place on others. First, we ask the House to disagree with amendment 90 on dispute resolution in children’s palliative care, and instead support the amendment we tabled in lieu. Our approach will require the Secretary of State to commission a full independent review of the causes of disagreements between the providers of care and persons with parental responsibility on the care of critically ill children, how these disagreements can be avoided, and how we can sensitively handle their resolution.

We also seek to reject Lords amendment 81. Although we agree on the need to make good progress on the Care Act 2014, it is not in the interests of good government to be forced to implement reform of this complexity and scale through a deadline set in primary legislation. We are getting on with implementing social care reform, and operational guidance is out for consultation. We have announced a small number of local authorities that will act as trailblazers to test the reforms from January 2023, but we must take time to engage with local authorities as they build the necessary infrastructure, and use these trials to refine delivery systems and guidance ahead of the national roll-out. We encourage the House to reject Lords amendment 81, which we believe affects the financial arrangements to be made by this House and, as such, is subject to financial privilege.

[Debbie Abrahams]

I would be grateful if the Minister answered my question about the triple aims, and the impact of not including in them an explicit reference to health inequalities. The Bill refers to health and wellbeing, but not to health inequalities. My main point is on the care cap. More than one in six of my constituents with dementia will not reach the cap, as it stands. The Lords amendments mean it would be one in five, so I would be grateful if the Minister could say exactly why he is prepared to let one in six of my constituents not reach the care cap.

[Edward Argar]

I will address the care cap, because there is a fair bit to say. I was just addressing the noble Lord Lansley’s amendment. I apologise for missing the hon. Lady’s first point. We do not think it is necessary to have health inequalities explicitly among the triple aims, as we believe that the issue runs through everything that ICBs do and everything the Bill sets out. We therefore feel that the Bill is effective, and that each ICB’s ICS will have regard to health inequalities and will see them as central to its objectives.

Before I turn to Lords amendment 80, I will briefly address Lords amendment 51, which relates to consultation with carers during hospital discharge planning. We have heard about the strength of feeling in the other place on that issue. We wholly agree that we must ensure that, where appropriate, unpaid carers are involved in planning around discharge. Although the Government appreciate the intention behind the amendment and want to address the concerns raised, we want to do so in the most effective way, and in a way that does not create unintended delays to discharge. I ask Members to support our amendment in lieu, which would achieve much of what Lords amendment 51 sought to achieve. It will introduce a new duty on trusts and foundation trusts to involve carers during adult discharge planning. Unlike schedule 3 to the Care Act 2014, this duty applies to all carers where the patient has care and support needs following discharge; and it applies to young carers as well as adults. Our amendment in lieu and the new statutory guidance will ensure that patients and carers are involved in discussions about post-discharge care as soon as they start.

[Liz Twist]

I am pleased that that concession has been made. However, a number of points of clarification would be really helpful to carers. One is about being given a choice about caring, carers having the right information, and carers being able to express their needs properly. The second is about disabled children, who are not referred to here, and the third is about ensuring that young carers are clearly covered by any guidance issued. Will the Minister say how those issues will be addressed?

[Edward Argar]

I hope that I can give the hon. Lady reassurance. When we refer to “carers”, we intend that to be a broad term, rather than a narrowly drawn one. She is absolutely right to highlight young carers; they are carers. They also face particular challenges, because they often juggle school and similar things with caring. It is our intention that all carers will be covered by this duty on trusts and foundation trusts to involve carers during adult discharge planning. That would apply to all adults who are being discharged, where a carer is involved. I hope that that gives the hon. Lady some reassurance. We would look to ensure that these points were suitably emphasised in guidance and in the advice we give to ICBs and ICSs. As she will know, the Department works with NHS trusts and NHS England, and has various mechanisms for guiding and informing trusts. I recognise the importance of the issue.

We ask that this House rejects Lords amendment 80, and that it reintroduces the clause that the Government originally inserted on Report in this House, alongside further amendments to support the operation of charging reform that were originally tabled in the other place. The Government have set out their plan for a sustainable social care system. We want to end unpredictable care costs for everyone by introducing a universal £86,000 cap on an individual’s personal care costs. I pay tribute to the Minister for Care and Mental Health, who, since taking up her post last September, has made driving this agenda forward a personal priority. I should also pay tribute to her predecessor, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), for her work in this area.

We entirely recognise and respect that there are strong views on this issue across the House, and it is vital that our approach is fair. The Government believe that the fairest version of the cap would be based on what people contribute towards their care, rather than our counting local authority contributions as well. It simply cannot be fair that two people living in different parts of the country, contributing the same amount, progress towards the cap at different rates because of the differences in the amount that their local authority is paying.

[Peter Aldous]

The Government’s plans are regressive when compared with the proposals under the 2014 Act. They are less equitable to those with moderate assets, including those living with dementia and working-age adults with disabilities. It would be fairer to keep to the original Dilnot proposals, but can the Minister outline how the £900 million saving that, it is estimated, will result from the Government’s proposals and the use of means-testing will better protect those with lower-value properties?

[Edward Argar]

I am grateful to my hon. Friend, who has been open and consistent in expressing his concerns about this issue. He cites the 2014 Act, but it is important to note that those proposals were never implemented and were not deemed to be financially sustainable or deliverable. There were other proposals, including in 2015, but although no proposal is perfect, the proposals before us are a dramatic improvement, in terms of the protections offered and the crippling care costs that many face under the existing regime. This is an important step forward. Let me make a little more progress, after which I may touch on some of my hon. Friend’s other comments.

[Liz Twist]

rose—

[Edward Argar]

I have given way to the hon. Lady already in this debate, as I did in the debate on the previous group of amendments, so I shall make a little progress. She knows that I am always tempted to give way, but I do want to make some progress.

20:00

If we did not make the change I have described, the situation that I outlined before I took the intervention from my hon. Friend the Member for Waveney (Peter Aldous) is exactly what would happen. If a less well-off person living in Hertfordshire or Hackney had more of their care paid for by their local council than somebody making exactly the same contribution towards their care in Hartlepool, the person from Hertfordshire or Hackney would hit the cap first, and more swiftly. As a Government, we are committed to levelling up, but it does need to be fair. We should not treat less well-off people in different parts of the country differently; rather, we should make sure that they benefit to the same extent and that support for levelling up comes because more people in less well-off regions will benefit than in better-off regions.

I wish to tackle head-on the idea that the cap on care costs is somehow a target that everybody should want to hit. That is absolutely not the case. Nobody should want to hit the cap, which is not a target designed to be hit: it is a backstop protection for people. The nature of the means-tested support will dramatically reduce the amount that less well-off users will have to spend on care. For example, wealthier people who entirely self-fund their own residential care are likely to have to spend £86,000 of their own money if they live in a residential home for just over three years. Older adults have around a one-in-three chance of living in a residential home for that long once they have entered it. Somebody who starts with £100,000 of assets would need to draw on care and support in a residential home for about 10 years to have to spend the same amount. They have just a one in 50 likelihood of that being the case. Somebody who starts with even lower assets is even less likely to spend that much of their own money. The reforms are therefore fair, because they mean it will be far less likely that less well-off people will face very high costs.

We believe that the approach I have set out is fair and is a significant improvement on the situation today, so we must insist that the House disagrees with Lords amendment 80 and the clause is reinserted.

[Karin Smyth (Bristol South) (Lab)]

I am reminded of some training I had a few years ago, when my trainer said, “Karin, people will often thank you for your brevity at this time of night,” so I shall not detain the House for too long.

As the Minister kindly alluded to, I spent some six weeks in the Bill Committee trying but failing to alter the original Bill from the Back Benches. I therefore praise the work done by my colleagues and others in the House of Lords. The list of improvements that have already been made is impressive. Unlike in Committee, when the Minister batted away every single proposal for change, the Government have adopted some changes and there has been some progress.

We support Lords amendment 90, on palliative care, which is a really difficult and complex subject that involves distressing issues for the people affected. The Government should further consider that amendment.

On unpaid carers, we support the finely crafted solution in Lords amendment 51 to protect carers. The intent behind the amendment is to prevent any further problems with discharge to assess. We need to enhance people’s rights as carers, not take them away. I know from personal experience that the removal of an assessment prior to discharge may result in less priority being given to the assessment once someone has left hospital. Families clearly worry that patients may be “out of sight, out of mind” once they have left hospital. It would be helpful if the Minister clarified the Government’s commitment to ensuring that carers are consulted as part of the discharge process. It is vital that steps go much further than simply “involving” the carer; we need to ensure that the carer is both willing and able to provide care for the patient and that the necessary community services are in place. Community services and primary care are currently badly stretched.

In Committee, I raised many issues relating to the membership of integrated care boards, particularly in respect of their lack of accountability to local people. None of my proposals made it into the Bill, so I was delighted to see that one proposal made it through the House of Lords. We are happy to support the approach agreed in Lords amendment 105, to give some positive recognition to parity of esteem for mental health. The broader issue of who else gets to be on an integrated care board will rumble on for years, but this is a good first step, and we expect it to happen. It is vital that there is a mental health voice on our integrated care boards, but as well as the Minister confirming that he expects that to happen, it would be really helpful if he could clarify what recourse or consequence would be available should that mental health representative somehow be blocked at a local level from serving on the ICB.

Let me turn to the broader issues. As I said in Committee, this is fundamentally another NHS reorganisation Bill. It is a restructuring of the NHS and a centralisation of power within the NHS. It does not nothing to achieve integration and nothing to improve accountability to the public, to patients and to communities. With the publication of the Ockenden report and the deeply worrying staff survey and patient satisfaction surveys, it is not a good day for the health service. It is clear that centralising control in the NHS is very much the wrong approach. Local representatives need much more power over local services, and accountability needs to be much better at a local level.

The Bill also does nothing to improve the appalling state of social care provision. No wait for care will be shortened because of this Bill and nobody excluded from care will now receive it, but we do now have a Bill that lays to rest the worst of the Health and Social Care Act 2012, the Lansley Act. Those of us who were on the other side of that Act and its implementation—in fact, it was that Act that brought me to this place, so appalling was it—and who fought and campaigned against it really should be having a bit of a party to celebrate the disappearance of some of the worst excesses of that Act.

With the changes to procurement and the many assurances given from the Government Dispatch Box, the main threats detected in the original Bill have largely been allayed. Compulsory tendering has gone; we have preferred provider in all but name. Procurement from the private sector must now be on a proper, open and transparent basis, which means no more crony contracts or jobs for friends and family, and Virgin Care and other large corporates no longer influencing commissioning.

With Lords amendment 11 excluding private interests from commissioning, we see a dramatic shift that is most welcome. We may start to get back to a public service model. That could start a journey to build an NHS where adequate investment and support means that patients do not have to start relying on the private sector.

The most serious issue in this bunch of Lords amendments has been ducked. The dead hand of the Treasury has clamped down and common sense has departed. Shoehorning the change in the calculation of contributions to the care cap into the Report stage of this Bill was parliamentary sharp practice of the highest order, designed to minimise scrutiny and stifle criticism. Our position is encapsulated by Lords amendment 80. This provision should never have been in the Bill. It is hugely significant to our constituents, and it has never been properly considered and cannot be today. I listened very carefully to the Minister outlining various scenarios. I, too, could outline various scenarios from the Dispatch Box, but I will not do so today. This is not the place to do that; there needs to be proper consideration and proper scrutiny. The Department has sneaked out the view that restricting contributions to the cap for those being means-tested for their care charges would save an estimated £900 million by 2027-28 in cash terms. Surely that means that there is time to look at this properly, and we are willing to work with the Government to do just that.

Let us be clear: if that is the true estimate, then that is what the Treasury is talking about saving from the poorest—from working-age adults with a disability and older people with few assets. That is where that money comes from. That is not fixing social care; that is asking people with less to pay more to protect the assets of the wealthiest—the less a person has, the more the Treasury will take.

Members of Parliament from across the north-east of England, Yorkshire and the Humber and the midlands really need to take note, because, from what we can gather at the moment—we do not know enough about this to be totally clear about how it impacts people—it looks like those areas will be worst hit by the Government proposals. Why are those MPs not here? Why are they not outraged by this? I suspect that it is largely because they do not know, and the Government do not want them to know. It is so hard to follow the detail of this.

It has been almost 3,000 days since the Care Act 2014—a carefully crafted piece of legislation, agreed across party lines and after a huge engagement with stakeholders— was granted Royal Assent. If the calculation towards the cap is to be changed, that change must come the same way, through cross-party working with the sector, patients and people involved, understanding the evidence on impact and considering the consequences—not through this half-arsed addition to an NHS reorganisation, which is essentially what the Government are doing.

If the Government are determined to leap into action, they should accept amendment 81 and get on with implementing the Care Act and the Dilnot proposals as originally agreed. I followed the implementation of the Act very carefully when I came to this place in 2015, and I think I have heard from the Government Dispatch Box today for the first time that it was never agreed, that it was undeliverable and not financeable. That is not what the people producing the Care Act or the Conservative Government of the time led us to believe. They moved the implementation to April 2020, expecting there to be a general election in that year, and never really came back to explain the rationale.

We will not get mired in details tonight because, as I said earlier, this is not really the place for it, but our constituents are being led up the garden path by this Government. This place should be considering the proposals properly. That is what the Lords have asked us to do, and the Opposition will support them in doing that. This question is too important to be left to a last-minute addition.

[Dame Caroline Dinenage]

I will speak briefly in favour of Government amendment (a) in lieu of Lords amendment 51. I draw hon. Members’ attention to my entry in the Register of Members’ Financial Interests and the fact that I am co-chair of the all-party parliamentary group on carers. My predominant interest is that this is a cause that I care very deeply for.

Ultimately, the aim of Lords amendment 51 is to focus on carers and the safe discharge of hospital patients. The Government’s amendment (a) in lieu will achieve most of what the noble Baroness Pitkeathley originally attempted to achieve in her amendment, ensuring that carers are involved at the point of hospital discharge.

Across the UK today there are about 6.5 million carers supporting a loved one who may be older, disabled or seriously ill. That is one in every eight adults providing unpaid care for their family or friends, whether around the clock or for a few hours a week. It is an enormous contribution and saves the health and social care system billions of pounds a year. It has an untold impact on carers’ own lives and livelihoods, but for the people they care for, it is literally a lifeline.

The amendment in lieu recognises the vital role that carers play and avoids any suggestion of their losing their rights, which could have been an unintended consequence with the wrong wording. It is important that carers are recognised in this legislation; it is clear that the Government have listened and reflected the strength of feeling about that, and I am grateful. We must do more to equip carers to care safely and well, and to juggle other aspects of their lives. That is why the requirement to consult carers prior to patient discharge is so important. The Lords amendment had cross-party support in the House of Lords, and I hope the amendment in lieu will achieve the same thing in the Commons.

According to Carers UK, there are still some worrying statistics on discharge: 56% of carers were not involved in decisions about discharge from hospital and what care and treatment the person they cared for needed, 82% of carers did not receive a carer’s assessment and 68% of carers were not asked about their willingness and ability to care at discharge. I am sure the House will agree that those are deeply distressing statistics, and that we have a lot of work to do to address them.

There are a few important points of clarification and assurances that I would like from the Minister. He mentioned earlier that young carers were covered, but the language is a little opaque, so can he confirm for me that he is talking about not only young carers who are looking after adults, but young carers who might be caring for brothers or sisters? Some young people perform that incredibly difficult task at enormous disadvantage to themselves, and I want reassurance from the Minister that this House and this Government have not forgotten them.

The second point of clarification is that the original amendment 51 included a test on whether a carer was willing and able to care, as in the Care Act 2014, and I want to ensure that this amendment in lieu will secure that. There are also important clarifications to be made around what “feasible” means; I hope the Minister can help me with that, so that carers are absolutely sure what he means by their rights.

Unpaid carers are so often invisible, their efforts unacknowledged, and I am pleased to see the Government taking steps to address that through their amendment in lieu. It is a start. There is much further to go to give unpaid carers the support and recognition they need—that is a discussion for another day, but it is a discussion I intend to have.

20:15

[Daisy Cooper]

I would like to start by talking about carers and safe discharge. I welcome the Government’s concession on this point. It is a pleasure to follow the hon. Member for Gosport (Dame Caroline Dinenage), who talked so eloquently about the fact that unpaid carers are often, in effect, invisible. She is seeking a number of assurances from the Minister, and I wonder if I might add another.

The Minister will be aware that on Report I tabled an amendment calling for a new NHS duty to recognise and identify unpaid carers who come into contact with the NHS so that their health and wellbeing could be taken into account when decisions are made concerning the health and care of the person or the people for whom they care. The amendment now before us is not as strong as that. In fact, it is not as strong as the Lords amendment. I welcome the Government’s concession on this, but I wonder whether the Minister might provide some assurances that the nub of my amendment at an earlier stage could, for example, be included in some of the ICB guidance. It is important that carers are consulted but also important that their health and wellbeing is taken into account when decisions are made about those for whom they care.

I have a couple of thoughts on the social care cap. First, it is a really terrible way to come up with policy to change a policy halfway through a Bill, because it starves important policies of public debate and parliamentary scrutiny. It is a very bad habit. We have seen it with other Bills, such as the Building Safety Bill—a national scandal that I have spoken about many times. This is a bad way of making law. It is important that the Government do not fall into bad habits.

The other point is on broken promises. The Prime Minister stood on the steps of No. 10 and pledged to

“fix the crisis in social care once and for all”.

He also promised that no one would have to sell their home to pay for care. He has now broken both those promises, because this Bill does not fix the social care crisis and it does continue to see people facing the prospect of losing their home to fund care costs. Quite frankly, it is appalling that the Government are arguing that they cannot afford to accept this amendment when the savings that are going to be generated for the Treasury come off the backs of the poorest people in our society. The Government really should think again.

[Steve Brine]

I have sat through all this debate and taken issue with the Government in some places and supported them in others. I am going to take issue with them on amendment 51. It is always hard to take issue with this Minister, but I seem to have done it twice already today. My hon. Friend the Member for Gosport (Dame Caroline Dinenage) and I did not compare notes but seem to have exactly the same comments, which suggests that this is an important amendment.

I want to make a few points about young carers in Hampshire and nationally who have been in touch with me about amendment 51. The amendment that we are being asked to strike out says at paragraph (5)(b) that

“a ‘carer’ means any person, including any child under the age of 18”.

It does not say that in the Minister’s amendment in lieu, but I have heard what he has said today and I hope that it will be heard clearly, because what is said at the Dispatch Box matters a great deal. The Minister in the Lords said on Report that there will be statutory guidance that hospitals “must have regard to” and that that is a sufficient measure for carers. Again, I hear that, but what is said at the Dispatch Box in the Lords matters as well. As young carers have said to me, ahead of today, this is not the same as primary legislative rights and it can be withdrawn or changed at the stroke of a Minister’s pen, intentionally or unintentionally. It does not mean the same for carers and young carers in the daily operation of the system. I would suggest that very few carers, especially young carers, have the energy, the means or the knowledge to go to judicial review if their rights are not followed.

When the Minister winds up, I beg him once again to make it absolutely crystal clear that his amendment in lieu does the same as the Lords amendment that he is asking us to strike out, because young carers, in particular, want and need that reassurance. Other than that, it is a good amendment that is worthy of our support, but I just want to hear a little bit more from my excellent Minister—and now that I have flattered him he cannot deny me.

[Margaret Greenwood (Wirral West) (Lab)]

I rise to speak in support of Lords amendments 51, 11 and 105. With this Bill, the Government are legislating so that a controversial approach known as “discharge to assess” can be used when discharging patients from hospital. This would see patients discharged from hospital before their social care needs have been assessed, with vulnerable patients potentially sent home without the support that they need in place, leaving families to pick up the pieces and those without family at risk of neglect. Lords amendment 51 is important in relation to that.

The amendment would retain the principle and duty on a hospital, whether an NHS hospital or an independent hospital, to ensure that a patient must be safe to discharge from hospital, and it mirrors carers’ rights established by the Community Care (Delayed Discharges etc.) Act 2003. This important amendment would recognise the vital role played by carers across the country in looking after their loved ones. However, it does not stop the Government from legislating for discharge to assess, a policy that has been piloted and was included in the Coronavirus Act 2020 as a temporary measure. I am concerned that the Government are not only going ahead with an approach fraught with risk for vulnerable patients, but are doing so in the knowledge that an independent evaluation commissioned by NHS England of the implementation of the hospital discharge policy has still not been published, despite the Government promising that the evaluation was due to report in autumn last year.

I am concerned, too, that the Government do not even understand the clinical outcomes of discharge to assess. When I submitted a question last year asking the Government how many patients discharged in this way were readmitted within 30 days, the Government said that they did not hold the data. I believe that to be a dereliction of duty.

Lord amendment 51 would put in place important rights for patients and carers at what can be a very difficult time. I note that the Government disagree with the amendment and have tabled an amendment in lieu, but I believe that it waters down carers’ and patients’ rights. It merely proposes that

“the relevant trust must, as soon as is feasible after it begins making any plans relating to the discharge, take any steps that it considers appropriate to involve…the patient, and…any carer of the patient.”

That gives inappropriate levels of discretion to trusts over patients’ and carers’ involvement, instead of guaranteeing their rights.

Lords amendment 11 is a step in the right direction, although it does not go far enough. It would ensure that conflict of interest rules that apply to integrated care boards would apply to commissioning sub-committees of integrated care boards. The Government have said that they disagree with the amendment and have proposed an amendment in lieu that would prohibit a chair of an ICB from approving or appointing someone as a member of any committee or sub-committee that exercises commissioning functions

“if the chair considers that the appointment could reasonably be regarded as undermining the independence of the health service because of the candidate’s involvement with the private healthcare sector or otherwise.”

I am concerned that the phrasing is clearly open to interpretation, and it by no means rules out people with interests in private healthcare from sitting on these sub-committees.

It is wrong, too, that the power should rest with one person, namely the chair of the ICB. If we are serious about providing governance that rules out the possibility of the private sector influencing the expenditure of public money, an organisation carrying out the functions of an ICB on its behalf should be a statutory NHS body. It is a great pity that the Government have not legislated for that.

We cannot forget that NHS guidance last year stated that the Health and Care Bill, if enacted, would enable ICBs to devolve budgets to provider collaboratives, which are one of a complex array of sub-committees that could take on commissioning functions. Representatives of private companies, which are accountable to shareholders, should not be able to influence these commissioning sub- committees in any way. Lords amendment 11 at least improves the original Bill, and I therefore welcome it.

I also welcome Lords amendment 105, which would mean that the membership of an ICB must include at least one member with expertise and knowledge of mental health in the integrated care board’s area. The fact that the Government did not provide for that originally shows that they are still not treating mental health with the level of seriousness it deserves. It is disappointing that the Government have indicated that they disagree with the amendment.

The amendment in lieu that the Government have proposed makes provision for the chair of an ICB to act

“with a view to ensuring that at least one of the ordinary members has knowledge and experience in connection with services relating to the prevention, diagnosis and treatment of mental illness.”

The Government have watered down the amendment, and it is regrettable that they have removed expertise in mental health as a characteristic that this member of an ICB must have. It is feasible that that person could be a manager who once dealt with mental health rather than a mental health clinician or health professional. I noticed that in the Minister’s opening remarks, he commented that ICBs would be able to commission out of area. I would be grateful if he gave some clarity about how A&E services will be guaranteed to people should they happen to fall ill out of area.

This is a devastating piece of legislation and it is all the more shocking that the Government have pressed ahead with it at a time when NHS staff are exhausted and patients and people across the country are still struggling with the pandemic. It will embed a postcode lottery and open up the NHS to widespread privatisation. In so doing, it does a disservice to patients in England and to NHS staff.

The Bill provides for the scope of “Agenda for Change”, the pay and terms and conditions of about a million people who work in the health service, to be undermined; it allows for NHS professions to be taken out of regulation; and, as I have mentioned in relation to Lords amendment 51, it will allow for vulnerable patients to be discharged from hospital before their social care needs assessments have been carried out. The NHS is our most treasured institution and I pay tribute to all those campaigners across the country who have fought hard to oppose the Bill.

[Sir Charles Walker]

I congratulate the Government on their amendments on mental health. As a former Minister with responsibility for mental health, Madam Deputy Speaker, you know that I have long taken an interest in the subject, so I am delighted that parity of esteem is included in the legislation. It is a very important amendment.

Parity of esteem must mean something, however, and should not be a jumble of words. It was the case that too many voices on both sides of the House fell silent during the covid pandemic. That may have been due to the fog of war, but the scarring of that silence runs deep in the communities that we represent—there are some very ill and damaged people out there. It is fine for us to talk about parity of esteem, but we have to live it and deliver it, and I am afraid that we fell short for 18 months.

I welcome the amendment and the recommitment of hon. Members, but we were all found wanting when it counted. I have the witness statements of more than 2,000 people who suffered with mental health problems during the pandemic and who wrote to me detailing what that was like. One day, I will make those statements available to the Government and to the inquiry, but today, I just thank the Minister and my right hon. Friend the Member for Maidenhead (Mrs May), who joined me in initiating the amendments. I hope that the next time that the country and this place are challenged, we rise to it, because mental health is as important as physical health.

[Liz Twist]

It was not my intention to speak in the debate, but I need to ensure that the point that has been raised about Lords amendment 80 and the cap is not missed. The Minister talked a great deal about fairness, but how can it be fair that my constituents and people across the north-east and the north generally will face what the King’s Fund described as

“people with low levels of wealth”

being

“exposed to very high care costs”?

It cannot be right that the northern regions and other areas will face that unfairness. The Government should reconsider the issue and come forward, as other hon. Members have said, with further discussions about how to resolve it. The proposal in the Bill is very different from that originally presented to the House on care costs.

On carers, I agree with other hon. Members who have raised the issue. As I mentioned earlier, we need much more detail and certainty for those carers and we need to be able to take part to ensure that the guidance issued is effective and represents and meets their need.

20:29

[Peter Gibson (Darlington) (Con)]

I believe that everyone should have high-quality, personalised palliative care, and that is why I am speaking in favour of Lords amendment 12 on palliative care. I wholeheartedly welcome the benefits that this Bill can bring to those in need of that care. I must mention the tireless campaigning of Baroness Finlay, as referenced by the Minister in his opening statement, and Hospice UK, which acts as the secretariat for the all-party parliamentary group on hospice and end of life care, of which I am a co-chair along with Baroness Finlay. Without their campaigning, we would not have been able to welcome this step forward. I should also declare my interest as a trustee of a hospice, and I draw the House’s attention to my entry in the Register of Members’ Financial Interests.

On the day of the publication of the Ockenden report and our discussion of good births, it is time that we started to talk about good deaths, too. There is far more that we need to do to ensure that hospices and palliative care providers have the tools they need to achieve this, and Lords amendment 12 certainly moves us forward. We need to ensure that the impact of the measures in this Bill are maximised. The Bill specifies appropriate palliative care, but we should expand on this to ensure that a fair minimum standard of care is provided. We should be providing statutory guidance to integrated care boards on the commissioning of palliative care, ensuring that the new requirements are clear. That point was ably raised by my hon. Friend the Member for North Warwickshire (Craig Tracey).

Funding certainty for hospices is essential. Certainty can enable them to better plan, support the needs of their local community and give commissioning boards confidence in relying on them as an integral part of local services. Certainty of funding will allow hospices to invest, innovate and integrate with the NHS and care system. Before the pandemic, adult hospices on average received 34% of their funding from Government, with some receiving little or none. Hospice funding came primarily from charitable donations, with the sector needing to raise £3.1 million every day. The pandemic saw donations, retail sales and fundraising activities fall dramatically, at the same time as an increase in service delivery. I want to put on record my thanks to the Government for the support that was given to all our hospices during the pandemic—and, in particular, to St Teresa’s in Darlington—but we need to see some certainty of funding for our hospices to deliver on this promise.

I am pleased that the Government accept Lords amendment 12. It is an important step forward for hospices and palliative care, and I welcome it.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

It is a pleasure to speak after my hon. Friend the Member for Darlington (Peter Gibson). He made some very strong points in his speech with which I absolutely concur. I want to speak to Lords amendment 80, and his constituency—I know it pretty well, having been there and spent a bit of time there prior to the last election—is the kind that will be affected by it. The Government’s decision is to resist that Lords amendment, which I cannot support. In my view, this is a classic policy for levelling down, not levelling up.

The Minister is absolutely right—both Ministers involved in this Bill are good friends of mine, and I do not want to make their lives more difficult in any shape or form—when he says that the policy across the board is a significant improvement on anything we have had before. That is absolutely right. He said that in his speech, and I agree with it, but I do not agree with him when he says that it is fair. I do not believe it is fair, and that must be the basic criterion on which we judge any proposals, not least these.

I think everybody, including the Minister, accepts that it is quite clear that a £900 million transfer is happening here, which was introduced just as the Bill went on to Report stage. That is a direct transfer of £900 million from household wealth to somewhere else. That is what it is: a transfer of assets—household wealth—to healthcare, the Treasury or wherever else it is going, because that is the way that council contributions are used when it comes to the speed at which somebody reaches the cap.

I could live with that, if we were trying to make the system more affordable, as the Minister says—if the burden was going to fall equally on everyone’s shoulders in different parts of the country. It also true to say that most people will not be affected, because only people on very long care journeys tend to be affected badly, but there are quite a few of them: according to the Department’s own figures, about 6,000 a year—10 people per constituency—would be affected in this way, and most of them have dementia. We know that there are 900,000 people with dementia in the UK today; according to the Alzheimer’s Society, there will be 1.6 million by 2040; and 70% of care home residents are dementia sufferers, and they are the sort of people who will suffer because of the changes. They have very long care journeys, and they move out of their house so it becomes one of the assets that we take into account when assessing how much people contribute to the care cap.

The Minister says we are making these changes to make the system sustainable. Well, okay, make it sustainable, but make it fair too. I do not believe that this is fair. I know I am comparing this with a system that never existed—my hon. Friend is right to say that—but one was proposed in which the council contributions would count in calculations of people’s contribution to the care cap. That is the change we have made—the specific measure to make the system more sustainable is that change, and that affects people with limited assets and wealth. We are balancing this on the shoulders of people with fewer assets and less wealth, and on certain areas as well, as people in some of the regions in the north that we represent tend to have fewer assets and less wealth.

Particularly affected are people who have wealth or assets worth between £75,000 and £150,000. The research provided by the Alzheimer’s Society is clear: under the Dilnot proposals, about 50% of people living with dementia benefited fully from the care cap—they reached the care cap. That was true across all the wealth quintiles—it was very fair. This is not. Only 13% of people in the least wealthy quintile will reach the cap, whereas 28% of the most wealthy will. Such huge disparity cannot be right, yet that is the change that we have made. That £900 million has been found from people with less wealth. That cannot be right, nor is it consistent with levelling up. Look at how different regions are affected: only 13% of people in the north-east reach the cap whereas 29% of people in the south-east do so. Previously, in almost every part of the country, about 50% of people did so. The cap was not as generous, but it was very fair across different wealth quintiles and different regions of the country. I cannot see how this is fair.

Instead of each of us having 10 people in our constituency affected, some will have more and those representing wealthy constituencies will have fewer. I and other Members representing the north-east will have more constituents affected by this change and less generously treated because of it. For that reason, and because in my view it levels down, I cannot support the Government and will vote against them this evening on Lords amendment 80.

[Edward Argar]

I am grateful to all colleagues who have spoken this evening. A number of the arguments were made on Report, and rightly, right hon. and hon. Members have reiterated some of those points where they felt it was appropriate. I will address a number of the points raised relatively briefly.

What we are legislating for in this Bill represents an evolution of our health and care system, and improved integration. My hon. Friends the Members for Gosport (Dame Caroline Dinenage) and for Winchester (Steve Brine) both spoke about carers. Young carers are included, which I hope reassures my hon. Friend the Member for Gosport. In respect of the statutory guidance, I hope that it will provide reassurance if I can set out that we will develop that guidance in partnership with Carers UK to ensure its input and so that it captures exactly the things that hon. Members have alluded to. Again, in statutory guidance, we will look at how to ensure that the duty to give people the information that they need is properly and effectively discharged.

I am grateful to my hon. Friend the Member for Broxbourne (Sir Charles Walker) and my right hon. Friend the Member for Maidenhead—she is now in the Chamber—for the work that they have done on the Bill to ensure that parity of esteem for mental and physical health is not forgotten and is explicit.

On a point made by the hon. Member for Oldham East and Saddleworth (Debbie Abrahams), I will clarify what I said earlier on the triple aim, which may give her a little reassurance, even if not necessarily sufficient reassurance. We have not created a quadruple aim or a fourth limb, but we have included a reference to health inequalities under the existing triple aim in the other place. It is not forgotten. I hope that gives her a degree of reassurance on that specific point.

Lords amendment 80 was the crux of much of the debate. I fear that many are comparing our proposals with something that was never done. We are significantly improving provision around the sustainability and affordability of social care. The Prime Minister was clear that he would grapple with the issue and resolve it. When the Opposition were in power, they had two Green Papers, one royal commission and one spending review priority on the issue and they utterly failed to address it. We are a Government who have made huge strides in creating a better system.

I listened, as always, with great care to my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake). I am sorry that he will not be joining me in the Lobby tonight. While I respectfully disagree with him, I know that he has thought long and hard about this matter and has strong and sincerely held views. With that in mind, I regret that we will have to ask the House to disagree with the Lords amendment on care metering.

Lords amendment 11 disagreed to.

Government amendment (a) made in lieu of Lords amendment 11.

Lords amendment 51 disagreed to.

Government amendment (a) made in lieu of Lords amendment 51.

Clause 140

Cap on care costs for charging purposes

Motion made, and Question put, that this House disagrees with Lords amendment 80.—(Edward Argar.)

20:43

Division 240

Ayes: 247

---

Conservative: 245

Noes: 150

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Labour: 122
Liberal Democrat: 10
Conservative: 8
Plaid Cymru: 3
Democratic Unionist Party: 2
Social Democratic & Labour Party: 1
Independent: 1
Green Party: 1

Government amendments (a) to (n) made in lieu of Lords amendment 80.

Lords amendment 81 disagreed to.

After Clause 148

Dispute resolution in children’s palliative care

Motion made, and Question put, That this House disagrees with Lords amendment 90.—(Edward Argar.)

20:57

Division 241

Ayes: 259

---

Conservative: 257

Noes: 147

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Labour: 127
Liberal Democrat: 10
Plaid Cymru: 3
Independent: 2
Democratic Unionist Party: 2
Social Democratic & Labour Party: 1
Alliance: 1
Conservative: 1
Green Party: 1

Lords amendment 90 disagreed to.

Government amendment (a) made in lieu of Lords amendment 90.

Lords amendment 105 disagreed to.

Government amendment (a) made in lieu of Lords amendment 105.

Lords amendments 1 to 10, 12 to 28, 31 to 41, 49, 50, 65, 83, 102 to 104, 106 and 107 agreed to, with Commons financial privileges waived in respect of Lords amendments 34 to 37.

Ordered, That a Committee be appointed to draw up Reasons to be assigned to the Lords for disagreeing to their amendments 29, 30, 57, 81, 85 to 88 and 108;

That Edward Argar, Michael Tomlinson, Saqib Bhatti, Gareth Davies, Karin Smyth, Chris Elmore and Martyn Day be members of the Committee;

That Edward Argar be the Chair of the Committee;

That three be the quorum of the Committee.

That the Committee do withdraw immediately.— (Mrs Wheeler.)

Committee to withdraw immediately; reasons to be reported and communicated to the Lords.