Health and Care Bill

(Limited Text - Ministerial Extracts only)

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[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?

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[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.

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[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.

[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.

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[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.

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17:11

Division 236

Ayes: 275

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Conservative: 266
Democratic Unionist Party: 7

Noes: 183

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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.

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17:26

Division 237

Ayes: 215

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

Noes: 188

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

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

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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?

[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.

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[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.

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19:10

Division 238

Ayes: 249

---

Conservative: 243

Noes: 167

---

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.

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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.

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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.

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[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?

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[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.

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[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.)

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20:43

Division 240

Ayes: 247

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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.

--- Later in debate ---

20:57

Division 241

Ayes: 259

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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.