Health and Care Bill

Consideration of Commons amendments
Tuesday 26th April 2022 Lords Chamber

Commons Amendments

20:51

Motion A

Moved by

[Lord Kamall]

That this House do not insist on its Amendment 29B, to which the Commons have disagreed for their Reason 29C.

29C: Because there is already a clause in the Bill about reporting in relation to workforce and it is not necessary to impose further or different reporting duties on that topic.

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

My Lords, with the leave of the House, in moving Motion A, I will also speak to Motions B, C and D. The amendments being considered today relate to the NHS workforce, reconfigurations, modern slavery risks in NHS supply chains and the adult social care cap.

I turn first to Amendment 29D. The unamended Clause 35 places a duty on the Secretary of State to report on workforce systems. Our report will increase transparency and enhance accountability by describing the workforce planning and supply system for healthcare workers, including those working in the NHS and public health alongside regulated healthcare professions working in social care and public health in England. The existing clause therefore already delivers, by and large, what Amendment 29D seeks to do.

I can confirm that we will be asking Health Education England and NHS England to assist in the preparation of the report. In addition, while the report will be published at a minimum of every five years, it can be published more frequently than that, if required. I can also confirm that, in the preparation of the initial report, we will also seek the views of key stakeholders. The report is in addition to the rest of our expansive work to improve workforce supply and planning, including the Health Education England strategic framework, which will be published in the coming weeks, and the NHS England long-term workforce strategy.

Moving to reconfigurations, I am very grateful for the constructive debates on these issues across both Houses, and in this place particularly to the noble Lord, Lord Stevens, and my noble friend Lady Cumberlege for their insightful and wise feedback on this power. The first set of changes we have proposed would mean that the NHS had to notify the Secretary of State only about the reconfiguration proposals deemed notifiable, which we will define through regulations. But we intend to align that definition with the existing duty on NHS commissioners to consult local authorities in the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013. Similarly, our amendment removes the requirement for commissioners and providers to inform Ministers of

“circumstances that are likely to result in the need for the reconfiguration of NHS services”.—[Official Report, Commons, 25/4/22; col. 522.]

Throughout the Bill’s passage, we have been clear that our intention is to use these powers only in respect of substantial reconfigurations. The vast majority of reconfigurations will be managed without any ministerial intervention. These amendments and our planned regulations reinforce that principle.

Under the Town and Country Planning Act 1990, the Secretary of State for Levelling Up, Housing and Communities has powers to call in any planning application. However, the stated policy for many years has been to be very selective about doing so, and Ministers will, in general, consider the use of call-in powers only if planning issues of more than local importance are involved. I should like to put formally on the record that our intention is that the same principle applies here.

On the Secretary of State’s call-in power, concerns have been raised about patient safety. I want to be clear that these powers should never, and will never, prevent providers making urgent temporary changes where there is a clear and acute risk to the safety of patients or staff.

Secondly, our amendments give local authorities, NHS commissioners and anyone else the Secretary of State considers appropriate, a right to make representations to the Secretary of State where he or she has called for a proposal for consideration. We expect this to include any relevant provider. The Secretary of State will be required to publish a summary of representations he or she receives, and we will set out in statutory guidance further detail on how local bodies, including providers, will be engaged. In addition, we also want the CQC’s expertise to be taken into account where it is appropriate for relevant reconfigurations. We will therefore look to make clear, in guidance, where information provided by the CQC should be taken into account.

Thirdly, transparency is vital to ensure that these powers are always used by Ministers in the public interest. We are therefore requiring the Secretary of State to provide the reasons for his or her decisions and directions when he or she makes them.

Finally, we have heard throughout these debates that reconfiguration decisions must be made quickly to improve the quality of services received by patients. Our amendment requires that, once he or she has called in a reconfiguration proposal, the Secretary of State must make any decisions within six months. We believe that this set of changes answers many of the key concerns raised in Parliament and I therefore urge noble Lords to consider supporting these amendments.

I now turn to Amendment 48C, particularly on the issue of modern slavery. We clearly share the strength of feeling expressed in both Houses on ensuring that the NHS is in no way inadvertently linked to slavery and human trafficking through its supply chain. That is why the Government brought forward an amendment in the first round of ping-pong that creates a duty on the Secretary of State to undertake a thorough review of NHS supply chains. Today, I can announce that we will go further than this. The Government’s further amendment in lieu will require the Secretary of State to make regulations with a view to eradicating the use in the NHS in England of goods or services that are tainted by slavery or human trafficking. The regulations can set out steps that the NHS should be taking to assess the level of risk associated with individual suppliers; the basis on which the NHS should exclude them from a tendering process; and what measures should be included in contracts. I am particularly grateful to my noble friend Lord Blencathra and also the noble Lord, Lord Alton of Liverpool, for their campaigning—in fact, their persistence—on this issue, and I welcome their support for the amendment. I will also continue, with other Ministers, to work closely with others across government to ensure that our measures to eradicate modern slavery in NHS supply chains are effective and targeted, and reflect best practice.

We must now turn to the issue of the adult social care cap. The Government have announced their plan for a sustainable social care system. It is fair and affordable, and designed to end the pain of unpredictable care costs by capping the amount anyone would need to pay at £86,000. The elected House has once again voted overwhelmingly in favour of our proposals, which are financially privileged—and I would remind the House of its proper role in considering matters that are financially privileged. On the issue of substance, this House will be aware that Governments of all parties, for many years, have considered social care but not implemented reforms due to concerns about the affordability of introducing a cap. I have said previously that reports have gathered dust on shelves but never actually been implemented. Now we have a real opportunity to grasp the nettle. If there are issues or unintended consequences, these will likely be found by the trailblazers, and we can then tweak the system to address any shortcomings. I ask noble Lords to not allow this opportunity once again to slip away.

The existing system is simply not good enough, and our reforms are a vast improvement. Our reforms ensure that more people are eligible for support with the costs of their care; that the amount they spend each week is reduced; and that they can retain more of their savings. At the moment, people get support with the costs of their care only once they have depleted their assets to under £23,250. We are increasing this fourfold, so that people with up to £100,000 in savings, who are currently paying all the costs of their care, will now be eligible for funding support from the state. Under the current system, only once you have depleted your assets to £14,250 do you no longer need to contribute from your assets. We are increasing this to £20,000. Most crucially, at the moment there is no cap. Our reforms mean that people will have more certainty and more peace of mind, and will be able to plan ahead, whatever part of the country they are in.

21:00

The changes introduced in this House make reform of the social care funding system unaffordable. These provisions are subject to Commons financial privilege and, again, the elected House has made its view clear in support of the Government’s position three times. I really ask your Lordships to listen carefully to the views of the other place.

Without the Government’s clause there would be a fundamental unfairness, because people would meter according not to what they paid but to what their council paid, for reasons they have no control over. Someone living in Hertfordshire, making exactly the same contribution towards their care as someone in Hartlepool, could hit the cap first purely because of variations in the costs of care in different part of the country that mean the local council in Hertfordshire is paying more towards their care.

We are committed to levelling up and must ensure that people in different parts of the country are benefiting to the same extent. Our provisions support this. Amendments 80A to 80N also contain crucial changes to support the operation of charging reform. These were lost by the removal of the clause.

Amendment 80S would require the Government to publish an evaluation and impact assessment of trailblazer local authorities before making regulations to amend how costs accrue towards the cap. The Government already intend to evaluate implementation in the trailblazer authorities. Learning from the trailblazer initiative will be shared with the wider adult social care sector through regular bulletins and events. We have to trust the learning process.

The amendments in front of us would cost the taxpayer nearly £1 billion per year extra by 2027-28. Ultimately, what does this mean? It would mean that we would need to make the same level of savings elsewhere. Where would we find those savings? This could mean making the system less generous. It could be by raising the cap, reducing means-tested support, or expecting people to make contributions towards their daily living costs that are unaffordable from most people’s income. It could also mean that we have to reduce investment in things that would improve the quality of people’s lives and experience of the care system, whether that is investment in the workforce, in appropriate housing or in digitalisation. That is not what the elected House wants us to do, as was clearly demonstrated by the vote last night in the other place.

Our approach, we believe, is the right one, and I ask noble Lords to agree to Amendments 80A to 80N but disagree with Amendments 80, 80S and 80T. I beg to move.

Motion A1 (as an amendment to Motion A)

Moved by

[Baroness Merron]

At end insert “, and do propose Amendment 29D in lieu—

29D: Page 42, leave out lines 14 to 19 and insert—
“(1) The Secretary of State must, at least once in every three years, lay a report before Parliament describing the system in place for assessing and meeting the workforce needs of the health, social care and public health services in England.
(2) NHS England and Health Education England must assist in the preparation of a report under this section.
(3) The organisations listed in subsection (2) must consult health and care employers, providers, trade unions, Royal Colleges, universities and any other persons deemed necessary for the preparation of this report, taking full account of workforce intelligence, evidence of trends in healthcare and demand for it, and workforce plans provided by local organisations and partners.””

[Baroness Merron (Lab)]

My Lords, I beg to move Motion A1 as an amendment to Motion A to insert the words as printed on the Marshalled List. My noble friend Lady Wheeler will speak to Motions D and D1 and I will focus my remarks on the issue of the health and social care workforce. However, before I do, I welcome the compromises reached on the reconfiguration of local services and on NHS procurement while avoiding modern slavery. I believe the constructive discussions that we have had have truly improved this Bill and I am grateful to noble Lords across the House and to the Minister for his efforts and commitment.

The importance of the workforce has been debated extensively, both in the other place and in your Lordships’ House. Once again, I am arguing for the importance of implementing a proper forward-looking plan. That I am doing this even after yesterday’s proceedings in the other place conveys just how strongly we feel on this issue. Over 100 organisations of healthcare professionals, think tanks, practitioners and patients have supported our efforts. They continue to press us to make the point that, without mandated forecasts of staff numbers, meaningful workforce planning—something that every other efficient organisation undertakes—cannot take place. They continue to despair at the Government’s now repeated refusal to demonstrate proper commitment to safely staffing our hospitals and other healthcare settings.

We all know that there is desperate understaffing. The staff know it; they feel the pressure and they see the adverse outcomes. The patients know it, often falling into a cycle of long waits, in pain and discomfort, because of staff shortages. Resolving this is quite straightforward. We need a national staffing picture, otherwise how will we know whether we are training enough staff to meet the needs of the country? Yet the Government continue to refuse to commit to producing such an assessment. They say that the necessary work has already been done, or is going to be done, but we, and stakeholders, vehemently disagree, and it is hard to follow the Government’s logic.

If the Secretary of State will not show leadership then NHS England must step up and produce its own requirements and projections, or the Local Government Association could commission such work across the country by local authority. Some way, somehow, every integrated care system and local authority will have to quantify their future workforce requirements and projections and plan for how these will be met.

The Government’s current drafting leaves open some serious questions. We do not know whether the plan will cover health and social care workforces. What is the intended timeframe of the commissioned NHS England plan, and will it be recommissioned once this period expires? Can the Minister confirm that robust data on staff numbers in our healthcare workforces will be published and, if so, when? I would be grateful for any clarification that the Minister can provide.

I deeply regret that the Government have felt unable to meet with parliamentarians—the Opposition, other political parties or indeed any of our experienced Cross Bench Members—even to discuss this issue. This is an irregular and unwarranted response. I hold out hope that, even at this late stage, the Government may see good sense in planning for the workforce that we need, instead of leaving it to chance. I beg to move.

[The Deputy Speaker (Baroness Henig) (Lab)]

Two noble Baronesses will be taking part remotely. I first call the noble Baroness, Lady Campbell of Surbiton.

[Baroness Campbell of Surbiton (CB) [V]]

My Lords, I strongly support Motion D1, to be moved later, in the name of the noble Baroness, Lady Wheeler. It attempts to salvage something of what we set out to achieve on Report. Noble Lords will remember that I was particularly keen to achieve a zero cap for working-age adults who have or who develop eligible care needs under the age of 40. This would enable them to save enough for an ordinary life, like other people.

Amendment 80S would allow regulations to decide how costs accrue under the Care Act, including local authority costs. Not to let them count is fundamentally unfair, adding years to the time it would take to reach the cap. The amendment ensures that the trailblazer pilots are assessed and reviewed by Parliament in the light of regional variations and the impact on younger disabled adults.

Disabled people are contributing to their care from benefits intended to cover the extra costs of disability. Four million disabled people in the UK are living in poverty and are particularly hard hit by the rising cost of living. Without some easing, they will remain trapped in poverty. The Minister has told us many times that the cap is proportionate and fair. He refers to the uprating of social care allowances, meaning the minimum income guarantee—what is left after being charged for care. In practical terms, it is minimal. To someone with the highest support needs and on the highest rate of disability benefits, it amounts to £4.55 a week. That barely keeps pace with the cost of living, let alone their extra disability costs, which are estimated at £583 per month. It is also far less than older people receive. Disabled people will be simply crushed by their rising debts.

If the Government’s proposals go through tonight, young disabled people will never participate in society as equal citizens, and those totally reliant on benefits will suffer even more financially—yet we know from the evidence that investing in social care to support disabled people improves their health, enhances their independence and reduces demand on welfare benefits.

The amendment in the name of the noble Baroness, Lady Wheeler, does not thwart the primacy of the elected House. Nobody says that the current system is acceptable, but these proposals from the Government are not the answer. The public are demanding better social care and support for all those who need it so that they can thrive as dignified human beings. The Government’s last-minute changes to their reforms, sprung on Parliament with no time for proper scrutiny, will not deliver the will of the people, who want investment in social care.

We must, and we will, continue our efforts to secure a better deal, especially for those young disabled people starting out in life, who simply want a life like anyone else. The least we can do tonight is support these reasonable and modest amendments, so that that can become a reality.

[The Deputy Speaker (Baroness Henig) (Lab)]

My Lords, I call the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, it is a privilege to follow the noble Baroness, Lady Campbell of Surbiton. I start by thanking the Minister for the large number of meetings during the passage of this Bill in the Lords—with some exceptions, but I will return to those shortly. It has been, for the most part, a very constructive engagement that has taken a considerable amount of the Minister’s and his officials’ time. I believe that the constructive nature of the discussions means that this Bill will leave your Lordships’ House in a better state, and more workable in practice, than when it arrived.

I will speak on Motions C, D and D1 and will leave Motions A, A1 and B to my noble friend Lady Walmsley. I pay particular tribute to her for her dedicated work on the Front Bench, which I have been unable to fulfil because of the strict rules relating to remote contributions.

On Motion C on modern slavery, I particularly thank Ministers for listening to the concerns across all parties in both Houses. Motion C addresses many of the concerns that there were about the willingness of the Government to carry out a review in order to better understand the risk of slavery, human trafficking and modern slavery in the NHS supply chain. It is, of course, only a first step. Eradication of slavery and human trafficking in health service supply chains must remain the key objective, but this will give the Government the tools they need. The publication arrangements will be transparent, and Parliament will have a chance to scrutinise it. For these reasons, these Benches will not oppose Motion C.

I turn now to Motions D and D1 on the social care cap. I start by thanking the Minister for his letter—received this afternoon—addressed to the noble Baroness, Lady Wheeler, and copied to myself and others who have attended meetings with him on the social care cap, which provided more detail on the trailblazer programme. By the way, in any other environment they would be called “pilots”, but there we go. I am struggling to see what is new about the trailblazer programme in that letter, other than one extraordinary sentence which says:

“I would be happy to arrange a further meeting with you and the policy team if you would like to discuss this in more depth”.

21:15

This is extraordinary because, as was alluded to by the noble Baroness, Lady Merron, until now Ministers have refused to discuss the detail of the social care cap with Peers, even when we met last week. Indeed, being told that if we tabled any amendments on this and workforce, then any concessions on the other two issues would be removed from the table, was a somewhat breath-taking breaking of convention, so I think that we are all relieved that Ministers removed that edict. I hope that we can safely return to the usual conventions.

Motion D still does not recognise that the proposed changes to the care cap, announced just before the Bill left the Commons before Christmas, have not had any wider consultation with stakeholders, and have had only the briefest timed debate in the Commons. That is important because the Government’s changes to the care cap, not mentioned by the Minister this evening, mean that the amounts accrued towards the £86,000 cap are now based solely on the individual’s out-of-pocket expenses. Although individuals will still qualify for means-tested financial support if their assets fall below £100,000, in practice this will no longer protect people with more modest means and will simply see them contributing over a much longer period.

This is a regressive arrangement which will leave many people in a much worse position than that outlined by the Prime Minister on the steps of No. 10 Downing Street or by the Secretary of State for Health when the White Paper on the health care levy was introduced and before any of this detail was published. The Minister has repeatedly said during the passage of the Bill that those under 60 who receive personal care will not be worse off. That is untrue, as was so ably explained just now by the noble Baroness, Lady Campbell, whom we support in her aim for a zero cap.

Even the Government’s own impact assessment shows that its proposals will benefit only around 10% of working-age care users, and that there will be a limited impact on improving the funding spent on working-age disabled adults. How many more times must we say that it is still a disgrace that younger adults with disabilities—who we know are more likely to be asset and savings-poor, likely to need care and support for much longer, and so will accrue much higher levels of costs than the elderly—will use the same arrangements as older people? Those older people will use personal care for much less time and will have had decades of income and asset-building behind them. The proposals from the Government are just not fit for purpose and must be reviewed for this group of younger adults in particular.

Motion D says that there must be an evaluation of the trailblazer and that assessments can happen as they go along, but there is a big risk to the Government there. If there are problems, which we believe there will be—not least the financial impact on some of the most vulnerable adults in our community—they will not surface until it is too late. Therefore, from these Benches we support Motion D1 and urge the Government, even at this last minute, to reconsider.

[Baroness Altmann (Con)]

My Lords, I follow the noble Baronesses, Lady Brinton and Lady Campbell, and will confine my brief remarks to social care, which I have long worked on. Sadly, the measures in the Bill will not rise to the challenge as required to sort out the social care system in our country.

I accept and congratulate the Government on the concessions that they have made. I am delighted to see Motion C on modern slavery. However, as far as social care is concerned, I would like to understand from my noble friend, on workforce planning, whether private care homes and non-state care home staff will be assessed as to adequacy. At the moment, there are horrendous staff shortages, and the current immigration policy does not seem to include carers—an essential element of the workforce—because of the pay structures. If he could explain what the social care workforce elements of the Government’s proposals are for the non-state social care sector, I would be most grateful.

I am not planning to vote against the Government on Motion D1, but I am afraid that I cannot support them. I put on record that I agree with everything that has been said about the Government’s changes to the social care cap. I believe that the measures are regressive; they will damage the least well off—or the lower end of the middle range of people, shall we say. They may be better than the current system, but they are not a solution and are not satisfactory. We will end up having to revisit the support for social care. Having said that, and in view of the fact that this is financial privilege, I will not vote against the Government on Motion D1.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise very briefly to offer Green support for both Motions A1 and D1. Motion D1 has already been very amply covered, most notably by the noble Baroness, Lady Campbell of Surbiton, so I will just address my remarks to Motion A1.

I know that many Members of your Lordships’ House feel as though we do not want to be political about things—I might have thoughts about that—but this is not a political amendment at all. As the noble Baroness, Lady Merron, said, more than 100 of our major healthcare organisations have expressed support for this workforce planning approach. Just a couple of hours ago, and this addresses your Lordships’ House directly, the British Heart Foundation put out a press release saying that, without this amendment, it is

“unclear how ambitious targets laid out in the Elective Recovery Plan and other NHS delivery plans can be met.”

The chief executive said that

“the Government has missed an open goal by failing … to address the workforce shortage”.

In addition, just yesterday the King’s Fund put out a report saying that the Government—they can welcome this—are “on track” to meet their target of “50,000 extra nurses” by 2024. However, the King’s Fund points out that the level of vacancies is still the same as it was when that promise was made. Just plucking figures out of the air and going, “Hey, we’ve got this great figure”, is not enough; we need to plan for the future. That is why this amendment is absolutely crucial for our NHS.

[Baroness Harding of Winscombe (Con)]

My Lords, I rise very briefly to speak to Motion A1. I will first thank my noble friend the Minister for his fantastically collaborative approach on the Bill. I am particularly delighted to see the Government’s proposals on reconfigurations, so I thank him very much for them.

On workforce, I fear that there is almost nothing more to be said. Throughout the passage of this Bill, at every stage in this House and across all sides, we have all been clear that if we do not resolve the workforce issues—the people issues in the NHS—everything else is for naught. Yet we come to end of this process and there have been no changes at all. It is with great sadness that I speak today because I feel that, despite the great work that has been done and all the best intentions, things will not improve. I would love to believe that I am wrong, that my noble friend the Minister is right and that the workforce elements of the Bill are sufficient, but I am afraid that the evidence of the last 20 years is that they are not.

[Lord Blencathra (Con)]

My Lords, I support Amendment 48C in lieu, and what an extraordinary amendment it is. The Government have accepted, for the first time, that they must make—and will make—regulations

“eradicating slavery and human trafficking in supply chains”.

This is an extraordinary turnaround, and I congratulate my noble friend the Minister and the Secretary of State, Sajid Javid, on it.

However, the real hero here is the noble Lord, Lord Alton of Liverpool. In every relevant—or even vaguely relevant—Bill we have considered in this Parliament, he has sought to pass an amendment or new clause tackling genocide or slavery in Xinjiang province. Every time, his amendments have been rejected on the absurd notion that only an international court can decide on genocide. He has articulated again and again the terrible abuses of the Uighurs in China: forced labour camps, sterilisation of women—that is slow-motion genocide—systematic rape, murder and torture. He has called for us not to trade with any company making anything which emanated from such slave labour, either in China or anywhere else in the world. His persistence has paid off and, aided by my right honourable friend Iain Duncan Smith in another place, the Government have now produced this amendment in lieu.

At this moment we have no idea what a change this will bring about. It may seem a small start now but I care to bet that in, say, 20 years’ time, historians will point to this amendment and the campaign of the noble Lord, Lord Alton, and say that it has changed world history. I will press my noble friend the Minister on the timescale here. I hope we will have the regulations on the statute book within about 12 months and will not have to engage in the formerly proposed and rather convoluted 18-month consultation system with everyone under the sun around the world. Indeed, the Secretary of State announced last week that he was banning CCTV cameras from Hikvision, a company with close ties to the Chinese Communist Party. I assume he did that without extensive consultation.

My noble friend the Minister probably cannot answer this, but I hope that the promised procurement Bill will have equally strong provisions. Indeed, it will not get through this House unless it mirrors what the Secretary of State has done here. There can be no back- sliding now.

In conclusion, and in addition to once again congratulating my noble friend Lord Alton, I wish to praise my right honourable friend Secretary of State Javid, who—if I may say so without being patronising—is turning out to be rather good. I tried amendments on single-sex provision in NHS hospitals and the Secretary of State has now urged NHS trusts to do it. I say to him, “Don’t urge them, Secretary of State—make them do it. You must re-write Annexe B and protect women.”

He has also rightly demanded a review of the consequences of children having their sex changed on the basis of inadequate evidence. As he points out, the zealots in the militant trans lobby who are marching children through the sex-change machine could be committing child abuse. That is the real conversion therapy that needs to be banned. It looks like we may have someone sensible in charge of the DHSC. The Motion moved by my noble friend tonight proves that and I commend it once again.

[Lord Alton of Liverpool (CB)]

My Lords, it is a great pleasure to welcome government Amendment 48C. To see an amendment committing the National Health Service to the eradication—that word “eradication” is amazing in itself—of slavery and human trafficking in NHS supply chains is as welcome as it is remarkable. This becomes like a mutual admiration society, but I take this chance to thank my noble friend Lord Blencathra and pay tribute to him for the work he has undertaken to secure this amendment; we have become good friends in the course of this amendment and other fights on these issues as the years have gone by.

I also want to reference the work of the Bill team, who my noble friend and I met yesterday along with the Minister. I pay tribute to them for the work that they have done; they have gone an extra mile. I also thank the Minister himself and the noble Earl, for helping us with his advice in earlier stages; it was candid but helpful, and I appreciate that. I thank the Secretary of State, who has been referred to. There is no doubt that this is not just another issue as far as he is concerned; he is deeply committed to it. He does not want to be the Secretary of State presiding over a National Health Service accused of purchasing goods made by slave labour in places such as Xinjiang.

I also pay tribute to the charities and NGOs that have campaigned for this—not least the charity Arise, of which I am a trustee, and its chief executive Luke de Pulford. Serendipitously, it held a reception here attended by some noble Lords who are in the Chamber tonight, including government Ministers, a former Minister and other Members from all sides. The reception included speeches from Sir Iain Duncan Smith, Sarah Champion and Danny Kruger, underlining the bicameral, cross-party and no-party support for this amendment.

The Minister knows that I have two short questions for him about the amendment. One concerns a point raised by my noble friend Lord Blencathra about the timetable for laying the regulations and seeks his assurance that nothing is being done—such as further reviews or consultations—to kick this down the road. I do not believe that that is the case but I would love to hear it from the Dispatch Box. Secondly, the amendment gives power to the Secretary of State to assess the circumstances in which the amendment will be implemented. As the Minister knows, I would like an assurance that the reference to the word “appropriate” in the amendment could never be used to frustrate the decision of Parliament to achieve the central objective of the amendment; that is, to eradicate slavery from the supply chains.

May I also press the Minister on two other related issues? They relate to the purchase of goods from a state that was, after all, described by the Foreign Secretary herself, Elizabeth Truss, as one committing genocide. The Minister knows that the Government continue to use, in his words, commercial sensitivity in answering questions about the loss of UK taxpayers’ money on faulty PPE and addressing legitimate questions involving transparency and accountability. The Minister has confirmed to me—I quote him—that

“the Department’s Anti-Fraud Unit received referrals from varying sources on 37 contracts.”

As recently as 7 April, the Minister told me:

“The Department is committed to transparency and a total of funds recovered may be published in future.”


I wonder whether the Minister can tell us when we will get to a point when publication will be allowed.

21:30

Secondly, in total, some £10 billion—the size of our entire depleted budget for overseas aid and development throughout the entire world—has been paid to the People’s Republic of China on PPE. That same amount of money could have been used to improve quality of life, save lives and reduce our dependency on the Chinese Communist Party—a point that the noble Lord, Lord Blencathra, and I have made on a number of occasions. It also could have been used to enhance the national resilience of this country, not least if we face another pandemic.

Only yesterday afternoon, a letter was issued by the Biometrics and Surveillance Camera Commissioner, Professor Fraser Sampson. He wrote to all government departments praising Sajid Javid’s decision to prohibit

“any further procurement of Hikvision surveillance technology”

by the Department of Health. Can the Minister confirm that existing cameras in his department are being stripped out? It has been reported that they are.

Like the amendment, these actions demonstrate on the procurement of PPE and other commodities coming into the NHS. I want to ask one other question of the Minister. Professor Sampson expressed concern about what he called

“clear ethical and human rights issues involved in public procurement of surveillance technology from companies associated with atrocities in China.”

He says that, eight months after asking Hikvision to address shocking allegations, it has failed to answer his questions. There are more Bills coming: there will be a new modern slavery Bill and a procurement Bill. As my noble friend said, there will also be an opportunity for more amendments. However, it would be helpful to know this evening whether this excellent amendment will be used as a yardstick when it comes to framing other putative legislation.

[Baroness Walmsley (LD)]

My Lords, I begin by welcoming Motion B, which puts in place government Amendments 30C to 30K, laid in another place. They relate to the Secretary of State’s role in major NHS reconfigurations and are a credit to the Minister, his ministerial team and the Bill team. They have listened to the strong arguments from across this House, led so ably by the noble Lord, Lord Stevens of Birmingham, who is unable to be with us tonight. I thank the Minister for agreeing—eventually—that the powers originally proposed in the Bill were excessive, disruptive and unnecessary.

Unfortunately, we have not had such a fruitful consensus on the matter of workforce planning. We do not agree with the Commons that our workforce amendment, Amendment 29B, was unnecessary because appropriate measures already appear in the Bill. If that were so, and if the sector had had confidence in the Government’s track record in planning for adequate and safe staffing levels in health and care services, we would not have had more than 100 organisations backing our earlier attempts, led so well by the noble Baroness, Lady Cumberlege, to put in place a mandatory system for reviewing the available workforce and predicting what will be needed in future. However, here we are, with the Government having set their face firmly against any compromise on or serious discussion about the matter. One has to ask what the Government are afraid of.

Any effective workforce strategy must be based on reliable information, be regularly refreshed and have numbers in it. This House and the whole sector have no confidence that what the Government are proposing will do that. I understand that the Treasury has had a hand in the Secretary of State’s determination to just say no. Perhaps the Treasury is unwilling to foot the Bill, which will prove to be essential when all is revealed.

I put it to the Minister one last time that our proposal would be cost-effective. Staff shortages are a false economy. Missing staff are often replaced by very expensive locums and agency staff, and the stress of unsafe staffing levels causes valued staff to leave the service. Training and recruiting staff to replace them also costs money. High staff turnover is not an effective strategy for any business or service, and poor treatment for patients often has to be done again or leads to greater and more expensive needs further down the track. No efficient shopkeeper would fail to do a proper stocktake or take account of what people are buying and therefore what he needs to order to replenish his stock—but that is what the Government are doing if they fail to plan effectively for safe staffing. It is much more serious than empty shelves, because it is playing with people’s lives, as was recently demonstrated so clearly by the Ockenden report.

If the Government are determined not to carry out the reviews and consultations in Amendment 29D, I would like to ask the Minister whether they would be happy for some other organisation, such as NHS England, to do so and whether they will take note of the results of that investigation. Amendment 29D from the noble Baroness, Lady Merron, in Motion A1, is not a silver bullet; it will not solve the current staffing crisis in the NHS and care services. But it would provide a strong foundation for future safe and cost-effective staffing, which would be to the benefit of the whole population. It is our duty to ask the Government to think again—again.

[Baroness Wheeler (Lab)]

My Lords, in closing the debate before we hear from the Minister, I make no apology for concentrating on social care, on how the care cap is to be implemented, and on my Motion D1, which implores the Commons to think again on this vital issue. I thank noble Lords who have given their strong support to Motions A1 and D1.

I wish to reinforce the key point that, from the outset, social care and Parliament have been treated pretty shabbily as part of this Bill. It is essentially an NHS Bill. As we know, the social care cap and charging arrangements were added to the Bill in the Commons, with no notice and after the Bill had finalised its Committee stages, and were then pushed through, without any opportunity for full explanation, scrutiny or time to consider the impact on the hundreds of thousands of people who are desperately in need of social care and support and will not receive it under these proposals. We later also had the money-saving bombshell announcement of local authority contributions not being allowed to accrue against the care cap, which was designed to achieve savings on the Government’s original package—even before any form of scrutiny of the Bill had commenced—that will be at the expense of some of the country’s poorest and most vulnerable people.

As noble Lords have pointed out, in reality, we in the Lords Chamber have had little actual time to consider and debate these vital social care provisions, despite many hours and days being spent overall on a long and complex Bill. Worst of all, we had the blank refusal by the Government to discuss or address any of the concerns and issues expressed or put forward by noble Lords from all sides of the House, with their deep expertise and knowledge across social care, or the detailed and painstaking evidence and modelling work undertaken by key stakeholders, such as Age UK, Mencap, the Alzheimer’s Society, and the King’s Fund, Nuffield Trust and Health Foundation expert think tanks. We have instead been told that Ministers have done their best to explain their proposals, but they have absolute red lines against making any changes whatever. Is this what must now pass for parliamentary dialogue, scrutiny and debate?

For the record, I will underline some of the key reasons why opposition to the Government’s proposal for the cap implementation is so clear and strong. The cap level and implementation strongly favour the better off and would bring almost nothing to the worst off. This is unfair and the opposite of levelling up. Older people and those with modest means all fare badly under the Government’s charging proposals.

Even the Government’s own impact assessment admits that only 10% of working-age disabled adult care users will benefit, that one in five older people will not see the benefits of the cap and that poorer care users are much more likely to die before they reach the cap than others with the same care needs. Among older people, those in the north-east, Yorkshire, Humber and the Midlands will be worse off. For dementia sufferers regionally, just 16% of people in the north-east and 19% in the east Midlands would hit the cap, compared with 29% in the south-east. The overall figure, as a result of disallowing local authority contributions towards the cap, is that only 21% of people living with dementia would reach it.

The mountain of evidence produced by stakeholders and think tanks shows that social care is not being fixed, as the Government continue to try to have us believe. The “nobody will have to sell their home” promise is firmly debunked, too, despite the Government desperately clinging on to it; it is a hollow and false claim. Somebody with assets of £100,000 will lose almost everything, while someone with assets of over £1 million will keep almost everything. How can this be the fair plan that the Minister insists it is?

The reality is that, as the Government holds to their solid red line, their arguments just do not stand up but get weaker by the minute. The Minister argues that his is the only affordable plan, but, if that is the case, why do the £90 million of savings have to be paid for by those who can least afford it, and why are there not better plans to protect those with fewest assets?

Local authority care contributions counting towards the cost are presented by the Government as unfair. Instead, they insist that setting the cap at the same level for everybody,

“no matter their age, where they live in the country or the nature of the care and support they need to draw on”,—[Official Report, 5/4/22; col. 1986.]

is the fairest system. Is that not also the opposite of how levelling up should work?

The argument that no one will be worse off than under the current system is just not borne out by the overwhelming evidence from the stakeholders and think tanks. The contention that the Government are reforming and changing the system where previous attempts have failed just is not true. There was cross-party agreement on the implementation of the Care Act after detailed scrutiny of the Dilnot proposals, and it was this Government who failed to implement it. I remind the House, as someone who was heavily involved in the scrutiny of that Bill, that there was no mention of the Care Act provisions being unaffordable when the Act and its implementation proposals were agreed in 2014.

On working-age adults, as the noble Baroness, Lady Campbell, has again forcefully underlined, the Government’s proposals will mean that they remain trapped in poverty. The Minister’s previous reference to the uprated social security benefits that they will receive instead under the minimum income guarantee completely missed the point of how social care needs have to be supported.

Ministers have doggedly stuck to their responses, without either acknowledging or addressing these clear counterarguments and evidence. My Motion again reinforces the key issues that we have tried all along to get the Government to respond to: the importance of implementing the care cap under the consensus provisions of the Care Act, and ensuring that local authority care costs are allowed to accrue towards the cap to avoid the huge unfairness that not doing so will cause to key groups in need of social care.

Finally, we want to make sure that the Government’s much-vaunted but little-explained trailblazer pilots are completed before regulations on the cap are agreed, as well as including the analysis of the impact on regional eligibility and the effect of the cap on working-age disabled adults under 40 with eligible care needs. Is this not both sensible and fairer to the key groups who stand to lose so much under the Government’s proposals? Why is this so difficult for the Government to agree to? I referred to “little-explained pilots”, but I did receive a letter three hours ago from the Minister, for which I thank him, setting out information about the pilots that in fact adds very little more than the DHSC press release in March and also shows that they will not be evaluating the key areas of impact that my Motion calls for.

I will also add that I have seen recent government claims in the media that deleting the social care cap arrangements in the Bill would jeopardise the whole Bill. I emphasise that that is not so. In their place we would instead have the rest of the Bill and the Care Act 2014 provisions, which would form the basis for moving forward quickly and implementing the cap in a much fairer and more inclusive way that would benefit many more people in desperate need of social care support.

I hope that even at this late stage the Government will listen, address the overwhelming concerns and evidence from all the stakeholders and experts on social care services and delivery and accept my Motion as the best way forward.

[Lord Kamall (Con)]

I thank all noble Lords who have spoken in this debate. I will turn to the issues as briefly and succinctly as I can.

On workforce planning, I hope I can assure noble Lords that we will engage with stakeholders on the preparation of the report, which will include the regulated workforce in health, social care and public health. I hope your Lordships also understand the work being undertaken by the Government, NHS England and Health Education England to improve workforce planning and to lead the improvements we all seek. This is why we think the amendment is unnecessary. I also remind noble Lords that at local level there is an incredible amount of local planning going on much closer to the ground.

21:45

I turn to reconfigurations. This power will ensure that decisions made in the NHS that affect the general public in England are subject to democratic oversight. I thank noble Lords across the House for their support and the fact that we are going to listen to local voices at the heart of decisions.

On modern slavery, I thank the noble Lord, Lord Alton, and my noble friend Lord Blencathra. It is right that the Government take action by identifying, mitigating and tackling the crime of modern slavery and human trafficking. Sometimes when we discuss these issues we find that legal arguments get in the way, but in this case the legal arguments worked in our favour because “avoid” could mean turning a blind eye to modern slavery, whereas “eradicate” means working with suppliers and saying to them, “Unless you change your practices, we will not buy any more stuff from you.” So, in fact, the lawyers have been our friends in this case—I wonder how often that is said.

The ambition is 12 to 18 months; we want to get this done as soon as possible, not to kick the can down the road. Both my right honourable friend the Secretary of State and I are personally committed to this, and we are incredibly grateful to the noble Lord, Lord Alton, my noble friend Lord Blencathra and Iain Duncan Smith for pushing us and being persistent on this.

I turn to Amendments 80, 80P and 80Q, as well as 80S and 80T. We ask that noble Lords reject these amendments and accept Amendments 80A to 80N instead. The cap on care costs clause is key to the Government ending the unpredictable care costs for everyone at the moment by introducing a universal £86,000 cap. It must stand part of the Bill, alongside the further necessary Amendments 80A to 80N. The elected House agrees with our proposals, having once again voted overwhelmingly in favour—with an even greater majority than when this matter was last considered.

Finally, I must reiterate that Amendments 80, 80S and 80T would all affect the financial arrangements to be made by the other place and will cost the taxpayer not £90 million extra a year but almost £1 billion— £900 million a year—by 2027-28. As such, they have financial privilege. There is no cap at the moment. Our proposals bring predictability: more people will receive support, have to spend less each week and keep more of their savings. Let us grasp this opportunity.

I also remind noble Lords that at the beginning of the consultation we had an open meeting with the Minister for Care, Gillian Keegan, to answer all questions, including on the cap and the metering. Please let us grasp this opportunity or we could be waiting for another proposal. This proposal could wait, gathering dust on shelves for many years to come, like previous proposals. Let us grasp the opportunity and have the courage to address social care. I ask that noble Lords support our amendments.

[Baroness Merron (Lab)]

My Lords, in opening this debate, the Minister said that Motion A by and large did the job that Motion A1 seeks to do. I beg to differ, and so do more than 100 key organisations that work day in, day out on health and social care. Unless we plan and prepare to have the right workforce in place, it will continue to be the case that we do not have the right workforce, so what is happening now will simply continue. We will not be sure of safe staffing levels, nor have the people in place to give the levels of service that mean patients do not have to continue to suffer long and painful waits.

I remain deeply disappointed that on workforce, a central pillar of how we run our health and social care services, the Government have refused to even discuss this matter. I ask the House to agree to Motion A1.

21:49

Division 9

Ayes: 169

Noes: 204

22:03

Motion A agreed.

Motion B

Moved by

[Lord Kamall]

That this House do not insist on its Amendments 30B and 108B, to which the Commons have disagreed; and do agree with the Commons in their Amendments 30C to 30K in lieu.

30C: Page 197, line 27, after “a” insert “notifiable”

30D: Page 197, line 28, at end insert—
“(2) For the purposes of this paragraph a reconfiguration of NHS services is “notifiable” if it is of a description specified in regulations.”

30E: Page 197, leave out lines 29 to 33

30F: Page 198, line 3, after “may” insert “, within the period of 6 months beginning with the date of the direction,”

30G: Page 198, line 17, at end insert—
“(3A) The Secretary of State must, before acting under sub-paragraph (2), give each of the following an opportunity to make representations to the Secretary of State in relation to the proposal—
(a) the NHS commissioning body,
(b) if the NHS commissioning body is an integrated care board, NHS England,
(c) each local authority (within the meaning of section 2B) to whose area the proposed reconfiguration of NHS services relates, and
(d) any other person that the Secretary of State considers appropriate.”

30H: Page 198, line 19, after “(2)(a)” insert “together with an explanation of the reasons for taking it”

30I: Page 198, line 20, at end insert “and the reasons”

30J: Page 198, line 20, at end insert—
“(5) The Secretary of State must publish a summary of any representations made under sub-paragraph (3A).”

30K: Page 198, line 34, at end insert—
“(2) The Secretary of State must publish any direction under this paragraph, together with an explanation of the reasons for giving it.”

Motion B agreed.

Motion C

Moved by

[Lord Kamall]

That this House do not insist on its Amendment 48B, to which the Commons have disagreed; and do agree with the Commons in their Amendment 48C in lieu.

48C: Page 64, line 38, at end insert the following new Clause—
“Eradicating slavery and human trafficking in supply chains
(1) The National Health Service Act 2006 is amended as follows.
(2) After section 12ZB insert—
“12ZC Eradicating slavery and human trafficking in supply chains
(1) The Secretary of State must by regulations make such provision as the Secretary of State thinks appropriate with a view to eradicating the use in the health service in England of goods or services that are tainted by slavery and human trafficking.
(2) The regulations may, in particular, include—
(a) provision in connection with the processes to be followed by public bodies in the procurement of goods or services for the purposes of the health service in England (including provision as to circumstances in which a supplier is excluded from consideration for the award of a contract);
(b) provision as to steps that must be taken by public bodies for assessing and addressing the risk of slavery and human trafficking taking place in relation to people involved in health service supply chains;
(c) provision as to matters for which provision must be made in contracts for goods or services entered into by public bodies for the purposes of the health service in England.
(3) In this section—
“health service supply chains” means supply chains for providing goods or services for the purposes of the health service in England;
“public body” means a body exercising functions of a public nature;
“slavery and human trafficking” has the meaning given by section 54(12) of the Modern Slavery Act 2015;
“tainted”: goods or services are “tainted” by slavery and human trafficking if slavery and human trafficking takes place in relation to anyone involved in the supply chain for providing those goods or services.”
(3) In section 272 (orders, regulations, rules and directions), in subsection (6), after paragraph (zze), insert—
“(zzf) regulations under section 12ZC,”.”

Motion C agreed.

Motion D

Moved by

[Lord Kamall]

That this House do not insist on Lords Amendment 80 in respect of which the Commons have insisted on their disagreement; do not insist on its disagreement with the Commons in their Amendments 80A to 80N in lieu; and do not insist on its Amendments 80P and 80Q instead of the words so left out of the Bill to which the Commons have disagreed for their Reason 80R.

80R: Because the Lords amendments and the disagreements by the Lords to Commons amendments could affect financial arrangements to be made by the Commons, and the Commons do not offer any further reason, trusting that this Reason may be deemed sufficient.

[Lord Kamall (Con)]

I have already spoken to Motion D. I beg to move.

Motion D1 (as an amendment to Motion D)

Moved by

[Baroness Wheeler]

Leave out from “House” to end and insert “do insist on Lords Amendment 80 in respect of which the Commons have insisted on their disagreement; do insist on its disagreement with the Commons in their Amendments 80A to 80N in lieu; and do not insist on its Amendments 80P and 80Q instead of the words so left out of the Bill to which the Commons have disagreed for their Reason 80R, and do propose Amendments 80S and 80T in lieu—

80S: After Clause 139, insert the following new Clause—
“Cap on care costs for charging purposes
(1) The Secretary of State may by regulations amend the Care Act 2014 as regards how “costs accrued in meeting eligible needs” for the purposes of section 15 of that Act are to be determined.
(2) The regulations must ensure that any costs incurred by any local authority to meet eligible needs are included within that determination.
(3) The regulations may not be made unless—
(a) an evaluation of the results of the Trailblazer pilot schemes has been completed, which takes account of regional eligibility and the effect of the care cap on disabled adults who have or have had eligible needs under the age of 40, and
(b) the Secretary of State has laid that evaluation before Parliament.”

80T: Clause 150, page 128, line 20, at end insert—
“(ca) regulations under section (Cap on care costs for charging purposes);””

[Baroness Wheeler (Lab)]

My Lords, time is short. The Minister has once again failed to respond to the evidence and the concerns that have been so forcefully expressed throughout the passage of the Bill. I wish to move Motion D1 and test the opinion of the House.

22:04

Division 10

Ayes: 160

Noes: 196

Motion D agreed.