Health and Care Bill

Baroness Bakewell Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Hollins (CB)]

My Lords, it is a pleasure to follow the noble Lord, Lord Bradley, and I support those amendments with respect to mental health. My Amendments 27 and 39 would provide for the addition of an expert in learning disability and autism on each integrated care board and ensure that the learning disability and autism lead was a person with knowledge and understanding of what good health and support look like for people with a learning disability and for autistic people.

As a starting point, this proposal has already been pledged by the Government in both the NHS long-term plan and the autism strategy, the latter stating:

“We also expect that all Integrated Care Boards, which will be established by the proposed Health and Care Bill, will focus on autism and learning disabilities at the highest level, for example by having a named executive lead for autism and learning disability.”


The reason for the Government’s firm commitment is that people with a learning disability and autistic people are among those who stand to benefit most from the integrated approach that the Bill seeks to implement. These are people whose needs frequently span health and social care systems. They are one of the largest recipient groups in terms of cost of health and social care provision and therefore a cohort with one of the greatest stakes in the effective integration of these two systems.

People with a learning disability experience huge health inequalities—very relevant to discussion on the first group of amendments today. On average, the life expectancy of men and women with a learning disability is 14 and 18 years shorter than for the general population respectively. Thirty-eight per cent of people with a learning disability die from an avoidable cause as against only 9% in the comparison population. These inequalities have been hugely exacerbated during the pandemic, with death rates of up to six times higher than among the general population, according to Public Health England. People with Down’s syndrome were identified as being at as high a risk as the over-80s. Yet they have had inappropriate DNACPRs put on their hospital records without their consent and had catastrophic reductions in care and support during the past two years, which will take years to recover from. There has been much greater reliance on family carers, who are too often dismissed as difficult by poorly trained health and social care decision-makers.

It is not learning disability and autism that are the cause; it is the situation that they are in as a result of ineffective plans and ineffective responses to their needs. Learning disability and autism, as well as foetal alcohol spectrum disorder—a much underdiagnosed and poorly understood condition but related to the groups I am speaking about—are lifelong states of being, but they are unequal states of being. Having a learning disability or being an autistic person is not like having cancer. People with learning disabilities and autistic people also get cancer; they also have a much higher prevalence of mental health problems.

The work I am overseeing for the Department of Health and Social Care places the major responsibility for inappropriate and lengthy detentions in long-term segregation under the Mental Health Act at the door of commissioners. It is a commissioning failure in the main. Some commissioners have relied on the availability of crisis admissions rather than collaborating to develop essential community services, including housing and skill support, social prescribing of meaningful activities and other innovative wellness approaches.

This is an urgent appeal to the Government to clearly signal a requirement for competent and accountable commissioning for people with a learning disability and autistic people. There is a lot of money being wasted at the moment through very poor commissioning. Please can we get it right this time?

[Baroness Bakewell (Lab)]

My Lords, before I address my Amendment 28, giving my support to my noble friend Lady Thornton, I wish to endorse the other amendments that are calling for representatives of particular groups—we just heard mention of two. I particularly endorse all those, especially as I am taking rather an oblique approach to this debate, which is not reflected in the other amendments.

Last year, there was a report in America that, increasingly, hospitals there were closing. The report said that hospitals were seen as businesses; a fifth of hospitals in America are run for profit, and globally, private equity investment in healthcare has tripled since 2015. In 2019, some $60 billion were spent on acquisitions. Globally, that includes—indeed, targets—us and the NHS. Where does that affect us? Increasing inroads are being made into the National Health Service by Centene and its subsidiary Operose, which now own 70 surgeries around this country. From Leeds to Luton, from Doncaster to Newport Pagnell, from Nottingham to Southend and many more, Centene now owns and runs for profit surgeries formerly owned and run by NHS doctors. It is now the biggest single provider of GP surgeries in this country. It has further designs on the existing fabric of the NHS, seeking to have its representatives sitting on the boards of CCGs, making decisions about the deployment of NHS funding. This is a direction of travel that needs to be monitored and checked. Safeguards must be written into the Bill against this takeover.

Why does it matter, just as long as patients have good and free treatment at the point of need? What is the reputation of Centene in America? It is not good. Indeed, it is regularly embroiled in lawsuits from either patients or shareholders, and the sums are not small. In June last year, Centene had to pay a fine of $88 million to the state of Ohio for overcharging on its Medicare department. This is one of many. Since 2000, there have been 174 recorded penalties for contract-related offences against Centene and its subsidiaries. That enterprise is now active in this country and targeting our NHS. It is not a fit company to be part of our health service. I therefore ask the Minister for safeguards to be written into the Bill against such people being represented on our boards. When I raised this at Second Reading, the Minister replied that there was no chance of us selling the NHS. We do not need to: they are buying us.

[Lord Davies of Brixton (Lab)]

My Lords, I will not detain the Committee in speaking to my Amendment 30. In truth, I am speaking in favour of my noble friend Lady Thornton’s Amendment 29. I could claim that my amendment has the virtue of being shorter but perhaps brevity is not always a virtue. Amendment 29 also makes the important point that it is the sub-committees and committees of the ICBs that will be crucial. The substantive point is that the Government have to accept that the amendment agreed in the Commons is totally inadequate. It depends on matters of judgment. We want a clear specification of who is appropriate to be a member of those bodies.