Health and Care Bill

Debate between Baroness Bakewell and Baroness Hollins

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.

Pensions Bill [HL]

Debate between Baroness Bakewell and Baroness Hollins

Wednesday 30th March 2011 Lords Chamber

[Baroness Bakewell]

My Lords, I support the idea that these changes to the pension age are going too fast. There was a successful film recently called “Made in Dagenham”, which helped to bring home to a new generation of women how much the gender equality gap had changed. It pointed up the distance that women have come today from what they called the bad old days of discrimination. Look at us today, the film said; we enjoy much greater equality, and now we have the law on our side to back us up. Barbara Castle featured in the film, brilliantly played, and she was feisty in her defence of equality for women. The film assumed that the audience who saw it would feel that the story was complete and that equality was an accepted part of our society.

Therefore, it is sad to see a necessary piece of legislation going through that harps on the idea that women will just have to put up with this new piece of discrimination. Half the population of this country are highly tuned to notice what happens to women and the disadvantages that are placed on their lives. Women have more complicated lives than men, as we know; they take time out to have children, to nurse older people and to create stable households—an ideal that I know the Government hold precious. Women therefore need consideration in the pattern of their lives that the amendment seeks to improve.

Bringing in this change to the pension age is extremely important; it is evident that we are an ageing population and we will all of us have to work longer. It is the method by which we bring that about that calls for nuance. Nobody is challenging the fact that we are getting older. Nobody is challenging the fact that, as the noble Lord said, men have been disadvantaged. We do not want them to be disadvantaged; we want people to be treated fairly and equally, and we want gender-free legislation.

This legislation is not gender-free. It cannot be said too often. My colleagues on these Benches have said so already. Listen to the numbers: one-third of a million women will see their state pension age rise by 18 months. Thirty-three thousand will see it increase by two years. It is not just those women who are affected by this but their children, families, neighbours and other women. Women are very aware of legislation that goes against them. It is unfair—we can see that it is. Women are being penalised out of the blue because the Government are rushing forward with pension proposals that need slower and fairer introduction.

One of the Government’s flagship aspirations is to get people to show a greater personal responsibility. That is an excellent thing but how can people do that—how can they plan for their old age, which will take a lot of complicated financial arranging as people live far longer—in so short a time? Indeed, as people age and begin to look forward to their retirement, they formulate attitudes towards it that are hard to change. They see it coming towards them; they make allowances for the time it will give them to look after their own, by now very aged, parents. They may feel they deserve to see a reward coming towards them for a life of hardship and trouble. I know people feel this because they write to me, as they do to my fellow Peers. They complain in their letters that it is an outrage.

This is not a matter of discrimination that will go on in the way that the film showed discrimination operating in the 1960s and 1970s and earlier. We know that this is a transition and one that is important. Of course we have to move to a fairer system. We will all work to 70 and things will eventually come right. However, is it legitimate to see them coming right at the expense of a group of poor and disadvantaged women, who somehow have to be sacrificed on the altar of this speedy operation? In this case there is an alternative.

[Baroness Hollins]

My Lords, I, too, am concerned about what the noble Lord, Lord McKenzie, described as disproportionate disadvantage. I am concerned about women, the great carers in our society—the people who care about the members of their family who are perhaps more vulnerable or dependent and need extra support. They are the people who, because they care so much, are willing to give up their time and perhaps work part-time. I belonged for a period to the Standing Commission on Carers. A survey was reported to the standing commission in its first year which found that the vast majority of family carers are indeed women. It found that when women care, they are more likely to work part-time or give up their occupation, and that men who cared did so extremely well but for fewer hours. Caring was much less likely to impact on their employment hours.

This change is being made too quickly and comes too soon. I acknowledge that, on the face of it, women live longer and that it is perhaps anomalous that their current pension age is lower. Yesterday I met the carers’ forum at the Royal College of Psychiatrists. It was made up of 12 people who represent carers of sons, daughters, partners and elderly parents with different mental health conditions. Some cared for somebody in their family with a learning disability or autism. The majority of them were women. I asked them how this change, and the speed of this change, would affect people in their position. They represent carers of people with mental health conditions, and they made some very important points quite forcibly.

They said that pension equality is fine, but that perhaps it should come into effect when society is more equal—when women start getting equal pay and occupational pensions, and particularly when men begin to share the caring burden more equally. They support the right of carers to work; they recognise the role of work as respite. They wanted me to stress the importance of not underestimating the effect on carers of a rapid change in their pensionable age when they might have made decisions about caring and occupation in anticipation of an earlier pension age. They talked about the need for health and strength to be an effective carer and the insidious nature of caring—the way in which it can lead to so much tiredness and often depression. They said: “Adrenalin keeps us going when we are caring. But sometimes when our caring responsibilities end, that is the moment when we ourselves begin to experience health problems which we have been storing up during those caring years”.

These are people who have saved the country huge amounts of money through giving up their own occupation and their own time to care and support more vulnerable members of their families. I appreciate that, in a good carers strategy, it might well be that welfare reform will attend to carers’ needs. What they would have liked as carers is a flexible pension that took account of individual need rather than assuming the same age was right for everybody. However, I support these amendments. The speed of change is too rapid particularly for this very vulnerable group, who represent a significant number of people if it is true that as many as a sixth of this particular age group are at the moment affected or carers, as the noble Baroness, Lady Hollis, suggested.