Covid-19: Personal Protective Equipment

Baroness Barker Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

I completely agree. I utterly reject the suggestion that British manufacturers are incapable in this area. I share with my noble friend, though, that this is a low-margin, high-volume game, and those low-margin, high-volume manufacturers are largely found in countries such as China, Turkey and Myanmar. That does not mean that we cannot do local manufacture. We have had 25,000 offers of support from businesses as of yesterday. We are processing those responses, and 175 are through to an advanced round. We have already had three companies deliver PPE goods to the NHS to help our hard-working NHS and care workers.

[Baroness Barker (LD)]

Has the Department of Health and Social Care raised with the Treasury the issue of care homes having to pay VAT on PPE, which the NHS does not?

[Lord Bethell]

The noble Baroness raises a good point. I do not know the precise answer and would be glad to write to her with a clear answer.

Covid-19: Social Care Services

Baroness Barker Excerpts

Thursday 23rd April 2020 Lords Chamber

[Baroness Barker (LD)]

My Lords, I thank the noble Baroness, Lady Wheeler, for this opportunity to hold the Government to account. I return to a point I made during the emergency legislation debate on 26 March on the difference between the NHS and local government. The NHS is a top-down, centrally driven organisation which, remarkably, was able almost overnight to change everything it did and to focus on the medical emergency caused by the pandemic. Local government is much more complicated and fragmented, is dealing with a care system that was already broken, and is having to keep other vital public services going at the same time. Therefore the Government need to treat it differently.

The Government are issuing detailed guidance for social care, but it changes nearly every day. Local government and care providers need clear messages, delivered in good time, and quick responses when things do not work. For example, the testing sites are just not working in the way envisaged. The Government should now start to work with local authorities and local resilience forums to plan and roll out a series of accessible testing sites, so that people can get to them and we can get the testing numbers up.

Some 750,000 people applied to volunteer for the NHS, which has never managed volunteers terribly well. Most of them are not being used. People who signed up to GoodSAM need a clear message that they can and should volunteer via local resilience forums and local authorities. The NHS needs to start telling local authorities how many people in their area are signed up to GoodSAM and who they are, so that they can get on to the job of supporting vulnerable people in the community.

On 18 April, the Secretary of State announced a further £1.6 billion of funding for local government and described the people working in it as the unsung heroes at the forefront of the national effort to beat the virus, but £3.2 billion will not cover the costs which local authorities will have incurred during these four months, nor their loss of income. The pandemic will have a much longer tail for local government than it has done for the NHS. Will the Government now start to plan the transfer of funds and other resources from acute health services to local authorities and communities, which will struggle to deal with the effects of this virus long after the NHS has completed the majority of its work?

Covid-19: Care Home Deaths

Baroness Barker Excerpts

Wednesday 22nd April 2020 Lords Chamber

[Lord Bethell]

I echo the noble Baroness’s timely comments on the role of BAME workers, many of whom have provided an amazing service and put themselves in harm’s way to care for those who are vulnerable. The idea that they are being disproportionately hit by this disease is extremely distressing. The numbers are not to hand so I cannot share precise numbers at the moment, but we are looking into this at speed and trying to understand the causes and the impact of this awful phenomenon. I commit to bring those numbers to the House as soon as they are available.

[Baroness Barker (LD)]

I have heard about a care home which lost one-third of the residents in one weekend. It is that bad. I am told that the Clipper system for ordering PPE is not working and consequently homes are having to try to source PPE by their own independent means and, unlike the NHS, they have to pay VAT on those expensive items. That will push some organisations that were already fairly vulnerable over the edge and they are going to close, so what are the Government going to do to stop that?

[Lord Bethell]

The noble Baroness is entirely right to raise the question of PPE. Looking into the medium and long term, there is undoubtedly going to be a massive demand for PPE in hospitals, care homes and the wider workplace. That has put a dramatic pressure on global supplies. Britain, like every other country, is queuing for supplies of PPE. The Government are throwing enormous resources at increasing supplies. The Clipper system is one of the essential components of getting supplies into the workplace and I believe that is beginning to kick in and is working well.

Coronavirus Bill

Baroness Barker Excerpts

3rd reading & 3rd reading (Hansard) & 3rd reading (Hansard): House of Lords
Wednesday 25th March 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, on behalf of these Benches, I thank the Minister for the way he has conducted the Bill. It has been a perfect exercise in consultation and work across the House. I thank not just the parties but other noble Lords who have taken part in this Bill for co-operating and working together in a way that has allowed us to scrutinise it as best we possibly could. I think we raised every issue that we could during its passage. It is important to have those things on the record because, as we move forward, we will need to know that we have asked those questions, and the Government will need to address them.

I thank my team, particularly my noble and learned friend Lord Falconer, who got drawn into this about a week ago, and my noble friend Lady Wheeler. I also thank the people in the office, who of course do all the work. In our case, that is Rhian Copple, who has done a brilliant job in keeping us informed and on the go.

I thank all my noble friends and noble Lords who are not here, but who gave us their views and have been patient. I know that they would have wanted to be here.

[Baroness Barker (LD)]

My Lords, from these Benches I too thank the Minister, the Bill team and all the civil servants who have worked with them for the collaborative and inclusive way that they have conducted the Bill through this House. I thank Members on other Benches for their immense understanding and patience as at times we have had to rattle through some very difficult issues that normally, in other circumstances, we would not have dealt with in that way.

Coronavirus Bill

Baroness Barker Excerpts

2nd reading & 2nd reading (Hansard - continued) & 2nd reading (Hansard - continued): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Baroness Barker (LD)]

My Lords, I, too, pay tribute not just to the staff of the NHS, who are doing a truly wonderful job, but to the army of cleaners, drivers and shop assistants who are playing an incredible role in the most difficult of circumstances.

I start by echoing what my noble friend Lord Newby —and, to a certain extent, the noble and learned Lord, Lord Falconer of Thoroton—said about the need for scrutiny and for this House in particular to scrutinise legislation. Speaker after speaker has said that at any other time, this legislation would simply not pass.

It is extremely important that when the Government have to take extreme measures—and they do—they do so in an open way and that there is detailed discussion involving people who themselves have the relevant experience and information, or who have access to outside expertise, as do we in this House. That way, we will go beyond the level of a television interview. We need to deal with matters in great detail and be part of the information and education programme that will be necessary throughout all this, to ensure public support for and recognition of the need for extreme legislation.

Secondly, we must recognise that the Bill comes before us at a moment when we do not have large-scale testing programmes or vaccination, and that that has a direct effect on everything in it. If we have both in a few months—as I very much hope we will—life will be very different, and it will be important then to revisit some of the assumptions built into the Bill.

I want to make a point that may seem obvious, but nobody has yet said it today. When we talk about the NHS and local government, we are talking about completely different systems. The NHS is a centralised system which is largely run on a not particularly democratic basis; it is run more on the basis of expertise. It is a command-and-control system that enjoys a political standing in this country which practically no other body does. Local government is different. It is based on an open democratic procedure, with elected officials, and it does not, by and large, enjoy the same standing. Therefore, local government is, quite naturally, often very defensive and cautious, and for good reason—it gets taken to town by the Daily Mail quite frequently. We are suddenly expecting those two systems to function together in the same way. I go back to the point that my noble friend Lord Scriven made earlier, which may seem terribly technical but is in fact very important. There needs to be a general power of direction for local government, so that it can take the decisions that will have a bearing on the health and social care outcomes of its local population.

It is really interesting to see what, even in an emergency situation, government considers to be important and not important. Three things in the Bill are problematic. The first is the removal of the duty on local authorities to provide adult social care. Everybody understands that local government will go through the most massive transformation; it will never be the same again. It will probably have to reorientate everything towards this for years to come, and certainly for a year. However, to remove that duty completely is wrong, because from it flows not just the way in which vulnerable people are dealt with now, during the emergency, but the recovery process for local services and so on. It would be preferable if local government retained its relevant social care duties, but that their application was amended so that it was required to implement them only so far as is reasonably practical. As the noble Baroness, Lady Verma, said, domiciliary care is under immense strain. If local authorities do not make those investments now because they think they will not have the money, the impact on the NHS in a few months’ time will be even greater.

When I talk to local government colleagues, as I am sure we all do, they say that one of the big issues worrying them is indemnity for volunteering. The Bill refers to volunteering for a local authority only in relation to health and social care. It may well be that, just to fulfil the health and social care duties, local authorities will have to rely on volunteers to do all manner of other things, such as carrying out some of their environmental responsibilities. They are really bothered, because local authorities have traditionally spent an awful lot of staff time doing DBS checks because of the nature of what they do. We need not only a fast-track system—for example, not allowing somebody who has ever been barred to be checked—but a much faster system. We should also have an indemnity for a local authority that has to reconfigure very quickly a number of its central functions.

The other point that it is important to make at this stage is that, more so than the NHS, local authorities have had whole ranks of staff taken out. They have a few central managers, and front-line staff. They do not have very much; in fact, unlike in the NHS, most of their services are not provided in-house, so they do not have the ability to command or summon up capacity in the same way the NHS does.

We are expecting that charities will step into that breach, but that sector, as people heard during the debate on the Question answered by the noble Baroness, Lady Barran, this afternoon, is on a cliff edge. Charities do not run with great margins or large amounts of reserves, and they cannot quickly scale up on nothing. You cannot have an entirely voluntary workforce; volunteers need to be managed, which is a skill in itself. Can the Minister talk about the need for there to be grant funds—some via the NHS, some via local authorities, and some direct to charities—in order to build up that capacity?

The Government have taken drastic action in respect of the Mental Health Act. Mental health tribunals are now to be a single judge on a phone—if we are talking in that way, we ought to require them at least to be videophones—and the three-month treatment rule will be changed. I, along with organisations like Mind and Rethink Mental Illness, accept that in a time of great stress on the NHS we cannot run the system as we do now. However, there are misgivings about people being sectioned under Sections 2 and 3 of the Mental Health Act. Having taken away some very fundamental safeguards with regard to people being deprived of liberty and incarcerated, will the Government reconsider the length of time before which somebody can have their case reviewed and make it much quicker, so that anybody who has been detained by one doctor instead of two will automatically go to the front of the queue for a swift review?

Having said that, one thing that has caused much remark in the social care sector is that there is no mention at all here of the mental capacity legislation. There are two problems with that. First, in emergency medicine there is still a requirement to establish that somebody has mental capacity and to ascertain their wishes. I understand that, at a time like this, an A&E department will not be able to go through such a comparatively bureaucratic process, and that it is possible to do a simplified version of that just for these purposes.

The other, bigger, problem is that we will have lots and lots of very vulnerable people in care homes without access to any sort of representation, or even assessment. So I say to the Minister, and this is a very difficult admission, that the Government may wish to take out some of the bureaucracy and form-filling that was in the Mental Capacity (Amendment) Act, which some of your Lordships worked on. We should be requiring people who run homes to enable relatives at the very least to have some kind of contact—remote contact, telephone contact, or something like that—if it is not possible to go in and visit. To ignore this completely sends out a really bad message to people.

I fully understand the Government seeing the need to free up medical resources by going down to only one doctor. I imagine that across the NHS people are looking at ways to free up time for medical staff, cut down visits and make sure that people are not going on public transport unnecessarily. As the Minister knows, I am concerned about women’s access to early medical abortions. We already have an agreement in England, Wales and Scotland that women can take at home the second of the two pills that they need, provided that they have ongoing support and access by phone to a medical practitioner. I ask the Minister to consider whether women can have a telemedecine interview with the staff of a clinic. They could then very quickly get the medicines that they need and take them safely at home. I am not asking for any other change to the grounds on which that might be done. It is simply an administrative procedure, but it would make an enormous difference to the ability of women, most of them young, to receive that healthcare.

On the next point, I declare an interest: my brother is shortly to retire as a police officer—this week, I think—having served in the Greater Manchester Police for over 30 years. All the provisions in the Bill are about health and social care workers, particularly health workers, returning. All the issues about their pensions apply to other people in public service. I rather suspect that there may come a time when we need police officers who are not long retired to come back, not least because they are first responders, they have some medical training, and all of that. I do not think anyone else has mentioned this issue. It is not a personal plea on behalf of my family in any way at all; it is a genuine point.

On the provisions to review this legislation, it seems wrong that the Government are going to say that the Bill cannot be amended in future. That is a mistake, a point that was made by David Davis in the Commons. As I said, the Bill has been made now on existing knowledge, but the position may well be very different in three or six months’ time. Inevitably, some of the proposals that the Government have put in the Bill will turn out to have been necessary, but some will not. It would be in the Government’s best interests to retain the flexibility for this Bill to be amended in the light of experience. I hope I have demonstrated, as other noble Lords have, that we say this in the spirit of seeking to be helpful to the Government, not to attack them or to try to achieve any kind of political advantage, and I hope the Minister and his colleagues will reconsider.

The Government have said that there are various powers in the Bill and they will be switched on and off as necessary. That is potentially very confusing. Have the Government thought about having a website, a place to which anyone who has to refer to the Bill can go, with a rolling update on which provisions of the Bill were active and which were not? I can see a number of people who will have to try to make this legislation work having problems doing so.

That said, sadly the Bill is very necessary. We will work hard, and although we will, I hope, be back here, we will work smart and in different ways to provide ongoing scrutiny and to help the Government, and indeed the country, to get through these extraordinarily difficult times.

Covid-19: Critical Care Capacity

Baroness Barker Excerpts

Monday 23rd March 2020 Lords Chamber

[Lord Bethell]

My Lords, the decision by Northwick Park was entirely welcome, because we welcome the realism and practicality on the part of the management in seeking help when it is needed. We are moving at pace to address the issues around PPE, and I can confirm that there is a massive amount going into the system as we speak. We currently have 3,700 critical care beds; total usage is currently 2,428, of which 237 are Covid-19 related; and our ambition is to increase this dramatically to perhaps 30,000 in time for the crisis arriving in full.

[Baroness Barker (LD)]

My Lords, to increase the number of freelance locums working in the health system, will the Government make specific changes to the NHS Pension Scheme, in particular the death in service benefits, so that we can increase the number of qualified staff? Can the Minister also confirm that the Government are making sure that all GPs and pharmacists have sufficient stocks of asthma and COPD medicines to keep people out of hospital?

[Lord Bethell]

My Lords, we are greatly relying on an influx of staff such as freelance locums in order to increase the numbers at the front line in dealing with Covid-19. Arrangements for the pension scheme are included in the Bill that we will bring to the House tomorrow. On supplies to GPs and pharmacies, a huge procurement programme is going on at the moment, and we are taking stocks out of our no-deal preparations in order to ensure that both GPs and pharmacies are well stocked.

Covid-19 Update

Baroness Barker Excerpts

Monday 16th March 2020 Lords Chamber

[Lord Bethell]

On the provisions for those on zero-hours contracts, that is an area that is particularly knotty and difficult. It is absolutely the focus of the current negotiations on statutory sick pay and other provisions; it is one we care very much about getting right. As for the advice for those in the House of Lords, I cannot repeat the advice of the CMO more times than I have already. I very much hope that everyone will follow it.

[Baroness Barker (LD)]

My Lords, based on the models that the Government are using, can the Minister say when he thinks we will reach the peak transmission spike?

[Lord Bethell]

The situation is fluid. The CMO spoke about this in detail at the press conference. He is not speculating or giving an exact date, because the modelling is not as clear as one would hope it to be. However, it will certainly be within weeks, rather than months.

Mental Capacity (Amendment) Bill [HL]

Baroness Barker Excerpts

Ping Pong (Hansard): House of Lords
Wednesday 24th April 2019 Lords Chamber

[Lord O'Shaughnessy (Con)]

My Lords, I want to speak briefly to offer some thanks to everybody who has participated in getting the Bill to this point.

First and foremost, I thank noble Lords. The noble Baroness, Lady Finlay, said that the Bill had been given a bumpy ride. As I was in the driving seat for some of that, I can tell noble Lords that it certainly did feel rather bumpy. However, once we got over the bumps and decided we could work together, we made considerable improvements to the Bill, driven largely, it has to be said, by this House and the expertise within it. The compromise reached on the issue of a code of conduct is a good example of that and reflects extremely well on the process this House has gone through in its desire to reach pragmatic solutions—perhaps there is a wider lesson for politics in that.

I want also to express my thanks to those in the Bill team, who have stuck with this and shown considerable and growing intellectual flexibility as the process has gone on. I am sure all noble Lords would want to thank them for both their input and feedback and the grace with which they have dealt with this.

I thank also my noble friend the Minister. This Bill was one of many passes I gave her when she took over, and she has handled it with great intelligence and grace, as she always does. I am delighted we have got to this point and that she has steered it so safely.

Finally, and most importantly, I thank those affected by this legislation: the cared for and the carers. I am sorry to hear the opinion of the noble Baroness, Lady Murphy, which I take very seriously. I am an optimist naturally, but it is not just my natural optimism that means I cannot agree with her gloomy outlook. I hope she is wrong, and I hope she will not mind my saying so. I believe that through this legislation we have made some positive changes and done some good for the cared for and their carers. I am sure this is a subject to which we will return, but, in the meantime, I hope the lives of those people have been improved by the work we have put in over the past few months.

[Baroness Barker (LD)]

My Lords, it has been a privilege to work again on a subject that we have now worked on several times in this House, from the original pre-legislative scrutiny and original legislation through to the post-legislative report on the implementation of the previous Bill. Apart from anything else, it shows the excellent results that can be achieved from the process that we put into scrutinising legislation and scrutinising its subsequent implementation. In light of all of that, I will say that I take a slightly different view from the noble Baroness, Lady Murphy. I think that we have done a very good job. The problem is that the legislation that came to us was fundamentally flawed, and we could not change that. But we changed the legislation where we could, and those changes will make it better.

The noble Baroness hit on two fundamental issues that are problematic. The first is the nature and scope of the Cheshire West ruling and the second is the lack of understanding of the original DoLS legislation. When it was introduced, the training for professionals—all sorts of different professionals—was lacking. Much of what has happened since has meant that we have fallen into a system that is deeply bureaucratic. A number of professionals are scared to exercise their professional judgment. Consequently, a whole bureaucracy has grown up around DoLS which, had it been introduced in the right way, would not have happened. Therefore, the noble Baroness was right to say that the Law Commission was trying to deal with that issue and could not. I have no doubt that what we have in front of us will not solve the problem. I doubt very much whether it will deal with the backlog of cases, about which people are rightly exercised.

My question is one that we were all concerned about—the resourcing for this. One of the first things that we did when we met the Bill team was to query the resourcing—half a day’s training for some doctors and no need for training for people in care homes. Much of that has got lost as we have gone deeper into the wording of the Bill. Will the Minister talk about the resourcing of training and the implementation of the code of practice? I have no doubt that, in due course, there will be further test cases that will shine a light on the deficiencies of this legislation and we will come back to dealing with the fundamental issue: how do we ensure that someone whose liberty is going to be deprived by an agency of the state can be enabled to understand their rights, and their carers enabled to understand their rights, in order that they and the professionals who work with them can ensure that everything is put in place to minimise the deprivation of liberty? If we had done that properly in the first place, we would not be dealing with the deficient legislation that we are now.

The noble Baroness, Lady Murphy, is right that we have not dealt with it, but I take some hope from a lot of the stramash, to use a Scottish word, that we have been through and the attention that has been paid to all of this by the department, by people in the sector and by the lawyers themselves. This is not the greatest job we have ever done, but what we should do today is put a marker down for the evidence that needs to be collated and gathered for the time in the future when we will, inevitably, return to this subject.

[Baroness Meacher (CB)]

I have a couple of points. Other noble Lords made detailed points about the work of this House and the contribution that noble Lords have made to the Bill—very effectively, I think. My experience, although in a sense peripheral, has been that this House has worked very effectively with both the noble Lord, Lord O’Shaughnessy, and the noble Baroness, Lady Blackwood, in their roles as Minister and with the Bill team, and has achieved a certain amount—which is all we ever expect. We do not normally expect to turn Bills upside down and back to front, but we have achieved certain things.

I will mention a couple of things for which I am grateful to the Government, if I am right that we have really seen them home. One of my concerns was the huge and growing number of people in domestic situations where very vulnerable carers are caring for very vulnerable loved ones. Of course we need some sort of safeguard to ensure that the deprivation of liberty, if it occurs, is proportionate, reasonable and all the rest of it, but I was very worried that these poor carers would have layers of bureaucracy that they really could cope with, in addition to the bureaucracy they already had to deal with. I think we had an agreement from the Government that the procedures for assessing deprivation of liberty, proportionality and the rest of it will be undertaken in the local authority’s normal care-planning process, in the work that local authority officials are already doing. That seems a very constructive way forward which will greatly benefit a huge number of carers and cared-for people. It is a small thing, but it may be quite significant.

Health: HIV

Baroness Barker Excerpts

Monday 25th March 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question. She is absolutely right that the key to us making progress is prevention and early intervention and also understanding about any crossover consequences with other illnesses. She is also right that the key is closing the gaps now. In 2017, 43% of diagnoses were made at a late stage of HIV and, although there has been a decline, the largest group diagnosed at late stage were black African heterosexual men and women. It is important that we close those gaps. Some key projects have been working on that through the HIV Innovation Fund so when we bring forward plans for HIV 2030 it is important that we find out how we can close those gaps if we are indeed to get to zero by 2030.

[Baroness Barker (LD)]

My Lords, does the Minister agree that in order to end HIV by 2030 all children need to understand their own risks through comprehensive relationship and sex education and that schools that refuse to teach it are jeopardising the health of all pupils? Does she agree that that should not happen?

[Baroness Blackwood of North Oxford]

Knowledge about safer sex and sexual health is essential for young people. They must be equipped to understand and to make safe, informed and healthy choices. That is why we have brought in compulsory SRE for the first time, which all schools should be required to teach.

Mental Capacity (Amendment) Bill [HL]

Baroness Barker Excerpts

Tuesday 26th February 2019 Lords Chamber

[Baroness Finlay of Llandaff]

My Lords, I apologise—I should have declared my interest as chair of the National Mental Capacity Forum at the beginning of the previous debate. Like others, I thank the noble Lord, Lord O’Shaughnessy, for having made sure that the Bill is now in much better shape than it was when it came to us.

I am very grateful to the Minister for confirming that the whistleblowing amendments are there, and in fact are, if I have understood correctly, stronger than when they left this House. I have a couple of questions for her, though. One relates to the group of people who can become approved mental-capacity professionals. I was concerned that she did not include speech and language therapists in her list. People who have communication difficulties can be extremely difficult to assess. Those with a brain injury affecting the speech area can be very difficult indeed to assess because they may also have frontal-lobe disorders, as the noble Baroness herself well understands.

I know that the regulations will be brought forward, and I hope that the Minister will be able to consider additional training—not part of general undergraduate training but additional, postgraduate training for speech and language therapists to be able to develop a full set of competencies and undergo the same training as other people. I think that, without it, we will end up with duplication of assessments and duplication of costs.

My other question relates to portability. I hope that the Minister can confirm that the portability concept, which was so welcomed in the liberty protection safeguards, remains and will be applicable so that people can move between different settings without needing a reassessment. Obviously, emergency medical treatment can arise at any time with anybody, and that is covered separately for someone who lacks capacity and must be treated: that would come under a best-interest decision-taking process anyway.

My last query relates to the determination conditions and the assessment. I have a slight concern on reading the amendments that the assessments seem to be separated from the determination. If I heard the Minister correctly, she said that the care-home managers would not be making either the assessments or the determinations. We had a lot of concern over care-home managers and conflicts of role in previous debates, and I would be grateful if she would confirm that this is my correct understanding, and that we have not had a way whereby the care-home manager can undertake the assessment, and then somebody else, based on that assessment, will make a determination, because the validity of the assessment will determine the validity of the later determination.

Those are my queries in relation to this, and the determination and assessment question relates in particular to Amendments 28 to 38, to which the Minister has already spoken.

[Baroness Barker (LD)]

My Lords, I will make three quick points. One is to thank the Minister for the way in which she set out the ways in which the Government listened to the debates at an earlier stage in this House. We had deep misgivings about the lack of attention that we have been able to pay to independent hospitals. I am very glad that the reassurance that they will no longer be the responsible bodies has been given by the Government in another place.

Anybody who has followed our deliberations in great detail, as some people have, will know that we have had to spend an awful lot of time during the passage of this legislation focusing on care-home managers and the inappropriate responsibilities that they were given in the initial draft of the Bill. I am not entirely convinced that in relation to independent hospitals or local authorities we have entirely separated responsibility for assessment, responsibility for determination of what constitutes a care package and deprivation of liberty, and responsibility for the financing of those care packages. If the Bill had started off in a better shape, perhaps we would have been able to spend much more time on that, as we should have done. Therefore, it is important that at this stage we take on board the points made in Amendment 41A tabled by the noble Baroness, Lady Thornton, and make sure that we have not left a conflict of interest anywhere in the Bill.

[Lord O'Shaughnessy]

My Lords, I thank the noble Baronesses, Lady Meacher, Lady Finlay and Lady Thornton, for their kind words. However, the credit for the improvements in this group, outlined by my noble friend the Minister, should go to this House. As everyone involved in the Bill will remember, we had some interesting, challenging and sometimes not quite bad tempered but difficult debates as we attempted to get this right. It is only because in the end noble Lords took a constructive approach to working together that we were able to make these changes. It is a credit to the process and to the people involved in it that we have been able to solve so many of these problems, whether they be on whistleblowing, independent hospitals or other issues.

I will reflect quickly on the intention behind the amendment regarding independence, as set out by the noble Baroness, Lady Thornton. In a sense, avoiding conflict of interest has been at the heart of the changes that everyone has wanted to see made to the Bill, and, as I understand it from what she has said, that is her intention here. My belief is that that is dealt with in this case by making the responsible body, which has responsibility for appointing the AMCP, the local authority or the health board in Wales—or, more specifically, not making it the independent hospital. That then puts it on a level playing field with care homes, which was obviously the subject of huge discussion during our debates. This is where I seek reassurance from the Minister.

If we are satisfied that the changes we have made on the care home front to make sure that the responsible body is the only person who can appoint an AMCP also make sure that there is not a conflict between the AMCP and their role in commissioning, given that local authorities often, although not always, commission social care places and in a sense have that contracting relationship between the local authority and a care home, and given that we are trying to put the independent hospital on a similar footing, and if we are also satisfied, which I think we are—or we were during the passage of the Bill and subject to the amendments that have been brought forward—that there is the appropriate independence and that there are appropriate mechanisms for avoiding conflicts of interest for care homes and the appointment of AMCPs, by deduction it ought to follow that they will be in place because of the Government’s amendments on independent hospitals, and even more so because every single independent hospital case will be referred to an AMCP.

If it is true, as I believe it to be as a consequence of the government amendments, that the commissioning relationships are essentially the same and that the responsibility to appoint an AMCP will essentially be the same for the local authority, whether it is vis-à-vis a care home place or a place in an independent hospital, I hope that it will be possible for my noble friend to reassure the noble Baroness, Lady Thornton, that what she is asking for is already the case and therefore that her amendment is not necessary. However much I applaud the intention behind it, as I said, I think that it would repeat what is already the case. With that reassurance to noble Lords, I hope that we will be able to move on on this issue.