Down Syndrome Bill

Baroness Brinton Excerpts

2nd reading
Friday 18th March 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association. I thank the noble Baroness, Lady Hollins, and Dr Fox for their time in answering questions at yesterday’s helpful briefing, and the various people and groups who have written to me and other Peers. It was also a pleasure to support the amendments to the Health and Care Bill of the noble Baroness, Lady Hollins, on mandatory training for staff working with people with learning disabilities and autism. I am delighted that the Government agreed. I too pay credit to the noble Baroness, Lady Hollins, for her outstanding campaigning over many years for people with learning disabilities.

My Spanish nephew Alex, now in his late 30s, has Down’s syndrome. As a family we have seen this baby grow into a fine young man, hampered only by the perceptions of others. My sister has had to fight for his rights, be it for a Covid vaccine this year or for his medical needs over many years. She had to take on the education authorities because there was no integration at all in schools: “children like that” went to a special school that was, in reality, a hospital, with locked doors and staff in white coats. She won her campaign and he was the first child with Down’s syndrome to go to mainstream primary in Majorca. But the most important part of his story so far is that he is a fantastic sportsman. Twelve years ago he won a European championship in karate; he has also swum in national competitions, and I cannot tell you how proud we are of his achievements. Yet too many people do not see past the condition, nor understand that every person with Down’s syndrome is an individual and has differing needs.

Another Alex, the same age as our Alex, is the daughter of our very close friend. She went to primary school and Sunday school with our children, and now lives happily in a house near her mum, with support from carers. She is non-verbal and needs constant support when awake. She loves her house, her daily routine and her family. As with almost all people with Down’s syndrome and their families, it has not been easy, but for this Alex, it works.

So when I read this ambitious and laudable Bill, my first question was: how will this help people with Down’s syndrome and their families? Our role in the Lords is to make sure that legislation delivers the intention of a Bill and does not create unintended consequences. I share the concern of the noble Baroness, Lady Neville-Jones, that inadvertently this Bill will create a hierarchy of disability that risks doing harm to the rights of other disabled people, particularly people with learning disabilities, which may also be discriminatory.

By their very nature, the Bill and subsequent guidance will create a unique and separate focus on the needs of people with Down’s syndrome, as well as duties and rights that are exclusive to this group, which risks undermining the principles of equality and non-preferential access to resources across education, health and social care, and employment. There is also a danger that it may disadvantage individuals with other disabilities who do not have the same legal recourse if providers fail to abide by the guidance. Can the Minister tell me what work will be undertaken to ensure that the Bill does not disadvantage people with disabilities other than Down’s syndrome? If the Minister believes that no such work is required, what is the purpose of legislating to provide exclusive duties relating only to people with Down’s syndrome?

I am also concerned that the Bill lacks power to achieve its aims, which risks causing confusion among public bodies and people with Down’s syndrome and their families about their duties and their rights.

In common with people with learning disabilities generally, people with Down’s syndrome and their families face significant inequalities and discrimination in our society. The current framework of legislation that we have to address this includes the Care Act, the Children and Families Act, and the Equality Act. However, they have been systematically weakened by underfunding and by removing mechanisms through which people can secure redress.

Understandably, expectations have been raised very high by the Bill, yet I see evidence from the Minister that it and the resulting guidance have no power to address these deep-seated problems. For example, can he explain how it will ensure that people with Down’s syndrome can secure appropriate and adequate social care and that our classrooms include additional teaching assistants? The Bill does not say that. Can the Minister provide examples of the differences he believes that this Bill will make in the context of health, social care and education?

Dr Liam Fox commented that the Bill

“sets a precedent that can be followed later on in other areas.”

That has been commented on by noble Lords this morning. Will the Minister tell me whether it is the intention of the Bill to set a precedent where each diagnosis will require a new set of guidelines and, if so, what continued role the Government see for the existing legal duties which underpin disability equality? In Committee in the Commons, Gillian Keegan said at the Dispatch Box:

“We recognise that people with genetic conditions other than Down syndrome may experience problems similar to those of people with Down syndrome, so we will consider the overlaps and linkages between such conditions and Down syndrome through consultation on the development of the guidance”.—[Official Report, Commons, 26/1/22; col. 8.]


I know that by giving one group rights when resources are scarce, others will not get them. I echo the question asked by the noble Lord, Lord Farmer: what happens to those who have other genetic conditions, or none, but have learning disabilities, who must rely on the good will of Ministers in the future, and to those with learning disabilities who may not fall into this category? Here in Watford, our CCG decided some years ago to close the children’s respite centre, Nascot Lawn, because in its view respite care was not statutory. Children eligible for respite care have multiple and profound needs, and personal care for them has to be delivered by nurses or by family members trained by hospitals. Twice the Nascot Lawn families won High Court judgments against the closure and the removal of that respite care and the lack of proper provision.

The CCG repeatedly said that its resources were scarce and it had to prioritise just statutory services. It closed in 2018, and these children and their families have struggled ever since to get the support they need. It did not matter that their EHCPs said that these children and families needed respite care; it was all about resource. At least one family could not manage to look after their child without that respite care: being on duty 24 hours a day and every night had taken its toll. Will other people with high levels of need but who are not people with Down’s syndrome move even further to the back of the queue?

There is also concern that the Bill and guidance risk undermining principles concerning person-centred assessment and support, embedded in law, whether in relation to support for children and families or support for adults, by elevating the condition and suggesting that this predicts needs. That is why I gave the illustration of our two people named Alex. This not only represents a regressive step politically, by advancing a medical model of disability and elevating diagnosis over individual needs; it will also create considerable legal and regulatory complexity for local councils, the NHS and schools at a time when they are already stretched in meeting statutory duties. Will the Minister recommit to the principles of person-centred rather than diagnosis-centred assessment and support and tell me what work will be undertaken to embed this person-centred approach at every stage of the development of the guidance?

Given that it was announced in the Commons that there may be a “named person” on integrated care boards, which we have discussed at some length during the passage of the Health and Care Bill, what role will they have in ensuring the compliance of public bodies with the guidance? Will that be solely for people with Down’s syndrome, especially in the light of the past practices of CCGs, which I have outlined?

I will make a brief point on the proposed guidance. As my noble friend Lady Jolly said, will Ministers ensure that the principles of “No decision about us without us” ensures that the voice of people with Down’s syndrome is represented? Although the Commons has a mechanism to scrutinise guidance, that is not true in your Lordships’ House, so will the Minister undertake to ensure that there is time for a debate on the guidance, as it is published and debated in the Commons? As the noble Baronesses, Lady Bennett and Lady Uddin, outlined, government resources have been a real issue. The net is full of holes not through a lack of guidance, White Papers and good will but through a lack of government investment and strategic leadership for over a decade.

I think that everyone who has spoken at Second Reading today and in the Commons is passionate about ensuring that people with Down’s syndrome and their families can remove the current structural and social barriers that they face. The concerns that a number of Peers have raised today are important, and the Lords needs to be able do its job and to have responses from the Government in Committee and on Report to ensure that the Bill can deliver its aspirations and that it will not penalise others with learning disabilities because of a new hierarchy of resources. So will the Minister agree to meet those who have spoken of their concerns today prior to Committee, when it is clear we will be looking at a number of amendments?

Health Protection (Coronavirus, Restrictions) (Self-Isolation etc.) (Revocation) (England) Regulations 2022

Baroness Brinton Excerpts

Thursday 17th March 2022 Lords Chamber

Moved by

[Baroness Brinton]

As an amendment to the above motion, at the end insert “but that this House regrets that the Regulations are (1) contradictory to guidance provided by the UK Health Security Agency and NHS England on what action to take when you test positive for coronavirus, (2) an example of public health messaging that has caused confusion amongst the public, and (3) financially exclusionary to those on low incomes who cannot afford either the costs of tests or to isolate without financial support.”

[Baroness Brinton (LD) [V]]

My Lords, I want to make it clear that this amendment to the Motion is not a discussion about plunging the UK back into lockdown or imposing mass restrictions on individual liberties. I am talking here about the Government’s decision to scale back sensible public health measures—measures that would help us to continue to manage and monitor this pandemic, which is far from over.

Last week, the WHO reminded nations such as the UK that even when a virus is endemic, it needs managing, including testing, self-isolation and mask wearing. Even if not required by law and regulation, the WHO says that messaging and communications from Governments are vital in ensuring that people can take personal care. I am talking about clear and consistent messaging from our leaders about what they mean by “personal responsibility”. I am talking about support and guidance for those who still want to do the right thing and avoid spreading Covid-19. We still need to protect our NHS and ensure that those who are most likely to get severe disease, even if vaccinated, are also protected. I hope that we can all agree on these principles.

By the way, the Government keep changing the terminology for the group who have variously been called shielders, the clinically extremely vulnerable, immunocompromised and immunosuppressed. I hope the House will forgive me if I just refer to them as the CEV as a shorthand; otherwise, it becomes a real mouthful.

Time and again over the course of this pandemic, we have seen boom and bust policies relating to controlling Covid, stretching our NHS and care systems to the brink of breaking point and then introducing half-baked policies to tackle a fire that is already raging. Now we are seeing the bust again, with the withdrawal of almost all our tools to tackle this pandemic.

While we continue to allow Covid to spread through our hospitals, we cannot possibly hope to tackle the backlog of over 6 million patients waiting for treatment. The weekly average for Covid hospital admissions last week was 1,500 per day—an increase of 18% on the previous week. I am hearing that the NHS in the east of England and in London regions is already at level 4, and cases are still rising extremely quickly. Can the Minister say what plans there are if hospital admissions continue at this pace, and, given that they are a lagging indicator to cases, which have risen over 50% on the government dashboard in the last few days, how will people be protected from infection without access to test and trace from 1 April?

Sickness absences everywhere are also rapidly increasing. What are Ministers doing specifically to help keep infection levels lower among key workers, especially, but not only, in the NHS and social care sectors? Today, the Health Service Journal reports that Covid sickness absence in the NHS is up 20% in one week. What is the contingency plan if that continues to rise?

Those against any precaution say that we have to learn to live with Covid, but many people with omicron BA2 are saying that it is more like a cold at the start, and then it is like flu and worse. The problem is that it is ultra-transmissible when it is asymptomatic and in those early sneezing days. Would Ministers consider a campaign to strongly encourage wearing face masks, and at the very least try to protect key workers and the clinically extremely vulnerable?

The difference between what is being said at the Dispatch Box and in the Government’s living with Covid plan and guidance published at the end of February is most concerning. The UKHSA webpage is very clear: you must self-isolate if you have symptoms and are unwell. But this is not a clear message coming from our leaders, with statements such as “Stay at home if you can” and “Take personal responsibility”. Can people afford to? Can they manage to arrange deliveries? Can they even be bothered? Will the Minister today state in clear terms that, even though the legal requirement to self-isolate has ended, it is still absolutely expected that anyone who tests positive for Covid-19 will self-isolate? Will employers be told that they should not tell staff—as Wilko and Asda have already done—that they must work even if they test positive?

Speaking of testing, the policy document on living with Covid mentions the continued availability of

“limited symptomatic testing available for a small number of at-risk groups”.

As for who is included in these at-risk groups, yet again the public are still in the dark. We are only two weeks away from 1 April and we still do not know. We are told that information on who will have access to tests is coming. Surely this has to have been decided already. Why are we left waiting for this vital information yet again? We know already the groups that should have access to tests: the clinically extremely vulnerable and their close contacts; pregnant women; NHS staff; those working with vulnerable patients; those who attend hospitals regularly; unpaid carers; and, frankly, at the moment, our military as well. These groups will make up a sizeable proportion of the population, and I wonder how the Government are planning to identify those who will qualify for free tests.

Portsmouth City Council is so concerned at the 74% increase of positive Covid cases in just one week—to 630 cases per 100,000—and the 50% increase in cases at the Queen Alexandra Hospital to more than 150 Covid beds that it took the decision yesterday to provide free lateral flow tests to residents for three months if the Government will not. This is really tough, given that local authority public health budgets this year have not even covered inflation, and there is no extra money for any Covid mitigations such as test and trace. By the way, the Minister said on Monday that local resilience forums will now cover test and trace as the central ones are being closed down. But what are they going to do that with? No money at all. But in Portsmouth, a city full of key workers, the council feels that it has to do it.

By not providing tests for asymptomatic contacts of the clinically extremely vulnerable, we are placing them in perpetual lockdown. Not providing asymptomatic testing in hospitals also puts patients at risk. It is interesting that PPE is still going to be provided free of charge for NHS trusts until March 2023. But why has PPE been prioritised over testing? We need to know where the Covid is, and we need to protect our patients and staff. Can the Minister please confirm that this “limited free testing” will be only for people with symptoms and that the plan is to end all asymptomatic testing?

From these Benches, we have talked about the lack of financial support for those who should be self-isolating, and the revocation of that means that many people will have no choice but to go into work unwell. We ask again for this to be reinstated. By taking away the little support that was offered, the Government are clear that people’s self-isolation sacrifices are not worth anything to them—it just does not matter. Ministers talk about personal responsibility but people need to be supported financially to do the right thing, especially with reinfection rates as high as they are.

To conclude, the Government are determined to tell everyone that we have to learn to live with Covid. But by throwing away all surveillance testing and tracing, leaving individuals, employers, our NHS and even the Government completely blind about what is happening, and standing down SAGE at exactly the time that we have the highest level of infection rates, with spiralling cases and hospital admissions and, sadly, a likely increase in deaths in the next couple of weeks, how on earth is the country meant to assess and take their own responsibilities? I hope that the Government will change their mind on these epicentral precautions and mitigations. I beg to move.

[Lord Hutton of Furness (Lab)]

My Lords, I have some sympathy with the arguments that the noble Baroness has just made, but I think this is probably not the time to have a general debate about the Government’s handling of the Covid-19 pandemic.

These regulations are fairly narrowly drafted and are designed to repeal the earlier regulations that required vaccination against Covid-19 to be a condition of deployment in the NHS. I support the repeal of these regulations. The Government have made a good case for the repeal in the Explanatory Memorandum, but none the less, it represents quite a significant and dramatic U-turn in government policy.

I do not think it made a lot of sense to require compulsory vaccination; there were other ways of ensuring the protection from harm of NHS patients. Of course, the loss of critical front-line NHS staff which the earlier regulations might well have produced would itself have represented quite a significant risk of harm to NHS patients.

Today, I have only one question I want to ask the Minister. Again, it is something that is contained in the Explanatory Memorandum. Paragraph 7.29 says that the Government will engage with NHS employers to review their policies on the hiring of new staff and the deployment of existing staff to take into account their vaccination status. I ask the Minister what the Government want to see change in NHS hiring and employment practices. Will new employees in the NHS, for example, need to have been vaccinated against Covid-19? What does this paragraph in the Explanatory Memorandum actually mean?

--- Later in debate ---

[Baroness Brinton (LD)]

My Lords, I thank all noble Lords who have spoken.

The Minister said that we were saying that the pandemic is over. Not one person speaking today has said that it was over. We have all said that is has been moving to endemic and that the WHO advice was about making sure that, as formal restrictions lift, there should be continuing precautions. The Minister said that omicron BA2 is substantially weaker. Yes, it is, but the maths is also simple. He said that it is the dominant strain, but, if you have a very high level of case numbers, hospital admissions, ICU admissions and deaths will also rise. The point about testing was well made by the noble and right reverend Lord, Lord Sentamu. If local government’s public health is a vital partner, will the Government please fund this extra work?

The Minister asked us whether we only fund the very poor for lateral flow tests. The point is that the virus does not distinguish and it is really important that those on low incomes, who are facing astronomically high cost of living rises, are given some support. I thank him for his comments about the CEV forum, but just talking, without any active support for the clinically extremely vulnerable, is a chocolate teapot. The noble Lord, Lord Hutton, asked a key question on whether this is the right time to change all these mitigations and, while the Minister thanked all the doctors, scientists and other NHS key workers, I think we all agree that most of them are saying that it is too early to lose these mitigations.

I regret that the Minister has not given me reassurance. However, I withdraw my amendment.

Amendment to the Motion withdrawn.

Health and Care Bill

Baroness Brinton Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[The Deputy Speaker (Lord Russell of Liverpool) (CB)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

[Baroness Brinton (LD) [V]]

My Lords, I have put my name to Amendment 172. I thank the noble Baroness, Lady Finlay of Llandaff, for tabling this improved amendment, with important changes since Committee, as she has very helpfully explained to your Lordships’ House. I believe that this helps to find a way to balance the views of the child’s parents and the child’s doctors, and it is reassuring that many of the stakeholders from different perspectives have come to agreement on this.

The amendment also makes it clear that nothing affects the principle of the best interests of the child. This means that no medical professional could ever be forced to provide a medical treatment that they do not believe is in the best interests of the child, and that any other provider of such medical treatment would have to provide evidence during the mediation that this would benefit the child.

Another key reason for the need for this amendment is that at the moment mediation provision across England is inconsistent. While there is certainly excellence, there are also some problem areas. Having in legislation an independent mediation process made available at the earliest stage possible can help facilitate less confrontational conversations while supporting both sides in the argument.

The issue of parent-doctor conflicts will continue to persist frequently unless the Government can consider this amendment, and I strongly urge them to do so. If the noble Baroness, Lady Finlay, were to call a Division, we would support her on this, but I hope that the Minister will be able to provide some positive news.

[The Deputy Speaker (Lord Russell of Liverpool) (CB)]

My Lords, the noble Baroness, Lady Masham, is also taking part remotely. I invite the noble Baroness to speak.

--- Later in debate ---

[Baroness Brinton (LD) [V]]

My Lords, I have signed Amendment 174 in the name of the noble Baroness, Lady Chakrabarti. I thank her for introducing it and for making it clear that this aims for global pandemic preparedness. The World Health Organization set a target to vaccinate 40% of the world by the end of 2021. However, 92 countries missed this target due to a lack of access. Despite the funding from high-income countries to the WHO-run COVAX and Gavi schemes, low-income countries have remained at the back of the queue as high-income countries have been able to jump in ahead, using their money to get second and third doses for their own population.

Frankly, we need a better system for future pandemics. We need to understand that openly licensing newly developed Covid-19 technologies, waiving intellectual property rights and sharing the manufacturing know-how would allow more companies to begin producing life-saving vaccines, drugs and tests across the world. However, pharma companies have widely refused to share their technology openly. We also need to source other key critical control products, such as testing equipment, PPE and masks. Relying on too few suppliers in too few countries caused immense problems for the first six months of the pandemic, and again as subsequent waves hit those countries. In addition, the UK, the EU and Switzerland continue to block South Africa’s and India’s proposal to temporarily waive certain provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights—TRIPS—on Covid-19 tools.

Despite regular pandemic exercises in this country, and despite previous experience with vaccines for other diseases not being shared with low-income countries, we have not learned the lessons. This amendment sets out what a Secretary of State should do within three months of the WHO declaring a public health emergency. I really hope that Ministers are prepared to help make progress on this issue. If not, and if the noble Baroness, Lady Chakrabarti, calls for a Division, we will support her from these Benches.

[The Deputy Speaker (Lord Lexden) (Con)]

I now invite the noble Lord, Lord Campbell-Savours, who is taking part remotely, to speak.

Health Protection (Coronavirus, Restrictions) (Self-Isolation etc.) (Revocation) (England) Regulations 2022

Baroness Brinton Excerpts

Monday 14th March 2022 Grand Committee

[Viscount Stansgate (Lab)]

My Lords, I have another brief question for the Minister. I preface it by paying tribute to the wonderful work of the NHS, the department and the Minister, and in particular to the scientists who have been involved in producing the vaccines, on whom we all depend.

This little debate is part of the business of living with Covid. I am delighted to hear that the noble Lord, Lord Lansley, has recovered from his brief infection. That is a hopeful lesson for us all, as a number of members of my family, despite being vaccinated, have also recently got it, including my pregnant daughter-in-law, so we hope all turns out well.

As the Explanatory Memorandum to the statutory instrument says:

“The Self-Isolation Regulations played a vital and necessary role in breaking the chains of transmission.”


How will this SI be translated into the official advice on travel to and from the UK? I know that it is not his department; nevertheless, I presume that the regulations will change the nature of the advice given by the Foreign, Commonwealth and Development Office.

[Baroness Brinton (LD) [V]]

My Lords, just before the Grand Committee started, I heard a bit of a discussion about why this Motion was in Grand Committee today while I had a regret Motion tabled for the Chamber on Thursday. I had wanted to do just the regret Motion in the Chamber, but the Government Whips’ Office said that was not possible given the timing, so the only offer available was, essentially, for this statutory instrument to be heard twice. I apologise for that, but unfortunately it was the only possibility.

The lifting of the self-isolation regulations in England at the end of this month seems extraordinary and way too early. Only a couple of days ago, the World Health Organization reminded nations like the United Kingdom that, even when a virus becomes endemic, it needs managing, including by testing, self-isolation and mask wearing. Even if they are not required by regulation and law, the World Health Organization said that the message and communications from a Government are vital in ensuring that people take personal care in what they do.

We are still learning about the long-term effects of Covid. Recent research studies, published in the last two or three weeks, into long Covid are showing cardiac, respiratory and neurological problems that are already having consequences. In the future, it will be absolutely vital to watch for the currently not visible long-term consequences of Covid-19. There is an excellent book by Laura Spinney called Pale Rider: The Spanish Flu of 1918 and How it Changed the World, which has a good chapter near the end on the early deaths of Spanish flu survivors in the immediate aftermath of the pandemic. Such early deaths went on for two to three decades—interestingly, often with heart, stroke and respiratory problems. Without surveillance and self-isolation, we risk living with Covid at a very high level, and the consequences for the population may become apparent only when it is too late.

The problem with the living with Covid plan, which was announced on 24 February, was that the Prime Minister called it yet another freedom day and public behaviour has already changed. One doctor said on Twitter today that they are abused on the Tube for wearing a mask on their way to work. That is because there is not a strong clear message to people that living with Covid means that we still have to be careful about it. Can I ask the Minister—as I have asked him on many occasions before—whether the Government plan to have a strong communications message about these changes and about people taking personal care?

I would also like briefly to return to the question that I asked the Minister as a supplementary to the Question from the noble Baroness, Lady McIntosh, earlier today. Given that members of SAGE are now confirming publicly that Ministers did not ask for any modelling to be done for the living with Covid plan, how does that square with his answer to me that Ministers have to take modelling into account along with the wider needs of society? Everyone understands that dilemma for Ministers, but that was not my question. If Ministers did not ask for modelling, how on earth can they balance that risk? The Minister referred to the BA.2 variant, saying that they were watching it, but it is now the dominant variant. The one that we are watching is deltacron, and there may be others in the future.

I am grateful for the earlier comments from the noble Lord, Lord Lansley, and the noble Baroness, Lady Thornton, on the worries that those who are immunocompromised face. The Minister knows that I am one of those severely immunosuppressed people; I have had my fourth vaccination, although I have been warned that, because of my medication, it is probably already waning. There are people with blood cancer, for example, who cannot make antibodies or for whom the vaccine is contraindicated. Lifting self-isolation for them is a real risk. Under the current guidance to the clinically vulnerable—a number of people somewhere between 500,000 and 3.7 million—they will have to risk assess what they want to do. They are keen to do that, but they need the data.

The NHS daily dashboard used to be a good starting point for the public alongside the ONS data and the ZOE study, but the dashboard is now unreliable and the ZOE study is about to lose its funding along with others. That means that the vulnerable and their families, friends and work colleagues cannot see where Covid is. They will have to pay for tests—and let us be clear: offering free tests only to a small number of the most severely clinically extremely vulnerable is not helpful; it is the people who visit them and work with them who need to test before they see them. Many of the surveillance projects are, as I have said, also under risk. The REACT study is ending at the end of March and funding has been withdrawn—remarkably—from the ZOE study, the SIREN and VIVALDI studies and the CoMix social contacts survey. How do the Government plan to monitor the ongoing management of the pandemic—as WHO says they should—and assess the impact of ending restrictions with our vital surveillance systems down?

On what scientific and clinical evidence was the decision made to recommend that the CEV

“follow the same general guidance as everyone else”

in the living with covid plan? That is, frankly, a fantasy and has condemned the millions of CEV to self-imposed lockdown with no support. It is, by the way, also completely contradicted by the advice to them on the specific guidance page for the clinically extremely vulnerable and the NHS page on what to do if you have Covid, where people are told that if they have a positive test for Covid they should stay at home.

Human Medicines (Coronavirus and Influenza) (Amendment) Regulations 2022

Baroness Brinton Excerpts

Monday 14th March 2022 Grand Committee

[The Deputy Chairman of Committees (Baroness Healy of Primrose Hill) (Lab)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite her to speak.

[Baroness Brinton (LD) [V]]

My Lords, I will speak about some the issues raised by the noble Lord, Lord Lansley, in relation to the current levels of Covid, when we discuss later on the third of the SIs before us today. I welcome the two sets of regulations that we are discussing in this first section. The first, the Human Medicines (Coronavirus and Influenza) (Amendment) Regulations 2022, modifies and extends regulations with a large number of measures relating to vaccinations for both Covid and influenza. The previous regulations were due to expire on 1 April. I want to put on record our thanks to Ministers and officials for the fact that, this time, we are considering a Covid SI before it comes into force. I hope that this will become routine again from now on.

This SI makes permanent changes to what medicines a range of registered healthcare professionals can administer to NHS and local authority staff. It could be transformational for the NHS if carefully assessed and if the wider group of staff have training and support built into their professional training. It is important that this is extended. The ability to deliver vaccines for coronavirus, influenza and—heaven help us—any other pandemic without the need for a wholesale dealer’s licence to be in place, and for the final stages of coronavirus vaccine preparation to be completed without those extra licences, is important. It is part of a complex legislative framework. I am glad that we do not need to discuss that today but, arising out of it, perhaps I may ask the Minister some questions.

There has been discussion in public in the past few days about the expansion of the fourth booster for certain groups. Can the Minister explain when, if a person has already had their fourth booster, as the severely clinically extremely vulnerable have already had, they would next expect a booster, which would in fact be their fifth? What is the timescale for those who are expecting a fourth booster, having had their third one in the autumn or more recently?

What are the Government doing to keep reaching out to hard-to-reach groups who are not yet fully vaccinated? On the case numbers going up at the moment, I think we all know that those in hospital with coronavirus are predominantly those who have not had any vaccines or their full vaccinations.

What progress is being made towards the development of nasal spray vaccines for Covid, such as the Fluenz Tetra nasal vaccines for influenza for children? Obviously, delivering nasal vaccines needs considerably less training for staff than do injections, although I note that the current flu nasal spray vaccine is live and therefore not suitable for the immunocompromised or immunosuppressed.

What are the Government doing to encourage pregnant and breastfeeding women to get vaccinated, given the confusion that there was last year and the delay before the JVCI said that they should be vaccinated?

As we lift restrictions, it is very much the unvaccinated who are at risk of serious illness, so what socioeconomic and ethnic divisions are there between the vaccinated and the unvaccinated? What has been the most recent clinical assessment of vaccine uptake for the severely clinically extremely vulnerable or, if the Minister prefers to call them this week, the immunocompromised and the immunosuppressed? That is a slightly naughty question because I know the answer, as does the noble Lord, Lord Lansley. We know that some will never make any antibodies at all, while others will make some but they will wane extremely fast.

I was interested to hear the noble Lord, Lord Lansley, discussing post-exposure prophylaxis trials, which are important. I note that, back in June and July last year, the Minister’s predecessor was telling us that pre-exposure prophylaxis treatment would be available very shortly, but in the last two or three meetings that I have been at with scientists and experts, they have said that it is much further away. I hope that the noble Lord, Lord Lansley, is right and that it is not far off. Can the Minister say whether it is going to happen? There is still a problem for the immunocompromised and the immunosuppressed in making sure that they get access to these antivirals and monoclonal antibody treatments.

I turn now to the human medicines amendments relating to the early access to medicines scheme. The review into EAMS in 2016 highlighted that, often, a medicine will be available to a patient under EAMS but, when it makes the transition to being fully available and is going through the final stages of approval, there can be a lull when patients are not able to access it. This is a very particular problem for those who were on it in the trial and for whom it is making their lives a lot more bearable and their health condition much more under control. Suddenly there is a period when they cannot access that medication. Is it proposed that this arrangement changes so that, if you are on a trial, you can continue on it until it definitely will not be approved, rather than having to wait? How will this legislation make that transition smoother? How are the Government prioritising pharmaceutical innovation for the clinically extremely vulnerable?

Covid-19: Restrictions

Baroness Brinton Excerpts

Monday 14th March 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we will have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, at the publicly streamed evidence session of the All-Party Coronavirus Group on 1 March, we asked some members of SAGE to outline SAGE modelling for the lifting of restrictions in the living with Covid plan. They replied to us that they had not been asked to model any such plans by Ministers. Given that cases, as the noble Baroness, Lady McIntosh, said, are now 221,000 a day, with active cases of more than 2 million and hospital admissions rising across England, exactly what modelling advice did the Prime Minister and Secretary of State for Health and Social Care take?

[Lord Kamall (Con)]

We constantly have meetings with the UKHSA and a number of different scientists join us for the calls when we have them, but we have always balanced things up. I shall give an example of a conversation I was having just before Christmas with some of the modellers. I asked them “What is your advice?”, and they said “Minister, before we give you the advice, you have to bear in mind that we are only considering the variant at the moment. It is for you to consider the wider medical balancing issues, and also the economic and social costs as well, and we recognise that you have to balance all those up.”

Care Homes: Evicted Residents

Baroness Brinton Excerpts

Thursday 10th March 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the noble Baroness, Lady Brinton, will make a virtual contribution.

[Baroness Brinton (LD) [V]]

My Lords, the provision of high-quality, personalised care in residential care settings is likely to reduce the chance of complaints being raised in the first place. The Skills for Care workforce review showed that only 44% of care staff have any training on dementia. Will the Government commit to all social care staff receiving tier 2 training in the dementia training standards framework?

[Lord Kamall (Con)]

The noble Baroness raises a very important point. When we look at the current landscape in the social care sector, it is clear that people do not really understand the overall sector. One thing that we are looking at in regard to the voluntary register is encouraging care staff to come forward to register. Registration includes their standard of education and the qualifications they have received. We will look at how we can improve and have a more consistent qualification system, so that being a care worker is a more rewarding vocation in the future.

Health and Care Bill

Baroness Brinton Excerpts

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association. I will speak very briefly from the Liberal Democrat Benches to offer our support for both the amendments in this group.

The amendment tabled by the noble Baroness, Lady Pitkeathley, Amendment 113, says that unpaid carers, including those under 18, must be properly consulted by the NHS to ensure that they are able to provide the care needed to keep patients safe. In Committee—and, more recently, at the excellent and moving round table with family carers organised by Carers UK, about which the noble Baroness, Lady Pitkeathley, just spoke—we heard evidence of hospitals discharging patients before assessments had been completed and before carers had even been told. The burden that this places on carers is totally unacceptable and unsafe. Worse still—and unsurprisingly—the home arrangements too often break down when family and unpaid carers are not a full part of the consultation process. We support the noble Baroness, Lady Pitkeathley, in this vital amendment.

The second amendment, Amendment 144, to which I have added my name, was tabled by the noble Baroness, Lady Wheeler. The amendment ensures that there are always proper social care needs assessments to ensure that both the family and unpaid carers are consulted, along with the relevant local authority; and that ICBs must have an agreement in place with the relevant parties to ensure that vulnerable people are not discharged without the right support. Some carers are themselves vulnerable people, and we need to make sure that all protections are in place for them too.

Equally importantly, it ensures reporting by the relevant authorities back to the ICB so that it can monitor discharge effectiveness. It says—as a bit of stick to go with the other carrot parts—that the ICB must pay for any

“additional costs borne by a local authority in caring for a patient whilst carrying out social care needs assessments”,

in the event that the patient has been discharged before this was completed.

There are 1.4 million unpaid carers who save the state just under £3 billion a year—and they need more than guidance. Both of these amendments will ensure that the patient and their unpaid carer are assessed and supported properly, and that the key stakeholders—the NHS, the relevant local authority and the ICB—must work together to make this happen.

[Baroness Meacher (CB)]

My Lords, I rise to support Amendment 113. I applaud the noble Baroness, Lady Pitkeathley, both on this amendment and on the years and years of commitment she has given to the support of carers.

It is extraordinary what this Government are prepared to do in this Bill. In revoking the Community Care (Delayed Discharges etc.) Act 2003, they are abolishing the “safe to discharge” test, which requires processes to have been followed to ensure that appropriate and adequate care is, or will be, in place for a patient’s discharge from hospital. The Government are proposing that carers’ rights in primary legislation should be put in statutory guidance instead.

As a member of the Delegated Powers and Regulatory Reform Committee, I am very conscious that, under this Government, secondary or delegated legislation is used more and more to concentrate power in the hands of Ministers rather than in Parliament. The only possible reason for the Government to remove carers’ rights from the Bill, and to put them into secondary legislation, is to weaken those rights. Can the Minister give any reassurance on that point? It is a very important question.

A number of us recently met with a group of so-called adult carers—teenagers and adults—and also with a group of young carers. Both of those experiences were humbling from my point of view. I will mention a couple of points that came up. One teenager rather casually mentioned that she had begun being a carer at the age of three. This is unbelievable, is it not? I forgot to ask her what she actually had to do at the age of three; it is difficult to imagine. But, whatever she had to do, the idea that she somehow had a sense of responsibility at that age is truly alarming.

The other memorable moment was when a teenager was asked, “What is the most difficult thing for you, or the biggest problem that you have as a carer?” I thought she would say that she did not have any time to play with her friends or that she had to do all sorts of boring and horrible jobs that her friends do not. But no, she did not say any of that; what she actually said was, “The biggest problem I have is that the hospital staff won’t tell me how much medication my mum needs. They say they’ve got to talk to my mum, but that’s impossible.” The selflessness implied in that is just completely extraordinary—and of course there were lots of other incredible points.

If these young carers are not consulted before their dependent relative is discharged from hospital, they may be at school or in the middle of a hockey match—it is just unimaginable that this requirement should be in any way weakened. I ask the Minister to take extreme care on this issue when going back and considering the Bill; only then can we be sure that patients are not just medically fit to be discharged from hospital, as the noble Baroness, Lady Pitkeathley, said, but are safe to be discharged—that is, carers or others are there to look after them.

BASW rightly points out that revoking a local authority’s Care Act duty to integrate care and support provision with health provision at the time of the key decision about where a person should be discharged to from hospital undermines the model of integration between social and health care staff—surely the absolute opposite of the whole objective of the Bill. I understand that discharge to assess is probably reasonable for medium and long-term care planning. However, an assess to discharge approach is even more important and should be done in hospital, from the date of admission to hospital. Where is that commitment in the Bill? I look forward to the Minister’s response.

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[The Deputy Speaker (Baroness Fookes) (Con)]

The noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

[Baroness Brinton (LD) [V]]

My Lords, I echo the thanks of my noble friend Lord Sharkey to the Ministers and their officials for the very helpful discussions that we have had with them on reciprocal healthcare agreements. I also thank my noble friend for his persistence in leading on those discussions between Committee and Report on the two points of difference between us—the definition of reciprocal healthcare, with our concerns about the ability to create a privatisation of parts of healthcare, and that an SI under a negative resolution is not strong enough for Parliament to scrutinise properly. My noble friend’s amendments are, as he said, very specifically aimed at removing these concerns, and I look forward to the Minister’s response.

I also particularly thank Ministers for understanding that the House was deeply unhappy with the original proposals for regulations via a negative resolution. I hope to hear that Ministers will now agree to the affirmative resolution proposed in the amendment of my noble friend Lord Sharkey. Scrutiny by Parliament needs to be timely, and Parliament needs to be allowed to effectively challenge proposals about which it has concerns.

[Baroness Thornton (Lab)]

My Lords, it is a great pleasure to speak about reciprocal healthcare, which is not how I felt several years when we dealt with this exact issue in your Lordships’ House, as many noble Lords might remember. It was with some trepidation that I and these Benches looked at this part of the Bill, because we were so concerned and had to do so much work to protect our NHS in the passage of the 2019 Act.

I am very grateful to the Minister and the Bill team for engaging with us so thoroughly to take on the board our concerns, which needed to be built into this part of the Bill. I say particularly how impressed I am by the noble Lord, Lord Sharkey, and how grateful I am to him for his understanding and persistence—and his ability to read long, complex documents, understand them and then translate them so that other people can understand them too. That is a great talent.

From these Benches, with the idea that the affirmative resolution will be agreed, we are very happy indeed.

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[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

[Baroness Brinton (LD) [V]]

My Lords, I thank the noble Baroness, Lady Wheeler, for introducing so comprehensively this group of amendments on care costs. Given the lateness of hour in Committee, the House needed to hear the detail of this.

Her Amendments 127 and 141, which I have signed and which we will support if she calls a Division, would remove the cap on care costs which was announced and introduced by the Government in the Commons. It was not widely consulted on, and is a deeply unfair element of the Government’s proposals for the new social care payments arrangements. Far from fixing the ongoing crisis in social care “once and for all”, which the Prime Minister said from the steps of No. 10 Downing Street in 2019 he would do, these divisive plans will not stop people needing to sell their homes to pay for care and are a breach of the Government’s promise in that election. It is very important that the Commons have the time to discuss the consequences of the detail of removing that cap now that the announcement has been better understood, especially by the professionals, including the think tanks, who are very concerned about it.

We also support the noble Baroness, Lady Campbell of Surbiton, who will speak to Amendment 143 in the name of the noble Baroness, Lady Bull, which would ensure a zero amount for personal care charges for those under 40. It is absolutely against the spirit of Dilnot and a deep injustice to those under 40 with personal care needs that they are treated the same as those whose working years are behind them. It is a huge injustice that we have an NHS that is free at the point of use and yet younger people with learning disabilities and life-limiting health conditions are charged for essential care. There are also a number of deep, practical contradictions in this arrangement that make it particularly shocking, including a survey that found that charges made by cash-strapped local authorities—made because they could charge them—had forced people to stop the care they needed or made them face difficult choices for financial reasons, with the results showing an increased reliance on family members and high levels of deteriorating mental health, including suicidal thoughts.

Amendment 144A from the noble Lord, Lord Lansley, and as outlined by the noble Baroness, Lady Wheeler, supports the principles behind both Amendments 127 and 141, which would remove Clause 155. It proposes that all provisions on the care cap are brought into force by 1 April 2023 by regulation under the Care Act, resulting in no delay to its implementation. We support that too.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, the noble Baroness, Lady Campbell of Surbiton, is also taking part remotely. I invite the noble Baroness to speak.

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

My Lords, the noble Baroness, Lady Brinton, is taking part remotely; I invite her to speak.

[Baroness Brinton (LD) [V]]

My Lords, the noble Lord, Lord Hunt, introduced his Amendment 144B on complaints about care services very well. He is absolutely right: this is a muddle. Are people to go to the CQC or to a particular home when they wish to make a complaint? Any complaints system where the person making the complaint feels in a less strong position than the organisation to which they are complaining, or indeed—sometimes they might even put this strongly—which is wielding power over them is a complaints system that will not work. I hope that the Minister will understand this, and will respond and ensure, first, that there is a clear and understood system, and, secondly, that if some funding needs to be restored to the CQC to take us back to where we were, that will happen.

I want to speak particularly to two of the issues covered in this wide-ranging group of amendments: the licensing of cosmetic procedures and medical practitioners’ financial and non-pecuniary interests. I also have sympathy for the other two, on registration of social workers and hospital rehabilitation accommodation.

The amendments laid by the Minister, beginning with 153A, on the licensing of cosmetic procedures by local authorities and, indeed, Amendment 169 in the name of the noble Baroness, Lady Finlay, on cosmetic procedures, which I have signed, set out models for registration for those who work using devices that breach the skin and who are not covered by medical registration or, currently, by any effective regulation. I know that considerable discussions have taken place between Committee and Report, and it is welcome that the Government have felt that they can now lay their own amendments, signed by the noble Baroness, Lady Merron, and the noble Lord, Lord Lansley. I look forward to hearing the comments of the noble Baroness, Lady Finlay, on those amendments.

Amendment 184ZBB in the name of the noble Baroness, Lady Cumberlege, which I have signed, brings us back to the debate on medical practitioners’ financial and non-pecuniary interests. Our debate in Committee highlighted the problem that the financial and non-pecuniary interests arrangements do not match those that many others in the public sector have to make, where the registration body holds the information. The GMC has said once again that it does not particularly like the style of this amendment and would prefer the records to be held directly by the employer. However, I believe the argument that the registration body, which also has the power to take action, should be the place where these are kept.

I hope that, regardless of whether a vote is called, the Minister will take this away and look at it in more detail. We need an open, transparent and clear system of registration of financial and non-pecuniary interests.

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

My Lords, the noble Baroness, Lady Masham of Ilton, is taking part remotely; I invite her to speak.

Health and Care Bill

Baroness Brinton Excerpts

Lords Hansard - Part 1 & Report stage
Thursday 3rd March 2022 Lords Chamber

Moved by

[Baroness Brinton]

60: Clause 20, page 27, line 43, at end insert—
“(3) This section however does not authorise—(a) the disclosure of patient information, or(b) the disclosure of personal information obtained from a specified authority which is a health or social care body.(4) For the purposes of this section a “health or social care body” means a public body which exercises functions in connection with the provision of health services or of adult social care in England.” Member’s explanatory statement
This amendment would prevent ICBs from disclosing patient information or certain personal information.

[Baroness Brinton (LD)[V]]

My Lords, I thank Ministers, officials and other Peers, including my noble friends Lord Clement-Jones and Lady Walmsley, and the noble Lord, Lord Hunt of Kings Heath, and the noble Baroness, Lady Finlay, for the discussions that we have had since Committee. I am particularly grateful for the letter from the Minister late yesterday and the meeting this morning.

I have laid Amendment 60, and I support Amendment 116, tabled by the noble Lord, Lord Hunt, which try to protect only the lawful disclosure of personal patient data. For the purposes of the debate on this group, can we accept that this is shorthand for the confidential personal and medical data currently mainly held by GPs and hospital doctors in England? Amendment 60 would provide that protection in legislation and was laid only because we have not yet had a clear response from Ministers on what is permitted and what the existing rules will be relation to ICBs taking over responsibilities from CCGs because ICBs are new bodies. This is in the light of new Section 14Z61. At Second Reading and in Committee, noble Lords expressed concerns that this new section, which outlines ICBs’ permitted disclosures of information, looks very wide ranging and could, for example, enable a police officer, or another person from a public body, to demand the disclosure of a patient’s personal data.

The new section uses the phrase that ICBs can disclose data where

“disclosure is necessary or expedient”

for the person making the request, but nowhere does it explain how the decision is made by the ICB or what the decision-making process is to release the data and, importantly, where the protection of that personal data sits in the hierarchy of the request of necessary and expedient demands. I have asked repeatedly how this process would work, and in responses at the Despatch Box, in meetings and in letters I have not really had a response that has laid out simply and clearly how this process would work. I shall therefore ask the Minister the following questions in an attempt to clarify how a patient’s confidential personal data will be protected and what the process would be for it to be released to a person making a request. What rules and guidance are available for staff, including those in ICBs, to manage a request from a non-NHS person requesting information other than through a court order? How would it be processed and reviewed? ICBs would not normally be the holder of such data, and new Section 14Z61 does not set out the balance between the rights of the patient and those of the requestor who believes they have a necessary or expedient reason for being sent this data.

We wish to be confident that the structures are in place for when shared care records come into force. Let me be clear: from these Benches, we welcome the principle of shared care records, but the processes need to be in place to ensure that personal data is protected when every part of NHS England would have access to that data. I raise this particularly because just this week Health Service Journal stated that the Secretary of State is speeding up the shared care records project to be complete and implemented by December 2023.

Can the Minister therefore commit that the powers in Section 14Z61(1) will be constrained such that for requests of disclosure that come from outside the health and care system, the ICB will only ever disclose the direct care providers the requester could ask instead? Can he confirm that if an ICB is to become data controller for shared care records, he will return to this clause with primary legislation on such implementation?

I am very grateful for the discussion with Ministers and officials and hope that the Minister will be able to provide your Lordships’ House with a response that demonstrates that patient, personal and confidential data remains secure. I look forward to his response, and I beg to move.

[Lord Hunt of Kings Heath (Lab)]

My Lords, first, I congratulate the noble Baroness, Lady Brinton, on the brevity of her remarks, which is a model for Report stage. I think she put this across very well indeed and I very much support her.

My Amendment 116 relates to the containment in the Health and Social Care Act 2012 of the concept of a safe haven for patient data across health and social care, which is required for national statistics for commissioning, regulatory research purposes and patient care. My Amendment 116 simply seeks to keep those statutory protections in place and ensure that NHS England does not take on this responsibility as a result of the merging of NHS Digital and NHSX within the structure of NHS England, which was a recommendation of the review led by Laura Wade-Gery. The noble Lord, Lord Clement-Jones, is going to speak in some detail—but with brevity as well, I hasten to add.

Kingsley Manning, the former distinguished chair of NHS Digital, has spelled out the implications of doing this. He believes the action of NHS England in taking over NHS Digital

“is a significant retrograde step in defending the rights of citizens with respect to the collection and use of their health data.”

In a letter to me, which I received yesterday, the Minister asked me why NHS England would be regarded as less independent, transparent or objective in the exercise of these functions, given its already significant responsibility for some data and the fact that it is a very similar organisation to NHS Digital, as a statutory arm’s-length body. In answer to him, NHS England has many different responsibilities and priorities, so, first, it will clearly not be able to give the same focus to the issue of protecting the safe haven and, secondly, it has many interests which could be deemed to at least be in tension with the concept of the safe haven. That is why I and other noble Lords believe it is important to have the statutory protection already contained in the current legislative arrangements.

I conclude by saying that I am at one with Ministers in wanting to speed up digital transformation in the NHS; after all, we have been dabbling with this over many years. But it has to be done right, and the way to do it right is to be very transparent and rigorous about the protection of patient information.

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

I now invite the noble Baroness, Lady Brinton, who is taking part remotely, to reply to the debate.

[Baroness Brinton (LD) [V]]

My Lords, I thank all noble Lords who have contributed to this debate, in particular for their brevity given the long day we have ahead of us. In particular I thank the Minister for his helpful response.

My Amendment 60 is very specific and I asked for a specific response. The Minister has confirmed what I wanted to hear: that health data is special category data, and that it requires additional protections due to its sensitivity, which would be applied by any ICB when it has had that request. The other key phrase that stuck out was that nothing in the clause overrides the range of requirements in law to provide those key protections and safeguards regarding individual personal data. I am therefore satisfied on that basis.

Briefly on Amendment 116, which is much broader in scope and very important for the future of data use with the proposals that are coming down stream, I agree with all the comments that were made by noble Lords. One particular thing that stood out for me was the proposal of the noble Lord, Lord Clement-Jones, that the publication of the Goldacre review is vital before any final version of Data Saves Lives is made public.

We will not get to a vote on Amendment 116 today. However, could the Minister assist the House and confirm that guidance will be issued, rather than a looser “may be” issued? With that, I beg leave to withdraw my amendment.

Amendment 60 withdrawn.

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In moving Amendment 80, I look forward to the debate in your Lordships’ House and to my noble friend the Minister’s reply. I hope he will recognise the strength of feeling in the House and in this country as a whole. If the amendment is not acceptable, I am afraid that I will be forced to test the opinion of the House. I beg to move.

[Baroness Brinton (LD) [V]]

My Lords, I shall speak shortly to Amendment 168, but want briefly to refer to Amendment 80, moved by the noble Baroness, Lady Cumberlege, and so eloquently introduced by her, and supported across the House. Workforce planning is critical. Frankly, it is surprising that Ministers resisted amendments in Committee which called for formal long-term workforce planning for the NHS, social care and public health to be embedded in legislation.

The noble Baroness said that that current arrangements can be a bit like sticking plasters, and she is right, but it is not just about the use of bank and agency staff but about planning healthcare professional education. We all know how long it takes to train a doctor, but most of the other professionals also cannot just be turned on and off at election time. There have been too many times when this Government have said at elections that they would suddenly magic thousands of extra doctors and nurses. We need to build timescales into that workforce planning. The noble Baroness also talked about population demand, but I want to make another point: this is not just about population numbers; it is also about demographics. We will need more GPs and hospital professionals managing our rapidly ageing population. If we do not encourage people to go into those specialisms, we will not be able to look after our population in 10, 15 or 20 years’ time.

I also agree with the noble Baroness, Lady Cumberlege, that if government resistance is because of the funding implications with delivering such a plan, that is very short sighted. Not planning will be even more catastrophic. Amendment 80 is more modest in nature but is a critical minimum to achieve a commitment to plan effectively for the NHS, social care and public health.

I turn now to Amendment 168. Given that there are a number of speakers on this important group, I will be very brief here too. The amendment from the noble Lord, Lord Hunt, echoes the one he laid in Committee, and I am pleased to have signed both. We heard in Committee about this frustrating loophole that meant that it was not possible for certain members of the Royal College of Physicians of Edinburgh, the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Emergency Medicine to be added to the list of colleges which could be involved in the appointment of NHS consultants. This is now slowing down the appointment of NHS consultants. I am very pleased to support the amendment and hope the Minister will be able to give good news to the House on this amendment too.

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

Now I invite the noble Baroness, Lady Masham, who is also speaking remotely, to speak.

Health and Care Bill

Baroness Brinton Excerpts

Lords Hansard - Part 2 & Report stage
Thursday 3rd March 2022 Lords Chamber

[The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)]

The noble Baroness, Lady Brinton, is contributing remotely.

[Baroness Brinton (LD) [V]]

My Lords, I start by commending Amendment 100 tabled by the noble Lord, Lord Warner, and I look forward to hearing him speak on it. It is an excellent idea to ask people how much choice they have actually had when offered treatment. I also thank the noble Lord, Lord Lansley, for explaining his two amendments, and I would like to say to him that he is not sad for carrying out his role in your Lordships’ House with interest and care. His expertise in matters that may leave others cold should be celebrated. The amendments of the noble Lord, Lord Hendy, ask that trade unions should be part of consultations on private providers, and that seems sensible.

I wish to focus, albeit briefly, on Amendment 106A, which proposes that Clause 70 be left out, and which will be spoken to later by the noble Baroness, Lady Thornton; I apologise to her that under the remote rules I have to speak first. I will confine my remarks to the views of the Delegated Powers and Regulatory Reform Committee’s 15th report, in which paragraphs 17 and 18 make plain its views about these proposed procurement arrangements and regulations. The first point that it notes is that the memorandum, at paragraph 481, says that

“full analysis has not been completed and there has not been time to produce a more developed proposal.”

Why on earth do the Government wish to bring into force legislation that they admit they have not had time to analyse, let alone produce a more developed proposal for? We from our Benches, along with other noble Lords, have repeatedly said that the Cabinet Office procurement Bill is likely to overtake the needs for NHS-specific procurement regulations.

Paragraph 17 of the DPRRC Report gets straight to the heart of the issue and provides a response to the amendments that the noble Lord, Lord Kamall, has tabled, starting with Amendment 101 in this group. It says:

“We do not accept that the inclusion of regulation-making powers should be a cover for inadequately developed policy.”


It is therefore more than a little surprising to see a slew of government amendments on this issue that, in the group under discussion, strengthen the powers under regulation.

Paragraph 18 of the Delegated Powers Committee report states that:

“Ministers would not ordinarily propose clauses in one Bill possibly requiring imminent amendment in a subsequent Bill without expecting to face questions. The House may wish to seek further and better particulars from the Minister concerning the possible effect of any Cabinet Office procurement Bill on the Health and Care Bill, and … to press the Minister on why it was necessary to include provision, based on inadequately developed policy, in the Health and Care Bill when the Government intend to introduce a procurement Bill.”


Not only have we tried this at an earlier stage, but there have been meetings between Committee and Report, and it appears that the Government are determined to press on. I know that the noble Baroness, Lady Thornton, has concerns about the Government’s intentions on the clause and its amendment; if she chooses to call a Division on stand part, we from these Benches will support her.

[Lord Hendy (Lab)]

My Lords, I support Amendments 98A, 98B and 98C. Among other things, the Bill is designed to facilitate the outsourcing to private contractors of NHS services currently carried out in-house. That is the Government’s policy for the NHS, although it is firmly opposed by most of the citizens of this island.

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[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

I now call the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, I am sorry to hear that the noble Lord, Lord Blencathra, is unwell, and I thank the noble Lord, Lord Alton, for his excellent introduction to Amendment 108, to which I have added my name. I also support the other two amendments in this group, which are in the name of the noble Lord, Lord Hunt, who I commend for his consistent campaign on these issues over the years. His Amendment 162 would ensure that there must be informed consent, with no coercion or financial gain, when organs are donated or when UK citizens go abroad for transplants. Amendment 173 would ensure that cadavers would no longer be used for public display unless it is the body of a person which is at least 100 years old, because, as with Amendments 108 and 162, there is real concern that people have been forced to have organs removed, or their bodies have been used after their death—sometimes murder, sometimes execution—but without their consent.

Returning to Amendment 108, it has two clear objectives: the first is to prevent the Government procuring health service goods produced in regions where there is a serious risk of genocide. While the Government say there is no evidence, a New York Times investigation found that PPE made through the Xinjiang labour transfer programme was present in US and international healthcare systems. As we have heard from the noble Lord, Lord Alton, there is increasing evidence that the NHS has procured such items already.

The second objective is to create a process through which the UK Government can be required to assess regions for serious risk of genocide and publish their assessment. This is necessary because the UK Government have given out PPE contracts worth almost £150 million to Chinese firms with links to forced labour abuses in the Uyghur region.

The Government have said that genocide amendments are not appropriate in the Bill and that the Modern Slavery Act 2015 offers protection, but the reality is that the UK is not leading the world here. The US Uyghur Forced Labor Prevention Act creates a “rebuttable presumption” banning all goods sourced in whole or in part from the Xinjiang region of China, unless clear and persuasive evidence can be provided to the contrary; and the European Union is now considering bringing forward new legislation to ban products made with forced labour from entering the European market. The UK’s Modern Slavery Act does not go nearly as far as either of these proposals, merely requiring that companies publish—but not that they act upon—modern slavery statements. People’s lives and human rights are at stake here. Frankly, it is time the UK followed suit with stronger legislation. This amendment would be a strong and careful start that means government and Parliament cannot look away. I look forward to the Minister’s response.

[Baroness Kennedy of The Shaws (Lab)]

I shall speak very briefly, because I am conscious of the time and that we have a lot of business to do. This amendment seeks nothing more than to create another human rights threshold for health procurement, adding to those that are already in place, which seek to address slavery but have major shortcomings, as the noble Baroness, Lady Brinton, has just described. I keep hearing it being said that a health Bill is not the proper place for an amendment concerning genocide. Well, I am afraid that I do not agree. This is an appropriate place.

We are not asking the Government or the Department of Health to decide whether there is a genocide taking place; we are asking the Minister to take on the duty to assess whether the source of instruments, test kits, protective equipment or whatever may be from forced labour and a situation of slavery. Xinjiang province is the obvious place for us to be concerned about, but there are other places—for example, in India—that we should be concerned about too, and I think that placing that duty on the shoulders of the Minister is a way of concentrating minds. That is why I really press this amendment and I pay tribute to the way the noble Lord, Lord Alton, has so assiduously pursued this. That is all I wanted to say, but I will support this amendment and I urge the House to support it too.