Pandemic Preparedness

Debate between Baroness Chakrabarti and Lord Markham

Monday 15th April 2024 Lords Chamber

[Lord Markham (Con)]

That is all a part of what I referred to as having a toolkit for a flexible response. The problem always in these things is that you tend to fight the next war on what happened in the last one. We have to be careful in what we do and that we are not trying to fight the next pandemic on the last one, because inevitably it will be different. Having a flexible and scalable response, including communications, is vital.

[Baroness Chakrabarti (Lab)]

My Lords, the Minister says that we have a—

Black and Minority Ethnic Babies: Mortality Rates

Debate between Baroness Chakrabarti and Lord Markham

Wednesday 15th November 2023 Lords Chamber

[Lord Markham (Con)]

Yes, absolutely. One main reason for that is that in London there is generally a more ethnically representative mix of staff, who are better placed to understand and work in that way. Clearly, we need to increase training as well as recruitment across the rest of the country to make sure that they achieve the same levels.

[Baroness Chakrabarti (Lab)]

My Lords, the Minister will know how highly regarded he is in this place as one of the most caring members of the Government, but what does he say to the comments of the president of the Royal College of Paediatrics and Child Health about how troubling these figures are in a wealthy nation such as ours and about child poverty in this country being a driver of child mortality? What will the Government do about that?

[Lord Markham (Con)]

That is specifically what the Best Start for Life programme is all about. It is a joint Department of Health and DfE £300 million initiative focused on the 75 most deprived areas and local authorities. As the noble Baroness might be aware, the whole reason Andrea Leadsom wanted to come back as a Minister—I was talking to her about this yesterday—was to drive this programme, which she is passionately behind. That work is being done through family hubs, making sure that the whole family is involved and bringing in the dads. That sort of action is very much focused on making sure we tackle this.

Strikes (Minimum Service Levels) Bill

Debate between Baroness Chakrabarti and Lord Markham

Committee stage
Thursday 9th March 2023 Lords Chamber

[Baroness Chakrabarti (Lab)]

My Lords, it is with a heavy heart that I welcome the Minister—the noble Lord, Lord Markham—to this Committee. That heavy heart is for a few reasons. The first is that in his time in your Lordships’ House I have found him to be one of the kindest and least combative members of the Government, so I can only imagine what he feels about applying this kind of approach to industrial relations in the health service.

That takes me to my second real regret about this aspect of the Bill. Of course I find the Bill objectionable per se, but I find it particularly distasteful in relation to health services. That is because these people have been the heroes of the pandemic. I am personally embarrassed that it feels like a very short time ago that I was standing with my neighbours, practically in tears, bashing pots and pans in gratitude to these people. We in this House are now talking about imposing minimum service levels on them, as if that is necessary.

What is more, some categories of these health workers are highly regulated and ethical professionals. Even outside pandemic circumstances, we all put our lives and those of our loved ones in their hands. We trust them to do things that we do not understand: that is the level of trust that we have in these people. It is, in the words of the right reverend Prelate, a terrible statement of a lack of trust—it undermines a sacred trust—for politicians to be inflicting this on these highly ethical health workers. I really wonder, if we were to have a focus group or a poll of the public, and measure the trust index of different categories of people in public life and in different professions, where nurses, doctors and other health workers would sit, compared to—dare I say it—lawyers and politicians.

That takes me to a further regret, which was put so well by the noble Lord, Lord Allan of Hallam, who, if he is not careful, is going to be competing with his noble friend Lord Paddick for who is the most legally literate non-lawyer. He hit on a very important point that is specific to health services: the litigious possibilities. In relation to the Bill more generally, we have already touched on the dangers of litigation in relation to whether the Secretary of State chooses to make regulations in an area or not. Some people might seek to challenge the making of regulations but, of course, there is also the possibility of judicial review by other groups of the Secretary of State not making regulations. This will come whenever something is effectively delegated to executive discretion. That executive discretion can be subject to judicial review and litigation. Governments of both stripes get annoyed with judicial review, but there it is: it is part of our rule-of-law system in a constitutional democracy.

In addition to that potential for litigation, we then have the negligence lawyers. As the noble Lord, Lord Allan of Hallam, put it so well, we now have oceans of possibility of claims made against particular employers for potentially not issuing these notices in circumstances in which they did not think it was necessary. To be in hospital is to be sick, and there will sometimes be bad outcomes, and we now have this new possibility for litigation about the extent to which issuing or not issuing work notices may have contributed to your loved one’s demise. That needs to be considered.

The Minister was not here during debate on the earlier group, so to help him out I say that he could borrow the script of his noble friend Lord Callanan. In relation to some points, he said, “I can’t explain this point to you because, of course, it is legal advice that I have taken; I’ve taken it very seriously but I can’t tell you what’s in the legal advice.”

When other points were put to the ever-resilient Minister, the noble Lord, Lord Callanan, he said, “The reason why this is in and that is out is a political decision”. It is either legal advice, which he will not comment on, or a political decision as to why these categories are so broad—or why there are six of them and not seven. If we wanted more, he was saying, the Government would give us more, but they would not give us fewer. The point is not about the length of this list of services but about the precision and rationale that went into making these choices.

The noble Baroness, Lady Noakes, says that it is all very well talking about the unions on the one hand and employers on the other, but I think she said that the Government are taking powers for themselves to act on behalf of service users. There are two points there: one is that when we talk about as many people as we are in the context of providers of health services, that is a lot and they are service users and providers at the same time. But the other, which was the crucial element in her remarks, is that the Government are taking powers for themselves. They should not be doing so. If legislation is truly necessary in relation to health services or anybody else, it should be for Parliament to have a Bill before it that is specific enough to provide foreseeability, in accordance with the law, and therefore comply with convention rights.

In the end, I have to hand it to the right reverend Prelate: the issue is about health services being too broad. As my noble friend Lady O’Grady of Upper Holloway asked, will it cover Amazon? I look forward to the answer on that because it would be pretty sweeping and concerning if it did. “Health services” is broad; it is not precise as a concept. My real sadness about health services being attacked in this way is the issue of trust. The Government should be building trust, post pandemic most of all, between people and vital healthcare workers and not undermining it.

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

I thank the noble Lord, Lord Collins, and the noble Baroness, Lady O’Grady, for their amendments. I also thank the noble Baroness, Lady Chakrabarti, for her kind words.

Amendments 3 and 4 seek to remove the health sector and health services from being within scope of having minimum service levels implemented. As my noble friend Lord Callanan said earlier, the key sectors outlined in the Bill broadly stem from the 1992 Act, as amended by the Trade Union Act 2016, as they have long been recognised as important for society to function effectively. Strike action in some areas of health services can put lives at risk or cause serious harm to patients. As my noble friend Lady Noakes rightly pointed out, it is about protecting the patients; that is why we have brought this provision. It has the potential for far-reaching consequences for members of the public who are not involved in the dispute. That is why we are looking to include the health services within the legislation.

I will try to answer some of the specific questions from the noble Baroness, Lady O’Grady, the noble Lord, Lord Allan, and others on why we are including health in the minimum service levels. We need to point only to recent experience in the ambulance negotiations, where there were concerns that many trusts were not sure, right up until the night before, whether derogations would be approved. The thinking behind the need for consultation was that we can have that certainty.

At the same time, the nurses’ and the doctors’ unions said, in their recent strikes, that they would not cover A&E. In those circumstances, noble Lords must accept that there was a real possibility of not being able to provide A&E services, which would obviously threaten the lives of patients. That is why we feel the need to put those protections in the minimum service levels. However, the most important thing in all this is that the Bill is just enabling legislation; our sincere hope is that it is never needed.

--- Later in debate ---

[Lord Markham (Con)]

We all agree that they did a huge amount. I do not think that there is a particular difference in circumstances: the principle behind the derogations today is to provide that life cover. That is absolutely there, which is why the hope and the thought is that this legislation might never need to be used. As I said, it is very much a back-pocket thing because, in the circumstances described today, it has managed—

[Baroness Chakrabarti (Lab)]

“Health services” need not be as broad in the Bill. In his gracious response, the Minister talked about the life and death level of risk. If that is the case, why should the provision not be narrowed from “health services” generally, which is incredibly broad—it covers everything from dental hygiene to nutrition advice—and tightened to the life and limb cover he refers to?

[Lord Markham (Con)]

We are talking about the absolute minimum services. As I said, we had the consultation process. Clearly, we would be saying that this is an area where there is a real concern over the risk to life and limb—that would not apply to some of the noble Baroness’s examples—and we would then go into the 12-week consultation period to work through that. The burden will be very much on us to show that that risk to life and limb absolutely is there, because that is that principle behind all of this.

--- Later in debate ---

[Lord Markham (Con)]

I thank the noble and learned Lord for his comments. As I have said, in these circumstances we are talking about putting in place those minimum service levels for the trust to be armed with and to be able to enact. We are not trying to put in place any legal framework that we can use to go back and sue the trust for not holding to it, and we are not trying to put legal obligations on the trust to do it. Instead, we are trying to give an enabling ability, to be used only, as I said, as a backstop in these circumstances, and with the hope that they will never need to take that forward.

[Baroness Chakrabarti (Lab)]

I appreciate that the framework of the Bill as a whole is not the Minister’s responsibility; he is in Committee to talk about health services in particular. So I will ask him a question specifically on health services. Given his very clear answers that he anticipates the life and limb health provision being a matter only for the Bill, would it not be wise, advisable and appropriate for the reference to “health services” in the Bill to be tightened, so that it is clear that the regulation-making power is only about the life and limb provision he has talked about so extensively and explicitly?

[Lord Markham (Con)]

Again, I believe that it is trying to work off the 1992 definitions and work. The beauty of these debates, as I have come to appreciate about the House of Lords and the job that it does, even in the short time that I have been involved, is that they make sure, through this good critical challenge, that we can ensure that the legislation is doing exactly what we want it to do. We need to make sure that we get those definitions correct and, clearly, the beauty of where we are at this stage is that we have that ability. I thank noble Lords for that, and I hope that they can see by my responses that this is something that I want to make sure we get right.

I am glancing through the remaining questions—but I hope that I have answered the substance of the questions.

Menopause

Debate between Baroness Chakrabarti and Lord Markham

Tuesday 18th October 2022 Lords Chamber

[Lord Markham (Con)]

I again agree with the point. Helpfully, the noble Baroness, Lady Thornton, pointed me towards the excellent Fawcett Society report this morning, for which I am grateful. It makes for a very interesting read. As I mentioned earlier, the statistic that 10% of women during the menopause end up leaving employment is a telling one. That is what the appointment of health ambassador for the employers is all about. I hope that noble Lords will see the seriousness with which I take this subject, because it is vital not only to women but to the economy and business as a whole. This time next year—if I am still here—I commit to doing a stocktake report on the progress that we have made on this over the year, because I think it is vital.

[Baroness Chakrabarti (Lab)]

My Lords, I am grateful to the Minister for the very serious tone of his response to this Question. I declare an interest which is not in the register but is self-evident from my date of birth, which is public information. Will he readdress that part of my noble friend’s question that was about the EHRC and whether that public body has a role in setting out guidance for employers? Will he, in the light of his commitment on this subject, suggest that the Equality Act needs to be at the very least enforced and possibly beefed up in this regard?

[Lord Markham (Con)]

I apologise if I have not answered the point on the EHRC satisfactorily and it is best that I follow it up in writing to make sure that I do so.

On the Equality Act, as I am sure everyone is aware, menopause should be covered as a protected characteristic within the terms of discrimination, be it on grounds of sex or age, and I believe there are cases where it has been shown to be used correctly in that regard, so the capability is there. However, if there is not adequate reason for redress under the Equality Act, that would obviously need to be looked at in the future.

Skills for Care Report

Debate between Baroness Chakrabarti and Lord Markham

Thursday 13th October 2022 Lords Chamber

[Lord Markham (Con)]

My Lords, my understanding is that there is a 10-year plan as part of a workforce plan, which rightly looks at the issues raised by the noble Lord. As I mentioned in my answer to the previous question, the workforce is key to this sector. We employ 1.5 million people; I think that they account for about 5% of our whole workforce. So making sure that this is an area that people want to come and work in, that people enjoy and that people see as a vocation is vital and will be part of the plan. I will look up the data requested and reply in writing.

[Baroness Chakrabarti (Lab)]

My Lords, I, too, welcome the Minister to his place. I congratulate him on the tone of his responses so far. I agree with him that the workforce is key. Another feature of the report is that a quarter of the adult social care workforce are on zero-hours contracts and get paid £1 an hour less than healthcare assistants on average. Given the projection in the report that, if we are to keep up with our ageing population, we will need the best part of 500,000 more of these workers by 2035, we must address their low pay, must we not?

[Lord Markham (Con)]

The noble Baroness is correct that a number of people are on zero-hours contracts. As I am sure she is aware, their employment is through a number of agencies and local authorities, but it is an issue in a number of places and goes to the wider conversation about how we make this sector an attractive place to work. Earlier, my colleague mentioned the Skills for Care working group, which found that a significant proportion of all employers—around 20%—have a turnover rate of only around 10% versus the 29% average. So, clearly there are areas where certain employers do a fantastic job of not only recruiting but retaining, and making the sector an attractive place to work. I believe that the whole emphasis of the conversation we are having now is exactly about how to make this sector an attractive place to work because, as we all know, it is a vital part of our care and health system.