Health and Care Bill

Debate between Baroness Chisholm of Owlpen and Baroness Bennett of Manor Castle

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a great pleasure to follow the noble Baronesses, Lady Thornton and Lady Brinton. I too will be brief. I have attached my name to the first of these amendments because it addresses such an important issue. We are seeing more and more signs of real competition between the resources being used for private work and for public purposes, for which the NHS is there. A report in the Guardian this month said that in January 2021, when there were enormous Covid pressures on hospitals in London, doctors wrote to their medical consultants begging them to reduce their private work so that their availability to those hospitals was greater. That is a measure of how Covid has accelerated and put extra pressures on the NHS.

I will quote from the websites of two hospitals, which I will not name; to do so would be unfair, as I suspect that they are very typical. One says:

“All profits from the provision of our private patient services are used to support the delivery of NHS clinical care for the benefit of all patients.”


Therefore, it is very easy to see how well-meaning people might say, “Well, if we do more private work, then we’ve got this money to put into our horribly underfunded public work”, but that is taking away terribly limited resources, particularly staff and staff resources, as we have discussed in considering so many other amendments. The other hospital’s website says of its private provision that it offers

“rapid access and flexibility for a wide range of conditions and care needs … the unit can also care for those patients admitted through”

the hospital’s

“emergency department who may wish to make use of their private insurance or indeed pay for their private care themselves.”

As noble Lords know or will recognise from my accent, I come from Australia, which has a two-tier system. Many people with resources have medical insurance, and the poorer people do not. There are clearly two utterly different levels of service, which means there is much less advocacy for, support for and fighting for public provision. If we look at the trend of travel, the amendment tabled by the noble Baroness, Lady Thornton, is important and must be thought about in the context of foundation trusts and much more broadly.

[Baroness Chisholm of Owlpen (Con)]

Well done. You need Baronesses to do this: they get to the point and get it done.

I thank noble Lords for explaining these amendments. As they may recall, in 2012 we abolished the private patient cap while clarifying that the foundation trusts’ principal purpose is

“the provision of goods and services for the purposes of the health service in England”.

This means that foundation trusts must make the majority of their income from NHS activity and must always have as their primary purpose the delivery of NHS services. We also retained the requirement that additional income should be used to benefit NHS patient care, and it has been used across the system to offset such things as maintenance costs, to finance alternative transport such as park and-ride and to fund patient care.

This amendment would introduce a new cap by requiring foundation trusts to agree with their ICB and ICP their income from non-NHS sources. However, this would be a significant bureaucratic burden on foundation trusts and would require them to forgo raising additional income or seek agreement via a multi-stage process before doing so. It would also mark a significant new restriction on foundation trusts’ freedoms and autonomy.

Similarly, Amendment 233 would restrict the freedom of NHS organisations to decide locally the most appropriate structures they need to support their operations. There are multiple reasons for trusts setting up subsidiary companies, including providing services for other trusts and being able to attract staff from the local employment market. Creating a subsidiary can also be an alternative to outsourcing services to the private sector, thereby maintaining its staff within the NHS family. Importantly, in November 2018 NHS Improvement issued guidance to trusts about forming or changing a subsidiary. Under that guidance, all subsidiary proposals must be referred to NHS Improvement for review. NHS England and NHS Improvement paused their update of the guidance to trusts on subsidiary companies to allow the sector to focus on supporting the response to Covid-19 and the recovery of services. However, we remain committed to the review and the publication of this updated guidance is now set for early summer 2022.

I hope I have given the noble Baroness sufficient reassurance for her to withdraw the amendment.

Health and Care Bill

Debate between Baroness Chisholm of Owlpen and Baroness Bennett of Manor Castle

Committee stage
Thursday 20th January 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

Before the noble Baroness sits down, I would just like to go back to some of the earlier amendments and some of the words she used. She said this is included in the guidance on using social prescribing, and that it is expected that ICBs will work with local social enterprises, et cetera. I want to ask a question. If we were talking about NICE-recommended medical treatments or the best possible surgical procedures, would we be saying that it is expected that ICBs will do this as it is included in the guidance? This picks up on the point the noble Baroness, Lady Morris, was saying that this still seems to be somewhere in the second class, and it should be up there in the first class, treated in the same way as a medical treatment or a medical device.

[Baroness Chisholm of Owlpen (Con)]

Well, I think it is, actually. We all realise how important it is. Social prescribing is a key component of the NHS’s universal personalised care. It is a way for GPs or local agencies to refer people to a link worker. Link workers give people time to focus on what matters and take a holistic approach to people’s health and well-being. They connect people to community groups and statutory services for practical and emotional support.

For instance, a man had bad bronchitis and asthma and was continually going to the doctor and costing the NHS a great deal of money; and it was agreed that a humidifier would be prescribed to him for his house at £800, and that has been a huge success, with the result that he has not gone to the GP once for a whole year. I think social prescribing can work well for those who are socially isolated, whose well-being is impacted by non-medical issues and who routinely present to primary or secondary care as a result. We certainly are taking it seriously.

Agriculture Bill

Debate between Baroness Chisholm of Owlpen and Baroness Bennett of Manor Castle

Report stage & Report stage (Hansard): House of Lords & Report: 1st sitting & Report: 1st sitting: House of Lords
Tuesday 15th September 2020 Lords Chamber

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, I am in favour of both these amendments. I was just reflecting on a visit I made to a small town in south Shropshire called Clun, which was then home to what was said to be the food bank in the smallest community anywhere in the UK. I am glad that both noble Lords introducing these amendments have focused not just on the individual situations, as pressing as they often are, but on the need for communities to be assured that money is coming in. On that basis, we want a Britain where there is no need for any food banks; we should not rest until the last food bank closes due to lack of demand. In the meantime, we have to find other ways to make sure that money is going into communities that sometimes are, and have for some time been, really struggling.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I hesitate to disagree with this amendment, tabled by my noble friend Lord Cameron of Dillington. He is godfather to my daughter and one of my oldest friends. When I say that, I mean that I have known him forever, not that he is old in age, obviously.

I understand where the noble Lord is coming from: the needs of farmers and their households, along with rural communities, must be supported through the challenges they face. Now that we have left the EU, we have the opportunity to drive enterprise and jobs by re-energising our rural areas and those who live and work in them, and the UK Shared Prosperity Fund will do just that. It will cut out bureaucracy and create a fund that invests in UK priorities and is easier for local areas to access. To that end, I know that departments are working closely together to address the challenges faced by our rural communities. I hope that the Minister can elaborate on how that will pan out, with the UK Shared Prosperity Fund being very much part of dealing with those challenges.

Importantly, the problem with the support programme suggested by my noble friend is, I believe, that it would bring unintended consequences, taking money away from the UK Shared Prosperity Fund and therefore muddying the waters—which, I am sure, is not what was intended by this amendment.