Health and Care Bill

Baroness Cumberlege Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Cumberlege (Con)]

My Lords, it is always a great pleasure to follow the noble Baroness, Lady Masham of Ilton. Listening to her makes me realise how wide-ranging this Bill this. It is complex, as well, and will be a great challenge to our Minister as he guides it through this House. Not only does there seem to be a growing acknowledgment of the Bill’s complexity; there is also a consensus that the workforce crisis is the most significant challenge facing health and social care. All roads lead back to this problem. If we do not have the right numbers of staff with the right skills and qualifications, we will not be able to reduce the backlog. If we do not have the staffing capacity in social care, we will not be able to help people leave hospital. If we do not have sufficient capacity in primary and community care, unnecessary strains will be placed on secondary care. While the workforce problem remains at crisis level, we are still putting patient safety at risk.

There is no single solution. It is difficult; it requires a range of actions focused on recruitment, retention, pay levels, career pathways and better use of the skills of the wonderful people who work in both health and social care. It requires short-term fixes, where we can enact them. It certainly requires long-term planning and a clear strategy.

I listened carefully to the debates when the Bill was in the other place, particularly at Report stage, and to the right honourable Jeremy Hunt. I am very grateful for his thoughts and for those of the King’s Fund, NHS Providers and all the other people who have been supporting us and pressing us with ideas. As the Bill progresses through your Lordships’ House, I hope that we will explore what steps we can take to ensure that it sets us in the right direction on the serious workforce issue. With the support of noble Lords, I will seek to amend the Bill.

I am also concerned about the extensive powers of the Secretary of State to intervene in local configurations, and about the sheer range of delegated powers that the Secretary of State will have, which could impede the independence and effectiveness of NHS England and Improvement. I look forward to examining these issues in Committee.

Your Lordships will know that I have spoken in some detail in previous debates about the recommendations in our review First Do No Harm. Thankfully, I am not going to repeat those points today, but the fact is that the healthcare system—the whole system—failed. It let patients down. These were not a few isolated incidents; there was a pattern. It affected thousands of people, significantly, women and children. It was not just minor inconvenience or short-term problems; it was harm of the most devastating nature that continues even today. It was all the more devastating because it could, and should, have been avoided.

I am pleased that the Government have agreed to implement some—sadly, not all—of our recommendations. Once enacted, those recommendations will improve patient safety and reduce the risk of avoidable harm. Although we can do more to reduce avoidable harm, we can never prevent it completely. Therefore, when things do go wrong, we need a system that is responsive and compassionate. Surely, that is the hallmark of any decent society.

During latter stages of the Bill, I intend to table amendments to establish redress schemes for those who have already suffered and for a fresh way of dealing with similar cases in the future—one based not on apportioning blame and not stressful, expensive and time consuming, but instead a no-blame non-adversarial system focused on systemic failings administered by an independent redress agency. Such a system exists in other parts of the world and it works well. We should have it here.

Finally, I see the main aim of this Bill as to recognise and correct failings in the experience of patients, remove barriers to delivery, and decide whether following the science is best delivered by politicians and civil servants or top management and medical expertise. These are big questions to which we must find the answers.