Health and Care Bill

Debate between Baroness Finlay of Llandaff and Lord Bradley

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, as others have spoken fully to other amendments in this group, I will confine my remarks to Motion L1 in my name. I thank the Minister for the open-door policy that he has had and for his willingness on many occasions to discuss with me the problems for parents who can feel completely overwhelmed in the face of not being listened to by clinicians. I am also particularly grateful to the noble Baronesses, Lady Brinton, Lady Masham and Lady Stowell, for their helpful comments and advice behind the scenes, and to the noble Lord, Lord Balfe, who has shared with me his extensive experience on mediation.

In drafting my amendment to the amendment, I was particularly concerned that we must take evidence directly from parents, including parents whose dispute has not necessarily progressed to court. While it is quite extreme to progress as far as court, there seem to be a lot of parents who have felt completely overwhelmed in the face of personal tragedy. In an interview, Rob Behrens, the Parliamentary and Health Service Ombudsman, said about mediation:

“We’ve got to get better at communicating with complainants, better at learning from bad experiences, and better at using early resolution and mediation so that sometimes we don’t have to use adjudication at all.”


He went on to point out some of the cultural characteristics of the health service that make these encounters hard. He listed professional dominance, clinical hegemony, hierarchy and defensiveness as characteristics that make it particularly difficult.

I am grateful to the noble Baroness, Lady Pitkeathley, for flagging up parent carers. They often feel deeply disempowered because they are completely dependent on the help of others to manage a very difficult situation and so particularly inhibited in the face of any professional dominance; of course, there have been some stories in the press.

In response to the Minister, I will gladly be involved in developing the scope of this review. I hope that he will rapidly put me in contact with the official who will be responsible for it because we need to start as soon as possible. The government amendment stipulates a year—actually a very short time to run an inquiry—so it needs to happen quickly. I hope that there will be funding resources attached to this; it cannot be done on thin air or a shoestring. I hope also that there will be support for it to be done properly so that we can take evidence. Developing the scope of the review will be very important and I think there are parent groups who would particularly wish to be consulted at that early stage as well.

In the letter that we were sent, I note that the Government said:

“Should the review make recommendations for legislative change, and the Government agrees with those recommendations, we would seek to bring forward legislation where parliamentary time allows.”


I see that the Government have left themselves a small out, but, if this is to be a properly conducted review with clear recommendations, I hope that they will listen to that evidence and will not shirk at taking whatever steps are necessary.

I conclude simply by thanking the Minister, the Bill team and the other officials who have engaged in many hours of discussion on this issue. I look forward to working with speed on getting this review up and running.

[Lord Bradley (Lab)]

My Lords, I will speak very briefly to Motion Q: Amendments 105 and 105A. I declare my health interests as in the register, particularly my role as a trustee for the Centre for Mental Health.

I was disappointed that the Government did not accept my Amendment 105, which was passed in this House on Report, regarding mental health membership on integrated care boards. I repeat my thanks for the support I received for the amendment from Labour and Liberal Back-Benchers, particularly the noble Baroness, Lady Walmsley, some Cross-Benchers, and from my own Front Bench, my noble friends Lady Wheeler, Lady Merron and especially Lady Thornton, who has been tremendously supportive throughout. I am also extremely grateful for the continuing and unstinting support of organisations outside Parliament, such as the Centre for Mental Health and the Mental Health Foundation.

However, I am satisfied that the Government’s amendment in lieu, Amendment 105A, captures the essence of my amendment: that the voice of mental health should be at the board table at the inception of the 42 ICBs, and play a crucial part from the start in determining service priorities, budget and resource allocation, workforce growth and development, and commissioning arrangements, among other things. The chairs of ICBs will now have responsibility for the appointment of mental health representation and will be held accountable for their decisions. This House, the other place, external bodies, the public and I will all scrutinise these appointments very carefully.

The Government’s amendment, devised by the noble Baroness, Lady Walmsley, and passed on Report, will put a double lock on mental health representation because of its intention to review the skill mix and expertise of ICB membership in the future. We had further assurance in the Minister’s letter to all noble Lords, which said:

“We strongly agree with the principle underpinning Lord Bradley’s amendment and with his view that ICBs will be strengthened by having at least one member with knowledge of Mental Health on the Board. As it stands, however, the current drafting would create significant legal ambiguity, which is why we tabled an amendment in lieu in the Commons to ensure that the principle is maintained in a legally robust way”.


I am grateful to the Minister for this assurance, and I believe that in taking it together with the two amendments, the ambition for parity of esteem between physical and mental health will, as a result, take a further significant step forward.

The Government’s amendment in lieu of my amendment should ensure that the voice of mental health is heard clearly on ICBs and in the wider integrated care system, and that the mental health and well-being services needed and demanded by the public are at the heart of integrated health policy in the future.

Health and Care Bill

Debate between Baroness Finlay of Llandaff and Lord Bradley

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

[Baroness Finlay of Llandaff (CB)]

My Lords, I must declare my interests: I am a fellow of the Royal College of Physicians, the Royal College of General Practitioners, the Academy of Medical Sciences, and the Royal College of Physicians of Edinburgh, which is affected by Amendment 168. I am an honorary fellow of the Royal College of Emergency Medicine, president of the Chartered Society of Physiotherapy and an observer on the Medical Schools Council. All those organisations have a vested interest in this amendment.

Very simply, this amendment just makes sense for the future. Without it, the cost of healthcare to the nation will rack up and never come under control. The talk about people working in the NHS is a fallacy. What matters is whole-time equivalents and the competencies of those people with whole-time equivalents. While it is absolutely right to say that it might take 15 years for somebody to come through training as a specialist, what is not understood is that, as soon as people qualify, having left their undergraduate training, they are then on the job. They are learning on the job, working incredibly hard and contributing, but they do not have the competencies developed. That is what takes a long time. The modern techniques that get things done much more quickly and that deal with more patients—laparoscopic surgery having been an example—are highly skilled, but highly efficient.

We have a shortage of 1,400 anaesthetists. Without anaesthetists, you cannot have good maternity services, you cannot operate and you cannot have good emergency services. They are absolutely essential to the whole running of secondary care. Then, of course, in primary care, we have the gaps as well, so the specialist training is really important.

As well as that, this cannot be handed over to algorithms on a computer and left to IT, because of the need for personal interaction between the clinician and the patient and their family. I do not believe that this will be replaced by AI. However, many jobs performed currently will be taken over by AI, freeing up clinicians to become even more specialist competent.

Building on the comments of the noble Baroness, Lady Harding, I remind the House that poor care overall is more expensive than good care in the long term. It is a very short-term view to think that you can provide poor care; in the long term, you really do stack up debt. Stopping workforce planning will not avoid costs at all; all it will do is move the costs from one year further into the future and create bigger problems. Although I hesitate to say it, I think it will also fuel the whole litigation culture.

Amendment 80 is absolutely essential. If it is accepted by the Government, or passed by this House, then Amendments 81 and 82 would fit very neatly into the criteria against which such reports are to be written on the workforce. I remind noble Lords who might be unaware of this that the royal colleges already collect workforce data. Verification of data collected from integrated care boards and areas will not be difficult, because you will simply see how the figures match up. The figures will be reported centrally, and planning can take place. The amendment of the noble Lord, Lord Hunt, is so straightforward; I cannot see why we want to rack up costs further by not putting it through. Vacant posts cost money, they do not save money. By putting that through, we will have more efficient appointment procedures. This is an historical anomaly which could be corrected easily.

Relying on bank staff is really dangerous. Mistakes happen much more often when staff come in who do not know the place, the team or who to call. You would never field a sports team consisting of a bunch of people brought together to play at a high level who had never played before. Yet, what we are doing in our NHS is bringing in bank staff who often do not know the hospital or the team. They do not know the strengths of the other people in the team, so they do not know to whom they can delegate. I hope that the House will approve Amendment 80 if the Government are too short-sighted to just accept it.

[Lord Bradley (Lab)]

My Lords, I rise briefly to support very strongly Amendments 80, 81 and others in the group. They have already been explained eloquently, so I will not repeat those arguments. I declare my interest as an honorary fellow of the Royal College of Speech and Language Therapists. We have already heard about their importance, as a profession, as part of the wider allied health professionals. It is always worth remembering that allied health professionals make up a third of the total workforce.

Responding to workforce planning in Committee, the Minister stated that he shares the view of the noble Baroness, Lady Finlay—from whom we have just heard—on the importance of

“integrated workforce planning across NHS and non-NHS employers … and that work is under way on it.”—[Official Report, 24/01/22; col. 102.]

Unfortunately, at that time the Minister did not set out what that work was. The response did not really give a great deal of hope regarding the long-term failings in workforce planning for allied health professionals in general and speech and language therapists in particular. We need to ensure that this is addressed. As we have heard, these amendments properly address the issue.

I draw particular attention to subsection (4) of Amendment 80, which clearly states that royal colleges must be consulted in drawing up the report which will be laid before Parliament on

“meeting the workforce needs of the health, social care and public health services in England.”

By that consultation, we should ensure that allied health professionals, and particularly speech and language therapists, are included. These professionals sometimes work directly in the NHS. Often, however, they work in other health settings and can be employed in those settings by the NHS. They might also work in settings such as education, the criminal justice system and other parts of the social care system, or in independent practice. They should all form part of the consultation to ensure that the plans which come forward on workforce planning are comprehensive in their nature and coverage. Therefore, these amendments are crucial to achieving this objective. I am sure that the Minister will want to give us that same assurance when he responds.