Healthcare (International Arrangements) Bill

Baroness Fookes Excerpts

Committee: 1st sitting (Hansard): House of Lords
Tuesday 19th February 2019 Lords Chamber

[Lord Marks of Henley-on-Thames]

That is a helpful intervention. It brings me back to the point that all that Parliament can do under CRaG is for the House of Commons to reject the entire treaty. If there is a stage at which a Government are interested in securing a trade Bill that even a majority in Parliament may regard as deleterious to the NHS, they may decide not to throw out the treaty because that is a very strong thing to do. Although I take the view that I suspect the noble Lord, Lord Lansley, takes—that the CRaG procedures are insufficient—that merely makes the point in favour of my amendment.

We ought to be looking to the question of international healthcare agreements outside the context of the very important aim we now have of replicating EU arrangements. Taken at their worst—obviously, not if the noble Lord, Lord O’Shaughnessy, and the noble Baroness are right that these agreements will be used for wholly benign purposes for the benefit of the NHS—they could do serious damage to the NHS, which is already cash strapped. They could encourage visitors coming here to seek treatment from the NHS in competition with UK residents. They could put added pressure on a service that is already suffering from staff shortages, which will be compounded after Brexit by the additional loss of large numbers of EU doctors, nurses and vital support staff.

What the Bill needs to do, and all it needs to do, is to ensure that in the appalling event of no deal, we can attempt to salvage our reciprocal healthcare arrangements by coming to replacement healthcare agreements with our present partners. That can be simply assured by our amendment, which would leave out all the offensive unrestricted powers in Clauses 2(2) to 2(4) and substitute a requirement that regulations may be used only to the extent necessary to replicate, as far as possible, our existing arrangements.

Agreements with the rest of the world can be left for another day under clearer, more carefully constructed and constitutionally appropriate legislation, for which we will need a great deal of time to consider. I beg to move.

[The Deputy Chairman of Committees (Baroness Fookes) (Con)]

My Lords, I point out that if Amendment 4 is agreed, I cannot call Amendment 5 by reason of pre-emption.

[Baroness Finlay of Llandaff (CB)]

My Lords, I listened to the first part of the debate today, and I add my welcome to the Minister to her new post. I regret that I was unable to be here at Second Reading because of a commitment that I could not cancel, and I declare that I am a member of the European advisory group to the Wales Assembly Government. I added my name to the amendment because the Bill goes far beyond its purported remit by providing the ability for the Government to create new policy relating to healthcare agreements with countries outside the European Union, the EEA and Switzerland.

We all understand that there is need for speedy passage of the Bill because of the approaching deadline, but the question arises: why not restrict it to the problem that it has to solve? Given that the purpose of the Bill is to ensure that reciprocal healthcare arrangements are in place once we have left the EU, it is appropriate that the Secretary of State’s powers are limited to do just that and nothing more. As I understand it, that is what the amendment is intended to, and does so for three reasons, because it aims to achieve three things.

First, it aims to ensure that UK patients in the EU and vice versa can continue to access healthcare easily, including those with long-term conditions. Secondly, our NHS is protected from a dramatic increase in demand for services that a failure to reach an agreement could generate. We anticipate that 190,000—some figures say 180,000—UK pensioners in Europe are currently reliant on reciprocal healthcare. They may otherwise have to return to the UK for treatment if healthcare agreements are not replicated. Thirdly, the General Medical Council has already pointed out that the medical profession could be deemed to be at breaking point. Those working in healthcare need to be able to focus on providing care rather than on cost-recovery and complex administration.

I have questions for the Minister on that. In the event that we do not have an agreement and cannot get reciprocity, as we would like, how will the identity for eligibility be confirmed? How many people will need to be employed to make the relevant checks? Do the Government plan to issue current NHS cards that must be presented to prove eligibility, and would such NHS eligibility be incorporated in visas to work, study or be resident here?

Clause 2 authorises the Secretary of State to make regulations,

“in relation to the exercise of the power conferred by section 1 … for and in connection with the provision of healthcare outside the United Kingdom … to give effect to a healthcare agreement”.

I fully accept the Minister’s sincere confirmation that this is not a trade Bill, but I have a question about that. We have had firm confirmation here but, in the other place, something contrary was said and recorded. Which has precedent? Does what was said in the other place take precedence over any assurances given here? I accept that they are given after the event but, as far as I am aware, we have not received anything in writing or had placed before us anything from the Minister to say that that was not the case.

Another issue, raised in previous debates by the noble Baroness, Lady Jolly, concerns the risk of the Bill being used as a political tool to promote a global healthcare strategy by enabling the Secretary of State to make arrangements with countries across the world, without restrictions on the terms under which that would happen. As a clinician working in the NHS, my concern relates simply to overburdened NHS services. At the same time, I understand that the Welsh Government have not yet provided a consent Order in Council on the Bill. Has there been consultation? How do the Welsh Government anticipate the Welsh NHS coping in the event of no deal and the failure of reciprocal arrangements?

Mental Health Services

Baroness Fookes Excerpts

Monday 19th October 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Lord makes a very good point. It is totally unsatisfactory that beds are not available for people suffering a severe mental health crisis. However, looking at the research done by the noble Lord, Lord Crisp, it is not the number of beds that is a problem, but the use of the beds we currently have. Far too many people still in in-patient beds could be treated outside. The answer is not more beds, but using the beds we have more effectively. I completely agree with the noble Lord. What he described I have seen myself. It is totally unsatisfactory.

[Baroness Fookes (Con)]

My Lords, will my noble friend look very closely at mental health provision in prisons, where a disproportionate number of people have mental health problems? This is a matter of many years’ standing.

[Lord Prior of Brampton]

The noble Baroness makes a very strong point that people with mental health problems who are in prison should be entitled to exactly the same care as people who are not in prison, and the extent to which that is not the case should be addressed. It is an issue that I will certainly take up outside the House.

Hospitals and Care Homes: Hydration

Baroness Fookes Excerpts

Monday 7th November 2011 Lords Chamber

[Earl Howe]

My Lords, the noble Lord is right to express concern about urinary tract infections. There is a programme of work designed to bear down on that, as there is for hospital-acquired infections generally. He is absolutely right to raise that concern, which has a direct bearing on the Question on the Order Paper and the need for proper hydration at all times.

[Baroness Fookes]

My Lords, could I suggest to my noble friend an experiment being done by a hospital that I know of—namely, that within 24 hours each patient should be assessed as to whether they are likely to have any difficulties drinking or eating? When that is found to be the case, they have specially marked jugs and trays in red, which immediately alerts staff on duty to the need for extra care.

Health: Breast Cancer

Baroness Fookes Excerpts

Monday 3rd October 2011 Lords Chamber

[Earl Howe]

Yes, I can, my Lords. It is very important that doctors should feel absolutely free to refer patients. I remind the noble Lord that it is a right for patients, under the NHS constitution, to expect to be referred within the laid-down waiting time maximum periods, so we are very clear that there should be nothing to interfere with doctors’ clinical judgment in this area.

[Baroness Fookes]

My Lords, am I right in thinking that screening comes to an end after a certain age for women? If that is correct, does it make any sense when the incidence of breast cancer increases with age?

[Earl Howe]

My Lords, my noble friend is right that we have historically targeted women in a certain age group for breast cancer screening. We are looking to see whether that age group should be widened but it is generally true to say that screening is more cost-effective in older women. It has certainly been the case that the breast screening programme over the past number of years has increased the detection of cancer and saved an estimated 1,400 lives a year.

Healthcare

Baroness Fookes Excerpts

Thursday 28th October 2010 Lords Chamber

[Baroness Fookes]

My Lords, unlike many of the contributors to this debate, I speak only as a lay man, but a lay man who is interested in the future of the NHS. I welcome the general thrust as set out in the Government’s White Paper. All I ask is that the revolutionary changes that are being made are made with particular care and sensitivity. I have seen a number of changes from the outside over the years and I know that, whatever happens, for those directly involved it is a period of great upheaval, anxiety, uncertainty and worries about how it will all shake down. I hope that this will be done sensitively, and that after that there will be a period of real stability. Thereafter, if changes need to be made, I hope that they are made on a steady basis so that we have evolution, not revolution.

I particularly welcome the idea of the patient being at the heart of the NHS. When I was young and naive, I would have assumed that that was bound to be the case. Experience has taught me, however, that that is not always the case—one can get very lost in systems, management and all the rest of it—so I am glad to see this brought forward. I have a tiny niggle about the expression “patient-led”. It could be considered ambiguous, and I would rather have the term “patient-centred”. As long as we get the actual work done so that it is patient-centred, though, the current expression is fine.

There are difficulties for patients. I shall use one small illustration from an acquaintance of mine who has a rather rare illness that has a number of appalling side effects, so that effectively she is suffering from a number of illnesses at the same time. That necessitates not one consultant being involved in her care but several. There came a crisis point when there were directly conflicting pieces of advice from two consultants. What were the unfortunate patient and her husband to do? One could argue that it should be the GP bringing all the threads together, but I suggest that, with a rare illness involving consultants, the GP is actually in no position to make judgements or insist on what should be done. I hope that when one is looking at the running of hospitals, there will always be the idea that a very senior consultant, perhaps even nearing retirement, could bring the various consultants together and, together with the patient, make sensible decisions.

I am of course delighted to see the end of targets, which so distorted clinical management and had an appalling effect. I hope that I can have the encouragement of the Minister to say that they will go completely. However, I see a case for them if they are done at very local level by the people intimately involved—say, a GP’s practice or an individual hospital—where they can see what they need to do and can set their own local target. That is the only place where I could see some sort of role for targets, and they could be useful.

When we come to outcomes—in my terrible lay man’s language, that means that you either kill the patient, cure the patient or something in between—I hope that the Government will be careful not to fall into the trap of the targets and have outcome measurements that do not actually fit the bill. It is an extraordinarily difficult thing to do and I hope that great care will be taken. That said, though, I welcome the White Paper and the Government’s intentions.