Health and Care Bill

Debate between Baroness Fraser of Craigmaddie and Baroness Walmsley

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

[Baroness Fraser of Craigmaddie (Con)]

My Lords, it is clear that there remain huge and serious concerns across the House and beyond regarding how the Bill addresses the chronic staff shortages in our health and care services. I say health and care services, because as we know, the staff shortages affecting the delivery of services are not just within the NHS but felt across the board, in health, care and public health services. While this is a current and urgent issue, future workforce planning will be the single most important factor in limiting our ability to deliver the ambitions we all have for the future of health and social care and importantly, the ambitions of the Bill.

Like many other noble Lords, I have the greatest respect for my noble friend Lady Cumberlege, and if she feels that the current duties the Bill places on the Secretary of State in Clause 35 to report at least every five years are inadequate, then I urge the Government to take note. As my noble friend said when she introduced her amendment, she is not alone: at least another 100 organisations are calling for this aspect of the Bill to be strengthened. I ask the Minister today, therefore: if the Government are not planning to accept the amendment, how do they plan to address the challenges of future workforce? How will they assess the future needs of health, social care and public health services? Previous work has not quantified the workforce numbers needed and we cannot wait for another review.

I have a couple of observations on the amendment itself, which I commend in that it does require the Secretary of State to report on this wider health, social care and public health workforce, unlike the current Clause 35, which refers only to the health service. However, I sound a note of caution, because if we simply assess vacancy rates, or get into the mindset of needing to replace like for like, role and service development, which will be essential to support future health and care services as they evolve, risk being stifled, as my noble friend Lady Harding referred to.

Those who hold much of the data on health and care professionals are not only the royal colleges, as the noble Baroness, Lady Finlay, mentioned, but also the regulators. I note that proposed new subsection (4) of the amendment does not mention health and care regulators, which I think should be consulted, in the spirit of my noble friend’s explanatory statement.

Finally, when describing the system in place for assessing and meeting workforce needs, as training and regulation are UK-wide, I hope there will be a spirit of co-operation between NHS England and the devolved nations to ensure that we are training the right people for the right roles across the UK NHS: this needs to be in any future workforce assessment as well. I also cannot understand why we do not accept that the royal colleges in Glasgow and Edinburgh can help us recruit. That seems completely bananas—that is the technical term. Will the Government accept that we cannot put workforce planning yet again into the “too difficult” box? We need to do more and go further, as my noble friend Lady Cumberlege urges. I accept there are no silver bullets, but the regular publication of independently verified projections of future demand and supply of workforce could, over time, create a sustainable model for improvement that would have a positive impact on both patient care and staff experience.

[Baroness Walmsley (LD)]

My Lords, I congratulate the noble Baroness, Lady Cumberlege, on the way she introduced Amendment 80—it was masterful. I point out that she took this amendment from the right honourable Jeremy Hunt, who unfortunately failed to get it through the House of Commons. In doing so, he expressed his regret that, when he was Secretary of State, he was not able to put in place a structure such as the noble Baroness proposes today.

The noble Lord, Lord Stevens, and the noble Baroness, Lady Harding, have both commented that it is self-evident that we need a workforce adequate to meet the demand. To do that, we need to anticipate increasing demand, changes in demographics, population growth and changes in practice. Crucially, we need to put in place resilience to health shocks. If we do not do that, we will continue to struggle to reach the OECD average of 3.7 doctors per 1,000 people, which is reasonable. To get there, we actually need 50,000 more doctors.

However, as the noble Baroness, Lady Jones, pointed out, this is not just about doctors. It is also about nurses and, as we have heard from the noble Lord, Lord Bradley, and the noble Baroness, Lady Whitaker, it is about allied health professionals. We need to train them all in a timely way, given, as the noble Lord, Lord Stevens, pointed out, how long it takes to train all these health professionals.

The Prime Minister claimed in the House of Commons recently that we have 45,000 more people working in the health service than before the pandemic. Unusually, that may be true, but it was not clear whether they were full-time professionals. However, that number bears no relation to the demand. There is no point in quoting raw figures if they are not related to the rise in demand. Moreover, there are fewer GPs than before the pandemic, and that is where people’s access to the NHS begins. If someone cannot get to see a GP, they cannot get a diagnosis or a referral, and their disease gets harder and more expensive to treat. Having too few GPs is not a cost-effective strategy, so I support Amendment 111, tabled by the noble Lord, Lord Hunt, and also his Amendment 168.

Health and Care Bill

Debate between Baroness Fraser of Craigmaddie and Baroness Walmsley

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I rise partly because my noble friend Lord Forsyth referred to me earlier and partly because I wanted to clarify what is happening in the Scottish Parliament. There is not actually a Bill in front of the Scottish Parliament. The Orkney MSP, Liam McArthur, carried out a consultation which was very wide-ranging and closed only at the very end of December. Liam McArthur has reported that the submissions to his consultation were wide-ranging and unprecedented, and I look forward with great interest to reading some of them. You can look some of them up. I commend the Scottish Partnership for Palliative Care’s website; its submission is published there. The Neurological Alliance of Scotland also published a submission—I declare an interest because I am a trustee of the latter.

Both those submissions illustrate that this is a very complicated issue, as noble Lords have acknowledged, and there are many things that need evening out before we even get to potentially having draft legislation—a Bill or whatever it is; I am still learning parliamentary procedure. I find it interesting that my noble friend Lord Forsyth mentions that there might be a majority for assisted dying in the Scottish Parliament. I remind him that there is currently a majority for independence in the Scottish Parliament, but that does not mean that the people of Scotland want independence.

In my short time in this House, I have seen many amendments that may have been worthy in their own right but were in the wrong place in the wrong Bill. I think Amendment 297 in the name of my noble friend—I feel very nervous suggesting this to such an esteemed colleague—may possibly be the wrong amendment in the wrong Bill.

[Baroness Walmsley (LD)]

My Lords, I rise to speak on my own behalf; I am not representing anybody. The substantive issue is a conscience issue. I do, however, support the amendment in the name of the noble Lord, Lord Forsyth, because I think it is a discussion whose time has come. I am very impressed and pleased that noble Lords have resisted the temptation to discuss the substantive issue this evening, because all of us here understand—unfortunately, many outside do not—that this amendment is not about the substantive issue.

However, I am somewhat disappointed that the noble and learned Lord, Lord Mackay of Clashfern, wishes to knock it out on a procedural point. I think it is much more important than that. The noble and learned Lord is a wily old politician, and he knows very well that if you want to defeat something, it is often a very good idea to try to get rid of it on a procedural point. He suggested that we should use the Private Member’s Bill procedure. He has been in this House long enough to know that very few Private Members’ Bills are taken up by the Government and given time, and if they are not given time, they are going nowhere. But it is clear that this country wishes to discuss the matter and have Parliament decide on it.

The noble Lord, Lord Moylan, suggested that we cannot put anything in the Bill that the Government do not want to do. I remind him that every time we defeat the Government on an amendment, we are asking them to do something they do not want to do—and we did it 14 times last week on the policing Bill.

I have one other point. The right reverend Prelate the Bishop of Carlisle talked about vagueness. I think the noble Lord, Lord Forsyth, has been deliberately vague, because it is for the draft Bill to be specific. That is important because we need something very specific to discuss, with specific powers and safeguards that Parliament has put in. Without that, we would have all the fear that we have around the country, much of which has been expressed in our inboxes in these last few weeks. People are afraid of what might be in the Bill and what Parliament might pass, and only if we have a specific set of proposals in front of us can we amend it to put in the proper safeguards. Parliament can then decide, and people can take their view about it. I think that will take away a lot of the fears of people who believe that there will be no safeguards, because I am convinced that this Parliament would put in proper safeguards. If it did not, a lot of noble Lords would suggest some that jolly well should be there, and rightly so. For those reasons, I hope the Minister will consider the amendment in the name of the noble Lord, Lord Forsyth.

On the amendment in the name of the noble Baroness, Lady Meacher, again, I am so glad that she said it is a probing amendment, because other noble Lords have suggested that the drafting would need to be changed to avoid some unintended consequences. I am quite sure that the noble Baroness would do that if it was more than a probing amendment. She is asking for something that patients need: choice at the end of life. I hear what the noble Baroness, Lady Finlay, said about what is already in place. She is an expert on this. It could well be that a conversation needs to be had about whether there needs to be anything further in legislation to strengthen the availability of what the noble Baroness, Lady Finlay, talked about, which sounds absolutely excellent. So I am not expressing a definite opinion on that amendment.

I hope the Minister will consider the amendment in the name of the noble Lord, Lord Forsyth, because we, as practical politicians, know that in the real world—in this Parliament—the Bill brought forward by the noble Baroness, Lady Meacher, is not going anywhere, but we need to have the discussion.