Health Bill

Baroness Harding of Winscombe Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Lord Mawson (CB)]

My Lords, I welcome this debate and I certainly support the amendment. I am encouraged by the letter that we received today that there is an open mind within government and a proper discussion taking place about these very important issues. I am a practitioner, as many of your Lordships know, and we are involved in trying to build some of this new health infrastructure around the country. Indeed, today I have been involved in quite an exciting conversation about a health innovation campus in Huddersfield that we are supporting, which has major implications for this Government’s direction of travel—a lot of which I support—around place, collaboration and other things that the Prime Minister has talked about.

However, we are also in touch at the front end with what is actually happening on the ground, and the word I keep hearing from colleagues across the country is “chaotic”, which is a worrying word to be hearing. Therefore, this debate and the detail that is being discussed today really matter for the NHS, for patients and for those of us who are trying to build this infrastructure. Therefore, I am encouraged that the Minister is starting off in an open, transparent and conversational manner in Committee. It is very helpful.

One of my concerns about the changes taking place at the moment is that there does not seem to be a clear vision about prevention. Those of us who have been involved in this space—in my case, I have been involved in east London, and now nationally, for over 40 years—know that on the ground, in very challenging communities, the real determinants of health often have nothing to do with doctors. If you asked our GPs in Bromley-by-Bow, they would tell you that a person getting a job does more for a person’s health than anything to do with doctors. That is why, in Bromley-by-Bow, we ended up building 97 businesses with local people, because we got real about the social determinants of health. It is about whether you have a decent home that is not damp. It is why we built a housing company, which now has 10,000 properties and owns 34% of the land in Poplar. It is to do with whether your relationships in your family are in a good place and whether you feel part of a community—all these things. The numbers that people far cleverer than me come up with say that the impact of all this is 70% to 80%.

I am not clear, with this real opportunity to reform the NHS in this century and with the things we now know, what this Government are saying about the prevention agenda and how clearly they are or are not joining the dots around the social determinants. Part of this conversation is really important, but part of it needs to be about the prevention agenda. As we work our way through Committee, we need far more clarity about what that will mean in practice and in detail in communities across this country.

[Baroness Harding of Winscombe (Con)]

My Lords, it is a privilege to follow the noble Lord, Lord Mawson, and the noble Baroness, Lady Gerada, who between them have many decades more experience than I do of NHS and health and care reorganisation. I have only one major experience from the inside: the last time we were debating the restructuring of the NHS in 2021-22. At the time, as someone from the private sector, I was somewhat surprised to discover that the NHS got on with the reorganisation before the legislation was passed. It is even odder this time: the NHS has started before the legislation but without a plan itself.

Therefore, I welcome this amendment from my noble friend Lord Howe. It is essential that we understand the plan and the timetable, what it will cost and what benefits it will bring. It really is very straightforward. If that does not exist, the idea that it can be complete by 1 April next year is completely gobsmacking. Maybe I am just an innocent businesswoman who does not understand the ways of the NHS, but it just does not seem right. I think this amendment is basic common sense.

Much as I hear the words of wisdom from Don Berwick, I support merging NHS England with the Department of Health. I saw from the inside, particularly during Covid, how important it is to have clear political accountability. I support the basic premise, but I am very worried that the tendency will be to centralise rather than to push resource out to the regions and local communities. As the noble Lord, Lord Mawson, just said, it is at the local ground level that change really happens.

I am very supportive of seeing fewer people employed in organisations that bear the NHS brand but do not actually treat patients. There are tens of thousands of people who are all trying hard and doing valuable work, but they are a long way away from patients. As we bring NHS England into the department, I would love to see, as part of this amendment, a clear breakdown of the cost savings at the national, regional and local level, so that we have sight of whether we are really pushing accountability, and resource and capability, down to where change will bring the benefits that we all seek.

[Baroness Rafferty (Lab)]

My Lords, I will be brief. I support the point made by my noble friend Lord Hunt that the Minister should reconsider the abolition of governors. I have to declare an interest as a former governor of King’s College Hospital NHS Foundation Trust. I spoke at Second Reading about the value of governors and the extraordinary breadth and depth of feedback and accountability that they provide to trusts. We just ask the Minister to reconsider that decision, for I fear that, if governors are abolished, we will have to find some mechanism to reinvent them.

Terminally Ill Adults (End of Life) Bill

Baroness Harding of Winscombe Excerpts

Committee stage
Friday 24th April 2026 Lords Chamber

[Baroness Hayman (CB)]

My Lords, it is an absolute privilege to follow the very moving and focused speech of the noble and learned Baroness, Lady Prentis. Perhaps the one good thing about the last year that has been a real revelation, and something that I respect enormously, is the number of people who have shared their experiences of death, dying and illness and their views about the best way forward. No one can pretend that there is unanimity on this issue. We have to respect all those views and listen to them.

Twenty years ago, I was a member of the Select Committee on Joel Joffe’s assisted dying Bill. That experience, the visits that we made and the evidence that we heard, convinced me that it was possible to frame legislation that safeguarded against coercion and did not compromise but rather complemented palliative care. For me, as the noble Lord, Lord Markham, said, it made the argument for regulation.

So, I was surprised to hear the noble Baroness, Lady O’Loan, describe what could go so badly wrong in an unregulated system—Shipman, coercion and no one knowing what happens. I simply do not accept that a tightly regulated Bill with the sorts of safeguards that are in this Bill is not better than the wholly unregulated system we have at the moment.

On that Select Committee, the visit to Oregon in particular made me very aware of another issue: that having legislation for assisted dying would directly affect only a small number of people who took up the option. The percentage of people who investigated the option and got a prescription—as that system required—but never used it, and who instead found that they could cope with the situation in which they found themselves, was about 30% across jurisdictions. But the very existence of legislation, and a system that they knew they could access if things became intolerable in the end, gave huge reassurance to the hundreds of people who would die under assisted dying legislation. There are thousands who would feel more secure and be reassured by the fact that there was an option. I put myself absolutely in that category and I suspect that many others in the House would do so too.

I participated in the debates. The noble Lord, Lord Baker, is in his place. I went head to head with the noble Baroness, Lady Finlay, on all those debates as well. I participated in all of them. I have been disappointed before and I have seen Bills fail before, but nothing has made me feel, in the words of the noble and learned Lord, Lord Falconer, “despondent” in quite the way that the process we have gone through in the last year has done. So, it is important that we reflect in today’s proceedings, because they should be a reflection on what I consider to be a collective failure.

I think we have failed those people who came to us with experiences, either through families or their own experiences, of the inability of palliative care, however good, to meet what they actually need at the end of life. We have failed those repeated campaigners who knew that the legislation would be too late for them but did not want others to go through what they had. We have failed to respect the consistent weight of public opinion on this issue that we ought to have a different, regulated and safe system, and we have failed to respect the elected House’s request to us to do the job that was described so clearly by the noble Lord, Lord Lansley.

We have to reflect, because all those failures have damaged the reputation of this House and they have damaged what many of us have respected and felt to be very much part of the House’s DNA—self-regulation. We have not fulfilled our duty to use our procedures on a Bill that has been passed by the House of Commons to focus either on the issue of principle by a vote at Second or Third Reading, or on specific detail where we need to calibrate the strength of opinion in this House—to vote—and send our conclusions to the Commons for its response. Instead, we have had the prolonged and painful process described by the noble and learned Lord, Lord Falconer. It has been a protracted, repetitive debate which, ironically, has led to us failing properly to address issues, such as those about the Delegated Powers Committee, which we have to take seriously. I find it disingenuous that the amendment to the amendment states that we have not taken proper account of this committee, when the reason we have not been able to is that we have not got to that bit of the Bill yet, because we have spent so much time on other bits.

There has been criticism of the noble and learned Lord, Lord Falconer, for not moving enough. I think he described the processes that he has been through. I have been present at many of those meetings, and attempts have been made to find a serious process to identify the issues that are most important to try to reach either consensus or a point where we can vote on them and decide what we want to tell the other place. Instead, we have spent hours focusing elsewhere. A very brave woman dying of stage 4 breast cancer said to me, “I’ve listened to you, and what you have been doing is focusing all the time on hypothetical harms, some of them bizarre—the pregnancy test and those sorts of issues. What you have done is ignore the actual and profound suffering that is before your eyes”. That is a serious accusation to us.

Of course, as legislators, we have a responsibility to scrutinise legislation like this for safety, but we also have a responsibility to have a full debate and reach conclusions. We have not discharged that responsibility, and we should all reflect very seriously on that.

[Baroness Harding of Winscombe (Con)]

My Lords, my mother-in-law died from motor neurone disease a couple of years ago. She was a primary school headmistress, and she took firm control of her life throughout it. Three weeks before she died, she called a multidisciplinary team meeting of all the various clinicians, including the palliative care team, and her family to express her wishes very clearly. She had reached the point where she could not move other than her face. She could not breathe without a CPAP mask for more than a few minutes, and life was intolerable. She told us that she intended to die in three weeks’ time.

That was an assisted death to the layman. It was completely legal because she could still speak. Three weeks later she told her nurse to take her mask off, she asked the nurse to give her a sedative and she passed away completely peacefully. That has completely shaped my view. As my noble friend Lord Markham set out so much more eloquently than I could throughout the course of this Bill, we have an unregulated system that is scary and unfair, so I am in favour of this Bill.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026

Baroness Harding of Winscombe Excerpts

Wednesday 15th April 2026 Grand Committee

[Lord Lansley (Con)]

I shall speak briefly to this statutory instrument and ask a number of questions, if I may, to which I hope the Minister will be able to respond. I think that I understand the structure of what is proposed and the exclusion of first aid so that it is not covered, but when I look at the providers that are likely to be affected, I am trying to work out carefully which are the providers concerned. I am assisted by a friend who is part of the Faculty of Sport and Exercise Medicine and who said that it had undertaken a survey.

It seems to me that many of the people who responded to that as healthcare professionals may well be working in registered providers already, so they may be concerned about the need to register in relation to the services that they provide at events but in fact they do not need to register. However, the event organisers themselves may need to register if they bring healthcare professionals on site in order to provide services that go beyond first aid at their event. I am trying to understand how, when the department went out and identified 89, or whatever the number was, potential providers that were not already registered, it ended up with a figure of 36, which seems very low. It certainly bears no comparison to what those who are working in the sector believe would be the number of presently unregistered providers. We need to understand who these 36 are, the character of those providers that the department has identified and why there is such a discrepancy between that and what others have been saying. I would be grateful if the Minister would tell us much more about that.

As a practical example, are all football clubs, or the major football clubs in the Premier League, the Championship and so on, already registered with the CQC? Clearly, they, as organisations, provide continuing healthcare to their players. Do we not need to worry about any of that? Is an event like one of the big festivals that take place already registered, because it has put a team together in order to provide more than simply first aid? Perhaps we are worrying about a need for registration when actually we do not need to worry so much.

I have only one other question. An essential part of the follow-up to the Manchester Arena inquiry was the preparation of an event healthcare standard. Would the Minister be kind enough to update us on that process? Where does it stand and when might we see its publication for consultation?

[Baroness Harding of Winscombe (Con)]

My Lords, I will also ask a few questions. I declare my interests as the senior steward—namely, the chairman—of the Jockey Club and as the mother of an elite athlete.

I spent last weekend at two quite different sporting events, juggling my time between the Grand National and the Home Internationals lacrosse competition, as my daughter played for England for the first time— I did check with her that I was allowed to mention that in the Grand Committee. I mention them both because while one is really a grass-roots sporting event—it has a small crowd, but none the less there is an ambulance in attendance because it is a potentially dangerous sport—the other, the Grand National, is the second largest attended sport in the country and the second most watched sporting event on television. As I understand it, both are captured by the same changes being proposed today.

I express my condolences to everyone who was affected by the tragedy at Manchester Arena. In no way do I want to suggest that the questions I am posing negate the need to address the recommendations of the public inquiry. It is hugely important that we learn the lessons.

First, I took some time to speak to a former chief medical adviser of the British Horseracing Authority, Dr Jerry Hill, who told me that a clear standard of healthcare for events is an extremely positive move. I put on record that I wholeheartedly support the event healthcare standard. I understand that there has been good consultation on the draft and that, in Dr Hill’s view, it will help event medics fight their corner for resource. He told me that, at the moment, event medics often feel that they are behind Portaloos and security in priority at events. It is important that we recognise that we need that standard.

However, in moving from that standard being guidance to putting it on a statutory footing—I appreciate that this SI does not do that, but it sets us on that path—we need to evaluate formally whether the draft is effective. As I understand it, the DHSC was somewhat swamped by people wanting to participate in evaluating the draft, and that it was perhaps not following the more scientifically robust approach that a number of sports suggested—I think two focus groups were planned to evaluate the draft. Can the Minister assure us that that event healthcare standard will be evaluated to a scientifically robust standard rather than that of a more politically normal focus group? It is very important that we get it right.

Secondly, I also understood that, as my noble friend Lord Lansley says, the CQC’s initial impact assessment had claimed that only 36 healthcare providers would need to register. Horseracing alone thinks that we have 350 individual clinicians who would need to register, even allowing for the fact that each clinician tends to work in three different sports. Potentially, the Faculty of Sport and Exercise Medicine UK’s estimate of 23,000 is an overestimate. Even if it is one-third of that, it is still massively more than the CQC expected.

I also understand that, in November 2024, the CQC said that it had a maximum capacity to register new providers of 1,000 per year. If we are not very careful, with all the best intentions we will be setting up a bureaucratic quagmire, which will mean that events, big and small, will not be able to find suitably registered clinicians to support them. What assurances can the Minister give us that the CQC can cope with the workload? Has the CQC recruited, or does it intend to recruit, anyone from the sports or cultural events sector? In the past, the CQC has had, in maybe more traditional healthcare settings, a bad habit of sending non-specialist inspectors—my noble friend Lord Lansley is laughing at that, but it is serious business. The best example I have is of occupational therapists being sent to inspect ambulance services.

What assurance can the Minister give us that the CQC is going to recruit the suitable expertise to deliver on this important obligation? Where will it sit in the priorities of the CQC which, after all, has an awful lot of important work to do? It currently has an interim chief executive and a chairman who wants to leave, so I am nervous about quite so much going on to the CQC. I support others who have called for pragmatism in the implementation of these regulations to allow time, if the CQC is struggling to put the resource to them that they need.

--- Later in debate ---

[Baroness Harding of Winscombe (Con)]

My Lords, I will be very brief. The Explanatory Notes say that a full impact assessment was not completed because

“no significant impact on the private, voluntary or public sector is foreseen”.

I think it entirely foreseeable that there could be significant cost and complexity, as well as an inability to deliver the healthcare benefits that we all seek, for two important sectors of society that provide important glue as well as economic value. Whether we are talking about grass-roots or world-class sporting and cultural events, if we implement this SI badly, there will be substantial negative consequences.

I am aware that I have asked an awful lot of questions. May I be presumptuous and ask the Minister for a meeting with the department and the CQC so that a number of us can properly understand how this measure will be implemented?

[Baroness Grey-Thompson (CB)]

My Lords, I declare an interest as the chair of Sport Wales; with that, I sit on the board of UK Sport. I am also a board member of Active Travel England.

I reiterate the comments made by others about how horrendous and horrific the Manchester bombing was, as well as how significant an impact it had on so many people. The recommendations are important. I absolutely understand why we want to protect people and improve the system. I am also going to ask a number of questions, so I would be very happy for a follow-up afterwards.

I have spoken to a number of organisations in the wider sport industry. It is fair to say, I think, that there is a level of concern about the statutory instrument that we are debating today and the impact that it could have on the wider sports industry. I understand that the Sport and Recreation Alliance has written to the Minister; I would be interested in the reply and to know what further work has been undertaken.

I know from speaking to a wide group of people who work in the sports industry that they generally feel as though His Majesty’s Government have failed to engage with the sector properly and have not understood the significant, negative effect that this measure may have on the provision of medical care at events. There is a real risk of this preventing some sports events and activities from going ahead, or going ahead without the medical cover that they currently have, in order to avoid the consequences of the proposals.

The noble Baroness, Lady Harding, made some interesting points on registration. Medics often work in a voluntary capacity across a number of events of various sizes. It is important that these people are not registered multiple times. We should try to avoid some of the failings of DBS checks, where people are registered on lots of different systems. That does not solve the problem that we are trying to solve.

The Sport and Recreation Alliance has called for a commitment to create a specific exemption for all treatment provided to athletes, performers and officials. This is also an important area for us to look at. We should include spectators in that as well, because some events have lots of spectators and some have absolutely none. Many believe that this would not be contrary to the recommendations of the Manchester Arena inquiry and could solve many of the issues that the regulations might cause.

Can the Minister explain what further considerations have been given to understanding the impact on sport and sporting events? I wonder if clarification is needed on the definition of different events and the sizes, because they are very different. Also, what is understood by “injury” and “first aid”? People working on the ground might struggle to understand that. I was also wondering whether the Department for Culture, Media and Sport has provided a view on this and on its impact.

Anaesthesia Associates and Physician Associates Order 2024

Baroness Harding of Winscombe Excerpts

Monday 26th February 2024 Lords Chamber

Finally, in the NHS we definitely need a shake-up. We know that we need new members of staff. I do not want to be somebody who says only the old roles count, but I came across something I refer the Minister to: the notion of medical assistants, put forward by Maureen Baker in July 2014 when she was chair of the Royal College of General Practitioners. Having visited the United States with Jeremy Hunt, she described this new group of people—medical assistants—which basically described what I think we need. I do not know why we cannot have them and why we have come up with this idea. I work with a lot of young people and there are plenty of bright young people desperate to enter medical school and become doctors and they are not able to. Why is that? That is the kind of situation that needs to be solved, rather than just making up PAs or getting into a row about the pros and cons of them.

[Baroness Harding of Winscombe (Con)]

My Lords, I support this Motion and, not for the first time in a debate on health, I find myself in almost complete agreement with the noble Lord, Lord Hunt, and the remarks he made earlier in an extremely powerful speech. We are exemplifying the right debate here, in that this is a subtle and important issue.

I do not wish to suggest that I challenge the esteemed clinicians from a number of the different clinical tribes who have spoken this evening. I speak as a non-expert, as a manager of people, and as a patient. Non-experts in healthcare would find it completely baffling that we have 3,000 people working day in, day out in clinical roles who are currently unregulated. It cannot be right, and I have not heard any argument this evening that suggests that anyone in the Chamber thinks it is right. I think we are all united in our agreement that these hard-working, brilliant people need proper professional statutory regulation.

I hope that, therefore, the order, as it stands, passes. But it is worth dwelling on why this has created so much controversy. Fundamentally, it is because change is hard—and people change is hard and scary. There is a real danger that we underestimate how important it is to look after the people who care for us, and that what we are really hearing from a number of the different clinical tribes is fear, frustration and hurt that they are not being looked after. The real tragedy is that, as the noble Lord, Lord Hunt, said, in the process we have made 3,000 more people feel hurt, unloved and uncared for in the awful debate out in the Twittersphere or X-sphere or whatever it is called.

I will not talk for very long. I just want to register that this has been far too long unfixed, that 20 years is too long for people to be practising without regulation, and that other countries around the world are far ahead of us on this. We should be discussing how we properly define the scope of practice and how we then extend that scope of practice, with the appropriate training for prescribing rights and the ability to order X-rays, just as happens in many other countries in the world. We are all in this Chamber rightly proud of the NHS, but we must not stick our heads in the sand and convince ourselves we are brilliant when others fixed this issue 20-plus years ago.

I finish by saying that regulation is clearly not enough. I completely agree with the noble Baroness, Lady Finlay: we have to recognise that our health and care workers feel unloved and uncared for. There are far too many stories of people unable to get a hot meal when they are working night shifts or having to cancel their own wedding because they are not rostered to be allowed to take the time off. None of that requires professional regulation; that requires professional management. We need both of those.

[Lord Bethell (Con)]

My Lords, I hope that my noble friend the Minister will not mind if I say that I am very grateful to the noble Baronesses, Lady Bennett, Lady Brinton and Lady Finlay, for the regret amendments and this debate today. Secondary legislation comes through the House and too often we overlook it. Every now and again we need to put a spotlight on some of the important measures that go through.

I regret two things. I deeply regret the way in which the professions of associate physician and associate anaesthetist have been denigrated in the press, in the lobbying material that has been sent around, and, frankly, in aspects of this debate. I agree with my noble friend Lady Harding and the noble Lord, Lord Hunt, that the feelings and sentiment of these hard-working contributors to our healthcare system have been overlooked. I was sent a very robust briefing by the BMA. I replied: “Is there nothing positive you can say about these hard-working healthcare professionals?” The reply came back—the noble Baroness, Lady Finlay, was copied in on it—that there was not: there was nothing positive it could say about them. I greatly regret that tone, and wish it had not happened.

I am not a clinician and I do not have anything to rival some of the comments made by the clinicians. However, I point out that our hard-working healthcare professionals are incredibly stretched. Take GPs, for instance: 350 million appointments were conducted in primary care last year, 160 million of which were by GPs themselves. That was 50 million more than in 2019, so 44 more appointments per practice. That trend is going up. Britain is getting less healthy, and there is a large amount of immigration. The number of full-time equivalent GPs—although the number of GPs has gone up, a lot of them are working fewer hours—has decreased from 28,000 in September 2015 to 27,000 in October 2023. The complexity of many people turning up to these appointments is very high.

We have to find people from somewhere to do some of these appointments, and there are going to be people who have a lot to contribute who do not necessarily go through the 10 years of qualification to become a GP. We should be embracing them. That is what is happening in every other professional walk of life—it is happening with the astronauts who fly to the moon, the people who fly our planes, and the lawyers who run our courts. The modernisation of workforces is happening everywhere; we should embrace that. My noble friend the Minister alluded to 12,000 AAs and PAs by 2036; that would be just 8% of the number of doctors. That is not a revolution or a threat that the doctors of Britain should be worried about.

If these regulations do not go through—the noble Baroness, Lady Bennett, has said that they will—then it would be difficult to enforce standards, there would be years of delay to regulate the professions, there would be a reduction in the number of healthcare professionals to support our healthcare system, and training programmes would be on hold. I support the passage of this legislation, so that we can modernise the workforce, increase primary care capacity, improve the lot of our hard-pressed GPs and make it easier for a wide range of talents to make a difference to the British healthcare system.

NHS Long-term Workforce Plan

Baroness Harding of Winscombe Excerpts

Tuesday 4th July 2023 Lords Chamber

[Lord Markham (Con)]

As I mentioned previously, the NHS plan is something that we or the NHS can publish, being the employer. With there being hundreds, if not thousands, of employers in social care, it is clearly a different situation. What we can do is make sure that we put the investment into the sector, so that there is pull through in the number of places. Over the next few years, we are looking at an increase of up to £7 billion, which is about 20%. We know that, of that £7 billion, around 65% to 70% flows through to staffing and wages. We are seeing a massive investment on our side, which we are looking to lots of employers to fulfil. By increasing the number of medically trained people, we will be increasing the supply base to fulfil that demand.

[Baroness Harding of Winscombe (Con)]

My Lords, I too thank and commend my noble friend the Minister, the Secretary of State and the leadership of the NHS for producing an extremely good plan. It is historic, not because it is the first time such a plan has been written but because it is the first time in 20 years such a plan has been published. The Minister has commented a couple of times that this is a living plan—one that will be updated at least every two years. Could he confirm that those updates will be published every two years, and that this House will be able to debate and discuss them?

[Lord Markham (Con)]

That is absolutely my understanding. For it to be a living document, people clearly need to have input and to be able to debate it in exactly the way we are doing here today.

Nursing: Recruitment

Baroness Harding of Winscombe Excerpts

Wednesday 26th October 2022 Lords Chamber

[Lord Markham (Con)]

We appreciate that recruitment is an ongoing process, and while I think the whole House would agree a 29,000 increase is a good record—up 9,000 in the last year alone—we cannot rest on our laurels. Vacancies of 50,000 is partially a function of a full-employment economy, which I think we would all support. We are showing that our recruitment is working and, as I say, we are over half way towards our target of 50,000 more nurses.

[Baroness Harding of Winscombe (Con)]

My Lords, a few months ago, the Secretary of State but two said that the NHS long-term workforce strategy would include numerical assessment of both supply and demand of nurses and other clinical professionals but that publishing those details would depend on cross-government agreement. There was broad agreement in this House, in June, that those numbers should be published. Could my noble friend the Minister put on record his support for publishing NHS workforce supply and demand numbers? If he does not feel able to, could he explain how we will know whether 50,000 is the right number of nurses?

[Lord Markham (Con)]

There is a long-term workforce strategy plan being put together, as I think we know, and that builds on the NHS people plan of 2020, which has seen this increase in numbers. I will find out where we are with that, and the details behind that, and write to my noble friend.

Health and Care Bill

Baroness Harding of Winscombe Excerpts

Consideration of Commons amendments
Tuesday 26th April 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise very briefly to offer Green support for both Motions A1 and D1. Motion D1 has already been very amply covered, most notably by the noble Baroness, Lady Campbell of Surbiton, so I will just address my remarks to Motion A1.

I know that many Members of your Lordships’ House feel as though we do not want to be political about things—I might have thoughts about that—but this is not a political amendment at all. As the noble Baroness, Lady Merron, said, more than 100 of our major healthcare organisations have expressed support for this workforce planning approach. Just a couple of hours ago, and this addresses your Lordships’ House directly, the British Heart Foundation put out a press release saying that, without this amendment, it is

“unclear how ambitious targets laid out in the Elective Recovery Plan and other NHS delivery plans can be met.”

The chief executive said that

“the Government has missed an open goal by failing … to address the workforce shortage”.

In addition, just yesterday the King’s Fund put out a report saying that the Government—they can welcome this—are “on track” to meet their target of “50,000 extra nurses” by 2024. However, the King’s Fund points out that the level of vacancies is still the same as it was when that promise was made. Just plucking figures out of the air and going, “Hey, we’ve got this great figure”, is not enough; we need to plan for the future. That is why this amendment is absolutely crucial for our NHS.

[Baroness Harding of Winscombe (Con)]

My Lords, I rise very briefly to speak to Motion A1. I will first thank my noble friend the Minister for his fantastically collaborative approach on the Bill. I am particularly delighted to see the Government’s proposals on reconfigurations, so I thank him very much for them.

On workforce, I fear that there is almost nothing more to be said. Throughout the passage of this Bill, at every stage in this House and across all sides, we have all been clear that if we do not resolve the workforce issues—the people issues in the NHS—everything else is for naught. Yet we come to end of this process and there have been no changes at all. It is with great sadness that I speak today because I feel that, despite the great work that has been done and all the best intentions, things will not improve. I would love to believe that I am wrong, that my noble friend the Minister is right and that the workforce elements of the Bill are sufficient, but I am afraid that the evidence of the last 20 years is that they are not.

Health and Care Bill

Baroness Harding of Winscombe Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Lord Stevens of Birmingham (CB)]

My Lords, I will speak in support of Motion B1 on workforce planning and Motion C1 on the Secretary of State’s powers on reconfiguration. As the noble Baroness, Lady Cumberlege, has just reminded us, there is a huge groundswell of support for the need to do proper workforce planning in the NHS, but the fact is that today we do not need to relitigate the fundamental arguments, because your Lordships have already decided, by a margin of 171 to 119 votes on 3 March, that that is indeed what is required.

Of course, if the facts change, we should change our minds. Have the facts changed since 3 March? Have we seen the long-awaited detailed workforce plan for the health and social care sector that has been promised yet suppressed for the last six years? Regrettably, we have not. Have we even had concrete commitments to the detailed, costed and quantified five, 10 and 15-year outlooks that will supposedly be forthcoming in the spring? No, we have not had commitments that those numbers will be able to be produced without fear or favour, or Treasury veto.

However, we have before us two new data points. One is the survey of 650,000 NHS front-line staff, half of whom—52%—are now telling us that they cannot do their jobs properly because of a shortage of staff in their local service. The second data point is the results of the British Social Attitudes survey, telling us that nearly half of our fellow citizens have noticed that fact; they too believe that one of the fundamental problems standing in the way of performance by the health service is the shortage of staff.

If the Government are not inclined to listen to the hundred or so organisations that have supported this amendment or, indeed, to the results of surveys of front-line staff or the public, perhaps they will listen to a commentator from the Spectator:

“The lack of workforce planning by the Government—and its continual refusal to commit to it—means satisfaction from patients and staff is likely to plummet still further.”


I do not believe the Government want that. Nobody wants that, which is why we should take this opportunity to listen to the clear message that we have been sent by patients, staff and the public.

I turn briefly to Motion C1 on the Secretary of State’s powers on reconfigurations. There is an obvious read-across between the discussion on workforce and the discussion on reconfigurations. In the real world, it is often staff shortages which give rise to concerns about the safe provision of services, hence the request for reconfigurations. In these circumstances, and coming just a few days after the Ockenden review of maternity safety, it is all the more dangerous that the new powers in Clause 40 and Schedule 6 would allow the Secretary of State to suppress changes needed to keep patients safe and to pre-empt and override the concerns of local clinicians, local patient groups, local authorities and even the Care Quality Commission.

There could be safeguards but, unfortunately, to date at least—perhaps, depending on what we do today, this will resurface after Easter—we are being asked to support the original text of the Bill, which has taken no account of any of the concerns that have been raised in both Houses during its passage. Instead, on the reconfiguration powers, today the Government are essentially praying in aid an argument not on the substance but on the merits of democratic oversight by the Secretary of State. This is despite the fact that previous Health Secretaries have managed democratically to supervise the National Health Service without requiring these new powers, despite the fact that former Health Ministers—Conservative Health Ministers, Labour Health Ministers and Liberal Democrat Health Ministers—all oppose these measures and have spoken out, including in your Lordships’ House, and despite the fact that democratically elected Health Ministers in just about every other European country have never sought and do not possess these types of powers.

If the Government want to argue Motion C on the crucible of democratic oversight, it seems that by that logic they should indeed support Motion C1 tabled by the noble Baroness, Lady Thornton, which further enhances the democratic oversight of the use of these proposed new powers, giving Parliament the ability to scrutinise these types of interventions. Therefore, for those reasons, frustratingly, perhaps, I find that we are in a position where Motions B1 and C1 are still necessary.

[Baroness Harding of Winscombe (Con)]

I rise to congratulate my noble friend Lady Cumberlege on her excellent speech and to support her on Motion B1. Addressing workforce shortages in our health system is a wicked problem. It is complex and complicated and it is a problem that is shared by every healthcare system in the world. I have no doubt that my noble friend the Minister and the Government are sincere in their belief that they are doing a lot to address the problem but, as my noble friend said, the problem is that we do not know its scale. Until we do and we are open and honest about the complexity and size of the problem. we will not be able to move forward.

Sadly, this ought to be one of the reasons why the NHS is the best healthcare system in the world. It, above all other healthcare systems, ought to be able to do this sort of long-term, complex, detailed planning as a single-payer, state-provided system. Most developed countries do not have those benefits, yet today we are in a place where the Government appear to be saying that we should just keep doing what we have always done. There is a basic maxim in life that if you always do what you have always done, you will always get what you have always got. The reality is that unless we are willing to bend and change, we will not get any meaningful, sustained solutions to this burning problem. My noble friend Lady Cumberlege has bent and changed and has adapted her amendment to try to address what I know were some of the major concerns of the Government about the risk of a verified, firm and unwavering false certainty in a forward forecast and the need to recognise that this is a complex problem where there is likely to be a range. If we are not open and honest about that, we will never really address the issues.

This is a wicked problem that requires us to be brave enough to admit that we do not have all the answers. That is the courage we would need to see in publishing a workforce plan and is why I support Motion B1.

Health and Care Bill

Baroness Harding of Winscombe Excerpts

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

[Baroness Tyler of Enfield (LD)]

My Lords, I will be exceptionally brief and make two very quick points, but first I need to apologise for, when I spoke earlier, omitting to mention my registered interest as a non-executive director of the Royal Free London NHS Foundation Trust.

I very strongly support Amendment 80, moved so ably by the noble Baroness, Lady Cumberlege, and pressed so very cogently by the noble Lord, Lord Stevens, and others. It is absolutely fundamental to everything that the Bill is designed to achieve, and we will not achieve those things unless the workforce is addressed.

In relation to Amendment 111 in the name of the noble Lord, Lord Hunt, I say that it is so important that we have a review into the distribution of GPs in England. I was very concerned when we debated in Committee the huge variation in list numbers in different parts of the country. The biggest lists were in the most deprived areas. If you track that back to the debate we were having on health inequalities, where there was a huge consensus across the House, it is clear that we are never going to fundamentally tackle health inequalities unless we have far greater equality in things like the size of GPs’ lists.

[Baroness Harding of Winscombe (Con)]

My Lords, I also support my noble friend Lady Cumberlege and Amendment 80. The noble Lord, Lord Stevens, made two points: I would just like to add a third to his argument. He argued that workforce planning needs to happen. There is no large employer of people that does not plan its workforce other than the NHS. We need to do it, and I do not think anyone in this Chamber is going to disagree. He also said that this would not happen without legislation. I will not repeat the points I made at Second Reading or in Committee, or those that he just made so eloquently.

My third point, which I would like to add, is very much addressed to my noble friend the Minister. It is that this amendment will not bring the downsize that the Treasury truly fears. This is actually an amendment of sound management that enables the NHS to manage finances and people better. While there will be more money spent on training, this is actually the way to control the costs of the ever-growing demand for health and social care. If you do not plan, you cannot control the costs. This is actually the way to do the very thing that the Treasury is most concerned about.

Far from locking in old, established ways of working, this is also the way to drive transformation because, unless we are honest about the ever-growing demand for clinicians of every profession, we will not face the fact that we will need to change the way those clinicians work together as medicine and science evolve and all of us age. This is a way to deliver the very thing that the Treasury most wants: control of the finances and transformation of our healthcare services.

With that, I add one final point, and I hope noble Lords will forgive me for repeating what I said in Committee. There is another reason why we need to do this now. Our NHS people are exhausted, and they have lost hope that we understand what it is really like on the ground for them. By passing this amendment, we will give them hope; we will show them that, collectively and cross-party, we really understand that it is they who make our wonderful, precious health and care system work, and we are committed to helping them going forward.

[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.

Health and Care Bill

Baroness Harding of Winscombe Excerpts

Lords Hansard - Part 1 & Report stage
Tuesday 1st March 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, before the noble Baroness, Lady Walmsley, speaks, I congratulate her and the Minister on Amendment 31. I also want to ask a question. It very much looks as if the integrated care board is marking its own homework, because the duty to keep the experience of members under review is placed on an integrated care board. It is then for the integrated care board itself to make a judgment as to whether it

“lacks the necessary skills, knowledge and experience”.

Quite clearly, any board that has already appointed a group of members is almost certain, in undertaking its review, to come to the conclusion that it was altogether wise in appointing the members with the balance it did. Who is going to monitor this? Who is going to check?

What if you are a local nursing body concerned that nursing issues are not being debated and reflected enough within an integrated care board? What do you do? Who do you go to? As far as I can see, apart from judicial review proceedings there is absolutely no way you can get any change. That is why—and I pay tribute to the noble Baroness, Lady Walmsley, for her work on this—you need amendments like my noble friend Lord Bradley’s to make some specification in relation to those critical areas where it is essential that the board has members with the relevant experience.

My second point for the Minister is this. In introducing her Amendment 9, my noble friend Lady Thornton essentially said that the Bill already lays out constraints on integrated care boards in relation to potential conflicts of interest. All she seeks to do is to extend that to sub-committees of the integrated care board, including place-based committees, which will commission a huge amount of health service provision in future. For the life of me, I cannot see how those sub-committees can be constituted under any different principle from that of the integrated care board itself. Unless the Minister really comes up with a convincing answer on this, I think the House should make its views clear.

[Baroness Harding of Winscombe (Con)]

My Lords, as this is my first contribution on Report, I begin by declaring my interest as the recently stepped-down chair of NHS Improvement and NHS Test and Trace.

I commend the noble Baroness, Lady Walmsley, and my noble friend the Minister and support Amendment 31. In Committee, we debated in considerable detail the constituent elements of the ICBs. I think it hugely important that integrated care boards have a loud, strong, forceful voice for mental health, public health and prevention in all its forms, but I also think it really important that we enable a board to be a proper board.

The noble Lord, Lord Hunt, questions whether a board would ever assess its own competence and members. Any really good, functioning board in the public and private sector views that as one of its primary obligations. The first line of defence to ensure that a board is performing well is whether it is actually doing an assessment every year of whether it has the appropriate skills. Yes, you should have second and third-line assessments through the CQC and NHS England, but it is the role of a board, and we should let them do that. I believe that Amendment 31 holds these boards to account to do that.

The amendments we have already debated today, enshrining the obligations around public health, health inequalities and mental health, ensure that that is the clear objective of those integrated care boards. I encourage my noble friend the Minister to hold firm and support his amendments and not the others.

[Baroness Walmsley (LD)]

My Lords, I thank noble Lords who have expressed their support for Amendment 31 and my role in it; it is very kind.

I go back to how this arose. It is to some extent influenced by what the noble Baroness, Lady Harding, said in Committee. It was quite clear that many noble Lords were very concerned that appropriate levels of skills, knowledge and experience were on an ICB so that it would be able to carry out all the functions that the Bill puts upon it; not perhaps just the list that the noble Lord, Lord Kamall, mentioned, because it was not intended to be an exclusive list. The amendment actually says:

“in order for the board effectively to carry out its functions”.

I think there it means all of its functions.

It was quite clear in Committee that the Government had set their face against prescribing all the different people who should be on a board. But there had to be a way of making sure that the board had all the necessary commissioning skills, and the knowledge and experience of all the areas of health services which that board had to deliver. The board had to have the duty to make sure it could do all of those things—perhaps without prescribing everything, which the Government are determined not to accept.

The solution came to me not just because of what the noble Baroness, Lady Harding, said but because of what my noble friend Lord Thurso said to me in private—not on the Floor of the House. He is a very experienced board chair. He called my attention to the National Audit Office advice on best practice in this respect and a paper on NHS leadership, which recommends something very similar: that the board must have the duty to make sure it has all the skills, knowledge and experience to carry out all its functions, keep that under constant review and report on what it has done and how.

It is inconceivable to me that, if ICBs had this duty, there would not be somebody who knew everything that needed to be known about mental health and public health to effectively commission those services. The duty to report is very important, to keep this in constant review every year and to report in its annual report on how it makes sure that it has got all those skills and that experience. I think the CQC would look very carefully at whether the board had actually carried out the duty put upon it by Amendment 31. If there were any gaps in a service which the board had to carry out, and it did not have the right skills, knowledge and experience to do that, the CQC would be very critical. I commend this amendment to your Lordships.

I will also say in concluding that on these Benches we also support Amendment 9. The noble Lord, Lord Bradley, had a very good point. The amendment in the name of the noble Lord, Lord Kamall, which I am supporting, is retrospective because it requires that, by the end of when an annual report comes around, the board has to show what it has done in respect of providing the right people to make the right decisions. From day one, what this House has done on mental health and how important it is, with the Government’s co-operation, is right.