Health and Care Bill

Debate between Baroness Jones of Moulsecoomb and Lord Hunt of Kings Heath

Lords Hansard _ Part 1 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Jones of Moulsecoomb (GP)]

My Lords, I hate to disagree with the noble Lords who have spoken against this amendment, almost as much as I loathe supporting the noble Lord, Lord Forsyth, on anything. But, for me, this is a matter of democracy. Public opinion is constantly moving on this, and it becomes more and more supportive as the public understand the issues involved. It is partly the duty of the Government to explain exactly what it is about. Having a proper debate like this is something we should all support.

Personally, I want this on the statute book before I need it. I have five grandchildren, and I try to talk them all into pushing me over a cliff if I were to get too ill. As soon as their mothers told them that it was illegal, they refused me. The idea remains that this is something which many of us want for ourselves, because we fear being incapable. Therefore, I support Amendment 170.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I would like to put a point to the noble Lord, Lord Forsyth. He said that his amendment simply provides time for Parliament to consider an assisted dying Bill. I note that proposed new subsection (2)(a) also says that the Secretary of State should

“respect that this is a matter of conscience”.

But a draft Bill is a draft Bill. It will be prepared by a government department; instructions will be given by solicitors, after consultation with Ministers, to parliamentary counsel; and that Bill will eventually be approved by Ministers in the relevant department and put before Parliament. There will be a Minister in charge of the Bill. Whatever mechanism is chosen—maybe a Joint Select Committee of both Houses—to consider the draft legislation, the Minister will be in charge and will be seen by the public to be driving through a Bill. If the noble Lord had said in his amendment that more time should be given for the Private Member’s Bill, I would have supported it. Businesses managers clearly need to take account of the obvious wish of this House to have more time to debate it—

Health and Care Bill

Debate between Baroness Jones of Moulsecoomb and Lord Hunt of Kings Heath

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

[Lord Hunt of Kings Heath (Lab)]

My Lords, I will just speak to my Amendments 111 and 168. On Amendment 111, when the noble Baronesses, Lady Brinton and Lady Masham, and the noble and learned Lord, Lord Mackay, have already put forward the arguments, there is very little for me to say, but the exclusion of the Scottish colleges from the appointment process needs to be rectified. It is an irritant, a hold-up.

In Committee, the noble Lord said that we needed to go through consultation. That was a dreary and negative response. The Scottish colleges have done that. They have consulted and got the support of the Academy of Medical Royal Colleges, NHS Employers and the NHS Confederation. Surely the Minister can just accept this amendment. To simply say that there is no need for it and lots of consultation has to take place is just a ludicrous waste of time and money. This is the time to do it. He should bring an amendment back on Third Reading and be done with it. The noble Lord says that he wants to improve efficiency in the health service. I am afraid I take that with a pinch of salt, because he is just letting officials run riot around him in relation to petty, bureaucratic objections to this change.

Obviously, my other amendment is not major compared to Amendment 80, which is substantial and very important. The noble Baroness, Lady Cumberlege, has really put it forward with great force. Again, I think the noble Lord needs to take a more vigorous approach with the Treasury, because clearly that is where the objection to this is coming from.

My other amendment is about the terrible problem of GP distribution, or the wide variations. I am not going to tempt the noble Baroness, Lady Cumberlege, to come in on the GP issue—but the latest figures, for 31 December 2021, show, for primary care networks in England, the huge variation in the number of GPs. In 24 of the networks, the average list of registered patients for fully qualified full-time equivalent GPs is more than twice the national average. There are five primary care networks where the average is more than three times the national average; these are often in the most deprived areas. No wonder there is an issue of burnout, early retirements and a move to part-time working.

The Government’s response so far is the targeted enhanced recruitment scheme—an incentive for GPs to go into these areas. It is not enough; a much more substantive piece of work is required, and I hope again that the Minister will come forward with a positive response.

[Baroness Jones of Moulsecoomb (GP)]

I shall speak to Amendment 82 in the name of my noble friend Lady Bennett of Manor Castle. I attended Second Reading and made my views felt then, but I have not been able to join the deliberations on the Bill since then because of the pressure of other Bills in your Lordships’ House.

Even I, as someone who does not know very much about medicine, know that the most urgent challenge currently facing our health service is a shortage of nurses. I have been lobbied very heavily by the Royal College of Nursing, because Amendment 82 is its number one priority. It feels that, without a co-ordinated work plan, a coherent forward view and knowledge of exactly how the situation is at the moment, it cannot possibly achieve the sorts of numbers that are needed. There were almost 50,000 vacancies before Covid, and you can imagine the pressure that Covid has put on to the NHS—extreme pressure at completely unsustainable levels, and with staff numbers that are actually unsafe. We all know this, yet Boris Johnson and the Conservatives made big promises at the last election—their manifesto made a promise of 50,000 more nurses—and instantly that number began to unravel, as it included existing nurses who do not quit. That is unclever and unsophisticated number crunching.

I do not understand why this Government will not live up to their manifesto commitments. One reason why I have not been able to speak on this Bill since Second Reading is because of all the other Bills coming through, on which the Conservatives have said that they are aiming to achieve their manifesto commitments. They are actually going rather beyond their manifesto commitments in lots of areas—but the fact is that they are picking and choosing as if from a box of sweets the ones that they prefer.

The Royal College of Nursing represents over 480,000 nurses in health and social care. These are people whose pay requests are constantly ignored—and who constantly have their pay cut; in real terms, it has reduced. Just at the point when MPs are getting very welcome extra pay, nurses hang on by their fingertips. We know that vacancies are also a huge problem, with retirement age approaching for a lot of nurses. Nurses need the certainty of planning, and I do not hear those plans coming from the Government, although this is really their job—to manage the economy and manage society in a way that benefits everybody. Clearly, if the NHS fails in any area, that does not benefit anybody at all.

I argue very strongly for Amendment 82, and I just hope that the Government wake up in time to see how necessary it is.

Police, Crime, Sentencing and Courts Bill

Debate between Baroness Jones of Moulsecoomb and Lord Hunt of Kings Heath

Lords Hansard - Part 1 & Committee stage
Monday 15th November 2021 Lords Chamber

[Baroness Jones of Moulsecoomb (GP)]

I congratulate the noble Baroness, Lady Burt, on her extremely moving opening speech. I agree wholeheartedly that pregnant women should not be in prison. We have abysmal conditions in many jails and they are not the place for a pregnant woman. A pregnant woman might be difficult. I have been pregnant twice and I can guarantee that I had some difficult days—some people might argue that I am still having them. When women suffer in this way—and trans men who are having babies—there are lifelong repercussions, I hope for the Government as well as for the women and their babies.

The Howard League for Penal Reform has highlighted the fact that pregnant women in prison are routinely denied access to suitable maternity care and that babies have died as a result. Many women and transmen in prison have very complex needs physically and sometimes mentally. As the noble Baroness, Lady Burt, explained, they often have a history of abuse, neglect, addiction and poverty. The Government are not helping. They are not recognising those problems and do not understand their role; while prison is a punishment, rehabilitation has to take place afterwards.

Women in prison should receive at a minimum the same standard of maternity services as women outside. Of course, they often have additional challenges and are in need of specialist midwifery care, which should be supplied. When we punish these women in prison, we also punish their babies, and that cannot be right. Getting this right will change the lives of prisoners and families, and have an impact for generations. Like the previous amendment, this is something the Government have to pick up.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have added my name to this amendment and I warmly commend the speeches of the noble Baronesses, Lady Burt and Lady Jones. Reading the report of the shocking death of Baby A is salutary indeed. It took me back to the debate we had earlier in Committee, looking at the special needs of women in prison and the effect of custody on those women and their children.

I refer back to the speech made by the noble Lord, Lord Marks, when he referred to the briefing from the charity Women in Prison. This related how more than 53,000 children each year were affected by their primary carers being sent to prison and that 95% of children whose mothers are in prison were forced to leave home. One sentence encapsulated it for him:

“‘We’ve been sentenced’, says a mother, ‘but they’ve been sentenced with us.’”.—[Official Report, 1/11/21; col. 1036.]


The point was also at the heart of the contribution made by the right reverend Prelate the Bishop of Gloucester. She said that parental imprisonment was, for the children concerned, a well-recognised predictor of mental ill-health, poor educational achievement and employment prospects, and future criminality. It sets a context for discussing the particular circumstances of Baby A and pregnant women prisoners.

Of course, there are many lessons to be learned in respect of both HMP Bronzefield and the prison system as a whole. The report of the Prisons and Probation Ombudsman made a number of very important recommendations. In particular, there was a recommendation of principle that, as the noble Baroness referred to, all pregnancies in prison should be treated as high-risk by virtue of the fact that a woman is locked behind a door for a significant amount of time and there is likely to be a high percentage of avoidant mothers who have experienced trauma and are fearful of engaging with maternity care.

The noble Baroness, Lady Burt, listed some of the key recommendations. I just want to focus on what I would call “system recommendations”. A specific recommendation was made to the director of health and justice for NHS England to consider the findings and recommendations of the report and ensure that the learning is applied across the women’s estate. It went on to say that this should include recognition that a clinic-based community model of midwifery care was not appropriate for custodial settings, and that all pregnancies in prison were high-risk. What response has been received from NHS England and what co-operation is being given by NHS England to the Prison Service to take forward that recommendation?

I, like the noble Baronesses, welcome the new policy framework for prisons on pregnancy, mother and baby units and maternal separation as a significant step forward, but I am sure we need to do more. I was struck by the comments of Dr Edward Morris, president of the Royal College of Obstetricians and Gynaecologists, who said:

“The next step is to ensure that these policy commitments are translated into practice on the ground across all women’s prisons, and that all staff in women’s prisons receive the right training to provide women with the information and support they need. Alongside strong links to the local midwifery team, we feel strongly that all maternity services located near to a women’s prison should have a designated obstetrician with responsibility for ensuring high quality care for women in prison.”


I very much agree with that. I, too, would welcome some reassurance from the Minister that his department is taking these recommendations seriously. I particularly urge on him the need for the closest co-operation between his department and NHS England. At the end of the day, the lessons learned from this tragic case must be applied to the prison system as a whole.

Police, Crime, Sentencing and Courts Bill

Debate between Baroness Jones of Moulsecoomb and Lord Hunt of Kings Heath

Lords Hansard - part two & Committee stage
Monday 1st November 2021 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I will speak to my Amendments 281 and 282, which concern police culture and police training. I say at once that I agree with my noble friend that the woeful police response, which the noble Lord, Lord Carlile, emphasised, sums up a real issue about culture that I do not see being tackled cohesively.

I understand why my noble friend favours her amendment because she wants an all-embracing Lawrence-type inquiry. I can see the strength of that. The benefit of the amendment that my noble friend Lord Rosser and I have signed is that it focuses on the culture of the police, which is a very important facet.

I was very struck by HM Inspectorate’s report, Police Response to Violence Against Women and Girls, which showed woeful inconsistency between the way police forces conducted themselves. The inspectorate highlighted that, at the level of individual cases, victims reported hugely different responses depending on which call handler they spoke to. Some were very sympathetic, others made the victim feel that they were not being believed. At force level, there were hugely unexplained variations about how forces used their protective powers and orders at their disposal. At local partnership level, the roles and responsibilities for partners working together in a multiagency safeguarding arrangement varied considerably. At the national level, actions to improve police responses were split over multiple government strategies. This surely has to be addressed if we are to make real inroads into these deep-seated problems about violence against women and girls.

Behind this woeful inconsistency, lack of leadership and lack of priority lies a great cultural impediment in so many of our police forces. I know that the Minister has commented before on the performance of her own police force, Greater Manchester Police, but I was struck by the Manchester Evening News investigation into the force last December. She might not want to comment on it and she might think it is not accurate, but it looked into the primary reason why the force missed 80,000 crimes last year. As noble Lords know, this led to action being taken, new management and a new chief constable, but what the Manchester Evening News said is that it discovered a tendency for

“obfuscation, denial, secrecy and an instinct to defend the indefensible”,

taking

“misleading and inaccurate statements, denial of official criticism and legal stonewalling; police officers fearful to report failure and those attempting external scrutiny being brushed off.”

As the article says:

“Understanding and fixing the causes and solutions of what was dubbed a ‘rotten’ culture four years ago will … be central to that”.


I do not want to tar every police force with Greater Manchester’s brush, but lying behind that are major issues about how the police conduct themselves, which is very relevant to our debate.

I was interested in the interview with the former Justice Secretary, Robert Buckland, in the New Statesman on 27 October. Commenting on the Sarah Everard case, he said that instead of being “defensive”, senior officers must be “constantly vigilant” about weeding out dangerous officers and supporting those who need to improve. He said:

“Leadership is all about being honest and there will be times when the police have to own up.”


Where are the signs that most police forces and most police leaders understand that? I do not think there are many signs at all.

Then there are the comments of Sir Tom Winsor, Chief Inspector of Constabulary, to the Commons Home Affairs Select Committee recently. He warned of a culture of colleague protection. He said that forces needed to be “much more assiduous” in throwing out probationary officers who had a fondness for violence or exercising power, exhibited misogyny, racism or homophobia, or showed a lack of maturity and judgment.

Why on earth did he have to make that comment in the first place? Why on earth do police forces not exercise a considerable degree of vetting over probationary officers at that crucial first stage? He went on to say—and this is controversial—that professional standards units, which countered corruption, were often not staffed with the best people, which meant that substandard officers, whom he referred to as

“cancerous growths within the force”,

were not identified or pushed out. He gave the example of a group of male officers in the locker room who did not challenge or report two colleagues who boasted of picking up a female assault victim and taking her home, where she was raped. The pair were ultimately prosecuted but nothing happened to the officers who did not report them.

I rest my case. There are so many examples of a really damaging culture. We can see this being played out in relation to this awful, horrendous number of crimes against women and girls. We can change the law. We can do all sorts of things like that but until we change police culture, I do not think we are not going to have the effect we need.

I like both amendments and clearly, on Report there will be an attempt to composite them—if I may use that word, which my noble friends here will well understand and not love. So far, we have heard weasel words from the chief police officers. There is little indication that they understand that the culture they lead has got to change. I very much hope that this House, through our debates on this Bill, will be able to influence a change of direction.

[Baroness Jones of Moulsecoomb (GP)]

My Lords, this issue of trust in the police is an interesting one. Trust has been eroding for many years now. Two cataclysmic events in the past couple of years have really made a difference. The first—not chronologically—is the murder of Sarah Everard and the way that the police policed the vigil and the ludicrous comments that solo women should hail a bus if they feel in danger and so on. Really, the whole police force needs some serious attention and serious guidance, and perhaps even a new police commissioner. That might be a very good idea.

The other thing was that during the pandemic we had law and we had guidance and then we had what the Ministers were saying at regular press conferences. That got very confusing for the police, to the point where they were trying to move people on for sitting and resting during a walk. That did not help the police and that was not the police’s fault. That was the Government’s fault for not being clear about instructions.

I support all the amendments in this group and agree that we need a statutory, judge-led inquiry. It cannot be allowed to drift past without real challenge by a judge. You have to remember that this was not somebody pretending to be a police officer: this was a real police officer abusing his position to abduct, rape and kill. The fact that he had a reputation already in the police is extremely damaging. This is a culture that we all know exists, and it should be fixed.

On Amendment 282, I have spoken many times here in your Lordships’ House about training for the police on domestic violence, because they have a reputation for assaulting quite a lot of the people they live with. We have to make sure that they get this sort of training. As far as I know, only about half the police forces in England and Wales have so far had domestic violence training. If they do not have that training, it really cannot be argued that they know what to look for and how to treat victims of abuse, so that is extremely valuable and important.

Trade Bill

Debate between Baroness Jones of Moulsecoomb and Lord Hunt of Kings Heath

Consideration of Commons amendments & Ping Pong (Hansard) & Ping Pong (Hansard): House of Lords
Tuesday 2nd February 2021 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure to support my noble friend Lady Thornton and to agree with my noble friend Lady Kennedy. I obviously listened with great care to what the Minister said, and the reassurance that he gave, but I hope that in winding up he will actually respond to the points raised by noble Lords. Essentially, he is asking us to take this on trust, but the problem is that, in relation to the issues that the noble Baroness, Lady Kidron, talked about, the same argument could be just as well used in relation to health issues.

As the BMA has pointed out, unless the health and social care sectors are specifically carved out from the scope of deals, common elements within free trade deals, such as standstill and ratchet clauses, could lock in and deepen the fragmentation of services. That could block new models of care. Other unintended effects might be to prevent NHS hospitals bringing support services back in-house, as they now seek to do.

Investor protection and dispute resolution mechanisms in UK trade deals open the door to the Government being sued for making legitimate public procurement and regulatory decisions. We heard of the Canadian example, but another is that of an EU investment treaty which resulted in the Slovakian Government being ordered to pay over €22 million in damages to a foreign private health insurance firm after they decided to reverse the privatisation of their national sickness insurance market. Investor protection mechanisms have also been extensively used to challenge public health initiatives such as plain packaging for tobacco.

I really must endorse the words of the noble Baroness, Lady Boycott, because it is exactly as she said: there are necessary interventions in health in relation to, say, issues of pricing and other things on foods that we might regard as harmful, but this can be extended to other health interventions as well. The noble Baroness talked about clever corporate lawyers, but take, for instance, the tobacco companies; globally, they fight their corner very fiercely indeed. The idea that they would use some free trade agreements to argue against some of the protections that the Government might want to put in strikes fear into my heart.

As my noble friend Lady Thornton said, we know that UK and US negotiators have had conversations about the health service. The US has also made clear its desire for the UK to change its drug-pricing mechanism. I am certainly with those noble Lords who say that trade deals could risk compromising the safe storage and processing of health data. We will hear from the noble Lord, Lord Freyberg, in a moment and I will be very interested in his remarks.

In the end, this amendment cuts to the chase of the debate about whether the NHS is on the table in trade negotiations. I am convinced that it has to be taken off the table; that is the only way that we will protect it. In this short debate, frankly, we have exposed the arguments of the Minister. I say this to him: we deserve an answer, because it is no good giving bland assurances about the Government’s intent. A lot of this is about unintended consequences, with the examples there are now globally of how trade deals can impact on the sovereignty of individual national Parliaments. I will not put Brexit in at this stage, but how ironic indeed that the Government who talked about taking back control are busy agreeing trade deals where they are in fact at great risk of losing control.

[Baroness Jones of Moulsecoomb (GP)]

My Lords, it is obviously a pleasure to follow the noble Lord, Lord Hunt. He told me off earlier for giving the Government a hard time. I thought about that and, in fact, until very recently, if I criticised the Government, I always offered another policy, a greener idea. I tried to be positive towards the Government, but I am afraid that my optimism is failing me. I shall come back to that.

I congratulate the noble Baroness, Lady Kidron, on her incredibly hard work, nudging the Government towards a more ethical stance on the protection of children. I hope that she can get them over the line. If she puts her amendment to a vote, I shall of course vote for it. The noble Baronesses, Lady Kennedy and Lady Boycott, gave such good ideas and sound arguments that it is difficult to imagine that the Government can overrule them.

There is a lot in this non-regression area. I assure noble Lords, as the only Green allowed to speak in this debate today, that Greens very much support the NHS, which has done the most incredible job during the pandemic and is now doing a fantastic job of vaccinating the population.

Children, animal welfare and human rights are all very close to my heart—but I shall speak about the environment. Environmental protections are always in danger, with any government, because it is so hard to understand how you can change from where we are now to where we really ought to be, given the climate emergency that we are all facing. I hope that the Dasgupta review that has been published will help all of us to understand the threat that we face.

I welcome the review—the good thing is that it actually uses the language that most politicians use, and it looks at the economic value of nature and natural resources. Greens tend to use the phrase “natural capital”. The Dasgupta review stresses that the economy is a complete subset of the environment and not the other way around. It uses the language that growth-oriented 19th-century political perspectives can get a handle on. When it says things like, “we can’t exist without a healthy world”, that is not only about air, water and having enough pandas and elephants and things like that; natural capital includes the soil and geology—it includes everything that we are destroying very fast. That review could be a moment when all politicians make the seismic shift to understanding that it is not all about growth. Quite honestly, with the Trade Bill, you really have to have that understanding. Embedding environmental considerations into our current systems will not work; you actually have to change the systems. We have already overshot our planetary limits—we are already in huge danger, and we are still failing to meet the basic needs of billions of people all over the world.

These amendments are absolutely crucial, not only for individuals but for every part of our planet, our system and our society. I really hope that we have another massive defeat for the Government on this, so that they might have pause in their complete lack of understanding of green issues.

Domestic Abuse Bill

Debate between Baroness Jones of Moulsecoomb and Lord Hunt of Kings Heath

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Wednesday 27th January 2021 Lords Chamber

[Baroness Jones of Moulsecoomb (GP)]

My Lords, I rise to support this amendment strongly: because this is done in such a patchy way, it needs a complete rethink.

I want to focus my comments on the training of police in domestic abuse. I have mentioned before in your Lordships’ House the organisation SafeLives, which has trained various police forces and found it incredibly effective in making them aware and more empathetic. Arrests and prosecutions rocket because, all of a sudden, police officers understand what is involved.

This week, at the APPG on Policing and Security, I asked Assistant Commissioner Louisa Rolfe, who is the NPCC lead for domestic abuse, about the number of police forces that had done this sort of domestic abuse training. The latest figures she had showed that 23 out of 43 forces had done the training, which I think noble Lords will agree is not enough. She made the valid point that it was not just about paying for it—which does hamper some police forces, because they have to pay for it themselves—but about the logistics of taking officers away from their day-to-day duties.

So, it is a postcode lottery. You might live in an area where training has been delivered, or you might not. There has to be blanket provision: this sort of training must be delivered as part of basic training to all police forces and any other public servants who may encounter survivors of domestic abuse. However, it is police officers who are in drastic need of this training. I ask that the Minister take this issue back to the Home Office and make it clear that the police should have this training as a matter of course. It represents the deep, far-reaching approach that all public organisations should be taking against domestic abuse. This is how we win against abusers.

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, I am delighted to have added my name to my noble friend’s amendment, to add my support to that of my noble friend Lady Crawley.

When my noble friend Lady Armstrong spoke at Second Reading, she described the challenge of supporting women at risk of losing custody of their children when the main need was identified as domestic abuse. We know that victims face many challenges, and that more than half of women victims have a common mental health problem. One in five has been homeless, and one in three has an alcohol problem. All too many are in poverty, and most women in contact with the criminal justice system have faced domestic or sexual violence. Supporting those victims who face multiple disadvantages requires a workforce with the skill, knowledge and awareness to understand the range of experience that victims have faced, so that they can effectively engage and support them.

But that is not always forthcoming. Many practitioners report that the ongoing training and awareness-raising needed to support that type of practice is often the first thing to be cut to save money. Women affected by domestic violence often highly value support when the person working with them knows what it is like to be in their shoes, and they value hearing from other women who have been through similar experiences. But effective involvement in the workforce of those with lived experience requires real support mechanisms, proper training and development, and for the organisations to use reflective practice to ensure that any challenges that may arise can be addressed effectively and in a supportive environment. We have heard in tonight’s debate that there are other challenges. There is a lot of evidence showing that public services are failing to pick up and respond to domestic abuse, so many survivors are passed from service to service before finally getting what they need, causing years of preventable hurt and even putting lives at risk.

It is clear that public services need to transform their approach to domestic abuse. Asking victims and survivors about their experience in a trained and compassionate way is crucial to ensuring that they get the support they need at the earliest possible opportunity. Both my noble friends Lady Armstrong and Lady Crawley referred to NICE guidelines that all mental health services should make trained inquiries into experience of domestic abuse among all those accessing their services. Yet the evidence is that many mental health service patients are still not asked about abuse. I take that as pretty hard evidence that guidelines are simply not sufficient. The case for a statutory duty on public authorities is therefore persuasive. I also agree with my noble friend Lady Armstrong: I see that not as a massively onerous task but as one that is essential if we are ever to ensure that public services respond to victims in a co-ordinated way.

Like other noble Lords, I hope that the Minister might take this back and consider it before Report. Of all the amendments that we have debated today, I cannot think of a more important one.