Health and Care Bill

Baroness Meacher Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Meacher (CB)]

My Lords, I rise to respond to this very important Bill and in so doing warmly welcome the noble Lord, Lord Stevens, who will clearly make a very significant contribution to the work of this House.

My biggest concern is that the Government are planning a major NHS reorganisation at a time when the NHS has suffered—and continues to suffer—the greatest workforce stress since its inception. Medical staff are burnt out, they are retiring early, leaving the service mid-career, reducing their hours, or planning one or other of these steps in terrifying numbers. Others have referred to this problem. Managers throughout the service, many of whom are doctors and nurses, will be focused on their own jobs and futures rather than tackling the unprecedented staffing crisis.

I gather the Government are considering deferring the implementation of this Bill for six months. But this is not a situation that is going to be resolved in a matter of months. I understand that the CEOs of the ICBs have already been appointed and for months senior staff have been focused on the forthcoming reorganisation, with detrimental consequences to the service.

Having said all that, I want to mention six issues. First, as other noble Lords have said, the urgent need is for the Government to focus their attention on workforce numbers, not only now but in the future, to deal with a haemorrhage of staff and the growing needs of the ageing population. The noble Lord, Lord Turnberg, put it rather well: they need to fill the hole at the bottom of the bucket as well as filling the bucket from the top. I will therefore be supporting the Jeremy Hunt amendment, which seeks to address this issue.

My second point is another general issue. I serve on the Delegated Powers Committee which recently published a major report condemning the growing trend toward skeleton Bills, excessive use of Henry VIII powers, disguised legislation and rules masquerading as guidance, which are never seen by Parliament and yet which government expect and require to be followed. The committee has not yet looked at this Bill, but on my reading of it there are at least 150 delegated powers, a tiny number of which involve some sort of parliamentary scrutiny. Huge parts of the Bill are skeletal, with disguised powers. When the Delegated Powers Committee reports, I hope this House will look very carefully at the powers in the Bill and amend them as appropriate. I hope the Government will support those changes.

Thirdly, I and many others have strongly welcomed the move away from the old legislative focus on competition on the assumption that this would improve services. Of course, it has not. There is a strong argument for having the NHS as the default option for NHS contracts so that private companies are involved only where absolutely necessary. A powerful argument for this approach is the fact, which I very warmly support and welcome, that the Government want to establish a joined-up collaborative service. Fracturing of the service works against that objective.

Fourthly, there is the composition of the ICBs, which I think we will talk about a lot. Private company representation is an issue, but most important will be to ensure clinical leadership, not only on ICBs but at every level of the integrated care system. We must also ensure representation on these boards from the many sectors of the NHS; public health and mental health must surely be included as essential on every ICB. We should take account of the pervasive impact of mental health problems and the permanent underfunding of mental health services, with appalling consequences for those affected. Finally, the voluntary sector also needs a voice on those boards.

Fifthly, end of life care and the urgent need to establish patient choice in palliative care are not mentioned in this Bill. Only 4% of the population have completed advanced directives and the medical profession in general is much more aware of the need to respond to the patient’s expressed wishes. Crucial to high-quality palliative care is the patient’s right to choose at the very end of life, and the Bill needs to play its part in this area—we cannot afford not to.

Finally, children’s services are also remarkably absent from the Bill; I believe the Government will want to put this right. These are just some of the most important issues and I look forward to the Minister’s response.