Health and Care Bill

Baroness Meacher Excerpts

Lords Hansard - Part 1 & Committee stage
Tuesday 18th January 2022 Lords Chamber

Moved by

[Baroness Meacher]

20: Clause 10, page 6, line 19, at end insert “including how it must be used to support service integration for children”
Member’s explanatory statement
This amendment would clarify and prioritise how use of sums paid to NHS England under section 223B of the National Health Service Act 2006, better known as the Better Care Fund, can be used towards service integration for children.

[Baroness Meacher (CB)]

My Lords, I will also speak to Amendment 177. Amendment 20 requires the Secretary of State to ensure that the better care fund, an important and successful initiative, is used to support service integration for children as well as adults. As the Bill stands, the better care fund will continue to be focused exclusively on adults. This is one of a number of amendments that we will debate over the coming weeks which together ensure the children are given equal treatment with adults in the Bill. I assume at the outset that the Minister agrees in principle with us that children and adults should be treated equally in the Bill. Can he give the House an assurance that this is the case—I cannot believe it is not—and if it is not, can he give us the reasons why?

We understand that the fund has focused on adults until now but surely it is time to extend it to children’s services. When the better care fund is all about integration of health and social care, it is hard to understand why children’s services should be excluded. Integrated multiagency support for children and families is key to delivering on the Government’s policy agenda, including for disabled children, those with special educational needs, children supported by the social care system and children during the first 1,000 days of life. Extending the scope of the better care fund to children would greatly accelerate this process of integration and support the Government’s ambitions for children.

I recognise that the funding streams and systems involved in services for children are complicated and it would involve work to extend the better care fund to incorporate those systems. However, this complexity is precisely why good and integrated services for children are so hard to achieve and why the better care fund could be so beneficial.

To illustrate the point, I will quote from a letter I received last week from Julian Wooster, the Somerset director of children’s services. He welcomes this amendment and explains that

“unfortunately we currently have a perfect storm of issues nationally in relation to placements of teenagers with complex needs, which is having a detrimental impact on their well-being.”

Apparently, the Association of Directors of Children’s Services has made a number of submissions, including the following commentary to the review of children’s social care which is under way:

“Despite long standing and ongoing discussions about the needs of children across the children’s social care, mental health and youth custody secure estate, the three systems continue to be separately commissioned, operate under separate legislative frameworks and are the responsibility of different government departments, each with different priorities. This can present practical barriers to local innovations and change. Locally in Somerset the council and NHS colleagues have worked well together on a joint initiative, which is receiving national interest. If the country is to benefit, Wooster claims, there needs to be a joint framework which the better care fund could provide.”


I am aware that officials from the department have been having positive conversations with colleagues from the Children and Young People’s Health Policy Influencing Group and the National Children’s Bureau, and I hope these will continue. But what I hope today is that the Minister will clarify to the House is that he has no objections to the principle of extending the remit of the better care fund to children, and that he is happy to explore how that might be achieved.

I turn briefly to Amendment 177, which seeks to ensure that the needs of those aged nought to 25 are adequately met under the integrated care systems. The amendment would require the Secretary of State to publish guidance on how ICSs should meet their obligations and with which ICS bodies would be required—that is a very important word—to comply. I do not think that I really need to persuade the Government that meeting the health needs of children from birth to adulthood is perhaps the most important investment in the health of the nation. Obviously, good health in childhood is likely to lead to good health in adulthood, to the benefit of every single one of us and to our NHS and taxpayers. We know that integrated care systems will have to cater for all ages in the context of the historically large backlog of appointments and treatments. It will be all too easy for particular groups to be left behind, unless there are specific provisions in the legislation to make sure that they are not.

As this Bill passed through the House of Commons, I was really pleased to hear that the Minister for Health had recognised the importance of meeting the needs of babies, children and young people. In particular, I warmly welcomed his commitment in Committee to ask his officials to develop bespoke guidance spelling out how ICSs should meet their needs. I understand that officials from the Department of Health and Social Care are currently engaged in discussion with the Children and Young People’s Health Policy Influencing Group on the development of that guidance, which is really encouraging.

I hope the Minister understands the reason for this amendment. Given that the Minister in the other place has shown his commitment to the principle of issuing guidance, our purpose here is to ensure that the guidance is published and will have statutory force to ensure compliance with it. I shall not go into the details of the amendment, but those are its objectives. I hope the Minister will be able to agree to this amendment, as it does nothing more than ensure that his colleague’s commitment in the other place is honoured by the new system. I beg to move.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the noble Baroness, Lady Masham of Ilton, is taking part remotely, and I invite her to speak.

--- Later in debate ---

[Baroness Meacher (CB)]

My Lords, I say a huge thank you to and congratulate Members from across the Committee who have made the most amazingly powerful contributions to this debate on the children’s amendments. I think that we are all just taken aback that there is no mention of children in these crucial clauses. I confess that I was very disappointed in the Minister’s response; we do not seem even to have managed to persuade the Government that the Bill should mention children somewhere, so I think that a number of us will want discussions with him before Report to see whether we can make some progress on making sure that children in future are taken care of. On that basis, I beg leave to withdraw my amendment.

Amendment 20 withdrawn.

Health and Care Bill

Baroness Meacher Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Lord Hunt of Wirral (Con)]

My Lords, in declaring my interests as set out in the register, I want to press my noble friend the Minister on conflicts of interest.

Paragraph 8 of Schedule 2 to the Bill provides that local NHS trusts and GPs are to appoint members of the integrated care board. Organisations that provide the bulk of NHS services will therefore be co-opted into the work of commissioning. It is currently the work of commissioners to hold providers to account, objectively determining whether they are best placed to provide a service and assessing their performance. The new integrated care boards must continue to perform that role.

Clause 14 introduces into the 2006 Act new Section 14Z30, subsection (4) of which provides, rightly:

“Each integrated care board must make arrangements for managing conflicts and potential conflicts of interest in such a way as to ensure that they do not, and do not appear to, affect the integrity of the board’s decision-making processes.”


Reference has already been made to amendments that seek to exclude individuals involved with independent healthcare provision from joining the ICBs. Does my noble friend the Minister agree that the membership of provider appointees on integrated care boards may at least risk creating a perception of a conflict of interest between the roles of those individuals on the board and any roles they may hold with provider organisations? How can the benefit of provider input into the work of an ICB be reconciled with the task of objectively assessing both the suitability and performance of providers? I believe that greater clarity from the very outset on the extent of the role that provider appointees will be expected to play will surely assist ICBs in developing robust governance arrangements, which would then enjoy public confidence.

[Baroness Meacher (CB)]

My Lords, I support Amendment 37. In so doing, I add my strong support to the comments of the noble Baronesses, Lady Bakewell and Lady Bennett.

Of course, the ICBs will be central to ensuring adequate funding and support, not only for the powerful acute health trusts and primary care but for the services that are historically underfunded. It is for these services that this amendment is particularly important. Before discussing these specific gaps in the Government’s vision for the new system, I want to stress that I am very concerned that we should not lose vital clinical leadership along with patient representation, which were the hallmarks of the CCG system. Of course, we want worker and carer representation but, in my experience, top medics are actually rather good at deciding how money should be allocated across services.

In my view, the absence of a public health representative from the shortlist of necessary ICB members in the Bill is an extraordinary oversight. This amendment seeks to put that right. ICSs are already in the process of developing their draft constitutions, which, while dependent on the final content of the Bill, provide a clear indication of their intent regarding clinical membership. It is particularly concerning that several ICSs have failed to include any role on their ICB for public health experts in their draft constitutions, with some failing to make any reference to public health at all. As the BMA points out in its briefing, this poses a significant risk to the role and prominence of public health within the work of those ICBs.

In relation to the importance of public health representation on ICBs, noble Lords should be aware of the impact of this on the vexed issue of drug addiction. Police services up and down the country are recognising that criminalisation and imprisonment are entirely counterproductive in this field. These responses only limit the young person’s education and employment options and tie them into a life of drugs and crime, with appalling consequences for them but also for their communities. Police services are increasingly adopting diversion to treatment as a preferable response when an individual is found in possession of drugs, but drug treatment services have been cut over the past 10 years. ICBs will need to tackle this situation as a matter of urgency if the police are to be able to stem the tide of county lines and other highly damaging consequences of our counterproductive and, in my view, idiotic drug policies and failure to treat addiction as a mental health problem, which, of course, it is. These urgent issues will not be confronted unless public health is strongly represented on ICBs and other boards and committees in the new structure.

Another cri de coeur is for mental health, as others have said. Having chaired a mental health trust for many years, I am acutely conscious of the impact of bed shortages on very sick people and their families and of the very high threshold for child mental health services. There is no doubt that if we do not treat children with mental health problems, we will have adults with these kinds of problems throughout their lives. The country cannot afford to continue neglecting this important field. I support the other amendments in this group. The NHS has major long-term workforce shortages and other problems. If they are to be addressed adequately, the staff need representation, along with patients and carers.

I end with a plea to ensure, through membership of ICBs, ICSs and ICPs, that clinical leadership is retained within the NHS. On ICBs, this must include at least two primary care members, at least one clinical representative of secondary care, acute care and mental health and at least one qualified and registered public health consultant. I hope the Minister will tell the Committee whether he agrees with this approach to ICB membership.

[Lord Patel (CB)]

My Lord, I rise very briefly to support Amendment 37 in the name of the noble Baroness, Lady Thornton, to which I have added my name. She and the noble Baroness, Lady Meacher, have identified in detail why this is a key amendment that identifies the core representation that is required for ICB boards to function satisfactorily and develop strategies for population health in their area, and I strongly support it.

Breast Screening

Baroness Meacher Excerpts

Tuesday 14th December 2021 Lords Chamber

[Baroness Morgan of Drefelin]

To ask Her Majesty’s Government what plans they have to ensure screening of the estimated 1.2 million women in England who missed breast screening during the COVID-19 pandemic; and what assessment they have made of the extent to which health disparities may have been exacerbated due to the reduction in screening attendance.

[Baroness Meacher (CB)]

My Lords, I beg leave to ask the Question standing in the name of my noble friend Lady Morgan on the Order Paper.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

Recovery of screening has been an ongoing priority and all NHS breast screening providers are now operational. We allocated £22 million towards mobile breast screening units and £50 million towards increased regional capacity, and have collaborated across cancer alliances, primary care networks and NHS England and NHS Improvement regional teams to promote uptake. We know inequalities in screening exist, exacerbated by changes to service provision during the Covid-19 pandemic. Inequalities remain key in restoration planning, and guidance was recently published on reducing inequalities in breast screening.

[Baroness Meacher (CB)]

My Lords, I thank the Minister for his reply. He appears to be aware that it is in fact minorities and socially deprived women who have been hardest hit by the shortfall in screening take-up due to Covid. I understand from his response that the Government are issuing guidance. What action will that guidance envisage to ensure that these minorities and deprived women receive screening for breast cancer?

[Lord Kamall (Con)]

The noble Baroness raises a very important point; we need to tackle inequalities not just in this area but across all healthcare. One of the things we have been looking at is research into why women in certain areas do not come forward. That is why we have invested in mobile breast screening units, so that we can take screening services closer to those people who are reluctant to come forward.

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.

Covid-19: Care Homes

Baroness Meacher Excerpts

Thursday 17th June 2021 Lords Chamber

[Lord Bethell (Con)]

I saw the images the noble Lord refers to and was shocked and moved by them. That is why we moved massively, including, in March, announcing £594 million in order to support care homes, and massively supporting them through the NHS. We did an enormous amount from the beginning. The effects on care homes have been profound and are extremely sad, but I am afraid to say that this presumption that we either did not enough or took the wrong advice is not supported by the facts.

[Baroness Meacher (CB)]

My Lords, let us focus on what government can do now. My concern is that the Government are overcompensating for the very high early death rate in care homes, for whatever reason, by imposing wildly disproportionate controls over double-jabbed, tested visitors. For example, they have to wear PPE and social distance, as we know, and there is no hugging—thus wrecking the final months for these people in care homes. I ask again: will our excellent Minister—I mean that; he is an excellent Minister—put to the Prime Minister the risks and benefits of scrapping these controls?

[Lord Bethell (Con)]

My Lords, I am extremely sympathetic to the noble Baroness’s point and conscious of her specific point that we could be in danger of over- reaching or in some way emotionally overcompensating for perceived mistakes in the past. We are conscious of that possibility, but I would like to reassure the noble Baroness that it is not the case. The decisions we have made on infection control and on visiting in care homes are tough—they are hard—but in recent weeks there have been outbreaks in care homes in London and Bolton in which vaccinated residents have caught the disease and had serious symptoms. That is something we are extremely wary of. When the vaccination has reached a higher proportion of the population and R is below 1, we will be in a position to change these policies. We will do so at pace and as quickly as we reasonably can, but until that moment arrives we have to take these tough decisions.

Covid-19 Update

Baroness Meacher Excerpts

Tuesday 15th June 2021 Lords Chamber

[Lord Bethell (Con)]

Yes, I entirely agree with my noble friend on this matter: we are of course only safe when we are all safe. As chair of the G7, we have done an enormous amount to try to show leadership in this area. The G7 committed to share at least 870 million doses directly over the next year and to make these doses available as soon as possible. But the numbers involved are absolutely enormous: 870 million is an astonishing figure, but it is not near to the 8 billion that we ultimately need. At the end of the day, we need manufacturing in all the regions of the world. That is why, as the supporter of the AstraZeneca vaccine, which is made on a profit-free basis and on extremely generous terms to manufacturers of the world, Britain has given an enormous benefit to the world. I very much hope that the manufacturing can ramp up to meet that need.

[Baroness Meacher (CB)]

My Lords, I welcome the small but vitally important concession to care home residents in the Statement. However, the Prime Minister has left in place the cruel and unnecessary controls over care home visits. Even visitors who have had two vaccinations and a negative test before visiting must wear PPE and maintain social distancing—no hugging, for example. This is inhuman, particularly for people with dementia, and the risk must be close to zero. Will the Minister plead for immediate changes to those really unnecessary rules? They are well overdue.

[Lord Bethell (Con)]

The noble Baroness makes the case extremely well, and I agree with her sentiment that the rules are extremely tough. I have heard loud and clear the many noble Lords who have made this case, and we look at it very carefully and thoroughly. At the beginning of the pandemic, one of the most alarming images—and one that has always stuck in my mind—was that of care homes in Spain in Italy, where so many of the residents had died. What we know for sure is that, even with the vaccine, the virus can spread through a care home at great pace—typically half of residents will be infected the moment the virus arrives in a care home. Even with the vaccine, we still have to step carefully, and that is why these measures are still in place. I very much hope that they will be lifted, and I will celebrate that along with all noble Lords who have made this case to me in the past.

Covid-19: Government Handling and Preparedness

Baroness Meacher Excerpts

Tuesday 8th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely share my noble friend’s frustration at the situation. Of course we all enormously regret the fact that our efforts to open up international travel were unfortunately reversed because of the presence of dangerous variants of concern in the Portuguese community—in this case, particularly the Nepal variant of concern. However, I cannot agree with her that quick decisions based on accurate data are not appropriate in the depths of a pandemic. It is absolutely right that we move quickly to close down a change of transmission and that we protect the vaccine from variants that may present a severe danger to this massive national project.

[Baroness Meacher (CB)]

My Lords, this is rather relevant to the previous question: how many additional Covid cases in the UK were caused by the delay in closing our borders to travel from India after we knew about the new variant? Is the Minister making representations to the Prime Minister and appealing that no such delay should occur again as variants emerge in different countries across the world, to protect the health of the people of the UK?

[Lord Bethell (Con)]

My Lords, I am not sure whether I have the data that the noble Baroness has asked for. I also contest the premise of her question. We have moved extremely quickly when presented with clear data, as my noble friend rightly pointed out, and I hardly need go over the timelines for the decisions around Pakistan, Bangladesh and India, which have been gone over many times indeed. I reassure the noble Baroness that we are absolutely determined, at this delicate phase of the pandemic, to ensure that our borders are extremely tough and that we do whatever we can to keep the variants out. At the same time, we are cognisant that people do have commitments overseas and we are leaning, wherever we possibly can, to opening up the borders.

Covid-19: Resuscitation Orders

Baroness Meacher Excerpts

Wednesday 24th March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, yes, I do.

[Baroness Meacher (CB) [V]]

My Lords, I should declare my interest as chair of Dignity in Dying. What plans do the Government have to increase dramatically the numbers of people who have advanced decisions expressing their views on medical treatment? Does the Minister agree that patients’ wishes should be central to DNACPR decisions, and indeed to all significant medical decisions, particularly at the end of life?

[Lord Bethell (Con)]

My Lords, we absolutely agree. That is exactly how the guidelines are written and exactly the guidance sent into the system. The issue we face is much more pastoral in nature: it is one of training and creating the space and resources necessary to have extremely difficult conversations. That is the kind of front-line support we need to put in place. It is a question of patient engagement rather than a change of guidelines, but I completely take on board the noble Baroness’s recommendations.

Health Protection (Coronavirus, International Travel) (England) (Amendment) (No. 7) Regulations 2021

Baroness Meacher Excerpts

Monday 22nd March 2021 Lords Chamber

[Baroness Meacher (CB) [V]]

My Lords, I add my welcome to the noble Baroness, Lady Chapman, and I enjoyed her speech. We know that our failure to secure our borders at the start of this pandemic led to considerable numbers of tourists coming back from their skiing holidays—in Italy in particular but also elsewhere—and not isolating. Those tourists, I would say, substantially led to the soaring Covid numbers a year ago. We now have a list of 33 countries on the red-list travel ban, which reads a bit like a list of developing nations. Again, surely the greatest risk is from people returning from our neighbouring countries in Europe such as France and Germany, where, as I understand it, the South African variant is taking hold. Are the Government urgently considering including our European neighbours on the red list to avoid repeating our mistakes of a year ago or, indeed, going rather further as the noble Baroness, Lady Wheatcroft, and others have suggested? It seems to me that, if we want to lead a more normal life through the summer and onwards, securing our borders much more effectively than this regulation will do is going to be absolutely critical. I look forward to the Minister’s response to that point.

Covid Contracts: Judicial Review

Baroness Meacher Excerpts

Monday 1st March 2021 Lords Chamber

[Lord Bethell (Con)]

My noble friend puts it extremely well. The judge said

“the overall picture shows the Secretary of State moving close to complete compliance. The evidence as a whole suggests that the backlog arose largely in the first few months of the pandemic and that officials began to bear down on it during the autumn of 2020”.

The judgment was entirely about the timing of the publication; it had nothing to do with the awarding of the contracts themselves. From that point of view, it is a ringing endorsement of the actions of officials in this matter.

[Baroness Meacher (CB) [V]]

My Lords, I strongly support the Secretary of State’s decision to prioritise saving patients’ lives, albeit that the contractual process appears to have breached the rules. Does the Minister agree that the real problem was the failure of Governments over the preceding 10 years to give proper attention to preparations for a pandemic which everybody knew could be around the corner? Can the Minister assure us that this failure will not be repeated, and systems are in place to ensure proper preparation in future?

[Lord Bethell (Con)]

My Lords, it is not for me to do the post-match analysis; that will be for those in the future. I reassure the noble Baroness that we have 32 billion units of PPE procured, including 19 billion purchased by the DHSC, 10 billion purchased by SSCL and 2.5 billion manufactured by our brilliant UK companies. We have 120 days of PPE ahead of us, and I can very confidently say that we are in great shape for anything the pandemic may throw at us.