Health and Care Bill

Debate between Baroness Meacher and Lord Hunt of Wirral

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.

Non-Contentious Probate (Fees) Order 2018

Debate between Baroness Meacher and Lord Hunt of Wirral

Tuesday 18th December 2018 Lords Chamber

[Baroness Meacher (CB)]

My Lords, I speak in support of the amendment in the name of the noble Lord, Lord Marks, to the statutory instrument on so-called non-contentious probate fees. As a member of the Joint Committee on Statutory Instruments, I am very concerned that—as other noble Lords have said—the SI appears to be introducing a hypothecated tax on estates for use in subsidising parts of the HM Courts & Tribunals Service that will not at all be used by the fee payer. The SI introduces a huge increase in the cost of probate, which is just a document to enable the executors to administer the estate. It is nothing to do with courts and tribunals, which obviously involve vast costs.

The current fee of £155 if the application is made by a solicitor, and £215 if it is made by the executors in person, completely covers the cost of the probate service. Until now the fee has rightly not included any tax element at all, so this is a major departure from the way probate fees have been exercised in the past. Will the Minister explain why we suddenly need an entirely new approach to probate fees? Has it something to do with the massive cuts in the Treasury’s support for the courts service? I presume it is, but I do not think that makes the action of the justice department acceptable.

As other noble Lords have said, the proposed new fees are going to be on a sliding scale, up to £6,000 for estates of £2 million. This is a hike of 3,770% on larger estates. All but about £200 of the fee will in fact be a tax.

The committee accepts that Section 180 of the Anti-social Behaviour, Crime and Policing Act 2014 allows a fee to be prescribed that exceeds the cost of the provision of the service. I imagine that this probably allows for, for example, exempting very small estates from the fee at all, so then you need to have a slightly higher fee on bigger estates. That is perfectly reasonable. But the term “fee” has a clear connotation of recovery of costs incurred in the provision of the service. Although Section 180 permits enhanced fees, it remains a power to prescribe a fee, which clearly limits it to a relationship with the costs incurred.

The word “fee” does not equate to the term “tax”. A fee surely cannot comprise £200 to cover costs and £5,800 to the individual as a tax on the estate. If Parliament had intended the Lord Chancellor to be able to raise taxes in this way, it would have included such provisions very clearly in Section 180 to acknowledge that charging such a tax might be ultra vires. In the committee’s view, the 2018 order is a measure of taxation for which there is no clear statutory basis. Indeed, the committee could find no evidence that the Government suggested to Parliament during the debates on the Bill for the 2014 Act that the Section 180 powers would be used to prescribe probate fees in order to fund the operation of the courts generally or to provide for such huge and immediate increases in fees—let us call them “taxes”—in the way now proposed.

Furthermore, our committee’s view was reinforced by the report of the House of Lords Secondary Legislation Scrutiny Committee, as the noble Lord, Lord Beecham, mentioned. This points out that the proposed fees do not appear to conform to paragraph 3.6 in chapter 6 of Managing Public Money, the standard guidance to government departments from HM Treasury. Of course, that guidance makes it very clear that a fee should be equal for everyone involved and should represent the cost of the service. There should not be a sliding scale of a fee: that is made very clear in the Government’s own guidance.

As others have mentioned, the original proposal was to have a sliding scale up to £20,000. That was dropped as a result of the objections of the Joint Committee on Statutory Instruments. Can the Government can explain why, when they now accept that £20,000 is unreasonable, they think that £6,000 is somehow reasonable in this context? I suggest that the importance of this issue is that it could represent a precedent for other government departments. Just imagine the implications for citizens if government departments increased fees by some 3,000% for a wide range of services in order to incorporate a tax element to fund public services more generally. This would of course be ultra vires, as they are meant to be fees, as they are in this case. I hope that the Minister will give an assurance to the House today that the department will revisit the proposed probate fees and reduce them to bring them within the permitted limit.

[Lord Hunt of Wirral (Con)]

I declare my interests as set out in the register, particularly my having been a practising solicitor for more than 50 years. During that time I have dealt with many estates and made many applications to the probate registry. Looking around the Chamber, I see several of your Lordships who have very kindly given me the honour of naming me as one of their executors. I am not seeking any further orders this evening, but this year, for example, I have been in constant touch with the probate registry in dealing with the estate of one of our colleagues who, sadly, died a little while ago.

I want to say at the outset how much I compliment the staff of the principal registry and the district registries, who give a service second to none. I want the House to be aware that they give considered, careful advice and guidance to anyone who contacts the registry. They are to be commended on that first-class service.

--- Later in debate ---

[Baroness Meacher]

Does the noble Lord accept that under the Government’s own guidance this will in fact be a tax, and that taxes should be raised in primary legislation and debated properly in both Houses of Parliament?

[Lord Hunt of Wirral]

No doubt the Minister will give a more considered reply, but I certainly do not regard it as a tax, particularly as it is described as, and actually is, an enhanced fee. I have to admit that I was troubled by the original proposal, but the Government have listened to those concerns and have significantly reduced the enhanced fees from that proposal.