Elderly Social Care (Insurance) Bill [HL]

Baroness Neville-Rolfe Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Baroness Neville-Rolfe (Con)]

My Lords, the Bill deals, although at one remove, with one of the greatest and most welcome developments of the last two centuries. I refer of course to the extraordinary increase in average human lifespan that has occurred over this period. The separation of clean and foul water, advances in medicine and the development of vaccines, the discovery and invention of antibiotics and the recognition of the importance of safety in industrial processes, taken together with a realisation of the effects of smoking and diet on health and other factors, mean we have seen a rise in the average lifespan from well under 60 to around 80. This is a wonderful achievement but, like all advances, has thrown up problems. The greatest of these is the increased and increasing need of many elderly people for care, especially residential care, and its financing. The present arrangements are creaking.

As a society, we have taken a long time to grasp this nettle and, while Governments of every colour have dallied, the situation has deteriorated. Meanwhile, the financial position of local authorities, at least in England, has become much more challenging for various reasons, one of the most important of which was the cutbacks following the financial crisis of 2008. Some allowance has recently been made for local authorities to raise extra funds for social care, but the sector needs a significant injection of cash if standards are to be maintained, staff are to be rewarded properly and operators are to find it worthwhile to remain in the system.

What are the problems other than the need for money? One is uncertainty. None of us knows, early in life, how much care we will need over our lifetime. We might need none or we might need decades of care. Most of us will fall somewhere between these two extremes, but the financial difference between them is enormous, running into hundreds of thousands of pounds. Accordingly, another problem is fear—fear that we might be faced in old age with vast financial claims that will eliminate our lifetime savings.

All this seems to point to the need for an insurance-based solution, since in many areas of life that is how we cope with risk, with the advantages of pooling risk that it provides, but as my noble friend Lord Lilley has so eloquently explained, this is an area where private insurance cannot operate, mainly because of the fear that calculations will be upset by changes in government policy. My noble friend proposes to solve this dilemma in a typically brilliant way by harnessing the value of people’s houses after death in the way he has outlined as a component of what amounts to a voluntary, but state-guaranteed, insurance system which will operate at minor cost to taxpayers. It has been welcomed today as a workable solution by my noble and learned friend Lord Mackay of Clashfern, and the noble Lord, Lord Wigley, in a powerful speech, said it could play a part. This Bill represents a responsible and timely way forward. We need to act now. There is no sign that the Government will be able to do so quickly, so we should enthusiastically support this Bill which would make a contribution, large or small, to one of the greatest problems of our time.

Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) (No. 2) Regulations 2021

Baroness Neville-Rolfe Excerpts

Wednesday 16th June 2021 Lords Chamber

[Baroness Neville-Rolfe (Con)]

My Lords, if anyone had told me when we first debated Covid controls that we would still be in lockdown over a year later despite, first, only 1% of hospital beds being filled by Covid patients, and, secondly, that vaccines that are between 92% and 96% effective had been given to over half the UK adult population, including the vast proportion of those most at risk, I would not have believed them. This creeping government control of daily life, aided by all opposition parties, in a country which used to be free, is depressing. There is always an excuse for new controls: pressure on the NHS; risks from new variants; long Covid. Will this ever end? Most importantly, what could be any different in four weeks’ time?

The extension is yet again a fait accompli, but I will make two points. First, it is extraordinary that cost-benefit is still neglected. Every week of continued lockdown is costing billions. We are crippling our economy, which is still well below last year’s levels. Debt is building up on a scale not seen since World War II. Inflation is taking off. Some 5 million are on NHS waiting lists, which will lead to unnecessary deaths. It is difficult to see your GP and visits to patients and old people’s homes are restricted, causing unhappiness. University students have had their academic careers affected and mental health problems have increased. The streets are blighted by old masks and the internet by Covid scams. There is almost no overseas travel. Furlough schemes are still running and being phased out too slowly, stopping the labour market working properly. Bars, fruit farms and even the NHS are short of staff, but billions are being spent on furlough, adding to the eye-watering £70 billion cost which the Minister mentioned yesterday.

There is an extraordinary, time-consuming bureaucratisation of life: costly social distancing; paperwork in every pub; a huge amount of time in every respectable company devoted to observing the rules. Now there are rafts of costly cancellations as well—for example, of cricket tickets, to declare a personal interest. My noble friend has always been resistant to cost-benefit analysis, which I find surprising given his esteemed business background. Is this being looked at in a broad way for the future management of pandemics?

My second point is about the misuse of emergency powers. Has the Minister read the blistering report by the Constitution Committee? I hope that that powerful paper leads to some necessary, even if tardy, reflection in government circles. When I worked in government, we took pride in helping Parliament to scrutinise, cost and help Ministers come to the right conclusions. I think that such an approach might lead to greater success.

Botulinum Toxin and Cosmetic Fillers (Children) Bill

Baroness Neville-Rolfe Excerpts

2nd reading
Friday 16th April 2021 Lords Chamber

[Baroness Neville-Rolfe (Con)]

My Lords, like the previous speaker the noble Lord, Lord Addington, I very much support this Bill.

The idea of cosmetic Botox and fillers for under-18s fills me with absolute horror; that horror has been magnified by the debate so far. I speak as a grandparent of five beautiful granddaughters who are adventurous and will grow up to experiment. These kinds of procedures used to be the preserve of those of us who are care-worn and ageing but, with social media, everything has changed. There is a very strong case for early action. I congratulate my noble friend Lady Wyld on her first Bill and her clear introduction. I also congratulate Laura Trott MP in the other place—another emerging talent. They have done really well to secure government support, as my noble friend Lord Lansley said. I look forward to his Bill.

Noble Lords will know that I am always concerned about enforcement. I am glad to see that the Bill uses the powers in the Consumer Rights Act 2015, which I had the pleasure of putting on the statute book when I was a Minister. There are parallels with tattoos and sunbeds. I have faith in local authorities as enforcers of such regulations and in stopping bad practice as such practices go underground, although I always fear that their funding is inadequate.

I am disappointed that no impact assessment is available, but then this is not a government Bill. I have heard that one has been made; perhaps I could have a copy. I would, however, ask my noble friend the Minister or my noble friend Lady Wyld where the new costs are likely to fall and on whom. I assume that operators will lose some of their ill-gotten gains and that there will be a cost in understanding the new requirements, in training and in identifying under-18s accurately.

I know that there was also some concern in the other place that the Bill did not respect the common commencement dates for regulations of 1 April and 1 October. I valued these conventions as a former operator across many regulatory areas when I was in retail—though not in Botox, I hasten to add. They allow for proper preparation and training. However, it is for the Government to set the commencement date under Clause 6, so they may be willing to support that policy.

I wish the Bill a speedy passage so that it is not lost in the forthcoming Prorogation of Parliament before the new Queen’s Speech.

Health Protection (Coronavirus, Restrictions) (All Tiers and Self-Isolation) (England) (Amendment) Regulations 2021

Baroness Neville-Rolfe Excerpts

Monday 1st March 2021 Lords Chamber

[Baroness Neville-Rolfe (Con)]

My Lords, it is a great pleasure to follow the noble Lord, Lord Clark of Windermere, for whom I enjoyed working when I was an official at the Cabinet Office many years ago. He was as courteous then as he is now.

Reflecting on our response to Covid has caused me to shift from being mainly a staunch supporter of strong law and order policies to one who is equally worried about the erosion of British liberties. Unfortunately, we know from history that Governments come to regard long-standing emergency measures as essential—look at the delay in lifting rationing after World War II. I would like some ministerial recognition of such dangers that now face us.

Taken together, the Covid rules represent a very authoritarian regime. A criminal offence can ruin an individual’s life chances, excluding them from some walks of life. Will breach of the various provisions we are discussing today give offenders a criminal record? If so, is there a defence against mistakes? A new system of data sharing is being opened up in these regulations. How do we ensure that any this information does not get into the wrong hands or stay on police computers for years?

Finally, when will the powers to which this SI makes changes end? Can the Minister confirm that there will be a proper opportunity for debate before the whole system of coronavirus measures under the Public Health Act is renewed, and will there be an impact assessment next time round? This is a vital way of ensuring that those involved in bureaucracy make sensible and proportionate regulations and, perhaps equally important, that they are ready to make changes if they are wrong—some evidence of which we have seen today.

I end with my personal observations of this past weekend. One London park was packed because of the glorious spring weather. The swings were a riot. The grass areas had been taken over by fathers and children playing tennis and cricket, with others queuing to follow them. Yet the dedicated tennis courts and hard playing areas were aggressively locked. There is a strong case for opening these up earlier in March, to the advantage of all. Can the Minister please think again on this and answer my detailed concerns?

Future of Health and Care

Baroness Neville-Rolfe Excerpts

Tuesday 23rd February 2021 Lords Chamber

[Lord Bethell (Con)]

I am extremely grateful to the noble Baroness, Lady Watkins, for her generous remarks on competitive tendering and discharge to assess. These are examples of where we have listened to stakeholders and those in the NHS who have called for changes. In terms of the powers given to the Secretary of State and the link with social care, it is worth remembering that this Bill is a stepping stone towards other changes. Changes to social care funding can take place largely without any legislative change; they can be introduced by secondary legislation. Changes to the funding model in social care are a matter for a very large engagement process that will include other parties, as the Prime Minister has outlined, and will include very considerable engagement with stakeholders.

In the meantime, we are seeking to correct an overreach in the seclusion and mandation of the NHS to give the Secretary of State the kinds of powers that are reasonable in a parliamentary democracy in the governance of such a large and important national institution. Those powers are to be used with restraint and a degree of circumscription, but they rebalance the political geography of the NHS to give it full accountability. As such, they give the kind of authority the Secretary of State needs to institute the kinds of social care reforms I know the noble Baroness, Lady Watkins, is interested in.

[Baroness Neville-Rolfe (Con) [V]]

While the costs of reorganisation are certain, the expected benefits may or may not be realised. The fate of the Lansley reforms is a lesson for us all. The country will judge the performance of the NHS over the coming decade in the light of this truth. Will the Minister specify objectives against which the new reforms can be assessed?

[Lord Bethell (Con)]

My Lords, the objectives outlined in the White Paper are reasonably clear. The four headline objectives are to make it easier for different people in the system to join up to find ways to address complex issues, to remove unnecessary bureaucracy, to empower local leaders to make the best decisions for the populations they serve and to facilitate a range of other improvements held back by existing legislation.

This is a large Bill with a very large number of measures. It is not, and does not pretend to be, unified by a single thought or held together by an ideology or motivation of any particular philosophy. It is the application of a very large number of recommendations that have come out of a huge engagement with the NHS family, patients and other stakeholders. As such, it is a pragmatic, thoughtful and restrained approach to an important piece of legislative housekeeping of this much-loved healthcare institution.

Covid-19

Baroness Neville-Rolfe Excerpts

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful for the noble Lord’s fascinating mathematics, but there are other principles at stake here and I am not quite sure that his arithmetic can be leaned upon. One of those principles is personal responsibility. We cannot pay the entire nation a huge wage to stay at home for the entire epidemic; we have neither the cash resources nor the value base to do that. We must look to people to do the right thing. If we do not, we will end up with a country that is dependent on the Exchequer for its money and has the wrong values for the kind of enterprise economy that we need to build to get out of this epidemic.

[Baroness Neville-Rolfe (Con)]

Does the Minister realise that the imposition of a 10-year prison sentence for providing an inaccurate travel history on Covid forms is wholly disproportionate? Existing powers should not be misused for this purpose. Such a measure would require proper reflection and parliamentary debate, and it should therefore be in a new Bill if the Government wish to persist with it. In the meantime, will the Minister amend the present proposals significantly?

[Lord Bethell (Con)]

I do not agree with my noble friend on this in any way—fraud is fraud. If you put people in danger, you deserve to serve the consequences. It will be up to either the magistrate or the Crown Court to determine the sentence. The sentence is laid out in law, not by me or any new measure. Those who put the entire nation at risk by bringing variants of concern into the country should be aware that the courts may take an extremely dim view of their actions.

Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020

Baroness Neville-Rolfe Excerpts

Thursday 7th January 2021 Lords Chamber

[Baroness Neville-Rolfe (Con) [V]]

My Lords, as time for scrutiny is so short, I turn to the main area of hope, which is vaccination. Does my noble friend the Minister agree that this Government are likely to be judged by whether they can manage the rollout of the vaccine effectively? The Prime Minister has more or less committed to vaccinating the highest four tiers by the middle of February. If that timetable is not met, excuses will cut no ice, and experience so far does not indicate that matters are proceeding with the urgent ruthlessness that is required.

Unfortunate bureaucratic obstacles, such as requiring vaccinators to be well versed in diversity, were identified weeks ago. Why were this and other similar obstacles not dealt with at once? Why is there not vaccination seven days a week and up to 24 hours a day? That would not require vaccinators to work seven days a week; there is such a thing as flexible working. There is a race between the virus and the vaccine. The victims include our schoolchildren and their life chances, our economy, those stuck in cramped urban homes and those suffering from cancer and other health conditions, so we must have a more rapid rollout.

The health department’s plan is too slow and centralised. Why did it not start injecting the AstraZeneca vaccine until Monday? Every day matters. We need to bring in the private sector, private doctors and hospitals, and of course private pharmacies, as many have said. These people, who run small businesses, will work day and night and together can deliver millions of doses. They can also charge; many people will be prepared to pay for a dose without affecting the NHS rollout. AstraZeneca has indicated that it could gear up supply. We need to bring in tens of thousands of Army members, some to administer jabs and others to organise them.

We need more action and less self-congratulation. I hope that my noble friend the Minister realises the seriousness of this situation.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020

Baroness Neville-Rolfe Excerpts

Wednesday 30th December 2020 Lords Chamber

[Baroness Neville-Rolfe (Con) [V]]

My Lords, I support the regulations. I have been a strong proponent and defender of the principle of tiers in defending us from Covid; in my view, it is the correct strategic approach. I thank my noble friend Lord Shinkwin for his kind words about my work on cost-benefit in this very interesting debate.

I congratulate the Government and my noble friend the Minister on the vaccine programme, and I thank Kate Bingham for her entrepreneurial flair in buying into several vaccine options. A key principle of investment, which she obviously understands, is to spread the risk. That has enabled us on this occasion to be genuinely world-leading. However, with the economy reeling, we must have a rapid rollout of approved vaccines. To judge by what has happened so far, that will prove challenging, and I welcome suggestions that the military will be involved at an early stage.

Like everyone, I am concerned about the situation in our hospitals—from Salisbury, my hometown, where cases are up sharply, to the outer reaches of the UK. I have been reflecting on what we can do to improve things and look forward to the Minister’s comments. I have four thoughts and questions.

First, on information, we have been plagued throughout this epidemic by a lack of timely information and transparency. The latest example is not knowing hospital by hospital how many admissions there have been by type, age, medical condition, postcode, Covid variant, and so on. Please can this deficiency be removed? Secondly, on local incentivisation, if any of us are informed that we are at risk or live in an area where our local hospital is in danger of being overwhelmed, we will change our behaviour. Thirdly, on oxygen, I know from my son’s experience in LA, from Boris Johnson’s in St Thomas’s and from the sad news this week from Woolwich that reliable supplies of oxygen and staff to administer it are literally the difference between life and death. Why have we not made better preparation for oxygen supply? Fourthly and finally, on staff, I was told by a friend at the WHO that the biggest problem in fighting this epidemic in the UK is the availability of trained staff to help with Covid. What have we been doing to tackle this, if necessary by bringing in retired staff?

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) Regulations 2020

Baroness Neville-Rolfe Excerpts

Tuesday 1st December 2020 Lords Chamber

[Baroness Neville-Rolfe (Con)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Watkins of Tavistock, with her nursing expertise and her kind reference to my regret amendment on the Order Paper. This is concerned with SI 1374, which imposes restrictions on gatherings and businesses in England in tiers 1 to 3. I have an interest, living in Wiltshire and working in London, both of which should probably not be in tier 2 at all.

However, my main interest and the focus of my amendment is in cost-benefit analysis as a powerful driver of good public policy. I first learnt of its merits while at university, studying the case for the Victoria line, which turned out to be so much more beneficial than we expected. I am dismayed that the regulations did not include a regulatory impact assessment outlining, as a minimum, the economic impact of each of the tiers and hence explaining the choices that the Government are proposing. This is apparently because they are “temporary measures”. This is a disappointing claim. Inaction on such grounds may have been just about excusable in March, but not now. Worse, the analysis belatedly published yesterday of the health, economic and social effects of Covid-19 and the approach to tiering barely helps at all. A proper cost-benefit analysis—impact assessment, call it what you will—should be guiding the Government’s decisions and should not be cobbled together to placate Parliament after the event.

All policy decisions in government need to be informed by an analysis of the costs and benefits, which necessarily involves giving both numerical values. Sometimes this is a challenge, but with ingenuity we can ascribe values or a range of values to outcomes based on real-life analogy or widely accepted decisions. We need to measure not only the immediate, first-level effects, but those of a second order. To give an example, if hospital appointments are cancelled because of our Covid policy, we know that there will be problems, including extra deaths from diseases such as cancer and heart disease. This needs to be quantified. The responsible approach is not to ignore or downplay such inevitable consequences of our policy, but to put the costs into the equation.

Although the Government have not produced a proper analysis of the costs and benefits of their policy, others—distinguished others—have done so. I refer to the paper of August 2020 by Miles, Stedman and Heald. I shall summarise and simplify: they find that the costs of the Government’s policy on lockdown 1 probably amount to between three and 10 times the value of the benefits. Does that not give us some cause to reflect?

One problem is that the Government have not even claimed to seek the optimum overall outcome. Instead they have, from the start, been fixated on Covid only—the illnesses and deaths it causes, and the impact on bed capacity in the NHS. Of course analysis of the kind I advocate is difficult, but those of us in business or involved in regulation know that it is always worth making estimates and perhaps giving ranges, as the ONS has done for the economy. Its work is summarised in section 7 of the government analysis. It is terrifying: we are looking forward to, at best, flat output by 2025-26 and, at worst, minus 6% compared to the outlook in March. The adverse effects include the destruction of capital and knowledge from business failure, loss of human capital from unemployment and so on.

Take restaurants and pubs: they have invested hugely to allow groups of people to dine together, with social distancing, ventilation and contact tracing, yet a cost-benefit analysis appears not to have been done weighing the slight increase in infection in tiers 2 and 3 against the risk of their financial failure. In that case, the response to criticism has been to promise the businesses more money, but that could be a road to fiscal ruin.

The next category of loss is health outcomes, addressed in part 5 of the analysis. There is much talk of the health system being overwhelmed over the winter but, if true, why have hospitals not been preparing for this since April, building extra capacity, taking on extra staff—as promised in our manifesto—and serving as a beacon of good practice?

We also need to look at the social effects of Covid policy. There have been some positives in the Government’s approach, such as bubbles for single relatives and the continuation of schools and childcare, which the Minister rightly emphasised. But the list of negatives, all of which need to be costed, gets longer: care home rules leaving desperate children unable to connect with their parents; partners of pregnant women banned from scans; grandparents unable to see their children and grandchildren; the bankrupting of small businessmen in their 50s who are unlikely ever to get work elsewhere; and the special problems for the disabled, as was explained by the noble Baroness, Lady Brinton.

Finally, we need to consider the money that has been misspent and add that. Top of my list is test, track and trace, and that is £22 billion according to the Treasury spending review and another £15 billion next year. The Government should reflect on the fact that a loyal and committed supporter of theirs is so disappointed in their policies on this vital matter of proper cost-benefit analysis. It is my present intention to divide the House on an amendment with which I think a majority of the House will privately agree.

--- Later in debate ---

Moved by

[Baroness Neville-Rolfe]

At end insert “but that this House regrets that the restrictions being introduced to address the COVID-19 pandemic were not informed by a wide and detailed analysis of the costs and benefits of the possible measures to be adopted.”

[Baroness Neville-Rolfe (Con)]

My Lords, sadly, I have heard nothing to change my mind and a great deal to stiffen the sinews. The ONS coronavirus social impact material, to which my noble friend the Minister referred to, is very useful, but it is not applying a wide and detailed cost-benefit analysis to the regulatory measures as they are adopted, and I would like to test the opinion of the House on my amendment.

Health Protection (Coronavirus) (Restrictions) (England) (No. 4) Regulations 2020

Baroness Neville-Rolfe Excerpts

Wednesday 4th November 2020 Lords Chamber

[Baroness Neville-Rolfe (Con)]

My Lords, I am glad to follow the noble Baroness, Lady Mallalieu, and agree with a great deal of what she said. The last time we debated a Covid SI, I said that I was unhappy with the direction in which policy was moving, but I agreed with the Government that, at all costs, another national lockdown had to be avoided. We have not avoided such a lockdown, and I am now even less happy.

First, I am not convinced by the explanations given for this change of tack. As we have heard, the charts purporting to show its necessity were, to put it politely, not based on the latest evidence. In particular, the apocalyptic claims about what was likely in December if nothing was done have been undermined. Secondly, and equally bad, Ministers’ presentations continue to ignore the other side of the ledger; for example, the extra cancer deaths and other miseries well described by my noble friend Lady Meyer and the noble Baroness, Lady Smith of Newnham. The lockdown’s enormous economic costs are of course also ignored. If we look only at the benefits of our policies and ignore the costs, it is easy to persuade ourselves that we are doing wonderfully when the reality is different. The House accepted a lack of cost-benefit analysis and impact assessment for the emergency measures in March. That was a failure of scrutiny by us but, deplorably, the Government have made it a habit.

Finally I turn to test, track and trace. But a short time ago, we were assured that the UK national system would be world beating. Not merely is it not yet world beating but struggles to reach the level of simple competence, especially in relation to trace. I begin to believe that it might be better to scrap the whole thing, save the money and rely on local endeavour. I also worry a lot about cleanliness and reinfection in hospitals.

I recognise all this is very difficult for the Prime Minister and my noble friend the Minister. Any Government would have a hard time, given the unknowns. There are a few positives. The Government have so far recognised the mistake they made last time and kept schools open. They also need to ensure that national exams are held next summer. Elite sport is provided for, unlike last time. However, overall, we are going in the wrong direction. We need to move towards a system where it is recognised that most people are not in real danger from Covid and are hampered as little as possible in everyday life, while those most at risk are helped to shelter if they feel it right. I agree on this matter with the noble Lord, Lord St John of Bletso, and my noble friends Lord Howard of Rising, Lord Forsyth and Lord Robathan, and I will not be voting for this measure.