Strikes (Minimum Service Levels) Bill

Debate between Baroness Noakes and Baroness Finlay of Llandaff

Committee stage
Thursday 23rd March 2023 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Bryan, and to add to her remarks. I strongly support Amendment 49 and point out to the noble Baroness, Lady Noakes, that the phrase in Amendment 19 of consultation implying a view to meeting an agreement is particularly important because in this Bill we are talking about devolved competencies directly, and I am afraid the track record has not been that good. Indeed, the Bill seems to have been announced without any prior consultation with the Welsh Government at all, and officials have been reluctant to share substantive information relating to the Bill which is not in the public domain but does affect devolved competencies.

In paragraph 141 of Schedule 7A to the Government of Wales Act it would seem that legislative consent is required over aspects of health, education, fire and rescue, and certain transport services. But the Welsh Government appear to be set to vote overwhelmingly to refuse legislative consent, and for good reason. As the Government themselves have conceded, the services are

“run differently in England, Scotland and Wales and are the responsibility of Scottish and Welsh Governments respectively.”

With that responsibility comes a requirement to set pay and terms and conditions of service, and those cannot be disentangled from strategic and operational decisions taken in Wales and Scotland. To give those powers to Westminster and override the devolved legislations would effectively undermine their ability to run the services that they run as effectively as they see fit to meet the needs of the population—the population which have voted those devolved Ministers into their positions in government.

There is a different approach to the unions, as has already been said. There is a model of social partnership, which I am familiar with in Wales. It was notable that, even going back to 2015, the junior doctors did not go on strike in Wales whereas they did in England, and the current rail strikes have shown a different pattern of working because an agreement was made with Transport for Wales.

It certainly is not incidental that this has been included in the Bill, because it threatens the Welsh Government’s ability to maintain a model that is interwoven with those responsibilities, as I have said. In fact, those services are essential to the running of the devolved nations. The approach would undermine accountability in Wales, as the Bill provides no role for the Senedd, despite the strong argument that it has the competences to legislate in areas contained in the Bill. The Secretary of State being able to set minimum service levels for local services in most parts of England is already questioned by some, but it seems almost an affront to devolved responsibilities to say that that could override the responsibilities in the devolved nations.

The consultation process set out in the Bill fails to specify who should be consulted; it is whoever the Secretary of State sees fit, and they do not seem to have to pay regard to the outcome of that consultation. That means there is no role for the Welsh Ministers, who are actually responsible for running the services. If the Bill is passed, the backdrop to negotiations undertaken in Wales will be fundamentally altered. There is a concern—a valid one, I think—that that could be used for political ends, because there is no protection in the Bill from a Secretary of State who wishes to provoke or prolong a dispute for political ends.

Sadly, no Minister in Wales or Scotland can take comfort from assurances given and being told that they will be consulted. Similar assurances were provided over the financial powers in the internal markets Act, but those are now being used to ensure that Welsh Ministers cannot take the decisions over EU successor funds provided in the form of the shared prosperity fund and the levelling-up fund. I hope the Committee will see that in order to maintain the integrity of the UK, it will be important to take Wales, Scotland and, I think, Northern Ireland out of the wording in the Bill.

[Baroness Noakes (Con)]

Has the noble Baroness realised that the Bill does not actually require any employer in Wales to issue a work notice? The only thing that the Secretary of State will be doing is setting minimum service standards. The implementation via work notices is entirely at the option of the employers, which will be either the Welsh Government or one of the various Welsh bodies that are answerable to the Welsh Government. I understand the point that she was trying to make, but she was implying that the UK Government were interfering in the operation of the services, which the Bill does not come close to doing.

[Baroness Finlay of Llandaff (CB)]

I remind the noble Baroness that we have already had a debate over the difficulty of setting minimum service levels and the dangers thereof. Minimum levels for nursing have already been set in Wales, for example, so we cannot disentangle the one from the other. That is the point that I was trying to make.

Professional Qualifications Bill [HL]

Debate between Baroness Noakes and Baroness Finlay of Llandaff

Committee stage
Wednesday 9th June 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare that I am registered with the General Medical Council and I am president of the Chartered Society of Physiotherapy. Like others, I know that the GMC has welcomed these amendments from the Government. Indeed, they address many of the concerns that we raised at Second Reading. I have had some discussions too with the Health & Care Professions Council. It still has some concerns that I hope the Minister will be able to address.

Government Amendment 6 leaves in the phrase “substantially the same” at Clause 1(3)(b)(i), in respect of knowledge, experience and standards. Currently, the processes demand that registrants meet certain standards in order to practise. There is a concern that the phrase “substantially the same” in the legislation risks lowering this standard, potentially creating a two-tier system in which applicants from overseas would need to meet a lower standard than their UK counterparts.

It is, of course, most welcome that the Government have recognised that regulators currently make a holistic assessment: they look at education, training, commitment to CPD and, importantly, the level of experience of each applicant rather than just at something on paper from the institution from which they received a qualification at some time in the past. This focus on the situation of the individual, whether it is an overseas qualification or experience demonstrating an equivalent level of knowledge and skills, is crucial.

Our current workforce shortage is acute. We have a lot of vacancies across the UK and there seems no longer to be the incoming workforce that there used to be. We have people leaving as well, so the vacancy factor is becoming more acute with a workforce that is already feeling the strain and burnout following all the pressures of Covid. I hope that there will be a clear assurance from the Minister that there will be no dropping of standards in a rush to try to fill vacancies and that there will be a concerted effort to provide the education and training needed to make sure that we have the appropriate number of properly skilled people in our workforce.

The amendment proposed by the noble Lord, Lord Lansley, as discussed, seems to raise an important point. I think that the general tenor of the debate so far has been that we hope the Government will take their own amendment away and have another look at it, rather than expecting it to be put into the Bill today. It could come in on Report when it had been appropriately amended if necessary. It certainly would seem to need some more thought.

I am well aware from my own discipline of medicine that many drugs and conditions have remarkably similar names. It is extremely easy for people to become confused over which is which; that is how errors occur. Even if someone passes an English language test, it is actually their command of the language in the relevant discipline that becomes so important.

The other thing I want to ask the Minister before I sit down relates to those disciplines that are not yet on a professional register but will need to be. They include physician associates, anaesthesia associates and nursing associates in particular. I know that the General Medical Council will take on the registration of physician associates and anaesthesia associates, but I would welcome from the Minister confirmation that the same criteria will apply to them as will apply to those in professions that are already regulated by regulators to whom this Bill currently applies.

There is also a question about what will happen in future to some other groups that are not regulated, such as some of the psychological therapies that we discussed at length during the passage of previous pieces of legislation—for example, the Domestic Abuse Bill—when many Peers across the House expressed serious concerns about some of the standards of practice. We know that some of the schools of psychology have evolved in different countries around the world. It is important that we do not inadvertently create another problem by allowing people to come here and practise in an unregulated way.

That brings me to my last point, which is on cosmetic interventions. Currently, they are unregulated. I hope that we will see them regulated, but I request from the Minister confirmation that the same ability for a regulator to determine criteria will apply and that it will not be separate if it concerns a group coming into regulation that was not regulated previously. We know very well the number of damage cases that there are, particularly from inappropriate cosmetic procedures.

At this point, I seek those assurances from the Minister but reiterate that the government amendments are most welcome. They have demonstrated that they have listened to the representation, particularly from the General Medical Council but also from others.

[Baroness Noakes (Con)]

My Lords, I will be brief. I support the Government’s amendments in this group and the amendment in the name of my noble friend Lord Lansley. Initially, I thought that his amendment was attached to the word “only”, which is often misused in the English language—most often as an inappropriate or misplaced modifier. Initially I thought my noble friend was going to say that it was a misplaced modifier. However, I listened to what he said, and he raised a very substantive concern about the drafting of the clause. Like other noble Lords, I hope that my noble friend the Minister will agree to take this away and look at it and, if necessary, bring an amendment back on Report to make proper sense of his new amendments.

Of course, there is a slight problem: once we have amended a Bill, we are not supposed to go back and amend it again at later stages. However, I think that if my noble friend were clear enough from the Dispatch Box today that he will look at this, it would not cause a problem.

My noble friend Lord Lansley may well have noted that, in our Conservative notes on the amendments that we are considering today, his Amendment 11 was described as an opposition amendment. I know that my noble friend has not always toed the party line—he is not alone in that—but I have never regarded him as the Opposition. I share this with the Committee in the hope that it will improve my noble friend’s street cred.

Health and Social Care Bill

Debate between Baroness Noakes and Baroness Finlay of Llandaff

Thursday 15th December 2011 Lords Chamber

[Baroness Finlay of Llandaff]

My Lords, this has been an interesting short debate because the whole business of the cap has imposed wide variations on trusts. Where trusts cannot have any private activity, there has been an unintended consequence if some staff, particularly consultants, undertake private work. They have carried out that work offsite and not been available if there has been an emergency onsite, and travel times also have worked against patient care.

I can therefore completely understand why these amendments are before us and why the Government wish to act as has been outlined. Perhaps in his closing remarks the Minister can provide us with an assurance that any guidance—it is not necessary to include this in the Bill—will ensure that trusts do not inadvertently double-pay staff. The point of splitting private and NHS treatment was precisely to ensure that staff do not carry out private work in their NHS time and receive double pay, and that the accounts are clear. There are advantages to staff doing private work on NHS premises and to a flexible interpretation whereby, when there is a medical emergency, staff can run down the corridor. Private patients completely understand when someone has to be called away because there is a life-threatening emergency. They are happy to wait until the staff return. That system operates at the hospital in which I work. Although I do not do any private work, some of the oncologists have clinics in the evenings.

There is a need for clarity and I hope that some reassurance will be given that in removing the cap there will be good husbandry of public money.

[Baroness Noakes]

More than 20 years ago, I was director of finance of the NHS, on secondment from my firm, as some of my noble friends will recall. One of my areas of responsibility was something we called the income-generation initiative. It was sponsored wholly by the Department of Health which was to encourage NHS hospitals to maximise their assets and to generate income for the purposes of the NHS. The origins of the private patient income lie with the Department of Health wanting to ensure that the NHS maximised the returns from its assets and took opportunities to generate income solely for the NHS. Those of us who were involved in developing that initiative would regard all these discussions as a mark of success of the initiative, as it has generated so much income that other questions are now asked.

I never supported any kind of cap, because the circumstances of individual foundation trusts vary so significantly that any cap would never be effective. The way in which income can be structured to flow into a trust can markedly change the impact of the cap. By structuring your relationships with partnership organisations, for example, you can massively change whether a cap bites or does not.

I support the amendments in the name of my noble friend, because perhaps it now needs stating that you should concentrate largely on the NHS—although, as I said, those of us who started this find it a rather surprising conclusion—and I support transparency. If I ever had one concern about the income-generation initiative, it was that costing was never particularly well understood in the NHS, and, therefore, neither was the net result from the activity nor how that activity was used. It is important to have transparency. I hope that other noble Lords will not encourage the Government to keep any limits which constrain the NHS from maximising its assets for the purposes of the NHS.