Health and Care Bill

Baroness O'Loan Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness O’Loan (CB)]

My Lords, I congratulate the noble Lord, Lord Stevens of Birmingham, on his excellent maiden speech. I think, too, that this is an appropriate time to pay tribute to those staff in hospitals, care homes and the community who have laboured so hard over the past two years. However, routine medical care did not happen. Elective surgeries were cancelled and treatment for the most serious conditions and illnesses was limited or not delivered, and now we have a major problem. The problem is actually worse in Northern Ireland, where people routinely wait five years for necessary treatment. Across the UK, the frustration of doctors and other medical practitioners at their inability to provide essential services because of staff shortages—resulting in part from the Covid emergency, but not just from Covid—is well-known.

I first served in 1996 on one of those health boards to which the noble Baroness, Lady Murphy, referred. Then people remained in hospital because they could not be discharged to their own homes with proper care packages or to residential and nursing accommodation. Some 25 years later, it is still a problem. For 25 years the issue has been discussed, papers written, committees formed, strategies devised—and the problem has got much worse.

The compulsory immediate Covid vaccination of staff, low levels of salary for the intense and difficult work of caring for those with reduced mobility, dementia and serious ill health, and a lack of support have resulted in a further loss of staff from the care sector. Care of this kind is inevitably resource-intensive. It is not just mechanistic; it requires a compassion and humanity that very often simply make it possible for people to settle in places where they would rather not be but must be. Will the Government ensure that there is a change of philosophy that will result in a greater respect for and appreciation of those who care in such circumstances, consistent with our proudly-proclaimed Great British values?

The repeal of Section 75 of the Health and Social Care Act 2012 is welcome. The new processes, which are still being developed, must enable proper procurement and remove unnecessary bureaucracy but ensure that contracts are awarded with proper scrutiny and that there is consideration of the impact of individual contract awards on the provision of services generally. Can the Government give an assurance that accountability and transparency really will result from the passing of this Bill?

There is also a need to ensure that the creeping privatisation of the NHS will not result in increased costs, reduced equality of access to services, and longer waiting lists. The public sector NHS trusts and NHS foundation trusts must be the default provider of NHS services.

The potential conflicts of interest for those such as employees of private healthcare providers as members of ICBs has been referred to repeatedly. They will be responsible for the commissioning of NHS services. I can see the benefit of private sector experience, but government must ensure proper accountability and there must be a mechanism for regulating and identifying conflicts of interest when they emerge.

Finally, the proposed level of delegation of power to the Secretary of State over operational clinical matters is quite simply unacceptable.