Health and Care Bill

Baroness Penn Excerpts

Lords Hansard - Part 1 & Report stage
Tuesday 1st March 2022 Lords Chamber

Moved by

[Baroness Penn]

1: Schedule 1, page 139, line 29, at end insert—
“the Armed Forces Act 2006, section 343AA (as inserted by section 8(3) of the Armed Forces Act 2021);”Member’s explanatory statement
This amendment is consequential on Clause 1 of the Bill which renames the National Health Service Commissioning Board “NHS England”.

[Baroness Penn (Con)]

My Lords, in moving Amendment 1, tabled in the name of my noble friend Lord Kamall, I will speak to the other government amendments in this group in his name.

Amendments 1, 76 and 77 are consequential amendments to two pieces of legislation that have been before Parliament during this Session. These amendments relate to the Police, Crime, Sentencing and Courts Bill and the Armed Forces Act 2021, and replace references to clinical commissioning groups with references to integrated care boards, and references to the NHS Commissioning Board with references to NHS England. Amendments 110 and 126 are purely minor and technical in nature to correct small drafting points in Clause 79 and Schedule 16.

I turn now to capital expenditure. The Government have listened carefully to the debate on Clause 54, and Amendments 88 to 91 will ensure that the powers in Clause 54, alongside our commitments to publish further operational guidance, are in line with the agreement between NHS Providers and NHS England in 2019. These amendments limit the powers to set capital expenditure limits for NHS foundation trusts, so that they cannot apply for periods longer than a financial year.

NHS England will continue to work with NHS trusts and foundation trusts to ensure sustainable use of capital expenditure, and it is our intention that a capital limit would be imposed only if other ways of resolution have been unsuccessful. A limit would be set only where usual financial reporting returns identify a likely breach of system expenditure limits. We therefore expect that the vast majority of capital limits will be set either in-year or shortly before the beginning of a financial year.

I reaffirm the Government’s commitment to ensuring that these powers are used only as a last resort, as NHS England agreed with NHS Providers. I am grateful to both NHS Providers and the noble Lord, Lord Crisp, for their constructive work in ensuring that these powers reflect that intention.

I hope noble Lords will therefore be supportive of these amendments. I beg to move Amendment 1.

[Baroness Walmsley (LD)]

My Lords, I thank the Minister for explaining the government amendments. I particularly welcome Amendments 88 to 91, because the Bill will now reflect the agreement made with the NHS foundation trusts in a much closer manner than in its original drafting. They are very welcome.

[Baroness Thornton (Lab)]

I absolutely concur with the noble Lord, Lord Crisp, and the noble Baroness, Lady Walmsley, and congratulate the Minister on a concise and accurate proposal of these amendments. Long may this continue.

[Baroness Penn (Con)]

My Lords, this has been a welcome, consensual and short start to Report stage, which I am sure we will continue through future groups. I am not sure there is much to add, so therefore I ask that these amendments be agreed.

Amendment 1 agreed.

--- Later in debate ---

Tabled by

[Lord Kamall]

7: After Clause 5, insert the following new Clause—
“NHS England: duties in relation to climate change etc
After section 13NB of the National Health Service Act 2006 (inserted by section 5 of this Act) insert—“13NC Duties as to climate change etc(1) NHS England must, in the exercise of its functions, have regard to the need to—(a) contribute towards compliance with—(i) section 1 of the Climate Change Act 2008 (UK net zero emissions target), and(ii) section 5 of the Environment Act 2021 (environmental targets), and(b) adapt to any current or predicted impacts of climate change identified in the most recent report under section 56 of the Climate Change Act 2008. (2) In discharging the duty under this section, NHS England must have regard to guidance published by it under section 13ND. 13ND Guidance about discharge of duty under section 13NC etcNHS England may publish guidance about the discharge of—(a) the duty imposed on it by section 13NC;(b) the duty imposed on integrated care boards by section 14Z43A;(c) the duty imposed on NHS trusts by section 26B;(d) the duty imposed on NHS foundation trusts by section 63B.””Member’s explanatory statement
The new Clause would require NHS England, in exercising its functions, to have regard to certain matters relating to the environment, including climate change.

[Baroness Penn (Con)]

My Lords, in moving Amendment 7 in the name of my noble friend Lord Kamall, I will speak to the other government amendments in his name.

We had a passionate debate on climate change in Committee. There is no doubting the profound relevance of environmental issues to the NHS; indeed, it is already leading the way as a health system in tackling climate change. These amendments will ensure that the NHS can continue in that vital work with the confidence needed to deliver. They place a duty on NHS trusts, foundation trusts, ICBs and NHS England to have regard to the Government’s key ambitions on climate change and the natural environment in everything they do. This could mean preparing thousands of NHS buildings to adapt to climate impacts, protecting and enhancing biodiversity across 25 million square metres of trust estate, or decarbonising the millions of kilowatts of energy used by trusts every year. I must emphasise to noble Lords that this includes decisions about the NHS’s procurement of goods and services. The noble Lord, Lord Stevens, was quite right to underline in Committee that, according to NHS England’s data, the NHS supply chain accounts for some 62% of its emissions footprint. It is clear that the NHS will need to take urgent action to decarbonise procurement.

These clauses will give vital legislative grounding and confidence to the Greener NHS programme and further strengthen the commitments made by the UK through the COP26 Health Programme: namely, to develop climate-resilient, low-carbon health systems. Importantly, Amendment 7 includes a power for NHS England to issue statutory guidance on environmental issues to the system. As discussed in Committee, NHS England already has some targeted net-zero guidance in place for current ICSs, but the system currently lacks that critical statutory guidance that sets the direction for the whole NHS. We expect this guidance, in the first instance, to be issued within 12 months of the Bill receiving Royal Assent.

In developing these amendments, we have had to consider the excellent work NHS England has already undertaken on these issues and gain clarity over what value a legislative solution could add. This has included working across government with BEIS and Defra, while also looking closely at the individual amendments proposed by noble Lords in Committee. I believe the amendments tabled in my noble friend’s name achieve these aims, adding the right value in the right way, to the benefit of our natural environment, the NHS and the people who depend on it. I pay tribute to the work of noble Lords in helping us reach this position. I beg to move.

[Lord Stevens of Birmingham (CB)]

My Lords, I thank the Government for supporting these amendments, which reflect the substance of amendments that my noble friend Lady Hayman, I and others brought forward in Committee. That debate rehearsed the health case for action very clearly, as we have just heard, so I will not detain the House by repeating that.

However, I think the events of the last 24 hours have underlined two other reasons why these amendments are so important. In addition to the health case, there is clearly a financial case and we also now clearly see the security and humanitarian case for action. The financial case was underlined by yesterday’s IPCC report:

“The financial value of health benefits from improved air quality alone is projected to be greater than the costs of meeting the goals of the Paris Agreement.”


In respect of the security and humanitarian consequences, yesterday, the Government welcomed Shell’s decision to sever its relationship with Gazprom, yet Ministers may have seen an important story in the Health Service Journal suggesting that, over the last two years, at least 17 NHS trusts have continued to rely on gas sourced from Gazprom, which has confirmed today that it continues to get its gas supplies through Ukraine. Decarbonising the health sector will take pound notes out of the hands of dictatorial regimes that are engaged in acts of aggression. For all these reasons, the clarity that these government amendments provide, putting on a sound statutory basis the ability to take fundamental action across the NHS, is most welcome.

--- Later in debate ---

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister and welcome these government amendments in response to the key concerns raised in Committee about the crucial importance of including the NHS’s duties on climate change and working towards net-zero emissions in the Bill, and the excellent supportive speeches today.

The amendments take on particular significance in the light of the stark warning in today’s UN report that climate breakdown is accelerating rapidly and there is only a brief and closing window of opportunity to minimise its catastrophic impacts. The duties rightly go across the roles of NHS England, integrated care boards, NHS trusts and NHS foundation trusts in relation to the Climate Change Act 2008 and the Environment Act 2021, and address the need for those bodies to have regard to the need to contribute towards compliance with government climate change and environment targets. Of particular importance is the duty of each body to adapt to current or predicted impacts of climate change and, in Amendment 7, recognition of the importance of NHS England guidance on how the climate change responsibilities are to be discharged within the promised 12 months of Royal Assent.

My noble friend Lady Young sought reassurance that the guidance on procurement will cover not just the need for the NHS supply chain to reduce emissions but also include the key environmental targets. I hope the Minister will be able to reassure her on that.

Strengthening the law to integrate an active response to climate change through every layer of the NHS has been welcomed by the UK Health Alliance on Climate Change, representing more than 900,000 healthcare professionals. Noble Lords made clear in Committee that omitting sustainability requirements from the Bill would have been a missed opportunity to enshrine and enforce the NHS’s historic commitment to reaching net-zero targets by 2040, and we are pleased the Government have recognised that.

As we heard from all speakers, the NHS has made huge progress, but this is just the start and there is much more to do. The amendments reinforce the importance of action in those areas, particularly for the new bodies and processes the Bill creates, and that progress will need to be managed, delivered, tracked and reported at every level.

My noble friend Lady Young’s point, reinforcing that guidance on duties across NHS bodies must include not just climate change but also the improvement of the natural environment, is well made. I look forward to the Minister’s response on that.

In relation to reporting, raised by the noble Baroness, Lady Walmsley, I understand from the contributions of the noble Lord, Lord Kamall, in Committee that progress is being made. He referred to NHS England’s green plans, and we are told that every NHS trust and interim care system is expected to have prepared a green plan and had it endorsed by its governing body. For trusts, the deadline for submission to ICSs was 14 January, so it would be good to know how they have done so far and how many trusts have submitted such plans. The next stage is for ICSs to develop “consolidated system-wide plans” by the end of the month, which will be

“peer reviewed regionally and published”.

Are we confident that ICSs will meet that deadline, and what is the expected assessment and timescale for ICSs to report back to NHS England and, subsequently, more widely on this vital issue?

[Baroness Penn (Con)]

My Lords, I thank all noble Lords for their welcome for the government amendments, and for setting the challenge for the Government that there is always more to do.

I agree with the noble Lord, Lord Stevens, on the additional points that he set out about the importance of decarbonisation, not just for the climate but for health, security and humanitarian reasons. I reassure the noble Baroness, Lady Young, and others, that I did not say that decarbonisation was there to exclude other issues; it is just that that particular point related to that.

I say to the noble Baroness, Lady Hayman, that it is a pleasure to work with her on these issues when we look at Bills, including the Financial Services Bill as it went through, but I have noted her and other Peers’ points about the reactive or proactive nature of the Government’s approach to these issues in legislation.

I can provide the noble Baroness, Lady Young, and others, with the reassurance that they seek that the NHS will have to have regard to wider environmental objectives in developing the guidance, and this includes, for example, biodiversity. That applies to procurement and any other guidance NHS England issues to the system using the new power. In my examples, I mentioned enhancing biodiversity and adapting to climate impacts, so I hope I was not inadvertently too narrow in how I spoke to the amendments.

The noble Lord, Lord Scriven, is right that decisions are being made all the time that will have a longer-term impact, so although I cannot go further than the 12-month commitment, I am sure that the NHS will want to work as fast as it can to bring out the guidance within that.

The noble Baronesses, Lady Walmsley and Lady Wheeler, asked about reporting, both on how the NHS will fulfil its obligations under these duties, and specifically under the green plan. NHS England will report on carbon emissions and progress against its wider objectives. The noble Baroness, Lady Wheeler, asked me a number of more specific questions; if I have not addressed them, and those asked by other noble Lords, I will seek to write after today.

Amendment 7 agreed.