Health and Care Bill

Debate between Baroness Pitkeathley and Baroness Bennett of Manor Castle

Lords Hansard - Part 2 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Pitkeathley (Lab)]

I want to follow the noble Lord, Lord Sharkey, because I am former chair of the Specialised Healthcare Alliance. I shall speak very briefly in support of Amendments 164 and 178 in his name and that of my noble friend Lady Wheeler.

Every reorganisation of the NHS leaves patients who have a rare or less common condition anxious about how their particular needs will be assessed, how they will be met and even how they will be noted. It is sadly true that the rarer or more specialised a condition, the more it comes down to a postcode lottery whether the patient will be able to access care in spite of established national standards. Not only is it harder to access care, it is also harder for these patients to access the support groups or information networks which are vital when finding out the sometimes rare information about these conditions. The suggestion in Amendment 164 that the CQC assess the provision by ICBs of care for those with rare or less common conditions would provide the assurance that is so badly need.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in part because I listened to the lecture with which we started this session but more because it is an old anecdote, I shall forbear from telling my hospital food horror story. However, I will pick up on the points made by the noble Lord, Lord Hunt, and the noble Baroness, Lady Barker, about hospital food and how hard people are trying to improve the situation. This relates to the answer the Minister gave me on Monday in Oral Questions. Of course, it is dependent on the budget that caterers have and the quality of the food that is available to them. I was pleased that the Minister then said that the Government are looking to tackle government procurement to improve the quality of vegetables and fruit. In terms of joining up the dots, that is a useful point to make.

On Amendment 243, I offer the Green group’s support and note that, having been in your Lordships’ House for only a little more than two years, I have debated a very similar amendment at least once before—I think it must have been on the Medicines and Medical Devices Bill. We have all seen briefings that are very much a cry from the heart from the nursing profession for this to happen. Surely we can get this into this Bill.

Health and Care Bill

Debate between Baroness Pitkeathley and Baroness Bennett of Manor Castle

Committee stage
Thursday 20th January 2022 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, what I want to say follows on very well from what the noble Baroness, Lady Finlay, said. I want to quote Sir Michael Marmot. He said:

“We need to adopt a health and social care system which prioritises not just the treatment of illness but how it can be prevented in the first place. The pandemic has made it crystal clear … why public health and … social determinants of health are so important. The health and social care agenda must be rebalanced towards prevention.”


This is essentially what the noble Lord, Lord Howarth, is saying. It is not just about the treatment of illness but about preventing it happening in the first place.

I commend my own general practice in north London. In despair at the quantity of antidepressants being prescribed with very little result, it took to organising community groups to do cooking, set up friendship groups and put people in contact with each other. It puts on bring and buy sales—all with people who, perhaps, in the past, might just have been prescribed antidepressants.

I want to say a word about the charitable aspect—the voluntary sector—to which the noble Lord, Lord Howarth, referred. Charities cannot operate unless their core costs are met. My own GP practice which did this wonderful work had to go to the local authority and to the lottery to seek some funding. We have to remember that, if we want voluntary organisations to participate in these wonderful preventive services, we need to ensure that they are properly funded.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I join pretty much everyone else in commending the noble Lord, Lord Howarth, for tabling these amendments. I have attached my name to Amendment 67, although it could have been to any of them.

It is worth making two broad points. In her wonderful contribution on the last group, the noble Baroness, Lady Cumberlege, used the really key phrase,

“the community provided the health”.

That is what this group of amendments is talking about.

A couple of groups back, the noble Baroness, Lady Thornton, talked about how, if the health system is working for people with learning disabilities, it is working for everybody. If we bring in the kind of institutions, frameworks and supports that we are talking about here—if we think about stopping people getting ill and caring for ill people—we will make our communities vastly better for everybody. This is an important point to make.

Like most noble Lords, I could come up with a list as long as your arm of wonderful places I have visited. I will not, but I will mention one, which brings together three elements of this: creativity, nature and culture. The Green Backyard in Peterborough is the most wonderful space. I defy anyone to walk into it and not smile. It has amazing, colourful, moving sculptures powered by water, with food growing—amazing salads filled with flowers. When I visited, I spoke to the carer of another visitor. This visitor had very profound disabilities—she was blind and non-verbal—but her carer said, “I’ve never seen anything like it. After the first time we came to visit, the next Monday, which she knew was the day we visited, she was all packed up, dressed and ready to go out.” This was obviously catering to someone’s needs absolutely brilliantly, but it nearly got bulldozed and turned into a block of flats a few years ago. Luckily, it was saved, but that is the situation we so often find ourselves in.

I also want to mention Amendment 90, in the name of the noble Lord, Lord Howarth. The noble Lord, Lord Best, has already said a great deal on this, so I will seek to add just a couple of small points—well, one small point and one quite big one. There is something called the lifetime homes standard, which I learned about when I visited Derwenthorpe in York with the Joseph Rowntree Foundation. The thing I remember about it, because it was so simple and obvious, was that the two-storey houses there had all been built with a space between the joists so that, if you needed to put a lift in up to the first floor, where the bedrooms were, it was a really simple and low-cost thing to do. It was a very simple piece of design. This will not be covered in the Health and Care Bill, but this relates to so many aspects of our society. You could say that housing is a health issue. In the first group this morning, we talked about social care and how many people cannot leave hospital and go home because their accommodation is unsuitable. We need to think all the way along the line across our society to make sure that does not happen.

Finally, I want to pick out one or two words in this amendment, which talks about housing and urban environments. I thought here of the New Ground co-housing development in north London, which is for women aged over 50. One aspect of it is looking at how people can support each other, be good neighbours and form a community that can provide support. This morning, I attended a King’s Fund briefing talking about social care and there was a great deal of talk about the need for digital innovation and technology. I tweeted, “What about social innovation?” We have to think about how we organise our societies and urban environments so that people can form those kinds of communities. If you visit any area of new housing being built around the country, there is typically precious little in it to encourage that kind of community development. The housing point is obvious, as is the environment point, but let us not lose the community and urban structure points from that amendment either.

Health and Care Bill

Debate between Baroness Pitkeathley and Baroness Bennett of Manor Castle

Lords Hansard - Part 1 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords, I share the outrage of my noble friends and the noble Lord, Lord Scriven, about how this is proceeding. In a way, I can see how some of this has come about. Perhaps the Minister will say that the Government are building on what is happening on the ground. It is perfectly true that many organisations at a local level found their way around the disaster that was the 2012 Act. They set up systems so that they did not have to follow it and could collaborate and not compete. Many of those systems operate practically on the ground, but they do not operate in a proper legislative framework, as we have heard, and nowhere is that more important than the outrageous decision in some areas to preclude local authorities, as noble Lords have said.

For those of us who know our way around the system, it is easy to ignore the fact that most patients and users—after all, the Bill is supposed to be focused on their experience and what their outcomes will be—have no idea about the difference between local authorities and the local health producers. To them, it is all the council or the NHS, and they have no idea that the GP, the district nurse, the care provider and the local care home do not talk to one another or have any mechanism for coming together. That is the kind of mechanism that we are trying to establish. We must ignore the informal arrangements that may have taken place as a result of the 2012 Act, and establish the proper legislative framework in which all those who have the interests of patients and users at heart are properly represented.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I declare my position as a vice-president of the LGA and the NALC. I will speak particularly to Amendment 23 in the name of the noble Baroness, Lady Thornton, to which I have attached my name; it is unfortunate that we have not heard from her yet. It is about consultation with local authorities, which is what so much of our debate on this group thus far has already addressed. I particularly associate myself with the comments of the noble Lords, Lord Hunt and Lord Davies. A great rearrangement of the NHS has happened entirely under the radar, and it is deeply disturbing to those of us concerned about the risk of the Americanisation of our NHS and its takeover by private US healthcare for-profit companies.

I am slightly surprised that no one has yet mentioned the report in the Times this morning about the Health Secretary seeking to model NHS hospitals on academy schools, which has been seen as a large privatisation of our education system. Also, we found out only recently and entirely by accident that the Chancellor was giving days of his time to visit US healthcare companies in California. When you look at those facts, the runes seem very disturbing. To defend against the incidents that the noble Lord, Lord Davies, referred to, and the restructuring by stealth, we need local authority involvement. That is what Amendment 23 seeks to ensure, at least in part.

I also want to comment briefly on another amendment in the name of the noble Baroness, Lady Thornton, Amendment 44, which is about protecting the collective arrangements for pay and conditions for staff. We have to look at it in the context of the survey this week that showed one in four doctors saying that they were exhausted to the point of being impaired in their work. We have an exhausted, utterly worn-down workforce, and we have nurses who are not paid enough and end up going into food banks to feed their families.

It is obviously a matter of justice that we at least protect, and in fact improve, the pay and conditions of healthcare workers. But more than that, it is very much an issue of health as well, because workers who are overworked and underpaid are simply unable to deliver the quality of care that we would hope to provide.

I very much hope that this group of amendments will get some attention, because this has all happened under the radar. There has been no public discussion of this and that desperately needs to happen, so once again it seems to fall to your Lordships’ House to try to get this on the agenda.

Finance Bill

Debate between Baroness Pitkeathley and Baroness Bennett of Manor Castle

2nd reading & Committee negatived & 3rd reading
Tuesday 8th June 2021 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise with the unusual luxury of 10 minutes’ speaking time, given because we have only a dozen Back-Bench speeches on this crucial taxation issue. I hope that some Peers in your Lordships’ House who specialise on issues of poverty and inequality—indeed, on any issues at all—will join these debates in future. Taxation, or the lack of it, shapes our societies. As the richly informative and powerful speech of the noble Lord, Lord Sikka, outlined, decades of decisions about taxation have helped to give us our deeply unequal, poverty-stricken society. We have been taxing the poor and allowing large companies and rich individuals to get away without paying.

The noble Lord, Lord Leigh, suggested that your Lordships’ House may need more experts in tax, finance and business, but this is a far broader issue that needs a far broader input. I quote the American historian Albert Bushnell Hart:

“Taxation is the price which civilized communities pay for the opportunity of remaining civilized.”


It is clear now, on the streets of London, that there are strong and rich debates about how the people who benefit from the investments of this and previous generations—in roads, public buildings, electricity supplies, and the services that we all pay for such as schools, hospitals and policing—make a fair contribution to the maintenance and restoration of our degraded physical and social infrastructure, and the impacts of austerity that we see in potholed roads, closed libraries and inadequate social care provision. These are not technical issues, but are at the very foundation of our society.

Noble Lords might worry about where they get sources of information. I thank Tax Justice UK for an excellent briefing and for drawing attention to the work of the Women’s Budget Group, which has identified how women, people on low incomes and BAME communities will benefit least from the tax breaks in the Bill and bear the chief brunt of the scheduled spending cuts.

It is interesting that, in the debates so far, the failures of regulation and of culture in our financial sector have come up again and again. Noble Lords who took part on the then Financial Services Bill might reflect on this. The noble Lord, Lord Bridges of Headley, talked about umbrella companies, which is an area where the UK is world-leading in entirely the wrong direction. The noble Lord, Lord Butler of Brockwell, talked about the “many-headed Hydra” of tax-dodging schemes, as did the noble Lord, Lord Sikka, in great detail. The fact is that we have too large a financial sector, which is milking not just the UK but the entire world and particularly the global south. The centre of global corruption is on our doorstep.

It has been suggested that we all live in social media bubbles these days, but in your Lordships’ House I feel like I am in the vigorous Atlantic surf of strong disagreement on economic issues. I particularly disagree with the noble Lord, Lord Forsyth, and the noble Baroness, Lady Neville-Rolfe, about their entire economic commentary. The ways and means mechanism and its implementation have existed for many years and show how the rules of the game have changed and that the old economic approaches failed disastrously and gave us the global financial crash. We are finally looking differently at how the economy works and what it is for. The noble Lord, Lord Forsyth, and many others said that we need to get the economy going again and focusing on growth. I remind your Lordships’ House, in the country that is the chair of COP 26, that we cannot have infinite growth on a finite planet. That is not politics; it is physics.

The noble Baroness, Lady Neville-Rolfe, recommended some reading to us. I have some alternative reading to suggest, a book I reviewed this week in the House magazine by Professor Tim Jackson. He is quite a mainstream economist and his book Post Growth is well worth a read. I also pick up on the points of the noble Lord, Lord Bilimoria, which focused on the importance, as he sees it, of giant multinational companies. I stress that 61% of employment in the UK is in small and medium enterprises. The Government talk of levelling up, but I would rather talk about spreading out prosperity. The foundation of prosperity for every community in this land needs to be built on strong local economies of small independent enterprises and co-operatives—a different and stable kind of economic model.

Having set the scene, I turn to some details in the Bill. I take the point made by several noble Lords about the thickness of the paperwork but, when you look at the measures, you see that it is actually a modest Bill. It talks about tidying up some Northern Ireland and VAT Brexit issues—another reminder that Brexit is by no means done. There are some modest measures that noble Lords have referred to about plastics, red diesel and cycling—very modest again for the chair of COP 26, when you think about the need to act on the climate emergency. We also have an increase in stamp duty land tax for overseas purchases of residential property in England and Northern Ireland which, should your Lordships take an imaginary scan of the boroughs around where we sit today, might be best described as shutting the stable door after the horse has bolted.

The headline measure is a super deduction for the largest companies, many of which have done very well out of the great tragedy and suffering of the global pandemic. This is estimated to be going to cost the Treasury £25 billion. That would be a lot of social care or a large injection that our education sector so desperately needs. The Office for Budget Responsibility said that £5 billion of the spending that would be covered by this will be spent on previously planned investments. The Times reported that tax advisers specialising in capital allowances have pointed out that jacuzzies are listed as one investment that could receive a 130% rebate.

Perhaps we also need to think about what is not in this Bill. It is interesting that, despite widespread debate in society now, both in the Bill and in the debate around it in the other place, no amendment was put down about a wealth tax. There was no real discussion of it in the other place despite that now being a major topic of discussion among even some quite mainstream economists and certainly among the public.

Of course, there is a lot of discussion about the levels of corporate taxation, led not by the UK but by Joe Biden’s America. When I asked the Minister on 14 April about the US President’s plans, he effectively gave me a “no comment” response when I asked what the UK stance would be. I am pleased to see that we have now signed up to the US initiative. The noble Lord in his answer to my supplementary question then said something very interesting. He said the Government had always been one that wanted to reduce taxation wherever possible. Perhaps he might like to consider the words of the Chancellor in deciding to end the race to the bottom in corporation tax by increasing the headline rate to 25% in 2023 after Her Majesty’s Treasury found that the cut in the headline rate since 2010 did not drive inward investment. To quote the Chancellor, it

“might not be the most effective way to drive capital investment up”.

I also refer to the comments from the noble Lord, Lord Bilimoria, about those statistics. He referred to inward investment. I would say that that inward investment very often has been the selling off of the family silver, whether that is our water companies, publicly held land or, indeed, the family beds when it comes to selling off our care homes to the hedge fund industry.

If we did have, let us say, a wealth tax, where might it go? Despite the Government’s talk of an end to austerity, a £15 billion cut in annual government departmental spending is planned. These budgets are already cut to the bone and, of course, are being hit by the huge and continuing impacts of the pandemic.

There is some very useful information about who is paying and who is not. I have referred noble Lords to a report from the CAGE institute at the University of Warwick. In 2015-16, a quarter of people who had more than £1 million in taxable income paid less than 30% tax, while one in 10 paid just 11%—the same as a person earning £15,000 a year. This is a key issue.

I come back to the inequality and the poverty in our society, issues so well covered by the noble Lord, Lord Sikka. We are talking about capital gains tax and inequality in the way income is taxed. These issues are all missing from this Bill. They will need to be confronted soon.

[The Deputy Speaker (Baroness Pitkeathley) (Lab)]

My Lords, the noble Baroness, Lady Wheatcroft, and the noble Viscount, Lord Trenchard, have withdrawn, so I call the noble Baroness, Lady Kramer.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2020

Debate between Baroness Pitkeathley and Baroness Bennett of Manor Castle

Thursday 10th December 2020 Grand Committee

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, it is a pleasure to associate myself with the comments just made by the noble Baroness about the risks of deregulation and self-regulation. We have seen a great deal of concerning and tragic events flowing from that in the building industry. However, my first question, of which I have given prior notice, addresses what follows from testing: self-isolation. The Minister himself is self-isolating today, and I wish him and his family all the best. It is very difficult for many people to do, for financial reasons, because of care responsibilities, or for other reasons. In recognition of that fact, the Government have brought in a £500 payment for people ordered to self-isolate, with the money paid through local authorities. I credit Martin Lewis’s MoneySavingExpert website for what I understand is its original research, published yesterday, in doing spot checks and identifying at least five local authorities where the allocation of money has run out. It is reported that therefore people are being told they cannot get a payment. Can the Minister confirm that? If so, do the Government plan to fix this as a matter of urgency?

On my second point, I appreciate the fact that the Minister took time to explain in his introduction how he saw the idea of a market operating in Covid-19 testing. I have problems with the whole idea of a market in healthcare, but at least it was outlined clearly. In that outline, he said that everyone should have access to affordable tests. The explosion in the use of food banks started before Covid-19 but has certainly increased. People are unable to afford to buy even food. It is clear that lots of people would not be able to afford the price of a Covid test that they might have very good reason to want. Will the Minister consider perhaps approaching the suppliers of these tests and seeing if they could supply some to each food bank in the land, so that they would be genuinely available to everyone who might have good cause to need them?

Secondly on the issue of markets, the purpose of trading in a market is generally to make a profit on the good or service provided. Given the clear high demand and need for Covid tests, how are the Government ensuring that windfall profits are not made? Indeed, I ask the Minister directly: what percentage profit does he consider it would be reasonable to make on a Covid test?

Finally, given that this statutory instrument is essentially a deregulatory one, how are the Government ensuring that the use and promotion of lateral flow testing, which has been reported in the real world to have up to a 50% false negative rate, is used appropriately? Clearly it can be useful at population level to identify asymptomatic infections, but does the Minister agree that it would be deeply dangerous if it was used to give people an all-clear to mix and mingle, with or without precautions?

[The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)]

The noble Lord, Lord Randall, has withdrawn, so I call the noble Lord, Lord Bourne of Aberystwyth.

Covid-19 Update

Debate between Baroness Pitkeathley and Baroness Bennett of Manor Castle

Tuesday 6th October 2020 Lords Chamber

[The Deputy Speaker (Baroness Pitkeathley) (Lab)]

The noble Lord, Lord Robathan, has scratched, so I call the noble Baroness, Lady Bennett of Manor Castle.

[Baroness Bennett of Manor Castle (GP) [V]]

My Lords, questions in your Lordships’ House on this Statement have understandably focused on Covid-19, but the Statement as delivered in the other place is a broad-ranging survey. It starts by talking about treatments for Covid and then shifts to approvals for new cancer treatments; it looks at the expansion of urgent and emergency care; and those mysterious 40 new hospitals appear yet again, as the noble Baroness, Lady Barker, alluded to. In that context, I ask the Minister whether this Statement is sufficiently balanced. If this is a survey, where is the public health element?

Covid has exposed, even more than we recognised before, a deeply unhealthy society with terrible diets, inadequate opportunities for exercise, poverty, stress, and a mental health epidemic. We know from Victorian and early 20th-century times that it is public health measures that really make the difference. In facing up to tackling Covid, surely that is the direction in which we need to be looking. For example, new research today showing the impact of air pollution includes some very stirring suggestions that childhood exposure has an impact on the rates of dementia and Alzheimer’s. My questions to the Minister are these. Are the Government paying enough attention to public health? Is their strategy sufficiently balanced? Are they funding and doing enough on the broad measures that will create the healthier society that is so clearly desperately needed in the time of Covid or at any other time?