Health and Care Bill

Debate between Baroness Thornton and Baroness Bennett of Manor Castle

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise briefly to offer Green support for this amendment, which I would have signed had there been space.

The noble Baroness, Lady Chakrabarti, referred to today’s report that a watered-down version of the India-South Africa proposal for a TRIPS waiver looks likely to go through the WTO. I quote Max Lawson, co-chair of the People’s Vaccine Alliance:

“After almost 18 months of stalling and millions of deaths, the EU has climbed down and finally admitted that intellectual property rules and pharmaceutical monopolies are a barrier to vaccinating the world.”


Bouncing off the comments of the noble Lord, Lord Russell, I think that the Cross Benches might find an even larger drinks fund if they go for “world-leading” as the key phrase to identify. The comment from Mr Lawson shows that, collectively, the world has done very badly throughout the Covid pandemic and done very poorly by the global south. If the Government want to be world-leading, they could leap in right now and accept the noble Baroness’s amendment.

[Baroness Thornton (Lab)]

My Lords, I congratulate my noble friend Lady Chakrabarti, the noble Baronesses, Lady Lawrence and Lady Brinton, and the noble Lord, Lord Russell, on supporting and promoting this amendment. Its explanatory statement says:

“In the event of a public health emergency of international concern, this new Clause requires the Secretary of State to support domestic and international knowledge-sharing, to combat the emergency.”


I cannot see why anybody would object to that.

I would like to say one more thing. The former Prime Minister, Gordon Brown, has led this country on how one should respond to a global pandemic with his work at the World Health Organization on the importance of sharing knowledge, vaccines and technology across the world. This amendment is about the pandemic that is coming down the track as well as the one we are dealing with at the moment, so we on these Benches certainly support it.

Health and Care Bill

Debate between Baroness Thornton and Baroness Bennett of Manor Castle

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

[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.

[Baroness Thornton (Lab)]

My Lords, I will speak to the amendments to Clause 14, which is a very important clause. There is absolutely no doubt about that, and the Minister can be in no doubt that that is exactly how we see it. It was touch and go whether we would have a clause stand part debate on this, and I am not sure that we were right not to do so, because this debate, particularly my noble friend Lord Hunt’s comments, has highlighted some serious problems.

My noble friend Lady Pitkeathley is quite right that the arrangements that we are seeking to put into statute, which have grown up over the last few years to allow areas to collaborate, were the right thing to do. In my area of the world, I have no doubt that it was important that the boroughs collaborated together, particularly in their relationship with and commissioning of services from the very big providers.

The question in Clause 14 is: what is going on with the arrangements that the Government are putting into statute? I am very pleased to follow the noble Baroness, Lady Walmsley, and to speak to Amendments 23 and 44 in my name. Amendment 23 addresses the vexed issue of boundaries for an ICB. In this Bill we are dealing with geography, whereas the 2012 Act dealt with GP lists. The area of an ICB is defined in terms of tier 1 local authorities.

Concerns have been expressed, because the NHS is often a bit clueless and sometimes very defensive about local government, its boundaries and its powers. Maybe the Minister will tell me I am wrong, but I suspect that one of the reasons why elected members have been precluded from the boards is that the NHS does not feel comfortable with the direct democratic accountability at that level. That is a great shame. I think it is wrong; accountability is extremely important.

How can we have an integrated service when social care is provided by local government, which is democratically accountable, and we want to integrate that with the NHS at a local level in an area to provide the best service that we can for that population and those patients? The almost offensive way of constructing a board that does not allow elected representatives is not acceptable.

My quite modest amendment seeks to change that situation for the future. There were exchanges in the Commons about this, and there have been meetings with disgruntled authorities that seem to have ended without agreement. We may need to take a step back and learn some of the lessons, perhaps from Scotland and Wales where more logical boundaries have been applied for their health boards.

We may learn a bit more about plans for integrated commissioning at this level when we get the promised but overdue White Paper on integration. It is possible that it will set up a third set of geographies, and who knows how that will line up? This seems to be the wrong way around. Our amendments at least elevate the need to consult with local authorities over boundaries to start off with. That is perhaps a pious hope, but we can agree that any future changes can be made only if the local authorities agree.

Amendment 159 arises out of lengthy discussions elsewhere. In the twin-striker model for ICS, we have the ICBs and the ICPs. We know almost nothing about ICPs; all that is said is that it is part of the “flexibility” and so should be valued. Referring back to my previous remarks, I just hope that local authorities will be genuinely involved in the ongoing discussions about ICPs, how they are set up and their governance. What we do know is that the ICPs will own the analysis of needs and the strategy that follows from that. What, therefore, is the role of local health and well-being boards?

There are echoes of 2012 here, as, during the consideration of the 2012 Bill, amendments were advanced on the same issue. In the 2012 version, it was the health and well-being boards that did the strategy and the CCGs that did the commissioning, at least of health. Nobody ever properly addressed how social care would be commissioned in any integrated way in a wider strategy. It was proposed in 2012 that the health and well-being boards had to approve the plans of the CCGs, and that was the glue that would hold the whole thing together. We know that that has not worked. It has sometimes worked on paper, but it is not the thing that has driven the work of the CCGs.

The answer so far for 2022 is that everyone will play nicely and it will all be resolved. I do not think that can possibly be the case when there is such a serious imbalance. Our Amendment 159 acknowledges that there just might be a dispute over whether some decision or plan of an ICB was genuinely aligned to the strategy that it was supposed to be following, so a process for resolution is needed.

I am not sure whether Amendment 44 sits easily in this group, but it is a matter on which assurance is needed. When foundation trusts came into being, they were rather bravely given the power to set their own terms and conditions for staff. One of them might have tried it, and it was not a great success. In general, despite whatever powers exist, almost every part of the NHS follows the Agenda for Change, the collective agreement that took 10 years to agree but which has stood the tests of time.

Now, as with CCGs, we have the power of ICBs to set their own terms and conditions. They are probably unlikely to do so, as it takes an enormous amount of work and the risks that it brings are probably not worth the effort. Without doubt, some staff are worried that they just might be the ones picked on for special treatment. The Minister will no doubt say that the ICBs need the flexibility, but surely, given the pandemic and everything else that faces the NHS, it would be much better to give staff certainty and confidence they will be treated properly.

We agree with the sentiments of Amendments 22 and 24, which try to ensure that agreement on ICB constitutions will be done promptly. We agree with the sentiments of Amendment 53, which echoes a previous amendment about the need to drive improvement. In my noble friend’s Amendment 45, he asks a legitimate question, which I think the Minister will need to answer.

Trade Bill

Debate between Baroness Thornton and Baroness Bennett of Manor Castle

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Thursday 1st October 2020 Grand Committee

[Baroness Thornton (Lab) [V]]

My Lords, I will speak in support of Amendment 51. I thank my noble friend Lord Bassam for setting the scene for this debate. The amendment inserts a new clause into the Trade Bill which protects the NHS and publicly funded health and care services from any form of control from outside the United Kingdom. Like my noble friend, I thank the BMA and the Trade Justice Movement for their briefings and the Library for an excellent brief. I also thank the noble Lords, Lord Patel and Lord Fox, and the noble Baroness, Lady Bennett, for their support.

The Government are pressing ahead with trade negotiations with the United States, the EU and elsewhere, despite there being no system of transparency or scrutiny of trade deals. Your Lordships’ House passed an amendment to the previous Trade Bill on parliamentary scrutiny. Since then, the Government have not made good on promises to give Parliament a say in new trade deals. Noble Lords should support a similar amendment to this Bill. The Trade Bill should be amended to protect the UK’s high food and animal welfare standards, and to protect the NHS and public health from provisions in trade deals.

The Covid crisis has hit global trade. It is essential that the UK’s trade policy maintains the right to regulate, protects the NHS and supports countries in the global south. We are concerned that, at present, Parliament does not have adequate powers to guide and scrutinise trade negotiations. My noble friends Lord Stevenson and Lord Lennie explained this to the Committee on Tuesday and the current process provides no legal mechanism to directly influence or permanently block trade agreements. This could mean the UK entering into trade deals that have a significant impact on public health and the domestic healthcare sector without Parliament having a meaningful role in scrutiny. As the Trade Bill is currently the only legislative vehicle for Parliament’s oversight of trade negotiations, we believe that additional scrutiny mechanisms are vital to protect the NHS and public health as the UK begins to negotiate independent free trade agreements in earnest.

As my noble friend said, this amendment seeks to ensure that our NHS is protected. It is necessary because this Government, and the one before them, have form in this area. Last year, noble Lords discussed the Healthcare (International Arrangements) Bill. It gave the Secretary of State powers, as the Constitution Committee put it, to make any healthcare deal with anyone, anywhere in the world. I am pleased to say that your Lordships’ House successfully refocused that Bill on to the issue of 27 million European health insurance card holders and their interests at the time, instead of laying the groundwork for trade deals involving our NHS. On 5 February last year, I said that

“it seems to open the door to healthcare negotiations across the rest of the world. In other words, it also lays the basis for trade and foreign affairs discussion concerning healthcare. One must ask: which countries do the Government have in mind, and for what purpose and why is the Bill addressing world issues and not limited to the European Union?”—[Official Report, 5/2/19; col. 1484.]

That was remedied by your Lordships’ House. However, it is clear that if that Bill had been agreed as originally drafted, it would have opened the way for this Government already to be in negotiations with the USA and others, and to give them open access to our NHS.

While the Government have repeatedly pledged that the NHS is “not on the table” in trade negotiations, leaked documents reveal that that is not the case, as my noble friend Lord Bassam outlined. Let us be quite safe. The Trade Bill should be amended to protect the NHS; we should have these safeguards in place, in statute. It is vital that the Bill protects the health and social care sectors by safeguarding future options for rolling back either privatisation or restructuring. We need to protect our right to restructure our health and social care services into a more collaborative model. Trade agreements must not be permitted to lock in current or higher levels of privatisation within the NHS in England, nor lead to privatisation in the devolved nations without their say so.

To do this, the Bill must ensure that the health and social care sectors are excluded from the scope of all future trade agreements. The Bill must rule out investor protection and dispute resolution mechanisms in UK trade deals to ensure that private foreign companies cannot sue the UK Government for legitimate public procurement and regulatory decisions that we decide to take with regard to our public services, including the NHS. If a future Government want to change the structure of the NHS, they must not be prevented from doing so by trade deals.

It is worth noting that an EU investment treaty recently resulted in the Slovakian Government being ordered to pay €22 million in damages to a foreign private health insurance firm after it decided to reverse the privatisation of its national sickness insurance market. Investor protection mechanisms have also been used extensively to challenge public health initiatives like tobacco plain packaging. There is a great deal at stake here. We need to include protections to ensure that NHS price control mechanisms and the UK’s current intellectual property regime are maintained.

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

My Lords, I begin by addressing Amendment 13 in the name of the noble Lord, Lord Bassam of Brighton—ably introduced by him—to which I was pleased to attach my name. Looking at this, I cannot but think of the many wearying social media debates I engaged in about how our membership of the European Union did not stop the bringing of disastrously outsourced public services back into public hands. But that is now all history. I think all sides of the House can agree about what won the 2016 referendum. The result was a clear direction from the public on this, if not much else: take back control. That must surely apply, as a matter of priority, to public services. I look back to the 2012 Olympics, an age ago now, but it is hard to forget the G4S security fiasco, when the Army had to step in. That is what has now happened with our railways: the control that the public has long been asking for. I recall that, even in 2015, a majority of Conservative voters wanted to see our railways run for public good, not private profit. It is what should happen with the disastrously underperforming, privatised, national Covid test and trace system. The private sector can always walk away. It makes a mess and leaves the public sector to pick up the pieces. The service users suffer, the providers are loaded with debt, the public pay more and a few walk away with the profits, usually stashed in a handy tax haven.

Given the rigid ideology of the Government, I will not even ask the Minister to agree with me, but I will ask him to agree with the idea of democracy, of keeping options open, including the option to take back control of public services. It is a legal principle that one Parliament cannot bind future ones, but locking us into trade deals where a country has given its word does, presumably, have that effect under the rule of law. The amendment does not force the Government to do anything, despite the obvious public good of bringing public services back into public hands. It does prevent the closing down of democratic decision making: it keeps control. I invite the Minister to tell me why keeping our options open is a bad idea and to support Amendment 13.

The noble Baroness, Lady Thornton, has ably laid out the detail of Amendment 51, to which I was pleased to attach my name alongside those of the noble Lords, Lord Patel and Lord Fox. There is little doubt that, of all the elements of the Trade Bill, protection of the NHS has attracted the greatest attention. As many Peers have already reflected in the Committee, this is a reminder that trade Bills are of far greater public interest and concern now than they were when this House and the other place last considered them. It is a powerful path for the argument for new systems of oversight equal to those our MEPs enjoyed and the US Congress regularly utilises.

I recall taking part in a march in 2014 with the group called 999 Call for the NHS. It started in Jarrow, following in famous footsteps, although I only walked the Luton to Bedford leg. We stopped for a comfort break at an establishment along the route. A young man behind the bar asked: “Why are we suddenly so busy?” We told him: “We are marching against the privatisation of the NHS.” He said: “What? It still says NHS above the door of my doctor’s surgery.”

Of course we know that that is not true: there is significant privatisation already. To cite just one statistic, 13% of in-patient mental healthcare beds in England are privately run. In Manchester, patients have a 50:50 chance of being admitted to a privately owned hospital and a one in four chance of the bed being provided by an American-owned company. We have lost control in significant areas of the NHS. This amendment makes sure that we can take it back and not lose further control.

Finally, I will refer briefly to Amendment 75. We have yet to hear from the noble Baroness, Lady Sheehan, and I look forward to her explanation, but my eye notes with approval the amendment’s provision against the use of investor-state dispute settlement procedures—another great threat to public democratic control and decision-making and something that the Green Party has long campaigned against. Protection of access to generic affordable drugs and preventing excess windfall profits for pharmaceutical companies: I cannot see anything not to like in this amendment.