Ukraine: Humanitarian Assistance

Baroness Tyler of Enfield Excerpts

Thursday 12th December 2024 Grand Committee

Asked by

[Baroness Tyler of Enfield]

To ask His Majesty’s Government what plans they have for enhanced humanitarian assistance for the people of Ukraine this winter, and in particular for mental health, energy and housing provision.

[Baroness Tyler of Enfield (LD)]

My Lords, we have recently had two major debates on the current situation in Ukraine. They concentrated mainly on the geopolitics of the conflict, the scale of NATO and EU strategic defence capabilities, the provision of weapons and resources to Ukraine, sanctions and the imminent return of President-elect Trump to the White House. In recent weeks, we have heard reports of offensives and counter-offensives on the front line, a rush to seize territory before any negotiations take place, the prospects of a ceasefire and a diplomatic settlement to the war and the need for strong security guarantees for Ukraine. While all this continues to rage, the number of fatalities and casualties grows ever higher.

My debate today is designed to draw attention to the scale of the humanitarian disaster unfolding before our eyes and focus our energies on what more can be done to alleviate the suffering of the people of Ukraine this winter, including what assistance can be given by the UK Government and civil society. Ever since Putin launched his illegal invasion of Ukraine, the Ukrainian people have faced almost unimaginable challenges, but this winter threatens to be particularly severe, with the deliberate targeting of power stations leaving many Ukrainians once again with no power or heating in the freezing winter months ahead.

A few weeks ago, I, along with other UK parliamentarians, met a group of inspirational female Ukrainian MPs. It was organised by the Ukraine-UK interparliamentary friendship group. Their suffering and, above all, their courage were humbling. I was particularly struck by what they said about the impact on children, so often the forgotten victims of war. They talked about the psychological impact on young children of constant air raid sirens, drone attacks, sleeplessness and periods of no power or heating, as well as the impact on their education and the adverse effects on their mental health.

They also shared harrowing figures estimating that almost 600 children have been killed and 1,700 wounded. Other estimates suggest that nearly 700,000 children have been deported to Russia, often resulting in citizenship changes, forced adoption and children placed under temporary guardianship—as it is called in Russia—effectively seeking to stamp out their Ukrainian identity. I am very grateful to the Library for its excellent research briefing, which highlighted that, according to UN agencies, since the full-scale invasion began, 5 million refugees from Ukraine have been recorded globally, more than 3.5 million people are estimated to be displaced inside Ukraine and—this is of key importance today—more than 14.6 million people inside Ukraine are in need of urgent humanitarian assistance.

I want to spell out in a bit more detail what that means. According to the UN Office for the Coordination of Humanitarian Affairs, the humanitarian situation in Ukraine worsened in August and September due to intensified attacks. The UN Human Rights Monitoring Mission in Ukraine reports that in September more than 1,400 deaths and injuries were verified, the highest number since the start of the full-scale invasion. Homes, hospitals and schools have been damaged, in addition to the disruption of other essential services, including water and electricity. The escalation of hostilities has significantly increased humanitarian needs near the front line. The World Health Organization has verified 66 attacks on healthcare facilities in Ukraine. This represents more than one-third of such attacks globally. Under constant shelling and with limited access to critical services, shops, pharmacies and banks, people remaining close to the front line need shelter repairs, hygiene products, clean water and food.

Damage to energy infrastructure is expected to worsen the challenges civilians will face in the coming months, which are forecast to be the toughest winter since 2022. The impact of the continued Russian large-scale aerial attacks targeted on Ukrainian energy infrastructure and the power supply is disrupting essential services such as water, gas and heating in Ukraine, particularly in front-line communities.

The UN World Food Programme estimates that more than 2 million people in Ukraine are suffering from insufficient food consumption, including 20% to 30% of people in the Kherson area. Earlier this month, the Financial Times reported that Russia was using drones to attack Ukrainian civilian targets in Kherson, including ambulances, police cars, fire engines and humanitarian convoys. Russian drone operatives were also reported to be targeting civilians at markets, petrol stations, cafes, post offices and aid centres, as well as dropping explosives in streets, playgrounds and public squares in non-occupied areas, injuring more than 500 civilians.

Turning to housing, the Council of Europe Development Bank noted earlier this year that housing continues to be one of the sectors most affected by the war, with more than 10% of the total housing stock in the country either damaged or destroyed, and close to 2 million households thought to be affected. Many thousands in Ukraine have been forced to leave their homes and are now homeless. While post-war reconstruction may be the only long-term answer to the housing crisis, urgent help is needed to provide services for people sleeping rough, including temporary accommodation and better housing support for people leaving the military, hospitals and prisons.

I shall now focus on mental health. The conflict continues to have profound effects on the mental health of those affected, including refugees, internally displaced people and those on the front line. According to the Ukrainian Health Ministry, the number of patients reporting mental health problems in 2024 has doubled since a year ago, with particular consequences for children’s mental health. A recent Save the Children report found that, for children, the psychological impact and emotional distress of the ongoing conflict remained at high levels across the country, regardless of whether children were displaced, returnees or residents who have not fled. Save the Children is working with a local partner in Ukraine to fund social workers to go into communities affected by the conflict to provide mental health support among other essential items. UNICEF anticipates that more than 2.2 million children need to access mental health and psychosocial support. It points to problems such as depression, insomnia and anxiety linked to children spending thousands of hours in shelters while alarms are sounding.

It is inspiring to hear about the many organisations and individuals who are doing their best to help, and I will mention a couple. UK-Med, a frontline humanitarian NGO which describes itself as “born of the NHS”, maintains a register of NHS medics who travel to global crisis areas and work alongside local staff. The organisation has sent more than 200 NHS and international medics to Ukraine to deliver services including mental health support via mobile medical units and by training civilians and local health workers in mental health support. Psychologists at the University of Manchester have created leaflets for Ukrainian parents, developed from the experiences of displaced Syrian parents living through the country’s civil war.

I have focused on children, but there is also a crying need to support veterans. It is encouraging to hear that the British Army Medical Corps has been providing training to Ukrainian armed forces medics, including psychologists, and that two-way exchange visits have been made. Whatever happens in the coming months, there will be a crying need to support veterans of the conflict with mental health problems.

Finally, I turn to the role of the UK Government. The Government’s assistance, particularly financial assistance, tends to be channelled through international organisations, such as the International Red Cross, which has used it to provide psychological support services for Ukrainian refugees in Poland, Romania and Moldova. It is welcome that, in September, the Foreign Secretary confirmed that bilateral funding for 2024-25 included £100 million specifically earmarked for humanitarian aid. Can the Minister give any breakdown of how this will be used and what proportion is going to support mental health? Has there been any follow-up to the First Lady Madame Zelenska’s very welcome visit in March, when she met children’s mental health services in London to discuss post-war mental health recovery in Ukraine, particularly how best to build community mental health services for children from front-line territories who are dealing with trauma?

Specifically on this point, we have a well-developed, if obviously overstretched, children’s mental health sector in this country, both in the NHS and the voluntary sector. As well as that sector helping displaced children and young people with mental health problems it could, I feel, help share expertise and knowhow, with a little help from government, and provide training for those in the frontline of providing such support in Ukraine. Are the Government actively considering that, and would the Minister meet me to discuss it? I very much look forward to hearing the contributions of other noble Lords.

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[Baroness Tyler of Enfield (LD)]

My Lords, can I just ask the Minister whether he will meet me in the new year to discuss the particular support for mental health?

Health and Care Bill

Baroness Tyler of Enfield Excerpts

Lords Hansard - Part 2 & Report stage
Monday 7th March 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

I thank the noble Baroness, Lady Bennett, for tabling these amendments, slightly amended from Committee, and in particular for responding to the Minister’s concerns that the first amendment had perhaps been too broad and would catch the day-to-day business of companies. That cannot be said about Amendment 145.

I also want to pick up a point that the noble Earl made in Committee. He said:

“A company’s working capital, by its nature, is money that is used to fund day-to-day operations in general, and one cannot associate a particular pound with a particular business activity.”—[Official Report, 4/2/22; col. 1161.]


Yet the Charity Commission does have the ability to intervene in the event that a charity, or series of charities stretches—shall we say?—those rules. Its Internal Financial Controls for Charities, CC8, provides very specific guidance. Indeed, in recent years, one charity, the Plymouth Brethren Christian Church, was investigated for a circular set of donations. Each donation to each different body was paid tax relief out of the public purse, coming back to serve the schools that the adults at the community church sent their children to. The way that was structured was similar to a financial instrument employed by the few companies that abused the funding they received from the public purse for social care.

The noble Earl also referred to the Treasury guidance Managing Public Money and Accounting Officer Assessments. I have been through that, too. It is very interesting and clear. Under the heading

“expenditure which may rely on a Supply and Appropriation Act”,

Managing Public Money lists

“routine administration costs: employment costs, rent, cleaning etc … lease agreements, eg for photocopiers, lifts”.

It does not say: “Re-charging sister/parent/daughter companies for large amounts of borrowing and the interest thereto”, which is what has been happening.

It is important that we start to debate how public funding is spent by these companies, particularly those overseas, when we cannot see how that money is spent. I also support the other amendments in the group, which ask for a review of financial regulation. It is interesting that the Treasury guidance refers constantly to the Nolan principles, which are absolutely vital in talking about transparency and responsibility when spending public money. These amendments might not be quite right to deliver that, but it would be good if there were a review under way.

The other thing we must have when these companies spend large amounts of public money is publication of their full accounts. They should not be able to hide behind very short, superficial accounts from overseas.

[Baroness Tyler of Enfield (LD)]

My Lords, I support these amendments tabled by the noble Baroness, Lady Bennett, as I did in Committee. In essence, they are about financial practices in the social care sector that I find completely unacceptable.

The social care provider market, as we all know, is complex, fragmented and too often inherently unstable. One of the causes of instability is financially risky behaviour by a small number of large, equity-backed, highly debt-laden companies in the residential care sector. This has resulted in some high-profile sudden exits from the market, such as Southern Cross and Four Seasons. The key point is that, in the event of the closure of a care home, the provider bears no responsibility for continuity of care. That falls on the local authority, with the direct impact felt by care home residents and their families. That just cannot be right.

It is also concerning that, in its 2021 social care market report, the NAO was unable to analyse the accounts of five of the large equity-backed providers because of difficulty in accessing their accounts. Of course, the issue of the lack of transparency over accounts, profits and shareholders is exacerbated when company ownership is offshore.

As the noble Baroness, Lady Bennett, explained, Amendment 147 seeks to require local authorities and other public bodies to commission care from non-UK domiciled companies only if they publish full accounts and offer transparency over their ownership. There is an interesting international precedent for the latter part of this. Indeed, in February 2022, the Biden Administration announced a set of measures around improving quality and transparency by requiring private equity firms to disclose ownership stakes in nursing homes.

I will finish by making a couple of broad points. For a measure like this to be implemented effectively, it will clearly be essential that local authorities are equipped with sufficient complex accounting knowledge to scrutinise the ownership and financial practices of a provider. Although this amendment would help ensure transparency and enable better scrutiny of offshore entities, I am conscious that complex ownership structures are not limited to companies owned abroad. I hope the time will come when this sort of financial transparency is extended across all providers, wherever they are based.

Health and Care Bill

Baroness Tyler of Enfield Excerpts

Committee stage
Friday 4th February 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I support Amendments 237, 238 and 239 in the name of the noble Baroness, Lady Bennett of Manor Castle, which aim to ensure that private providers are regulated, especially those using obfuscatory financial structures, instruments with inter-company loans and large amounts of debt. They should be fully transparent about those arrangements. She was right to highlight the excellent reporting of the Financial Times on this, along with the financial editors and journalists of other papers.

The typical small business social care home owner does not fall into the category I have just described. The problem in the sector is the private equity providers who decided to start buying up care home groups because they felt that the assets could be milked to provide healthy-looking returns for them. This differs from those homes borrowing in order to, perhaps, buy new homes to enlarge their group; what is happening here is purely financial instruments to benefit the directors and investors. Typically, private equity-backed providers spend around 16% of the bed fee on complex buyout debt obligations. The accounts of Care UK show that it paid £4.1 million in rent in 2019 to Silver Sea Holdings—a company registered in low-tax Luxembourg, which is also owned by Care UK’s parent company, Bridgepoint.

These kinds of buyouts are also associated with an 18% increase in risk of bankruptcy for the target company. In the case of Four Seasons Health Care, heavy debt payments contributed to the company’s collapse into administration in 2019. Two of the other largest care home providers in the UK, HC-One and Care UK, have also undergone leveraged buyouts and, as a result, their corporate group structures remain saddled with significant debts. Some of these types of company are also struggling to provide the best possible care with their overall CQC scores—so it is affecting the lives of the most vulnerable patients.

The Office for National Statistics says that 63% of care home residents are paid for by the public purse. Surely the Government must have a duty towards the public purse. It is not acceptable for the public purse to pay for these complex financial arrangements that are intended to provide not care or capital for the growth of a care business but purely a larger return for directors and shareholders. These amendments would provide for transparency and accountability and an assurance that the public purse and the private payer are not being taken for a ride.

[Baroness Tyler of Enfield (LD)]

My Lords, I support these amendments from the noble Baroness, Lady Bennett. I thank her for putting them forward. The care sector is both complex and very little understood. Back in 2020, there were approximately 15,000 care homes in the UK, run by approximately 8,000 providers. Some were very small; others were providing very large networks of homes—it is a mixed economy. These figures are a couple of years old but, at that time, 84% of homes were run by the private sector, including by private equity firms, both British and offshore.

Funding is a complex mix of private funders, local authorities and the NHS. I was very grateful to the noble Baroness, Lady Bennett, for highlighting the work that the Financial Times has done, because I was first alerted to this issue by an investigation that the paper did back in 2019 which revealed how Britain’s four largest privately owned care home operators had racked up debts of £40,000 per bed, meaning that their annual interest charges absorbed eight weeks of average fees paid by local authorities on behalf of residents. Many have argued, and I absolutely agree, that this sort of debt-laden model, which demands an unsustainable level of return while shipping out profits of 12% to 16%, often to tax havens, is entirely inappropriate for social care.

I want to make it clear that I do not have an ideological problem with the private sector being involved in the care sector and providing care homes—provided that they are good quality—but I have a real problem with the financial models used. Most fair-minded people in this country, not least those whose loved ones are in care homes, would, frankly, be horrified if they knew how the money—either theirs, if they are self-funded residents, or indeed the money of hard-pressed local authorities—was being used and where it was being siphoned off to.

I greatly support amendments to increase transparency and reporting. Frankly, I would like to see the regulator being a lot tougher and a lot more proactive in this area, so I very much support the review in the amendment put forward by the noble Baroness.

[Baroness Altmann (Con)]

My Lords, I support the thrust of the amendments laid by the noble Baroness, Lady Bennett. I fully agree with her that there is a systemic problem in the care home sector.

In 1991, the community care Act reforms meant social care was transferred from a public sector function—or NHS function when it came to nursing homes—to what was called a mixed market. But, having observed the worsening care crisis, the financial engineering, the periodic failure of large care home operators and the inadequacy of regulation or oversight of their financial backing, I cannot help but urge my noble friends on the Front Bench to look urgently at the need for much greater controls. Southern Cross and Four Seasons Health Care have been in and out of insolvency or near bankruptcy for the past few years, but there are still inadequate controls on their ownership structure.

Health and Care Bill

Baroness Tyler of Enfield Excerpts

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

[Lord Lansley (Con)]

My Lords, perhaps I may make two quick points. At an earlier stage in the Committee, using the example from the noble Lord, Lord Mawson, in relation to Bromley by Bow and north-east London, I asked why the legislation cannot allow clinical commissioning groups, as they have established themselves over years, to continue as place-based committees or subsidiary elements of an integrated care system. I am sure that many of them would be willing to do so; we should allow them to do exactly that, because there is otherwise a gap in relation to how large ICBs will do their place-based work.

Secondly, the noble Lord, Lord Hunt of Kings Heath, referred to what I said about provider collaboratives. I still think it. Where are we going to end up with this? It will be with NHS England having within it, as each integrated care board has within it, the provider interest and the commissioner interest. The Government purport to be abolishing the purchaser/provider split. Every Secretary of State prior to the former Secretary of State, Matt Hancock, seemed to believe in it, with the exception of Frank Dobson. There was a reason why we did that: because it is a fact. We might legislatively abolish the purchaser/provider split, but, in reality, it will exist. As my noble friend Lord Hunt of Wirral said earlier, if that conflict of interest is not properly recognised and managed, it will emerge with potentially damaging consequences. Transparency about how provider interests are to be properly managed inside the NHS is not something I yet see in the substance of the Bill. I hope that my noble friend on the Front Bench will agree to think hard about this and perhaps talk about how we might give transparency and accountability to that conflict of interest.

[Baroness Tyler of Enfield (LD)]

My Lords, I have added my name to Amendment 165 in the name of the noble Lord, Lord Hunt. This is a small but important group of amendments.

I have added my name to the amendment because I am interested in what is happening to primary care and particularly the voice of GPs in the new arrangements. Frankly, we are not hearing much about them. As it stands, the legislation will place NHS trusts and foundation trusts in quite a privileged position in deciding how plans are made and resources allocated. I am not quite sure where the voice of GPs comes into the new arrangements. I understand that NHS England has commissioned a review of the role of primary care in the NHS structures, but my understanding is also that it will not report until after the Bill has been passed if we continue with the current timetable. Frankly, by then, it will be a bit late to make sure that we have got the arrangements absolutely right.

It is right that primary care commissioning is undertaken at a local level by people with relevant knowledge and skills, and with the necessary experience of what primary care needs to look like at locality level. That is why it is right that the new place-based partnerships are to be given that commissioning role. However, like the noble Lord, Lord Hunt, I think it is important that these primary care commissioning arrangements are established in statute, because it is only if that happens that Parliament will be clear about the accountability arrangements and the governance and leadership. It is also important that there is real transparency in the system. At the moment, it all feels a bit opaque. I hope that the Minister can give some assurances on this point.

[Lord Stevens of Birmingham (CB)]

My Lords, I just wanted to respond to the last set of very important questions that have arisen. It is fair to say that the Bill increases the accountability for commissioning primary care services locally, as compared with its predecessor, the 2012 Act. That is because one consequence of having GPs represented on the clinical commissioning groups was that clinical commissioning groups could not, therefore, be the commissioners of local primary care services, at least in statute. One had the paradox that the most local of all the services in the NHS was stripped out from the local commissioning bodies, the CCGs, and instead given nationally to NHS England, as a work-around to deal with the conflict of interest that GPs would otherwise have had in commissioning themselves on the CCGs.

In practice, the CCGs have been given the ability to influence those local commissioning arrangements but, to be clear, that is not the accountability mechanism set through the 2012 Act. What this Bill does is to improve the position, in that it is local integrated care boards that have that local commissioning responsibility for GP and other family health services, as compared with NHS England nationally.

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Not all of my reassurances today have landed well, but I hope I have provided reassurance to the Committee that place-based commissioning structures are already an intention and sufficiently catered for in the current provisions, and that the noble Lord, Lord Hunt, will feel able to withdraw his amendment.

[Baroness Tyler of Enfield (LD)]

Before the Minister sits down, is he in a position to answer the question I asked about the timing of the review regarding the position of GPs within this new set of arrangements?

[Earl Howe (Con)]

I shall need to write to the noble Baroness about that timing because I do not have it. I meant to say that I was grateful to the noble Lord, Lord Stevens, for his intervention on the way in which we hope that primary care will be better built into the commissioning arrangements than it has been up to now.

Health and Care Bill

Baroness Tyler of Enfield Excerpts

Lords Hansard - Part 2 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I support this group of amendments in the name of the noble Lord, Lord Hunt. My name is attached to Amendment 149, but I want to talk more generally about this group. Like the noble Lord, Lord Hunt, I am very supportive of the work of Healthwatch, at both national and local level. It provides very helpful and important insights about what it is like to be at the receiving end of our healthcare system. We sometimes do not hear quite enough about that. The national-local structure is helpful, ensuring that local bottom-up insights are then reflected in national-level reports.

Like the noble Lord, Lord Hunt, I have found some of the reports produced by Healthwatch recently, and during the pandemic, extremely helpful. I am thinking of its work on mental health—particularly, children’s mental health. It has also done a series of projects on social care that are very relevant to the current situation. One project particularly dear to my heart involved engaging with care home residents and their loved ones, and feeding insights into the development of national visiting guidance—very practical, important work. Another recent report, which I have already quoted in your Lordships’ House, looked at vaccine confidence and, particularly, what might need to be done to help support those communities with a higher degree of vaccine hesitancy; again, Healthwatch does some really important work.

I turn now to the amendments more specifically. In the recent survey of ICS leaders for Healthwatch England and NHS England, 80% of respondents said that they would support Healthwatch having a formal seat on the ICB if this was set out in legislation or guidance. We have already heard the question: what about the other 20%? Should noble Lords have the time, I recommend a quick look at the Healthwatch document and the survey, mapping the relationship between local Healthwatch and integrated care systems. There is a lot of important information in it. I particularly noted in the survey that 100% of ICS respondents said that they would support a mandated seat for Healthwatch on the integrated care partnership. That was one of the main reasons that I wanted to add my name to Amendment 149.

Fundamentally, why I think this so important is that I am not convinced that, in all our important deliberations so far, sufficient weight has been given to what we might call the service user voice or the individual patient voice more generally. These deliberations have, understandably, been very much about structures and how these new integrated care systems will work. I feel that there is scope for the Bill to set out some minimum requirements to ensure that the patient voice is heard at the decision-making table. It is fine to have lots of other sentiments about patient voices but, are they there, and are they heard at that table?

The principle is really quite simple. Patient choice at an individual level—that is, in relation to the patient’s own healthcare—has changed radically. We have moved from a situation where the doctor knows best and will tell you what is happening to the doctor setting out the options and you making a decision with the doctor—almost a co-produced decision. We need to think more about that approach, at the community level, the local level and then the integrated care system level. This will be particularly important in relation to tackling health inequalities because, frankly, if people are not involved in the decision-making or feel that their voice is not being heard, they often do not trust the outcome.

A recurrent theme in our discussions so far has been who should be on what body. We have had those big debates about whether there should be public health and mental health representatives and so on, which are very important, and those conversations still have some way to go, and we have just had this very interesting debate about place-based partnerships and “insiders” and “outsiders”. Again, that has quite a long way to go, but it would be ridiculous if the patient was seen as the outsider; patients need to be front and centre of all this and the reason we are undertaking a restructuring in the first place.

My main plea is that in all our discussions we consider the user voice and how it can be heard. I think that Healthwatch is an obvious way of doing it; it has the existing infrastructure. There may well be other ways of doing it, but that was the reason I was keen to support the noble Lord, Lord Hunt.

[Lord Harris of Haringey (Lab)]

My Lords, I refer to my health interests as declared in the register; in particular, I chair the General Dental Council, but I should make it clear that I am not speaking on its behalf in Committee.

Almost exactly 35 years ago, I became director of the Association of Community Health Councils for England and Wales, which was then the national statutory body representing the interests of the patients and the public in the NHS. Since then, both local and national representation of patients has gone through a series of iterations—indeed, the number of occasions on which I have been sitting on the opposite side of the Chamber from the noble Earl, Lord Howe, talking about patient representation seems too many to recount. After community health councils, we went through a series of iterations of which local Healthwatch is the latest version. I admit that when we had the debate which my noble friend Lord Hunt began by referring to, I was extremely dubious about whether local Healthwatch would be able to flourish and the national body be effective. I have to say that my worst fears have not been founded, but it has to be recognised that the way in which it was structured, in particular the late changes introduced by the Government during that legislation, made it much more difficult for Healthwatch, both at local and at national level, to be as effective as it might be.

The context of this debate is the centrality of patients and service users in delivery. Every time the NHS is reorganised, whether it was the reorganisation of the noble Lord, Lord Lansley, or the reorganisations we have every three years or so, there is always a grand White Paper which says, “Patients will be at the centre of this new structure”, but it is never quite like that. In the new arrangements being brought forward, the Government need to make sure that the local patient voice is represented and articulated and that, at national level, those voices can be aggregated and put forward. That is why this group of amendments is so important.

We have just had a debate which ended up revolving around how many separate interests should be represented on the various bodies that we are creating. I can see the problems if we add and add, and how difficult that is going to be. However, what I hope the Government will take away from the consideration of this amendment and look at before Report is how they can make the patient representative structure within the future arrangements better and more effective. I think that a number of things could be done.

The first is about the budgets. The budgets for local Healthwatch go through a complicated, notional process. It is very difficult to define why the allocations are what they are. It would be far better if it was clear what the expectations were to run a local Healthwatch and to deliver what is needed.

The second thing that can be done concerns the degrees of independence: from the local authority, health providers and health commissioners, at the local level, and from the CQC at the national level. The noble Lord, Lord Patel, talked about the problems of Healthwatch England being a sub-committee of the CQC. I understand that the relationship has actually worked quite well, but that is probably because of the good will of all concerned. It might be that, in the future, Healthwatch England has serious criticisms of the regulator. How can it do that, as a sub-committee of that body? Whether formally or informally, you can see the difficulties.

Procedure and Privileges

Baroness Tyler of Enfield Excerpts

Tuesday 13th July 2021 Lords Chamber

[Baroness Tyler of Enfield (LD) [V]]

I welcome some of the relatively modest procedural changes being proposed today, such as retaining lists for Oral Questions and changing our working hours to make them more family-friendly, argued very cogently by the noble Lord, Lord Adonis.

However, my main purpose today is, first, to register my deep disappointment that a real opportunity has been missed to overhaul and modernise our working practices, many of which were designed for a very different age, despite the many voices calling for change in our debate on 20 May, which seem to have been ignored. Secondly, while strongly welcoming the proposed new arrangements for those with long-term disabilities—I found the contribution of the noble Lord, Lord Shinkwin, particularly poignant—I draw specific attention to the plight of those Members with long-term health conditions, the clinically extremely vulnerable, those with shorter-term disabilities and those with caring responsibilities, for whom no provision is being made after remote participation finishes.

My starting point in our debate in May was that the ability to participate remotely, while developed to deal with the pandemic, should continue in certain forms to give everyone in your Lordships’ House an equal chance to participate. I was not alone in voicing those sentiments.

We are taking decisions today on the future working practices of the House at the same time as the Government have decided—recklessly, in my view—to scrap all measures introduced to keep us safe in the face of rapidly rising infection rates driven by a far more transmissible variant. This has real consequences for those for whom leaving home to take public transport and entering public buildings, such as Parliament, will become impossible if they cannot guarantee that others will be wearing face coverings after that ceases to be a legal requirement. That includes Members of this House who are clinically extremely vulnerable, as well as those living with family members who fall into this category.

Parliament, as we all know, with its many small and narrow corridors, its very crowded areas around the Chamber and its really tightly packed Division Lobbies, is an extremely difficult building to make Covid-secure. So I ask the Leader of the House whether, in September, we will be following the Chief Medical Officer’s advice to continue to wear masks in crowded indoor spaces, of which this Chamber is clearly one? What assurances can she give me that concerns about overcrowding will be taken into account when new proposals to vote in person using pass readers are put to the House in the autumn?

For me, this is personal. Having had two knee operations in the last nine months, my mobility has been severely impaired, making me effectively housebound for much of the period. Using the Tube has been pretty much impossible for me. Participating remotely, which I have done continuously during this period, has been my only real means of participating and contributing. In brief, I have had a short-term disability. So yesterday I sought some advice from employment law experts on how the requirements of the Equality Act 2010 to provide reasonable adjustments applies to people who may not have a long-term disability, as defined in the Act, but nevertheless have an impairment which impacts on their ability to perform day-to-day activities. I was advised that any good employer would be expected to make reasonable adjustments in these circumstances. I was also advised that, if someone had caring responsibilities that required them, for example, to be present at a prescribed time to supervise medication, it would be considered discrimination by association not to make reasonable adjustments to allow them to do so, if the means existed—which they clearly do; the system for remote participation is up and running.

So will the Leader say what legal advice has been sought on how removing the ability to participate remotely for those relatively few noble Lords with real and genuine needs to do so complies with the Equality Act? Will she also explain why there was no consultation about the new arrangements for people like myself with shorter-term disabilities—those with post-operative restrictions, the clinically vulnerable, and so on—and why the definition of “disability” has been drawn so tightly?

Finally, I make a heartfelt plea that the House of Lords Commission, which will be overseeing the process for deciding who will be eligible for continued remote participation, will look again at the issues I have raised, in the hope that good sense and common decency will prevail.

House of Lords: Remote Participation and Hybrid Sittings

Baroness Tyler of Enfield Excerpts

Thursday 20th May 2021 Lords Chamber

[Baroness Tyler of Enfield (LD) [V]]

My Lords, it is always a pleasure to follow my noble friend Lord Addington. It is quite hard to have completely new insights at this point in a debate, so I will focus on those things I feel most strongly about. I have listened very carefully to the debate and there are essentially two camps. I have a very clear and simple view on this issue: the ability to participate remotely through our hybrid proceedings, although developed to deal with the pandemic, should continue in certain specific forms to give everyone in your Lordships’ House an equal chance to participate.

As we have heard, virtual participation has had some important benefits, including enabling Members to participate who might otherwise find it difficult to attend the House in person. This includes Members with disabilities, long-term and sometimes fluctuating health conditions or caring responsibilities, as well as those who are geographically distant from Westminster. It was deeply moving and humbling to hear the contribution from the noble Baroness, Lady Campbell. I totally support her view that remote participation should be classed as a reasonable adjustment—something any decent employer would do and, frankly, is obliged to do. We make the laws of this country; how can we possibly say that they do not apply to us?

The needs of Members with caring responsibilities are something we very rarely talk about, but they are a real constraint for some of them. We heard powerful contributions on this from my noble friends Lady Humphreys and Lord Bradshaw. At a time when we are rightly promoting better support for this in the workplace more generally, we should also apply these considerations to ourselves. Remote participation has contributed to levelling the playing field for parliamentarians with caring responsibilities, many of whom are women.

Unlike other noble Lords, I do not see that retaining some hybridity for those who need it as being in opposition to doing a good job of exercising our scrutiny function and holding the Government to account. As most Members happily return to the House physically over the coming months—and I look forward to doing so when it is safe—the two can happily coexist if there is a will to make it part of a broader modernisation agenda. It will make our representations more representative of the overall population and, frankly, make us seem more relevant to the world at large. As many noble Lords have said—the noble Baroness, Lady Quin, was particularly eloquent on this point—at the moment virtually every organisation is fundamentally reviewing its working practices to retain the benefits of flexible and remote working and we should too; otherwise we will, in the memorable words of the noble Lord, Lord Bourne of Aberystwyth, simply be preserved in aspic.

Speaking personally for a moment, remote participation has been a godsend for me following knee surgery last autumn and a very long recovery period when I simply would not have been able to come in physically because of my restricted mobility. Participating remotely has been my only realistic opportunity to make a contribution to proceedings. I would be very unhappy if that opportunity was not available in future, so I agree with Professor Meg Russell of University College London’s Constitution Unit that decisions about the workings of Parliament need to be underpinned by the fundamental principle of equal participation. That fundamental principle should extend beyond the pandemic and become enshrined in our ways of working.

It is quite wrong for us simply to ape the arrangements in the other place. We have heard the charge many times today that as it is going back to the old normal so we must too, but such an approach fundamentally fails to respect the fact that we are meant to be a different type of House with part-time Members as well as full-time Members. We should take seriously the real benefits of having Members who are still actively engaged in external work, be it paid or voluntary, who are able to bring up-to-date expertise into the Chamber. Part-time Members need to be able to plan their work commitments on a sensible basis, and that requires some flexibility. It is quite different from the Commons and requires a different set of working arrangements, so I respectfully disagree with the noble Lord, Lord Forsyth, on that point.

There is one point I would like us to learn from the Commons. We should review our working hours and try to bring them into at least the 20th century, if not the 21st. The Commons has managed to do this to provide greater certainty about hours and the timing of votes to allow more predictable planning more in line with modern expectations and caring commitments.

On Oral Questions, I strongly support the line that many noble Lords have taken in support of a list. Our old habit of shouting and baying and the bear pit at Question Time frankly often brought this House into disrepute, and the loudest voices too often drowned out those with the most to contribute.

To summarise, I strongly support the views of the noble Baronesses, Lady Finlay and Lady Bennett, my noble friends Lady Bowles and Lady Bakewell, and many others—they do not all begin with “B”—that this is a great opportunity for us to embrace a long-overdue modernisation of our working practices, to get rid of some of our more anachronistic ways, which were designed for a very different age, and to adopt a new normal which appears far more relevant to the outside world.

Covid-19 Update

Baroness Tyler of Enfield Excerpts

Thursday 13th May 2021 Lords Chamber

[Baroness Evans of Bowes Park (Con)]

I am afraid I cannot say anything further than that the inquiry will begin work in spring 2022. But I can certainly assure the noble Baroness that my right honourable friend the Chancellor of the Duchy of Lancaster spoke to all the First Ministers about the announcement of the inquiry, and we have pledged to work with them to establish it and ensure they are involved—so, yes, conversations have been had and will continue to be ongoing.

[Baroness Tyler of Enfield (LD) [V]]

My Lords, I searched the Prime Minister’s Statement in vain for any mention of care homes or social care. We must never forget that during the first wave almost 20,000 care home residents died, representing 40% of all Covid deaths registered in that period—and that is likely to be an understatement of the true toll. So what assurances can the Leader of the House give to the bereaved families that the reasons for this catastrophic failure to protect our most vulnerable citizens will be fully investigated and the lessons learned, so that such a tragedy can never happen again?

[Baroness Evans of Bowes Park (Con)]

As I have said, the inquiry will be a thorough examination across the breadth of our response. Obviously, the situation in care homes has been at the forefront of our minds throughout this pandemic. It is not for me to make commitments, but I cannot believe that this would not be something the inquiry looks at. I am sure that it will be and that relatives and those who work in care homes will be called to give evidence.

Financial Services Bill

Baroness Tyler of Enfield Excerpts

Report stage
Wednesday 24th March 2021 Lords Chamber

[Baroness Tyler of Enfield (LD) [V]]

My Lords, I am pleased to speak in support of Amendment 1. First, I must apologise to the House that I have been unable to participate in earlier stages of the Bill—a matter of real regret to me—but I have been following proceedings closely. I declare an interest as a member of the Financial Inclusion Commission and president of the Money Advice Trust.

I am very keen to support this amendment, which takes forward a very important recommendation from the report of the Financial Exclusion Select Committee, which I chaired, in 2017. That report recommended an expansion of the remit of the Financial Conduct Authority to include both a statutory duty to promote financial inclusion, and a statutory duty of care. In my view, the two are closely linked, but I will obviously focus now on this very important duty of care amendment.

At the Liaison Committee’s follow-up inquiry on financial exclusion, held only last week, powerful evidence was received from charities and others active in the sector that the commercial model only goes so far, and that legislation is required to put an obligation on banks and other financial service providers to provide appropriate services to customers and have proper regard to inclusion.

House of Lords: Working Practices

Baroness Tyler of Enfield Excerpts

Thursday 1st November 2012 Lords Chamber

[Baroness Tyler of Enfield]

My Lords, I congratulate the noble Lord, Lord Filkin, on securing this debate and on all his efforts to maintain momentum on the much needed modernisation of the working practices of your Lordships’ House. I speak as a relative newcomer to this House and, after just under two years, hope to add the perspective of someone who is still able to view its often rather arcane and mysterious workings through fresh eyes.

It was clear to me that it is important to view the recommendations in the Goodlad report as a coherent package that needs to be addressed in the round. I was therefore encouraged when the Leader of the House in our debate last year said:

“I … intend to ensure that a large number of the group’s recommendations are considered promptly by the relevant committees of the House so that the House may take a view on them at the earliest opportunity”.—[Official Report, 27/06/11; col. 1552.]

As we have heard today, some of those recommendations have been addressed and indeed accepted by the House, and I welcome that, but to me the response has felt rather piecemeal. To the best of my calculations, and I am more than happy to be corrected on this point, roughly half of the recommendations have yet to be addressed. One good example of that is what I felt were the very good recommendations for pre-legislative scrutiny and post-legislative scrutiny and the establishment of a legislative standards committee, which I strongly support as part of the package. In my view, a legislative standards committee would provide a powerful incentive to improve the quality of legislation coming forward and ensure that legislation was being used for the right purposes and was capable of being implemented.

My almost 20 years as a civil servant in Whitehall taught me that hurriedly drawn-up legislation often backfires, and nothing has more forcibly underlined that to me than the many hours I spent with others debating all stages of the Health and Social Care Act. It was the first Bill that I had scrutinised in depth, and something of a baptism of fire. I am conscious that the Bill left this House in a very different shape from that in which it came in, which in my view is very much to be welcomed, but I am also conscious that after the myriad amendments that were passed there was no proper opportunity to look at it in the round and ask whether it all hung together sensibly. I have to ask myself whether that is a sensible, let alone optimal, way to make the laws of the land.

I also strongly support the proposal for a Back-Bench debates committee to help with the choice and scheduling of debates. I hope that it would be able to use criteria such as topicality, interest to the wider public, variety, coverage of key subject areas and the opening up of the process to much-needed transparency.

I welcome the setting up of two additional ad hoc Select Committees and have the privilege to sit on the new Select Committee on Public Service and Demographic Change. This is an excellent example of taking a longer-term view of some very cross-cutting issues; indeed, I can hardly think of a more pressing social challenge facing this country. We should have more such committees to allow others to contribute their expertise, and perhaps fewer of some of our more traditional types of business.

There are many other issues that I would have liked to have talked about, not least how the House’s highly unpredictable nature impacts on part-time Peers, colleagues like me from all Benches, who are still active in their professional and external lives—with one foot in the outside world, you could say—in a way that helps to ensure that the much vaunted virtue of this House, expertise, is indeed up to date.

I shall conclude with a suggestion that I suspect some will find rather barmy. Most modern-day institutions have regular satisfaction surveys to gauge the views of their members or their staff. We have surveys, but they are generally to do with the satisfaction or otherwise with the services and facilities of this House. I would like to see a survey sent to all Members asking how satisfied they are with the way that business is currently conducted and what else could be done to make better use of their skills and expertise. I recognise that this would be quite an innovation but I ask my noble friend the Leader of the House to give it serious consideration. As an incentive, should one be needed, I am more than happy to offer my services in suggesting what questions we should be asking.