Health and Care Bill

Baroness Walmsley Excerpts

Lords Hansard _ Part 1 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

I was coming on to that point. I would really appreciate a dose of honesty in this House. If those people who are so hostile to smoking a legal product believe that it is the killer they allege, they should call for smoking to be made illegal and be done with it. At the moment, tobacco companies are legal companies. People talk about them with such distaste, as though they should be abolished. It would be better and more heartfelt if they argued that tobacco should be illegal; then we would have a different debate. Public health is not always neutral when you talk about public health lobbyists, in my opinion. The freedom to choose to do something that is bad for your health is still allowed in a free society, despite some people wishing it was not.

[Baroness Walmsley (LD)]

My Lords, I do not recall anybody suggesting in the debate that tobacco companies should be made illegal. I hope that the noble Lord, Lord Naseby, is not suggesting that, just because the number of smokers is going down, nothing more should be done. I thought I heard the noble Lord, Lord Crisp, suggest that, if we carry on at this rate, it will be another 25 years before we get to where we need to be.

[Lord Naseby (Con)]

I was suggesting that we do carry on because the evidence is there in government data, not in a forecast from the noble Lord, Lord Crisp, or some minor operation that he—

[Baroness Penn (Con)]

I remind noble Lords that only short questions of elucidation are allowed on Report.

[Baroness Walmsley (LD)]

Many thanks. I suggest to the noble Lord, Lord Naseby, that a lot more people will be dead from tobacco if we carry on at this rate. He suggested that, just because this measure was not in the Conservative Party’s manifesto, perhaps we should not carry it forward. Well, the Conservative Party does not have all the best ideas, although I congratulate the Government on the sugary drinks levy, which has been highly successful. We support the polluter pays amendment introduced by the noble Lord, Lord Crisp. I might call it the killer pays amendment because, make no mistake, this is a killer substance.

I happen to live in Wales so I want to raise a matter that has not been mentioned yet. I am glad that the Welsh Government have committed to a smoke-free Wales by 2030. However, although England announced its intention to go smoke-free by 2030 two years before Wales did, Wales has leapt ahead as regards action, which is why I hope that the Minister will either accept Amendment 158 or give adequate assurances. In the Green Paper of July 2019, the Government said:

“Further proposals for moving towards a smoke-free 2030 will be set out at a later date.”


Approaching three years later, still nothing has happened. There are no further proposals and no funding has been announced. In contrast, Wales has published concrete proposals, but many of the interventions require action from the UK Government. Examples include the polluter pays funding mechanism, which could help to fund tobacco control in Wales; raising the age of sale; and putting warnings on cigarettes and pack inserts. I am concerned that, by being so slow, the UK Government are undermining the ability of the devolved Administrations to achieve their smoke-free ambitions. We will support the noble Lord, Lord Crisp, if he chooses to put this amendment to a vote.

[Baroness Merron (Lab)]

My Lords, I am grateful to noble Lords for their contributions to this debate and for putting forward this group of amendments. In introducing Amendment 158 and the consequential amendments, the noble Lord, Lord Crisp, outlined that they would establish a consultation on a polluter pays levy whereby funds are raised by the scheme to pay for the cost of tobacco control measures to deliver a smoke-free 2030. This strikes me as wholly pragmatic; a wide-ranging consultation would undoubtedly help to strike the right balance between all the parties involved.

We know from this debate and many previous debates that tobacco use carries huge health risks, and disproportionately so for the most disadvantaged in society, whose likelihood of smoking is four times higher in the most deprived areas compared to the least deprived. If ever there was a case for levelling up, this is it. My noble friend Lord Faulkner rightly highlighted that we have seen cuts to stop-smoking services, and this group of amendments seeks to redress the situation in a practical way. It is vital that we motivate and support more smokers to quit, while reducing the numbers of children and young people who start to smoke. Greater action is clearly needed now.

The scheme proposed in this group of amendments would provide a well-funded and much-needed boost, and a consultation would allow this proposal to be tested, refined and shaped. I hope that the Minister will accept the opportunity of a consultation but if the will of the House is tested, these Benches will support the amendments.

--- Later in debate ---

[Baroness Bennett of Manor Castle (GP)]

My Lords, I feel I have to respond immediately to that. I intended to speak anyway, having attached my name to an amendment on alcohol advertising in Committee. I would have attached my name to this amendment both in Committee and on Report, had there been space.

The noble Lord, Lord Vinson, talked about freedom of choice. I do not know how many people know that a bottle of wine can contain anywhere between zero and 59 grams of free sugar per bottle. Surely the public do not have the freedom of choice to decide which wine they consume and which level of sugar they consume.

The noble Lord made a point about the difficulty of labelling. Bottles of wine are shipped to many different countries with labels in different languages. We have computers these days which can cope with these things quite simply and easily. It is clearly not beyond the wit of producers to achieve this.

The Government often like to talk about being world-leading. I point them to an editorial in the Lancet Gastroenterology & Hepatology titled Shining a light on international alcohol industry lobbying, showing just how powerful this incredibly wealthy industry is in influencing and damaging public health messages around the world. Would the Government not like to be world-leading in standing up against this industry lobbying, in the interests of public health?

[Baroness Walmsley (LD)]

My Lords, at the risk of being boring, I am one of those people who has been asking for this for the last 20 years. I started off asking for the number of units of alcohol in a bottle of wine. Every manufacturer of these alcoholic drinks knows exactly what goes into them. On the issue of labelling products from abroad, there are a lot of foodstuffs that come from abroad and they have to abide by British rules on labelling, so why not wine and spirits? It is time we did this. It is terribly important for public health, and I hope the Minister will say yes.

[Baroness Merron (Lab)]

My Lords, I thank the noble Baroness, Lady Finlay, for bringing forward Amendment 163, and thank other noble Lords for outlining their support for or concerns about it. The amendment refers to publishing a report on alcohol labelling to improve consumer knowledge.

Government data comparing pre-pandemic and post-pandemic figures has shown that sales of alcohol increased by some 25%. This is, as we know, a booming market and consumers need to be equipped with the right information to make informed choices. They have a right to know what is in their drinks and decide what and how much to drink. The consultation promised by the Government, with this in mind, remains something of a consultation in long-overdue waiting.

Currently there is no requirement for alcoholic drinks to include health warnings, drinking guidelines, calorie information or even ingredients. As my noble friend Lord Brooke said, this is very much out of step with any other information on what we consume. There is, as always, a balance to be struck between health improvement measures, consumer information and industry regulation, but this amendment supports a necessary move in the right direction and I hope the Minister will agree to it.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

My Lords, I was glad to have been able to put my name to Amendment 166 about PERT. In this Bill, the Government have introduced a milestone in changing the care of people who are facing serious illness at the end of life.

The reality, as we have already heard, is that the majority of patients with pancreatic cancer are diagnosed late, because it comes in the head of the pancreas. The pancreas has two parts—the head and the tail. But, because it can grow without causing much pain in the initial stages, it often goes undetected until it is fairly advanced. That means the outlook is poor. The other thing it does, as it grows, is block off the flow of enzymes into the gut. Without replacement, these patients get a malabsorption syndrome; they can get terrible diarrhoea and muscle wasting, because they are not absorbing the nutrients they need.

This amendment is very important. It could quite easily build on the network that will now be in place to commission specialist palliative care services. The move the Government have made has been welcomed across palliative care in this country and is being seen as a way to dramatically change the care of patients. With data information flows now integrated and networked across the NHS, we will be able to get accurate data on how many patients with pancreatic cancer are getting replacement therapy when they need it. Some people do not need it; some need it later on. This is part of building on the important foundation the Government have laid. It was that which persuaded me to put my name to Amendment 166.

Another point I would like to make is about improving things for the lowest quartile of the population. Incidence of pancreatic cancer is highest in the most deprived areas and it is higher in women than in men. Part of levelling up, to help people to live well for as long as they can, is making sure they get the enzyme replacement they need.

[Baroness Walmsley (LD)]

My Lords, I have in my hands the latest cancer waiting time figures. It is very unfortunate that, despite the hard work of NHS staff, every single metric was worse in January than in December. It therefore seems a great pity that not all patients who have a diagnosis of this dreadful disease of pancreatic cancer can get this medicine, which can improve and even extend their lives.

I well remember a senior, well-loved and well-respected Member of the Labour Benches who died of this dreadful disease. We lost him far too early, because this disease takes people very quickly. Anything at all the Minister can say to encourage us that this effective and approved medicine can be made fully available to everybody who needs it—depending on the conditions, as outlined by the noble Baroness, Lady Finlay—would be helpful.

[Baroness Thornton (Lab)]

My Lords, can I say how much I support this suite of amendments? I congratulate the noble Lord, Lord Moylan, for tabling and speaking to them. This most lethal of killers has been defying science—or we at least have not had enough investment in the science—for many years. This means the survival rate is still not as it should be and as it is for other cancers. Anything that pushes the NHS and research community to tackle this and to set the targets that are needed to do so is very welcome. I look forward to what the Minister has to say.

--- Later in debate ---

[Baroness Grey-Thompson (CB)]

My Lords, I have spoken numerous times about my opposition to assisted suicide for many different reasons. It is not, for me, about the sanctity of life. Not everybody who believes that the law should not be changed has strong faith. However, we are continually being asked to vote through the principle and think about the detail later. The devil is in the detail.

Detailed scrutiny is our role as a revising Chamber. The Commons has so many of its amendments guillotined. However, we have to take an issue such as this, which is about ending people’s lives, very seriously and we have to debate some of the detail. I know that the noble Baroness, Lady Meacher, feels strongly about this and I wish she had pressed much harder and much earlier for a Committee stage for her Bill. In an issue such as this, when we are talking about ending people’s lives, there should be hundreds of amendments, because it has to be debated properly.

I would like to briefly go on the record to thank the hundreds of people who have written in. We are really lucky right now that we live in a democracy and that people are able to freely express their opinions, whether we agree with them or not. Our role in the House of Lords is to deal with those people who write in. Lots of people from both sides have written to me. However, we must also be really careful in our language and not scare people into thinking that assisted suicide is the only option for them.



As a disabled person who sits in this Chamber with a red stripy badge, I have a huge amount of privilege. Many, many thousands—tens of thousands or more—of disabled people do not have privilege in respect of protection. This amendment and what it seeks to do will fundamentally change the political and societal landscape for disabled people. If people have not read it, they should look at the article by the noble Lord, Lord Shinkwin, this weekend about how disabled people are encouraged to think that they would be better off dead than live with an impairment. Even in this Chamber, we hear about things such as incapacity and incontinence and all the things that people fear. I push back on that, and I push back on the view that public opinion is overwhelmingly in support of this. On the Dignity in Dying website, 284,881 people have signed the public petition. On the Commons website, asking for a change in the law, 46,483 people have done so. That is not overwhelming public opinion.

I know the frustration of people who want to change the law. I can feel it; we hear it, and I admire the fact that the noble Lord, Lord Baker, says that we are a democratic Chamber. There are plenty on the outside who would not agree with that in terms of the way that we operate. This, however, is a constitutional matter. For all those arguing in favour of this tonight, I really look forward to them supporting my Private Member’s Bills asking for things such as good education, work, social care and access to trains, which are the things for which disabled people are arguing. This is not it: this is not the right time and not the right place. I do not support this amendment.

[Baroness Walmsley (LD)]

My Lords, I think the mood of the House is that the Front Benches—

[Lord Shinkwin (Con)]

My Lords, may I just be indulged by the House in following the excellent speech by my noble friend Lady Grey-Thompson? Exactly seven weeks ago, not just to the day but to the exact hour, I started to feel very ill. I was barely 36 hours out of the operating theatre after surgery that had gone incredibly well and I knew something was seriously wrong. By midnight I was in agony, my bowels totally blocked by the combined effects of the anaesthesia and the pain relief. By the morning, I was passing blood and my haemoglobin levels had plummeted. That was just seven weeks ago. It was at that point that a decision was made to transfer me by ambulance to St Thomas’ A&E so that I could have an urgent blood transfusion. I lived to tell the tale, but tell it I would much rather not have done. I would much rather forget the whole episode—the unbelievable pain, the helplessness and the acute sense of vulnerability. My family do not know any of this; I have not told them. I am hoping they do not read Hansard.

I share it with your Lordships’ House because I believe that my recent experience is directly relevant to Amendment 170. We have been assured that this is not about the merits of assisted dying, but noble Lords should not underestimate the magnitude of what is at stake in this amendment. This is not the start of some cosy conversation about a harmless, anodyne measure. The end goal is assisted suicide and the means is a Bill proposed in this amendment. If this amendment were passed tonight, I firmly believe that in years to come, we would look back and say that today—16 March 2022—was a pivotal moment.

--- Later in debate ---

We are summoned by our sovereign to this place, whether physically in person or remotely, precisely because it is our obligation and responsibility—indeed, our solemn duty—to fast-forward to the worst-case scenario and to pre-empt and prevent that worst-case scenario in law. I fear that the effect of the amendment would be the opposite.

[Baroness Walmsley (LD)]

My Lords, as the noble Baroness, Lady Grey-Thompson, rightly said, the devil is in the detail. That is what Parliament does and it is what the noble Lord, Lord Forsyth, is asking your Lordships to allow Parliament to do.

Like many families across the country, my family has had discussions about the substantive issue of assisted dying. Different views have been expressed and no one has fallen out, but it is not around our dinner table that decisions must be made about an issue as serious as this; that is for Parliament. I trust Parliament, and I do not think it should be—as the noble and learned Lord, Lord Falconer, pointed out—for the Director of Public Prosecutions to make decisions about these issues. Assisted dying is happening and Parliament must decide how or if it should be done.

It has been suggested that this House should not instruct the Secretary of State to do anything. As we have gone through the Bill, we have asked the Secretary of State to do quite a lot of things; in fact, we have voted that the Secretary of State should do a lot of them. What happens to those amendments? They go to the elected House. I have great respect for the noble Lord, Lord Cormack, and I understand how important he feels it is that issues as controversial as this should be decided by the elected Chamber. Well, if we vote for this amendment, those issues will be decided by the elected Chamber. If this novel procedure of a draft Bill being laid before Parliament is used, I trust Parliament; there will be proper debate and I hope that what will come out of it will be a very measured piece of legislation that takes all the concerns into account. The game-changer that my noble friend Lady Finlay has successfully introduced to the Bill will be taken into account by the elected Chamber.

It is very important that people who want to have palliative care to ease their suffering at the end of life actually get it—everyone should get it; there should be no postcode lottery—but even in those situations there may be people who do not want it and instead want to do something else. It is for Parliament, not for my dinner table or anyone else’s around the country, to make that decision and to be given the proper amount of time to come up with something that I hope will reassure those who rightly have fears. They have fears because they do not know what Parliament will decide. If we give Parliament the opportunity, I am quite sure that even a draft Bill, however well drafted, will probably be amended as it goes through the elected House. What will come out at the other end will probably reflect public opinion—genuine public opinion, that is; I am not quoting any polls on either side—as they will have given serious thought to the issue and listened to everyone who wants or does not want this measure on the statute book.

We must give the elected Chamber the opportunity either to accept an amendment that we may pass tonight or to send it back to us, but at least we will have asked them to think again. This House does that very well. We ask another place to think again. I hope we will tonight.

[Baroness Merron (Lab)]

My Lords, I have listened very closely to the many passionate, informed and often personal contributions from noble Lords this evening. This debate has inevitably been about not only parliamentary process and legislative approach but consideration of assisted dying. I thank the noble Lord, Lord Forsyth, for opening the debate on Amendment 170, which proposes, as your Lordships’ House is more than aware, a new clause to bring forward a draft Bill on what the noble Baroness, Lady Campbell of Surbiton, described as a complex and difficult issue.

However, for me, the challenge of this debate is encapsulated in the contributions in the middle of it. The first, from the noble Baroness, Lady Davidson, was that not allowing time for discussion is not a neutral act. This was followed swiftly by my noble friend Lord Hunt taking a different tack, saying that allowing for this amendment is also not a neutral act, and it is that which your Lordships’ House has wrestled with this evening.

It is indeed a matter of profound moral, personal and legislative importance that we find ourselves dealing with in Amendment 170. The noble Lord, Lord Forsyth, will be seeking a Division and these Benches will approach this on free votes. It is a shame that this is not the case on the Government Benches. Your Lordships’ House heard from the noble Lord, Lord Baker, about the importance of principle, whereby matters such as this should be subject to nothing other than a free vote. I certainly share that view. I know that noble Lords will exercise their vote this evening with the greatest of care.

Health and Care Bill

Baroness Walmsley Excerpts

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

[Baroness Walmsley (LD)]

My Lords, I wish we were talking about restricting the advertising of gambling; that would have more effect on the health of the country than this. However, these are very important measures. Before I talk about the three major groups in this grouping of amendments, I thank the noble Lord, Lord Hunt, and my noble friend Lady Barker for raising the really important issue of nutrition to patients in hospital and people living in residential care homes.

The rest of the amendments fall into three broad groups. First are the amendments in the name of the noble Lord, Lord Moylan. While he was telling us the very sad story about the manufacturers of the Grenade bar, about how much protein it has and how little carbohydrate, I was wondering: what about the other major nutrient, fat? Noble Lords will remember from their biology lessons that, gram for gram, fat has twice as many calories as either carbohydrate or protein, and if you eat an awful lot of those bars, you will get fat—the “F” in HFSS foods. Of course, one “S” in HFSS foods stands for salt, and the noble Lord, Lord Krebs, has now told us exactly what is in that bar—far too much fat and far too much salt.

However, the noble Lord, Lord Moylan, raises a point which I raised in Committee: the nutrient profiling model is 11 years old. I asked the Minister whether there are any plans to update it, because companies really need up-to-date information about exactly what will fall within the ban and what will not. So I ask the question again: are there plans to update that 11 year-old guidance? We really do need it, because then companies such as the one mentioned by the noble Lord, Lord Moylan, and many others, will really know what they are dealing with. It certainly does not sound to me as though that bar will fall outside the restriction on advertising.

I have added my name to the amendments in the name of the noble Lord, Lord Bethell. I remember when, in Committee, the Government introduced this power to extend the deadline—they did not say how long for—and I asked what this was for and why the Government needed to extend the implementation of these restrictions. The Minister, the noble Baroness, Lady Penn, said it was just in case there were any hitches with the consultation. I think the noble Lord, Lord Bethell, is right and there is certainly a hint of long grass in what the Government were trying to do. I was a bit suspicious about it in Committee, and I still am. I support what the noble Lord, Lord Bethell, is trying to do.

All the industries concerned with these measures have had plenty of notice of what the Government wanted to do, and I think, once the detail comes forward, they will have had plenty of time. Perfectly reasonably, the noble Lord, Lord Bethell, is asking for that power that was taken to extend the deadline to be limited to just three months. That is quite enough.

As for the amendments from the noble Lord, Lord Black, I agree with my noble friend Lord Clement-Jones, although not necessarily for the same reason. Of course, there is a fairness issue here, but I think that, if the responsibility for implementation and making sure there was compliance was extended to online platforms, it would strengthen the objectives of these measures from the Government, which I support. Therefore, if he puts his amendment to the vote, we will vote for him.

[Baroness Merron (Lab)]

My Lords, we have had a considerable debate on these issues, in Committee and this evening in your Lordships’ House. From these Benches, we absolutely support the provisions to tackle obesity. The reasons have been gone over many times, but I make one point in respect of children—that children with obesity are five times more likely to become adults with obesity, and increase their risk of developing a range of conditions, including type-2 diabetes, cancer and heart and liver disease. It is incumbent on us to take the steps that are necessary.

Given the lateness of the hour—and I know that noble Lords wish to get to the question whether there is to be a Division—I shall focus my comments on the amendments relating to advertising, Amendment 151A, in the name of the noble Lord, Lord Black, and the subsequent amendments, to which I have put my own name. There has been a great clarity of argument as to why those amendments deserve favour, but the one that sticks out for me is about ensuring the effectiveness of the legislation that we are speaking about.

We already know that legislation can have a huge impact. For example, the soft drinks industry levy has led to manufacturers reducing 44 million kilograms of sugar each year from drinks in the UK. We also know of the support for the measure of the watershed for advertising of high-fat sugar and salt products—in other words, to protect children from those influences. We know that the measure is supported by organisations such as the British Heart Foundation, the Food Foundation and many other experts as being able to make the difference, because children are influenced by advertising. We should really be ensuring that children see adverts for healthier food and drinks.

Should the will of the House be tested on these amendments, these Benches will certainly be in support, because we feel that the Government should make sure that the proposed pre-9 pm ban on advertising unhealthier foods on TV, with a total ban online, has to be implemented effectively and appropriately across all media and platforms. If it is not and remains as it stands, it will not do the job that it is intended to do, and we will miss an opportunity, which we hope the Minister will reflect on, as the case has been made so clearly and directly.

Health and Care Bill

Baroness Walmsley Excerpts

Committee stage
Friday 4th February 2022 Lords Chamber

[Lord Bethell (Con)]

I will also speak briefly in support of the register for social care workers, and I very much echo the words of my noble friend Lord Young. During the pandemic, we faced a huge challenge in identifying who social workers were. That meant that we struggled to distribute PPE, to get testing to the right people, to allocate and reallocate responsibilities when we tried to move away from itinerant service, and to create the vaccine prioritisation list. In the longer term, the question of the education of social care workers is absolutely essential, and a register is imperative to do that. In contrast with the NHS, the lack of a register of social care workers is a real impairment to the modernisation of social care working. For that reason, I ask the Minister to say a little more about his consultation and think very carefully about a mandatory register.

[Baroness Walmsley (LD)]

My Lords, last week, when we debated the call for a separate list of properly qualified cosmetic surgeons, I received a briefing from the GMC about the forthcoming new system of professional regulation. I asked the Minister when this would be forthcoming, but I fear that he was not able to give me a clear answer. This matter has been hanging around for a very long time, but, when I scrutinised Clause 142, I saw that there was another problem: in future, the regulation of healthcare professionals can be made through secondary legislation—and whether this would be agreed by the negative or affirmative procedure is not clear.

The Explanatory Notes make clear that subsection (2)(e) —the powers to remove certain professions from regulation—

“includes the currently unenacted provisions concerning social care workers”.

Like the noble Lord, Lord Young of Cookham, I want to ask the Minister about this, because many noble Lords, including me, have been asking that social care workers have the opportunity to obtain qualifications that would provide them with registration and a career path to better pay and conditions—but this sounds like the opposite to me. Perhaps the Minister can explain this and tell the House when the new regulatory system will be ready. The 2017 report of your Lordships’ House’s Select Committee on the long-term sustainability of the NHS said:

“The current regulatory landscape is not fit for purpose. In the short term, we urge the Government to bring forward legislation in this Parliament to modernise the system of regulation of health and social care professionals”—


I emphasise “social care professionals”—

“and place them under a single legal framework as envisaged by the 2014 draft Law Commission Bill.”

That was five years ago.

I have also received a briefing from the Health and Care Professions Council. It appears from this that the HCPC has a rather different view from the GMC: it wants the new professional regulation of health and care professionals to be collaborative and innovation focused. It believes that the current system is “siloed”, and it is looking for multiprofessional regulation, which, it believes, better reflects current working practices in the NHS. I am not an expert in this matter, so I express no opinion on that, but I am looking for some clarity from the Minister on which direction the new regulation system will take and the evidence that this will be better than before and contribute to better quality and safety of care for patients. I would also like to know when it will happen, because Clause 142 appears to me to open the door to a fight between different regulators, which would not be helpful.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

I thank all noble Lords who spoke in this debate. As a number of noble Lords have acknowledged, the case for reforming professional regulation has long been acknowledged, and stakeholders have long expressed concern that having nine separate professional regulatory bodies is confusing for the public. So our response in 2019 to the public consultation on regulatory reform reflected the desire for fewer regulatory bodies to deliver benefits to the professional regulation system.

In the 2020 consultation Regulating Healthcare Professionals, Protecting the Public, we committed to a review of professions that are currently regulated in the UK to consider whether statutory regulation remains appropriate for these professions. A consultation seeking views has been published, and it will close at the end of March this year. We also commissioned KPMG to carry out an independent review of the regulatory landscape, and it submitted its report at the end of last year. Officials and others are now poring over the findings to consider how best to respond. However, as with any use of Section 60, a public consultation will be carried out on any legislation made under these powers, and this would face scrutiny through the affirmative parliamentary process.

On the core criteria and principles, the professions protected in law must be the right ones, and the level of regulatory oversight must be appropriate and proportionate to the risks to the public. This is why we have sought a number of views on the criteria for determining whether statutory regulation is appropriate. As I said, we will wait for the outcomes.

These proposals have been developed in partnership with the devolved Administrations, and we will continue to work in partnership with Scotland, Wales and Northern Ireland in taking forward any proposals for using these powers. This will also be subject to affirmative parliamentary approval.

Clause 142 provides additional powers that would widen the scope of Section 60 of the Health Act 1999 and enable the Privy Council to make additional changes through secondary legislation, as was acknowledged. Subject to consultation, we are aiming to enable the professional regulatory landscape to become more streamlined and work more flexibly. We think that this clause will make it easier to ensure that the professions protected in law are the right ones and that the level of regulatory oversight is proportionate to the risks to the public. The Government keep the professions subject to statutory regulation under review. As I said, as part of our work to reform healthcare professional regulation, we are continuing to consult.

As I said, any secondary legislation made using the new powers would be subject to Schedule 3 of the Health Act 1999, public consultation and the affirmative parliamentary procedure, thus ensuring that there is clear parliamentary scrutiny and transparency in relation to any changes made by secondary legislation in this area.

I also refer back to the questions on the social care register, which I discussed at length, both before and after the recent Oral Question. When I spoke to officials about why the register cannot be compulsory, they said that this was fair, given the demographics of some of the people in the skilled sector, who quite often have some suspicions of authority and a lack of trust—we have seen that with vaccine take-up, for example—and so there were concerns about making it compulsory at this stage. It is voluntary. They want to understand the range of qualifications across the sector. There are a number of different qualifications, and, in professionalising the sector better, they want to make sure that they are consistent at all the various levels in our education system—levels 2, 3, 4, 5, 6 and upwards—to make sure that those qualifications are mutually accepted and recognised to make social care an attractive career and vocation.

For these reasons, I ask that Clause 142 stand part of the Bill.

--- Later in debate ---

[Lord Willis of Knaresborough (LD)]

My Lords, I first apologise for not being present at Second Reading. It is unusual for me not to be there when a health Bill is being discussed, but I have had a lot of personal family problems.

Never, in the years I have been in both the Commons and the House of Lords, have I been as proud of a committee as I have been chairing the one on sport and recreation. I thought the committee would look very narrowly at sport and recreation and what could be done for them, but it ended up with a set of proposals that are quite revolutionary, which state something really quite different about the way forward, not only for sport and recreation but for the NHS itself. I am deeply indebted to the noble Lord, Lord Moynihan, for his leadership as our special adviser and for his membership of the committee, and of course to the noble Baroness, Lady Grey-Thompson, and the noble Baroness, Lady Morris, who is not here today, whose experience of working in the Department for Education was invaluable. As we heard earlier in the debate, that department has a crucial role to play in developing some of these key policies.

Like the noble Baroness, Lady Grey-Thompson, I would have preferred for this proposed new clause to be debated as a separate entity, but perhaps it was fitting that it was grouped with amendments that have a common theme, because despite the disagreements between various parts of the House on the previous set of amendments, they are all based around the same issue of how we get a healthier nation. It was incredibly rewarding to see that.

It might seem quite obvious that during the Health and Care Bill in the House of Lords we should be talking about health matters and improving health, but I have to say that, together with the 2012 Bill, so much of this legislation is about shifting the chairs again; it is not about looking at the future health of the nation. There will be marginal improvements from the bureaucratic changes in the Bill, but I was looking at what we can do to make a fundamental difference, and we will not do that until we change the fact that, as the noble Lord, Lord Stevens, said in that debate, the NHS is currently a repair-and-maintain service. It cannot go on like that because the money will run out and the number of people serving it will run out. We have to change it to a prevent-and-improve service, and that is what the new clause proposed by Amendment 297C is about.

It proposes just a minimum of reorganisation: for instance, simply moving sport from DCMS to the Department of Health is not a massive reorganisation. With moderate investment—nowhere in our report do we spend time talking about massive investments to get change; this is really about changes of attitudes—it has the potential to change the way in which the NHS operates to a very different mode of making sure that people do not get ill, as the noble Lord, Lord Stevens, quite rightly said. Indeed, the previous amendments were all about that too. Those amendments rounded on obesity and childhood obesity, and that is an area that we should be tackling; there should be masses of things in this Bill which are about supporting that, not just the odd one or two. Making people active from the cradle to the grave, or near the grave, seems to me the right thing to do.

Other amendments in this group rightly observe that what people eat and drink is related to their health outcomes. Given the alarming levels of obesity we have heard about this morning, I am very supportive of some of those, and particularly what the Government are doing in advertising. I fully support their approach, though clearly it is not a once-and-for-all idea.

How is it possible that the UK is world-leading in elite and professional sports, that 3 billion people across the world watch our Premier League matches in over 187 different countries and that, as the noble Baroness, Lady Grey-Thompson, has consistently said, at Olympics after Olympics we are near the top of the league in terms of our elite activities, yet for decades we have failed at grass-roots level to get more people from more diverse backgrounds to be more active, despite all the investment that successive Governments have made?

With one-third of the adult population at the moment getting less than 150 minutes of moderate activity each week; with schoolchildren doing consistently less activity both at school and at home; with PE marginalised in the school curriculum and no longer inspected by Ofsted while, as we heard in our evidence, many primary school teachers get less than three hours’ training in a three-year degree course, which is shameful, so physical literacy in most of our primary schools means nothing, frankly, because it does not appear on the league tables; with access to facilities ever more difficult; with local authorities closing swimming pools and leisure centres to save resources; and with transport non-existent for large parts of the day for large swathes of the community, we have become one of the most lazy, inactive nations in the modern world. Those sections of the population with the poorest diets and the worst levels of deprivation are, not surprisingly, the least active, too, and of course the pandemic has disproportionately affected all the target groups.

My colleagues and I sought in our report not to blame Governments, local authorities or sports and recreation providers, who have worked hard to maintain facilities. This is not a party-political amendment at all; all the groups on the committee were totally united. All the empirical evidence that we looked at shows the huge benefits from being active: improving learning at school; improving mental health; building up resilience and resistance to disease; and, above all, making people happier and more positive in life.

What is more, investing in active lives, as the Health Foundation research demonstrated, would save countless billions of pounds of future NHS spending by placing sport, physical activity and well-being at the heart of government within the Department of Health; by establishing in law an office for health promotion, sport and well-being to replace the Office for Health Inequalities and Disparities—whatever that means—with the same personnel as initially proposed by the Prime Minister himself; by making the Minister for Public Health, Sport and Wellbeing responsible for preparing the national plan that the noble Lord, Lord Moynihan, has so ably proposed, a plan that is at the centre of government policy in New Zealand, Australia, Norway and Sweden; by ensuring that the school curriculum places physical literacy alongside numeracy and literacy as a core subject; by making it mandatory for local authorities to provide active-life facilities; and by ensuring that the duties of care and safeguarding, so brilliantly articulated in the earlier review by the noble Baroness, Lady Grey-Thompson, are actually given legal enforcement status, years after they were proposed. We can begin by addressing the physical well-being of this nation. There need be no massive new bureaucracies. Using existing organisations, centralising policy and using the office for health promotion would be a game-changer.

If the noble Earl, Lord Howe, is a supporter of the levelling-up agenda, and I am pretty sure that he is a strong supporter, how better to make his mark than by supporting this amendment? It goes right to the heart of those government policies. If you are going to level up, level up at the start and make sure that we have an active nation.

[Baroness Walmsley (LD)]

My Lords, I regret that I cannot follow the edict of that late, great Liberal Democrat, Nicholas Parsons, and speak for only one minute. The Committee knows that it is my habit to speak very briefly, but unfortunately I cannot do that on this occasion, although I will do my best. It is my duty as a member of the APPGs for health, obesity and a fit and healthy childhood to scrutinise this legislation and the large raft of amendments that have been made to it.

The intention of Clause 144 is of course to reduce the rise in childhood obesity, an objective with which we all agree. An early attempt to do this via legislation was the UK soft drinks industry levy, the so-called sugar tax, which was introduced in 2018. Before the levy was introduced, it had already resulted in over 50% of manufacturers reducing the sugar content of their products after it was announced in March 2016, the equivalent of 45 million kilograms of sugar every year. That was the intention: to reformulate, not to raise tax. Since then it has continued to be highly effective in encouraging reformulation. In the 12 months following its introduction, the consumption of soft drinks rose by 7.7% as people chose healthier options, so neither the food industry nor the TV advertising industry suffered at all.

--- Later in debate ---

I say to the Minister that these amendments are effective and are required. They not just give people information so that they can make informed choices but, as the Canadian example shows, reduce the amount of alcohol that people purchase. They are vital now that we have a real understanding of the economic, social and health effects of a lack of investment in treatment services. If they are invested in, they can bring not just economic but social and health impacts.

[Baroness Walmsley (LD)]

My Lords, I have been in this House for 22 years and I have been asking for this for at least 20 of them. It really is time that the Government got on with it. At the time, I was told that most wine comes from abroad and we cannot legislate for what is put on the labels, but it cannot be impossible to put information on the shelf labels or online. If people do not know what they are putting inside their bodies, they cannot moderate it.

[Lord Sentamu (CB)]

My Lords, I support this amendment. I will tell a true story of a teetotal preacher who harangued his congregation that nobody should be drinking because it is dangerous, damages our health and damages everything else. “Alcohol should be banned,” he said, “and the best thing to do is go and drown it in the river.” Unwittingly, he then said, “Our final hymn is ‘Shall We Gather at the River?’ The beautiful, the beautiful river.” He did not see the contradiction in what he said. This amendment is full of clarity, clarifying areas that need to be put fairly clearly. The obligation that it puts on the Secretary of State and, incidentally, all of us is very clear. Because of the real danger in what overdrinking does to a lot of people, I say: no, we shall not gather at that river, that beautiful, beautiful river.

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, I certainly support these three amendments so ably introduced by the noble Lord, Lord Hunt, and the noble Baroness, Lady Cumberlege. The beauty of their presentations is that they not only outlined the terrible suffering that can be caused by the things we are discussing but came up with very reasonable solutions to make the situation better. That is what we always try to do in your Lordships’ House.

My noble friend Lord Storey put down Amendment 297E in this group. Because he was unable to make it today, I do not intend to speak to it. I do not think that would be appropriate in case he wishes to bring it back on Report. I think he would be happy to support all three of the other amendments, in particular Amendment 268 from the noble Lord, Lord Hunt.

I was interested to hear the noble Baroness, Lady Hodgson of Abinger, say just now that clinical negligence costs £2.26 billion per year. That is about the same as the whole budget of the Ministry of Justice and, as a result, hardly anybody can get legal aid these days. That is a very good reason why we should look carefully at the performance of NHS Resolution. There is clearly no incentive for the NHS lawyers to get things through quickly, because they are being paid anyway. The fact is that there is no equality of arms; I have said this on this subject before. It should be a principle of justice in this country that there is equality of arms, but in this case there is not—so I very much support the noble Lord, Lord Hunt.

[Baroness Wheeler (Lab)]

My Lords, this is an important group and there is little to add to the expert contributions on the amendments, which have been spoken to so comprehensively. We have always championed the need for patients’ voices to be heard and listened to in the care and treatment they receive, and are doing so in pressing for the patient voice to be properly embedded in the new structures established under the Bill.

When appalling safety incidents occur, such as those so graphically spelled out in the First Do No Harm report from the noble Baroness, Lady Cumberlege, we need not only to ensure that there are effective systems to make sure that victims receive the care, treatment and proper financial compensation needed but to enable the NHS to acknowledge and learn from what has happened, both to prevent further harm and to promote future patient safety.

In opening this group, my noble friend Lord Hunt made a strong case for an urgent, expert-led review of the 40 year-old Vaccine Damage Payments Act in the light of major developments and growth in vaccine usage and, of course, huge gains in population health and ill-health protection as a result. But the small numbers of individuals and their families who sustain serious injury or adverse reactions to vaccines—now to the fore as a result of the highly successful Covid vaccination programme—need legislative protection and a scheme that is up to date, fit for purpose, properly resourced and based on compensation levels and criteria that fully reflect the needs of today’s victims.

I am sure the noble Lord, Lord Storey, would have made an equally strong case for the repeal of the NHS Redress Act, a slightly younger 16 year-old scheme for adverse health incidents, which is out of date and also not fit for purpose.

The noble and learned Lord, Lord Mackay, led an expert and informed debate in Grand Committee last December on the NHS clinical negligence scheme and its ever-escalating costs, which is reflected today in my noble friend Lord Hunt’s Amendment 268 and its call for a major review of the scheme, including consideration of the Law Reform (Personal Injuries) Act and repealing its Section 2(4).

Health and Care Bill

Baroness Walmsley Excerpts

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

[Baroness Walmsley (LD)]

My Lords, I will be as brief as I can. I have a few words about some of the amendments in this wide-ranging group.

Amendment 243 would protect the title “nurse”. I know from family members that the qualification of registered nurse is always hard won, the result of very hard work. It involves rigorous basic training, often followed by further training in a specialty such as mental health nursing or surgery. The title provides a high level of trust among patients and the general population, because we know that a nurse must be registered with the Nursing and Midwifery Council, or a different responsible body for dental or veterinary nurses. There should therefore be clarity about who can use the title, and it could be sorted out very simply by the Minister—I hope he will do it.

A further anomaly, which the Minister can easily sort out in his reply, is that of the appointment of surgeons. I hope he will remove that anomaly as well.

I commend the work of my noble friend Lord Sharkey on rare diseases. I will not repeat what he said about what is needed, but I hope the Minister can give him some assurance.

I strongly support Amendment 266 on the need for a register for those who practise aesthetic non-surgical interventions. I will not repeat what my noble friend Lady Brinton and others have said about the reasons for this.

Amendment 293 requires a special register for cosmetic surgery. It is important that we have an up-to-date, comprehensive and rigorous method of assessing and registering the qualifications of surgeons safely to carry out cosmetic surgery. The question is: how is that done? I have received a briefing from the GMC, which tells me that it does not support the creation of a separate register for cosmetic surgery practitioners. Instead, the GMC believes that its proposal to move to a single GMC register that includes all doctors, anaesthesia associates and physician associates, and special annotation with work to develop relevant credentials, will provide additional assurance beyond that which could be provided by a separate additional register.

We are told that something better is coming down the track and that the forthcoming regulatory reform programme is intended to rationalise and streamline registration across all the UK healthcare regulators, and will allow the GMC to deliver an accessible, flexible and discretionary registration framework for all registrant groups. That is why the GMC believes that that will provide greater flexibility to develop and amend registration rules and improve its ability to innovate. Given the rapid development of new spheres of medicine and practices, such flexibility could be advantageous.

I understand that the GMC is now developing credentials with royal colleges and health education bodies, and that the first group of those is led by one on cosmetic surgery, plus four other disciplines. So, while I heartily agree with the intention of Amendment 293, I ask the Minister: when will the regulatory reform mentioned in the GMC briefing be completed? When will Parliament be able to see it and, in the meantime, how can we be assured that the current system gives the assurance on patient safety that is required?

I too support the noble Lord, Lord Hunt, on hospital catering and I too will resist giving my anecdote.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

I thank noble Lords for their contributions and for sharing their knowledge and expertise—and, in the case of hospital food, not sharing their tales of inadequate and unhealthy food. I will try to answer as many of the questions as possible but, given the experience of the noble Lord, Lord Patel, of being advised by a nurse Whip, I am keen to make sure that I do not suffer those same warnings, as it were.

On rare diseases, specifying requirements in the way proposed by the amendment would restrict the ability of the CQC to collaboratively develop its assessments of integrated care systems. However, the Government are committed to improving the lives of people living with rare diseases. The noble Lord, Lord Sharkey, rightly talked about the UK Rare Diseases Framework that we published in January 2021, which set out our key priorities for tackling rare diseases. England’s action plan will be published at the end of next month.

I have had conversations with some in the life sciences industry who are keen on the fact that we are focusing on rare diseases and extremely rare diseases, and see that as a positive. One of the things that we are trying to do across government is to make sure that we are seen as a hub for expertise in rare diseases and especially rare diseases. One of my predecessors as a Minister suffered from a rare disease. The momentum is still there in the department to make sure that we tackle the issue.

Also, the CQC, through its ICS assessment methodology, will seek to understand how system leaders are monitoring and meeting the needs of the local population, including those with rare diseases. We expect the CQC, in collaboration with system partners, to use its experience as the independent regulator of health and adult social care in England to develop an approach to those reviews. I know that noble Lords may be tired of hearing this but it is important that the legislation allows the CQC flexibility to do so.

On Amendment 240, while the Government have sympathy with the need to raise awareness, we do not consider it appropriate to put such a requirement into primary legislation. I hope I have reassured the noble Lord about our programmes and our push to raise the profile of rare diseases and extremely rare diseases. We prefer that all healthcare professional regulators require professionals to have the necessary skills and knowledge to practise safely, including awareness of rare conditions. It is the responsibility of the regulators to determine what specific role they should play in raising awareness of rare and less common conditions.

On—and I apologise if I mispronounce this—liothyronine and the power of direction, the NICE guideline on the assessment and management of thyroid disease, as the noble Lord acknowledged, does not recommend liothyronine for primary hypothyroidism. NICE states that there is not yet enough evidence that it offers benefits over levothyroxine monotherapy, and its long-term adverse effects are uncertain. If new evidence was to emerge, I am sure NICE would consider it.

In addition, we must be careful not to override NICE guidelines. But, given the concerns raised by the noble Lord, Lord Hunt, and my noble friend Lord Borwick, I would like a further conversation, if that is okay, to see what can be done in this area, as well as where it is appropriate for me to act and what conversations would be appropriate, given the noble Lord’s experience as a Health Minister.

On Amendment 178, we are committed to further strengthening the innovation metrics and to improving our understanding of how innovative medicines and these products are used in the NHS. Noble Lords will be aware that following the publication of the final report of the Accelerated Access Review, the Government established the Accelerated Access Collaborative—AAC—last year. In fact, last year alone we helped over 300,000 patients access proven innovations, resulting in 17,000 fewer hospital admissions and 140,000 fewer days spent in hospital.

As noble Lords are aware, we published our ambitious Life Sciences Vision, which laid out our priorities. We want to make sure that the NHS is seen as a partner in innovation and that research is embedded into everything the NHS does. I know that this has been raised in relation to other amendments. We are currently developing implementation plans for delivering on these commitments.

As noble Lords acknowledged, NICE is in the final stages of the review of its methods and processes, and is proposing a number of changes that will introduce real benefits to patients, including rare disease patients. The Government are also committed to developing an innovative medicines fund, which my noble friend referred to, and a consultation on detailed proposals for the fund closes on 11 February.

Finally, our rare disease framework outlines the key priorities for rare diseases in the UK over the next five years. One priority area is to improve access to specialist care, treatments and drugs.

On hospital food, although we recognise the expertise and declarations of the noble Lords who spoke, we believe that this amendment is unnecessary because the issues are already covered, either as part of the ongoing work to implement recommendations from the hospital food review or in the NHS food standards document, to be published in spring 2022.

The Government are supporting NHS England to implement the recommendations from the independent review. These recommendations cover a broad range of issues, including nutrition, hydration, healthier eating and sustainable procurement. It is important for me to learn more about this as a Minister, given what the noble Baroness, Lady Barker, said about many people not receiving the recognition they deserve. It would be appropriate, perhaps, for us to meet and follow this up.

In addition, the Government already have sufficient legal powers and obligations to enable them to consult on proposed food standards, and we have engaged with NHS trusts, the food standards and strategy group, and the NHS food review expert group through the NHS food review. We will continue to do all this.

On Amendment 264, the regulations already allow trusts to seek alternative members to contribute to the process. They can be from colleges such as the Royal College of Surgeons of Edinburgh, the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Emergency Medicine. However, the Government agree that the changes proposed by noble Lords in Amendment 264 would potentially be advantageous —to put it that way—and we have undertaken to review the situation with officials.

The National Health Service Act 2006 stipulates that consultation with affected parties must be undertaken before any changes are made. Therefore, before we jump to it and agree, we are required to consult the relevant parties. It does seem a clear-cut case, but we are still under a duty to consult.

--- Later in debate ---

[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.

[Baroness Walmsley (LD)]

My Lords, we have been reminded many times during the debates in Committee of the aims of the Bill to improve the health and well-being of the population, to improve the quality of care and to use NHS resources sustainably through integration, co-operation and collaboration. Of course, the point at which these resources are used at the coalface, known as “place” in the Bill, is in these place-based organisations. To ensure integration at this level, we are told that the ICB must create an integrated care partnership, otherwise known as a place-based integrated care board, which probably has an acronym as well. There is, however, very little detail about those, despite their crucial importance, and these amendments from the noble Lord, Lord Hunt, are an attempt to put a bit of flesh on those bones.

I put my name to Amendment 166, but I could just as easily have put it to Amendment 165. Amendment 166 says that, within the place-based partnership, there should be mandated a provider network board with duties delegated to it by the ICB. It would be under parliamentary scrutiny and have an obligation to meet in public. These networks already exist and exert considerable influence, but it is essential that they operate in this new integrated care system under a regulated constitution, with obligations to consult and financial provisions. This amendment would ensure the transparency, for which the noble Lord, Lord Lansley, called, over how well integration is operating at this very important level so that there can be proper control and accountability and scrutiny as to where the money is being spent and whether it is achieving the duties placed on all these systems by the Bill.

[Baroness Thornton (Lab)]

I thank my noble friend for tabling these amendments; I have added my name to both of them. They are about transparency and legitimacy, raising very important questions which the Minister needs to answer.

I go back to what the noble Lord, Lord Lansley, said at Second Reading, which I think my noble friend referred to. He said that

“we have new provider collaboratives which, in fairness, is where the power in the NHS will lie. The Bill makes no provision for them in terms of transparency, openness or accountability.”—[Official Report, 7/12/21; col. 1789.]

I do not need to say any more than that. The Minister needs to answer that question, because it needs to be resolved before the Bill completes its passage.

--- Later in debate ---

[Lord Warner (CB)]

My Lords, it is a delight to follow the noble Lords, Lord Lansley and Lord Hunt, on this set of amendments, with which I totally agree. I want to dilate for a few moments on the realpolitik of being a Minister in the great, august organisation called the Department of Health and Social Care. I can say some things that the noble Lord, Lord Lansley, as a former elected Minister, possibly cannot.

When I ceased to be a Parliamentary Secretary and was promoted to work with the big boys and girls as a Minister of State, and had to deal with issues such as reconfiguration, poor performance and so forth, I became used to regularly meeting elected MPs who wanted to tell me about the errors of their ways in decisions that had been taken in the public interest. There was a steady flow of them, which, if I may say, tended to get bigger the nearer you got to an election. If people wanted to go through the archives, I would refer them to the history of Lewisham Hospital and of Chase Farm Hospital, to name but two.

Very often in these situations, it is not about closing a whole hospital but about re-engineering—we will come to some of this in the next group. I give the example of stroke services in London. It is re-engineering a particular set of services, which the local MP is then put up for trying to ensure that change does not happen. That is where you need to help Ministers do the right thing, when it is in the public interest to make changes. The amendments from the noble Lord, Lord Hunt, help Ministers do the right thing.

The point the noble Lord, Lord Lansley, made is absolutely valid. In many of these circumstances, it becomes very difficult if you are an elected Minister—as distinct from an appointed Minister, who does not have to face the electorate—to resist some of the local pressures to avoid change which would be disadvantageous to a local hospital. For those realpolitik reasons, I think the noble Lord, Lord Hunt, is on the right track and we should support the amendments.

[Baroness Walmsley (LD)]

My Lords, I support the noble Lord, Lord Lansley. Clauses 39 and 64 give the widest possible powers of intervention to the Secretary of State and even the power to delegate that power to someone else. The noble Lord, Lord Hunt, and other noble Lords clearly believe that the Government are going too far, hence the large number of amendments in this and the next group.

I believe that the Clause 39 powers could justifiably be used only in the case of some cataclysmic failure of the NHS. There are four questions to ask. Is it possible that the Secretary of State would ever need these powers of intervention at an operational level, given that he already has the mandate? Does the Secretary of State have any other powers which could be used prior to this atomic bomb of a power? Has the NHS survived well enough over the last 10 years without the Secretary of State having such powers? Does Clause 39 upset the balance between the Secretary of State and the autonomy of NHS England? I think the answers are no, yes, yes and yes—your Lordships can work it out.

The Health and Social Care Act 2012 removed the Secretary of State from this sort of meddling. I thought at the time that it might also avoid him or her taking the blame for failure, but that was just me being cynical and there has actually been no failure of political accountability over the last 10 years. The ninth report of the House of Lords Constitution Committee refers to this issue. It notes that, in 2011, it

“raised concerns that that Bill could erode ministerial responsibility due to the proposed duty on the Secretary of State to promote autonomy for persons exercising functions in relation to the health service. What is now section 5 of the Health and Social Care Act 2012 was amended, such that the Secretary of State instead must have regard to the desirability of securing autonomy. This helps ensure a balance between enabling those providing health care services to deliver services in a manner that they consider appropriate, whilst ensuring ministerial responsibility.”

The Constitution Committee believes that, in combination with Clause 64, the powers taken for the Secretary of State by Clause 39 would undermine that autonomy and upset the balance. They also risk

“undermining accountability by making it more difficult to understand which body is responsible for a particular function of the NHS.”

The fact is that the Secretary of State already has the power to change the mandate of NHS England—as the noble Lord, Lord Lansley, pointed out—to adjust its funding or to bring political pressure upon it to behave in certain ways, without the need for the powers in this clause. Indeed, I think it would be very unwise to use these powers, and he or she will certainly get the blame if it all goes pear-shaped. The Bill, as has already been pointed out in some detail by noble Lords, the DPRRC and the Constitution Committee, gives the Government considerable regulatory and guidance powers, about half of which allow no parliamentary scrutiny at all. Does that not give the Secretary of State enough ability to ensure things are done in the way the Government wish? The Secretary of State already wants to be Henry VIII; does he also want to be King Herod?

Health and Care Bill

Baroness Walmsley Excerpts

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

[Baroness Finlay of Llandaff (CB)]

My Lords, I must declare that I am an elected member of the BMA ethics committee and a past president. The BMA has been particularly concerned about ICB membership. I know we have already debated this, so I expect this group to be quite quick—I am sure the Committee would also hope that.

The Bill sets out a core minimum membership of integrated care boards, but this does not go far enough. We have just discussed not being prescriptive, but there are dangers in that. There is no guarantee of clinical leadership on the board and there is a real danger of undercutting truly representative clinical leadership by failing to retain some of the positive elements of clinical commissioning groups. Clinicians are already demoralised and a failure to give space to their voice and enthusiasm will only worsen this.

ICBs should have clinical representation from primary care and this amendment suggests that there should be two people for this, given the wide area that the boards cover and the very different types of practice within each area. Boards also need a secondary care clinician who is in a front-line, not a management, role and a public health representative. As we have already discussed, without public health representation on the board, there is a real danger that the evidence of health gain and the potential to reduce inequality will not be adequately voiced. The board needs public health input to be able to act as a population health organisation.

Some boards have acknowledged the shortcomings and allocated additional positions for general practice, secondary care and public health within their draft constitutions, but others have not. They appear to be ignoring the voice of the very people who work in front-line healthcare. Unless these voices are heard, along with the voice of public health, there is a real danger that the boards’ decisions will be distant from the reality and that they will become bad decision-makers themselves by losing clinical trust and confidence. I hope that the Government will rethink and ensure that the boards are able to have members who can provide a solely professional view of the whole population for whom the board has responsibility. I know we have already debated much of this, but I want the Government to think again, given the dangers of a further demoralisation in both primary and secondary care. I beg to move.

[Baroness Walmsley (LD)]

My Lords, it is essential that the board have available to it the skill set that you find in people at the clinical front line. I was interested to see that, putting the amendments from the noble Baroness, Lady Finlay, together, we have three people who are not representing one of the big acute hospitals, and one who is. Given the danger referred to by a number of noble Lords that the big acute hospitals will continue to have more influence in an integrated system than perhaps they should, that is a good element of putting the two amendments together.

As I said, it is important that clinical knowledge and experience be available to the board, but I would like to know that there is a balance and that this does not overwhelm other skill sets which all of us want to see represented; that became clear in the discussions we had last week about who should be on the board. With that caveat—the noble Baroness, Lady Finlay, might respond to that if she chooses to withdraw her amendment—I offer qualified support to what she is suggesting.

[Baroness Thornton (Lab)]

The two amendments put forward by the noble Baroness, Lady Finlay, add to those we have already discussed about who should serve on the board and what range of experience its members should have. Of course, we all agree that it is important to have clinical experience brought to the board. However, if this is about integration—I may have said something similar to this last week—mental health, social care, primary care and public health need to be part of the planning on these boards. In that respect, I give these amendments my support, but I think we need more discussion about this. At the moment, as far as I can gather—perhaps the noble Lord can enlighten me—the boards are pretty much made up and I do not think they fulfil the criteria of things we will need to bring to bear to have properly integrated planning in the places covered by these ICBs.

--- Later in debate ---

[Lord Mackay of Clashfern (Con)]

My Lords, I strongly support that. It seems to me that the National Health Service is devoted to looking after patients. Therefore, it is very strange that there is no national voice for patients to speak to it. In a way, Healthwatch England fulfils that—but in a very awkward position.

I do not know exactly the relationship within the constitution of the committee and the CQC. For example, it may be important that knowledge that Healthwatch has goes to the CQC, but it must be much better for it to be independent at every level, national and local, and to not take part in any of the particular arrangements but rather independently give the pure voice of the patients, which it has received, as it were, from the people who have been served by the National Health Service, whether that is complimentary or otherwise, according to what has actually happened. That seems to me to be essential. I cannot think that it is effective to have a National Health Service with no voice to be heard at the centre from the patients.

[Baroness Walmsley (LD)]

My Lords, I quite often buy things online and, a few days after the product has arrived, I often get an email saying, “How did we do? Give us one, two, three, four or five stars.” That can be very irritating, and I suspect that, on the whole, people do not respond, unless the service has either been dreadful or brilliant—that is certainly so in my case. The voice of the patient is far more important than that and, if we are to assess the performance of different ICSs, the voice of the patient is absolutely fundamental to gathering the evidence, using which we can compare their performance.

A few years ago, I had to be in hospital, just for a few days. At the end of my treatment, when I was about to go home, I was handed a little slip of paper. I do not know if they still do this, but it had some kind of snappy title like, “Tell us how we did”. I thought it was totally inadequate, because here was I, as a patient, having had a general anaesthetic, feeling a bit wobbly, but crucially, having had only the experience of that particular treatment in that particular hospital. The beauty of Healthwatch is that it can compare the experience of patients, heard directly from those patients, of a lot of different treatments in different settings. It can bring together the voice of the patient and—absolutely crucially—it has the ear of the people who deliver those services and can authoritatively explain to them where they are doing well and where they are doing badly.

In this group of amendments, the noble Lord, Lord Hunt, and others have got it right in their suggestions about the level at which Healthwatch should have a voice: non-voting membership of the ICB, voting membership of the ICP and, crucially, independence from the CQC. The noble Lord, Lord Harris, put it very well: how on earth could Healthwatch criticise the CQC as the regulator if it is part of it? It is a little bit like asking a civil servant to criticise the Prime Minister, is it not? The noble Lord, Lord Hunt, and others who have spoken have got the level right at which Healthwatch should play its part in this great new world of integrated services. The view of the patient of the experience that they received at the hands of all the health and care services is absolutely crucial to being able to compare the performance of these bodies that we are setting up.

Health and Social Care

Baroness Walmsley Excerpts

Thursday 9th September 2021 Lords Chamber

[Baroness Evans of Bowes Park (Con)]

I am afraid I have already set out the timescale on which we are doing this. This is a complex area and, as I said, the new cap will come in in October 2023. As I said, the funding in this package covers the cost to local government of implementing the charging reforms, including the cap, the increased capital limit moving towards paying a fair rate for care and the associated implementation costs. We will be working closely with local authorities to make sure that we can implement this to the benefit of all our citizens.

[Baroness Walmsley (LD)]

My Lords, can the noble Baroness say how much additional employers’ NICs will be paid by struggling care home providers in respect of their staff? Could that not be sufficient to make them go under?

Afghanistan

Baroness Walmsley Excerpts

Wednesday 18th August 2021 Lords Chamber

[Baroness Walmsley (LD) [V]]

My Lords, I will focus on the humanitarian situation. I declare an interest as an honorary fellow and former board member of UNICEF UK, to which my allowance for today will be donated. I know that many of my colleagues will be making similar donations.

The ordinary Afghan people, particularly children and their mothers and carers, are defenceless. They have no choice about their future; they just want peace and security. Currently, about half the population— 18 million people—needs humanitarian aid. Only the NGOs are there to help them. In addition to UNICEF, Save the Children, the International Rescue Committee and many others need donations, because our Government have drastically cut international aid to Afghanistan over the past year. The UK slashed its international aid commitment from $78 million last year to only $18 million so far this year. The Foreign Secretary’s statement yesterday that UK aid to Afghanistan will be increased by 10% left me aghast. That 10% of a very reduced amount is pathetically little and the Government should be ashamed of themselves. My first question to the Minister is: will the Government immediately restore their cuts to the international aid budget and ensure that an increased amount goes to Afghanistan and the region, through reliable NGOs and working together with other western donors?

Although the top priority must be to rescue those whose lives are in imminent mortal danger, there are 350,000 internally displaced people on the move in the country—women and children, fleeing to Kabul from the violence in their villages, sitting on the street or in bus stations, with no food, water, protection or medical help. With the breakdown of the Government, only the NGOs can help them. The majority of NGO staff are Afghanis, but they need supplies and organisational expertise from abroad. Many of them know their lives are in danger, as the noble Lord, Lord Adonis, just mentioned. The next priority should be to help the thousands of vulnerable people who cannot travel abroad and thus remain on the street. Therefore, my second question to the Minister is: what are the Government’s plans to provide practical help to the NGOs? Are they engaging in the Doha talks and will they press the Taliban to ensure the safety of NGO staff at all levels, as they go about their brave work?

Finally, 30,000 people are fleeing the country every week, many to Commonwealth countries, such as Pakistan and India, before the borders were closed. My last question is: what discussions did the Prime Minister have with the Prime Minister of Pakistan yesterday, regarding our and Pakistan’s commitments to Afghan refugees?

Covid-19

Baroness Walmsley Excerpts

Wednesday 23rd September 2020 Lords Chamber

[Baroness Evans of Bowes Park (Con)]

I thank the right reverend Prelate. I am afraid I am not so on top of that detail as to be able to give him an answer I would have confidence in, but I will certainly take his point back to MHCLG, which I believe is the lead department on this. I am sure that Ministers there will want to talk to representatives from the Church and other faiths to make sure the rules make sense.

[Baroness Walmsley (LD) [V]]

My Lords, is the noble Baroness aware that there has been a considerable rise in mental and emotional ill health since the pandemic began? Many people are fearful, anxious and depressed. In the Government’s messaging on the virus, does she agree that there needs to be a balance between frightening people about the seriousness of the disease so that they will obey the rules and reassuring people that, if they do obey the rules, they will probably be okay? Does she think the Prime Minister got that balance right yesterday? I am afraid I do not.

[Baroness Evans of Bowes Park (Con)]

The noble Baroness is right about how incredibly important it is that we get messaging right. We are in a very complicated situation and everyone is doing their best. She is also right about concerns over mental health; for those with severe needs or in crisis, all NHS mental health providers have established 24/7 mental health crisis lines, and PHE has published its surveillance tracker to monitor the impacts of Covid-19 on the population’s mental health. These are proactive steps to help ensure that our response to the effects of the pandemic is shaped by emerging data. I am sure work such as that will help feed in as we think about messaging now and going forward.

European Union (Notification of Withdrawal) Bill

Baroness Walmsley Excerpts

Monday 20th February 2017 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, every day we start our deliberations by asking for wisdom and understanding. We pray that our counsels may result in,

“the public wealth, peace and tranquillity of the Realm, and the uniting and knitting together of the hearts of all persons and estates within the same”.

Whether or not we are religious, these objectives should unite us all. Currently this country is very divided and very angry.

When I came to the House of Lords, I knew that I did not represent a geographical constituency. I understood that I was here to represent all the people of the United Kingdom and to do what I judge the right thing according to my conscience. That is what I propose to do. Last time I looked, every Member of this House was equal. His or her opinion was equal and his or her conscience was equal. Last time I looked, it was customary to treat the opinions and consciences of other Members of the House with some civility and respect. I have to say that the speech before last did not do that and did not serve that Member’s cause very well.

Your Lordships’ House has a duty to scrutinise legislation in detail and to ask the Government to think again when they are going in the wrong direction. There is precious little detail in the Bill but I judge that the Government have chosen to take the country in the wrong direction. There is no mandate for it. There is no majority to leave the single market. If we continue along this path, our people will be poorer and our country will be more isolated and less influential in the world. So I will be supporting amendments to protect the rights of citizens of other EU countries who live and work here, to protect our access to the single market and to allow the people of this country to have the last word, for the sake of our unity and democracy. That is what I believe democracy is.

As your Lordships will be aware, I speak for these Benches on health and social care. There are three main healthcare reasons why I believe the Bill should be amended. They boil down to: people, healthcare and Donald Trump. There are tens of thousands of EU citizens working in our health and care system and the Government are using their future, and the future of those they care for, as a pawn in a misguided game of cat and mouse with the other 27 countries. Without them, the staff shortages we are already experiencing will be a lot worse and patients will suffer. 1 am pleased there has been a cross-party outcry from your Lordships about this, so I hope all will vote for an end to that foolishness.

Secondly, the businesses which provide the drugs, medical devices and treatments that British people need will be badly affected by a hard Brexit. That is why I support access to the single market rather than just waving a white flag and not even trying. The pharmaceutical products most of us depend on are developed by research by networks of scientists working together across Europe. These networks are already suffering and the massive EU funding from which they benefit is being put at risk. Clinical trials taking place here in the UK are at risk. UK patients get access to new and cutting-edge treatments because of them. The UK has played an enormous role in the regulation and licensing of medicines for the whole EU. Indeed, much of the expertise is here. It makes no sense to develop our own system. We could lose a lot of that expertise.

Companies will always develop products for big markets where the profits are. Why would they want to develop a product to satisfy the regulations in a market of 68 million people when they could sell to a market of 400 million? Medicine distributors warn of cost increases, decreased access and even shortages. Harmonised regulation is not a burden. It gives us the freedom to sell and the confidence to buy. Why throw it away? Medcare products frequently cross borders in the course of their manufacture, packaging and labelling. Having tariffs imposed on them will increase their costs and decrease their competitiveness. So, for the sake of UK patients and their access to affordable and cutting-edge medicines and treatments, I will be supporting an amendment to give us continued access to the single market and the customs union.

Then there is Donald Trump. Our NHS is probably our most valuable asset. Already a lot of American healthcare companies are sniffing around to see what they can pick up. We all heard what Trump said about trade deals putting America first—America first, not the UK first. So anyone who thinks a trade deal with the USA will not result in a lot of our health services being run by American companies must be completely mad.

Finally, I will be supporting an amendment to ensure the approval of the British people for the deal put before them by the Government. All those who are most affected should have a say, including those who were denied one in the last referendum with its gerrymandered electorate, such as: citizens of other EU countries who live here; British citizens who have lived for many years in other EU countries; and 16 to 18 year-olds whose future study and work opportunities will be damaged by Brexit.

We have a representative Parliament and we are not used to referenda. But perhaps, having ventured into that area, we should have taken a leaf out of the book of the Swiss. Here, our future wealth and well-being are being hijacked by an advisory referendum in which only 37% of a gerrymandered electorate voted for the change. That means that 63% did not. I believe I am here to speak for the 63%, along with all those groups that were not allowed to vote at all. So for those reasons, and, as other noble Lords have mentioned, because times have changed since 23 June, we need a referendum on the final proposals. You cannot start the process with some form of democracy and finish with a stitch-up. The long-term future of the UK and its population is at serious risk and this House must do its duty and ignore bullying threats about its own future.

Outcome of the European Union Referendum

Baroness Walmsley Excerpts

Tuesday 5th July 2016 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I am proud to speak from the Liberal Democrat Benches, where we have a leader whose position is secure and who has the support of all of us. I am also proud that it was a Liberal Democrat MP, Tom Brake, who took the only real action to secure the position of EU citizens living and working here. Yet these are small consolations to me today because I have such concern about the effect on the NHS.

Of all the disasters that will result from the EU referendum, one of the worst is the effect on our health and social care services, on which the outcome is likely to inflict significant damage. It was also the subject of the biggest, fattest lie of the leave campaign, one of those that was retracted almost before the ink was dry on the result. “Three hundred and fifty million pounds extra per week for the NHS” was plastered all over the campaign buses and, even though it was frequently pointed out that this could not happen, the leave campaigners cynically waited until after the result reluctantly to admit that it was not true. Where does that leave those who voted leave because they thought it would help the NHS which so desperately needs more funding? Betrayed and angry, that’s where it leaves them. They were conned into delivering their precious votes into the hands of a bunch of charlatans. I know that the noble Baroness the Leader of the House would prefer us to sweep these facts under the carpet and be positive, but they matter—not least because some of those now seeking to lead this country had every opportunity to correct this misinformation, and they did not take it.

So where are we now? We have an NHS which has to rely completely on funding from a thriving economy if it is ever to be able to deliver on the needs of an ageing population—one that rightly demands the benefits of the latest medical and scientific research. It also relies on immigrants. It is estimated that 10,000 EU doctors and 52,000 EU nurses are working in our NHS today. What have we heard from the Government and from those wishing to lead it about these people? Only that they are to be used as pawns in the negotiations to leave the EU. There are 335 EU citizens working in the Norfolk & Norwich University Hospital alone. They do not know what will happen to them in two years’ time. How would that hospital manage if they got fed up waiting for some assurances and went home? It is disgraceful to play a game of poker with these people’s lives and their contribution to our health service. The Government must do the right thing now and give these workers the confidence of knowing that the UK wants to keep them here, contributing to our care and to our economy. What about the thousands working on very low pay in our social care sector, caring for the old and vulnerable and putting up with minimum wages for doing a very difficult job? It is time that the Government took the initiative and said that these EU citizens will be allowed to stay if ever the UK leaves the EU.

Then there is the effect on our ability to recruit the best research talent from abroad and on the pharmaceutical companies that have to invest millions of pounds to develop new drugs and treatments. Reducing corporation tax is not going to reverse the damage to them. Investment decisions are already being made or postponed. Why would highly qualified researchers and medical staff come here when they do not feel welcome and have to jump through all sorts of hoops to get here? The UK is part of a worldwide marketplace for talent and there is a chronic global shortage of highly qualified research and clinical staff. We have just made it more difficult to attract the best.

On the big issue of resourcing, we have heard many times in your Lordships’ House about the £30 billion gap in NHS funding and the £6 billion gap in social care funding. My right honourable friend Norman Lamb has long called for a new Beveridge commission, an independent commission to look at how health and social care should be funded. This is needed now more than ever because the economy is in crisis and it is our taxes that pay for the NHS.

In the next few months, the biggest threat to the NHS will come from a recession-driven round of additional spending cuts, hitting non-ring-fenced budgets such as social care. Such cuts would be almost as bad for the NHS as direct funding cuts and would significantly exacerbate the financial problems of the acute hospital trusts. The promises from the current Chancellor and at least one of the candidates for Conservative leader to abandon their manifesto promise to remove the deficit by 2020 is quite sensible, as they are hardly likely to be able to deliver it if we have an economic recession. While I welcome this pledge, I cannot see how a failing economy will be able to deliver the funding that public services need to survive. The Government need to steady the ship, but we have no captain. This captain is to be elected by 0.03% of the electorate. I do not call that democracy.

Changing models of care are essential for the sustainability for the NHS, but there are now far too many uncertainties to allow health service managers to plan for change. Uncertainty is just as bad for the NHS as it is for the City of London. One recent change with great potential for patient benefit has been the devolution to Manchester of the powers to deliver health and social care. However, even if the Government remain committed to this kind of devolution, the Civil Service will be so busy disentangling us from Europe that they will not have the capacity to do the work. In the longer term, there will be issues about the working time directive. The junior doctors and all the other staff will have to negotiate new maximum working hours and all the other elements of contracts that have been so hard-fought.

Will the Government now pledge that there will be no further cuts to public services? Brexit could undermine staffing, research, service reform, devolution and funding. I find it very difficult to obey the exhortation of the most reverend Primate the Archbishop of Canterbury in his excellent speech to be hopeful and positive. The only thing that gives me hope is the ability of the NHS and care staff to keep calm and carry on in the interests of their patients, despite the turbulent waters into which we have been steered by the man without a plan.