Elderly Social Care (Insurance) Bill [HL]

Baroness Watkins of Tavistock Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as outlined in the register, but particularly as a NED of a housing association that provides care in people’s homes and residential care.

The noble Lord, Lord Lilley, has, I am certain, brought the Bill for our consideration for highly principled reasons; namely to try to reassure older people who are home owners that if they are insured against care home costs through a Government-owned company, they will be protected against having to sell their homes in future. I cannot, however, support the Bill, because I believe that if enacted, it would protect a small minority of people who have been fortunate enough to purchase a relatively valuable home, and it would fail to address the real and urgent problem regarding social care funding. There are people who need assistance in their own homes, as well as those who need residential facilities in later life.

The Government have promised to bring a Bill on social care funding policy to Parliament before the end of this year. But, as others have reported, the papers today tell us it might be here on Tuesday. It is essential that this is achieved and that the suggestions in any Bill are properly debated in both Houses and achieve cross-party support. If this is effectively achieved, there will be a long-term solution for the whole of the United Kingdom, enacted and supported by successive Governments, irrespective of which party is in power.

This was announced in the Conservative party manifesto, which was clear to voters, who demonstrated that they wanted a long-term policy that would be fair to older people today and to their families in the future through their resounding support for the manifesto, resulting in a majority of 80 in the other House. Failure to deliver on that promise would lose significant support for this Government, and therefore I believe that the Bill will be forthcoming.

I hope the Government’s Bill will be based on some of the principles laid out in the Dilnot report, which received overwhelming support from the majority of health and social care organisations. We need, as the Bill from the noble Lord, Lord Lilley, implies, long-term funding strategies that may involve some kind of government-backed insurance solution. Others have spoken about the insecure employment of care workers. It is essential that care work is properly funded and that care workers themselves have good contracts in order to facilitate high-quality care.

In summary, I thank the noble Lord, Lord Lilley, for the work he has done to prepare this Bill and trust that it can be used to assist the Government in their own planning for their intended social care reforms. I ask the Minister to outline a more detailed timetable for when the Government’s reforms are to be brought to Parliament, which would make the Bill before us today unnecessary. We need a strategy that will support not only home owners but renters with savings and those on low incomes, rather than a piecemeal approach, which I fear would be an unintended consequence of this Bill.

Social Care and the Role of Carers

Baroness Watkins of Tavistock Excerpts

Thursday 24th June 2021 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I congratulate the noble Baroness, Lady Jolly, on securing the time to discuss this vital topic. I draw attention to my interests in the register, particularly as a qualified nurse. Despite extensive knowledge and expertise as a country, we have moved forward at a snail’s pace in trying to address the real problems and opportunities that face us in the domains of respite and support for carers and readily available social care support, as other noble Lords have said.

Social care is funded and paid for differently in the four nations, yet we have a central funding system for the NHS. Unless more resources are allocated for social care, the NHS will continue to attract staff much more readily because of the employment terms there compared with the zero-hour contracts on which many care staff are employed. Today I looked for a job that I would apply for in social care, and noble Lords will be pleased to know that I found one on Housing Today, but it requires me to be the Swiss army knife of care: to work flexibly, and to use the salary-sacrifice system in order to have a pass to go around the city in which I would work. In return, they will give me a regular full day’s work—which are actually really good terms for many people. When will the Government take initiatives to drive the parity of esteem between the NHS and social care employment so that we can recruit, train and retain an excellent social care workforce with the skills and compassion needed for this intimate personalised work? The Government have a real opportunity to correct this by providing apprenticeships and meaningful, secure employment, while demonstrating to the current social care workforce how much we value its work through career development opportunities and fairer terms and conditions of employment.

Respite for carers is particularly important at this time, because most family-based carers have managed with little or no respite or external assistance during lockdown. Many are now exhausted and need respite to rest and recuperate in order to continue with their caring responsibilities. Some are young carers who have had particularly difficult challenges: for example, supporting a single parent with issues including mental illness, addiction and long-term physical disabilities.

It will surprise noble Lords to know that Bumble, the social dating platform, has given all its staff an extra week off for respite, due to the demands of the increased workload associated with the gradual reduction of lockdown and people seeking new partners. How will the Government instigate and monitor policy to guarantee a similar respite for all informal carers? Will they give young carers the right to have breaks? How will their support be prioritised, promoted and guaranteed?

Covid-19 Update

Baroness Watkins of Tavistock Excerpts

Tuesday 18th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am extremely grateful to my noble friend for her insight. She is entirely right; this awful pandemic does have a silver lining, which is that it can be an inflection point for a complete transformation in our public health messaging. The work we are doing on communicating the threat of the variants is one example of that. The next front line will be the flu jab rollout in the autumn, where take-up rates have been okay but not great. I hope that, when the flu jab campaign begins this autumn, a completely different generation and spread of people will step up to that opportunity. We are working extremely hard to use the public mood and sentiment behind preventive medicine to full effect to ensure that the flu jab works, that therefore a much smaller proportion of the population will transmit flu, and that deaths and severe disease from flu will be reduced. That can be the legacy of this awful pandemic.

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, I welcome the vigilant focus described in this Statement that has been adopted by the Government, and that the response is being co-ordinated through the UK Health Security Agency. Could the Minister explain how England is working with the other three countries in the UK to ensure that a proactive approach is taken to the new virus variant, that the uptake of vaccines increases, that the monitoring of transmission continues, and to enable early intervention should the number of cases increase? In particular, what data are the Government collecting on the number of people in quarantine hotels testing positive for coronavirus and how many people have absconded from quarantine? Would the Government consider adopting a process similar to the electronic tagging undertaken in South Korea, to more accurately monitor the movement of people in and out of the country at its borders?

[Lord Bethell (Con)]

I am enormously grateful to the noble Baroness for that creative and thoughtful question. The good news is that the number of absconding residents from managed quarantine is minimal; it can be counted on one hand and many of them have been retrieved. The bad news is that the positivity rate in managed quarantine is far too high. I do not have the precise number in front of me and do not want to guess at it, but it is clearly true that far too many people are getting on planes when they are infected and far too many people are catching the disease on their travels. When we think of how to manage any vaccine-evading and highly transmissible variants, we have to look to the red list for secure protection for this country. She asked another question I cannot remember, but I will be glad to write to her about it.

Social Care: Person-centred Dementia Care

Baroness Watkins of Tavistock Excerpts

Monday 17th May 2021 Lords Chamber

[Lord Bethell (Con)]

I pay tribute to those who deliver person-centred care. The noble Lord referred to hospices, and I am extraordinarily touched and impressed by the way in which they delivered on an enormously difficult task during the pandemic. We debated earlier the financial arrangements around hospices and the delicate state of their finances. We continue to be in touch with the industry and will take whatever measures necessary to ensure its financial stability.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Minister explain what plans the Government have to invest in socially rented supported housing for people with early dementia? It is very clear that this would reduce short-term admissions to acute hospital beds, which will be necessary in order for us to meet the challenges that the NHS faces with current waiting lists. If the Government have no plans for considering this kind of supported housing, which many people who can afford it purchase for themselves, can the Minister assure us that he will ask the Government to consider this issue?

[Lord Bethell (Con)]

My Lords, the noble Baroness puts the case for supported housing social care for those with low levels of dementia extremely well. It is slightly beyond the purview of the Department of Health, but the case she makes is strong. I would be glad to go back to the department and find out if any measures are taking place.

Office for Health Promotion

Baroness Watkins of Tavistock Excerpts

Thursday 29th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, as my noble friend knows, the publication of the consultation on advertising is due soon, and I look to it very much. She is entirely right that obesity, seriousness of illness and death from Covid are clearly related; this has been a wake-up call and we are stepping up to the challenge as of now.

[Baroness Watkins of Tavistock (CB)]

My Lords, the Royal College of Nursing has called for a substantial increase in the number of school nurses to ensure the monitoring and promotion of healthy lifestyles for pupils, so that they are better prepared for learning after substantial absences associated with Covid-19 lockdowns. Can the Minister outline how the Office for Health Promotion will work with the Department for Education to co-ordinate and lead improvements in children’s health, including in school nursing reform?

[Lord Bethell (Con)]

My Lords, I am grateful to the Royal College of Nursing and the noble Baroness for that extremely constructive and thoughtful suggestion. That is exactly the kind of cross-government, inter- departmental suggestion that the OHP will focus on. I will be glad to take that to the OHP and make it clearly.

Care Home Occupancy Rate

Baroness Watkins of Tavistock Excerpts

Wednesday 28th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I absolutely join my noble friend in commending the incredible contribution of care home staff, domiciliary staff, unpaid care workers and all those who support loved ones, neighbours and residents. The Covid pandemic has shone a light on the selfless contribution of those people. The service continuity and care market review keeps a careful eye on the financial stability of the market. We are in constant contact with some of the biggest providers. The scene we see at the moment is not one that causes a huge amount of concern, but we keep close to the market.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interests as outlined in the register in relation to the Outcomes First Group quality committee. Can the Minister explain how he will ensure that the Government work with the Care Quality Commission to see how we can deliver a strategy that promotes care home financial stability so that there are sufficient beds available this winter to enable the NHS to deliver suitable care for those on waiting lists, without older people having to go into hospital unnecessarily?

[Lord Bethell (Con)]

The noble Baroness makes a good point. There is always a tension in having enough beds in care so that those who need somewhere to be supported are not sent to hospital, thereby occupying valuable beds that should be used for elective surgery or other more complex and important procedures. We are working closely with the CQC to ensure that the right strategies are in place to deal with that.

Covid-19: One Year Report

Baroness Watkins of Tavistock Excerpts

Thursday 25th March 2021 Lords Chamber

[Lord Bilimoria (CB) [V]]

My Lords, Covid-19 was an unpredictable and unprecedented crisis—a health crisis, an economic crisis, a supply shock, a demand shock—reverberating across the globe. It came out of the blue. How you deal with, respond to and adapt to crises is what matters. The Covid-19 crisis has brought huge emotional tragedy, with sad deaths and a social and economic toll. It has forced us to reckon with the things that mattered most to us as a society and instilled a deep-rooted desire to build back better, looking ahead.

Also, the crisis has seen the best of what business can do in the service of the nation. I declare my interest as president of the CBI. Our UK economy has so many strengths. We have just 1% of the world’s population but six of the world’s 30 best universities, 12% of Nobel Prizes, and 16% of the highest-rated research papers. We are recognised globally as a magnet for international students, start-ups, and entrepreneurs and inward investment. The World Bank consistently rates us as one of the best places in the world to do business Now we need to harness that expertise and ambition as we build back from the crisis, creating jobs, opportunities and shared prosperity across the UK. This year, 2021, is a golden opportunity for the UK to redefine its position in the world.

Right now, businesses are focused on Covid and keeping employees, customers and communities safe. We need to look ahead to the next quarter, the next year, the next decade. At the CBI, we have worked closely with the Government and are grateful for the huge rescue packages, including the furlough scheme, which have saved millions of jobs and businesses. The Budget was a seminal moment and, overall, it succeeded strongly in protecting the economy now and helping to kick-start recovery. The Chancellor has spent more than £400 billion. He has also set out a longer-term economic vision and a further boost to investment. We at the CBI will soon come out with our economic vision for Britain over the next decade to 2030.

To improve business confidence, companies would welcome greater clarity about the evidence base for why the working from home message is not evolving with restrictions, alongside guidance about what companies can and cannot instruct their employees to do in certain situations. The potential availability of home testing is increasingly seen as a crucial enabler for employers. We welcome long-term clarity about workplace testing because businesses see the vital role that testing can play in combating Covid-19 and reopening the economy. Through workplace testing, many have noted the benefits of being able to detect asymptomatic cases that would otherwise have gone unnoticed.

The CBI has also submitted evidence to the Global Travel Taskforce, calling for

“A risk-based roadmap for re-opening … A platform for UK leadership in reopening global traffic, supporting, amongst others, the country’s world-leading aerospace, international high-speed rail and maritime sectors.”


Full credit needs to go to Kate Bingham, who headed the Vaccine Taskforce. She was appointed on 18 May last year. Less than seven months later, on 8 December—V-day—we saw the first inoculation. An amazing three and a half months later, almost 30 million people have been inoculated. Full credit also to Nadhim Zahawi, our Vaccinations Minister. I predicted that we would be able to do 1 million vaccines a day; we did more than 800,000 and, if the supplies are there, we should be able to.

However, we should note what one leading vaccine manufacturer said:

“Our vaccine contains 280 different components that are manufactured in 86 different sites across 19 different countries.”


Any disruption to this supply chain would affect supply. The Oxford/AstraZeneca vaccine was developed with AstraZeneca headquartered in Cambridge in partnership with the Serum Institute of India, with 1 billion doses contracted. Wow—it is phenomenal. We have 400 million doses, three approved vaccines and two more coming down the line. The Prime Minister has already said that we will share our surplus vaccines with the rest of the world. Vaccines, mass testing, a travel protocol and a reopening road map will help tourism and business travel and the hospitality sector, which suffered so much. Can the Minister confirm that, if the numbers of sad deaths and hospital admissions go down to zero before the dates, including 21 June, the economy can reopen sooner, safely?

Finally, what about therapeutics? We are not talking about them enough. Can the Minister tell us about them? They could be a game-changer. Dexamethasone was one. There is Regeneron in the States. Nature published an article on EIDD-2801. There is Ivermectin, a cheap, off-patent, anti-parasitic drug; Oxford University has already started trials. Israel has invented an inhaler that it claims cures Covid-19 in just five days.

One year on and three lockdowns later, the pandemic has seen uncertainty, ambiguity, tragedy, bravery, resilience and adaptability at speed, with government, universities, businesses and citizens all collaborating and working together in a caring, compassionate and empathetic way, which makes me so proud of our great country.

[The Deputy Speaker (Baroness Watkins of Tavistock) (CB)]

I call the noble Baroness, Lady Noakes.

Covid-19: Resuscitation Orders

Baroness Watkins of Tavistock Excerpts

Wednesday 24th March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the report is crystal clear that we accept that more training is needed. Front-line care support workers need to be given more support in their interactions, and we will be putting that in place.

[Baroness Watkins of Tavistock (CB)]

My Lords, I draw attention to my interests in the register, in particular the fact that I am a nurse involved with the Outcomes First Group, which supports people with learning disabilities. In order to increase the population’s awareness of care planning in relation to living and dying well, will the Government, in addition to training, consider incentivising healthcare workers to ensure that they have sufficient time to undertake proper assessment of individuals with cognitive impairment and learning difficulties as part of their routine care planning, which should be recorded and reviewed at least biannually?

[Lord Bethell (Con)]

The noble Baroness makes a very fair point; such care needs to be in the work plan particularly of those with learning difficulties, but of all those in care. We absolutely endorse the approach taken by the Resuscitation Council, which has extremely good guidance in this area.

NHS: Staff Numbers after Covid-19

Baroness Watkins of Tavistock Excerpts

Thursday 4th March 2021 Grand Committee

[Lord Clark of Windermere]

To ask Her Majesty’s Government what plans they have for the number of National Health Service staff after the COVID-19 pandemic.

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

The time limit for this debate is one hour.

[Lord Clark of Windermere (Lab) [V]]

My Lords, I count myself very fortunate to be introducing this Question. This is an invaluable parliamentary means whereby questions can be asked in a more discursive manner than usual and the Minister will listen and, we hope, provide answers. I shall make a couple of obvious general points.

The people of Britain love the NHS, as has been seen during the Covid-19 pandemic, but there were problems prior to the pandemic. I shall make three basic points to set the scene. The NHS is the fifth-largest employer in the world, yet we spend less on health as a percentage of our GDP than almost every other developed country in the world. To compound the situation domestically, there was a shortage of hospital beds prior to the pandemic. Indeed, we are bottom of the Euro league for intensive care beds, with 7.3 beds per 100,000 of population, compared with the best, Germany, with 33.8 beds—what a difference. Thus, prior to the previous cuts we were ill-prepared, and there have been too many cuts under the austerity measures of the early 21st century.

I am certain in my own mind that it was due only to the dedication, brilliance and sacrifice of NHS staff that we got through—and I mean all staff, from the top consultant to the most junior worker. And it has been at tremendous cost to many of them in stress, burnout and mental health challenges. We owe them a tremendous amount and I hope that, in his summing up, the Minister will confirm that this will be recognised when we have won the battle with Covid-19.

I will begin with nurses. Over the years, the Minister must have become tired of me pursuing him on the issue of nurses. I remain concerned. Currently, we are at least 40,000 nurses short. Over the next seven years we will face a shortfall of 108,000 nurses. I must ask the Minister very bluntly: will HMG drastically increase the training of fully qualified nurses? What discussions has he had to ensure the provision of the educational means to do so?

The Royal College of Nursing has conducted surveys and expressed deep concern about the exodus of qualified staff following the pandemic. I share that concern. Will the Minister push ahead and prepare plans to deliver what is necessary to persuade staff that they are valued, and to retain them in the NHS? According to the RCN survey, 35% of nurses are contemplating leaving the profession within the year. Will HMG also provide the NHS with the means to fund occupational health and psychological support, and, if necessary, breaks beyond annual leave?

Nurses are due a pay rise. They are currently worse off than they were a decade ago. Will HMG ensure that the upcoming pay settlement is really meaningful and commensurate with the ever-rising skills of nurses?

I turn now to GPs. If we are to meet the demands and expectations of the general public, we will have to increase the number of doctors, especially GPs. Does the Minister accept that we are still suffering in the training of doctors from the austerity years, over which his party presided? In spite of the modest increases of late to close the gap, does he accept that we face a shortfall of 7,000 GPs in the next two years? As a starter, we need to double the number of medical school places from 7,500 to 15,000 by the end of the decade.

I will move on from numbers to talk about processes. I am concerned about the reluctance of younger practitioners to enter general practice in many parts of the country, leaving it often to only elderly GPs to carry on as single practitioners, supplemented by agencies and bank locums. Do the Government really feel that that is satisfactory and sustainable?

I have a personal problem with this in Windermere at the surgery I am registered with. It operates from a fine purpose-built building but has been without a permanent GP for a number of years. It functions largely due to the skill, experience, training and commitment of nurse practitioners and other staff with specialist skills. Their work is supplemented by local doctors—if they can be persuaded to come. Five years ago, the practice was leased to a private company, OneMedical Group, 80 miles away in Leeds. Last autumn it took advantage of a break clause in its lease and surrendered it, and we are back to square one; it is far from a satisfactory situation.

The key issue is that younger GPs do not wish to buy into practices which might involve hundreds of thousands of pounds. I know a number of practices in Cumbria have had to undertake severe reorganisation and mergers simply to survive. In a letter to the Guardian on 1 March, a GP who has worked in the NHS for over 30 years made the same point, that younger GPs will not buy in to practices. I ask the Minister the most critical question that I am asking today: is this model, requiring such large financial commitments by individuals, suitable to the 21st century? Would the department do a preliminary examination of this problem?

The pandemic has changed so much, and we were found wanting. The years of austerity caused serious damage to our NHS. Only because of the beliefs of our NHS staff are we getting through it. One thing is clear: there is increased demand on our health service. There will have to be much change, including permanently increasing spending. The Government will have to recognise that what may have worked in the past may not do so in future. Models which have been sacrosanct may need to be examined and, if necessary, changed. All this is essential, with a radical White Paper bringing health and social care together. I ask the Minister: are the Government up to it?

--- Later in debate ---

[Baroness Greengross (CB) [V]]

My Lords, the All-Party Group on Adult Social Care—[Inaudible.]

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

We are having difficulty hearing the noble Baroness. We will come back to her after the next speaker, the noble Lord, Lord Willis of Knaresborough.

[Lord Willis of Knaresborough (LD) [V]]

My Lords, I will make a very brief reference to a group of NHS staff who have gone largely unnoticed during this pandemic and the debate but have been trailblazers and lifesavers in equal measure. I refer to the newest recruits in the registered healthcare workforce, nursing associates. The nursing associate register commenced two years ago, and today there are 4,036 registrants with a further 7,000 who commenced training at the height of the pandemic. Many plan to train on as registered nurses. These remarkable people, most of whom were dedicated care assistants, have risen to the greatest nursing challenge ever seen, saving patients and, indeed, the NHS. What steps are the Government taking to recognise the contribution of nursing associates and to redouble the investment in the recruitment and training of future cohorts?

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

I will move to the next speaker, the noble Baroness, Lady Altmann. We hope by the end of her speech to have resolved Baroness Greengross’s communication issue.

[Baroness Altmann (Con)]

My Lords, I am pleased to see that the numbers applying for nursing have been increasing. I know that the Government have started on their task of recruiting 50,000 more nurses by the end of this Parliament. What progress has there been towards that target? More crucially, what is the plan for improving retention rates in the NHS, as well as recruitment? Is there any further plan for improving recruitment and retention in the social care sector, which has not been mentioned so far?

I know that there is also a potentially significant issue with GP shortages being caused by early retirement, which has been encouraged by pension rules. Is there a plan to look into that issue as well?

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

I call the noble Lord, Lord Green of Deddington.

[Lord Green of Deddington (CB) [V]]

My Lords, as the noble Lord, Lord Clark, outlined, we have for years failed to train the medical staff we need. To take doctors, for example, the numbers are astonishing: over one-third of our doctors—35%—obtained their qualifications overseas, yet in both France and Germany the figure is below 10%. Meanwhile, some 8,000 British applicants are being turned away every year.

The figures for nursing are even worse. Until 2016, more than 30,000 UK applicants were turned away every year, while tens of thousands of nurses were recruited from abroad, often from countries that need them far more than we do.

Finally, the Covid crisis is an opportunity for a major reform of medical training. I certainly hope the Government will take it. The NHS’s standing has never been higher and the number of volunteers has never been greater. We need some firm action. Our young people deserve these opportunities. I look forward to the Minister’s response.

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

I now call the noble Baroness, Lady Greengross.

[Baroness Greengross (CB) [V]]

My Lords, I am co-chair of the All-Party Group on Adult Social Care. Our recent report found that the government target of recruiting 20,000 additional social care workers was not enough—[Inaudible.]

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

I am sorry; I think the difficulty is that the noble Baroness is not close enough to her microphone. When she was tested, it was fine. If we cannot hear her again, perhaps she could write and the Minister will pick up the issues she would like to raise? I will give the noble Baroness one more try right now.

I am sorry; our connection is just too poor for us to hear the noble Baroness. If she could send an email in, the Minister will pick up the issues when he sums up. I thank her very much for her patience.

I call the noble Lord, Lord Winston. No, the noble Lord has withdrawn. I call the noble Lord, Lord Balfe. No, he has withdrawn too. I call the noble Baroness, Lady Bennett of Manor Castle.

Future of Health and Care

Baroness Watkins of Tavistock Excerpts

Tuesday 23rd February 2021 Lords Chamber

[Baroness Watkins of Tavistock (CB) [V]]

My Lords, I declare my interests as outlined in the register and broadly welcome this paper. I particularly applaud the removal of the need for competitive tendering and the introduction of the discharge to assess model, which I and many other professionals have long advocated. However, could the Minister explain why such extensive powers are planned for the Secretary of State prior to the reforms of social care coming before Parliament? Why can they not come concurrently? He has partly just explained that, but it would be much better if we waited and did the two things together. Section 5.153 of the White Paper is designed to widen the scope of Section 60 of the Health Act 1999 to provide further powers enabling the Secretary of State to

“make a large number of changes to the professional regulatory landscape through secondary legislation.”

I seek assurance that there will be ample opportunity to debate this latter issue during the passage of the Bill.

[Lord Bethell (Con)]

I am extremely grateful to the noble Baroness, Lady Watkins, for her generous remarks on competitive tendering and discharge to assess. These are examples of where we have listened to stakeholders and those in the NHS who have called for changes. In terms of the powers given to the Secretary of State and the link with social care, it is worth remembering that this Bill is a stepping stone towards other changes. Changes to social care funding can take place largely without any legislative change; they can be introduced by secondary legislation. Changes to the funding model in social care are a matter for a very large engagement process that will include other parties, as the Prime Minister has outlined, and will include very considerable engagement with stakeholders.

In the meantime, we are seeking to correct an overreach in the seclusion and mandation of the NHS to give the Secretary of State the kinds of powers that are reasonable in a parliamentary democracy in the governance of such a large and important national institution. Those powers are to be used with restraint and a degree of circumscription, but they rebalance the political geography of the NHS to give it full accountability. As such, they give the kind of authority the Secretary of State needs to institute the kinds of social care reforms I know the noble Baroness, Lady Watkins, is interested in.