Restoration and Renewal

Baroness Wheeler Excerpts

Wednesday 13th July 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I thank the noble Baroness the Leader for moving the Government’s Motion and for her introduction to the joint report of the House of Commons and House of Lords Commissions. I also thank my noble friend Lord Blunkett for moving his important amendment on the key principles of accessibility and public engagement going forward, and I thank the noble Baroness for her reassurances to him in her speech.

As the House will know, my noble friend Lady Smith has long been a passionate advocate for the visionary, strategic and structured management and delivery of the programme for the restoration of the Palace as set out in the 2019 Act, and she will sum up for us later. She and I worked closely on the then Bill on behalf of these Benches, and I note that many other noble Lords who were also heavily involved in that, and who are highly committed advocates, are also speaking today. They will share our deep frustration at the position we are now in. Nevertheless, we have obligations to meet and we must move forward.

Under the 2019 Act, we all thought we had established restoration and renewal governance structures and accountability that were vital to the safe and efficient execution and delivery of such a huge and complex project. By passing the Act, MPs and noble Lords accepted the necessity for the arm’s-length sponsor body to oversee the entire project, provide the expertise needed and avoid the constant political interference, changing objectives and moving goalposts that was greatly feared would happen under an in-house delivery alternative. It also meant full acceptance of the extensive analysis and costings that had been undertaken, showing clear evidence of the overwhelming safety, security, logistical and practical reasons why full decant of both Houses to alternative venues during the works was absolutely necessary and the only viable and realistic option in terms of overall costs and minimising project delivery timescales.

Sadly, the argument for a continued presence—primarily of MPs—and remaining in the building, like latter day Miss Havishams, has still not been laid to rest. A decision on whether to decant is not now to be made until after the intrusive survey work is completed and there is greater understanding of the condition of the House and the work that needs doing.

We also know that persistent attempts to revisit the basis and scope of the programme began pretty much as soon as the sponsor board started its work. The Lords’ spokesperson on the body, the noble Lord, Lord Best, who I am pleased to see is in his place and will be speaking later, has made clear his view that it has been hampered from the outset by political interference and has not been allowed to get on with the job Parliament gave it to do.

However, despite the regrettable changes to the established managerial and delivery structures and our disappointment at the stage we are now at, the House will know that, yesterday, the Commons supported this joint report produced by the two commissions. We strongly urge our Members in a free vote to support it today. We recognise that the joint report is now the only show in town—the only way to keep moving forward the vital restoration work that must take place on this wonderful building. It is the only opportunity we now have to try to make sure that the urgent and vital works that are needed are proceeded with in as coherent and managed a programme as possible, and the only way to get the essential House of Commons buy-in.

It is of considerable comfort that the joint report fully acknowledges the huge challenges and scale of the work that has to be done and outlines the key initial priorities of essential work that must be addressed to prevent the building falling into even further decay: on fire and safety; building services; asbestos elimination; and on the building’s stonework and framework.

The noble Baroness has set out the new structures and arrangements under the joint report, and I will not repeat the details. The sponsor body is disbanded, and the much-reduced numbers of expert staff that we have succeeded in retaining from it will be transferred to the new joint department of the two Houses. We will have a new in-house client body, advised by an independent panel of experts.

The Public Accounts Committee’s report on what has or has not taken place since the passing of the 2019 Act, and on the new mandate—surprisingly not referred to by the noble Baroness the Leader—raises a slew of key questions for her on how it will all work. I will come back to those later.

First, I pay tribute to the role played by our representatives on the sponsor body and draw the attention of noble Lords to their contributions in last year’s Grand Committee debate in November, on the parliamentary sponsor body’s 2020-21 annual report and accounts, led by the noble Lord, Lord Best. I commend it to noble Lords. It is a master class in the management of major renewal and construction management, with contributions from the noble Lord, Lord Best, and from my noble friend Lord Carter of Coles and the noble Lord, Lord Deighton, both of whom have extensive experience of managing and delivering large-scale construction and building projects —on NHS pricing and procurement in the case of my noble friend Lord Carter, and on the 2012 Olympics in the case of the noble Lord, Lord Deighton. The detailed analysis of the sponsor body’s accounts by our Finance Committee chair, the noble Lord, Lord Vaux, was particularly insightful and informative in the light of the PAC’s subsequent observations.

My noble friend Lord Carter and the noble Lord, Lord Vaux, are both speaking today, but it is worth placing on record the view of the noble Lord, Lord Deighton, that full decant is

“the only truly viable option which would produce the best value for money for the taxpayer.”—[Official Report, 16/11/21; col. GC 58.]

He also stressed the inescapable fact that for any total budget for renovation, three-quarters of the costs would be for the necessary core engineering work—a key factor that the Government must remember when the key priority areas are being planned and budgeted for.

My noble friend Lord Carter warned that:

“Without a decision, or if the decision is to kick the can down the road, we will be faced with a catastrophe at some point.”—[Official Report, 16/11/21; col. GC 64.]


This is a warning that we have heard many times and which no doubt will be repeated today. It is reinforced in the escalating media coverage on the state of the Palace, such as in the recent Observer article, “Britain’s Notre Dame?”, with some very graphic pictures of the decaying basement and antiquated engineering and plumbing works.

The steady but extremely slow-moving work of the sponsor body on the intrusive surveys and drilling down into the buildings and courtyards has urgently to be stepped up so that the maximum work can be achieved over the Summer Recess. I serve on the Services Committee, under the excellent chairpersonship of my noble friend Lord Touhig. We have spent a great deal of time over the past two years combing through detailed sponsor body reports on the urgent works needed and the proposed surveys—what they will cover, how they will work and what they are designed to find. My noble friend Lord Blunkett will be pleased to hear that this included ensuring that all the accessibility issues while the work takes place are fully addressed.

Can the noble Baroness the Leader assure the House that the surveys are going ahead at full steam on the priority areas of work over the summer, so that we know what we are starting with and the viable costs? The PAC report calls for this particularly in respect of determining what the asbestos removal plan should be and the safety of remaining in the Palace while these works take place.

The PAC report makes for some pretty sober reading, recognising of course the realities of the post-Covid financial environment. However, it contains no real surprises to most of us: the colossal sums wasted; the loss of the critical professional skills built up by the sponsor body to develop the business case for the programme funding and undertake the specialist construction and technical work; and the delay and prevarication that has resulted in the start date for major works being pushed back by many years, up to 48 or even 76 years under some worse-case scenarios. The PAC pulls no punches on these issues and on the increasing risks that the delays have caused.

Can the Minister comment on three of the issues that it raised? First, the PAC calls for a clear plan and structure on how the short-term risks to value for money and to avoid nugatory expenditure and further health and safety incidents will be managed. What timescales are envisaged for this extremely urgent area of work? Secondly, given the lack of time to consider other options for going forward and why the 2019 Act structures have not worked, how will the performance and governance lessons be learned in the delivery phase for the new arrangements? Thirdly, how will transparency and accountability to Parliament be managed in the future? What are the plans to report regularly to Parliament and its various committees on progress, potential costs and risks? How will the independent expert advice needed to support decision-making be truly independent and objective?

In conclusion, and despite the many unanswered questions from the Public Accounts Committee and that I am sure that will be asked by noble Lords today, I come back to where I started. The joint commission report on a new mandate, and the Motion before the House, must be approved. It is the only way forward to meet our obligations and to preserve and develop this wonderful building—the only show in town. Comfort can be drawn from the joint report’s undertaking to start the safety-critical works as soon as possible. There are definite signs of optimism in the first stage engagement survey of 20,000 members of the public, which shows strong support for the preservation and renovation of the Palace as the heart and centre of our democracy. This is a very welcome development and it must not be squandered.

Her Majesty the Queen’s Platinum Jubilee

Baroness Wheeler Excerpts

Thursday 26th May 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I am very pleased to contribute to today’s debate. I have heard with great interest the range of contributions from noble Lords paying tribute to Her Majesty in celebration of the forthcoming Platinum Jubilee weekend. As usual in your Lordships’ House, as varied as the speeches have been, they have gelled together extremely well to paint a full picture of Her Majesty’s remarkable life and work.

A number of noble Lords have related their own memorable and moving experiences of meeting the Queen. Although I have not had that privilege, my own memory is of being a young working-class child living in south London in the post-war early 1950s and celebrating the Queen’s Coronation Day, with my own Coronation dress, Coronation mug and Coronation doll—but not a beer mug, as the noble Lord, Lord Newby, recollected. I was also convinced that I saw the Queen’s carriage go along the street I lived in. However, unless the carriage passed down the Old Kent Road and Camberwell Green on its way from Buckingham Palace to Westminster Abbey, that memory is obviously a mistaken one.

I remember all of us sitting around a very crackly wireless and listening to the Coronation. What was clear to me, even at that young age, was the strong and solid support that the monarchy enjoyed among working-class communities struggling to recover from the devastation of the Second World War. The young princess shortly to become Queen provided people with hope for the future and, as we have heard, has succeeded during her long reign in retaining and building respect, trust and admiration across the UK among our diverse communities and nations.

We have heard much today about the Queen’s famous work ethic. In the short time available, I would like to underline this in respect of her unique role in supporting charities. As we celebrate her long reign, recent research by the Charities Aid Foundation has shown that she is among the world’s greatest supporters of charities, helping to raise more than £1.4 billion. Clearly, she has ensured that the Royal Family maintains this as an essential part of its work. The Queen is a patron of 519 charities, including Cancer Research, the British Red Cross and Barnardo’s; her wider family supports 2,215 charities in Britain, rising to nearly 3,000 worldwide.

The Queen is a patron of one of the excellent charities I am involved in: the Stroke Association. Her role as patron is greatly valued and appreciated by the association. I have been a strong supporter of its work since joining your Lordships’ House in 2010 and as a carer of a disabled adult stroke recoverer. Stroke strikes every five minutes in the UK and 100,000 people have strokes each year. It is a leading cause of death and adult disability in the UK, with more than two-thirds of people suffering a stroke leaving hospital with a disability.

The Queen’s sister, Princess Margaret, died of a stroke after having had several previously. The Princess Margaret Fund for stroke research was established in her name. It provides a unique opportunity for people who care about stroke to invest in areas of stroke research that have the greatest potential to change our understanding of this disease and develop new life-saving treatments. Stroke research is vital to drive improvements in care and treatment but has been historically underfunded, receiving only a fraction of the research investment in other comparable life-threatening conditions. Annual research per stroke patient in the UK is £48 but it is £241 for cancer, so there is a great deal of catching up to do.

Stroke is a complex condition. A wide range of healthcare professionals are involved across the stroke care pathway, from GPs, primary care, ambulance paramedics, hospital doctors, specialists, nurses and support staff through to key rehabilitation specialists. The Stroke Association is campaigning vigorously to ensure that acute staff shortages in many areas of the stroke pathway can be addressed, in particular for the game-changing acute treatment for many strokes of thrombectomy to be available to all who would benefit from it. Thrombectomy is an extremely cost-effective treatment that reduces the chances of disabilities such as paralysis, blindness and aphasia. So watch out for the association’s July campaign on this vital issue, of which I feel certain Her Majesty would fully approve.

I too am very much looking forward to the jubilee celebrations and I pay tribute to all those who have worked so hard and played such a vital part in designing, planning and organising the exciting and imaginative events and initiatives taking place up and down the country. The one I especially commend is the inspirational Queen’s Green Canopy, inviting us to plant a tree for the jubilee. As well as inviting the planting of new trees, the QGC highlights 70 unique and irreplaceable ancient woodlands across the UK. We have seen how hundreds of families, especially children and children’s groups, have taken up the challenge to plant trees, with special environmental and horticultural projects running alongside the canopy initiative to encourage young people in particular to get involved and to think about taking up careers in this important work through such initiatives as the Junior Forester Award. The BBC’s excellent “Countryfile” programme has played a key role in building understanding of how crucial trees are for people and nature and for encouraging communities in all parts of the UK to be a part of the Green Canopy. The need both to protect our existing wood stock and to increase the percentage of the UK under tree cover could not be more important to the future of our planet. Having the Green Canopy as an inspirational and core part of the jubilee celebrations reinforces this crucial message.

Finally, I stress that I am particularly pleased and honoured to be attending the National Service of Thanksgiving to celebrate the Platinum Jubilee at St Paul’s Cathedral next weekend. I am looking forward to what will be a very memorable occasion.

Health and Care Bill

Baroness Wheeler Excerpts

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

[Baroness Wheeler (Lab)]

My Lords, my noble friend has returned with his amendment on the need for an expert-led review on the 40 year-old Vaccine Damage Payments Act, and I am pleased that the meeting he sought with the Ministers has taken place. The amendment is a timely reminder for all of us that while the vaccination programme against Covid has been hugely successful, for a small group of people suffering very serious adverse effects and deteriorating health as a result of having the vaccination, the experience has been devastating, as the noble Baroness, Lady Brinton, underlined. The current legislation dealing with compensation arrangements is not fit for purpose: in the words of my noble friend, it offers too little, too late and to too few people. I hope the Minister acknowledges the need to meet and engage with the families of those affected, and that he looks urgently at the ways in which claims under the current system can be speeded up, and he also accepts the need for the review of the scheme and the next steps that have to be taken on this.

My noble friend has also added his name to Amendment 180 from the noble Baroness, Lady Cumberlege, on her unrelenting campaign for separate compensation schemes to meet the cost of care and support for the victims highlighted in her First Do No Harm report. Once again, we have heard convincing and forceful contributions from the noble Baronesses, Lady Cumberlege and Lady Brinton, which we on these Benches strongly support, calling for an independent redress agency for the three patient groups covered by the First Do No Harm report. The Government’s positive response to another key aspect of the First Do No Harm report, to improve patient safety for the future, including establishing the patient safety commissioner, is a welcome and necessary development. But the redress agency needs to be there to provide care and support for the thousands of women who suffered, and whose needs will not be met by the healthcare system, social care support or social security benefits support.

I hope the Minister has considered the matter carefully since Committee, and will report positively to the House on the ongoing discussions and progress which will ensure the strongest recompense possible for the people we are concerned about.

[Earl Howe (Con)]

My Lords, I will turn first, if I may, to the amendment in the name of the noble Lord, Lord Hunt of Kings Heath, on the Vaccine Damage Payment Scheme, and start by thanking him for his campaigning on this issue, and for the informative debates we have had today and in Committee.

As we discussed in Committee, since the NHS Business Services Authority took over responsibility for the Vaccine Damage Payment Scheme from the Department for Work and Pensions in November 2021, we have started to find ways to improve the operation of the scheme. The most important thing the NHS Business Services Authority is looking do to is to improve the claimant journey on the scheme, and that means making engagements with claimants more personalised, as well as giving claimants access to more general support. The crucial part of this drive is to reduce response times, which the authority knows has been a cause of dissatisfaction, particularly during Covid; in other words, the whole process is being modernised.

The NHS Business Services Authority has done its best to hit the ground running. Since taking over in November, it has already contacted all applicants to update them on their cases and it has also allocated additional resource to the operation of the scheme. I can assure the noble Lord that the department will further engage with the NHS Business Services Authority to ensure that these service improvements, greater digitisation in particular, really do make headway. There is already regular dialogue on this.

With all this enhanced activity happening, I do not think this is right time to establish an independent review into the VDPS. As the noble Lord will know, reviews take significant time and they carry substantial costs to the organisation, not just financial but in terms of leadership focus and energy. Instead, we think it is a better use of resources to focus on making the changes that we know need to happen; that is, to improve the claimant’s journey, and to modernise the process for claimants, as well as scaling up the capacity of the VDPS. We will keep the progress on these under regular scrutiny, and I am sure we will report regularly to this House as we do so.

I will address the noble Lord’s three key questions. First, I should be happy to facilitate a meeting with representatives of the families, and my honourable friend Maria Caulfield, who is the Minister with direct responsibility for the scheme, will be pleased to see them. Secondly, as I have already indicated, reducing response times is one of the NHS Business Services Authority’s key objectives. Thirdly, the noble Lord asked whether the Government would undertake a review of the scheme. I simply remind the noble Lord that the scheme has been revised many times since its inception, which shows that it is reviewed regularly as a matter of course, but perhaps it is worth my making the point that the VDPS is not a compensation scheme; nor is it designed to cover all expenses associated with severe disablement, which are catered for from the public purse in other ways. I hope that is helpful to the noble Lord, and that on the basis of those assurances he will feel able to withdraw his amendment.

Before I address the detail of Amendment 180, I would like to again put on record my thanks to my noble friend Lady Cumberlege for her continued commitment to the issues she has so powerfully spoken about, and the diligence and dedication of the IMMDS team, and the brave testimonies of those who contributed to the IMMDS review. As my noble friend knows, the Government have accepted the majority of the report’s nine strategic recommendations and 50 actions for improvement, and are taking forward work to improve patient safety. This includes establishing specialist mesh removal centres, the ninth of which opens in Bristol this month, and work to improve the care pathways for children and families affected by medicines during pregnancy.

We remain committed to delivering improvements in patient safety across the board. We are focusing government funds on initiatives that directly improve future safety. For this reason, the Government have already published their decision that redress schemes will not be established for people affected by hormone pregnancy tests, sodium valproate or pelvic mesh. I realise that was a disappointing decision for my noble friend, and I am always very sorry to disappoint her, but, for the reasons I have given, I ask her not to move Amendment 180 when it is reached.

--- Later in debate ---

[Lord Clement-Jones (LD)]

My Lords, I rise briefly to support Amendment 165, in the name of the noble Lord, Lord Hunt, and thank him for putting it forward. Self-care has an important role to play in supporting people to manage their own health needs, and also in alleviating an unsustainable demand on GP and A&E services. As the noble Lord described, prior to the coronavirus pandemic there were some 18 million GP appointments and 3.7 million visits to A&E every year for conditions which people could have looked after themselves or sought advice from a pharmacist. It is estimated that this was costing the NHS in the region of £1.5 billion a year.

During the coronavirus, again as the noble Lord described, surveys have shown a much greater willingness among members of the public to self-care for these self-treatable conditions. But it is vital that appropriate policies are put in place to ensure that, as we emerge from the pandemic, people who can self-care continue to do so. It is evident now that self-care can help address many of the challenges we face in the NHS today, but to do so we need to address some of the system barriers to self-care, as described in this amendment, and unlock the important behavioural shifts that enabled people to self-care during the pandemic.

In particular, I will highlight how the NHS can make much better use of digital technologies and community pharmacists to enable people to self-care. We need to make better use of the technologies that the NHS has embraced over the course of the pandemic, such as the Covid-19 symptom checker on the NHS website. The digital triaging technology should be used to support the expansion of the community pharmacist consultation service to enable people to follow an algorithm online to get a referral for a consultation with a local pharmacist. It is critical, if we are to optimise the role of pharmacists—I am a big supporter of community pharmacists—that we give them the digital tools and information they need to support people. At present, a pharmacist cannot routinely record the advice or medication they give people, despite receiving training. The NHS must address the question of interoperability in IT systems, so that pharmacists can have access to read and to input into people’s medical records and enable pharmacists to be a core part of an individual’s primary healthcare team.

6.15 pm

The pandemic has highlighted how quickly the NHS and patients can adopt technological and digital changes. Realising the Potential: Developing a Blueprint for a Self Care Strategy for England, a document launched last October, is an excellent blueprint for this. A whole range of organisations, including NHS clinical commissioners, the RCN, pharmacy organisations, the Self Care Forum and, of course, the PAGB, have worked together to develop this blueprint for a comprehensive national self-care strategy to support the introduction of self-care policies throughout the NHS in England. It contains policy proposals and case studies, in particular in relation to digital technologies, which set out how the NHS can fully embed self-care and pharmacy into primary care.

I hope the Minister today will outline how the Government are ensuring that the NHS can adopt these proposals, which learn from the pandemic, and will expand them to support individuals to enable self-care.

[Baroness Wheeler (Lab)]

My Lords, we had a good debate in Committee on the issue of self-care and the management of health conditions, particularly on its importance as a key part of the primary care pathway. This was underlined in diabetes care and, as I also emphasised, in the care and treatment of people with rare diseases, most of whom are living with lifelong conditions. As vice-chair of the Specialised Healthcare Alliance of charities supporting this key group of patients, I know that they often do not feel sufficiently supported in terms of care and support and health and system information, and with physical and daily living.

As the two noble Lords have stressed, the Health Foundation’s research on the effective self-management by patients has shown a significant reduction in the need for emergency admissions to hospital and in A&E attendances, and fewer GP appointments. In this context, Amendment 165 makes a great deal of sense. If patients with, for example, rare diseases receive appropriate support to manage their less intensive care needs, then promoting self-care has the potential to help them prevent their conditions from deteriorating, to improve their lives and to reduce demands on the NHS, as the noble Lords have stressed.

We therefore strongly support the need for the development of a national self-care strategy, starting with awareness raising among primary and secondary children on how to self-care, and with appropriate staff and management training of healthcare professionals. Improved technologies, as underlined by the noble Lord, Lord Clement-Jones, especially those developed during the pandemic, will have a key role in broadening access to effective self-care and ensuring the better support from primary and community pharmacists that we all want to see. I hope the Minister will respond positively to this amendment.

[Baroness Penn (Con)]

My Lords, I thank the noble Lord, Lord Hunt, for bringing forward a debate on this issue. I reassure him and other noble Lords that the Government absolutely agree that supporting people to maintain their health and well-being and to manage self-treatable conditions is a vital part of delivering a comprehensive health service. Indeed, much of what the amendment seeks to achieve is already government policy. However, I do not agree that requiring the Secretary of State to prepare a single national strategy would add value. Instead, we are threading self-care through a wide range of work, reflecting the range of areas that it impacts upon.

A good deal of work is already under way. The community pharmacy contractual framework for 2019 to 2024 five-year deal sets out how community pharmacy will support the NHS long-term plan. Community pharmacies, which provide easy access to the NHS, are already required to support patient self-care, signpost to other parts of the NHS and local services as necessary, and help people to live healthily.

I am especially aware of the interest the Proprietary Association of Great Britain has shown in this area. The Department of Health and Social Care officials have met with it to discuss its blueprint for a self-care strategy in England and will continue to engage with it about further supporting self-care throughout our healthcare system.

We do not think placing an additional duty on the Secretary of State would be the right way to support this work, as it would take it out of the NHS long-term plan, where it belongs as part of a holistic approach to the provision of a health service. It could risk making it more disjointed rather than integrated in its approach, but noble Lords made a really important point about demand on our health service and the role that self-care has in this. Prevention was a key theme of a speech by my right honourable friend the Secretary of State last week and, clearly, elements of self-care and prevention go hand in hand with each other, particularly in the use of new technology.

Noble Lords also made an important point about how we can use self-care, particularly at community pharmacies, to reduce pressure on GPs and A&E departments. All community pharmacies are required, as I said, to provide support for self-care. To ensure that people get directed to the right support for their health needs, we have introduced referral systems from NHS 111 and GPs to pharmacies for advice and treatment for minor illnesses. We are also exploring expanding referrals from other settings, including urgent treatment centres and A&E to community pharmacies.

I hope that gives noble Lords some reassurance that we place an importance on self-care, as part of our health service. That will only increase in future and work is under way in multiple areas of the health service to do that. I hope, therefore, that the noble Lord is able to withdraw his amendment.

Health and Care Bill

Baroness Wheeler Excerpts

Committee stage
Friday 4th February 2022 Lords Chamber

[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 Wheeler Excerpts

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

Moved by

[Baroness Wheeler]

164: Clause 26, page 37, line 35, at end insert—
“(4A) The indicators of quality set by the Commission under subsection (4) must include—(a) whether national standards in the care of people with rare and less common conditions are being met;(b) whether the views of patients with rare and less common conditions are being represented;(c) whether people with rare and less common conditions have access to a named clinical nurse specialist.”Member’s explanatory statement
This amendment would require integrated care boards to be assessed by the Care Quality Commission on the provision of care for people with rare and less common conditions, in particular.

[Baroness Wheeler (Lab)]

My Lords, Amendment 164 heads this wide-ranging group and probes how the proposed Care Quality Commission rating system for ICBs’ work in practice, with a particular focus on rare and less common conditions, although this debate is more broadly relevant to all aspects of the CQC’s role.

Amendments 178 and 240 from the noble Lord, Lord Sharkey, to which I have added my name, also relate to people with rare diseases and their access to innovative medicines and medicinal products, and the general need for awareness-raising about those conditions among health and social care staff. I remind the Committee of my role as vice-chair of the Specialised Healthcare Alliance. The noble Lord will speak to those amendments later.

The group also covers amendments on wider care and safety issues that impact on patients, including ensuring that liothyronine T3 is available to patients when it is prescribed by a doctor and the regulation of healthcare and associated professions. This includes safeguards to apply under the Secretary of State’s power to alter the professional regulatory framework; protecting the use of the title “nurse”; hospital food standards for patients and training for staff; reviewing the surgical consultants’ appointment process; and licensing aesthetic non-surgical cosmetic procedures in registering cosmetic surgery practitioners.

The noble Lords who have their names to these amendments will speak to them, so I will leave them to it and concentrate on my rare disease issues and the matters that our Front Bench team have added their names to. Returning to the CQC, and following on from the previous debate on Clause 26, on the amendment tabled by the noble Lord, Lord Lansley, regarding the role of the Secretary of State in setting objectives and priorities, overall, we welcome the extension of the CQC’s remit to ICBs but now need to understand how it will work in practice.

As it stands, the Bill establishes an overarching framework under which the CQC will need to determine for itself the quality indicators against which it will assess ICBs. My amendment raises the issues about the quality indicators relevant to those with rare and less common conditions. If the purpose of the rating system is to protect patients, it must help to ensure that national standards of patient care, where they exist, are being met. Under the NHS’s plans to jointly commission or delegate commissioning responsibility for specialised services to ICBs, set out in NHS England’s Integrating Care paper, an important assurance given is that specialised services will

“continue to be subject to consistent national service specifications and evidence-based policies determining treatment eligibility.”

Will the CQC ensure that services organised by ICBs are organised in line with these national specifications?

Moreover, people with rare diseases are concerned that if services are to be commissioned in some way by ICBs in future, rather than just NHS England, their voices may be lost. NHS England’s specialised commissioning team meets regularly with representatives of the rare disease community, including the SHCA, and it is important that ICBs can hear their views too. How will this happen and how will the CQC rating system act to ensure that this happens?

Finally, one of the key asks of patients with rare diseases to help deliver continuity in their care is that they have access to a named clinical nurse specialist, which is commonplace for patients with more common conditions. That continuity of care is an important marker of quality. Will the CQC rating system help to deliver it?

Beyond these questions are broader ones. If the bulk of the CQCs work will continue to focus on inspecting providers, can the Minister explain how it will ensure that its ICB ratings are not unnecessarily duplicative, given that providers will form part of ICBs? Also, the CQC looks at whether services are safe, effective, caring, responsive and well led. Given that the first three of these should continue to be the primary concern of those providing care, rather than of the ICBs organising it, how will the CQC ensure that the new rating system clarifies rather than dilutes this accountability? How will the CQC’s work align with the wider performance management of ICBs undertaken by NHS England? How specialised services will operate is a complex area and I am happy for the Minister to write to me on some of the specifics of my questions.

As I said, I will speak briefly to other amendments in this group, to which Labour Front-Benchers have added their names. Amendment 243, tabled by my noble friend Lady Merron, covers the important issue of the protection of the title “nurse”, and is supported by three respected medical and healthcare professionals whose contributions I look forward to. The recent Health Service Journal survey found hundreds of roles that do not require Nursing and Midwifery Council registration but use “nurse” in the job title. While “registered nurse” is a title protected by the NMC, “nurse” is not. The term may be used by anyone in the UK to offer professional advice and services, and people with no nursing qualifications or experience, or who have been struck off the professional register, may use it.

Obviously, this is worrying and even dangerous—a dangerous trend which potentially compromises patients’ health. What progress is being made on the Government’s review of healthcare professional regulation following their consultation last year? Surely we must follow the example of other countries, such as France and Australia, in giving the consistently most trusted profession in the UK the recognition and protection that it deserves.

My noble friend Lady Thornton has added her name to Amendment 258, from my noble friend Lord Hunt, to the welcome new Clause 145, on hospital food standards. It underlines the importance of investment in the food served to patients in hospital and other care and treatment settings. It is welcome because it specifies food quality and standards and stresses the importance of recognising staff skills, experience and training, as well as ensuring investment in NHS kitchens and catering equipment to ensure that the highest standards can be maintained.

On Amendment 266 from my noble friend Lady Merron, we seek to give the Secretary of State power to introduce a licensing regime for aesthetic non-surgical cosmetic procedures and to introduce an offence of practising without a licence. This area is crying out for regulation. The Department of Health’s own report has said that non-surgical interventions which can have major and irreversible adverse impacts on health and well-being are almost entirely unregulated. We fully recognise that this is also a highly complex policy area. However, I understand that noble Lords concerned about this issue had constructive and positive discussions yesterday with the Minister, and I look forward to the Minister updating the House on the scope and discussions of the Government’s ambition in this important area.

Finally, I offer my strong support for my noble friend Lord Hunt’s Amendment 176, which seeks to ensure that the general powers of the Secretary of State to direct the functions of NHS England include ensuring that when T3 is prescribed to patients with hyperthyroidism, the drug is made available to them. My noble friend rightly raises this issue at every opportunity, and I hope the Minister will have a bit of good news for him today and tell us that some real progress has been made. It is clear that many thyroid patients would benefit hugely from the declassification of T3 as a high-cost drug, back to a drug that is routinely prescribed in primary care. It is much cheaper now, and the many patients who were taken off the drug and continue to be denied it need to have it restored. The Government must ensure that the now updated NICE guidelines which reflect this new position are implemented consistently across the new NHS structures, rather than repeat the record of the nearly 50% of CCGs which failed to ensure that the drug is properly prescribed.

I will leave it at that, and I look forward to the debate.

[The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)]

I remind the Committee that both the noble Baronesses, Lady Brinton and Lady Masham, will be contributing remotely. I call the noble Baroness, Lady Brinton.

--- Later in debate ---

[Lord Kamall (Con)]

If it is as straightforward as the noble Lord suggests, I will see if that can be done.

[Baroness Wheeler (Lab)]

My Lords, I thank noble Lords for their many expert and very informative contributions. It has been a fascinating debate on a number of issues.

On specialised care services and rare diseases, I note the Minister’s comments and thank him for some of his reassurances, but there were some issues that he did not cover, particularly in relation to my noble friend’s Amendment 178. However, I welcome the dialogue that is taking place on these issues, and the recognition of their complexity, and am very hopeful that that will continue. We will take stock to see if anything else needs to come back on Report. I also thank my noble friend Lady Pitkeathley for her support on this issue.

In the general debate, noble Lords will, I am sure, follow up on the points that they made, as the noble Lord, Lord Patel, just did. I thought the contributions of my noble friend Lord Hunt and the noble Baroness, Lady Barker, on the hospital food situation, really drove home the importance of this issue. We must make progress on it and move forward.

On the title “nurse”, strong support was expected and we certainly got it from across the House. I hope that progress can be made. The issue will not go away, as the Minister knows, and neither will the determination of my noble friend Lord Hunt to pursue the issue of the availability of T3 for thyroid patients. We hope that progress can be made on that, because again it is a situation that a must be addressed.

The noble Baronesses, Lady Masham and Lady Brinton, and other noble Lords made valuable points on the vital need for a licensing regime for non-surgical cosmetic procedures, again underlining the need for urgent, step-by-step progress, and demonstrating in particular why the current situation is unacceptable. Progress can be made. As the noble Lord, Lord Lansley, pointed out, it was seen in the recent Private Members’ Bill on Botox fillers. We need progress to be made, and steadily.

Finally, on the reference to when the review of the regulatory system will be completed—the noble Baroness, Lady Walmsley, also raised this—the issue was about timescales. We know there is a review. We are told that KPMG is on the case and has delivered its report, but we need timescales and action as soon as possible.

With those comments, I beg leave to withdraw my amendment.

Amendment 164 withdrawn.

Health and Care Bill

Baroness Wheeler Excerpts

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

[Baroness Wheeler (Lab)]

My Lords, I strongly support my noble friend Lord Hunt and other noble Lords in their quest in this suite of amendments to underline the important and crucial role played by Healthwatch, particularly at local level, and to ensure that the new NHS structures and processes in the Bill fully recognise this.

Under the 2012 Bill, the noble Lord and others who have put their names to the amendment and who have spoken in today’s debate were all strong advocates of Healthwatch, and clearly remain so today. The concerns deeply expressed then of the Government’s decision to make national Healthwatch a sub-committee of the CQC, and not the independent organisation that it needed to be, have again come to the fore. Amendment 220 would add a new clause after Clause 80, seeking to establish Healthwatch England as a body corporate that provides an annual report of its activities to Parliament; it has the full support of these Benches. As the noble Lord, Lord Patel, has strongly emphasised, failing to provide for the independence of Healthwatch was a fundamental error that needs to be put right. He set out a particularly strong case, as have other noble Lords this time around.

Amendment 42 to Schedule 2 seeks to ensure that Healthwatch is a non-voting member of the ICB, so that there can be a genuine championing of patients’ voices and views, which many noble Lords have spoken so strongly about today. These are views fed back from evidence and surveys conducted by both national and local Healthwatch organisations. At the very least, it is crucial to seek to ensure—as set out in Amendment 103 to Clause 20—that the ICB is obliged to fully consider Healthwatch reports and that that body leads any local consultations proposed in the ICB forward plans.

Amendment 149 to Clause 21, seeking to ensure that ICPs have a Healthwatch nominee in membership, is also important, given the local Healthwatch links to both the NHS and local authority bodies, patients and clients.

Key questions on how Healthwatch, both at national and system level, is to be funded were raised by my noble friends Lord Hunt and Lord Harris, particularly about the whole process of allocating funds. This is important in view of the increased role of Healthwatch in the additional 42 ICSs. I look forward to the Minister’s response.

Finally, I also endorse noble Lords’ comments on the excellence of the reports produced by national and local Healthwatch organisations. Their guidance on access to social care, mentioned by several noble Lords, and comments on the detailed proposals later in the Bill on the care cap and the recent White Paper, are clear and accessible to service users, and closely examine the impact for them, and for the thousands of people currently waiting for assessment and access to key services. However, those are issues for another day. I hope that the Minister has listened to the debate.

[Earl Howe (Con)]

My Lords, these amendments deal, in their several ways, with the role of Healthwatch both locally and nationally. I begin with Amendment 42, in the names of the noble Lords, Lord Hunt of Kings Heath and Lord Patel, and the noble Baroness, Lady Thornton. This amendment would require ICBs to make provision in their constitutions for a non-voting member to be appointed from local Healthwatch branches.

I lay great importance, as do other noble Lords, on Healthwatch’s work on patient advocacy. However, as I said in relation to other amendments on the membership of ICBs—I know this is turning into something of a mantra—we want to avoid the Bill’s provisions being too prescriptive. It is essential that we provide local leaders the flexibility to design the board in a way that best suits each area’s unique needs. Even a non-voting member risks making the boards less nimble, undermining their ability to make important decisions efficiently. As I am sure the Committee is already aware, the ICB can appoint more members, including a Healthwatch representative, if it wishes, and I am sure many of them will. What is key is that local boards should be able to decide for themselves to appoint individuals with the necessary expertise to address local needs, and we want to allow them as much scope as possible to do so by not prescribing who all those members should be.

That said, I recognise that the growing complexity of health and care demands that we listen to the voice of patients, carers and the public. We want to ensure that they are heard throughout the system. I contend that there is adequate provision in the Bill to ensure that patients and the public are appropriately consulted and involved in decisions made by the ICB. I draw noble Lords’ attention to new Section 14Z36, regarding the duty to promote the involvement of each patient, and new Section 14Z44, regarding public involvement and consultation by ICBs.

I listened carefully to the noble Lord, Lord Harris of Haringey, as I always do, about the particular need for adequate and appropriate funding of local Healthwatch. If I may, I shall take away the points he made on that issue and others and write to him about them. We would expect Healthwatch to be closely involved with ICBs in carrying out their engagement and involvement duties. On what do we base that expectation? Many systems already have some system-level arrangements in place with Healthwatch. Indeed, NHS England has published guidance, which would apply to ICBs, on working with people and communities that encourages working closely with Healthwatch. Therefore, given that ICBs will already be required to engage patients closely in their decision-making process, and that we expect Healthwatch will be closely involved in that, we consider it unnecessary to require in legislation a member drawn from Healthwatch.

Amendment 103 would alter ICBs’ duties in relation to public involvement to require them to make adequate arrangements for the receipt and consideration of any relevant Healthwatch reports. As I said, the existing ICBs’ duties in relation to patient involvement are already comprehensive, and the amendment could unintentionally limit ICBs’ ability to form relationships with Healthwatch and other organisations appropriate for their area. As was the case for CCGs, ICBs will be required to make arrangements to involve patients in the planning of commissioning arrangements in areas that may impact the manner in which services are delivered, or the range of services available. This will ensure that patients receive appropriate representation where decisions are being made that could affect them.

I previously mentioned that NHS England, in its guidance to ICBs, has encouraged close working with Healthwatch. This guidance comes with the acknowledgement that what an appropriate relationship with Healthwatch looks like will vary from system to system. For this reason, we are seeking to establish comprehensive duties and requirements in the legislation while leaving the specifics of local relationships with organisations such as Healthwatch for ICBs to determine for themselves.

--- Later in debate ---

[Baroness Brinton (LD) [V]]

My Lords, I am speaking in support of the amendments in the name of the noble Baroness, Lady Bennett, starting with Amendment 46. After many helpful discussions both today and earlier on in Committee looking at membership, structures and representations of ICBs, these amendments take us back to the first principles and ask your Lordships’ House to look at what should be in scope for the provision of NHS services. This is a really valid question.

The noble Baroness, Lady Bennett, referred to maternity services, but if I were to pick one of the services listed in Amendment 169, it would be dental services. There are millions of people in the country who cannot access an NHS dentist. The result is a worsening of dental health, which is especially worrying for children and young people. I am sorry to say that, over the years, Ministers have ignored the wider needs of the public regarding dental services. I think the point about specifying the provision of services such as this puts a very particular duty on the Secretary of State to force Ministers to make sure that they are also holding other parts of the health service to account.

The amendments turn our focus on to whether we still have an NHS that is a public health system or one that perhaps is paid for mainly by the public but run by a disparate number of bodies, including unaccountable private companies increasingly not based in the UK. They are particularly important in light of the report today in the press that the Secretary of State is planning to create the equivalent of school academies for failing hospitals and says that there will be a White Paper in due course. Just as an aside, do we need yet more reforms? Surely it would have been better to have a full range of Green Papers with an overarching vision of what the NHS in the 21st century should look like and how the structures should work. We are now waiting for two White Papers, while the passage of this Bill is irrevocably changing the structures of our NHS system.

Today’s announcement rings a number of alarm bells because there is an analogy with the education sector that is quite helpful. I remember that, in the 1990s, academies were going to be free from local authority control and that that, on its own, would inevitably make them improve—but that has not been the case. Various reports over the last 20 years have shown that a number of failing schools taken into multi-academy trusts and free schools have remained low performing. Structures on their own do not necessarily resolve this. Indeed, some multi-academy trusts have failed in their entirety, and one of their issues is the lack of public accountability—because Ministers have direct responsibility in the public realm for academies, and I worry that the Secretary of State may be proposing the same. If I was a senior leader in NHS England, I would be very concerned about that.

I am grateful for the earlier comments of the noble Earl, Lord Howe, on the need for Ministers to have the ability to appoint and, presumably, remove senior personnel on ICBs. But would the Secretary of State have responsibility for these academy equivalents and give them the right to access separate funding for capital expenditure and special projects? I raise this because part of the problem that we have at the moment is a diversity of funding mechanisms, structures and strands, which often take the eye of a leader—whether a Minister or one in the NHS—away from the provision of services.

The foundation of a public system was essentially removed by the 2012 Act, and, as the noble Baroness, Lady Bennett, said, the Constitution Committee suggested that there needed to be an interim remedy. It is important that we have reassurance that this Bill will not weaken it any further at all. I hope that the Minister can reassure your Lordships’ House that the Government want to protect the provision of NHS services, as part of a truly public health service.

[Baroness Wheeler (Lab)]

My Lords, I thank the noble Baroness, Lady Bennett, for moving her amendment and other noble Lords for their contributions, particularly on the specific points about particular services, such as dentistry. All three amendments look back to the Health and Social Care Act 2012 and the National Health Service Act 2006 on the powers and duties of the Secretary of State in relation to the NHS and the services that it provides, restoring certain provisions in the 2006 Act.

Under the Bill, the ICBs and NHS England will have the duties to secure the provision of the services that make up the comprehensive NHS. There are probably noble Lords here today who were Members of your Lordships’ House in 2006. I came in in 2010, just as the equally marathon Health and Social Care Act from the coalition Government got under way, when the whole issue of the Secretary of State’s powers and duties came to the fore. As explained at the time, the aim was to separate the political from the operational responsibility and to better align the language to the reality of the purpose of the NHS, in “securing the provision of services”.

The arguments in 2010 and 2011 were fierce and passionate, centred around the subtle changes in the way that the duties were defined, as compared to the words in Sections 1 and 3 of the 2006 Act. They caused suspicion, confusion and fears that the NHS would be changed forever. These arguments remain a bit of a blur in my memory, but I recall the overwhelming view among leading experts on NHS law that the changes were technical and did not involve any substantial change in practice. We know that, in respect of this role, no change has happened.

I also recall the 2012 consideration of the issue by our Constitution Committee and the compromise recommendation subsequently adopted in the 2012 Bill of what became Section 1(3) of the 2006 Act, as amended:

“The Secretary of State retains ministerial responsibility to Parliament for the provision of the health service in England.”


No matter what is in any Act, this is and will always be the political reality.

Currently, the law places the duty on the Secretary of State to

“continue the promotion in England of a comprehensive health service designed to secure improvement … in the physical and mental health of the people of England, and … in the prevention, diagnosis and treatment of physical and mental illness”—

very much in the spirit of the NHS’s founding 1946 Act.

Amendments 46 and 168 seek to continue the 2006/2012 debate. It was claimed about the 2012 Act, and now about this Bill, that the change in wording implies that people will be denied access to treatment from the NHS because, for example, a particular ICB decides to exclude a service and because there is no duty on the Secretary of State to prevent this happening. However, there is no evidence that anyone has ever been denied access to an NHS service or that any service has been refused in general simply because of the change in the wording of the responsibilities of the Secretary of State. Amendment 169 returns to the same point, seeking to place a duty on the Secretary of State to “provide” a list of services, with some general headings such as ambulance services. But the reality is that this is not how the NHS functions or indeed ever has.

I endorse many of the comments made by the noble Baroness, Lady Brinton, about today’s announcement of yet another restructuring on the academy front, but, again, that is a debate for another day.

We could go back on the Secretary of State issue to the 2012 arguments and spend a lot of time on it. While we fully understand the concerns and fears that the current wording could engender among those who suspect a deeper reason for the changes in language, continuing to argue over this issue would not be very productive or get us anywhere. We need to get on with scrutinising the sweeping delegated and Henry VIII powers later in the Bill that our current Constitution Committee and Delegated Powers Committees have expressed such deep concern about.

Health and Care Bill

Baroness Wheeler Excerpts

Lords Hansard - Part 2 & Committee stage
Tuesday 11th January 2022 Lords Chamber

Moved by

[Baroness Wheeler]

6: Clause 3, page 2, line 8, at end insert—
“(ba) after subsection (2) insert—“(2A) The Secretary of State must specify in the mandate maximum waiting times for access to NHS services, including—(a) a maximum waiting time standard of 18 weeks from GP referral to first treatment;(b) a waiting time standard for the time it takes to diagnose rare and less common conditions following a GP referral.””Member’s explanatory statement
This amendment would require the Secretary of State to deliver the existing 18 week waiting time target and ensure a maximum waiting time standard for the diagnosis of rare and less common conditions is introduced.

[Baroness Wheeler (Lab)]

My Lords, with 6 million people in England waiting for operations and routine procedures, many of whom are in pain, I make no apology for moving my amendment at the start of this grouping, which seeks to ensure that the 18-week waiting time target is maintained as a key part of the NHS mandate. This group also covers key amendments on the commissioning role of integrated care boards in relation to specialised healthcare services, and on the duty of ICBs to share best practice on innovation and the quality of services.

On waiting lists, the pandemic has resulted in a huge backlog of care and treatment, compounding pre-existing challenges. The 18-week waiting time standard has not been met by the NHS since 2016. Instead, we have a situation where the NHS’s latest planning guidance sets out plans to eliminate only waits of 104 weeks, to reduce waits of 78 weeks and to support an overall reduction in 52-week waits. Even as a temporary measure this should be unacceptable, and at best we should have a commitment and a plan to restore performance.

Last week’s report from the Health and Social Care Select Committee described the unquantifiable challenge faced by the NHS in addressing the backlog, with 300,000 people now waiting for more than a year for treatment for surgery, such as hip or knee replacements. We know the devastating suffering that the long delays in diagnosing cancer and other diseases such as heart conditions or stroke are causing. The Secretary of State himself said that the waiting list might grow to 13 million, and that was before the current omicron wave, which has only exacerbated this challenge. His promise in November to publish the Government’s plans to meet the workforce requirements needed to address staff shortages and the record waiting lists has yet to materialise.

Of course, this is not just about elective care. In emergency departments, waiting lines in October 2021 were the worst since records began, with one in four patients waiting longer than four hours to be admitted, transferred or discharged, and with trolley waits at a record high. October last year saw the highest number of 999 calls on record. There is a serious risk that the ongoing crisis in emergency care could derail the elective recovery programme.

Although the problems are manifold, prioritisation of the elective backlog is understandable. However, a focus on those areas most amenable to numerical task risk effectively deprioritises other equally important areas such as primary care, community services and mental health services, which all play a crucial role in keeping people healthy and out of hospital. It would be helpful if the plans around recovery in other aspects of care, with some sort of target or at least objective spelled out, were also made known—access to GPs being a primary example.

We know that workforce shortages are the key limiting factor on success in tackling the backlog. Without better short and long-term workforce planning, the 9 million additional checks, tests and treatments will not be deliverable. NHS England’s chief executive, Amanda Pritchard, told the Select Committee that the NHS currently has 93,000 vacancies for NHS positions and shortages in nearly every speciality. The social care workforce has, at present, 105,000 vacancies and a turnover rate of 28.5%, rising to 38.2% for nurses working in social care. Changing the way the cap is calculated will not help this, and of course discussions on both the cap and the need for a credible and systematic workforce plan in the light of the current chronic staff shortages will follow later in the Bill.

The waiting times focus of my amendment, which seeks to insert a new paragraph into Clause 3(2), is tangible and measurable, as are the constitutional targets. In the context of the huge challenges the NHS faces, the 18-week waiting time target remains vital. The discipline it imposes helps focus the entire system on the needs of patients. It drives behaviour and focuses funding, and it facilitates the organisation of seamless care for the patient, from the GP practice through diagnostic tests, out-patient care and, ultimately, if needed, to in-patient treatment. It gives leaders at local level in particular the leverage they need to unblock barriers to speedy care, such as delayed discharges from the hospital—another key issue on which we will focus later in the Bill.

The second part of my amendment reinforces the importance of the target for care for people with rare conditions and mental health conditions, which can all too often be Cinderella areas—overlooked in favour of more common conditions. I have a personal interest, which I declare, as vice-chair of the Specialised Healthcare Alliance, a coalition of more than 100 patient-related charities, groups and corporate supporters campaigning for improvements to care for patients with rare and specialised conditions, and for greater awareness of their needs, treatment and support.

The amendment also underlines the need for speedy diagnosis for this key group of patients. The SHCA chair, the noble Lord, Lord Sharkey, has added his name to my amendment and will speak on the importance of this in his contribution. He will also speak to Amendment 19 in this group, to which I have also added my name, which would ensure that ICBs

“commission specialised services in line with national standards”,

that their performance in this regard is published and monitored, and that there are safeguards that will operate if this commissioning role is removed from an ICB.

On treatment standards, can the Minister reaffirm that despite the current situation, every patient legally retains the right to treatment within 18 weeks? If so, what steps can patients take if the NHS does not deliver in line with this requirement? Can he assure the House that the Government have no plans to weaken this legal right and are fully committed to returning the NHS to an 18-week standard?

I am also speaking to Amendment 60 from my noble friend Lady Thornton, which would insert a new subsection, within the proposed new sections in Clause 20 on ICBs, to ensure that innovation and best practice on the quality of services

“is shared … openly and prevents individual trusts and foundation trusts from refusing to share beneficial developments or improvements through any issues around competition between organisations.”

This is crucial in helping to overcome any obstacles linked to the autonomy or independence of the organisations evolved.

We also support Amendment 215 from my noble friend Lady Merron, which would insert an important new clause after Clause 80, requiring the Secretary of State to publish an annual report to Parliament

“on waiting times for treatment in England, including disparities”

across the country. It is vital that this report also details the steps taken to ensure that patients, in line with their rights under the NHS constitution, are able to access services within minimum waiting times.

We also note Amendment 21 from my noble friend Lord Davies. He will be fully aware of Labour’s support in commissioning from the NHS as the preferred provider. His amendment is borne out of the right motivations but, I am afraid, misses the point that there are many social enterprises, charities and community organisations whose delivery of healthcare is vital to the functioning of the NHS and social care—for example, in end-of-life care—and we fully support the key role that they play.

The situation facing the NHS as it struggles to address waiting times and lists is dire, yet the recent NAO report on waiting times recovery pointed to some reasonable projections indicating that, far from improving on the current trajectory, the position will be even worse in March 2025 and beyond. That takes into account all the Government’s promised funding. The situation has echoes of the 1990s; Labour was able to address the challenges then, under different circumstances, but the current challenges are even harder. By 2010, the situation had improved to such an extent that demand for private healthcare had dropped. Now we see the opposite, with people having to pay to jump the queues.

Targets were an important part of how improvement was achieved through Labour’s three terms, backed by greater investment and a genuine commitment to public service solutions. The NHS responded to the confidence placed in it but today, there is no plan and no commitment, and totally inadequate funding to address the waiting times issue—the issue that patients are usually most concerned about. The NHS Mandate and the NHS constitution contain crucial rights and standards of care for patients and stakeholders, ensuring that the NHS has basic stability, knows what is expected of it and can be judged on its performance. We must keep the 18-week target and make sure that it is not fudged away. I beg to move.

[Lord Sharkey (LD)]

My Lords, I declare an interest as chair of the Specialised Healthcare Alliance. I will speak to Amendment 6 and 19. I added my name to Amendment 6 and I wholeheartedly support the points made by the noble Baroness, Lady Wheeler, in her eloquent opening remarks. I will make a few brief supplementary points on rare and less common diseases.

Proposed new subsection (2A)(b) in Amendment 6 refers to waiting times for a rare disease diagnosis and is intended to probe the Government’s ambitions in this area. The Government’s rare disease framework noted that it can take years to receive a final and definitive diagnosis of a rare disease and that some people living with a rare condition may never receive one at all.

In 2019, the Government’s national conversation on rare diseases found, perhaps not entirely surprisingly, that getting the diagnosis right was the number one challenge in rare disease care. But the process of getting this diagnosis has been called, entirely understandably, an odyssey—many journeys, many ports of call, and many difficulties. This odyssey frequently involves multiple referrals, inconclusive tests and even incorrect diagnoses before a final definitive diagnosis is arrived at.

The rare disease framework makes a very welcome commitment to making improvements in this journey. I would be grateful if the Minister could say what concrete steps are being taken to bring about the desired improvements to arrive at Ithaca much earlier and in better shape. For example, the rare disease framework talks of a need to improve diagnosis rates. How is this to be measured and what is the baseline to be? Is there a target that the Government are working towards? If there is, when is it expected to be reached? The framework also commits to making use of advanced diagnostics to improve the speed of diagnosis. Can the Minister say what new technologies are being deployed and which are under active consideration? Finally, the spending review announced funds for a new newborn genetic screening programme. What might we expect in terms of a timeline for the piloting of this programme and its wider implementation if the benefits are proven?

I turn to Amendment 19, in my name and that of the noble Baroness, Lady Wheeler, for whose support I am grateful. We have around 3.5 million people with rare or less common diseases or complex conditions. This number grows as our population ages. Many of these people require specialised treatment of one kind or another. Currently, these treatments are provided by the specialised commissioning team of NHS England. In total, there are 149 specialised services directly commissioned by NHS England, and in 2018-19 £18 billion or so was spent on these services.

There are some problematical aspects to the large-scale direct national commissioning of this very large range of specialised services. The NHS points to these in its paper of last January, Integrating Care: Next Steps to Building Strong and Effective Integrated Care Systems across England. It said that

“these national commissioning arrangements can sometimes mean fragmented care pathways, misaligned incentives and missed opportunities for upstream investment and preventative intervention.”

The paper goes on to propose a new model whereby the provision of some specialised services can be delegated to be more responsive to place-based needs and local collaborations.

The NHS proposes that there will be four principles underlying this new approach to the delivery of specialised services. The first is that all specialised services will continue to be subject to consistent national service specifications and evidence-based policies determining treatment eligibility. The second is that strategic commissioning, decision-making and accountability for specialised services will be led and integrated at the appropriate population level. The third is that clinical networks and provider collaborations will drive improvement, service change and transformation across specialised and non-specialised services. The fourth is that funding of specialised services will shift from provider-based allocations to population-based budgets, supporting the connection of services back to base.

Amendment 19 is a probing amendment to allow us to ask a few detailed questions about how these principles will operate in practice. The first is to do with the ability of ICBs to commission specialised services in line with ongoing national standards. How will this ability be assessed, and by whom? Can the Minister confirm that being judged to have the appropriate ability will be a transparent decision and an absolute condition of delegation? Following this, can the Minister also confirm that there will be at least an annual published review of ICBs’ performance in the commissioning of these specialised services? Can the Minister tell us what the circumstances are in which such a delegation of specialised commissioning may be withdrawn? What is the legal mechanism for doing that? Finally, there is the question of money. How can we be sure that the appropriate funds are spent by ICBs on specialised commissioning? Is a ring-fencing of funds being considered, for example?

I close by noting the many successes of the NHS specialised commissioning group and its frequent and very welcome engagement with patient groups and the Specialised Healthcare Alliance.

--- Later in debate ---

[Baroness Wheeler (Lab)]

I thank the Minister for his detailed and considered response; I very much appreciated it. I listened carefully to what he said about waiting lists; I did not exactly hear his commitment to the 18 weeks, but I understand the reasons that he set out for the Government’s current position on that. I just stress the importance of retaining the 18-week waiting time standard: it must remain a key part of the NHS mandate. Without this target, this discipline—particularly the importance of organising around patients’ needs—will be lost.

I am particularly grateful for the Minister’s detailed explanation on specialised services. I know he has a background in this, as do I and the noble Lord, Lord Sharkey. Commissioning specialised services is very complex and detailed. I was pleased with the way that the Minister described the different roles there would be at national and ICB level. We need to look carefully at what he said to see whether we need to come back to anything, but I hope the Minister will commit to having a full discussion and consultation with charities, patient groups and noble Lords on these complex issues. A number of noble Lords spoke very deeply and movingly about specialised services and their importance, and that is important to the House. Continued discussions, particularly on how the relationship between national standards and ICBs will work, are also important.

I thank my noble friend Lady Young for her support for Amendment 60 and her salutary comments on how difficult it can be to make sure best practice is achieved and followed. That was very helpful. On the Minister’s comments about the reporting to Parliament role, I need to look carefully at what he said about what exists and takes place. I take the point made by the noble Lord, Lord Warner, that it needs to be much more coherent, and we will look carefully at that to see if there is anything we need to come back to. Meanwhile, I am happy to withdraw my amendment.

Amendment 6 withdrawn.

Business of the House

Baroness Wheeler Excerpts

Wednesday 25th March 2020 Lords Chamber

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, the Coronavirus Bill and the Contingencies Fund Bill will receive Royal Assent this evening, and that will be notified to both Houses tonight. This means that the House will no longer sit tomorrow or next week. Noble Lords who have tabled an Oral Question will receive a written response from a Minister.

The House will return after Easter on Tuesday 21 April as planned. The usual arrangements for the recall of Parliament will apply, should the House need to meet before then. The previously announced adjournment for the VE Day bank holiday weekend will go ahead as planned.

When we return, we will make some changes to the way that our business is arranged. In light of the circumstances, and having consulted the usual channels, it has been agreed that, for the first three weeks after Easter, the House will sit only on a Tuesday, Wednesday and Thursday. So the House will sit on 21, 22, 23, 28, 29 and 30 April, and on 5 and 6 May, when we will rise for the VE Day long weekend. Further discussions will take place to inform what happens after that.

It has also been agreed that until the Whitsun Recess—until Thursday 21 May—we will not consider any Private Members’ Bills, balloted debates or ordinary Questions for Short Debate. No Back-Bench Member will lose out. My noble friend the Chief Whip, who I am pleased to report is feeling better, will be in touch with those Members who had an agreed slot for their business to discuss alternative arrangements.

For the convenience of Members and those staff who have to come in, the House will sit earlier on Tuesday and Wednesday, at 1 pm on Tuesday and at 11 am on Wednesday. This will enable business to conclude at around 7 pm on both days rather than the usual 10 pm. Tuesdays and Wednesdays will be used as, they are now, to scrutinise the Government’s legislation. Grand Committees will be scheduled only if absolutely necessary. Party debates and topical Questions for Short Debate will continue on Thursdays, so the Opposition parties, Cross-Bench Members and Back-Bench Members will retain the ability to initiate debates to maintain the House’s key function of holding the Government to account. Oral Questions will continue as normal at the beginning of every sitting day, with a topical Question asked on each day the House sits. A new Forthcoming Business will be issued as soon as possible.

We will also have to think about how we conduct our business, not just what we consider and when. We will have to look carefully at what sensible adjustments can be made to our working practices and procedures. We will continue to work with the usual channels and the House authorities on these issues, but I can tell the House that a working group of senior officials from both Houses and the Parliamentary Digital Service has been set up to develop effective remote collaboration and videoconferencing. The Parliamentary Digital Authority is doing all it can to enable rollout to Members as soon as possible.

The social distancing measures we have put in place this week will need to continue for the foreseeable future. Noble Lords who do not need to attend the House should not do so, and that particularly applies to those in the vulnerable groups. We have all seen noble Lords in their 70s and 80s in their places this week. I simply say, as the Speaker said last week, that as parliamentarians we have a duty to show leadership and to heed the advice of the public health experts.

Finally, I am sure all noble Lords will join with me in putting on record our thanks to all those members of staff who have supported us so ably in recent days. On a personal note, I express my thanks to my fantastic team for all the help they have provided to me ever since I became Leader. I know that all staff will continue to work very hard on our behalf in the weeks ahead, and we are lucky to have them. I beg to move.

[Baroness Wheeler (Lab)]

My Lords, I thank the Leader of the House for her Statement today and for the constructive usual channels discussions held away from the Chamber, including with my noble friends Lady Smith of Basildon and Lord McAvoy, who have, while working at home, continued to be active and involved throughout the week. It is vital that Parliament continues its essential role of scrutiny, particularly at a time of crisis, and this House must continue to play its part. It is right that the Leader of the House referred to the programme planned for after the Easter Recess, which has been discussed by the usual channels. It is also right that the business that the Government outline keeps to a more limited programme while ensuring opportunities for scrutiny of ongoing legislation, as well as preserving time for Opposition parties and groups. She will know that the leaders in the usual channels are all fully committed to keeping in close contact between now and when we return.

The Leader will know that Members across the House are very keen to see the introduction of changes to how we work in future, using new technology such as remote collaboration and videoconferencing. For example, committees can meet online, but there are many other ways in which we can fulfil our obligations and maintain social distancing, as a number of noble Lords have outlined in speeches this week. Many businesses are being far more innovative, and we should also be taking a lead on this. I underline that the working group the Leader of the House referred to needs to work with a sense of urgency so that new technological solutions to the current situation can be agreed and introduced as soon as possible, preferably in time for when we return from the Recess.

I also thank her for emphasising that the House returns on 21 April, as previously planned, as there was some confusion in the media, not for the first time, on this issue. Normal procedures will apply, even in this situation. However, should there be any significant change or action required, a recall of Parliament has to be an option.

I also thank the Leader of the House for her comments about the staff of your Lordships’ House. I too thank all the staff of the House, including the cleaners and the security and catering staff, as well the House administration and party staff. Whatever decisions are made on the future working of this House, we must consider them, too.

[Lord Oates (LD)]

My Lords, I, too, thank the Leader of the House for her statement, and I join other noble Lords in giving immense thanks on behalf of these Benches to all the people in Parliament who have worked so hard on our behalf. We understand the decision that has been made that the House should rise early, but there are some reservations in the country because we are facing the greatest national emergency in my lifetime.

I share to some extent the concerns highlighted earlier today, for example by the noble Lord, Lord Adonis. As he mentioned, we understand that the self-employed package will be announced on Friday. It is a big worry that there will be no ability for Parliament to scrutinise that. I also believe that other regulations and SIs will be laid on Thursday to put the powers in place to implement what the Prime Minister announced on Monday. Again, there will be no scrutiny.

There are also a whole series of other issues that people raised to do with PPE and testing which Parliament will not have a chance to scrutinise. Will the Leader of the House absolutely guarantee that Parliament will come back on 21 April, because the Leader in the other place seemed to suggest that there was a slight caveat to that? I really hope that it will, because it is very important that we are here. Could she also tell us whether it would be possible to arrange immediately a substantive debate on the emergency on that day, so that these issues can be discussed in detail?

I was pleased to hear what the noble Baroness had to say about remote working. My noble friend Lord Newby raised these issues in his Second Reading speech yesterday. He, my noble friend Lord Stoneham of Droxford, and a number of other Peers on all sides of the House have made many sensible suggestions. We know that Select Committees in the other place will meet virtually; indeed, I think one of them already has. Can the Leader of the House tell us that Select Committees, indeed any other committees of this House, can meet virtually immediately? If not, can we make very rapid progress on that?

There have been wider suggestions to do with how Members could ask Questions remotely. It should not be technologically impossible for them to also take part in debates remotely, and we should be ambitious about that. Given that a number of noble Lords have particular expertise on technological issues—I am not one of them—perhaps they might be consulted and be able to input into the committee which the noble Baroness mentioned. Can she ensure that that committee, and the House in general, has discussions with the various organisations that provide videoconferencing technology, as they may very well be willing to advise the House on how it could facilitate remote contributions? The noble Baroness, Lady Bennett, mentioned in the debate yesterday that her party’s conference had been held using a service called Hopin. We should investigate all these things; there are technologies out there that we could use. The noble Lord, Lord Anderson, told some of us earlier how the Supreme Court locked up its building and moved immediately, and its cases are continuing remotely. I really hope that we can move on that.

As the noble Baroness, Lady Wheeler, said, it is really important that we use the time between now and when we return to do this. It just will not be on for us to come back and find that progress has not been made. We cannot have this Parliament, and this Chamber in particular, being represented only by those of us who are younger, or more closely located geographically, or who do not have underlying health problems. Now, more than ever, when the people who are most affected are older people and those with underlying health conditions, not hearing from other representatives is a really bad thing.

I heed and understand the Leader’s point about the example that we as a House need to set for the public and the advice for people aged over 70. However, in our debates over the last two days, we have had some excellent and important contributions from noble Lords and noble Baronesses who are over that age, and the only way they could contribute in that way was by being here. We should not berate them for coming here; we should berate ourselves for not having put in place processes by which they could contribute remotely. We must not lose their contributions.

Parliamentary Buildings (Restoration and Renewal) Bill

Baroness Wheeler Excerpts

3rd reading (Hansard): House of Lords
Thursday 5th September 2019 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I speak on behalf of these Benches and of my noble friends Lady Smith and Lord McNicol, who helped me take the reins of the Bill from our side when my noble friend Lady Smith became somewhat otherwise engaged with developments elsewhere. I too place on record our thanks to the Government for their co-operation on this Bill and to parliamentarians in both Houses who helped ensure that the Bill is in the good place that the Minister referred to at the end of Report. In particular, I thank my noble friends Lady Smith and Lord McNicol, the noble Earl, Lord Howe, and the Leader of the House for their work and commitment throughout the various stages of the Joint Committee deliberations and the passage of the Bill.

I also thank my noble friend Lord Blunkett, who played such a key role in ensuring that public engagement, consultation, the involvement of parliamentarians and staff in the project and the key issue of disability and public access were at the heart of the Bill. The Bill team has—I agree—worked in a particularly exemplary and collaborative way with your Lordships and deserves special thanks, as do Beth Miller, who provides the noble Lord, Lord Blunkett, with support, and the excellent team from our Opposition office, Ben Wood and Dan Harris.

[Lord Blunkett (Lab)]

My Lords, perhaps I may lighten the atmosphere a little. I remember a Lonnie Donegan song which was a reflection of the war for American independence and the red coats fighting a losing battle. It went:

“There wasn’t nigh as many as there was a while ago”.


There are fewer of us in here than there were a few moments ago, for fairly obvious reasons, but this Bill is critical not just to the fabric and well-being of the heart of our democracy—the Palace of Westminster itself—but to a futuristic look at how might restore trust in and engagement with democracy. I am particularly grateful to all those who have played their part in making this a substantive measure which we can be proud of and which gives the sponsor body of the future and delivery authority clear direction in implementing it. I shall not repeat the names of everyone who has been involved, but I endorse entirely the thanks offered to those who have been part of it. I give my personal thanks not just to my own Front Bench but to the noble Earl, Lord Howe, who has reflected the best of the way in which we can conduct business in the House of Lords.

In implementing this Bill and taking forward the kind of advice that we had from all quarters on all matters in the joint scrutiny committee, it will be critical to draw down on the best possible expertise across the UK. If we do that, we will have something to be proud of in the years to come.

Parliamentary Buildings (Restoration and Renewal) Bill

Baroness Wheeler Excerpts

Report stage (Hansard): House of Lords
Tuesday 3rd September 2019 Lords Chamber

[Lord Cope of Berkeley (Con)]

My Lords, I too support these amendments. Seeing the reference to “remote access” in one of them, I thought it not inappropriate to draw the House’s attention to the tremendous changes there have been in recent years. I first became a Member of the House of Commons 45 years ago. Since then it has changed immensely, largely because of the electronic advances that there have been. The amount of contact with constituents that Members of Parliament now have through emails and so on is one thing. You can also watch Parliament any time you want on the parliamentary television channel. This started with your Lordships’ House, and broadcasting from the Commons followed. There have been tremendous advances and there is no doubt at all in my mind that these have not stopped but will go on in ways that we cannot envisage—any more than we could have envisaged 45 years ago that things would be as far advanced as they are now. So we are not just starting this process; we are hugely advanced along it. It will speed up, in all probability, and of course the sponsor body must take account of it as it goes about its work on this building.

[Baroness Wheeler (Lab)]

My Lords, we welcome the Government’s amendments in this group, and their focus on public engagement and awareness. Amendment 1 creates a duty on the sponsor body to promote public understanding of restoration and renewal, while Amendment 2 introduces a need for the sponsor body to ensure the works facilitate engagement and a participatory democracy. Amendment 5 ensures that the sponsor body carries out its duties with the views of Members, staff and the public at the front of its mind. We also welcome Amendments 3 and 4, which strengthen the reference to the parliamentary building works in regard to ensuring the safety and security of staff and the public, as well as to educational facilities.

At the start of the Bill’s passage, one of the main areas on which we sought government reassurance was engagement with the public, as well as with staff and Members in both Chambers. The Joint Committee recommended that the sponsor body should,

“promote public engagement and public understanding of Parliament”,

and we are pleased that the Government now fully accept this. Engagement must be at the heart of the programme of restoration and renewal, as this Palace, as well as the democratic processes and structures it represents, can often feel very distant to many people across the country. It is vital that there is a strong relationship between the sponsor body and the public, so that they have confidence in the programme throughout the process. These amendments help to alleviate our concerns and ensure that restoration and renewal becomes about far more than the necessary bricks and mortar, rewiring and replacement, and sewerage and stairways. They also allow us to change the way Parliament looks and feels, both inside and out.

Like other noble Lords, we read with great interest the results of the 2019 Members survey on R&R, confirming the themes and issues raised during the passage of this Bill in both Houses on accessibility, remote and digital integration, and safety, security and protection. The first survey showed just how vital regular communication, consultation and engagement are now and will be as the programme progresses to its successful completion. In particular, this is a working building for more than 8,000 members of staff, and the omissions in the original Bill on the importance of seeking their views about the works have now been rectified. Amendment 5 is a welcome step forward in helping improve their working conditions throughout restoration and renewal, and this must be an aim for the sponsor body.

In closing, I of course pay tribute to my noble friend Lord Blunkett for his tireless work on these issues throughout the Bill’s passage, and to the Government for their willingness to discuss and address our concerns and arrive at the good place to which the Minister referred.

[Earl Howe]

My Lords, I am most grateful to the noble Lord, Lord Blunkett, for his very kind remarks and the constructive suggestions he has made. I express once again my appreciation to him for working with us as he has done and for the support he has demonstrated for these amendments. I am grateful, too, to other noble Lords who have endorsed the approach that we and the noble Lord have taken. It has been important throughout the Bill’s passage that we should listen to all Members and, where possible, seek to work with them towards an agreed position. I hope and believe it is clear that we have done exactly that. I thank other noble Lords who have spoken in the debate: my noble friends Lord Norton, Lord Cope and Lord Haselhurst, and the noble Baronesses, Lady Scott and Lady Wheeler.

My noble friend Lord Haselhurst asked two questions that go back to the issue, which I know has been considered by both Houses, of whether it would be possible to retain a foothold, so to speak, during the R&R programme in the Houses of Parliament regarding Westminster Hall and the Elizabeth Tower. I can tell him that these matters were partly covered at earlier stages of our debates, but it was agreed by both Houses in early 2018 that the Bill should allow for a full and timely decant of the Palace without retaining a foothold. Analysis by the programme in 2017 found that continued use by Members and/or the public of Westminster Hall or the area surrounding it would be highly disruptive and costly for no additional quantifiable benefit. The costs would be connected to maintaining a secure perimeter in close proximity to construction works and the additional cost to construction from managing a complex and partially occupied site. Having said that, access to the Elizabeth Tower could be a different matter. In fact, it is a matter for the sponsor body and Parliament to decide in due course. Members of the other place and noble Lords will be free to offer their view to the sponsor body on this issue as part of its consultation strategy.

As I said, these amendments build on the current work the shadow sponsor body is undertaking in these areas, in my judgment very capably. What matters now is the future. Like all noble Lords, I look forward to seeing how the sponsor body builds on this work and fulfils the specific obligations the amendments set out.

--- Later in debate ---

Moved by

[Baroness Wheeler]

7: Clause 6, page 5, line 11, at end insert—
“( ) recommendations from the Sponsor Body for the future maintenance of the Palace of Westminster over the longer term after completion of the works;”

[Baroness Wheeler]

My Lords, this is an important amendment in the name of my noble friend Lady Smith. It aims for us to learn the lessons of the past and ensure that we have the necessary long-term plans and steps in place after the new building has been completed and handed back to Parliament to facilitate its ongoing and future maintenance and improvement.

Amendment 7 takes the Minister at his word in Committee, when this issue was raised by us and a number of noble Lords. Our original proposal was to incorporate future-proofing recommendations under the sponsor body’s reporting requirements in Schedule 1, but this amendment follows the Minister’s suggestion that it could better placed in Clause 6 as part of the parliamentary relationship agreement and that recommendations on the future maintenance of the Palace over the longer term be part of the hand-back arrangements.

I thank the Minister and the Bill team for their helpful discussions and reassurances since Committee, particularly in relation to the sponsor body’s reporting processes and business case development. Obviously, we recognise that the sponsor body will be abolished following the completion of the parliamentary works, so it is important that we have clarity now on exactly how future maintenance of and improvements to the Palace will be facilitated and taken forward. I understand that the latest view from the Government is that it should be included in the sponsor board business case summary and not that of the PRA. I look forward to the Minister’s confirmation of this. I would also be grateful if he would facilitate a meeting on this issue between the sponsor board and my noble friends so that we can be assured that effective future-proofing measures are a key part of the R&R programme.

Throughout this process, we have stressed that we must ensure that the estate does not fall into its current level of disrepair. We had 40 fires between 2008 and 2012; 4,000 windows need to be repaired or replaced; 40% of pipes, ducts and cables will be at critical or high risk of failure by next year; most building services will be at a high risk of failure by 2025; we rely on a sewage ejector system that is more than 130 years old; and asbestos can be found everywhere.

As we said in Committee, the can has been kicked down the road for far too long. While parliamentarians have not wanted to be seen spending money on themselves, inaction has come at a heavy price. We are now spending huge amounts of money on everyday maintenance and repair, and it has been estimated that every year of delay increases the cost of the works by £100 million. We must not get to a point again where the Palace is at risk of a catastrophic failure and the building can be described as no longer fit for purpose. Using the expertise gathered by the sponsor body, it would be of great benefit for the sponsor body to produce recommendations on long-term maintenance—ideally on five-year, 10-year and 20-year plans which can be reviewed. Making specific safeguards now will save us money, save this building and save future parliamentarians from facing a similarly dire situation in a few decades’ time. I beg to move.

[Baroness Scott of Needham Market]

My Lords, I am sure that the sponsor body would be happy to meet the noble Baroness and her colleagues—indeed, any noble Lord on any matter relating to this programme. I may regret saying that, but it is important that the shadow sponsor body and the sponsor body are as open and receptive to Members as it is possible to be. I also give the assurance that future-proofing the work is very much part of the design brief that the shadow sponsor body will be working towards. Anyone who has ever spoken to any of the contractors trying to do the work in this place will know that one of their biggest problems is simply getting access to things—they have all been buried and hidden underneath more modern work. Given this opportunity to take it all out and start again, we would certainly expect one of the outcomes to be the facilitation of future work, be it ongoing maintenance or larger jobs that may need doing in 50 or 60 years.

--- Later in debate ---

[Baroness Wheeler]

I thank the noble Earl for his reassurances on the importance of this matter and for his thorough and helpful explanation of both the reporting and future monitoring delivery arrangements. I feel very reassured. Obviously, I thank the noble Baroness, Lady Scott, in particular for her willingness to meet with me and my colleagues to discuss this further. I certainly welcome the reassurance, and on that basis I beg leave to withdraw the amendment.

Amendment 7 withdrawn.

--- Later in debate ---

If it is not possible for the Government to accept the words of this amendment, I very much hope the Minister will be able to indicate that the spirit of the amendment is agreed to. I beg to move.

[Baroness Wheeler]

My Lords, we welcome and fully support the principle behind Amendment 8, which underlines that the work should be carried out without delays and must be cost effective. The sponsor body has said it expects the current timeline for the project to be around 10 years, from the mid-2020s to the mid-2030s. Of course, there remains some vagueness around this length of time, and we hope the sponsor body is able to provide a more detailed timeline as soon as possible, with some clarity on milestones and gateways for both the decant and the completion of the full works. Obviously, this will most likely come after the business case has been presented and discussed by Parliament. Nevertheless, providing clear information on timelines and milestones will most certainly be important for public engagement and the engagement of staff and Members. We very much support this amendment.

[Earl Howe]

My Lords, I am grateful to the noble and learned Lord, Lord Wallace of Tankerness, for his amendment, which would require the sponsor body’s reports on the progress made on the parliamentary building works to incorporate a timeline for the works that would include likely dates for decant and completion. As the noble and learned Lord said, he tabled a similar amendment in Committee, to the effect that as part of its consultation strategy the sponsor body must publish a timeline for completion of the Palace restoration works, including details on the dates of decant and return to the Palace.

In my response in Committee, I agreed that all noble Lords would—quite obviously—wish to seek further clarity on dates around decant, and I am in absolute agreement with the noble and learned Lord’s point that the sponsor body should publish details regarding decant and completion of the works not just once but throughout the course of the project. Here it is important to convey that the shadow sponsor body has always explicitly recognised that, as part of the sponsor body’s reports as set out in paragraph 27 of Schedule 1, it would rightly be required to include timescales on decant and the progress of the works. I can confirm that the shadow sponsor body is in agreement with this approach and therefore the expectation is that the reports produced by the sponsor body will include information on the timetable for the works, including details on timings for decant and return to the Palace.

I spoke at some length in Committee on various points addressing the issue raised by the noble and learned Lord. However, I thought it important to clarify what the Bill requires the sponsor body to do as regards reporting. Under the Bill, the delivery authority is required to formulate proposals for the parliamentary building works, including the timing of those works. These proposals are provided for in Clause 2(2)(e). Parliament will need to approve the proposals before any substantive works commence. If for any reason those timings change significantly, the sponsor body will need to come back to Parliament for further approval. The parliamentary approval of these proposals, as well as the shadow sponsor body outlining its agreement that the sponsor body should include information relating to the timeline for the works in reports it produces, will, I hope, provide noble Lords with the reassurance that this information will be forthcoming.

This is a matter that will surely interest all noble Lords throughout the currency of the works, whether that is before commencement, during or near their completion, so let me again thank the noble and learned Lord for tabling this amendment. I hope that I have provided him with significant reassurance on this important matter.