Health and Social Care Bill

Debate between Baroness Williams of Crosby and Lord Mawhinney

Wednesday 29th February 2012 Lords Chamber

[Baroness Williams of Crosby]

In replying to the last group of amendments the Minister referred to the fact that concern was expressed in many parts of the House about those issues. I am pleased to say that exactly the same is true of this group. Voices from the Cross Benches and from Labour as well as from the Conservative Party have been raised to address the need to ensure that CCGs always cover every resident individual so that we can ensure that the services of clinical commissioning groups are available to all the residents of the United Kingdom—or more precisely of England, although one could extend it to the United Kingdom.

One concern which has been expressed in the House on several occasions is whether, for example, people who are homeless or belong to Travelling groups, such as Gypsies or Didicois, would strictly be covered by the clinical commissioning groups given that there is not total coterminosity as there was in the old National Health Service. The purpose of Amendment 75, in particular, and the related Amendment 94 is specifically to ensure that nobody resident in the United Kingdom is simply left out of the new machinery. It is very important that this should be so as the people likely to be left out tend to be the most vulnerable members of society—the ones who slip through the cracks, if I can use that phrase. I am delighted to see that the noble Lord, Lord Laming, seems to share that view.

[Lord Mawhinney]

Can the noble Baroness tell us whether this amendment would also encompass illegal immigrants?

[Baroness Williams of Crosby]

The phrase used, which I think is also used in other parts of the Bill, is “resident in England”. It is not for me but for others, particularly the immigration tribunal, to judge whether somebody who is an immigrant to this country counts as a resident, but I would assume that if he was an illegal immigrant he would not be. If he or she were here except as an asylum seeker then clearly they would be covered by the amendment, which does not purport to set out a new set of immigration regulations. It would be inappropriate for the health service to do that. Therefore, let me turn back for a moment to Amendment 94 as well.

Health and Social Care Bill

Debate between Baroness Williams of Crosby and Lord Mawhinney

Wednesday 21st December 2011 Lords Chamber

[Lord Mawhinney]

My Lords, at the risk of irritating my noble friend, I should like to make a brief comment about this matter. I assure him that it does not fall into the category of wishing to irritate him. If there is any virtue, it is a virtue of consistency on my part.

Clause 247 again deals with the interplay between the Secretary of State and the NHS board. We have already clearly established in this Committee that the Government wish to give the board a freedom from the overall influence of the Secretary of State that would mark a fundamental change in the way that the NHS has been conducting its business over many years.

Subsection (1) of the clause gives powers to both the Secretary of State and the board, and either can exercise them. I look down to subsections (3) and (4) and see that both the Secretary of State and the board can exercise powers in relation to the provision of health services. I wondered whether this was a belated recognition regarding the board for those of us who have been encouraging our noble friend to give primacy to the Secretary of State and maybe a stepping stone towards returning to the traditional position. On the other hand, if it is a stepping stone, and given the fact that until we hear from my noble friend there is not a lot of clarity as to what is intended here, these provisions may simply confuse the matter, not clarify it.

I am old-fashioned, as my noble friend knows, and I think that the Minister is ultimately responsible for the area for which Her Majesty has called him or her to be responsible. The Secretary of State could delegate powers to the board, but that is not the way that the Government have chosen to interpret this. All of us are grateful to my noble friend for the fact that he has been so willing to review this whole issue and to come back with new proposals on Report. I cannot be the only Member of your Lordships' House who looks forward to seeing what those proposals contain and measure them against the views that have been expressed on this subject over some months now.

However, since we moved away from the first few clauses, there have been examples of this ambiguity and potential conflict between the Secretary of State and the board running right through the Bill. I have tested my noble friend’s patience on a number of occasions by drawing his attention to various examples of that as we have gone through the Bill. I draw his attention to what is but another example of the importance of getting this relationship right—and my noble friend knows what I believe is right and I know what he believes is right. We are both grateful for the opportunity to review that before Report. I should therefore be interested to hear what my noble friend thinks is actually meant, or intended to be meant, by this clause.

Finally, because we have already established that the risk register is legitimate to discuss under Clause 247, I share the view that it would be very helpful to the Committee to have a definitive decision before Report gets under way. In keeping with what my noble friend Lord Newton of Braintree just said, were the Government to lose and to decide to pursue the matter to the next stage, I hope that the Minister will not think that such a decision would be without friends in this House. I cannot be the only former Minister who has conducted examination of potential legislation on the basis of “What if?”.

[Baroness Williams of Crosby]

I underline the point made by the noble Lord, Lord Mawhinney, because the whole area of information is a crucial aspect of the constitutional issues about accountability. In particular, the clauses we are discussing are expressed in complicated ways that are difficult to understand. For example, I find it hard to be clear that personal and identifiable data will not fall within the terms of the clauses, because the phrases “other persons”, “other bodies”, and so forth are scattered throughout the clauses. That disturbs me. Perhaps the Minister could add a little on data protection legislation and address the important point raised by the noble Lord, Lord Mawhinney, about this aspect of the Bill, which of course relates to several others besides.

Health and Social Care Bill

Debate between Baroness Williams of Crosby and Lord Mawhinney

Thursday 15th December 2011 Lords Chamber

[Lord Mawhinney]

My Lords, I should like briefly to comment on the amendments proposed by my noble friend Lady Williams of Crosby. In one respect, I was sorry that she spoke so briefly because I should have liked to have heard more of her reasoning for Amendment 296. I am not at all clear about what the advantage is to either the Commissioning Board or the hospital if one serves on the board of the other. Is it because that is the only conduit of information? Frankly, I do not think that anyone believes that. If that is actually the argument then the whole NHS is in a much greater state of peril than any of us thought was the case until now. I honestly do not see the importance of or justification for the amendment. It may be a probing amendment, but it would have been helpful if the noble Baroness had given us a bit more of the thinking behind it. As of this moment, pending her winding up, I am not at all convinced that the amendment is either important or necessary.

However, I turn to the noble Baroness’s Amendments 300 to 303, which are also in the name of our noble friend Lord Marks of Henley-on-Thames, who I am sorry to hear is unwell. I very much support what she said about those amendments, even though—to use the word of the noble Baroness, Lady Finlay—she explained them concisely. They take us back to one of the main issues of this legislation: where is the Secretary of State in this brave new world? The Minister knows that a number of us think that the Government are thus far underplaying the role of the Secretary of State.

As my noble friend Lady Williams of Crosby was speaking, I thought of the condition of a number of foundation hospitals that have been the product of a PFI system. That was triggered in my mind by her comment that if there was a coming together of hospitals, or if some element of service was not provided, it may be of a sufficient scale for the Secretary of State to want to take a significant interest. The truth, to the best of my probing, is that a number of hospitals out there—the products of PFI—are in very difficult and probably, without help, unsustainable positions.

I know that the Minister understands that and that it is a matter of concern to the department, so I do not make any comment prejudging the outcome, but my noble friend brought the Secretary of State into this precisely because there could be serious, significant or catastrophic effects on the provision of healthcare in the hospital sector which, by definition, would include the importance of ministerial—that is, Secretary of State—involvement and consideration.

I welcome Amendments 300 to 303, but I say to my noble friend Lady Williams of Crosby and the Minister that I think they are part of the bigger picture of where the Secretary of State will be when the Bill finally reaches the statute book. The Minister has kindly and, I think, genuinely agreed to reconsider all those issues and bring them back for our consideration at Report. Subject to him saying the same about the issues raised by our noble friend Lady Williams, I hope that she in turn, hearing his response, will not feel it necessary to push the amendments to a vote today, although that might become an issue, depending on where we are at, on Report.

[Baroness Williams of Crosby]

Perhaps I may respond briefly to the points raised by the noble Lord, Lord Mawhinney. I apologise if I spoke too briefly, but I am conscious that there are an awful lot of amendments to get through and I do not want to steal the time of other people on other crucial amendments.

On the group of four amendments that the noble Lord is in accord with me about, as he will be well aware, consideration has been given to the material put before us by my noble friend Earl Howe, the Minister of State, about an attempt to bring together discussion within the House and among lawyers about the issue which the noble Lord, Lord Mawhinney, rightly identifies as being central to the Bill: the responsibility and powers of the Secretary of State. Because we are in Committee and the Committee will, we hope, be ending in a few days’ time, the only opportunity we have to table amendments that would bear on the issue of the Secretary of State’s powers is on the Bill as it stands—prior to any changes that may be made. It is in the light of that that we tabled this group of amendments to highlight the areas where, in our view, the responsibility of the Secretary of State is central. That is true of this group of amendments, and I am delighted that the noble Lord, Lord Mawhinney, takes the view that they should be seriously considered by the Minister.

The point of Amendment 296 is to recognise that, in many cases, CCGs have to take account of the services given by foundation trusts—not least in respect of, for example, pathways and networks for people with chronic conditions. We thought, therefore, that it was important that there be not just sharing of information between the two but, rather, a process of interactive education, where the foundation trusts become increasingly aware of the responsibility that CCGs bear, particularly for those clinical conditions that lie beyond the capacity of a single CCG. That is why we suggested that a governor should be named by the national board to set up that communication—which, as the noble Lord, Lord Mawhinney, knows far better than I do, because he is an expert on the subject, sometimes, sadly, does not exist.