NHS: Primary Care Surgeries

Lord Adonis Excerpts

Wednesday 24th November 2021 Lords Chamber

[Lord Kamall (Con)]

We all understand the importance of the role that GPs play in our NHS. I remind noble Lords that, when the NHS was created, once the state had seized the voluntary hospitals and hospitals from churches, it left GPs independent. It has been left up to them how to run their services. What is important is that we expect all GP services to offer the best-quality care, despite the business model they use.

[Lord Adonis (Lab)]

My Lords, I commend the Minister for congratulating Tony Blair, who, of course, led the best Government of modern times in this country. The Blair Government trebled health spending in real terms—three times the rate of growth under this Government. I encourage the Minister to learn further lessons from Tony Blair, in particular to significantly increase health spending and leave the National Health Service in a better condition than he found it, rather than, as is now happening, in a worse condition.

[Lord Kamall (Con)]

I pay tribute to the noble Lord on his contributions to the Blair-Brown documentary, which I am sure a number of noble Lords enjoyed watching and learning from. It is important that we learn the right lessons from whichever political party, so when Tony Blair, a former Labour Prime Minister, says that we should encourage the private sector to be more involved in partnership with the public sector, we will take that advice.

Flu Vaccination and Blood Test Cancellations

Lord Adonis Excerpts

Tuesday 14th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I had a similar text. I point out that it was about “routine” use. We were able to accommodate acute use through the whole period. However, the noble Baroness makes a good point, so I will look into it and see whether something can be done along those lines.

[Lord Adonis (Lab)]

My Lords, the HGV driver shortage has clearly been exacerbated by Brexit. Will the Minister tell the House what he intends to do about that?

[Lord Bethell (Con)]

I do not quite know how to answer that question. When it comes to test tubes for blood collection and the flu vaccine, I am not sure that there is a Brexit angle and we have it covered.

Mental Health Act Reform

Lord Adonis Excerpts

Monday 18th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I can reassure the noble Lord only by saying we have put an ambitious report on the table. We will follow it up with a detailed consultation process that will engage Parliament in due course and lead to an ambitious Bill. That will be backed by substantial financial investment; thereby, we hope to make a major impact on the issues he describes, which I recognise and acknowledge.

[Lord Adonis (Lab)]

My Lords, Sir Simon’s report makes no reference to international best practice and gives no internationally comparative statistics—for example, on sectioning. I gave the noble Lord notice of a question I would like to ask about what international best practice the Government have in mind. Will he be able to make available to me, perhaps in correspondence, internationally comparative, population-adjusted statistics for sectioning? This will be important for putting the reforms he suggested in context before we proceed to legislation.

[Lord Bethell (Con)]

I am enormously grateful to the noble Lord for sending me his question, but I am embarrassed to say that I did not receive the correspondence. I would love to have the figures to hand, but I will write to him with details. If I could gently push back: this is not an easy issue to make international comparisons on, and we are not necessarily led by what other countries do in this area. We have to own this problem ourselves and find an approach that fits the NHS and people in Britain, and we have to be accountable to the people of Britain for our performance.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) Regulations 2020

Lord Adonis Excerpts

Thursday 22nd October 2020 Lords Chamber

[Lord Adonis (Lab)]

My Lords, the isolation of school pupils is a crucial issue, and the Minister kindly agreed to address five questions which I posed on Tuesday. First, will the Government undertake in England not to follow Wales and close all secondary schools as part of any revised tier 3 or circuit-break arrangements? Secondly, will the Government codify advice to schools on best practice and the definition of bubbles with a view, where infections are identified, to only groups who sit together being sent home rather than whole classes and year groups, as is often happening at the moment? Thirdly, will Ofsted give best practice guidance on what constitutes adequate online learning where pupils are sent home, including live instruction and interactive learning? Fourthly, where pupils are sent home and do not have the necessary IT equipment or wi-fi, will the Minister undertake that schools can apply for laptops for pupils who do not have them up-front under the Government’s scheme without having to wait until pupils are actually sent home so that learning can start immediately? Fifthly, where pupils, by the nature of their home circumstances, do not have wi-fi, will the Government set out to schools what they should do, where possible, to provide it, including the provision of financial support?

Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 5) Regulations 2020

Lord Adonis Excerpts

Tuesday 20th October 2020 Lords Chamber

[Lord Adonis (Lab)]

My Lords, it is vital that schools are kept open, wherever possible, and that full online learning is provided where they cannot be. I will ask the Minister five specific questions about what is going on in the schools sector. The first is on the closure of schools. Under the tier 3 regulations, schools will be the last institutions to be closed. According to the Government’s guidance, schools will be the last sector to shut, if further restrictions are required. But the Welsh regulations, which were introduced today, have closed secondary schools beyond year 8 for the first week after half-term. Will the Minister assure the House that similar regulations will not be introduced as part of tier 3 in England?

Secondly, even when schools are open, a lot of pupils are being sent home because of Covid infections, but there is no uniformity in the definition of the rules by which they should be sent home, how bubbles are defined and how many students are sent home, depending on how many have been infected. The latest figures show that only 68% of schools do not have substantial closures and one in 10 students is not in school, with whole year groups often being sent home because of one or two infections. I am told by head teachers that there is no adequate guidance on this from the Department for Education. They would like pupils to be sent home only when infections are traced to groups that sit together. This would dramatically reduce the incidence of pupils being sent home and schools being closed and would bring the state system in line with the private sector, where very few pupils are being sent home.

Thirdly, this time, unlike the last closure, the temporary continuity direction provides that there should be online learning, but there are no standards of provision for what it should constitute. Ofsted is inspecting online learning, which is a big step forward from last time. Will the Minister undertake to provide the lessons of that to all schools?

I will ask the last two questions quickly. Where online learning is required, because pupils have been sent home, the provision for laptops to be given to poor students is not uniform. Many schools are finding that they can apply for free laptops only after the pupils have been sent home.

[Baroness Penn (Con)]

My Lords, could the noble Lord respect the time limit for his speech?

[Lord Adonis (Lab)]

Will the Minister undertake that all schools are able to apply for laptops upfront, without having to wait until pupils are sent home?

Coronavirus Bill

Lord Adonis Excerpts

2nd reading & 2nd reading (Hansard - continued) & 2nd reading (Hansard - continued): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Lord Adonis (Lab)]

My Lords, I join the noble Lord, Lord O’Shaughnessy, in paying tribute to NHS staff. I will pick up on his point about the importance of diagnostic testing. If we are to find a way through this that does not involve people being off work for months and months, which could be the alternative, we need to start mass testing of the population. I know that the Minister has been on to this, and preparations are being made for ensuring that the tests meet appropriate standards, and so on, but this clearly is a way through. Just as we are having to make it up as we go along, to some extent boldness on the part of the Government would be appreciated.

I commend the Minister and my noble and learned friend Lord Falconer on their opening speeches, which were well judged. Nobody wants to be here but we are where we are. It is because we trust the Minister and his colleagues to use these powers in the public interest and we are defending our way of life and not attacking it that we entrust these powers to them. However, to quote the Book of Proverbs

“Where there is no vision, the people perish”.


We need to look beyond the crisis; the crisis measures need to look beyond so that people have significant hope. I will make a few practical suggestions to the Minister which he might be able to latch on to in his reply or in a letter in respect of three extremely significant and vulnerable groups: young people, the low paid, and those in rented accommodation.

Massive disruption is taking place to young people’s education at the moment—that is unavoidable. Appropriate steps are being taken with regard to ensuring online learning, guaranteeing places at university and in sixth forms for students who will not be able to go through the proper exam systems, and so on. However, there will be a huge impact on education, and I suggest to the Minister that the Government should think about making an offer while this crisis is proceeding for people to repeat years at public expense when this is over. That will be particularly important to people in the final years of GCSE, A-level and university courses, where they may not be able to complete those courses properly or get properly graded exams. The opportunity for them to complete and for this to be offered at public expense—or, in the case of the universities, which have quite large reserves from the big increase in fees, maybe partly at their expense—would be a big step forward.

Secondly, on the low paid, we had a Statement earlier on the self-employed—or rather, we had a Statement saying that there would be measures in respect of the self-employed; we still do not have them. However, this group was already vulnerable. Those most vulnerable in the community at the moment regarding employment protection and the protection of their wages and rights are the vast number of workers in the gig economy—I had to stop myself saying “employees”, because that is the fundamental point.

A whole slew of cases is going through the courts at the moment, so this is about whether the 5 million people in the gig economy, a number which has doubled in the past three years, are or are not employees. There is the big Uber case that is going to the Supreme Court later this year along with a load of other cases. Because of zero-hours contracts, people in this group do not have secure employment and in many cases they do not even appear to qualify for the scheme that the Chancellor announced last Friday. In many cases, people in this already vulnerable group stand to see their incomes cut to ribbons and with no great future to look forward to afterwards. If the Government want to offer hope and security to people, I suggest that they should indicate their willingness to look at the really vexed issue of the employment status of gig economy workers. We have had the Taylor review which contained a set of recommendations, but the Government have not actually moved on them. They said that they would—it was a big theme for the last Prime Minister and it was in the Conservative manifesto—so if they are able to indicate that they are moving forward on this, that would be a big and positive step which would give people the confidence they need in the period ahead.

The third issue is people’s accommodation. In his opening speech, the noble Lord referred to the huge transformation in technology that took place in the First World War. The element of that war which sticks the most in my mind, where delivery did not match promise, was Lloyd George famously saying that there would be homes fit for heroes. The homes never materialised and we had a housing crisis that took the best part of the next 60 years to resolve through mass housebuilding on the part of local authorities.

One of the biggest and most sorely felt issues of the current crisis is that of people in rented accommodation, who are in a very insecure state. I would like to press the Minister to say in his reply whether he can further elucidate the meaning of Schedule 29, related to the provisions in respect of renters that were inserted late last night in the House of Commons. It is extremely complex and I do not fully understand it—I am not a legal mind, although there are others in the House who may be able to help us in Committee tomorrow. My understanding is that while Schedule 29 meets the concerns of people who may potentially be evicted by preventing actual evictions during the period of the coronavirus crisis, it does not prevent evictions or action being taken against tenants afterwards in respect of the non-payment of rent while the crisis is proceeding. That simply does not seem reasonable to me if our aim is to offer security and decent support for people because of the crisis. We need to see to it that not only are they not evicted, but that they are not waiting until the day after the crisis ends to be evicted because they have not been able to pay the rent in the interim. The rent waiver provisions which have so far been announced by the Government are quite weak. I know that it is not his area and I do not know how the Government are going to handle the Committee stage tomorrow, but perhaps I may ask for an elucidation of what Schedule 29 actually means. If he is able to come forward with stronger assurances that it is not just that people will not be evicted during this crisis but that that will not happen afterwards, we will be able to offer some genuine hope to those whose lives have been made a misery through this crisis.

Covid-19 Update

Lord Adonis Excerpts

Monday 16th March 2020 Lords Chamber

[Lord Bethell]

The situation is fluid. The CMO spoke about this in detail at the press conference. He is not speculating or giving an exact date, because the modelling is not as clear as one would hope it to be. However, it will certainly be within weeks, rather than months.

[Lord Adonis (Lab)]

My Lords, there is a gaping black hole in the economic package announced in response to this crisis. I hope that the Minister has picked up from the repeated questions of noble Lords on all sides that there is acute concern about this. I do not think it is possible to separate the public health emergency from the wider social and economic emergency. People will not go off sick and companies will not be able to give clear guidance to their employees until the Government can answer the questions which have been asked around the Chamber. There is an absence of a clear government policy on sick pay, which is after all the means by which people will survive if they self-diagnose or are diagnosed with this virus. Each day that the Government cannot answer this will lead to more needless spreading of the disease. I know that the noble Lord is the Health Minister and not an Economy Minister, but it is totally unsatisfactory that the Statement gives no clear guidance to the country on the economic aspects. He talked about this being published on Thursday, with the Bill, but that is three days’ time. We are in a massive national emergency; that statement should come tomorrow. Every hour that the Government delay will see the disease spread further, cause needless distress and lead to people going out of business.

[Lord Bethell]

The noble Lord is entirely right in his analysis that getting the social and economic package right is imperative for delivering the social behaviour response to the virus. It is completely understood by the Government that, to get people to abide by the kinds of provisions and recommendations coming from the CMO, there has to be a whole-person solution, and that includes figuring out the money. We understand that and are working on it. We have already altered some of the provisions for statutory sick pay so that people can claim after one day instead of four, which is an important change. We are negotiating with the Treasury, the DWP and other parties on making further changes.

Queen’s Speech

Lord Adonis Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Berkeley (Lab)]

I wish the noble Baroness good luck in those five years.

My Lords, I declare an interest as a former chairman of the HS2 review. I will talk about railways and HS2, if I may, in the short time available. I welcome the references in the Queen’s Speech to prioritising investment in infrastructure and giving

“communities more control over how investment is spent so that they can decide what is best for them.”

Ministers have supported that since then. In her opening speech, the Minister made it very clear. She said that you need investment so that people can get to work on time. That is very simple but it is absolutely the core of the whole matter.

I welcome the Government’s commitment to the regions, particularly in transport. This is the first time we have seen that for decades, and it i is pretty good. It needs doing because TransPennine Express has cancelled 40% of its services this month, or during some part of this month. Northern Rail is apparently about to be stripped of its franchises. How can you hold down a job if 40% of your trains on the days on which you want to go to work are cancelled? Who is to blame? It is easy to blame people. The rail operator blames a lack of trains but 400 electric coaches are sitting in sidings funded by the Department for Transport because electrification was cancelled. Those 400 coaches could be operating today. That does not include Crossrail, which is a separate subject for another day. We have got to get our act together. This is about Leeds, Manchester, Liverpool and the north-east. As we know, the result is not good.

I am grateful to my noble friend Lord Griffiths for his positive comments about my HS2 report. I will not go into great detail today as there is not enough time—I will do it another time—but we need to consider how to deal with the poor economic performance in the north and parts of the Midlands and the effect that HS2 may or may not have. Therefore, what are the most important improvements to the rail network in those areas and is HS2 the best way of achieving them? We consulted widely within the review team but we have now got to a cost of £100 billion. HS2 does good things around Crewe and Manchester and Leeds and Sheffield, but is it the right answer further south?

This goes back to the fundamentals of the businesses in those areas. From talking to a lot of people, it is my perception that it is managing directors, and us politicians, who want to get to London more quickly, but the people who work in those businesses want to commute, and they probably commute daily whereas we do it perhaps weekly, or whatever. That is where the money needs to be spent. The Government could commit £50 billion over 20 years really to improve those services. So, Ministers have to answer this question: if HS2 needs £100 billion and regional rail services need £50 billion—if they have £150 billion, then fine, do the lot—which do they prioritise?

[Lord Adonis (Lab)]

My Lords, my noble friend referred to localism and local decision-making but the Mayor of the West Midlands, the Mayor of Greater Manchester and the leader of Leeds City Council are strongly in favour of HS2 continuing. They prioritise it very highly. Does that not weigh with my noble friend?

[Lord Berkeley]

I am aware of those prioritisations. They want both. I have talked to them. However, when I asked them, “Do you want HS2 to get to London quicker or do you want better commuter services?”, they said, after a lot of thinking, that commuter services came first.

[Lord Adonis]

I do not accept that that is correct. If my noble friend asks the Mayor of the West Midlands, he will not find him prioritising other services over HS2.

[Lord Berkeley]

I will conclude. I am grateful to the Economic Affairs Committee, under the great chairmanship of the noble Lord, Lord Forsyth, for its excellent report. I hope that Ministers will read it, if they have not done so already, and I hope that we will have a debate on it. I hope that we will have another opportunity to debate this issue. It really is a question of money: do we have £150 billion or £75 billion? That is the decision for Ministers to make. I will be grateful if, when he winds up, the Minister can give me some idea of when that decision might be made.

Healthcare (International Arrangements) Bill

Lord Adonis Excerpts

2nd reading (Hansard): House of Lords
Tuesday 5th February 2019 Lords Chamber

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, before I revert to my usual mode of careful scrutiny, I offer a sincere triple congratulations to the Minister: first, on her elevation to this place—she did a great job in the other place and we welcome her here—secondly, on her appointment as Minister; and thirdly, as the noble Lord, Lord O’Shaughnessy, said, on a really excellent maiden speech. She comes to us with a great reputation and, I understand, undoubted ability. Given this Bill, she is going to need a lot of that.

This is an astonishing piece of legislation. With respect, relatively few have understood the wide and serious implications—and the consequences—of this Bill. I am astonished that the Scottish Government have not seen the implications, and that some of my colleagues down in the other place have not yet seen them. Thankfully, our Delegated Powers and Regulatory Reform Committee has understood it and produced a very good report. I am particularly grateful to the noble Lord, Lord Blencathra, and his colleagues for it. It particularly refers to Clause 2. I have read a few reports in my time, but this is really quite devastating. I will quote from it:

“We draw attention to clause 2 of the Bill. If the reason for the Bill’s introduction is to protect British citizens if a ‘no deal’ scenario affects current reciprocal healthcare agreements with other EU countries”,


which it does,

“clause 2 of the Bill goes considerably wider. It allows the Secretary of State to make regulations”,

first,

“in relation to the payment by the Secretary of State of the cost of all forms of healthcare … provided by anyone anywhere in the world”—

astonishing—secondly,

“for and in connection with the provision of any such healthcare, provided by anyone anywhere in the world”,

and thirdly,

“to give effect to international healthcare agreements”.

It goes on to say:

“Clause 2 has a breath-taking scope. Indeed, the scope of the regulations could hardly be wider … There is no limit to the amount of the payments … There is no limit to who can be funded world-wide … There is no limit to the types of healthcare being funded … The regulations can confer … powers and duties … on anyone anywhere … The regulations can delegate functions to anyone anywhere … the regulations can amend or repeal any Act of Parliament ever passed”—


astonishing powers—and that:

“The Government say that clause 2 ‘enables the Secretary of State to address essential matters relating to healthcare abroad’. But the powers in the Bill go much wider than essential matters”.


It continues:

“All regulations made under clause 2 are subject only to the negative procedure”.


My noble friend Lord Adonis knows that that is a very—

[Lord Adonis (Lab)]

Dangerous.

[Lord Foulkes of Cumnock]

—dangerous procedure, but also that there is very scant scrutiny in that procedure. The report states that the regulations are subject to the negative procedure,

“save where they amend primary legislation. If, without such amendment, the Secretary of State wished to fund wholly or entirely the cost of all mental health provision in the state of Arizona, or the cost of all hip replacements in Australia, the regulations would only be subject to the negative procedure”.

It is really quite astonishing. That is a great report. I could not have done better myself.

[Lord Adonis]

Why Arizona?

[Lord Foulkes of Cumnock]

Anywhere. That is just a random choice. It could be Texas or Alaska—it would be a bit more expensive in Alaska.

That is a really wide provision. Before we finally pass this Bill, Clause 2 needs drastic amendments. I say to my noble friends on the Labour Front Bench, to my friends—and they are my friends—on the Liberal Democrat Front Bench, to members of the committee and to Cross-Bench and Conservative Members that I hope that we will see those amendments in Committee. I hope that we will properly scrutinise this Bill because it has not yet been done.

The inevitable consequence of the Bill is to replace a system that works well and gives peace of mind to many thousands of British citizens with completely unnecessary worry and uncertainty. Whatever the Minister says, it will be about damage limitation. Of course, the worst of all options is no deal, which would immediately remove the guarantees which British citizens living in the European Union and European Union citizens in the UK currently take for granted. That the no-deal option is still on the table is an indictment of the Government and their failure to face up to the consequences of their attempts to appease the hard right of the Tory party. All we are offered by the Bill is uncertainty and “Trust the Minister; everything’ll be okay”. The Bill allows her or him to do just about anything, but instructs them to do absolutely nothing. That is a recipe for uncertainty.

Let us first take the S1 scheme, which is central to this debate. This allows individuals from one EEA member state to receive healthcare in another, with the cost of that care met by the state in which the patient would ordinarily reside. Some 190,000 UK pensioners living in the European Union or the EEA are currently registered for this scheme. What happens to their rights if we leave without a deal? Many would have to return to the United Kingdom in fear of facing astronomical health bills elsewhere. That would affect not only those currently benefiting from the S1 scheme but the NHS, which would have to take the strain of the increase in number of elderly returning citizens. A report by the Nuffield Trust estimated that if expats returned in large numbers, we would require 900 extra beds and over 1,000 more nurses. Where would they come from? It certainly would not be from European Union countries, since the Government are already busy telling them that they are not really welcome in the United Kingdom.

That brings me to the EHIC. I hope that everyone has it. I have mine. Every time I go abroad, I take it with me. We rely on it to make travel abroad a possibility. At present, 27 million active United Kingdom EHICs are in circulation. They are used to pay for around 250,000 medical treatments each year. Incidentally, I tried to find out how to apply for or to renew an EHIC. I put “European health insurance card” into the Google search. I pressed it and what did I get? “This page cannot be displayed”. We cannot find out. Can the Minister tell us why the Government are not allowing people access to the EHIC? Is it in anticipation of a decision relating to it? Is it in anticipation of a deal or no deal?

[Lord Adonis]

“Alternative arrangements”?

[Lord Foulkes of Cumnock]

If we lose this right, the only ones celebrating will be the insurance industry. When I tweeted something about the EHIC no longer going to be available, lots of people tweeted back saying, “Ah, but we can get travel insurance”. That is all right if you are reasonably wealthy, but for ordinary people who have struggled just to get enough money to go abroad, it is an extra cost.

These arrangements are the cornerstones of the freedom of movement principle which the European Union rightly sees as its own but which the UK Government, sadly, are hell-bent on opting out of. There are those who point to the deal that the EU has with Switzerland at present. It is true that, under the Bill in the event of no deal, we would be able to implement new bilateral agreements with European Union states, Norway, Iceland and Switzerland. This would be lengthy and costly, ultimately leaving the European Union without reciprocal arrangements for an unknown period. I raised this with the Minister and her counterpart in the Commons when they kindly held a briefing on it. They would be scrabbling around the European Union—indeed around the world—negotiating bilateral agreements. If the Health Secretary is as successful in doing deals as the Trade Secretary, there are going to be an awful lot of sick Britons scattered around the world for years to come.

We need to approve the Bill—of course we do; the Minister said it; the noble Lord, Lord O’Shaughnessy, said it—but with some appropriate and significant amendments to Clause 2. Without it, the Secretary of State will not even be allowed to do the deals which will protect British citizens abroad. However, there should be no doubt at all that the very good arrangement which we have at present is being replaced by, at the very least, an inferior one. It remains to be seen if the operative word really is “inferior” or if, as I fear, “disastrous” is a better way to describe what we are facing if we go for no deal. I hope everyone in this House will do everything they can to ensure that that does not happen. For the health of British expatriates and of those of us who travel overseas, it is vital that we do so.

Blood Safety and Quality (Amendment) (EU Exit) Regulations 2019

Lord Adonis Excerpts

Wednesday 19th December 2018 Lords Chamber

[Lord Adonis (Lab)]

The Minister referred a moment ago to a “responsible Government”. The idea that a responsible Government would be preparing for a no-deal Brexit is a contradiction in terms. No responsible Government would be preparing for this country to leave the European Union without a proper treaty arrangement next March. Let us be very clear: the Government are seeking to intimidate Parliament into voting for the Prime Minister’s deal by holding us hostage to the idea that there could be a no-deal exit next March. This is a phenomenal waste of the time of Parliament. It is also deeply disreputable in terms of the Government’s dealings with all those external partners, including the Minister’s partners in the NHS, whom he is winding up into thinking that there could be a no-deal exit for which they are preparing but which there is no chance whatever of this Parliament or this Government agreeing. The Minister should withdraw these regulations, say clearly that we are not doing a no-deal exit and prepare an orderly arrangement for us to hold a people’s vote next March so that we do not leave the European Union at all.

[Lord O’Shaughnessy]

It was Parliament that agreed that the exit day should be 29 March: it was voted on. Yes, we may have to work harder than normal in order to be prepared for all eventualities; I am sure that that is something noble Lords would not shirk. There is no sense at all that Parliament is being leaned on or taken for granted. The noble Lord has not been in the debates that I have been in—very good, substantive debates about important issues. That is what matters, not this silly game-playing.