Health and Care Bill

Lord Bishop of St Albans Excerpts

Lords Hansard - Part 1 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I am delighted to speak to this group of amendments, which I support; I am particularly delighted to speak to Amendment 156, as one of its co-sponsors. I very much support the comments of the noble Lord, Lord Young, who has highlighted the appalling health disparities faced by people who are the most socially excluded. I, too, ask the Government to recognise how amending the Bill in the way proposed would help them to realise their ambitions in this area.

We know that the level of ill health among people who would be considered under inclusion health is significant. We have heard the shamefully low average age of death for people experiencing homelessness in England and Wales. We also know that the life expectancy of Gypsy, Roma and Traveller communities is around 10 to 12 years fewer than that of the general population, although one study has found that this gap can be as high as 28 years. This disparity in life expectancy clearly demonstrates the devastating impact of extreme social exclusion.

It is clear to me that the health and social care system has a significant role to play in tackling the health inequalities experienced by these groups. These amendments would facilitate crucial progress towards that and encourage social enterprise involvement to reach the most socially excluded individuals. We have seen examples of this at the relatively new Plymouth dentistry school, where the training clinic has been set up as a social enterprise to serve some of the poorest people in Plymouth.

In relation to Amendment 156 in particular, we know that NHS services must be integrated with wider services to reflect how people’s lives work. A main aim of the Bill is integration, yet integration could not be more important for the groups that experience the most complex needs and require very effective, co-ordinated care. As I know from my time in nursing, there has been a historic lack of integration between housing, health and social care, yet housing is fundamental to reducing health inequalities. Without integration across these different systems, people will continue to develop acutely poor health.

People who experience social exclusion, and extreme health inequalities as a result, often fall through the gaps in the provision of primary and secondary care, mental health and substance misuse services, health and social care, and even health and wider systems, such as housing. For example, we know that people experiencing homelessness attend A&E six times as often as people with a home, are admitted to hospital four times as often, and stay three times as long. One study has found that homeless people attend A&E 60 times more than the general population. This has tragic results for the individual and also places incredible strain on our healthcare system.

We must act to alleviate the pressures on the NHS where we can. Severe and multiple disadvantage is conservatively estimated to cost society more than £10 billion a year. It is clear that the cost of doing nothing is too high, both to the individual suffering severe health inequalities and to the NHS. This amendment would help address these issues by ensuring that housing is considered by integrated care partnerships. It is non-mandatory, therefore speaking to the Government’s aims of enabling local decision-making and flexibility, but would ensure that partnerships think of the important role that housing plays by providing a stable place from which people can then engage with wider health services. A wide range of expert organisations are supportive of this amendment and related Amendments 152 and 157, including Crisis, Social Enterprise UK, Doctors of the World, and Friends, Families and Travellers.

The NHS must work effectively for all who are entitled to use it, including those who need it most. If we get access and outcomes right for the most marginalised in our society—those who experience the poorest health —we will likely get access and outcomes right for everyone. That is why I call on the Government to support the amendments in this group.

[The Lord Bishop of St Albans]

My Lords, Amendments 68 and 95 are in my name. I declare my role as president of the Rural Coalition. I support the broad drift of these amendments, which engage with the important issue of reducing inequalities.

Rural health and social care has often presented challenges in terms of proximity to services, the types of services available within a local area and the demographics of rural areas. It is complicated. Rural areas have a higher proportion of older residents, which is always a greater burden on healthcare services compared with areas with younger populations.

Furthermore, a variety of issues that feed into rural health and social care are beyond the remit of the Bill. In March 2017, Defra produced its Rural Proofing practical guidance to help policymakers assess the impact of policies on rural areas. At the time, this was a welcome initiative to ensure that rural interests were being adequately considered and, to quote the report, that

“these areas receive fair and equitable policy outcomes.”

Unfortunately, concerns have since grown among rural groups that this guidance has become a sort of bureaucratic box-ticking exercise in Whitehall that does not take into account the complexities of rural life.

Funding allocations are often the result of specific metrics or formulas, many of which disadvantage rural communities. For example, a 2021 report by the Rural Services Network, Towards the UK Shared Prosperity Fund, highlighted how many of the post-Brexit levelling-up funds disadvantaged poor rural areas due to way in which they measured poverty. The Department for Transport’s own 2017 statistics showed that, on average, travel from rural areas to either a GP or hospital was 40% longer by car and 94% longer via public transport when compared with travel in urban locations.

Further, 2017 figures from Rural England highlighted the higher rates of delayed transfer of care from hospitals in rural areas: 19.2 cases per 100,000 compared with 13 per 100,000 in urban locations. Analysis by the RSN has shown that, when compared with predominately urban areas, rural local authorities received significantly less grant funding per head to pay for services such as social care and public health responsibilities, in spite of the fact that they generally deal with older populations. Other problems include limited intensive care capacity in rural areas, the loss of local services through amalgamations, the relatively few specialist medical staff in rural areas, and the general staff shortage and retention issues facing rurality.

It is commendable that the Government have legislated in this Bill to introduce a duty on integrated care boards to reduce inequalities between patients with respect to their ability to access health services. My amendments would extend this principle and reduce those health inequalities with respect to where someone lives, whether it is an urban or rural area, and place a duty on ICBs to co-operate with each other for the purpose of reducing healthcare access inequalities. In effect, this is a statutory rural-proofing requirement.

This duty to consider rural access when reducing inequalities extends to co-operation between ICBs because rural areas often exist on the periphery of a large geographical region where patients in one area may reside closer to crucial services in a neighbouring board. Naturally, rural areas lack the economies of scale of urban areas, and greater cross-ICB co-operation will be required to utilise joint resources most effectively when delivering different services to rural areas that fall within border zones of ICBs.

One area where a collaborative approach between ICBs will be crucial for rural areas in the near future is the current reorganisation of non-emergency patient transport by NHS England, which will shift to ICBs shortly. Although rural areas undoubtedly are being considered as part of this re-organisation, patient transport is already a rural inequality that needs addressing. Putting rural proofing with respect to health care on a statutory footing presents a more concrete way to implement the existing rural-proofing guidance. The need for co-operation between administrative areas and for overall plans to be rural proofed will become more essential, particularly for secondary health services, if teams of specialist clinicians become increasingly consolidated in ever fewer locations.

Can the Minister outline how the Government intend to reduce the inequalities in healthcare access and funding that many rural areas face, and how they will effectively ensure that ICBs adequately rural proof their plans in line with the Government’s own guidance?

[Lord Faulkner of Worcester (Lab)]

My Lords, I am very pleased to follow all noble Lords in supporting all the amendments in this group. I congratulate my noble friend Lady Thornton on the way in which she introduced the debate when moving Amendment 11. I will speak briefly to Amendment 66, which was tabled by the noble Lord, Lord Young of Cookham, and signed by the noble Lord, Lord Rennard, and me.

It was enjoyable listening to the noble Lord, Lord Young, taking a voyage down memory lane to more than 40 years ago, when he was a Health Minister. He could perhaps have added that we would have become a smoke-free country rather earlier, had his advice and proposals for tobacco control been accepted at the time, and had he not been removed from health on the instruction of Sir Denis Thatcher and given another role in government. He is and remains a pioneer, and I am delighted to be behind him with his amendments; we shall come to other smoking amendments later.

Amendment 66 would require integrated care boards to address the leading preventable causes of sickness and death, particularly smoking. The Bill as drafted fails to get to the root causes of health inequalities and will have only a limited effect. Our amendment would correct this oversight as far as smoking is concerned. In 2019, there were 5.7 million smokers in England, one in seven of the adult population. As the noble Lord, Lord Rennard, said, in England smoking is the leading cause of premature death, killing over 70,000 people a year and leaving 30 times as many suffering from serious smoking-related disease and disability.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2021

Lord Bishop of St Albans Excerpts

Tuesday 14th December 2021 Lords Chamber

What is the current recruitment and retention in care homes in particular, as so many in your Lordships’ House have raised concerns in that regard?

[The Lord Bishop of St Albans]

My Lords, I think many of us are grateful for the comments from the noble Baroness, Lady Noakes, about process and impact assessments, and I echo those.

I shall make one or two comments about the substantive issues. Incidentally, we have been thanking the Government and medics for the rollout, but I want to pay tribute to the people who are going to be sitting up half the night: the managers of GP practices—they are the ones who get people there to get the vaccine. Very often they are forgotten, so I want to make that point.

I want to make some points about the very real problems that there are with this way forward. I am very sympathetic and, on balance, I think this is the way forward, but for many decades we have taken very seriously those who have very real concerns about receiving a vaccination. Those are not concerns that I share personally, but there are those, for example, who are concerned about the use of aborted foetal cells or testing on animals. We—both myself and more widely in the Church of England—have always maintained the position that freedom of belief or religion should not be compromised by the introduction of any form of coercion or forced decree. This is difficult, because it is not just about someone’s right but about the effect that they have on someone else. Recently, I heard from someone who was jabbing—giving vaccinations—that someone came in without a mask on. They challenged him and he said, “I don’t get on very well with masks”, to which one of the nurses said, “Well, I hope you get on well with a ventilator.” That is the implication; we know what the medical science is.

The problem is that there is the danger of a subtle form of racial discrimination via the backdoor. Ethnic minorities comprise a much higher percentage of healthcare staff compared with the overall population. We know that they are more likely to be religious than the white British majority, and vaccine hesitancy is much higher among these communities. There is a whole range of complex issues to do with social trust and people’s position in society that I do not want to steamroller over without raising and putting on the record as we move forward with this programme. A worrying confluence of factors could leave those historically discriminated against being forced to choose between violating deeply held principles and unemployment. No one, whether white or from an ethnic-minority background, should be forced into that corner.

This raises the really important issue of how we are addressing vaccination hesitancy. I have been talking to the noble Lord, Lord Sharpe, about how can we help with that more widely across the globe. This is a reminder to those of us who are in touch with—particularly if you are in my line of business—black churches and so on that we need to up our game in addressing the reasons for vaccination hesitancy. We need to do it urgently, because the more that we can win the argument, the more we will save ourselves a lot of unintended consequences of discrimination that may result from these regulations.

[Lord Cunningham of Felling (Lab)]

My Lords, I declare an interest as a member of the Secondary Legislation Scrutiny Committee. Your Lordships will no doubt be delighted to know that, in January, I shall be leaving it—not by choice but because I have been cycled off.

At the heart of this dispute with the Department of Health and Social Care is the requirement, not option, that any department submitting secondary legislation—principally to this House, since it is almost never discussed at the other end of the Corridor in the House of Commons —should include an impact assessment. This is not an optional extra. It is not a take it or leave it. It is a requirement at the heart of the process. The committee is meeting at the moment—it may have concluded—and it has a Conservative chairman, who is very good. There is no predetermined disposition among its members to seek a confrontation with any government department. However, in this case, the Secretary of State and his department have point-blank refused to carry out an impact assessment. It is a challenge to Parliament and to the parliamentary process. That is what is taking place.

I agree with almost everything that the right reverend Prelate said about enforcing vaccination and I realise that there are some very serious problems to be resolved there. But that is not what the argument is about. It is about whether Parliament—in this case, your Lordships’ House—has the right to require any government department to produce an impact assessment about its proposals for legislation. It is quite a simple matter. It is not onerous in most cases. It is necessary for the committee to consider the impact assessment—along with other aspects of the legislation, of course—before reporting to your Lordships’ House. I did not hear in the Minister’s opening remarks a coherent explanation—and I have never received or seen one—of why that is not possible in this case.

As I said, your Lordships require their colleagues on the committee to analyse secondary legislation. That is our role and, if we do not have an impact assessment, we cannot fulfil it. That is the issue. I agree with what the right reverend Prelate said, but this is not about enforcing vaccination. It is about trying to learn to understand the impact, through an impact assessment, of this proposed secondary legislation. If committees are not allowed to take a stand on this, there is little purpose to them, because this is one of the fundamental issues of secondary legislation. That is our job and our responsibility and it is what we have been trying to do.

Medical Schools: Training Places

Lord Bishop of St Albans Excerpts

Monday 13th December 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for sharing the experience of Northern Ireland. It is really important that we ensure that we have more training places and that we address the types of training that we do. As the noble Baroness will be aware, it is no longer a simple question of nurses and doctors: we are training a number of physicians’ assistants and specialists, and we will continue to do so.

[The Lord Bishop of St Albans]

My Lords, this latest Covid omicron variant has made us realise that we are one human race, and we are now facing a scandal whereby we are relying on bringing in doctors from some of the poorest parts of the world to look after our needs. For centuries, this country was renowned for sending doctors and nurses abroad and founding hospitals in all parts of the world. What consideration have Her Majesty’s Government given to ensuring not only that we are producing enough of our own doctors but that we are expanding our tertiary education and bringing in more people to send them back to help some of these countries as part of our global Britain initiative?

[Lord Kamall (Con)]

When training doctors from abroad, we follow international guidelines and World Health Organization ethical guidelines. For example, when I recently had a meeting with the Kenyan ministry to talk about the UK-Kenya health partnership, the point was made to me that they were training far more people than they had places for in their own country. They thought that their talent was a valuable export, while at the same time, remittances went back to their country.

Organ Tourism and Cadavers on Display Bill [HL]

Lord Bishop of St Albans Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[The Lord Bishop of St Albans]

My Lords, I too support this Bill and welcome the very excellent speech by the noble Lord, Lord Hunt of Kings Heath, and this important priority to equalise the law so that, whether a body or an organ comes from someone in this country or some other part of this world, they will be given the same protections and treated with the same dignity.

Noble Lords have already spelled out with great and horrifying clarity some of the allegations of organ harvesting by the Chinese authorities targeting minorities. I have risen to speak today because I have been raising again and again in this House the issue of the Uighurs, and this absolutely touches on what is happening to this incredibly persecuted group of people. It is terrifying to see what is unfolding before our very eyes. In June 2021, a group of independent UN experts said that they had received information that detainees from ethnic and religious groups such as the Uighurs, Tibetans, Falun Gong and Chinese Christians were being subjected to examination without their consent, with the express intention to facilitate organ allocation.

We know that, back in 1984, harvesting organs from political prisoners was permitted in Chinese law. We know that the subsequent crackdown against the Falun Gong in 1999 meant that many of its members are likely to have been subject to forced organ harvesting. It is rumoured that, in the 1990s, prisoners of conscience of Uighur origin were the largest source of organs, before being surpassed by Falun Gong. Now, however, the Uighurs are again in the sightlines of the Chinese Communist Party, and the accounts of harvesting organs are rising. Expert estimations of the number of Uighurs killed in Xinjiang for their organs range from 20,000 to 25,000 per year. There are also stories of vast lanes to streamline the distribution of these organs, and of crematoria to dispose of the victims’ bodies and to deny the deceased a proper Islamic burial.

I had previously refrained from using the term “genocide” to describe the awful repression of the Uighur minority, but, following the House of Commons debate in April and its Motion, when it was labelled as such, it seems to me that we now have to name it and not mess around any more. A genocide is being perpetrated against Uighur minorities. I am not blind to the difficulties that our own Government have in trying to save these lives, but we must become far more robust in terms of the representations and, if necessary, the actions that we are willing to take against China. I have found Her Majesty’s Government’s response to the situation in Xinjiang disappointing over recent months. The current law allows British citizens to receive organs from unknown and possibly non-consenting sources without consequences. If that happens, British citizens are acting as accessories to genocide.

I will make one final, brief point. I am glad that this Bill extends to the treatment of the bodies of those who have been executed, but it is also for those who have died peacefully. It remains unacceptable that they should be displayed without appropriate consent. Christianity has always held that our bodies have been created by God and are temples of the Holy Spirit, and as such that we must reverence them and treat them with dignity, both in life and in death. For centuries, the Christian tradition has taught that burying the dead is one of the seven acts of corporal mercy. It is rooted in the belief that the body is sacred. This is so fundamental to us as we look to the future. I hope that Her Majesty’s Government will bring this Private Member’s Bill into law as soon as possible.

Covid-19 Vaccines Deployment

Lord Bishop of St Albans Excerpts

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I reassure the noble Baroness that the interval protocols for the Pfizer vaccine have been completely endorsed by the JCVI, the CMO and the MHRA. They are extremely clearly endorsed by the British authorities, and she should feel enormous confidence in our approach to that.

However, the noble Baroness is right: I do not know, and cannot say for certain, what the long-term prognosis is. We do not know what the transmissibility of the disease will be with the current vaccine. We are working on new versions of it that should address the South African variant, but we do not know for sure whether that will prove dominant in the UK. It is the view of the CMO, Jon Van-Tam, that it will not beat either Covid classic or Covid Kent—but it is not certain whether that is the case right now.

We do not know whether there will be a rolling programme of mutations that roll on to the shore and require us to update the vaccine regularly—or whether we will have to hold our borders as they are now until we have the kind of vaccine development programme that can turn around refreshed vaccines within, say, 100 days. Those are all possibilities; we are putting in place the necessary plans in case that should be required, but it is my confident hope that the current vaccine will have a massive impact on Covid and that we can return to something that approaches normal in the very near future.

[The Lord Bishop of St Albans]

I too add my congratulations to Her Majesty’s Government on an extraordinarily rollout of the vaccines. I pay tribute to all those involved, not least one group not often mentioned —the practice managers, who often work through the night. Can the Minister comment on the community champions scheme? Faith leaders across Hertfordshire and Bedfordshire, where I live, have been waiting to use our huge, extensive network of people on the ground to communicate with hard-to-reach groups, such as ethnic minorities and so on. Only now are we being brought into that opportunity. Will the Government commit to working with us, since we are keen to use all our resources to help get those messages out to those hard-to-reach groups?

[Lord Bethell (Con)]

I am enormously grateful to the right reverend Prelate for mentioning practice managers. Managers in the NHS are sometimes given a bit of a hard time and are too often overlooked. But, my goodness, if the vaccine deployment has been a success and been run smoothly—and if the constant reports I get of two-minute turnarounds, accurate invitations and appointments made briskly and accurately are correct—it is because of those managers. The NHS practice managers are running a tight ship and delivering huge value for the NHS. They are too often overlooked but, boy oh boy, have they delivered on this occasion.

The right reverend Prelate is entirely right to raise the issue of not only community champions but volunteering overall. It has been one of the toughest aspects of our response to Covid to make use of the hundreds of thousands of people who have stepped forward in various schemes to help with it. There are returning practitioners from healthcare; there are community champions, which he rightly described, along with the faith groups; there is also St John Ambulance and the vaccinating volunteers. Quite often, hygiene protocols and the necessity to put in place measures to avoid transmission of the disease have meant that it has been difficult to mobilise the army of volunteers. One thing that we should look back at, when we do our post-mortem, is how we as a country can deploy civic society more effectively.

Regarding the faith groups the right reverend Prelate specifically mentioned, I pay tribute to their role in the vaccine deployment. The sight of vaccines being given out in synagogues, mosques, gurdwaras and temples up and down the country surely has a huge part to play in their successful deployment among many difficult-to-reach groups.

Coronavirus

Lord Bishop of St Albans Excerpts

Wednesday 16th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I note my noble friend’s comments. However, I flatly deny that the social care system and social care homes have been in any way marooned. We have made a profound commitment, particularly in the testing environment, to supporting social care. One hundred thousand tests a day out of our capacity of between 200,000 and 250,000 are ring-fenced for social care and delivered to social care every day. Many of the challenges that we have for walk-in and drive-through testing centres are exactly because we are so committed to the ring-fenced testing for social care. That is a commitment that we are proud of and remain committed to.

I want to clarify with my noble friend that it is not an appropriate use of government test and trace capacity for relatives to use test and trace as a convenient method to find out whether they have the disease before they go to see relatives. That is not an appropriate use and not in the guidance.

As for UNISON, we are very much engaged with the union and are supporting staff in every way we can. However, I very much take on board my noble friend’s notes, and we will maintain that correspondence.

[The Lord Bishop of St Albans]

My Lords, can the Minister clarify one or two issues? Does the rule of six mean that it will no longer be possible to have any public marking of Remembrance Sunday outdoors this year? Will he also clarify whether this effectively means that all public protests and demonstrations are now illegal?

[Lord Bethell (Con)]

I thank the right reverend Prelate for his question. I thank greatly those local authorities and charities that are putting in place Remembrance Day service arrangements that will abide by the new rule of six. Some of those guidelines are being written now, and I will be glad to share the guidelines with the right reverend Prelate when they are published. One thing I note is that virtual attendance at these services and the use of virtual remembrance books will be an aspect of Remembrance Day this year.

Covid-19: Government Response

Lord Bishop of St Albans Excerpts

Wednesday 6th May 2020 Lords Chamber

[Lord Bethell]

“Track, test and isolate” does not necessarily depend on doing millions of tests. South Korea, which has an extremely effective regime, does only 20,000 tests a day. That is because its whole society has worked hard to get the prevalence of the infection as low as possible. I celebrate the fact that the British public have committed to the lockdown, but I cannot disguise from the House the fact that the lockdown needs to continue to get the prevalence rate lower.

[The Lord Bishop of St Albans]

My Lords, yesterday the deputy chief scientist said that we needed to “get to grips” with what is occurring in our care homes. As data shows that deaths in care homes are rising while hospital deaths are plateauing, what specific actions are Her Majesty’s Government taking to put a stop to this dreadful crisis, which is unfolding before our very eyes?

[Lord Bethell]

The right reverend Prelate is entirely right to focus on care homes. It is an awful aspect of this disease that it attacks the most vulnerable who live in enclosed environments such as care homes. They have been an absolute priority for the Government. One aspect of our response is to massively increase testing in care homes. The increased capacity that we announced last week has been shifted massively towards care home testing. We are using mobile units and satellite drop-offs to increase the screening of patients and care home workers.

Unpaid Carers: Support

Lord Bishop of St Albans Excerpts

Thursday 13th June 2019 Lords Chamber

[The Lord Bishop of St Albans]

My Lords, I am sure that we all want to encourage stronger family and community life, which is the very bedrock of healthy societies, but there is one group in particular that needs help and that is the 166,000 underage carers in England. Research by the Children’s Society suggests that that is just the tip of the iceberg—indeed, a huge underestimate. Many of these young people do not realise that they classify as carers: it is just what they have had to deal with. In many cases it is affecting their schooling and mental health. What are Her Majesty’s Government able to do to help and support underage carers in particular?

[Baroness Blackwood of North Oxford]

The right reverend Prelate is quite right to identify this as a crucial issue. The Government believe that children should be protected from inappropriate and excessive caring responsibilities. We changed the law to improve the way that young carers are identified, and we are supporting schools to support carers and working with the Carers Trust to identify and spread best practice. Just today, working with the Children’s Society, which he rightly says has led this project to identify and disseminate best practice, guidance and resources will be published to enable young adult carers to make positive transitions between the ages of 16 and 24. We hope that this will improve the outcomes that young carers experience.

Mental Health Budget: Domestic and Sexual Violence

Lord Bishop of St Albans Excerpts

Thursday 22nd November 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right. The strategy, of course, has a focus on women and men. Women are the greater victims of abuse; indeed, the more severe the abuse, the more likely it is that the victim is a woman. However, I can tell her that it is a broad strategy which encompasses both. We still have a problem, in that men are much less likely to come forward if they have been abused than women.

[The Lord Bishop of St Albans]

My Lords, it is much to be welcomed that the Government are allocating this money. I am also glad that the needs of young people have been highlighted, but the Minister will be aware that statistics show that roughly 340,000 elderly people are suffering abuse in the community each year. If we are not tracking how the money is spent, how can we be sure that the mental health needs of the elderly are being properly addressed at a particularly vulnerable point in their lives?

[Lord O'Shaughnessy]

The right reverend Prelate makes an excellent point. The intention is that there will be greater reach into care home settings as well as domestic settings, so that people who experience abuse in those settings are able to come forward and we can provide such protections for people in homes.

Brexit: Risks to NHS Sustainability

Lord Bishop of St Albans Excerpts

Wednesday 12th July 2017 Lords Chamber

[The Lord Bishop of St Albans]

My Lords, I thank the noble Lord, Lord Warner, for introducing this important topic for us this evening and for his helpful and comprehensive opening remarks.

Ensuring the sustainability of the NHS is undoubtedly a significant challenge, even before the potential consequences of Brexit are considered. The uncertainty surrounding the Brexit negotiations has created significant stress for many working in already pressurised health and social care systems. There is no doubt that urgent action must be taken to ensure the stability of the current system. That being said, I wonder whether we might be able at this time of significant pressure to begin to confront some of the deeper challenges that our health system faces. The challenges of Brexit for our health and social care services might only reveal the deeper, long-term problems of these systems as a whole. It would be unfortunate for Brexit to be only the latest in a long line of short-term crises rather than an additional opportunity for reflection.

The report of the Select Committee on the Long-term Sustainability of the NHS, published in April of this year, stressed:

“Whatever short-term measures may be implemented to muddle through today, a better tomorrow is going to require a more radical change”.


I note particularly its recommendation of,

“a new, independent standing body enshrined in statute to safeguard the long-term sustainability of the NHS and social care”.

The nature of the political cycle means that it is difficult for politicians to rise above the fray and consider the long-term sustainability of the system as a whole, and there is substantial room for a body to oversee and scrutinise independently and to report directly to Parliament. National health and social care service provision affects the lives of citizens in profound ways, quite literally from cradle to grave. It is no surprise that it is of paramount importance to both individuals and politicians, and we should consider novel ways to safeguard these systems. Bold leadership is required, but this should be an area where politicians can show courage in finding common ground to make meaningful and lasting change.

Much has been said in this Chamber about the deep feeling of division in this country in the light of the Brexit referendum. Nevertheless, the NHS, and the importance we place on caring for one another, is at the core of the “British values” discussed in the Queen’s Speech. Indeed, these values are a part of many faiths, including Christianity. Part of what it means to be British is to care for one another, even when it comes at significant cost. We must acknowledge, however, that that cost is increasing, and adjustments must be made at both an individual and societal level. We have a duty to one another and to future generations to ensure that necessary resources are in place and are safeguarded in order for care to be maintained.

It is unfortunate that the NHS is not in a better position to be able to respond to the challenge of Brexit; we are still suffering the consequences of short-term thinking and acting. The waiting list for elective treatment has risen to 3.78 million, which is 5% higher than a year ago, and the number of delayed discharges from hospital caused by waits for home care rose by 45% in 2016-17. Even within my own diocese, two wards in St Albans hospital are scheduled to be closed to cut costs despite the clear demand for beds. By taking a more long-term approach to healthcare, even in the light of Brexit, we may be able to address the issues that have weakened the system substantially and prepare for the additional challenge of our ageing population. If we can work towards preventing weakness in the system, we will be far better placed to respond to sudden challenges.

The potential loss of EU personnel in both the health and social care systems will be an enormous short-term challenge. More than 60,000 people from EU countries outside the UK work in the English NHS and around 90,000 work in adult social care. Support must be provided for these individuals, many of whom work long hours in difficult circumstances and have made significant sacrifices to make the UK their home. We need to take account of them, not just in negotiated discussions but also in any plans, after we leave the EU, to alter immigration policy.

It should never be overlooked that the NHS is heavily reliant on workers from outside the UK. Despite this, the Royal College of Physicians describes our hospitals as chronically understaffed, almost half of community mental health teams had staffing levels judged as less than adequate in 2013-14, and the Royal College of Midwives believes that in England we need 3,500 more midwives to ensure that every woman can receive one-to-one midwifery care in labour.

Not only must we have sufficient numbers of personnel, we must ensure that they have the correct skills and training that the service needs. This means that we need to invest in those currently serving in the NHS, as well as making sure that we train enough doctors and nurses here in the UK. However, in 2016 there were unfilled nursing places in UK universities, and we know that care homes would collapse without their non-UK workforce. This is in part because these roles are not sufficiently valued and hence do not attract UK applicants. Sustainability of the workforce cannot be achieved, even if all EU workers remain, unless attitudes to some health and social care roles change significantly.

As we seek to manage the staff of the NHS wisely—that staff is undoubtedly one of our greatest assets—prudent financial planning will also be required. The quality of care which we have come to expect and demand comes at a significant cost. Some 86% of the NHS’s sustainability and transformation fund of £2.1 billion has been set aside to sustain current services and meet expected deficits. As deficits increase year on year, a radical rethink of healthcare funding is required. We need a broader social dialogue about funding for health and social care, one to which the Church and other faith communities can contribute.

Along with the right to healthcare, which we are undoubtedly privileged to enjoy, as users of health and social care services we have associated responsibilities. In remembering that we both benefit from and contribute to the NHS, we must consider the impact of our own lifestyles on our ability to care for others. In treating others as we wish to be treated, we must be prepared to think creatively and make sacrifices for all to enjoy a good standard of care.