Homecare Medicines Services (Public Services Committee Report)

Lord Blencathra Excerpts

Thursday 2nd May 2024 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I am delighted to participate in this important debate, and I regret that it is tail-end Charlie today when the report deserves much greater prominence. The only credit I can take for this excellent report is that I suggested the topic. I pay tribute to our brilliant chair and her devastating summary today, and to colleagues on the committee and to the officials, who did all the probing and heavy lifting and concluded that this is a major opportunity lost.

My personal interest is that I get two different medicines for multiple sclerosis delivered to my home. The one which sparked this inquiry is called fampridine. Most people with MS cannot lift their feet and they drag on the floor; I can trip over a dead fly on the carpet. Fampridine enables us to lift our feet by as much as 5 millimetres—that is all—but it is the difference between walking and not walking at all. To me and others, that little fact makes it a miracle drug, and I was lucky enough to get in on the trials when they started. As an aside, NICE will no longer approve it for new patients, but all those of us in the trials can keep getting it. That is grossly unjust—like many other NICE decisions.

I had excellent service until 2017, when the delivery contract was allocated to a new company; it is named in the report and I will not name it again, but it began to fail abysmally in getting the deliveries to me before the last pills ran out. I complained on many occasions and it came to a head in July 2021, when I had no delivery and no pills for 10 days. I was unable to walk—or stagger, in my case—from where I park my Ferrari at the Bar of the House even to get to this Front Bench here.

I looked up the company in Companies House, found the names of the main directors, tracked down their addresses and sent them a stinking note with my full rank and titles and a draft of my letter to Sajid Javid, the then Secretary of State, calling for the company’s contract to be terminated. The net result was that, two days later, some poor chap was dispatched on a 500-mile round trip to deliver on a Saturday my fampridine to Penrith in Cumbria.

I looked further into this company and found that the Care Quality Commission—a thoroughly useless body if ever there was one—had just published a report in May 2021 showing that over 9,885 patients had also failed to get deliveries of their drugs, and some had to be hospitalised. The CQC report gave the company an overall rating of “inadequate”. On patient safety it rated it “inadequate”, and on “Are services well led?”, it rated it “inadequate”. Therefore, with all these negative ratings, what did the CQC do? It listed all the regulatory breaches and asked the company to kindly send it a report on how it would behave better in future. As Bob Geldof might have said, “Is that it?”

That is one reason why I say that the CQC is a useless regulator, which our report also suggests—or hints at, in very strong terms. By the way, a month after the scathing CQC report, the company changed its name and pretended to be a completely different supplier altogether.

I wrote to the Secretary of State calling for the contract to be removed, but that did not happen because he was not properly in charge of it and he was not sure quite who was. I now get Rolls-Royce service from this company because of who I am and because I created a big stink, but the other 9,884 victims, who have conditions far worse than mine, might not be so well served.

When I joined the Public Services Committee, colleagues were looking for a short-term inquiry to fill a gap as we looked at suggestions for a longer inquiry. I suggested investigating the delivery of medicines at home and supplied details of my own experience. I think that initially my colleagues thought that I was perhaps exaggerating the shambles I had described, but when our excellent clerk, Samantha Kenny, looked at it, she thought that it deserved a deeper look.

My colleagues thought that there may be a bit of a mess here, and then the evidence started to come in from various patient groups such as Crohn’s & Colitis UK, and the superb report from the British Society for Rheumatology which suggested that the system was a complete shambles and cited countless examples of failure to deliver medicines on time. I think colleagues then concluded that old Blencathra was not so barking after all.

We have called the report An Opportunity Lost and that is true, but we could easily have called it “A Complete Shambles”. Those are not just our words; the Chief Pharmaceutical Officer for England told us that our inquiry had unearthed,

“a complicated picture that is quite hard to understand even when you are working in the area”.

That is a nice way of saying “a complete shambles”.

The then Minister for Health and Secondary Care, Will Quince MP, stated:

“It is certainly complicated. That is an understatement”.


That is, again, a nice euphemism for “a complete shambles”. As the noble Baroness said, the NHS has not a clue how much it costs. The National Clinical Homecare Association told us that the Treasury spends £4.1 billion per annum on homecare medicines, but the NHS told us it is only £3.2 billion. We asked the Minister—he said it was £2.9 billion. As we say, it is utterly shocking that no one in the NHS can give us an accurate figure for the billions spent on home deliveries, but then the NHS does not have a clue about how bad it is and how many patients have suffered. KPIs are a mess, as the noble Baroness explained.

We said in our report:

“Different sets of performance data are available to manufacturers and the NHS. This creates confusion and prevents effective monitoring … NHS England must develop and implement one consistent set of performance metrics”.


Performance data must be published.

The National Clinical Homecare Association told us that

“98.8% of deliveries were delivered on the day they were intended to be delivered on”.

That is a very clever form of words but quite misleading. Yes, 98.8% were delivered on the dates that the delivery company decided they were to be delivered on, but those were not the dates the doctors prescribed, which were always much earlier and before the medication for patients ran out. Part of these failures are delays in the NHS prescribing system and delays by the delivery company.

Chapter after chapter of our report highlights the failings of the system. Thus we say:

“No one—not the Government, not NHS England, not patient groups, not regulators—knows how often, nor how seriously patients suffer harm from service failures in homecare”.


Let no one misconstrue our conclusions as an attack on the private provision in the NHS. While we found myriad flaws in the provision at all levels, God help us if the NHS tried to run a courier delivery service, since that would be infinitely worse. Delivering medicines at home by couriers is eminently sensible but has to be better managed at all levels. The problems that we identified all relate to the fact that there is not one single person or NHS body in charge. Different people and organisations negotiate different contracts. There is no quality control or negotiating competence, there are no consistent KPIs to measure performance and the various regulators are all fairly useless. It seems there is no one with the power to sanction failure or cancel contracts. Worst of all, I got the feeling that the NHS rather likes it this way because when things go wrong there is no one individual or organisation to blame. They can all carry on presiding over a shambles but carry no personal responsibility for it.

I get exceptionally good medical care from the National Hospital for Neurology in Queen Square, the Royal Marsden and the Lakes Medical Practice up in Penrith, but if you want to see the general bureaucratic incompetence of the NHS and why it is failing so badly in so many areas, the bureaucratic shambles that we are reporting on here is a perfect microcosm example.

However, in the report we did not just criticise but offered solutions. Theoretically, there is a Minister in charge, but he or she has no say in the running of the system, which is delegated to the NHS. The Minister should be charge and have a very senior person reporting to them. We say:

“NHS England should designate a senior, named person with responsibility for the homecare system. That person should be given sufficient powers and resources to discharge that responsibility”.


That person’s responsibilities should include:

“Setting clear national KPIs for organisations commissioning and providing homecare medicines services … Collecting data on those KPIs, and publishing data on those KPIs in a way which supports public scrutiny of the homecare medicines system … Holding relevant bodies such as individual providers, Chief Pharmacists, the National Medical Homecare Committee and pharmacy teams to account for work on homecare medicines services … Responsibly using new powers to issue appropriate penalties to under-performing providers”.


That is essential; there must be sanctions.

The fifth recommendation is:

“Ensuring trusts or hubs procuring homecare medicines services have access to sufficient financial and expert procurement advice and information, including template legal agreement frameworks, so they are able to effectively deliver value for money services and influence the homecare medicines services market”.


As in every government department I have served in and witnessed over 40 years in Parliament, the lawyers employed by the outside commercial contractors are infinitely better than government lawyers trying to negotiate contracts; they outwit and outmanoeuvre us every time.

Finally, we said that:

“Achieving value for money and increasing transparency on homecare funding”


should be another part of their individual duties.

As the noble Baroness said, the government response accepted about 90% of what we say—that is jolly good. On that basis, let us have urgent action to implement those proposals and the remaining 10% as well.

[Lord Evans of Rainow (Con)]

My Lords, I remind the House that there is an advisory speaking time of nine minutes.

Health and Care Bill

Lord Blencathra Excerpts

Consideration of Commons amendments
Tuesday 26th April 2022 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I support Amendment 48C in lieu, and what an extraordinary amendment it is. The Government have accepted, for the first time, that they must make—and will make—regulations

“eradicating slavery and human trafficking in supply chains”.

This is an extraordinary turnaround, and I congratulate my noble friend the Minister and the Secretary of State, Sajid Javid, on it.

However, the real hero here is the noble Lord, Lord Alton of Liverpool. In every relevant—or even vaguely relevant—Bill we have considered in this Parliament, he has sought to pass an amendment or new clause tackling genocide or slavery in Xinjiang province. Every time, his amendments have been rejected on the absurd notion that only an international court can decide on genocide. He has articulated again and again the terrible abuses of the Uighurs in China: forced labour camps, sterilisation of women—that is slow-motion genocide—systematic rape, murder and torture. He has called for us not to trade with any company making anything which emanated from such slave labour, either in China or anywhere else in the world. His persistence has paid off and, aided by my right honourable friend Iain Duncan Smith in another place, the Government have now produced this amendment in lieu.

At this moment we have no idea what a change this will bring about. It may seem a small start now but I care to bet that in, say, 20 years’ time, historians will point to this amendment and the campaign of the noble Lord, Lord Alton, and say that it has changed world history. I will press my noble friend the Minister on the timescale here. I hope we will have the regulations on the statute book within about 12 months and will not have to engage in the formerly proposed and rather convoluted 18-month consultation system with everyone under the sun around the world. Indeed, the Secretary of State announced last week that he was banning CCTV cameras from Hikvision, a company with close ties to the Chinese Communist Party. I assume he did that without extensive consultation.

My noble friend the Minister probably cannot answer this, but I hope that the promised procurement Bill will have equally strong provisions. Indeed, it will not get through this House unless it mirrors what the Secretary of State has done here. There can be no back- sliding now.

In conclusion, and in addition to once again congratulating my noble friend Lord Alton, I wish to praise my right honourable friend Secretary of State Javid, who—if I may say so without being patronising—is turning out to be rather good. I tried amendments on single-sex provision in NHS hospitals and the Secretary of State has now urged NHS trusts to do it. I say to him, “Don’t urge them, Secretary of State—make them do it. You must re-write Annexe B and protect women.”

He has also rightly demanded a review of the consequences of children having their sex changed on the basis of inadequate evidence. As he points out, the zealots in the militant trans lobby who are marching children through the sex-change machine could be committing child abuse. That is the real conversion therapy that needs to be banned. It looks like we may have someone sensible in charge of the DHSC. The Motion moved by my noble friend tonight proves that and I commend it once again.

Health and Care Bill

Lord Blencathra Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I rise to speak to my Motion D1. It is straightforward and I need not detain the House long. We all know the situation in Xinjiang province; it has been set out in graphic detail in this House by the noble Lord, Lord Alton, and others.

In recent years, the Government have procured billions of pounds’ worth of medical equipment sourced in whole or in part from Xinjiang. Despite widespread reports of forced labour in that region, our supply chain laws have failed to prevent such procurement. The Government have repeatedly condemned China over its treatment of Uighur Muslims in Xinjiang province and has imposed sanctions in response to its human rights abuses. Indeed, my right honourable friend the then Foreign Secretary said that torture “on an industrial scale” was happening there. Then the new Foreign Secretary, my right honourable friend Liz Truss, told our ambassador to China that China was committing genocide—at last someone in the FCDO was admitting the truth. Everyone knows that it is genocide. The independent Uyghur Tribunal, the US Government, our own Parliament and five other Parliaments determined it.

However, every time we try amendments, however modest, on trade with companies using slave labour in Xinjiang, the Government throw a wobbly if we use the word “genocide” and give the usual, simply unbelievable answer that only a court can pronounce on that, despite there being no court capable of holding China to account. There have been an awful lot of government pronouncements in the past two days about Putin and Russia committing war crimes and atrocities, and rightly so, but there has been no suggestion of a court needing to pronounce on that. However, let us park all that.

The Government will not accept any amendment which remotely hints at genocide. So my amendment does not seek to go there. Instead, it uses the Modern Slavery Act 2015, which is already on the statute book. We sent a simple, three-section amendment to the Commons: first, to make regulations ensuring that the DHSC did not buy goods and services from a country which may be in contravention of the genocide convention; secondly, a Minister should assess whether there was a serious risk of genocide; and, thirdly, a Minister had to make that assessment if a chair of a Select Committee requested it. That was rejected in the Commons and the Government gave us back the complicated and rather complex Amendment 48A in lieu. As we see from the government amendment, the Secretary of State would have to carry out a review in case there was slavery and human trafficking. He would determine the scope of the review and what parts of the NHS it might apply to. Then he must lay it before Parliament within 18 months and give his own views on how he would mitigate it.

My amendment combines that government review amendment with a simple one-line clause. This one-line amendment was moved in another place by my right honourable friend Iain Duncan Smith MP and was supported by all Opposition Front Benches and Conservatives who included the former Secretary of State, Jeremy Hunt MP, and the latterly Lord Chancellor, Robert Buckland MP. In the other place this simple amendment was rejected by my honourable friend Ed Argar MP. Now Ed Argar is a good Minister but someone drafting his speech obviously found an old “Yes Minister” script and wrote a classic Sir Humphrey response:

“In developing the modern slavery strategy review, it will continue to be important to engage across Government and civil society, nationally and internationally, to collect the necessary evidence to agree an ambitious set of objectives … We remain of the view that this is not the right legislation for the proposed changes.”


Can your Lordships not just hear Sir Humphrey adding, “A very courageous decision, Minister”?

Well, the right time is right now and the right legislation is this Bill. Of course, the Government always have a better Bill coming along in the future. The government amendment in lieu relies on the Modern Slavery Act, and so does mine, and while I criticise the obfuscating waffle of the government amendment in lieu, I am not attempting to replace it or reject but will support it. I am merely adding a one-line sentence to it. It is simple and does what the Minister in the other place said the Government wanted; that is, to

“further strengthen the ability of public sector bodies to exclude suppliers from bidding for contracts where they have a history of misconduct—or extreme misconduct in the case of slavery, forced labour or similar.”—[Official Report, Commons, 30/3/22; cols. 926-27.]

Ignoring the fact that genocide and slavery are a wee bit worse than misconduct, my amendment gives the Department of Health and Social Care the opportunity to desist from buying goods and services from anywhere practising modern slavery.

I do not blame those involved in procurement for the sorry fact that slave-trade goods have entered our supply chains. Those working in the Cabinet Office, NHS procurement and the Department of Health have worked jolly hard in very difficult circumstances over the past few years. The fault is not theirs. We clearly need better tools to keep slavery out of our supply chains and this neat little amendment would allow the Government to do exactly that.

We do not need to engage the whole of government, nor civil society here and abroad. After all, Dominic Raab has just cancelled a contract for solar panels on prisons because parts were made in Xinjiang province, and I am certain that he did not consult civil society here or overseas before doing so. If the Secretary of State for Justice can make that unilateral decision, so can the Department of Health and Social Care. Nor need we worry that we will be deprived of essential PPE from Xinjiang. On 31 March, I found the following announcement by the Department of Health and Social Care:

“Personal protective equipment for sale by the Department of Health and Social Care (DHSC) including visors, gowns, aprons and goggles”,


alongside a link to a site listing:

“Various Locations - Online Auction of Pallets of New PPE Equipment to include Gowns, Visors, Goggles, Sanitizer & Aprons - NO RESERVE!”


Let us be honest: the DHSC is the Government’s biggest procurer and happens to be the department with the biggest problem. More than any other department, it needs extra help to keep slavery away. I am grateful for what my noble friend the Minister has said, but in view of the fact that the Government will not support my amendment, I regret that I shall have no option but to test the opinion of the House in due course.

[Lord Hunt of Kings Heath (Lab)]

My Lords, first, I thoroughly endorse what the noble Lord, Lord Blencathra, has said. I find it extraordinary that the Government are taking such a slow pace in relation to the important issue he raises. Of course, I relate it to my own amendments on forced organ harvesting, which is yet another example of the deplorable behaviour of the Chinese authorities. I refer the House to the China Tribunal, led by Sir Geoffrey Nice in 2019, which stated:

“The Tribunal’s members are certain—unanimously, and sure beyond reasonable doubt—that in China forced organ harvesting from prisoners of conscience has been practiced for a substantial period of time involving a very substantial number of victims.”


Current human tissue legislation covers organ transplantation within the UK, but it does not cover British citizens travelling abroad for transplants. My amendment, which the House accepted, went to the other place. It was not accepted there but, as the Minister has kindly said, the Government put in their own amendment in lieu which we see here this afternoon. I am very grateful to the Minister for this. The impact of the Government’s amendment is to ensure that offences under Section 32 of the Human Tissue Act 2004, which currently prohibits people in this country from commercial dealings in human material for transplantation, will now be extended to acts outside the United Kingdom. The amendment covers people who give or receive a reward for the supply or for an offer to supply an organ or any controlled material. That is very welcome indeed. It is welcome because it deals with a gap in UK legislation, but it is especially welcome because it sends a powerful message internationally that the UK will not be complicit in this appalling crime. I am very grateful to the Minister and very much support the amendment he brings.

I now turn to my Amendment 57B, set out in Motion F1, which relates, as the Minister said, to issues to do with patient data and the proper protection of it. Laid out in the Health and Social Care Act 2012 is the concept of a safe haven for patient data across health and social care. Because of the sensitive nature of that data, I sought, and the House agreed, to keep those statutory protections in place and not allow NHS England to take on that responsibility because of a potential conflict of interest in that role.

The issue arises because, last November, the Secretary of State announced that NHS Digital and NHSX would merge with NHS England to accelerate the digital transformation of the NHS. The Bill gives the Secretary of State powers to do this by the transfer of a function from one relevant body to another. NHS Digital is currently the statutory safe haven for patient data and my concern is whether it is appropriate to place that responsibility in NHS England, in view of the inherent conflict of interest that might occur in its wider role. As a matter of principle, I and a number of other noble Lords consider that the collection, analysis and publication of public data should be independent of any operational body. In effect, NHS England will be able to decide that its legitimate interests override those of the citizen and the patient, with little or no external constraint or scrutiny.

The noble Lord and I are at one in wanting to speed up digital transformation. I will set out what I am trying to do here, with the noble Lord, Lord Clement-Jones, and the noble Baroness, Lady Brinton. We are trying to be helpful. We want to make sure that the integrity of the safe havens is retained within this digital transformation. As the noble Lord said, we have had an extremely useful discussion with officials who are leading this programme in the department. I hope the Minister will be able to offer assurances that the integrity of the safe haven concept will be retained; that no transfer will take place until those safeguards are fully set out in the regulations necessary to bring the transfer into force; and, in particular, that strict governance arrangements will be put in place, subject to external independent scrutiny and oversight established on a statutory basis.

Can the Minister also confirm that the merged entity will at the least maintain the status quo of transparency and, indeed, go further for the patients whose data it is and whose trust and confidence are so necessary? Can he further confirm that a data usage register will be published which covers all projects accessing patient-level data and shows which data was accessed? Will the National Data Guardian be consulted on all this before the Government progress the regulations? Finally, will the Minister ensure that the regulations will avoid the need for NHS England—this was raised by the noble Lord, Lord Clement-Jones—to be in the difficult position of sending legal directions to itself, and can he say how in practice this would work?

--- Later in debate ---

[Lord Kamall]

Moved by

That this House do not insist on its Amendment 48 and do agree with the Commons in their Amendment 48A in lieu.

48A: Page 49, line 3, at end insert the following new Clause—


“Review into NHS supply chains


(1) The Secretary of State must carry out a review into the risk of slavery and human trafficking taking place in relation to people involved in NHS supply chains.


(2) The Secretary of State may determine which NHS supply chains to consider as part of the review or otherwise limit the scope of the review.


(3) But the review must at least consider a significant proportion of NHS supply chains for cotton-based products in relation to which companies formed under section 223 of the National Health Service Act 2006 (taken as a whole) exercise functions.


(4) The Secretary of State must publish and lay before Parliament a report on the outcome of the review before the end of the period of 18 months beginning with the day on which this section comes into force.


(5) The report must describe—


(a) the scope of the review, and


(b) the methodology used in carrying out the review.


(6) The report must include any views of the Secretary of State as to steps that should be taken to mitigate the risk mentioned in subsection (1).


(7) NHS England must assist in the carrying out of the review or the preparation of the report under this section, if requested to do so by the Secretary of State.


(8) In this section—


“health service in England” means the health service continued under section 1(1) of the National Health Service Act 2006;


“NHS supply chain” means the supply chain for providing goods or services for the purposes of the health service in England;


“slavery and human trafficking” has the meaning given by section 54(12) of the Modern Slavery Act 2015.”


Motion D1 (as an amendment to Motion D)

[Lord Blencathra]

Moved by

At end insert “and do propose Amendment 48B in lieu—

48B: After Clause 40, insert the following new Clause—


“Health service procurement and supply chains: modern slavery


The Secretary of State must by regulations make provision for the purposes of ensuring that procurement of all goods and services for the purposes of the health service in England avoids modern slavery.””

Health and Care Bill

Lord Blencathra Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

Relevant documents: 15th and 16th Reports from the Delegated Committee, 9th Report from the Constitution Committee

[Lord Blencathra (Con)]

My Lords—

[The Deputy Chairman of Committees (Baroness Henig) (Lab)]

My Lords, we come to Amendment 213A. I inform the House that the noble Baronesses, Lady Brinton and Lady Harris of Richmond, will be taking part remotely.

Amendment 213A

Moved by

[Lord Blencathra]

213A: After Clause 70, insert the following new Clause—
“Health service procurement and supply chains: genocide convention obligations
(1) Regulations whether made under section 70 or otherwise may, in particular, make provision for the purposes of ensuring that procurement of all goods and services for the purposes of the health service in England is consistent with the United Kingdom's obligations under the Convention on the Prevention and Punishment of the Crime of Genocide.(2) For the purposes of subsection (1), procurement is not consistent if a Minister of the Crown has assessed that there is a serious risk of genocide in the sourcing region.(3) A Minister of the Crown must make an assessment as to whether there is serious risk if the chair of a relevant select committee of either House of Parliament requests one, and must complete such assessment within two months.”

[Lord Blencathra (Con)]

My Lords, I apologise for my enthusiasm to get stuck into this vital amendment. I will speak to Amendment 213A in my name and that of my noble friend Lady Hodgson of Abinger, the noble Baroness, Lady Kennedy of The Shaws and the noble Lord, Lord Alton of Liverpool, whom I also consider to be a noble friend.

Allow me to begin by stating the obvious: UK taxpayers do not want to be complicit in genocide. It feels strange that this still needs to be said in 2022, 73 years after the genocide convention was agreed and nearly 80 years after the world became aware of the abominations of Auschwitz. Yet here we are in the age of ESG and corporate social responsibility, when the UK boasts of leading the world in the fight against modern slavery, and what do we find? We find hundreds of millions in public money poured into the pockets of companies profiting from Uighur forced labour; hundreds of millions of pounds poured into a region that our closest ally, the United States, has identified as the site of an ongoing genocide—an area so tainted with forced labour that President Biden has just signed into law the Uyghur Forced Labor Prevention Act, banning all imports from Xinjiang province unless it can be proven that they are slavery-free.

Those wondering why this Bill and why now have the answer. Credible reports have demonstrated that our existing procurement policy has been insufficient to prevent the Government spending hundreds of millions on slave-made PPE. With noble Lords’ permission, I will address a concern with the amendment head on. I would normally favour this sort of regulatory reform to apply across all government departments and would therefore look askance at focusing on just one department solely, as I am today. However, health is a special case, especially during the current pandemic. According to its modern slavery statement from 2021, the first year that the department has produced any such statement, the DHSC procured 280 regular non-Covid-19 contracts, but how many contracts did it produce for Covid? The answer is 708—708 contracts to address the pandemic, with a heavy preponderance of contracts being awarded to China.

I hope that noble Lords will permit me a brief digression to note that the Government revealed in reply to a recent Parliamentary Question that a billion lateral flow tests were procured from China despite some local production capacity. Why we would eschew British business in favour of companies in China, with all the attendant human rights risks, is beyond me.

Back to the point of his amendment: how many of those 708 Covid contracts went to Xinjiang-based companies? We simply do not know. What did the DHSC have to say about PPE widely reported to have been made by Uighur slaves? It said:

“This statement does not cover the Vaccines Taskforce (co-owned by BEIS), personal protective equipment (PPE) or UKHSA (formerly Public Health England (PHE) and Test and Trace) contracts.”


Those 708 contracts excluded a huge variety of other contracts by different organisations of our Department of Health and associated bodies.

Frankly, that is not good enough. If our laws do not prevent investment in modern slave-traders then, simply, our laws need to be changed. Noble Lords will recall debates surrounding genocide during the passage of the Trade Bill. Your Lordships voted by huge majorities in favour of allowing the High Court to make determinations of genocide, agreeing with the noble Lord, Lord Alton, and others that it was insufficient to outsource our genocide convention obligations to international courts, especially where those courts lack the power to hold back certain states, such as China. These efforts were resisted by the Government and the amendment before your Lordships today does not attempt to resurrect that campaign.

This brings me to the function of the amendment. Its first and core purpose is to apply a human rights threshold to government health procurement. If this new clause stood part of the Bill, it would be illegal for the Government to procure health service equipment from any regions in the world where they believe there to be

“a serious risk of genocide”.

That is a very high bar. It will be present only where the most serious human rights abuses are widespread. We would expect to see crimes against humanity, torture and mass enslavement in such areas.

The spirit of the Modern Slavery Act goes much further than this, discouraging business with companies which facilitate modern slavery offences. Modern slavery is much more widespread and common than genocide, affecting an estimated 40 million people worldwide. But the spirit of the law and the letter of the law are very different things. It is widely acknowledged that Section 54 of the Modern Slavery Act, which seeks to regulate supply chains, lacks teeth.

This amendment seeks to give it some more teeth in a limited and proportionate way. It applies only to government health procurement, allowing us to get our house in order first before pointing the finger at business. It applies only to the most serious human rights abuses of all, those which indicate a serious risk of genocide. Best of all, it leaves the assessment of “serious risk of genocide” to the Government and allows broad scope for the Government to define a process surrounding these risk assessments through regulations. In short, it is a very reasonable amendment. Candidly, while Uighurs in Xinjiang province are being forcibly sterilised, forced to work and detained in their millions, we ought to be doing a lot more. But this is a modest little amendment.

That brings me to the second purpose of the amendment, which is to move forward UK policy on genocide. We have heard ad nauseum from the Government that they have no view on genocide and will only use the word when “a competent court” has ruled on it. This policy has many problems, chief among them being that it makes genocide prevention impossible. The Committee may or may not be aware that our responsibilities under the genocide convention arise “at the instant” we become aware of a “serious risk” of genocide. Those quotes are direct from the International Court of Justice’s Bosnia v Serbia judgment in 2007. Let me repeat; it should happen at the very instant we become aware of a serious risk of genocide. That is when our convention obligations should apply. They do not arise when a court formally determines genocide, which usually happens many years after the genocide in question has ended. They arise at the instant we learn of a serious risk of genocide.

That simply means that the United Kingdom should be making regular assessments of serious risks of genocide and acting where appropriate. But we do not do this. This amendment before your Lordships’ Committee today puts that right and gives Parliament a limited role in ensuring that such assessments are performed in a timely manner, commensurate with the severity of the issue. It does not require the UK to make a formal determination of genocide, nor for the Government to behave like a court. It merely requires the Government to do a risk assessment—something we ought to be doing already.

I shall address the criticism that this is an “anti-China amendment”. This is false. The amendment makes no mention of China and would apply to every country. But I make no apology whatever for my motivation in bringing this amendment forward, which is to address President Xi Jinping’s heinous persecution of the Uighurs.

Finally, I was contacted the other day by the British Medical Association, which says:

“The BMA is deeply concerned about labour rights abuses in supply chains. Evidence shows that medical equipment, including PPE, has been procured from regions in which labour abuses are common, as this BMA report shows. The BMA notes the Uyghur Tribunal judgment, which found the PRC guilty of genocide, and the extensive procurement of NHS supplies from this region of China. This is deeply troubling; acquiring PPE from this region continues the systematic oppression of the Uyghurs and other minorities. The BMA believes all NHS supplies must be ethically sourced and this amendment would significantly reduce the risk of health service goods used in the UK being produced by individuals who are having their human rights abused.”


I hope I have demonstrated the need for this amendment. Having led the world in confronting modern slavery, the UK is falling behind—and we do not need to fall behind. The Covid pandemic has been a sorry period for many reasons, and making the UK taxpayer complicit in the persecution of Uighurs through PPE procurement is one of the sorriest. Let us take the opportunity to put that right: life-saving must not be dependent on life-taking. I beg to move.

--- Later in debate ---

[Earl Howe (Con)]

My Lords, I am grateful to my noble friend for enabling us to debate the serious and important issue of ensuring that health service procurement and supply chains are consistent with the United Kingdom’s international obligations. I have listened very carefully to the contributions from all noble Lords who have spoken.

I begin by making clear what the regulation-making power under Clause 70 is designed to do, and not do. The Clause 70 power is limited in scope to healthcare services and, with the exception of some mixed procurements, will not extend to the procurement of goods. The vast majority of healthcare services procured by the NHS are provided by domestic suppliers or, indeed, by the NHS itself.

However, there is a wider point to address in response to the contributions of noble Lords. As a party to the Convention on the Prevention and Punishment of the Crime of Genocide, the UK is fully committed to the prevention and punishment of genocide as appropriate under the convention. Indeed, the UK is active in fulfilling its duties under the genocide convention. Given that the majority of mass atrocities occur in and around conflict, the Government believe that a focus on conflict prevention is the best means to prevent most mass atrocities. To that end, this Government adopt a consolidated, whole-of-government effort using our diplomatic, development, defence and law-enforcement capabilities to help find pathways to global peace and stability.

As my noble friend is well aware, it is the long-standing policy of the Government that any judgment as to whether genocide has occurred is a matter for a competent national or international court, rather than for Governments or non-judicial bodies. It should be decided after consideration of all the evidence available in the context of a credible judicial process.

Having said that, our policy on genocide determination does not prevent us taking robust action to address serious violations of human rights. The Government are clear that they expect all UK businesses to respect human rights throughout their operations, in line with the UN’s Guiding Principles on Business and Human Rights. In response to the guidelines, the UK is proud to be the first state to produce a national action plan, and we continue to develop our approach in line with the Modern Slavery Act 2015. Section 54 places a requirement on businesses with a turnover of £36 million or more to publish an annual modern slavery statement setting out the steps they have taken to prevent modern slavery in their operations and supply chains.

Following a public consultation, the Government committed to a package of measures to strengthen our transparency in supply chain requirements. This includes extending the reporting requirements to public bodies with a budget of £36 million or more to create public and private sector parity. The Government have led the way in this endeavour and, in 2020, the UK became the first country in the world to publish a government modern slavery statement, setting out the steps we have taken to identify and prevent modern slavery in our own supply chains. The noble Lord, Lord Collins, indicated that he had not seen evidence of action in this area. In November 2021, we published a progress report on how we have met the ambitious goals set out in that statement and, at the same time, each UK ministerial government department voluntarily published their first annual modern slavery statement. As the noble Lord mentioned, the FCDO and the Cabinet Office are also working together to introduce new guidance to UK government bodies to exclude suppliers where there is sufficient evidence of human rights violations in any of their supply chains. Further detailed guidance is being developed that will be mandatory for government contracting authorities.

The UK’s G7 presidency demonstrated how we are revitalising G7 co-operation to tackle the most pressing global challenges. At the meeting in Carbis Bay, in June 2021, G7 leaders reaffirmed their commitment to uphold human rights and committed to prevent, identify and eliminate forced labour in global supply chains. This was followed up by the G7 Trade Ministers’ meeting in October, building on those commitments to eradicate forced labour, protect victims and improve global supply chain transparency, including by upholding international labour standards in their own business operations and procurement policies. This is one of a number of recent, clear demonstrations of our continued leadership and commitment to ending human rights abuses in global supply chains.

The noble Baroness, Lady Brinton, indicated that she did not think that the Department of Health and Social Care in particular was doing enough in this area, but if we look at the health service specifically, we see that the Department for Health and Social Care published a statement in October 2021 explaining the steps it has taken to identify, prevent and mitigate modern slavery within its own operations and supply chains for all goods and services that it procures. This aligns with the Cabinet Office guidance advising public sector contracting authorities on how to assess suppliers in terms of mitigating the risk of modern slavery. Contracts are normally placed in line with the department’s terms and conditions, which include clauses requiring good industry practice to ensure that there is no slavery or human trafficking in supply chains.

My noble friend also asked why the 2021 modern slavery statement did not cover the Vaccine Taskforce, PPE, UKHSA—formerly Public Health England—or test and trace contracts. Some indication of preventive steps taken in relation to these areas were included in the statement, and, as was outlined later in that statement, all areas will be covered in 2022 statements.

My noble friend, and the noble Baronesses, Lady Brinton, Lady Harris and Lady Kennedy, the noble Lords, Lord Alton, Lord Collins and Lord hunt, my noble friends Lady Hodgson and Lady Sugg, and others, raised issues about Xinjiang, in particular. The Government have taken robust measures in respect of UK supply chains. We have introduced new guidance for UK businesses on the risks of doing business in Xinjiang, supported by a programme of ministerial engagement, and we have announced enhanced export controls, as well as the introduction of financial penalties under the Modern Slavery Act. Taken together, these measures will help to ensure that no British organisations —government or private sector, deliberately or inadvertently—are profiting from or contributing to human rights violations against the Uighurs or other minorities.

I am conscious that the noble Lord, Lord Alton, asked me a series of questions. If he will allow me, I will write to him on those that I am unable to answer today. The same applies to the points raised by the noble Lord, Lord Rooker, to whom I listened with great care.

For the multiple reasons that I have set out, I cannot accept my noble friend’s amendment. I hope, nevertheless, that I have been informative, and that he will have derived at least some reassurance from what I have said about the seriousness with which the Government view the issues around human rights violations, and the actions that we are taking.

[Lord Blencathra (Con)]

My Lords, I am grateful to every noble Lord and noble Baroness who has taken part in the debate, every single one of whom spoke in favour of the amendment, apart from my noble friend Lord Howe—I perfectly understand that he had to adhere to the DHSC brief. I am certain that, if every other noble Lord were to speak in the debate, each one would support the amendment as well.

I am grateful for the particularly powerful speech of the noble Lord, Lord Rooker, on determining the provenance of goods. Just as an aside, I can tell the House that, before Christmas, I thought I would impress my wife by trying to buy a couple of Oxford pillowslips myself, without troubling her. I wanted something with a thread count of over 400—for my delicate little skin, of course—and it took me hours and hours on the web to try to find a supplier among the major retailers that could guarantee that it would not be from Xinjiang province. I ended up contacting one supplier and asking, and three weeks later it replied by email guaranteeing me that the cotton was not from Xinjiang. I bought the pillowslips, and I still do not know whether or not I have been sold a pup—but they are quite nice against the skin. The noble Lord is right: we can tackle this problem only if we can trace provenance, and using DNA or other scientific evidence may be the best way to do that.

I do not want to go down the route of criticising some of the initial contracts that the Government entered into, as some noble Lords have done. There is no doubt about it: we were ripped off by some of them, we bought some duff equipment, and there will have been some dodgy contracts. But I remember that, at the time, every medic was calling out, “Get us PPE from wherever you can!” The whole world was scrabbling to get PPE. If your house is on fire, you do not spend ages on the web trying to find the cheapest fire bucket; you buy whatever you can. So I do not want to spend time on whether those contracts were value for money; that is for another day.

Someone asked: when did genocide start? I recall that the noble Lord, Lord Adonis, who was in the Chamber briefly, made a powerful speech a few months ago, saying that when genocide was happening, the whole world noticed that it was happening but did nothing about it, and then afterwards said that it must not happen again. We knew that Jews were being exterminated, and after 6 million were killed we said, “It must never happen again”. We knew what Pol Pot was doing, and afterwards we said, “It must never happen again”. We knew what Stalin was doing, and afterwards we said, “We must never let it happen again”. Then there was Srebrenica, and afterwards we said, “We must never let it happen again”. We know that genocide is taking place in Xinjiang province, yet we are just putting in place systems that may, one day, eventually, stop us trading with some of the people there who are committing genocide. That is not good enough. We must act faster than that.

NHS: Nursing Workforce

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Wednesday 8th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Baroness raises a really important point. We addressed it nearly 18 months ago, before the pandemic, when we had a crackdown on racism and abuse from patients. I would be very grateful if she could send me the details of her correspondence, and I shall look into whether we need to do more on that immediately.

[Lord Blencathra (Con)]

Why should patients with vulnerabilities and vulnerable conditions, who have obediently had their injections, risk their lives by attending hospitals or medical facilities and encountering staff who have refused vaccinations? Will the Minister make it absolutely clear that there is no place in the NHS for vaccine refuseniks either among the medical staff or among those tens of thousands of people who seem to wander around carrying files or doing non-medical work?

[Lord Bethell (Con)]

My Lords, we are looking at ways in which to take testing and other treatment out of hospitals and into the community. On my noble friend’s substantive point I say that, as he may know, we have promised to have a consultation on mandatory vaccination for healthcare. We are determined to do that in partnership with the workforce, and I look forward to updating the House on our progress.

Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) (No. 2) Regulations 2021

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Wednesday 16th June 2021 Lords Chamber

[Lord Blencathra (Con) [V]]

My Lords, I reluctantly support this extension for the reasons my noble friend the Minister has given. Personally, I would have taken the risk since, although the number of cases is rising, deaths are not. There is no danger of the NHS being overwhelmed and, in any case, I always thought the NHS was there to save us, not the other way round.

But I am afraid the Government had to do this or else they would have been accused of not following the scientific advice and we would have yet more rent-a-quote professors from SAGE, NERVTAG or whatever these groups are called popping up in the media, spouting about catastrophe. Like my right honourable friend Michael Gove, I am heartily sick of scientists now. From even the first press conference way back last March, as soon as Vallance or Whitty sat down, the media—both TV and press—produced a professor from SAGE who contradicted them and said it was too slow or too fast, or few would die or half a million would die. Will my noble friend not insist on collective responsibility from these advisory organisations and sack those who do not accept it? They are frightening the public unnecessarily with their one-off, individualistic views.

I must congratulate the Government again on their masterful handling of the vaccination programme. The NHS gets the credit for sticking needles in arms, but there would be no needles or vaccinations to stick in arms if the PM had not given Kate Bingham the instruction to save lives, and she pulled together a fantastic private enterprise team to do just that. Then we had the brilliant decision of the Secretary of State for Health to tell Oxford to go with AstraZeneca. AstraZeneca deserves our everlasting praise and thanks.

Look at the top 20 countries in the world for percentage of population vaccinated; nine of them are the United Kingdom and our overseas territories. Look at the countries that have done the most injections overall; we are in the top three. Therefore, in terms of population vaccinated and sheer numbers, we are the first in the world and I congratulate my noble friend and all Ministers on that magnificent achievement.

I was pleased to read today that the Government will make it compulsory for care home staff to be vaccinated—and about time too—but what about NHS staff? It is utterly unacceptable for there to be refuseniks among NHS staff. That should be a gross misconduct offence, leading to a final written warning and dismissal. Why should patients who have followed the rules and had their vaccinations be put at risk going into an NHS hospital and brushing shoulders with staff who refuse to be vaccinated?

Finally, I hope the whole country will not be stuck in lockdown again because some areas or groups of people refuse to be vaccinated. If people in London or Bolton do not want vaccinations, tough luck on them, but the rest of the country should not suffer because of their stupidity. They should be at the end of the queue for hospital treatment, behind people who have had their vaccinations but require other essential medical care.

Health Protection (Coronavirus, Restrictions) (All Tiers and Self-Isolation) (England) (Amendment) Regulations 2021

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Monday 1st March 2021 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I begin by praising my noble friend the Minister for yet another appearance at the Dispatch Box. He must have set a record for the sheer number of times he has briefed this House and for his depth of knowledge and courtesy. He is an outstanding Minister, but so too have been the Prime Minister and the whole ministerial team in rolling out the world’s best vaccination programme.

A writer in the Guardian yesterday began with the sentence:

“For diehard Remoaners like me, all this endless good news about jabs and carbon emissions is pretty hard to take.”


He went on:

“Nearly 20 million … doses administered. A forward-thinking procurement plan. The leading large nation, far ahead of the US and, more gallingly for us frothing Remoaners, miles ahead of Europe. Nothing could be more depressing for the honest self-loathing liberal Brit … the vaccine programme has turned out to be a slick collaboration between hard-nosed businesspeople, big pharma and the academic establishment.”


So says the Guardian, so it must be true. So thank you, Ministers, and thank you, Brexit.

I have one point for my noble friend about vaccination refuseniks, and I neither want nor expect an answer today. Along with the vast majority of the public, we demand that all NHS staff either get vaccinated or get out. Everyone has the right to refuse a vaccination, but free choice brings consequences. As a vulnerable patient, I have followed NHS instructions not to visit hospitals in the past year, and all my appointments have been virtual, and all have worked exceptionally well. This is going to be the future for many appointments.

I and millions of others have done our bit to protect the NHS and now it is the duty of all NHS staff to protect us. We have all clapped the dedication of NHS staff who have worked incredibly stressful hours over the last year, but that does not give a minority the right to think that they can do what they like and jeopardise patients’ lives. When we go into hospitals, now that we have highly effective vaccines, we have the right to expect that every staff member in there has been vaccinated—front-line staff and all those admin people I see wandering around wards and corridors carrying files.

If the figure is true, it is appalling that 25% of staff in London are refusing vaccinations. Who do they think they are? Of course, the Government should explain and persuade, but, if that fails, the next step should be a final written warning and then dismissal. Yes, we are short of NHS workers, but the public demand that we do not have thousands of Typhoid Marys wandering around our hospitals and spreading the virus. I commend the care home industry for its policy of “no jab, no job,” and ask that it be extended to all NHS staff. The whole country has been through hell for the last 12 months and we are coming through it. We cannot let the ignorant and selfish wishes of a minority undermine all those sacrifices. We respect the absolute right of NHS staff to refuse being vaccinated, but we ask that they respect our right not to keep them in a job if they refuse.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2021

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Monday 8th February 2021 Grand Committee

[Lord Blencathra (Con)]

My Lords, from the cheap seats at the far end, I pay a warm tribute to my right honourable friend the Prime Minister for his masterful handling of the vaccination drive. As the NHS called me a critically endangered species, I had my jab last Thursday night and I am in no doubt that it was months ahead of where it would have been were it not for the brilliant handling of vaccination by the Government.

It has been a textbook operation. The Prime Minister gave Kate Bingham the order: “Stop people dying”. She formed a task force that rapidly decided the best vaccines to back and funded their production, bypassing NHS bureaucracy. It was based on scientific judgment, not just buying up everything in sight. The Secretary of State for Health told Oxford University to dump Merck and go with AstraZeneca. That was inspired. It was a masterstroke for which he deserves the highest praise. Then the logistics were fine-tuned, with Professor Van-Tam apparently demanding freezers way back last June. Then contracts for vaccine supply were signed three months ahead of other countries.

I also thank the Prime Minister for getting us out of the slow-moving EU oil tanker. What a perfect description of the EU—a lumbering monster, unable to move quickly and full of last century’s concept of power. If we had stayed in then there is no way we would have approved the emergency use of the AstraZeneca vaccine. Theoretically, of course, we could have, but a vote to remain would have made us a very tame, subservient puppet, afraid to do anything on our own. We would also have been trapped into the corrupt EU purchasing racket, paying for French Sanofi vaccines that have not yet been invented. Little did we know four years ago that leaving the EU could save thousands of British lives or we would probably have put that on the side of the bus as well.

While the NHS staff, the military, the volunteers and others are doing a fantastic job of sticking needles in people’s arms, there would be nothing much to inject if it were not for the leadership, judgment and far-sightedness of the Prime Minister, Ministers and all in the Government. Thank you, Prime Minister, personally—the Boris haters will have to gnash their teeth a while longer.

I have a couple of ethical and moral questions to pose to my noble friend, but I do not want answers today. It seems that we will have tens of thousands of vaccine refuseniks. I defend their absolute right not to be vaccinated, so long as they respect my right to get hospital treatment ahead of them if they catch Covid. Hundreds of thousands of people with all other life-threatening illnesses—cancer, heart conditions and so on—have had their treatment postponed to give priority to Covid cases. That may have been the right thing to do when there was no cure for Covid, but now that there is a vaccine it will be intolerable if honest patients who have been vaccinated cannot get into hospital because refuseniks are blocking beds. My message is simple: if you refuse vaccination and catch Covid, then tough luck. You have absolutely no right to displace from a hospital bed a decent patient who has been vaccinated. No matter your colour, ethnicity or age, if you refuse vaccination you forfeit the right to jump the hospital queue.

Related to that, I assume that if, for example, care home or medical staff wandered round the wards, smoking 40 cigarettes a day they would be dismissed on the spot. Therefore, if medical or care home staff refuse vaccinations and wander round wards, belching out Covid all day, which is 100 times more lethal than passive smoking, should they not be considered to be sacked on the spot as well? I simply leave that for consideration.

Finally, we are repeatedly told that we must not call it the Chinese virus, but the variants are called the South African, Brazilian, Kent and UK variants. It simply identifies where they came from or were discovered. China is directly responsible for more than 2 million dead in the world. Since China let this virus escape from its Wuhan lab, covered it up and lies about it every single day, is it not about time that we called it by its true name—the China virus?

Covid-19: Vaccinations

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Wednesday 13th January 2021 Lords Chamber

[Lord Blencathra (Con)]

My Lords, will my noble friend accept my congratulations? The Government have done an absolutely magnificent job on vaccinations. They bought more than enough of the right vaccine, approved it first in the world, injected it first in the world and have vaccinated more people than the whole of Europe put together. I hope the Government will now not be distracted by some of the pathetic media trivia we have heard about how far you can ride a bike, whether a Scotch egg is a meal, whether it is 2 metres or 3 metres, or tier 3 or 4, or whether things have been too fast or too slow. Does my noble friend agree that the only thing that matters now is vaccinating all our people, in the whole of the United Kingdom, as quickly as possible—and 24/7 if vaccine supplies permit—to build on the success we have had so far?

[Lord Bethell (Con)]

My Lords, I am enormously grateful for my noble friend’s kind words. I think that, as a Government, we would prefer to be judged at the third act of this important performance, so I think it is probably too early to take too much praise, but I would like to say a massive thanks to the British nation.

In three ways, the nation has really stood up. The amount of collaboration between different groups—I alluded to it in my previous answer—between the Army, industry, the NHS and local authorities has been enormous. At the beginning of this pandemic, there were arthritic elements to the way in which Britain is governed that meant that different parts of our political and administrative machinery did grind into action slightly slowly, but, my goodness, over the vaccine deployment it has been absolutely athletic, and I take my hat off to every part of the machinery of government. On the union, this has been such a strong example of a national solution: all of Britain has come together in order to purchase and deploy the vaccine. Lastly, I would observe the resilience of the British public. It makes me enormously proud that the country puts the elderly and the infirm first and stands by and celebrates the weakest and most vulnerable in our society being put first in the queue. That is a national quality we should all be proud of.

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

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Tuesday 20th October 2020 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I support these regulations, and I apologise to the Minister, because that is probably the most helpful thing I will say in the next two minutes. I am heartily sick of the media producing so-called experts who contradict everything Whitty and Vallance say within seconds of their briefings concluding. There is a never-ending stream of attention-seeking professors who are undermining public confidence in everything the Government do.

The others undermining government efforts are the police service of this country. I was a Police Minister and I defended the police every day of my life, but no more. They are a national disgrace, because they are deliberately refusing to enforce the laws passed by this Parliament. The Times revealed yesterday that, despite tens of thousands of breaches of the face-mask-wearing rules in shops, in the last three months, three-quarters of the police force have not given a single fine for breaking the law, and only 28 fines have been handed out by the rest of the police. They have just handed out 18 fines for mass lawbreaking. No wonder Covid is on the rampage in some of our major cities, when people see the police turning a blind eye to blatant law-breaking.

Can we also stop these idiotic euphemisms of circuit breakers and fire breaks, which are just code for total shutdown again? Shutdowns do not cure Covid; they just suppress it for a few weeks, then it takes off again. We have to learn to live and die with it, and survive by using social distancing, face mask wearing and handwashing.

We are told by the Government that we have to save the NHS, but why? I thought the NHS was supposed to save us, not the other way around. We are told the NHS must not get overwhelmed, but it already is. In its fetish to empty hospitals in case Covid kicks off, it has dumped tens of thousands of cancer patients and people with heart attacks, strokes and other serious illnesses. Some 90% of operations and treatments have been cancelled. These people will die prematurely and that is a disgrace. We can all clap the NHS medical staff, but the incompetent NHS bureaucracy is still stuck in Soviet-style government.