Care Bill [HL]

Debate between Lord Campbell-Savours and Lord Hunt of Kings Heath

Monday 22nd July 2013 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, the Opposition strongly support the intention behind deferred payments. I hope therefore that the Minister will be able to give a serious response to my noble friend Lord Lipsey, because the issues before us are how the scheme is going to operate, the complexity that is necessarily involved and the ability of local authorities to do the right thing. Around all those matters, there remain some question marks.

While I would not necessarily support my noble friend on the specification of the interest rate, there are questions to be answered about how the Minister thinks the scheme will operate among the many local authorities which will be charged with discharging the scheme. For instance, on the question asked by the noble Baroness, Lady Barker, we could see large differences emerge between different local authorities. That would be unfortunate, and I would be interested to hear from the Minister what work his department has done in trying to model how it thinks local authorities will operate the deferred payment scheme.

The argument for a model deferred payment scheme is pretty persuasive. Even if local authorities are to have discretion—I do not disagree with that—in operating their own scheme, surely the production by the Minister’s department of a model scheme would ensure greater consistency and save local authorities a great deal of work in having to work out the details of their own scheme. Given all their other responsibilities, as much support as possible should be given to local authorities. A model payment scheme would be very useful.

I have two points to make on my noble friend’s Amendment 92ZZY. First, it is very specific on the loans being made available for the purchase of point-of-need insurance policies secured against an adult’s legal or beneficial interest in their home. That raises the whole issue of the insurance market. I again ask the Minister to reassure the House that he is confident that the insurance industry is prepared to come to market with suitable products. I know that he commented on this last week, but there remains some doubt about whether insurance companies really wish to operate in this market. Given that the whole thesis of Dilnot is that capping cost would lead to the development of an insurance market, this is something that we need to debate fully and be reassured on.

On Amendment 92ZZZ and the commencement date, I agree with my noble friends Lord Lipsey and Lord Warner about the complexity of what local authorities are being asked to do. We of course need to consider delay, but I do not understand why a different date has been chosen for the deferred payment scheme in contrast to other parts of the Dilnot implementation. It does not seem to make sense and, I would have thought, would be very confusing for people involved.

That brings me back to the second part of Amendment 92ZZY, which is the issue of regulated independent financial advice being made available to a person considering taking out a deferred payment. Surely the Minister will have been convinced by now that the financial consequences of decisions made by people in relation to the provisions in this Bill will be momentous. I would have hoped that by now he would recognise that the assurance that can be given through independent financial advice would be an important safeguard. Unless we have that, I fear that many people will have to make very difficult decisions, involving potentially large sums of money, without the necessary advice. That would detract from the generally consensual way in which we need to go forward. I hope that the Minister will perhaps have some good news for us on that front.

[Lord Campbell-Savours]

My Lords, I intervene briefly to ask the Minister a rather pedantic question. Subsections in Clause 35 all use the word “may”. There is no actual requirement for the Government to introduce regulations and therefore for local authorities to be placed in a position whereby they can charge. Why has it been left open, rather than using the word “shall”? If we could take the wording as meaning “shall”, can we assume that each further instance of the word “may”—that is to say:

“The regulations may specify costs … The regulations may require or permit adequate security…The authority may not charge interest under regulations…The regulations may make other provisions”—

is part of a whole package? Or, if “may” does mean “may”, might only individual parts of this clause be introduced, as opposed to the whole clause? For example, subsection (2) states that:

“The regulations may specify costs which are, or which are not, to be regarded as administrative costs for the purposes of subsection (1)(b)”.

If that particular part of the clause were not implemented, it would leave local authorities open to decide for themselves what the administrative costs could be. Whatever internal reasons they may have—and my noble friend Lord Lipsey referred earlier to the reluctance of local authorities—should local authorities have that ability to be flexible? I am seeking to establish whether, if this is all going to happen and we should read “shall” for “may”, all the subsections of Clause 35 will be implemented and that isolated subsections will not be introduced in the regulations. That might create difficulties that we are not foreseeing during the passage of the Bill.

Care Bill [HL]

Debate between Lord Campbell-Savours and Lord Hunt of Kings Heath

Wednesday 12th June 2013 Lords Chamber

[Lord Campbell-Savours]

But does the noble Baroness recognise that that might then determine the policy of nursing homes concerning whether they are prepared to take on the responsibility of carrying NHS patients? They will then be chargeable with an offence which otherwise—if they were not to take on those patients—they would not be subject to.

[Lord Hunt of Kings Heath]

Perhaps I may ask my noble friend whether that then comes to the point that the noble Baroness raised earlier about needing to extend this duty to GPs and social care providers. The reality is that if the duty were extended to social care providers, most of those homes would not be viable unless they accepted either local authority-funded clients or clients from the health service. Is not the answer to extend the duty to make sure that we cover GPs, community health and so on?

[Baroness Northover]

In terms of the division that the noble Lord pointed to, if a provider decides that it does not want to take on NHS patients because it will have to reach higher standards than for private patients—which appeared to be part of what he was saying—once that is publicised and becomes apparent, that will not exactly encourage people to use those providers.

Care Bill [HL]

Debate between Lord Campbell-Savours and Lord Hunt of Kings Heath

Monday 10th June 2013 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, we now come to the tariffs to be imposed in respect of education and training. Clause 95 establishes a tariff-based system for funding clinical education and training, whereby providers receive the same payment for the same activity. This is intended to enable a national approach to the funding of clinical payments and to provide for equality of treatment between different providers. What the clause does not do is to provide for equality of treatment between the public and private sectors. The noble Earl will be aware of Monitor’s fair playing field review that looked at a number of different activities and the impact on different providers, including public sector providers, private sector providers and the third sector. On education and training it remarked:

“Many stakeholders voiced concern that the private or charitable sectors are able to employ clinical staff without facing the cost of training them”.

It has been reported recently that surveys show an increase in the use of the private sector by the NHS in recent years and enforced marketisation. The Section 75 regulations are likely to increase that. The question that I put to the Minister is, if the NHS is developing much more into a mixed economy, what is the provision for the private sector to contribute to education and training?

[Lord Campbell-Savours]

As a layman among all these very professional people, I raise a very simple point. Returning to the private care home paying workers something like £7 an hour, I presume that that care home, if it so wished, could use the LETB.

Business of the House

Debate between Lord Campbell-Savours and Lord Hunt of Kings Heath

Thursday 31st January 2013 Lords Chamber

[Lord Campbell-Savours]

My Lords, perhaps I could just add that I have tabled a whole series of Questions to the Chairman of Committees on this matter of availability of resources to the House against the number of Peers to be created. Perhaps the Government might take note of the answers that I am receiving, because clearly the figures do not add up.

[Lord Hunt of Kings Heath]

My Lords, I can see that the noble Lord is looking forward to this debate next week. If I may follow up on the question asked by my noble friend Lord Grocott, at the moment the number of Conservative Peers is anything up to about 39% or 40% of the Peers in this House who carry a political label. Therefore the Conservative Party already has a higher proportion of Peers than of the votes cast at the last election. The noble Lord needs to clarify exactly what the Government are committing themselves to.

Health and Social Care Bill

Debate between Lord Campbell-Savours and Lord Hunt of Kings Heath

Thursday 8th March 2012 Lords Chamber

[Lord Campbell-Savours]

I want to intervene briefly because we want to vote on these matters today. The amendment subtly gets to the problem at the heart of the Bill, which totally underestimates the new pressures that will build up within foundation trusts on management to change the nature of the patient body that comes into the trust for financial reasons. The noble Lord who has just spoken in many ways let the cat out of the bag. Pressures are exerted on clinicians by management to take actions that they do not necessarily want to take. If a trust is building up a substantial body of patients referred to it by insurance companies, it will want to be sure that within that trust’s operation some element of priority is given to its patients if only to minimise the liability that the insurance company has to the patient to pay their bills. In 10 years’ time, when the Government review the Bill, they will find that the pressure on management to change what happens in hospitals will lead to the beginning of the destruction of the National Health Service as we know it.

[Lord Hunt of Kings Heath]

My Lords, I have a great deal of sympathy with the amendment. When I first worked in a hospital in 1974, the Nuffield Orthopaedic Centre in Oxford, we had a private patients’ ward called Mayfair. The succession of senior consultants, the head OT and head physio, gave me an impression of the priority that was given. There will always be debate about the phasing out of paid beds—this was the case even under Barbara Castle—but some of it arises from real concerns over differentiation in equity of treatment.

I take the amendment to be very focused on the board of an NHS foundation trust, not on individual clinicians. It is an important safeguard regarding the way in which the board of a foundation trust may wish to deal with the financial pressures that it is under. We should not be under any doubt, and I speak as an FT chair, that many foundation trusts are facing financial pressures alongside the rest of the NHS. They are required to make efficiency savings and, probably, to move resources from acute hospitals into primary care without any reassurance that primary care is going to demand-manage. There is a real worry that GPs will give more money to themselves but with no guarantee that that will impact on the flow of patients through acute hospitals. There is concern that the pressure on acute hospitals, instead of reducing, which we would like to see, will actually grow.

House of Lords: Working Practices

Debate between Lord Campbell-Savours and Lord Hunt of Kings Heath

Monday 12th July 2010 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, we, too, very much welcome the initiative of the noble Lord, Lord Strathclyde, and I am happy to reiterate what my noble friend Lady Royall said many hours ago that we will play a constructive role in reviewing our working practices, under the auspices of a Leader’s Group. That will be valuable in itself, but could also lay a good foundation for the more fundamental reform of your Lordships’ House that we are promised. As the noble Lord, Lord Cope, said, it is likely that a fully elected House would need very different procedures; but as there is likely to be a transition period, we will need working practices that help us now, see us through at least the first part of the transition and perhaps make a substantial contribution to the more substantive reforms that we are promised. My noble friends Lord Brooke and Lady McIntosh put it well, so I ask the noble Lord, Lord McNally, how he sees discussions on working practices feeding into the wider reform process.

Any reforms of our working practices will command the general support of this House only if they are seen as improving its overall effectiveness as a revising Chamber. The noble Lord, Lord Strathclyde, has long championed the value of this House in acting as a check on government. Most commentators feel that we have become increasingly effective in that since the reforms of 1999. That has much to do with the quality of our debates and the undoubted calibre of noble Lords.

The noble Lord, Lord Strathclyde, pointed to the large number of amendments made in the previous Session. Of course, some of them were routine tidying up, but I suggest that the House’s reputation is not unconnected with the number of defeats suffered by the previous Government—more than 500 since 1997. Those defeats gave the House considerable leverage and caused the previous Administration to think again on many occasions. That is why the House became so effective. I suffered more than my share of those defeats and make no complaint: that is what the House is here to do.

We come now to the circumstances of the coalition Government. As the noble Lord, Lord Elton, said, it is the job of Parliament to control the Executive. It is early days, but there is a genuine question about how the House will continue to control the Executive in the circumstances of the coalition. I would be very interested in the views of the noble Lord, Lord McNally. What role does he expect the House to perform if he and his colleagues on the Front Bench are determined to force through every clause of every piece of legislation that they put before us?

We are coming to the closing stages of the Academies Bill. If ever a piece of legislation fitted the description of “ill digested legislation” made by the noble Lord, Lord Strathclyde, this is it. It has been rushed through your Lordships' House at an unseemly pace because Mr Michael Gove, in one of a number of misjudgments for which he is becoming so well known, insisted that some academy schools had to be up and running by September. That is why the noble Lord, Lord Skelmersdale, was forced to stay so long last week. As the noble Lord, Lord Lucas, said, on Report three amendments were voted on. They were defeated by the Government, who had the votes to do so. Fair enough—but if the future pattern is that the Government will win every vote, the House will begin to lose some of its hard-won reputation. Again I ask the noble Lord, Lord McNally, how he sees the House acting as a check on the Executive in those circumstances. The noble Lord, Lord Lucas, put his finger on it.

When it comes to working practices, we are not short of material. The Wright committee’s work in the other place is of equal significance. I agree with noble Lords who talked about the relationship between the two Houses being of great importance when it comes to changes in working practices. I should be interested in the Minister’s response on how he thinks the Houses might work together. I should also like him to respond to questions raised about the role of the Lord Speaker. Clearly, among some noble Lords, there is a sense of frustration about self-regulation and how it works. Self-regulation depends on Members observing the spirit of the Companion. I say to the noble Lord, Lord Skelmersdale, that I am not sure that it is new Members who do not observe the spirit of the Companion. I fear that it is often very experienced Members.

The problem is most clearly seen at Question Time. It is a very important occasion. The House is full, Ministers are on their mettle and it sets the tone for the day; but not all noble Lords are happy with the way in which it proceeds. Supplementary questions are often read, are long-winded and exceed the two points that are permitted, and some ministerial responses are equally lengthy. My noble friend Lady Jones identified that nearly half the supplementary questions were asked by only 8 per cent of our Members, and that the current shouting match may not create an encouraging environment for all Peers to take part. The noble Lord, Lord Luce, shared that view. There is a case for looking at whether the Lord Speaker should perform the role currently performed by the Leader at Question Time, perhaps for a trial period. I should say that I have no criticism of the way in which the noble Lord, Lord Strathclyde, has conducted himself in that matter since he became Leader of the House.

Having performed that role myself for about 20 months, I am well aware of the pressures all round the House. Like my noble friend, I, too, have the statistics from my time discharging that awesome responsibility. During that time, the Government batted under its weight. The Conservatives were a little bit over, the Liberal Democrats were an awful lot over and the Cross-Benchers batted quite a lot under their weight. My current statistics show that the Government and the Opposition are getting roughly equal treatment in terms of the number of supplementary questions, with the Cross-Benchers again batting under their weight. As far as concerns the gender balance, so far about 28 per cent of supplementary questions have been asked by women, who make up less than 28 per cent of the House.

Question Time is a crucial part of what the House does. It is important that the spontaneity and liveliness of Question Time is not lost with any change that we might make. Many Members have mentioned Lord Williams of Mostyn and the reforms that he made. One of those reforms, to increase the number of Questions to six Questions, did not work; nor do I believe that the Questions to the Secretaries of State worked. We must be prepared to try these things, but it is important that the central focus of Question Time is not lost. I know that many Peers are reluctant to see the departure of self-regulation, but self-regulation will not survive an elected House. At the very least, the Leader’s Group will have to discuss these matters.

I want to comment briefly on a number of other matters which have been raised. My noble friend Lord Brett asked some searching questions about debates and particularly about how the Government should respond. That is a very relevant matter indeed. On the suggestion of the noble Lord, Lord Butler, that Statements might be made in Grand Committee, I am not at all convinced. I believe that major Statements of government policy ought to be made in this Chamber; for example, the announcement made today about the NHS, agree with it or not, was a very important Statement. Surely, such Statements ought to be heard in prime time in the Chamber. Frankly, the problem during the Statement was that experienced Members did not observe the spirit of the Companion. However, I agree with the noble Lord, Lord Skelmersdale, that it might be useful to circulate to all noble Lords a pocket guide of the three or four essential points in the Companion.

[Lord Campbell-Savours]

My Lords, on that subject, under this so-called self-regulatory regime, it is extremely difficult for individual Members, who may feel embarrassed, to stand up, thereby asking others to sit down. That is why self-regulation does not work. Very few of us are prepared to get up and challenge others. There is a great onus on those on the Front Bench to do that, but very often they do not.

[Lord Hunt of Kings Heath]

My Lords, that is a fair point. I would certainly encourage the Whips on the government Front Bench to intervene. They would certainly have the support of this side of the House if they sought to do so. Essentially, their role is to help the House to regulate itself.