Health and Care Bill

Lord Davies of Brixton Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Bakewell (Lab)]

My Lords, before I address my Amendment 28, giving my support to my noble friend Lady Thornton, I wish to endorse the other amendments that are calling for representatives of particular groups—we just heard mention of two. I particularly endorse all those, especially as I am taking rather an oblique approach to this debate, which is not reflected in the other amendments.

Last year, there was a report in America that, increasingly, hospitals there were closing. The report said that hospitals were seen as businesses; a fifth of hospitals in America are run for profit, and globally, private equity investment in healthcare has tripled since 2015. In 2019, some $60 billion were spent on acquisitions. Globally, that includes—indeed, targets—us and the NHS. Where does that affect us? Increasing inroads are being made into the National Health Service by Centene and its subsidiary Operose, which now own 70 surgeries around this country. From Leeds to Luton, from Doncaster to Newport Pagnell, from Nottingham to Southend and many more, Centene now owns and runs for profit surgeries formerly owned and run by NHS doctors. It is now the biggest single provider of GP surgeries in this country. It has further designs on the existing fabric of the NHS, seeking to have its representatives sitting on the boards of CCGs, making decisions about the deployment of NHS funding. This is a direction of travel that needs to be monitored and checked. Safeguards must be written into the Bill against this takeover.

Why does it matter, just as long as patients have good and free treatment at the point of need? What is the reputation of Centene in America? It is not good. Indeed, it is regularly embroiled in lawsuits from either patients or shareholders, and the sums are not small. In June last year, Centene had to pay a fine of $88 million to the state of Ohio for overcharging on its Medicare department. This is one of many. Since 2000, there have been 174 recorded penalties for contract-related offences against Centene and its subsidiaries. That enterprise is now active in this country and targeting our NHS. It is not a fit company to be part of our health service. I therefore ask the Minister for safeguards to be written into the Bill against such people being represented on our boards. When I raised this at Second Reading, the Minister replied that there was no chance of us selling the NHS. We do not need to: they are buying us.

[Lord Davies of Brixton (Lab)]

My Lords, I will not detain the Committee in speaking to my Amendment 30. In truth, I am speaking in favour of my noble friend Lady Thornton’s Amendment 29. I could claim that my amendment has the virtue of being shorter but perhaps brevity is not always a virtue. Amendment 29 also makes the important point that it is the sub-committees and committees of the ICBs that will be crucial. The substantive point is that the Government have to accept that the amendment agreed in the Commons is totally inadequate. It depends on matters of judgment. We want a clear specification of who is appropriate to be a member of those bodies.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 6) Regulations 2021

Lord Davies of Brixton Excerpts

Wednesday 15th December 2021 Lords Chamber

I fear that I have not added anything new to this debate, but I think that we need to be clear about some of the issues that I have raised.

[Lord Davies of Brixton (Lab)]

My Lords, I have three points. First, I was struck that the noble Lord, Lord Robathan, introduced his speech by referring to the scarifying effect of the debate in the Commons yesterday. Subsequently he went on—as have other speakers—to try to scare us about these regulations. It has been, to a large extent, a scare story about these proposed regulations. In truth, they are oh-so limited in their extent. It is quite possible that we might have to introduce stronger restrictions, so what we are being scared about is a slippery slope, that sooner or later these regulations will lead to an oppressive state. Well, they do not—they are just keeping us a little bit safer.

Secondly, on the idea that omicron is milder, we do not yet know that it is milder in the UK context. What we do know is that it is much more invasive. It will infect many more people. Even if it is milder—which we do not yet know—a milder effect on a much larger number may place a heavier burden on the health service. There is even the perverse, non-intuitive effect that a milder disease could place a heavier burden on the health service because, sad though it is to say, if people do not die so quickly of this disease, they will be in hospital for longer.

Thirdly, the debate on vaccine passports has been mentioned. I do not quite understand what people are saying, because I already have a vaccine passport—I guess that the great majority of people in this Chamber have one. I have used my vaccine passport. These regulations are saying that, in certain circumstances, that is one way of showing that there are good odds of you not being as infectious. I agree that there is a slippery slope here—I am totally against ID cards—but this information is already contained in the vaccine passports. The regulations are about how they should be used.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, I am getting indications from the Chief Whip that we should move to the winding Front-Benchers. The noble Baroness, Lady Brinton, will be speaking remotely. I invite her to speak for the Liberal Democrats.

Covid-19 Update

Lord Davies of Brixton Excerpts

Monday 29th November 2021 Lords Chamber

[Lord Kamall (Con)]

My noble friend will be aware of the constant debate that there has been in the public sphere about the effectiveness of masks, when they are effective and who is affected. Therefore, we have always followed scientific advice on the wearing of masks and where would be most appropriate. We know that many noble Lords and others have called on us literally not to let the masks slip, as it were, and to make sure that people continue to wear masks. There have been others, however, asking why people still need to wear masks. We have always been vigilant, and the fact that we now have this new variant means we are taking a precautionary approach. We will continue to review it and it could well be that, in three weeks’ time, we will see how dangerous it has been and how effective mask wearing has been in the places that we have specified.

[Lord Davies of Brixton (Lab)]

My Lords, it is now recognised widely that none of us is safe until we are all safe, leading to the conclusion that we need a worldwide vaccination programme. However, there is mounting evidence that populations that are immunocompromised, especially people living with HIV, provide a particularly ideal environment for the mutation of the virus. Does the Minister accept that we must therefore contemplate the possibility of having a global programme of antiretroviral medicine as part of our response to Covid?

[Lord Kamall (Con)]

I thank the noble Lord for the point he just made. If he will allow me, I will take that back and try to get an answer for him.

Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)

Lord Davies of Brixton Excerpts

Wednesday 20th October 2021 Grand Committee

[Lord Davies of Brixton (Lab)]

My Lords, it is a pleasure to take part in this debate. We most certainly owe the noble Lord, Lord Patel, and his committee a big vote of thanks for their excellent report. I am only sorry that I was not here to participate.

As an actuary, life expectancy is my subject and I hope that I will be forgiven for emphasising aspects of how the issue is discussed. A crucial distinction, which needs to be understood in such discussions, is that between period and cohort life expectancies. It is not that one is right and the other wrong, but it is important to understand the distinct roles that both play in such discussions.

Period life expectancy is defined as the average number of additional years a person can be expected to live for, if he or she experienced the age-specific mortality rates of a given era in the current time period, for the rest of his or her life. The latest figures from the ONS are based on the experience of people for the three years 2018 to 2020. If you want to compare current mortality experience with that of the past—the experience of 2018 to 2020 with that of 20 years previously—the period life table is the one that you want.

In contrast, cohort life expectancy makes allowances for mortality improvements by combining observed and projected changes in mortality into future years. A cohort refers to a group of people with the same year of birth. For example, if someone is aged 18 in 2018, they were born in 2000 and would therefore be part of the year 2000 birth cohort. It has to be accepted that estimating future changes in mortality is difficult, but to ignore them would be even worse. Over many years, we have seen consistent improvements: people are living longer. However, the report points out that the rate of improvement has slowed in the last decade. While there are no uncontested explanations for this slowdown, I, along with many other practitioners, have no doubt that austerity has played a key role. In any event, this is a subject worthy of further study.

The report also points out the gross differences in life expectancy by social circumstances—one might even say class. But it is not the absolute level that differs by social circumstances; it is the rate of improvement. The wide differences that we see in rates of improvement are as much or more of a cause for concern as the current position. As has been mentioned, we await the levelling-up White Paper and it will be judged by how effective we think it is at addressing these issues. Can the Minister give us any reassurance that this will be a headline in the White Paper?

I come back to period and cohort life expectancies. Period life expectancies are based on solid data: we actually know how many people died in a particular period and what the population was. Cohort life expectancies depend on the exercise of some judgment about what changes in life expectancy are to be expected in future—over a period of many years, in the case of young people. However, if you want to know how long someone is expected to live—so that you could, for example, advise them on how much they need to save for retirement—you really need to use the cohort expectancy. In the same way, if you want to know what the future population will be then you need to adopt the approach of the cohort and build in allowances for potential improvements. This important distinction appears in the report, with footnotes that provide links to a detailed explanation. However, I am disappointed that the report focuses on period life expectancy. Fortunately, that does not affect its key conclusions, but it would be better to have used the more useful figure.

I am running out of time but want to say something about the impact of the Covid-19 pandemic on life expectancy. Quite understandably, given when it was written, the report itself says little. In any event, it is still relatively early days and the pandemic itself is a moving target. What we can be sure about is that it is here to stay. Every death is a tragedy, and the latest estimate from the Covid-19 Actuaries Response Group—I can recommend its website—is that the pandemic has cost 155,000 lives in the UK. It would be natural to assume, therefore, that this has had an adverse effect on life expectancy, particularly next year when more up-to-date data covering the period of the pandemic will be available. However, as is so often the case, it is more complicated than that, particularly when we come to cohort life expectancies. There are many consequences of the pandemic on future mortality, but not all are necessarily negative. For example, the improvements in hygiene, working from home leading to less traffic and pollution, and the mask wearing have clearly had some success—whatever their effects on Covid-19—in controlling influenza and other illnesses. I am sure that I, along with many others, will maintain these behaviours. We wait to see whether there will be the feared rebound, but the long-term effect will probably be positive overall.

There have also been significant improvements in medical science that might have a substantial effect on future mortality. The pandemic has spurred scientific innovation and collaboration from immunology and vaccine science through to new approaches to the collection and processing of health data and the organisation of healthcare. In particular, it has catalysed research and medical advances. RNA therapies are being harnessed to develop vaccines for personalised cancer therapy, infectious and autoimmune diseases and other disorders, not least cystic fibrosis and haemophilia. Work was already under way, but there is no doubt that Covid-19 has brought forward the time when these new treatments will be of value and extend human life.

I mention these positive effects not to make light of a pandemic where every death is a tragedy. However, it sets the Government a higher target: are they prepared to take advantage of these advances and deliver not just for those in the lucky groups who gain from improvements but across the board, focusing on those with fewer social advantages?

Health: Type 2 Diabetes

Lord Davies of Brixton Excerpts

Tuesday 12th October 2021 Lords Chamber

[Lord Kamall (Con)]

I first thank the noble Lord very much for his warm welcome and his modest appraisal of my performance thus far. I am told that, coming from him, that is high praise indeed; he may disagree afterwards. As he knows, the Government are committed to this, but one thing we always have to look at in introducing new laws, bans or taxes is unintended consequences. Before I came to this role, I read some research which said that there were unintended consequences of some of the sugar taxes; for example, did they force people from poorer families or poorer communities to buy alternative, cheaper brands of the same drinks with the same sugar content, or did they just take the hit to their pockets and pay more? Were the outcomes any better? When looking at some of the programmes being put in place to tackle type 2 diabetes and the taxes proposed, it is important that we make sure it is all evidence-based and work out whether there are unintended consequences. If there are, we must find other ways to make sure we tackle obesity and some of the other issues that lead to type 2 diabetes.

[Lord Davies of Brixton (Lab)]

My Lords, the figures in the report are shocking, so I hope the Minister understands that with diabetes, as much as or more than other conditions, there is a need for close and consistent monitoring, not just for the patient’s sake but to avoid greater subsequent demand on the NHS. Is he therefore concerned by reports that in too many areas the essential regular reviews of patients’ conditions are simply not happening because of pressure on clinics or even a shortage of the equipment required to undertake the necessary tests?

[Lord Kamall (Con)]

I take a personal interest in diabetes; I have two very close family members with diabetes, one type 1 and one type 2. I noticed during the Covid lockdown the different approaches in meeting their clinicians—telephone calls rather than meeting in person, and reviewing their charts and sugar graphs over time, which is regularly done at these reviews. I agree completely that it is really important that we now try to address this backlog as much as possible. I know that the Secretary of State is committed to making sure that, with the uplift, we try to tackle as much of the backlog as possible, including for patients with type 2 and type 1 diabetes.

Social Care Funding: Intergenerational Impact

Lord Davies of Brixton Excerpts

Thursday 16th September 2021 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, I first thank the noble Baroness, Lady Greengross, for initiating this important debate, albeit within the constraints of a three-minute speaking time limit. The noble Baroness has an unparalleled record of work and thought leadership on behalf of people in retirement. The report from the Intergenerational Fairness Forum, to which she has drawn our attention, is supported by distinguished Members of this House. It is an important contribution to the urgent debate we need to have about social care. It provides a helpful analysis of the problems we face. But—noble Lords may have sensed that my remarks were heading towards a “but”—I am afraid that, for all its virtues, I do not share the report’s conclusions. This includes, but is not limited to, the proposals on the triple lock.

Others will talk about how to address the problem of social care specifically. My basic problem arises from the more general issue of the way the question is being framed. It is widely understood that the way you frame arguments is crucial, and whenever I see the word “intergenerational” I become concerned. How policies will affect different generations is of course a valid field of study, but framing the question in terms of generations presupposes that that is the answer, and I have to say that I profoundly disagree. I do not believe that there is a divergence of interests between young and old and that they are in any way in conflict. I have mentioned this before. As I said in Grand Committee in January in a debate on the report from the former Intergenerational Fairness and Provision Committee:

“The problems we do face are real enough, but they are political in nature and looking at them within a framework of intergenerational fairness does not help in any way in finding a solution.”—[Official Report, 25/1/21; col. GC 138.]


Where I think there is a divergence of interests is between rich and poor. I believe that the inequalities that permeate our society are based not on one’s age but on the wide and—if I might use the word—immoral inequalities of wealth and income. Until we recognise this, we will continue to struggle with issues of social justice, not least in the field of social care.

Commonwealth Fund Report: NHS Ranking

Lord Davies of Brixton Excerpts

Tuesday 14th September 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I take my noble friend’s point: there are hot spots of innovation and change in the NHS, of which we should be proud, but she is right that the NHS is a large organisation and change can be challenging. In particular, I pay tribute to the Office for Life Sciences, the Accelerated Access Collaborative and NHSX—three organisations within the NHS that are driving change. I also pay tribute to the People Plan, which is putting innovation at the centre of the culture within the NHS. I agree with my noble friend that more can be done in this area.

[Lord Davies of Brixton (Lab)]

The report says little about the important area of services for mental health, because of a shortage of comparative data. However, a new measure has been introduced into this report for the first time, dealing with access to counselling and treatment for mental health issues. Is the Minister concerned that the data in the report shows that the UK lags behind the comparators in this important area of mental health?

[Lord Bethell (Con)]

My Lords, I have not studied the report’s comments on mental health but, in the broad terms in which the noble Lord describes the issue, I agree. We are very committed to improving access to mental health in this country—we have invested in it, but there is more to be done. It is an area of our health system that requires more investment, which is why we have committed more money to it.

Elderly Social Care (Insurance) Bill [HL]

Lord Davies of Brixton Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Lord Davies of Brixton (Lab) [V]]

My Lords, we must thank the noble Lord for providing the opportunity to debate this crucial issue—one very much of the moment, as evidenced by the front pages of today’s Times and Telegraph. Unfortunately, I do not support the Bill because it misses the point. Put simply, I cannot support a system that depends on housing tenure and the geographical lottery of the housing market. The noble Lord said that everyone would have the option of adopting this plan, but those who do not own their house would not have that option. This Bill is a diversion. Instead, we need a comprehensive national care service, paid for by a fair taxation system. However, the proposal usefully illustrates one fundamental point: the solution cannot be left to the private sector.

I will use my remaining time to put this debate in context. We must keep on reminding people that in his first speech as Prime Minister in July 2019—two years ago—Mr Johnson stood outside No. 10 and said

“we will fix the crisis in social care once and for all with a clear plan we have prepared.”

We are still waiting. This clear plan that has been prepared was not in the Tory election manifesto. Now we are told in the Times:

“Boris Johnson is backing proposals for a new tax to pay for reforms to Britain’s social care system under plans that could be agreed within weeks.”


Note the words “could be agreed”; in other words, they have not yet worked it out. The report goes on to tell us:

“Intensive work is under way … to finalise a deal”,


with Downing Street wanting to make an announcement to coincide with the second anniversary of Johnson’s “clear plan” promise. With key elements of policy clearly yet to be finalised, I confidently predict that, even if an announcement is made, it will be light on details and no more dependable than all the other vague promises made by this lightweight Prime Minister.

Covid-19: One Year Report

Lord Davies of Brixton Excerpts

Thursday 25th March 2021 Lords Chamber

[Lord Davies of Brixton (Lab) [V]]

My Lords, I take this opportunity to register my concern at the many government failings in dealing with the pandemic. This is against not just the number of deaths we have experienced but the long-term effects we will suffer, including both the effects of the illness itself and the collateral damage that it has inflicted on so many families and other human relationships more generally. My sympathy goes to those who have been directly affected; they make it all the more imperative that we recognise what has gone wrong on this Government’s watch.

I make my remarks with slightly mixed emotions because I am happy to report that, earlier today, I booked my second vaccine shot, due to the efficiency of the NHS and an excellent local GP practice. To them I say thank you.

In expressing my concern, I make it clear that I in no way wish to give comfort to the anti-lockdown libertarians, who prioritise profit over people and, especially, the care of our elderly. There has to be a public inquiry, sooner rather than later after our next crisis, but that is no substitute for speaking out now.

At this stage of the debate, many points have been made and many concerns expressed about how the pandemic has unfolded. I shall highlight five of them. The first is the inadequate financial support for millions of people, particularly the poorest-paid, including the most vulnerable in our society. That has led to tragedy, not only for the individuals concerned but for society more generally as many simply could not afford to take the steps necessary to protect the rest of us.

Secondly, there is the asymmetry in the legislation, with little or no enforcement aimed at unsafe workplaces. The case of meat processing plants is one particularly salient example, but it is not unique. As far as I am aware, there have been no prosecutions in relation to an unsafe building site, warehouse or call centre where people have been required to attend by unscrupulous employers, some of whom have multiplied their wealth to obscene levels as a direct result of the pandemic.

Thirdly, there have been problems in schools that have particularly affected those families on the lowest incomes, who could not afford the internet connections, the computers or even the pens and paper, not to mention the basic nutrition, needed to gain from at-home, and in some cases in-school, education.

The fourth issue that I want to highlight is the provisions relating to detention and dispersal. These powers are particularly egregious for a state to hold, and it is interesting that they have been retained even though, as I understand it, no declaration has been made in England.

Fifthly, it is clearly not necessary or proportionate to have emergency legislation on the statute book when we have had a year to regularise the position. We must not regularly have emergency legislation lasting for extended periods. We could have had more considered legislation rather than the somewhat rushed legislation that we got. That was understandable in the circumstances at the time but there has been time since to replace it with more considered and detailed legislation to deal with this difficult situation.

We now know that the powers have proved seriously disproportionate and we know about the enormous gaps in support for ordinary people who have lost so much in terms of liberties, livelihoods and even their loved ones during this time.

Mental Health Act Reform

Lord Davies of Brixton Excerpts

Monday 18th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I certainly do not condone that treatment in any circumstances, but I acknowledge the noble Baroness’s point: there have been some instances in the past—reasonably rare but consistent—where those with autism and learning difficulties have been subject to the most inappropriate regimes and where a completely different type of support, therapy and accommodation from the kind found in mental health institutions was needed. The campaign to which the noble Baroness alluded is entirely right and we are moving quickly to address those points.

[Lord Davies of Brixton (Lab) [V]]

My Lords, the White Paper is certainly to be welcomed, as there is much to be done. The number of people being detained in hospital under the current Mental Health Act has increased over the past few years. One reason is the lack of resources to provide the support needed in the community and respite care. While we are told that there has been investment, the resources often do not reach hard-pressed mental health trusts. More resources will be needed, not only to grow the workforce but for the workforce to receive education and training in the values and practices needed to deliver the radical changes envisaged in this review. We should also ensure that the workforce better reflects the communities it serves. Again, while I welcome the promise of further investment in mental health services, will the Minister give a commitment that this will be new money and that it will reach mental health trusts, to provide the workforce growth, and Health Education England, to provide the workforce training essential for delivering the aims of the White Paper?

[Lord Bethell (Con)]

The noble Lord is right; the numbers are inappropriate. Fifty-one thousand detentions under the Act in 2019-20 seems far too many. Detentions under the Act rose by 40% in the 10 years to 2015, and we thought of this Act to try to address that injustice. The £2.3 billion is new money, and it will make a huge impact on the mental health trusts he describes.