Excess Deaths in Private Homes

Lord Davies of Brixton Excerpts

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

This whole area is all about the number of beds and the occupancy. This analysis was done around the October plan for patients, where we said that we were going to put in 7,000 beds and a £500 million discharge fund. What was clear, as per the announcement yesterday, was that the high level of Covid beds—9,500—and the over 5,000 flu beds were far more than any of us estimated. That increased bed occupancy means that we have had to look to increase supply again and at the number of discharges to social care. That is the root cause of the problem. That is why we acted again yesterday to provide even more care in those places.

[Lord Davies of Brixton (Lab)]

My Lords, although my noble friend quite rightly emphasised the particularly concerning figures in a particular week, this is a reflection of a longer-term trend that has taken place. Does he accept that a particular concern is the high number of non-Covid-related deaths during the last summer? Normally, you expect to see a dip during the summer, and it simply did not take place this time. Is he seized with the urgency of dealing with this issue?

[Lord Markham (Con)]

I am definitely seized with the urgency. I was able to speak to Sir Chris Whitty about a number of those, including last summer. The heatwave was a factor then: we had over 2,500 excess deaths caused by the heatwave over those couple of weeks. There were multiple factors. You have heard me say, again from Sir Chris Whitty, that cardiovascular disease is a real concern: for those three years that people missed going to their primary care appointments, they did not get their blood pressure checked in the same way, and we did not get the early warning indicators. That is another thing that you will hear me talk further about, so that we can get ahead of the curve, because those are the areas of excess death that we risk in future.

NHS and Social Care Workers

Lord Davies of Brixton Excerpts

Thursday 15th December 2022 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, I thank the noble Lord, Lord Allan of Hallam, for raising this issue today. As he says, this debate is extremely timely. I have to say that I am a bit surprised and disappointed that so few speakers have signed up for this debate. It is obviously for noble Lords to make their own decisions about which issues they wish to raise, but this one is crucial. You only have to look at the front pages of today’s newspapers to realise how important this is.

There is a whole range of issues that could be raised in discussing these issues; I will focus on just two. That is in no way intended to diminish the importance of other issues. As a veteran of the long-lost and unlamented healthcare Bill, I am glad mention was made of the workforce plan. There was a whole debate then in which the Government were resistant to introducing a workforce plan, but it has suddenly become a priority for them. Maybe there is a case there that they need to listen.

The first of the two issues I will focus on is pay in general, and because today is today, I will talk about nurses’ pay. Secondly, I am going to take this opportunity to talk about pensions in the National Health Service and, in particular, the impact of taxation rules, particularly the annual allowance and the lifetime allowance, on employment in the NHS. When I first thought of contributing to this debate, I thought I would have less time and would focus on just that issue. However, now I have the luxury of 10 minutes, I have expanded my remarks.

First, pay is an issue across the whole service. All workers within the National Health Service have seen problems with their pay and the need for action to be taken to overcome the clear requirement to sort out the problems that we face. I do not think there is any question that there are big problems and that sorting out pay is a crucial element in resolving them. It is not the only answer, but it is the one I am focusing on today.

In particular, I am focusing on nursing, where we have compelling figures: there are 47,496 nursing vacancies. No doubt the Government will tell us that they have increased the number of nurses, but there is still a horrendous level of nursing vacancies. Over 7 million people are waiting for treatment in the National Health Service, and there are 363,000 people who are out of work because of long-term illness. So, pay is one of the direct measures to address those issues. I hope the Minister will say that he recognises that, even though the Government believe that they are under various constraints. The issue, therefore, is not about whether we can afford to meet the demands that have been made for improved pay; the issue is, with the problems faced by the health service, can we afford not to sort out pay?

To be clear, I support the nurses’ demand for a significant pay rise, achieved through collective bargaining. The Government cannot hide behind the independent pay review process because it is clearly broken. I will not undertake a full analysis of the pay review process today, but sticking the word “independent” into a phrase does not make it independent. The Government appoint the members of the pay review body and issue a remit letter that sets out what they can do. It is no criticism of the members of the pay review body to say that this is not a truly independent process: they have to play the cards that they are dealt.

The nurses’ action today—the fact that they are on strike—is a clear indication of the gravity of the problem. CPIH, the agreed appropriate prices index, has increased by about 33% since 2010. Private sector earnings have gone up faster than that, by something like 40%, providing a real-terms increase. Public sector pay in general has gone up by a lesser amount: it has gone up by only 28%, which is a 5% real reduction. Within that, the nurses have done particularly badly, with an increase of under 20%. So there has been a real-terms reduction of over 10% over the last 12 years. One can only admire their moderation in seeking to recover only half of that fall in real terms. A similar case can be made for other groups of employees within the health service, but the Government have to recognise that the way to see this issue resolved is to accept the RCN’s request for direct negotiations. The so-called independent pay review process is just not working any more.

On pensions, a consultation is of course currently under way, and the Government say that this will

“retain more experienced NHS clinicians and remove barriers to staff returning from retirement.”

This is actually the Government’s second go at this issue: some regulations have already gone through, but we will have a debate, which I am looking forward to, with the Minister early in the new year on the previous set of regulation changes—and now we are going to get a different set, following a period of consultation. Unfortunately, my regret Motion on the first set still stands. They will be insufficient to address fully the problems with staff retention in the NHS arising from the NHS pension arrangements that the House of Commons Health and Social Care Committee described in its report last autumn as a “national scandal”. The committee was of course chaired by the current Chancellor of the Exchequer.

Given that we will have another debate, and probably further debates on further regulations, I will spare the House a full discussion of this issue—I do not have enough time for that in any event. The issues are complicated, but they are explained on the BMA website, and I invite noble Lords and noble Baronesses to see what the issues are. I admit that, in the regulations currently under consultation, the Government do address one particular issue about the mismatch of the CPI on various indices—but that was not the only problem, and they do not propose to address one of the worst problems. So I am using this opportunity to focus the Minister’s mind on this issue, which we will return to. I hope that he will perhaps give us a commitment today that he will take the issue seriously and take part in further discussions.

Draft Mental Health Bill

Lord Davies of Brixton Excerpts

Tuesday 28th June 2022 Lords Chamber

[Lord Kamall (Con)]

The noble and learned Lord makes an important point. I am very much aware of today’s earlier discussion, when I was smiling, perhaps over-smugly, thinking, “At least we’ve got pre-legislative scrutiny.” However, I accept the noble and learned Lord’s point that it has to be proper pre-legislative scrutiny. I hope he will forgive my lack of experience on this. I am not yet aware of the difference between good and thorough pre-legislative scrutiny and brief pre-legislative scrutiny, so I will have to take this back to the department and will write to him and others.

[Lord Davies of Brixton (Lab)]

We thank the Minister for the draft Bill. Although it is on the law of mental health, it has clear financial implications and so a specific commitment to provide the resources to implement the changes in the law would be valued. In addition, however, given the agreement that there is about what will be in the Bill, what steps are the Government taking to get it implemented straightaway? There are so many proposals in Sir Simon Wessely’s report that could be implemented immediately, so I hope the department is pursuing that proactively.

It is important to understand a bit of the context here. We are heading into financially difficult times. We know that there is a close connection between people’s personal financial problems and mental health and that there will be an increasing level of indebtedness, which automatically means greater need for services. Maybe the Minister can reassure us that the resources will be there to carry out what is in the proposals.

[Lord Kamall (Con)]

The noble Lord makes an incredibly important point. We have seen the impact that the pandemic has had on mental health across all age groups. During the Health and Care Bill, the noble Lord and many others raised the issue of parity between mental health and physical health, and I thank him for that. That brought home that the current legislation is out of date, which is why we really need to update it. I also thank noble Lords who have spoken so far for agreeing that this is not a party-political issue at all. We all want to address this issue, and maybe the issue of funding will come up. The Government remain committed to achieving parity between mental and physical health services to reduce inequalities. We are making good progress; investment in NHS mental health services continues to increase each year, from almost £11 billion in 2015-16 to £14.3 billion in 2020-21. We expect all current CCGs—and ICBs once operational —to continue to meet the mental health standard, and we have made a number of amendments. We are investing more than £400 million over the next four years to eradicate mental health dormitories. Clearly, as we go through the Bill, there will be financial implications, which will be considered as we debate it. I cannot give a clear pledge on which measures will be implemented until we have seen the Bill. Clearly, however, we understand that a lot of this is long overdue, so the quicker we can get this done and come to an agreement satisfactory to all sides of the House, the sooner we can get on with implementing it.

Health and Care Bill

Lord Davies of Brixton Excerpts

Lords Hansard - Part 1 & Report stage
Tuesday 1st March 2022 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I welcome all the amendments in this group. The importance of parity between mental and physical health is key, and I am grateful to the Minister for confirming that that is the intention behind the Government’s amendments. The explanatory component of the amendment is important, but a question remains over what precisely constitutes mental health spending. I would be grateful if the noble Lord could clarify this. For example, will the report on the expected change and expenditure by NHS England and the ICBs, and the comparison with the previous year, include other aspects of mental health investment not covered by the mental health investment standard, including dementia and learning disabilities? Will the Minister consider identifying in the report whether each ICB has increased the proportion of spending on children and young persons’ mental health, with details of any failure to increase spend?

Turning to Amendment 184, tabled by the noble Baroness, Lady Tyler, to which I also added my name, Dr Adrian James, president of the Royal College of Psychiatrists, said:

“These new standards will help patients get the treatment they need when they need it by setting more rigorous standards and generating vital data, helping to put mental health on a more equal footing with physical health. The standards will only have this impact if matched with similarly ambitious investment and action on the workforce crisis to ensure that no-one has to wait too long for the treatment they need. It’s vital the government provides further clarity on how it will support the implementation of these standards as part of the broader recovery from COVID-19.”


I would add that the range of treatments available in all localities needs to be thought about very carefully by ICBs, just as in surgical teams the right specialist expertise is required for each condition, with reasonable adjustments being made for people who have difficulties in accessing specialist services. I include here, of course, people with learning disabilities. It would be unfortunate if waiting times simply led to an increase in medication clinics, rather than the development of a gold standard treatment in mental health, which would include appropriate skills and psychotherapeutic help alongside appropriate social prescribing.

[Lord Davies of Brixton (Lab)]

I want to reiterate a couple of points on this issue that I made at earlier stages of the Bill. I welcome all these amendments, and I am glad about the movement from the Government and that they have recognised the issues raised. Obviously, the key issue here is funding, and a move to better funding for mental health services within the health service is clearly important. It is also important that mental health is referred to in the legislation, and good that the standards have some statutory backing.

I have to express one concern: waiting times and access are important in and of themselves, but they are not a direct reflection of the standard of care. We need to do more work to understand how we can measure the standard of care being delivered by our mental health services. I have mentioned the issue of the differential mortality. I am sure that there are other issues, but mortality is something that I know a little bit about; those other issues could be brought in so that we directly assess the output as well as the input.

These amendments are important and will address the way in which mental health services suffer because of a lack of esteem. However, they are only treating the symptoms of this lack of esteem. We need to understand a lot more about why mental health, in all sorts of subjective ways, has not achieved a parity of esteem within medical culture as a whole. It is a deep-seated problem which needs to be addressed. The money and standards are important, but we need to understand a lot more about this differential level of esteem and how it can be addressed at its heart—not just by addressing the symptoms.

[Baroness Finlay of Llandaff (CB)]

My Lords, I support these amendments and all that has been said already.

I will put a slight tone of reality on the size of the mountain which has to be climbed to get to the point we want to reach. I do not know how many people last night watched the Channel 4 documentary, “Emergency”, about four trauma centres. It is well worth watching if noble Lords want to see what the NHS is like now under pressure. I happen to know that, on one day last week in one of those major trauma centres, there were seven mental health acute patients in the emergency department but only one mental health nurse was present for all of them. One-to-one care should have been provided. There was nowhere for these patients to go; a further 20 acute patients also needed admission and there were no beds available in the hospital.

This illustrates that the intention behind all this is excellent and laudable—we are finally getting there. However, we have not got to the end of the road; we are just at the beginning. I hope that no one in the public, or in the service, has unrealistic expectations, because it will take a lot of work on everyone’s part to reach the goals we want to reach.

Integration White Paper

Lord Davies of Brixton Excerpts

Thursday 10th February 2022 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, the one thing I admire about the document is the way in which the meaningless term “levelling up” has been shoehorned into the text. I want to raise the bundle of issues which have been grouped under the heading of parity of esteem between physical and mental health. It is not an issue we need just to have in the back of our minds; it needs always to be front and centre in the development of policy. More could be covered than is in the White Paper. One of the examples given in the White Paper is of Mandeep. It is well chosen. It is a case of someone with mental health problems and diabetes where there is a success to point to: where joined-up working has reduced the differential in suffering from diabetes experienced by people with and without mental health problems. That is a good example of what can be achieved. I hope that parity of esteem will be central in what the Minister is doing.

[Lord Kamall (Con)]

I thank the noble Lord for raising the issue of mental health and parity of esteem, not only here but in our debates on the Health and Care Bill, and for our continuing conversations. We hope that we will be able to find a solution to make sure that mental health has parity of esteem. In previous Bills, health has meant physical and mental health, but I recognise the mood of the House when noble Lords ask for it to be stated explicitly somewhere, even in the triple aim. We are looking at solutions for that. He is absolutely right that it is not just about physical health; it is about mental health, about well-being, about tackling inequalities and about disparities. However, we cannot do that from here. We have to make sure that the place-based organisations, working in partnership with integrated care systems, really understand what is happening locally and are best placed to do that.

Covid-19: Lockdowns

Lord Davies of Brixton Excerpts

Wednesday 9th February 2022 Lords Chamber

[Lord Kamall (Con)]

Had I still been in academia and was asked to referee this paper for a journal, I would have pointed out a number of issues, including the focus and bias on one particular study, for example, and the studies that were excluded without justifying why.

[Lord Davies of Brixton (Lab)]

My Lords, I understand that the rules on replying to Questions mean that there is not enough time for the Minister to explain everything which is wrong with this particular paper. Does he agree that it would be useful to draw your Lordships’ attention to the work of the Science Media Centre, which has provided a comprehensive explanation of its deficiencies?

[Lord Kamall (Con)]

If the noble Lord would like to write to me with details of that paper, I would be happy to share it with other noble Lords.

Health and Care Bill

Lord Davies of Brixton Excerpts

Lords Hansard - Part 2 & Committee stage
Monday 31st January 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, having attached my name to Amendment 233 in the name of the noble Baroness, Lady Bull, and Amendment 235, in the name of the noble Baroness, Lady Greengross, I shall rise briefly. I am not quite sure why I did not attach my name to Amendment 234 in the name of the noble Baroness, Lady Bull. I certainly meant to, so I apologise for not doing so. I did that because I was approached to show broad cross-party support. Indeed, my name and that of the noble Lord, Lord Lansley, on the same amendment definitely demonstrates that.

As someone concerned about poverty and inequality, I could not but do that. The noble Baronesses, Lady Bull and Lady Greengross, have set out the cases very clearly. I am not going to run through again the levels of poverty and inequality and the sheer struggle that so many people currently face and will face in future. As we have been around the houses for quite a long while on whether Clause 140 stand part, I shall just refer to one sentence in the Age UK report because it sums up where we are very clearly. It says:

“It is clear that these changes have the potential to save the Government hundreds of millions of pounds, but at the expense of those on low incomes, with modest assets and living in parts of the country where houses values are lower.”


It is the very opposite of levelling up.

However, in the context of this debate and particularly after the comments of the noble Lord, Lord Lipsey, I want to set out an alternative vision—a vision that is much more radical than anything noble Lords have heard from anyone else tonight. It is the vision that was passed at the Green Party conference in October after a long and very hard-working campaign, particularly by our group of disabled members. It calls for free social care for all adults. Members of your Lordships’ House will have often heard me talking about a universal basic income, and I see the other side of that as universal basic services. I regard social care as a basic service. If you need help to eat, wash and lead a full life under your own control, that should be provided free at the point of need in the same way as the NHS is provided. This is a basic philosophical difference from others who have said that we need it all means-tested and that we need to be able to look at where a person is. I say that if someone needs this help it should be provided and then, whether or not people who have the means to contribute to that, whether they have been unfortunate enough to suffer a disability or a limiting illness, they should all be in that position.

I am aware of the time, so I will make just one final point on postcode lotteries. We often express a great deal of concern about postcode lotteries, but there is another lottery that occurs to people in this situation. Some people who suffer very serious disabilities or very serious illnesses that affect their living conditions are able, through the courts, to receive payments. Perhaps their parents are able to show that they suffered some disability at birth as a result of inadequate care, and they receive a very large payment that is set at a level to provide them with a decent level of care for life. Perhaps they are a young adult who is knocked off their bicycle and it is possible to hold a driver responsible. They get a very large court payout absolutely rightly. I am not challenging that under the current system at all, but they get that payment. Someone with exactly the same condition who cannot go to court and the people caring for them, their parents or relatives, have to struggle and fight at every level and at every moment to get the care that they need. That is just not right.

[Lord Davies of Brixton (Lab)]

My Lords, I just want to contribute to this debate. I fully support the remarks of my noble friend Lady Thornton. I was particularly struck by her dissection of this Government’s totally preposterous claim to have a plan for social care. They do not have a plan. All they have is a regressive tax and a broken promise.

I am tempted by the remarks of my noble friend Lord Lipsey to enter into a broader debate on these issues. Clearly, this issue is not going to go away. This is not the end and the issues that were raised will come back again and again until we move towards something fairer and more comprehensive. I cannot resist saying that I am unconvinced that deferred annuities will have any part in any sort of mass market provision of care. As a product, they are fatally flawed, in my view.

My noble friend’s remarks also made me think of the extent to which this debate is taking place while ignoring the key factor in these issues, which is housing or, rather, property management. That is really what we are talking about, but we do not mention it in the context of these debates, which is unfortunate. I am glad my noble friend raised these issues. However, I think the substantive point this evening is the imperative of sending this clause back to the Commons where they can reassess it with greater time than they were allowed initially.

Finally, I just want to highlight the revealing and outrageous statement by the Minister in the Commons, Mr Argar. He said the Government

“have always intended for the cap to apply to what people personally contribute, rather than on the combination of their personal contribution and that of the state.”—[Official Report, Commons, 22/11/21; col. 110.]

I do not believe that means-tested benefits are any more money being given by the state than my pension that I get from the national insurance scheme. It is outrageous to cast people as, in a sense, recipients of charity. It is their rights as citizens to have this money, and it is their money; it is not the state’s money. It reveals the Poor Law mindset of this Government.

[Lord Kamall (Con)]

My Lords, I understand the concerns about the lack of debate in the other place on this issue. The Government are putting in place a package of reforms to be implemented in 2023. The introduction of the £86,000 cap on costs is part of a package through which we hope that no one will lose out when compared to the current system. I will get the source that the noble Baroness, Lady Thornton, asked me for. I think that is a reasonable question.

The Government believe that having the cap in place allows people to balance their personal responsibility of planning for later years and puts in place a system where we hope that no one faces unpredictable care costs. Without Clause 140, two people with the same level of wealth, contributing the same amount towards the cost of their care, could reach the cap at very different times, driven not by how much they are spending on their care but how much the local authority is. We wanted to address that perceived unfairness.

Instead, the Government made the decision to offer the same cap for everyone. However, the cost for people with more modest means will be reduced in two important ways: first, through means-tested support, including for those living in their home. This kicks in as soon as someone’s assets fall below £100,000, potentially right from the start of their care journey. We chose to offer the same threshold for means-tested support, no matter where somebody draws on care, because we want to support and encourage people to be able to stay in their own homes whenever they can. That was an ambition set out in our White Paper, People at the Heart of Care.

Health and Care Bill

Lord Davies of Brixton Excerpts

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

Clause 80: Hospital patients with care and support needs: repeals etc

[Lord Davies of Brixton (Lab)]

I was going to oppose the question that Clause 80 stand part of the Bill, but I thought the order of speakers was going to be somewhat different. I am sorry—I am looking to my Front Bench for guidance.

[Baroness Wheeler (Lab)]

My noble friend wrote to the Table Office and said that he did not want Clause 80 to stand part and that he wanted Amendment 217, which I shall be moving, to start this group, as it did originally.

--- Later in debate ---

[Lord Davies of Brixton (Lab)]

It would help the House not to proceed with the debate on whether Clause 80 stand part of the Bill. Then we can move on to the amendments.

Clause 80 agreed.

--- Later in debate ---

I cannot understand how this got through the sifting systems when Minister after Minister has stood at this Dispatch Box and sworn undying fealty to the needs of carers. We are seeing stuff stuffed into this Bill which damages the position of carers by removing the protections that were there for them. Let us not mince our words: what the Bill does in practice is shove the problem of dealing with the discharged person on to an unpaid carer, without any protections as to whether they can cope in the situation in which they find themselves. I regard that as pretty intolerable in this day and age and think we would do well to say to the Minister that we need to support these amendments, particularly Amendments 221 and 225. If the Minister is not willing to go down that path, I hope noble Lords will move them to a vote on Report.

[Lord Davies of Brixton (Lab)]

My Lords, I apologise for the confusion at the beginning of this debate. My understanding of the ways of this House is still a work in progress. I gave notice of my intention to oppose the question that Clause 80 stand part to provide the Government with an opportunity to explain more clearly than they have their intentions for the management of hospital discharge. I hope in so doing they can allay the concerns that surround the proposal to revoke Section 74 of the Care Act 2014. For example, there are the concerns of the National Care Forum, which points to the danger that

“the removal of an assessment prior to discharge will result in less priority to undertake the assessment once someone has left hospital—for someone needing support to remain in their own home, this is concerning.”

The process of hospital discharge is a crucial element within the integrated care system established by this proposed legislation. From the perspective of the service user, this is where it all comes together. It must be done right. The Explanatory Notes tell us that this clause introduces flexibility for local areas to adopt the discharge model that best meets local needs, including an approach known in England as discharge to assess, the argument being that people will be assessed at a point of optimum recovery, allowing a more accurate evaluation of their needs. Who could possibly object?

The first problem is that there is a widespread lack of trust in the Government’s motives and intentions on this, like on other changes in the Bill. It is possible to argue that the change means that people will be assessed where most appropriate. But it is also possible to argue that the change will facilitate premature discharge that is in the interests of the service provider, not the people receiving the service. As well as explaining and stressing the advantages of the proposed change, the Minister needs to tell us what the Government are doing to ensure that it will not lead to the disadvantages that many of those involved in the process fear.

The second issue that the Government need to address is that hospital discharge is still seen predominantly as a medical matter, with concern that insufficient attention is given to the social care aspects. A survey from December 2020 of social workers who were involved in hospital discharges made it clear that the vital contribution of social work in the multidisciplinary team was being marginalised by the medicalisation of people’s journeys out of hospital. Most importantly, social workers were found to feel that the voice of the individual, the person receiving the service, was being lost, indicating that arrangements were being made without consent or against people’s views and wishes.

It is also important to understand the context within which this change is proposed. On the one hand, there is the current crisis in social care. Even without the impact of the Covid pandemic, demand is outstripping supply, there are waiting lists for assessments of need and support, and local authorities are operating with significantly reduced budgets following a decade of austerity. On the other hand, there is the widely understood pressure on the hospital sector, with increased demand and mounting waiting lists. Both these factors are the result of the long-term underfunding of our system of health and social care. This will have to be addressed—just let it not be at the cost of the service user.

We must ensure that community health teams and social care teams have the resources they need to provide a needs assessment as soon as an individual is discharged. Too often, the issue of hospital discharge is discussed in terms of the needs of the service and not of the individual person.

[Baroness Watkins of Tavistock (CB)]

My Lords, it is a pleasure to speak on this group of amendments, but I want to focus particularly on Amendment 219. There are around 6.5 million unpaid carers in the UK, a number which increased to 13.6 million, or about one-fifth of the population, during the height of the pandemic. Some 1.4 million people provide more than 50 hours of unpaid care per week. Unpaid carers are often relied on to provide this care, yet receive minimal or no formal support themselves. Instead, many report feeling isolated, undervalued and pressured by the challenges of stress and responsibility. Being a carer is emotional and physical labour.

A lot has been said about the Carers UK survey, which identified that 56% of unpaid carers were not involved in decisions about patients’ discharge, with seven out of 10 respondents not being asked whether they were able to cope with having the patient back home and six out of 10 receiving insufficient support to protect their own or the patient’s health and well-being. This lack of support reflects the absence of a unified and systematic approach to identifying and supporting unpaid carers. It demands urgent remediation, especially as we know that unpaid carers are twice as likely as non-carers to have ill health, and the majority have reported worsening mental and physical health during the pandemic.

I endorse Amendment 219 because it talks about carers who work with people who come into contact not just with hospital services but with NHS services. In my work as a community mental health nurse, in many instances I saw that people were not admitted to hospital for years—which was actually a very good outcome—but their carers’ needs were just as great in supporting them with long-term problems in their own homes. This amendment would create a duty in respect of any person receiving NHS care, whether that is in the community or in hospital. The NHS must identify unpaid carers, particularly young carers, and ensure that their health and well-being are properly considered. This is a vital public health duty.

Health and Care Bill

Lord Davies of Brixton Excerpts

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Lord Davies of Brixton (Lab)]

I wish to address Amendments 201A, 201B and 201C—my name has been left off Amendment 201A for some reason, but I support all three. Indeed, I support the stand-part debate initiated by the noble Lord, Lord Lansley.

I have attended virtually the whole debate in Committee and have been pretty sparing in my contributions, but on this occasion, I am going to make three speeches in one. I have been asked to pass on the thoughts of my noble friend Lord Hendy, who is unable to be here this evening, particularly given the time—though we are meeting a bit earlier than we perhaps expected. The same is true of my noble friend Lady Blower. Both my noble friends have considerable experience in this area and wanted their thoughts to be added to our debates this evening.

My noble friend Lord Hendy tabled these amendments. I have his remarks here; what he says might be of assistance to the noble Lord, Lord Lansley, in that he explains that this Bill, among other things, is designed to facilitate the outsourcing to private contractors of NHS services which are currently carried out in-house. That may not be explicitly stated, but it is clearly one of the underlying aims.

That is the Government’s policy, even though it is firmly opposed by most of the citizens of this island. That said, the purpose of these amendments is to protect NHS workers from the consequences of this policy. Usually when public services are outsourced, the contractor makes profit by reducing the number of staff performing the work formerly done in house and by cutting staff wages, terms and conditions. The TUPE regulations mitigate that process, but usually only by delaying it.

These amendments do not prevent staff reductions consequent on outsourcing beyond the protections in TUPE. In any event, the danger of staff reductions is diminished, bearing in mind that at the end of last year the NHS had 93,000 vacancies and an additional 110,000 staff off sick, half with Covid.

Amendment 201A seeks to prevent cuts to the wages, terms and conditions of NHS staff who are outsourced, and prevent contractors’ staff on worse terms undercutting in-house staff. It does so by requiring that the pricing rules for paying contractors must preserve, then and for the future, NHS staff rates and terms as negotiated between the NHS unions and NHS employers. Payment of those prices will depend on honouring those terms.

I hope the Minister will accept the legitimacy of the need to protect NHS staff in this way, perhaps—my noble friend adds—by better drafted amendments than mine. I am sure the Minister recognises that NHS staff need protection from wage cuts consequent on outsourcing. We must not have a two-tier workforce.

NHS staff are grossly underpaid and the real value of their wages is falling. After years of pay freeze, last year’s miserable 3% wage increase is destroyed by 6% inflation this year. The inadequacy of their terms and conditions is the prime reason for the extraordinarily high level of vacancies—a vacancy rate that increases as more and more work is done by fewer hands. Only heroic dedication by NHS staff prevents the vacancy level becoming a catastrophe.

Amendment 201A also protects against a different kind of two-tier workforce: contractors using the NHS payment scheme to fund salaries above NHS rates to attract certain categories of staff away from NHS posts. The current starting salary for an NHS nurse is £25,655, whereas the equivalent in the private sector is £37,500. No one could begrudge nurses earning whatever they can for their vital work, but NHS funds should not be used to finance a higher rate outside the NHS than within it.

Amendments 201B and 201C are intended to ensure that unions are among the consultees on the likely impact of payment schemes. Obviously, the workforce should be consulted.

My noble friend Lady Blower added her name to all three amendments, and she draws our attention to the fact that my noble friend Lord Hendy is one of our foremost labour lawyers. Some in your Lordships’ House have long experience of trade unions and trade unionism. I therefore hope that they will recognise this quotation:

“Trade unions have been an essential force for social change, without which a semblance of a decent and humane society is impossible under capitalism.”


That was not Marx, Engels or any of the great leaders of the TUC, or a general secretary of a major trade union. The quotation is actually from Pope Francis. Given that we all want to live in a decent and humane society, we should all promote the important role of trade unions. This is in part what these amendments would do; they are about fairness and justice for workers.

Health and Care Bill

Lord Davies of Brixton Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, as the noble Lord, Lord Hunt, said, Clause 21 is about representation on the integrated care partnerships, and new Section 116ZA specifies who should be on the committee of the partnership. The Bill currently specifies that one member of the ICP should be appointed by the ICB and one by each of the local authorities. The partnership is also free to appoint others. My Amendment 148 requires that one of these additional members must have responsibility for public health—and in that I include public mental health—and one must demonstrate that he or she can represent local voluntary organisations.

It is tempting in a Bill such as this to assume that all the members of these very influential committees should be from the major health organisations or local authorities in the area. However, there are many small community organisations run by charities or not-for-profit groups that play a very valuable role in providing services to local communities in a very cost-effective manner. Unless they are represented at ICP level, it is quite possible that their survival will be threatened by the new arrangements—and we heard in previous debates that they already do feel threatened. I am sure that the Government do not want that.

Similarly, public health has a major role to play in addressing many of the preventable diseases that contribute to health inequalities—and it looks after the tracing of communicative diseases. We saw the value of that recently when it was a great deal more effective than the national test and trace service at tracing the contacts of Covid-positive patients.

So, the work of both groups is very cost effective. If the ICB and the ICP are to use their resources efficiently and fulfil their duties to level up health inequalities, it is important that both groups are represented on the integrated care partnership. I echo the comments from the noble Lord, Lord Hunt: the Bill is quiet on the structure of and representation on the integrated health partnership. Given the duties that it is being asked to perform, it is perfectly reasonable for us to suggest that some of those important duties are properly covered in representation.

[Lord Davies of Brixton (Lab)]

My Lords, in speaking in support of my Amendment 150, the issue is simple. We have much to learn about ICPs; I associate myself with the remarks of my noble friend Lord Hunt.

My proposal is that the rules determining the membership of ICPs should be consistent with the rules for membership of ICBs. As the Committee will be aware, it has been agreed, with the amendment made in the House of Commons, that ICBs will not and cannot be controlled by the private sector, in any way. I believe that the Health Minister, Edward Argar, made the point of principle clear when speaking during the Commons Report stage. He said that

“ICBs will not and cannot be controlled in any way by the private sector, as NHS-accountable bodies guided by the NHS constitution and with NHS values at their heart.”

Let us just remind ourselves that the requirement added by the Government to Schedule 2 is that an ICB’s constitution “must prohibit” a candidate being appointed to it if the person making the appointment considers, in the Government’s words in the amendment,

“that the appointment could reasonably be regarded as undermining the independence of the health service because of the candidate’s involvement with the private healthcare sector or otherwise.”—[Official Report, Commons, 22/11/21; cols. 119-61.]

We might not agree with the wording adopted by the Government, as previously discussed, but the principle is accepted on all sides.

So, as with ICBs, we should have a parallel provision for ICPs. In this, I am simply following what the Minister said in relation to ICBs: he wanted

“to put the matter even further beyond doubt.”—[Official Report, Commons, 22/11/21; col. 116.]

I emphasise “even further”. The debate here is not really about the precise wording of any amendment; it is about the principle of extending to ICPs the same protection that, as has already been agreed, should be extended to ICBs.

I look forward to the Minister’s reply. It is possible that, given the way in which ICPs are appointed—on the one hand, by ICBs, which are already protected by the Government’s amendment to Schedule 2, and on the other hand, by local authorities—it might be suggested that the issue simply does not arise and that protection is already there. However, if only to put the matter even further beyond doubt, why not accept my amendment?