Health and Care Bill

Lord Davies of Brixton Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 24th January 2022 Lords Chamber

I wonder also whether the Minister could tell us something about the thinking of the National Institute for Health Research, going beyond the helpful remarks of the Baroness, Lady Chisholm, in her response to the last debate on Thursday. I appreciate that its budget, albeit very substantial, is under constant pressure from the insatiable demands of clinical research and that many high-quality research bids have to be turned down. I also appreciate the requirement not to compromise academic standards. However, does the NIHR appreciate the need to fund and develop research methodologies that differ from the time-honoured models such as RCTs and support other types of research, including coproduction methodologies, vital to improving our capacity for both prevention and bringing about a health-creating society?

[Lord Davies of Brixton (Lab)]

My Lords, I want to direct a few remarks to the issue of research, in broad support of the speeches made so far. The amendments in this group, taken individually, are generally to be welcomed, not least because they highlight the issues involved. However, taken as a whole, they suggest that there is a need for a more coherent approach, based on the common principles that apply across the whole range of providers and the whole spectrum of health and social care.

The point of principle is that there is a demonstrable association between the provision of high-quality care and participation in high-quality research. Put simply, patient outcomes in services that actively take part in research are better. This does not mean just future improvements in care, diagnosis and so on; the actual care provided alongside the research benefits from involvement in that research. It is reasonable to assume that the same is true of care services; I direct my remarks at healthcare, but I am sure these principles apply equally to those involved in the provision of social care.

Given the principle that research is so important, it is worth making a few additional points. First, research must be an essential element in a system of healthcare, involving both the bodies that deliver healthcare and service users. Hence ICBs need to have a research strategy and not just promote research but take practical steps to facilitate it. In this context, the importance of national research objectives should be emphasised. The involvement of these bodies in research should be more than just one more administrative hoop they have to jump through. It should be part and parcel of their core function, delivering better mental and physical healthcare. They also need to commit to training clinical staff in how they can participate to best effect in research, or at least in the importance of research to clinical care.

Secondly, there is a need to consider a duty on private providers of NHS services to participate in research. Of course, private providers have a duty to support and contribute to the training as well. It is easy for private providers to ignore the need for research, and this reduces the opportunities for those for whom they care.

Thirdly, on Amendment 96, I suggest that we need to go beyond the idea that clinical trials need to be considered by ICBs and other relevant agencies. We could go further and require ICBs to use their best endeavours to encourage and accept reasonable requests to support clinical trials and offer opportunities for patients to take part.

Fourthly, as we have touched on in previous debates in this Committee, it must be emphasised that, when addressing the issue of research, there is a need to refer explicitly to mental as well as physical health.

Finally, all of us should bear in mind the importance of service users being involved in research and of ICBs and other agencies keeping this in mind throughout the process of providing care. This includes the involvement of service users in developing the priorities of research in its design and in overseeing its carrying out. This is vital for making sure that the outcomes can be easily embedded in clinical and care services. It is worth emphasising this in the context of mental health, where most advances in patient involvement have taken place.

[Lord Kakkar (CB)]

My Lords, I thank the noble Baroness, Lady McIntosh of Pickering, and the noble Lord, Lord Sharkey, for the thoughtful way in which they introduced the amendments in this group to which I have added my name. In so doing, I remind noble Lords of three interests: I am chair of the Office for Strategic Coordination of Health Research, chair of the board of trustees of UK Biobank and chair of King’s Health Partners.

As we have heard in this debate, research is not only fundamental to securing the best outcomes for patients being treated in our hospitals and throughout our healthcare system; it is critically important for the sustainability of the healthcare system itself. Numerous reports and strategies have been published over the last 10 years, to the great credit of Her Majesty’s Government, in terms of putting innovation and research at the heart of repeated NHS strategies. It is therefore only right that your Lordships’ House pays particular attention to how securing the opportunity for that research and promoting the opportunities that will flow from it are reflected in the Bill. There is no question but that Her Majesty’s Government are deeply committed to this area, but, as the Bill is currently drafted, there is some anxiety that the provisions and clauses do not provide sufficient emphasis or obligation for the new NHS organisations, the integrated care systems and the integrated care boards—and, indeed, the continuing obligation for NHS trusts—to be actively involved in research.

Now why is this important? At the very least, we know that we need to continue to innovate, be it therapeutic innovation or innovation through devices—or, indeed, innovation of new working practices, pathways of care and delivery—if we are to continue the important advances in outcomes that we have been able to achieve in recent years and decades. As we have heard, research is at the very heart of our ability to improve the experience and clinical outcomes of our patients. Research is also fundamental in improving our ability to prevent disease. We have an obligation in this Bill to promote healthcare services and well-being and to avail ourselves of the substantial opportunities that exist with regard to a more focused prevention agenda. Much of that agenda must inevitably be driven by prospective research, to be conducted across broad and diverse populations on our fellow citizens.

There is the question of sustainability—the fundamental sustainability of the NHS. Here we recognise that, without research and the adoption of innovation resulting from that research, the demographic changes and increasing demands that attend the delivery of healthcare in our country will make the NHS unsustainable in future. Therefore, there is a very deep obligation, beyond what we can do for patients in terms of clinical outcomes, to put at the heart of NHS thinking and strategy, as well as delivery, the delivery of a substantial research agenda. We know that that that research agenda is secured centrally through the substantial commitment of public funds to the National Institute for Health Research, UKRI and Research Councils, which provide funding for research—and, indeed, for other contributions from government departments, including the third sector contribution and the substantial contribution for research provided by the pharma and biotech industries, and associated research opportunities.

All that needs to be directed towards NHS institutions that are ready to receive that substantial commitment to research and conduct in particular those clinical research opportunities which, regrettably, have been subject to variable performance over many years in the NHS. It is for that reason that this Bill must take the opportunity to address that variability in research participation and performance. If we do not achieve that, we are not going to utilise the full potential of the NHS to be able to deliver the benefits that have been so rightly predicted. Most of all, without ensuring a broad research culture across all NHS institutions and organisations, we are going to lose the direct consequences of such a research culture and infrastructure in terms of the fact that patients in research-active institutions have better clinical outcomes.

To move away from those two broad areas—the important impact on patients and the important opportunity to provide the broader research agenda with the innovation that flows from it—there is a third imperative: our capacity to attract and retain staff. As with any facet of manpower planning, it is vital to provide the opportunity for NHS staff members and healthcare professionals to be research-active. It provides a substantial incentive and encouragement and allows for career development, ensuring that we retain colleagues for longer and are able to develop them to make different contributions—all vitally important. If we take this as a whole, it is appropriate that Her Majesty’s Government give some very careful thought to the purpose of these different amendments and how what is being said in your Lordships’ House today might be included in the Bill in such a way to strengthen these research obligations and ensure that NHS organisations deliver on the health agenda.

Health and Care Bill

Lord Davies of Brixton Excerpts

Lords Hansard - Part 1 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Baroness, Lady Walmsley, brought us very persuasively to the point of Clause 14, which I must say I am extremely puzzled about, because it purports to set out the whole set of arrangements that have to be gone through before integrated care boards can be set up as statutory bodies. However, it appears that that has already been done.

I register a very strong protest with the Minister at the actions of NHS England in going ahead and establishing these bodies, issuing extraordinary edicts such as no local authority councillor being able to serve on an ICB. What right does a quango have to say that local authority councillors cannot be represented on ICBs? This is absolute abuse of parliamentary power, because quangos do not have the right to set out what should happen on governance issues at local level in the NHS without parliamentary endorsement.

NHS England has put out a note that says that, subject to parliamentary progress, arrangements for the new statutory bodies are to come in now, on 1 July. How can that be, when we have not even gone through the sections that deal with the composition of integrated care boards? It is quite possible that your Lordships might insist on Report that local authority councillors are members of the ICBs. That is not impossible, so what will happen? Will the Minister say that, despite what Parliament says, the ICBs will go ahead, or does it mean, as I read this legislation, that the Government have to start again?

Lots of issues will be raised in this and the next group, not least the outrageous governance issue, which says that NHS England basically appoints the chair and the chief executive officer is also at its disposal. There is no attempt locally to have a board that elects its own chair or one that is appointed independently; they are essentially place-people put in there by NHS England. These are matters that Parliament should decide. I accept that Parliament may say that it is happy to go ahead on that basis—but I strongly object to this clause. It is dishonest; it purports to go through a process from the start that says that this is how ICBs will be set up—but they have all been set up, the boundaries settled and the chairs nominated, without any proper public accountability process whatever.

I hope that, when we come to agree Clause 14, the Minister will think again and that he will issue instructions to NHS England to withdraw the letter that says that the new arrangements will come into place on 1 July. I do not understand how that can possibly be.

[Lord Davies of Brixton (Lab)]

My Lords, I speak to my Amendment 45. This is a disparate group of amendments, dealing with the issue of integrated care boards. I strongly support the comments already made. My amendment addresses another issue. There are questions about what the boards are; the issue is for whom they provide services, and how they are defined.

I have been made aware of a case that raises real questions about how this is going to develop. The case was reported in September, in the Manchester Evening News, about a woman who suffered burns while on holiday. She returned to her local urgent care centre in Rochdale and was advised that, because of long waiting times, she should go to another A&E in Bury. When she arrived there, she was told that that centre did not treat people from Rochdale, because of rules laid down by the integrated care board predecessor, which had established the rules in that part of Lancashire. She was left literally on the pavement, unable to obtain the care that she required.

That is a specific case under the existing rules, but it points out the lack of clarity in the Bill about how the integrated care boards will operate. The fear is that they will be membership bodies along the lines of health management organisations in the United States, which are responsible for providing services to members. That contrasts with the residential basis on which the NHS was based, at least up to 2012.

Proposed new Section 14Z31(4) gives the Secretary of State astounding power to set out which ICB is responsible for a particular individual’s care. I hope that the Minister will be able to provide some reassurance, but the problem with membership-based organisations is that, first, there will be cherry picking of patients and, somewhat counterintuitively, at the same time they will be competing for the less expensive patients. Without far more clarity through the Bill from the Minister, people will have reasonable fears over how these new organisations will work and how people will attain the services that they currently expect from a seamless provision of services. My amendment seeks to address the issue of it being a single service. We have these 43 ICBs, or whatever they are, but it is a single service, and patients can access services wherever it is best for them and not best for the service.

[Lord Scriven (LD)]

My Lords, I echo the comments from the noble Lord, Lord Hunt of Kings Heath.

We are living in a parallel universe. We are discussing the legislative framework for this new system while, out in the real world, the foundations and the bricks are being built. People are in place. Dates are being set. People are being told that they cannot be on boards. This Parliament has not decided. Under what legislative framework are these organisations working? They have no legitimate powers or approval from Parliament, yet they are being set up. People are being put in place. Chairs are being appointed. Councillors are being told that they cannot sit on ICBs.

This Parliament has not decided that yet. Letters are going out from NHS England telling the system when it will start, and Parliament has not gone through the legislative process. This is not collaborative working at a local level, because many local authorities feel that they are not even in the car let alone in the driving seat; the car is leaving and they are being asked to join at a later date. This is not a good start for collaborative working. It has to stop. NHS England has to be reined in and told that, until there is a legislative framework, the system must stay still.

In that sense, I support Amendment 23, because, significantly, it would give local authorities powers to determine their own destinies. As a former NHS manager, I am not somebody who says that this is a bunch of bureaucrats who are a waste of time. I understand the importance of NHS leaders and managers, but they cannot start drawing lines on a map and ignore local authorities’ democratic mandate. This system is not just about administrative convenience; there are real questions about the identity of local authorities, which have built regional boundaries.

Some local authorities look two ways. Let me give noble Lords an example, not a health example but something that happened in south Yorkshire and in which I was involved. The people and the authority of Barnsley, on the edge of south Yorkshire, look to west Yorkshire as well as looking to, and being administratively in, south Yorkshire. As I am sure the noble Baroness, Lady Bennett of Manor Castle, will know, because she knows the local area, when we set up the economic framework it caused a lot of distrust and bad blood for four years, simply because the local authority was not allowed to use the democratic mandate that it had been given and people from the centre were pushing how local economic partnerships and mayoral authorities should be set up.

If we are talking about local authorities and the National Health Service working in a collaborative way, the democratic right of local authorities must be taken into consideration. They know the nuances of their local people in a way that NHS managers do not. I say that having been an NHS manager, a councillor and a leader of a council. It is important to establish the democratic mandate in the system right from the beginning. I can tell you now that if you get a system where two local authorities out of four are forced into an area that they do not want to be in, I can tell you now that it will not work. There will be years of fighting and distrust. This is not just a plea; this is really important. The system has to stop. It has to be a collaborative approach in which local authorities’ elected mandate is key, but NHS England must also take its foot off the brake and wait until this Parliament has set the legislative framework before the system gets going. This is a parallel universe and it has to stop.

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.