Health and Care Bill

Lord Kamall Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

Moved by

[Lord Kamall]

That this House do not insist on its Amendment 11 and do agree with the Commons in their Amendment 11A in lieu.

11A: Page 138, line 35, at end insert—
“(4) If the constitution includes provision under this paragraph allowing committees or sub-committees to exercise commissioning functions, the constitution must—
(a) provide for the members of any such committee or subcommittee to be approved or appointed by the chair of the integrated care board, and
(b) prohibit the chair from approving or appointing someone as a member of any such committee or sub-committee (“the candidate”) if the chair considers 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.
(5) In sub-paragraph (4) “commissioning functions” means the functions of an integrated care board in arranging for the provision of services as part of the health service.”.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, I start with the amendments on ICB membership, children’s palliative care, hospital discharge and adult social care.

On integrated care boards, I hope noble Lords will recognise that the Government have listened to both this House and the other place. We have proposed some changes to the drafting of Amendment 105 in the name of the noble Lord, Lord Bradley, which I am aware that the noble Lord has seen. We hope that he recognises that our amendment in lieu meets the original intent of his amendment.

On Amendment 11, we hope that Amendment 11A in lieu, proposed in the other place, meets the expectations of your Lordships’ House. To avoid a number of unintended consequences or implications, we proposed an amendment in lieu that will ensure that those who pose a threat to the independence of the health service are excluded from the ICB and its committees. We have applied the same test to committees as we have to the main board, and the conflict of interest provisions and safeguards in the Bill also apply. We are grateful for the discussions on this question that we have had with noble Lords, including with the Front Bench opposite, and we hope that this amendment will be satisfactory.

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[Baroness Walmsley (LD)]

My Lords, I shall make a few brief comments about Motions A, E, G1, L1 and Q. On Motion A, we very much welcome the Government’s amendments in lieu, to make it clear that no commissioning organisation within the ICS can have a member appointed to it who could reasonably be regarded as undermining the independence of the health service because of their involvement in the private sector. The Government have listened to the concern expressed by the noble Lord, Lord Hunt of Kings Heath, whom I congratulate for spotting the loophole, and that is very good and welcome.

On the matter of carers and safe discharge in Motion E, we on these Benches were concerned that unpaid carers would not be sufficiently consulted and their own health and well-being might not be sufficiently taken into account. I am grateful to the Minister for spelling out, at my request, how the impact on carers will be assessed before a patient is discharged into her or his care. However, at the moment, when there is an outbreak of Covid-19 in a hospital ward, the carers are not allowed to visit the patient. Therefore, those conversations are not taking place. I should be very interested to know what the Minister will suggest about how those conversations can take place in that situation.

It is very important that appropriate action is taken to address the carer’s needs as well as those of the patient. Indeed, if those needs were not addressed, it would affect the ability of the carer to look after the patient, so both would suffer. I know this is a big responsibility for local authorities, which are strapped for cash, but it is vital that these needs are catered for, especially in light of the fact that those many thousands of unpaid carers save the public purse a massive amount of money, as well as looking after their loved ones with the loving care and attention that it would be very difficult for professionals, however dedicated, to give.

On Motions L and L1, I have listened carefully to the concerns of the noble Baroness, Lady Finlay, and she is quite justified. Governments have a habit of promising action but then moving on to something else, so we on these Benches, like the noble Baroness, will be looking out very carefully for the results of the review and the actions which we hope will follow.

We very much welcome Motion Q and congratulate the noble Lord, Lord Bradley, on achieving what he has. We particularly welcome the mention in the amendment in lieu of the word “prevention” of mental ill-health, as well as diagnosis and treatment.

Finally, as my noble friend Lady Brinton said, we support Motion G1 from the noble Baroness, Lady Wheeler. I want to add just two comments to those of my noble friend. We should support the amendment because the government savings will be paid by the poorest and most vulnerable, and 80% of those with dementia who have very long-term caring needs will be worse off under the Government’s proposals, and that is not right.

[Lord Kamall (Con)]

I thank all noble Lords who took part in this wide-ranging and interesting debate. Perhaps I can deal quickly with some of the issues. On mental health membership of the ICBs, I thank the noble Lord, Lord Bradley, for his persistence, but also for accepting the amendment that we produced in lieu.

On conflicts of interest, I thank all noble Lords for acknowledging the work that the Government have done, and I shall try to answer a couple of points. The noble Lord, Lord Hunt, asked about the chairs of the ICBs. They are appointed by NHS England, with the Secretary of State’s approval, which is the route by which the Department of Health and Social Care can ensure that the chair does not undermine the independence of the NHS. NHS England and the Secretary of State will want to appoint people who meet the highest standards and will not undermine the interests of the NHS. On the second question, ICBs will have to make arrangements to manage conflicts of interest to ensure that they do not affect, or appear to affect, the integrity of ICBs’ decision-making. This would implicitly include data sharing and access to information. I hope that that meets with the noble Lord’s approval and addresses his concerns.

On palliative care, I once again thank the noble Baroness, Lady Finlay, for all her work and for teaching me so much about the subject. Indeed, the officials in my department are very grateful for what they have learned about the whole palliative care process: the noble Baroness has definitely put it right on the agenda for consideration.

It is clear that the views of parents are very important, and it is essential that their voices are heard. That is why we expect the review to include evidence from both parents and clinicians who have been involved in disagreements in the care of critically ill children.

I also thank my noble friend Lord Balfe for the points that he made and I hope that we will have further conversations. I would be happy to put my noble friend in touch with officials in my department, so that they can benefit from his wisdom and many years’ experience of mediation.

There are already robust duties to involve parent carers in hospital discharge planning. Parent carers of a disabled child are covered by the right, under the Children and Families Act 2014, to request a carers assessment at any time. We will continue working closely with the Department for Education to ensure that, in guidance, we signpost to existing rights and protections for these individuals. The existing guidance stresses that discharge teams should ascertain whether the carer is willing and able to provide care and support post discharge, before an assessment of longer-term needs. No assumptions should be made about their willingness or ability—that includes all forms of ability—to care. This will be set out in the new statutory guidance. As the noble Baroness rightly knows, we will be working with Carers UK on the guidance.

I will finish on the adult social care cap. I understand the concerns that many noble Lords have expressed. In the current system, individuals with more than £23,500 face unlimited costs. The cap is not a target to work towards; it is a backstop to make sure that people are not liable for unlimited costs of care. There are a number of different issues and views on this, but we believe that our proposal is better than the current system. Although I understand the concerns of this House, I once again urge noble Lords to consider that the other place has considered this and rejected noble Lords’ amendments. The Government Benches will be opposing Motions G1 and G2.

I am also grateful to my noble friend Lord Lansley for the points he raised. We will look at all aspects of the trailblazer schemes; it would not be wise to limit what we look at. We want to get the best from that discovery and learning process, and perhaps spot with the trailblazing and piloting any unintended consequences. So we will look in a holistic way at how the trailblazer schemes are working before we roll them out nationally. We believe that that is wise and prudent.

I think that completes my points.

Motion A agreed.

Moved by

[Lord Kamall]

That this House do not insist on its Amendment 29, to which the Commons have disagreed for their Reason 29A.

29A: Because there is already a clause in the Bill about reporting in relation to workforce and it is not necessary to impose further or different reporting duties on that topic.

[Lord Kamall (Con)]

My Lords, I have the notes just in time. I just hope I have impressed noble Lords with our lean operation—although sometimes the leaner the operation, the more brittle it is.

The amendments in this group all relate to questions of accountability. Amendment 29 addresses the question of workforce projections. I draw noble Lords’ attention to the sustained disagreement of the other place to this amendment. The Government are committed to improving workforce planning and we recognise the importance of having a properly trained workforce. Indeed, during my short time as Minister, noble Lords have asked a number of parliamentary Questions on workforce issues.

We are taking a number of steps to ensure that we have record numbers of staff working in the NHS and we are committed to continue to grow and invest in the workforce. This year, we have seen record numbers of staff in NHS trusts and CCGs, including doctors and nurses. The monthly workforce statistics for December show that there are more than 1.2 million full-time equivalents.

These workforce numbers come on the back of our record investment in the NHS, which is delivering on our manifesto commitment of 50,000 more nurses. We are on target with that, with nursing numbers a little over 27,000 higher in December 2021 than they were in September 2019. The spending review settlement will also underpin funding the training of some of the biggest undergraduate intakes of medical students and nurses ever. We recognise that doctors are liable to stay in the places they are trained, which is why we have opened up a number of new medical schools. That will take time to come through, but it is making sure that we are looking at the workforce in terms of longer timeframes.

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[Baroness Merron (Lab)]

My Lords, I sense a deepening of support in your Lordships’ House for the issues contained within this group. I start by thanking the noble Baroness, Lady Cumberlege, for introducing Motion B1. I also put on record my thanks to the 100 organisations which have indicated their support and got involved to make this an even better Motion for us to consider.

Yesterday’s Health and Social Care Committee report said:

“Neither earlier diagnosis nor additional prompt cancer treatment will be possible without addressing gaps in the cancer workforce”


through a workforce plan. The lack of staff, both currently and projected, is not restricted to the cancer workforce but extends to the total staff shortage of some 110,000 across the NHS as well as 105,000 vacancies in social care, while some 27,000 NHS workers voluntarily left the health service in just three months last year, the highest number on record.

As we have heard, just last week your Lordships’ House debated the Ockenden review, which I believe has provided great focus on the issue of workforce planning. The review shockingly laid bare the reasons why hundreds of babies’ lives were avoidably cut short or damaged and mothers died; to their great credit, the Government have accepted every one of the recommendations. The clear finding here is that we must safely staff our maternity wards, yet midwives are leaving the NHS in greater numbers than it is possible to recruit them. If the Ockenden review does not illustrate why we need a workforce plan then I do not know what does.

It is worth reflecting on what Motion B1 is not about, in case that offers some late reassurance to the Minister. Despite needing all of these things, it does not commit the Government to hiring thousands more doctors and nurses, nor does it commit to new funding for the NHS. It does not even commit the Government to finally publishing the workforce strategy that the NHS is crying out for—even though the NHS has not had a comprehensive workforce strategy since the Government’s plan was published in 2003.

What Motion B1 talks about is an independent review of how many doctors, nurses and other staff are needed in health, social care and public health, both now and for the future, and that the report, which must be brought before Parliament, must be informed by integrated care boards, employers, trade unions and others—people with expertise and a great contribution to make. This is not just a question of recruitment, important though that is, but one of retention. There is absolutely no way out of planning and preparation; without them, it is just not possible to magic up the necessary staff. Motion B1 is about facing up to the scale of the workforce challenge so that we can see safe and efficient health and care. These Benches will certainly be supporting Motion B1 if the will of the House is tested.

I turn now to Motion C1 in the name of my noble friend Lady Thornton. The inclusion of a clause about changes to reconfiguration shows that not all of the Bill was what the NHS was asking for. The powers in this clause are unnecessary and introduce a very considerable new layer of bureaucracy. Just about every commentator and representative group has said that this approach of an interventionist Secretary of State is quite wrong. As many have pointed out, the power that any proposal can be taken over by the Secretary of State takes us down a road of politicisation and will deter some from even trying to pursue necessary but controversial changes. It matters not that we are told that this power will be used only sparingly; if it is there, that will influence behaviour.

Given where we are in the parliamentary process, outright rejection of this provision would, of course, be problematic. Our alternative in this Motion is to say that, if the power is only rarely to be used—in exceptional circumstances, when intervention is justified—then the way to deal with this is to make that case to Parliament, to put it up for proper scrutiny and to show the evidence. If we are potentially to deprive people of their right to be consulted, then at least let Parliament do a proper job of examining this.

I now turn very briefly to Motions D1 and K. I thank the noble Lord, Lord Blencathra, for presenting Motion D1 today. It seeks to ensure that health service procurement of all goods and services avoids modern slavery; in other words, it takes us further than Motion D. I thank the Minister for the move forward contained within that Motion; however, if the noble Lord, Lord Blencathra, wishes to test the will of the House, we on these Benches will certainly be in support.

I congratulate my noble friend Lord Hunt and other noble Lords for their persistence in ensuring that Motion K is before us today. Again, I thank the Minister for being so responsive on this point. I hope that, in the votes that follow, your Lordships’ House will swiftly take the opportunity to ask that we might further improve this Bill.

[Lord Kamall (Con)]

I thank all noble Lords for their contributions and their constructive debate and engagement, not only this evening but throughout the process of the Bill. I thank noble Lords also for their agreement to the measures we have drawn up on organ tourism. I thank the noble Lord, Lord Hunt, for the way he pushed the Government, making sure that we were able to find a constructive way of closing that gap.

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Moved by

[Baroness Penn]

That this House do not insist on its Amendments 30 and 108, to which the Commons have disagreed for their Reasons 30A and 108A.

30A: Because it is appropriate for the Secretary of State to have greater powers to scrutinise and intervene in NHS reconfigurations given the Secretary of State’s accountability to Parliament in relation to these matters.

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Motion D

[Lord Kamall]

Moved by

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

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


“Review into NHS supply chains


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


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


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


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


(5) The report must describe—


(a) the scope of the review, and


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


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


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


(8) In this section—


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


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


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


Motion D1 (as an amendment to Motion D)

[Lord Blencathra]

Moved by

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

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


“Health service procurement and supply chains: modern slavery


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

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Moved by

[Lord Kamall]

That this House do not insist on its Amendment 51 and do agree with the Commons in their Amendment 51A in lieu.

51A: Page 70, line 20, leave out “omit section 74 and” and insert—
“(a) for section 74 substitute—
“74 Discharge of hospital patients with care and support needs
(1) Where a relevant trust is responsible for an adult hospital patient and considers that the patient is likely to require care and support following discharge from hospital, the relevant trust must, as soon as is feasible after it begins making any plans relating to the discharge, take any steps that it considers appropriate to involve—
(a) the patient, and
(b) any carer of the patient.
(2) In performing the duty under subsection (1), a relevant trust must have regard to any guidance issued by NHS England.
(3) For the purposes of this section, a relevant trust is responsible for a hospital patient if the relevant trust manages the hospital.
(4) In this section—
“adult” means a person aged 18 or over;
“carer” means an individual who provides or intends to provide care for an adult, otherwise than by virtue of a contract or as voluntary work;
“relevant trust” means—
(a) an NHS trust established under section 25 of the National Health Service Act 2006, or
(b) an NHS foundation trust.”;
(b) omit”.

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Moved by

[Lord Kamall]

That this House do not insist on its Amendment 57, to which the Commons have disagreed for their Reason 57A.

57A: Because the Amendment would limit the power to transfer functions under the Bill.

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Moved by

[Lord Kamall]

That this House do not insist on its Amendment 80 and do agree with the Commons in their Amendments 80A to 80N in lieu.

80A: Page 116, line 41, leave out from beginning to end of line 9 on page 117 and insert—
“(a) in relation to eligible needs met by a local authority, to any amount the local authority charged the adult under section 14(1)(a) or 48(5) for meeting those needs;
(b) in relation to eligible needs met by a person other than a local authority, to what the cost of meeting those eligible needs would have been to the local authority that was the responsible local authority when the needs were met.”

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Moved by

[Lord Kamall]

That this House do not insist on its Amendments 85 to 88, to which the Commons have disagreed for their Reasons 85A to 88A.

85A: Because it is unnecessary to impose a legal duty to carry out a consultation in relation to the subject-matter of this Amendment.

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88A: Because it is consequential on Lords Amendment 86, and the Commons do not offer any further Reason, trusting that this Reason may be deemed sufficient.

[Lord Kamall (Con)]

My Lords, I beg to move Motion J and, with the leave of the House, I will speak to Motions M, N and P. This group of amendments relates to questions of patient safety, patient engagement, public health and building a learning culture in the NHS.

Last week in the other place we tabled amendments to ensure the full operability of Lords Amendment 91, in the name of the noble Baroness, Lady Hollins, on mandatory training on learning disabilities and autism. We have discussed and agreed these changes with the noble Baroness, and together these amendments will require all health and social care providers who carry out regulated activities to ensure their staff receive specific training on learning disabilities and autism.

At Report stage of this Bill the Government committed to accept in principle the amendment by the noble Lord, Lord Sharkey, on reciprocal healthcare and to change the process for regulations that give effect to international healthcare agreements so that they are subject to the affirmative resolution procedure. To ensure this Bill achieves the intended effect, the Government tabled Amendment 95A in lieu, which achieves the same objective but amends the international healthcare agreements clause, rather than the regulations clause. This will ensure that all regulations made under the soon to be named healthcare (international arrangements) Act 2019 are subject to the affirmative procedure, including any regulations made by the devolved Governments. I urge noble Lords to accept all these amendments.

I now turn to the issue of abortion at home pills. This group contains Lords Amendment 92 and related amendments. Both this House and the other place voted to make provision to permanently allow both pills for early medical abortions to be taken at home. These were, rightly, free votes of both Houses, but the Government brought forward this amendment in lieu to ensure that the legislation operates in the way that this House intended it to. I therefore ask noble Lords who agree with the intention of my noble friend Lady Sugg to instead support the Commons amendment in lieu.

I am also grateful to my noble friend Lady Eaton for bringing the important topic of safeguarding before the House. I reassure her that the well-being and safety of women and girls accessing abortion services has been, and will continue to be, our first and foremost priority. Safeguarding is an essential aspect of abortion care, and it has been long-established that a doctor or health professional is legally able to provide contraception, sexual and reproductive health advice, and treatment, including abortion, without parental knowledge or consent to a person aged under 16 years, provided that the doctor or healthcare professional is satisfied that certain conditions, including ability to consent, are met.

As a matter of best practice, every effort should be made to encourage those under age 16 to involve their parents, and if they cannot be persuaded to do so, they should be assisted to find another adult, such as another family member or specialist youth worker, to provide support. All abortion providers are already required to have effective arrangements in place to safeguard vulnerable children and to assure themselves, regulators and their commissioners that those are working. Having effective safeguarding arrangements in place will be essential for clinicians to make a robust assessment of whether a home abortion is suitable for anyone under age 16 and those under age 18.

I noted the statement from the Royal College of Paediatrics and Child Health, which stated that all young women aged under 18 and care leavers aged under 25 should be actively encouraged to attend an abortion service in person. With that in mind, we will work with the royal colleges, including the Royal College of Paediatrics and Child Health, and NHS safeguarding leads, to ensure that children and young people are actively encouraged to take up a face-to-face appointment and that anyone at risk of harm is identified and supported appropriately, including through referrals to other agencies.

The Government will continue to work closely with relevant professional bodies to ensure that the principles and duties of safeguarding children, young people and adults at risk are consistently and rigorously applied and that we continue to monitor all impacts of home use of both abortion pills. I hope that my noble friend will be reassured to hear that we will work with NHS England, the Care Quality Commission and abortion providers to ensure that they can safely offer telemedicine abortion services on a permanent basis and that all women are genuinely offered the choice of a face-to-face appointment.

On other issues, the Government cannot accept Amendment 88B, which has been put forward by the noble Lord, Lord Crisp, as an amendment in lieu of Lords Amendments 85 to 88, which were rejected by the other place. It would bind the Government in statute to consult, to a particular timeframe, on all recommendations within the Khan independent review which in the opinion of the Secretary of State require a consultation to implement. The review itself is not yet complete and is not scheduled for publication until May, when we will of course consider our next steps.

As the review is currently in the process of being drafted, the Government should not pre-empt what it will include. Importantly, the Government should not be put under a duty to consult on a range of proposals that they have not yet seen and may not support. Some proposals may require further development and agreement across government and across the UK before a consultation. We risk wasting government resource and time to consult, and stakeholders’ time to respond, by consulting on proposals that we may not intend to pursue.

The Government are firmly committed to Smokefree 2030 and we look forward to the outcome of the independent review. The review will inform both the health disparities White Paper and the Government’s new tobacco control plan, which will be published later this year. If any changes to tobacco legislation are proposed by the Government in that plan, I can commit that they will be consulted on. The need for additional spending to deliver our Smokefree 2030 ambition—and possible funding mechanisms—will be considered as part of the tobacco control plan and agreed with Her Majesty’s Treasury in the usual way.

I beg to move the Motion standing in my name and commend many of these amendments to the House.

Motion J1 (as an amendment to Motion J)

Moved by

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[Baroness Thornton (Lab)]

I shall be very brief, because it is time we draw this ping-pong session to an end. First, I congratulate the Minister on his introduction to the tele-abortion amendment, and on the reassurance that he gave to the House and the noble Baroness, Lady Eaton. The issue has been expressed very eloquently by the noble Baronesses, Lady Sugg and Lady Barker, and I have no intention of going into detail.

The only other matter before us right now on which we need to take a decision is that of the amendment put by the noble Lord, Lord Crisp. From these Benches, I need to say that we absolutely support the noble Lord in his amendment, and we will vote with him, if he divides the House.

[Lord Kamall (Con)]

I thank all noble Lords who have taken part in this debate and the debates throughout the day. We managed to stick to the point and tried to be as brief as possible. I am afraid I will not be as brief as the noble Baroness, Lady Thornton, but I will try to be briefer than I usually am.

I should just make some acknowledgements, looking at the whole group. First, on learning disabilities and autism, I thank the noble Baroness, Lady Hollins, in her absence, for her constructive engagement with the Government.

On tobacco, I once again urge noble Lords to reject Amendments 85 to 88 and 88B. The independent review is not scheduled for publication until May, when we will of course consider our next steps. I understand that the noble Lord told us to get on with it, but we do not want to pre-empt the independent review. As it is in the process of being drafted, we really want to make sure that we have proper consultation and agreement, both across government and across the UK with the devolved Administrations.

I hope the noble Lord is in no doubt that we are also committed to the tobacco plan and the reduction of smoking. We just do not feel that this is the right amendment, but the noble Lord may feel otherwise. Any changes to tobacco legislation proposed by the Khan review, a plan supported by the Government, will be consulted on. We firmly want to make sure we reach our smoke-free 2030 ambition or get as close to it as feasibly possible.

There is a debate about the polluter pays principle. I am sure the noble Lord, Lord Crisp, will recognise the debate about Pigouvian taxes, taxing negative externalities and who is responsible. Who is the polluter? In the car industry we tax the driver, as they put more petrol in. Should it be the smoker or the industry? There is a debate about this, but I hope these issues will be considered by the Khan review.

I also thank the noble Lord, Lord Sharkey, for his constructive engagement on reciprocal healthcare. I am pleased that we were able to narrow the gap and get to the same place.

I turn now to the telemedicine abortion issue. The Government felt that we should have gone back to pre-pandemic measures, but it was right that there was a free vote. We saw the results of the votes in your Lordships’ House and the other place, and we accept them. The democratic will of both Houses is quite clear. At the same time, we also accept that there were some concerns, as my noble friend Lady Eaton rightly said, about underage women being forced to have abortions and safeguarding. My noble friend Lady Verma also made a point about issues in certain communities; we know that these things go on in certain communities and that there are close relationships.

After the reassurances I gave at the beginning, my noble friend Lady Eaton said she was reassured enough not to push her amendment to a vote. I hope that remains the case and that my noble friend has not been persuaded otherwise. It is important that we consult, treat this sensitively and get the appropriate guidance, but the decision has been made by both Houses and we have to make sure that it works and that we address some of the legitimate concerns that noble Lords have raised in this debate.

Given that, I ask this House to accept the Motions in my name.

[Lord Crisp (CB)]

My Lords, let me first say how much I respect the Ministers and appreciate the time they have given to me and other noble Lords to discuss the “polluter pays” amendment. I really appreciate it and found it very useful. I think it was the noble Baroness—I cannot remember the name.

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Moved by

[Lord Kamall]

That this House do not insist on its Amendment 89 and do agree with the Commons in their Amendment 89A in lieu.

89A: Page 123, line 35, at end insert the following new Clause—
“Commercial dealings in organs for transplantation: extra-territorial offences
(1) After section 32 of the Human Tissue Act 2004 insert—
“32A Offences under section 32 committed outside UK
(1) If—
(a) a person who is habitually resident in England and Wales, or who is a UK national and not habitually resident in
Northern Ireland, does an act outside the United Kingdom,
(b) the act, if done in England and Wales, would constitute an offence under section 32(1), and
(c) the controlled material to which the act relates is controlled material consisting of or including a human organ,
the person is guilty in England and Wales of that offence.
(2) In this section “United Kingdom national” means an individual who is—
(a) a British citizen, a British overseas territories citizen, a British National (Overseas) or a British Overseas citizen,
(b) a person who under the British Nationality Act 1981 is a British subject, or
(c) a British protected person within the meaning of that Act.”
(2) After section 20 of the Human Tissue (Scotland) Act 2006 insert—
“20A Offences under section 20 committed outside UK
(1) If—
(a) a person who is habitually resident in Scotland, or who is a UK national and not habitually resident in Northern Ireland, does an act outside the United Kingdom, and
(b) the act, if done in Scotland, would constitute an offence under section 20(1), and
(c) the part of the human body to which the act relates consists of or includes a human organ,
the person is guilty in Scotland of that offence.
(2) In this section “United Kingdom national” means an individual who is—
(a) a British citizen, a British overseas territories citizen, a British National (Overseas) or a British Overseas citizen,
(b) a person who under the British Nationality Act 1981 is a British subject, or
(c) a British protected person within the meaning of that Act.
(3) Where a person outside the United Kingdom commits an offence under section 20(1) the person may be prosecuted, tried and punished for the offence—
(a) in a sheriff court district in which the person is apprehended or in custody, or
(b) in a sheriff court district determined by the Lord Advocate, as if the offence had been committed in that district.
(4) Where subsection (3) applies, the offence is, for all purposes incidental to or consequential on the trial and punishment, deemed to have been committed in that district.
(5) In this section “sheriff court district” is to be construed in accordance with section 307(1) of the Criminal Procedure (Scotland) Act 1995 (interpretation).”

[Lord Kamall (Con)]

I have already spoken to Motion K—more than once. I beg to move.

Motion K agreed.

Moved by

[Lord Kamall]

That this House do not insist on its Amendment 90 and do agree with the Commons in their Amendment 90A in lieu.

90A: Page 127, line 39, at end insert the following new Clause—
“Review into disputes relating to treatment of critically ill children
(1) The Secretary of State must arrange for the carrying out of a review into the causes of disputes between (on the one hand) persons with parental responsibility for a critically ill child and (on the other) persons responsible for the provision of care or medical treatment for the child as part of the health service in England.
(2) The Secretary of State must publish and lay before Parliament a report on the outcome of the review, within one year beginning with the date on which this section comes into force.
(3) In this section—
“child” means a person aged under 18;
“health service in England” means the health service continued under section 1(1) of the National health Service Act 2006;
“parental responsibility” has the meaning given by section 3 of the Children Act 1989.”

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Moved by

[Lord Kamall]

That this House do agree with the Commons in their Amendment 91A as an amendment to Lords Amendment 91.

91A: Line 2, leave out subsections (1) to (6) and insert—
“(1) The Health and Social Care Act 2008 is amended in accordance with subsections (2) to (6).
(2) In section 20 (regulation of regulated activities), after subsection (5) insert—
“(5ZA) Regulations under this section must require service providers to ensure that each person working for the purpose of the regulated activities carried on by them receives training on learning disability and autism which is appropriate to the person’s role.”
(3) After subsection (5C) (as inserted by section 145) insert—
“(5D) In subsection (5ZA)—
“learning disability” has the meaning given by section 1(4) of the Mental Health Act 1983;
“service provider” means a person registered under this Chapter as a service provider in respect of a regulated activity.”
(4) After section 21 insert—
“21A Learning disability and autism training: code of practice
(1) The Secretary of State must issue a code of practice about compliance with requirements imposed by virtue of section 20(5ZA) (requirements relating to training on learning disability and autism).
(2) The code must make provision about—
(a) the content of training; (b) training appropriate to different roles;
(c) circumstances in which it is appropriate for training to be delivered in person;
(d) the involvement of people with learning disability, autistic people, or their carers, in the provision of training;
(e) accreditation of training;
(f) procurement of training;
(g) monitoring and evaluation of the impact of training;
(3) The code may make different provision for different cases or circumstances.
(4) The Secretary of State must, at least once every five years—
(a) review the code, and
(b) lay before Parliament a report setting out the findings of the review.”
(5) In section 22 (consultation in relation to code of practice under section 21)—
(a) for the heading substitute “Codes of practice: consultation and Parliamentary scrutiny”;
(b) in subsection (1), after “21” insert “or 21A”;
(c) in subsection (2), after “21” insert “or 21A”;
(d) in subsection (3), after “(2)” insert “in relation to a draft of a code or revised code under section 21”; (e) after subsection (5) insert—
“(5A) Where, following consultation under subsection (1) or (2) in relation to a draft of a code or revised code under section 21A, the Secretary of State decides to proceed with the draft (in its original form or with modifications), the Secretary of State must lay a copy of the draft before Parliament.
(5B) The Secretary of State may not issue the code or revised code if, within the 40-day period, either House of Parliament resolves not to approve it.
(5C) In this section “40-day period” means—
(a) the period of 40 days beginning with the day on which the draft is laid before Parliament, or
(b) if the draft is not laid before each House on the same day, the period of 40 days beginning with the later of the days on which it is laid before Parliament.
(5D) For the purposes of subsection (5C), no account is to be taken of any whole days that fall within a period during which—
(a) Parliament is dissolved or prorogued, or
(b) either House of Parliament is adjourned for more than four days.”
(6) In section 25 (effect of code under section 21 and guidance under section 23)—
(a) in the heading, after “s. 21” insert “or 21A”;
(b) in subsection (1), for “A code of practice under section 21” substitute “Codes of practice under sections 21 and 21A”;
(c) in subsection (2),
(i) for “A code of practice under section 21 or” substitute “Codes of practice under sections 21 and 21A and”;
(ii) for “is” substitute “are”;
(d) in subsection (3), after “21” insert “or 21A”.
(7) Until the first regulations made by virtue of section 20(5ZA) of the Health and Social Care Act 2008 (as inserted by subsection (2)) come into force—
(a) the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (S.I. 2014/2936) (“the 2014 regulations”), and
(b) the Health and Social Care Act 2008, are to be read as if regulation 18 of the 2014 regulations contained such requirements.”

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Moved by

[Lord Kamall]

That this House do not insist on its Amendment 92 and do agree with the Commons in their Amendment 92A in lieu.

92A: Page 127, line 39, at end insert the following new Clause—
“Early medical termination of pregnancy
(1) Section 1 of the Abortion Act 1967 is amended as follows.
(2) In subsection (3), for “subsection” substitute “subsections (3B) to”.
(3) In subsection (3A)—
(a) the words from “includes” to the end become paragraph (a);
(b) after that paragraph insert—
“(b) is not limited by subsections (3C) and (3D).”
(4) After subsection (3A) insert—
“(3B) Subsections (3C) and (3D) apply where—
(a) the treatment referred to in subsection (3) consists of the prescription and administration of medicine, and
(b) the registered medical practitioner terminating the pregnancy is of the opinion, formed in good faith, that, if the medicine is administered in accordance with their instructions, the pregnancy will not exceed ten weeks at the time when the medicine is administered (or in the case of a course of medicine, when the first medicine in the course is administered).
(3C) If the usual place of residence of the registered medical practitioner terminating the pregnancy is in England or Wales, the medicine may be prescribed from that place by the registered medical practitioner.
(3D) If the pregnant woman’s usual place of residence is in England or Wales and she has had a consultation (in person, by telephone or by electronic means) with a registered medical practitioner, registered nurse or registered midwife about the termination of the pregnancy, the medicine may be self-administered by the pregnant woman at that place.””

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Moved by

[Lord Kamall]

That this House do not insist on its Amendment 95 and do agree with the Commons in their Amendment 95A in lieu.

95A: Clause 150, page 112, line 27, leave out paragraphs (c) and (d) and insert—
“(c) for subsection (4) substitute—
“(4) A statutory instrument containing regulations under this Act may not be made by the Secretary of State unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.”;
(d) omit subsection (5);
(e) after subsection (5) insert—
“(5A) Regulations made by the Scottish Ministers under section 2A are subject to the affirmative procedure (see Part 2 of the Interpretation and Legislative Reform (Scotland) Act 2010 (asp 10)).
(5B) A statutory instrument containing regulations under section 2A may not be made by the Welsh Ministers unless a draft of the instrument has been laid before and approved by a resolution of Senedd Cymru.
(5C) Regulations may not be made by a Northern Ireland department under section 2A unless a draft of the regulations has been laid before and approved by a resolution of the Northern Ireland Assembly.””

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Moved by

[Lord Kamall]

That this House do not insist on its Amendment 105 and do agree with the Commons in their Amendment 105A in lieu.

105A: Schedule 2, page 137, line 41 at end insert—
“(5A) The chair must exercise the approval function mentioned in subparagraph (1)(b) with a view to ensuring that at least one of the ordinary members has knowledge and experience in connection with services relating to the prevention, diagnosis and treatment of mental illness.”