Queen’s Speech

Lord Leigh of Hurley Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Leigh of Hurley (Con)]

My Lords, back to the economy.

We have been fortunate to date that the UK economy has outperformed expectations. Employment remains at a record high and unemployment, at 3.8%, is at a record low. Perhaps unsurprisingly, though, economic growth has been steady rather than spectacular, albeit better than many other countries in the EU and beyond. Given the Brexit backdrop, steady was okay but now we must raise our expectations and ambitions. While it is now right to borrow to invest in infrastructure, the debt-to-GDP target has been dropped and we are told that fiscal policy will be reviewed if debt interest exceeds 6% of national income. I would welcome the Minister’s comments on whether reducing net debt is still the Government’s target.

It is perhaps worth taking a moment to consider what might have been if people had not wisely returned a Conservative Government last month. Labour planned to meet economic uncertainty with policies that would have led to decline, recession, unemployment and capital flight. I am talking of course about the plans to nationalise swathes of private industry and pass the costs straight back to the taxpayer. Its plans to appropriate 10% of the equity of all public companies would have led to a complete and probably irreversible decline in our culture of enterprise. I heard this on the doorstep in the many constituencies in which I canvassed, so we have a responsibility to produce competent economic plans for the country.

I wish to draw your Lordships’ attention to my disclosed interests in the register at this point, as I would like to talk about the need to support more equity investment, rather than debt.

The market has once again been tempted by so-called “cov-lite” loans, almost to epidemic levels, and banks continue to support excessive levels of corporate debt which will surely yield higher levels of insolvency, non-performing loans and, once again, bad debts on the banks’ balance sheets. I have seen transactions with debt at 10 times profit levels completed by private equity houses. This is dangerous territory. Instead, we should look to do more to support equity investment. At the smaller end of the market, I very much hope that once we are outside the EU we will be able to lift restrictions on the enterprise investment scheme and venture capital trusts to support properly priced equity for growing businesses.

For listed companies, we need to look again at barriers to investing in terms of onerous corporate government requirements, disclosure and regulation. This is particularly true in the area I know, AIM. Among AIM-listed businesses, one finds some of the highest-growth-potential companies in the world. The market is unrivalled anywhere in the world, but it will not stay that way unless we continue to review and reduce regulation to make sure it is attractive for both investors and would-be listed businesses. Sadly, the number of companies on AIM is falling and it is all for the wrong reasons. The cash is out there, and the need exists. The Government must facilitate a market which functions more efficiently.

On a separate matter, I understand the manifesto pledge to “review” entrepreneurs’ relief to make sure it is not abused. However, let us recognise that this has become a foundation of our tax system that sends the clearest message to entrepreneurs who set up their business here that they can keep more of the wealth they create. Entrepreneurs I know have gone through their £10 million limit—good luck to them. Does reducing it send the right encouragement to start another business? I hope this will not be put at risk.

Finally, few issues concern business and citizens alike as much as skills and migration, and Brexit has brought this to the fore. The announcement of the national skills fund is welcome, but let us briefly consider the supply of doctors to the NHS. Can my noble friend the Health Minister confirm that, in 2019, 61% of doctors who took up jobs in the NHS had been trained abroad? These 12,000 people will not be easily replaced by the mere l,500 extra graduates to qualify in the five new medical schools, which will not come into play until 2025. In this country, there are large numbers of willing, able and suitable domestic A-level candidates who are desperate to study medicine in the UK. What urgent steps are planned to train more doctors here?

The circumstances we find ourselves in call for a legislative agenda that projects confidence and certainty, as well as a vision for the future of our economy and our country. This exciting and promising Queen’s Speech delivers a mixture of both, but it is only the beginning. We must make clear that, yes, we will deal with Brexit, but we will also ensure that this country realises the tremendous potential we have for a future outside the EU.

Organ Donation (Deemed Consent) Bill

Lord Leigh of Hurley Excerpts

2nd reading (Hansard): House of Lords
Friday 23rd November 2018 Lords Chamber

[Lord Leigh of Hurley (Con)]

My Lords, I join in the congratulation to the noble Lord, Lord Hunt of Kings Heath, on his promotion of this Private Member’s Bill. This is of course a very difficult and sensitive subject. First, one must recognise the importance, for those awaiting transplants and their loved ones, of increasing the number of donors as much as we can. I note that the number of donors has been steadily increasing, both in absolute amounts and as a percentage, for the last 10 years—from 771 in England in 2008-09 to 1,349 in 2017-18—and this is of course very welcome.

I have no medical training whatever but I wish to draw your Lordships’ attention to my register of interests, which discloses that I am a vice-president of the Jewish Leadership Council and the president of Westminster synagogue. As such, speaking as a progressive rather than Orthodox Jew, I point out that, as some of your Lordships might be aware, as in many religions there are many strands within Judaism. The Orthodox community would probably be guided by the traditional biblical prohibitions against making any cuts to a body. The body is regarded as a holy vessel, because it has housed a soul created by God. The body therefore has to be honoured, as much as if it still contained a living person. However, I have discussed this matter directly with the Chief Rabbi, Ephraim Mirvis, and he believes that all Jews would temper that view by recognising that there is a higher value of saving a person’s life, and that that trumps all considerations.

Needless to say, every rabbi has a view and the old saying that for every two Jewish people you will find three opinions seems as valid in this field as any other. I am also a member of Hurley’s local synagogue in Maidenhead. The rabbi there, Dr Jonathan Romain, points out that there is the issue of personal autonomy and the fact that our body belongs to us, not to the Government or the NHS. So while it may be very worthy to donate organs after our death, we alone should make that choice. This was before he concluded that whatever the ethics of personal autonomy, and despite biblical objections to making cuts to the body, saving life is the highest objective.

Other rabbis, particularly Rabbi Sylvia Rothschild, point out that, ethically, for any medical procedure a person should be informed about and understand what is to happen, including any risks, and should consent explicitly to each procedure. That would not be possible with an opt-out system, which she encapsulates by pointing out that presumed consent would arrogate to the state rights that were hard won, including the right to own and make decisions about our bodies. The right reverend Prelate the Bishop of Carlisle pointed this out. But she goes on to say—and others make this point—that perhaps the better way to increase the number of organ donors, which I believe currently stands at 24.9 million, is to invest in educating the public to understand the importance of registering if they wish to be a donor.

I am, however, supportive of this Bill, mainly because of the letter that the Minister, Jackie Doyle-Price, wrote to the president of the Board of Deputies of British Jews on 25 October in which she stated that,

“organs and tissue will not be taken without full consultation with persons in a qualifying relationship”.

The Minister specifically stated in that letter:

“There will always be a personal discussion with the family and full consideration … given to the views of a person’s loved ones”.


I thank her for that clarification but it does of course raise certain questions. First, should not this commitment be in the legislation rather than a side letter? Secondly, if this is to be a requirement, do we need the Bill? If in every case there will be a consultation before organ donation, which the letter confirms will require organ donation staff to go to extensive and far-reaching lengths to speak to family members, the opt-out does not really seem to change that much—particularly as there is a commitment that if family members cannot be reached, organs will not be taken from the deceased. I understand and am reassured to know that NHS organ donor teams will in any event need to talk to families as a matter of best practice, to try to determine whether the deceased had any allergies, history of drug abuse or other medical issues.

Leaving my reservations aside, I look to the Minster to confirm today that the terms of this letter will be honoured in full. This commitment is very important; of course, it raises some unresolved issues. For example, some families, such as mine, are mixed. My mother is Orthodox and may have reservations about organ donations, while other family members do not share this view. How will a consensus be reached? If any one person has reservations, will there be a prohibition? It is very hard for someone to determine another person’s faith and ethical views, and rational analysis of what a person would want could be very difficult and stressful at a moment of grief. It is much easier if the deceased has chosen to donate organs by opt-in, but that may be impossible, in reality, if we move to an opt-out system. Accordingly, we need legal recognition of the organ donor register, which is not in the Bill. Indeed, recognition is needed of other first-hand wishes, like the codicil of a will, which frequently specifies such matters in addition to selecting preference on the nature of burial or cremation.

In conclusion, a person’s decision to donate their organs to save the life of another human being is a wonderful act of humanity which deserves the utmost respect and support. Giving the state the right to take those organs, and depriving individuals of the ability to do so as a gift, is a very big step for our society to take. It must therefore carry with it respect for people’s ethical and religious views. I personally would not stand in the way of this Bill, but seek at this Second Reading the assurance from the Minister that I have set out in my remarks.

Health: Online Services

Lord Leigh of Hurley Excerpts

Monday 23rd April 2018 Lords Chamber

[Lord O'Shaughnessy]

That is an excellent question. It is important to distinguish between the independent sector and the NHS. The CQC report was about the independent sector, so a patient would continue to be registered with their NHS GP practice and have an augmenting consultation, if you like. With GP at Hand, as it is an NHS practice, they would switch their registration. One issue that has come up is whether people have full enough information about that switching, which is one thing that NHS England is reviewing in the independent review that it has commissioned about the success or otherwise of that service.

[Lord Leigh of Hurley (Con)]

What steps are the Government taking to encourage people—I appreciate that they cannot force them—throughout the UK to use only online medical services which are registered with the CQC?

[Lord O'Shaughnessy]

This is of course the way the economy is going in general and is a great passion of the Secretary of State. Indeed, he made a commitment at the NHS Expo conference last year that, by the end of this year, every patient would have access to an NHS app online which will enable them to do things such as book consultations, see who has viewed their medical record and set their preferences about things such as blood and transplant donations. A huge stream of work is going on to ensure that those services are available to all patients in the NHS.

Mental Health Care: Vulnerable Children

Lord Leigh of Hurley Excerpts

Tuesday 28th November 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is right to highlight these disturbing facts about the mental health of looked-after children. Nearly 50% of looked-after children have a diagnosed mental health disorder, so that is what we are up against. In terms of how we are dealing with it, the increases in funding to raise the number of treatments that are taking place by 70,000 will obviously help vulnerable children, and there is the additional assessment that I have talked about. She asked particularly about children with learning difficulties. I am sure that she is aware of it, but I would point her and other noble Lords to the Lenehan review, which set out several recommendations, all of which the Government have adopted. One of the actions that stems from that includes new guidance from the Local Government Association and NHS England on commissioning mental health services for children with learning difficulties.

[Lord Leigh of Hurley (Con)]

Does my noble friend the Minister agree that we can take some comfort from, particularly, chapter 4 of the first phase of the CQC report, which was commissioned by the Prime Minister only in January this year? With 80% of specialist mental health care for children and young people being rated as good or outstanding, there is much, to quote the report,

“we should celebrate and learn from”

[Lord O'Shaughnessy]

My noble friend is right to highlight that overall the provision is good. There is still work to do, particularly in specialist community mental health services. Part of the strategy we are undertaking is to make sure that those services have the staff they need. There will be 21,000 more posts in mental health services to ensure that the average rating improves over time.

National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017

Lord Leigh of Hurley Excerpts

Thursday 16th November 2017 Lords Chamber

I hope that the Minister will be willing to think again, to look at the evidence and to hear the concerns. I hope that he will review the situation, look again at the guidance and realise that this is not a quick way of getting more money into the National Health Service.

[Lord Leigh of Hurley (Con)]

My Lords, the National Health Service is a cherished national institution, historically the envy of the world, and in theory none of us has a problem with overseas visitors using it. However, we currently have a huge issue of capacity. Unfortunately, it is not clear that we have the capacity to treat on the NHS all the overseas visitors that we would like to treat. Already the NHS is in breach of vital targets, such as waiting times for operations and to start treatment for cancer. Consequently, our cancer survival is the worst in western Europe, Canada and Australia. Only a few countries in eastern Europe have worse survival for common cancers.

We all love the National Health Service, so it is only right that anyone using our very valued NHS should make a fair financial contribution to help ensure its sustainability and the continued provision of world-class facilities—just as the British taxpayer does. Although I do not agree with the Motion, I am pleased that the noble Lord, Lord Hunt, tabled it, because it allows this House the opportunity to discuss matters relating to it, and the implementation.

I have no interest to declare, but I have been taking an interest in health tourism since I raised an Oral Question on this subject in March 2014, and we have seen great progress from the Government since then. Indeed, it was mentioned as an objective in my party’s manifesto. Over the past four years the Government have prioritised improved cost recovery, and as a result we have achieved more than ever before, with identified income for the NHS from overseas visitors quadrupling from £89 million to £360 million. All that income is, of course, directed back into front-line services. That sounds good. However, it should be recognised that £200 million of the £360 million comes from the immigration health surcharge, and in return 450,000 IHS visas are issued every year. Therefore, for £200 for immigrants and £150 for students—a subject that has been debated in this House—free NHS treatment is offered, without exclusion of pre-existing conditions, for nearly half a million people.

The regret Motion shows that the noble Lord, Lord Hunt, is concerned about racial profiling but, at the time of registration and to avoid any form of discrimination on arrival for a new hospital appointment, the same baseline question must be asked by an overseas visitor manager of every patient, in every department—using, according to the guidance, these exact words:

“Where have you lived in the last 6 months?”.


If the patient replies “In the UK only”, no further questions are asked regarding residency or immigration status. That is it. If the answer given is yes, there are to be no further questions. I fear that it will soon become common knowledge that, in the NHS, care is free to anyone who answers yes to this single baseline question.

This is spelled out in chapter 11, on page 88, of the Department of Health Guidance on Implementing the Overseas Visitor Charging Regulations. Furthermore, it clearly states at chapter 11.16:

“Administrative staff must avoid discrimination when asking these questions”.


Needless to say, vulnerable groups will be excluded from up-front charging. The guidance issued by the NHS specifically excludes asylum seekers, trafficked people and every other variety of vulnerable grouping. Furthermore, the guidance confirms that up-front charging will apply only to patients presenting for elective treatment. GP services and A&E are, of course, specifically excluded.

Health tourism is a huge issue. On 1 February 2016, my noble friend Lord Bates, the then Minister in this department, gave an estimate to the House that the cost to the NHS was some £2 billion. Possibly unlike the noble Lord, Lord Hunt of Kings Heath, I am pleased that the Government are now running 35 pilot schemes in 19 NHS trusts to ask patients for two forms of identification to show ordinary residence. Again, this is just for elective surgery, for which there is plenty of time to plan, not emergencies such as complicated pregnancies, where we have seen real evidence of people coming specifically to the UK and literally being taken to hospital from the airport for free—for them—using extremely expensive medical assistance. Needless to say, in Europe if one is unfortunate enough to have to go to hospital, anecdotal and other evidence says that the first thing the hospital asks is to look at your insurance or E111. Our system of state-funded and provided medicine has for too long been lax in properly obtaining payment where it is due.

The real issue we should be discussing is how inadequate we are in terms of OVMs. In September 2017, Professor Meirion Thomas, who has become the country’s expert in this area purely as a matter of public service, sent freedom of information requests to NHS trusts. He asked eight acute trusts in London, two acute trusts in Birmingham and eight acute trusts in Greater Manchester for details of their OVMs. The trusts in London and Birmingham do have OVMs, but a grossly inadequate number. I will not bore your Lordships’ House with the numbers but the proportions are frightening. However, in Manchester, the results are even worse. Only one trust—the Christie hospital—has an OVM, and I would be pleased to provide my noble friend the Minister with details, should he so wish. This research proves that the NHS is not prepared for new legislation: seven acute trusts in Manchester have no mechanism for up-front charging. Therefore, I am afraid that I cannot support this regret Motion. The question we have to ask at another time is not how up-front charging can work in terms of the Motion, but how we are going to implement this to ensure a fair playing field for those who pay for and deserve proper treatment.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, I thank all noble Lords who have contributed to the debate. While, as ever, I disagree with the Motion in the name of the noble Lord, Lord Hunt, I am grateful to him for raising the topic of cost recovery for the NHS from overseas visitors. It is a very important policy issue and it is crucial that the objectives of these regulations, and the safeguards that we have put in place, are discussed and understood by Members of the House.

In July this year, my department introduced amendment regulations to extend and improve the recovery of NHS costs from overseas visitors who are not ordinarily resident in the UK. This followed a period of public consultation in 2015-16. The Government’s response to that consultation, which set out our intentions, was published in February 2017.

Let me first be clear about the principles that sit behind our policy on cost recovery. As my noble friend Lord Leigh has said, the NHS is a cherished national institution. It is paid for by millions of British taxpayers, who care deeply about it being used fairly, so we must protect it carefully. Our country has always welcomed visitors and the NHS is no different, but I hope noble Lords also agree that it is only right that, when using its services, visitors should also make a fair financial contribution to the NHS’s sustainability. On that basis I welcome the support in principle of the noble Lord, Lord Hunt, and the noble Baroness, Lady Hamwee, for cost recovery. However, it would be wrong not to point out that, when specific proposals come forward, they seem less robust in offering that support.

This principle was not introduced by this Government; regulations and guidance requiring cost recovery from overseas visitors have been in place for over 30 years, as my noble friend Lady Redfern pointed out. As the number of visitors to the UK has grown over the years, the Government have supported the NHS to identify more income than ever before, quadrupling that income over four years to £360 million. The regulations we are discussing today continue this policy of seeking fair payment for NHS services provided and allow the NHS to take further action to support cost recovery in a way that is more efficient, more equitable and more effective.