Health and Care Bill

Lord Mackay of Clashfern Excerpts

Lords Hansard - Part 2 & Committee stage
Tuesday 18th January 2022 Lords Chamber

Against that background, I hope that I have said enough to persuade my noble friend to move her amendment when the time comes for it to be called and to persuade the noble Lords, Lord Hunt and Lord Clement-Jones, not to press theirs.

[Lord Mackay of Clashfern (Con)]

My Lords, the Minister is much in agreement with others that the leadership being enthusiastic for progress is important. I understand that nominations have already been made for the various positions that are likely to come up. To what extent has enthusiasm for digital transformation been a criterion in nominating those people? It is vital that the leader really believes in what is to happen if it is to happen at all. Therefore, it would be useful to know to what extent that consideration has applied in the prospective nominations of people for the local positions.

[Earl Howe (Con)]

Noble Lords will remember that, even 10 years ago, when I was appointed as a Health Minister, there was an acronym, QIPP, which stood for “quality, innovation, productivity and prevention”. While I think the acronym has largely fallen out of use, those four principles remain alive and kicking in the strategic thinking that happens at the top of the health service, and indeed in the department.

--- Later in debate ---

I remember that, back in the dim distant days when I was director of the association, and even when I was a community health council member 10 years earlier than that, 45 years ago, it was often the local community health council representative sitting there at meetings with the professionals and managers, all of whom speak their own language, which is rather different from that of the patients. They were being told things about the way in which the local service was operating and being delivered at the local level, which they would not have heard otherwise. That is why, at the centre of our deliberations, at both local and national level, the patient voice must be heard and properly supported and resourced.

[Lord Mackay of Clashfern (Con)]

My Lords, I strongly support that. It seems to me that the National Health Service is devoted to looking after patients. Therefore, it is very strange that there is no national voice for patients to speak to it. In a way, Healthwatch England fulfils that—but in a very awkward position.

I do not know exactly the relationship within the constitution of the committee and the CQC. For example, it may be important that knowledge that Healthwatch has goes to the CQC, but it must be much better for it to be independent at every level, national and local, and to not take part in any of the particular arrangements but rather independently give the pure voice of the patients, which it has received, as it were, from the people who have been served by the National Health Service, whether that is complimentary or otherwise, according to what has actually happened. That seems to me to be essential. I cannot think that it is effective to have a National Health Service with no voice to be heard at the centre from the patients.

[Baroness Walmsley (LD)]

My Lords, I quite often buy things online and, a few days after the product has arrived, I often get an email saying, “How did we do? Give us one, two, three, four or five stars.” That can be very irritating, and I suspect that, on the whole, people do not respond, unless the service has either been dreadful or brilliant—that is certainly so in my case. The voice of the patient is far more important than that and, if we are to assess the performance of different ICSs, the voice of the patient is absolutely fundamental to gathering the evidence, using which we can compare their performance.

A few years ago, I had to be in hospital, just for a few days. At the end of my treatment, when I was about to go home, I was handed a little slip of paper. I do not know if they still do this, but it had some kind of snappy title like, “Tell us how we did”. I thought it was totally inadequate, because here was I, as a patient, having had a general anaesthetic, feeling a bit wobbly, but crucially, having had only the experience of that particular treatment in that particular hospital. The beauty of Healthwatch is that it can compare the experience of patients, heard directly from those patients, of a lot of different treatments in different settings. It can bring together the voice of the patient and—absolutely crucially—it has the ear of the people who deliver those services and can authoritatively explain to them where they are doing well and where they are doing badly.

In this group of amendments, the noble Lord, Lord Hunt, and others have got it right in their suggestions about the level at which Healthwatch should have a voice: non-voting membership of the ICB, voting membership of the ICP and, crucially, independence from the CQC. The noble Lord, Lord Harris, put it very well: how on earth could Healthwatch criticise the CQC as the regulator if it is part of it? It is a little bit like asking a civil servant to criticise the Prime Minister, is it not? The noble Lord, Lord Hunt, and others who have spoken have got the level right at which Healthwatch should play its part in this great new world of integrated services. The view of the patient of the experience that they received at the hands of all the health and care services is absolutely crucial to being able to compare the performance of these bodies that we are setting up.

Procedure and Privileges

Lord Mackay of Clashfern Excerpts

Tuesday 13th July 2021 Lords Chamber

[Lord Mackay of Clashfern (Con)]

My Lords, it is a great privilege to speak after the noble Lord, Lord Blunkett, whose career I have followed with great interest for many years. I wish him continued attendance in the House; he is always welcome.

I begin by thanking the Leader of the House and all those who have been concerned with helping us during this pandemic to reasonably participate in the responsibility of helping the Government to get through legislation that is satisfactory and attempting to stop legislation that we do not always consider to be completely satisfactory. In the period of tremendous trouble that we have just come through, which has not necessarily finished, we have been able to do what I regard as a pretty good job.

Before I speak briefly about the three amendments, I want to say that I very much support the need for disabled people to be able to participate as much as possible in the affairs of this House. I regard their point of view, which I have considerable experience of hearing, to be extremely valuable in deciding not only what is relevant for disabled people but other matters where they have a special point of view.

I join the noble Lord, Lord Adonis, in mentioning the leaders, and I would like to add the Lord Bishops as another group that has been extremely helpful when participating in the previous time.

I must say that I am fairly attracted to the argument of the noble Lord, Lord Adonis, but it has been fundamental that this is a part-time House that includes people who have full-time work. From the House’s point of view, the value of that is that they bring expertise to legislation in particular but also to other aspects of the House’s business. Therefore, the times at which we start is a very balanced question. I came from Edinburgh this morning, so it is not all that difficult, but it does require a fairly early start.

On the second point, made by my noble friend Lord Cormack, I agree with my noble friend Lord Balfe that Question Time before the pandemic was not always the most dignified aspect of the House’s activities. Not many of us worked on the assumption that one should in honour prefer one another. It is important that Question Time is more organised than it was, and the idea of having a list is satisfactory in that respect. But it may be wise to reduce the total time allowed for the listed questions in order to enable the asking of supplementary questions that may arise, to be dealt with at the discretion of the Lord Speaker or whoever is on the Woolsack. We have experience of listening to Question Time when the Minister’s Answer, short as it may be, does not always fully meet the point that the main Question has put, and an opportunity to raise that kind of question would be rather useful. In the vote that has been referred to, I voted to have the list, but there was no option to vote for something such as that—but I did take the opportunity to make that point in discussion after the vote.

It seems to me that voting is now a matter of some importance. We should be willing to give our attention, if we can, to being here to vote, and the restriction on voting is satisfactory. On the other hand, those who are disabled should be exempt.

I have overstayed my time and I would like to conclude.

His Royal Highness The Prince Philip, Duke of Edinburgh

Lord Mackay of Clashfern Excerpts

Monday 12th April 2021 Lords Chamber

[Lord Mackay of Clashfern (Con) [V]]

My Lords, it is with profound and humble sympathy that I express my sympathy for Her Majesty the Queen, in her tremendous loss, as she approaches her birthday. I also wish to convey my similar sympathy to all the rest of the family. I believe each one—the whole family—has suffered a tremendous loss.

It was my privilege to meet the late Duke, when I was the Dean of the Faculty of Advocates and he was a member of the faculty, in 1978. On behalf of my wife and myself, I would like to say how thankful I am for all the kindnesses that he showed us since then—tremendous kindnesses in many different ways. It is just possible for me to say something about one or two of these.

The first is that he was a person who delighted in trying to help and see that all was right, and I found that that repeatedly happened in our meetings together. It is also a source of great pride to me that the Duke was called the Duke of Edinburgh, because that is where I was born, and it makes it a very worthwhile place. There are many other things that make it worth while too, but he is a very worthwhile person to have emerged with that title. The Duke of Edinburgh made it clear to us that he wanted to help in any way that he could, and we certainly found that. When I was Lord Chancellor, we had the privilege of seeing him quite often, and my wife had the privilege of taking his arm into a dinner for a foreign sovereign.

It is also important to remember the number of different societies to which he was connected, some of which I have some connection to. The first was the Royal Society of Edinburgh; he usually presented the royal medals, until he retired and Prince William took over that function. He was also in the service of Trinity House as master for many years and was chancellor of the University of Cambridge. It was very interesting for me to know that he was particularly interested in science during his time as chancellor of the University of Cambridge, as has been said several times. He sometimes found matters being discussed in science that were of value to Trinity House, so he took them over from one of his functions to another. I am extremely glad that the Princess Royal has succeeded him as master of Trinity House. It shows his connection with the Navy—which the noble and gallant Lord, Lord Boyce, referred to—as a very important aspect of the matters that Trinity House has to deal with.

The nature of his work across the world has been tremendous and in many ways it has been acknowledged only more fully—not yet fully—for the first time since his death. It was a great shock and a great sadness, and we are very thankful that he gave us so much in the course of his life, which we hope we used in the way in which he would have wished.

Business of the House

Lord Mackay of Clashfern Excerpts

Wednesday 4th September 2019 Lords Chamber

[Lord Mackay of Clashfern (Con)]

My Lords, it is worth noting that the House of Commons has passed the Bill by a majority of 29, according to my BBC announcement.

[Baroness Smith of Basildon]

Second Reading of the Bill has passed.

Business of the House

Lord Mackay of Clashfern Excerpts

Thursday 4th April 2019 Lords Chamber

[Lord Mackay of Clashfern (Con)]

My Lords, I understand that the European Union has made it clear that, for an extension to be granted, it must know the reason for it. I would have been much happier with a decision in the House of Commons—not necessarily through this sort of procedure—that told the Prime Minister, by agreement, what it wanted to give as the reason. This is a fundamental part of the Bill. It is asking the Prime Minister to go and ask for an extension without specifying the reason to be put forward. Surely if the House of Commons requires the Prime Minister to do that, the minimum it should do is give an instruction as to the basis on which it wants that. However, for reasons I do not completely understand, we are in this position.

It is worth remembering that the European Union said at the beginning of these negotiations, described so eloquently by the noble Lord, Lord Owen, that it was determined to agree the withdrawal agreement before any substantial discussion about the future. Therefore, it is now urgent to agree the withdrawal agreement. The Prime Minister’s agreement with the European Union has come before the House of Commons a number of times, yet, as far as I know, no amendment to it has been proposed. Surely if we are dealing with the withdrawal agreement, it is important that what is wrong with the Prime Minister’s one, in the eyes of the House of Commons, is made clear in an amendment to it. Of course, the European Union says that it will not agree to such an amendment, but if the option is a no-deal departure instead of an agreed departure, the European Union might well prefer a revised agreement. I do not know whether that is the case—needless to say, I am not party to these negotiations. I do not intend to be here all night either.

I am trying to understand what is going on. I believe that we need to concentrate on the withdrawal agreement. Nearly all the discussions in the House of Commons, so far as I have been able to follow them—they are quite detailed—have been about the future relationship. One problem is the provision in the present agreement about the future arrangement in the shape of the Irish backstop. It seems to me that that should not strictly be part of the withdrawal agreement, but part of the arrangements for the future. That is a possible amendment to the Prime Minister’s deal that might be of some interest.

[Lord Forsyth of Drumlean]

I am most grateful to my noble and learned friend. The House of Commons passed a Motion saying that the agreement should be amended to replace the backstop. That is what the House of Commons decided but, unfortunately, the Government do not appear to have asked the European Union to do that.

[Lord Mackay of Clashfern]

I understand that. To ask to amend the agreement is one thing, but to tell them the specific alteration is another. I am very familiar with that particular Motion, which passed. The point that I am trying to make is that if you want to change a document, you should propose the amendment you have in mind. The amendment tabled—very wisely, if we wanted to get some agreement—did not do that. All it said was that we must get alternative arrangements. What alternative arrangements are likely to be suitable? This point seems very important.

[Lord Hamilton of Epsom (Con)]

Has the EU not made it absolutely clear that it is impossible to reopen the agreement?

[Lord Mackay of Clashfern]

That is what it says, but why should we accept that? It is supposed to be a negotiation. If we wanted an alternative arrangement, I should have thought that the position should be us saying what that alternative is. I have heard, “We don’t know what the UK wants”, again and again. A specific amendment to the agreement might well be subject to further consideration.

[Lord Pannick (CB)]

My Lords, the House of Commons sent us a Bill that its Members consider urgent. We should get on and consider its merits and demerits. Forty-nine noble Lords have put their names down for Second Reading, including the noble Lord, Lord Forsyth. There will be ample time during Second Reading for all these points to be explored. I suggest that we get on and do it.

Leaving the European Union

Lord Mackay of Clashfern Excerpts

Monday 21st January 2019 Lords Chamber

[Baroness Evans of Bowes Park]

Clearly, the exchange of letters between the Government and the EU last week did not provide the assurances that we hoped for but I reinforce the point that those letters have legal force, as a matter of international law. The letters must be considered when interpreting the agreement, including during arbitration. We are determined to deliver on our commitment to the people of Northern Ireland that there will be no hard border, but there needs to be a mechanism in place to deliver that. It was clear from last week’s debate and vote that concerns remain about what assurances the Prime Minister has managed to achieve so far. That is why a key part of the conversations that will be had over the coming week will be to focus on what reassurance Members across the House need to support a deal that can ensure a strong relationship with the EU.

[Lord Mackay of Clashfern (Con)]

Is there any suggestion of some other solution to the Irish border than what has already been achieved? Unless there is some pretty fundamental proposal to deal with this matter, it is quite hard to see how that opposition in the House of Commons can be overcome. I understood that it was that matter which really produced the result that it did there. It therefore seems that that particular question, which has been there from the beginning, requires a solution. I would like to know whether any of the people who have been invited to Downing Street—I saw quite a number going in, one way or another—have produced a solution different from that which the Prime Minister has already proposed.

[Baroness Evans of Bowes Park]

As my noble and learned friend will know, neither the EU nor the UK wishes to use the backstop. We have already set out a number of other mechanisms that could be used if a deal is not completed by December 2020, as we believe it will be; for instance, extending the implementation period or looking at facilities for technology. There are other options but, in relation to the backstop itself, the assurances that the Prime Minister brought back from her conversations with the EU did not satisfy Members across the House so we are continuing to work on that. The Prime Minister is focused on solutions and she is interested in the ideas of others but, of course, we have to make sure that whatever we take to the EU is something that it will ultimately be able to agree with.

Leaving the European Union

Lord Mackay of Clashfern Excerpts

Monday 14th January 2019 Lords Chamber

[Lord Mackay of Clashfern (Con)]

My Lords, a hard border is defined as a situation where the conditions for going one way are different from the conditions for going the other way. That can happen without anybody wanting it if they wish to have different conditions. Therefore, the point of this is to ensure that future arrangements at the Irish border will be such that the conditions are the same whether you are going from north to south or from south to north.

[Baroness Evans of Bowes Park]

I agree entirely with my noble and learned friend. We do not want a hard border between Ireland and Northern Ireland, which is why we urge MPs to support the deal.

Brexit: Withdrawal Agreement and Political Declaration

Lord Mackay of Clashfern Excerpts

Wednesday 5th December 2018 Lords Chamber

[Lord Mackay of Clashfern (Con)]

My Lords, it is a privilege to follow the most reverend Primate the Archbishop of Canterbury. I feel the responsibility of that and appreciate what he said.

The Prime Minister has been criticised for the so-called red lines. I think these were very reasonable attempts to focus on what the referendum had done and to try to follow through on the intention of those who had voted in the majority. Therefore, as far as I am concerned the Prime Minister is seeking to implement the recommendation—the advice—she got in the referendum. It is against that background that one has to evaluate what has happened. The advisory time is seven minutes, and I am determined to keep to that. Therefore, I shall be selective in what I talk about, because I could easily go on for much longer.

When I was appointed Lord Chancellor in 1987, one of my responsibilities was the nomination of judges in Northern Ireland and the political supervision of the court system there. Shortly before my appointment, a Lord Justice had been blown up after crossing the great boundary between Northern Ireland and Ireland; the Lord Chief Justice had been shot at; and a Lord Justice’s wife had come home from shopping to find a note on the kitchen table saying, “Get out quickly, because the place is going to be blown up”. She did get out quickly and her home was blown up. So the dangers facing the judiciary of Northern Ireland then were very severe, and it is extraordinary how they were able to live in those surroundings.

The peace and security of Northern Ireland are very much an issue in my life, and I will do everything I possibly can to defend them. The Belfast agreement, and all that followed it, is a wonderful step forward, and the situation in Northern Ireland is now, happily, very different from when I took office. But it is not perfect, and we need to be careful to secure what has happened.

The peace and prosperity of Northern Ireland is not a temporary matter. I would like it to last as long as possible. The steps taken to secure it should therefore also be permanent. Others in this House who had political responsibilities in Northern Ireland agree that the only way to secure a soft border or eliminate a hard border is to apply pretty similar customs rules on both sides of the border. That is the purpose of the backstop.

The backstop will be permanent if it is necessary for it to be permanent. I can see no way out of that if you like the peace and prosperity of Northern Ireland—as I said, I certainly do. The necessity for the backstop to be permanent is obvious, unless and until the conditions are satisfied in which it can be changed. One of those conditions is the agreement of a new customs arrangement between the United Kingdom and the EU. That is one objective of the agreement that has been reached.

The withdrawal agreement is a binding legal agreement. The political proposal is not binding in that sense, but it is the agenda for an agreement. The agreement will be enforced by the law of the United Kingdom, as well as by the law of the EU. My view of these documents—and I was glad that Mr Trump was able to give a view on them, having read the whole lot very quickly—is that they are well written but complicated. As legal documents go, they are readable for those who have not been burdened by being lawyers. The agreement requires that the treaty that follows on the political agenda will be brought into force with the best endeavours of the two sides. That is a legal requirement that can be enforced under the procedures in the withdrawal agreement.

The other day, the noble and learned Lord, Lord Goldsmith, asked what could be done on enforcement. He correctly pointed out that although it would not be an arbitration tribunal that fixed the new agreement, it would have the power to enforce the best endeavours provision. Therefore, I would expect the result to be a full treaty according to these provisions within the time allotted. My time allotted has finished.

Leaving the European Union

Lord Mackay of Clashfern Excerpts

Monday 26th November 2018 Lords Chamber

[Lord Mackay of Clashfern (Con)]

My Lords, on the second question, it seems to me that the Prime Minister is seeking to operate on the decision of the referendum. In other words, she is operating on the view that the people want to leave the European Union. Therefore, the second question is not appropriate. The question is: is it the best deal that can be obtained if we leave the European Union? I have a feeling that, if this deal is not accepted, the proper question will then be what to do next—and it is for Parliament to answer that question rather than for there to be a further period of delay and indecision, which will damage the livelihoods of so many of our fellow citizens who work in businesses that depend on trade with the European Union.

[Baroness Evans of Bowes Park]

My noble and learned friend is right, and the political declaration sets out a clear vision for our future relationship, covering an economic partnership, a security partnership and specific agreements on cross-cutting co-operation. It will deliver economic benefits and shows that, in our relationship with the EU, we are not just another third country. This will be the most ambitious free trade agreement that the EU has with any other country, and it will allow us to develop our own independent free trade policy to ensure that we remain a global Britain.

Salisbury Incident Update

Lord Mackay of Clashfern Excerpts

Monday 12th March 2018 Lords Chamber

[Baroness Evans of Bowes Park]

As the Statement made clear, we have asked the Russian ambassador to respond within 24 hours to the questions that we have put to him, and I do not think it is right for me to prejudge any of the responses. I have made clear that we will be returning to the House once those conversations have been had and a decision is made as to how to proceed on the basis of the information received.

[Lord Mackay of Clashfern (Con)]

My Lords, I read recently that the Russians complained that they had not been shown the evidence in relation to Litvinenko’s case. I hope it is possible to show them evidence this time that should convince them of the rightness of our conclusion, although that is of course subject to other aspects that I am not aware of. But I think we ought to do our best to convince them, if they are open to being convinced, that this is true.

[Baroness Evans of Bowes Park]

As the Statement set out, we have spoken to the Russian ambassador and set out, on the basis of the evidence that we have, what we believe the two possible explanations are for what happened in Salisbury, and we are waiting to hear their response.