Healthcare (International Arrangements) Bill

Debate between Lord O'Shaughnessy and Baroness Andrews

Committee: 1st sitting (Hansard): House of Lords
Tuesday 19th February 2019 Lords Chamber

[Lord O’Shaughnessy]

That is a separate issue. As I said at the beginning, the issue here is actually in two parts. The first is whether we ought to use the new legislation to strike deals with a subset of countries, those with which we already have reciprocal deals through our membership of the EU, or to strike broader ones. The secondary question is: what ought to be the correct process for Parliament to provide scrutiny of the kind of deals that are set up, either to provide continuity with the ones that we have under the EU or with new partners? Those are different questions. It is up to this Committee to make its decision about what it feels is the appropriate route to go forward, but it is important to expose that those are different and separate questions and we ought to consider them as such.

Perhaps I may respond to the point made by the noble Baroness, Lady Andrews, and others about trade. It is absolutely not the case that this is some Trojan horse for privatisation of the NHS, as the noble Lord, Lord Brooke, said, or anything else. My noble friend the Minister made that completely clear in her letter, as I used to in the letters that I once sent the noble Lord as well. Consider this: one of the reasons that we have deep reciprocal healthcare agreements with EU countries is due to the fact that we are part of a large trading bloc called the European Union. It is perfectly normal for partners engaged in economic, social, cultural, scientific and other activities to have these kind of agreements, partly because they facilitate the movement of people from one to another, whether on holiday or for work and other things.

I would hope, regardless of whether we were leaving the European Union or not, that we would want to have these kind of agreements with our partner countries throughout the world. Regardless of one’s views on Brexit, we ought to want to do that. It is not something that we have the legal basis to do at the moment and the Bill gives us that. I want to correct the impression given by the noble Baroness, Lady Andrews, which I do not think is fair, that this is somehow a Trojan horse for some sort of nefarious agenda. That is absolutely not the case; it is about taking a broader view of the kind of relationships that we currently enjoy with the EU and want to enjoy with other countries, whether they are Commonwealth partners or the overseas territories and Crown dependencies noted by my noble friend Lord Ribeiro.

I hope that I have described clearly what I believe the intent is in this regard. It is absolutely noble and will facilitate the broader movement of people throughout the world.

[Baroness Andrews]

I take the noble Lord’s personal assurances on that. Who could disagree with what he has just said about the need to have these sorts of vigorous, expansive and generous trading arrangements, which we hope will involve skills, health and knowledge? My question is really: why are these powers in this Bill? If they are necessary and within our reach, why can we not have them in an appropriate Bill with appropriate powers, which we can all be certain will not be exploited and lead to perverse consequences?

[Lord O’Shaughnessy]

I take the noble Baroness’s point but the critical thing here is that the powers set out in the Bill are constrained by giving effect to healthcare agreements, which themselves sit under the aegis of the creation of international agreements. My noble friend’s letter set out how the entire so-called CRaG arrangements govern how they ought to be approved. To satisfy my noble friend Lord Cormack’s concern, it is simply not the case that this Bill could be used unilaterally to fund the healthcare of the people of Venezuela, which might be a concern of the leaders of the Labour Party, as he pointed out.

NHS and Social Care Services: Parity of Esteem

Debate between Lord O'Shaughnessy and Baroness Andrews

Thursday 5th July 2018 Lords Chamber

[Lord O’Shaughnessy]

I am concerned to hear the story that the noble Earl has raised: I am sure that he will write to me with specific details. We know that at the moment only 25% of people with a mental health problem are seen. That needs to rise. We want to get that up to 33%, but clearly that is not enough. To do that we need more staff at every level. We have committed to training another 21,000 mental health workers to provide exactly the kind of leadership and support that he describes.

[Baroness Andrews (Lab)]

Is the noble Lord aware that on 4 July 1948, on the eve of the creation of the National Health Service, Aneurin Bevan also said that the NHS was the highest expression of moral leadership? Does he agree that we now need an equally high expression of political moral leadership? The fundamental of that is to tell the truth about the funding challenges facing the NHS, whether they are in manpower or in innovation and drugs. Does he agree, therefore, with the Prime Minister that there will be a Brexit dividend? How much is it going to be and where is it likely to be accounted?

[Lord O’Shaughnessy]

I agree with the noble Baroness about the need for leadership and I think the Prime Minister has shown that leadership. Despite the many challenges that we face at the moment as a country and have done for many years, she has committed to a five-year funding settlement worth more than £20 billion extra in real terms by 2023-24. That is an admission that there are funding challenges, not just in the NHS and social care, and of course one of the ways that that will be funded will be through our not paying subscriptions to the European Union any more.

South East Coast Ambulance Service

Debate between Lord O'Shaughnessy and Baroness Andrews

Wednesday 1st November 2017 Lords Chamber

[Lord O'Shaughnessy]

I would have liked to have given data at the level that the noble Baroness asked for but it is not available in a way that has been centrally assured by NHS England. I have a responsibility to provide good-quality, verified data, and I hope she will understand that. However, the bigger point, with which I do not disagree, is that this is the worst-performing ambulance trust in the country, and that is the case whether you look at calls data or performance standards for call-outs. The question, as she rightly points out, is what you do about it. The CQC rated the service as inadequate about a year ago and has just followed up. Unfortunately, it is still inadequate, although the CQC says that some progress has been made. About half a million pounds of special measures funding has gone in. A new CEO has been in place since spring this year, and the local sustainability and transformation partnership has asked the ambulance trust for a business-case bid for transformatory funding. Therefore, I realise that this is playing catch-up, because clearly the level of service is not good enough. I understand that the latest data month on month—that is, September compared with July—shows some improvement since bottoming out in July, but I agree with the noble Baroness that it has a long way to go.

[Baroness Andrews (Lab)]

How many ambulances are there across East Sussex and West Sussex at the moment compared with five and 10 years ago? If it is difficult to collect that information centrally, can the Minister make efforts to make it available to us in some other way? I ask that because I had reason to be involved with the ambulance service earlier this year. There is a terrific amount of stress and pressure on paramedics, although they do the very best they can. I would also like to know how many paramedics there are in the service compared with five and 10 years ago. After two years of special measures, it is really worrying that this trust is failing on basic issues of patient safety and response times.

[Lord O'Shaughnessy]

I do not disagree with the noble Baroness. I do not have the specific data on the number of ambulances in that area but I can tell her that the paramedic workforce in that particular ambulance trust increased from 635 in May 2010 to 992 in July 2017. So there are more people, but there is a huge growth in demand, which they have to meet. However, the truth is that there are other ambulance trusts all over the country that do a much better job with similar resources. Therefore, as much as anything, it is a question of leadership and management, and that is part of the special measures process.