Health and Care Bill

Lord Warner Excerpts

Lords Hansard - Part 2 & Report stage
Thursday 3rd March 2022 Lords Chamber

Briefly, Amendments 98B and 98C are intended to ensure that the unions are among the consultees on the likely impact of payment schemes. I am grateful to the noble Baroness, Lady Brinton, for her support for that proposal. The Minister sees no place for unions in setting the terms and conditions of external providers, so it is even more vital that trade union consultation is made an explicit requirement of the pricing process. This is particularly so given that the providers themselves are to be consulted on the prices they are to be offered—in stark contrast to the workers, under the current draft. I hope the Minister will agree to modify these provisions accordingly.

[Lord Warner (CB)]

My Lords, my Amendment 100 requires NHS England to

“conduct a public survey of whether patients have been offered choices about where they obtain treatment and must report to the Secretary of State what action they will take as a result of the survey.”

I am grateful for the support of the noble Lords, Lord Hunt and Lord Lansley, and the noble Baronesses, Lady Cumberlege and Lady Brinton.

Currently, there is no regular survey of whether patients are aware of their right to choose or of how many have exercised it. The last NHS England official survey of whether patients were aware of their choices was in 2015, when just 47% of those questioned said they were aware.

Waiting times vary enormously by geography. Knowing about the right to choose could mean a significant cut in the waiting time for treatment. For example, waiting times for orthopaedic care vary from 89 weeks in Bedfordshire Hospitals NHS Foundation Trust to 25 weeks in the relatively nearby Milton Keynes trust. Recent polling by the Royal College of Surgeons showed that 73% of patients questioned would willingly travel to a surgical hub which was not their local hospital if they could be treated more quickly.

There is no system for monitoring whether patient choice is working. Amendment 100 fills this gap and restores the situation to where it was before 2015. I hope the Minister will accept this simple amendment in the interests of patients.

[Baroness Jones of Moulsecoomb (GP)]

My Lords, I am implacably opposed to privatisation of the NHS—not for ideological reasons, although the Green Party is strongly opposed as well. I think it is inefficient. Privatisation has not worked. It has failed to deliver on promises to increase quality, decrease cost and help patients. Rather than save money through reduced bureaucracy, the main cost savings of privatisation seem to be in cutting the terms and conditions—chiefly the pay and pensions—of staff. If private companies can compete for public services, let them compete on a level playing field, rather than simply capturing staff and paying them less.

I am pleased that the noble Lord, Lord Lansley, explained his Amendment 98 because I had understood it completely the other way around—that he was protecting private services. I was going to have a word with him afterwards about it, but there is now no need.

As the noble Lord, Lord Hendy, just said, most people in Britain do not want a privatised NHS. They want a public service because that is what will give them the best results.

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Tabled by

[Lord Warner]

100: Clause 69, page 63, line 21, at end insert—
“6H Survey relating to patient choiceNHS England must annually conduct a public survey of whether patients have been offered choices about where they obtain treatment and must report to the Secretary of State what action they will take as a result of the survey.”

[Lord Warner (CB)]

I am grateful to the Minister for his reassurances on the issue of patient choice. I suggest that the arrangements that he outlined in his response to my amendment are not well known, even to those such as the Independent Healthcare Providers Network, so I wonder whether he might look at the arrangements for publicising that information. In the meantime, I shall not move my amendment.

Amendment 100 not moved.

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Moved by

[Lord Warner )]

112: After Clause 80, insert the following new Clause—
“PART 1AHEALTH AND CARE SUSTAINABILITYOffice for Health and Care Sustainability
(1) There is to be a body corporate, independent of the Government, called the Office for Health and Care Sustainability (“the Office”) to safeguard the long-term sustainability of an integrated health and adult social care system for England. (2) The Office must be established within six months of the passing of this Act and must publish a report of its initial findings relating to its main functions within a year of its establishment.(3) The role of the Office is to continually assess the outlook for the health and care system over the coming five, 10 and 15 years.(4) The Office has no function in operational or service delivery aspects of the health and care system.(5) The Office must—(a) monitor and publish data relating to demographic trends, disease profiles and the likely pace of change relating to future service demands,(b) assess the workforce and skills mix required to respond to those changes and publish regular reports on those matters, and(c) consider the stability of health and adult social care funding relative to changing demographic and disease trends, including the alignment between health and adult social care funding, and publish regular reports.(6) The functions of the Office are to be exercised on behalf of the Crown as if it was a public department.(7) The Office is to consist of—(a) an executive chair appointed by the Secretary of State with the consent of the Public Accounts and Health Select Committees of the House of Commons,(b) two other members appointed by the Secretary of State with the consent of the Public Accounts and Health Select Committees of the House of Commons, and(c) two other members nominated by the Office and appointed by the Secretary of State.(8) The initial appointments under subsection (7) are for a term of five years and no more than two terms may be served.(9) The remuneration of the executive chair is to be agreed by the Secretary of State but may not be less than that paid to the Permanent Secretary of the Department of Health and Social Care; and all other salaries and gratuities for members may be agreed by the Office with the consent of the Secretary of State for Health and Social Care.(10) The Office may employ staff on terms and remuneration consistent with that of the civil service.(11) The Office may—(a) establish such committees and sub-committees as it deems necessary,(b) determine its own procedures and those of its committees and sub-committees, and(c) do anything calculated to facilitate, or conducive or incidental to, the carrying out of any of its functions.(12) The annual budget of the Office is to be provided by the Secretary of State after consultation with the Public Accounts Committee of the House of Commons.(13) The Office must keep proper accounts and records in relation to its accounts, and must prepare and publish each year an audited statement of accounts.(14) The Office must prepare an initial report on its work within one year of its establishment, and thereafter annually, and may at any time publish a report on its functions when it considers that this assists safeguarding the long-term sustainability of an integrated health and adult social care system in England.(15) The Secretary of State must lay any report prepared by the Office before both Houses of Parliament.”Member’s explanatory statement
This amendment implements recommendations 33 and 34 of the 2017 report by the House of Lords Select Committee on the Long-term Sustainability of the NHS and Adult Social Care. It draws on the legislation setting up the Office for Budget Responsibility.

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[Lord Warner (CB)]

My Lords, Amendment 112 is my name and the names of the noble Lords, Lord Hunt, Lord Scriven and Lord Kakkar. I am grateful for their support. This amendment goes much wider in terms of independence from the Secretary of State than Amendment 80, moved so convincingly by the noble Baroness, Lady Cumberlege, earlier today.

Amendment 112 establishes a new body to help to secure the long-term sustainability of our health and care system. That body is an independent office for health and care sustainability as recommended by this House’s Select Committee on the Long-term Sustainability of the NHS and adult social care. This new body is based on the model of the Office for Budget Responsibility. That body is widely accepted as having worked well over a number of years. My amendment draws heavily on the 2011 legislation setting up the OBR.

The new office of health and care sustainability has three main functions which are set out clearly in the amendment, so in the interests of time I will not repeat them. The new body would look five to 10 to 15 years ahead and publish regular reports which would be laid before both Houses of Parliament. It would produce an initial baseline report within a year of its establishment. Like the OBR, the new body would have an executive chair and five members. The chair and two members would be appointed by the Health Secretary but—and this is a very big but—with the consent of the House of Commons’ Public Accounts Committee and Health and Social Care Committee. The remaining two members would be chosen by the office itself. Like the OBR, the new body would not have a membership controlled by Ministers.

The new office of health and care sustainability would be much more independent of the Secretary of State than is provided for in Amendment 80. It would have a much wider remit in terms of improving the balance between the NHS and social care, on both staffing and funding. The greater long-term independence seems essential given that the Department of Health—now the Department of Health and Social Care—has a political and official track record which was revealed to the Lords Select Committee as pretty unsatisfactory.

The Department of Health has been failing to plan for the future for a very long time. The evidence given by its Permanent Secretary totally failed to convince the Select Committee that it took long-term planning seriously. That Permanent Secretary is still in place. I do not like personal attacks, but in evidence to the Select Committee this person actually said that he did not see long-term planning as part of his job description. So we have a situation where the long-term planning of the NHS and social care is simply not on the agenda of the government department responsible for it.

With this track record and the Covid recovery programme that the Department of Health and Social Care now faces, it seems to me a triumph of optimism over reality to rely on that department and its harassed political head to undertake long-term planning. I say that despite the House passing Amendment 80. We are looking for a situation in which there is more independence of the Secretary of State and, indeed, more independence in the collection of information, the sifting of that information, and the analysis that that information shows—and that covers funding as well as workforce issues.

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[Baroness Penn (Con)]

My Lords, I thank noble Lords for bringing this debate before the House today. As mentioned in the debate in Committee, the specific functions described in Amendment 112 are crucial functions that the Government are committed to ensuring are discharged. This commitment is underlined by the fact that there are already bodies and mechanisms in place to fulfil these functions. These are core components of the Government’s commitment to evidence-based health provision. This commitment has been made clear in many of the Bill’s provisions, in our wider programme of public health reform and in the proposals set out in the Government’s plan for health and care.

The amendment makes recommendations on both appraisal and scrutiny of funding and of social and demographic trends. With regard to the monitoring of trends, the department already publishes data relating to disease profiles, which incorporates demographic trends where relevant. This is supported by independent academic modelling from the Care Policy Evaluation Centre, CPEC, to produce projections of the long-term demand on adult social care services. As for funding, noble Lords will also be aware that successive Governments have used the well-established spending review process to set public service budgets. This takes into account the needs of service users, but crucially also considers the fiscal context and how healthcare expenditure balances with the range of priorities across government.

As noble Lords have noted, aligned to those spending decisions, the Office for Budget Responsibility already scrutinises the Government’s fiscal approach and our management of fiscal risks. For example, in October 2021 the OBR provided an independent analysis of the Government’s reform to the funding of adult social care in England and has announced that it will provide more analysis of the long-term implications in its next fiscal sustainability report. There is also, as noble Lords will know, a wide range of highly influential non-governmental bodies dedicated to the kinds of functions proposed for this new body—the King’s Fund, the Health Foundation and the Nuffield Trust to name just three. All of these contribute richly to the public debate on financial sustainability and on the size and composition of the workforce, as well as other related issues, and to the ability of this House to scrutinise government decisions on spending and policy.

The Government therefore do not think that the creation of a further body would add value. At this crucial time for the health and care system, we must proceed with the reforms we have outlined. For these reasons I hope that the noble Lord, Lord Warner, will feel able to withdraw his amendment.

[Lord Warner (CB)]

My Lords, no chance. I wish to test the opinion of the House.