Health and Care Bill

Baroness Altmann Excerpts

Committee stage
Friday 4th February 2022 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I support these amendments from the noble Baroness, Lady Bennett. I thank her for putting them forward. The care sector is both complex and very little understood. Back in 2020, there were approximately 15,000 care homes in the UK, run by approximately 8,000 providers. Some were very small; others were providing very large networks of homes—it is a mixed economy. These figures are a couple of years old but, at that time, 84% of homes were run by the private sector, including by private equity firms, both British and offshore.

Funding is a complex mix of private funders, local authorities and the NHS. I was very grateful to the noble Baroness, Lady Bennett, for highlighting the work that the Financial Times has done, because I was first alerted to this issue by an investigation that the paper did back in 2019 which revealed how Britain’s four largest privately owned care home operators had racked up debts of £40,000 per bed, meaning that their annual interest charges absorbed eight weeks of average fees paid by local authorities on behalf of residents. Many have argued, and I absolutely agree, that this sort of debt-laden model, which demands an unsustainable level of return while shipping out profits of 12% to 16%, often to tax havens, is entirely inappropriate for social care.

I want to make it clear that I do not have an ideological problem with the private sector being involved in the care sector and providing care homes—provided that they are good quality—but I have a real problem with the financial models used. Most fair-minded people in this country, not least those whose loved ones are in care homes, would, frankly, be horrified if they knew how the money—either theirs, if they are self-funded residents, or indeed the money of hard-pressed local authorities—was being used and where it was being siphoned off to.

I greatly support amendments to increase transparency and reporting. Frankly, I would like to see the regulator being a lot tougher and a lot more proactive in this area, so I very much support the review in the amendment put forward by the noble Baroness.

[Baroness Altmann (Con)]

My Lords, I support the thrust of the amendments laid by the noble Baroness, Lady Bennett. I fully agree with her that there is a systemic problem in the care home sector.

In 1991, the community care Act reforms meant social care was transferred from a public sector function—or NHS function when it came to nursing homes—to what was called a mixed market. But, having observed the worsening care crisis, the financial engineering, the periodic failure of large care home operators and the inadequacy of regulation or oversight of their financial backing, I cannot help but urge my noble friends on the Front Bench to look urgently at the need for much greater controls. Southern Cross and Four Seasons Health Care have been in and out of insolvency or near bankruptcy for the past few years, but there are still inadequate controls on their ownership structure.

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[Baroness Barker (LD)]

My Lords, it has been a great privilege to work alongside the noble Baroness, Lady Deech, and I can only admire the persistence with which she has stayed on this issue to get the change which so many people have wanted for so long, and for such good and compelling reasons. I am but one of several Members of your Lordships’ House who have taken part in debates on assisted reproduction over many years.

It was a privilege to discuss these matters in the presence of Baroness Warnock, who was responsible for setting the ethical framework, all those years ago, to which we still refer when dealing with these matters. She was a remarkable person and one of the most important things she did was to foresee that science, knowledge and society would change. What she did was to set down a basic ethical framework, to which we could return as knowledge and scientific understanding increased. This provision is one such part of that.

Other issues in the field of reproductive medicine are equally deserving of our attention. For example, we are starting to uncover the extent to which LGBT people face unfair discrimination when it comes to access to assisted reproductive technology. If, in a heterosexual couple, one of the partners happens to be HIV positive but it is undetectable, and therefore untransmissible, the couple will not be disbarred from receiving treatment; that is not so for lesbians and gay men.

In the last week, some of us who work on these issues have been engaging on the issue of access to telemedicine. In this field it is true, as it is right across the NHS, that it is important to make these services more widely and easily accessible to women by using telemedicine. I hope the Minister might confirm that on another important aspect of women being able to control their fertility, in access to abortion services, we may see the extension of the highly successful scheme which has been run throughout the pandemic to enable women to have consultations and receive treatment at home. In that vein, and in the hope that we may fairly soon have a more comprehensive review of advances in reproductive medicine, which is needed across the piece, it is very pleasing today to welcome this amendment.

[Baroness Altmann (Con)]

It is a pleasure to follow the noble Baroness, Lady Barker, and I too commend the noble Baroness, Lady Deech—my noble friend, really—for all her work in this area. I particularly thank my noble friends the Minister and Lord Bethell, who I know have listened carefully and responded in the most compassionate and caring way. They have done a great service for many women across the country. I thank my noble friend for these amendments.

[Baroness Thornton (Lab)]

When the Minister and I were discussing government amendments, on this issue I said: “If Baroness Deech is happy with this, then I am happy with this,” and indeed I am.