Health and Care Bill

Baroness Bennett of Manor Castle Excerpts

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

Moved by

[Baroness Bennett of Manor Castle]

46: Clause 16, page 13, line 28, leave out “it” and insert “the Secretary of State”
Member’s explanatory statement
This amendment, with the new Clauses before Clause 35 in the name of Baroness Bennett of Manor Castle, restores the duty on the Secretary of State to provide or secure the provision of services to that in the National Health Service Act 2006.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in moving Amendment 46, I will speak also to Amendments 168 and 169 in my name. In an earlier group this morning we were talking about democratic accountability at the local or ICB level, particularly in relation to Amendment 23 from the noble Baroness, Lady Thornton. We were also, through the agency of Amendment 45 from the noble Lord, Lord Davies of Brixton, looking at the risk that people in England could be left without NHS cover. Those amendments were about the ways in which this Bill could go horribly wrong—certainly, I have no doubt, in terms of what the public want, if not necessarily in the unintended consequences of where the Health Secretary and the Chancellor are apparently thinking of taking our NHS.

A couple of hours ago, the noble Lord, Lord Hunt of Kings Heath, talked about how the Government are centralising power, with ICBs having to look upwards to the hierarchies above them. He used the phrase that they will be “beaten up by the centre”. As he was saying that, I was struck that a briefing arrived in my inbox at that moment from the NHS Confederation, NHS Providers and the King’s Fund, which very much focused on that concern about the Secretary of State’s power to direct. It is clear that the Bill will give the Secretary of State enormous power potentially to interfere in the most minute aspects of healthcare locally. That concerns a great many people. I think it is already clear that your Lordships’ House will keep talking about this and, very likely, try to change it in future, but we know we are unlikely to be able to entirely transform this Bill and the relationships between the centre and the local.

--- Later in debate ---

[Earl Howe (Con)]

My Lords, as I was about to say, the 2012 Act does provide for the ability of the Secretary of State to intervene when that is necessary for the smooth and effective running of the system. Furthermore, we should not exaggerate the extent to which this Bill modifies the 2012 provisions. As the noble Lord said, we will debate the powers of direction on a future occasion but, when we come to do so, my colleagues and I on the Government Benches will contend that the powers of direction, such as they are, are very narrow and specific in their scope. They have been deliberately framed in that way to reflect experience over recent years. I would not be in favour of reopening this piece of drafting, given its history and the effort that noble Lords from all sides of the House made to build an effective consensus in respect of the 2012 Act.

The noble Baroness, Lady Brinton, asked about dental access. The department is working closely with NHS England to increase levels of service as quickly as possible. Practices are continuing to prioritise patients based on clinical need. Dental practices are now being asked by NHS England and NHS Improvement to deliver at least 85% of contracted units of dental activity—UDAs—between January and March 2022 to provide improved access for patients. These updated figures are based on what many practices have been able to deliver to date. They take into account adherence to the latest infection prevention and control guidance. I hope that this is helpful to the noble Baroness.

I hope also that I have explained to the noble Baroness, Lady Bennett, why I cannot entertain her amendments, but also that I have reassured her that the accountability chain between health services, Ministers and Parliament, which lies at the centre of her concerns, remains intact.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank the Minister for his response and thank all noble Lords who have taken part in this debate. I particularly thank the noble Baroness, Lady Brinton, for her support. She stressed how this is very much about restoring a public health system with full public accountability.

I was a little surprised, not so much by the direction as by the emphatic nature of the comments from the noble Baroness, Lady Wheeler, given that it was members of her party who moved the amendments in the other place. To address the Minister’s comments—this also picks up the point raised by the noble Lord, Lord Hunt—we are talking about a significant change in relation to power of direction; a power that we will be discussing further, at great length, and about which we have seen considerable expressions of concern. I come back to the way I framed my speech: if you have more powers, you have more responsibility. If you say, “We covered all this in the 2012 Act—it’s all fine”, once could argue that the 2012 Act did not work out fine, but we are in a new situation, creating very new structures.

Thinking about the success or otherwise of accountability, some issues where we have failed in terms of accountability—and we will see amendments on these later—are workforce planning and, as the noble Baroness, Lady Brinton, highlighted, dental provision.

This is about ensuring that people have faith, know who to look to and cannot be fobbed off, as the noble Baroness, Lady Brinton, said, by this terrible, complex diversity of funding and arrangement structures. Like other Members of your Lordships’ House, I took part in the public debate in 2012, not in this place but in the public domain, and I have given many speeches on this issue. The complexity must not be allowed to cover over the fact that what people want to know is that the healthcare is there when they need it, and if it is not that they know who to point to.

I will of course withdraw the amendment at this point, but I reserve the right to consider this and come back to it at a future point.

Amendment 46 withdrawn.