Health and Care Bill

Baroness Bennett of Manor Castle Excerpts

Lords Hansard - Part 2 & Committee stage
Monday 24th January 2022 Lords Chamber

[Baroness Neuberger (CB)]

My Lords, most of what needs to be said about this group of amendments, which I support, has been said, and said brilliantly well—it has been a wonderful debate. However, I would like to make one more key point. I chair University College London Hospitals Foundation NHS Trust and Whittington Health NHS Trust. In the last two years, during Covid, much of my time has been spent not in your Lordships’ House but walking around both of those institutions, saying thank you and listening to my exhausted staff.

One of the key reasons for putting the issue of reporting to Parliament on workforce planning into the Bill is that our staff—not just their organisations but the individuals themselves—want it to be there. They know what the issues are; they live with the shortages and they know that it has not been thought through. My noble friend Lord Stevens made that very clear: it has not been thought through. If they are not taking early retirement, as some are, they are living with the consequences. We could and should do so much better for them, and for the long term—and our staff know that. For their sake, if for no other, we must put this on the face of the Bill.

[Baroness Bennett of Manor Castle (GP)]

My Lords, this has been an extremely rich and vital debate on crucial amendments, albeit conducted in two parts. I will briefly offer the Green group’s support for all of these amendments. I aim not to repeat anything that has been said but to offer some uniquely Green perspectives on this set of amendments.

I will take them in two groups, starting with Amendments 170 and 173 in the names of the noble Baronesses, Lady Cumberlege and Lady Merron. These are particularly important because they very clearly and explicitly lay out the responsibility of the Secretary of State. When I tabled some amendments last week on the Secretary of State’s duty to provide, they met with something of a frosty reception in some quarters—but it is clear from all sides of your Lordships’ House that it has to be the responsibility of the Secretary of State to ensure that there is a plan for the workforce. I stress that that is coming from all sides of your Lordships’ House.

It is worth referring to the King’s Fund briefing, which I do not think anyone has mentioned yet. I will quote one sentence:

“The measures in the Bill to address chronic staff shortages remain weak.”


That is what a respected outside observer says. Your Lordships’ House is seeking to plug that gap. The noble Lord, Lord Lea, suggested that this was all terribly difficult, and that is undoubtedly true, but a lot of people have been thinking about this for a very long time. I was at a briefing for the Royal College of Physicians before the pandemic, in person, with no masks in sight. It was more than two years ago and they were talking about the need for workforce planning, saying, “We know how this should be”. Indeed, on the Royal College of Physicians’ website, more than four score organisations are listed as backing these amendments for workforce planning. So the support is very much there.

That focuses particularly on the medical side of things, but I will refer also to the Age UK briefing. We have had some very valuable contributions about care workers from the noble Baronesses, Lady Verma and Lady Hollins, but Age UK considers that we need to look at this much more broadly. It is calling for a robust accreditation scheme for care workers working in CQC-accredited facilities. We need a different system.

I think it was the noble Baroness, Lady Hollins, who talked about how this is a low-pay sector, but we also need to talk about this differently and recognise that it is also a high-skill sector. I think of some of the care workers whom I have met: care workers who cared for doubly incontinent, aggressive, advanced Alzheimer’s patients, and who had done so for decades. Anyone who claims that these are not people with amazing levels of skill really is denying an obvious fact. We need to acknowledge the skills of care workers and to make sure that they are appropriately remunerated.

I want to pick up another, perhaps specifically Green Party, point that no one else has picked up on. I noted that the chief executive of NHS England was recently forced into a new deal with private hospitals, which she said did not provide good value for money. The deal provides more care in private hospitals to help recovery from the Covid pandemic; it sees the Government going against NHS England and deliberately pushing up the role of the market in healthcare. For those who deny that this is happening, I am afraid this is very clear evidence of it.

I turn to a report of the Centre for Health and the Public Interest, which notes that the great majority of private hospitals rely entirely on NHS staff contributing outside their NHS hours on a self-employed basis. We are talking here about doctors and associated health professionals such as anaesthetists and other clinicians. The NHS paid for their training, pays for their pensions and covers their insurance, yet we talk about private hospitals “helping the NHS”. Listening to this debate, I think that perhaps as part of the amendments on Report, we need to think in the context of workforce planning about the financial contribution to be made by the private sector to the cost of training to adequately recompense the NHS for what the private sector gets out of it to make profits.

--- Later in debate ---

[Lord Warner (CB)]

My Lords, I will briefly speak in support of the amendment in the name of the noble Lord, Lord Hunt, and echo many of the points made by the noble Lord, Lord Lansley, although I draw slightly different conclusions to him.

We have been around this track on social enterprise over the last 15 or 16 years and, in what I might call the good old days, there was a social enterprise unit in the Department of Health. That arose—it is worth remembering this—because many NHS staff preferred to work in a social enterprise unit rather than be direct employees of the NHS. The early days of social enterprises saw a number of groups of staff, particularly nurses, producing, in effect, co-operatives to work as social enterprises. While the noble Lord is entitled to feel a little anxious if there is nothing in the Bill even as modest as Amendment 93 in the name of the noble Lord, Lord Hunt, that arrangement gives some degree of protection to social enterprises which have served the NHS pretty well over the last 15 or 16 years. So, the least the Government could do is accept Amendment 93.

To some extent, the points made by the noble Lord, Lord Lansley, relate to the points I made earlier about Amendment 72. The bottom line on all this is that the way the Government have gone about trying to say, in Clause 70, that there needs to be a new provider selection regime, while not declaring their hands, has actually created the worst suspicions. If indeed, as the noble Lord, Lord Lansley, says, there is adequate provision already, why create the suspicion that some dastardly deed is going to be produced at a later stage by putting in Clause 70 and then not producing the draft regulations before the House clears the Bill?

The Government have got themselves into a fair tangle over this issue, and the Minister would perhaps do well to take this back to the department and try to reassure people as to what the Government are up to. Are they trying to change the Section 75 arrangements, and, if so, in what way? We want a lot more clarity about what the future provider regime will actually look like.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I will speak very briefly, having attached my name to a couple of amendments in this group. The issues around Clause 70 have been very clearly addressed, and I will just add one reflection, looking back to a discussion on an earlier group last week, when I said that if the Secretary of State gets great power, with that comes great responsibility. From the debate in your Lordships’ House, the noble Lord, Lord Hunt, is right to say that the Bill will not leave the House in this condition, but, if it were to, or if, after future amendments and ping-pong it were to end up back in this condition, the Secretary of State would really be in quite a dangerous place.

I pick up on social enterprises and the amendment of the noble Lord, Lord Hunt. We will be coming to some amendments, perhaps on Wednesday, when I will be talking about the impact of privatisation on social care. There will at some point—we have already seen this several times—be a huge crisis of the financialised social care sector, particularly care homes. When large chains fall apart and we have to find a way forward, social enterprises will be one way. I am aware that Clause 70 mentions healthcare and associated services, but to think about this in a whole and integrated way, we should ensure that there is recognition for social enterprise.

I attached my name to Amendment 208 because I thought it was important to demonstrate maximum cross-party support. Dare I say that events in the House earlier today demonstrated the need for transparency and openness in official contracts? There is great public concern about the misallocation of resources and the need for a guarantee of openness in government and official spending, so that amendment is crucial.

I do not know how I missed Amendment 209 in the name of the noble Baroness, Lady Thornton, but I certainly would have attached my name to it had I not done so. It is often commented that I cover a very broad range of subjects in your Lordships’ House, so I often talk about trade deals in other contexts, but there are very grave concerns about trade deals undercutting principles and priorities that have been identified in British politics, so that amendment is also important.

Finally, on Amendment 211, we have seen that giving government contracts to the lowest cash bidder has had disastrous consequences across a whole range of sectors. It has benefited a handful of giant companies, some of which have collapsed, some of which have engaged in rampant fraud and all of which have delivered a disastrous quality of services, exploiting poorly paid staff. Social enterprise is a different approach, a different way of commissioning and a way out of that. It is a way of relocalisation: stopping those few large companies that keep winning contracts because the whole thing is structured so that only a handful of companies can bid for them anyway. These are all really important amendments.