Health and Care Bill

Baroness Fookes Excerpts

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

Amendment 41B not moved.

[The Deputy Chairman of Committees (Baroness Fookes) (Con)]

We come to Amendment 42, where the noble Baroness, Lady Masham of Ilton, will be taking part remotely.

Amendment 42

Moved by

--- Later in debate ---

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have a number of amendments in this group concerning Healthwatch and, although it is important, I shall attempt to be brief.

We debated this, of course, in the Health and Social Care Bill 2012. I remember the noble Lord, Lord Patel, led a debate in which he called for the national Healthwatch to be made independent. He said then that embedding Healthwatch in England in the CQC was a mistake. I agreed with him then and I agree with him now. I would argue to the Government that there would be a big advantage in making Healthwatch fully independent. Of course, I am also concerned about local Healthwatch, to make sure it has enough influence in the new system as well.

It is right to pay tribute to the work of Healthwatch. I think it has done a good job since it has been established. Recent reports of national Healthwatch have been about access to dental care, on which I have an Oral Question in a week or two’s time. It undertook a very interesting analysis of the Government’s social care plans compared with proposals, and compared that with what people had told Healthwatch would make social care better.

Locally, my own Healthwatch in Birmingham has done some excellent work. I particularly mention a recent report on digital exclusion during the pandemic, when there was a sudden shift—like everywhere—towards remote access to care. Birmingham Healthwatch identified five principles for post-Covid-19 care, to ensure that everyone has access to the appointments they needed. This included a commitment to digital inclusion by treating the internet as a universal right. I believe its work has contributed more generally to the way in which this is being taken forward in the system. I think that, under the circumstances it has been operating in—not without difficulty and not without some tensions with local authorities—it has made a good start.

I want to just push Healthwatch on a little further and I want the Government to help. First, I am absolutely convinced that national Healthwatch should be an independent body. I have never understood the thinking that it should be a statutory committee within the CQC. I assume it is because, at the time, the Government were going through one of those wearying bonfire of the quangos that all Governments go through before they set up new quangos, to then have another bonfire a few years later. It just makes no sense. Clearly, they have complementary roles, and I am sure that the CQC takes note of what Healthwatch says, but they are different roles: one is the statutory regulator; the other has a responsibility for raising issues on behalf of the public who use the health services.

The question then arises of how we can strengthen Healthwatch at the local level. Will the systems, the integrated care partnerships and integrated care boards, listen to what Healthwatch has to say? A recent survey of ICS leaders—all there, in position—for Healthwatch England and NHS England shows that 80% would support Healthwatch having a formal seat at the table of the ICB if it were set out in legislation or guidance. What about the other 20%? Should it really be down to the vagaries of local leadership to exclude Healthwatch from those local bodies? I really do not think so.

I do not know if the noble Earl, Lord Howe, in answering, is going to be of a centralist or localist philosophy, or both, but it is always interesting to discuss. He and I have been discussing NHS structure for some 25 years now, and somehow the arguments tend to go on. It would be a real advantage for boards and partnerships to have Healthwatch around the table. It need not have voting members—indeed, I do not think it should. It is doing incredibly good work and has not been given enough publicity or recognition by people in the NHS. This surely is a way in which we can do this.

The Government also need to look at the budgets of Healthwatch England, which is going to have to support extra work and will need to be given more resources. Through local authorities, we need to make sure local Healthwatch has enough resources to deal with the pressing issues and challenges it is going to face. Having said that, our job today is just to encourage national and local Healthwatch to build on what they have done. I hope we can do this in as positive a way as possible. I beg to move.

[The Deputy Chairman of Committees (Baroness Fookes) (Con)]

The noble Baroness, Lady Masham, is now able to speak and I invite her to do so.

[Baroness Masham of Ilton (CB) [V]]

My Lords, I am pleased to see that the noble Lord, Lord Hunt of Kings Heath, is taking part today. He has been involved in a family emergency, which shows how important grandparents are in the care of children.

I have added my name to some of the amendments in this group but support them all. The Bill will be improved if the patient voice is included in both the integrated care boards and integrated care partnerships by Healthwatch, which could collect data from different sources representing patients. There should be co-operation and working together throughout the NHS, co-operation with the CQC and better integration throughout so that standards are kept high across the country.

The recent report, chaired by the noble Baroness, Lady Cumberlege, First Do No Harm, also demonstrates how important the patient’s voice is. As Healthwatch is spread so thinly at the moment across England, it will have to be bolstered so that it can do the job. The Bill should set clearer expectations for local systems on the need to use the views and experiences of their local communities to inform decisions. The aim is to establish Healthwatch as an independent body rather than a sub-committee of the CQC. The voice of patients will provide so much first-hand experience, and public involvement is so important to help improve standards throughout the country.

Patients can highlight good experiences and services that need improving. Often, communication needs improving, as does hospital food, which differs across the health service, waiting times, late diagnosis, ambulance provision and many other concerns. Many patients want to give something back to the health service when they have had to use it. Being a dedicated member of Healthwatch could be a solution. I hope the Government will appreciate the benefit of the public working with them rather than against them.

Health and Care Bill

Baroness Fookes Excerpts

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

[Lord Hunt of Kings Heath (Lab)]

My Lords, it has been rather a long wait, though I doubt that we shall spend as much time on this group as we did on the last. I do not pretend that the issue of procurement is as important as that of the workforce; none the less, when we come to Clause 70 there are some very important considerations.

I should say that, although my own two amendments are narrowly focused, in opening this debate I must register with the Minister concerns about the open-ended nature of the power to be given to Ministers under this clause. In essence, through secondary legislation, the whole procurement regime can be changed at the whim of an executive order. Services could be privatised or outsourced or whatever Ministers choose to do with them subject to regulations. It seems rather extraordinary that we are taking out the marketisation sections from current legislation only to replace them with an open-ended power and a procurement regime when we simply do not know what it will be.

I remind the Minister that the Delegated Powers Committee has been very clear that Clause 70 needs very careful attention. As it says,

“initial consultation has been carried out by NHS England on the content of the”

procurement regime, but

“full analysis has not been completed and there has not been time to produce a more developed proposal.”

The Delegated Powers Committee concluded:

“We do not accept that the inclusion of regulation-making powers should be a cover for inadequately developed policy.”


I hope that the Minister, when he winds up the debate, will say something more about this and how the Government intend to respond. I think it very unlikely that we will let this Bill leave this House with this clause unaltered. Indeed, I note that the noble Lord, Lord Lansley, intends to oppose that Clause 70 stand part of the Bill.

My two amendments are probably the easiest that the Minister will have to deal with in this group and I hope that, for once, he will just get up and say that he accepts them both because they are very sensible and helpful to the way in which one wishes to see the NHS develop commissioning arrangements at the local level. The first, Amendment 93, requires NHS England and integrated care boards to consider the impact of their decisions on the diversity of provision for health and social care services, particularly social enterprises and charities.

I just want to talk about social enterprises: they are set up with a social mission and deliver that mission with all the income that they receive. Over the past 20 years, they have become an ever more important part of delivery of healthcare services. My understanding, from Social Enterprise UK, is that there are 15,000 social enterprises delivering health and care services in this country and that there is very strong evidence to suggest that these organisations are very good at what they do—often better than the alternatives. Indeed, according to a review of public service mutuals, a form of social enterprise, commissioned by DCMS in 2019, these organisations are developing high levels of productivity and better outcomes than their peers and the private sector. Their productivity has increased 10 times faster than that of the rest of the public sector over the past decade. Why? They have done it through innovation: by listening to communities and focusing on their social mission, social enterprises have been able to prepare to make changes to service delivery that other providers have been unwilling to do. As a consequence, a report in 2020 by the King’s Fund described social enterprises as

“‘engines of innovation’ within health and care”.

The Bill as it stands does not provide any duty, responsibilities or guidance for integrated care systems or NHS England to consider social enterprises within their activity. My understanding is that, because we already have these shadow ICBs, it is being interpreted at local level that there is not a future for social enterprises within local systems. There is a risk that decisions are now being made by these shadow organisations, which have no statutory being at all, that there will be a reduced role for these social enterprises in the future. That would be a tragedy, and I must ask the Minister to look at my amendment. It is very innocuous: all it asks ICSs and the NHS to do is to consider the impact of their decisions on a wider provider lattice. He could go further. It would be very simple for a message to be sent down the service from this debate to say that they got it wrong about social enterprises and they should indeed be thinking of commissioning more services in the future from there.

My Amendment 211 is linked to it. It deals with social value and how they should be embedded into procurement processes by integrated care boards. The definition of social value is the process by which public bodies seek to maximise the additional social, environmental and economic outcomes of the money that they spend. The coalition Government in 2012 supported the passage of the Public Services (Social Value) Act 2012. The adoption of the Act in the NHS has been very patchy indeed. I shall not delay the Committee by going into the details, but it is very disappointing. All my amendment would do is put a simple duty on NHS England to create guidance and ensure that social value is clearly understood across the system. It would be only guidance: it surely could not be a problem for the Government to endorse their own policy on social value in the NHS. I hope that the Minister will be sympathetic. I beg to move.

[The Deputy Chairman of Committees (Baroness Fookes) (Con)]

The noble Lord, Lord Howarth, is taking part remotely and I now invite him to speak.

[Lord Howarth of Newport (Lab) [V]]

My Lords, I support my noble friend in his aim, expressed in Amendments 93 and 211, to require that procurement practices by the NHS are such as to ensure diversity of provision and maintain social value. The case was made convincingly, I hope, in previous debates that the non-clinical and voluntary community and social enterprise sectors have important contributions to make to preventing ill health, both physical and mental, aiding recovery and reducing health inequalities. That being so, it is only common sense that the NHS, and ICBs in particular, should use their power and influence to ensure that there is a flourishing ecology of the community organisations that share their agenda. The NHS should engage with them, listen to them, enlist them and cherish them.

Although the value of community organisations to healthcare has long been obvious, that has been all too little recognised in the actual practice of the NHS. Responsibility here, however, does not rest only with the NHS. The non-clinical sector must help the NHS to relate effectively to it. The King’s Fund has been doing important work on contractual models for commissioning integrated care. This was the basis, for example, for the way arts and cultural organisations came together in Gloucestershire to enable the CCG to fund the work without having to deal with lots of small organisations and individual artists. In Suffolk, the CCG has provided administrative support and leadership in providing training for arts and cultural workers to connect to link workers. We cannot expect ICB commissioners to deal with a mass of organisations in the VCSE sector, but they can support that sector to develop suitable models of co-ordination. I think “market-placed development” is the bureaucratic term here. Organisations such as the National Centre for Creative Health and the Culture, Health and Wellbeing Alliance stand ready to support non-clinical providers to get their act together to enable ICBs to negotiate with them productively.

Health and Care Bill

Baroness Fookes Excerpts

Lords Hansard - Part 2 & Report stage
Tuesday 1st March 2022 Lords Chamber

[The Deputy Speaker (Baroness Fookes) (Con)]

My Lords, the noble Baroness, Lady Brinton, and the noble Lord, Lord Howarth of Newport, are taking part remotely; I invite the noble Baroness to speak first.

[Baroness Brinton (LD) [V]]

My Lords, I shall speak to Amendment 17, to which I have added my name, but first I thank the Ministers for listening to the noble Baroness, Lady Finlay, and others, and for tabling Amendment 16. I also thank Together for Short Lives for its helpful briefing.

Your Lordships’ House had a moving debate in Committee that captured the practical and economic need for the wider range of provision of palliative care, and how ICBs can properly fund and plan for it. In Committee, the Minister, the noble Lord, Lord Kamall, said that

“ICBs will be required to have regard to the National Institute for Health and Care Excellence guidelines in their provision of services, as CCGs currently are … NHS England will continue to support commissioners of palliative and end-of-life care services through their palliative and end-of-life care strategic clinical networks. These networks support the delivery of outstanding clinical care by ensuring palliative and end-of-life care is personalised for all.”—[Official Report, 18/1/22; col. 1637.]

The noble Lord’s Amendment 16 provides the specialist services we sought, but it says only

“as the board considers … appropriate as part of the health service”.

Although I join other noble Lords in thanking the Ministers for the amendment, please can the noble Earl confirm that, although the wording of the amendment requires ICBs to commission palliative care “where appropriate”, it is his intention that all ICBs should deem it appropriate, and therefore all of them should commission palliative care services, including for seriously ill children and their families? We know that the provision of palliative care services is very patchy. Will he provide statutory guidance to supplement the amendment and support ICBs to interpret their responsibilities, including for children? When will this be available? What action will Ministers take to ensure that ICBs have the financial resources needed to fulfil the new duty? Finally, what action will the Minister take to ensure that there are enough professionals with the skills and experience needed to provide the palliative care for children that ICBs will have a duty to commission?

We covered all this in very moving stories in Committee. Can the noble Earl confirm that all I have outlined will be covered in regulations and statutory guidance?

Health and Care Bill

Baroness Fookes Excerpts

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

[Baroness Pitkeathley (Lab)]

I apologise to your Lordships. I will just say that the noble Lord said it was a “backward step” to leave only guidance.

This is not only morally wrong but very short-sighted. If a discharge is unsatisfactory, the inevitable consequence is readmission—and think how much that costs. The Government believe that the new discharge to assess procedures will deal with discharge problems, but carers report that discharge to assess takes place as the discharge itself is happening, with no chance to order suitable devices, equipment or changes to the home, let alone to consult the carer. I must point out that two earlier versions of the discharge to assess guidance did not even mention carers and did so only after pressure from Carers UK.

I am sorry to say that the Government and the NHS have form on ignoring carers. They were not mentioned in the health and care White Paper, which set out the foundations for the Bill and only marginally in the integration White Paper, yet I have never heard any Minister say anything other than that carers are essential, that they must be valued and respected and that we owe them a debt of gratitude. Similarly, I have always heard Ministers and officials agree that carers must be supported to combine paid work with caring to help them financially now and to avoid future poverty, yet here we are with a Bill which states baldly that carers must allocate more time, requiring a reduction in work hours and associated financial costs. I asked the Minister at Second Reading and I ask him again: does he expect carers to go on benefits in order to provide care?

Carers and patients need this amendment badly, and I hope the Minister understands that. I have no doubt of his good intention, but I fear for the plight of carers and patients if he does not accept the amendment, which is essential if we are to ensure that all carers, including young carers, are not overlooked in the hospital discharge process but retain concrete rights and recognition in primary legislation. I beg to move.

[The Deputy Speaker (Baroness Fookes) (Con)]

The noble Baroness, Lady Brinton, is taking part remotely, and I invite her to speak.

--- Later in debate ---

Amendment 125 agreed.

[The Deputy Speaker (Baroness Fookes) (Con)]

On Amendment 125A, I think there may be a number of amendments in a similar vein.

Amendment 125A

Tabled by

--- Later in debate ---

[Lord Etherton (CB)]

I am so sorry, Deputy Speaker, but I asked for my amendment to be dealt with by way of just removing the whole of Part 4, but I was told by the Public Bill Office that every single clause had to be mentioned. The Public Bill Office was unable to explain why that was, other than that was how it had always been.

[The Deputy Speaker (Baroness Fookes) (Con)]

If it is down on the Marshalled List, it has to be dealt with. May I assume that the noble Lord is seeking not to move Amendments 125A to 125M?

[Lord Etherton (CB)]

Yes.

--- Later in debate ---

I close by offering my sincere thanks to the Minister and his officials for their very close engagement on all the issues that I have mentioned. I am very grateful for their generosity in providing time for our many discussions, and I look forward to the Minister’s response. I beg to move.

[The Deputy Speaker (Baroness Fookes) (Con)]

The noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

[Baroness Brinton (LD) [V]]

My Lords, I echo the thanks of my noble friend Lord Sharkey to the Ministers and their officials for the very helpful discussions that we have had with them on reciprocal healthcare agreements. I also thank my noble friend for his persistence in leading on those discussions between Committee and Report on the two points of difference between us—the definition of reciprocal healthcare, with our concerns about the ability to create a privatisation of parts of healthcare, and that an SI under a negative resolution is not strong enough for Parliament to scrutinise properly. My noble friend’s amendments are, as he said, very specifically aimed at removing these concerns, and I look forward to the Minister’s response.

I also particularly thank Ministers for understanding that the House was deeply unhappy with the original proposals for regulations via a negative resolution. I hope to hear that Ministers will now agree to the affirmative resolution proposed in the amendment of my noble friend Lord Sharkey. Scrutiny by Parliament needs to be timely, and Parliament needs to be allowed to effectively challenge proposals about which it has concerns.

Health and Care Bill

Baroness Fookes Excerpts

3rd reading
Wednesday 23rd March 2022 Lords Chamber

Amendment 2 agreed.

[The Deputy Speaker (Baroness Fookes) (Con)]

The Question is that the Bill do now pass. As many as are of that opinion will say, “Content”—

[Baroness Penn (Con)]

I think that noble Lords may want to make a few remarks before we reach the Question.