Health and Care Bill

Baroness Garden of Frognal Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I will address the amendments in what is now group 4, commencing with Amendment 18 in my name, which address the various ways in which the board of an ICB should be constituted. I thank the noble Lords who have supported the amendments in my name and will speak also to Amendments 28 and 37.

Amendment 18 covers who should be on the board and, crucially, who should not. These amendments are about the governance of ICBs. They are going to be very powerful bodies—they are already operating in a shadow way, as it were—which will allocate hundreds of millions of pounds of public funds on our behalf. The question is about who should have a seat at the table where the decisions are taken. We should perhaps begin with who should not be on an ICB. There appears to be agreement that private sector interests should not be permitted, so I see no point in repeating the debates that took place in the Commons because that principle has already been settled. However, as ever, the devil is in the detail of how that translates into legislation and the ICB constitutions. It is my belief that what is in the Bill so far is not strong enough.

The objective is that private providers cannot have any part in decisions about how NHS resources are allocated or how contracts are placed. In my other amendments, I have extended the scope of this to ban GPs with APMS contracts, as they are definitely private sector interests. How someone from a social enterprise or the voluntary sector might be regarded is an issue to address sensibly, and I very much welcome that the Minister has said on several occasions that he believes that a margin of flexibility will be needed to make that happen. We all know that there is a single example of someone from Virgin Care being on a non-statutory non-decision-making ICS, one out of the 42 ICBs and one person on a body with 20-odd other members. That is still one too many. It is the principle that matters.

Private providers are bound essentially and legally to be addressing shareholder value, which is absolutely right and as it should be for their particular business interests, but they are not the values that underpin the NHS, which is absolutely not about striving for profit and shareholder value in any way. That is not to say that the NHS at every level should not strive for value for taxpayers’ money and effectiveness, but the best service for patients and communities is surely the underpinning objective of our NHS and it should be that for ICBs. Nor is it saying that the NHS should not be commissioning or working with a variety of providers, but we need to safeguard those values and the social value that underpin the NHS.

In the Commons this has been debated and Ministers are on the record about their intention not to have private providers represented. Sadly, some of us are still sceptical. This is particularly so when one looks at the easing of the 2012 commissioning and procurement regime. I await with interest the Minister’s reply on this matter. In making appointments to ICBs we are clear that there should be some kind of test so that if someone has something in their background which a reasonable person might think makes them unreasonably favourable or disposed to the use of private providers within the NHS, then they have no role on an ICB. I suspect that one might have to see, when the Bill finally takes effect as an Act, that those tests might be brought to bear on some of the ICS/ICB chairs and non-executive directors who may fail it.

The ICBs have similar duties to the CCGs they replace, at least on paper, but the board of an ICB will be very different from the CCG GPs and sometimes, it has to be said, the rather ad hoc arrangements that existed there. ICBs will be much closer to the unitary board model of trusts, FTs and the PCTs of recent memory. We agree with the intention of more effective commissioning of health services in the new era of co-operation and collaboration and with better integration with related services, so there should be a new kind of board made up of fewer NHS insiders and more who may have a wider perspective and fit better into the new model and the aspirations of the Bill.

We have had what feels like a dozen different ways of making commissioning work, and I have been directly involved in some. My observation is that as soon as they look like they are starting to work, they get reorganised. The trouble has always been the split between commissioners and providers, which some may say is essentially bogus. Both bits are still core NHS, and the big trusts have massive influence because they are massive. There is no democratic accountability, and the big providers had all the clout, not the commissioners. The NHS commissioning operation is often in splendid isolation from the rest of the public services, disconnected even from social care, to say nothing of where primary and community care and public health come in. This Bill aspires to be different, so we need to look at how it is served differently by the ICBs.

There has been some pretence that this will all change under the Bill, just as there has been for previous ones on commissioning. ICBs are given flexibilities and can build place-based sublevels, but the reality is that, as they are constructed at the moment, they are the same old NHS cartels. They have all the freedom they are allowed, but they may ultimately be powerless. The public will have as much idea about what ICBs do as they did about CCGs, and we all remember the marches to save our PCTs in the distant past. Just to make this clear, vested interests get a place in the ICB as of right but the public, patients and staff are not given that honour and responsibility. That is what part of these amendments does. Amendment 37, in my name and that of others, sets out our view about which voices are most important, and it breaks the mould of NHS appointing.

I divert briefly to say that elsewhere we will discuss more about how those appointments are made. Our view is that some independent appointments commission ought to make a comeback. I took great encouragement from the comments of the noble Earl, Lord Howe, on Tuesday, which helped in this regard. But there is still far too much control from the top and far too little say from the bottom on all the appointments that will be made under the Bill. Amendment 37 at least offers a way to have some diversity and possibility to challenge the interests that dominate the NHS.

Surely nobody who looks at what the amendments suggest would argue that these interests do not have a right to some voice. The public, patients, staff, social care, public health, mental health—which of these can be safely ignored and which has no part to play? We know the Minister in the Commons gave a minimalist defence in the interests of the new mantra of flexibility. He rightly said that boards should be of a manageable size and that ICBs should have some flexibility—as much as NHS England would allow—to add others to the board, beyond the minimum. The NHS actually has to do what it is told and, unless a more stringent requirement is put in the legislation, it will do what it has always been allowed to do. If we really want a better care system and some change to make organisational upheaval worthwhile, let us have a go at doing something different, with a wider group of voices to be heard and take decisions.

Our Amendment 37 deals with appointing key non-executive board members to represent interests, but within a unitary board. On Tuesday, colleagues pointed out that all board members share collective responsibility, which is a tried and tested model, but we need a discussion about this. I can see from the amendments in this group that other noble Lords have views—my noble friend Lord Bradley and the noble Baroness, Lady Finlay, for example—but our amendments and others in the group, if we discuss them together, would make for a better balanced board, which does not necessarily have to be a larger board. I hope the Minister will consider these submissions carefully. I beg to move.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

My Lords, the noble Baroness, Lady Masham of Ilton, is taking part remotely. I invite the noble Baroness to speak.

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

My Lords, I want to support the proposed new paragraph (h) in Amendment 37, which says,

“at least one member appointed to represent the voice of patients and carers in the integrated care board’s area.”

The patient’s voice should be heard throughout the Bill. What is the National Health Service for if not patients? Patients should be involved in planning, ensuring that patients’ and carers’ views continue to be represented. Their experience should be collected. They, with their carers, are the people who know what good, safe care is and what poor results are. I hope the patient’s voice will be involved. I am pleased that many Members already stated this in amendments last Tuesday. I hope the Government agree, and I look forward to hearing from the Minister.

Health and Care Bill

Baroness Garden of Frognal Excerpts

Committee stage
Thursday 20th January 2022 Lords Chamber

Amendments 55 and 56 not moved.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

I call the noble Lord, Lord Low of Dalston, to move Amendment 56A—or the noble Baroness, Lady Hollins. Is the noble Baroness, Lady Finlay, moving Amendment 56A?

[Baroness Finlay of Llandaff (CB)]

My Lords, perhaps I might put in a slight plea to the Committee on behalf of the noble Lord, Lord Low. He has sat patiently through this debate for a long time. He was expecting that the other amendment would be moved and, on realising that it was not, has made every attempt to return to his place as fast as possible.

Amendment 56A

Health and Care Bill

Baroness Garden of Frognal Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

I apologise for not forewarning noble Lords that the noble Baroness, Lady Brinton, and the noble Lord, Lord Howarth of Newport, wish to speak remotely on this group of amendments.

[Baroness Brinton (LD) [V]]

My Lords, Amendment 219 in this group is in my name and I thank the noble Baronesses, Lady Pitkeathley, Lady Watkins of Tavistock and Lady Meacher, for also signing it. Just before I speak to that amendment, can I say that I also support the other amendments in this group so helpfully introduced just now by the noble Baroness, Lady Wheeler? I find her clarification of the difference between care workers and unpaid carers particularly helpful and vital in this debate because unpaid carers are invisible.

My amendment deals with unpaid carers. I am very grateful for the briefing from Carers UK which estimates —as we heard from the noble Baroness, Lady Wheeler—that there are as many as 13.6 million unpaid carers in the UK and, shockingly, over 1.4 million people providing over 50 hours of unpaid care a week. My brother looked after my mother for eight years, probably for 40 to 50 hours a week for most of that time. It meant that he just could not work at all. He is not alone.

I am sure we all know someone who is an unpaid carer. Even if they want to fulfil this role for their loved ones, society and the Government need to recognise the difficulties this gives the carers. The census in 2011 showed that carers are more than twice as likely to be in poor health than those who do not have a caring role—and they need support too, especially if they are isolated at home with the person they are caring for, whether that is day services or short in-patient respite care. Some 72% of carers have not had any breaks from caring during the pandemic and, as a result, are exhausted and worn out.

Health and Care Bill

Baroness Garden of Frognal Excerpts

Committee stage
Friday 4th February 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, this is a very broad group. As part of the Government’s obesity strategy, Clause 144 and Schedule 17 introduce advertising restrictions on less healthy food and drink, a 9 pm watershed for TV and on-demand services and the prohibition of paid-for advertising online. I declare my interest as chair of the Commission on Alcohol Harm. I will speak only to my amendment, which addresses the problem that currently, the definition of “less healthy food and drink” does not include alcohol beverages as it was drawn from the 2001 Nutrient Profiling Technical Guidance.

The amendment requires the Government to consult on including alcohol in the proposed advertising restrictions, because alcohol is the leading cause of death and ill-health among 15 to 49-year-olds in England. Under the Bill, adverts for sugary soft drinks will be restricted but adverts for alcoholic drinks will not, even though they can be very obesogenic. To quote from the Government’s own obesity strategy, they recognise that

“alcohol is highly calorific … It has been estimated that for those that drink alcohol it accounts for nearly 10% of the calories they consume … each year around 3.4 million adults consume an additional day’s worth of calories each week from alcohol, that is nearly an additional 2 months of food each year.”

The calorie load of 100 millilitres of 40% spirit is 244 calories, compared to just 42 calories in 100 millilitres of coke. A pint of beer has the same calories as a Mars bar and a glass of wine equates to three Jaffa cakes.

Some sweet alcohol products contain more than 100% of the daily recommended sugar intake in a single serving. There is significant evidence that children exposed to alcohol marketing drink more and drink earlier than they otherwise would, and early-age drinking is linked to higher risk drinking and even alcohol dependence in adolescence and early adulthood.

Existing advertising codes are failing. In the past month more than 80% of 11 to 14 year-olds have seen alcohol advertising. Almost 60% of 11 to 17 year-olds had seen alcohol adverts on television and more than 40% saw alcohol adverts on social media platforms. One-fifth had interacted with alcohol marketing online in the past month, despite being underage and therefore not allowed to buy alcohol. These adverts achieve their aim. Children as young as 11 can identify, reference and describe brands and logos of various alcohol companies—which leads them to start drinking more and earlier—making these images most attractive. Ten to 15 year-olds are exposed to more TV alcohol marketing than adults.

Alcohol itself is linked to more than 200 diseases and conditions, including seven cancers, is obesogenic and should be classified as a less healthy product. It should be included in the advertising restriction codes proposed, because the current self-regulatory codes are clearly failing. Children would accept this. The Children’s Parliament investigators and the Young Scot health panel have recommended a TV watershed for alcohol advertising. I beg to move.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

The noble Lord, Lord Howarth of Newport, should be taking part remotely. If the noble Lord is there, would he like to speak? We will continue with the debate and when we can get hold of him, we will bring him in.

[Baroness Boycott (CB)]

My Lords, I declare my interests—there are a lot of them in terms of food, but this is for a specific reason: I am a trustee of the Food Foundation, chair of Feeding Britain, a patron of Sustain, an adviser on the national food strategy and chair of VegPower. I also work with Cancer Research and the Obesity Health Alliance.

We welcome the Health and Care Bill, which contains provisions to limit adverts of unhealthy food and drink on TV and online to protect children’s health. I also support the amendment tabled by the noble Baroness, Lady Finlay, on alcohol, which is not covered in my amendment. She is completely right about the fact that such advertising encourages people to drink—something I know a lot about, to my cost—and put on weight.

These provisions are found in Schedule 17 of the Bill. All the different charities and NGOs I have worked with have argued for this for many years and we are incredibly pleased that the Government have made these provisions part of the Bill. They have been supported by all of us, and the Obesity Health Alliance and all cancer charities. So, I am shocked—we all are—and puzzled that during this Committee, quite a lot of amendments have been tabled in the names of the noble Lords, Lord Moylan and Lord Vaizey of Didcot, that would directly weaken or delay these proposals. As far as I know, and I have worked in the food business for a long time, I have not seen their names associated with campaigns to do with children’s health—in particular, around obesity.

I want quickly to explain what these amendments would do. Amendments 245, 255, 256, 257 and 317 would delay implementation of the various restrictions—for example, blocking the 9 pm TV watershed until a full calendar year after Ofcom publishes the technical guidance. This would delay the planned implementation by at least six months. We all appreciate that the food and advertising industries will need time to review the technical guidance, but this is just too long.

Amendments 245A and 250ZA would limit the restrictions, so that they apply only at weekends, but kids do not watch TV only at weekends. Amendments 247, 250A and 253A would enshrine exemptions for brand adverts if specific products are not displayed; for example, McDonald’s could advertise lettuce. The Government have already stated that brand advertising will be exempt from some of these restrictions, so why do we have to go further?

Amendments 248 and 251 would exempt certain unhealthy products from the restrictions, including

“chocolate confectionery in portion sizes smaller than 200 kcal”.

The amendments conflict entirely with the purposes of the policy, which is to limit children’s exposure to the advertising of products that are high in fat, sugar and salt. Quite frankly, some products of under 200 calories can contain more than half of a child’s recommended daily sugar limit.

--- Later in debate ---

[Lord Faulkner of Worcester (Lab)]

My Lords, I move Amendment 270, and add my support to Amendments 271 to 279 in this group. I have added my name to each of these, and they will be spoken to by noble Lords in all parties in the Chamber and by the noble Baroness, Lady Masham. I pay particular tribute to them for all being present at this late hour on a Friday—but this is an important issue.

We have signed these amendments because we see them as important steps on the journey towards a smoke-free Britain by 2030, which is the aspiration the Government have identified. They are in line with the approach that has been repeatedly taken in your Lordships’ House in recent years, to reduce harm caused by tobacco smoking and which has been consistently supported by the noble Earl, Lord Howe, when he was answering for the department of health in earlier debates. His support for tobacco control measures has always been appreciated.

As recently as 14 July, your Lordships approved the Motion to Regret that I tabled, regretting that the draft pavement licences regulations were not revised to take into account the evidence of benefits of 100% smoke-free pavement licences. That was agreed by a majority of 30 in a Division.

The amendments in this group are based on the recommendations in the 2021 report of the All-Party Parliamentary Group on Smoking and Health; I declare an interest as an officer of it. The Public Health Minister in the other place has committed carefully to review these recommendations as she develops the forthcoming tobacco control plan. I suspect that we may hear a little more about that from the noble Earl.

The rationale for Amendment 270 is clear. Raising the age of sale would have a larger impact in reducing smoking rates among young adults than any other single intervention. Experimentation has been found to be rare after the age of 21, so the more we do to prevent exposure and access to tobacco before this age, the more young people we can stop from being locked into a deadly addiction from which they may never escape. Two-thirds of those who try smoking go on to become regular smokers and only a third succeed in quitting during their lifetime, with the remainder at serious risk of smoking-related disease, disability and premature death.

When the age of sale was raised from 16 to 18 in 2007, smoking rates among 16 and 17 year-olds declined by 30%. When the age was raised to 21 in the United States, there was a similar reduction there, which in the UK would equate to 100,000 fewer smokers aged 18 to 20, simply by making it harder for young adults to buy tobacco.

Raising the age of sale would also help to reduce inequalities. Compared with non-smokers aged 18 to 20, smokers in this age group are more likely to be from lower socioeconomic backgrounds. This means that the effect of increasing the age of sale would be particularly beneficial in poorer and more disadvantaged communities. The Government’s levelling-up White Paper, published earlier this week, rightly states on page 203:

“Tobacco is still one of the single largest causes of preventable mortality, and smoking rates remain high in some areas of the UK. In 2019, the UK Government set the ambition for England to be Smokefree by 2030. A new Tobacco Control Plan for England is due to be published in 2022, setting out how the UK Government will deliver on this commitment, with a focus on reducing smoking rates in the most disadvantaged areas and groups.”


Elsewhere, the White Paper states:

“These and other changes will contribute to narrowing the gap in Healthy Life Expectancy … between local areas where it is highest and lowest by 2030, and increasing Healthy Life Expectancy by five years by 2035”.


I hope that, with those very desirable aspirations, the Government may be able to accept these amendments or propose similar ones of their own on Report. These amendments are designed to help them to achieve what they want to do.

Raising the age of sale is simple and inexpensive to implement and enforce, as retailers are already required to check the age of young people trying to purchase tobacco, so it is not an additional regulatory burden. Raising the age to 21 would do more than any other measure to help achieve the Government’s ambition of a “smokefree generation” and has already proved effective in the US.

I shall conclude with a brief word on Amendment 271. This requires the Government to prohibit the free distribution of nicotine products to under-18s and to regulate the marketing of any novel nicotine products, not just e-cigarettes. Unsurprisingly, tobacco companies have shown themselves more than willing to exploit this loophole. Free vapes have reportedly been handed out without age checks in cities all around the country. After all, it is not illegal to do so, although it clearly contravenes the spirit of the existing regulations, which set the age of sale at 18. I hope the Minister will agree that the current situation is unacceptable and will take action now to prevent e-cigarettes and other nicotine products being promoted to children. Including all nicotine products, not just e-cigarettes, will ensure that any new nicotine products introduced into the UK in future will be properly regulated from the outset.

I commend all the amendments in this group to the Committee, and remind the Minister that all that Amendment 270 requires at this stage is a consultation and a report back to Parliament. Surely that is not too much to ask for a measure which has majority support among small tobacco retailers as well as the adult population, makes a major contribution to public health and reduces health inequalities. I beg to move.

[The Deputy Chairman of Committees (Baroness Garden of Frognal) (LD)]

My Lords, the noble Baroness, Lady Masham of Ilton, is taking part remotely and I invite her to speak.

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

My Lords, I support all these amendments but will speak to Amendments 276 and 277, to which my name is attached, requiring health warnings on cigarettes and inserts in cigarette packs containing quitting advice.

My father used to smoke, as very many people did in the war. At the age of 52, he died of coronary thrombosis; I always felt that smoking caused his death. In addition, one of my best friends who smoked died early. At this very time, my housekeeper is in St James’s University Hospital in Leeds receiving treatment for cancer. The other day, she scolded herself for having smoked. Smoking causes serious disability as well as premature death; far too many people have died because of smoking.

I strongly support the Government’s Smokefree 2030 ambition. The measures in the amendments will help put us on track; they are well-evidenced, cheap to implement and easy to enforce. Health warnings on cigarette packs have progressively increased in size over time and, most recently, their impact has been enhanced by the removal of colourful banding. Warnings on cigarettes is the logical next step, and it will have particular impact in preventing children and young people starting to smoke. Hundreds of children start smoking every day in the UK. Children are much more likely to have access to individual cigarettes than full packs, meaning that warnings on cigarettes are likely to be particularly effective in preventing youth uptake. This measure has strong public support. Adding health warnings to cigarettes and cigarette papers is a simple measure with minimal cost which would help deliver the Government’s Smokefree 2030 ambition.

Amendment 277 would give the Government powers to require that health information messages be inserted in cigarette packs. This is not a novel idea; it has been a legal requirement in Canada since 2000. They are proven to work, and there is already good evidence from Canada on which messages are most effective. If the Government could give an assurance today regarding the increased use of health warning inserts—they already have the power to do this—these amendments might not be necessary and we could save time on Report. If not, Amendments 276 and 277, which are by no means the only measures needed to address this terrible addiction, would be a small and significant step in the right direction. I commend them to the Committee.

Health and Care Bill

Baroness Garden of Frognal Excerpts

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

[Baroness Wheeler (Lab)]

My Lords, I will also speak to my Amendment 141, which would delete Clause 155. I am very grateful to the noble Baronesses, Lady Campbell and Lady Brinton, and to the noble Lords, Lord Warner and Lord Lansley, for their combined support of these amendments. Sadly, the noble Baroness, Lady Bull, and the noble Lord, Lord Lansley, cannot be here, but the noble Baroness, Lady Campbell, and the noble Lord, Lord Warner, will speak to my amendments. I understand that they will move Amendments 143 and 144A.

In the Care Act 2014, we have a carefully crafted, step-by-step, cross-party agreement implementing the key recommendations of the 2011 Dilnot commission on the cap-and-floor model of social care funding, which went through the full parliamentary processes in both Houses. It built a consensus for implementing and funding the introduction of the care cap in 2016, and enshrining the key Dilnot principles of fairness and equity across all those needing social care. However, as we know, this agreement was never implemented following two separate postponements and a final cancellation in 2019.

Instead, the short Clause 155 we have before us on the Government’s proposals is a last-minute, hastily scraped together, ill-thought-through mishmash of subsections added to an essentially NHS Bill after its Commons Committee had finished, which was then bombarded through that House without any time for close scrutiny and debate. Our own Committee session on this clause started late in the evening at 10.30 pm and lasted not much more than an hour, so we fared little better on such a major and fundamental issue that will impact hundreds and thousands of lives. Moreover, the Minister, despite his offer on the record in Committee to talk to noble Lords about their questions and concerns, has been given no authority to discuss or agree any possible changes to the clause, which is so clearly ill thought through—contrast this with the fruitful discussions that have been held on a number of other important issues in the Bill.

My Amendments 127 and 141 to delete Clause 155 would ask the Commons to think again about how it implements the care cap. It presents a key opportunity for fundamental reconsideration of the Government’s proposals. There has now been time for greater analysis and scrutiny of the proposals and their impact by key stakeholders and expert think tanks, such as the Nuffield Trust and the King’s Fund, both of which have called for the clause to be removed. Its deletion would restore the full provisions on the cap under the Care Act 2014. It would mean that there would be reconsideration of how the cap should be implemented, not whether it would be implemented. Amendment 144A would reinforce this.

Labour strongly supported the 2014 negotiated care cap, its charging package and the costs involved. This has always been in the context of the care cap as part of a much wider social care reform that is needed to address the current crisis and build long-term sustainability and growth, which the Government have yet to address. We know that the Government’s proposals for the cap were discounted by Dilnot in 2011 as unfair, because they will result in people with low levels of wealth spending the largest proportion of their income on their care. The cap at £86,000 is set too high to benefit the majority of people who need to be protected, and the bombshell of abandoning the key safeguarding Dilnot principle enabling local authority care costs to count and accrue towards the cap means that poorer people will be exposed to the same care costs as the very wealthiest in society.

Despite the pledge that nobody should have to sell their homes, the fact is that someone with assets of £100,000 will lose almost everything, whereas someone with assets worth £1 million and over will keep almost everything. This is clearly shown in the extensive modelling by stakeholders such as Age UK, Mencap, the Alzheimer’s Society and the think tanks. That was detailed during our Committee debate, particularly the impact across some of the most deprived areas in the country. The Government’s own figures show that more than one in five older people will not see the benefit of the cap at all, and poorer care users are much more likely to die before they reach the cap than someone who is better off with the same care needs. Only 19% of people with dementia will reach the cap.

Moreover, Amendment 143, which will now be spoken to by the noble Baroness, Lady Campbell, and the principle of which we strongly support, reinforces the key point that a fair cap and charging system has to provide essential support to older adults and working age disabled adults, many of whom have lifelong conditions, including those with learning difficulties and who have to draw on social care support for their daily needs and support. The Dilnot proposals recognise this by seeking to ensure that adults entering the care system under the age of 40 or who were under 40 when they first entered it would have their care capped at zero.

I commend Amendment 144A from the noble Lord, Lord Lansley, to which I added my name. This fully complements the deletion of Clause 155 in restoring the current charging provisions in the Care Act. It would add a new clause to require the Secretary of State to make regulations under the Care Act to ensure that all its provisions on the care cap—Sections 15 and 16—come into force before 1 April 2023. This would mean that there would be no delays to the implementation of the care cap based on the relevant sections of the Care Act. It also means that the uprating of the care cap value from the level fixed in 2014 could take place—the concern of Amendment 182.

What is crystal clear is that the Minister’s repeated claim—or rather, as he described it in Committee, his “hope”—that

“no one will lose out when compared to the current system”—[Official Report, 31/1/22; col. 751.]

or face “unpredictable care costs” just is not borne out by the evidence proving otherwise, which is stacking up every day. Increasing the complexity of local authority charging arrangements on personal budgets, as the government amendments to the Care Act seek to do, makes an already hugely complex and system-heavy admin and technical system even worse. How many care users will be able to understand what is happening? I was particularly interested in the comment by the noble Lord, Lord Lansley, in Committee that a number of the issues that the government amendments sought to rectify or amend were never introduced in 2014 anyway.

How much more straightforward to use the sections of the Act developed for implementation than to try to patch up the provisions and hang them on a different Bill. We support the ambitions of self-funders to pay the same rate for care as local authorities pay for the people they fund, but there is absolutely no evidence of any government intention to provide cash-starved councils with the huge costs involved in this, and bearing in mind the massive underfunding of social care over the past decade.

Clause 155 must be deleted so that the key Dilnot principles of fairness and equity across all those needing social care can be reinstated. Deletion of the clause would mean that implementation of the care cap could proceed but under the provisions of the fully scrutinised Act designed to implement it: the Care Act. Under Amendment 144A, all provisions relating to the cap would be implemented by 1 April 2023.

At the appropriate time, I shall withdraw Amendment 127 and then move Amendment 141 in its place and seek to test the opinion of the House. I understand that the government amendments to Clause 155, which come before Amendment 141, will be agreed on the nod and will then fall if Amendment 141 is carried. I beg to move.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

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

[Baroness Brinton (LD) [V]]

My Lords, I thank the noble Baroness, Lady Wheeler, for introducing so comprehensively this group of amendments on care costs. Given the lateness of hour in Committee, the House needed to hear the detail of this.

Her Amendments 127 and 141, which I have signed and which we will support if she calls a Division, would remove the cap on care costs which was announced and introduced by the Government in the Commons. It was not widely consulted on, and is a deeply unfair element of the Government’s proposals for the new social care payments arrangements. Far from fixing the ongoing crisis in social care “once and for all”, which the Prime Minister said from the steps of No. 10 Downing Street in 2019 he would do, these divisive plans will not stop people needing to sell their homes to pay for care and are a breach of the Government’s promise in that election. It is very important that the Commons have the time to discuss the consequences of the detail of removing that cap now that the announcement has been better understood, especially by the professionals, including the think tanks, who are very concerned about it.

We also support the noble Baroness, Lady Campbell of Surbiton, who will speak to Amendment 143 in the name of the noble Baroness, Lady Bull, which would ensure a zero amount for personal care charges for those under 40. It is absolutely against the spirit of Dilnot and a deep injustice to those under 40 with personal care needs that they are treated the same as those whose working years are behind them. It is a huge injustice that we have an NHS that is free at the point of use and yet younger people with learning disabilities and life-limiting health conditions are charged for essential care. There are also a number of deep, practical contradictions in this arrangement that make it particularly shocking, including a survey that found that charges made by cash-strapped local authorities—made because they could charge them—had forced people to stop the care they needed or made them face difficult choices for financial reasons, with the results showing an increased reliance on family members and high levels of deteriorating mental health, including suicidal thoughts.

Amendment 144A from the noble Lord, Lord Lansley, and as outlined by the noble Baroness, Lady Wheeler, supports the principles behind both Amendments 127 and 141, which would remove Clause 155. It proposes that all provisions on the care cap are brought into force by 1 April 2023 by regulation under the Care Act, resulting in no delay to its implementation. We support that too.

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, the noble Baroness, Lady Campbell of Surbiton, is also taking part remotely. I invite the noble Baroness to speak.

[Baroness Campbell of Surbiton (CB) [V]]

My Lords, I support Amendments 127 and 141 in the name of the noble Baroness, Lady Wheeler; Amendment 143 in the name of my noble friend Lady Bull; and Amendments 144A and 182. Sadly, my noble friend Lady Bull is unwell, so I will speak to Amendment 143 and do my best to encapsulate her reasons, as well as mine, for returning to it on Report. I shall not move it later when it is called.

Unfortunately, at this hour, my voice is fading because I have had to use it a great deal today, so I shall use my speech facilitator, as allowed by the House, more than I would usually.