Health and Care Bill

Baroness Morgan of Cotes Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Morgan of Cotes (Con)]

My Lords, it is a pleasure to follow the two previous speakers. I particularly congratulate the noble Lord, Lord Stevens of Birmingham, on an assured, entertaining at times, but also extremely interesting speech. It is good to have him in the House, particularly as we come to consider the Health and Care Bill. I know that he will make an enormous contribution through his membership.

I declare my interest as a trustee of the Loughborough Wellbeing Centre charity, which offers mental health support to those facing mental health challenges. As we have heard, this is clearly a Bill that those outside this House and Westminster, but also inside, feel strongly about, given the quantity of briefing that we have received so far. I am sure that that will only continue.

In the time available, I want to cover two points that I shall return to later. First, I alert the Minister that I and others will be picking up on two amendments tabled but not voted on in the House of Commons that recognise that the NHS is an institution that covers the whole of our United Kingdom. As we know, there are huge disparities in service quality and delivery between different parts of the United Kingdom. That is unfair on patients and, I suspect, extremely wearying for staff and those caring for those seeking treatment.

The first amendment raised in the Commons would place a duty on NHS England to consider the likely impact of its decisions on the residents of Wales, Scotland and Northern Ireland and to consider the impact of services provided in England on patient care in Wales, Scotland and Northern Ireland.

The second proposal

“would enable the Secretary of State to specify binding data interoperability standards”

across the whole of the United Kingdom. It would

“require the collection and publication of comparable information about healthcare performance and outcomes across the United Kingdom and would require Ministers in the devolved institutions to provide information on a comparable basis.”

Surely, the lesson of the last 18 months of facing the Covid pandemic is that more data and more transparency are better at putting more power in the hands of patients and those seeking care.

My other point relates to mental health provision. I was delighted to hear the noble Lord, Lord Stevens, mention this and I know that it will come up elsewhere in the debate today. I am very grateful to those who have worked in this field for a very long time for pointing out that this Bill is not ambitious enough on preventing mental health issues or on the need to provide earlier support to those experiencing mental health distress. I am also deeply concerned, given the declaration that I have already given, that there seems to be no role for the voluntary and community sector in the new structure of integrated care partnerships—yet we know that the voluntary and community sectors do a huge amount to support people with health needs, particularly in mental health but with other conditions as well. They take the burden off our National Health Service and often provide that support for a much more efficient cost or price than the statutory services ever could.

We have already heard about the NHS triple aim. I would argue that the Bill should mention parity of esteem and mental health specifically in that triple aim. My understanding is that Ministers agree with this, so I hope that they might agree to say so clearly in the Bill. It sounds to me as though the triple aim may become slightly more than triple, given all the requests that my noble friend the Minister will get to expand it. So I wish my noble friend well as he takes the Bill through the House. I look forward to future proceedings and to covering the issues that I have mentioned today.

Health and Care Bill

Baroness Morgan of Cotes Excerpts

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

Moved by

[Baroness Morgan of Cotes]

17: After Clause 5, insert the following new Clause—
“Duty to consider residents of other parts of UK
For section 13O of the National Health Service Act 2006 substitute—“13O Duty to consider residents of other parts of UK(1) In making a decision about the exercise of its functions, NHS England must have regard to any likely impact of the decision on—(a) the provision of health services to people who reside in Wales, Scotland or Northern Ireland, or(b) services provided in England for the purposes of—(i) the health service in Wales,(ii) the system of health care mentioned in section 2(1)(a) of the Health and Social Care (Reform) Act (Northern Ireland) 2009 (c. 1 (N.I.)), or(iii) the health service established under section 1 of the National Health Service (Scotland) Act 1978. (2) The Secretary of State must publish guidance for NHS England on the discharge of the duty under subsection (1).(3) NHS England must have regard to guidance published under subsection (2).””Member’s explanatory statement
This new Clause places a duty on NHS England to consider the likely impact of their decisions on the residents of Wales, Scotland and Northern Ireland, and to consider the impact of services provided in England on patient care in Wales, Scotland and Northern Ireland.

[Baroness Morgan of Cotes (Con)]

My Lords, in moving my amendment I will speak also to Amendments 205 and 301. I thank my noble friends Lord Moylan and Lady Fraser of Craigmaddie for their support for these amendments.

It is a pleasure to follow two excellent debates. I suspect—although, as the noble Baroness, Lady Hayman, said, we are never quite sure how feisty the debates on these groups will get—that we may spend an even shorter time on this group to enable the Committee to make progress. These amendments are relatively simple, designed to improve transparency, quality and access to healthcare for residents in all parts of the United Kingdom. I thank Ministers for their engagement so far on the amendments. In particular, Amendments 205 and 301 were tabled in the House of Commons by Robin Millar MP and others.

The NHS is a UK institution. It could not have been developed without the combined economic strength of our United Kingdom and has developed from unifying United Kingdom values—you might even say that the NHS embodies them. It includes a promise that, wherever in the United Kingdom you are from and whatever your situation, you are entitled to the same protection and treatment. That is why the first two amendments, Amendments 17 and 205, are about access by patients to a consistent national standard of healthcare.

The unfortunate reality, of course, is that many UK residents do not have equal access to healthcare. Referral-to-treatment waiting times for England, Scotland and Wales are, respectively, 11 days, 32 or 42 days—depending on whether you are talking about in-patients or out-patients in Scotland—and 21.5 days. These headline figures are concerning enough. However, they obscure even more stark differences when treatments are considered separately.

--- Later in debate ---

[Earl Howe (Con)]

Rather than give a wrong answer to the Committee, I had better take advice on that and write to the noble Lord, if he will allow it.

I say to the noble Baroness, Lady Walmsley, that if we look at this area in general, we are clear that we must and will continue to work closely with the devolved Administrations to ensure a fully interoperable, UK-wide approach to healthcare, including in relation to the provisions in this Bill.

It is worth adding that the devolved Administrations already have powers in legislation under Section 255 of the Health and Social Care Act 2012 to request NHS Digital to collect and analyse data, so they have that ability if they wish to exercise it. I am very grateful for my noble friend’s interest in this important area. I assure her that we will continue to keep listening to ways in which we can make the NHS work for all four nations of our union. It is vital that we do so and implicit in the collaborative processes we are engaged in. However, for the reasons I have set out, I ask my noble friend to understand why I am unable to accept this amendment.

[Baroness Morgan of Cotes (Con)]

I thank my noble friend very much for his response. Although this has been a short debate, it has been a very good one. It has certainly been very helpful in noble Lords on all sides sharing their experiences and thoughts. It has raised some important issues and some comments on drafting. I am grateful to noble Lords for them. It has also enabled your Lordships to share some practical experiences, not least about the NHS Covid app. It sounds as if it is moving towards a resolution.

I was slightly amused that some of those who said that these issues do not need to be addressed in the Bill are often those who say that other issues need to be addressed in primary legislation so, when we are talking about consistency, we all need to think about that.

I am very grateful to my noble friend for saying that he agrees that more needs to be done and is being done to align healthcare across the United Kingdom and for stressing the importance of collaboration. I will, of course, withdraw this amendment, but the amendments in this group raise important issues and I hope that discussions can continue. As the noble Baroness, Lady Walmsley, I think, said, this is about practical, positive treatment and outcomes for patients, which is what we all want to see regardless of where they live.

Amendment 17 withdrawn.