Health and Care Bill

Baroness Pinnock Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Pinnock (LD)]

My Lords, in the absence of the noble Baroness, Lady Donaghy, I will speak next. I draw the attention of the House to my relevant interests as a vice-president of the Local Government Association and a member of Kirklees Council. I intend to concentrate on those elements in the Bill that impact on local government.

In West Yorkshire and, I suspect, other parts of England, planning is well advanced for establishing integrated care boards. There is a flavour here of a reorganisation that is already a done deal, yet there are important issues that remain unanswered by the proposals in the Bill. The first of these is that the Government proposed three reform programmes: this Bill; the adult social care White Paper, which was published last week; and the missing one—the care integration White Paper, which has been delayed yet again and will be vital as a part of all these reforms. I do not see how you can do this Bill without the White Paper that is missing. Another missing piece of reform is any detail at all about the delivery of health and care at the level defined as “place”. A further, major missing element is an adequate increase in funding for local government delivery of adult social care. You cannot have one without the other: reform without the funding will simply not work.

The final missing piece is democracy and accountability to local people. An opportunity to bring explicitly elected local voices into the governance of health and care at a local level has been ignored. Robust governance models that reflect the people and places served and allow for transparency and accountability provide the best outcomes in the end. However, the model proposed provides for even greater central powers and even less for the people for whom the service is provided.

I now turn to the issue of who pays what towards the cost of their care. There are a number of anomalies in the current proposals beyond the issue of the cap; this is not about the cap. If you are in residential care, you will need to pay a contribution towards the hotel costs; that has been fixed at £200 per week. This means that, if you are living in an older care home in a part of the country with low property values, your fees might be, say, £800, of which £200 might cover the accommodation costs, as these are lower. However, in a new, modern care home, in an area of high property values, your fees per week might be £1,000, of which £400 are accommodation costs. Bear with me—the maths is coming. Under the new rules, both people would pay £200 towards the hotel costs. This is important because the individual in the modern care home would then count £800 towards the cap on their contributions, whereas the second person, in the older care home, would count only £600 towards the cap, even though the value of the care that they receive is the same. In other words, the current proposals favour people in parts of the country with higher property values. I wonder how this approach reflects the so-called levelling-up agenda.

Finally, I refer to the clause related to adding fluoride to the water supply. This is obviously in order to combat tooth decay, which is caused by an excess of sugary foods. However, prevention is better than cure, and substantially reducing sugar intake is surely a better way forward—besides which, adding fluoride to the water supply is not as straightforward as it may first appear because water can be, and is, piped from one water company to another and from one part of the country to another.

I now look forward, with immense expectation, to the maiden speech of the noble Lord, Lord Stevens of Birmingham.