Health and Care Bill

Baroness Pitkeathley Excerpts

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

I hope also that Ministers will recognise the breadth and depth of support from the health and local government sectors for these amendments. They will know that bringing together so many organisations with varying roles and priorities is very difficult. The fact that so many are singing the same song is a triumph and I am sure that my noble friends on the Front Bench will consider these views and give pause for thought. I am sure that they will not be dismissive. That is not in either of their natures, as we have witnessed on other matters. However, I want some reassurance that these amendments are not totally negative and are not to be totally dismissed. I hope that my noble friends will seek to work towards some of these amendments because they are really important. Those of us who have been through the whole process of reconfigurations in a position of authority—not as a Minister, as the noble Lord, Lord Warner, was, but as junior Ministers—know how fraught reconfigurations are. I therefore hope that these amendments will find some favour with my noble friends on the Front Bench.

[The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)]

I call the noble Lord, Lord Howarth, who is participating remotely.

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

My Lords, your Lordships’ Select Committee on the Constitution, of which I have the honour to be a member, has advised the House, as has the Delegated Powers and Regulatory Reform Committee, that this Bill is a skeleton or framework Bill. It provides a multitude of vaguely delineated powers and duties. It is often impossible for noble Lords to scrutinise these meaningfully because their meaning is so unclear

The Bill is also an instance of a growing tendency in the Government’s legislative practice to create “soft law”—that is, guidance, rules and directions which are not susceptible to parliamentary scrutiny but are, in, effect binding. It also creates “hard law”, which is not susceptible to parliamentary scrutiny, as in the Henry VIII power in Clause 15, but is subject only to the negative resolution procedure.

This manner of legislating is part of a pattern documented in a long series of reports by the Constitution Committee, drawing the attention of the House to Henry VIII clauses which are convenient to the Executive but subversive for parliamentary democracy, and to the creation of delegated powers enabling Ministers to bring in significant policy change subject to little or no parliamentary scrutiny. The DPRRC has reported that the Bill contains no less than 155 delegated powers.

What is egregious, however, are the autocratic powers that the Bill accords to the Secretary of State. I had sought to indicate that I wished to speak on the previous group, but there was some confusion, and the Chair did not invite me to do so. I hope therefore that noble Lords will bear with me as I take us back for a moment.

As the noble Lord, Lord Hunt, and others, noted Clause 39, entitled

“General Power to Direct NHS England,”


states:

“The Secretary of State may give NHS England directions as to the exercise of any of its functions.”


It goes on to say:

“The directions that may be given include a direction as to … when or how a function is, or is not, to be exercised”


and

“matters to be taken into account in exercising a function.”

The autocratic power provided by Clause 39 is exacerbated by Clause 64, which repeals the duties previously placed on the Secretary of State to respect autonomy within the NHS.

The mischief, which the noble Baroness’s amendments in this group seek to mitigate, is further compounded by Clause 40 and Schedule 6, which confer comprehensive powers on the Secretary of State in regard to reconfiguration of NHS services. Effectively these three clauses together confer upon the Secretary of State, with only the exception stated at proposed new Section 13ZD in Clause 39, mainly in relation to clinical discretion, absolute power over the NHS.

We are told that the Secretary of State has no intention of bossing NHS England around and that he needs powers to sort out failures within the NHS system. In our earlier debate today on continuing care, and in his response to the last debate, the Minister said it is not the Government’s intention to interfere unduly in the affairs of ICBs. However, in a letter to the Times today, referred to by the noble Baroness, the chief executive officers of the King’s Fund, NHS Providers and the NHS Confederation warn of the danger that the Bill may lead to politicisation of decision-making in the NHS, of the kind which the noble Lord, Lord Warner, described in the last debate and which the noble Baroness, Lady Cumberlege, has just explained. The fact remains that Clauses 39, 40 and 64 make the Secretary of State untrammelled master of the NHS.

With such power comes temptation, not least for Department of Health officials. What might “unduly” mean in practice? The Secretary of State may often refrain from interfering, but too often he, or officials acting in his name, may not. In any case, to accord the Secretary of State such excessive power is wrong in principle. The legislation should strike an acceptable balance between the autonomy which NHS leaders and managers need if they are to do their jobs well, responding as they judge appropriate to local needs, and a due accountability of the NHS to the Secretary of State and, through him, to Parliament. Here, however, we have neither. The Bill concentrates power over the NHS in the hands of a Minister who is poorly accountable to Parliament in the exercise of much of his power.