Health and Care Bill

Baroness Uddin Excerpts

Committee stage
Thursday 20th January 2022 Lords Chamber

[Baroness Uddin (Non-Afl)]

My Lords, I hesitate to rise. I had not originally intended to participate in this debate, but I feel obliged to speak and make some general points in support of the noble Lord, Lord Low, and his powerful and compelling arguments for his amendments. I declare an interest: the House will be well aware that my son, who is 43 years old, has a learning disability and is autistic, so I have some experience of the arguments spoken about by the noble Lord. I have also been a member of the All-Party Parliamentary Group for Disability for more than a decade, and I know of the fantastic work that SeeAbility has undertaken for its membership for many years.

I want to say something, because this group of adults has suffered dreadfully over the past two years, particularly during lockdown. They do not have the privilege of being at school or in early college education and being looked after by the system. I hope the Minister and the whole NHS system will agree with the suggestions made by the noble Lord, Lord Low, including the suggestion that these services should be available. I assume that making ophthalmic services available in schools and colleges is one of the easiest things to achieve. However, it is not so for adults with a learning disability and autism who have just left school and are at that age when nobody cares about them anymore. That is where the problem occurs.

I had enormous difficulties. I do not want to speak about myself in any way, because I am more than able to argue my case, find out where services are by ringing people and looking at services on the internet, and challenge when I face difficulty. I challenge more now than I was when my son was younger. I am also well attuned. I speak regularly with organisations on the ground that work with the parents and carers of people with learning disabilities and autism, so I know fully how much they struggle to ascertain and obtain information about ophthalmic care.

I want quickly to share the experience I had with my adult son. All his appointments were cancelled for nearly a year. I could see that his eyesight really suffered. He was not able to co-ordinate his way even around his own home where he is very comfortable. I had to push them hard. It was suggested that I should speak to the nearest ophthalmologist and look for these services. I admire all these services, which are trying hard to work with the NHS in the absence of patients being able to go to hospital for ordinary services, but they are not equipped or trained. They do not have the necessary equipment to produce the best results or give effective services to the people who need them. As the noble Lord, Lord Low, said, it is grossly unfair when there is sight and all someone’s eyes need are a little attention to make a fundamental difference and enrich their life. It is really important that the Government take the noble Lord’s amendments on board with the same passion that he argued with. I hope they also understand the passion of the millions of parents, carers and service users who stand behind him.

I thank noble Lords from all sides of the House for their leniency over this interruption.

[Lord Scriven (LD)]

My Lords, I have attached my name to a whole raft of amendments in the name of the noble Lords, Lord Crisp and Lord Hunt. I am pleased to follow the noble Baroness, Lady Uddin, who has explained powerfully and passionately why primary care in one area is so important to the health and well-being of people. I also thank the noble Lord, Lord Low, for introducing this suite of amendments with such a graphic and powerful explanation of why primary care, particularly for people with learning disabilities, is also important in relation to ophthalmology.

I wanted to put my name to these amendments, because they go right to heart of the purpose of the Bill. Let us be clear about the purpose of the Bill. Its purpose is to integrate healthcare to improve health outcomes and to reduce health inequality. You cannot do that if your focus is purely on the acute sector. The acute sector is the repair system. It is not the part of the system that can really deal with the prevention and innovation that keeps people out of hospital. I am sure that was never the intention of the drafters of the Bill, and I am sure that it is not the Government’s intention. However, the way the Bill is written, the power emphasis is with the acute sector in monitoring, reviewing and strategic plans.

I am sure the Minister will say that that is not the case, but the way the Bill is written it is the acute sector that will have the power over who sits in the ICB and whose plans they are. So I say to the Minister in a very friendly way that the noble Lords, Lord Crisp and Lord Hunt, and I have been involved in the management and leadership of health in different parts of the system. I was involved in acute and primary care myself. When I came into the health service, the noble Lord, Lord Crisp, was so powerful and mighty that he was the chief executive of NHS England. It was the same with the noble Lord, Lord Hunt. I feel in very esteemed and very grand company.

However, the point we are trying to make is that the real way in which healthcare works and how it is developed is that the acute sector is very powerful, even at place. If you do not give a voice and power to primary care, you will not have the innovation and the change that you require. These amendments are a way of trying to make sure that the purpose of the Bill at least moves faster and is eased by having that primary care voice right at the heart of the ICB, and, being statutorily in the Bill and having been there right at the beginning in the planning, monitoring and evaluating, being able to determine what is happening. That is what these amendments are about, nothing more. They are not amendments that should be deemed difficult or trying to slow things down. They are genuinely helpful amendments.

I say very gently but powerfully to the Minister that he really needs to incorporate these amendments. If he cannot incorporate and accept them now, the Government need to come back with a set of amendments that really crystalise the role of some great primary care people, whether they are in GP surgeries, ophthalmology, pharmacy or dental, who can actually help with the purpose of this Bill, which is to improve health outcomes, integrate healthcare and reduce inequalities. It is vital.