Health and Care Bill

Charles Walker Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Edward Argar]

I think my right hon. Friend is talking about executive posts. Yes, there will be processes in place to ensure that employment rights are respected. There will be some roles that are completely new and there will be a competition, but I would expect that those with a significant track record and experience would therefore find themselves in a strong position. I will not prejudge any of those individual decisions.

[Sir Charles Walker (Broxbourne) (Con)]

rose—

[Edward Argar]

I will give way to my right hon. Friend.

[Sir Charles Walker]

I am not a right hon. Member, but I am very happy to take the promotion.

I have tabled a number of technical, totemic amendments on parity of esteem that appear on today’s amendment paper and tomorrow’s. They propose taking general references to “health” in the Bill and changing them to “physical and mental health”. I hope that the Minister will receive those amendments with his usual generosity and make the necessary changes over the next two days.

[Edward Argar]

I take my hon. Friend’s amendments in the spirit in which they are of course intended. I recognise the importance and value that those on both sides of this House put on parity of esteem of mental and physical health. I suspect that we may debate the amendments in subsequent groupings and I look forward to responding then.

We have, in the process of drafting this amendment, heard suggestions that we should simply ban private company employees completely from the boards of ICBs. I am afraid that doing so is not so simple, nor would it achieve the desired result in all cases. In fact, our amendment goes further to underline the importance of NHS independence than would an amendment that focused purely on banning employees of private providers. There are clearly some candidates who would be suitable but may have minor interests in private healthcare. GPs, for example, do provide, and have provided, their excellent knowledge and experience of their patients in guiding commissioning decisions, and some may have private practices as well. Excluding them would be to lose their experience from the NHS, and therefore such an involvement with the private sector would clearly not risk undermining the independence of the NHS.

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[Bell Ribeiro-Addy (Streatham) (Lab)]

I rise to speak against the Bill overall but in favour of new clauses 56 and 57, tabled in my name, and those amendments and new clauses tabled by any Member who has sought to change the pernicious outcomes of the Bill.

Our NHS is really one of the best things about this country, but the Bill is the biggest threat to it yet. It rolls out the red carpet for private companies, ramps up the Government’s long-standing attempts to privatise the NHS, and makes easier what we have witnessed over the past 18 months: the awarding of contract after contract without a competitive process, and the rewarding of failing companies with new contracts again and again.

The Bill will be the destruction of our NHS as we know it, and will widen the inequalities that the pandemic has exacerbated. We now have more than 5.7 million people on NHS waiting lists. Of course, that is not solely because of the pandemic—far from it. After the Government won the 2010 election, around 500,000 to 750,000 people were on NHS waiting lists, and the number rose every year before the pandemic, so the waiting lists are the long-term effect of the Conservative policies of underfunding and privatisation.

Waiting lists have now doubled, and our NHS is in danger of toppling over. All the while, health inequality is rising. That is why, with the support of the Health Foundation, I tabled new clause 57, which would compel the NHS to set out data-collection guidelines on health inequalities. We know that health inequalities exist and have seen them play out with the worst consequences, from postcode lotteries to racial disparities, and it is time that we accepted that, collected the proper data—it is a farce that we do not already do so—and set out to make real change.

Since 2010, improvements in life expectancy in England have slowed more than in any other country in Europe, and the gap between rich and poor in respect of the number of years people can expect to live in good health has widened even further. During the pandemic, that was shown by the higher death rates among people who live in more deprived areas and among certain populations, most notably disabled people and people from black, Asian and minority ethnic communities. Among people younger than 65, the covid-19 mortality rate was almost four times higher for the 10% living in the most-deprived areas than for those living in the least-deprived areas. This is nothing new; the Marmot reviews have covered that many times.

Earlier this year, the King’s Fund found for the NHS Race and Health Observatory that any success we have in tackling health inequalities is always drowned out by other strains, such as waiting times and other clinical priorities. Put quite simply, we cannot tackle inequalities because this Government have never put equality at the front and centre of their policy making. That makes their so-called levelling-up agenda meaningless.

The Bill will enshrine in law the new so-called triple aim to promote various different factors, but the Government are so short-sighted that they have declined to incorporate health inequalities into the triple aim. What a complete missed opportunity that is—or a clear indication that the Government really could not care less. Before anybody says any different, and that the NHS has other means of doing that, we need to look at the state of the outcomes, because what is happening is clearly not working.

The Government continuously and repeatedly fail to accept examples of institutional discrimination, let alone meet their duties under equalities law. We recently heard about how the issues in respect of oximeters and dark skin will have contributed to worse outcomes. The Secretary of State for Health and Social Care has called for a review of gender and race bias in medical equipment; quite frankly, that is groundbreaking—all we seem to do is have reviews. We would already have these types of policies had we just heeded past Government reviews and looked at the equality impact assessments. There is no excuse for the Government to keep ignoring the requirement that is already set out in law for them to meet their equalities duties to people right across this country.

[Sir Charles Walker]

I caught your eye half a minute ago, Madam Deputy Speaker, and you indicated to me with that look that I was next. My heart rate quickened. I am always nervous when I speak in this place because we do really important stuff here—all of us do—and this is an important Bill.

Before the Health and Social Care Bill became an Act in 2012, it was amended by the Conservative Government. It was amended in pursuit of parity of esteem. The Coalition Government changed general references to health to “physical health and mental health”, which was not a courageous thing to do—it was entirely the right thing to do.

I have tabled a series of amendments—10, if I have counted them correctly—for debate over the next two days. They ask the Government to change all general references to health to “mental health and physical health”. It is a call to arms. These changes are not just totemic, but hugely important. Over the next few years, we need to recruit 9,000 more mental health nurses to look after our constituents and more than 800 new psychiatrists, and we need to give all organisations charged with delivering healthcare that nudge, that push, that call to arms that they need to make these important things happen. We also need to send another message from this place—on top of all the other messages that we have sent over the past nine years—that we believe that there is no physical health without good mental health, and that good mental health means good physical health.

I am looking at the Minister because he has made a couple of staggering interventions on colleagues tonight. Colleagues in full flow, prostrating themselves at the feet of Government, have suddenly been rewarded with his stylish, charming intervention of, “The Government have heard your cries, and they shall act on them.” I looked at the joy that spread across the face of my right hon. Friend the Member for Basingstoke (Mrs Miller), and across the face of my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the former Secretary of State, who spoke before me. I look at the support I have from my right hon. Friend the Member for West Suffolk (Matt Hancock), the most recent former Secretary of State—there are a few of them—and from a former Prime Minister. May I ask the Minister to make one of those generous interventions on me this evening? I am still here. I want to sit down, but if he is not going to make that generous intervention right now, I shall be back tomorrow. I shall also be travelling up to the other place and knocking on its door to make sure that these amendments are tabled there, so that, eventually, we get our way.

[Karin Smyth]

I came to this place largely on the back of the disastrous Lansley Act, and I am pleased to see it banished to the dustbin of history, which is what this Bill essentially does. It also banishes to the academic shelves that example of how not to make policy. Lansley took a sledgehammer to our work in primary care trusts, to partnerships, to morale, and to our capacity to forward-plan. Along with the austerity funding that came with it, the Act directly led to the poor state in which we entered the pandemic, and that must be front and centre of any review of the pandemic.

This Bill is a seminal point in the history of the NHS, because it banishes again to the history books experimental competition as an organising principle and a driver of efficiency. The key issue is what replaces it. Now we have in its place local cartels dominated by hospital trusts, and the supreme power of the Secretary of State to interfere in all local decisions. There is no power here for local elected representatives, no power for primary care or community care or mental health, no voice for patients, no voice for the public, and no voice for the taxpayer, who is asked to pay ever more. As we move to an ever more costly health service, accountability and transparency of our NHS in this role has to be at front and centre in order to bring people with us on that journey of paying more.

I have tabled two amendments to this part of the Bill. One is on the need for the local boards to be cognisant of palliative and end-of-life care. The other is on local improvement finance trusts, the local public private sector bodies introduced under the last Labour Government that are instrumental in providing good primary and community care estate—something that this Government are allowing to wither on the vine. My own South Bristol Community Hospital needs more support through these trusts in order to thrive, so that people have decent, good-quality estate from which to receive their care.

I also draw hon. Members’ attention to my new clause 23 on a good governance commission, which will be discussed tomorrow. I genuinely offer it as a helpful way forward. If it were enacted by the Government, it would avoid the cronyism that we have become used to, and would ensure that local bodies are more democratically accountable to their populations and more cognisant of the needs of their local populations. It would ensure that the people leading the local bodies are fit and proper, meet basic criteria regarding what is expected of them and have crucial accountability to local populations. It is akin to the Appointments Commission, which was abolished in the abolition of the quangos; that was a huge mistake. If the Government took notice of it, the new clause would really help us to get around some of the real concerns about how our local health services are governed.

Let me finally address new clause 49 on social care. It is a disappointment and unexpected. We had six weeks in Committee. In that time, we could have looked carefully at the proposal and shone a bit of light on it. The right hon. Member for West Suffolk (Matt Hancock), who is no longer in his place, clearly tried to say what this provision is really about, in that one part of the state should not be subsidising another part of the state. He started to say that that was a true Conservative principle and he was absolutely right. This provision will remind people who are in receipt of benefits that they are in receipt of those benefits, and that anything they may have built up should not be counted towards their future. It is a punitive property tax. I am old enough to remember what happened to the last Conservative Government who introduced a regressive property tax; this Government really ought to think again.