Health and Care Bill

Dan Poulter Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[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.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests as a practising NHS doctor. A number of GPs have, in recent times, sought to group together into confederations of practices, which could create a bloc interest within a local board area. How will that potential conflict of interest in the commissioning and provision of services be addressed by the Government through legislation?

[Edward Argar]

I am grateful to my hon. Friend, who knows of what he speaks in terms of the operation of healthcare services. We would not wish to exclude GPs or groups of GPs from being able to participate in decision making. That expertise, as we have seen with clinical commissioning groups, can be hugely valuable. What we have sought to do, in an amendment that is technically worded, for want of a better way of putting it, is to strike the right balance while also ensuring that the additional measures on the constitutions of the ICBs and ICPs have to be approved by NHS England to avoid any obvious conflict of interest. But we are not seeking to avoid GPs being able to operate in that space and sitting on ICBs.

--- Later in debate ---

[Richard Burgon (Leeds East) (Lab)]

The Health and Care Bill is deeply problematic. I want to focus on two issues that, when combined, mean that it is a complete disaster. It not only makes it easier for private health giants to profit from the national health service; it also makes a charter for corruption because it opens the door to even greater private sector involvement in our NHS. That is why this Bill should really be called the NHS corporate takeover Bill. For example, it allows private corporations to sit on health boards, which make critical decisions about NHS budgets and services, and the Government’s amendment 25 does not go nearly far enough.

Even before this Bill, an unbelievable £100 billion has gone to non-NHS providers of healthcare over the past decade alone, and earlier this year half a million patients have had their GP services quietly passed into the hands of a US health insurance giant. This Bill would lock in yet more privatisation in future, with even less scrutiny, because it means less transparency. It means private health giants getting an even bigger slice of the action with less scrutiny.

[Dr Poulter]

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests as a practising NHS doctor. On the issue of private healthcare provision, the hon. Gentleman will recognise that GPs are in fact small businesses in their own right, and some of them quite large businesses. How does he equate the role of the GP as a small business in the context of his concerns about private healthcare?

[Richard Burgon]

We are not seeking to wage war on GPs; we want to support GPs and properly resource them. We see so many GPs retiring and not being replaced. It is this Government who are waging war on our NHS with this further Americanisation of our NHS. It is a dangerous cocktail where the dodgy contracts we have seen throughout covid risk becoming the norm. The billions squandered on test and trace should serve as a warning of what the Government could do to the whole of our NHS.

There is a sleight of hand going on with this Bill. It is true that under the Bill NHS bodies will no longer have to put services out to competitive tender to the private sector. Such tendering to the private sector was made a requirement under section 75 of the coalition Government’s Health and Social Care Act 2012. It was a shameful Act and its scrapping has long been demanded by those opposed to privatisation of our national health service. However, the change in this Bill does not reverse privatisation, because without making the NHS the default provider, that simply means that contracts can not only still go to private healthcare corporations but can do so without other bids having to have been considered.

To prevent all this, I tabled amendment 9, which I want to put to a vote—unless of course the Government accept it—because it establishes the NHS as the default option. [Interruption.] Conservative Members groan, but the only reason for people not to support my amendment is if they do not believe in the NHS not moving to a privatised insurance model. Why else would people object to the NHS being the default provider of healthcare? The British Medical Association supports it, so the Tory groans are groans against the position of the British Medical Association. Unison supports it, so the Tory groans are groans against the voices of those who work in the NHS—for most of whom, if they need to have more than one job, it is because they do not get paid enough, not because they are trying to get their own snouts in the trough. I will be voting against the whole Bill, but if the Government refuse to accept amendment 9 to make the NHS the default provider, that shows what the Government of the party that objected to the foundation of the NHS in the first place are really up to, despite all the warm words.

Health and Care Bill

Dan Poulter Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Edward Argar]

I am grateful to my hon. Friend for his intervention.

Let me turn briefly to amendments 93 to 98 in the names of my hon. Friend the Member for Broxbourne (Sir Charles Walker) and my right hon. Friend the Member for Maidenhead (Mrs May). I can reassure all right hon. and hon. Members that the Government remain committed to supporting everyone’s mental health and wellbeing. I pay tribute to my right hon. Friend for the work that she did in advancing this agenda when she was Prime Minister.

Secondly, let me clarify that the current references in the Bill to illness and health cover mental and physical health and, therefore, the view taken was that it was not necessary to make that explicit.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

Will the Minister give way?

[Edward Argar]

I fear that I do not have time to cover the other amendments in the four minutes that I have left.

Although I appreciate that my right hon. Friend the Member for Maidenhead and my hon. Friend the Member for Broxbourne will continue to press this matter, may I offer them a meeting with me and the Mental Health Minister to discuss further what they are proposing in advance of the Lords stages? I cannot make any promises or say anything beyond that, but I will meet them to further discuss the sentiments that sit behind their amendments.

Let me turn to my hon. Friend the Member for Aberconwy (Robin Millar), who made his points powerfully and eloquently, as he always does. As a Government of the whole United Kingdom, we have a duty of care to all citizens in the UK, which is why I welcome the clauses already in this legislation that will bring benefit to residents across the UK.

--- Later in debate ---

[Sajid Javid]

I am happy to give my hon. Friend the commitment that we will look at that. I think everyone in the House agrees that the principle is vital, and I am sure it is supported across the House.

Let me briefly highlight the changes that we have made. First, we have heard the desire of the House to rate and strengthen the safety and performance of the integrated care systems. Working with members of the Health Committee, we have introduced an amendment that gives the Care Quality Commission a role in reviewing ICSs.

Secondly, we have heard concerns about the independence of integrated care boards. While it has never been our intention that anyone with significant involvement or interests in private healthcare should be on an ICB, following a productive meeting with the hon. Members for Nottingham North (Alex Norris) and for Ellesmere Port and Neston (Justin Madders) we tabled an amendment that ensures we write that principle into the constitution of ICBs.

Thirdly, we heard concerns from hon. Members about the potential impact of our proposed restrictions on advertising less healthy food and drink. We must, of course, do that in a pragmatic way, so we have introduced amendments to ensure we do not unintentionally impact UK businesses when they advertise to overseas audiences. Further, we will consult with stakeholders on any further changes to the nutrient profiling model.

Fourthly, and very importantly, the Bill now reflects our commitment to end the crisis in social care and the lottery of how we all pay for it. It is not right and not fair that the heaviest burdens often fall on those who are least able to bear it, so we are introducing a cap on the costs of care so that no one will have to pay more than £86,000 over their lifetime. That cap that will be there for everyone, regardless of any conditions they have, how old they are, how much they earn, or where they live. We will introduce a far more generous testing system, so that everyone will be better off under the new system.

We move a Health and Care Bill that is stronger than before, with those three underpinning principles reinforced: embedding integration, cutting bureaucracy and boosting accountability. On integration, it is not about simply telling the NHS, local authorities and others to work together; it is about helping them to do it by doing things like merging NHS England and NHS Improvement into a single statutory body and establishing integrated care boards to deliver as one.

[Dr Poulter]

I declare an interest as a practising NHS doctor. On integration, my slight disappointment with the Bill is that while it pulls people together in joined-up commissioning boards, there is no commitment to put the money into the same place. If we want to drive joined-up commissioning, we need to put the money into the same place. Will the Secretary of State consider that and how true integration can be achieved as the Bill goes to the House of Lords?

[Sajid Javid]

My hon. Friend makes a very important point and he speaks with deep experience. What I can tell him is that we will shortly be publishing an integration White Paper, which, given what he has just said, I am sure he will welcome.

Health and Care Bill

Dan Poulter Excerpts

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

[Margaret Greenwood (Wirral West) (Lab)]

Amendment 29B goes much further than the Bill’s current provisions on workforce reporting, which are extremely weak. It would require the Government, at least once every three years, to lay a report before Parliament describing the system in place for assessing and meeting the workforce needs of health, social care, and public health services in England. What could be more reasonable? One has to wonder why the Government do not support amendment 29B. Surely any Government who were committed to running the NHS as a public service would see these provisions as crucial.

The Royal College of Physicians has pointed out that clause 35

“will not set out how many health and social care staff are needed to meet demand”

and has stated that, without long-term projections, which amendment 29B would provide, there is no way to assess how changes in workforce trends, such as retirements or working part time, will impact the delivery of healthcare. The Royal College of General Practitioners has spoken of unsustainable pressures driving GPs out of the workforce and threatening to destabilise general practice.

Just a few weeks ago, the Royal College of Nursing said that nursing staff are exhausted and that staff shortages are undermining their efforts to give safe and effective care—a sentiment reflected by a nurse I met on bank holiday Monday. That is hugely concerning. As the RCN has said, there is a clear evidence base showing that staffing levels have a direct impact on the safety and quality of patient care. When I met members of the RCN last year, they made clear to me the increased stress levels that nurses are experiencing as a result of staff shortages and the impact that is having on the care they so desperately want to deliver.

According to the Health Foundation:

“In the next 25 years, the number of people older than 85 will double to 2.6 million”

in England, so demand for social care is increasing and we need to know that there will be enough doctors, nurses and social care workers to meet people’s needs. The “Strength in Numbers” campaign, a coalition of more than 100 health and care organisations, says that we must put

“measures to adopt a sustainable long-term approach to workforce planning on a statutory footing.”

Without credible, up-to-date numbers, the system cannot plan.

I support Lords amendment 29B. I urge the Government to think about those NHS staff who are working so hard and are so stretched by the amount of stress they are under because they do not have enough colleagues around them, and to listen to the clinicians who are calling on the Government in this regard.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests as a practising NHS doctor. I welcome the Government’s concessions on modern slavery and procurement and on the reconfiguration of NHS services. However, I remain concerned about two issues: the care cap and independence in the staffing assessment process.

To touch briefly on the issue of the care cap, a number of years ago I took through this House the Care Act 2014, as a Minister in the coalition Government. We based that Act and the care cap on the Dilnot proposals. I continue to be concerned that the current proposals deviate from the Dilnot proposals, in that those with lower or more moderate net assets will be asked to pay disproportionately more than those with greater assets. That is something I find very difficult to accept. It deviates from the principles of the 2014 Act and the Dilnot proposals, and I hope that even at this late hour the Government will reconsider their position on it.

I rise in particular to speak in support of Lords amendment 29B and the comments by my right hon. Friend the Member for South West Surrey (Jeremy Hunt). It is undoubtedly the case that we cannot have safe staffing in the NHS if we do not have the right number of staff. We cannot meet the increasingly complex care needs of patients with not just one, two or three but sometimes four comorbid conditions if we do not have staff with the right skills and in the right numbers to meet those care needs.

We talk often of building new hospitals and of our programme of capital investment in hospitals, but unless we have the right numbers to staff those hospitals, we will not be able to deliver safe care. In every constituency represented in this Chamber, we recognise that there are staff shortages in the local NHS. We recognise particular challenges in the medical workforce among fully qualified GPs—over the past seven years the number of full-time equivalent GPs has fallen. We recognise challenges in the midwifery workforce, which were brought tragically to our attention by the Ockenden report, and we recognise challenges in areas such as intensive care and paediatrics and throughout the health service.

The problem with health workforce planning is that Governments see the NHS in electoral cycles, but workforce is much more complicated than that. From starting medical school to becoming a consultant it takes perhaps 15 years, and to become a fully qualified GP takes about 10 or 11 years. It is important that we have a genuine independence to the process of workforce planning. I have great faith in Health Education England and I am sure it will produce a good report and assessment, but unfortunately it will be doing so with one hand tied behind its back, because it must do so within the confines of the financial envelope in which it is working, and it lacks the genuine independence to say what the NHS really needs.

If we care about patients and about the future of the NHS and its needs, true independence in a report on workforce is required. That is in the best interests of patients, of the health and care workforce and of the future of our health service. I hope the Minister will reconsider.