Health and Care Bill

Baroness Laing of Elderslie Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Matt Hancock (West Suffolk) (Con)]

I support new clause 49 because I support the action that is needed to make reforms to social care that are long overdue. I have listened carefully to the debate, and it is vital that we understand that the new clause would deliver one part, but not the whole, of the package that was set out by the Government in September. There is no doubt whatever that that package, as a whole, improves the provision of social care, makes the way it is paid for fairer, and removes some injustices that have existed in the system for far too long.

First, the proposal that has been put forward—and I think it is the right proposal—is for a cap on the costs that individuals face in paying for their care. The contributions from the state, even if they are from another part of the state such as local government, are not individuals’ care costs, and it is therefore wrong that they should be contributions towards the cap. The cap has the stated goal of being a cap on the cost of care to an individual, not a cap on the cost that accrues to both the individual and a local authority.

Let us look at what would happen if the new clause were not passed. The provision of care by local authorities is different in different areas, largely according to how well off those local authorities are. A richer council that pays more costs than the statutory minimum as set out in the Care Act 2014 would help local residents to meet the cap sooner than a poorer council that pays only the statutory minimum of care costs, and therefore people who live in poorer areas would take longer to reach the cap, so we would end up, in effect, with a postcode lottery cap meaning that people from poorer areas would tend to have to contribute more. That is wrong, and I am very glad that it is put right by the proposals that are before us today.

Secondly, for those with lower asset values, the rise in the floor in the means test is more important. It is the rise in that floor that makes this system fair. When the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), read out a long list of places with low asset values on average—places where house prices tend to be lower—he listed exactly the areas that will benefit most from the rise in the floor. [Interruption.] We can see what Labour Members are doing. [Interruption.] They are taking a narrow area, and they are taking a specific detail, and they are ignoring all the parts of the package that benefit the people who will benefit from this package as a whole. [Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. We will not get anywhere if people shout. This is supposed to be a reasonable discussion.

[Matt Hancock]

Thank you, Madam Deputy Speaker.

A further point that is being ignored by those who are trying to make a meal of this new clause is that the cutting of the daily cost offset is much more valuable to those on low incomes than any change in the cap, because the cap, by its nature, is there to protect assets, and those who do not have many assets gain far more benefit from the cut in the daily cost that would otherwise clock up their contributions to the cap much more slowly.

Taken together, these elements make up a package that is beneficial to those on low incomes. It helps to make the system fairer.

My final point on new clause 49 is this. For years and years—including the years when I was Secretary of State, and including the entire 13 years when Labour was in power—nobody fixed the problem of social care. This Government have come forward with a package, and if we pull apart one part of the package, there is a risk to the package as a whole. As Sir Andrew Dilnot said on the radio this morning,

“the whole package is a significant step forward”.

It is always easy in politics, and in life, to say, “I just accept the bits of the package that I like”—and, in the case of the Labour party, to say, “I accept the bits that are very expensive for taxpayers.” Instead, we must look at the package as a whole, which is funded, and which can be delivered, for the first time in several decades, because it hangs together. The Government have presented a whole package, and it is the best possible option in the fiscally constrained times in which we live.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. It will be obvious to the House that a lot of people wish to speak and that there are a lot of amendments still to be spoken to. We have only an hour left, so I am going to impose a time limit of four minutes immediately. I apologise to the hon. Member for Bootle (Peter Dowd) for not giving him notice that he would have only four minutes, but I am sure that he will manage.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

I am going to reduce the time limit to three minutes in the hope that as many people as possible can get in.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Members will appreciate that I have had to give precedence to people who have amendments in their names on the Order Paper, so not everyone else will have a chance to speak this evening.

[Apsana Begum (Poplar and Limehouse) (Lab)]

In the interests of time, I will just speak to my amendment 99 and new clause 57 tabled by my hon. Friend the Member for Streatham (Bell Ribeiro-Addy).

The Government often talk the talk on health inequalities but fail to walk the walk. New clause 57 sets out a requirement that NHS England must publish guidance in relation to health inequalities, which I wholeheartedly support. My amendment 99 seeks to put in provisions to reduce inequalities between non-migrant and migrant users of health services. Campaigners and experts have argued that the pandemic has shown more tangible action is needed to tackle health inequalities. The increased risks of those on lower incomes and black, Asian and minority ethnic communities catching and dying from covid-19 have been well documented, yet the provisions outlined in the Bill will likely make the situation much worse.

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The Deputy Speaker put forthwith the Questions necessary for the disposal of the business to be concluded at that time (Standing Order No. 83E).

[Madam Deputy Speaker (Dame Eleanor Laing)]

Amendment 102 has been selected for separate decision. I call Mrs Maria Miller to move the amendment formally.

The right hon. Lady is not here, but I understand that the Minister can move the amendment formally.

Clause 19

General functions

Amendment made: 102, in page 21, line 25, at end insert—

“(c) set out any steps that the integrated care board proposes to take to address the particular needs of victims of abuse (including domestic abuse and sexual abuse, whether of children or adults).”—(Edward Argar.)

This amendment requires the joint forward plan for an integrated care board and its partners to set out any steps it proposes to take to address the particular needs of victims of abuse (including domestic abuse and sexual abuse, whether of children or adults).

[Madam Deputy Speaker]

There is great excitement on the other side of the House, but there is no doubt about the procedure. As the Minister had already indicated his intention to accept amendment 102, it was perfectly in order for him to move it.



Clause 25

Care Quality Commission reviews etc of integrated care system

Amendment made: 114, page 37, line 27, at end insert—

“(2A) The priorities set by the Secretary of State under subsection (2)(a) must include priorities relating to leadership, the integration of services and the quality and safety of services.”—(Jeremy Hunt.)

The Secretary of State has the function of setting priorities for the Care Quality Commission in carrying out assessments in relation to integrated care systems. This amendment requires the Secretary of State to set priorities relating to certain matters.

Clause 69

Procurement regulations

Amendment proposed: 72, in page 64, line 1, at end insert—

“(3A) The regulations must make provision in relation to the procurement of the services referred to in paragraph (1)(a) (other than primary medical services, primary dental services and primary ophthalmology services) that before any contract for a service with an annual value in excess of £5m may be awarded to an organisation that is not an NHS trust or NHS foundation trust—

(a) the business case for the award of the contract must be published;

(b) any responses to the proposal in the business case must be considered and published;

(c) the process for awarding the contract must be open and transparent and non-discriminatory at every stage, including (but not limited to)—

(i) procurement strategy and plan,

(ii) invitation to tender,

(iii) responses to invitations,

(iv) evaluation of tenders,

(v) decision to award, and

(vi) contract awarded;

(d) the process for awarding the contract must demonstrate due regard to the principles established in the Public Contracts Regulations 2015 (S.I.2015/102) or any regulations which may supersede them;

(e) in any case where it is claimed that an emergency justifies an award without the process being used then the responsible body must within 14 days publish the business case for the award of the contract and the record of the decision.”—(Justin Madders.)

Question put, That the amendment be made.