Health and Care Bill

Justin Madders Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Edward Argar]

I am afraid I am about to conclude. I suspect that the hon. Gentleman will come back in with a speech and I will endeavour to pick up on that in the wind-ups.

There are a number of similar amendments, such as amendment 101 in the names of the hon. Members for Wirral West (Margaret Greenwood) and for Brighton, Pavilion (Caroline Lucas). I hope they might feel, to some degree, reassured by our amendment and the intent behind it, but that is obviously for them to say. We believe that the Government’s amendment puts beyond doubt what we believe was already entirely clear but were determined to put beyond doubt—that ICBs will not and cannot be controlled in any way by the private sector, as NHS-accountable bodies guided by the NHS constitution and with NHS values at their heart. These principles, I believe, irrespective of other debates we may have this evening, command respect from both sides of this place. I therefore commend the amendments to the House.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

A wide range of issues that are part of this group of amendments demonstrate the cold reality of this Bill. It is a jumble sale of bits and pieces. Of course a Bill can be wide-ranging, but having breadth is not the same as having coherence, or indeed clarity. Such are the issues within scope in this grouping that I will not comment directly on every new clause and amendment but hope to have time to say at least a few words on those emanating from the Opposition Front-Bench team, as well as on any Government new clauses or amendments that we oppose. Some amendments refer to matters that have been dealt with in Committee where we have expressed our views and put forward amendments that failed to persuade the Government. Sadly, we have insufficient time to go over the same ground again, particularly given the rapid shifting of the goalposts we have seen in the past week.

I turn first to integrated care boards, or ICBs, and, more widely, the issue of governance. The question of governance and accountability remains an important matter to us and needs greater clarity than currently appears in the Bill. For Members who may not be familiar with the detail, the Bill proposes yet another reorganisation of the NHS, creating 42 new integrated care systems where decisions on how NHS and care spending will be made. The decision-making bodies within these systems are the ICBs, replacing the CCGs, which fall away into the annals of history alongside the primary care groups, the primary care trusts and all the other permutations that we have seen.

Our discussions on these matters in Committee showed that our disagreements tended to centre around an intention by Government to limit what is in statute and to leave maximum flexibility at local level, as opposed to our desire to ensure that safeguards and protections were in place for those matters we felt were too important to be left out. It is wholly ironic, therefore, that the Bill proclaims, on the one hand, local freedoms and flexibilities, yet on the other proposes sweeping top-down powers for NHS England and the Secretary of State. Our view remains that some flexibility is fine to allow shaping to local needs, but that some key principles need to be put into the Bill to ensure that there are no misunderstandings or unintended consequences.

We know that the genesis of this Bill has been the realisation that increasingly large parts of the NHS were ignoring the 2012 Lansley Act. Along with changes to procurement and pricing, this grouping deals with the main elements of reversing parts of that Act. We could spend all our time referring to what we said 10 years ago, and how the Health and Social Care Act 2012 has proved to be the disaster that we said it would be, but we will spare the Government the “We told you so” lectures, because even those on the Government Benches are now aware that the 2012 Act has been among the worst policy mistakes in the history of the NHS. Whether that damage was worse than the damage done by a decade of austerity remains to be seen, but repairing the damage done by austerity is not for today, as there is little in the Bill to address the ongoing consequences of a decade of underfunding, particularly the wholly appalling waiting times that we now see across the board.

--- Later in debate ---

[Geraint Davies]

Perhaps my hon. Friend can illuminate me. I was going to ask the Minister who owns the assets of the ICBs. Can the ICBs sell some of those assets and rent them back as a service? What constraints are there to stop people on the board enabling that, because they have some strange link to the people buying the assets?

[Justin Madders]

At the moment, ICBs are not a legal entity, so they do not own anything. When the Bill comes into force, they will effectively take over mainly administrative buildings from the CCGs, and the trust will hold ownership of most of the assets. We hope that there will not be the risks that my hon. Friend outlines, although it is not impossible for ICBs to set up their own trusts at some point in the future.

We do not believe that the question of private providers sitting on the place-based boards can be left open in this way, because this is really about who runs the NHS. There is a complete and utter incompatibility between the aims of private companies and what we say should be the aims of the NHS and the ICBs. I can do no better than refer to the evidence of Dr Chaand Nagpaul from the Bill Committee. He identified the concern perfectly:

“We forget at our peril the added value, the accountability, the loyalty and the good will that the NHS provides. We really do…I am saying that it does matter. Your local acute trust is not there on a 10-year contract, willing to walk away after two years. It is there for your population; it cannot walk away.”––[Official Report, Health and Care Public Bill Committee, 9 September 2021; c. 90, Q113.]

Those final words sum it up perfectly. Put a company on the board, and its interest lasts as long as the contract, and those interests will of course not be the same as the NHS’s anyway. A company’s primary concern is the shareholders, not the patients. With that clear and unanswerable concern about conflicts of interest, we invite the Government to withdraw their amendment and support ours.

We have already had some discussion of who goes on the ICB. Apparently, the answer is not the most appropriate people chosen by an independent external process or individuals directly accountable to the public; the answer is left to guidance that leaves open the risk that voices we think need to be heard will slip through the net. Our amendment 76 deals with that by setting out the requirements for ICB membership. Allocating scarce NHS resources should be robustly debated and will always be political. Tough choices have to be made, so we need people on the ICB who will be there to cover all the necessary interests for the wider good.

If Members look at what amendment 76 suggests, I hope nobody would argue that those interests do not have to have some voice. The public, patients, staff, social care, public health and mental health—which of those can be safely ignored and which has no part to play? As I have already mentioned, there is a major area of uncertainty because of the complete absence of anything that sets out how the much-vaunted place-based commissioning will work. Who will sit at the place-based table is, I am afraid, still completely opaque.

The next major area covered in the Bill is a further deconstruction of Lansley with the removal of compulsory competitive tendering for clinical services. We have seen the NHS proposals for a provider selection regime to replace the regulations under section 75 of the 2012 Act. That is to be regarded as a work in progress, so our amendment 72 covers the issue and would reintroduce some safeguards into how our money is spent. Since its inception, the NHS has always relied on some non-NHS providers, with the model developed for GPs being an obvious example. However, in recent decades there has been an increase in the use of private providers of acute care, most notably in diagnostics and surgery.

To be clear, we on the Opposition Benches believe that the NHS should be the default provider of clinical services. If it is not the only provider, it should be the predominant provider in geographical and services terms. Where a service cannot be provided by a public body because the capability or capacity is not there, there is still the option to go beyond the NHS itself, but that should be a last resort and never a permanent solution. Amendment 72 therefore sets out a clear framework for how we could achieve that. We hope that extra transparency and extra rigour would mean we avoid buying stuff that is unsuitable and sits in container mountains, stuff that does not meet specifications, and stuff made by companies that have no experience, but are owned by friends and family. In short, we would stop the covid crony gravy train.

The use of private sector capacity in the covid emergency turned out to be a farcical failure. It became very clear, very quickly that it was not there to support the NHS; it was there just to make profits. Use of private providers through dodgy deals during the PPE scandal has highlighted the need for greater transparency and greater capacity in the NHS. We can never allow a repeat of what we have seen there. We need the rigour set out in the amendment to be put into legislation, rather than left to guidance. We need to be able to challenge NHS bodies that do not comply, as well as Ministers who try to flout the rules.

I will now deal with new clause 49, saving the best—or more accurately, the worst—until last. Because of how Report stage works, it has fallen to me to express our opposition to this measure, rather than my expert colleague, my hon. Friend the Member for Leicester West (Liz Kendall), who shares my dismay at what has been produced and how it has been presented to us. Starting with the process, it is wholly wrong to bring such a fundamental change forward as a last-minute addition to this Bill. That means it cannot be debated properly today. There is no impact assessment and, as we have already heard, this change was not discussed in Committee at all. In fact, in 22 Committee sessions spanning some 50 hours, we never once heard mention of this amendment coming forward or discussion on the care cap. Indeed, when this Chamber was busy debating the social care levy, we were beavering away in Committee on the Bill, oblivious to the fact this measure was coming down the track. If the Government cannot even get their decision-making processes integrated, what hope is there for integrating health and social care?

As we know, the aim of the new clause is to remove means-tested benefits from the costs that count towards the care cap. As has been pointed out far and wide by Members from all parts of the House, that change adversely impacts some more than others. It is a wholly regressive measure, to say the least, to give support through means-testing, but then to penalise people later for receiving it in the first place. We will vote against this iniquity, and I hope many Conservative Members will vote with us. They should be used to the Prime Minister’s broken promises by now; this is their chance to make the point that he should stand by what he says.

[Mike Amesbury]

Does my hon. Friend agree that it is Robin Hood in reverse? I encourage Conservative Members who wax lyrical about levelling up, particularly in the north, to do the right thing.

[Justin Madders]

My hon. Friend must have sneaked a look at my speech, because I will say later that it is Robin Hood in reverse.

[Barbara Keeley]

The proposal is grossly unfair. I gave the example earlier that in our region, 15% of people with dementia will reach the cap, whereas 34% would have under the Dilnot proposals. The cap also does not protect working-age adults who are accessing social care, or people with a disability, but Sir Andrew Dilnot’s proposals would have done. It is the second major area in which the proposal is grossly unfair.

[Justin Madders]

Again, my hon. Friend must have read my speech because I will make that point later. The proposal shows that the Bill is not a plan to fix social care but a very thin attempt to change parts of the system. There are many other elements that clearly need dealing with.

In case Conservative Members need reminding, in the Prime Minister’s first speech on taking office, he promised to,

“fix the crisis in social care once and for all, with a clear plan that we have prepared”.

We are still to see that plan. What we have is a new tax and a broken promise.

[Alison McGovern (Wirral South) (Lab)]

My hon. Friend and neighbour is making an excellent speech. We should be talking about a plan for social care, but we are actually talking about a tax on the people who have lost out over the past decade and more from the excessive house price growth in the south compared with other parts of the country. This is a tax that doubles down on inequality, rather than addressing it.

[Justin Madders]

I thank my hon. Friend and neighbour—I am getting all my neighbours in tonight. She makes a brilliant point: the proposal exacerbates regional inequalities through an unfair tax and is certainly not a plan to fix social care. Hon. Members should look at what my hon. Friend the Member for Leicester West has said about what needs to be done to tackle the social care crisis in this country; it is an awful lot more than putting in place a cap that benefits only some people in certain parts of the country.

Not only will the proposal not stop people having to sell their home to pay for their costs, but it will bake in unfairness for a generation. It does nothing for working adults with long-term care needs, who seem to have been completely missed out, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) said. It is not what was promised, but hon. Members do not have to take my word for it. Let us listen to the experts. Age UK says:

“The change the Government has announced makes the overall scheme a lot less helpful to older people with modest assets than anyone had expected. It waters down Sir Andrew Dilnot’s original proposal to save the Government some money, but at the cost of protecting the finances of older home owners…This feels like completely the wrong policy choice and we are extremely disappointed that the Government has made it”.

The King’s Fund says of people with more modest assets that,

“the Prime Minister’s promise that no one need sell their house to pay for care…doesn’t seem to apply to them.”

Instead, it will only “benefit wealthier people”.

[Barry Gardiner]

My hon. Friend referenced the Prime Minister’s statement that nobody would have to sell their house to pay for social care. I know that my hon. Friend would never seek to call the Prime Minister a liar in this Chamber, but does he wonder, as many hon. Members do, why the Bill appears to be turning the Prime Minister’s words into a lie?

[Justin Madders]

I thank my hon. Friend for his intervention—I think. What I can say here and what I might say outside are not the same, and I do have to finish my speech, so I will leave it there. I am sure that the public will make up their own minds about the veracity or otherwise of comments made by the Prime Minister.

Sir Andrew Dilnot said that the proposals will create a north-south divide, that those with assets of £106,000 will be hardest hit and that anyone with assets under £186,000 will be worse off than under his proposals. According to the Health Foundation, assuming care costs of about £500 a week, those with assets of £150,000 will take a year and a half longer to reach the cap than they would have under the Dilnot proposals, those with assets of £125,000 will take four and a half years longer, and those with assets of under £106,000 will never reach the care cap. Contrary to what the Minister has said, people with assets of £106,000 or less will not benefit from the proposal at all.