Health and Care Bill

Karin Smyth Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Edward Argar]

I am grateful to the shadow Secretary of State who, while I do not necessarily agree with what he says, as ever puts it courteously. We hold true to what we put in that “Build Back Better” document. It is necessary for this one particular element to see further primary legislation, hence the amendment today.

[Karin Smyth (Bristol South) (Lab)]

Will the Minister give way?

[Edward Argar]

I am afraid that I will not give way because I do need to make some progress.

[Karin Smyth]

Will the Minister give way on that point?

[Edward Argar]

I have been very generous with my time and to the shadow Front Bench, so forgive me, but no.

[Karin Smyth]

On that point, will the Minister please give way? Six weeks in Committee and not a mention.

[Edward Argar]

Forgive me, but no.

To reiterate, as my right hon. Friend the Prime Minister said on 7 September nobody—nobody—will be “worse off” than under the current system. Currently around half of all older adults in care receive some state support. This will rise to roughly two thirds under these reforms. On the minor technical amendments that I made to other sections of the Care Act, I would not wish to belabour each one, but I can reassure the House that those changes will ensure that the legislation works as intended and that everyone who is eligible—

[Karin Smyth]

Will the Minister give way?

[Edward Argar]

I will not give way. I want to make some more progress.

--- Later in debate ---

[Edward Argar]

My right hon. Friend is exactly right. I am grateful to him for giving me an opportunity to highlight that this improves in this respect on the Dilnot proposals. I put on record my tribute to Andrew Dilnot for his work, but we believe that this is a better package, and, as he highlighted, a sustainable package from a financial perspective.

[Karin Smyth]

Will the Minister give way. We have had six weeks in Committee.

[Edward Argar]

The hon. Lady implores me, saying that after six weeks of having to sit opposite me in Committee, the least I can do is allow her to intervene.

[Karin Smyth]

Several times in that Committee, I offered to help the Government in a cross-party way. The Minister has been dealt a bad blow here tonight, having to come here and defend this proposal. In those six weeks—I think 21 sessions—not one iota of this proposal was mentioned or brought forward. We all know about bad legislation, rushed legislation, and legislation that does not have the commitment on something so important. I have commended the Government for starting this conversation, but this is a poor legislation move. I am sure that Members here would support the Minister tonight if he were to withdraw this proposal, go back to the Chancellor and ask him to think again. We would all be behind him if he took that opportunity.

[Edward Argar]

I did wonder whether I would regret that intervention. It was typically courteous, although I have to say that when a Member of the Opposition says that, “We’re here to help you”, I am not always sure. [Interruption.] Of course, when the hon. Lady does it, I know that she is sincere about it. The point I make is that this important change is necessary to deliver on the pledge we have made. It is being introduced on Report. While ICBs and integrated care systems, which we will speak about shortly, are hugely important, I suspect that this matter will dominate the debate in this group on Report. Equally, I suspect that it will be fully debated and scrutinised in the other place.

--- Later in debate ---

[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.

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

I draw the attention of the House to my entry in the Register of Members’ Financial Interests in that I am married to an NHS doctor, who is employed by a hospital trust that serves my constituency.

Let me turn first to new clause 49. Those of us who have been in the world of local government for a long time will have seen the attempts by Governments of various parties to address the financial settlement around social care. I chaired a social services committee that pushed through the charging policies introduced by the last Labour Government in an attempt to address these costs. I also chaired a social services committee that had to balance the demands of the fair access criteria, and saw the last Labour Government drive a coach and horses through a lot of local provision.

I recognise that we should all seek to ask questions of Governments about how we address in particular the impact on working-age adults. In response to the people asking whether we are proud of what we are here to do tonight, I would say that we should be proud of the fact that we are willing to take what are sometimes difficult decisions to ensure that we balance the books and have a sustainable financial settlement that supports social care for our constituents. It is too late for my two grandparents, who went through the process and saw very modest assets consumed by the cost of long-term care, but I welcome the fact that my constituents, and people up and down the country, will benefit from what this Government are seeking to achieve.

I will move on, briefly, to new clause 55, which addresses the responsibilities for ICSs regarding the provision of services and planning for services for our youngest children. My right hon. Friend the Member for South West Surrey (Jeremy Hunt) made a helpful intervention, in which he pointed out the effectiveness of Ofsted-style regulation in ensuring the quality of provision at a local level.

We had an excellent debate in the Chamber just a few weeks ago, discussing the work done by my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), which was reflected in the budgetary decisions that were brought forward previously. Having had that debate, it seems clear to me that in tabling an amendment supported by more than 70 organisations in the field of children’s care, we have an opportunity—one which was debated and touched on through various assurances from Ministers in Committee. It is an opportunity to ensure the right level of rigour and accountability in what we ask of ICSs, so that we can make sure that our youngest children, babies, neonatal care, and indeed young people up to the age of 25 who are already covered by statutory provisions in respect of special educational needs and care leaving, are appropriately covered.