Health and Care Bill

Laura Trott Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

Therefore, it is vital to ensure that the staff have that confidence. We will be asking them to talk about their part in an incident—what role did they play in something going wrong—if we are to understand how it could have been prevented. The principal aim is to ensure that shift from blaming to learning, to turn the NHS in England into a learning organisation. The end result of that would be greater patient safety. That is surely what all of us are trying to achieve.

[Laura Trott (Sevenoaks) (Con)]

I will speak mainly to new clause 1, but I cannot start without paying tribute to my hon. Friend the Member for North West Durham (Mr Holden) for his work to ban virginity testing. It is an abhorrent practice and high time it was made illegal.

I speak to new clause 1 in the names of my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) and the right hon. Member for North Durham (Mr Jones), among others. The existing situation, absurdly, is that someone may walk into a clinic and easily and legally get a treatment that could blind them, and there is absolutely no regulation whatever. For some time, we have talked about fixing the issue, and my private Member’s Bill—now the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021—which was passed with the support of many Members of the House, has been able to bring some regulation to this space. Under-18s are now able to get only non-cosmetic interventions, and that by legal practitioners alone.

For those over the age of 18, however, there is no protection. Save Face, a campaigning organisation, last year received 2,000 complaints from people. Those are complaints not about the clinics people were in being dirty, but practitioners being uninsured or unable to fix the problems created when patients were given injections or fillers. People had necrotic or rotting tissue, which individuals would have to pay for themselves to get fixed. It is unacceptable that we are in a situation where that can take place with no regulation by Government.

I am afraid that is a pattern over time, across many Governments, of issues that primarily affect women not having the attention that they deserve. I am hopeful that we make some progress today. I pay tribute to my right hon. Friend the Member for Romsey and Southampton North on tabling her amendment.

[Margaret Greenwood (Wirral West) (Lab)]

The Health and Care Bill allows for

“a profession currently regulated to be removed from statutory regulation when the profession no longer requires regulation for the purpose of the protection of the public.”

Labour voted against the relevant clause in Committee, but we were defeated by the Government. I therefore tabled amendment 57, which would remove clause 127 from the Bill and ensure that a profession currently regulated cannot be removed from statutory regulation, and that statutory regulatory bodies cannot be abolished. I am grateful that the amendment received cross-party support.

The removal of a profession from regulation is deeply concerning because, once a profession is deregulated, we can expect the level of expertise in that field to decline over time, and along with that the status and pay of those carrying out those important roles. It also brings with it serious long-term implications for the health and safety of patients. In the White Paper that preceded the Bill, the Government stated:

“This is not about deregulation—we expect the vast majority of professionals such as doctors, nurses, dentists and paramedics will always be subject to statutory regulation. But this recognises that over time and with changing technology the risk profile of a given profession may change and while regulation may be necessary now to protect the public, this may not be the case in the future.”

It is notable that the Government only “expect” that the vast majority of professionals will be subject to statutory regulation, but they give no guarantee. The fact is, if the Bill passes, Ministers will be able change their mind at any point and make changes through secondary legislation.

The Government appear to be arguing that technological advances may change roles to such a degree that the high level of professional expertise that currently serves the NHS will no longer be needed. I will make two points about that. First, if the work of an NHS profession has changed to such a degree that regulation is no longer needed, I would argue that it is a different profession and needs a new job title. Secondly, when deploying new technology, there is always a need for professional staff with a high level of expertise and understanding of not only the functionality of that new technology, but its shortcomings. Technology has the power to improve productivity, but it should not be used as an excuse to deregulate professions.

It is important to consider where the impetus for that proposal may be coming from. The recent lobbying scandal certainly gives us a clue when we consider the number of MPs on the Government Benches with private interests in medical technology—I do not want to elaborate on that today, but to make the point. Certainly, big business is keen on deregulation, because it allows them to pay lower salaries to staff.

During a seminar on wellbeing, development, retention, and delivering the NHS people plan and a workforce fit for the future, a representative of Virgin Care said:

“We should have flexible working for all. We should consider what that means. We should embrace what that means. Both of those things really push what has been quite a traditional work model across the NHS. We need to be more modern. We need to have a think about how we rip up the old rule book. But change in an area that is very risk averse because the nature of the work we do is really tricky, so we need our leaders and our workforce to embrace trying things”.

That was an alarming statement for her to make. I think we would all agree that healthcare professionals’ understanding of risk and the importance of mitigating risk is incredibly important. It is always a matter of concern when business says that it wants to “rip up” the rule book on employment rights and pay.

Yesterday, in the Minister’s summing up, he said that

“the Bill does not privatise the NHS.”—[Official Report, 22 November 2021; Vol. 704, c. 151.]

I have to say, however, that I disagree. ICBs—integrated care boards—will be able to delegate functions, including commissioning functions, down to provider collaboratives, and provider collaboratives can be made up of private companies. I do not understand what it is that the Minister does not understand about that.

Add to that the fact that the abolition of the national tariff will open up the opportunity for big business to undercut the NHS, this is a potent situation indeed, and one that will be exploited by big business if the Bill goes through. The late Kailash Chand, former honorary vice-president of the British Medical Association said:

“The core thrust of the new reforms is to deprofessionalise and down skill the practice of medicine in this country, so as to make staff more interchangeable, easier to fire, and services more biddable, and, above all, cheaper”.

The removal of professions from regulation is a part of that scenario he described.

I turn now to workforce planning. There is a workforce crisis in the NHS. In fact, that is probably an understatement. Earlier this year, I met members of the Royal College of Nursing in the north-west, who told me of the sheer exhaustion that they are experiencing because of staff shortages. I was struck by how, even at this point when they were describing how they are on their knees with exhaustion, their primary concern was patient safety. We owe it to them to address the matter. The British Medical Association highlighted:

“Burnout has led to significant numbers of medical professionals considering leaving the profession or reducing their working commitments”.

According to the latest figures, there are well over 90,000 full-time equivalent vacancies in England’s NHS providers. The best the Government can come up with is in this Bill is to require the Secretary of State to publish a report, at least once every five years, describing the system in place for assessing and meeting the workforce needs of the health service in England. That is woefully inadequate. The Royal College of Physicians says that this duty on the Secretary of State

“falls short of what is needed given the scale of the challenge facing the health and care system”.

The Royal College of Paediatrics and Child Health is among those who have called for this duty to be strengthened in the Bill. I ask the Government to listen to the expertise of those bodies.

The Government’s plans to remove NHS professions from regulations is wholly unacceptable and it is particularly alarming at a time when there are such acute shortages of staff, right across NHS professions. We all value the NHS highly and respect the high level of professionalism in the service. Instead of looking to deregulate professions, the Government should be investing in the training of the next generation of professionals.