Health and Care Bill

Lord Adebowale Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Adebowale (CB)]

My Lords, I declare my interests as the founder and co-chair of Visionable, a provider of services to the NHS; as a board member of Nuffield; and as an adviser to Telstra UK. I also chair the NHS Confederation, the largest body representing health leaders in the UK.

I welcome my noble friend and colleague, Lord Stevens, to this House. We have often had debates. It is great to see him here. It is obvious now to all of us that he is very smart and very funny. He is a certified national treasure. He has been welcomed to the House, and deservedly so.

I want to make a few points on this Bill—hopefully briefly, given the hour. First, this Bill is a ground-up Bill; it is not an imposition from on top. Rather oddly, it would be strange if we did not support the Bill, not least because the restructuring would be the result of us not supporting it. We have chairs of ICSs in place; we have chief executives of ICSs in place; and we have strong relationships across health, local government, housing and education in place. This Bill provides the legislative infrastructure to enable ICSs to go faster. Not to support this Bill is a backwards step. I know because the last Bill, in 2012, could be seen from space. I chaired the NHS England sub-committee that authorised some 211 CCGs. I wake up perspiring in the middle of the night at the thought of going back there. This is better, and it is not just me saying that; it is the majority of health leaders in the UK.

I also point out that those noble Lords who are concerned about privatisation need not worry. I say that again because the leaders in the NHS Confederation, in the health system, in the acute care system and in the social care system are not. Personally, as the son of a nurse of 40 years, I would not be standing here supporting this Bill if that were the case. I would not support this Bill, and neither would members of the NHS Confederation. It is already in place and happening because the people leading those systems believe that ICSs and population health will make a significant contribution to the thing at the top of 95% of their to-do lists: health inequity and inequality, exampled by the experience of Covid. The Covid experience has forced systems to work together—for example, local authorities to work with acute trust and acute trust to work with social care. It is imperfect but necessary. It is as a result of that learning that we need population health and the infrastructures to support it. To that extent, I support this Bill.

There are examples. Many Peers have talked about particular sections of the community. The noble Baroness, Lady Hollins, referred to people with learning disabilities. In West Yorkshire and Harrogate, the ICS decided to prioritise people with learning disabilities as part of its acute waiting list response. It could do that because it was operating on a good understanding of population health needs, stratified according to real need in that area. That is what ICSs can do, and that is what we should encourage them to do.

However, there are some concerns. Ministerial powers are the number one concern of many health leaders. I do not quite understand it, to be honest; I am not convinced by the introduction to the Bill from the noble Lord, Lord Kamall. The powers are sweeping. In informal discussions, I did say to him that my feeling was this: why would he want all these powers? How would he feel having them? It is the equivalent of attaching a lightning rod to your derrière and dancing blithely into the middle of a lightning storm. Why would you do it?

More seriously, let me give noble Lords an example of why this really matters in practice. Following a review of Kent and Medway’s stroke service in 2015, the local council referred a decision to create three hyperacute stroke units—HASUs—to the then Health and Social Care Secretary, who then passed it to the independent reconfiguration panel, which approved the changes in autumn 2019. The green light for the decision sat on the desk of successive Health and Social Care Secretaries until just a few weeks ago. This means that those HASUs will not be up and running until 2024. It is estimated that 25 people a year would avoid death or disability if HASUs were established, so those delays have cost lives.

These powers are not necessary. They work against the very principle of this Bill: to distribute leadership so that it is as near as possible to the people who need health and social care. I will be supporting amendments to this Bill that reduce the powers of the Secretary of State so that the Government can benefit from the principles enshrined in this Bill.

The noble Baroness, Lady Harding, summed up the position on the workforce brilliantly, ably supported by my noble friend Lord Stevens. The fact is that, without a credible plan, you plan to fail. It is as simple as that. The thing in the room that people are afraid of noting is that a proper analysis will cost money. Well, not having a proper analysis will cost lives and money.

I will say a couple of things to close. First, I support the comments of my noble friend Lord Stevens on mental health and I will support amendments that give greater clarity on that issue. Secondly, the idea that we might slow down this Bill is for the birds. We need to examine it, obviously, but we need to move with full speed because people are waiting for services that are joined up. The then chief executive of the NHS commented on the last major change as being one that could be seen from space. This is not that change. It is a change which will enable health and social care to be felt by patients and citizens, which is what I commend this Bill to the House to do—though it is not for me to commend it. However, we should support this Bill for that reason and support the leaders of our health and social care system, who have worked so hard through the pandemic. Now they want this support; let us give it to them.

Coronavirus Bill

Lord Adebowale Excerpts

2nd reading & 2nd reading (Hansard - continued) & 2nd reading (Hansard - continued): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Lord Adebowale (CB)]

My Lords, I support the Bill. Clearly, we are in the throes of a pandemic, and the Government’s attempt to make it a slow pandemic rather than a fast one needs to be supported.

I want to make three points, the first of which relates to the vulnerable. It is in a time of crisis that the real values and priorities of a society become apparent, and I will reference homelessness in this regard. The homeless will be on the front line of whatever happens next in the Covid-19 pandemic, and I wonder whether we are really doing enough to ensure that they get the support that they need. I am aware of the hotels opening up rooms for the homeless, but more needs to be done to co-ordinate the efforts of the homelessness organisations, which are attempting to do their best for and with the homeless.

Here, I refer in particular to the Faculty for Homeless and Inclusion Health, formerly known as Pathway, which has been working very hard with UCL professors to ensure that there is a proper care pathway for homeless people. Will the Government ensure that organisations such as the Faculty for Homeless and Inclusion Health, which I know are struggling for funds while doing this important work to ensure that the most vulnerable homeless get the support they need during this pandemic, are supported? Will the Government go as far as they can to ensure that homelessness services are co-ordinated in their attempts to provide support for those on the streets?

That leads to my second point, which is about testing. I know that the Government are looking to bring forward testing, but what will they do to prioritise it? The World Health Organization has made it clear that we need to test, test, test; we cannot manage what we do not know. In so doing, however, it is important that we are very clear about the priorities and stratification as to who gets tested first. In my view, that should be the most vulnerable and those who are working on the front line in the NHS and other areas. Can we have some assurances about the timing of that testing and how it will be prioritised?

Moving on, I declare an interest as the incoming chair of the NHS Confederation. In preparing for this debate, I sought feedback from NHS Confederation members about the Covid-19 Bill. There continue to be concerns about PPE supplies. The Government need to work closely with the NHS Confederation and providers in ensuring that supplies are available for those in most need on the front line. I am receiving emails from doctors and nurses who are very concerned about the supply of PPE to them and their colleagues.

I have mentioned that testing must be ramped up for all staff; staff in the NHS need to be prioritised. We welcome the £5 billion emergency fund in the Budget for public services, but we need to ensure that money can be accessed quickly to manage additional workloads and to cover absences due to staff sickness. Relaxing the rules on PCN underspends would be a positive enabler of this. Further, there is a need for care and nursing home staff, who will require training and preparation for scale, which will be difficult.

I should mention the efforts being made to make transport more available for staff on the front line. I am concerned: I have read reports that reducing transport has an impact on staff who work shifts, particularly in London, and there are reports of overcrowding.

Before I leave this issue, I note the self-employed. Notwithstanding the Government’s statement on the self-employed, I am concerned, because I am aware that people who are self-employed in the health and social care sector feel forced to go to work in order to put food on the table. I note the Minister’s comments on the self-employed. Shakespeare, of course, wrote some wonderful works during a time of stress, but I note that he had a patron; these people do not. It is very, very important, not just for their welfare but for the welfare of all of us, that people are not forced into a position where they have to work in order to feed their family and put a roof over their kids’ heads. I hope that those proposals are brought forward now and are focused with particular rigour on those in the health and social care sector.

Finally, I know the Minister is aware that social enterprises are also businesses. Some 38% of community services are provided by social enterprises. They need to be treated in exactly the same way as other providers in the health and social care sector. Indeed, the fact that social enterprises are run not just to provide dividends should be taken into account as a favourable aspect of them. I am sad to report, however, that many social enterprises have not yet received the communication that others in the health and social care sector have, and some are relying on emails being passed via CCGs. Details of reimbursement for any additional services are not being provided to the social enterprise sector, and day-forward and other Covid-19 payments have not been extended to social enterprises, nor have evaluations of supply of PPE. This is important, because social enterprises tend to provide services in our poorest communities. Not many Peers have mentioned the fact that those are the communities that will suffer most from this pandemic. I urge the Minister to communicate with social enterprises and ensure that they are treated in exactly the same way as other providers of health and social care during this crisis.