Healthcare (International Arrangements) Bill

Lord Cormack Excerpts

Committee: 1st sitting (Hansard): House of Lords
Tuesday 19th February 2019 Lords Chamber

Amendment 44, in the name of my noble friends Lord Patel and Lord Kakkar and my noble and learned friend Lord Judge, is particularly to the point on sunsetting. I suggest with all respect to them that it is no more than a sticking plaster to put over some of these areas of serious concern, but it deserves serious consideration in your Lordships’ House at this stage of the Bill.

[Lord Cormack (Con)]

My Lords, I associate myself entirely with the remarks of the noble Lord, Lord Lisvane. We have been here before. We went through these issues many times last year, when a number of us spoke about constitutional issues. I want to concentrate my remarks there today. Before doing so, I add my welcome to my noble friend on the Front Bench. I am sure that she will have a distinguished career in your Lordships’ House. I was extremely sorry to miss her Second Reading speech but I was recovering from surgery, so I could not be present and take part as I would have otherwise sought to do.

The noble and learned Lord, Lord Judge, and the noble Lord, Lord Lisvane, are members of a group that I have the privilege of chairing: the Campaign for an Effective Second Chamber. I want to reflect on those words for a few moments. You can have a truly effective second Chamber in a Parliament, or indeed an effective first Chamber, only if you do not have an overbearing Executive. Everything that the noble and learned Lord, Lord Judge, and the noble Lord, Lord Lisvane, have said underlines the fact that we are in extremely dangerous territory.

Of course, as they have done, I entirely absolve my noble friend on the Front Bench. She has been given a poisoned chalice and she will handle it with dexterity and finesse, but whatever she does, she will not be able to remove the hemlock and replace it with quaffable wine because this really is a very dangerous Bill. The name of Henry VIII has already been quoted a number of times—and even Henry XVI, although I am not quite sure what he will be up to. But I prefer to call this Bill a carte blanche Bill because what we are being asked to do is to give the Executive a totally blank cheque. That is inimical to constitutional parliamentary democracy. There has been a great deal of talk recently, and there will be more next week, about the role of Parliament vis-à-vis the Executive. We have to have a proper balance, but we do not have a proper balance if we have an Executive invested with so much power that Parliament really counts for nothing.

Of course, I know why we are going to have to give this Bill a speedy passage, but I deeply regret it. It goes against the parliamentary grain as far as I am concerned. In the almost 49 years that I have been in one House or the other, I have seen what the noble and learned Lord, Lord Judge, referred to as the steady accretion of power to the Executive branch. No lip service to the power of Parliament paid by the setting up of Back-Bench committees and all the rest of it has really disguised that. It is one of the reasons why colleagues in another place have recently been flexing their muscles in seeking to wrest back power from the Executive to Parliament. I will not pursue that argument now because, frankly, in a Committee stage it would be straying out of order. But what I will say to your Lordships is that if we give this Bill its passage, as I suppose we must, it is crucial that we redouble our resolve to ensure that this sort of thing happens less frequently in the future.

In a parliamentary democracy there has to be a true balance of power and a responsibility to scrutinise legislation, but how can you scrutinise legislation which is so open-ended that it gives unbridled power for years to come? The noble Lord, Lord Lisvane, referred to that. I do not want to trespass on the private grief of friends opposite—and I do regard them as friends—but do I really want powers like these to be exercised by Mr McDonnell or Mr Corbyn? No, I do not, and I suspect that there are very few, if any, in your Lordships’ House who do.

I therefore put down a marker in total support of the eloquence of the noble and learned Lord, Lord Judge, and say that when we have got over the next few traumatic weeks, if we get over them—I suppose we will—we must send an emphatic message to the Executive that this sort of sharp practice is something up with which we will not put.

[Baroness Andrews (Lab)]

My Lords, first, I welcome the Minister. I will not add to her burdens by trying to find another metaphor for the difficult position she is in. We have had poisoned chalices and hand grenades, but I am sure she would be more than capable of dealing with all that. I am sure she will already have picked up some of the deep frustrations in the Committee about the position we find ourselves in—having to deal with legislation that is, frankly, rather surreal. We are trying to deal with the worst possible scenarios just in time, just in case we should need to be as draconian as necessary in the most extreme emergency situations. We are focusing on the exercise of powers that may never need to be used but which we may have to reach for in the most ghastly circumstances—so we are over a barrel. This is an essential Bill. We have to protect UK citizens from the worst that could happen to them, having sadly neglected to do what we could have done at the very beginning of this two-year process and given them assurances and the sort of security—as we would have been expected to be able to offer EU citizens in this country—that many in this House tried to achieve.

My speech in support of the amendment moved by my noble friend will be much shorter, because I can do hardly anything other than compliment the noble and learned Lord, Lord Judge, on his most forensic and splendid interpretation of what the Delegated Powers and Regulatory Reform Committee said, and my colleague on that committee, the noble Lord, Lord Lisvane. The one thing on which I might take issue with him is that in that committee we have not, in fact, become habituated to the ways in which government departments always try to take more power. We are not naive but we deeply resent the ways in which government departments have tried to accumulate powers over the past few years and to sneak it under our noses.

Coming down the track we have Bills—the noble Lord, Lord Lisvane, has already referred to them—with swathes of inappropriate delegation cultivated by civil servants and Ministers, for whom, frankly, this is Christmas. They have wanted to acquire these sorts of powers for years and have tried on many different occasions. They have been stopped in Bill after Bill and sent back. But now they have the power of post-Brexit uncertainty to aid them. It is extremely difficult to know where our vocabulary might lead us next. It is a fabulous opportunity, because for years they have chafed against the boring predictability of our scrutiny committees telling them to go away and think again. They come back with excuses about urgency, technicalities and flexibilities, yet when we expose these for what they are, they tend to try to do it again in another form.

One of the most disappointing things is that this was our second report; our first was blunt enough. We thought that between November and now the department and Ministers would respond more sensitively—perhaps more in the spirit of the European Union (Withdrawal) Bill, with our agonised discussions over the fine-tuning of appropriateness and necessity—but we received not a word; not a blink. I am sad to say that what the department came back with—I know the Minister was not responsible—was another 43 paragraphs about all manner of explanations, most of which were not relevant. They did not address the fundamental question that the Committee is raising this afternoon: why are these powers necessary? What is it that only these powers will be able to achieve? The Minister was very flattering to the scrutiny committees at Second Reading; she called our powers “forensic”. There is nothing that needs forensic scrutiny here. You could take a spade to this Bill; it is that blunt.

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[Lord Cormack]

Or a backstop.

[Lord Lansley]

Yes. It might have been part of the backstop agreement in the old days, I do not know.

The second limb of Amendment 8 is to say that although care is free to NHS patients in the United Kingdom, the object of the support is to put people in the same position in other countries as if they were residents of that country. Of course, care is not free in other countries. In a significant number of EU countries—I think about half—some out-of-pocket expenses are required in relation to their healthcare provision, which would not necessarily be reimbursed. We should not expect to pay more than would be the case if somebody were a resident of that country. The expectation should not be that because the NHS is a free service here, there should be a free service everywhere.

Health and Social Care Act 2012

Lord Cormack Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord O'Shaughnessy]

My Lords, since the 2012 Act was passed, there have been some significant improvements in NHS performance, not least in cancer outcomes, for example. There are also around 42,000 more staff since 2010. So improvements have clearly been able to happen within the legal framework set by Parliament in 2012. Nevertheless, we recognise that as the service is required to become more integrated and people across different care functions are required to work together, we need to look at the structure. There is already joint working, for example, between NHS England and NHS Improvement at the regional level. But if the NHS identifies any barriers, we will look at those.

[Lord Cormack (Con)]

My Lords, when we are looking at the structure, which is clearly important, can we also look at priorities within the National Health Service? I heard this morning that certain treatments and unnecessary medicines are to be ruled out. Can we have a comprehensive list of those? It is not right that dandruff shampoo should be on prescription. It is not right that we should be looking at funding the treatment of gaming machine addiction. Can we have a real look at the priorities?

[Lord O'Shaughnessy]

My noble friend makes a very important point, which is that as we move ahead, even with the funding settlement, it is essential that the NHS becomes more productive. That means looking at whether there are medicines or treatments that are no longer producing the outcomes it was suggested that they would and taking those out of service. It is very important to state that this has to be a clinically led process. We have already begun that with certain low-value prescriptions. NHS England is now leading that process—as I say, it is clinically led—to look at whether there are other treatments that could be discontinued.

Disabled People: Social Care

Lord Cormack Excerpts

Tuesday 20th February 2018 Lords Chamber

[Lord O'Shaughnessy]

I am glad to be able to publish the response at last, and apologise again for how long it has taken. I am pleased to report that we have not just changed the name of the department but given the strategic direction for social care policy back to it. That also includes strategic direction of funding—but the actual funding settlement happens through the local government funding settlement. I have to disappoint the noble Lord on that because there are no current plans to change it.

[Lord Cormack (Con)]

My Lords, in his Answer to the noble Baroness, Lady Campbell of Surbiton, my noble friend referred to a forthcoming round table that will address some of the issues that provoked the Question. Can my noble friend assure me that the noble Baroness will be invited to participate in that round table?

[Lord O'Shaughnessy]

My noble friend makes an excellent suggestion. It is not my round table, so the invitation is not mine to extend, but I shall certainly be seeing my colleague the Minister of State this evening and shall do everything that I can to encourage that invitation to come.

Health: Atrial Fibrillation and Stroke

Lord Cormack Excerpts

Tuesday 12th December 2017 Lords Chamber

[Lord O’Shaughnessy]

As the noble Lord will know better than anyone, making them mandatory is a challenge because of the importance of clinical autonomy. What we can make mandatory is an understanding of those guidelines and that they inform every treatment pathway. That is part of what the NHS RightCare programme, which is now rolled out across the country, is doing. It is introducing new things such as stroke pathways so that there is clarity about the options available. Patient choice is at the centre of that decision.

[Lord Cormack (Con)]

My Lords, I have this condition but I had never heard of it until I was diagnosed about seven years ago. I urge my noble friend to try to ensure that greater publicity is given to it. Could we start by making sure that every Member of your Lordships’ House has the opportunity to be tested for it?

[Lord O'Shaughnessy]

I like my noble friend’s idea of putting on a special clinic. I hope he is getting excellent care with his own AF. The idea of publicity is an important one, and I draw attention again to the role that the Stroke Association is playing within the development of the new plan, because clearly it has fantastic reach to patients and is a trusted voice. It has a key role in making sure that there is that understanding among both patients and the clinical community.

Brexit: Risks to NHS Sustainability

Lord Cormack Excerpts

Wednesday 12th July 2017 Lords Chamber

[Lord Cormack (Con)]

My Lords, the noble Lord, Lord Warner, has performed a very signal service in introducing this debate and I congratulate him most warmly on the way that he did so. We desperately need clarity from the Government—we have not had it, but I hope that tonight we might begin to see it. It could all have been so much more simple. The noble Lord, Lord Warner, referred to the pledge to EU nationals in this country. Would the number of nurses have declined in the way that he illustrated, with that figure of 90%, if we had in fact used our sovereign power, taken control, and said from the onset, as the leave campaign did say from many a platform, “Your position, for those of you who came here in good faith, who have paid your taxes, who have become part of our communities, is not at risk”? It is still not too late for Ministers, led by the Prime Minister, to say this.

The Prime Minister has appealed recently for cross-party work and consensus. When I spoke in the Queen’s Speech debate, I suggested that one way of dealing with these matters was to have a joint Grand Committee of both Houses, which could look at these things. I did not get any answer to that; I hope that I will. The previous week, I was sacked from the Home Affairs Sub-Committee of the European Union Select Committee of your Lordships’ House, on which I enjoyed serving, for my vote on the Article 50 amendments. That is hardly consistent with the principle of appealing for cross-party accord. When we have a Government who do not have a majority and who lost their majority in a thoroughly needless general election, we need a new start and to call upon the talents sitting on all the Benches in your Lordships’ House.

This afternoon, I had the pleasure—I think that others in the Chamber probably also had this pleasure—of hearing in the Royal Gallery a very moving and inspiring speech from the King of Spain, who expressed his wish and determination that relations between our two countries should continue to thrive and prosper. We would all say amen to that. However, he made equally plain his sadness at our leaving the European Union, where we and Spain have, as constitutional monarchies, played a constructive part. We must not be hamstrung by doctrine, particularly the doctrine of those behind the £350 million pledge pasted on buses, to which the noble Lord, Lord Warner, has already referred. We need a real route map; we need to know where we are going and how we are going to get there.

The speech of the noble Lord, Lord Warner, illustrated very graphically that the greatest of our national services—our National Health Service—is teetering on the brink of collapse. We desperately need plurality of funding and to look at some of the proposals of the committee so ably chaired by the noble Lord, Lord Patel, at the end of the last Parliament, which I think reported on 5 April. We have all the pointers. We have diagnosed the disease. The Government seem unable to accept that there is a remedy and it is in their hands. We need to work together across this House and the other place to address matters of enduring importance and continuing worth, of which the National Health Service is perhaps the greatest and most important example as it touches all our citizens at unpredictable as well as predictable points in their lives.

I just hope that my noble friend, for whom I have a high regard—he has competently mastered his brief since he took on his responsibilities—will be able to give us some hope this evening. I hope that he will also talk to the Secretary of State and others because we desperately need a leadership that is not hamstrung by doctrine. Brexit will dominate all our debates for the foreseeable future, but let it not dominate them in a totally negative way.

I accept, with great reluctance, the result of the referendum—of course I do, like others in your Lordships’ House. But we have to start talking in detail about transitional periods. All this cannot be accomplished in under two years, especially as the real negotiations will not begin until after the German election later this year. That gives a period of a little over 12 months. Therefore, if we are to avoid what the Prime Minister has called the cliff edge, we have to have proper transitional arrangements, in particular when we are considering the invaluable, and in the short term irreplaceable, contribution of EU nationals to our National Health Service. That 90% figure is alarming, and if it is replicated across the National Health Service, it will place countless British citizens at risk.

Therefore, in supporting the noble Lord, Lord Warner, I ask my noble friend to forget the lies on the bus and put aside the doctrine that Brexit means Brexit—which I think is the most meaningless slogan I have ever heard in my 50-odd years in politics. Let us now tackle the real issues with a real programme and bring parliamentarians of all parties and both Houses together to contribute their suggestions and their solutions.

I therefore end more or less where I began, by asking my noble friend to pass on to those in high authority—I do not want him to tell us that it is above his pay grade—the idea of something unique: a joint Grand Committee of both Houses of Parliament. A committee can put party political considerations to one side and concentrate on trying to ensure that, from what the noble Lord, Lord Warner, called the mess that we are in at the moment, a stronger nation can indeed emerge.