Health and Care Bill

Lord Duncan of Springbank Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 26th January 2022 Lords Chamber

I tabled these amendments and have put this on the record because they are about the detail and practicality. The opportunity is there for transformation, but the worry out in our communities is: will this Government, like others before them, be serious about transformation or will it be about old men in new clothes?

[The Deputy Chairman of Committees (Lord Duncan of Springbank) (Con)]

I now call the noble Lord, Lord Howarth of Newport, who will be taking part remotely.

[Lord Howarth of Newport (Lab) [V]]

My Lords, I support the spirit of these amendments. The noble Lord, Lord Mawson, in his working life at Bromley-by-Bow and more recently in north-west Surrey, and in his very full speech, has demonstrated the significance to healthcare of the principle of subsidiarity, the freedom to innovate and the mobilisation of community resources. If ICSs are to mobilise the full power of place this must indeed be a governing principle.

Although there might be definitional issues to clarify, I particularly applaud the ambition expressed in Amendment 159A that resources should be used at local discretion to promote collaboration by local groups, and that the procurement processes should take account of the benefits of stable partnerships. How could anyone dissent from that? Yet, the experience of so many non-clinical and VCSE organisations is of chronic financial instability and of promising work being aborted because of policy discontinuity.

I will give one instance of damaging discontinuity of funding. The Alchemy Project used dance as a form of early intervention in psychosis. The project was developed jointly by Dance United, South London and Maudsley, and King’s College London. Two cohorts of participants were drawn from young people in south London boroughs where the rate of psychosis is very high. With no previous experience of dance, after four weeks they performed a specially commissioned piece at the Shaw Theatre and Sadler’s Wells. Academic evaluation demonstrated clinically significant improvements in well-being, communication, concentration and focus, trust in others and team working. The project helped participants to develop relationships with their peers and restore relationships with their families. The Alchemy Project had to be abandoned, however, when a fragile consortium of funders did not renew its funding. ICBs and ICPs will need to be less fickle and less prodigal, bolder in supporting innovation, and more consistent and farsighted in their relationships with their providers and communities.

Health and Care Bill

Lord Duncan of Springbank Excerpts

Lords Hansard - Part 2 & Report stage
Thursday 3rd March 2022 Lords Chamber

Amendments 101 to 104 agreed.

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

I shall not call Amendment 105, as it has been pre-empted by Amendment 103.

Amendment 105 not moved.

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108: After Clause 71, insert the following new Clause—
“Health service procurement and supply chains: genocide convention obligations
(1) The Secretary of State must by regulations make provision for the purposes of ensuring that procurement of all goods and services for the purposes of the health service in England is consistent with the United Kingdom's obligations under the Convention on the Prevention and Punishment of the Crime of Genocide.(2) For the purposes of subsection (1), procurement is not consistent if a Minister of the Crown has assessed that there is a serious risk of genocide in the sourcing region.(3) A Minister of the Crown must make an assessment as to whether there is serious risk if the chair of a relevant select committee of either House of Parliament requests one, and must complete such assessment within two months.”

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

I should note, for the convenience of the House, that the noble Baroness, Lady Brinton, will be taking part in this debate remotely.

[Lord Alton of Liverpool (CB)]

My Lords, as we move to Amendment 108, I should declare my interests as set out in the register: my involvement in a number of all-party parliamentary groups, and the fact that I am patron of the Coalition for Genocide Response. I should also declare my support for the other two amendments in the group, Amendments 162 and 173, which will be spoken to by the noble Lord, Lord Hunt, who has trenchantly and consistently pursued the arguments around forced organ harvesting and the public exhibition of anonymous cadavers from Chinese jails. I have spoken in favour of those amendments previously and will not repeat my arguments today.

Like those two amendments, Amendment 108 is an all-party amendment, which was tabled in Committee by the noble Lord, Lord Blencathra, by the noble Baronesses, Lady Hodgson of Abinger and Lady Kennedy of The Shaws, and by myself, and supported by the noble Baroness, Lady Brinton, who is a sponsor today. It would have been moved by the noble Lord, Lord Blencathra, but he has had to self-isolate in Cumbria with Covid, and we all wish him a speedy return to his place.

Yesterday the noble Lord, Lord Blencathra, was able to attend an online meeting with the noble Earl, Lord Howe, and the noble Lord, Lord Kamall, and he asked me to move the amendment in his place. I thank both Ministers for their constructive engagement, and perhaps I might pursue further with them some of the arguments and issues raised yesterday. During our discussion the department told me that it had found no evidence of child labour, forced labour or unethical behaviour. Indeed, that was a repeat of a statement made to me in a parliamentary reply by the noble Lord, Lord Bethell, when he was a Minister.

--- Later in debate ---

I end by simply citing public support: two-thirds of those polled, some 65%, say they would support preventing the Government from procuring health equipment for the National Health Service from regions where they believe there is a serious risk of genocide. So there is widespread public support for what the promoters of this all-party amendment are asking the House to do. The House should seize this opportunity to ensure that our National Health Service is free from slave labour and, on behalf of the noble Lord, Lord Blencathra, I beg to move.

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

I now call the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, I am sorry to hear that the noble Lord, Lord Blencathra, is unwell, and I thank the noble Lord, Lord Alton, for his excellent introduction to Amendment 108, to which I have added my name. I also support the other two amendments in this group, which are in the name of the noble Lord, Lord Hunt, who I commend for his consistent campaign on these issues over the years. His Amendment 162 would ensure that there must be informed consent, with no coercion or financial gain, when organs are donated or when UK citizens go abroad for transplants. Amendment 173 would ensure that cadavers would no longer be used for public display unless it is the body of a person which is at least 100 years old, because, as with Amendments 108 and 162, there is real concern that people have been forced to have organs removed, or their bodies have been used after their death—sometimes murder, sometimes execution—but without their consent.

Returning to Amendment 108, it has two clear objectives: the first is to prevent the Government procuring health service goods produced in regions where there is a serious risk of genocide. While the Government say there is no evidence, a New York Times investigation found that PPE made through the Xinjiang labour transfer programme was present in US and international healthcare systems. As we have heard from the noble Lord, Lord Alton, there is increasing evidence that the NHS has procured such items already.

The second objective is to create a process through which the UK Government can be required to assess regions for serious risk of genocide and publish their assessment. This is necessary because the UK Government have given out PPE contracts worth almost £150 million to Chinese firms with links to forced labour abuses in the Uyghur region.

The Government have said that genocide amendments are not appropriate in the Bill and that the Modern Slavery Act 2015 offers protection, but the reality is that the UK is not leading the world here. The US Uyghur Forced Labor Prevention Act creates a “rebuttable presumption” banning all goods sourced in whole or in part from the Xinjiang region of China, unless clear and persuasive evidence can be provided to the contrary; and the European Union is now considering bringing forward new legislation to ban products made with forced labour from entering the European market. The UK’s Modern Slavery Act does not go nearly as far as either of these proposals, merely requiring that companies publish—but not that they act upon—modern slavery statements. People’s lives and human rights are at stake here. Frankly, it is time the UK followed suit with stronger legislation. This amendment would be a strong and careful start that means government and Parliament cannot look away. I look forward to the Minister’s response.

Health and Care Bill

Lord Duncan of Springbank Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

We have been through this very difficult period. I am not so sure that measures that were appropriate during that time are appropriate now and should simply be rolled over. We need a fuller debate and it cannot come at the end of this stage. It was not there at the beginning, when there would have been a lot of debate. I would find it difficult if the Minister accepted the amendment, because the Government announced that this measure would come to an end, like all the other measures brought in because of extreme circumstances.

[Lord Duncan of Springbank (Con)]

My Lords, I have listened to many remarks this evening. There are three things we must remember. First, this approach was brought in during a time of necessity and it has worked. Not only has it worked but it has worked well. It has worked well for vulnerable groups; it has worked well for the wider community, and we should not lose sight of that fact.

Secondly, as we consider what we must do next, we must recognise that it has worked and, on that basis, we should move towards the next step, which is recognising how we can move this forward. It is not an easy issue; it is late at night, but at the same time, we are building on what has already been done. In so doing, we must recognise what can be done further.

Finally and importantly, there is a much wider issue. Many noble Lords have touched on it this evening. That needs to be addressed in the appropriate place, but it is not tonight. Tonight, we have a very simple amendment. It is a very careful amendment and a very simple extension of what we expect to deliver. On that basis, I hope the House will support the amendment. It is simple, it is straightforward, it is right and it is timely.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I appreciate the lateness of the hour and, therefore, I want to make just a very few comments.

Without apology, I believe in the sanctity of human life. I believe that it is important to preserve the life of a mother. It is also right to preserve the life of the unborn child. When this measure was originally presented, it was clearly stated that it was an emergency policy introduced because of the unprecedented circumstances of the coronavirus pandemic. The policy was said to be time-limited but many, like me, feared that this was another way of extending abortion on demand. However, many noble Lords accepted that the at-home abortion powers would be exercised only temporarily and be used only for the purpose for which they were granted and in a manner proportionate to the situation. I commend the Government for the actions they took to turn the coronavirus crisis around to the situation we have today. Therefore, continuing the policy is not proportionate, although I did not think it ever was.

At-home abortion endangers the health of the woman and the girl. Consultation revealed that among a number of concerns raised about safety the most common was the risk of women being coerced. I do not think that is an unimportant issue for this House to consider. Therefore, I shall oppose Amendment 183.

Health and Care Bill

Lord Duncan of Springbank Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

I remain grateful for all the work and consideration this House has given to the Bill and I hope that noble Lords will feel able to accept the Motions standing in my name.

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

I remind the House that we have three noble Baronesses beaming in. The first is the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, I declare my interests as a vice-president of the Local Government Association and vice-chair of the APPG on Adult Social Care.

I thank the Government for their Motion E relating to carers and safe discharge, which goes a considerable way to providing the reassurance that patients and their unpaid carers will be included in discharge planning. I am pleased to hear that Carers UK is working closely with the department on the guidance, and it is good to see that the guidance will be further updated when the Bill is passed and will include more mentions of carers and young carers—that is also welcome.

The guidance links to a number of background documents, such as action cards and the Home First documents, which are short, summary versions to help discharge from hospital but seem to be slightly out of step with the new provisions. So, while I am grateful for the Government’s amendment, will the Minister clarify whether these will also be updated?

I turn to Motions G, G1 and G2 on the social care cap. The Government’s changes to the care cap announced, late in the passage of the Bill in the Commons, that the amounts accrued towards the £86,000 cap are now based solely on the individual’s out-of-pocket expenses. Although individuals will still qualify for means-tested financial support if their assets fall below £100,000, in practice this will no longer act to protect people with more modest means and will simply see them contributing over a longer period. This is much more regressive and would leave poorer, older people and working-age adults with less protection from the catastrophic care costs than others who are wealthier.

I have been happy to sign previous amendments to remove the social care cap, and these Benches support Motion G1. The measures in Motion G1, especially in Amendment 80P, ensure that the original principles of the Dilnot commission recommendations are fully implemented. It is also important that the results of the trailblazer pilot schemes can be fully evaluated with an impact assessment and that Parliament has a proper opportunity to debate that review. The changes proposed by the Government just before the Bill came to your Lordships’ House are very different from those that Parliament understood right at the start of the Bill’s passage.

This is not just a problem for older people. Mencap has reminded us that the Government’s impact assessment shows that their proposals will benefit only around 10% of working-age care users and that there will be a limited impact on improving the funding spent on working-age disabled adults. It is still a disgrace that the arrangements for older people, which assume decades of working and earning, are also used for younger adults with disabilities, who we know are much more likely to be assets and savings poor and to need care and support for much longer, and who will therefore accrue much higher levels of cost than older people. These proposals from the Government are just not fit for purpose and need to be reviewed for this group of younger adults. That is why we support Motions G1 and G2.

Finally, on Motions L and L1 on the dispute resolution for children’s palliative care, I thank the Government for their amendment, which goes a considerable way towards achieving what the noble Baroness, Lady Finlay, sought. As one of the signatories to her previous amendments, I ask the Minister to give firm assurances to your Lordships’ House that the review will definitely take written and oral evidence from parents. In his speech he mentioned clinicians, other stakeholders and professionals, but it is important that parents are involved as well at an early stage, particularly making sure that what they are seeking with disputes achieves mediation rather than ending up in court.

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

My Lords, the second beaming Baroness is the noble Baroness, Lady Campbell of Surbiton.

[Baroness Campbell of Surbiton (CB) [V]]

My Lords, I wish to speak to and strongly support Motion G1 in the name of the noble Baroness, Lady Wheeler. These amendments will ease the catastrophic effects of the Government’s proposed charging cap reforms on the lives of those dependent on social care.

Disabled people who rely on social care just to survive, let alone thrive, are deeply disappointed that the Government’s charging proposals have been overturned by the other place and are now returning to this House. Amendment 80P would help to alleviate these detrimental effects by addressing the worst affected, particularly those under the age of 40. The trailblazer pilots are also very welcome, but evaluation is key. Crucially, it must assess the impact of charging reform on a variety of social care users, including younger adults, where there is so little current data, and should cover every aspect of their rights. These people are not statistics.

A further impact assessment is also vital. The current one is totally illogical. It needs to focus on the impact on younger adults and encourage proper mechanisms for data analysis: for example, the significant impact on the under-40s of having their contributions paid from benefits. The chronic financial hardship that long-term disabled people endure, with additional costs averaging £583 a month, remains a very worrying issue.

This is a bleak time to endorse charging for social care, capped at an extortionate £86,000. Hundreds of thousands of disabled people in Britain are in crisis because of the ever-increasing cost of living. Local authorities in England are imposing stricter charging policies for care because they are basically running out of money. Disabled people are already being referred to debt collection agencies because they cannot pay their care charges.

The Government talk about levelling up for disabled people, but really they are doing the opposite. These charging reforms force them to contribute to their care and stop local authority care costs counting towards the cap. They deny disabled people the life opportunities that others take for granted.

If Motion G1 is not supported, the Government will be defying the principles of the UN Convention on the Rights of Persons with Disabilities. The UK is signed up to the convention. Article 19 recognises the equal right of all disabled people to live in the community, with the same choices as others; it requires parties to the convention to ensure that they can enjoy full inclusion and participation in the community. Yet this Bill does not respect it.

Far from ensuring the rights enshrined by the convention, I fear the Bill will lead to increased poverty, ill health and poorer life outcomes for disabled people. Some will undoubtedly die. What does that say about our moral compass, especially when disabled people have already endured two years of disproportionate suffering and death during the pandemic?

This Bill provided a small opportunity to take action before it was too late, but it was squandered by the other place. I hope the Government will think again when the White Paper on social care integration is finally published, and address this deep injustice. For now, I urge noble Lords to support Motion G1.

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

My Lords, the final remote participant is the noble Baroness, Lady Masham of Ilton.

[Baroness Masham of Ilton (CB) [V]]

My Lords, I will speak about disputes in the critical care of children.

First, I thank and congratulate the Minister, the noble Lord, Lord Kamall, on his hard work in trying to understand the enormity of the Health and Care Bill. I also thank my noble friend Lady Finlay of Llandaff for her persistence in including the importance of palliative care in this Bill, especially dealing with the heart-rending problems when there are disputes between parents or legal guardians responsible for critically ill children and their doctors and care staff.

To understand the anxiety and fear parents have, and their wanting to do the very best for their child, they need a sympathetic doctor in charge. Some treatments are available abroad, and desperate parents sometimes know better than the doctors if they are not experienced in the very rare conditions. There is a vital need now, in this difficult time of staff shortages, to listen and help solve the problems if there are disputes.

I will understand if my noble friend thinks that today, unfortunately, a bird in the hand is worth two in the bush. I also support many of the other amendments.