Health and Care Bill

Lord Patel Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Patel (CB)]

My Lords, it is a pleasure, on behalf of the whole House, to welcome the noble Lord, Lord Stevens of Birmingham, and to congratulate him on his thoughtful, inspirational and brilliant speech. There ends the good news.

The noble Lord did not say much about himself, so I am going to fill in the gaps. He has been a household name for many years. Coming from a council estate and a comprehensive school, he went on to win a scholarship to Oxford to read PPE, received an MBA from Strathclyde University, and attended Columbia University on a Harkness Fellowship, followed by management training in health. He worked as a porter in a hospital and as a mortuary clerk—those clients could not complain about him. He served on several management boards in England, was CEO and president of UnitedHealth Group in the United States and, finally, was CEO of NHS England—and he is still quite young.

The noble Lord is regarded as the second most important person in the history of the NHS—the first being Nye Bevan—and the fourth most important person in the United Kingdom. My first contact with him, which he might remember, was when he was very young, hardly 30, and was a health policy adviser to Prime Minister Tony Blair and subsequently to Secretaries of State for Health Frank Dobson and Alan Milburn. His efforts resulted in the NHS getting the biggest rise in funding in its history. He played a major part in the reforms that followed. One light-hearted anecdote of the time is—and he may well remember—that he persuaded Frank Dobson to make Viagra available on the NHS. More importantly, he has been a central and respected figure in health policy for most of his career. Simon Stevens makes the weather in all his dealings. He knows health, he knows policy and he knows politics, which he is deft at exploring, always in the best interests of the people.

There is another side to the noble Lord apart from health. At Oxford, as president of the Union, he was drawn into controversy following an invitation to a visiting speaker. He also took part in a debate defending the proposition that patriotism is the last refuge of the scoundrel. I do not know whether Boris Johnson opposed him, but he credits the noble Lord with his own election as president of the Oxford Union. They both toured the United States in a debating society and it is said that Boris won the hearts of the audience and Simon won their heads. Once when asked if Boris Johnson could have led the NHS instead of him, the noble Lord evaded answering and sought refuge in a book entitled Napoleon’s Hemorrhoids.

For fun, the noble Lord indulges in competitive offshore sailing and cooking. I am told that he likes cooking without recipes: I wonder if there might be an analogy to health policies. Today, however, I thank him on behalf of us all for a brilliant, thoughtful and thought-provoking speech.

I now turn to my meagre contribution, which will be short because the time is limited. The Bill contains more than 150 clauses and 16 schedules; it proposes changes to several existing Acts. The policy objectives are equally broad: there are approximately 138 delegated powers and at least seven Henry VIII powers.

While I welcome the emphasis on increasing collaboration between and with different parts of the health and care system, the possible benefits are not clear; nor is it clear, with myriads of smaller organisations and sub-committees, who is in overall charge, or who will be responsible for improving standards of care.

The Bill has no clear plan for how workforce shortages, tackling inequalities in healthcare and the variation in care that exists will be addressed. Workforce shortages are the greatest threat to NHS and social care, as the House of Lords report alluded to. Covid-19 has exacerbated the pressures that staff have been under. They are exhausted. I know that from three of my family members. Without an adequate workforce, none of the reforms will come to full fruition.

Proposals in the Bill fall way short of what is needed and Health Education England’s framework 15 will not solve the problem. The Bill includes very limited measures in Clause 35. It fails to address whether the system is training, educating and retaining enough people in the workforce to meet the needs of the service in future. There needs to be a fundamental change to workforce strategy and planning on a much firmer footing than the Bill can provide. I will strongly support amendments to Clause 35, to which the noble Lord, Lord Stevens of Birmingham, referred.

Covid-19 has exposed and exacerbated existing health inequalities. Progress on reducing inequalities is slow. The Bill has no new ideas; it merely transposes the current duties of CCGs to ICBs. One area where there is scope for improvement relates to strengthening reporting on health inequalities. NHS England should publish national guidance on performance data and indicators, which should be collected and reported on by NHS bodies.

The new triple aim is another area where the scope of the Bill can be amended to go further. It should explicitly reference the need for all NHS organisations to report on the impact that their decisions will have on reducing inequalities. The first part of the triple aim of the health and well-being of the population does not suffice. I will support amendments to address that.

There are also issues about the wide-ranging new powers of the Secretary of State, not least on reconfiguration, which I have no doubt other noble Lords will address, but also his involvement in professional regulation and regulators. I will have comments to make about safety, as I chaired the National Patient Safety Agency for five years and know much about what learning is all about. What is important is how the learning is implemented, but the Bill is very short about how that will be done. I look forward to Committee.