Health and Care Bill

Debate between Margaret Greenwood and Charles Walker

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Margaret Greenwood (Wirral West) (Lab)]

I rise to speak in support of Lords amendments 51, 11 and 105. With this Bill, the Government are legislating so that a controversial approach known as “discharge to assess” can be used when discharging patients from hospital. This would see patients discharged from hospital before their social care needs have been assessed, with vulnerable patients potentially sent home without the support that they need in place, leaving families to pick up the pieces and those without family at risk of neglect. Lords amendment 51 is important in relation to that.

The amendment would retain the principle and duty on a hospital, whether an NHS hospital or an independent hospital, to ensure that a patient must be safe to discharge from hospital, and it mirrors carers’ rights established by the Community Care (Delayed Discharges etc.) Act 2003. This important amendment would recognise the vital role played by carers across the country in looking after their loved ones. However, it does not stop the Government from legislating for discharge to assess, a policy that has been piloted and was included in the Coronavirus Act 2020 as a temporary measure. I am concerned that the Government are not only going ahead with an approach fraught with risk for vulnerable patients, but are doing so in the knowledge that an independent evaluation commissioned by NHS England of the implementation of the hospital discharge policy has still not been published, despite the Government promising that the evaluation was due to report in autumn last year.

I am concerned, too, that the Government do not even understand the clinical outcomes of discharge to assess. When I submitted a question last year asking the Government how many patients discharged in this way were readmitted within 30 days, the Government said that they did not hold the data. I believe that to be a dereliction of duty.

Lord amendment 51 would put in place important rights for patients and carers at what can be a very difficult time. I note that the Government disagree with the amendment and have tabled an amendment in lieu, but I believe that it waters down carers’ and patients’ rights. It merely proposes that

“the relevant trust must, as soon as is feasible after it begins making any plans relating to the discharge, take any steps that it considers appropriate to involve…the patient, and…any carer of the patient.”

That gives inappropriate levels of discretion to trusts over patients’ and carers’ involvement, instead of guaranteeing their rights.

Lords amendment 11 is a step in the right direction, although it does not go far enough. It would ensure that conflict of interest rules that apply to integrated care boards would apply to commissioning sub-committees of integrated care boards. The Government have said that they disagree with the amendment and have proposed an amendment in lieu that would prohibit a chair of an ICB from approving or appointing someone as a member of any committee or sub-committee that exercises commissioning functions

“if the chair considers that the appointment could reasonably be regarded as undermining the independence of the health service because of the candidate’s involvement with the private healthcare sector or otherwise.”

I am concerned that the phrasing is clearly open to interpretation, and it by no means rules out people with interests in private healthcare from sitting on these sub-committees.

It is wrong, too, that the power should rest with one person, namely the chair of the ICB. If we are serious about providing governance that rules out the possibility of the private sector influencing the expenditure of public money, an organisation carrying out the functions of an ICB on its behalf should be a statutory NHS body. It is a great pity that the Government have not legislated for that.

We cannot forget that NHS guidance last year stated that the Health and Care Bill, if enacted, would enable ICBs to devolve budgets to provider collaboratives, which are one of a complex array of sub-committees that could take on commissioning functions. Representatives of private companies, which are accountable to shareholders, should not be able to influence these commissioning sub- committees in any way. Lords amendment 11 at least improves the original Bill, and I therefore welcome it.

I also welcome Lords amendment 105, which would mean that the membership of an ICB must include at least one member with expertise and knowledge of mental health in the integrated care board’s area. The fact that the Government did not provide for that originally shows that they are still not treating mental health with the level of seriousness it deserves. It is disappointing that the Government have indicated that they disagree with the amendment.

The amendment in lieu that the Government have proposed makes provision for the chair of an ICB to act

“with a view to ensuring that at least one of the ordinary members has knowledge and experience in connection with services relating to the prevention, diagnosis and treatment of mental illness.”

The Government have watered down the amendment, and it is regrettable that they have removed expertise in mental health as a characteristic that this member of an ICB must have. It is feasible that that person could be a manager who once dealt with mental health rather than a mental health clinician or health professional. I noticed that in the Minister’s opening remarks, he commented that ICBs would be able to commission out of area. I would be grateful if he gave some clarity about how A&E services will be guaranteed to people should they happen to fall ill out of area.

This is a devastating piece of legislation and it is all the more shocking that the Government have pressed ahead with it at a time when NHS staff are exhausted and patients and people across the country are still struggling with the pandemic. It will embed a postcode lottery and open up the NHS to widespread privatisation. In so doing, it does a disservice to patients in England and to NHS staff.

The Bill provides for the scope of “Agenda for Change”, the pay and terms and conditions of about a million people who work in the health service, to be undermined; it allows for NHS professions to be taken out of regulation; and, as I have mentioned in relation to Lords amendment 51, it will allow for vulnerable patients to be discharged from hospital before their social care needs assessments have been carried out. The NHS is our most treasured institution and I pay tribute to all those campaigners across the country who have fought hard to oppose the Bill.

[Sir Charles Walker]

I congratulate the Government on their amendments on mental health. As a former Minister with responsibility for mental health, Madam Deputy Speaker, you know that I have long taken an interest in the subject, so I am delighted that parity of esteem is included in the legislation. It is a very important amendment.

Parity of esteem must mean something, however, and should not be a jumble of words. It was the case that too many voices on both sides of the House fell silent during the covid pandemic. That may have been due to the fog of war, but the scarring of that silence runs deep in the communities that we represent—there are some very ill and damaged people out there. It is fine for us to talk about parity of esteem, but we have to live it and deliver it, and I am afraid that we fell short for 18 months.

I welcome the amendment and the recommitment of hon. Members, but we were all found wanting when it counted. I have the witness statements of more than 2,000 people who suffered with mental health problems during the pandemic and who wrote to me detailing what that was like. One day, I will make those statements available to the Government and to the inquiry, but today, I just thank the Minister and my right hon. Friend the Member for Maidenhead (Mrs May), who joined me in initiating the amendments. I hope that the next time that the country and this place are challenged, we rise to it, because mental health is as important as physical health.

Backbench Business

Debate between Margaret Greenwood and Charles Walker

Thursday 16th March 2017 Westminster Hall

[Margaret Greenwood]

I thank the hon. Lady for that; she makes a good point.

Eligibility for the Work and Health programme will be much more restricted than the programmes it replaces. It will be open to certain disabled people and to people who have been unemployed for two years or more. In the light of that, the Employment Related Services Association estimates that as many as 45,000 fewer disabled people will have access to specialist employment support in every remaining year of this Parliament. Employment support for almost everyone else will be provided by Jobcentre Plus, including many disabled people with specialist needs.

How does the programme of jobcentre closures square with the Government’s aim of meeting their manifesto commitment of halving the disability employment gap? The longer and more complicated journeys to jobcentres as a result of the closures will particularly affect disabled people and people with caring responsibilities. Why has the DWP not yet published an equality impact assessment to analyse the effect of the closures on claimants and the local community?

More difficult journeys also increase the risk of claimants being sanctioned by staff for being late for or missing appointments. Will DWP issue guidance that, when considering sanctions, jobcentres should take account of increased journey times due to closures? There is already a backlog of sanctions, which in some cases is leading to money being withdrawn from claimants months after non-compliance, even though claimants may in the meantime have done what they were asked to do.

The roll-out of universal credit is continuing and will also present additional challenges for Jobcentre Plus. Jobcentres are having to do a huge range of things: provide careers advice to schools; deliver the new youth obligation under universal credit, which involves much more intensive support for 18 to 21-year-olds for the first six months of their claim; assess the viability of businesses for self-employed people claiming universal credit; and extend services to the partners of jobseekers, because universal credit applies to a household, so for the first time a spouse or partner of a claimant can be asked to attend a jobcentre to discuss work, even if they themselves have not made a claim or are in work. In future, jobcentres will also have to operate in-work conditionality under universal credit. In other words, people on low incomes who are working will be required to increase their earnings or risk being sanctioned—another first.

There is growing evidence that the supposed six-week wait for payment at the start of a universal credit claim is much longer in some areas, leading to people being in arrears with their rent and building up debts. Will the Minister assure us that the DWP has fully taken into account the need to tackle existing delays in processing claims in its plans for closures? Furthermore, universal credit is being rolled out at a rate of five jobcentres per month, rising to 30 jobcentres per month from July and 50 jobcentres after September, but by the end of last year the Department was ready to announce a dramatic programme of closures at the very time it was going to speed up the roll-out of universal credit.

Universal credit is, of course, designed for claims to be made and managed online. The Minister, in his statement of 26 January, highlighted that

“99.6% of applicants for Universal Credit full service submitted their claim online.”

As has been said by many Members, however, not everyone is confident of using IT, and many people rely on access to a computer in local libraries to do so—and libraries, too, are under threat from the cuts to local authority funding, with which we are all so familiar.

Just because a claim is made online does not mean that it can then be completely managed online. When there is a problem, a claimant may have little choice but to ring the DWP helpline or to go to a jobcentre to resolve it. We know from parliamentary questions last year that many claimants are spending long periods on the phone to DWP’s universal credit helpline.

The DWP is not alone in closing offices. HMRC is also planning to close all its 170 offices nationwide by 2020, replacing them with only 13 regional centres. Employment support works best when people have a good relationship with their adviser or work coach and it is tailored to a claimant’s specific needs. I am concerned that the system is already buckling under increasing pressure and that, in closing so many jobcentres at the same time as speeding up the roll-out of universal credit, the Government are simply asking the impossible of work coaches, who are at the heart of our system of employment support.

It is vital that we have a reliable social security system that is there for any one of us should we fall on hard times. Those closures look set to erode the infrastructure in place to deliver that system without the Government’s even having made an equality impact assessment. I urge the Government to think again.

[Mr Charles Walker (in the Chair)]

Before I call the Minister, I remind him that we would like Mr Stephens to have two minutes at the end. Would the Minister mind sitting down by 4.28 pm?