Health and Care Bill

Matt Hancock Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Dr Whitford]

I rise to speak to my amendment 82, which is on legislative consent if the Bill is used in the devolved aspects of healthcare in future. The bulk of healthcare—certainly its delivery through the Scottish NHS—is devolved. Having been on the Bill Committee, I was surprised that in the original version of the Bill there was not one mention in that context of the word “consultation”, let alone the word “consent”.

I do welcome amendments 118 and 121. I recognise that the Minister is trying to work constructively with the devolved Governments, but health is devolved. I am sorry, but after the United Kingdom Internal Market Act 2020, because of how the funds to replace EU funding post Brexit are being used to cut the devolved Governments out of decision making, there is a real fear among the public in Scotland that their health services could be changed in future. I ask anyone who supports devolution in principle to support amendment 82.

[Matt Hancock (West Suffolk) (Con)]

I rise to support new clauses 60 and 61, which relate, like the amendments that the hon. Member for Central Ayrshire (Dr Whitford) spoke about, to the UK-wide application of the Bill.

Health is rightly devolved, and as Secretary of State I worked very closely with Ministers in the three devolved nations, but there are nevertheless areas in which it is vital that the NHS, as a British institution, supports all our constituents right across this United Kingdom. Two areas in particular are critical and, in my view, need legislative attention.

The first area is the interoperability of data. As well as being vital for stronger research, it is necessary not least so that if you travelled to Caerphilly or Glasgow and were ill, Mr Deputy Speaker, the NHS could access your medical records to know how best to treat you. We can see right now, in the application of the NHS app for international travel, what happens without the data interoperability that new clause 61 would require.

[Geraint Davies (Swansea West) (Lab/Co-op)]

Is the right hon. Gentleman aware that there is concern in Wales, where we are protecting the private personal data of people receiving medicine and healthcare, that in England there will now be a gateway for the private sector to take people’s data and use it for its own reasons? That is one reason that we would not want to give the English our data.

[Matt Hancock]

On the contrary: data protection laws are UK-wide, so it is appropriate that this should be done UK-wide.

The second area is services. For instance, if a new treatment is available to Scottish patients in Edinburgh, which has one of the finest hospitals in the country, and if on rare occasions it is available to a Welsh person in Wales with a rare disease, should that person not be able to benefit from it? Likewise, if a treatment is available in one of the great London teaching hospitals and somebody from Stirling needs it, should they not be able to get it? At the moment, access to such specialist services is available on an ad hoc basis, but it is not broadly available. That is what new clause 60 seeks to address.

[Dr Whitford]

I simply point out that it is available; it is just that funding has to follow from the domestic health board to pay for it. I have sent patients to Leeds for MRI-guided biopsy, and patients used to come to Glasgow to have eye melanoma removed without losing their eye. That already exists.

[Matt Hancock]

It happens on an ad hoc basis, but it is not a right. The NHS is a great British institution, and access should apply right across the board.

Finally, in my last few seconds, may I simply say how strongly I agree with my right hon. Friend the Member for Maidenhead (Mrs May) about amendments 93 to 98?

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I rise to speak to amendment 73, which would introduce safeguards around the discharge-to-assess process.

The discharge-to-assess process may have been a necessary element of the NHS’s pandemic response, but it contains gaps in safeguarding that leave unpaid carers vulnerable to financial impact and risks to their health. Many unpaid carers have to begin caring overnight, when their relative or friend, who may be quite unwell, is discharged from hospital without a plan for their care at home. Without a carer’s assessment to check whether a person has the capability or capacity to take on such a commitment, weeks can pass before any plan is made, leaving carers and the people they care for struggling in a desperate situation.

The Government’s own impact assessment on discharge to assess states baldly:

“There is an expectation that unpaid carers might need to allocate more time to care for patients who are discharged from hospital earlier. For some, this could require a reduction in workhours and associated financial costs.”

Organisations that support unpaid carers are outraged by that statement. The Government’s expectation that carers can just drop everything to take on a new caring burden is insulting, particularly given the extra caring burden that 3 million people have already taken on during the pandemic.

I recently queried that point with the Secretary of State at the Health and Social Care Committee. In response, the he wrote to the Committee to say that the Government do

“not expect unpaid carers to need to give up work or reduce their working hours to look after friends or family while their long-term health and care needs assessments are completed”.

When the impact assessment says one thing and the Secretary of State, after being questioned about it, says another, I have to question the understanding in the Department and among Ministers of the discharge-to-assess policy and its impact on the 13 million carers in the country.

--- Later in debate ---

[Matt Hancock]

I welcome the passage of the Bill and congratulate all those who have been involved in bringing it to this place and getting it to Third Reading: the Secretary of State; the Minister, who has worked on it for an awfully long time; and the official Bill team, who were the best team I ever worked with in government. I am not saying that just because they are sitting in the Box.

The Bill gives the NHS what it needs. Critically, it learns the lessons of the pandemic and embeds them in legislation by removing bureaucracy and silos. I can see that the Secretary of State is already acting on that to merge parts of the NHS so that they can work better together.

I want to make a specific point in response to a comment from the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), about accountability. Although the Bill rightly devolves decision making and discretion more locally to the new integrated care boards and panels, it also gives Ministers the right to make sure that the NHS is accountable to them; it removes the so-called independence. That is right, and it is surprising not to see Labour Members supporting it, because it was in the Labour party’s manifesto as well as the Conservative party’s.

When £150 billion of taxpayers’ money is at stake, imposing apparent independence is not just impractical, but wrong. The NHS should be accountable to Ministers so that they can be accountable to the House, which is accountable to taxpayers through the ballot box. That is right constitutionally, morally and practically, which is why it was in both major parties’ manifestos. It is how the NHS operates anyway in practice, but the Bill will remove some of the unnecessary friction in the senior relationships that resulted from the attempt at independence.

Of course clinical voices should always be listened to, but as we saw during the pandemic, we can listen to clinical voices and then make a decision that is held to account on a democratic basis. The Bill will therefore strengthen not just the running of the NHS, but how we constitutionally govern the huge amount of taxpayers’ money that is spent on it. For that reason alone, it is worth supporting the Bill.