Health and Care Bill

Mel Stride Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Edward Argar]

I simply take my hon. Friend back to my previous point: when compared to the current system, this is a significant improvement and step forward, particularly when taken in the round with the overall package of measures that see the floors go from £23,250 up to £100,000 and from £14,250 up to £20,000. We have to look at this issue in the round, considering all those aspects rather than purely one element alone.

[Mel Stride (Central Devon) (Con)]

Will the Minister give way?

[Edward Argar]

I would like to move on to ICBs and ICSs, but I suspect that, assuming there is time, my right hon. Friend, who chairs the Treasury Committee, may have the opportunity to intervene during my winding up, or to give a speech during the course of the debate.

Currently, the NIS regulations cover NHS providers in England, rather than commissioners. Government amendment 30 allows us to mitigate cyber-risk in a wider sense, making cyber-security a responsibility for organisations that have duties across the system, and to drive forward a shared and collaborative effort towards reducing the risk to patients. I hope that Government amendments 29 and 30 will be uncontentious and supported on both sides of the House.

--- Later in debate ---

[Richard Burgon]

We are not seeking to wage war on GPs; we want to support GPs and properly resource them. We see so many GPs retiring and not being replaced. It is this Government who are waging war on our NHS with this further Americanisation of our NHS. It is a dangerous cocktail where the dodgy contracts we have seen throughout covid risk becoming the norm. The billions squandered on test and trace should serve as a warning of what the Government could do to the whole of our NHS.

There is a sleight of hand going on with this Bill. It is true that under the Bill NHS bodies will no longer have to put services out to competitive tender to the private sector. Such tendering to the private sector was made a requirement under section 75 of the coalition Government’s Health and Social Care Act 2012. It was a shameful Act and its scrapping has long been demanded by those opposed to privatisation of our national health service. However, the change in this Bill does not reverse privatisation, because without making the NHS the default provider, that simply means that contracts can not only still go to private healthcare corporations but can do so without other bids having to have been considered.

To prevent all this, I tabled amendment 9, which I want to put to a vote—unless of course the Government accept it—because it establishes the NHS as the default option. [Interruption.] Conservative Members groan, but the only reason for people not to support my amendment is if they do not believe in the NHS not moving to a privatised insurance model. Why else would people object to the NHS being the default provider of healthcare? The British Medical Association supports it, so the Tory groans are groans against the position of the British Medical Association. Unison supports it, so the Tory groans are groans against the voices of those who work in the NHS—for most of whom, if they need to have more than one job, it is because they do not get paid enough, not because they are trying to get their own snouts in the trough. I will be voting against the whole Bill, but if the Government refuse to accept amendment 9 to make the NHS the default provider, that shows what the Government of the party that objected to the foundation of the NHS in the first place are really up to, despite all the warm words.

[Mel Stride]

I rise to speak to new clause 49. In doing so, and whatever its merits or otherwise, it is worth reflecting on the comments made by the Minister that we are at least here this evening looking at a part of a process that will lead to some progress in meeting social care costs going forward and removing the catastrophic risk that has hung above the heads of all our constituents up and down the country: that their healthcare costs may end up costing them all of their assets. We are also here having taken the tough decisions around having raised taxes to fund those arrangements.

I have problems with new clause 49. It seems to me that to make good law in this place, first, we need time to consider the matters put before us and secondly, we need the appropriate information upon which to take those decisions. On both those points, I have real concerns about how new clause 49 has been brought forward. The first we heard of it was not in Committee or in September when the general measures were put forward, including the taxation measures on which we all divided and voted, but on Wednesday evening, when the amendment was tabled.

It was fortuitous that the Treasury Committee happened to have Sir Andrew Dilnot before us the very next day. We were able to discuss many of the issues inherent in new clause 49. A number of issues were raised, to which only the Government have the answers. One of them has been put forward powerfully by speaker after speaker tonight, which is: what are the impact assessments associated with these measures? I wrote to the Chancellor immediately after that session and asked him for some impact assessments, including geographical impact assessments, of which we have had none.

It seems that the only information we have had was released by the Department of Health and Social Care on Friday night, in a document called “Adult social care charging reform: analysis”. I am very short of time, which is a shame, but there is, for example, a chart of a 10-year care journey that looks at individuals with different asset levels. While it is true, as my hon. Friend the Minister said, that these arrangements, even with new clause 49, are better for almost every level of wealth than under the status quo, it is not the case that everybody is better off compared with the measures brought forward in September.

[Alison McGovern]

The right hon. Gentleman gets to the heart of the matter, which is what people will get, compared with what they were promised. Is that not the heart of this matter?

[Mel Stride]

I think the heart of the matter is that we have to be clear and wide-eyed about what this change will do. Yes, it is true that it will leave us in a better position than the status quo, but it is not the case that it will leave those who are less well-off in a better position than if new clause 49 were not passed by the House. For those with assets of about £106,000, by my read of this graph, about 59% of their assets would be lost on average under the original proposals. Under the amended proposals, that figure would rise to 70%. When it comes to those who would be better off as a consequence of new clause 49, many are the better off, because they benefit from the changes being made to daily living costs, to which my hon. Friend the Minister referred.

I am out of time, but I believe that these measures should have been better ventilated in this House—certainly in Committee, if not earlier. We would then have had better information and more time in which to make these important judgments.

[Dame Diana Johnson (Kingston upon Hull North) (Lab)]

I want to speak briefly to amendment 15, which focuses on the membership of integrated care partnerships—the bodies that will be responsible for developing plans to address the health and care needs of local populations. The amendment would enable the Secretary of State to make specific provisions ensuring the representation of particular areas of healthcare on ICPs via secondary legislation.

In particular, I am concerned about having a strong voice for women’s health in ICPs. I also mention in passing the need for other groups to be represented, such as carers, in an ICP area. As co-chair of the all-party parliamentary group on sexual and reproductive health, I have seen how the experience of women in relation to their healthcare is often an afterthought in a fragmented health system, as in the case of the vaginal mesh scandal; the recent debate about pain during the insertion of intrauterine devices, a form of contraception; maternity provision; and cuts to contraceptive services.

The amendment would ensure that the issue of representation was considered by the Government. It has strong support from the medical bodies in this area, including the Faculty of Sexual and Reproductive Healthcare and the Royal College of Obstetricians and Gynaecologists, as well as in other areas of healthcare, such as childhood cancer, and, as previously mentioned, carers groups.

It is important to protect the independence of ICPs and ensure that they can set a strategy that effectively meets local needs, but there is also a need to ensure that women’s voices are not left behind in the decision making. Without this amendment, it cannot be assumed that those voices will be heard on all ICPs. I hope that the Government will consider the purpose of the amendment, which is to strengthen the Bill.