Health and Care Bill

Baroness Kennedy of Shaws Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Kennedy of The Shaws (Lab)]

My Lords, my little granddaughter is appearing today in her first school nativity play, rather wittily titled “A Midwife Crisis”. I am sure it was a midwife crisis, but a veil was drawn over the actual birth of the infant child—I think it was a do-it-yourself affair. Sadly, we too have a midwife crisis, along with a nurse crisis, a doctor crisis and indeed an across-the-NHS crisis.

If we take the pulse of the NHS, we find that it is in serious trouble. If we ask why, the quick answer is now always “Covid”—but of course that is not true, and the Benches facing us know that in their hearts. When the Conservative Party came into government in 2010, waiting lists were low. Today waiting lists are at 6 million, and they were already at 4 million before Covid struck. Why? The answer is that for a decade annual NHS funding increases had been at their lowest levels ever. That withdrawal of funding was described as efficiency cuts. How can it ever be efficient to cut 17,000 beds or to have over 100,000 vacancies for doctors and nurses? George Osborne, in his austerity policies, took a scythe to training places in his very first Budget. So let us not hear from the Conservative Benches that somehow this has all just come upon us by surprise; it was a deliberate set of policies.

Let us look at the whole business of the public health budget. Colleagues spoke about its importance in creating health and preventing illness. That budget has been cut by 24% since 2015-16. Do we think it is going to be restored in the Bill? Not one bit, yet that money would be well spent because it would reduce the number of people who got ill. As we know—all the statistics have shown it, along with the work of the Institute for Fiscal Studies—the Sure Start programme, which was cut, in itself reduced the hospitalisation of children by 18%, but that project has been thrown to the winds.

There is now an emergency in our hospitals and GP surgeries, and people are worn out. I recently completed a report for the Royal College of Surgeons on improving diversity and inclusion in the surgical profession. When you dug deeper and asked why women had left the profession in their thirties, the answer was that it was the whole business of their lives. Staying on was impossible because of the failure of any real consideration of the demands made on people’s lives and the ways in which women just found it too difficult to combine all those things, including childcare and having a home somewhere close to where they worked. If you are married to another doctor, they are often sent miles away and given a job nowhere connected to you. That whole lifestyle has not been considered in any of this. However, the Bill addresses none of that.

The original plan was worthy: it was to undo the vandalism done to the NHS by David Cameron and the noble Lord, Lord Lansley—I make no apologies about saying that, even if he is in this Chamber—which blew the NHS into marketised fragments that were forced by law to compete rather than co-operate. Now the word is “collaboration”, but that was not the word being thrown around then. The whole point is that in 2012 that Act opened up all contracts to private tenders. Competition law should have no place in the running of our National Health Service because services need to work together. Yes, the word should be “collaboration”, and I have heard it from any number of persons in this House. Collaboration and integration should be the bywords of our National Health Service.

The original plan was to have integrated care systems across the country to rationalise and plan local services. The idea was to include local authorities and combine social care with health, but the Bill does not marry social care and health. The NHS and local authorities could be pooling their resources, but there is no machinery for doing so in the Bill. The Government have given themselves the absolute power to appoint all the directors of an integrated care service, and refuse to bar private providers from sitting on those boards. The Government have also resisted an amendment in the other place to make the NHS a preferred provider in any tendering process. This is all about privatisation, and it is always done by stealth. Look at all the disgraceful cronyism that was displayed in distributing contracts at the outset of Covid. Many in this Government have a distrust of public service. They refuse to accept all the evidence that a state-run NHS is a success story, yet we spend less money on it than our comparators, we run it with too few doctors, nurses and other healthcare professionals, and we pay them all badly.

This could have been a great opportunity to create an even better NHS but also to create a unified national system of health and social care that worked together in a seamless way. Unfortunately, it is in the hands of an ineffectual, incompetent and ill-led Government, so I do not have much confidence in what is being promised.

Health and Care Bill

Baroness Kennedy of Shaws Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

[Baroness Harris of Richmond (LD) [V]]

My Lords, the noble Lord, Lord Blencathra, has explained that Amendment 213A is an important statement of intent, if put in the Bill, by Parliament and the Government that, on behalf of the people of this country, we will take all the steps that we can to prevent procurement of goods made in places where there is evidence of likely genocide and where human rights abuses and modern slavery are thereby inevitable.

My noble friend Lady Brinton has just explained the problem of the sourcing of PPE from China and from companies that may be using Uighurs’ enforced labour. This is extremely worrying. Given that the Government have previously ignored an amendment passed in your Lordships’ House in the Trade Act 2021, despite rising international concerns about genocide against the Uighurs, it is vital that we remember the duty placed on nation states to use a deterrent effect.

In its judgment of 26 February 2007, in Bosnia and Herzegovina v Serbia and Montenegro, concerning the application of the Convention on the Prevention and Punishment of the Crime of Genocide, the International Court of Justice found at paragraph 431 that the duty to prevent arises

“at the instant that the State learns of, or should normally have learned of, the existence of a serious risk that genocide will be committed”,

as the noble Lord, Lord Blencathra, stated. The judgment continues:

“From that moment onwards, if the State has available to it means likely to have a deterrent effect on those suspected of preparing genocide, or reasonably suspected of harbouring specific intent … it is under a duty to make such use of these means as the circumstances permit.”


This amendment echoes that judgment by saying that all endeavours must be made to prevent and deter the procurement of goods from an area where genocide is suspected.

I am also concerned about legislation on slavery, also a scourge of our times, and hope that the Government will not rely on it as a possible alternative. As we have heard, the Modern Slavery Act 2015 merely requires companies with a turnover of £36 million or more to produce a modern slavery statement. The legislation does not prevent companies, or the Government themselves, procuring slave-made goods. The Foreign Prison-Made Goods Act 1897 makes some procurement illegal in certain narrow circumstances, but it is very old legislation and now considered largely defunct. I am grateful to a number of NGOs for their excellent briefings on this subject.

The former Foreign Secretary, Dominic Raab, said that torture “on an industrial scale” was being carried out in Xinjiang, even though his Government decided not to take action by creating import controls for Xinjiang. This Health and Care Bill offers the opportunity to return to the issue and to improve DHSC procurement policy.

[Baroness Kennedy of The Shaws (Lab)]

I, too, have my name to this amendment and support it, as I have previous amendments to other Bills relating to genocide. Health procurement is a very problematic area that warrants the special attention of Parliament. Not to put too fine a point on it, we will probably all have been wearing slave-made masks, even here. But it is a particular concern if great institutions such as our National Health Service are purchasing them in contravention of the standards we would like to set.

According to the Institute for Government, the UK has spent at least £15 billion on PPE since the onset of the pandemic. To put this into context, the normal annual spend on PPE is around £150 million. Perhaps we should have been putting aside more money for it. Anyway, many PPE contracts use products sourced from China. We do not know how much came from the Uyghur region but one news report alone alleged that we had purchased millions of pounds-worth of PPE from a company strongly suspected of using forced Uighur labour. That is just one report and I suspect we will see more investigations and more coming to light.

Even where the PPE is not manufactured in the Uyghur region, it may contain cotton, plastics and some other constituent parts that were. It has always surprised me that we do not have the import control regime that the United States has had for some time. The USA requires importers to document the source of products, not just the town and city but the particular factory, and to make tracking possible. Indeed, DNA tests can locate the source of the cotton, for example—the very region where it has come from.

What do we mean when we talk about serious risk of genocide? These are not just words. They represent the trigger for state responsibility under the genocide convention, as other speakers have mentioned. The International Court of Justice in 2007, in a judgment of a case involving Bosnia and Serbia, was crystal clear that state responsibility to prevent genocide arises

“at the instant that the State learns of, or should … have learned of … a serious risk”

of genocide. We have taken the words from that judgment. By incorporating those words into regulations, we are providing the Government and Parliament with a mechanism to take action to prevent genocide. This is something they lack in their current policy, which makes all actions dependent on a judgment from an international court—which, as we know, bears the Catch-22 that the very countries getting close to genocide or in the process of committing it do not usually want to play by the international rules of law.

Why should a serious risk of genocide be our procurement threshold? There will always be widespread human rights abuses with attendant supply chain risks for businesses where already there is talk of a possible genocide being in play. This should not represent an obstacle to the United Kingdom because since the Modern Slavey Act—which we passed here proudly as leading the world back in 2015—our aspirations have been to ensure that no business can sell slave-made goods into our market. A serious risk of genocide represents a higher threshold than any modern slavery offence, so the bar is set high here. The ban on procurement that a positive finding of serious risk would attract is proportionate. We need take these steps urgently. It is not, as others have said, just about China, but the amendment would, we hope, have an immediate effect in the Uyghur region.

As many noble Lords will know, last autumn the Uyghur Tribunal sat not very far from here, in Church House, led by a sort of jury of persons and the distinguished international lawyer Sir Geoffrey Nice QC. The tribunal concluded that China was, in fact, committing genocide in the Uyghur region and there was a violation of pre-emptory norms in international law that ought to require government action, by us. We are under a duty to act. If a genocide is in train or in progress, we have a duty to try to prevent it. That is what the convention says.

Although the amendment, rightly, does not identify any single country, I would expect it to have some immediate effect in China. The situation is urgent, and we are having this debate because 800,000 Uighurs are working to produce goods against their will. By some estimates, as many as 300,000 children are separated from their parents, which is really part of a process to take them away from the culture, religion and traditions of their people and to deracinate them. At any one time, up to 1 million are in re-education camps. There has also been shocking evidence of forcible sterilisation of Uighur women and many other heinous crimes. There really is an international legal obligation upon us. This House has expressed its views in previous votes and I hope we will eventually be joined by many noble Lords when this comes at some point to a vote.

We are looking at our supply chains and they are being seriously tainted by human rights abuses. We have taken proud steps, leading the world, in seeking to do something about these supply chains, and here is an opportunity to take it even further.

[Lord Alton of Liverpool (CB)]

My Lords, it is a great pleasure to support the noble Lord, Lord Blencathra, who so ably moved this amendment; to concur with the speeches just made by the noble Baronesses, Lady Kennedy of The Shaws, Lady Harris and Lady Brinton; and to associate myself with friends from across the House in respect of the work they have put in over many months to push to the top of the agenda the issue of honouring our duties under the 1948 convention on the crime of genocide. I have two things I would like to add. The first concerns our international treaty obligations, referred to a moment ago, what we are required to do from the moment we know that a genocide is under way, and how we must never utilise to our benefit slave labour in a state credibly accused of genocide. The second concerns the way in which the lack of transparency in our procurement policies has led to the improper use of public money.

The amendment is a logical extension of the debates on the genocide amendment, which, as the noble Lord, Lord Blencathra, said earlier, was passed by three-figure majorities in this House in an attempt to provide a mechanism in the Trade Act 2021 to evaluate when a genocide is or is not taking place. Many promises were made by the Government during that amendment’s many iterations, including the provision of an effective mechanism to determine what constitutes a genocide and to honour our obligations under the 1948 convention. Demonstrably, those promises have not been kept. Worse still, we have established the illusion of a procedure to examine and deal with this most odious and reprehensible of crimes. The fact that we cannot, under that procedure, even look at what is happening in Xinjiang with the Uighurs shows how inadequate it really is.

Can anyone doubt the seriousness of this issue, not least in the light of the pronouncement by the Foreign Secretary, Liz Truss, that a genocide is under way in Xinjiang; or the resolution passed by the House of Commons; or the December judgment just referred to of the Uyghur Tribunal; or the declaration of genocide by United States President Biden; and much more besides? Do we have any excuse, therefore, for not taking action?

The noble Lord, Lord Blencathra, referred to a report by the British Medical Association, which seems particularly pertinent in the context of this Health and Care Bill. It sent a letter on 26 January, which noted

“the shocking reports of human rights abuses, including torture, forced labour, political indoctrination, and reported forced sterilisation. Since then, the situation has developed in the most abhorrent manner and we”—

the BMA—

“issued a joint statement with the Academy of Medical Royal Colleges and other Royal Colleges in December”—

I repeat, December—

“urging the UK Government and international actors to exert pressure on the Chinese Government without delay.”

It goes on to refer to the independent tribunal, saying:

“It found beyond reasonable doubt that the People’s Republic of China … is guilty of genocide. The Tribunal determined that biological genocide is occurring through restriction of births by forced sterilisation and abortion, segregation of sexes within the detention centres, and forced matrimony and procreation between Uyghur women and Han men. Furthermore, mutilation and biological experiments take place in the detention centres.”


If anybody is in any doubt about the enormity of what is taking place, they should read some of the personal testimonies which were given to the Uighur tribunal. I sat through many of its hearings and found the whole process incredibly harrowing. Let us be clear that there will be amendment after amendment to every possible piece of legislation until the promise to hold to account those responsible for these most heinous crimes against humanity are actually honoured. So my first point is that continuing to source goods for the NHS from Xingang is clearly not consistent with the duties laid upon us in the convention on the crime of genocide.

Health and Care Bill

Baroness Kennedy of Shaws Excerpts

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

[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.

[Baroness Kennedy of The Shaws (Lab)]

I shall speak very briefly, because I am conscious of the time and that we have a lot of business to do. This amendment seeks nothing more than to create another human rights threshold for health procurement, adding to those that are already in place, which seek to address slavery but have major shortcomings, as the noble Baroness, Lady Brinton, has just described. I keep hearing it being said that a health Bill is not the proper place for an amendment concerning genocide. Well, I am afraid that I do not agree. This is an appropriate place.

We are not asking the Government or the Department of Health to decide whether there is a genocide taking place; we are asking the Minister to take on the duty to assess whether the source of instruments, test kits, protective equipment or whatever may be from forced labour and a situation of slavery. Xinjiang province is the obvious place for us to be concerned about, but there are other places—for example, in India—that we should be concerned about too, and I think that placing that duty on the shoulders of the Minister is a way of concentrating minds. That is why I really press this amendment and I pay tribute to the way the noble Lord, Lord Alton, has so assiduously pursued this. That is all I wanted to say, but I will support this amendment and I urge the House to support it too.