Health and Care Bill

Matt Hancock Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Edward Argar]

I am grateful to the hon. Lady. I do not think that she posed a question, but she made her point clearly, as she always does.

[Matt Hancock (West Suffolk) (Con)]

rose—

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

rose—

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[Edward Argar]

Before I give way to the right hon. Gentleman, I will give way to the former Secretary of State.

[Matt Hancock]

Is not the right way to think about this change to consider the proposal in front of us and compare it with the current system? The reason that the Dilnot system, as previously proposed, was never put in place was that there was never a proposal to pay for it, whereas this package is paid for. That is why this Government have been able to deliver a package where no previous Government have been able to do so.

[Edward Argar]

I am grateful to the former Secretary of State. He is absolutely right. We deal in the reality and we should compare the reality of the system that we have in place now with what we have proposed here, which not only moves us forward, but is funded and sustainable.

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[Margaret Greenwood]

I thank my right hon. Friend for putting the case so clearly. She hits the nail absolutely on the head: as a result of the Bill, contracts could be handed out to the private sector without the stringent arrangements that one would expect in the awarding of public money. That is a recipe for the kind of cronyism that has become all too familiar, as she says.

I turn to the cap on care costs. I was proud to stand on a manifesto in 2019 that pledged to

“build a comprehensive National Care Service for England”,

to include

“free personal care, beginning with investments to ensure that older people have their personal care needs met, with the ambition to extend this provision to all working-age adults.”

The Conservative manifesto in 2019 did not go that far, but it at least made the guarantee that

“nobody needing care should be forced to sell their home to pay for it.”

We now know that that was a sham—another broken promise by this Government.

Last week, Ministers sneaked out changes to social care plans that would mean that poorer pensioners will not after all be able to count means-tested payments by the state for their care towards a total cap of £86,000 for any individual. The Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), described it as “deeply disappointing” that the new plans were “not as progressive” as those put forward by Andrew Dilnot, the economist who drew up the original plans for a cap on individual contributions. Mr Dilnot has said that the Government’s plan is

“a big change that…finds savings exclusively from the less well-off group.”

A former Conservative Cabinet Minister has urged the Government

“to adopt a different approach”,

while another Conservative MP, a former Under-Secretary of State for Health, has said that

“it will be poorer pensioners who have relatively modest assets that will be most affected by these changes.”

I hope that Members on the Government Benches are listening to those points from Government as well as Opposition Members and will do the right thing. Elderly people deserve better. All Members, including Government Members, have a responsibility to vote these measures down.

When the Prime Minister was discharged from hospital in April 2020, having spent seven nights there, of which three were in intensive care, he said that

“the NHS has saved my life, no question.”

Now he and his Government should save the NHS by withdrawing the Bill. The national health service is this country’s greatest social achievement. It is devastating that this Conservative Government are intent on taking it off us.

[Matt Hancock (West Suffolk) (Con)]

I support new clause 49 because I support the action that is needed to make reforms to social care that are long overdue. I have listened carefully to the debate, and it is vital that we understand that the new clause would deliver one part, but not the whole, of the package that was set out by the Government in September. There is no doubt whatever that that package, as a whole, improves the provision of social care, makes the way it is paid for fairer, and removes some injustices that have existed in the system for far too long.

First, the proposal that has been put forward—and I think it is the right proposal—is for a cap on the costs that individuals face in paying for their care. The contributions from the state, even if they are from another part of the state such as local government, are not individuals’ care costs, and it is therefore wrong that they should be contributions towards the cap. The cap has the stated goal of being a cap on the cost of care to an individual, not a cap on the cost that accrues to both the individual and a local authority.

Let us look at what would happen if the new clause were not passed. The provision of care by local authorities is different in different areas, largely according to how well off those local authorities are. A richer council that pays more costs than the statutory minimum as set out in the Care Act 2014 would help local residents to meet the cap sooner than a poorer council that pays only the statutory minimum of care costs, and therefore people who live in poorer areas would take longer to reach the cap, so we would end up, in effect, with a postcode lottery cap meaning that people from poorer areas would tend to have to contribute more. That is wrong, and I am very glad that it is put right by the proposals that are before us today.

Secondly, for those with lower asset values, the rise in the floor in the means test is more important. It is the rise in that floor that makes this system fair. When the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), read out a long list of places with low asset values on average—places where house prices tend to be lower—he listed exactly the areas that will benefit most from the rise in the floor. [Interruption.] We can see what Labour Members are doing. [Interruption.] They are taking a narrow area, and they are taking a specific detail, and they are ignoring all the parts of the package that benefit the people who will benefit from this package as a whole. [Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. We will not get anywhere if people shout. This is supposed to be a reasonable discussion.

[Matt Hancock]

Thank you, Madam Deputy Speaker.

A further point that is being ignored by those who are trying to make a meal of this new clause is that the cutting of the daily cost offset is much more valuable to those on low incomes than any change in the cap, because the cap, by its nature, is there to protect assets, and those who do not have many assets gain far more benefit from the cut in the daily cost that would otherwise clock up their contributions to the cap much more slowly.

Taken together, these elements make up a package that is beneficial to those on low incomes. It helps to make the system fairer.

My final point on new clause 49 is this. For years and years—including the years when I was Secretary of State, and including the entire 13 years when Labour was in power—nobody fixed the problem of social care. This Government have come forward with a package, and if we pull apart one part of the package, there is a risk to the package as a whole. As Sir Andrew Dilnot said on the radio this morning,

“the whole package is a significant step forward”.

It is always easy in politics, and in life, to say, “I just accept the bits of the package that I like”—and, in the case of the Labour party, to say, “I accept the bits that are very expensive for taxpayers.” Instead, we must look at the package as a whole, which is funded, and which can be delivered, for the first time in several decades, because it hangs together. The Government have presented a whole package, and it is the best possible option in the fiscally constrained times in which we live.

[Dr Julian Lewis]

I am sorry to be unhelpful to my right hon. Friend, but if this element is so integral to the overall package, why was it not brought forward right at the beginning?

[Matt Hancock]

This part of the package was described in September, because it was made clear in September that the £86,000 cap was a cap on individual costs. It did not say then that that included the costs that local government may make on someone’s behalf. I think it is a strong Conservative principle that, when we say we are capping the costs that an individual pays, we do not include the costs that another part of the state should pay. I think that that was clear, and more details have now been set out. Most importantly, this is a package that takes things forward in a way that has not been achieved for decades.

[Rob Roberts]

I do not think anyone across the House would argue that the measures that have been put forward are a significant step forward from where we are. However, as my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) and my right hon. Friend the Member for South West Surrey (Jeremy Hunt) mentioned earlier, they are not necessarily what we might have been led to expect. Would my right hon. Friend like to comment on that?

[Matt Hancock]

I will happily comment on that. In the debate over the past few days, many people have been comparing the package put forward by the Government with the proposals from Sir Andrew Dilnot in 2014-15, but there is a reason those proposals were never enacted and never came into force. It is because they had a huge price tag, and there was no successful debate on how to pay for them. It has been easy to ask for social care reform for the past three decades, but until this Government did it, nobody had come forward with a plan for how to pay for it. We simply cannot magic things out of thin air. If we are a grown-up Government, we have to come forward with a grown-up package, which includes saying how it will be paid for. That is what has happened, and that is why this package hangs together. We should support this new clause, because it is part of that overall funded package.

I want to turn briefly to the measures on integrated care systems. The purpose of the ICSs is to have a more preventive, more flexible and less siloed approach than we have under the current clinical commissioning groups, without removing the grit in the oyster that is the purchaser-provider split and without upsetting the 1948 settlement involving local authorities doing social care and having a national NHS. Amendment 76 in particular contains a lot of suggestions that might seem tempting. There are people who have an important voice in the debate. The problem, as we have seen with existing legislation, is that if we put too much into statute, it is far harder to deliver high-quality services that are integrated on the ground. That is why the Government are right to resist putting too much detail into legislation. However, I do support the change proposed by the Government, which makes it clear that the purpose of ICSs is not to have private providers on the board. I can confirm that, as the Minister said, it never was. Mischievous rumours were put about, some of which have been repeated today, that that was the intention, and I am glad that the Government’s amendment puts that matter beyond doubt.

I am attracted to amendments 89 and 90 and, in another group, amendments 91 to 98 and amendment 23, tabled by my hon. Friend the Member for Broxbourne (Sir Charles Walker). I was going to say this before I knew that I would be sitting next to him in the debate today, and I hope that the Government will look on these amendments kindly. The parity of esteem between mental and physical health is incredibly important, and I commend the amendments to the House.

[Several hon. Members rose—]

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.

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[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.

Health and Care Bill

Matt Hancock Excerpts

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I will be brief, Madam Deputy Speaker.

Operational procurement is a devolved matter but, given our interest in trade policies, we welcome the progress on procurement to ensure that healthcare supply chains are not linked to modern slavery and human trafficking. We support UK Government amendment 48A in lieu of Lords amendment 48, and we also support Lords amendment 48B in lieu. It is perhaps worth reflecting on the fact that in Scotland half of all PPE is now produced locally and that the overall costs of pandemic procurement were a third less than those of the UK. Such measures can, then, be cost-effective and help to safeguard against global supply chain issues.

[Matt Hancock (West Suffolk) (Con)]

I rise to support the compromise measure on reconfigurations and to ask the Government to take forward the work on UK-wide statistics with vigour and gusto.

First, on reconfigurations, it is right and reasonable that the largest organisation in the country, which is funded by taxpayers through the taxes that every single citizen pays, should be accountable to Ministers who are in turn accountable to this House. Although that principle has been accepted in the Bill across the board and in general terms, the other place has decided that it should not apply in the specific circumstances of reconfigurations. It is vital that when a reconfiguration happens, not only the clinical voices but the voice of the local community should be heard. The two need to go together. The best way to make happen any reconfiguration that is needed on clinical grounds is to engage the local community and get it onside. If we are to save lives through a reconfiguration, we can win the argument, but only if we engage and make the argument. In my experience, too often a reconfiguration was put on the table, perhaps for good clinical reasons but without enough local engagement, and in practice the process just ran into the sand.

I welcome the six-month delay—I hope the Secretary of State will work quicker than six months most of the time, but it is a good backstop; I welcome the de minimis threshold, because relatively small reconfigurations happen all the time; and I welcome the removal of some of the bureaucracy in the amendment. To my hon. Friend the Minister, who has done a magnificent job on the Bill right from the start, before it even came to this House—I thank all his officials for their service—I say: let us take this compromise but say clearly to the other place, “Thus far and no further.” The principle of democratic responsibility for the NHS and for winning the argument with the public about its local design is at the heart of the Bill and it must stand.

In the final minute I have in which to speak, let me make a point about statistics. Those on the Treasury Bench have decided not to include in the Bill measures on the UK-wide measurement of health services and on the interoperability of data in the four nations of the UK, but I put on the record the importance—I hope the Minister reiterates this—of getting UK-wide measurements. In Wales, it was decided to discontinue the measurement of some aspects, especially in respect of A&E performance. A suspicion was raised—I am sure this could not possibly have been true—that those measurements were discontinued so that unfavourable comparisons with England could no longer be made. If that were true, it would be an outrage. I very much hope that it is not, but we should put it right anyway and measure NHS service delivery throughout the UK on the same basis, so that comparisons can be made, so that we can learn about and improve services across all four nations, and so that accountability can properly apply to the four different Governments who run the four parts of the one NHS, which operates across this United Kingdom.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I rise to speak to the Lords amendment on workforce—probably for the dozenth time during the Bill’s passage. I make no apologies for repetition because some things are worth repeating and the importance of our workforce can never be understated. Everything comes back to workforce: the grandest plans, strategy documents, reorganisations, integrations and configurations will all count for very little if the fundamental cog in the machine and the glue that holds the whole thing together—the workforce—is not a central part of those plans. The consistent failure to invest in the workforce and to provide a plan for it so that it is able to meet demand over a sustained period is at the root of many of the challenges that the NHS faces today. We should correct that.

On Friday night, a constituent contacted me as he suspected he had dislocated his hip and had been told that his situation did not warrant an ambulance. Eventually, he managed to get to A&E, but in the end he went home without receiving treatment because it was so busy that people were standing outside the department. That is just one example, but there are countless others like it—the frustrated constituents who can never speak to their GP; the many people left in agony because waiting lists are at record levels; those whose teeth rot away because they cannot get dental treatment; and those who receive no help for their mental health issues because they do not reach the threshold for intervention. Every one of those examples arises because, to a greater or lesser extent—I would say to a greater extent most of the time—there simply are not enough staff to meet the demand.

There is a pattern of disconnection in respect of the action required to meet the Government’s ambitions, let alone getting the NHS to meet its constitutional targets. Unless workforce is addressed in a meaningful way as part of all the plans and strategies issued, the Government are just fooling themselves that their plans are credible and deliverable. Even if the Government wish to fool themselves, they are not fooling anyone else. They are certainly not fooling us Members on the Opposition Benches or the 100 or so health and social care organisations that support what we are trying to achieve with the workforce amendment.

The most recent Department-commissioned NHS workforce strategy, the People Plan, did not include a forecast on staffing numbers. When asked about it, Baroness Harding, who authored the plan, said that the strategy did not include staff numbers not because

“the Government disagreed with the numbers”

but

“because we could not get approval to publish the document with any forecasts in it.”—[Official Report, House of Lords, 7 December 2021; Vol. 816, c. 1814.]

Perhaps that means the Government do have figures but just do not want us to see them. If that is right, perhaps the Minister could let us in on the secret when he responds. If that is not right, will he tell us what other organisation with more than a million staff manages to operate successfully without accurate figures on workforce projection?

In addition to the obvious arguments about why we need accurate information on workforce requirements, it is important that we collect such information for existing staff, because they need hope that help is on the way. We need to show that those claps on a Thursday night were not an empty gesture and that there is a determination to do something about the persistent rota gaps that mean staff are both exhausted and demoralised. Just look at some of the challenges we face: 93,000 vacancies; a £6 billion annual spend on agency staff; staff working extra unpaid hours; and some 40% off with work-related stress at some point or other. With all those things conspiring together, it is little wonder that retention is an issue, so we need to give staff hope that we have an answer—that we have a plan. As the Select Committee report on workforce burnout said:

“The way that the NHS does workforce planning is at best opaque and at worst responsible for the unacceptable pressure on the current workforce which existed even before the pandemic.”

With so many challenges currently facing the NHS, why do we want to make it worse by refusing to accept the evidence before our eyes? It is no coincidence that NHS satisfaction ratings are reported to be at a 25-year low at the same time as record numbers of NHS staff say they would not recommend working at their own trust. Those issues are not disconnected in any way, which is why we need to support the workforce amendment.