Health and Care Bill

Baroness Bennett of Manor Castle Excerpts

Lords Hansard - Part 2 & Report stage
Monday 7th March 2022 Lords Chamber

Moved by

[Baroness Bennett of Manor Castle]

145: Clause 156, page 126, line 37, at end insert—
“(c) after subsection (2) insert—“(3) No financial assistance provided under this section may be used for the purposes of—(a) repaying debt incurred outside of the business's normal day-to-day operations;(b) paying interest on debt incurred outside of the business's normal day-to-day operations;(c) making distributions to shareholders.””Member’s explanatory statement
This amendment ensures that financial assistance given by the Secretary of State is not distributed to shareholders or used to repay debt obligations incurred as “financial engineering” or leveraging.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in moving Amendment 145, which appears in my name, I will also speak to Amendments 146 and 147. I thank the noble Lord, Lord Howarth of Newport, who has swung behind these amendments since Committee, and I also very much thank the noble Baroness, Lady Tyler of Enfield, for her support for Amendment 147.

As we discussed at some length in Committee, all of these amendments address predatory finance in the care sector. We keep seeing more and more reports, whether from “Panorama”, Tortoise Media or the Financial Times, that there is a huge unfolding scandal in this area.

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[Earl Howe (Con)]

My Lords, the noble Baroness, Lady Bennett, has brought us back to issues that we debated in Committee and I understand her concern about propriety in the deployment of public funds. I have no problem with the idea that Ministers and public servants should do all they can to ensure that public money is used effectively for the greater good. That is what they are obliged to do anyway. However, I do not feel that this duty is best served by accepting the amendment, even though it has been newly worded.

In my answer in Committee, I described how during the pandemic we learned about the importance of speed and flexibility in the way that we respond to a crisis. I suggest that this amendment would impede the Government’s ability to provide emergency support to critical providers. That does not mean handing out money willy-nilly. Any use of the power will be subject to the usual scrutiny and safeguards around the use of public funds, as set out in Treasury guidance on Managing Public Money and Accounting Officer Assessments.

There is a fundamental problem with the proposition that the noble Baroness has advanced. The amendment refers to “day-to-day operations” but there is no single accepted definition of that term. Any company could find itself excluded from receiving critical funding depending on how its accounts and finances are structured. For example, there are potential scenarios where the Government could ask providers to carry out activities at pace which may involve them in creating unavoidable debts, for which they would need reimbursement. In that situation there would be nothing improper in any government funding being used to repay that debt, but even if there were no such debts involved, the problem remains that any private company would be prevented paying dividends, as it would be logically impossible to disassociate the long-term effects of the assistance from the ability of the company to pay such dividends. I understand the concerns of the noble Baroness about unscrupulous people and fraud, but the amendment as worded is not well conceived.

Turning to Amendments 146 and 147, again, nobody can be comfortable with the idea of rogue investors or unscrupulous care providers. However, I made clear in Committee that the Government are committed to ensuring that we have a sustainable care market. We have already set out a number of planned actions, most notably in the People at the Heart of Care: Adult Social Care Reform White Paper, to achieve this objective. Noble Lords are aware that the adult social care sector is complex, as it contains both the public and the private sector. One thing that the two sectors have in common is the need to maintain not only quality of care but financial stability. To ensure that these businesses provide the care that they are required to, local government and regulators, such as the Care Quality Commission, monitor, regulate and support the sector.

As I mentioned in Committee, the CQC has market oversight responsibility, and in discharging those responsibilities, it performs comprehensive financial sustainability analysis for each provider in the scheme, including some private equity ownership structures. Debt leverage and capital structure are important components of this work, but consideration is also given to current and future trading trajectories, cash headroom and market positioning.

We also have in place the CQC-operated market oversight scheme, which monitors the financial health of the largest and most difficult-to-replace providers in the adult social care sector, ensuring that people’s care is not interrupted due to provider failure, which must be a proper concern. Since its establishment in 2015, there have been no major business failures of care providers that have resulted in the cessation of care.

We have always been clear that fraud is unacceptable. We are acting against those abusing the system; 150,000 ineligible claims have been blocked on the Covid-19 schemes, and £500 million was recovered last year. The HMRC tax protection task force is expected to recover an additional £1 billion of taxpayers’ money. Therefore, even if cash is diverted fraudulently, there is still the ability of the authorities to recover such cash.

I assure the noble Baroness that the Government will continue to keep the measures which I have outlined under review but, at present, we do not believe that the proposed and very prescriptive amendments are either proportionate or necessary. I hope she feels that she can come back to this matter at a future date. With that, I am clear that these amendments should not be accepted.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank all noble Lords who have taken part in this debate, and the Minister for his typically comprehensive response. It is interesting that the Minister very much focused on the issue of fraud and fraudulent transactions. I go back to the words of the noble Lord, Lord Howarth of Newport, who referred to what is happening as “legalised theft”. None of these amendments seeks to deal with things that are illegal; they seek to deal with things that are now an established part of our financialised, privatised system, which has all this simply built in.

I thank the noble Baroness, Lady Brinton, particularly, who provided a pre-answer in advance of the Minister’s response to Amendment 145, by saying that it was very difficult to separate out day-to-day operations and debts versus financialised debts. In demonstrating what the Charity Commission has done, the noble Baroness showed an effective example of how that can be done and different kinds of debt can be identified. The Minister said that you might need to create some special new financial structure to deal with an emergency situation. I think we know the practical reality of the financial-type structures that we are talking about, and that they are not created under those sorts of situations; they are created in a way to hide where the money is going—to ship the money offshore. That is not something that you would do in a situation where you are simply trying to rescue something.

The point made by the noble Baroness, Lady Tyler, about the inherent instability really brings home the point that what we are talking here, with regard to care homes, is people’s homes. I am glad to see that the noble Lord, Lord Kamall, is in his place, because in another discussion I raised with him the fact that people who are forcibly moved when homes are closed can actually die as a result of it happening. I hope he has made himself more aware of that situation and the risk it presents to people’s lives.

The noble Baroness, Lady Tyler, focused on some of the difficulties that the National Audit Office has had in scrutinising this whole situation. She highlighted the facts that I was talking about—how, when the National Audit Office is able to scrutinise situations, all we get is complaint. The noble Baroness highlighted how it is not even able to conduct scrutiny in this sector because of the kind of financialised structures that we have.

I am pleased that the Minister finished by noting that I am likely to come back—he perhaps even invited me to come back on these issues. It is something that I certainly intend to do. These are very complex areas, as I acknowledge, and this is an attempt to take on some extremely well-funded organisations and professional groups. Just to conclude, it is interesting that the noble Lord, Lord Howarth of Newport, as I did, contrasted the Russian kleptocrats we will talk about on Wednesday versus what we are talking about here. Of course, it is possible that they are not two groups and there might be some overlap. I invite any investigative journalists listening to have a look at whether we might be able to see an overlap there.

At the moment, it is my intention to withdraw the amendment, but I do not regard this issue as in any way dealt with or finalised. I beg leave to withdraw the amendment.

Amendment 145 withdrawn.

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[Baroness Bennett of Manor Castle (GP)]

My Lords, I wish to briefly reinforce a point made by the noble Lord, Lord Krebs, backed up by the noble Baroness, Lady Boycott, about how so much food is advertised as being healthy when it is clearly nothing of the sort. I want to pick up the point made by the noble Lord, Lord Moylan. I will not advertise any further a particular brand of allegedly healthy food for athletes, but these foods are presented as though they are consumed by people who have just done extraordinary physical efforts—as exemplified in your Lordships’ House by the noble Lord, Lord Bethell, who, I can attest, I saw at the APPG for Running, looking like he was appropriately involved in the acts that he was supporting. However, more than half the calories consumed in the UK are in ultra-processed foods. That figure rises to 65% for children and teenagers. We need action urgently. This is a health crisis; it is an epidemic.

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[Baroness Finlay of Llandaff (CB)]

My Lords, the hour is late and I shall be brief. The findings of the systematic review of the subject need to be taken into consideration. Screening of over 3,000 papers resulted in careful analysis of 254—quite a large number for a systemic review. Going through this, there are overall benefits. The benefits outweigh any documented harms, and I welcome the clause.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I am also aware of the hour, and offer Green support for the amendment of the noble Baroness, Lady McIntosh. We are talking here about a cost-benefit analysis. Some of the costs on which I would focus, and their impacts, go beyond the narrowly medical impacts of the people who consume the water. The question I raised in Committee was whether people today actually consume tap water, and whether they will continue to do so. I made the point that 90% of people drank tap water in 1978, but that figure had fallen to 73% by 1998. I do not believe that there have been detailed national figures since then.

I thank the noble Lord, Lord Kamall, for writing to me in response to that debate and providing a set of figures which the Government had researched. I will note two of the figures which the Minister cited in that letter. One was a 2010 Ipsos MORI survey in the West Midlands showing that two-thirds of surveyed people supported water fluoridation if it was going to improve dental health. That, of course, shows that a third of people are not supporting it. This is the group about which I am concerned—a group which I have encountered many times and in many parts of the country. I do not agree with all their concerns, but that is a fact.

I noted that the Minister also cited a north-east survey from 2021 where 60% of people backed water fluoridation. As the noble Baroness, Lady McIntosh of Pickering, said, we are talking about people not having a choice about consuming that water, unless they choose to buy bottled water. Anyone going to a supermarket in Sheffield, particularly in its poorer areas, will see people buying bottled water in very large quantities. One of my concerns, and where I hope the cost-benefit analysis would come in, is looking at the sociological issues. The Government should be doing a great deal more to promote the consumption of tap water and to discourage the use of bottled water. However, as the Bill currently stands, it risks pointing us in the opposite direction.

The noble Lord, Lord Storey, talked in Committee about how Liverpool City Council had very successfully engaged in a targeted programme to address the most vulnerable communities and ensure that dental health was improved. It demonstrably was improved.

The Minister said, “Oh well, any local authority can do the same thing.” I point out to him that local authorities’ budgets are enormously overstretched—something we have addressed in the social care elements of the Bill in particular. Would the Government consider perhaps taking the money that might be spent on fluoridation and giving it to local authorities for targeted campaigns to reach the children who need it most?

[Baroness Merron (Lab)]

I thank the noble Baroness, Lady McIntosh, for moving this amendment. I feel that we have discussed these issues at considerable length at previous stages of the Bill, so I do not wish to go over old ground, other than to say that the Royal Society for Public Health, the British Dental Association, the Chief Medical Officer and many others are very much in favour of greater fluoridisation because, on balance, there is strong scientific evidence that it is an effective public health intervention. In other words, it is the single most effective way to reduce oral health inequalities and tooth decay rates, especially among children, and it is, as your Lordships’ House knows, recommended by the World Health Organization. On all these positive points, I am very much inclined to agree, and do not feel that the amendment before your Lordships’ House would be helpful to support that intervention.

Ukraine

Baroness Bennett of Manor Castle Excerpts

Thursday 24th February 2022 Lords Chamber

[Baroness Evans of Bowes Park (Con)]

Yes. In the Statement, it was quite clear that the sanctions will also be applied to Belarus for its role.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in responding to the Front-Bench questions, the noble Baroness the Leader of the House said the international community must speak as one. That is identifying it, I think rightly, as a world crisis, not just a European one, as it has sometimes been painted. I note the very powerful contribution from Kenya’s ambassador to the United Nations reflecting on his own country’s experience that the recovery from the “embers of dead empires” must be completed without creating new forms of oppression and domination. Will the UK go to the United Nations General Assembly to seek collective action under the uniting for peace procedure created by Resolution 377A, given that it is obvious that action by the Security Council would be blocked by Russia?

[Baroness Evans of Bowes Park (Con)]

The noble Baroness will be delighted to know that my noble friend hotfooted it back from the UN this morning and will no doubt be able to give more information on that in the debate tomorrow.

Health and Care Bill

Baroness Bennett of Manor Castle Excerpts

Committee stage
Friday 4th February 2022 Lords Chamber

Moved by

[Baroness Bennett of Manor Castle (GP)]

237: Clause 141, page 119, line 17, at end insert—
“(c) after subsection (2) insert—“(3) No financial assistance provided under this section may be used for the purposes of—(a) repaying debt;(b) paying interest on debt;(c) making distributions to shareholders.””Member’s explanatory statement
This amendment ensures that financial assistance given by the Secretary of State is not distributed to shareholders or used to repay debt obligations.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I will also speak to Amendments 238 and 239 in my name. Predatory and rent-seeking financial practices by investment firms and hedge funds, which are often based in tax havens and have extremely complex ownership structures, have placed unmanageable financial and human costs on the UK care sector. I first learned about this issue in 2016 from the brilliant Centre for Research on Socio-Cultural Change, which was then based in Manchester but is sadly no longer extant. Since then, the issue has become a staple on the pages of the Financial Times. If any noble Lord does not know about this issue, I urge them to look up “UK social care” on ft.com. They will see there a long string of stories from a publication that does not generally represent my side of politics saying how much of a problem this is.

I also note that, last week, the noble Lord, Lord Sikka, not currently in his place, initiated an Oral Question that highlighted some of the worst abuses in financialised care homes, from HC-One siphoning off 20% of its revenues to offshore affiliates through intra-group transactions to—as was highlighted by the noble Baroness, Lady Brinton, who may raise this again later—the industry average of 16% of the money going not to care but to the financial sector. The crisis is here and was further highlighted by the recent “Panorama” report.

What is lacking, however, and I have been looking for them since 2016, is solutions. How do we change this situation? It is worth pointing out that this is not how things have always been. Back in the 1980s, the NHS was generally known as a world leader for geriatric care, as it was then known, picking up half of the care sector for older people. In 1982, there were only 44,000 private care home beds. By 1994, there were 164,000. The number of charity, non-profit, local authority beds plummeted and the private sector came in or displaced the public.

The amendments to the Health and Care Bill that I am presenting today rely on the work of the All-Party Parliamentary Group on Limits to Growth. Its excellent report covers these issues in much more detail than I have time to do today and I urge noble Lords to look at it. The group worked on and produced these amendments.

Amendment 237 takes what I think could be a deeply dangerous element of the Government’s Bill, which has received little attention thus far. It is the provision allowing for government support of private care facilities. This is not possible now. Amendment 237 would add the provision that these funds cannot be used to make payments on debt obligations for for-profit bodies or in distributions to shareholders—huge payouts that were highlighted in last week’s debate.

However, that takes us further, and it is interesting that the government amendment—I suspect unintentionally—actually gives us a way forward to start to unwind the privatisation, as there is a potential problem. We have already seen two major private care home crashes: Southern Cross in 2011 and Four Seasons Health Care in 2019. When—I will not say if—more crash, how do we start to move towards worker co-operatives, social enterprises, local authority homes and charity-run homes? How do we ensure that people can stay in those homes safely and be cared for, and not see the money siphoned off into offshore tax havens? We can use Clause 141 with this amendment for potentially very positive, even revolutionary, purposes.

Amendment 238 picks up a point that I often make that a foundation for tackling our out-of-control financial sector and ensuring that fair taxes are paid by companies is country-by-country reporting. The amendment requires any related companies within the same corporate group that are registered offshore to be under the same financial reporting and publication requirements as those bodies registered in the UK. That means that expenditure on dividends, directors’ fees, interest payment and similar would have to be fully and transparently declared. I have to ask the Minister: what does he have against transparency in the financial sector? What could the Government possibly have against seeing exactly where the money goes—whether it is the money of older, vulnerable people in our society or the state money that is supporting them? That is all that this amendment does; it demands that transparency.

These two amendments are not a total solution—I do not have a panacea for the situation—but they are a start, and that is why they combine with the third amendment in this group, Amendment 239, which calls for a review. It is a very simple, obvious amendment of a type often seen in your Lordships’ House. I note that I am joining the former Conservative Health Secretary Jeremy Hunt, who also recently called for a review of the funding. We see some unusual alliances in this House; this is an unusual alliance between the two Houses.

As we all know and has just been highlighted, the many hours of this debate have focused on what a mess the care sector is. These are the most vulnerable members in our society, and a significant part of that mess is because money is being siphoned away from their care. We can use the Bill, with these three modest amendments, to start to turn around that situation. I beg to move.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite her to speak.

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I am afraid I cannot provide the noble Baroness, Lady Bennett, with any comfort on these amendments. However, I hope I have been of some help to her and the Committee in explaining the Government’s position and what we are doing to address some of the important priorities associated with the adult social care agenda.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank the Minister for his courteous and comprehensive response, which was very useful. I very much thank all noble Lords who took part in this debate, which was a powerful exploration of the issues.

The noble Baroness, Lady Brinton, talked about assets being milked. If we think about what we are actually talking about here—some of our most vulnerable citizens—and what is happening to them, that is a really crucial point. The noble Baroness, Lady Tyler, talked about a stunning figure: £40,000 of debt per bed. If you think of that physically, visually, that is just unsustainable—a word the Minister himself used.

I particularly thank the noble Baroness, Lady Altmann; I hope the Government will listen to their noble friend. She made a comparison with the insurance sector and stressed that this is about people’s most basic security. These care homes—people’s homes—being ladened with debt in the circumstances we are talking about is supremely insecure.

I thank the noble Lord, Lord Blunkett, for raising the plight of workers. These are people who, both through the pandemic and just in their everyday lives, have gone above and beyond the call of duty to care for people. They do really difficult jobs paid at the absolute base level.

I actually take some comfort from the Minister’s response. I take his point about how Amendment 237 is worded on debt. It is meant to address the kind of debt held in hedge funds, not debt to the local linen washing service or something, and I will think about how that might be addressed in different terms.

I pick up what the Minister said about dividends. I suggest that, should a care home chain be rescued by the Government in a state of great financial crisis, it should pay that rescue money back before it pays out any dividends. The Minister talked about the use of public funds, and I could almost feel the House restraining itself, since we are in constructive Committee form, from giving any reaction at that point. If the Government wish to avoid future scandals, the transparency offered by these amendments or something like them would be an ideal way for them to do that.

We were discussing yesterday in Grand Committee the Registration of Overseas Entities Bill—how long it has taken, how much we have been waiting for it and how crucial it is. This is picking one sector, producing a trial run to see how it works and taking it forward immediately in an emergency situation where we cannot wait many years for change.

This has been a very useful debate. I note the expressions of support from all sides of the House, and I reserve the right to take this issue forward on Report. In the meantime, I beg leave to withdraw the amendment.

Amendment 237 withdrawn.

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[Baroness Stowell of Beeston (Con)]

I will be very brief. I declare my chairmanship of the Communications and Digital Committee. A lot of powerful speeches have been made all around the House today and clearly, we are all united in our care and concern for the issue of child obesity. The complexity of what is proposed in this legislation has been illustrated to such an extent that there is a case for delaying implementing these measures so that it is got right.

But the main reason for my decision to speak in this debate is the issue of fairness, equal treatment and the difference in the way these regulations apply to broadcasters and to the online platforms. The noble Viscount, Lord Colville, and my noble friend Lord Black of Brentwood have already spoken in some detail about the inequality of treatment between broadcasters and news publishers, and the online platforms.

I spell out clearly that what we are talking about here is that responsibility for the control and compliance of advertising that appears on television or radio rests with broadcasters, which can be sanctioned severely with huge fines by regulators if they allow anything that is non-compliant to air. But responsibility does not rest with the online platforms, which take far more in profit from the advertising they publish on their sites than any broadcaster is able to. They are equally able to control what appears on their platforms, as the noble Viscount powerfully described. Could my noble friend the Minister therefore explain why the Government are not ensuring parity between broadcasters and the likes of Google and Facebook at the point of legislation, to ensure parity in the way this will be applied?

Also under the heading of fairness, I say that, in the case of the small manufacturers of the products affected by the advertising ban, I support the amendment tabled by the noble Lord, Lord Clement-Jones, which ensures that the definition of “SME” in the Bill does not provide a loophole exempting large international manufacturers from these advertising restrictions just because they have a small workforce in this country.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I feel the need to balance the sides of this debate. I attached my name to Amendment 244 in the name of the noble Baroness, Lady Finlay. I associate myself with everything said by her and the noble Baroness, Lady Boycott, in particular, as well as the noble Lord, Lord Krebs, who gave powerful and well-evidenced presentations of why we need to see action here. Given the time and the fact that I have a train to catch, I will be brief.

The noble Lords, Lord Black and Lord Moylan, talked about freedom of speech—the freedom of the advertisers to push on to children whatever they want to push. I put against that the freedom to flourish and live a healthy life with a decent lifespan. The figures quoted by the noble Lord, Lord Stevens, illustrated that that is not being achieved and there is a deep inequality in our society.

The noble Lord, Lord Lansley, talked about how difficult it would be to measure or separate out the impact of these measures. We are in a hugely obesogenic environment. We have this huge problem with obesity not because human nature has suddenly changed and people have lost self-control, but because they are bombarded and barraged from all sides with ultra-processed pap, which we should stop all advertising of. I do not think that “High in fat, sugar and salt” goes far enough. There is evidence that under-11s—primary school kids—cannot distinguish between adverts and editorial content, so we have to protect them.

Finally, the noble Lord, Lord Black, asked about the international comparisons. Perhaps one of the most obvious ones is Norway, which brought in a ban somewhat similar to this in 2012. It has struggled for the reasons outlined by many noble Lords. Indeed, a study was produced by Oslo Metropolitan University last year, using the categorisation of the WHO European Office for Prevention and Control of Noncommunicable Diseases. Eight out of 10 adverts that young people in Norway were seeing online were for unhealthy food. That is a problem, but it is an argument not for doing nothing but for tackling the whole obesogenic environment that our young people are growing up in, with demonstrable effects. Norway, which has taken similar action to that which we are talking about today, as have Spain, Portugal, Slovenia, Latvia and Lithuania—that is just a shortlist—has half the level of childhood obesity that we do, and it regards it as a serious problem.

Ukraine

Baroness Bennett of Manor Castle Excerpts

Wednesday 26th January 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, in responding to the Front-Benchers, the noble Baroness the Leader of the House said, regarding dirty money, “I accept there is more to do”. She may be aware of the report yesterday from the Center for American Progress, a think tank known for being close to the Biden Administration, suggesting what to do if Russia invades. In its recommendations, it mentions, at paragraph 1.2, the formation of a

“U.S.-U.K. counter-kleptocracy working group.”

It explains this by saying that the US should propose the working group

“in part to prod stronger action from the U.K. government.”

Will the UK Government be waiting for that prod, or will they take stronger action immediately, not in the long-term future?

[Baroness Evans of Bowes Park (Con)]

In answer to questions at the beginning, I set out a whole range of things that we have done, and are doing, to tackle money-laundering and economic crime. We will continue with that work.

Health and Care Bill

Baroness Bennett of Manor Castle Excerpts

Lords Hansard - Part 2 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Pitkeathley (Lab)]

I want to follow the noble Lord, Lord Sharkey, because I am former chair of the Specialised Healthcare Alliance. I shall speak very briefly in support of Amendments 164 and 178 in his name and that of my noble friend Lady Wheeler.

Every reorganisation of the NHS leaves patients who have a rare or less common condition anxious about how their particular needs will be assessed, how they will be met and even how they will be noted. It is sadly true that the rarer or more specialised a condition, the more it comes down to a postcode lottery whether the patient will be able to access care in spite of established national standards. Not only is it harder to access care, it is also harder for these patients to access the support groups or information networks which are vital when finding out the sometimes rare information about these conditions. The suggestion in Amendment 164 that the CQC assess the provision by ICBs of care for those with rare or less common conditions would provide the assurance that is so badly need.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in part because I listened to the lecture with which we started this session but more because it is an old anecdote, I shall forbear from telling my hospital food horror story. However, I will pick up on the points made by the noble Lord, Lord Hunt, and the noble Baroness, Lady Barker, about hospital food and how hard people are trying to improve the situation. This relates to the answer the Minister gave me on Monday in Oral Questions. Of course, it is dependent on the budget that caterers have and the quality of the food that is available to them. I was pleased that the Minister then said that the Government are looking to tackle government procurement to improve the quality of vegetables and fruit. In terms of joining up the dots, that is a useful point to make.

On Amendment 243, I offer the Green group’s support and note that, having been in your Lordships’ House for only a little more than two years, I have debated a very similar amendment at least once before—I think it must have been on the Medicines and Medical Devices Bill. We have all seen briefings that are very much a cry from the heart from the nursing profession for this to happen. Surely we can get this into this Bill.

Health and Care Bill

Baroness Bennett of Manor Castle Excerpts

Lords Hansard - Part 2 & Committee stage
Tuesday 18th January 2022 Lords Chamber

Moved by

[Baroness Bennett of Manor Castle]

46: Clause 16, page 13, line 28, leave out “it” and insert “the Secretary of State”
Member’s explanatory statement
This amendment, with the new Clauses before Clause 35 in the name of Baroness Bennett of Manor Castle, restores the duty on the Secretary of State to provide or secure the provision of services to that in the National Health Service Act 2006.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in moving Amendment 46, I will speak also to Amendments 168 and 169 in my name. In an earlier group this morning we were talking about democratic accountability at the local or ICB level, particularly in relation to Amendment 23 from the noble Baroness, Lady Thornton. We were also, through the agency of Amendment 45 from the noble Lord, Lord Davies of Brixton, looking at the risk that people in England could be left without NHS cover. Those amendments were about the ways in which this Bill could go horribly wrong—certainly, I have no doubt, in terms of what the public want, if not necessarily in the unintended consequences of where the Health Secretary and the Chancellor are apparently thinking of taking our NHS.

A couple of hours ago, the noble Lord, Lord Hunt of Kings Heath, talked about how the Government are centralising power, with ICBs having to look upwards to the hierarchies above them. He used the phrase that they will be “beaten up by the centre”. As he was saying that, I was struck that a briefing arrived in my inbox at that moment from the NHS Confederation, NHS Providers and the King’s Fund, which very much focused on that concern about the Secretary of State’s power to direct. It is clear that the Bill will give the Secretary of State enormous power potentially to interfere in the most minute aspects of healthcare locally. That concerns a great many people. I think it is already clear that your Lordships’ House will keep talking about this and, very likely, try to change it in future, but we know we are unlikely to be able to entirely transform this Bill and the relationships between the centre and the local.

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[Earl Howe (Con)]

My Lords, as I was about to say, the 2012 Act does provide for the ability of the Secretary of State to intervene when that is necessary for the smooth and effective running of the system. Furthermore, we should not exaggerate the extent to which this Bill modifies the 2012 provisions. As the noble Lord said, we will debate the powers of direction on a future occasion but, when we come to do so, my colleagues and I on the Government Benches will contend that the powers of direction, such as they are, are very narrow and specific in their scope. They have been deliberately framed in that way to reflect experience over recent years. I would not be in favour of reopening this piece of drafting, given its history and the effort that noble Lords from all sides of the House made to build an effective consensus in respect of the 2012 Act.

The noble Baroness, Lady Brinton, asked about dental access. The department is working closely with NHS England to increase levels of service as quickly as possible. Practices are continuing to prioritise patients based on clinical need. Dental practices are now being asked by NHS England and NHS Improvement to deliver at least 85% of contracted units of dental activity—UDAs—between January and March 2022 to provide improved access for patients. These updated figures are based on what many practices have been able to deliver to date. They take into account adherence to the latest infection prevention and control guidance. I hope that this is helpful to the noble Baroness.

I hope also that I have explained to the noble Baroness, Lady Bennett, why I cannot entertain her amendments, but also that I have reassured her that the accountability chain between health services, Ministers and Parliament, which lies at the centre of her concerns, remains intact.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank the Minister for his response and thank all noble Lords who have taken part in this debate. I particularly thank the noble Baroness, Lady Brinton, for her support. She stressed how this is very much about restoring a public health system with full public accountability.

I was a little surprised, not so much by the direction as by the emphatic nature of the comments from the noble Baroness, Lady Wheeler, given that it was members of her party who moved the amendments in the other place. To address the Minister’s comments—this also picks up the point raised by the noble Lord, Lord Hunt—we are talking about a significant change in relation to power of direction; a power that we will be discussing further, at great length, and about which we have seen considerable expressions of concern. I come back to the way I framed my speech: if you have more powers, you have more responsibility. If you say, “We covered all this in the 2012 Act—it’s all fine”, once could argue that the 2012 Act did not work out fine, but we are in a new situation, creating very new structures.

Thinking about the success or otherwise of accountability, some issues where we have failed in terms of accountability—and we will see amendments on these later—are workforce planning and, as the noble Baroness, Lady Brinton, highlighted, dental provision.

This is about ensuring that people have faith, know who to look to and cannot be fobbed off, as the noble Baroness, Lady Brinton, said, by this terrible, complex diversity of funding and arrangement structures. Like other Members of your Lordships’ House, I took part in the public debate in 2012, not in this place but in the public domain, and I have given many speeches on this issue. The complexity must not be allowed to cover over the fact that what people want to know is that the healthcare is there when they need it, and if it is not that they know who to point to.

I will of course withdraw the amendment at this point, but I reserve the right to consider this and come back to it at a future point.

Amendment 46 withdrawn.

Health and Care Bill

Baroness Bennett of Manor Castle Excerpts

Lords Hansard - Part 2 & Committee stage
Tuesday 11th January 2022 Lords Chamber

[Lord Bethell (Con)]

My Lords, I want to say a brief word in support of the amendment on innovation in the name of the noble Baroness, Lady Thornton.

Having just been the Minister for Innovation, I can tell noble Lords that they could fill their entire diary travelling the country and seeing fantastic innovation in the NHS up and down the country. Noble Lords could fill their Zoom calls speaking to countries around the world that look to the NHS for some of the best innovation and partner with it on innovative programmes. However, that innovation is often extremely isolated and rarely spread evenly across the whole country. In fact, I often thought that my job title should have been not Minister for Innovation but Minister for Adoption because my role should have been to take the best that the NHS does and spread it across the country more evenly. That is the objective of the Government’s health policy at the moment: to see a much more even spread of best practice right across the country.

Although we cannot legislate for culture, we can give signals to the system about what we think is important. I therefore think that the noble Baroness, Lady Thornton, is on to something in suggesting this amendment. It should be given careful thought by the Minister.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise to offer Green support for all the amendments in this group. I will split them into two groups internally. First, I will speak to Amendments 6, 19, 60 and 215; I will then deal with Amendment 21 in the name of the noble Lord, Lord Davies, separately.

All these amendments are about transparency and targets. When we look back to when targets were a particular focus—when the NHS was under the control of the party on these Benches—there were concerns that targets could sway provision and medical judgments. There was a concern that this was about the management of targets rather than the outcome for the patient. However, if we think of targets as foundations and basic standards that need to be met, it is really important that we ensure that there is enough funding for local priorities and concerns to be addressed to reach a higher level.

Amendment 215, which refers to an annual report, is particularly interesting; I know that it has full cross-party support. This is about people knowing what the NHS is achieving and, importantly, whether there is enough provision in it. Of course, your Lordships’ House is not in a position to demand that more money goes into the NHS; by constitutional norms, we cannot deal with spending. However, I think that we should frame this debate—this is my first contribution in Committee—by looking at the pre-Covid figures. The UK was spending £2,989 per person on healthcare; this was the second-lowest in the G7. France was spending £3,737; Germany, £4,432.

Of course, the great outlier in this is the US, spending £7,736 a year. It is worth noting that we seem to be chasing so much after the US healthcare model, which is so absolutely disastrous. Most of the amendments in this group are a way for your Lordships’ House to give the public the tools to say that we need to improve the resources of our NHS.

Covid-19

Baroness Bennett of Manor Castle Excerpts

Thursday 6th January 2022 Lords Chamber

[Lord Walney (CB)]

My Lords—

[Baroness Bennett of Manor Castle (GP)]

My Lords—

[Lord Ashton of Hyde (Con)]

My Lords, we have not had anyone from the non-affiliated Benches yet.

--- Later in debate ---

[Baroness Evans of Bowes Park (Con)]

The noble Lord is absolutely right, which is why a huge amount of work around NHS reform is going on in government. The integrated care White Paper and other things will be coming down the line.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Minister addressed ventilation and air filtration in schools but the noble Baroness, Lady Smith of Basildon, asked about stepping the issue up more broadly. In her response, the Minister said that antiviral drugs were the key to the next stage of dealing with the pandemic, but surely we need to get beyond treating infected people. As a ballpark figure, air sanitation provides a 70% reduction in the transmission of disease. This is a long-term, systematic solution that should be implemented not just in schools but everywhere, particularly in public buildings. Should we not be getting ahead of the viruses rather than continually chasing after them?

[Baroness Evans of Bowes Park (Con)]

I agree with the noble Baroness’s last point but I think that she miscategorised me slightly. I did not say that antivirals were the only answer; I said that they are one part of a suite of things that we need to be doing, from ventilation through to hygiene and cleanliness. There is a whole range of things that we will need to do, but she is absolutely right: we need to understand how we can live with Covid and not continually chase our tails, because we can see the damage that it causes.

House of Lords: Governance

Baroness Bennett of Manor Castle Excerpts

Wednesday 8th December 2021 Grand Committee

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Lord, Lord Wei. I very much agree with his desire to get greater public involvement in, understanding of and engagement with the operation of your Lordships’ House.

Today, we have the rare luxury of a seven-minute speaking slot, despite the subject, the operation of your Lordships’ House, being what some might dismiss uncharitably as navel-gazing—this being, as we are always told, the unelected House, limited in power and so unable to block the Government doing things, even when we know they are wrong. That is, of course, two minutes longer than we had yesterday to speak on the enormous changes to our NHS proposed in the Health and Care Bill.

I begin by apologising to the noble Lord, Lord Davies of Brixton, and doing some violence to his division of governance, management and administration, by simply classifying three things into those groups. First, if we look at administration as being about the fabric of this place, we see that there are clearly issues. I am not terribly interested in them, because I think this place should be turned into what it clearly is—a museum—and we could get a new, modern, functional institution; Birmingham would be the obvious place.

On management, if we think about staff, I agree with the noble Lord, Lord Strathclyde, and say how wonderful I have found the staff in the Bill Office, the Table Office, the Library—I do not want to miss anyone out here—and the canteen, and the doorkeepers. So many staff are absolutely brilliant. Like the noble Lord, Lord Davies, I want to think about the unions, and I worry about how some of the staff are treated sometimes; I hope that the unions stand up for them.

That brings me to the third category, which is governance. I will focus on what are generally referred to as the usual channels, on which there was a short paragraph or two in the Library briefing. Given that we have quite some time, I thought I would step back and take a very long view that reflects my current reading: David Graeber and David Wengrow’s The Dawn of Everything: A New History of Humanity. It focuses particularly on the Palaeolithic and the Neolithic, with a reminder that people tens of thousands of years ago were just as intelligent and creative as we are today—they were biologically identical—and arguably more so, given that they did not have the foundation of the centuries of development on which we build. I do not fully have time to explore this fascinating issue—I definitely recommend a read—but the point I want to draw from it for our subject is that humans have created many different ways of getting together and making decisions. The authors, and many modern archaeologists, posit that we do not require hierarchical, rigid structures, or monarchs or aristocrats, to operate societies, just people gathering together and deciding new ways of doing things.

It is interesting that many have referred to your Lordships’ House being self-governing. That might, at least in theory, be what you would describe as an anarchist collective. In that frame, I will explore some possibilities for governance of your Lordships’ House, particularly regarding what is done by the usual channels. It struck me that we have structures very like those with which many nations and groups are now successfully experimenting: citizen’s or people’s assemblies—representative groups that seek to arrive at consensus decision-making, as has been done in the UK and France with the climate assemblies, in Ireland on the difficult issues of abortion and equal marriage, and in some local contexts in the UK, some organised by the Government. These are forms of deliberative democracy. They sound a little like the townhall meetings that the Senior Deputy Speaker proposed. I suggest that these are structures rather like our Select Committees: groups that hear expert evidence, carefully weigh and examine it, and arrive at conclusions.

The way that the usual channels make decisions is utterly opaque and utterly unknown, as many noble Lords pointed out. What if it was replaced with a representative committee that operated openly and made decisions based on evidence and testimony expressed as the will of the House? I have previously raised issues about Select Committees, notably the fact that membership is decided on the basis of allocation by four groups, effectively excluding a large and increasing part of the House’s membership. But they are broadly representative —far more so than the usual channels—and from everything I hear, not having had the opportunity to participate myself, they operate in a broadly collegiate and constructive way. My suggestion is that that is how we reorganise the decisions made by the usual channels.

I started by saying that some might view all this as navel-gazing, but the fact is that what happens in your Lordships’ House is astonishingly important in our current circumstances; we are far more representative of the country than the elected other place, where 44% of the votes in 2019 got Boris Johnson 100% of the power. Looking at the fact that our Cross Benches have the balance of power in your Lordships’ House, they are quite a representative group, a little like a citizen’s assembly or perhaps the kind of structures the noble Lord, Lord Wei, suggested.

I have looked at the big scale, but I want to pick up on a couple of small and immediate points. The first is the disappointment that I know is shared by many Peers about our return to a free-for-all at Oral Questions; here I disagree with the noble Lord, Lord Taylor of Holbeach. We know that there is a gender discrimination aspect to that, although that is not the only discrimination. It benefits the loud, the pushy and the experienced—and yes, I know which of those categories I might belong in.

The second point I wish to raise specifically is about the current deeply uncertain situation concerning Covid-19—indeed, I believe announcements are being made as I speak. Media reports suggest that the Government are about to announce a work from home directive. I do not expect the Senior Deputy Speaker to comment on that, or indeed on the procedures of the House right at this moment, but I very strongly propose that we should hear tomorrow about what will happen in your Lordships’ House in light of the Covid situation. I expect that we will see significant changes. On this point, I will finish by coming back to and reflecting on the unsuitability of the fabric of this place. I really hate to think what a carbon dioxide monitor would show in this Room at this moment because I do not think that it is anything resembling Covid-secure.

COP 26

Baroness Bennett of Manor Castle Excerpts

Tuesday 16th November 2021 Lords Chamber

[Baroness Evans of Bowes Park (Con)]

I thank my noble friend. The UK presidency marked Ocean Action Day at COP, championing a call for action to protect and restore ocean health and resilience. For instance, more than 100 countries have now signed up to protect at least 30% of the global ocean by 2030. My noble friend Lord Goldsmith is obviously very heavily involved in this work and will continue to lead international action in this area.

[Baroness Bennett of Manor Castle (GP)]

My Lords, like the noble Lord, Lord Newby, I was surprised that the Prime Minister rather bravely referred to Aristotelian virtue in the Statement. Four essential characteristics of virtue, according to Aristotle, are prudence, temperance, courage and justice. There is no provision in the Glasgow agreement for loss and damage payments—reparations for the fact that the global south is already suffering deadly horrendous damage because of the emissions of the global north. The Statement says that Alok Sharma will push countries to go further. Will the UK lead in putting in funds for loss and damage, as Scotland has already done, reflecting the fact that the most vulnerable nations made it very clear at COP that they expect this to be fully sorted out at Sharm el-Sheikh?

[Baroness Evans of Bowes Park (Con)]

I am surprised that the noble Baroness did not realise that this was, in fact, the first COP decision that included a position on loss and damage, which is a recognition of how seriously developed countries are taking their obligations. The Glasgow dialogue was launched better to co-ordinate financial support for extreme impacts, and it agreed that there would be a dialogue between parties, relevant organisations and stakeholders to discuss the arrangements for funding activities to avert, minimise and address loss and damage. We also established the functions of the Santiago network, which will provide technical assistance to developing countries to address loss and damage. So progress was most certainly made.

--- Later in debate ---

[Baroness Evans of Bowes Park (Con)]

I completely agree with the noble Viscount. That is why we were so pleased, for instance, with the 140 leaders representing over 90% of the world’s forests pledging to halt and reverse forest loss by 2030. We also had 45 nations pledge action and investment to protect nature and to shift to more sustainable ways of farming and, as I mentioned earlier, there was action on the global ocean. The noble Viscount is absolutely right, and that is why we put this front and centre and included it in COP in a way that had not happened before. My colleague, my noble friend Lord Goldsmith, is leading this: he is passionate about it and will continue to talk to global colleagues in order to keep this agenda going forward.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Statement says that we have seen countries that really should know better dragging their heels on their Paris commitments. The Minister will be aware that the Beyond Oil & Gas Alliance has launched, led by Denmark and Costa Rica and also involving the states of California and Quebec. Given that we are committed to 1.5 and one of the commitments of the Beyond Oil & Gas Alliance is 1.5, meeting Paris commitments, are we not dragging our heels by not signing up to this alliance?

[Baroness Evans of Bowes Park (Con)]

No. We have been central to action in this area. For instance, we were central to setting up the Powering Past Coal Alliance which now has 165 members, including national and subnational Governments, businesses and organisations. We will obviously continue to look at this area but we are certainly leading the way. In fact, the transition is already under way. In OECD countries, the share of coal in power generation has fallen from a peak of 40% in 1990 to a low of 23% in 2019. As we have said, although perhaps we had watered-down language, as we have all accepted, the end of coal is in sight, and that is what we want to continue to work to.