Baroness Brinton debates involving the Leader of the House during the 2019 Parliament

Wed 16th Mar 2022
Health and Care Bill
Lords Chamber

Lords Hansard _ Part 1
Mon 7th Mar 2022
Health and Care Bill
Lords Chamber

Lords Hansard - Part 2
Wed 26th Jan 2022
Health and Care Bill
Lords Chamber

Lords Hansard - Part 2
Thu 20th Jan 2022
Tue 18th Jan 2022
Health and Care Bill
Lords Chamber

Lords Hansard - Part 2 & Lords Hansard - Part 2
Tue 16th Nov 2021
Lord Geddes Portrait The Deputy Speaker (Lord Geddes) (Con)
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My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, I speak from these Benches to support both amendments in this group. The noble Lord, Lord Hunt, introduced his Amendment 164 on vaccine damage payments, explaining that the current law as set out in the Vaccine Damage Payments Act 1979 is now over 40 years old. The amendment asks for a judge-led review on what parts of the Act need to be updated, especially the maximum payable as a result of vaccine damage.

The amendment proposes a small and focused review that will assist those who have been damaged by vaccines and will help the NHS, Government and Parliament ensure that the legislation is fit for purpose in the 21st century, especially for the families of those damaged by the Covid vaccine and of the very few who died. They may be an infinitesimally small percentage of those who have been vaccinated but their lives have been turned upside down because of doing the right thing.

Amendment 180 in the name of the noble Baroness, Lady Cumberlege, is an important pillar of delivering the recommendations from her First Do No Harm review, which outlined routes to assist those who had been harmed by an avoidable harm as a result of using certain HPTs, sodium valproate or pelvic mesh. The victims of this avoidable harm are not to blame for it either, but are living out the consequences, including needing additional care for the rest of their lives. I know that the Government have been very supportive of the First Do No Harm review. I hope that they can be persuaded that now is the time to introduce schemes that will help these people. While I fear that there may not be movement on these two amendments today, I hope that the Minister can outline when there is likely to be progress on these two financially modest but essential areas that could right some long-term wrongs.

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Baroness Henig Portrait The Deputy Speaker (Baroness Henig) (Lab)
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My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, the noble Lord, Lord Forsyth, has introduced his amendment very clearly, so I will be brief and say that I will also support him if he chooses to call a Division.

The majority of the British public support the legalisation of assisted dying. In a Populus poll of more than 5,000 people in 2019, 84% of respondents said they supported giving dying people the right to an assisted death. I am pleased that the noble Lord, Lord Forsyth, has managed to praise the Scottish Parliament system that has enabled my colleague Liam McArthur to have time for his Bill in its Parliament.

As the noble Lord, Lord Forsyth, has said, it is important to note that the amendment would not actually change the law on assisted dying. What it would do is to ensure that some proper parliamentary time is made available, as in Scotland, within 12 months of the Bill passing into law, to ensure that there can be a planned and proper debate with the wider public and with MPs and Peers that is just not possible in the Private Members’ Bill process that we have in our Parliament.

It is important to note that the amendment does not require government to support the legislation through Parliament, merely to ask for the time, and that this procedure has happened before with Section 16 of the European Union (Withdrawal) Act 2018. I hope that the Minister will change the Government’s mind on this so that the noble Lord, Lord Forsyth, does not have to call a Division.

Baroness Henig Portrait The Deputy Speaker (Baroness Henig) (Lab)
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My Lords, the noble Lord, Lord Howarth of Newport, is taking part remotely. I invite the noble Lord to speak.

Baroness Pitkeathley Portrait The Deputy Speaker (Baroness Pitkeathley) (Lab)
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My Lords, the noble Baroness, Lady Brinton, is also taking part remotely. I invite her to speak next.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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I thank the noble Baroness, Lady Bennett, for tabling these amendments, slightly amended from Committee, and in particular for responding to the Minister’s concerns that the first amendment had perhaps been too broad and would catch the day-to-day business of companies. That cannot be said about Amendment 145.

I also want to pick up a point that the noble Earl made in Committee. He said:

“A company’s working capital, by its nature, is money that is used to fund day-to-day operations in general, and one cannot associate a particular pound with a particular business activity.”—[Official Report, 4/2/22; col. 1161.]


Yet the Charity Commission does have the ability to intervene in the event that a charity, or series of charities stretches—shall we say?—those rules. Its Internal Financial Controls for Charities, CC8, provides very specific guidance. Indeed, in recent years, one charity, the Plymouth Brethren Christian Church, was investigated for a circular set of donations. Each donation to each different body was paid tax relief out of the public purse, coming back to serve the schools that the adults at the community church sent their children to. The way that was structured was similar to a financial instrument employed by the few companies that abused the funding they received from the public purse for social care.

The noble Earl also referred to the Treasury guidance Managing Public Money and Accounting Officer Assessments. I have been through that, too. It is very interesting and clear. Under the heading

“expenditure which may rely on a Supply and Appropriation Act”,

Managing Public Money lists

“routine administration costs: employment costs, rent, cleaning etc … lease agreements, eg for photocopiers, lifts”.

It does not say: “Re-charging sister/parent/daughter companies for large amounts of borrowing and the interest thereto”, which is what has been happening.

It is important that we start to debate how public funding is spent by these companies, particularly those overseas, when we cannot see how that money is spent. I also support the other amendments in the group, which ask for a review of financial regulation. It is interesting that the Treasury guidance refers constantly to the Nolan principles, which are absolutely vital in talking about transparency and responsibility when spending public money. These amendments might not be quite right to deliver that, but it would be good if there were a review under way.

The other thing we must have when these companies spend large amounts of public money is publication of their full accounts. They should not be able to hide behind very short, superficial accounts from overseas.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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My Lords, I support these amendments tabled by the noble Baroness, Lady Bennett, as I did in Committee. In essence, they are about financial practices in the social care sector that I find completely unacceptable.

The social care provider market, as we all know, is complex, fragmented and too often inherently unstable. One of the causes of instability is financially risky behaviour by a small number of large, equity-backed, highly debt-laden companies in the residential care sector. This has resulted in some high-profile sudden exits from the market, such as Southern Cross and Four Seasons. The key point is that, in the event of the closure of a care home, the provider bears no responsibility for continuity of care. That falls on the local authority, with the direct impact felt by care home residents and their families. That just cannot be right.

It is also concerning that, in its 2021 social care market report, the NAO was unable to analyse the accounts of five of the large equity-backed providers because of difficulty in accessing their accounts. Of course, the issue of the lack of transparency over accounts, profits and shareholders is exacerbated when company ownership is offshore.

As the noble Baroness, Lady Bennett, explained, Amendment 147 seeks to require local authorities and other public bodies to commission care from non-UK domiciled companies only if they publish full accounts and offer transparency over their ownership. There is an interesting international precedent for the latter part of this. Indeed, in February 2022, the Biden Administration announced a set of measures around improving quality and transparency by requiring private equity firms to disclose ownership stakes in nursing homes.

I will finish by making a couple of broad points. For a measure like this to be implemented effectively, it will clearly be essential that local authorities are equipped with sufficient complex accounting knowledge to scrutinise the ownership and financial practices of a provider. Although this amendment would help ensure transparency and enable better scrutiny of offshore entities, I am conscious that complex ownership structures are not limited to companies owned abroad. I hope the time will come when this sort of financial transparency is extended across all providers, wherever they are based.

Living with Covid-19

Baroness Brinton Excerpts
Tuesday 22nd February 2022

(4 months, 2 weeks ago)

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Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, the 3.7 million clinically extremely vulnerable people already follow government advice for them, regularly checking the daily Covid dashboard to see how many cases there are in their area. This will be even more important when others no longer have to self-isolate when they get Covid. They cannot do this when widespread testing and the daily dashboard stop. What advice would the Leader give these people on how to assess their own risk after 1 April?

Baroness Evans of Bowes Park Portrait Baroness Evans of Bowes Park (Con)
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The noble Baroness is absolutely right that throughout the crisis we have led the way on data reporting, and have ensured that data is always available to the public. UKHSA will keep the content and frequency of reporting on Covid—including the GOV.UK dashboard—under close review, to ensure that statistics are being produced of the appropriate quality and transparency, and that they remain useful and relevant in accordance with the code of practice for statistics. So we will continue to publish information.

Health and Care Bill

Baroness Brinton Excerpts
Friday 4th February 2022

(5 months ago)

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Lord McFall of Alcluith Portrait The Lord Speaker (Lord McFall of Alcluith)
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My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite her to speak.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, I support Amendments 237, 238 and 239 in the name of the noble Baroness, Lady Bennett of Manor Castle, which aim to ensure that private providers are regulated, especially those using obfuscatory financial structures, instruments with inter-company loans and large amounts of debt. They should be fully transparent about those arrangements. She was right to highlight the excellent reporting of the Financial Times on this, along with the financial editors and journalists of other papers.

The typical small business social care home owner does not fall into the category I have just described. The problem in the sector is the private equity providers who decided to start buying up care home groups because they felt that the assets could be milked to provide healthy-looking returns for them. This differs from those homes borrowing in order to, perhaps, buy new homes to enlarge their group; what is happening here is purely financial instruments to benefit the directors and investors. Typically, private equity-backed providers spend around 16% of the bed fee on complex buyout debt obligations. The accounts of Care UK show that it paid £4.1 million in rent in 2019 to Silver Sea Holdings—a company registered in low-tax Luxembourg, which is also owned by Care UK’s parent company, Bridgepoint.

These kinds of buyouts are also associated with an 18% increase in risk of bankruptcy for the target company. In the case of Four Seasons Health Care, heavy debt payments contributed to the company’s collapse into administration in 2019. Two of the other largest care home providers in the UK, HC-One and Care UK, have also undergone leveraged buyouts and, as a result, their corporate group structures remain saddled with significant debts. Some of these types of company are also struggling to provide the best possible care with their overall CQC scores—so it is affecting the lives of the most vulnerable patients.

The Office for National Statistics says that 63% of care home residents are paid for by the public purse. Surely the Government must have a duty towards the public purse. It is not acceptable for the public purse to pay for these complex financial arrangements that are intended to provide not care or capital for the growth of a care business but purely a larger return for directors and shareholders. These amendments would provide for transparency and accountability and an assurance that the public purse and the private payer are not being taken for a ride.

Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (LD)
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My Lords, I support these amendments from the noble Baroness, Lady Bennett. I thank her for putting them forward. The care sector is both complex and very little understood. Back in 2020, there were approximately 15,000 care homes in the UK, run by approximately 8,000 providers. Some were very small; others were providing very large networks of homes—it is a mixed economy. These figures are a couple of years old but, at that time, 84% of homes were run by the private sector, including by private equity firms, both British and offshore.

Funding is a complex mix of private funders, local authorities and the NHS. I was very grateful to the noble Baroness, Lady Bennett, for highlighting the work that the Financial Times has done, because I was first alerted to this issue by an investigation that the paper did back in 2019 which revealed how Britain’s four largest privately owned care home operators had racked up debts of £40,000 per bed, meaning that their annual interest charges absorbed eight weeks of average fees paid by local authorities on behalf of residents. Many have argued, and I absolutely agree, that this sort of debt-laden model, which demands an unsustainable level of return while shipping out profits of 12% to 16%, often to tax havens, is entirely inappropriate for social care.

I want to make it clear that I do not have an ideological problem with the private sector being involved in the care sector and providing care homes—provided that they are good quality—but I have a real problem with the financial models used. Most fair-minded people in this country, not least those whose loved ones are in care homes, would, frankly, be horrified if they knew how the money—either theirs, if they are self-funded residents, or indeed the money of hard-pressed local authorities—was being used and where it was being siphoned off to.

I greatly support amendments to increase transparency and reporting. Frankly, I would like to see the regulator being a lot tougher and a lot more proactive in this area, so I very much support the review in the amendment put forward by the noble Baroness.

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I hope that my noble friend will agree that those who have suffered so much through no fault of their own from harm that could and should have been avoided deserve the practical help and support that the amendment would deliver.
Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, I support the noble Baroness, Lady Cumberlege, in her Amendment 283, which would include financial and non-pecuniary interests of medical practitioners alongside clinical interests and their recognised and accredited specialisms on a register. I particularly thank her for explaining exactly why this is so important for patients. Currently, the GMC does not require them to hold or publish that data, but it is the obvious place for it to be held—and then linked, as she explained, to local employers, contractors and organisations. Anything that reduces the complex maze for a patient or a member of the public trying to find out whether a doctor is being paid for doing some work or using particular devices, and might therefore have an interest, has to be one of the cornerstones of a truly accessible and accountable register of interests. In today’s data-rich society, patients and the wider community want to understand what interests a doctor may have, but which may not be obvious.

A website called whopaysthisdoctor.org at Sunshine UK—so-called, I presume, because sunlight is always the best disinfectant—was set up by number of doctors, including Ben Goldacre. It is a database where doctors who want to be transparent about their interests can declare and register them, and the public can see whether their doctor is listed. The problem, of course, is that those who do not want to make these declarations voluntarily may be those we most want to see. That is why the amendment would make it compulsory.

I thank the GMC for its helpful brief, in which it recognises that the

“current arrangements to register conflicts of interest fall short of delivering adequate transparency and assurance for patients.”

However, the GMC would prefer this register to be maintained just at a local level and

“published by a doctor’s employer, contractor or organisation”.

The noble Baroness, Lady Cumberlege, has already referred to the recommendations in the First Do No Harm review and the Government’s response, in which they said that it was proposed that information would be published locally at an employer level. However, I believe that there is also a golden thread from the obvious place to go, where doctors already have a duty to register other information, and that is the GMC.

Like the noble Baroness, Lady Cumberlege, I am keen to see action on this. Personally, I believe that the registration body is a good place to hold that data and, as she said, we need to start somewhere. But, frankly, we need to see progress on a register of interests. I hope the Minister can give your Lordships’ House some encouraging news on this.

Baroness Finlay of Llandaff Portrait Baroness Finlay of Llandaff (CB)
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My Lords, I was—it is fair to say—flattered when the noble Baroness, Lady Cumberlege, asked me to co-sign her amendment, because I have admired all the work she has done, and I think her report, First Do No Harm, has had influence way beyond the group of patients she was looking at. Indeed, I was vice-chair of a NICE review, and we referred to it in terms of helping to empower the voice of the patients we had in that review process, which was, first, very important and, secondly, particularly helpful because they were very clear in their thinking, and they worked extremely hard.

I am also grateful to the noble Baroness, Lady Brinton, for referring to the General Medical Council’s briefing, because the GMC agrees that a solution to this needs to be

“Accurate, up-to-date, accessible and presented in a way that is useful for patients, so that they can have confidence in it”.

It also said that it must be “Enforceable”, and the GMC also wants it to be “Multi-professional”. However, I agree that we have to start somewhere. Your Lordships may think that the advantage of a local register is that it is more accessible, but the disadvantage is that doctors move around in different jobs, particularly trainees—but even consultants’ time in one post is now relatively short; it used to be a lifetime appointment.

It is important that, as a doctor, I am prompted to be completely open so that there can be no subliminal influence on my decision-making. The most dangerous influences are the subliminal ones—not the ones where you are completely open about what is going on. There has been a great clamp-down over recent decades on the pharmaceutical industry because of sponsorship and so on, and that has decreased influences on prescribing. But when it comes to using other products in medicine, the same can apply. I think that a register would help the profession itself in making clinical decisions. I do not see this in any way as inhibiting research; on the contrary, it would display who is research active and who is achieving results through their research.

A register would support the development of innovative healthcare and support novel thinking because it would be declared and open. It would also support the move that people should always publish their results, whatever they are.

Lord Lansley Portrait Lord Lansley (Con)
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My Lords, the purpose of Clause 26 is to introduce a process by which the Care Quality Commission inspects integrated care systems. The structure of this is the subject of my Amendments 162A and 164A. Those two amendments go together—they are not separate, but entirely linked. The purpose of Amendment 162A is to remove the process by which the Secretary of State sets objectives and priorities for the Care Quality Commission in undertaking such inspections of integrated care systems; Amendment 164A then seeks to insert a process by which the Secretary of State, and indeed others, are consulted by the Care Quality Commission over the quality indicators that it would use to assess the quality and performance of integrated care systems.

A bit of background would be helpful for noble Lords in this respect. Think back to what the Care Quality Commission’s existing statutory arrangements are in relation to reviews and performance assessments of existing bodies in the National Health Service. The structure is very straightforward. The commission is asked to set quality indicators, to consult on those and then to review against them and produce reports. I know from personal experience that the Secretary of State cannot direct the Care Quality Commission to undertake a particular review, but they can certainly make a request, and their role as steward of the whole healthcare system has certainly led Secretaries of State to do that from time to time. But the legislation does not permit the Secretary of State to direct the Care Quality Commission in how it does its job; it is an independent body corporate. There is intrinsic merit in the Care Quality Commission, as an inspectorate, operating independently. The structure of this clause in this Bill is at odds with the way in which the existing legislation is structured in the 2008 NHS Act as amended. The effect of these two amendments would be to restore the independence of the Care Quality Commission in undertaking its activities and in the way in which it goes about its job.

The Government’s drafting of the legislation is wrong anyway. There are references to objectives and priorities. The priorities are referred to in new subsection (3), inserted by Clause 26(2), which says that they

“must include priorities relating to leadership, the integration of services and the quality and safety of services.”

I have to say that this is teaching grandmothers to suck eggs. There is no way in which the Care Quality Commission is not going to incorporate such indicators of quality. We know that from the generic nature of the quality indicators that it uses generally for existing NHS bodies. The reference to setting objectives is not only novel but completely undefined. The Secretary of State can set whatever objectives they wish to; we do not know what they are and there is no indication of what they might be. Taking out references to objectives and priorities seems to me to be a very good thing.

As it happens—I declare my own role in this—in the 2012 legislation there was previously a process by which the Secretary of State set standards for the Care Quality Commission in determining what the quality indicators should look like. We actually took that out of the 2012 legislation, precisely on these grounds: that the Care Quality Commission is, and should be, as independent as possible.

I think this clause proceeds from the mistaken apprehension that the Care Quality Commission is a part of the management process of the NHS. It is not. If the Secretary of State wishes integrated care systems to proceed in any particular way, the Secretary of State has the means to do so available via the mandate; the Government plan to add specific powers of direction; and NHS England has duties that go in exactly the same direction. The Care Quality Commission is not part of the management process for integrated care systems; it is an inspectorate. If—and this is a risk we must avoid—the Secretary of State were directly intervening to set objectives for integrated care systems to be inspected subsequently by the Care Quality Commission, whereas NHS England is itself setting objectives for integrated care systems through its responsibilities and duties, those two may come into conflict.

For all those reasons, the Government would be well advised to accept these two amendments and put the Care Quality Commission into the independent role in relation to ICSs that it, and people working in the National Health Service, would recognise as being its role. I beg to move.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, the noble Lord, Lord Lansley, has set out the tensions underlying the Bill about returning to the Secretary of State powers over independent, arms-length bodies; specifically, in this amendment, the inspections carried out by the Care Quality Commission in its role as a regulatory body. He rightly reminded us of the current arrangements, which give the CQC the ability to set its indicators and which, frankly, work well. I will not repeat his arguments, except to say in a slightly wider context that almost every piece of legislation brought to Parliament by this Government has given Ministers more powers—including, as in Clause 26, the power to intervene and to change remits.

The noble Lord’s amendments maintain the independence that the CQC—and other regulatory bodies—need to be able to inspect and make rulings without fear of favour or influence from politicians, while ensuring that the CQC must consult the Secretary of State when it revises indicators of quality for the purposes of assessment. That seems to me to provide the requirement for the CQC and the Secretary of State to engage in dialogue, but without the political intervention outlined in Clause 26(2) and (5).

Can the Minister explain why the Government feel the need to remove the independence of the CQC—whether this is an issue of management, as the noble Lord, Lord Lansley, said—and how giving the Secretary of State these powers can maintain the independence of a regulatory body?

Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, it is essential that we get the arrangements for the Care Quality Commission right throughout the Bill, and I am grateful to the noble Lord, Lord Lansley, for trying to do that through these amendments. If the health and social care provided is to be of the highest standards, we must ensure, through the powers of scrutiny and review in your Lordships’ House, that we enable the watchdog to have the proper tools and framework to achieve that, so I support the amendments.

As the noble Baroness, Lady Brinton, emphasised, this is about putting the responsibility in the right place to ensure that a key inspectorate can do an independent job and support proper integration and delivery. I hope the Minister will accept the good sense in these amendments.

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Baroness McIntosh of Hudnall Portrait The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
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I remind the Committee that both the noble Baronesses, Lady Brinton and Lady Masham, will be contributing remotely. I call the noble Baroness, Lady Brinton.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, I have signed two amendments in this very wide-ranging group. The first, in the name of the noble Lord, Lord Hunt, is Amendment 264 on the appointment of surgical consultants. As the noble Baroness, Lady Finlay of Llandaff, said in your Lordships’ House recently, 48% of advertised consultant posts last year went unfilled. Given our discussions about the workforce earlier this week, we need as many posts filled as possible and to remove any bureaucratic barriers to so doing.

Part of the problem at the moment is that trusts are having difficulties establishing appointment panels which can make these consultant appointments. Currently, the rules are too tightly drawn in the National Health Service (Appointment of Consultants) Regulations 1996 and the subsequent 2005 guidance. The members of all the royal colleges across the UK have a wealth of expertise, but the current legislation says that only members of English royal colleges can help trusts fill their appointment duties. In its helpful briefing, the Royal College of Surgeons says that the Royal College of Emergency Medicine, the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Physicians of Edinburgh are excluded from being eligible to join these panels. This amendment would be a simple remedy and speed up the appointment of much-needed consultants, and I do hope that the Minister can agree to it.

I have also signed Amendment 266 in the name of the noble Baroness, Lady Merron, on the urgent need to ensure that practitioners undertaking non-surgical aesthetic procedures such as lip fillers, injectables, thread lifts, semi-permanent make-up, laser treatments, piercings and tattoos are properly trained and licensed. These treatments are easily available to members of the public, but without the safeguards required when being carried out in the health sector. I am afraid that we see daily in the press and media reports on the many problems when treatments go wrong, which can include infection, disfiguration and burns, among other serious issues. When treatments do go wrong, it is usually the NHS that has to pick up the pieces, so I believe it is very much in the interests of the Department of Health and Social Care to accept this amendment.

The signatories to this amendment have been working with the Chartered Institute of Environmental Health, alongside a coalition of public health organisations and industry representatives, so that we can make sure that a licensing scheme can be introduced for all non-surgical aesthetic procedures. This will enable the setting of appropriate standards, a level playing field for practitioners and, importantly, protect consumers in this sector.

Covid-19

Baroness Brinton Excerpts
Thursday 20th January 2022

(5 months, 2 weeks ago)

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Earl of Kinnoull Portrait The Deputy Speaker (The Earl of Kinnoull) (CB)
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The noble Baroness, Lady Brinton, will speak remotely and I invite her to speak now.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, the Leader of the House just said that there is no advice for people who were formerly shielding, the clinically extremely vulnerable, but there is; the noble Lord, Lord Kamall, confirmed this to me last night. It says that this group should still consider meeting people only 14 days after they have been fully vaccinated, social distancing, asking friends and family to have rapid lateral flow antigen tests, asking any visitors to their homes to wear face coverings and not going into enclosed crowded spaces. Putting this guidance on a website is not the same as telling this group of people, or the wider public, especially their employers, directly that this group still need to take care. Will the Leader take this back and ensure that communications go to this vulnerable group of just under 4 million people?

Baroness Evans of Bowes Park Portrait Baroness Evans of Bowes Park (Con)
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I apologise to the noble Baroness and will certainly take that back to government colleagues. I recognise what she says.

Baroness Henig Portrait The Deputy Chairman of Committees (Baroness Henig) (Lab)
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My Lords, the noble Baroness, Lady Brinton, is taking part remotely, and I invite her to speak.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, I am speaking in support of the amendments in the name of the noble Baroness, Lady Bennett, starting with Amendment 46. After many helpful discussions both today and earlier on in Committee looking at membership, structures and representations of ICBs, these amendments take us back to the first principles and ask your Lordships’ House to look at what should be in scope for the provision of NHS services. This is a really valid question.

The noble Baroness, Lady Bennett, referred to maternity services, but if I were to pick one of the services listed in Amendment 169, it would be dental services. There are millions of people in the country who cannot access an NHS dentist. The result is a worsening of dental health, which is especially worrying for children and young people. I am sorry to say that, over the years, Ministers have ignored the wider needs of the public regarding dental services. I think the point about specifying the provision of services such as this puts a very particular duty on the Secretary of State to force Ministers to make sure that they are also holding other parts of the health service to account.

The amendments turn our focus on to whether we still have an NHS that is a public health system or one that perhaps is paid for mainly by the public but run by a disparate number of bodies, including unaccountable private companies increasingly not based in the UK. They are particularly important in light of the report today in the press that the Secretary of State is planning to create the equivalent of school academies for failing hospitals and says that there will be a White Paper in due course. Just as an aside, do we need yet more reforms? Surely it would have been better to have a full range of Green Papers with an overarching vision of what the NHS in the 21st century should look like and how the structures should work. We are now waiting for two White Papers, while the passage of this Bill is irrevocably changing the structures of our NHS system.

Today’s announcement rings a number of alarm bells because there is an analogy with the education sector that is quite helpful. I remember that, in the 1990s, academies were going to be free from local authority control and that that, on its own, would inevitably make them improve—but that has not been the case. Various reports over the last 20 years have shown that a number of failing schools taken into multi-academy trusts and free schools have remained low performing. Structures on their own do not necessarily resolve this. Indeed, some multi-academy trusts have failed in their entirety, and one of their issues is the lack of public accountability—because Ministers have direct responsibility in the public realm for academies, and I worry that the Secretary of State may be proposing the same. If I was a senior leader in NHS England, I would be very concerned about that.

I am grateful for the earlier comments of the noble Earl, Lord Howe, on the need for Ministers to have the ability to appoint and, presumably, remove senior personnel on ICBs. But would the Secretary of State have responsibility for these academy equivalents and give them the right to access separate funding for capital expenditure and special projects? I raise this because part of the problem that we have at the moment is a diversity of funding mechanisms, structures and strands, which often take the eye of a leader—whether a Minister or one in the NHS—away from the provision of services.

The foundation of a public system was essentially removed by the 2012 Act, and, as the noble Baroness, Lady Bennett, said, the Constitution Committee suggested that there needed to be an interim remedy. It is important that we have reassurance that this Bill will not weaken it any further at all. I hope that the Minister can reassure your Lordships’ House that the Government want to protect the provision of NHS services, as part of a truly public health service.

Baroness Wheeler Portrait Baroness Wheeler (Lab)
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My Lords, I thank the noble Baroness, Lady Bennett, for moving her amendment and other noble Lords for their contributions, particularly on the specific points about particular services, such as dentistry. All three amendments look back to the Health and Social Care Act 2012 and the National Health Service Act 2006 on the powers and duties of the Secretary of State in relation to the NHS and the services that it provides, restoring certain provisions in the 2006 Act.

Under the Bill, the ICBs and NHS England will have the duties to secure the provision of the services that make up the comprehensive NHS. There are probably noble Lords here today who were Members of your Lordships’ House in 2006. I came in in 2010, just as the equally marathon Health and Social Care Act from the coalition Government got under way, when the whole issue of the Secretary of State’s powers and duties came to the fore. As explained at the time, the aim was to separate the political from the operational responsibility and to better align the language to the reality of the purpose of the NHS, in “securing the provision of services”.

The arguments in 2010 and 2011 were fierce and passionate, centred around the subtle changes in the way that the duties were defined, as compared to the words in Sections 1 and 3 of the 2006 Act. They caused suspicion, confusion and fears that the NHS would be changed forever. These arguments remain a bit of a blur in my memory, but I recall the overwhelming view among leading experts on NHS law that the changes were technical and did not involve any substantial change in practice. We know that, in respect of this role, no change has happened.

I also recall the 2012 consideration of the issue by our Constitution Committee and the compromise recommendation subsequently adopted in the 2012 Bill of what became Section 1(3) of the 2006 Act, as amended:

“The Secretary of State retains ministerial responsibility to Parliament for the provision of the health service in England.”


No matter what is in any Act, this is and will always be the political reality.

Currently, the law places the duty on the Secretary of State to

“continue the promotion in England of a comprehensive health service designed to secure improvement … in the physical and mental health of the people of England, and … in the prevention, diagnosis and treatment of physical and mental illness”—

very much in the spirit of the NHS’s founding 1946 Act.

Amendments 46 and 168 seek to continue the 2006/2012 debate. It was claimed about the 2012 Act, and now about this Bill, that the change in wording implies that people will be denied access to treatment from the NHS because, for example, a particular ICB decides to exclude a service and because there is no duty on the Secretary of State to prevent this happening. However, there is no evidence that anyone has ever been denied access to an NHS service or that any service has been refused in general simply because of the change in the wording of the responsibilities of the Secretary of State. Amendment 169 returns to the same point, seeking to place a duty on the Secretary of State to “provide” a list of services, with some general headings such as ambulance services. But the reality is that this is not how the NHS functions or indeed ever has.

I endorse many of the comments made by the noble Baroness, Lady Brinton, about today’s announcement of yet another restructuring on the academy front, but, again, that is a debate for another day.

We could go back on the Secretary of State issue to the 2012 arguments and spend a lot of time on it. While we fully understand the concerns and fears that the current wording could engender among those who suspect a deeper reason for the changes in language, continuing to argue over this issue would not be very productive or get us anywhere. We need to get on with scrutinising the sweeping delegated and Henry VIII powers later in the Bill that our current Constitution Committee and Delegated Powers Committees have expressed such deep concern about.

COP 26

Baroness Brinton Excerpts
Tuesday 16th November 2021

(7 months, 3 weeks ago)

Lords Chamber
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Baroness Smith of Basildon Portrait Baroness Smith of Basildon (Lab)
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My Lords, in line with the arrangements, the Statement made in the Commons yesterday is not repeated by the Leader, but I think most Members will have heard what the Prime Minister had to say in his enthusiasm for the agreement.

The world came together in Glasgow for what was the most important summit the UK has ever hosted. Future generations will look back on COP 26 as a time when we either met the moment or missed the opportunity. We add our thanks to all those involved in the organisation and planning of the summit—and to the residents of Glasgow, who, despite the disruption, welcomed visitors from all over the world into their city and their homes.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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Can you hear me?

Baroness Smith of Basildon Portrait Baroness Smith of Basildon (Lab)
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There seems to be some disruption; I do not know whether we are being haunted. If the noble Baroness, Lady Brinton, could mute, that might be helpful—just on this occasion, I hasten to add.

This is the decisive decade for tackling the climate emergency. Although we better understand the seriousness of the issue, the real threat to progress is no longer denial but delay.

For film fans—bear with me on this—when Rick said the immortal words to Ilsa in “Casablanca”, “We’ll always have Paris”, he could not have imagined how apt they would be, 80 years later. The Paris summit in 2015 built an international alliance to limit global warming to 1.5 degrees. The Prime Minister says in the Statement that COP 26 succeeded not just in keeping that 1.5 degrees target alive but in going further. I hope and want his optimism to be justified, but it feels more like the 1.5 degrees target is on life support. Meeting it would mean halving global emissions by 2030. The challenge for COP 26—so that we would always have Paris—was to close the gap between that aspiration and the reality of the pledges made. If Rick and Ilsa could do it, so can we. But did we?

We have to be honest about what has been achieved. Progress has been modest. We saw encouraging agreements on methane, deforestation, and the sales of petrol and diesel cars. Too often, however, the real delivery that will make a difference will come too late. According to the Climate Action Tracker, the pledges made at Glasgow for 2030, even if fully implemented, represent less than 25% of the ambition required. Rather than limiting warming to 1.5 degrees, we are now on track for a devastating 2.4 degrees rise. That is not just a number: it really matters. It could lead to billions of people facing extreme heatwaves, millions forced to leave their homes, and increased threats to both the natural wonders of the world and overall security. The Prime Minister kicked off the conference by saying that it was “one minute to midnight” on the doomsday clock. Can the Leader tell the House what time it is now, and whether we will still have Paris?

For years, coal has been the elephant in the room at these summits, so having an explicit reference in the agreement for the first time is really important. Who could not have been moved by Alok Sharma’s emotional reaction to that last-minute change to “phase down”? That really illustrates that hopes were cruelly dashed, despite the Prime Minister’s approval in the Statement. The raw emotion that we saw from Alok Sharma was also palpable among the Pacific Islanders. For many, climate change is genuinely existential, so even the announcement that 190 countries and organisations had agreed a timetable to end the use of coal does not bear scrutiny. Of those 190, only 46 were actually countries, of which 23 were new signatories and 10 do not even use coal. It is a coalition that includes NatWest and the national grid but not China, the United States or India.

There then came climate finance. It is a moral plight on developing nations that the 2009 commitment to provide $100 billion a year to emerging economies still has not been delivered; it will not be until 2023. That failure to deliver is self-defeating because it damages trust and prevents a high-ambition international coalition being built.

With his now typical overexuberance, the Prime Minister lauded the net-zero commitments made. Yet Saudi Arabia, for example, is still increasing oil production, despite its 2060 net-zero claim, and Australia will not even legislate for its 2050 net-zero target. We all know the importance of trade deals, but will the Leader explain why the Government dropped the Paris temperature commitment from the trade deal that we now have with Australia?

I had hoped that the Statement would refer to Thérèse Coffey’s welcome boast at the summit of the UK being

“the first country to legally require pension trustees to assess and publish the financial risks from climate change”.

I am sorry that it was not in the Statement, but the Leader of the House may recall that it was a Labour-led amendment in your Lordships’ House, supported across this House, that secured that historic commitment. We are pleased that we were able to be helpful, so that the Government could boast about that achievement at COP.

For the next 12 months, we have the COP presidency, and that gives us a key leadership responsibility. But the Government’s ability to step up and deliver is called into question by the Climate Change Committee’s recent report to Parliament, which said that the Government had been

“too slow to follow its climate promises with delivery”.

We cannot just put climate policy in a separate box: all government policies need to be linked to climate commitments, including trade deals. Yet Rishi Sunak’s Budget failed to mention climate change; it did not secure the necessary green investment, but it did give a tax break for domestic flights. That we were the only G7 country to cut overseas aid when seeking international co-operation on climate clearly damaged trust at COP.

When we wanted to focus on the summit issues and the climate emergency, many of us found it very difficult to watch the Prime Minister seeking to assure the world’s media that the UK was not corrupt, following his political shenanigans away from the summit. It was not exactly Mr Johnson’s finest hour.

Looking forward, I hope that the Leader is able to update us today on how Ministers can get a grip, reorder their priorities and invest in the green recovery. Can she give us an assurance that the net-zero test will be applied to all future decisions? Given what was said at COP 26, what is the Government’s renewed plan for phasing out fossil fuels, including rewriting the planning framework to rule out coal and say no to the Cambo oil field?

In conclusion, there was some welcome progress at COP 26 but it could have, and should have, achieved far more. Real action, not more rhetoric, must now follow, because the world just cannot wait any longer.

Tributes: Sir David Amess MP

Baroness Brinton Excerpts
Monday 18th October 2021

(8 months, 3 weeks ago)

Lords Chamber
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Lord McFall of Alcluith Portrait The Lord Speaker (Lord McFall of Alcluith)
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My Lords, I will call three remote contributions before opening up to the rest of the House.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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My Lords, my noble friend Lord Jones of Cheltenham cannot be in his place today but has asked me to start by saying something on his behalf about Sir David Amess. As noble Lords have already heard, my noble friend Lord Jones was himself attacked, and his aide and friend, Councillor Andy Pennington, was killed, at a constituency surgery in 2000.

My noble friend wants me to say on his behalf:

“To learn David’s life has been taken is the most unimaginable shock. I simply can’t believe this has happened again, and to the kindest, most decent of men.


He was a mate, David. We were on opposite sides of every debate, he voted the wrong way on most things and disagreed with me on just about everything. We were in different parties but always got on well. He was a wonderful personality and worked exceptionally hard for his constituents.


He was a proper parliamentarian, a dedicated public servant and a lovely man. If he bumped into me when he had visitors to the House, he’d say, ‘Oh and this is my friend Nigel, he was attacked, you know? Do you remember, he was on the television?’ I’m appalled that he has suffered like this.


David, like my friend Andy Pennington and I, was just trying to do the job to the best of his ability. Our democracy relies on an open channel between those in power and the people who we represent. It’s vital to be able to meet people face-to-face so they can feel we are here and working for them.”


Turning to my own tribute, I first got to know Sir David when I joined your Lordships’ House a decade ago and he quickly nobbled me—there is no other word—to join the all-party group for fire safety and rescue, which he chaired; I really did not have a choice. He had been a friend of my father, Tim Brinton, having met when they were MPs together, and David knew that my stepmother, Jeanne, had been a Conservative chairman of the Kent fire safety committee and that I had campaigned actively for sprinklers in schools. But that was David: every argument well researched, compliments paid and, before I knew it, I was even an officer of the all-party group too. To the utter bemusement of the much younger members of the all-party group and visiting experts, he usually introduced me as Tim Brinton’s daughter, which always made me very proud. Their friendship was based on rejecting preferment but loving the core job of being an MP, both in the constituency and in the House.

Over the decade that followed, I saw David’s campaigning zeal through the work of the all-party group, holding Ministers and sector professionals to account. Schools Fire Minister after Schools Fire Minister and Building Planning Minister after Building Planning Minister were truly held to account in David’s inimitable style. Of course, our work became even more important after the tragedy of the Grenfell fire and still is not over. We will carry it on in his memory.

Many have spoken since Friday of David’s kindness, decency, courtesy and humour. I have seen all in plenty. I was unwell for a large part of last year, and he rang me regularly to check on my progress. I want to send my deepest sympathy to Julia, their children, his wider family and all his staff and colleagues.

In this day and age of daily abuse—online and in person—death threats, attacks and even murders, David stood as an oasis of reasonable behaviour and genuine affection for all those who crossed his path. In 2017, Christians in Politics ran a campaign for learning to disagree well. I cannot think of a better example than David of always disagreeing well. In political terms, we were polar opposites, but, with him, that was never a barrier: he always found what we had in common, and we could stand together. His faith was intrinsic to every action, every word he uttered and every passing smile to faces that he recognised. May he rest in peace and rise in glory.

Health and Social Care

Baroness Brinton Excerpts
Thursday 9th September 2021

(10 months ago)

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Lord Brougham and Vaux Portrait The Deputy Speaker (Lord Brougham and Vaux) (Con)
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The noble Baroness, Lady Brinton, is taking part remotely and I invite her to speak.

Baroness Brinton Portrait Baroness Brinton (LD) [V]
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I declare my interest as a vice-president of the Local Government Association. My noble friend Lord Newby asked, but the noble Baroness did not answer, so I ask again whether she will give an undertaking from the Dispatch Box to guarantee that social care will receive the bulk of the revenue raised by the levy, in the medium term, regardless of whether the NHS has completed the backlog of waiting lists. Otherwise, this is no reform to social care at all, however delayed.

These proposals do nothing to help the current problems in the social care sector. The noble Baroness referred to the extra £1 billion to local government, but all the experts say a minimum of £4 billion a year is needed to help solve them. Can the Minister confirm that, given the current severe crisis in staffing and funding in our care homes, there will be funding on top of that £1 billion at least to start to remedy the problems in social care?

Baroness Evans of Bowes Park Portrait Baroness Evans of Bowes Park (Con)
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As I said in my opening remarks, we are committed to spending an additional £5.4 billion across the next three years. This will end the risk of unpredictable care costs and include at least £500 million to support the social care workforce.