Social Care in England

Baroness Chisholm of Owlpen Excerpts

Thursday 14th October 2021 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, I thank the noble Baroness, Lady Pitkeathley, for securing a debate on such an important subject. I also thank the noble Baroness, Lady Donaghy, for her commiserations on my having this post. I pay tribute to the noble Baroness, Lady Pitkeathley, for the experience she brings to the debate today, including her contribution to carers as former chief executive of Carers UK and her work in the voluntary sector, being a founding member of the Association of Chief Executives of Voluntary Organisations and chair of the New Opportunities Fund—one of the National Lottery distributors.

I am sure we all wish to recognise and thank the social care workforce, both paid and unpaid, and many noble Lords have done so in their tributes today. We should thank them for the work they do in care homes, in people’s homes and in day services, day after day, week after week and month after month.

I also thank the noble Baroness for her thoughtful comments and the well-argued case she has put before the House. We have heard many moving testimonies from across the Chamber. As noble Baronesses have said, this pandemic has provided a once-in-a-generation challenge for this country. There is no getting away from the fact that the past 18 months have been incredibly tough for social care. The challenges have been unprecedented—what Nassim Nicholas Taleb would describe as a black swan event. Many people, not only in the UK but in many other countries, have lost loved ones because of the virus. Our hearts go out to each and every one of them. It demonstrates the importance of this debate today.

I thank the noble Baroness for summing up the numbers that we should all be aware of: 9 million unpaid carers before Covid, 4.5 million new carers, totalling 13.5 million—including 2.5 million who are holding down jobs. I also thank the right reverend Prelate the Bishop of Oxford for his quote from one of the 10 commandments. I am sure he will agree that people of many other faiths and no faith also agree very strongly with the importance of parents and looking after our loved ones as they get older.

Many have said that it has been a real challenge, and we agree. As the Prime Minister said,

“we are … committed to learning lessons”—[Official Report, Commons, 12/5/21; col. 138.]

from the pandemic. When the pandemic hit, the Government worked hard to ensure that the sector got the support it needed as quickly as possible. The Government published guidance tailored to care homes and care providers, domiciliary care, unpaid workers and local authorities on how to continue to safely provide care during the Covid-19 outbreak. We rolled out regular testing for the sector and have sent more than 42 million PCR swab test kits and 117 million lateral flow devices to care homes to date. We set up a massive PPE supply chain from scratch and, through the PPE portal, have provided over 3.6 billion items of free PPE for providers’ Covid-19 needs, and, since April 2020, more than 478 million items through local resilience forums and local authorities.

The Government also moved as quickly as possible to provide financial support to the sector, making available almost £2.4 billion in specific funding for adult social care throughout the pandemic. This is in addition to over £6 billion that has been made available to local authorities to address pressures on their services. Many noble Lords spoke about the importance of local authority funding.

Crucially, we have provided health and care workers and older residents with vaccines. From 11 November, vaccinations will be a condition of deployment for care home staff. I know many will want to reflect on this point. It is worth noting that many staff—the vast majority of care home staff—have been vaccinated. It is our responsibility to do as much as we can to encourage others to be vaccinated to reduce the risk in our care homes. I know if I had a relative in a care home, I would feel much better if they were cared for by someone who had been vaccinated. I hope that across the House we can encourage more care workers to be vaccinated. Of course, there are some who are unable to be vaccinated for medical reasons and we should address their concerns too. Those people should call 119 to apply for a medical exemption.

As noble Lords can see, the Government have provided a huge number of resources to the sector to deliver better care. Of course there will always be a debate on whether the spending is enough. I have heard from across the House how many have responded to the numbers suggested. Looking to the future, the Government will maintain support, both in the short term to address the impact of Covid-19 and, more crucially, in the longer term through the social care reforms. In the short term, the sector will be supported by continuing to be provided with free PPE to protect against Covid-19 until the end of March 2022. This is also extended in designated settings, backed by the extension of the designated settings indemnity support scheme, to March 2022, so that no patient who has tested positive for Covid in the past 14 days is discharged from hospital to a care home.

In addition, in September, the Government announced an additional £388 million to prevent the spread of infection in social care settings. This package includes funding for infection control measures, as some have spoken about, £25 million to support care workers to access Covid-19 and flu vaccines over the winter months, and funding for testing costs, allowing testing to continue for staff, residents and visitors, to ensure that residents can see their loved ones as safely as possible. As part of the preparations for winter, plans are being developed in conjunction with the NHS and social care sector stakeholders. This will draw on the recommendations of Sir David Pearson’s review of last year’s winter plan, advice from SAGE and UK HSE, and—more importantly—on the lessons learned so far in the pandemic.

Our country’s social healthcare system has never been under such pressure as it has been over the past year. Many noble Lords have spoken about the pressure. The coronavirus pandemic posed unprecedented challenges to the sector, so we all agree that we must address the long-term future of social care in this country.

Many people have said that this issue has been live for a number of years. The noble Baroness, Lady Tyler, spoke of social care having been “in the shadows” for many years; the noble Baroness, Lady Warwick, said that people have been talking about this for years; the noble Lord, Lord Lipsey, spoke of the 1999 minority report. However, this debate has been going on for much longer. It has been decades—I think someone said 50 years. If we are honest about it, various experts have warned for decades that the combination of an ageing population and increased life expectancy poses a real challenge to social care. What happened? The debate continued, more think tank reports were produced, other reports were produced, and parties published suggestions in their manifestos. But in reality, all of these were placed on the shelf and just gathered dust, while successive Governments, of all colours, kicked the proverbial can down the road.

The Prime Minister decided that his Government would not shirk the responsibility and stepped up to publish a plan, Build Back Better: Our Plan for Health and Social Care, pledging an extra £5.4 billion over three years for social care. I also thank my noble friend Lord Astor for his comments on a bolder programme of reform. We need to make sure that, whatever additional funds are provided, there is reform, so that the public can have confidence that the additional funds will be well spent.

The Prime Minister’s September announcement was an important step on the journey to reforming adult social care. Of course there will be debate—any reform or change leads to debate. I worked for many years in organisational change and know that any change always generates a large debate. There are some short-term winners and losers—many people will clearly claim that they have lost out and others will gain, but, quite often, the gainers are not as vocal as those who have lost out, and rightly so. We should address those who have genuine concerns. It is really important that we learn from many of the concerns across the House today.

The Prime Minister’s announcement showed a real commitment to delivering world-leading health and social care across the whole of the UK. As we speak, details are being discussed in preparation for a White Paper on reforming adult social care, to be published later this year, as the noble Baroness, Lady Wheeler, pointed out in her intervention. We hope that the reforms will make a real difference to front-line adult social care. This includes both care users and the dedicated care workforce, who have been so brilliant throughout the pandemic.

We also know that there has been a debate over whether funding should come from general taxation or national insurance contributions. Having looked at this debate when I was head of research at a think tank, I have seen a range of views across the political spectrum—there are even some who have asked why people should not sell their homes to fund their care. So you can imagine the range of views that we have heard and read over many years. We really hope that these reforms will make a difference. While there is a range of views, I will outline some of the proposed reforms that we hope will deliver better care for adults of all ages.

First, the £86,000 cap on care costs, funded by a health and care levy, means that, for the first time, everyone will have protection from unlimited costs. There are those who have prudently saved for their old age and who have been hit hard by the unpredictable costs associated with their health and care needs; currently, one in seven faces fees of over £100,000.

Secondly, individuals with limited or no savings will be safeguarded by a more generous means test. The increase in the upper capital limit from £23,250 to £100,000, and in the lower capital limit from £14,250 to £20,000, means that the number of adults receiving some state support will increase from around half to two-thirds. In short, some people who need care, and their loved ones, will have the certainty of support when it is needed and will not have to live in fear of unpredictable costs.

In wanting to propose the fairest reforms possible, the Government decided to fund these measures with a new UK-wide health and social care levy. The Government are absolutely clear that we should not pass on the costs to future generations and increase public debt even further. There is much debate over this, but, by using national insurance contributions, the Government are ensuring that both businesses and individuals contribute. Those who are earning more will pay more. It has a clear UK-wide approach, meaning that everyone pays the same, wherever they live in the UK. In addition, by extending the levy to those working over the state pension age from April 2023—many will of course complain, and I understand that—the Government have listened to those concerns and balanced them with intergenerational justice. Many young people have asked why they are being asked to pay for people. We need to make sure that individuals of all ages play their part.

However, we should also recognise that this is not just about the over-65s. In adult social care currently, over half of all state spending goes towards under-65s—so working-age people will also benefit from limits on what they have to pay if they need care for themselves in later life. This was considered consistent with the contributory principle for national insurance contributions, whereby working-age employees pay these NICs and this gives them access to contributory benefits when out of work, including the state pension.

I will turn to the paid social care workforce, which many of us have paid tribute to. We have listened to the sector and prioritised the adult social care workforce, recognising their tireless commitment and dedication during the pandemic. The noble Baroness, Lady Finlay, spoke movingly about the hospice movement and the work/life balance that we want to see. Many people have asked what is being done to ensure that working carers can balance their caring responsibilities with work. The Government are committed to promoting the benefits of retaining unpaid carers in the workforce, for both the carer and the employer. The Government’s response to the consultation on carers’ leave confirms their intention to deliver on the manifesto commitment to introduce a new entitlement to one week of leave for unpaid carers. This will be a day 1 right, available to all employees who are providing care to a dependant with long-term care needs. I will obviously send more details to any noble Lords who would like them.

The noble Baronesses, Lady Pitkeathley and Lady Finlay, and my noble friend Lord Astor and others mentioned spending. We need to make sure that the Build Back Better plan for health and social care sets out an intention to make care work a more rewarding vocation. Many noble Lords have spoken about this. We need to offer a career where people can develop new skills and take on new challenges as they become more experienced. The Government are committed to spending at least £500 million over three years to deliver hundreds and thousands of training places and certifications, pathways, and well-being and mental health support. This workforce package is a significant investment that will support the development and well-being of the workforce. I hope that that partly answers some of the questions of the noble Lords, Lord Bichard and Lord Sikka, and the noble Baroness, Lady Pitkeathley.

We will continue to support the social work fast-track programmes Step Up to Social Work and Think Ahead, designed to support those wanting to change specialism to become a social worker and make a real difference to people’s lives. As one noble Lord said today, this is an incredibly noble profession. We will continue to introduce further reforms to improve recruiting and support for social care, with more details in the forthcoming White Paper. I am as eager as anyone in this House to see that paper, so that we can have a proper cross-party discussion on the reforms that are much needed.

Speaking as Minister for Technology, I will touch on one of the points that many have raised. I have made digitisation and data sharing one of my key priorities, as Minister for Technology, Innovation and Life Sciences. I hope that digital technology will play a key role in helping adult social care workers to do their jobs even more effectively.

However, we should also recognise the vital role of unpaid carers, as many have said, including the noble Baronesses, Lady Warwick and Lady Tyler. We want to build a system of care to better support unpaid carers, as well as helping recipients of care to have more choice and control over their lives, what they do and how they choose to live. Throughout the pandemic, the Government have taken a number of steps to support unpaid carers, such as funding charities that support carers, producing Covid-19 guidance tailored for carers, helping carers self-identify and ensuring access to and priority for PPE and vaccinations. The Government will work with representatives across the sector, including those who represent carers, to develop more detailed plans for social care reform together, ensuring that unpaid carers receive the support, advice and respite that they need.

As the noble Baroness, Lady Wheeler, said, there is an incredible amount of expertise in this House, and that has come through in the many contributions to today’s debate. I will work with noble Lords across the House as the health and social care Bill goes through it.

I am not sure how much longer I have.

[Baroness Chisholm of Owlpen (Con)]

Three minutes.

[Lord Kamall (Con)]

Thank you. Noble Lords will have to forgive the new boy. Now someone is saying I have two minutes—there we are.

There are many questions I wanted to go through in detail, so I hope noble Lords will accept my apologies for being too verbose in many ways and not answering the detailed issues. I will write to noble Lords on any particular points. Clearly, I do not have a realistic estimate of my speaking time—let us put it that way.

Once again, I thank the noble Baroness, Lady Pitkeathley—

Health Protection (Coronavirus, Restrictions) (Steps etc.) (England) (Revocation and Amendment) Regulations 2021

Baroness Chisholm of Owlpen Excerpts

Wednesday 15th September 2021 Lords Chamber

[Lord Bethell]

That the Regulations laid before the House on 15 July and 19 July be approved.

Relevant document: 11th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 14 September.

[Baroness Chisholm of Owlpen (Con)]

My Lords, on behalf of my noble friend Lord Bethell and with the leave of the House, I beg to move the three statutory instruments in his name en bloc.

Motions agreed.

Covid-19: Obesity

Baroness Chisholm of Owlpen Excerpts

Wednesday 21st April 2021 Lords Chamber

[Lord Bethell (Con)]

The right reverend Prelate puts the case extremely well. The community kitchen measures she describes are beyond my brief. I do not have the details to hand, but I should be glad to follow this up and write to her.

[Baroness Chisholm of Owlpen (Con)]

My Lords, as we know, there are no real redeeming features to Covid but, my goodness, it has managed to magnify the obesity problem in this country. As my noble friend said, it is a real wake-up call. Does the Minister feel, like me, that we have had enough initiatives that last for a period and then disappear without any real success? Is it time to put someone in charge of this serious health problem who has time and real clout to take on the food industry, tackle the root causes and work with all government departments to deliver change?

[Lord Bethell (Con)]

I do agree with my noble friend that the answer to this issue is sustained action. This is not something where snazzy initiatives are going to have the necessary impact. But the key to our efforts is creating cross-governmental co-ordination—that very difficult thing to achieve. We are working extremely hard with other departments, particularly with DCMS and DCLG, in order to address the kind of housing, cultural, advertising and nutritional issues at the heart of this problem.

Social Care

Baroness Chisholm of Owlpen Excerpts

Wednesday 28th October 2020 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

My Lords, technology innovations have been used by healthcare professionals in the community during the pandemic. Really, they have flourished and have been shown to be of great benefit to social care. Will the Minister reassure the House that, during the reform of social care, funding is put forward for those innovations to carry on and indeed grow to their full potential?

[Lord Bethell (Con)]

My noble friend is entirely right. One of the experiences of Covid has been the mobilisation of technology to help those in social care. That has ranged from very basic implementation, such as sending iPads to people in social care so that they can message and video their loved ones when in some form of lockdown, to the work done with broadband providers to ensure that those without it can have access to it, all the way through to the use of the most complex artificial intelligence and big data, to help with diagnosis in social care, and the management of care itself. That commitment to technology will continue and will form an important part of improving the commitment to social care as part of the new regime.

Hospitals and Nursing Homes: Do Not Resuscitate Notices

Baroness Chisholm of Owlpen Excerpts

Thursday 1st October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I completely agree with the noble Baroness’s sentiments—so does the department and so do the Government. We have noted what happened during the Covid epidemic. The CQC is investigating potential lapses at that time. We have reinforced guidance in the winter plan and the CQC continues to review the situation. New training and guidance provisions are being put in place. We take the situation extremely seriously and are putting in the procedures and investment necessary to ensure the right outcome.

[Baroness Chisholm of Owlpen (Con)]

What training is being given to physicians and healthcare workers for when they discuss DNR with patients and next of kin?

[Lord Bethell (Con)]

The department is aware of the Queen’s Nursing Institute report on training and, although the majority of responses were positive, it raised questions about the training of, in particular, care home staff on the instruction to change resuscitation orders for patients without discussion. We are looking at that report very carefully. We cannot comment on individual cases but the report raises important questions. In the meantime, the General Medical Council is providing additional support and guidance to clinicians and the Resuscitation Council is creating a large range of resources for clinicians to help guide them and provide training.

Childhood Obesity

Baroness Chisholm of Owlpen Excerpts

Wednesday 2nd September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I welcome the IPPR report, but it is not true that the Government do not have a whole-society approach. Our approach to obesity involves physical education, supporting underprivileged families, addressing issues with marketing and a whole range of different issues. As for the noble Baroness’s points on profit, this Government are not against profit, but we are for healthy outcomes for young people.

[Baroness Chisholm of Owlpen (Con)]

My Lords, clearly prevention is better than cure and there is no panacea. However, there seems to be some evidence that, where families are brought together in family programmes to help them bring about behavioural change, there is more likelihood of them sticking to a healthier lifestyle. I ask my noble friend the Minister whether these programmes are ongoing and, if not, whether they can be started again and rolled out countrywide? It seems that, if families are brought together to help them think about behavioural change, this could be one way of tackling the obesity crisis.

[Lord Bethell (Con)]

My Lords, I pay tribute to the noble Baroness, Lady Chisholm, for her expertise in this matter. She is entirely right that decisions made by families together are more powerful than those made by individuals. The obesity campaign launched in July seeks to achieve exactly that by having a campaign on better health targeted at the whole population. I also emphasise the Healthy Start vouchers, a scheme to provide a nutritional safety net to hundreds of thousands of pregnant women and families with children aged under four, which is one way of bringing families together around healthy food.

Queen’s Speech

Baroness Chisholm of Owlpen Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Baroness Howe of Idlicote (CB)]

My Lords, like the noble Lord, Lord McNally, I too have found myself having to change what I had intended to say today, following an announcement by the Secretary of State for the Department for Digital, Culture, Media and Sport last week that the Government no longer intend to implement Part 3 of the Digital Economy Act 2017. The profundity of this announcement and its political implications for the Government have not yet made their presence felt, for the simple reason that the announcement was made, probably on purpose, in the epicentre of the Brexit storm. The simple political reality, however, that the Government cannot escape, and the consequences of which they cannot circumvent, is that the 2015 Conservative manifesto stated, on page 35, that,

“we will stop children’s exposure to harmful sexualised content online, by requiring age verification for access to all sites containing pornographic material”.

That was a simple, profound, high-profile manifesto commitment that brought hope to parents up and down the country and to children’s charities. You simply cannot make this kind of commitment, introduce the legislation, appoint a regulator, ask the industry to prepare for the law change and then suddenly make a U-turn and not expect serious political consequences.

The Government may have to face an election, and therefore they may want to think again too. The actions of the Secretary of State suggest that even seminal Conservative manifesto commitments cannot be trusted, so I gently ask the Minister why anyone should believe what they say after some of the events of last week. How will we know that key commitments will not subsequently be swept away because the Government claim to have better plans?

On the subject of better plans, one of my difficulties is that the Government have not really said what these better plans are, other than that they will find expression in the context of their work on online harms, further to the White Paper. This is particularly problematic because, although I have spoken to children’s charities and parents, no one has been able to tell me of a better way to prevent children accessing pornographic websites than through the introduction of statutory age verification enforced by a regulator IP blocking non-compliant sites. Moreover, no one can imagine a more efficient way of facilitating children’s access to pornographic content online from the day that statutory age verification would have come in than abandoning this commitment so that it does not come into force.

Hopes had been expressed that the online harms White Paper process might extend that protection to social media but, let us be clear, nothing can take the place of statutory age verification in relation to pornographic websites. The best way to deal with pornographic websites is not necessarily the best way to deal with pornography on social media platforms, yet the Government seem to be using a rather crude one-size-fits-all logic to justify not introducing the most effective mechanism for protecting children from pornographic websites, in favour of some vague commitment to an undefined mechanism that can address everything. All this is simply not credible. In the world of online safety, there are no one-size-fits-all solutions. I am pleased, of course, that the Government want to do more to prevent children accessing pornography through social media platforms, but they should not use this as an excuse to justify jettisoning the most effective and efficacious way of protecting children from pornographic websites—statutory age verification—especially having made it a manifesto commitment.

I wonder whether whoever came up with this idea actually reminded the Prime Minister that they were recommending that the Conservative Party renege on a headline manifesto commitment—better, surely, to have never made that promise than to make it, introduce the legislation, prepare industry and then change their mind.

I also think the Government should think very carefully about how it looks to have people vote for a manifesto containing a simple, clear commitment to introduce statutory age verification and to then subsequently go back to them and say, “We know you voted for this but now we have a better idea”. In the context of Brexit, where they are saying that the political class should take care to respect how people have voted and not come back and tell them that they know better, they should apply the same logic to themselves.

The other consideration in all this which should not be overlooked is Britain’s influence in the world. The Government were leading the way in this space and multiple jurisdictions were watching with the greatest interest, including within the EU. If the Government recover their nerve, Britain will still have the opportunity to play a key role in setting global standards on statutory age verification. It seems bizarre that we should invest millions in developing world-leading legislation and technology and then, through an apparent loss of nerve—and with no moral compass as far as honouring manifesto commitments is concerned—turn our backs on a great opportunity for Britain to help protect children, not just in the UK but across the world. I very strongly suggest that if the Government do not want to alienate parents up and down the country, they should rapidly reconsider their strategy and lay the BBFC age verification guidance before Parliament as soon as possible.

[Baroness Chisholm of Owlpen (Con)]

My Lords, please let us try to keep to six minutes; otherwise, when we come to the wind-up speeches, they will be galloping, rather than being able to give noble Lords the answers they want.

Mental Health: Weight and Shape-related Bullying

Baroness Chisholm of Owlpen Excerpts

Monday 22nd July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is right that children exposed to persistent bullying risk experiencing these problems. This is related to the experience of face-to-face bullying, but exposure on social media can also cause the problem. That is why the Department for Education is providing over £2.8 million of funding between September 2016 and 2020 to four anti-bullying organisations—Internet Matters, the Diana Award, Anti-Bullying Alliance and the Anne Frank Trust—to support schools to tackle bullying. Of course, all schools must have in place an anti-bullying policy, which Ofsted regulates.

[Baroness Chisholm of Owlpen (Con)]

My Lords, we have already heard from noble Lords how important this problem is, but of course it is partly the responsibility of the Department of Health. I ask my noble friend whether we are also talking cross-departmentally. Surely schools have a role to play here, so are teachers being taught about the problems this can bring? Is DCMS being taught about online bullying, et cetera?

[Baroness Blackwood of North Oxford]

My noble friend is quite right. As I have already pointed out, DfE-funded anti-bullying work is ongoing. Work is also increasing to join up the provision for young people through the children and young people Green Paper, which will put in place early intervention provision to make sure that young people do not have to wait until they are ill before they can get support. This problem needs to be challenged right across government, which is why we have also brought in the online harms White Paper to make sure that social media companies play their part.

NHS Long-term Plan

Baroness Chisholm of Owlpen Excerpts

Monday 1st July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord raises two hugely significant issues, which probably deserve a full debate. On clinicians and NHS systems being prepared to respond most effectively to those facing terminal illness, and their families, we have improved but there is much more to do—not just for the health service but for us all as a society. We need to become more open and comfortable with discussing that; some work has been done but more is needed. On mental health services providing support for families as well as individuals, we are still some way from where we would like to be but it is recognised as something that needs to be done.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I want to ask my noble friend the Minister about GPs’ training in mental health. I think it has been acknowledged that when parents take their children to the GP, quite often that is for a physical ailment but it turns out that the child could have a mental problem. It is difficult for GPs to pick that up, perhaps partly because of a lack of training and partly because they have only 10 minutes to see the child.

[Baroness Blackwood of North Oxford]

My noble friend raises a hugely important issue. We are seeing an improvement in the quality of training for GPs; the RCGP has been playing an important role in this, especially in raising specialist areas such as perinatal mental healthcare through the champions that it spreads through its system. We are seeing the impact on the ground, with CCGs meeting the mental health investment standard and rolling out specific access waiting times, so it is having an impact. But there is always more to do and the royal colleges have a specific role to play in raising awareness and the quality of training.

Healthcare (International Arrangements) Bill

Baroness Chisholm of Owlpen Excerpts

Report stage (Hansard): House of Lords
Tuesday 12th March 2019 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I too support the amendments in the names of the noble Baroness, Lady Thornton, and my noble friend Lord Marks. I repeat the view that he and the noble and learned Lord, Lord Judge, expressed: we should be producing only legislation resulting from the decision to leave the EU. I thank the Minister very much for meeting us and for the government amendments—particularly to those Henry VIII clauses, which have absolutely no part in modern legislation.

I agree with previous noble Lords, but any Bill dealing with healthcare agreements outside the EU is different. I would be happy to look at these issues in another Bill at another time. As has just been said, the expansion in scope of the Bill looks opportunistic and is completely inappropriate at the moment.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I cannot agree with these amendments. As we pointed out during the progression of the Bill, we live in a global world, with more people travelling internationally for all kinds of reasons. There is obviously a huge demand for healthcare systems between countries, giving the traveller peace of mind that the foreign country they are in can respond to healthcare needs.

As was also mentioned, we already have simple reciprocal agreements with non-EU countries. The domestic implications are limited, and our current powers to charge domestic overseas visitors, and the regulations under such powers, provide for domestic implementation. Importantly—

[Lord Foulkes of Cumnock]

May I interrupt the noble Baroness?

--- Later in debate ---

[Baroness Chisholm of Owlpen]

No, let me finish. The Bill will not replace or limit the prerogative power to enter into international healthcare agreements. My understanding is that agreements will still be subject to appropriate parliamentary scrutiny.

It is surely right for us to take advantage of the Bill and look at the opportunities it can offer us. We are not trying to shoehorn something dastardly into it. It could offer all kinds of things. It seems to me that planning ahead is a refreshing thing to do. Many of the arguments raised have nothing to do with protecting or giving peace of mind to travellers. As a nurse, my main priority will always be those needing care. The Bill allows them reciprocal healthcare outside the EU and just that. Should there be a Division, I hope that noble Lords will keep in mind those people who, under the Bill, will be able to travel globally with renewed peace of mind about their healthcare.

[Lord Ribeiro (Con)]

My Lords, this is an enabling Bill and no more. In a letter to the chairman of the Delegated Powers and Regulatory Reform Committee on 8 March, the Minister confirmed that these powers would be used only in the exceptional circumstances of EU exit. We will discover the outcome of that tonight.

In these circumstances, the regulations’ implementing powers would be subject to parliamentary scrutiny. The assurances and clear message from our debates in Committee—when the Minister was very clear, in answer to a question from the noble Lord, Lord Brooke of Alverthorpe, that reciprocal healthcare arrangements with the United States would present significant challenges because of the different payment systems and such an arrangement was unlikely—should surely be enough to satisfy those who believe that the Government still have a cunning plan to sell the NHS to Donald Trump and others.

As I said in Committee, I believe that the implementation of our international arrangements should be phased, giving priority to our overseas territories, as has been noted; our Commonwealth partners, of which Australia and New Zealand have already been mentioned; and our important international partners, perhaps excluding Venezuela and the Galapagos Islands from that list, as suggested by the noble and learned Lord, Lord Judge.

Anything enabling this to happen should be considered seriously, given the risks of what I believe is likely to be a no-deal Brexit. I do not support these amendments and I hope that the Minister will be able to come up with suggestions for how this can be implemented to overcome some of the concerns expressed from the other side.