Health and Care Bill — House of Lords, 2022-01-11
Topic: Government Operations
Dorothea Glenys Thornton (Labour, Centre-left): My Lords, I move Amendment 1 and speak to Amendment 313 in my name, but I shall allow those noble Lords to leave who do not particularly wish to hear my peroration this afternoon It is a pleasure to open proceedings in Committee on the Bill. These amendments concern the need to publish an impact assessment, a matter with which your Lordships’ House is very familiar. I expect that the Minister will now tell us that the Government have now delivered on this amendment because—guess what?—first thing this morning, into our inboxes popped an impact assessment, so I of course claim that as my first victory. We need to find out whether this impact assessment is actually any better than the ones that have gone before and whether it fulfils the requirements in both the amendments, and I confess I have not had time to read it yet, but I commend it to your Lordships’ House. The real issue is that the Government’s lack of serious and realistic impact assessments is symbolic of the lackadaisical manner that this Government take to Parliament and the legislative process, which is why I intend to take this opportunity to make a few general points for context on themes which I expect will recur throughout deliberations on the Bill We have received a highly critical report from the Delegated Powers and Regulatory Reform Committee and, more recently, a report from the Select Committee on the Constitution. In the words of the Delegated Powers Committee, the DHSC is again introducing a Bill which "falls so short of the standards which the Committee — and Parliament — are entitled to expect." The Bill lamentably fails to address the recommendations set out in the Cabinet Office’s Guide to Making Legislation, and the Constitution Committee agrees with that assessment. It says: "We regret that the powers under this … complex bill are structured in a way that hampers greater detailed parliamentary scrutiny, and note that the Bill … was not subject to pre-legislative scrutiny", from which it would have undoubtedly benefited. The Delegated Powers Committee further says: "The Health and Care Bill is a clear and disturbing illustration of how much disguised legislation a Bill can contain and offends against the democratic principles of parliamentary scrutiny." These are serious charges, and ones which tell of the nature of the task before the House in the next few weeks. The Bill allows 21 affirmative regulations and 42 negative. It provides for Orders in Council, schemes, rules, licence conditions, 46 directions, and makes 17 references to guidance and one to publishing the document. Of the 156 delegated powers, more than half are subject to no parliamentary procedure. I urge noble Lords to read and reflect on both those reports and allow their concerns to govern the process that we have before us over the next few weeks. Our job, surely, is to put some flesh on this skeleton framework Bill. We need to test the Bill with these reports, and the splendid, if concerning, document Democracy Denied? On that theme, we on these Benches are concerned about how the Bill centralises powers, with the system being effectively top-down, managed by the new, improved NHS England—for example, with powers to appoint and dismiss key staff without any kind of democratic oversight. On top of that, we have a power grab by the Secretary of State that has drawn widespread opposition At Second Reading, and previously in the Commons, views have been expressed about the Bill: how it fails to address the main issues facing the care system and that it risks disruption in the NHS at a time when attention should be elsewhere as we struggle against Covid, which continues Of additional concern, we are told to expect two vital streams of information of great relevance: a White Paper on integration and further announcements on changes to social care. It would help to know when these will be available. Is it sensible to proceed without them It is welcome that the implementation date has been pushed back and that we have more time to undertake effective scrutiny of the Bill. Our position is clear. We support the parts of the Bill that come directly from the long-standing requests from the leadership of the NHS to remove the worst aspects of the previous 2012 Act. We have already made the point that we warned about the consequences of that Act and, in general, we welcome a return to principles of collaboration and co-operation Our aim will be to ensure that the NHS’s desired outcome is achieved with appropriate safeguards against unintended consequences such as a rise in private sector involvement or an increase in the power of vested interests over those of patients, but we will do so in a way that minimises any disruption It would of course have been far simpler to have a Bill just reversing the previous Act, which should have been introduced years ago as soon as the negative impacts had been properly recognised. Such a Bill would have passed much more easily, but we are where we are It would not be too harsh to say that the Bill has become a bit of a mess and we are here to do our best to get the legislation into shape. So far, there is evidence of a lot of agreement on the major issues with three or four glaring exceptions which we hope we will be able to resolve perhaps between the end of Committee and Report. Our challenge is how valid concerns are dealt with and how much the House is prepared to leave to ministerial assurances of good intent—as it always has been The amendment regarding implementation sets out concerns about the extent of any disruption to an already hard-pressed care system. Cynics say, and the evidence tends to confirm, that reorganisations rarely achieve anything much other than disruption and unintended consequences, and this is an NHS reorganisation Bill above all else. It is to be hoped that ending compulsory competitive tendering, putting the integrated care bodies on to a stronger statutory footing and consolidating the top level of the NHS can be done with limited impact It should be mentioned that many aspects of the changes are either already implemented or will go ahead even before the legislation is passed. The NHS has got into the habit of ignoring the legal niceties in recent years to get round the problems created by the 2012 legislation, and I am not sure whether it should be congratulated on that or not. However, it should be a fundamental part of our scrutiny that we have a full and comprehensive impact assessment with all the assumptions and expectations spelled out. I am not sure whether this document fulfils that; we may return to it later in the Bill The previous impact assessment was very poor and incomplete. Our amendment points this out and suggests that, with a system as fragile and complex as the NHS, there ought to be a reasonable period for assessing the impact and planning accordingly. This is not intended as a delaying tactic. If the alleged impact assessment that we have so far had been a great deal better, the need would not be so strong. Delay will not help the NHS but neither will a bad Bill. Let us remember that aspects of the previous Act were still being argued about years after it had passed Others are also intending to contribute on the general point about the need for some assessment of impact, perhaps through a review or through a parliamentary process such as a sunset clause. We will support those too. I beg to move.