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Health and Care Bill

Volume 712: debated on Monday 25 April 2022

Consideration of Lords message

I must draw the House’s attention to the fact that financial privilege is engaged by Lords amendments 80, 80P and 80Q. If they are agreed to, I will cause the customary entry waiving Commons financial privilege to be entered in the Journal.

Clause 35

Report on assessing and meeting workforce needs

With this it will be convenient to consider the following:

Lords amendments 30B and 108B to words restored to the Bill, Government motion to disagree, and Government amendments (a) to (i) in lieu.

Lords amendment 48B in lieu, Government motion to disagree and Government amendment (a) in lieu.

Government motion to insist on disagreement with Lords amendment 80, insist on Commons amendments 80A to 80N in lieu, and disagree with Lords amendments 80P and 80Q.

The Lords amendments before the House today relate to the NHS workforce, reconfigurations, modern slavery and the adult social care cap. In respect of amendments 30B and 108B on reconfigurations, I am grateful for the constructive debate on these issue across both Houses. This House has twice voted strongly in favour of the ability for the Secretary of State to call in reconfiguration proposals when needed, and it remains a key principle that decisions on how services are delivered should be subject to ministerial oversight. However, my right hon. Friend the Secretary of State and I have listened carefully to the debates throughout the Bill’s passage, and as a result we have proposed a series of amendments to minimise bureaucracy and ensure transparency.

The first set of changes would mean that the NHS had to notify the Secretary of State only about those reconfiguration proposals that were deemed notifiable, which we will define through regulations. We intend to align that definition with the existing duty on NHS commissioners to consult local authorities where there is a substantial development of variation in the health service. We also propose to remove the requirement for commissioners and providers to inform Ministers of

“circumstances that are likely to result in the need for the reconfiguration of NHS services”.

Taken together, these changes will mean that the NHS will need to notify the Secretary of State only about proposals that are substantive and of great importance to people.

Secondly, we will give local authorities, NHS commissioners and anyone else the Secretary of State considers appropriate a right to make representations to the Secretary of State when he has called in a proposal for reconsideration. We expect this to include any relevant provider. The Secretary of State will be required to publish a summary of the representations he receives, and we will set out in statutory guidance further detail on how local bodies, including providers, will be engaged.

Thirdly, transparency is vital to ensure that these powers are always used by Ministers in the clear interest of the people we all serve. We will therefore require the Secretary of State to provide the reasons for his decisions and directions when he makes them. Finally, we have heard throughout these debates that it is vital that decisions are made expeditiously and expediently in order to give certainty to local bodies so that reconfigurations can be made quickly to improve the quality of services received by patients. We are therefore introducing a requirement that, once a reconfiguration proposal has been called in, the Secretary of State must make any decisions within six months. We believe that this set of changes addresses the key concerns raised in this House and the other place, and I commend it to the House.

I turn to Lords amendment 48B, and the Government’s amendment in lieu, on modern slavery. We share the strength of feeling expressed in both Houses on ensuring that the NHS is in no way inadvertently linked with modern slavery and human trafficking through its supply chain. That is why the Government brought forward an amendment in the first round of ping-pong to create a duty on the Secretary of State to undertake a thorough review of NHS supply chains. I am pleased to announce today that we are going further. The Government’s amendment in lieu of Lords amendment 48B will require the Secretary of State to make regulations with a view to eradicating the use by the NHS in England of goods or services tainted by slavery or human trafficking. The regulations can set out steps the NHS should be taking to assess the level of risk associated with individual suppliers, and the basis on which the NHS should exclude them from a tendering process.

I particularly commend my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith) for his consistent and vocal campaigning on this issue. I am delighted that he has confirmed his support for the amendment in lieu. I look forward to working further with him and his supporters to bring these measures forward.

I congratulate the Minister and the Department on taking this extraordinary step. The public may believe that we already do not use slave-made goods, but unfortunately we do. It is remarkable that the Department has taken this step, and it is incredibly important that we look at Xinjiang in particular, where Sir Geoffrey Nice QC determined there has been a genocide, as there was in Bosnia. The sanctioned MPs and all our colleagues in the inter-parliamentary alliance on China will work with the Department to ensure we have no Uyghur slave-made products in our NHS.

I paid tribute to my right hon. Friend the Member for Chingford and Woodford Green, but my hon. Friend the Member for Wealden (Ms Ghani) has also taken a keen interest in this issue. The Secretary of State and I will continue to work closely with others across Government to ensure that our measures to eradicate modern slavery in NHS supply chains are effective and targeted, and reflect best practice.

On Lords amendment 29B, the Government are committed to improving workforce planning and are already taking the steps needed to ensure that we have record numbers of staff working in the NHS. In July 2021, the Department commissioned Health Education England to work with partners on reviewing the long-term strategic trends for the health and regulated social care workforce over the next 15 years. We anticipate the publication of that work in the coming weeks.

If the right hon. Member for South West Surrey (Jeremy Hunt) were to pursue the matter, my party and I would be minded to support him. Although I understand from the figures in the press today that there are significant numbers of new nurses coming into the NHS, there is still a large shortfall. Will the Minister confirm for Hansard in the Chamber today that every step is being taken to recruit the nurses needed to address the issue of workforce safety?

The hon. Gentleman is right to highlight the work we are already doing, which I will address in a moment, and the number of nurses we have recruited. I believe we have now recruited 29,000 or so en route to our target of 50,000 more nurses by the end of this Parliament.

I will make a little progress, if I may—a few more paragraphs—as I am very conscious of allowing time for Back-Bench colleagues to speak.

Building on this work, we recently commissioned NHS England to develop a workforce strategy. We will set out the key conclusions of that work in due course. In addition, we have committed ourselves to merging Health Education England with NHS England to bring together responsibility for service, financial and workforce planning in one organisation. We will continue to grow and invest in the workforce. There are record numbers of staff, including nurses, working in the NHS.

I am grateful to the Minister for giving way. He will know of my interest as chair of the all-party parliamentary group on stroke, and he will be aware of the particular concern of the Stroke Association and others about the number of qualified therapists to provide the therapy people need after a stroke. Will he commit himself to that being part of the workforce strategy and to moving swiftly? This is already a pressing problem for stroke survivors who are not getting the care they need.

I reassure my hon. Friend that my right hon. Friend the Secretary of State has made it clear that he wishes the whole health and care workforce landscape to be considered by Health Education England.

The growth in our workforce comes on the back of our record investment in the NHS, which is helping to deliver our manifesto commitments, as I said to the hon. Member for Strangford (Jim Shannon), including our commitment to 50,000 more nurses by the end of the Parliament. The spending review settlement will also underpin funding for the biggest ever intake of undergraduate medical students and nurses.

Although I might not be able to say anything sufficient to fully convince my right hon. Friend the Member for South West Surrey (Jeremy Hunt), I put on record my gratitude to him not only for the insight, expertise and knowledge he has brought to our debates on this issue but for the typical courtesy he has displayed throughout our interactions and conversations. I do not know what he will say in a moment, but I have tried to pre-empt him. I hope that he may be tempted to stick with it.

I hope that the House will recognise that the Government are already doing substantial work to improve workforce planning, and that placing a requirement such as Lords amendment 29B on the statute book is therefore unnecessary.

I thank the Minister for giving way. More than 100 organisations, including the Royal College of General Practitioners and the British Medical Association, have expressed their support for Lords amendment 29B. Does he agree that the only way to ensure that we recruit and retain the talented staff that our NHS and social care sector desperately need is through a long-term workforce plan in consultation with the experts in the field, such as health and care employers, unions and integrated care boards?

That is exactly what we are doing through the work commissioned by my right hon. Friend the Secretary of State, which is why Lords amendment 29B is unnecessary.

I fear that I cannot, but my hon. Friend may catch me during my winding-up speech. I want to make progress, as about 10 Back-Bench colleagues wish to speak.

Finally, on the adult social care cap, the Government have announced our plan for a sustainable social care system. It is fair, affordable and designed to end the pain of unpredictable care costs by capping the amount anyone needs to pay at £86,000. Without clause 140 there would be a fundamental unfairness: two people living in different parts of the country, contributing the same amount, would progress towards the cap at different rates based on differences in the amount their local authority is paying. We are committed to levelling up and must ensure that people in different parts of the country are benefiting to the same extent, and our provisions support this. Amendments 80A to 80N also make crucial changes to support the operation of charging reform, as these changes were lost by the removal of clause 140 in the other place.

Lords amendments 80P and 80Q insert a regulation-making power to amend how

“costs accrued in meeting eligible needs”

is determined in section 15 of the Care Act 2014. However, if regulations were made using this power, they would result in anyone entering the care system under the age of 40 receiving free personal care up to that age. As local authority contributions would count towards the cap under these changes, a 35-year-old with average care costs would reach the cap and not have to pay anything towards the cost of their care, yet a person who enters care the day after their 40th birthday would need to contribute towards the £86,000 cap over their lifetime. We believe this is unfair. Our plan already includes a more generous means test that means more people will be eligible for state support towards the cost of care earlier, enabling them to keep more of their income.

The changes introduced in the other place also threaten the affordability of our reforms. Lords amendments 80, 80P and 80Q would clearly affect financial arrangements to be made by this House and, as such, have financial privilege. These new Lords amendments would cost the taxpayer more than £1 billion a year by 2027-28. Ultimately, this would mean we need to make the same level of savings elsewhere, making the system less generous for other users. I hope I have been able to provide some reassurance that we believe our approach is still the right one, and I ask the House to disagree with the other place’s amendments.

Finally, I put on record my gratitude to my hon. Friend the Member for Aberconwy (Robin Millar) and the noble Baroness Morgan of Cotes for their constructive and positive engagement during the Bill’s passage on ways to strengthen co-operation between the UK Government, the UK Statistics Authority, the Office for National Statistics and the devolved Administrations, and for their passion for strengthening the Union. I am pleased we are taking forward that work, albeit outside this Bill. I am stimulated by their important work.

We have sought throughout the passage of the Bill to be pragmatic and to listen to this House and the other place in either accepting their amendments or addressing them in lieu. I hope the House recognises that this approach continues to characterise our work, save where we sadly cannot agree with the other place in respect of its amendments on both the workforce and social care caps.

The problem we have is that this debate has to finish at 7.55 pm. This means that, after the shadow Minister has spoken, I will have to impose a time limit to get in a lot of Back Benchers. The time limit will start at four minutes.

I call the shadow Minister, Karin Smyth.

Thank you, Madam Deputy Speaker. This Bill has been significantly improved. It delivers changes to the 2012 legalisation the NHS called for. Some other issues have been addressed by ministerial assurances and many valuable new clauses have been added. I am pleased that much of what we argued for in the six weeks of the Bill Committee has finally been accepted. On two issues—the Secretary of State’s powers on reconfiguration, and procurement and modern slavery—the Lords have wrestled important concessions that we support. As a former senior NHS manager, I know that reconfiguration is necessary, important and often difficult; it is often wrongly associated purely with cuts and taking something away. We are interested in improving outcomes for people, and that sometimes requires difficult change. For two decades, a comprehensive process has existed, which includes local people, is informed by expert assessments and operates pretty well. Throughout Committee, and during numerous debates, I have heard no sound argument to change it, but the Government seemed hellbent on doing so, and it is only at the eleventh hour that they have finally agreed to some changes.

If I listened to the Minister correctly, he says that now the NHS will have to notify the Secretary of State when there is something notifiable. That is going to be as clear as mud for everybody, isn’t it? We look forward to the regulations. The point is that the Government’s initial plan inhibits improvement. If NHS managers and, in particular, clinical leaders know that the Secretary of State is hovering, they will be less likely to promote changes that may be clinically necessary but politically difficult. It appears now that the Secretary of State finally agrees and does not want this big pile on his desk, and although the amendment is far from perfect, it does enough for now. On the procurement issue, I commend the work of many people from across both these Houses and the excellent case that has been put forward. Labour has been pushing for measures such as these for many months, and I think the intentions of the Government appear to be aligned to a shared view of what is required.

However, there remain two substantial issues, workforce and the care cap, where I hope the Government, even at this late hour, will listen to reason. Many experts have spoken, and many ideas, alternatives and suggestions have been put forward, but we have had very little engagement from the Government. On these two matters, we speak for the stakeholders, experts and Members from all parties, who are united in opposing the Government’s proposals. Workforce planning is a huge issue in its own right, but it is also fundamental and cuts through everything we are talking about on health and social care. Chiefly, the problem is that unless we face up to the scale of the workforce challenge, the Government will not deliver the shorter waiting times that patients need. Until this Government break out of their straitjacket—unless somebody can make the Chancellor see reason—nothing is going to change for all our constituents. The Government should start today—otherwise patients will be left wondering why they are paying more and more in taxes but waiting longer for care.

Time precludes my repeating all the arguments. I could simply repeat what the Chair of the Select Committee said last time or I could offer the wise words of the previous chief executive of the NHS and more—who can add to the variety and strength of the evidence? The logic of this approach escapes me. Every MP knows that our family, friends and constituents are now in a cycle of long waits in pain and discomfort, with worry. All that is asked for in this Lords amendment is a proper report that sets out the system to address the likely staffing requirements—that is so obviously necessary. If this amendment falls, we, as legislators, have failed. If the Secretary of State will not show leadership, NHS England must step up and produce its own requirements and projections. Additionally, the Local Government Association could commission work across the country, in every local authority, on the needs for social care and public health staff. I suggest that every MP asks their own integrated care system and local authority what workforce requirements and projections they have, and how credible these plans are. Unless we do that, how can anyone have confidence in the delivery for the people we are elected to represent?

Finally, we come to the proposed changes to the care cap calculations. Those were snuck in at the last moment and were not subject to any scrutiny in our six weeks in the Bill Committee. They have not been discussed in any detail at all. The proposals are a less generous version of what was in the Care Act 2014 and this is a massive step backwards. Once again, I could read out a ring binder full of analysis and evidence provided by the legion of stakeholders, none of it complimentary. We hear the repeated claim, “This solves the problem of social care. It is fixed.” It simply is not. Let us leave aside the deeply insulting attitude that the care and support of people in need, who could live better more fulfilled lives, is a “problem” to solve; we should be celebrating the fact that people can live better, for many years longer, with multiple conditions, with decent support and care. We all know that to be true.

The proposals the Government have put forward do not deliver any more care; they just change who pays for it. Money will go to those with assets, and the less you have, the more they will take. The proposals will have no real impact for years, but we all know that people need help now. They will not improve the quality of care by anything like what is needed and will not stop those 15-minute visits. The proposals do nothing to assist working-age adults who have a disability. They do not stabilise the collapsing market for care home place provision. They do not shorten any wait for care or reduce any waiting list. They will have no impact on improving access to care for hundreds of thousands of people currently excluded. They do not address the issues around a care workforce with many vacancies and poor terms and conditions. They do nothing to address the catastrophe of the past decade of cuts to local government. This is not a solution to social care. This ill-thought-out idea should not have been pasted into the Bill. Some more informed Conservative Members have also recognised the unfair impact on the poorest, especially those in parts of the north; levelling up this certainly is not.

To respect the views of the countless stakeholders who oppose this measure, we have surely to try to find a way forward. Someone sensible in the Department of Health and Social Care has decided that changes of this impact and complexity should be subject to a proper pilot; there are to be “trailblazers”. We do not know much about them, but I believe we have assurances from Ministers in the other place that everything will be considered and the results will be made known. Will the Minister assure us that the evaluation of the trailblazers will be published and the impact assessments updated so that this hugely important policy change can be properly considered by Parliament? What on earth will be lost by allowing the evidence to inform the policy? What we are voting on tonight is simply that:

“The regulations may not be made unless—

(a) the results of the Trailblazer pilot schemes have been evaluated, and the Secretary of State has laid that evaluation before Parliament, and

(b) the Secretary of State has completed a further general impact assessment covering distributional regional analysis”.

We all think we know what that looks like, but we would like to see the details.

In conclusion, my colleagues and I will be supporting the Lords amendments on workforce and the care cap. The time for politics is over; we just need common sense and the will to listen and look objectively at the evidence to find a way forward for the good of everyone.

Thank you, Madam Deputy Speaker. I rise to speak in support of Lords amendment 29B. Even though I believe the Government will reject it today and this may be the last time this House can debate it, I will try to make my comments with the customary courtesy that the Minister for Health attributed to me just now, with his customary courtesy. He said that this amendment was unnecessary, but I wish to ask the House: what precisely is unnecessary about an amendment that simply requires independent, regular estimates of the numbers of doctors and nurses we should be training? What could drive the Government to want to vote down such a harmless amendment, not once, not twice, but, including today, three times? I will tell the House why the Government are going to vote this amendment down. They will do so because they know that any such independent estimate would conclude that we need to be training more doctors and nurses. Why on earth would we not want to train more doctors and nurses, if we looked objectively at the challenges facing the NHS today? We last debated this on the day the Ockenden report was published in Parliament. That report talked about more than 200 babies’ lives that would probably have been saved with better care. The key recommendation in that report was for 2,000 more midwives and 500 more obstetricians, and that would not have been necessary had this amendment been in place. We can put this right.

I immensely respect the work done by the Minister for Health and the Secretary of State, and I am grateful for their engagement, but I say to them, from the bottom of my heart, that not training enough doctors and nurses is a false economy. It costs patients’ lives, it costs taxpayers’ money, it demoralises the workforce and it lets down the people who are waiting for their NHS operation. The Health Minister’s argument is that we will have 50,000 more nurses by the end of this Parliament and we are training more doctors than ever, but today’s report by the King’s Fund shows that that is a hollow claim, because even though we are on track for our 50,000 nurses, the number of vacancies is still not going down. In other words, more nurses does not mean enough nurses, and we can never know what enough is unless we are honest enough to ask ourselves the hard questions.

The lesson of Mid Staffs, Morecambe Bay, Southern Health and Telford is that the first step in dealing with poor care is to be honest about the issue. We now have in the NHS a workforce issue of enormous proportions, which is why Lords amendment 29 is supported by every NHS leader, every royal college, every health think-tank, every union and more than 100 NHS organisations in total. I am afraid that, by voting down a simple request for independent estimates of the number of doctors and nurses we should be training, the Government are actively choosing to sweep the problem under the carpet. I say to Ministers, who have listened to my arguments genuinely and in good faith, that NHS and care staff deserve better after two years of the pandemic, and the people waiting for their NHS operations deserve better, too.

I will be brief, Madam Deputy Speaker.

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

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

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

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

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

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

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

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

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

“the Government disagreed with the numbers”


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

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

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

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

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

I will speak briefly to Government amendment 48A, which is in lieu of amendment 48B. Essentially, it requires the health service to ensure that it does not use products made under forced or slave labour anywhere in the world. That is a big statement by the Health Department, and one that I think we all welcome—I have certainly campaigned on this issue for some time.

In the great sweep of this health legislation, on which there are agreements and disagreements across the board, that may not seem to be something that will directly affect our lives, but in truth it will resonate beyond our shores. It is already resonating among the Uyghur, who have found themselves under distinct pressure, with husbands often separated from wives and families broken apart for forced labour thousands of miles away from their homes. This measure will speak to them; it is, in a way, a sign that Governments in the free world are taking up this real cause and recognising that it is intolerable for us to turn a blind eye and buy equipment, clothing and so on simply because it is cheaper and helps our cost balance. I do not believe that it will in the end; the trade-off between cost and the human rights of those who have suffered so much under the heel of those totalitarian states is an abysmal one.

Child labour is used in rare-earth mines; when we use those rare-earth materials for the manufacture of our computers, we turn a blind eye to it. When slave labour is used in the Xinjiang region to produce the cotton and the cloth for our personal protective equipment, making it quicker and easier to get, we turn a blind eye to it. It is not just done there; it is done in many countries around the world because it is easier and cheaper, and we tolerate it. I therefore welcome that my right hon. Friend the Secretary of State and the Ministers have tabled the amendment. It will speak volumes to those who are oppressed. It will say to them, “The free world has not forgotten you.” I am certain that in due course the rest of this Government will do the same, and other Governments will then follow suit. I congratulate us for making the right decision.

I will speak to the workforce amendment and the amendment on the social care cap.

The Lords have compromised on the workforce amendment—they have now asked for projections every three years instead of every two, and they no longer require independent verification of the projections—so it is deeply disappointing that the Government have not moved to meet them halfway, especially when outside the Government there is so much cross-party consensus that the amendment is badly needed. I know from my constituency of St Albans, as I am sure many Members know from theirs, that our NHS and care staff are burnt out. They are understaffed and overworked. Those people, who continue to turn up every single day, need to know that the cavalry is coming, and without this workforce amendment, they simply will not.

There have been worrying reports that NHS trusts have been silenced when they have tried to talk about the numbers of staff that they need to recruit, so will the Minister address this question in his response: if the Government will not produce workforce planning numbers, will they at least commit to not interfere with or silence any part of the NHS or care sector that decides that it wants to produce its own workforce projections? I look forward to hearing the Minister’s assurances on that point.

When it comes to the social care cap, Ministers have stated time and again that their changes would save the Treasury £900 million a year by 2027-28, but that saving comes at the expense of people with fewer assets and savings, including those who will have been paying five years of increased national insurance contributions, which were put in place partly to fund these care reforms. The Government continue to say that that improves on the current situation, but they conveniently ignore that it is much worse than their original proposal. The social care cap provision does nothing to generate more care; it does nothing to give protections to unpaid carers, who are often on lower incomes but save the Government millions of pounds; and it does nothing to help the social care workforce. I know from my constituency that hospitality, the NHS and social care are all fighting for the same people, and nothing in the Bill will help to improve that situation.

I am grateful to have a few minutes to say a few words on the cap on care costs and on workforce planning.

With regard to the care cap, it is important to congratulate the Government on tackling a problem—or attempting to defuse a ticking time bomb—that all their predecessors shied away from. However, there is concern that the proposals are a rushed tag-on to a Bill that was designed for a different purpose: the integration of health and social care and the setting up of integrated care systems. I accept that there is a clear correlation, but the legislation that addresses the problem of people being forced to sell their homes to pay for their care should have been considered and scrutinised separately and carefully, with the objective of putting in place a system that has political consensus and will stand the test of time. That is what the Dilnot proposals and the Care Act 2014 achieved, and they should be the foundation stone on which we build this new system.

My concerns are twofold. First, clause 140 is extremely unfair to those with limited assets and modest incomes. The changes may save the Government hundreds of millions of pounds, but they do so at the expense of those on low incomes and those who live in parts of the country where house values are lower, such as Lowestoft in my constituency. Secondly, there is a worry that working-age adults with disabilities will be unfairly penalised, hence the introduction by the other place of a provision to address it. I acknowledge the Government’s worries about the cost implication of that additional provision, but that iniquity needs to be addressed.

On workforce planning, there is a staffing crisis both in the NHS, where there are 110,000 full-time equivalent vacancies, and in social care, where there are another 100,000 vacancies, high staff turnover and very limited respite for unpaid and family carers. Those deficiencies cascade through the health and care system, creating bed-blocking in hospitals and impeding the efforts made to reduce waiting lists. There is an urgent need for strategic planning to address this crisis. There is concern that framework 15 is not working because of inadequacies in the collection of data, lack of assessment of workforce numbers, and unresponsiveness to societal shifts.

Since we last considered the issue last month, the other place has sought to address the Government’s concerns and, as we have heard, has made reasonable concessions. There is a crisis that must be addressed, and I hope that at this very late stage the Government will accept this reasonable amendment, so that we can get on with this much-needed work.

Amendment 29B goes much further than the Bill’s current provisions on workforce reporting, which are extremely weak. It would require the Government, at least once every three years, to lay a report before Parliament describing the system in place for assessing and meeting the workforce needs of health, social care, and public health services in England. What could be more reasonable? One has to wonder why the Government do not support amendment 29B. Surely any Government who were committed to running the NHS as a public service would see these provisions as crucial.

The Royal College of Physicians has pointed out that clause 35

“will not set out how many health and social care staff are needed to meet demand”

and has stated that, without long-term projections, which amendment 29B would provide, there is no way to assess how changes in workforce trends, such as retirements or working part time, will impact the delivery of healthcare. The Royal College of General Practitioners has spoken of unsustainable pressures driving GPs out of the workforce and threatening to destabilise general practice.

Just a few weeks ago, the Royal College of Nursing said that nursing staff are exhausted and that staff shortages are undermining their efforts to give safe and effective care—a sentiment reflected by a nurse I met on bank holiday Monday. That is hugely concerning. As the RCN has said, there is a clear evidence base showing that staffing levels have a direct impact on the safety and quality of patient care. When I met members of the RCN last year, they made clear to me the increased stress levels that nurses are experiencing as a result of staff shortages and the impact that is having on the care they so desperately want to deliver.

According to the Health Foundation:

“In the next 25 years, the number of people older than 85 will double to 2.6 million”

in England, so demand for social care is increasing and we need to know that there will be enough doctors, nurses and social care workers to meet people’s needs. The “Strength in Numbers” campaign, a coalition of more than 100 health and care organisations, says that we must put

“measures to adopt a sustainable long-term approach to workforce planning on a statutory footing.”

Without credible, up-to-date numbers, the system cannot plan.

I support Lords amendment 29B. I urge the Government to think about those NHS staff who are working so hard and are so stretched by the amount of stress they are under because they do not have enough colleagues around them, and to listen to the clinicians who are calling on the Government in this regard.

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests as a practising NHS doctor. I welcome the Government’s concessions on modern slavery and procurement and on the reconfiguration of NHS services. However, I remain concerned about two issues: the care cap and independence in the staffing assessment process.

To touch briefly on the issue of the care cap, a number of years ago I took through this House the Care Act 2014, as a Minister in the coalition Government. We based that Act and the care cap on the Dilnot proposals. I continue to be concerned that the current proposals deviate from the Dilnot proposals, in that those with lower or more moderate net assets will be asked to pay disproportionately more than those with greater assets. That is something I find very difficult to accept. It deviates from the principles of the 2014 Act and the Dilnot proposals, and I hope that even at this late hour the Government will reconsider their position on it.

I rise in particular to speak in support of Lords amendment 29B and the comments by my right hon. Friend the Member for South West Surrey (Jeremy Hunt). It is undoubtedly the case that we cannot have safe staffing in the NHS if we do not have the right number of staff. We cannot meet the increasingly complex care needs of patients with not just one, two or three but sometimes four comorbid conditions if we do not have staff with the right skills and in the right numbers to meet those care needs.

We talk often of building new hospitals and of our programme of capital investment in hospitals, but unless we have the right numbers to staff those hospitals, we will not be able to deliver safe care. In every constituency represented in this Chamber, we recognise that there are staff shortages in the local NHS. We recognise particular challenges in the medical workforce among fully qualified GPs—over the past seven years the number of full-time equivalent GPs has fallen. We recognise challenges in the midwifery workforce, which were brought tragically to our attention by the Ockenden report, and we recognise challenges in areas such as intensive care and paediatrics and throughout the health service.

The problem with health workforce planning is that Governments see the NHS in electoral cycles, but workforce is much more complicated than that. From starting medical school to becoming a consultant it takes perhaps 15 years, and to become a fully qualified GP takes about 10 or 11 years. It is important that we have a genuine independence to the process of workforce planning. I have great faith in Health Education England and I am sure it will produce a good report and assessment, but unfortunately it will be doing so with one hand tied behind its back, because it must do so within the confines of the financial envelope in which it is working, and it lacks the genuine independence to say what the NHS really needs.

If we care about patients and about the future of the NHS and its needs, true independence in a report on workforce is required. That is in the best interests of patients, of the health and care workforce and of the future of our health service. I hope the Minister will reconsider.

When I spoke on workforce issues on this Bill last time, I said I was prepared to support the Government’s position on the basis of what the Minister and the Secretary of State had said. The Whips do not need to worry too much, because that remains the case, but I feel a huge amount of sympathy for my right hon. Friend the Member for South West Surrey (Jeremy Hunt) and Lords amendment 29B. Fundamentally, if the Government are not prepared to accept what the House of Lords has proposed, they are making their relationship with NHS staff and those associated with the NHS somewhat more difficult.

I ask the Minister to ensure that he doubles down on the commitment he made previously to engage relentlessly, publicly and as extensively as possible with that workforce. If the Government do not do that, there will never be that sense that the cavalry is coming over the hill.

When my right hon. Friend the Member for South West Surrey was Secretary of State, we established a new medical school in Lincoln—a huge achievement of his, and one I continue to try to take as much credit for as possible. However, saying to doctors in my local constituency, who are working so hard at the Pilgrim Hospital in Boston and in Skegness, that we are recruiting more people locally who will be able to make a difference is a challenge, because they do not yet see it on the wards. Part of that, as has been said, is because it takes such a long time to train people and bring them to fruition.

A number of us have been successfully lobbied by the Royal College of Nursing in our own constituencies, showing us the figures—a shortage of 250 nurses in our A&E at the hospital in Gloucester—and staff surveys showing that morale is not where it should be. Does he agree that those things are influencing why some of us are not happy with the Government’s position?

I agree that the Government need to continue to address that issue in the way I have described, through more extensive engagement to try to demonstrate some of what is happening.

That brings me to my second point—I will try to stick to the original time limit—which is that these issues are about trust. We need trust with the NHS workforce. As my right hon. Friend the Member for West Suffolk (Matt Hancock) said, with reconfiguration it is very often the case, as it is in my constituency, that even though the data says we will save lives by moving a service from Boston to Lincoln or vice versa, we need to engage with local communities, because right now they simply do not believe that a service that is further away may yet save lives. That does not ring true, and often the data is not yet there.

I simply appeal to my hon. Friend the Minister to deliver on what he said at the Dispatch Box about engaging with the profession, because that is essential to try to improve the morale that the pandemic has damaged so much. I also appeal to him to ensure that local NHS organisations engage with local people, because only that will win public support for the reconfiguration that is so essential for our NHS both locally and nationally.

With the leave of the House, I would like to thank right hon. and hon. Members who have spoken in this debate. I am grateful to the shadow Minister, the hon. Member for Bristol South (Karin Smyth), and indeed to the hon. Member for Ellesmere Port and Neston (Justin Madders), with whom we spent many happy hours over many weeks in Bill Committee.

I also put on record my gratitude to the amazing Bill team in the Department, with whom it has been a pleasure and a privilege to work on this piece of legislation. They have done an amazing job.

I thank my right hon. Friend the Member for West Suffolk (Matt Hancock), under whose leadership we saw the genesis of this Bill, and whom it was a pleasure to work with and work for over a long period of time.

On reconfigurations, and on tackling modern slavery and supply chains, I hope and believe that these measures attract support across the House, and therefore will not reprise the case for them here.

In respect of workforce planning, I join my hon. Friend the Member for Boston and Skegness (Matt Warman) and many others who have spoken in highlighting our gratitude to the NHS workforce and our recognition of the pressures they have faced, particularly over the past two to two and a half years, but also more broadly. That is why we have not only put in place the measures I outlined to deliver an assessment through Health Education England of the needs of the workforce and the framework for growing it, but rather than waiting for that, already put in place measures to continue to significantly increase the workforce.

When I visit the elective orthopaedics team at Royal Hampshire County Hospital in Winchester later this week, I suspect that they will not tell me that the workforce is not one of the things on their worry list, so it is regrettable that the Government cannot accept amendment 29B. They are obviously going to get their way and win the vote, but will the Minister and his team reflect on the argument that has been had between the two Houses over the past year and, in that spirit, take this issue forward? It is not going away, I need to have an answer for the team on Friday, and what I am hearing right now is not going to satisfy them.

I hope I can reassure my hon. Friend that I always reflect carefully not just on what he says and what my right hon. Friend the Member for South West Surrey (Jeremy Hunt) says, but on what the other place, and other hon. and right hon. Members on either side of this House, say.

I hope I have provided the majority of colleagues with sufficient reassurance about the steps the Government are already taking and our commitment to ensuring that we have the right number of people working in the NHS, coupled with the increases in staffing that we have already delivered and continue to deliver. I hope that the House will again agree that the substantial work already being undertaken by the Government to improve workforce planning is leading to the improvements we all seek, and I therefore urge hon. Members to reject their lordships’ amendment.

We also ask that amendments 80, 80P and 80Q are rejected and amendments 80A to 80N are accepted in lieu. The cap on care costs clause is key to this Government ending unpredictable care costs for everyone by introducing a universal £86,000 cap. That must stand part of the Bill, alongside the necessary further amendments 80A to 80N, and we encourage hon. Members to back us on this.

This Bill is an important step forward in evolving our health and care system to meet future needs, and it comes from a Government who are clear in both their record and their future plans in their support for our NHS. I hope that the other place will heed the large majorities with which this House has already sent these measures back to it, and I hope that we will do so again this evening. We always listen to the other place, but we believe that this House has, on multiple occasions and hopefully again this evening, expressed a clear view of our position on these matters.

Question put, That this House disagrees with Lords amendment 29B in lieu.

Lords amendment 29B in lieu disagreed to.

More than one hour having elapsed since the commencement of proceedings on the Lords message, the proceedings were interrupted (Programme Order, 30 March).

The Deputy Speaker put forthwith the Questions necessary for the disposal of the business to be concluded at that time (Standing Order No. 83G).


That this House disagrees with Lords amendments 30B and 108B to the words restored to the Bill, and agrees to Government amendments (a) to (i) in lieu.—(Edward Argar.)


That this House disagrees with Lords amendment 48B in lieu and agrees Government amendment (a) in lieu.—(Edward Argar.)

Motion made, and Question put,

That this House insists on its disagreement with Lords amendment 80, insists on Commons amendments 80A to 80N in lieu, and disagrees with Lords amendments 80P and 80Q.—(Edward Argar.)

Motion made, and Question put forthwith (Standing Order No. 83H(2)), That a Committee be appointed to draw up Reasons to be assigned to the Lords for disagreeing to their amendment 29B and for insisting on disagreement to Lords amendment 80, for insisting on amendments 80A to 80N in lieu and for disagreeing to Lords amendments 80P and 80Q;

That Edward Argar, Michael Tomlinson, Saqib Bhatti, Gareth Davies, Karin Smyth, Chris Elmore and Martyn Day be members of the Committee;

That Edward Argar be the Chair of the Committee;

That three be the quorum of the Committee.

That the Committee do withdraw immediately.—(Miss Dines.)

Question agreed to.

Committee to withdraw immediately; reasons to be reported and communicated to the Lords.

Business of the House (Today)


That, at today’s sitting, the Speaker shall put the Questions necessary to dispose of proceedings on—

(1) the motion in the name of the Prime Minister relating to the Chair of the United Kingdom Statistics Authority not later than one hour after the commencement of proceedings on that motion;

(2) the motion in the name of Secretary Nadhim Zahawi relating to the Higher Education (Freedom of Speech) Bill (Carry-over) not later than one and a half hours after the commencement of proceedings on that motion;

(3) the motion in the name of Secretary George Eustice relating to the Animal Welfare (Kept Animals) Bill (Carry-over) not later than one and a half hours after the commencement of proceedings on that motion;

(4) the motion in the name of Secretary Grant Shapps relating to the High Speed Rail (Crewe-Manchester) Bill not later than one and a half hours after the commencement of proceedings on that motion; and such questions shall include the questions on any amendments selected by the Speaker which may then be moved; proceedings may continue, though opposed, after the moment of interruption; and Standing Order No. 41A (Deferred divisions) shall not apply.—(Mark Spencer.)