Clause 138 - Commencement

Health and Care Bill – in the House of Commons at 6:00 pm on 23rd November 2021.

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Votes in this debate

Amendments made: 129, page 118, line 4, at end insert—

“(1A) Section (Pharmaceutical services: remuneration in respect of vaccines etc)(2) comes into force on such day as the Welsh Ministers may by regulations appoint.”

This amendment gives the Welsh Ministers a regulation-making power to bring into force subsection (2) of NC62.

Amendment 130, page 118, line 7, after “(1)” insert “, (1A)”.

This is consequential on Amendment 129.

Amendment 131, page 118, line 9, after “appointed” insert

“under subsection (1A) or (3)”.

This is consequential on Amendment 129.

Amendment 132, page 118, line 11, at end insert—

“(5A) The Welsh Ministers may by regulations make transitional or saving provision in connection with the coming into force of section (Pharmaceutical services: remuneration in respect of vaccines etc)(2).”

This amendment confers power on the Welsh Minsters to make transitional provision in connection with a provision that they have power to bring into force.

Amendment 133, page 118, line 12, after “(5)” insert “or (5A)”.—(Edward Argar.)

This is consequential on Amendment 132.

Third Reading

Photo of Sajid Javid Sajid Javid Secretary of State for Health and Social Care 6:29 pm, 23rd November 2021

I beg to move, That the Bill be now read the Third time.

For years, colleagues in health and social care have worked hard and as one to deliver for the benefit of their patients, but their ambition has not always been matched by the structures they have had to work with. This Bill provides the framework in legislation to help them to achieve just that.

We are not only recovering from the pandemic but learning from it, and the principles that underpin the Bill—embedding integration, cutting bureaucracy, boosting accountability—have never been more important. I am hugely encouraged by the support that the Bill has received from so many quarters, from the NHS Confederation to the King’s Fund, the Health Committee and even those on the Opposition Front Bench.

Photo of Margaret Greenwood Margaret Greenwood Labour, Wirral West

Will the Secretary of State comment on the discharge-to-assess proposals? I am concerned, because his Department told me that a report about how the process goes was meant to be published in autumn. His Department told me back in May that 4 million people have been discharged under discharge to assess—that is, having their care needs assessed after they have left hospital rather than before—but the same Department did not know what the clinical outcomes were and it did not know how many people had been readmitted to hospital within 30 days. I would have thought that it was essential that MPs were provided with that information and with a full outline of the clinical outcomes of that policy. Will he comment on that and tell us what he can do about it, so that we really understand what is happening?

Photo of Sajid Javid Sajid Javid Secretary of State for Health and Social Care

I listened carefully to the hon. Lady and I will look into the specifics of what she said, but it is clear—I hope she agrees—that if people are clinically ready to be discharged, it is better that they are discharged rather than staying in hospital a moment longer.

I take this opportunity to thank everyone who has helped us to shape this important legislation, including hon. Members across the House and colleagues in Wales, Scotland and Northern Ireland, whose engagement will help us ensure that the Bill delivers for the four nations of the United Kingdom. I also thank members of the Public Bill Committee for their constructive scrutiny. The Bill is a lot better for it.

Let me draw the House’s attention to some of the changes that we have considered since Second Reading.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

The Secretary of State referred to how the Bill delivers for the four regions of the United Kingdom. I just put it on the record that 60% of people in Northern Ireland are opposed to abortion on demand, so when it comes to representing the views of those in Northern Ireland—elected representatives and the local people—I am afraid that Westminster and the House do not relate to the people of Northern Ireland on abortion.

Photo of Sajid Javid Sajid Javid Secretary of State for Health and Social Care

I heard what the hon. Gentleman said. He will know that there are strong feelings on the issue of abortion across the House, on all sides of that issue. If legislation does ever come to the House, it is important that it is always a matter of conscience, and that is how MPs are expected to receive such legislation.

Photo of John Redwood John Redwood Conservative, Wokingham

Will the Secretary of State confirm that, when carrying through this rather extensive national health service reorganisation, value for money and keeping the costs of reorganisation down will be at the forefront of his mind?

Photo of Sajid Javid Sajid Javid Secretary of State for Health and Social Care

Yes, absolutely, I can confirm that. My right hon. Friend is absolutely right to stress the importance of that. The NHS will be spending the best part of £150 billion a year, and it is vital that the best value is achieved with every penny that is spent.

Photo of Charles Walker Charles Walker Chair, Administration Committee, Chair, Administration Committee

May I thank my right hon. Friend and his ministerial team for taking into account my concerns about parity of esteem between mental health and physical health? Although I was unsuccessful in amending the Bill at this stage, I thank him for being willing to look at that, or to have colleagues look at it in the other place. I really do appreciate that level of engagement.

Photo of Sajid Javid Sajid Javid Secretary of State for Health and Social Care

I am happy to give my hon. Friend the commitment that we will look at that. I think everyone in the House agrees that the principle is vital, and I am sure it is supported across the House.

Let me briefly highlight the changes that we have made. First, we have heard the desire of the House to rate and strengthen the safety and performance of the integrated care systems. Working with members of the Health Committee, we have introduced an amendment that gives the Care Quality Commission a role in reviewing ICSs.

Secondly, we have heard concerns about the independence of integrated care boards. While it has never been our intention that anyone with significant involvement or interests in private healthcare should be on an ICB, following a productive meeting with the hon. Members for Nottingham North (Alex Norris) and for Ellesmere Port and Neston (Justin Madders) we tabled an amendment that ensures we write that principle into the constitution of ICBs.

Thirdly, we heard concerns from hon. Members about the potential impact of our proposed restrictions on advertising less healthy food and drink. We must, of course, do that in a pragmatic way, so we have introduced amendments to ensure we do not unintentionally impact UK businesses when they advertise to overseas audiences. Further, we will consult with stakeholders on any further changes to the nutrient profiling model.

Fourthly, and very importantly, the Bill now reflects our commitment to end the crisis in social care and the lottery of how we all pay for it. It is not right and not fair that the heaviest burdens often fall on those who are least able to bear it, so we are introducing a cap on the costs of care so that no one will have to pay more than £86,000 over their lifetime. That cap that will be there for everyone, regardless of any conditions they have, how old they are, how much they earn, or where they live. We will introduce a far more generous testing system, so that everyone will be better off under the new system.

We move a Health and Care Bill that is stronger than before, with those three underpinning principles reinforced: embedding integration, cutting bureaucracy and boosting accountability. On integration, it is not about simply telling the NHS, local authorities and others to work together; it is about helping them to do it by doing things like merging NHS England and NHS Improvement into a single statutory body and establishing integrated care boards to deliver as one.

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

I declare an interest as a practising NHS doctor. On integration, my slight disappointment with the Bill is that while it pulls people together in joined-up commissioning boards, there is no commitment to put the money into the same place. If we want to drive joined-up commissioning, we need to put the money into the same place. Will the Secretary of State consider that and how true integration can be achieved as the Bill goes to the House of Lords?

Photo of Sajid Javid Sajid Javid Secretary of State for Health and Social Care

My hon. Friend makes a very important point and he speaks with deep experience. What I can tell him is that we will shortly be publishing an integration White Paper, which, given what he has just said, I am sure he will welcome.

Photo of Andrew Murrison Andrew Murrison Conservative, South West Wiltshire

I declare an interest similar to that of my hon. Friend Dr Poulter. Does the Secretary of State agree that there is an opportunity with integrated care boards and panels to ensure the end of the awful spectacle of people at end of life and frail elderly people coming towards the end of their days being expected to live out those days in an acute hospital ward, when they should be looked after in more homely settings in the community? That has gone on for too long and consecutive pieces of legislation have failed to address it. We have an opportunity here, probably with the help of the other place, to sculpt the measure we are considering today to ensure that stops. It must stop now, so that our frail elderly can have a future that does not involve an end as grisly and as sad as so many are forced to endure.

Photo of Sajid Javid Sajid Javid Secretary of State for Health and Social Care

I absolutely agree with my right hon. Friend, who also speaks with deep experience. I very much agree with what he has just shared with the House.

On bureaucracy, we are removing the rules and regulations that make sensible decision making harder. On accountability, our healthcare must be accountable to democratically elected Members of this House. We spend well over £140 billion pounds of taxpayers’ money on our healthcare system, so it is right that there is more accountability to this place.

In closing, the unprecedented challenges of the pandemic have only deepened our affection for everyone working in health and care. They have been the very best of us. It is on us in this place, and on everyone who can make a difference, to give them the best possible foundation to work together to meet the challenges of the future. The Bill does that and a lot, lot more.

Several hon. Members:


Photo of Rosie Winterton Rosie Winterton Deputy Speaker (First Deputy Chairman of Ways and Means)

Order. Before I call the shadow Secretary of State, I should say that I will probably introduce a three-minute time limit after the shadow Secretary of State and that I am unlikely to call anybody who intervened on the Secretary of State during his opening speech.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health and Social Care 6:39 pm, 23rd November 2021

I start by thanking all those who served on the Bill team and the Clerks, the Library and all the staff of the House who supported them. I also thank Mr Bone, my hon. Friends the Members for Sunderland Central (Julie Elliott) and for Birmingham, Selly Oak (Steve McCabe) and Mrs Murray who chaired the Committee deftly. I put on the record Labour’s thanks to the Minister for Health, Edward Argar—my constituency neighbour in Leicestershire—who both in Committee and over the past two days in the House has been courteous and patient in responding to the various amendments and in how he conducted himself across the Dispatch Box. We are grateful for that.

Equally, I thank my hon. Friends the Members for Nottingham North (Alex Norris) and for Ellesmere Port and Neston (Justin Madders) for working so hard on this Bill and making the case for our amendments. My hon. Friend the Member for Ellesmere Port and Neston had his birthday yesterday—there is no greater place to celebrate one’s birthday than at the Dispatch Box—and I am told that he may well be putting in an appearance at the Strangers’ Bar after tonight’s vote. I am sure that hon. Members from both sides of the House may want to join him in his celebrations.

Of course, Labour welcomed parts of this Bill. It did indeed scrape some of the worst remaining vestiges of the Lansley reorganisation off the boots of the NHS. The compulsory competitive tendering of contracts, which we warned against nearly 10 years ago, are finally put in the dustbin. Of course, it was this Secretary of State, as an enthusiastic and loyal Back Bencher, who spoke in those debates supporting that reorganisation, but we welcome the ending of section 75.

We also welcome some of the provisions around public health, particularly those on childhood obesity and advertising, but we wish the Bill had gone further on smoking cessation and alcohol. Madam Deputy Speaker, I know it is not the convention to praise Members on Third Reading as one does on Second Reading, but I praise Christian Wakeford—the constituency in which I grew up and went to school—who spoke with great eloquence, emotion and very personally about the impact of alcohol addiction on his family. It has also had an impact on my own family, as some hon. Members know. Although the Secretary of State did not accept either the hon. Gentleman’s amendments or ours, perhaps he will be prepared to meet us on a cross-party basis to discuss how we can take that agenda forward.

In saying all that, however, we are not minded to support the Bill in the Lobby tonight. We remain unconvinced by the arguments put forward by the Minister for Health in the past 48 hours. We still believe that this is the wrong Bill at the wrong time. As John Redwood said in his intervention on the Secretary of State, this is an extensive reorganisation of the national health service at a time when we are still in a pandemic and when NHS staff are exhausted and facing burnout. We should be prioritising the monumental waiting lists, the huge referrals for mental health treatment, the crisis in A&E, and the huge pressures on ambulance services and general practice. This Bill is not only a distraction, but it contains provisions that Labour thinks are deeply damaging.

Yesterday, the House focused on the care cap amendment. It represents a change to existing policy and differs from the position outlined in the “Build Back Better” document, under which the House was asked to endorse a national insurance rise. The change means that those with wealthier estates and more expensive houses will see a greater proportion of their assets protected. Somebody with a £1 million house will have 90% of that asset protected, but somebody with an £80,000 house in Barrow, Mansfield or Hartlepool will lose nearly everything. That cannot be fair.

The Secretary of State, who was working the phones yesterday, may have won the battle, but I dare say that there are further skirmishes ahead. I suspect that Members in the other place—certainly those on the Labour Benches —will return to the matter, and I hope that they send the Bill back to us so that we can look at it again.

There are other provisions in the Bill with which we are uncomfortable. We are not convinced about the prohibitions on the private sector’s role in sitting on integrated care boards; we do not think that the Government’s amendment is strong enough. We will return to that point at a future opportunity.

Although the Bill gets rid of the Lansley competitive tendering requirements, it still allows the Secretary of State to hand contracts out to the private sector without proper scrutiny. We have seen a £10 billion contract going to the private sector to use 8,000 beds. That money would have been better spent on elective treatment in the national health service.

In conclusion, the Opposition cannot support the Bill, so we will divide the House tonight. On the care issue, I know that the Secretary of State thinks that he got his policy through the House yesterday and that it is all over, but I am afraid that it most certainly is not.

Photo of Matthew Hancock Matthew Hancock Conservative, West Suffolk 6:45 pm, 23rd November 2021

I welcome the passage of the Bill and congratulate all those who have been involved in bringing it to this place and getting it to Third Reading: the Secretary of State; the Minister, who has worked on it for an awfully long time; and the official Bill team, who were the best team I ever worked with in government. I am not saying that just because they are sitting in the Box.

The Bill gives the NHS what it needs. Critically, it learns the lessons of the pandemic and embeds them in legislation by removing bureaucracy and silos. I can see that the Secretary of State is already acting on that to merge parts of the NHS so that they can work better together.

I want to make a specific point in response to a comment from the shadow Minister, Justin Madders, about accountability. Although the Bill rightly devolves decision making and discretion more locally to the new integrated care boards and panels, it also gives Ministers the right to make sure that the NHS is accountable to them; it removes the so-called independence. That is right, and it is surprising not to see Labour Members supporting it, because it was in the Labour party’s manifesto as well as the Conservative party’s.

When £150 billion of taxpayers’ money is at stake, imposing apparent independence is not just impractical, but wrong. The NHS should be accountable to Ministers so that they can be accountable to the House, which is accountable to taxpayers through the ballot box. That is right constitutionally, morally and practically, which is why it was in both major parties’ manifestos. It is how the NHS operates anyway in practice, but the Bill will remove some of the unnecessary friction in the senior relationships that resulted from the attempt at independence.

Of course clinical voices should always be listened to, but as we saw during the pandemic, we can listen to clinical voices and then make a decision that is held to account on a democratic basis. The Bill will therefore strengthen not just the running of the NHS, but how we constitutionally govern the huge amount of taxpayers’ money that is spent on it. For that reason alone, it is worth supporting the Bill.

Photo of Peter Aldous Peter Aldous Conservative, Waveney 6:48 pm, 23rd November 2021

I am grateful to you for giving me time to speak, Madam Deputy Speaker. I would have liked to speak on new clause 18 on Report, but that was not possible.

Access to NHS dentistry is a problem that has been brewing for a long time and has been exacerbated by covid. There are now parts of the country, particularly in rural and coastal areas, that have dental deserts. It is invariably children from poorer backgrounds and vulnerable adults who suffer the most. The crisis is acute in Suffolk and Norfolk, but is not confined to East Anglia. Sir Robert Francis, who chairs Healthwatch England, commented:

“Every part of the country is facing a dental care crisis, with NHS dentistry at risk of vanishing into the void.”

There are five issues that need to be tackled to address the problem. The Bill can provide the framework to ensure that that happens without delay or prevarication. First, funding must be increased. Secondly, it is vital for the new NHS dental contract, which has been being developed for more than a decade, to be rolled out next April. There are rumours that it will be kicked into the long grass, and I should be grateful for confirmation that that will not happen. Thirdly, we need to step up the recruitment and retention of dental professionals. Fourthly, it is important to highlight the role that water fluoridation can play in improving the oral health of future generations, and in that context clauses 132 and 133 are to be welcomed. Finally, there is a need for greater accountability, and for dentistry to have a voice on integrated care boards and partnerships.

People are currently pulling out their own teeth, while children are having whole-mouth replacements and early signs of cancer are going undetected. We need to act now to put in place an NHS dentistry system that is fit for the 21st century, instead of reversing into the 19th. My hon. Friend the Minister has advised that the Government will not accept new clause 18, and I should therefore be grateful if, without delay, my right hon. Friend the Secretary of State could ensure that his Department comes up with a clear plan for addressing a crisis that is affecting people throughout the country.

Photo of Bob Seely Bob Seely Conservative, Isle of Wight 6:51 pm, 23rd November 2021

Let me start by thanking my hon. Friend Peter Aldous for that superb speech. We have a huge problem with NHS dentistry on the Isle of Wight, and also with independent pharmacies. I have written to the Health Minister about that several times, and there is an ongoing conversation, for which I thank him very much.

In the short time that I have, I want to speak about fairness and equality. The Secretary of State spoke eloquently—as he always does—about equality between the four nations. I want to see equality between isolated and non-isolated communities as well, specifically in relation to unavoidably small hospitals. There are about a dozen in England and Wales, and for obvious reasons they tend to be in isolated areas. The most isolated of those hospitals is St Mary’s on the Isle of Wight, which has a 100% isolation factor because it is separated from everywhere else by sea. Such areas tend to have populations of less than 200,000.

Unavoidably small hospitals find it difficult to achieve the economies, and the economies of scale, that are possible elsewhere in the NHS, because they do not receive tariff payments. They have to provide baseline services at a certain cost, but they do it for many fewer people. It is therefore likely that fewer people will use the services of that particular surgeon or those particular nurses, and as a result they are under permanent pressure. On the Island, our additional costs are estimated, at 2019 prices, to be some £12 million a year. That covers acute services, ambulances—including helicopters, for us—and travel to other destinations, which may involve ferries.

The NHS long-term plan—pre covid, back in January 2019, almost a lifetime ago—set out a 10-year strategy, stating that it would develop a standard model for delivery for smaller hospitals. May I ask the Secretary of State and the Health Minister what has happened to that plan and to the community services formula, which we hoped would support unavoidably small hospitals?

I am, however, delighted that, thanks to the excellent work of Maggie Oldham, the superb chief executive of the Isle of Wight NHS Trust, St Mary’s Hospital has been taken out of special measures and is now good. I would welcome either of the Ministers if they came to see us on the Island, not only to congratulate Maggie but to understand the pressure that one of the 12 unavoidably small hospitals in the United Kingdom is under, so that they can work with me to provide a better funding model for it and the other 11.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 6:54 pm, 23rd November 2021

It is a pleasure to be able to make some comments on Third Reading. The Secretary of State and the Minister will know my position on these matters. I should like to commend Fiona Bruce and my hon. Friend Carla Lockhart for their dedication to these issues. Their passion in this House is matched by many in my constituency who, despite the fact that their view is constantly disregarded, still urge me in their hundreds—I received hundreds of emails yesterday and hundreds today—to do what I can to speak for life. That is what I do here today. I care about the life of the woman and I care about the life of the unborn child. I am starting from the position that both lives matter, and it is one on which I stand firm.

In this House, there is a large number of MPs who are opposed to abortion on demand and who have an opinion on that. They include those who represent Northern Ireland and other parts of the UK in this House. I want to reiterate my position on the last vote that took place in Northern Ireland. An opinion poll found that 60% of constituents were opposed to abortion on demand. I am sure that I am far from being alone in recognising the double standards that our medical guidelines currently endorse, fighting for a life at 22 weeks in one case and ending it at 22 weeks in another case.

There are those who advocate that choice comes above viability, but that view is not replicated even by the many who support abortion in principle. It is a pity that clause 31 and clauses 51 and 52 were not brought to the House today. We expressed our concern some time ago that this House making the decision for Northern Ireland over and above the views of its elected representatives, its constituents and a majority of people across Northern Ireland would have an impact on the abortion rules in this House. We would have had an example of that today if new clause 50 had been approved, which it was not. It would have removed vital safeguards for women and girls seeking abortions up to 28 weeks of pregnancy, such as the requirement for two doctors, or even any medical professional, to be involved. The law change that was agreed in this House for Northern Ireland could have the shocking impact of placing at risk women and girls in abusive situations. It could legalise abortions that women and girls would carry out on themselves up to 28 weeks of pregnancy, for any reason.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I have almost finished my speech.

The Health and Care Bill is an opportunity to improve health and wellbeing, and it should not be usurped to remove essential safeguards such as contact with a medical professional, counselling and referral to appropriate care pathways. This House must be mindful, whatever decisions it takes here, that those decisions will have an impact on Northern Ireland. We in Northern Ireland are very concerned, and there is great disappointment at where we are.

Question put, That the Bill be now read the Third time.

Division number 122 Health and Care Bill — Clause 138 - Commencement

Aye: 292 MPs

No: 244 MPs

Ayes: A-Z by last name


Nos: A-Z by last name


The House divided: Ayes 294, Noes 244.

Question accordingly agreed to.

Bill accordingly read the Third time and passed.