Motion A1 (as an amendment to Motion A)

Health and Care Bill - Commons Amendments – in the House of Lords at 9:00 pm on 26 April 2022.

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Baroness Merron:

Moved by Baroness Merron

At end insert “, and do propose Amendment 29D in lieu—

29D: Page 42, leave out lines 14 to 19 and insert—“(1) The Secretary of State must, at least once in every three years, lay a report before Parliament describing the system in place for assessing and meeting the workforce needs of the health, social care and public health services in England.(2) NHS England and Health Education England must assist in the preparation of a report under this section.(3) The organisations listed in subsection (2) must consult health and care employers, providers, trade unions, Royal Colleges, universities and any other persons deemed necessary for the preparation of this report, taking full account of workforce intelligence, evidence of trends in healthcare and demand for it, and workforce plans provided by local organisations and partners.””

Photo of Baroness Merron Baroness Merron Opposition Whip (Lords), Shadow Spokesperson (Health and Social Care), Shadow Spokesperson (Digital, Culture, Media and Sport)

My Lords, I beg to move Motion A1 as an amendment to Motion A to insert the words as printed on the Marshalled List. My noble friend Lady Wheeler will speak to Motions D and D1 and I will focus my remarks on the issue of the health and social care workforce. However, before I do, I welcome the compromises reached on the reconfiguration of local services and on NHS procurement while avoiding modern slavery. I believe the constructive discussions that we have had have truly improved this Bill and I am grateful to noble Lords across the House and to the Minister for his efforts and commitment.

The importance of the workforce has been debated extensively, both in the other place and in your Lordships’ House. Once again, I am arguing for the importance of implementing a proper forward-looking plan. That I am doing this even after yesterday’s proceedings in the other place conveys just how strongly we feel on this issue. Over 100 organisations of healthcare professionals, think tanks, practitioners and patients have supported our efforts. They continue to press us to make the point that, without mandated forecasts of staff numbers, meaningful workforce planning—something that every other efficient organisation undertakes—cannot take place. They continue to despair at the Government’s now repeated refusal to demonstrate proper commitment to safely staffing our hospitals and other healthcare settings.

We all know that there is desperate understaffing. The staff know it; they feel the pressure and they see the adverse outcomes. The patients know it, often falling into a cycle of long waits, in pain and discomfort, because of staff shortages. Resolving this is quite straightforward. We need a national staffing picture, otherwise how will we know whether we are training enough staff to meet the needs of the country? Yet the Government continue to refuse to commit to producing such an assessment. They say that the necessary work has already been done, or is going to be done, but we, and stakeholders, vehemently disagree, and it is hard to follow the Government’s logic.

If the Secretary of State will not show leadership then NHS England must step up and produce its own requirements and projections, or the Local Government Association could commission such work across the country by local authority. Some way, somehow, every integrated care system and local authority will have to quantify their future workforce requirements and projections and plan for how these will be met.

The Government’s current drafting leaves open some serious questions. We do not know whether the plan will cover health and social care workforces. What is the intended timeframe of the commissioned NHS England plan, and will it be recommissioned once this period expires? Can the Minister confirm that robust data on staff numbers in our healthcare workforces will be published and, if so, when? I would be grateful for any clarification that the Minister can provide.

I deeply regret that the Government have felt unable to meet with parliamentarians—the Opposition, other political parties or indeed any of our experienced Cross Bench Members—even to discuss this issue. This is an irregular and unwarranted response. I hold out hope that, even at this late stage, the Government may see good sense in planning for the workforce that we need, instead of leaving it to chance. I beg to move.

Photo of Baroness Henig Baroness Henig Deputy Chairman of Committees, Deputy Speaker (Lords)

Two noble Baronesses will be taking part remotely. I first call the noble Baroness, Lady Campbell of Surbiton.

Photo of Baroness Campbell of Surbiton Baroness Campbell of Surbiton Crossbench

My Lords, I strongly support Motion D1, to be moved later, in the name of the noble Baroness, Lady Wheeler. It attempts to salvage something of what we set out to achieve on Report. Noble Lords will remember that I was particularly keen to achieve a zero cap for working-age adults who have or who develop eligible care needs under the age of 40. This would enable them to save enough for an ordinary life, like other people.

Amendment 80S would allow regulations to decide how costs accrue under the Care Act, including local authority costs. Not to let them count is fundamentally unfair, adding years to the time it would take to reach the cap. The amendment ensures that the trailblazer pilots are assessed and reviewed by Parliament in the light of regional variations and the impact on younger disabled adults.

Disabled people are contributing to their care from benefits intended to cover the extra costs of disability. Four million disabled people in the UK are living in poverty and are particularly hard hit by the rising cost of living. Without some easing, they will remain trapped in poverty. The Minister has told us many times that the cap is proportionate and fair. He refers to the uprating of social care allowances, meaning the minimum income guarantee—what is left after being charged for care. In practical terms, it is minimal. To someone with the highest support needs and on the highest rate of disability benefits, it amounts to £4.55 a week. That barely keeps pace with the cost of living, let alone their extra disability costs, which are estimated at £583 per month. It is also far less than older people receive. Disabled people will be simply crushed by their rising debts.

If the Government’s proposals go through tonight, young disabled people will never participate in society as equal citizens, and those totally reliant on benefits will suffer even more financially—yet we know from the evidence that investing in social care to support disabled people improves their health, enhances their independence and reduces demand on welfare benefits.

The amendment in the name of the noble Baroness, Lady Wheeler, does not thwart the primacy of the elected House. Nobody says that the current system is acceptable, but these proposals from the Government are not the answer. The public are demanding better social care and support for all those who need it so that they can thrive as dignified human beings. The Government’s last-minute changes to their reforms, sprung on Parliament with no time for proper scrutiny, will not deliver the will of the people, who want investment in social care.

We must, and we will, continue our efforts to secure a better deal, especially for those young disabled people starting out in life, who simply want a life like anyone else. The least we can do tonight is support these reasonable and modest amendments, so that that can become a reality.

Photo of Baroness Henig Baroness Henig Deputy Chairman of Committees, Deputy Speaker (Lords)

My Lords, I call the noble Baroness, Lady Brinton.

Photo of Baroness Brinton Baroness Brinton Liberal Democrat Lords Spokesperson (Health)

My Lords, it is a privilege to follow the noble Baroness, Lady Campbell of Surbiton. I start by thanking the Minister for the large number of meetings during the passage of this Bill in the Lords—with some exceptions, but I will return to those shortly. It has been, for the most part, a very constructive engagement that has taken a considerable amount of the Minister’s and his officials’ time. I believe that the constructive nature of the discussions means that this Bill will leave your Lordships’ House in a better state, and more workable in practice, than when it arrived.

I will speak on Motions C, D and D1 and will leave Motions A, A1 and B to my noble friend Lady Walmsley. I pay particular tribute to her for her dedicated work on the Front Bench, which I have been unable to fulfil because of the strict rules relating to remote contributions.

On Motion C on modern slavery, I particularly thank Ministers for listening to the concerns across all parties in both Houses. Motion C addresses many of the concerns that there were about the willingness of the Government to carry out a review in order to better understand the risk of slavery, human trafficking and modern slavery in the NHS supply chain. It is, of course, only a first step. Eradication of slavery and human trafficking in health service supply chains must remain the key objective, but this will give the Government the tools they need. The publication arrangements will be transparent, and Parliament will have a chance to scrutinise it. For these reasons, these Benches will not oppose Motion C.

I turn now to Motions D and D1 on the social care cap. I start by thanking the Minister for his letter—received this afternoon—addressed to the noble Baroness, Lady Wheeler, and copied to myself and others who have attended meetings with him on the social care cap, which provided more detail on the trailblazer programme. By the way, in any other environment they would be called “pilots”, but there we go. I am struggling to see what is new about the trailblazer programme in that letter, other than one extraordinary sentence which says:

“I would be happy to arrange a further meeting with you and the policy team if you would like to discuss this in more depth”.

This is extraordinary because, as was alluded to by the noble Baroness, Lady Merron, until now Ministers have refused to discuss the detail of the social care cap with Peers, even when we met last week. Indeed, being told that if we tabled any amendments on this and workforce, then any concessions on the other two issues would be removed from the table, was a somewhat breath-taking breaking of convention, so I think that we are all relieved that Ministers removed that edict. I hope that we can safely return to the usual conventions.

Motion D still does not recognise that the proposed changes to the care cap, announced just before the Bill left the Commons before Christmas, have not had any wider consultation with stakeholders, and have had only the briefest timed debate in the Commons. That is important because the Government’s changes to the care cap, not mentioned by the Minister this evening, mean that the amounts accrued towards the £86,000 cap are now based solely on the individual’s out-of-pocket expenses. Although individuals will still qualify for means-tested financial support if their assets fall below £100,000, in practice this will no longer protect people with more modest means and will simply see them contributing over a much longer period.

This is a regressive arrangement which will leave many people in a much worse position than that outlined by the Prime Minister on the steps of No. 10 Downing Street or by the Secretary of State for Health when the White Paper on the health care levy was introduced and before any of this detail was published. The Minister has repeatedly said during the passage of the Bill that those under 60 who receive personal care will not be worse off. That is untrue, as was so ably explained just now by the noble Baroness, Lady Campbell, whom we support in her aim for a zero cap.

Even the Government’s own impact assessment shows that its proposals will benefit only around 10% of working-age care users, and that there will be a limited impact on improving the funding spent on working-age disabled adults. How many more times must we say that it is still a disgrace that younger adults with disabilities—who we know are more likely to be asset and savings-poor, likely to need care and support for much longer, and so will accrue much higher levels of costs than the elderly—will use the same arrangements as older people? Those older people will use personal care for much less time and will have had decades of income and asset-building behind them. The proposals from the Government are just not fit for purpose and must be reviewed for this group of younger adults in particular.

Motion D says that there must be an evaluation of the trailblazer and that assessments can happen as they go along, but there is a big risk to the Government there. If there are problems, which we believe there will be—not least the financial impact on some of the most vulnerable adults in our community—they will not surface until it is too late. Therefore, from these Benches we support Motion D1 and urge the Government, even at this last minute, to reconsider.

Photo of Baroness Altmann Baroness Altmann Conservative 9:15, 26 April 2022

My Lords, I follow the noble Baronesses, Lady Brinton and Lady Campbell, and will confine my brief remarks to social care, which I have long worked on. Sadly, the measures in the Bill will not rise to the challenge as required to sort out the social care system in our country.

I accept and congratulate the Government on the concessions that they have made. I am delighted to see Motion C on modern slavery. However, as far as social care is concerned, I would like to understand from my noble friend, on workforce planning, whether private care homes and non-state care home staff will be assessed as to adequacy. At the moment, there are horrendous staff shortages, and the current immigration policy does not seem to include carers—an essential element of the workforce—because of the pay structures. If he could explain what the social care workforce elements of the Government’s proposals are for the non-state social care sector, I would be most grateful.

I am not planning to vote against the Government on Motion D1, but I am afraid that I cannot support them. I put on record that I agree with everything that has been said about the Government’s changes to the social care cap. I believe that the measures are regressive; they will damage the least well off—or the lower end of the middle range of people, shall we say. They may be better than the current system, but they are not a solution and are not satisfactory. We will end up having to revisit the support for social care. Having said that, and in view of the fact that this is financial privilege, I will not vote against the Government on Motion D1.

Photo of Baroness Bennett of Manor Castle Baroness Bennett of Manor Castle Green

My Lords, I rise very briefly to offer Green support for both Motions A1 and D1. Motion D1 has already been very amply covered, most notably by the noble Baroness, Lady Campbell of Surbiton, so I will just address my remarks to Motion A1.

I know that many Members of your Lordships’ House feel as though we do not want to be political about things—I might have thoughts about that—but this is not a political amendment at all. As the noble Baroness, Lady Merron, said, more than 100 of our major healthcare organisations have expressed support for this workforce planning approach. Just a couple of hours ago, and this addresses your Lordships’ House directly, the British Heart Foundation put out a press release saying that, without this amendment, it is

“unclear how ambitious targets laid out in the Elective Recovery Plan and other NHS delivery plans can be met.”

The chief executive said that

“the Government has missed an open goal by failing … to address the workforce shortage”.

In addition, just yesterday the King’s Fund put out a report saying that the Government—they can welcome this—are “on track” to meet their target of “50,000 extra nurses” by 2024. However, the King’s Fund points out that the level of vacancies is still the same as it was when that promise was made. Just plucking figures out of the air and going, “Hey, we’ve got this great figure”, is not enough; we need to plan for the future. That is why this amendment is absolutely crucial for our NHS.

Photo of Baroness Harding of Winscombe Baroness Harding of Winscombe Conservative

My Lords, I rise very briefly to speak to Motion A1. I will first thank my noble friend the Minister for his fantastically collaborative approach on the Bill. I am particularly delighted to see the Government’s proposals on reconfigurations, so I thank him very much for them.

On workforce, I fear that there is almost nothing more to be said. Throughout the passage of this Bill, at every stage in this House and across all sides, we have all been clear that if we do not resolve the workforce issues—the people issues in the NHS—everything else is for naught. Yet we come to end of this process and there have been no changes at all. It is with great sadness that I speak today because I feel that, despite the great work that has been done and all the best intentions, things will not improve. I would love to believe that I am wrong, that my noble friend the Minister is right and that the workforce elements of the Bill are sufficient, but I am afraid that the evidence of the last 20 years is that they are not.

Photo of Lord Blencathra Lord Blencathra Conservative

My Lords, I support Amendment 48C in lieu, and what an extraordinary amendment it is. The Government have accepted, for the first time, that they must make—and will make—regulations

“eradicating slavery and human trafficking in supply chains”.

This is an extraordinary turnaround, and I congratulate my noble friend the Minister and the Secretary of State, Sajid Javid, on it.

However, the real hero here is the noble Lord, Lord Alton of Liverpool. In every relevant—or even vaguely relevant—Bill we have considered in this Parliament, he has sought to pass an amendment or new clause tackling genocide or slavery in Xinjiang province. Every time, his amendments have been rejected on the absurd notion that only an international court can decide on genocide. He has articulated again and again the terrible abuses of the Uighurs in China: forced labour camps, sterilisation of women—that is slow-motion genocide—systematic rape, murder and torture. He has called for us not to trade with any company making anything which emanated from such slave labour, either in China or anywhere else in the world. His persistence has paid off and, aided by my right honourable friend Iain Duncan Smith in another place, the Government have now produced this amendment in lieu.

At this moment we have no idea what a change this will bring about. It may seem a small start now but I care to bet that in, say, 20 years’ time, historians will point to this amendment and the campaign of the noble Lord, Lord Alton, and say that it has changed world history. I will press my noble friend the Minister on the timescale here. I hope we will have the regulations on the statute book within about 12 months and will not have to engage in the formerly proposed and rather convoluted 18-month consultation system with everyone under the sun around the world. Indeed, the Secretary of State announced last week that he was banning CCTV cameras from Hikvision, a company with close ties to the Chinese Communist Party. I assume he did that without extensive consultation.

My noble friend the Minister probably cannot answer this, but I hope that the promised procurement Bill will have equally strong provisions. Indeed, it will not get through this House unless it mirrors what the Secretary of State has done here. There can be no back- sliding now.

In conclusion, and in addition to once again congratulating my noble friend Lord Alton, I wish to praise my right honourable friend Secretary of State Javid, who—if I may say so without being patronising—is turning out to be rather good. I tried amendments on single-sex provision in NHS hospitals and the Secretary of State has now urged NHS trusts to do it. I say to him, “Don’t urge them, Secretary of State—make them do it. You must re-write Annexe B and protect women.”

He has also rightly demanded a review of the consequences of children having their sex changed on the basis of inadequate evidence. As he points out, the zealots in the militant trans lobby who are marching children through the sex-change machine could be committing child abuse. That is the real conversion therapy that needs to be banned. It looks like we may have someone sensible in charge of the DHSC. The Motion moved by my noble friend tonight proves that and I commend it once again.

Photo of Lord Alton of Liverpool Lord Alton of Liverpool Crossbench

My Lords, it is a great pleasure to welcome government Amendment 48C. To see an amendment committing the National Health Service to the eradication—that word “eradication” is amazing in itself—of slavery and human trafficking in NHS supply chains is as welcome as it is remarkable. This becomes like a mutual admiration society, but I take this chance to thank my noble friend Lord Blencathra and pay tribute to him for the work he has undertaken to secure this amendment; we have become good friends in the course of this amendment and other fights on these issues as the years have gone by.

I also want to reference the work of the Bill team, who my noble friend and I met yesterday along with the Minister. I pay tribute to them for the work that they have done; they have gone an extra mile. I also thank the Minister himself and the noble Earl, for helping us with his advice in earlier stages; it was candid but helpful, and I appreciate that. I thank the Secretary of State, who has been referred to. There is no doubt that this is not just another issue as far as he is concerned; he is deeply committed to it. He does not want to be the Secretary of State presiding over a National Health Service accused of purchasing goods made by slave labour in places such as Xinjiang.

I also pay tribute to the charities and NGOs that have campaigned for this—not least the charity Arise, of which I am a trustee, and its chief executive Luke de Pulford. Serendipitously, it held a reception here attended by some noble Lords who are in the Chamber tonight, including government Ministers, a former Minister and other Members from all sides. The reception included speeches from Sir Iain Duncan Smith, Sarah Champion and Danny Kruger, underlining the bicameral, cross-party and no-party support for this amendment.

The Minister knows that I have two short questions for him about the amendment. One concerns a point raised by my noble friend Lord Blencathra about the timetable for laying the regulations and seeks his assurance that nothing is being done—such as further reviews or consultations—to kick this down the road. I do not believe that that is the case but I would love to hear it from the Dispatch Box. Secondly, the amendment gives power to the Secretary of State to assess the circumstances in which the amendment will be implemented. As the Minister knows, I would like an assurance that the reference to the word “appropriate” in the amendment could never be used to frustrate the decision of Parliament to achieve the central objective of the amendment; that is, to eradicate slavery from the supply chains.

May I also press the Minister on two other related issues? They relate to the purchase of goods from a state that was, after all, described by the Foreign Secretary herself, Elizabeth Truss, as one committing genocide. The Minister knows that the Government continue to use, in his words, commercial sensitivity in answering questions about the loss of UK taxpayers’ money on faulty PPE and addressing legitimate questions involving transparency and accountability. The Minister has confirmed to me—I quote him—that

“the Department’s Anti-Fraud Unit received referrals from varying sources on 37 contracts.”

As recently as 7 April, the Minister told me:

“The Department is committed to transparency and a total of funds recovered may be published in future.”

I wonder whether the Minister can tell us when we will get to a point when publication will be allowed.

Secondly, in total, some £10 billion—the size of our entire depleted budget for overseas aid and development throughout the entire world—has been paid to the People’s Republic of China on PPE. That same amount of money could have been used to improve quality of life, save lives and reduce our dependency on the Chinese Communist Party—a point that the noble Lord, Lord Blencathra, and I have made on a number of occasions. It also could have been used to enhance the national resilience of this country, not least if we face another pandemic.

Only yesterday afternoon, a letter was issued by the Biometrics and Surveillance Camera Commissioner, Professor Fraser Sampson. He wrote to all government departments praising Sajid Javid’s decision to prohibit

“any further procurement of Hikvision surveillance technology” by the Department of Health. Can the Minister confirm that existing cameras in his department are being stripped out? It has been reported that they are.

Like the amendment, these actions demonstrate on the procurement of PPE and other commodities coming into the NHS. I want to ask one other question of the Minister. Professor Sampson expressed concern about what he called

“clear ethical and human rights issues involved in public procurement of surveillance technology from companies associated with atrocities in China.”

He says that, eight months after asking Hikvision to address shocking allegations, it has failed to answer his questions. There are more Bills coming: there will be a new modern slavery Bill and a procurement Bill. As my noble friend said, there will also be an opportunity for more amendments. However, it would be helpful to know this evening whether this excellent amendment will be used as a yardstick when it comes to framing other putative legislation.

Photo of Baroness Walmsley Baroness Walmsley Co-Deputy Leader of the Liberal Democrat Peers 9:30, 26 April 2022

My Lords, I begin by welcoming Motion B, which puts in place government Amendments 30C to 30K, laid in another place. They relate to the Secretary of State’s role in major NHS reconfigurations and are a credit to the Minister, his ministerial team and the Bill team. They have listened to the strong arguments from across this House, led so ably by the noble Lord, Lord Stevens of Birmingham, who is unable to be with us tonight. I thank the Minister for agreeing—eventually—that the powers originally proposed in the Bill were excessive, disruptive and unnecessary.

Unfortunately, we have not had such a fruitful consensus on the matter of workforce planning. We do not agree with the Commons that our workforce amendment, Amendment 29B, was unnecessary because appropriate measures already appear in the Bill. If that were so, and if the sector had had confidence in the Government’s track record in planning for adequate and safe staffing levels in health and care services, we would not have had more than 100 organisations backing our earlier attempts, led so well by the noble Baroness, Lady Cumberlege, to put in place a mandatory system for reviewing the available workforce and predicting what will be needed in future. However, here we are, with the Government having set their face firmly against any compromise on or serious discussion about the matter. One has to ask what the Government are afraid of.

Any effective workforce strategy must be based on reliable information, be regularly refreshed and have numbers in it. This House and the whole sector have no confidence that what the Government are proposing will do that. I understand that the Treasury has had a hand in the Secretary of State’s determination to just say no. Perhaps the Treasury is unwilling to foot the Bill, which will prove to be essential when all is revealed.

I put it to the Minister one last time that our proposal would be cost-effective. Staff shortages are a false economy. Missing staff are often replaced by very expensive locums and agency staff, and the stress of unsafe staffing levels causes valued staff to leave the service. Training and recruiting staff to replace them also costs money. High staff turnover is not an effective strategy for any business or service, and poor treatment for patients often has to be done again or leads to greater and more expensive needs further down the track. No efficient shopkeeper would fail to do a proper stocktake or take account of what people are buying and therefore what he needs to order to replenish his stock—but that is what the Government are doing if they fail to plan effectively for safe staffing. It is much more serious than empty shelves, because it is playing with people’s lives, as was recently demonstrated so clearly by the Ockenden report.

If the Government are determined not to carry out the reviews and consultations in Amendment 29D, I would like to ask the Minister whether they would be happy for some other organisation, such as NHS England, to do so and whether they will take note of the results of that investigation. Amendment 29D from the noble Baroness, Lady Merron, in Motion A1, is not a silver bullet; it will not solve the current staffing crisis in the NHS and care services. But it would provide a strong foundation for future safe and cost-effective staffing, which would be to the benefit of the whole population. It is our duty to ask the Government to think again—again.

Photo of Baroness Wheeler Baroness Wheeler Shadow Spokesperson (Health and Social Care), Opposition Deputy Chief Whip (Lords), Shadow Spokesperson (Levelling Up, Housing, Communities and Local Government)

My Lords, in closing the debate before we hear from the Minister, I make no apology for concentrating on social care, on how the care cap is to be implemented, and on my Motion D1, which implores the Commons to think again on this vital issue. I thank noble Lords who have given their strong support to Motions A1 and D1.

I wish to reinforce the key point that, from the outset, social care and Parliament have been treated pretty shabbily as part of this Bill. It is essentially an NHS Bill. As we know, the social care cap and charging arrangements were added to the Bill in the Commons, with no notice and after the Bill had finalised its Committee stages, and were then pushed through, without any opportunity for full explanation, scrutiny or time to consider the impact on the hundreds of thousands of people who are desperately in need of social care and support and will not receive it under these proposals. We later also had the money-saving bombshell announcement of local authority contributions not being allowed to accrue against the care cap, which was designed to achieve savings on the Government’s original package—even before any form of scrutiny of the Bill had commenced—that will be at the expense of some of the country’s poorest and most vulnerable people.

As noble Lords have pointed out, in reality, we in the Lords Chamber have had little actual time to consider and debate these vital social care provisions, despite many hours and days being spent overall on a long and complex Bill. Worst of all, we had the blank refusal by the Government to discuss or address any of the concerns and issues expressed or put forward by noble Lords from all sides of the House, with their deep expertise and knowledge across social care, or the detailed and painstaking evidence and modelling work undertaken by key stakeholders, such as Age UK, Mencap, the Alzheimer’s Society, and the King’s Fund, Nuffield Trust and Health Foundation expert think tanks. We have instead been told that Ministers have done their best to explain their proposals, but they have absolute red lines against making any changes whatever. Is this what must now pass for parliamentary dialogue, scrutiny and debate?

For the record, I will underline some of the key reasons why opposition to the Government’s proposal for the cap implementation is so clear and strong. The cap level and implementation strongly favour the better off and would bring almost nothing to the worst off. This is unfair and the opposite of levelling up. Older people and those with modest means all fare badly under the Government’s charging proposals.

Even the Government’s own impact assessment admits that only 10% of working-age disabled adult care users will benefit, that one in five older people will not see the benefits of the cap and that poorer care users are much more likely to die before they reach the cap than others with the same care needs. Among older people, those in the north-east, Yorkshire, Humber and the Midlands will be worse off. For dementia sufferers regionally, just 16% of people in the north-east and 19% in the east Midlands would hit the cap, compared with 29% in the south-east. The overall figure, as a result of disallowing local authority contributions towards the cap, is that only 21% of people living with dementia would reach it.

The mountain of evidence produced by stakeholders and think tanks shows that social care is not being fixed, as the Government continue to try to have us believe. The “nobody will have to sell their home” promise is firmly debunked, too, despite the Government desperately clinging on to it; it is a hollow and false claim. Somebody with assets of £100,000 will lose almost everything, while someone with assets of over £1 million will keep almost everything. How can this be the fair plan that the Minister insists it is?

The reality is that, as the Government holds to their solid red line, their arguments just do not stand up but get weaker by the minute. The Minister argues that his is the only affordable plan, but, if that is the case, why do the £90 million of savings have to be paid for by those who can least afford it, and why are there not better plans to protect those with fewest assets?

Local authority care contributions counting towards the cost are presented by the Government as unfair. Instead, they insist that setting the cap at the same level for everybody,

“no matter their age, where they live in the country or the nature of the care and support they need to draw on”,—[Official Report, 5/4/22; col. 1986.] is the fairest system. Is that not also the opposite of how levelling up should work?

The argument that no one will be worse off than under the current system is just not borne out by the overwhelming evidence from the stakeholders and think tanks. The contention that the Government are reforming and changing the system where previous attempts have failed just is not true. There was cross-party agreement on the implementation of the Care Act after detailed scrutiny of the Dilnot proposals, and it was this Government who failed to implement it. I remind the House, as someone who was heavily involved in the scrutiny of that Bill, that there was no mention of the Care Act provisions being unaffordable when the Act and its implementation proposals were agreed in 2014.

On working-age adults, as the noble Baroness, Lady Campbell, has again forcefully underlined, the Government’s proposals will mean that they remain trapped in poverty. The Minister’s previous reference to the uprated social security benefits that they will receive instead under the minimum income guarantee completely missed the point of how social care needs have to be supported.

Ministers have doggedly stuck to their responses, without either acknowledging or addressing these clear counterarguments and evidence. My Motion again reinforces the key issues that we have tried all along to get the Government to respond to: the importance of implementing the care cap under the consensus provisions of the Care Act, and ensuring that local authority care costs are allowed to accrue towards the cap to avoid the huge unfairness that not doing so will cause to key groups in need of social care.

Finally, we want to make sure that the Government’s much-vaunted but little-explained trailblazer pilots are completed before regulations on the cap are agreed, as well as including the analysis of the impact on regional eligibility and the effect of the cap on working-age disabled adults under 40 with eligible care needs. Is this not both sensible and fairer to the key groups who stand to lose so much under the Government’s proposals? Why is this so difficult for the Government to agree to? I referred to “little-explained pilots”, but I did receive a letter three hours ago from the Minister, for which I thank him, setting out information about the pilots that in fact adds very little more than the DHSC press release in March and also shows that they will not be evaluating the key areas of impact that my Motion calls for.

I will also add that I have seen recent government claims in the media that deleting the social care cap arrangements in the Bill would jeopardise the whole Bill. I emphasise that that is not so. In their place we would instead have the rest of the Bill and the Care Act 2014 provisions, which would form the basis for moving forward quickly and implementing the cap in a much fairer and more inclusive way that would benefit many more people in desperate need of social care support.

I hope that even at this late stage the Government will listen, address the overwhelming concerns and evidence from all the stakeholders and experts on social care services and delivery and accept my Motion as the best way forward.

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

I thank all noble Lords who have spoken in this debate. I will turn to the issues as briefly and succinctly as I can.

On workforce planning, I hope I can assure noble Lords that we will engage with stakeholders on the preparation of the report, which will include the regulated workforce in health, social care and public health. I hope your Lordships also understand the work being undertaken by the Government, NHS England and Health Education England to improve workforce planning and to lead the improvements we all seek. This is why we think the amendment is unnecessary. I also remind noble Lords that at local level there is an incredible amount of local planning going on much closer to the ground.

I turn to reconfigurations. This power will ensure that decisions made in the NHS that affect the general public in England are subject to democratic oversight. I thank noble Lords across the House for their support and the fact that we are going to listen to local voices at the heart of decisions.

On modern slavery, I thank the noble Lord, Lord Alton, and my noble friend Lord Blencathra. It is right that the Government take action by identifying, mitigating and tackling the crime of modern slavery and human trafficking. Sometimes when we discuss these issues we find that legal arguments get in the way, but in this case the legal arguments worked in our favour because “avoid” could mean turning a blind eye to modern slavery, whereas “eradicate” means working with suppliers and saying to them, “Unless you change your practices, we will not buy any more stuff from you.” So, in fact, the lawyers have been our friends in this case—I wonder how often that is said.

The ambition is 12 to 18 months; we want to get this done as soon as possible, not to kick the can down the road. Both my right honourable friend the Secretary of State and I are personally committed to this, and we are incredibly grateful to the noble Lord, Lord Alton, my noble friend Lord Blencathra and Iain Duncan Smith for pushing us and being persistent on this.

I turn to Amendments 80, 80P and 80Q, as well as 80S and 80T. We ask that noble Lords reject these amendments and accept Amendments 80A to 80N instead. The cap on care costs clause is key to the Government ending the unpredictable care costs for everyone at the moment by introducing a universal £86,000 cap. It must stand part of the Bill, alongside the further necessary Amendments 80A to 80N. The elected House agrees with our proposals, having once again voted overwhelmingly in favour—with an even greater majority than when this matter was last considered.

Finally, I must reiterate that Amendments 80, 80S and 80T would all affect the financial arrangements to be made by the other place and will cost the taxpayer not £90 million extra a year but almost £1 billion— £900 million a year—by 2027-28. As such, they have financial privilege. There is no cap at the moment. Our proposals bring predictability: more people will receive support, have to spend less each week and keep more of their savings. Let us grasp this opportunity.

I also remind noble Lords that at the beginning of the consultation we had an open meeting with the Minister for Care, Gillian Keegan, to answer all questions, including on the cap and the metering. Please let us grasp this opportunity or we could be waiting for another proposal. This proposal could wait, gathering dust on shelves for many years to come, like previous proposals. Let us grasp the opportunity and have the courage to address social care. I ask that noble Lords support our amendments.

Photo of Baroness Merron Baroness Merron Opposition Whip (Lords), Shadow Spokesperson (Health and Social Care), Shadow Spokesperson (Digital, Culture, Media and Sport) 9:45, 26 April 2022

My Lords, in opening this debate, the Minister said that Motion A by and large did the job that Motion A1 seeks to do. I beg to differ, and so do more than 100 key organisations that work day in, day out on health and social care. Unless we plan and prepare to have the right workforce in place, it will continue to be the case that we do not have the right workforce, so what is happening now will simply continue. We will not be sure of safe staffing levels, nor have the people in place to give the levels of service that mean patients do not have to continue to suffer long and painful waits.

I remain deeply disappointed that on workforce, a central pillar of how we run our health and social care services, the Government have refused to even discuss this matter. I ask the House to agree to Motion A1.

Ayes 169, Noes 204.

Division number 9 Health and Care Bill - Commons Amendments — Motion A1 (as an amendment to Motion A)

Aye: 169 Members of the House of Lords

No: 204 Members of the House of Lords

Aye: A-Z by last name

No: A-Z by last name

Motion A1 disagreed.

Motion A agreed.