That this House do not insist on its Amendment 29B, to which the Commons have disagreed for their Reason 29C.
29C: Because there is already a clause in the Bill about reporting in relation to workforce and it is not necessary to impose further or different reporting duties on that topic.
My Lords, with the leave of the House, in moving Motion A, I will also speak to Motions B, C and D. The amendments being considered today relate to the NHS workforce, reconfigurations, modern slavery risks in NHS supply chains and the adult social care cap.
I turn first to Amendment 29D. The unamended Clause 35 places a duty on the Secretary of State to report on workforce systems. Our report will increase transparency and enhance accountability by describing the workforce planning and supply system for healthcare workers, including those working in the NHS and public health alongside regulated healthcare professions working in social care and public health in England. The existing clause therefore already delivers, by and large, what Amendment 29D seeks to do.
I can confirm that we will be asking Health Education England and NHS England to assist in the preparation of the report. In addition, while the report will be published at a minimum of every five years, it can be published more frequently than that, if required. I can also confirm that, in the preparation of the initial report, we will also seek the views of key stakeholders. The report is in addition to the rest of our expansive work to improve workforce supply and planning, including the Health Education England strategic framework, which will be published in the coming weeks, and the NHS England long-term workforce strategy.
Moving to reconfigurations, I am very grateful for the constructive debates on these issues across both Houses, and in this place particularly to the noble Lord, Lord Stevens, and my noble friend Lady Cumberlege for their insightful and wise feedback on this power. The first set of changes we have proposed would mean that the NHS had to notify the Secretary of State only about the reconfiguration proposals deemed notifiable, which we will define through regulations. But we intend to align that definition with the existing duty on NHS commissioners to consult local authorities in the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013. Similarly, our amendment removes the requirement for commissioners and providers to inform Ministers of
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The changes introduced in this House make reform of the social care funding system unaffordable. These provisions are subject to Commons financial privilege and, again, the elected House has made its view clear in support of the Government’s position three times. I really ask your Lordships to listen carefully to the views of the other place.
Without the Government’s clause there would be a fundamental unfairness, because people would meter according not to what they paid but to what their council paid, for reasons they have no control over. Someone living in Hertfordshire, making exactly the same contribution towards their care as someone in Hartlepool, could hit the cap first purely because of variations in the costs of care in different part of the country that mean the local council in Hertfordshire is paying more towards their care.
We are committed to levelling up and must ensure that people in different parts of the country are benefiting to the same extent. Our provisions support this. Amendments 80A to 80N also contain crucial changes to support the operation of charging reform. These were lost by the removal of the clause.
Amendment 80S would require the Government to publish an evaluation and impact assessment of trailblazer local authorities before making regulations to amend how costs accrue towards the cap. The Government already intend to evaluate implementation in the trailblazer authorities. Learning from the trailblazer initiative will be shared with the wider adult social care sector through regular bulletins and events. We have to trust the learning process.
The amendments in front of us would cost the taxpayer nearly £1 billion per year extra by 2027-28. Ultimately, what does this mean? It would mean that we would need to make the same level of savings elsewhere. Where would we find those savings? This could mean making the system less generous. It could be by raising the cap, reducing means-tested support, or expecting people to make contributions towards their daily living costs that are unaffordable from most people’s income. It could also mean that we have to reduce investment in things that would improve the quality of people’s lives and experience of the care system, whether that is investment in the workforce, in appropriate housing or in digitalisation. That is not what the elected House wants us to do, as was clearly demonstrated by the vote last night in the other place.
Our approach, we believe, is the right one, and I ask noble Lords to agree to Amendments 80A to 80N but disagree with Amendments 80, 80S and 80T. I beg to move.
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.””
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.
The Deputy Speaker (Baroness Henig) (Lab)
Two noble Baronesses will be taking part remotely. I first call the noble Baroness, Lady Campbell of Surbiton.
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“circumstances that are likely to result in the need for the reconfiguration of NHS services”.—[Official Report, Commons, 25/4/22; col. 522.]
Throughout the Bill’s passage, we have been clear that our intention is to use these powers only in respect of substantial reconfigurations. The vast majority of reconfigurations will be managed without any ministerial intervention. These amendments and our planned regulations reinforce that principle.
Under the Town and Country Planning Act 1990, the Secretary of State for Levelling Up, Housing and Communities has powers to call in any planning application. However, the stated policy for many years has been to be very selective about doing so, and Ministers will, in general, consider the use of call-in powers only if planning issues of more than local importance are involved. I should like to put formally on the record that our intention is that the same principle applies here.
On the Secretary of State’s call-in power, concerns have been raised about patient safety. I want to be clear that these powers should never, and will never, prevent providers making urgent temporary changes where there is a clear and acute risk to the safety of patients or staff.
Secondly, our amendments give local authorities, NHS commissioners and anyone else the Secretary of State considers appropriate, a right to make representations to the Secretary of State where he or she has called for a proposal for consideration. We expect this to include any relevant provider. The Secretary of State will be required to publish a summary of representations he or she receives, and we will set out in statutory guidance further detail on how local bodies, including providers, will be engaged. In addition, we also want the CQC’s expertise to be taken into account where it is appropriate for relevant reconfigurations. We will therefore look to make clear, in guidance, where information provided by the CQC should be taken into account.
Thirdly, transparency is vital to ensure that these powers are always used by Ministers in the public interest. We are therefore requiring the Secretary of State to provide the reasons for his or her decisions and directions when he or she makes them.
Finally, we have heard throughout these debates that reconfiguration decisions must be made quickly to improve the quality of services received by patients. Our amendment requires that, once he or she has called in a reconfiguration proposal, the Secretary of State must make any decisions within six months. We believe that this set of changes answers many of the key concerns raised in Parliament and I therefore urge noble Lords to consider supporting these amendments.
I now turn to Amendment 48C, particularly on the issue of modern slavery. We clearly share the strength of feeling expressed in both Houses on ensuring that the NHS is in no way inadvertently linked to slavery and human trafficking through its supply chain. That is why the Government brought forward an amendment in the first round of ping-pong that creates a duty on the Secretary of State to undertake a thorough review of NHS supply chains. Today, I can announce that we will go further than this. The Government’s further amendment in lieu will require the Secretary of State to make regulations with a view to eradicating the use in the NHS in England of goods or services that are tainted by slavery or human trafficking. The regulations can set out steps that the NHS should be taking to assess the level of risk associated with individual suppliers; the basis on which the NHS should exclude them from a tendering process; and what measures should be included in contracts. I am particularly grateful to my noble friend Lord Blencathra and also the noble Lord, Lord Alton of Liverpool, for their campaigning—in fact, their persistence—on this issue, and I welcome their support for the amendment. I will also continue, with other Ministers, 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.
We must now turn to the issue of the adult social care cap. The Government have announced their plan for a sustainable social care system. It is fair and affordable, and designed to end the pain of unpredictable care costs by capping the amount anyone would need to pay at £86,000. The elected House has once again voted overwhelmingly in favour of our proposals, which are financially privileged—and I would remind the House of its proper role in considering matters that are financially privileged. On the issue of substance, this House will be aware that Governments of all parties, for many years, have considered social care but not implemented reforms due to concerns about the affordability of introducing a cap. I have said previously that reports have gathered dust on shelves but never actually been implemented. Now we have a real opportunity to grasp the nettle. If there are issues or unintended consequences, these will likely be found by the trailblazers, and we can then tweak the system to address any shortcomings. I ask noble Lords to not allow this opportunity once again to slip away.
The existing system is simply not good enough, and our reforms are a vast improvement. Our reforms ensure that more people are eligible for support with the costs of their care; that the amount they spend each week is reduced; and that they can retain more of their savings. At the moment, people get support with the costs of their care only once they have depleted their assets to under £23,250. We are increasing this fourfold, so that people with up to £100,000 in savings, who are currently paying all the costs of their care, will now be eligible for funding support from the state. Under the current system, only once you have depleted your assets to £14,250 do you no longer need to contribute from your assets. We are increasing this to £20,000. Most crucially, at the moment there is no cap. Our reforms mean that people will have more certainty and more peace of mind, and will be able to plan ahead, whatever part of the country they are in.
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.