Health and Social Care Act (Northern Ireland) 2022 (Consequential Amendments) Order 2022

Considered in Grand Committee

Moved by

That the Grand Committee do consider the Health and Social Care Act (Northern Ireland) 2022 (Consequential Amendments) Order 2022.

My Lords, I hope to be even shorter with this piece of legislation. The Health and Social Care (Northern Ireland) Act was passed by the Northern Ireland Assembly earlier this year and received Royal Assent on 7 February 2022. The Act provided for the dissolution of the regional Health and Social Care Board and the transfer of its functions to the five Northern Ireland health and social care trusts.

A number of UK Parliament and Scottish Parliament Acts reference the now dissolved regional Health and Social Care Board, where amending those references would be outside the legislative competence of the Northern Ireland Assembly. Secondary legislation is therefore required to make consequential amendments to update references to the regional Health and Social Care Board so that the

“Northern Ireland Department of Health or health and social care trusts”

are referenced instead. This technical order seeks to update these references.

Although the order is primarily for administrative purposes, I would like to give a bit of background on the Health and Social Care (Northern Ireland) Act. All noble Lords will be aware that health is a devolved matter in Northern Ireland. The primary purpose of the Act was to implement recommendations made following a number of independent reviews and reports that had been commissioned over a number of years, from Donaldson to Bengoa, which found the current health system to be “overly bureaucratic and complex”. Those recommendations included the dissolution of the regional Health and Social Care Board and the transfer of its functions to the five Northern Ireland health and social care trusts.

As I said, the Act to give effect to this received Royal Assent on 7 February 2022, after which the Northern Ireland Health Minister, Robin Swann, requested that my department take forward secondary legislation to make consequential amendments to UK Parliament and Scottish Parliament Acts where the regional Health and Social Care Board is referenced.

It will not be quite so short and uncontroversial next week—I suspect the Minister will have a few more hours on his feet than today—but on this one he is absolutely right. It is something we support.

It reminds us that there is of course an Assembly, which passed these changes some time ago. It also reminds us that this is an attempt to ensure that the health service in Northern Ireland is more efficient than it was. From a very good point of view, it shows the rest of the United Kingdom that health and social services go together. This operates well in Northern Ireland—it always has—and I am not quite sure why we do not take a leaf from the Northern Ireland book. It is something we admire.

What we cannot admire is the fact that there are no Ministers in Northern Ireland running the show, so far as health is concerned. We all know that there is a serious problem with waiting lists in Northern Ireland at both primary and secondary healthcare levels. There are huge difficulties in staffing, finance and so on. The problem is that there is no political authority in Northern Ireland to deal with these huge issues.

In a day we will have a new Prime Minister, and we might have a new Secretary of State for Northern Ireland. I hope that we do not have a new Minister for Northern Ireland in the Lords and that the Minister retains his position, because he knows a huge amount about the issues and the place, but there has to be even greater impetus. I know we have the protocol Bill and the legacy Bill coming up—these are all difficult issues to address—but, at the end of the day, unless we have a functioning Government in Northern Ireland only one other thing can happen. Ultimately, it will have to be direct rule. It would be a complete disaster if that had to happen, but you cannot leave civil servants running the show in Northern Ireland any longer, particularly with regard to health, so there is an impetus for the new Government and new Prime Minister, and possibly new Secretary of State, to resolve the impasse in Northern Ireland. We all know why it is there—I will not go into any of that—but I am sure that all Members in this Committee, particularly those from Northern Ireland, understand the significance and importance of having a Minister of Health who can operate as other Ministers can in a liberal parliamentary democracy.

My Lords, I will intervene from the Liberal Democrat Front Bench on this one. I could see the alarm in the Minister’s eyes that a Westminster health and care spokesperson might try to intervene on an order to do with Northern Ireland health and care. I assure him that it is as technical as his contribution at the beginning. We have no problem at all with the statutory instrument in front of us today.

I want to make one point, which I hope the Minister will take back. The noble Lord, Lord Murphy, may be aware that the Health and Care Act is the first real attempt by a Government in this country to combine health and social care, so Westminster, on behalf of England, is finally getting its act together and combining the two—which, whatever opposition we had to elements of it, we certainly welcomed. In March, during its passage through your Lordships’ House, a number of amendments were ruled out of order because they referred to some of the UK-wide legislation that the Minister referred to in his opening. We were told that an agreement had been struck by the Government with all three devolved nations, which had already taken their legislation through, and therefore that amendments we wished to lay could not be laid.

They were very minor and technical, so I will not go into them here. However, if we are going to talk about the importance of devolved responsibilities and try to mend some of the complex technical issues around legislation that crosses into UK-wide legislation, those working on Bills, certainly in your Lordships’ House, need to know at a much earlier stage where those discussions need to be had. It would have helped the transition of the Health and Care Bill, which was enacted on 28 April—some two months after the Act we are discussing was enacted—because there were things we would have liked to change and would have raised much earlier, had we been aware that there were issues.

My Lords, I support this very technical order. Like the noble Lord, Lord Murphy, I make a plea yet again for negotiation between all parties and both Governments to get the institutions up and working to look at the areas where there are problems or impediments, including in the protocol, and any other issues.

The most important thing that the people of Northern Ireland require is a functional Government who are delivering for all of us on health and social care, the economy, infrastructure and job creation. In relation to this, I agree with the noble Lord, Lord Murphy. There are chronic waiting lists in Northern Ireland for specific disciplines. There are also waiting lists to get on to waiting lists, which can cause such consternation for individuals who are ill. That has been the situation for quite some time.

I do not disagree with the assimilation of the Health and Social Care Board into the Department of Health and the five health trusts. As a former MP I had experience of dealing with the Health and Social Care Board and the health trusts. I could never fully understand or appreciate the difference in their workload, because the health and social care board commissioned the services and acted as the prescriber of what services were required. Notwithstanding that, that is a job better done by the Department of Health.

In relation to that, maybe the Minister would have talked to the current caretaker Minister, Minister Swann, who served as Health Minister for the last nearly three years, about what savings are projected from the assimilation of the Health and Social Care Board into the department and trusts. Will those savings be ploughed back into the delivery arm of the trusts so that people can access services in the medical and clinical areas to which they are entitled?

When my noble friend comes to reply, could he give the Committee an impression of whether the problems with the health service in Northern Ireland, although very considerable, have deepened yet further during this unfortunate period, which strengthens the reasons why we want devolution back?

I am incredibly grateful to noble Lords for their contributions on what I rightly described as a very technical piece of secondary legislation. The main theme of contributions was the current problems in the health service in Northern Ireland and the need for a properly functioning Executive and Assembly to address them. I think we all agree on that. I reiterate what I said on the previous regulations: the Government and the Northern Ireland Office are fully committed, and I am personally committed, to doing whatever we can do ensure that those institutions are back up and running as quickly as possible.

The noble Lord, Lord Murphy, was not entirely accurate when he said that there were no Ministers in place at the moment. He will know, as the noble Baroness, Lady Ritchie of Downpatrick, acknowledged, that as a result of the Northern Ireland (Ministers, Elections and Petitions of Concern) Act, which we passed earlier this year, there is provision for Ministers to stay in place for up to 28 weeks after an election.

I realised after I said it that I had dropped a clanger, but the point I was trying to make, which I am sure the Minister will come to, is that they are not Ministers in the sense of being completely accountable in the way that an ordinary Minister would be in any other legislature. Although they have limited powers, which they undoubtedly exercise as well as they can, it is not the same as if they were Ministers in a functioning Assembly and Executive.

The noble Lord is absolutely correct to point that out. It is 24 weeks; I said 28 because the current deadline is 28 October. Although Ministers can stay in place, they are very limited as to what they can do—they cannot take decisions that would require executive agreement because there is no functioning Executive and they cannot take decisions that would be cross-cutting with other departments—but it is a preferable situation to the one we had when the Assembly was last down, when just civil servants were running the show. I am all too well aware of the limitations. For that reason, noble Lords are absolutely right to set out once again the urgency of restoring a properly functioning Executive and Assembly in which Ministers are fully accountable to the Assembly and, through the Assembly, to their respective electorates within Northern Ireland.

The noble Baroness, Lady Ritchie, again underlined with her questions on certain aspects of the legislation the importance of getting the Assembly back. Although her questions were directed at me they really should be directed by MLAs to the Health Minister. I am very happy to look into the matter for her, but it is essentially a devolved one on which further elucidation would be gained through Health Minister’s Questions in the Assembly rather than in a House of Lords Grand Committee.

I asked the question because we as a House of Lords are being asked to approve an order that would enable a change in in English, Welsh and Scottish legislation to reflect the dissolution of the Health and Social Care Board. In view of that, would the question not be quite prescient? I also thank him for going to ask the current Minister for that information on the projected savings and whether they will be ploughed back into the service.

As I said to the noble Baroness, I am perfectly happy to do so. I appreciate that no MLA is able to stand up in the Assembly and ask those questions at the moment, so I am happy to look into the matter and come back to her.

I welcome the noble Baroness, Lady Brinton, to her place. She correctly identified my look of alarm at the fact that a Westminster health spokeswoman had come into a debate on Northern Ireland matters. She will be aware that I played no role whatever in the passing of the health and social care Act, so I must confess to a certain degree of ignorance of some of the matters she raised. Again, I am happy to look into them for her.

I was making a generic point for Ministers to take away that, where these things emerge, I suspect it would be useful if there were some wider discussions, at least with the Front-Benchers involved with the relevant Bills. It is somewhat frustrating three-quarters of the way through a Bill to suddenly be told that amendments cannot happen, but I am absolutely not asking the noble Lord to deal with that on its own. We respect devolved authority and think it is really important, but we all have to learn how to work together. In this Bill, for once, it was the Westminster side that was left out until after other things had happened.

I am grateful to the noble Baroness. Like her and many others in this Committee, I am a strong supporter of devolution across the United Kingdom and wish to see it function smoothly, efficiently and harmoniously across all parts of our country. I am very happy to have a look at what she suggested.

My noble friend Lord Lexden asked again about the problems in the health service. On the measures that might be necessary, I talked about the limitations on Ministers in the current scenario we face. Without straying into devolved policy areas, there are probably some quite radical measures and actions that need to be taken to deal with the situation that would be cross-cutting in the Executive, would require executive approval and would need to be quite bold, but which simply cannot happen within the current constraints, without a properly functioning Executive.

My noble friend is absolutely right: things are in a pretty poor state in Northern Ireland and this just underlines the need for the devolved Government to be back up and running as soon as possible. Although I do not necessarily share the reasons, I completely understand why the institutions are not up and running. That is why, without wishing to stray too much into other policy areas, the Government—including under the new Prime Minister, I am sure—are committed to resolving the issues which are preventing the establishment of the devolved Government that we all wish to see up and running. On that note, I commend the order to the Committee.