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Glenys Thornton on the challenges facing ministers once peers get into the finer detail of the Health and Care Bill

The Health and Care Bill is in some respects a worthwhile piece of legislation. But it is also going through Parliament at the wrong time, and fails to deal with the issues deeply affecting our health and care system, including increased inequality, long waits, workforce shortages, weak and underfunded public health, and wholly inadequate levels of provision and funding. 

The bill began as a legislative response to the NHS leadership wanting to reverse key aspects of the Health and Social Care Act 2012 deemed incompatible with the development of their Long Term Plan. These included ending compulsory competitive tendering for certain services and allowing greater cooperation and joint working among various bodies. In addition, informal organisational arrangements that the NHS had developed in Sustainability and Transformation Partnerships, were to be put onto a statutory basis – and these are reflected in the proposed 42 Integrated Care Systems.

Legislation expected in 2017 emerged in 2021, with the addition of a raft of new powers (and some new functions) for the Health Secretary – including direct involvement in service reconfigurations, the transfer and delegation of various functions in relation to arms-length bodies, professional regulation, and reporting on workforce needs. Labour considers all of these to be unnecessary, as they compromise the separation of political and operational responsibilities that were one of the few 2012 changes that appeared to add value.

The bill also includes proposals around information standards and information sharing, setting up the Health Service Safety Investigations Body, and given CQC powers to investigate adult social care; as well as medical examiners, where some serious questions have been raised over the impact. Plus, there are some genuine health matters relating to food advertising, fluoridation, and virginity testing. And, of course, the highly contentious new clause concerning the social care costs cap – something the Government introduce only once the bill had gone through Commons Committee stage.

Labour has broadly supported the proposals that remove the worst of the 2012 Act but will seek to add safeguards to ensure proper governance and accountability, and to prevent new arrangements being open to abuse. Appointments to key positions must be made properly not just awarded. Services should ideally stay within the NHS – but contracts made with the private sector must be subject to a proper procurement regime. All new bodies must be completely open and transparent, and not pretend to be businesses with secrets to hide.

Amendments relating to yet another NHS reorganisation are clearly going to be of major importance when we reach the later stage of the bill; as will those relating to the new Integrated Care Boards which will have responsibility for billions of pounds of public money.  These boards will be crucial in working towards a more integrated care system, involving local authorities, voluntary organisations, and others. It is vital that yet another attempt to try to resolve how NHS services are commissioned will learn from the earlier CCGs, PCGs, and PCTs.  

Labour Peers will be looking to put checks on the new powers of the Secretary of State, ensure effective workforce planning across the whole of the care sector, and tackle the attempt to reduce the value of the care costs cap. Doing so, however, is going to involve the building up of a wide coalition of interest both within and beyond Parliament – and we especially look forward to parliamentarians on the government’s own benches doing the right thing.

Baroness Glenys Thornton is Shadow Health Minister in the House of Lords. She tweets @GlenysThornton

Published 7th December 2021

What next for the government's NHS reform plans?

Glenys Thornton on the challenges facing ministers once peers get into the finer detail of the Health and Care Bill

Vernon Coaker on ensuring shop workers get the protections they deserve

Respect for Shopworkers Week is an annual event organised by the trade union Usdaw and supported by many retail employers and organisations, including the Co-op Group, British Retail Consortium and Association of Convenience Stores. Taking place this week, it highlights the appalling levels of abuse, and all too often violence, that retail workers face while simply going about their jobs.

During the pandemic, many of these same workers helped keep food and essential supplies on the shelves for their communities. A survey, however, of those serving on the frontline showed that abuse of retail workers doubled during the first few months of the pandemic, with one in six reporting daily verbal attacks. Sadly, these were often triggered by the very things they were doing to keep the rest of us safe, promoting and enforcing public health measures, social distancing and mask wearing.

Since then, the situation hasn’t improved. Usdaw’s latest annual survey, released this week, reveals that in the past year nine in ten retail workers have been verbally abused, 64% threatened, and one in ten assaulted. The Co-op Group has seen a 12% increase in violent assaults in the first 9 months of 2021 compared to 2020 and an almost 700% rise over the past six years. A trend that is typical of much of the sector.

Nearly half of the respondents to the Usdaw survey don’t believe that reporting the abuse they have faced makes a difference. Indeed, it’s clear the police have not viewed attacks against shopworkers as a priority. A Freedom of Information request made by the Co-op Group showed that the police did not attend 65% of the reported serious incidents in its stores last year. None of this is acceptable.

Abuse is not part of the job and it should never become normalised, common, or accepted. Nobody should be going to work expecting to face abuse, threats, and violence. But if it does happen, they need to be confident that the system is on their side. The current situation clearly needs to change and the only way to do that is through strong and decisive action at Parliament.

Despite overwhelming evidence of the scale of the problem, and a clear call for action – from workers, employees, and representative groups from across the sector – the UK government has so far failed to respond. In stark contrast to the Scottish Parliament, which has unanimously backed Labour MSP Daniel Johnson’s Protection of Workers Act.

The Police, Crime, Sentencing and Courts Bill, currently making its way through the Lords, provides an opportunity to give retail workers the protection they deserve. Along with others in the House, I have tabled amendments that would do exactly that – and these are due to be debated this evening. It's not too late for Ministers to act but should they fail, we will look to give MPs another chance for a say on this hugely important issue.

Lord Vernon Coaker of Gedling is a Shadow Home Office Minister. He tweets @Vernon_Coaker

Published 17th November 2021


Retail politics

Vernon Coaker on ensuring shop workers get the protections they deserve

Sue Hayman on why the Government must act now to break the stark link between air pollution and poor health outcomes

It is now widely accepted that spending time enjoying the great outdoors can boost our health and wellbeing, something reinforced no doubt by people’s personal experiences of lockdown. But the air breathed by many in the UK contains toxic levels of pollution and has become a silent killer, leading to around 36,000 premature deaths per year.

Fine particulate matter, or PM2.5, can cause terrible damage. It comes predominantly from vehicles and heavy industry, and has been linked to increased risk of illnesses as diverse as lung cancer, heart disease, type 2 diabetes, and dementia.

Poor air quality is not spread equally across the UK. The most deprived parts of our towns and cities tend to be the most severely polluted, meaning the impact is disproportionately felt by those on the lowest incomes. Groups that are already among the most vulnerable – pregnant women, infants and children, the elderly, and those with lung conditions – are, sadly, the most likely to be hardest hit.

The dangers of toxic air are not new. In 2005, the World Health Organisation (WHO) set targets for governments to reduce levels of air pollution to try to avoid the worst health impacts. WHO revised its guidelines this September, significantly reducing the recommended levels for all pollutants in response to overwhelming evidence of the dangers of exposure.

Analysis from Asthma UK and the British Lung Foundation has found that around a third of children in the UK are growing up in areas with dangerous levels of pollution. As if this weren’t bad enough, almost a third of England’s hospitals, schools, colleges, and GP surgeries, as well as a quarter of care homes, are in areas that breach the 2005 WHO rules. It is a travesty that people are at risk in the places where they should feel most safe.

Many will be familiar with the tragic case of Ella Kissi-Debrah, whose death the crown court ruled last year was partially due to exposure to high levels of pollution. But they might be less aware that a staggering 88% of Asthma sufferers in the UK state that toxic air significantly impacts on their daily lives, triggering symptoms and trapping them indoors on days when levels rise.

The government has consistently failed to prioritise the issue, missing its own legal limits for Nitrogen Dioxide and with PM2.5 still well above recommended levels. Ministers keep telling us that its flagship Environment Bill will “deliver cleaner air for all” but at the same time kick the can down the road, promising unspecified future action rather than clear legislative commitments.

The science is clear, as is the Labour Party’s commitment: tackling air pollution is a primary health and environmental objective. Keeping everyone safe from its effects is a cornerstone of our public health policy, with Keir Starmer committing a future Labour government to passing a Clean Air Act.

For the best part of a year, I have been working with colleagues across the House of Lords to amend the Environment Bill to include a 2030 target for meeting the WHO’s clean air guidelines. This is an ambitious but achievable timeframe that would not only benefit public health but set the pace for pollution reductions in line with the 2050 net zero emissions target.

Although our amendment was rejected in the Commons last week, senior Conservative MPs – such as Neil Parish and Bob Neill – expressed clear concern that the government was being too slow to act on air quality. Tomorrow, when the issue comes back before the Lords, I will again make the case for the inclusion of a clear, binding target in the Bill. By agreeing to do so, Ministers could prevent millions of our fellow citizens from being consigned to a lifetime of poor health.

Baroness Sue Hayman of Ullock is a Shadow Defra Minister in the House of Lords. She tweets @SueHayman1

Published 25th October 2021

Breathing space

Sue Hayman on why the Government must act now to break the stark link between air pollution and poor health outcomes

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