Members of the Lords continued to discuss proposals seeking to define the duties and responsibilities of the Secretary of State for Health for the NHS. Debate started with amendments setting out the Secretary of State's control of what the NHS Commissioning Board does.
Line by line examination continues on Monday 28 November.
What's happened to the Bill so far in the LordsDay six
Members of the Lords continued to consider the Secretary of State’s responsibility for education and training and addressed proposals for change on alcohol dependence, changes in budgets which will have an effect on health outcomes and inequalities in communities.
The House of Lords voted in favour of a proposal to require the Secretary of State for Health to report on the effect of VAT for charities commissioned to provide healthcare services for the NHS, defeating the Government.
The opposition minister for health also called for the immediate publication of the Government’s risk assessment of the implementation of the NHS reforms the bill introduces.
Amendment 46, moved by Lord Patel of Bradford, Commissioner of the Healthcare Commission 2003-05, seeks to address the ‘VAT disadvantage’ of charities in the provision of services to the NHS, such as hospices and long-term palliative care providers.
Moving his amendment, Lord Patel explained: ‘It was only in January this year that we debated the unfair burden placed on charitable organisations that take on public services but cannot claim the same VAT exemptions as the health service providers they have succeeded. A major inequality exists with respect to irrecoverable VAT for charities providing healthcare services. While the NHS is able to recover VAT on, for example, certain non-business supplies, charities are not.’
Lord Patel added: ‘It is surely unreasonable to expect those who give charitable donations to organisations such as Sue Ryder to pay tax twice – their donations are from income that is already being taxed, yet the vital services which their donations go towards supporting are then taxed again for VAT.’
Speaking in support of the amendment, Lord Warner, a member of the Commission on Funding of Care and Support (Dilnot Commission), said: ‘This is a barrier to entry. It is stopping voluntary organisations participating fully on the basis of a level playing field as a qualified provider.’
Baroness Finlay of Llandaff, physician and Professor of Palliative Medicine at Cardiff University; Lord Noon, chair of a charitable foundation that provide palliative care; Baroness Pitkeathley, chair of the Council for Healthcare Excellence and former chief executive of Carers UK (1986-98); and Lord Turnberg, a former President, Royal College of Physicians (1992-97) were among Members of the Lords who took part in debate on the amendment.
The House of Lords agreed to the amendment by 195 votes to 183, a defeat for the Government by 12 votes.
Baroness Thornton, the opposition spokesperson for health in the Lords, intervened at the start of debate, to seek clarification on the Information Commissioner’s ruling that the Government must make public the risk assessment report on NHS reforms under the Bill. Baroness Thornton said: ‘The Commissioner finds that there is a very strong public interest in the disclosure of this information given the significant change to the structure of the NHS proposed by the Government.’ She was concerned about the ‘ability of the House to conduct a comprehensive consideration’ of the Bill if it ‘does not have access to this potentially very important information.’
Discussion focused on the Secretary of State’s duty for medical research and the provision of education and training for NHS employees on Wednesday 9 November.
Committee stage: day three
Members of the Lords considered a range of proposals for change to the Bill on Monday 7 November including:
- a transparency duty on the Secretary of State to ensure patients and carers are given full information about treatment
- amending the duty to reduce inequalities of health outcomes between people across England, and
- removing the duty to promote autonomy of health services providers.
Committee stage: days one and two
Members of the Lords discussed proposals concerning the duties and responsibilities of the Secretary of State for the health service in England during the second day of committee stage on 2 November, while discussion during day one of committee stage centred on the key elements of the Bill: setting out the principles of the health service.
Second reading: main debate on the Bill
Two of the largest House of Lords votes for over a decade took place during the second reading – debate on the main principles of the Bill – which took place over two days with 102 Members of the Lords taking part – on 12 and 13 October.
About the Bill
The Health and Social Care Bill, which aims to modernise the NHS:
- changes how NHS care is commissioned through the greater involvement of clinicians and a new NHS Commissioning Board
- introduces new mechanisms to improve accountability
- empowers patients to increase their voice and involvement in their care
- gives NHS providers new freedoms to improve quality of care
- establishes a provider regulator to promote efficiency.
In addition, the Bill will underpin the creation of Public Health England, a new integrated national public health organisation, which will support the provision of local services and take forward measures to reform health public bodies.
Detailed line by line examination of the separate parts (clauses and schedules) of the Bill takes place during committee stage. Any Member of the Lords can table amendments to make changes to the Bill.
Amendments can allow the House of Lords to make revisions to Government Bills (plans for laws). Members of the Lords, often with specialist knowledge or experience of the subject, submit amendments to explore possible effects of the planned law and the policy that lies behind it.
Members of the public can attend House of Lords debates and follow proceedings from the public gallery.