Wednesday 28th October 2026
(1 day, 12 hours ago)
Lords ChamberHealth Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: HL Bill 52-I(Rev)(a) Amendments for Committee (Supplementary to the Marshalled List) - (28 Oct 2026)
Lord Rennard
“(c) reduce inequalities in the prevention, diagnosis and treatment of diabetes, including variation in access to structured education, glucose monitoring technology and insulin pump therapy.”Member's explanatory statement
This amendment would make diabetes-related health inequalities an explicit, named consideration within the Secretary of State’s general duty to reduce inequalities, rather than leaving diabetes provision to be addressed only implicitly.
Lord Rennard (LD)
My Lords, my father might be considered to have been lucky in that, despite losing a leg in the First World War and developing diabetes in the 1920s, that was the decade in which insulin was developed, and it saved his life. His treatment with insulin was so successful that it enabled me to be born in 1960, when he was over 70. When I developed diabetes myself in my 30s, it got way out of control, and I needed daily insulin injections for 20 years. But with great support from St. Thomas’ Hospital, making major lifestyle changes, obtaining a continuous glucose monitor, and being prescribed Mounjaro, I was able to come completely off insulin two years ago. My long-term blood sugar levels have now fallen to just 41 millimoles, which is below the pre-diabetic range.
But many people are much less fortunate than me and do not get the care I do. The prevalence of diabetes is increasing. Over 4.6 million people in the UK live with a formal diabetes diagnosis, and that is predicted to exceed 5 million very shortly. An estimated 1.3 million people are living with undiagnosed type 2 diabetes, while 5.7 million adults in England live with pre-diabetes. In total, more than 12 million adults, one in five, are living with diabetes or pre-diabetes. The direct cost of diabetes care to the NHS has been estimated at £10.7 billion per year, representing around 10% of the entire NHS budget. When indirect impacts are included, total costs exceed £23 billion to £26 billion annually. Diabetes UK estimates that this will surge to between £39 billion to £44 billion per year by 2035 if current trends continue.
Most damningly, 80% of this vast expenditure is spent not on proactive care but on treating people with largely preventable complications. Every week across the UK, there are many preventable complications arising from diabetes: on average, 812 strokes, 568 heart attacks and 2,909 cases of heart failure. In England alone, there are more than 160 lower-limb amputations every week, four out of five of which could be avoided with timely high-quality care. People with diabetes occupy one in every six hospital beds, and diabetes is taking a severe toll on economic productivity. The more than 360,000 working-age adults living with diabetes are now economically inactive due to long-term sickness, a 43% increase in seven years. We cannot continue to address this crisis with short-term financial thinking. Treasury models such as those we are hearing much about today too often demand short-term savings within tight budgetary cycles, ignoring the immense long-term savings that could result from preventing complications.
Nowhere is this short-termism more evident than in the unwarranted regional variations and postcode lotteries exposing vulnerable patients across our health system. The flagship Getting It Right First Time national report on children and young adults, published this year, reveals alarming disparities across England’s integrated care boards. For the 56,000 children and young adults living with type 1 diabetes and the 9,000 with early onset type 2 diabetes, median blood sugar control ranges from just below 55 in top performing units to over 70 in others. While some paediatric units complete all essential annual care checks for 98% of young patients, others achieve just 6%. Patients are literally forced to move house across ICB boundaries just to access life-changing technology.
We now possess transformative tools that can eliminate these disparities if made consistently available. Continuous glucose monitors, or CGMs, have reached over 60% of people with type 1 diabetes, yet access remains quite restricted for those with type 2 diabetes who, like me, could benefit from them immensely. Similarly, while over half of children with type 1 diabetes now use hybrid closed loop systems, known as artificial pancreas systems, overall adult pump provision in the UK stands at just 15%, compared to over 60% in the United States and far higher rates across Europe. Furthermore, for those under 18, hybrid closed loop uptake ranges from 37% to 79% across different ICBs.
Equally vital is the issue of early diagnosis, intervention and specialised care. Currently, 25% of individuals with type 1 diabetes and up to 30% of children and those from deprived backgrounds are diagnosed with diabetes only when presenting in emergency departments with life-threatening diabetic ketoacidosis, known as DKA. Evidence from Germany demonstrates that systematic early screening reduces DKA presentation rates from 30% down to just 2.5%.
Likewise, we must confront the alarming rise of early-onset type 2 diabetes among working-age adults and under-40s. As we approach yet another major NHS reorganisation, we need to guarantee long-term sustainable funding for targeted initiatives such as the NHS T2Day programme and the type 2 diabetes path to remission programme, while rolling out at greater pace GLP1 medication supplies, such as Ozempic and Mounjaro, for many more people with diabetes.
This brings me directly to the amendments tabled in my name after Clause 84. If we plan to abolish NHS England, we must address a critical moment of vulnerability for our public health infrastructure. My first amendment would establish a statutory requirement for the Secretary of State to secure the continuity of key national diabetes programmes to at least the same extent as before the potential abolition of NHS England. This encompasses the NHS diabetes prevention programme, the type 2 diabetes path to remission programme, national provision of continuous glucose monitors, the rollout of hybrid closed-loop technology, and essential diabetes audits, including those for foot care and in-patient safety. It would require an explanatory statement on continuity before making any transfer schemes, alongside annual mandatory reports laid before Parliament, detailing patient access, waiting times and clinical outcomes.
My second amendment would require the Government to publish annual assessment reports over the next four years, specifically evaluating the impact of NHS England’s abolition on diabetes services. These reports must scrutinise changes in funding allocations, the operation of clinical audits, patient access to glucose monitoring and insulin delivery services, as well as specialist workforce capacity.
Consistency in high-quality care, equitable access to modern technology, robust prevention and early diagnosis are not luxury add-ons; they are the essential building blocks of a sustainable healthcare system, a productive economy and a healthy society. I therefore hope that the Minister will see how these amendments would protect national diabetes services, enforce parliamentary accountability and ensure that we give millions of people living with diabetes the care they need, which is very much in the national interest. I beg to move.
Lord Hunt of Kings Heath (Lab)
My Lords, it seems that this goes to the heart of some of the issues we were discussing in relation to the noble Earl’s Amendment 4. It is about the balance between what the noble Lord, Lord Rennard, is attempting to seek, which is much more central direction in relation to diabetes services, and the wish for the NHS to be able to make its own decisions locally. Going back to the round table that we had on Monday, the CEO of the NHS Alliance was concerned about central interference, as I think he would call it, into decisions made locally.
Baroness Pidgeon (LD)
My Lords, these amendments tabled by my noble friend Lord Rennard raise some important points and are intended to safeguard national diabetes services following the planned abolition of NHS England, and to ensure that patients do not lose access to proven programmes during that transition.
This is a point that has come to me time and again from different charities representing different disease groups. They are concerned that the specialism and some of the services that are commissioned will be lost. I am sure we will discuss this again on other Committee days.
As we have heard, diabetes is one of the greatest health challenges facing us all. According to Diabetes UK, over 12 million people in the UK are living with diabetes or prediabetes, and it costs the NHS around £10.7 billion every year. That expenditure is linked to complications that can often be prevented through early intervention, effective treatment and consistent monitoring, as well as routine diabetes care.
The amendments would therefore require the Secretary of State to maintain, at a minimum, the current provision of key national programmes. As we have heard, these include the NHS type 2 diabetes prevention programme, the diabetes path to remission programme, continuous glucose monitoring, the rollout of hybrid closed-loop technology and the national diabetes audit programme. I flag that the type 2 diabetes prevention programme is recognised as a world-leading prevention intervention. We do not want to see that lost with this reorganisation.
The amendments would also strengthen transparency and accountability. Before any transfer of functions, the Secretary of State would be required to set out how continuity of these services would be guaranteed. Annual reports to Parliament would then provide clear information on patient access, waiting times and outcomes, while separate assessments over the first four years following the abolition would monitor the impact on funding, workforce capacity or clinical audits, and access to technologies.
At a time when diabetes continues to rise and the impact felt both by individuals and financially throughout the NHS is so significant, it is essential we have confidence that these vital national programmes will not only survive the organisational change but continue to improve outcomes for people living with diabetes. I look forward to hearing the Minister’s response.
Earl Howe (Con)
My Lords, I too am grateful to the noble Lord, Lord Rennard, for bringing forward these amendments and for drawing the Committee’s attention to the important issue of diabetes prevention, treatment and care. I particularly welcome the focus in these amendments on innovation, because this is an area in which we see some genuinely promising developments. One example, mentioned by the noble Lord, Lord Rennard, and the noble Baroness, Lady Pidgeon, is the emergence of hybrid closed-loop systems. For people living with type 1 diabetes, this technology has the potential to make an enormous difference.
In April 2024, NHS England began a five-year programme to roll out this technology to eligible children, young people and adults living with type 1 diabetes. That was a very welcome development, and I hope we will continue to see the programme expanded so that more patients who would benefit from the technology are able to access it. It would be helpful to hear from the Minister about that, and about how the rollout of the programme is progressing and how many patients have received the technology so far. As with any issue like this, improvements in accessing the technology are always forefront of commissioners’ minds, so it would be helpful if the Minister can say anything about that. I would also be interested to hear what assessment the Government have made of the availability of specialist staff to support this rollout. Developing an effective new technology is one thing; ensuring that patients can access it, and that clinical teams have the resources and expertise to provide it, is another.
More widely, these amendments raise an important question about the future scale and impact of diabetes in this country. The noble Lord, Lord Rennard, highlighted the statistics and predictions from the International Diabetes Federation. Those predictions present a considerable challenge for not only patients and their families but for the health service. They also reinforce the importance of prevention, particularly in relation to type 2 diabetes, where earlier intervention can make a considerable difference. Can the Minister tell us what steps the Government are taking to strengthen prevention and early diagnosis and to support the wider adoption of new technologies?
Finally, I want briefly to touch on Amendments 225 and 226, which raise a wider point about the abolition of NHS England and the continuity of existing national diabetes programmes. During our consideration of the Bill, we have discussed at some length the importance of ensuring that the abolition of NHS England does not disrupt the delivery of essential services or lead to the loss of programmes and expertise that are already delivering benefits to patients. The noble Lord is absolutely right to raise that concern in the context of diabetes. I am not necessarily persuaded that we need to place each of these requirements in statute, but he raises some entirely legitimate questions. I would welcome assurances from the Minister that these programmes will continue to receive the attention and support they require throughout the transition. I look forward to what the Minister has to say.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I am most grateful to the noble Lord, Lord Rennard, for tabling this amendment, and to other noble Lords for their contributions. The Government recognise the importance of high-quality diabetes prevention, treatment and care services, and I believe that our actions on this reflect that. Programmes such as the NHS Diabetes Prevention Programme, the NHS Type 2 Diabetes Path to Remission Programme and the National Diabetes Audit all play an important role in improving outcomes for people living with diabetes.
I turn specifically to Amendments 225 and 226. The Bill allows for the transfer of functions and responsibilities from NHS England following its abolition—that means a transfer that will not impact service provision. I say to the noble Earl, Lord Howe, that the Government support effective diabetes services and innovations in various ways, but that includes ensuring the continued commissioning, monitoring and improvement of these programmes without the need for disease-specific provisions in primary legislation. Moreover, specifying programmes at this level of detail would restrict our ability to adapt to new and changing evidence on effective treatments and technologies; I know that is something noble Lords would not want to restrict. Similarly, a diabetes-specific reporting clause would duplicate existing monitoring and oversight arrangements that provide additional assurance without adding administrative burden and additional bureaucracy.
To turn to Amendment 12, improvement of outcomes for people with diabetes absolutely includes reducing health inequalities, which we debated in an earlier group. That is already captured in the general duty to reduce health inequalities set out in Clause 4. Furthermore, the modern service framework for cardiovascular disease, which was published in July, advocates a holistic cardiovascular/kidney/metabolic approach, including finding those with undiagnosed or unmanaged diabetes, initiating treatment and increasing the number of people whose treatment is optimised, with a strong focus on reducing inequalities.
On Amendment 25, I reassure your Lordships that the Secretary of State and the NHS already have powers to promote innovation across the health service. The risk of singling out diabetes technologies in primary legislation is that it would create inconsistency with the approach taken for other conditions. Rollout of glucose monitoring and automated insulin delivery technologies is already supported through NHS implementation arrangements, based on established NICE guidance. Therefore, listing specific technologies in legislation could reduce the flexibility of the NHS to be as truly innovative as we would all want, as new technology emerges.
Lord Rennard (LD)
My Lords, I thank the Minister for her sympathy on these issues, and I thank all the people in her department, who I know are sincerely committed to trying to help people with diabetes, to help prevent its occurrence and to provide the best possible care and treatment. But at the heart of the problem, as the noble Lord, Lord Hunt of Kings Heath, said, is a dilemma: as people try to treat medical conditions such as diabetes differently and say there should be a localist approach, there is a fundamental problem for the whole of the country in that, if we fail to deal with this, the cost is on all of us. The costs to taxpayers, the costs of people not working, the costs of not paying to HMRC and the costs of drawing down on the DWP are growing enormously. This is such a huge problem that, as we have said at many points today, we have to look across all government sections at how we work together on all these issues. On that note, I beg leave to withdraw my amendment.
Lord Hunt of Kings Heath
Member’s explanatory statement
This amendment seeks to ensure that health and care partners can be involved in decisions about a patient.
Lord Hunt of Kings Heath (Lab)
My Lords, clearly, it is not ideal to start a really important debate at this time of night, but I hope noble Lords will feel they are able to take part in it as they would have done if we were doing this at a reasonable time. I have four amendments in this group: Amendments 21, 173, 174 and 214. I am grateful for the support of the right reverend Prelate the Bishop of Newcastle, the noble Baronesses, Lady Finlay and Lady Barker, and the noble Lord, Lord Blackwater.
At Second Reading, many Peers expressed the wish to promote actions that would directly improve the health outcomes and experiences of NHS patients. I believe there is a good opportunity here. There were fewer mentions of social care, yet the lived experience of people reliant on care services, particularly those in residential care, is just as important as that of those treated in hospitals. Many of these considerations also apply to mental health service in-patients. We know that, clearly, many people are fearful of entering hospital. Some say they would rather die than move into a care home. Treatment in mental health units must routinely be enforced by the process of being sectioned, a term that evokes fear.
My amendments are designed to offer all service users the assurance that, if there is someone who matters to them and is prepared to support them when they are receiving care or treatment, not only in their own home, they can nominate that person as their health and care partner. In most cases, this would be an entirely voluntary role, accepted by a spouse or partner, a close relative or a special friend. Some people who live with a paid companion, or individuals with complex needs who employ a personal assistant, may choose to nominate that person as their health and care partner. The essential element is that it must be the individual who makes the choice.
Baroness Finlay of Llandaff (CB)
My Lords, I added my name to several of these amendments because I think they are crucial. I read them very carefully to make sure that, in the event of there being major safeguarding concerns, it would not cut across them, and I do not believe it would. I think it will improve care.
It requires a change of attitude on behalf of healthcare staff to accept the fact that sometimes the person who is the relative, the carer who has been looking after someone at home, knows only too well exactly how to communicate with them if they have communication difficulties and how to manage even complex equipment such as their ventilator, sucking them out or whatever. In the hospice where I was medical director, I clearly remember one lady with a horrible tumour; her children wanted to do her dressings for her, and she wanted the children to do them. It was important for those children to be able to help, and encouraged to care as they wanted to, so that they were with her right through her illness. We provided accommodation for them to sleep there when she was dying. We also provided a family room and even had beds that we could put together, so a relative could sleep next to somebody. It really transformed care. It took a lot of pressure off the nursing staff, because there was somebody there all the time and if they became agitated, they could ask for help.
The staff in many units, however, can feel threatened by relatives who say the person would prefer something done one way or another. It is important that if there is someone with a person who is the patient, they have access to food and drink and comfortable seating, not a hard plastic chair, and that it is clear where they can use the toilet or even take a shower and be accommodated. It does not cost anything, but it saves a lot of staff time.
I hope that these amendments will be adopted into the main Bill to bring about that change. Those of us who went to the meeting about DEBRA, which is epidermolysis bullosa, were very touched by the cases we heard in which the mother was doing the child’s dressing changes. It was essential that the mother could go with that child into hospital, and that even when they became an adult they could go on an adult ward, because they knew exactly the least painful way to do the dressing changes. The staff who did not know the person beforehand just did not have the same knowledge and therefore could not apply the same skills.
The noble Baroness, Lady Campbell of Surbiton, spoke very powerfully about the need for a personal health budget. I know she has extensive experience of having her husband with her on many occasions when she has been in hospital, and there have been occasions when he has saved her life. This is not minor. This is very important.
Baroness Tyler of Enfield (LD)
My Lords, I underline first of all what the noble Lord, Lord Hunt, said about how very less than ideal it is to be dealing with an important group of amendments of such sensitivity this late in the day, but we are where we are. I very much support the amendments put forward by the noble Lord. I remember clearly my personal anguish at not being able to visit my mother for a long time in her care home. It really was agony for me. What happened during Covid must never be allowed to happen again. I think of those care home residents who died without the love and support of any of their relatives by them. It is an absolute scandal. It is shocking. We must make sure it does not happen again.
My amendments are about unpaid carers and their relationship with the NHS. As we know, unpaid carers have very frequent contact with the NHS, but recognition and support for them can be very variable indeed. This Health Bill presents an important opportunity to place essential rights and support for unpaid carers in legislation for the first time, to bring them on a par with existing rights that carers already have in relation to local authorities. My amendments are designed to improve the identification, health and well-being of carers, as well as improving the provision of breaks, to which they should be entitled.
There are some 4.7 million unpaid carers in England, and the value of carer support is worth £152 billion in England alone. That happens to be about the same as the budget of the whole NHS. We have so many unpaid carers that they are holding the NHS together.
Turning to Amendment 88, on the duty to identify and record unpaid carers, the Care Act 2014 already places duties on local authorities relating to the identification of unpaid carers, but no equivalent duty exists for integrated care boards, which commission in the vast majority to health services. Unpaid carers are more likely to come into contact with health services earlier than they are with local authorities, and there is evidence of significant underidentification of unpaid carers within the NHS. Analysis by the Nuffield Trust of 13 million GP records found that for every one carer identified by GP practices, four were not, meaning around 1 million carers were effectively missing from GP records. So, there are real problems with identification rates, which are compounded by the fact that more carers are identified in affluent areas than in deprived areas.
There are many cogent reasons why identification is important. For example, public health measures can be targeted at unpaid carers, such as free flu vaccinations and assessments for common health problems. Winter pressures on the NHS can be alleviated with targeted support and advice for unpaid carers, and of course, inclusion of unpaid carers in hospital discharge planning could help to reduce avoidable readmissions. That is just to name but three.
The last key point I will make here is that, ironically, unpaid carers can take a long time to identify themselves and understand that they are carers. In fact, some research I saw said that for some 36%, it took up to three years to understand they were a carer. Without a statutory duty, I fear that identification of carers will continue to depend on local priorities and resources. While some areas have excellent systems, others identify very few carers. A statutory duty here would introduce much greater consistency.
Amendment 89 would place a duty on ICBs to promote the health and well-being of carers. I think we all know that unpaid carers consistently experience poorer physical and mental health outcomes than non-carers: they just forget and neglect their own health needs. I have just one statistic here: the GP Patient Survey 2025 found that 72% of carers reported a long-term condition or disability, compared with 60% of non-carers. Many carers are just not able to prioritise their own health. Most tellingly, Carers Week research from last year found that 40% of current carers said they had postponed or cancelled a medical appointment, test, scan, treatment or therapy because of caring. That is an estimated 4.8 million people. My final point here is that ICBs rely heavily on unpaid carers to keep people well at home and reduce hospital admissions. Therefore, supporting carers’ health, I maintain, is vital to NHS sustainability.
Finally, my Amendments 175 and 176 are about a right to a break for unpaid carers and a national respite scheme, and I very much thank other noble Lords who have added their names to these amendments, and to all my amendments in this group. These two amendments essentially do the same thing: they ensure that carers who are assessed as being entitled to a break actually receive one, because although many carers in England are entitled to this assessment under the Care Act, many assessments just do not result in meaningful breaks or replacement care. There are many statistics here, but I will mention just one: official data from 2023-24 shows that only 8% of all unpaid carers were assessed or supported by their local authority, which is a shockingly low figure. Unsurprisingly, carers describe severe exhaustion, burnout, isolation and worsening mental health resulting from being unable to step away from these caring responsibilities.
Local flexibility in the delivery of breaks has too often resulted in inconsistency and postcode variation. Whether an unpaid carer can access a meaningful break should not depend on where they live or the financial pressures facing their local authority. That is why Amendment 176 also establishes a requirement for the Secretary of State to provide financial assistance to deliver this. There was much more I wanted to say, but the time is very late.
Baroness Pitkeathley (Lab)
Noble Lords will not be surprised to know that I give my enthusiastic support to the amendments on unpaid carers in the name of the noble Baroness, Lady Tyler. As she clearly said, one of the great difficulties about the carers’ movement is that people do not identify themselves as carers. That is partly because you become a carer in different ways: sometimes it creeps up on you, and you start by doing your dad’s shopping and then gradually do more for him until you are in a caring situation; or your mum has a stroke and there you are, suddenly in the carer role. Either way, you do not prepare for it, you do not discuss it with anybody, and you certainly do not identify yourself as a carer. That is why having somebody else identify you is of huge importance, and the only way that you are going to identify yourself as a carer and therefore have access to any kind of services at all.
Ironically, although carers have rights with local authorities under various other Acts in the past, they have no rights as far as health services are concerned, and yet it will probably be with their GP that they make initial contact. We did at one point have a duty on GPs to identify carers, but, sadly, that fell by the wayside during a different Government.
Identifying carers should be a duty, to help them and to support that huge workforce. Similarly, that applies to promoting the health and well-being of carers, because, as we have heard, 72% of carers report a long-term condition compared with 60% of people who are not carers. They do not take care of and neglect their own health because they are too busy caring.
As ever with unpaid carers, there is an economic as well as a moral case for supporting them. Here we have this huge workforce of 5 million people providing care worth, as the noble Baroness reminded us, the equivalent of another health service. It is in everybody’s interest to keep them well and doing what they want to do—they do so lovingly and willingly, usually—and to support them as much as possible.
Baroness Watkins of Tavistock (CB)
I support the amendments in the name of the noble Baroness, Lady Tyler. I have little to add to what the noble Baronesses, Lady Tyler and Lady Pitkeathley, have said, except to say that, for young carers, regular respite is essential. That might be going to a club once a week, to get out of the house and maintain other connections outside of school, for example. We know how important that is in preventing mental health problems.
There is huge inequality. For three years, I was a carer for my mother, who had Alzheimer’s disease. When I had had enough, I could afford to pay, along with her, to put her into a really nice nursing home for two weeks—which is in fact where she ended up for the last eight months of her life. It is not difficult if you have the money to plan it, but there are lots of people who do not. I cannot emphasise that enough. It kept me well and, in her moments of lucidity, made my mother feel independent, since she was paying to give me a break. We need to think about how difficult it is for people who cannot do that.
Particularly for people with dementia, admiral nurses should be able to identify those carers who are in need of respite. For many people, two weeks may not be what they need; what they need is 24 hours, once a week. Again, the care home that my mother was in is now offering that, and managing to have three people twice a week. That enables other people to go off. I am pleased to say that some of the beds in that nursing home are now paid for by the local authority, so things may be a bit more equitable than they were then.
There is clear evidence that, if you give respite to foster carers, foster carers can go on. Let us learn from that and see how we can apply that to carers right across the country, but with a particular emphasis on those who cannot fund anything to help themselves.
Lord Young of Cookham (Con)
My Lords, I will briefly follow in the slipstream of the noble Baronesses, Lady Tyler, Lady Pitkeathley and Lady Watkins, and speak about carers. They all spoke very movingly. I will speak in particular about young carers.
Last week, at Oral Questions, I pointed out that there were 15,000 schoolchildren spending more than 50 hours a week looking after their parents or siblings, and 3,000 of those were aged between five and nine. In that context, I pointed out the disadvantages they face in the field of education: being suspended, arriving late and underachieving. Young carers also underperform —if that is the right word—in terms of mental and physical health. They are rarely identified by the relevant authorities until, on average, three years have passed. In health terms that could include the GP, other health practitioners or those providing mental health services. It takes an average of three years to identify the young carers. Carers Trust polling found that just under a third of young carers said that they felt stressed or worried simply because of their caring role. The GP Patient Survey shows that young adult carers are notably more likely to live with long-term physical health conditions themselves—around 40% for young carers as opposed to 29% for young adults who are not carers.
Despite these health inequalities, very few young carers are identified by health professionals. That was brought home by the recent tragic case in the child safeguarding practice review Cooper and Harris. Two boys were living with their mother who had multiple health issues and had regular emergency hospital admissions. She told the hospital and medical staff several times that her young sons looked after her at home. The ambulance staff recognised the distress experienced by the boys when their mother had a particularly bad fall. Despite this, neither boy was identified as a young carer. Tragically, because the support for that family was not adequate, one of them found his mother lifeless one morning and had to call the emergency services. While the previous NHS long-term plan included specific measures relating to young carers, such as top tips for GPs on improving access to local support for young carers, the current long-term plan does not mention young carers at all.
Amendment 88, as has been explained by the noble Baroness, Lady Tyler, would go a long way to helping improve the identification of unpaid carers of all ages, including young carers, by placing requirements on ICBs to identify them, mirroring the responsibility of local authorities. Amendment 89 would introduce a duty for integrated care boards to promote the health and well-being of carers, including young carers. Through my role as the vice-chair of the APPG for Young Carers and Young Adult Carers, I routinely hear about the impact of caring on the health and well-being of young carers.
The Sutton Trust’s study found that young carers are more likely than young people without caring responsibilities to report severe psychological distress and are more vulnerable to self-harm and attempts on their own lives. The harrowing child safeguarding practice review Molly showed that even though the young carer was identified, professionals supporting Molly’s mother, such as GPs, did not sufficiently consider the needs of Molly, who took her own life with her mother’s medication when she was just 14.
I turn finally to respite care, mentioned by the noble Baroness, Lady Watkins. The provision of regular respite breaks can help support the health and well-being of unpaid carers. One of the things that carers always say makes the biggest difference are breaks. For young carers, respite can take many different forms: young carer groups; trips in the school holidays, which so many miss out on; or even being supported to access opportunities as a family. The Welsh Government actually do this.
These amendments complement the recent Unpaid Carers Action Plan: Recognise, Refer, Reach, which I welcome. I very much hope that the Government can respond sympathetically to this group of amendments.
Baroness Grey-Thompson (CB)
My Lords, Amendment 214 complements other amendments in my name. It concerns people with high support needs when they go into hospital and the care that they receive.
At two of my stays in hospital in the summer, I was repeatedly asked whether I had a carer. It felt very patronising as opposed to supportive. However, Second Reading of this Bill gave me another opportunity to have a lived experience of the NHS. This time I spent a week in St Thomas’ Hospital, which was an entirely different experience. It also gave me the opportunity to talk to people who would be affected by this amendment.
Nurses might be trained but not able to offer the appropriate support that someone with high care needs requires. If a person is unwell, it might be difficult for them to explain quite complicated care. There is a real fear among disabled people with high support needs about going into hospital in terms of the impact on their personal health budget—that it might be taken away or changed and about who pays for that care while the individual is in hospital. At a time of great worry, you do not want people to avoid going into hospital because they are worried about their personal health budget.
Hospitals might be accessible but not have the appropriate facilities for disabled people. This is where carers can make a real difference. Another individual contacted me to say that the nursing staff did not know how to use the hoist. It took four members of staff to operate it. It takes one person at home, but that one person was not allowed on the ward to help the individual. In another case, someone with cerebral palsy who was awaiting surgery could transfer to a hospital bed but was told that if they cannot transfer to the surgical bed—which they cannot do—they cannot have the surgery. Their carer is not allowed in to help them, so they are wasting all the pre-operative time. They know that they will be told that they cannot have the surgery.
We need to explore some of these issues further and might be able to in further groups. The current system is, at best, disjointed. We should be able to do better around the whole issue of carers.
Baroness in Waiting/Government Whip (Baroness Hyde of Bemerton) (Lab)
My Lords, this would seem to be a convenient time to pause proceedings for the day.