Health Protection (Coronavirus, Restrictions) (No. 2) (England) Regulations 2020

Baroness Andrews Excerpts

Friday 24th July 2020 Lords Chamber

[Baroness Andrews (Lab) [V]]

My Lords, these regulations expose both the way the management of the pandemic is being improvised day in, day out and the failure to provide Parliament with proper time to scrutinise. Inconvenience is hardly an excuse.

We are also debating them in the knowledge that, such is the loss of trust in this Government’s ability to plan safely, people are deciding for themselves not to take risks. Our streets are still silent, shops and restaurants are still empty and people do not feel safe returning to work. The wider and fundamental failure behind these regulations was, amazingly, not including the economic fallout in the risk scenario planning.

Finally, these regulations are being introduced without certainty as to how social behaviour has already been affected by the relaxation of controls to date or whether risk is increasing. Indeed, where is the R number in all this? What will the Government be guided by in their decisions on review? At what point does the science kick in again? What would count as success on 31 July? I look forward to the Minister’s responses.

Covid-19: Personal Protective Equipment

Baroness Andrews Excerpts

Thursday 16th July 2020 Lords Chamber

Asked by

[Baroness Andrews]

To ask Her Majesty’s Government what steps they are taking to ensure that there is a sufficient supply of personal protective equipment for (1) hospitals, and (2) care homes, in the event of a second wave of cases of COVID-19.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]]

My Lords, we have made our supply chains more resilient by massively expanding both our supply from overseas and our domestic manufacturing capability. We are now confident in our supply of PPE to meet the needs of health and social care over the next seven-day and 90-day horizons and are looking further ahead. We continue to model future demand from health and care services to cover the approach of winter and bring resilience to the supply chain.

[Baroness Andrews (Lab) [V]]

My Lords, the Government are being warned, urgently, on all sides to prepare for a second wave of Covid this winter. I hear what the Minister has said but last week, the Public Accounts Committee found that the Government are still not treating the supply of PPE with similar urgency. Will the Minister now commit to publishing a detailed plan by September, as the committee has asked for, explaining what exactly will be different, so that mistakes are not repeated and health and care workers are better protected?

Covid-19: Care Home Deaths

Baroness Andrews Excerpts

Wednesday 22nd April 2020 Lords Chamber

[Lord Bethell]

The noble Baroness is entirely right. This is an evil disease which strikes the elderly and those with pre-existing conditions the worst, and those who live in care homes are the most vulnerable. The Government have sought to put a ring of steel in place. We have resourced care homes enormously. Testing is now being focused on care homes to try to reduce the prevalence of the disease, and we will continue to focus on protecting our care homes.

[Baroness Andrews (Lab)]

My question is about the information we have on the deaths of care workers in care homes. Given that so many of our care homes are extensively staffed by BAME workers, and we are incredibly grateful, can the Minister say whether we are likely to have figures for the proportion of BAME staff in those homes who have died? On that point, and in the context of the review, which we welcome, into the disproportionate numbers of BAME workers generally in the health service who have been affected, can the Minister tell us when it will start, who will lead that inquiry and what timetable the Government will be working to?

[Lord Bethell]

I echo the noble Baroness’s timely comments on the role of BAME workers, many of whom have provided an amazing service and put themselves in harm’s way to care for those who are vulnerable. The idea that they are being disproportionately hit by this disease is extremely distressing. The numbers are not to hand so I cannot share precise numbers at the moment, but we are looking into this at speed and trying to understand the causes and the impact of this awful phenomenon. I commit to bring those numbers to the House as soon as they are available.

Healthcare (International Arrangements) Bill

Baroness Andrews Excerpts

Committee: 1st sitting (Hansard): House of Lords
Tuesday 19th February 2019 Lords Chamber

[Lord Cormack (Con)]

My Lords, I associate myself entirely with the remarks of the noble Lord, Lord Lisvane. We have been here before. We went through these issues many times last year, when a number of us spoke about constitutional issues. I want to concentrate my remarks there today. Before doing so, I add my welcome to my noble friend on the Front Bench. I am sure that she will have a distinguished career in your Lordships’ House. I was extremely sorry to miss her Second Reading speech but I was recovering from surgery, so I could not be present and take part as I would have otherwise sought to do.

The noble and learned Lord, Lord Judge, and the noble Lord, Lord Lisvane, are members of a group that I have the privilege of chairing: the Campaign for an Effective Second Chamber. I want to reflect on those words for a few moments. You can have a truly effective second Chamber in a Parliament, or indeed an effective first Chamber, only if you do not have an overbearing Executive. Everything that the noble and learned Lord, Lord Judge, and the noble Lord, Lord Lisvane, have said underlines the fact that we are in extremely dangerous territory.

Of course, as they have done, I entirely absolve my noble friend on the Front Bench. She has been given a poisoned chalice and she will handle it with dexterity and finesse, but whatever she does, she will not be able to remove the hemlock and replace it with quaffable wine because this really is a very dangerous Bill. The name of Henry VIII has already been quoted a number of times—and even Henry XVI, although I am not quite sure what he will be up to. But I prefer to call this Bill a carte blanche Bill because what we are being asked to do is to give the Executive a totally blank cheque. That is inimical to constitutional parliamentary democracy. There has been a great deal of talk recently, and there will be more next week, about the role of Parliament vis-à-vis the Executive. We have to have a proper balance, but we do not have a proper balance if we have an Executive invested with so much power that Parliament really counts for nothing.

Of course, I know why we are going to have to give this Bill a speedy passage, but I deeply regret it. It goes against the parliamentary grain as far as I am concerned. In the almost 49 years that I have been in one House or the other, I have seen what the noble and learned Lord, Lord Judge, referred to as the steady accretion of power to the Executive branch. No lip service to the power of Parliament paid by the setting up of Back-Bench committees and all the rest of it has really disguised that. It is one of the reasons why colleagues in another place have recently been flexing their muscles in seeking to wrest back power from the Executive to Parliament. I will not pursue that argument now because, frankly, in a Committee stage it would be straying out of order. But what I will say to your Lordships is that if we give this Bill its passage, as I suppose we must, it is crucial that we redouble our resolve to ensure that this sort of thing happens less frequently in the future.

In a parliamentary democracy there has to be a true balance of power and a responsibility to scrutinise legislation, but how can you scrutinise legislation which is so open-ended that it gives unbridled power for years to come? The noble Lord, Lord Lisvane, referred to that. I do not want to trespass on the private grief of friends opposite—and I do regard them as friends—but do I really want powers like these to be exercised by Mr McDonnell or Mr Corbyn? No, I do not, and I suspect that there are very few, if any, in your Lordships’ House who do.

I therefore put down a marker in total support of the eloquence of the noble and learned Lord, Lord Judge, and say that when we have got over the next few traumatic weeks, if we get over them—I suppose we will—we must send an emphatic message to the Executive that this sort of sharp practice is something up with which we will not put.

[Baroness Andrews (Lab)]

My Lords, first, I welcome the Minister. I will not add to her burdens by trying to find another metaphor for the difficult position she is in. We have had poisoned chalices and hand grenades, but I am sure she would be more than capable of dealing with all that. I am sure she will already have picked up some of the deep frustrations in the Committee about the position we find ourselves in—having to deal with legislation that is, frankly, rather surreal. We are trying to deal with the worst possible scenarios just in time, just in case we should need to be as draconian as necessary in the most extreme emergency situations. We are focusing on the exercise of powers that may never need to be used but which we may have to reach for in the most ghastly circumstances—so we are over a barrel. This is an essential Bill. We have to protect UK citizens from the worst that could happen to them, having sadly neglected to do what we could have done at the very beginning of this two-year process and given them assurances and the sort of security—as we would have been expected to be able to offer EU citizens in this country—that many in this House tried to achieve.

My speech in support of the amendment moved by my noble friend will be much shorter, because I can do hardly anything other than compliment the noble and learned Lord, Lord Judge, on his most forensic and splendid interpretation of what the Delegated Powers and Regulatory Reform Committee said, and my colleague on that committee, the noble Lord, Lord Lisvane. The one thing on which I might take issue with him is that in that committee we have not, in fact, become habituated to the ways in which government departments always try to take more power. We are not naive but we deeply resent the ways in which government departments have tried to accumulate powers over the past few years and to sneak it under our noses.

Coming down the track we have Bills—the noble Lord, Lord Lisvane, has already referred to them—with swathes of inappropriate delegation cultivated by civil servants and Ministers, for whom, frankly, this is Christmas. They have wanted to acquire these sorts of powers for years and have tried on many different occasions. They have been stopped in Bill after Bill and sent back. But now they have the power of post-Brexit uncertainty to aid them. It is extremely difficult to know where our vocabulary might lead us next. It is a fabulous opportunity, because for years they have chafed against the boring predictability of our scrutiny committees telling them to go away and think again. They come back with excuses about urgency, technicalities and flexibilities, yet when we expose these for what they are, they tend to try to do it again in another form.

One of the most disappointing things is that this was our second report; our first was blunt enough. We thought that between November and now the department and Ministers would respond more sensitively—perhaps more in the spirit of the European Union (Withdrawal) Bill, with our agonised discussions over the fine-tuning of appropriateness and necessity—but we received not a word; not a blink. I am sad to say that what the department came back with—I know the Minister was not responsible—was another 43 paragraphs about all manner of explanations, most of which were not relevant. They did not address the fundamental question that the Committee is raising this afternoon: why are these powers necessary? What is it that only these powers will be able to achieve? The Minister was very flattering to the scrutiny committees at Second Reading; she called our powers “forensic”. There is nothing that needs forensic scrutiny here. You could take a spade to this Bill; it is that blunt.

--- Later in debate ---

[Lord O’Shaughnessy]

That is a separate issue. As I said at the beginning, the issue here is actually in two parts. The first is whether we ought to use the new legislation to strike deals with a subset of countries, those with which we already have reciprocal deals through our membership of the EU, or to strike broader ones. The secondary question is: what ought to be the correct process for Parliament to provide scrutiny of the kind of deals that are set up, either to provide continuity with the ones that we have under the EU or with new partners? Those are different questions. It is up to this Committee to make its decision about what it feels is the appropriate route to go forward, but it is important to expose that those are different and separate questions and we ought to consider them as such.

Perhaps I may respond to the point made by the noble Baroness, Lady Andrews, and others about trade. It is absolutely not the case that this is some Trojan horse for privatisation of the NHS, as the noble Lord, Lord Brooke, said, or anything else. My noble friend the Minister made that completely clear in her letter, as I used to in the letters that I once sent the noble Lord as well. Consider this: one of the reasons that we have deep reciprocal healthcare agreements with EU countries is due to the fact that we are part of a large trading bloc called the European Union. It is perfectly normal for partners engaged in economic, social, cultural, scientific and other activities to have these kind of agreements, partly because they facilitate the movement of people from one to another, whether on holiday or for work and other things.

I would hope, regardless of whether we were leaving the European Union or not, that we would want to have these kind of agreements with our partner countries throughout the world. Regardless of one’s views on Brexit, we ought to want to do that. It is not something that we have the legal basis to do at the moment and the Bill gives us that. I want to correct the impression given by the noble Baroness, Lady Andrews, which I do not think is fair, that this is somehow a Trojan horse for some sort of nefarious agenda. That is absolutely not the case; it is about taking a broader view of the kind of relationships that we currently enjoy with the EU and want to enjoy with other countries, whether they are Commonwealth partners or the overseas territories and Crown dependencies noted by my noble friend Lord Ribeiro.

I hope that I have described clearly what I believe the intent is in this regard. It is absolutely noble and will facilitate the broader movement of people throughout the world.

[Baroness Andrews]

I take the noble Lord’s personal assurances on that. Who could disagree with what he has just said about the need to have these sorts of vigorous, expansive and generous trading arrangements, which we hope will involve skills, health and knowledge? My question is really: why are these powers in this Bill? If they are necessary and within our reach, why can we not have them in an appropriate Bill with appropriate powers, which we can all be certain will not be exploited and lead to perverse consequences?

[Lord O’Shaughnessy]

I take the noble Baroness’s point but the critical thing here is that the powers set out in the Bill are constrained by giving effect to healthcare agreements, which themselves sit under the aegis of the creation of international agreements. My noble friend’s letter set out how the entire so-called CRaG arrangements govern how they ought to be approved. To satisfy my noble friend Lord Cormack’s concern, it is simply not the case that this Bill could be used unilaterally to fund the healthcare of the people of Venezuela, which might be a concern of the leaders of the Labour Party, as he pointed out.

NHS and Social Care Services: Parity of Esteem

Baroness Andrews Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord O’Shaughnessy]

I am concerned to hear the story that the noble Earl has raised: I am sure that he will write to me with specific details. We know that at the moment only 25% of people with a mental health problem are seen. That needs to rise. We want to get that up to 33%, but clearly that is not enough. To do that we need more staff at every level. We have committed to training another 21,000 mental health workers to provide exactly the kind of leadership and support that he describes.

[Baroness Andrews (Lab)]

Is the noble Lord aware that on 4 July 1948, on the eve of the creation of the National Health Service, Aneurin Bevan also said that the NHS was the highest expression of moral leadership? Does he agree that we now need an equally high expression of political moral leadership? The fundamental of that is to tell the truth about the funding challenges facing the NHS, whether they are in manpower or in innovation and drugs. Does he agree, therefore, with the Prime Minister that there will be a Brexit dividend? How much is it going to be and where is it likely to be accounted?

[Lord O’Shaughnessy]

I agree with the noble Baroness about the need for leadership and I think the Prime Minister has shown that leadership. Despite the many challenges that we face at the moment as a country and have done for many years, she has committed to a five-year funding settlement worth more than £20 billion extra in real terms by 2023-24. That is an admission that there are funding challenges, not just in the NHS and social care, and of course one of the ways that that will be funded will be through our not paying subscriptions to the European Union any more.

Older Persons: Human Rights and Care

Baroness Andrews Excerpts

Thursday 16th November 2017 Lords Chamber

[Lord Balfe (Con)]

My Lords—

[The Deputy Speaker (Baroness Andrews) (Lab)]

The Question is that this Motion be agreed to.

[Lord Balfe]

I shall try to get it right this time.

I draw attention to my entry in the register and congratulate my fellow member of the Council of Europe, George—the noble Lord, Lord Foulkes—on tabling this Motion. As he rightly said, his report was adopted unanimously, which means, of course, that our side voted for it as well. I also welcome the noble Baroness, Lady Thornton, back to the Front Bench, where I am sure she will continue to make a distinguished contribution.

As many noble Lords know, I have spent far too long in Europe and probably spend far too long following what is going on. I was interested to see that this Friday in Gothenburg there is a meeting of the Social Affairs Council to discuss social rights and the 20 principles of social rights. The Commissioner, Marianne Thyssen, has indeed said:

“We go for a Europe where our citizens come first”.


I only mention that in passing because this is yet another thing we will lose when we leave the European Union. We will no longer be part of these conversations and discussions on how to get best practice.

The report we are discussing talks about ensuring,

“appropriate assistance and support for older persons living in their homes, including medical and nursing care, meals on wheels and domestic assistance”.

I regret that, of all the briefings we have received for today’s debate, none has come from UNISON, the major trade union involved, or other representatives of what one might call the workers. Indeed, the only document I have received, which is a very valuable one, is an article from the Institute of Employment Rights on why collective bargaining is needed for workers in this sector. We often forget how many people work in social care. It is 1.1 million, the same number who work in all the pubs, restaurants, bars and cafés in England put together, but these are an unsung army. These are the people you see at 5.30 in the morning by the bus stop, going to help to get people up. They are the backbone of the social care system in this country, but sadly they often go unrecognised. Part of the reason for that is because it is very difficult to enforce individual rights if you are basically a lone employee of a privatised service.

I know that we have saved lots of money through privatisation but we have also saved much of it at the expense of the people right at the bottom of the pile—the people who dare not claim their holidays and who are afraid to put their head above the parapet because it could mean the end of their job. I do not think my next point is a party one because I think that we have both been as bad as each other, frankly. I want to hear us say that although this work is individual in nature, we need individual rights that are easier to enforce. We have one of the weakest law enforcement structures in relation to the rest of western Europe, and we have gone backwards. If noble Lords go back to the much underrated but signal figures of the Conservative Party, Stanley Baldwin and Neville Chamberlain, they will see that, during the 1920s and 1930s, with the erection of wages councils, the protection of certain groups of workers came right to the fore—and stayed there until the wages councils began to be dismantled in the late 1970s.

We need a central collective bargaining mechanism which lays down basic principles for workers within this specialist field. The issue is not just about the minimum wage; there are also questions about, for example, sleepover allowances and casualisation. When we are told that employers cannot afford to pay the minimum wage, my reaction is that there is something wrong with the system, not with the employers.

I appeal to both parties to look at the need for a system of collective bargaining and responsibilities—an end to the excessive casualisation of this sector and an acceptance that care for the older person, which is the heart of this report, has also to include respect for the carer, who puts so much into making life reasonable for many older citizens. We have a duty to them. I thank the noble Lord for introducing this report, which enables us to look at a very wide range of problems.

South East Coast Ambulance Service

Baroness Andrews Excerpts

Wednesday 1st November 2017 Lords Chamber

[Lord O'Shaughnessy]

I would have liked to have given data at the level that the noble Baroness asked for but it is not available in a way that has been centrally assured by NHS England. I have a responsibility to provide good-quality, verified data, and I hope she will understand that. However, the bigger point, with which I do not disagree, is that this is the worst-performing ambulance trust in the country, and that is the case whether you look at calls data or performance standards for call-outs. The question, as she rightly points out, is what you do about it. The CQC rated the service as inadequate about a year ago and has just followed up. Unfortunately, it is still inadequate, although the CQC says that some progress has been made. About half a million pounds of special measures funding has gone in. A new CEO has been in place since spring this year, and the local sustainability and transformation partnership has asked the ambulance trust for a business-case bid for transformatory funding. Therefore, I realise that this is playing catch-up, because clearly the level of service is not good enough. I understand that the latest data month on month—that is, September compared with July—shows some improvement since bottoming out in July, but I agree with the noble Baroness that it has a long way to go.

[Baroness Andrews (Lab)]

How many ambulances are there across East Sussex and West Sussex at the moment compared with five and 10 years ago? If it is difficult to collect that information centrally, can the Minister make efforts to make it available to us in some other way? I ask that because I had reason to be involved with the ambulance service earlier this year. There is a terrific amount of stress and pressure on paramedics, although they do the very best they can. I would also like to know how many paramedics there are in the service compared with five and 10 years ago. After two years of special measures, it is really worrying that this trust is failing on basic issues of patient safety and response times.

[Lord O'Shaughnessy]

I do not disagree with the noble Baroness. I do not have the specific data on the number of ambulances in that area but I can tell her that the paramedic workforce in that particular ambulance trust increased from 635 in May 2010 to 992 in July 2017. So there are more people, but there is a huge growth in demand, which they have to meet. However, the truth is that there are other ambulance trusts all over the country that do a much better job with similar resources. Therefore, as much as anything, it is a question of leadership and management, and that is part of the special measures process.

Care Sector

Baroness Andrews Excerpts

Tuesday 25th November 2014 Lords Chamber

[Baroness Andrews (Lab)]

My Lords, it is a real privilege to take part in this debate. Like so many other noble Lords, I am extremely grateful to my noble friend for creating the opportunity for us to have this debate but even more so, obviously, for the force and clarity with which she presented the evidence and the recommendations of the report. She said that while writing the report she was shocked. I was certainly shocked when reading it.

This is a report that sets out a long-term and sustainable future for care workers and deals with the historical failures and the immediate challenges. In summary, it graphically describes a largely poor, privatised workforce marked by low status and low wages, who work in intensely personal and stressful conditions, in uncertainty and insecurity, with poor and unco-ordinated training, few national standards, a weak and fragmented regulatory environment, irresponsible procurement and poor workforce planning and management skills. That summary of working conditions could have been written as an account of early industrial Britain, where rights and effective regulation were won, but largely by men and for men. The difference is that we are not dealing with history but very much with the present and with a workforce that is largely female, highly fragmented and comprises a high proportion—70%—of immigrant workers. They are not dealing with machinery or factory processes. As many noble Lords have said, they are dealing with the most frail and elderly and the consistently lonely in our society, many of whom have chronic and complex conditions which require highly skilled under -standing as well as compassion. Many of them are confused and lonely and the visit by the care worker is often the highlight of their day because it is about emotional as well as physical support. When one considers that the visit can be rationed to 15 minutes, it diminishes the carer just as much as the client and is a recipe for bullying conditions as well as for neglect.

Andrew Smith said in a recent debate in the other place that luck and money were only too likely to decide people’s quality of care. My family were very lucky. My mother was looked after by a wonderful collective of Welsh aunties in her residential care home—Cartref Aneurin Bevan—who were not only affectionate but highly skilled and gave all the time that they could to these wonderful elderly ladies and gentlemen. They were typical of the kindness and selflessness that we have always relied on and which, unfortunately, we have always exploited. This report shows that this is no longer sustainable. It has never been sustainable but we have neglected to challenge it. Changing this is not just about finding the money because the crucial failure is the failure to value the sector, to promote and articulate the workers’ skills and to understand that this is the front line of healthcare, not just community care.

This is a notoriously low-paid sector, as the Low Pay Unit recently documented. As we have heard, wages have been driven down by the failure of providers to pay more than 200,000 of these workers the minimum wage, the refusal to pay travel costs and by the fact that a fifth of workers are on zero-hours contracts and there is very little career progression or incentive. What makes the failure to enforce the minimum wage more intolerable—which makes me angry—is that there are mechanisms in place to limit the exploitation of care workers that are simply not being used.

Astonishingly, HMRC, having revealed the extent of the breach of the minimum wage regulations, has stopped carrying out proactive investigations of compliance in home care. One in five councils responding to an ADSS survey did not even know whether their providers paid the minimum wage. The only recourse care workers have is to ring up HMRC’s pay and rights helpline. I am fairly sure that that does not go down well with their employers. So can the Minister tell me exactly what he and his department are doing to galvanise HMRC into doing its simple duty of rooting out this total failure? Will he agree to meet HMRC and BIS to take the concerns in the report forward? Does he agree with me and other noble Lords that we should aim for a living wage and not a minimum wage? All this means that this is a sector that sets records for vacancy and turnover rates. A culture of uncertainty means that thousands of care workers do not know where their next paid work will come from and where clients face a stream of strangers in their houses. The Minister in the other place said that it would not survive without migrant workers, who account for about 17% of the workforce. Perhaps the Minister can say whether he endorses that opinion, which was so clearly expressed.

As my noble friend Lord McKenzie has shown, all the problems have been exacerbated by cruel cuts in funding. Without acknowledging that reality, it is difficult to see how the Care Act, with all its good intentions, and the guidance will bring about the changes that we want to see. In contracts that in reality are bound to be driven by price, how will the guidance be able to enforce the intention that local authorities’ contract terms, conditions and fee levels will not compromise the ability of care providers to pay at least minimum wages? Does the Minister agree that the guidance would be much more effective if it simply said that councils “must” act to end illegal practices rather than “should”? There have been some very good changes—I count the care certificate among them—but without the implementation of the recommendations in this report we will not see the scale of changes that we need to see.

Ebola

Baroness Andrews Excerpts

Monday 13th October 2014 Lords Chamber

[Earl Howe]

I am not aware that the system being conveyed to GPs, which is not for diagnosis but for the referral of patients, can be called an algorithm, but there is a checklist of questions that we are recommending GPs use. That advice has been adapted for use in all healthcare settings, including NHS 111, as I mentioned in the Statement. Naturally, we shall take advice on whether the questionnaire and the sequence of questions are adequate. If it needs amending, we shall certainly not hesitate to do that.

[Baroness Andrews (Lab)]

The Minister mentioned SARS in his Statement. We have very few precedents, and he has already described this as being uncharted territory in relation to Ebola. What lessons were learnt after the SARS epidemic, particularly in relation to the organisation of global research? It was a different case because the virus was unknown but the same issues of mutation came up as those to which my noble friend referred. How will the lessons learnt be applied?

[Earl Howe]

The main lesson learnt from SARS, which in general was a very successful exercise, was that there are two keys to this. The first is informing people what to do if they think that they have symptoms, and the second is making sure that the NHS knows what to do if presented with a possible case of the illness. I hope my comments have conveyed that those two things are the focus of our activity in this country. We also need to make sure that adequate isolation facilities are available for patients with these highly transmittable conditions. That work has been done in the mean time, hence the isolation facilities at the Royal Free and other hospitals to which I have referred.

People with Learning Disabilities

Baroness Andrews Excerpts

Thursday 12th June 2014 Lords Chamber

[Baroness Andrews (Lab)]

My Lords, I, too, congratulate the noble Baroness, Lady Hollins, on securing this debate, and I want to congratulate her even more on the work she has done literally over decades to bring this extraordinarily important problem to the attention of other professionals as well as government. I had the pleasure of serving with her on the committee that reviewed the Mental Capacity Act 2005 and I learnt a great deal from her expertise and wisdom. Of course, it is in the context of the MCA itself that this report should be seen and why it is important.

Over the years I have become familiar with the challenges around the vulnerability of people with learning disabilities and mental incapacity in general. It has been borne in on me how the failure to invest in getting things right in the NHS has the greatest impact on the most vulnerable, and therefore how much more urgent is their need for the prescriptions for change that would make a difference to all of us. At the top of the list are issues such as quality of care, respect and empathy, but it is also about the tools that enable good practice: good data, good sharing of information and good co-ordination of services. That is why it is so vital that the CIPOLD recommendations are implemented not only diligently but quickly.

It has been my experience in this House that not being too burdened with expertise can actually reinforce one’s capacity to be outraged and shocked. I was very shocked when I read about the catalogue of neglect and indifference which has led to the failures identified in the CIPOLD report, such as failures to diagnose and treat, and the proportion of preventable deaths. Since it is predictable that people with learning difficulties are much more likely, especially as they grow older, to have long-term medical conditions such as epilepsy, cardiovascular disease or dementia, it is truly appalling to discover that 37% of those deaths would have been, potentially, avoidable if the right healthcare had been provided. The fact that the average age of death for women with a learning disability is 20 years earlier than for other women is extraordinary. It is dreadful.

It is now almost a year since the Government’s response, in which I thought they sounded rather chastened. It is good to see that they have certainly taken on board the inescapable recommendations. However, many of the responses, for example those on access to better healthcare, while positive, are, shall we say, a bit vague in terms of process and timelines. I know that this is complex, but the language is still that of further discussions, appropriate use of guidelines and proactive referrals. It is generally “work in progress”. However, there is an opportunity today for the Minister to update us on specific progress, which I am sure he will do.

Clearly, whatever progress has been made has not been sufficient either for Mencap or the health ombudsman. Three of the recommendations, and the responses they prompted, also seem to require some particular exploration. As the noble Baroness, Lady Hollins, noted, it is indefensible that only 200,000 out of an estimated 900,000 people have their condition noted in their medical records. If it were a physical condition, this would be unacceptable. It is symptomatic of the relative invisibility of learning disability that health professionals do not record it as a matter of course. We need that information not just for appropriate care but for the better co-ordination of services with social care.

That leads on to our old friend in health debates, the failure to co-ordinate services for people with complex and multiple health needs. The confidential inquiry was clear about this, too. A fifth of premature deaths were of people who had seven or more medical conditions, many of which are eminently preventable, such as pressure sores. The failure to offer an annual check-up is part of the source of the problem here—failing to anticipate complications certainly does not make co-ordination any clearer. Can the Minister tell us what progress has been made on improving medical records and standardised health checks?

The third question I have for the Minister on this point is whether we can have an update on the timetable for the implementation of the recommendation on having a named person for people with complex conditions. This is a really good step forward. As the noble Lord, Lord Ribeiro, pointed out, many issues are about communication but also the fact that people become very anxious in strange settings, particularly in hospitals, and therefore sometimes resist care and treatment. It is also important that these named contacts, whatever they do, should have learning disability awareness training whichever setting they are in. I would be interested to know how that will be managed.

However, the major disappointment, as the noble Baroness, Lady Hollins, said, is of course the failure to meet the deadline for the national mortality review body. This is the game changer. Could the Minister share with us what is holding this up? Is it an issue of resources? Is it an issue of governance? Is it an issue of relationships? Where are the complexities? I know that the Minister will be anxious to give the noble Baroness the assurances that she has sought this afternoon.

I am afraid, for me, the report underlined the fact that before legislative parity between mental and physical health—which we are so pleased we have achieved—becomes a reality, an enormous amount of work has to be done to change attitudes and practice. It was fascinating in the committee to hear the evidence from Ministers, who seemed to have discovered the problems around mental capacity only because the Select Committee had actually been set up.

The noble Earl may recall with great pleasure, as I do, the work we did on the Mental Capacity Bill. It had its moments but, at the end of it all, we were very pleased that we had achieved legislation that put the positive rights of those with mental incapacity in a framework of ethical, practical and legal reach. In the Select Committee, it was reassuring to know that this ambitious Act is still seen as a radical and progressive piece of legislation. Failure has been around consistent and effective implementation, which has often been ascribed to a lack of knowledge by medical and psychiatric practitioners and the fact that the Act was not embedded in assessments, diagnosis, behaviour or treatment.

In short, the cultural change that was our highest expectation has not yet been achieved. It is significant, therefore, that the government responses to the recommendations vis-à-vis the MCA were essentially exhortatory and pointed up the problem that we had already identified in the Select Committee. Simply wishing things to change does not bring change into force. The emphasis that we put on the content of and the priority given to training is absolutely vital. It has been referred to already.

In conclusion, we found that GPs seemed to have a poor understanding of the Act, and we pointed to the need for greater emphasis on medical training and medical leadership. I am delighted to say that that finding seems to have struck a chord with the medical colleges and the Government. I hope we will be able to debate that in more detail when we debate the report itself. In the mean time, I thank the noble Baroness for creating the opportunity for us to share our feelings about this report, and I look forward to the Minister’s reply.