Junior Doctors Contract

Baroness Barker Excerpts

Friday 20th November 2015 Lords Chamber

[Lord Prior of Brampton]

The Secretary of State has said that he is open to conciliation. Frankly, it would be so much better if we could sort this out ourselves rather than go to conciliation, but he has said that he is open to it. If there is a terrorist attack, speed will be of the essence if people are severely injured. Junior doctors care hugely about their patients, so I think we have to rely on junior doctors to be available in hospitals in the event of some awful terrorist outrage, even if they are on strike. I will certainly draw to the attention of COBRA and the relevant authorities the question of the impact of terrorism on a demonstration by junior doctors.

[Baroness Barker (LD)]

My Lords, if, as appears to be the case, the Government’s proposals discriminate against junior female doctors who take time off to have children or against doctors who devote some of their time to research, will the Government be prepared to reconsider their proposals?

[Lord Prior of Brampton]

I probably did not make the situation clear enough. The Secretary of State said that there are no preconditions. If there are concerns about time off to have children or to carry out research, those are absolutely the kinds of issues that should be discussed around the table.

Gender-based Violence: Screening

Baroness Barker Excerpts

Monday 9th March 2015 Lords Chamber

[Earl Howe]

My noble friend has emphasised an issue which I am sure all noble Lords feel equally strongly about. The Department of Health has been quite clear that abortion on grounds of gender alone is illegal. We reissued that guidance last year in no uncertain terms. It is a pity if there is any misconception about that.

[Baroness Barker (LD)]

My Lords, health and well-being boards have a responsibility under the Health and Social Care Act to commission sexual and reproductive health services and HIV services. Are they being asked to include gender-based violence in the commissioning formats that they put forward to the NHS?

[Earl Howe]

Most certainly. Gender-based violence is one of the issues which sexual health clinics, and indeed all parts of the NHS, are now alert to. New guidance from NICE was issued in February last year on domestic abuse and how health and social care services and the organisations with which they work can spot and respond to abuse earlier in a more joined-up and preventive way.

Maternity Services in Morecambe Bay

Baroness Barker Excerpts

Tuesday 3rd March 2015 Lords Chamber

[Baroness Barker (LD)]

My Lords, back in 2006 the Minister and I had the unhappy experience of being in opposition when the NHS Redress Act went through your Lordships’ House. We are both on record as saying at the time that we felt that it was a fairly inadequate piece of legislation. I think the 44 recommendations in this report are searing evidence that that is in fact the case.

In the wake of the reports by Dame Carol Black, Sir Robert Francis and Sir Bruce Keogh, does the Minister agree that it is now time for a thorough root and branch review of the legislation underpinning the NHS complaints system? I have very little time in which to deal with the great many points in this report, but I wish to ask the Minister about two, which are important. First, in recommendation 27, the regulatory bodies, the GMC and the NMC, are asked to reconsider the guidance to professionals about what to do if they suspect that clinical standards or services are not being fulfilled. It seems to me that in this case there was a failure at every level in that respect. That is unacceptable. Secondly, the report points to the breakdown of the relationship between the CQC and the Parliamentary and Health Service Ombudsman. They had no communication and the consequence was that the families had nowhere to go to seek redress. It is difficult because that ombudsman is both the parliamentary and the health service ombudsman for Members of Parliament to make recommendations about ways in which the health service might be reformed. Will the Government act quickly on the recommendation of this report that there should be a memorandum of understanding between the CQC and that ombudsman?

[Earl Howe]

I am grateful to my noble friend and I do indeed recall our debates on the NHS Redress Act. It is telling that the previous Government chose not to bring that Act into force in the end. The recommendation in the report that there should be a fundamental review of the NHS complaints system is one that we will consider very carefully. We agree that there are still challenges to improving NHS complaints handling, including improving the culture around complaints. Those challenges have been well documented. Our work to improve complaints handling across the board was set out in our update on progress in response to the Francis inquiries in February. Complaints and how they are handled is now one of the key strands of inquiry in all inspections of the CQC.

On my noble friend’s point in relation to recommendation 27, the GMC, the NMC and the PSA have guidance in place on how to raise and act on concerns about patient safety. We will work with these bodies to determine whether this guidance needs strengthening in the light of this report. The GMC has been undertaking its own review of how it deals with doctors who raise concerns in the public interest.

On my noble friend’s final point about the disjointedness of the CQC and the Parliamentary and Health Service Ombudsman, a new MOU was signed in September 2013 which outlined how the two organisations would collaborate, co-operate and share information relating to their respective roles. It is without question that the lack of co-ordination between the CQC and the PHSO was a contributory factor to the ongoing inability of the wider system to identify and act on failings at the trust.

Jimmy Savile: NHS Investigations

Baroness Barker Excerpts

Thursday 26th February 2015 Lords Chamber

[Baroness Barker (LD)]

My Lords, there is one fact about this excellent report on a very difficult subject which is so obvious that it is in danger of being overlooked. We are talking here about events within the NHS and specifically about events within NHS organisations which had among their staff people who, due to their professional expertise, should have been able to spot the signs of abuse, as they are experts to whom people turn for treatment when they have been abused. I am not talking about the BBC; I am talking about the NHS. Repeatedly they did not see it or did not speak about it. That makes me draw an uncomfortable conclusion which goes to the heart of a couple of the recommendations—that is, that it is possible, even in the best of organisations which exist for the best of reasons, for there to be a culture so powerful that people can ignore things which are bad almost to the point of disbelief.

Therefore, when the Government consider their response to all this, I ask them to look at recommendations R5 and R8 in the lessons-learnt section. Those recommendations talk about trusts having a review process of their own procedures. They also make reference to the local authority designated officer and the role that he or she might play. I put it to the Minister that, in order to break a culture of silence, it must be possible to bring in a reference to an external expert. If victims and staff had access to such a person as a backstop, it would be a very important means of ensuring that we never saw organisations operating in this way again.

[Earl Howe]

My noble friend makes a series of extremely powerful and pertinent points and I am in agreement with the thrust of them. She is absolutely right that this is a matter of the culture of an organisation. While I think we can say hand on heart that the culture in the NHS has in many respects changed for the better in recent years, we must never be complacent about this. This matter was particularly identified by Sir Robert Francis in his recent report on whistleblowing, and we have accepted his recommendations. For example, we will ask every NHS organisation to identify one member of staff to whom other members of staff can speak if they have particular concerns and are not being listened to. We will also consult on establishing a new independent national whistleblowing guardian as a full-time post within the CQC to fulfil the kind of independent role that my noble friend refers to. In that context we are legislating to protect from discrimination whistleblowers who apply for NHS jobs. Therefore, I think that there are things that we can do with the mechanisms to ensure that the NHS is a more benign place for people who would otherwise feel too frightened to speak up.

Nevertheless, the further consultation on mandatory reporting which I have undertaken we will carry out will, I am sure, bring all this into the frame again. I have no doubt—at least, I hope—that my noble friend will feed into that consultation in the way that she has just indicated.

Human Fertilisation and Embryology (Mitochondrial Donation) Regulations 2015

Baroness Barker Excerpts

Tuesday 24th February 2015 Lords Chamber

[Lord Alton of Liverpool]

I serve on my own university’s ethics committee, which looks at the use of animals in experiments. Apparently, one of my roles on that committee is to be, as it were, the animals’ friend and to ask whether the experiment is repetitive, whether it is necessary to do such things and what it is going to lead to. There is no one on the HFEA who is the friend of the human embryo. That is a bizarre situation and one I would like to see rectified. But to take the noble Lord at his word, of course I think the HFEA often does a good job, and I admire many of its members.

I will simply say one other thing to the noble Lord. The HFEA is a regulator, not a legislator. That is our duty here today and that is why we are having this discussion. I am conscious that others wish to intervene and I am grateful for the patience of your Lordships’ House in allowing me to put these points. As we ponder on these serious issues revolving around public safety and questions of definition and legality, they deserve far better consideration and scrutiny than has been provided thus far. Surely we should remember the wise advice that those who legislate in haste repent at leisure. Therefore, the proposal of the noble Lord, Lord Deben, for a Joint Committee of both Houses to examine the safety and legality of these regulations deserves our support.

[Baroness Barker (LD)]

My Lords, since 1990, this Parliament, and, in particular, this House, has shown the rest of the world how these matters should be dealt with. It is for that reason that I hope that we will pass these regulations today.

In 1990, the noble Baroness, Lady Warnock, set down the ethical framework within which we make decisions and within which scientists must do their work and regulators must regulate. In 2008, as the noble Lord, Lord Walton, the noble and learned Lord, Lord Mackay, and others will remember, we debated these and related issues at considerable length. At that time, the scientists came to us and said, “We believe that very shortly it will be possible for mitochondrial transfer to happen”. At that point, Parliament sat and listened to the scientists and said, “Not yet. Not yet”. That is why we passed the permissive legislation that we did, which has led to these regulations.

The noble Lord, Lord Deben, in putting forward his very cogent and persuasive argument, missed out one crucial fact that undermines his argument: research is not linear. Researchers do research and it takes them to places that they had not imagined or they hit obstacles that they did not anticipate. Things change radically, as they did in the case of animal hybrids. That is why we operate as we do, within a system whereby Parliament sets out the principles and the ethics. We require the scientists to come back to us again and again and we are dependent on the information that they give to us.

I went to the same meeting as the noble Lord, Lord Deben, and I formed a very different impression of the scientists. Our top scientists have been making themselves available to Members of Parliament for all of the past year to explain as clearly as they can this science as it is emerging. I do not think that we should abrogate our responsibility in this House. I think we should continue to listen to the scientists. I like the fact that I live in the United Kingdom where we debate these matters. We have the involvement of people from the church and from different faiths and walks of life. We also listen to contributions from people such as the noble Lord, Lord Alton, who are consistently and wholly opposed to this issue. However, it is important that his voice is heard. I do not want the ethical decisions to be sent off to the courts as they are in the United States.

Noble Lords have talked a lot about the emotional issue of meeting the needs of families but they have also discussed the safety of these issues. However, I simply put before the House the response of parents to the suggestion that they might have a child who proved to be infertile. When they were asked how they would feel about that, they gave the clear response, “We love our children as they are and we would not have not had them. However, if we could have had a child who did not have the illnesses that they have, we would have opted to have such a child, even if that child proved to be infertile”.

The scientists have been absolutely straight with us and have given us the relevant information. They have not said that this process is safe or guaranteed because they cannot do so. The noble Lord, Lord Alton, is right—they will have to come back to us if techniques developed in the future prove to be better and safer than those we are discussing. However, given the information that we have, I for one feel that this Parliament has been fully informed and that we can make a decision—and I hope that we do.

Adult Social Care Contracts

Baroness Barker Excerpts

Wednesday 11th February 2015 Lords Chamber

[Earl Howe]

No, my Lords, it does not, because we rely on local authorities to arrive at a fair system of charging that is fair to all. What we do wish to see, however, is greater transparency in these matters, and I think that the Care Act will lead to that.

[Baroness Barker (LD)]

My Lords, commissioning of social care is changing fundamentally, not least because of increased use of individual budgets and integration with health commissioning. Does the Minister agree that it is time for the CQC to do a thorough review of the commissioning skills and capacities of local authorities?

[Earl Howe]

I think that that would be premature. As I have said, we are developing statutory guidance for local authorities, as well as commissioning standards. We have no evidence to date that the process to which the noble Lord, Lord Laming, has drawn attention is leading to perverse results. If there is such evidence, we would be interested to hear about it. But until we are aware that there is a problem, I think that the noble Baroness’s suggestion is not timely.

Francis Report: Update and Response

Baroness Barker Excerpts

Wednesday 11th February 2015 Lords Chamber

[Baroness Barker (LD)]

My Lords, will the Minister please say whether the proposals in the report relate to the provision of mental health services as well as physical health? The proposals are very much focused on hospitals. Secondly, review after review has shown that in a hospital the one group of staff who know better than anybody else what is going wrong are the junior staff—junior doctors and so on. In the work going forward, will the Government pay particular attention to junior doctors and non-clinical staff who are whistleblowers, and what happens to them? Finally, the report mentions the extension of this work to an examination of avoidable deaths in community settings. Will the Minister say who will be involved in that work and when we can anticipate a report on it?

[Earl Howe]

We envisage that all NHS providers should be subject to whatever practical measures are agreed. We are not yet in a position to be prescriptive about what those arrangements should be. We will consult on how best to implement Sir Robert’s recommendations in the least burdensome way possible but in a way that fulfils his ambitions to the maximum extent. I totally take my noble friend’s point that junior doctors and non-clinical staff are often in the best position to judge the health and culture of an organisation. Indeed, I am aware that the CQC, when inspecting a hospital, often makes a point of convening a focus group consisting of junior doctors because it knows that there is a great deal to be learnt from that source. On community care, again, we have taken no firm decisions on how this will come about, but we wish to take the advice of those whose views we value.

NHS: Financial Tariff for 2015-16

Baroness Barker Excerpts

Wednesday 4th February 2015 Lords Chamber

[Earl Howe]

My Lords, it should not cause us any surprise that, at a time of financial stringency in the NHS and increasing demand, it should have proved more difficult than usual to arrive at a settled position on the tariff. The process is undoubtedly complex and challenging but we will continue to work with and support Monitor and NHS England in managing this in a way that attempts to be as fair as possible to all parts of the system.

[Baroness Barker (LD)]

My Lords, given the historic underfunding of mental health services in this country, will the Government make representations to Monitor to ensure that mental health trusts are not required to make savings at the same rate as other trusts?

[Earl Howe]

My Lords, we remain absolutely committed to achieving parity of esteem between mental and physical health. The proposals for mental health services in the national tariff arrangements for 2015-16 will get us closer to that aim, should they be finally agreed.

Meals on Wheels

Baroness Barker Excerpts

Monday 19th January 2015 Lords Chamber

[Earl Howe]

My Lords, I was not seeking to doubt the figures obtained through a freedom of information request; they just do not happen to be available to my department. However, it is worth noting that the data on the numbers using services also reflect longer-term trends. For example, the proportion of older people in receipt of local authority-supported social care has been declining steadily for the last 10 years. Among those receiving meals on wheels, the numbers have also been declining steadily over 10 years.

[Baroness Barker (LD)]

My Lords, Age UK County Durham runs an innovative scheme called “Come Eat Together”, which addresses not only the issue of older people having the right food but matters such as loneliness as well. Does the noble Earl consider that that is the sort of innovation that local authorities should bring to social care under the Care Act?

[Earl Howe]

My noble friend makes an important point—that it is not only the value of the meal that is important to elderly people; it is the relief from isolation and loneliness. Many of the solutions to that lie with local authorities. However, what the Government centrally have been able to do is to raise awareness of the impact of isolation and loneliness and encourage local commissioners to tackle that. To that end we have funded a digital toolkit for local commissioners, which has been supporting them in understanding and mapping commissioning for loneliness and social isolation in their communities.

HIV

Baroness Barker Excerpts

Thursday 15th January 2015 Lords Chamber

[Earl Howe]

I will gladly take that suggestion from my noble friend away and give it consideration and I am grateful to him for it. The position on testing is, however, quite encouraging. We have seen more than 1 million HIV tests in sexual health clinics in 2013, which is up 5% from the previous year, and that is only in sexual health clinics. As my noble friend knows, there are other routes to testing through GP surgeries, self-sampling kits and so on. Additional testing is vital if we are going to make sufficient inroads into diagnosing this condition.

[Baroness Barker (LD)]

My Lords, the organisation Halve It reported in a survey last year that one-third of GPs who are in high-prevalence HIV areas were unaware that that is where they worked and consequently were not testing people for HIV routinely. Can the Government work with Public Health England and the RCGP to remedy that?

[Earl Howe]

My Lords, I pay tribute to the work of the Halve It coalition in raising awareness about the importance of increasing HIV testing. My noble friend is right that apart from ignorance often GPs are reluctant to discuss HIV testing or are unaware of the importance of early diagnosis and possible indicator symptoms. My department was pleased to fund the Medical Foundation for AIDS and Sexual Health’s HIV testing in primary care project that provides a web-based interactive resource for GPs in primary care to help make testing easier in GP surgeries.