Older Persons: Care and Human Rights

Baroness Barker Excerpts

Tuesday 11th July 2017 Lords Chamber

[Lord O'Shaughnessy]

Rules affecting this House will, of course, be decided by its Members, who are probably the least likely group in the entire country to be ageist. The noble Lord is quite right to highlight this incredibly serious point. Any form of negative stereotyping or discrimination is, of course, wrong. I mentioned a couple of things that the Government are already doing and a lot is going on to counter any kind of discrimination. This Government have got more older workers into employment and are tackling the discrimination in the workplace that, unfortunately, still takes place.

[Baroness Barker (LD)]

My Lords, given the salutary experience of the general election, does the Minister now agree that the previous Conservative Government were wrong to kick the Dilnot commission recommendations into touch and that now would be the time to get that report back off the shelf, dust it down and hold proper discussions about the funding of long-term care?

[Lord O'Shaughnessy]

The noble Baroness is quite right that this is a nut we have to crack. The Government are going to begin consulting widely on proposals at the end of the year and this consultation will be on specific proposals rather than being open ended. As we have discussed in this House before, it is important that we do that in a spirit of consensus, because I do believe that there is a way forward which all parties can support.

NHS (Charitable Trusts Etc) Bill

Baroness Barker Excerpts

Friday 26th February 2016 Lords Chamber

[Baroness Barker (LD)]

My Lords, I thank the noble Baroness, Lady Massey, for introducing the Bill today with such clarity. In preparing for today’s debate, the words “history” and “innovation” kept coming into my mind. The charitable sector is full of some wonderful historical stories, and the legacy of charity law is that from time to time one comes upon them.

Back in a previous century, when the first ever law was passed requiring a charity to have a board of trustees, one Dr Barnardo thought that he had better be in compliance with the law. He gathered together a few of his friends and acquaintances for a meeting. These august people resolved that they would meet again upon the death of Dr Barnardo, and they duly waited until this great social innovator, who did remarkable things in a wholly independent way, was not there to be hidebound by a board of trustees upholding the law.

It is interesting to think about that on a day when we are to hear the maiden speech of the noble Lord, Lord Bird. As those of us who work in the charitable and voluntary sector know, he has been at the forefront of bringing about innovation and change, not just in what charities and the charitable sector do but in how they do it. He has been at the forefront of bringing to the world of philanthropy and good deeds the disciplines of business. In so doing, he has made it very clear to the sector that some of the old strictures under which charities used to work need to change and, in particular, that we must have different forms of organisations in order to pursue what we need to do. I am very much looking forward to hearing what the noble Lord is going to say.

The legislation talked about by the noble Baronesses, Lady Blackstone and Lady Massey, is, in a sense, historical. It arose when there was a limited form that a charity could take and when there were very strict laws about the ways in which charities could hold property. If they belong to a charity that is an unincorporated association, noble Lords may know that special holding trustees have to be appointed to hold property in trust. So it is quite right today that in trying to bring about the best of business and to free charities up to pursue what they do in the most effective way, we should begin to make the sorts of changes that are in the Bill. It is, I know, very technical stuff, but it means in practice a great deal, and it will make a great difference to the ability of a body to do its basic job.

I want to make one other point that I think is important at the moment. It has been a terrible year for charities. Charities have been in the firing line right, left and centre—sometimes quite fairly but other times not. Being a trustee at the moment is really difficult and I imagine will become more difficult, because, when money is tight, people begin to look in even greater detail at what charities do. There has never been a more important time to support trustees in their governance of charities. Charities and trustees play an important part in our civic and social life and, therefore, anything that helps and supports trustees to do their job properly is to be welcomed. In this Bill, sorting out the anomalies between a charity and the bodies with which it works can be only to the good.

I want to ask one technical question of the Minister. It is a question that has been around before; it arose in your Lordships’ House when the Bill setting up foundation trusts and so on was going through. A certain noble Lord, Lord Hunt of Kings Heath, was at the Dispatch Box when we bowled him this question from opposition: will this Bill in any way affect the reporting, and particularly the accounting, burden on charities? NHS charities have always had a double burden of accounting: they have to account for their work as charities but they also have to account for their income and expenditure within NHS accounts. If the Minister could supply an answer to that, I would be very grateful. This is a Bill for the future, as much as a Bill that takes account of anomalies in the past. I wish it well.

Four Seasons Group

Baroness Barker Excerpts

Monday 11th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, clearly, it is a matter principally for local authorities. However, the Government are making available in the spending review another £1.5 billion for the better care fund and allowing local authorities to raise a special precept of 2%. The oversight provisions of the CQC cover 45 providers, which cover some 20% of the market. It is intended that that will give early warning to local authorities of any likely collapse.

[Baroness Barker (LD)]

My Lords, can the Minister confirm that anyone who has their care package funded by a local authority is entitled to alternative provision? Anyone who is a self-funder under the law is entitled only to advice. Are the Government taking steps with local authorities to ensure that older people and their families are aware exactly what their entitlement would be in the event that their care home were to close?

[Lord Prior of Brampton]

My Lords, it is up to local authorities to have contingency plans in place in the event of the closure of a home in their area. As I said earlier, the Local Government Association has indicated that at least 95% of local authorities have contingency plans in place.

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.