NHS: Bullying

Baroness Blackwood of North Oxford Excerpts

Wednesday 5th June 2019 Lords Chamber

[Lord Clark of Windermere]

To ask Her Majesty's Government what are the latest figures for bullying in the National Health Service; and what are their plans to reduce the level of such bullying.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Government are committed to supporting NHS organisations in their responsibility to tackle bullying. Some 28.3% of staff responding to the 2018 NHS staff survey experienced bullying from patients, service users or the public, 3.2% from managers and 19.1% from colleagues. Through the NHS Social Partnership Forum’s collective call to action and commitments in the NHS people plan, the Government are working with these arm’s-length bodies, the royal colleges, the NHS national “freedom to speak up” guardian, NHS organisations and health unions to reduce levels of bullying for all staff, and they deserve our thanks for all their work.

[Lord Clark of Windermere (Lab)]

I thank the Minister for her Answer. As she indicated, the NHS depends entirely on the commitment and dedication of its staff. It is really appalling that 28% of them experienced bullying and harassment in the last year alone, as she said. Just 12 months ago, her predecessor as Minister told me that over 70,000 members of staff had suffered physical violence in the service, and those figures are three years old. That is indefensible. We need to protect these employees. Will she make it clear that physical attacks will simply not be tolerated? Will she upgrade the service’s register of violent and abusive patients, relatives and friends, and will she confirm that there will be zero tolerance against physical attacks on our NHS staff?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his Question and I share his outrage. We absolutely must have zero tolerance of violence against any NHS workers, wherever they work within the National Health Service. That is exactly why the Secretary of State made a commitment to the national NHS violence reduction strategy, which was launched on 31 October 2018. It will put in place arrangements to support trusts in their responsibilities to protect staff. The recommendations include improving governance, improving staff training and development, improving the work environment and better use of legislation, including the new Assaults on Emergency Workers (Offences) Act, which had its first conviction in November. That is a significant improvement, but we know that improving general morale and the workforce environment are important, which is why we published the people plan this week.

[Baroness Manzoor (Con)]

My Lords, zero tolerance is really important in a workplace, but what are the Government doing to ensure that more senior managers and clinicians do not sexually harass and bully more junior staff?

[Baroness Blackwood of North Oxford]

My noble friend is right that we must ensure that bullying, wherever it comes from, is reported. It is just as unacceptable that bullying should come from managers and senior people as from those below. As I said in my Answer, the reported level of bullying from managers is 3.2%. This is one reason why we have introduced the “freedom to speak up” guardian, so that NHS workers are free to speak up and feel that they can do so in a safe space.

[Baroness Watkins of Tavistock (CB)]

My Lords, the interim report by the noble Baroness, Lady Harding, on NHS staffing highlights persistent shortages of staff, particularly of registered nurses, in many parts of the NHS. To what extent does the Minister believe that bullying is associated with managers focusing on NHS targets without sufficient staff to deliver high-quality care?

[Baroness Blackwood of North Oxford]

The Interim NHS People Plan identified bullying and violence in the workplace as a key challenge that must be addressed, and identified some measures to address them. However, the noble Baroness is absolutely right that an underlying challenge is staffing, which is a major concern for the NHS workforce. The plan looks to address them in a serious and concerted way by recruiting more staff, retaining existing staff, and looking at innovative ways to entice former staff back into the NHS so that we reduce the pressure on the entire system. She will know that the plan includes commitments to recruit 40,000 more nurses over the next five years and to reduce the vacancy rate to 5% by 2028, down from the current 8%, and reiterates the commitment to recruit 5,000 more GPs on top of the 20,000 extra support staff to be recruited in the coming years.

[Baroness Brinton (LD)]

My Lords, in addition to the figures cited by the Minister at the beginning of this Question, it has also been revealed that a number of hospital trusts still use non-disclosure agreements effectively to gag people when there has been a resolution to an incident. What guidance do the Government provide to NHS England to ensure that so-called gagging clauses are used only on sensitive matters, such as any compensation payment, and absolutely not to stop whistleblowing?

[Baroness Blackwood of North Oxford]

The noble Baroness is right that non-disclosure agreements cannot cover up bullying. All staff are free to speak up. Non-disclosure agreements should not be used for that purpose in any case. The Government have been very clear on this.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, I am sure noble Lords will recall my maiden speech 21 years ago, when I spoke about bullying in schools. One of the points that I made then, and I shall make again now, is that an answer to this problem is an independent hotline which people can ring to report misconduct of all kinds, not just bullying, so that organisations do not seek retribution for those who report misconduct.

[Baroness Blackwood of North Oxford]

I am afraid I was not here 21 years ago to hear the noble Lord’s maiden speech, but I shall look it up with utmost urgency upon leaving the Chamber and I thank him for his proposal. As the work moves from the interim people plan to the people plan, in which the work on bullying and the violence reduction strategy will be developed, I am sure that his proposal will be considered as a very sensible plan.

[Baroness Masham of Ilton (CB)]

My Lords, how seriously does the CQC take bullying and what does it do about it?

[Baroness Blackwood of North Oxford]

The CQC takes this extremely seriously. One proposal in the people plan is for the CQC’s scorecard to include a proper measure of a sustainable workforce, so that the new staff engagement metrics for the NHS oversight framework can be taken into account in the CQC’s well-led assessments during inspections, and that includes questions about bullying.

[Lord Lansley (Con)]

My Lords, I hope that my noble friend will agree that good leadership in the NHS is critical to removing a bullying culture. In that respect, might the Government support the NHS Leadership Academy to the extent that all aspiring chief executives in the NHS should themselves have gone through its Aspiring Chief Executive programme?

[Baroness Blackwood of North Oxford]

My noble friend, as ever, makes a very good point. Obviously there are a number of routes where leadership has been shown on this issue. In 2016 the Social Partnership Forum, which is chaired by Ministers but works across the system, gave a call to action, tasking employers and trade unions in all NHS organisations with working in partnership to create positive workplace cultures and to tackle bullying. In addition, recognising that no one organisation has the answer, royal colleges and others have joined together to create an alliance to tackle workplace bullying. They concluded that:

“Bullying behaviour is unacceptable. It is unprofessional and unnecessary. It affects the wellbeing of individuals and the teams within which they work”.


My noble friend’s proposal is another part of the picture. We need to come together across the system to tackle a completely unacceptable set of behaviours in the NHS—one that needs to be stamped out entirely.

Food and Feed Hygiene and Safety (Miscellaneous Amendments) (EU Exit) Regulations 2019

Baroness Blackwood of North Oxford Excerpts

Tuesday 4th June 2019 Lords Chamber

Moved by

[Baroness Blackwood of North Oxford]

That the draft Regulations laid before the House on 8 April be approved.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, consumers in the UK benefit from a high standard of food and feed safety and quality. The Government are committed to ensuring that this high standard is maintained when the UK leaves the European Union. This instrument is crucial to meeting our objective to continue to protect public health from risks that may arise in connection with the consumption of food.

This instrument, which concerns food and feed law, is made under the powers in the European Union (Withdrawal) Act 2018 to make necessary amendments to UK regulations. The UK’s priority is to ensure that the high standard of food and feed safety and consumer protection we enjoy in this country is maintained when the UK leaves the European Union. The instrument will correct deficiencies in certain regulations to ensure that the UK is prepared in the event that the UK leaves the EU without a deal.

Amendments are limited to the necessary technical amendments to ensure that the legislation is operative on EU exit day. No policy changes are made through this instrument and we have no intention of making any at this point. While we continue preparations for an orderly withdrawal from the EU, it is the job of a responsible Government to prepare for all possible scenarios, including the potential outcome that we leave the EU without a deal. We are committed to ensuring that our legislation continues to function effectively and that public health remains protected in the event of no deal. It is for this scenario that this instrument has been laid.

This instrument will address a range of minor deficiencies in retained EU law relating to food and animal feed that have not been addressed in earlier instruments, and recent changes made to EU law that could not have been addressed in previous instruments. As in the case of previous statutory instruments recently presented to the House, I wish to make clear again that no policy changes are made through this instrument. It makes only the essential changes necessary to ensure we have an effective and fully operable statute book on exit day. Its primary purpose is to ensure that legislation continues to function effectively after exit day. These proposed amendments are critical to ensuring that there is minimal disruption to food controls in the event that we leave the EU without a deal.

This instrument also transfers powers to UK entities to support a UK regulatory regime. It will transfer responsibilities incumbent on the European Commission to Ministers in England, Wales, Scotland and the devolved authority in Northern Ireland. It also transfers responsibility for risk assessment from the European Food Safety Authority, EFSA, to the food safety authorities, the FSA and FSS. They will continue to deliver independent, open, transparent and science and evidence-based advice. In addition, this instrument changes references to the import of food and feed into the EU to references to the import of food and feed into the United Kingdom. The contents of this instrument cover several policy areas, and I will address these specific areas.

The health mark for carcasses of certain animals—such as cattle, pigs and sheep—and the identification mark for all foods of animal origin will change once the UK has left the EU, with the letters “EC” no longer used. The Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019 retain the requirement for the health and identification marks to contain either “UK” or “United Kingdom”. This instrument allows for the abbreviation “GB” to be used in the marks, as this is the International Organization for Standardization—ISO—two-letter country code for the United Kingdom.

The instrument also provides for a transitional period of 21 months after exit day during which UK food businesses can apply their current health and identification marks on carcasses and foods of animal origin respectively when placed on the UK domestic market. This transitional period will assist businesses by providing a smoother transition into the new requirements and permit them to use up existing labels and packaging.

The instrument also addresses deficiencies in retained EU law regarding trichinella testing requirements to ensure that these rules are fully enforceable, replacing references to EU institutions and bodies with appropriate UK bodies and authorities. EC regulation 2074/2005 is an EU tertiary implementing measure that provides certain technical and administrative refinements to the EU regulations for food products of animal origin. For example, it sets out specific rules on analytical methods and rules relating to fishery products used in the production of fish oil. The instrument will assign powers and responsibilities currently incumbent on EU entities to appropriate UK entities to ensure that this diverse regulation is fully operational. The model health certificates for imports of certain products of animal origin, such as fishery products, gelatin and collagen for human consumption, are amended so they can be used solely to import foods to the UK.

This instrument also amends the definition of “imports” within the existing legislation so that it is clear any new facilities approved by EU member states in the future would no longer be automatically approved for food imported into the UK. Without this instrument there could be a lack of clarity around the status of newly approved facilities. The instrument also includes provisions to set minimum charging rates for hygiene controls for fishery products by amending the Fishery Products (Official Controls Charges) (England) Regulations 2007. It updates provisions for these charges: for example, these rates are currently set in euros with an exchange rate to British pounds. It also updates the exchange rate from 2008, as it is now somewhat out of date and would not be in line with central DExEU and HMT guidance on amending outstanding references to euros. The current regulations are national and stipulate the necessary qualifications and experience required for an official control laboratory analyst in England. This instrument will not become completely inoperable on EU exit and can continue to be used to regulate qualifications of official analysts.

The proposed amendments address minor drafting errors in the previously laid Food Additives, Flavourings, Enzymes and Extraction Solvents (Amendment etc.) (EU Exit) Regulations 2019 which were identified by the JCSI. The FSA provided an undertaking to the JCSI that this deficiency would be addressed in its response. EU authorisation decisions relating to genetically modified food and feed have also come into force since the laying of the Genetically Modified Food and Feed (Amendment etc.) (EU Exit) Regulations 2019, which will implement retained EU law on exit day. This instrument introduces amendments to make these decisions fully operable by specifying the UK entity to which the authorisation holders must submit annual reports on activities set out in their environmental monitoring plans and to remove references to the European Community in connection with the register of authorised GM food and feed.

This instrument makes equivalent changes to the relevant Northern Ireland legislation to ensure that the body of Northern Ireland food law can function properly and is enforceable once the UK leaves the EU. It also inserts a definition of “Northern Ireland devolved authority” or, where appropriate, identifies the department that is the correct and appropriate authority, replacing references to EU institutions and bodies in various EU regulations. The amendments also include naming the relevant legislature for Northern Ireland where the regulation-making procedure is provided in various EU regulations.

Let me be clear: there are no new changes for food businesses introduced into how they are regulated and how they are run. The formal public consultation was carried out by the FSA covering changes to the UK health and identification marking, which received overwhelming support for the proposal. The instrument will provide continuity for businesses and protection of consumers’ interests, and ensure that enforcement of regulations can continue in the same way. The changes will ensure the retention of a robust system of controls which underpins UK businesses’ ability to trade both domestically and internationally. Devolved Administrations have provided their consent for this instrument, and have been engaged positively. It provides the necessary controls for food to continue to function effectively after exit day.

I urge noble Lords to support the amendments proposed in this instrument to ensure the continuation of effective food and feed safety and public health controls.

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, I too thank the Minister for outlining all the technical details of this SI. Of course, this instrument has been withdrawn from the Order Paper twice before. Some of the changes made since we originally saw it are small but crucial. We are lucky that they have been spotted, but that raises concerns for the industry that there may be others. Now that the leaving date has changed, are the Government planning on conducting additional scrutiny on the other SIs that are being rushed through this House to make sure that they are up to scratch? How do the Government intend to convey these changes to the relevant individuals and companies on whom they will impact?

I add my support to the question asked by the noble Baroness, Lady Thornton, about the capacity of the FSA. This is probably about the 16th time that we have asked the same question and we are still concerned about the capacity to replace all of the other measures.

Some of these changes reflect very recent EU law that has come into force, as the Minister mentioned, so what do the Government intend to do about any new EU law that might come into force between now and 31 October or whenever we happen to leave? Will these SI and the ones that preceded them have to be further amended if there are other changes to EU law?

The Minister mentioned that the system for minimum charging rates for hygiene controls of fishery products is somewhat out of date. Will the Government confirm whether they aim to change the pound-euro exchange rate from the 2008 level at which it is currently set? Although these charges, as we know, are rarely levied by local authorities, any change in the exchange rate, which could happen after Brexit, could have a big impact on the ability to pay of those against whom the charge is levied. We saw a big difference in the rate of the pound against the euro after the 2016 referendum, and the way in which we might, unfortunately, leave the EU, could have a similar serious effect on the exchange rate. What are the Government planning to do about those charges if there is such a big change in the exchange rate? Are they planning to bring it up to date from 10 or 11 years ago?

[Baroness Blackwood of North Oxford]

I thank the noble Baronesses for their important questions. We have been through a number of periods of scrutiny on FSA SIs between us, so I feel that we are old hands at this.

The noble Baronesses will know that leaving the EU does not change the FSA’s top priority, which is to ensure that UK food remains safe and is what it says it is. We are working hard with the FSA to ensure that the high standard of food and feed safety and consumer protection we enjoy in this country is maintained when the UK leaves the European Union. That is one of the reasons for this SI.

The noble Baroness is right to identify that this is one of the ways that we are keeping up to date with EU changes in legislation while we remain part of the European Union, but of course once we have left we will be responsible for identifying how we want to proceed and whether we want to introduce our own legislation and additional food safety standards which mirror those in the EU or whether we want to go further. That is a commitment—excuse me, I am having a Theresa May moment—that has been made before.

I shall touch first on the issue raised by the noble Baroness, Lady Thornton, at the end of her remarks about trade. I want to nail that one if I can. We have debated this before. The UK is committed to maintaining the high standards of food and feed safety which we currently enjoy. I shall repeat a line which has been used by No. 10. We have always been clear that we will not lower our food standards as part of a future trade agreement. From day one, we are committed to having a robust and effective regulatory regime in place which will mean that business can continue as normal. For most food and feed businesses there will be no change in how they are regulated and how they manage. Leaving the EU does not affect that, regardless of comments that may have been made this week.

[Lord Davies of Stamford (Lab)]

Can we be clear that that very important undertaking she has just given the House also applies to animal welfare standards in the European Union and currently in this country?

[Baroness Blackwood of North Oxford]

That is obviously not my brief, but I know that those commitments have been made from this Dispatch Box and I am very happy to give the noble Lord that commitment.

I shall move on to the important questions that were raised regarding trichinella resources. We have brought in these amendments today because we recognise the importance of maintaining standards when it comes to trichinella testing. The Food Standards Agency’s spend on trichinella testing in financial year 2018-19 was £565,000, of which £275,000 was recovered through charges for official controls. The figure includes the cost of taking samples and of the UK’s trichinella national reference laboratory. The figure is approximate and is a proportion of the total cost of official controls applied across the food industry. The UK will maintain the requirements of EU food safety legislation after leaving and will not only maintain the standards applicable to most domestic and imported food but will also ensure that UK food businesses can continue to apply controls that are widely accepted by other countries. The FSA has made a commitment that it will ensure that there are the resources required to maintain those standards and the level of testing for trichinella control after exit.

I know that I have given these statistics to the noble Baroness before, but I can reassure her once again that an extra £14 million was provided to the FSA for 2018 in order to ensure extra funding and capacity for EU exit and an extra £16 million was provided for 2019-20. This has translated into an extra 140 staff who have been recruited. More than 90% of them are already in place. That is supported by an expanded role for the independent scientific advisory committees on food. It covers risk assessment, for which the FSA has an outstanding international reputation. It was strengthened by recruiting new experts, establishing three new expert groups and expanding its access to scientific experts, who can provide scientific advice, and to other scientific services in order to meet the potential need for increased risk assessments in future. This is part of the wider priority of the FSA to ensure that it can maintain its current commitments to promoting robust food standards nationally and internationally, protect consumer interests and facilitate international trade and ensure that consumers can have confidence in the food that they buy—to know that the food is what it says it is. I hope that reassures the noble Baroness on that point.

The noble Baroness asked about official controls charges for fishery products. This was also raised by the noble Baroness, Lady Walmsley. She is absolutely right regarding the exchange rate, and that is why we are updating the provisions for these charges so that they are in line with the more sensitive DExEU and HMT guidance on amending outstanding references to euros. The instrument does two things. First, it adjusts for the fact that in the future European Union member states will become third countries for the purposes of these charges. Therefore, we can no longer offer the European Union differential treatment in terms of costs levied for hygiene controls performed on directly landed consignments of fishery products. Secondly, as I have said, it addresses the references to euros. The Government do not anticipate any increase in the extent to which these charges are levied by local authorities in England after the UK exits the EU. It is currently reported to be a very low rate. As such, we believe that food business operators in England are not expected to face any extra costs. We will expect local authorities to keep it under review, but we anticipate that it will remain low. I hope that reassures the noble Baronesses.

I hope that I answered the questions from the noble Baroness, Lady Walmsley, about the way in which risk assessment is done in my earlier answer about the increasing staffing that has become available through the increased investment in the FSA to prepare for EU exit and strengthen its risk assessment capability. On her question about how decisions are made, obviously there will be some ministerial involvement but it is important to say that maintaining the UK’s high food standards is a top priority for the Government. Part of that is to continue the long-standing commitment to openness and transparency and evidence-based decision-making from the FSA. Food safety authorities will publish the advice they provide to Ministers as well as the evidence and analysis it is based on so that stakeholders can see the basis on which decisions are made. I hope that that reassures the noble Baroness.

On the final point about devolved Administrations, raised by the noble Baroness, Lady Thornton, Scotland, Wales and Northern Ireland have provided their consent to these instruments. They have been closely involved in the development of them. The principles and rules that are set out in retained legislation and which these SIs will correct are intended to ensure the same level of food and feed safety and protection throughout the UK and the free flow of trade within it and—exactly as she said—to ensure clear lines of communication, engagement and co-operation between all four nations so we can, as has been said, pick up on any risks throughout the four nations. The FSA has a very close working relationship with the Administrations of Scotland, Wales and Northern Ireland, and we are confident that, in practice, it will be possible to make arrangements to operate a framework for food and feed safety and regulation across all four Administrations.

In conclusion, I thank noble Lords for their contributions to this debate and ask for their support.

Motion agreed.

Children: Gaming

Baroness Blackwood of North Oxford Excerpts

Thursday 23rd May 2019 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what plans they have to sponsor research into the benefits of gaming for children’s mental health and wellbeing.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the department funds research through the National Institute for Health Research. The NIHR spend on mental health research for 2017-18 was £74.8 million, the highest ever. The NIHR welcomes funding applications for research into any aspect of human health. Existing research has shown some positive impacts of gaming—such as cognitive, emotional, motivational and social benefits—but has also shown that a small number of young people’s gaming can become harmful.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful for that reply. Yes, gaming can be harmful, and this Question is about gaming, not gambling. There is increasing evidence that gaming can help children in a whole variety of ways, particularly with mental health problems, yet little research is being done and the Minister did not really give a great list of what is happening with that. I wonder whether she could try to give more information about the scale of it and see whether we can try to persuade the internet companies to get more involved and to use their funding to start producing games of goodness and benefit to children rather than negative ones. She reported recently that there had been a summit at which the Secretary of State spoke to the internet companies. I wonder whether she will look into the possibility that, when the next meeting takes place with him or his colleagues, this item will be on the agenda and those companies will be encouraged to participate jointly in providing games of good to the country.

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question. He is absolutely right that gaming can have positive effects; there are some areas in which the UK Government are funding research into this. In partnership with industry, NHS England is funding work to develop and test how immersive gaming technology can be used to increase therapy adherence and tackle children’s anxiety. He is absolutely right that, following the Secretary of State’s social media summit, a partnership between industry and the Samaritans was formed. I shall certainly raise his proposal with the Secretary of State. The NIHR is also funding research to develop and evaluate therapy that uses virtual reality technology to treat patients with psychosis. The noble Lord is absolutely right that more can and should be done in this area, and I shall take that point away with me.

[Lord Kirkhope of Harrogate (Con)]

Does my noble friend not agree with me, though, that we should deal with this extremely carefully? I am aware of a number of cases in which children have become obsessed with gaming. In desperation, parents have been in touch with their representatives and medical advisers to try to deal with the effect of the psychosis that results from the obsession with gaming among quite a lot of young people. Can she therefore make sure that, however she looks at the positive effects in certain cases, she also fully recognises the dangers of an open approach to this?

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question. Hundreds of millions of people globally play videogames, and for the majority it is a positive recreational activity. He is right, however, that there is some evidence of a moderate correlation between gaming and depression and anxiety symptoms in young adults, and evidence that exposure to violent gaming can have an impact on sleep and mood. However, that is dependent on the nature and duration of gaming. We also support the WHO’s classification, which identifies addiction within the classification of diseases. The CMO said in her evidence review, however, that there is insufficient evidence to support a specific evidence-based guideline on screen time. That is why we support more applications to the NIHR for research so that we can have a better understanding of the impact of gaming on young people. We would encourage anyone who is concerned to contact their GP.

[Baroness Walmsley (LD)]

My Lords, as the noble Lord, Lord Brooke, said, this is about gaming, not gambling. Although some games can indeed be beneficial, some of them have covert elements of gambling in them such as loop boxes. Will the Minister assure the House that the PSHE curriculum in schools will cover elements of gambling, including those hidden in otherwise innocuous activities such as gaming? How do parents find out which are beneficial and which are the harmful ones?

[Baroness Blackwood of North Oxford]

My Lords, the noble Baroness is absolutely right, as ever, on this point. There is a challenge for parents and young people to be more educated and more critically engaged with online harms. The Online Harms White Paper is out for consultation until 1 July and I encourage all Members of this House to engage with that consultation. It is about setting clear responsibilities for tech companies to keep UK citizens safe but also about thinking about how teachers, parents and young people can get the best out of their engagement with the internet. To encourage the noble Baroness, our children and young people’s mental health Green Paper addresses these issues and we shall make sure that we drive that agenda forward.

[The Lord Bishop of Ely]

My Lords, there has been much conversation already about research into gaming addiction among young people. My right reverend friend the Bishop of St Albans raised the issue of a mandatory pause function following calls from healthcare providers. As that was raised again in conversation and discussion around the Online Harms White Paper, will the Minister confirm that the Government are assessing the value of this function?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

I thank the right reverend Prelate for his question. He is absolutely right that it is one of the issues that will be considered with the Online Harms White Paper. I encourage him and his colleagues to engage with the consultation. It is a very important part of that consultation and something we should consider very carefully.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Government carefully consider encouraging NHS innovation to invest, with other independent companies, in developing games to promote healthy lifestyles in children? In particular, there could be a game that would attract children who are prone to obesity associated with mental health problems to get them engaged in health promotion programmes and associated healthy activities—innovative action research rather than pure research.

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right on that point. Emerging augmented reality and VR markets should be encouraged to offer these opportunities. Interesting evidence emerged from the AR game “Pokémon Go”, which encouraged many young people to go out walking and exploring, for example, and we have programmes that are investing in promoting exactly that kind of innovation. We also have the video games tax relief, which has benefited projects such as Eye Gaze Games, a series of games for children with mobility problems. We would like to continue investing in such programmes, which give the particular benefits that the Government would like encourage.

Social Workers: Recruitment and Retention

Baroness Blackwood of North Oxford Excerpts

Thursday 16th May 2019 Lords Chamber

[Baroness Donaghy]

To ask Her Majesty’s Government what is their strategy for increasing the number of social workers and improving their retention rate.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Government remain committed to supporting local authorities and other social work employers to meet their duties regarding social work workforce planning and helping them to understand best practice in recruiting, retaining and developing staff. We have invested over £1.2 billion since 2010 in supporting both mainstream and fast-track qualifying routes into the profession, and our improvements to the supervision and leadership that social workers receive support people to remain and progress in social work.

[Baroness Donaghy (Lab)]

I thank the Minister for that Answer but I do not think that they can fulfil their requirements or their responsibilities. Particularly for directly employed local authority social workers, workloads must be at red on the risk register and must have been like that for some years. Stress levels, staff shortages and the inability of some areas to recruit—there is a 26% vacancy rate in London—indicate that this must have a much higher priority than this Government are prepared to give. Will she give some more practical answers on how to stop the increasing numbers of social workers leaving the profession, how to recruit more—there has been a 6% drop—and how to get some support for a very pressed service?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for what is a very important Question. She is absolutely right that we have to ensure that we recruit and retain the social work workforce: it is vital and, like any employers, local authorities are responsible for ensuring that they have the right staff with the right skills. The Government also recognise that we have a role in supporting them. That is why we provide financial support to students who qualify as social workers. We make sure that those entering social work receive the best training possible, with some new programmes to support those who are newly qualified, such as the assessed supported year in employment, so that those who come in with quite a significant workload can be supported in their first year. We understand that high caseloads can be a challenge. Local authorities are responsible for the recruitment and deployment of social workers, but we work with them to think about how they can best manage the delivery of services and make caseloads manageable so that we retain those social workers who are vital to delivering care and support for some of the most vulnerable in our society.

[Baroness Manzoor (Con)]

My Lords, social work can be a very rewarding career but it can also be very stressful, as has been said, so can my noble friend say exactly how we are supporting young graduate social workers? She said a bit about that but how, in their first, second and third year, can we actually retain them?

[Baroness Blackwood of North Oxford]

My noble friend is absolutely right that social workers do vital jobs and that it is an attractive career choice. More than 4,000 students enrol in social work courses every year, and we have introduced a fast-track graduate programme that has brought 2,000 more into the social work programme. However, it will work only if we retain those within the system, so we have developed some post-qualifying standards for social workers at key stages of their career to create a consistent, practice-based career progression. In particular, we have introduced the assessed year in the workforce to provide that key level of support in the first year, so that those who experience the shock of the caseload in their first year have the support that they need to remain in the profession and develop the key skills to be able to manage that workload.

[Baroness Butler-Sloss (CB)]

My Lords, as a former family judge, I have worked very closely with social workers. Will the Minister consider the aspect of lack of respect and status? If they were given a better status, they would be much easier to recruit and retain.

[Baroness Blackwood of North Oxford]

The noble and learned Baroness makes an excellent point. Social workers play a crucial role in our society and should have the respect and status they deserve. One way in which that can be achieved is through the increasing professional standards being brought into the service. As I have said, these include key reforms such as improving leadership and providing high-quality continuous professional development, through which we seek to improve the quality of social workers’ professional lives while raising standards and recognition for the profession.

[Baroness Jolly (LD)]

My Lords, the named social worker programme demonstrates a new way to support particularly vulnerable people. Social workers and their clients felt more confident and supported; social workers felt more job satisfaction, and we have just heard how important that is. What plans are there to expand this programme to more areas?

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right: that is a vital part of the programme. It is part of a wider suite of programmes that have been introduced so that we can bring individuals into social work at different points within the system. This has included the new social work degree apprenticeship scheme and, as I have said, we have 4,000 a year entering the normal degree programme. We have also introduced the fast-track training programme for high-potential graduates and the Think Ahead graduate programme for mental health social work. We are trying to attack this challenge from all angles, as well as guaranteeing that we retain those in the system through continuous professional development. This will ensure that it is a rewarding profession, as she rightly says, but also one in which people feel supported and that they have the skills to deliver for the most vulnerable in our community.

[Baroness Wheeler (Lab)]

My Lords, the Minister said earlier this week that the need to ensure that we recruit, retain and build on workforce development will be at the heart of the social care Green Paper when it arrives. Has she anything further to say about when we will actually get the Green Paper, other than that it will be very important? In view of the chronic problems of low morale, inadequate pay in the face of unmanageable caseloads and resulting problems in providing key services to vulnerable people, as we have heard about today, can she assure the House that making sure that social care work is valued is recognised as a top priority in the Green Paper?

[Baroness Blackwood of North Oxford]

The noble Baroness will know that we discussed this two days ago. I am happy to reassure her that social work and the social care workforce will be core not only to the social work Green Paper but to the workforce strategy, which will come forward imminently. She is absolutely right that we must ensure that we have the right models to retain and recruit the social care workforce, but we must also have the right funding. That is one reason why the Government have invested £9.4 billion in social work over the last few years, why we have to make sure that we integrate the long-term plan and the social care Green Paper alongside the funding settlement for local authority funding, and partly why we are working in the way we are to bring these papers forward.

Mental Health of Children and Young Adults

Baroness Blackwood of North Oxford Excerpts

Thursday 16th May 2019 Lords Chamber

[Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank the noble Baroness, Lady Royall, for introducing this debate and giving us the opportunity to discuss such an important issue during Mental Health Awareness Week. She spoke movingly and importantly. We have had an extraordinary debate today, with many personal reflections; it is an incredibly valuable contribution to this week. I also thank those who have asked the huge range of questions which I am now tasked with trying to respond to in less than 20 minutes. I hope your Lordships will forgive me if I do not cover each one; I will write on those points I am not able to cover today.

The noble Baroness, Lady Royall, is absolutely right when she says that, unfortunately, it remains true that many young people who seek help for their mental health find it difficult to access the right support at the right time. This is wrong, and we need to work harder and faster to get it right.

I would like to start by responding to a point about data, made by the noble Lord, Lord Storey. We have recently improved the available data in two key areas, with a significant prevalence survey on mental health in young people that was done in 2018 with 9,117 children and young people aged between 2 and 19. It showed that the prevalence of mental health diagnosis has increased by 1.1% since the previous survey, and that 25.2% of young people with a diagnosable disorder report having been in contact with NHS mental health specialist services in the last year. This is important, because the previous prevalence survey was 10 years old, and during that period social media has intervened, which we expected to have had a significant effect. The CMO then did a review which created evidence-based guidelines on screen time—an important intervention. In addition, we have brought in the dashboard to track data at a local level and the implementation of various standards which we have brought in.

This is a huge improvement on the level of data and tracking that we have on mental health within the community and the performance of our mental health trusts compared to the last time I was in the post. Therefore, I would like to reassure the noble Lord on the point about data. It is not where we would like it to be, but it is still a significant step forward. I wanted to start on that, because you cannot talk about policy and where we are if you do not have the data to know about it. That is why I want to talk about where we have come to before I talk about where we need to go.

We are on track to meet the commitment to improving access that we made in the five-year forward view, and to have 70,000 more children and young people accessing treatment each year by 2020-21 compared to the 2014-15 baseline. We have introduced the first-ever access and waiting time standards for mental health services. For young people experiencing their first episode of psychosis, we have a target for early intervention to ensure that treatment begins within two weeks for more than 50%. Nationally, the NHS is exceeding this: over 75% of patients started treatment within two weeks in March 2019. We have also set a target for 95% of children and young people with eating disorders—which have been on the increase—to access treatment, with a one-week referral for urgent cases and four weeks for routine cases by next year. Nationally, we are on track to meet this, with the most recent data showing that over 82% of patients started routine treatment within four weeks. We need to pay tribute to those who work incredibly hard within the mental health system and are making some very difficult changes to achieve this, coming from what was a very low base. It is important to pay tribute to them for their achievements.

I would like to move on to some questions put to me by the noble Baroness, Lady Royall, about crisis care, before moving on to those from the noble Baroness, Lady Thornton, about out-of-area placements and the private sector. The noble Baroness, Lady Royall, is absolutely right that we need to improve access to crisis care for those young people who need it most. A commitment has been made that we will invest £400 million in 24/7 crisis resolution home treatment teams in every local area by next year, and £249 million in mental health teams in A&E departments to improve the system. The long-term plan makes a commitment to ensure timely, universal mental health crisis care for everyone, including young people, and to drive out the variability which we recognise exists for them.

We also recognise the concerns raised by the noble Baroness, Lady Thornton, about out-of-area placements. We have made a commitment that inappropriate out-of-area placements must come to an end. Where there are specialist cases, a young person will need to travel, but we want in-patient stays to be as close to home as possible and to avoid inappropriate stays. For that reason, we have introduced the accelerated bed scheme, which has already created 117 new beds, with 69 new beds on the way. This is being done to reduce variability of access to in-patient care, but we also want to reduce that care by bringing in more prevention and earlier access to lower-level care, such as that pointed out by the noble Lord, Lord Layard. I shall return to the point that he made.

We are very concerned about the recent reports of failings within mental health care, which the noble Baroness raised. She is absolutely right that all providers of NHS services, whether NHS or private, must abide by the same high standards. Where this is not the case, we are ensuring that the NHS looks into the circumstances and considers what action should be taken. Private providers play an important role in the provision of children’s mental health services, but these must be safe and of high quality. We have tough regulators to ensure that that happens.

I will move on now to the points made on early intervention by the noble Baroness, Lady Royall, and the noble Earl, Lord Listowel, who is not in place.

[Baroness Thornton]

He is there.

[Baroness Blackwood of North Oxford]

I apologise—perhaps the noble Earl is sitting low in his seat.

They are absolutely right that prevention and early intervention are crucial. We prioritised improving perinatal mental health when I was previously the Mental Health Minister for exactly that reason. The noble Earl put it so eloquently: it is vital for newborns to form that early attachment with their mother and father. We must also consider the role played by the wider family, as those on our own Benches have put it. From 2020-21, we have put in place increased access to perinatal mental health services in all areas for at least 30,000 women, backed by £365 million in funding, as part of the five-year forward view for mental health. The long-term plan will also go further, with a commitment to increase evidence-based care for women with severe perinatal mental health difficulties and a personality disorder diagnosis, to benefit an initial 24,000 women per year by 2020-21. That is reassuring, but we also need to ensure that it carries on beyond the early years and into the school years—a point made by a number of your Lordships.

I recognise the impatience surrounding the Green Paper, but I would like to clarify a few points. The commitment within the Green Paper is to have a pilot, for 25 schools in the first instance, but it is then to incentivise every school and college to identify and train a designated senior lead for mental health to create new mental health support teams in and near schools and colleges. We are starting by piloting so that we can work out what the best design is and then move it across to all schools. The idea is not to have variability but to drive it through the whole system. While I recognise the frustration with rolling out these proposals in a phased way, it is a very ambitious commitment. We need to recruit and retain a workforce numbering in the thousands for the mental health support teams alone. We cannot do that overnight, given that there are over 20,000 schools and colleges. To roll out a fifth to a quarter of these by 2022-23 is already a challenging target. We must ensure that we train that workforce in an appropriate way to meet the challenges they will face.

I will also respond to the eloquent words of the noble Baroness, Lady McIntosh, and the moving experience which she spoke of. She is right that I do not speak for the Department for Education, but the thing about being at the Dispatch Box is that I can say whatever I like; once I am up here, they cannot pull me down. As she said, I speak as a former music graduate of Somerville, and I believe strongly in the importance of the arts, and in particular music, for education and mental health. I back her entirely on its importance for social prescribing as well. I will advocate strongly for that in this role. I agree with the noble Baroness that it is extremely important that young people’s experience should be safe, inspiring and nurturing. We should all be pushing in our roles for more joy within our society.

I know that I will run out of time quite quickly, so I will move on. I would like to talk a little about the work we have been delivering for university students. This key aspect has arisen on a number of occasions, and I know that the mental health of young people in universities is vital. Noble Lords will be pleased to hear that NHS England and Universities UK are working together on a programme to support and improve mental health at universities through Universities UK’s StepChange programme, which calls on higher education leaders to adopt mental health as a strategic priority and to take a whole-institution approach to mental health. As part of this programme, the Government are actively backing the introduction of a sector-led university mental health charter, which will drive up standards in promoting student and staff mental health and well-being.

NHS England is also working closely with Universities UK through its mental health in higher education programme to improve welfare services and access to mental health services for the student population, including focusing on suicide reduction while improving access to psychological therapies. There is funding attached to this and I am happy to meet with the noble Baroness if she would like to discuss that further, as it is a vital part of the picture.

I will move on to the questions raised regarding stigma and social media, which are crucial if we are to have a preventive approach to the situation we find ourselves in. The noble Baroness, Lady Massey, and the noble Lord, Lord Bragg, spoke incisively on this issue. We are committed to eliminating the stigma around mental health and are providing £20 million in funding to the Time to Change national anti-stigma campaign, which has been hugely successful. As the noble Baroness rightly said, it involved high-profile individuals who cut through the noise that often comes at young people every day. The campaign aims to improve social attitudes towards mental health, including promoting the importance of well-being in all areas.

However, we should also think about one area that did not get aired within the debate, and that is those who face double stigma when they have a chronic condition. As I think was raised by the noble Baroness, Lady Tyler, there are those have learning disabilities and mental ill-health. It is challenging for them to navigate their way through the system. Public Health England is delivering a £15 million national health campaign called Every Mind Matters, with the aim to equip 1 million people to be better informed to look after their own mental health. This will be of huge benefit going forward.

It is important that we do not imply, in this place, that everybody who suffers from mental ill-health will end up in the criminal justice system. I do not believe that is the case.

I also point out that this Government have been committed to addressing the agenda of social media and the harms it can produce, even though it is beneficial in other areas when it is used as an effective tool. That is why the Secretary of State has not only taken this on as a personal commitment in the round tables he has held with internet companies, but we are also bringing forward the online harms White Paper. The noble Lord, Lord Haskel, was right when he said that we have to make sure this has teeth. That is why there are commitments to bring forward a new regulator under it and why the CMO brought forward recommendations on screen time.

None of this is relevant if we do not have the workforce and funding that we need. I am pleased that NHS funding for young people has increased. I was concerned to hear the noble Lord, Lord Bradley, and his comments about reduced funding. The information I have is that children’s mental health funding is increasing. It has gone up from £516 million in 2015-16 to £687.2 million in 2017-18. Planned spend next year is £727.3 million, an increase of 5.8% compared to the previous year. This will be monitored with the investment standard and dashboard. I am happy to follow this up with the noble Lord, but I believe that NHS funding for mental health is increasing and at a faster rate than overall NHS funding. We are tracking this and ensuring that local CCGs stick to that commitment. This transformative investment will ensure that more young people receive the mental health support they need.

I finally turn to the questions about suicide prevention, which was movingly spoken about by the noble Lord, Lord Giddens, and others. The noble Lord is right that we have an excellent suicide prevention strategy. It must be based on accurate data. It is challenging to ensure we have that data, but I have a great deal of confidence in Public Health England working with local authorities to ensure we raise the standards of that work. Understanding the reasons for suicide is complex. Suicides among children are relatively rare, but each is an appalling tragedy, so we must work with every ounce of our abilities to move forward and make that better.

I am proud that we recently increased the amount of research funding for mental health, by a record amount, to £74.8 million. This will play an important role in helping us understand the sources of all forms of mental ill-health, including those that drive individuals to suicide.

While I am sure that noble Lords feel there are other areas I could have covered, and would like answers to other aspects, I hope that, by pointing out the areas of rising investment today and that we are improving access and waiting times, I have communicated to you that the Government are genuinely working across all departments to ensure that we see this as a priority agenda. I have demonstrated that we understand that we still face significant challenges. While we are impatient for faster improvement, there can be no question of our commitment to a brighter, healthier and more joyful future for our children and young people.

I was deeply moved to hear the words of the noble Lord, Lord Bragg, his testimony of his own experience some years ago and how different he feels things are today. Each of us still feels frustrated by how far we still have to come and how many things we still have to deliver to give our children the services that they deserve. I cannot think of a better way to close than by repeating some of the comments that he gave in his speech. We are only as good as the way we treat the weakest among us. There is a long way to go, but we are now on the road. If we can make as much progress in the next 20 years as we have in the last 20 years, we can give young people the stigma-free lives that they deserve.

Learning Disabilities Mortality Review

Baroness Blackwood of North Oxford Excerpts

Wednesday 15th May 2019 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, with the leave of the House, I shall now repeat as a Statement the response given to an Urgent Question on the learning disabilities mortality review originally made by my honourable friend the Minister of State for Care in the other place. The response was as follows:

“Mr Speaker, I should like to start by restating our commitment to reducing the number of preventable deaths among those of our population with a learning disability and to address the persistent health inequalities that they experience. It is completely unacceptable that people in our country with a learning disability, and indeed autism, can expect a shorter life than the rest of the population as a whole.

Each and every death that might have been prevented is an absolute tragedy. We must not compound that tragedy by failing to learn lessons we can that might improve the care that is provided in the future. That is why the Government in the first place asked NHS England to commission the learning disability mortality programme, known as LeDeR.

The principle behind it is a relentless determination to learn from these deaths and to put in place changes to the way that care is organised, provided and experienced to make a real difference both locally and nationally. It means challenging often deep-rooted, systematic cultural issues that have existed for decades. It is driven by the fact that we are clear that the quality of care offered to people with a learning disability sometimes falls very short of the standards we expect—and that is simply not good enough.

The existence of the LeDeR programme testifies to our commitment to address that. It is so that people with a learning disability can access the very best possible care and support. The annual reports published by the LeDeR programme and the recommendations it makes, to which we respond, are a key part of this.

Over the weekend, the media reported on the findings of a draft of the third annual LeDeR report, which is due to be published shortly, and in making this Statement I record my deep regret at this apparent leak. It is also my regret that Her Majesty’s Opposition should table a UQ based on leaks, and indeed that the Speaker’s Office should see fit to grant it. I have committed in the past, and I will commit once again, to bring the final report before Parliament on the day of publication, which we are told by NHS England will be in the next few weeks. I know that honourable Members will feel as concerned as I do by some of the things that have been leaked in the report, which I shall be very happy to discuss in more detail when the report is fully published”.

[Baroness Thornton (Lab)]

I thank the Minister for repeating the Statement. I just make the obvious point that the Government have had the draft report since 1 March, and if they had published it in a reasonable time it might not have leaked.

I am sure that we can all agree that people with a learning disability have worse physical and mental health than people without a learning disability, and that the Confidential Inquiry into Premature Deaths of People with Learning Disabilities found that the average age of death from different levels of impairment was between 46 and 67 years, which is massively below the average lifespan for those without a learning disability. I look forward to the report, which the Government have told us that we will soon see.

Will the Minister now say that it is always unacceptable for learning disability to be given as a reason for not resuscitating someone? For this programme to work properly, does she agree that it needs to be resourced so that it can consider all reported cases in a timely manner? I suggest to her that many families feel that the review is the NHS marking its own homework, and that what is required here is a truly independent national body to review the premature deaths of people with learning disabilities.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important questions. On her first point, which is that the Government have had the report since March, I should like to be very clear that this is not a government report; it is an independent report from the University of Bristol. It is free to publish it when it is ready, although it was commissioned by NHS England, so the Government are not in control of the timetable for publishing it.

The noble Baroness is 100% right, however, on her point about “do not resuscitate” orders. The reports that we have heard that disabilities such as Down’s syndrome are being used by some doctors as a reason not to resuscitate are entirely unacceptable. We are taking immediate action and a letter will be sent to health professionals to make clear that that is not an acceptable reason to put in place a “do not resuscitate” order. On her last point about resourcing and the effectiveness of the LeDeR programme, progress has been made in implementing it: 15 out of 24 of the recommendations have already been completed, and in others we are making real progress. NHS England has trained more than 2,100 experts to carry out reviews, 1,500 reviews have been completed and a further 1,500 are in progress, but I have no doubt that given the situation in which we find ourselves, questions will be taken into account by NHS England and the department.

[Baroness Jolly (LD)]

My Lords, I should declare my interests. I am chairman of Hft, a learning disability charity which cares for more than 2,000 adults. I thank the Minister for repeating the Statement and understand the limitation of her responses, but I am not sure that the Secretary of State’s words will console parents and other relatives of someone with a learning disability. If the Secretary of State were to take immediate action on any part of the leaked report, I should like it to be on the issue that the noble Baroness, Lady Thornton, just raised about “do not resuscitate” orders.

No one dies from a learning disability or Down’s syndrome. The reason for the annual report is to identify why people with learning disability die much earlier than the population average. Why and how well-trained doctors do not know and appreciate that appals me. Can the Minister put a note in the Secretary of State’s in-tray to suggest that this might be an area to look at urgently and remedy quickly? Can she ask him to ensure that all doctors in training learn to care for people with a learning disability, and that that is regularly refreshed as part of their ongoing professional development? Will she flag up to him that I look forward to discussing the report with him as soon as it is finally published?

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right that this issue must be a top priority, and I assure her that the Secretary of State is taking it as such. I repeat that it is entirely inappropriate that disability of any kind—in particular, learning disability or Down’s syndrome—should ever be used as a reason for a DNR, and that NHS England will be writing to all doctors to remind them of this fact. It will be made absolutely clear.

The noble Baroness is right that there should be no reason for people with learning disability to have a different life expectancy. A commitment has already been made in the long-term plan to address those challenges, including increasing the uptake of annual GP health checks for people with learning disabilities to 75%, as it is recognised that physical care for those with learning disabilities is not as effective as it should be; creating a digital flag on patient records for all people with learning disabilities and autism by 2023; and reducing the number of in-patients with learning disabilities by half by 2024. We are increasing the pace with which we do that.

The noble Baroness’s last point, which is really important, concerns ensuring that all those working in the health system are trained to treat those with learning disabilities. A consultation on this matter has just closed and we will respond to that in the next two to three months.

[Lord Arbuthnot of Edrom (Con)]

My Lords, I thank my noble friend the Minister for her helpful answers so far. Is one of the problems that there is a contradiction between our natural desire to make sure that there is no variation in treatment or administration across the country and our equally natural desire to ensure that local people can make decisions on the basis of their local resources? Is there a sense that the Government cannot win?

[Baroness Blackwood of North Oxford]

In my view, there should be no variability in the quality of care that a person with learning disabilities receives in whatever part of the country they are in. That is exactly why the LeDeR was brought in, why we have brought in a care review to understand why there is variation, why we are bringing in support through training for those delivering care and why we are bringing in measures under the long-term plan: so that individuals can be identified and flagged up to healthcare professionals who, once they have the training, can apply it and bring in proper healthcare for individuals so that they do not see the life expectancy challenges in healthcare we have been seeing until now.

[Lord Wigley (PC)]

My Lords, I draw attention to my registered interests and involvement with Mencap and Mencap Wales. A moment ago, the Minister finished her answer by referring to the need for nurses to be trained, and to have the awareness and ability to deal with people with learning disabilities so as to mainstream what is happening. Can she assure us that some priority will be given to this issue? Until we get the lack of capacity sorted, we cannot make the reasonable adjustments that will solve the problem we are addressing.

[Baroness Blackwood of North Oxford]

I can say absolutely that priority will be given to this. The mandatory training consultation, which has just been completed, was published on 13 February. The consultation lasted eight weeks but such was the volume of responses to it that it was extended by a further month; it received more than 5,000 responses, which the department is currently going through. There has been a commitment to a response within two to three months. The Government are taking this extremely seriously.

[Lord O’Shaughnessy (Con)]

My Lords, I thank my noble friend for her answers and the commitment and empathy she has shown, but let us be clear: what we are describing is appalling. The fact that people with learning disabilities—Down’s syndrome, autism and the like—have shorter life expectancies is completely unacceptable. I know that the Government and the Minister personally are committed to doing something about that but I want to return to the issue of training. To change a culture, we need to change not just the curricula of people training to enter the profession but the attitudes of everybody already working in the caring profession who do not always take these issues seriously. I appreciate that my noble friend will not be able to give details ahead of the consultation response in two to three months’ time, but can she give a commitment that we will think about not only training—in medical colleges, on nursing courses and so on—but continuing professional development so that everybody who is likely to have contact with people with learning disabilities in a care setting will have the opportunity to retrain, to understand the needs of these people and to make sure that we provide them with the care they deserve?

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question. He is absolutely right: it is a disgrace that the reports demonstrate that too many people with learning disabilities are still dying prematurely and, all too often, for preventable reasons. We must ensure that we drive through the entire health system a change to make this come to an end. This is partly a matter of leadership, which is why it is absolutely right that Stephen Powis, the NHS England medical director, will write personally to doctors saying that it is not appropriate for DNRs to be based on disability and learning disabilities. It is why learning disabilities have been made a priority throughout the long-term plan and key programmes in the plan prioritise improving the physical healthcare of people with learning disabilities; that is important because it drives the issue up the priorities list of those working on an already busy schedule. It is also why the consultation on mandatory training will be brought forward as a matter of priority. Only when you have that combination of leadership, the practical healthcare programmes funded in the long-term plan and training will you get the culture change that my noble friend rightly identified as necessary.

Social Care: Green Paper

Baroness Blackwood of North Oxford Excerpts

Monday 13th May 2019 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what assessment they have made of the costs and effects of the delay in publishing their green paper on social care.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Green Paper remains a priority for the Government, and we will publish it at the earliest opportunity. Despite the delay in publication, the Government are committed to improving adult social care. We recently launched our social care recruitment campaign, Every Day is Different, and continue to support the sector by distributing £12 million a year through the workforce development fund. The Government have also given councils access to up to £3.9 billion of funding for social care for 2019-20.

[Baroness Wheeler (Lab)]

My Lords, the Green Paper was first promised in 2017, when the Government said that,

“we cannot wait any longer—we need to get on with this”,—[Official Report, 6/7/17; col. 987.]

and pledged to publish by the end of that year. I remind the House that this was a year after they abandoned the Dilnot provisions on future care funding, which had cross-party support under the Care Act and were due to start in 2016. The Alzheimer’s Society has estimated that, over the past 26 months, there have been more than half a million delayed transfers of care for people affected by dementia; nearly 3 billion hours of unpaid care have been provided; and, at any one point, more than 120,000 people with dementia in England receive no help from social care or family carers. Emergency cash injections do not address the chronic underfunding of local services, change the eligibility criteria or help people plan for future care needs. When we finally get the Green Paper, can the Minister promise the House that it will address these issues and provide the major, immediate and long-term funding that is urgently needed?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for an extremely important question. I know that she will agree that decisions on future reforms must be aligned. That is precisely why the long-term plan and the upcoming social care Green Paper have been considered alongside each other. Some important measures within the long-term plan are already beginning to improve social care; for example, the enhanced health in care homes model, which will ensure stronger links between primary care networks and local care homes; the comprehensive model for personalised care, which will put the individual at the centre of services; and personal health budgets. However, the noble Baroness is also right that we have to make sure that we get funding reform right—that is why we have increased funding from £3.6 billion in 2018-19 to £3.9 billion in 2019-20. She is also right that we must ensure that we build on the carers action plan and put carers at the heart of social care. Finally, we must ensure that we recruit, retain and build on workforce development at the heart of the social care Green Paper. That is what we will do, and I look forward to the debates in this House when we bring it forward.

[Lord Forsyth of Drumlean (Con)]

My Lords, is my noble friend aware that the Economic Affairs Committee is conducting an inquiry at the moment into social care? One of the manifestly obvious conclusions is that we will not be able to address this important issue unless we are able to get a degree of consensus between the Opposition and the Government? Would it not be a good idea for the Opposition to take a constructive approach when the Green Paper is published?

[Baroness Blackwood of North Oxford]

I think that the noble Lord speaks for the whole House when he calls for consensus on social care. One reason why it is taking slightly longer to bring forward the plan is that we are doing a lot of work on consultation and collaboration to ensure that we produce a robust proposal which can command the support of the House and be delivered effectively and implemented well. The Government are committed to ensuring that everyone has access to the care and support they need, but we need to be clear that there should continue to be a principle of shared responsibility and that people should expect to contribute to their care as part of preparing for later life. The Green Paper will bring forward ideas for including an element of risk pooling in the system to help protect people from the highest costs. We look forward to support from the Opposition on those proposals.

[Baroness Brinton (LD)]

My Lords, in 2009 there was a proposal that we should all work together, cross-party, for social care, started by the then Labour Government. All three major parties signed up to it, and then one party withdrew, making it undeliverable—it was neither the Labour Party nor the Liberal Democrats. The Minister said all the warm words that we want to hear about support for health and social care integration, but the new Health for Care coalition of 19 major health organisations is very clear that, while it is doing all it can for social care services and the NHS working together, and integration is improving, it can go only so far when services are being placed under so much strain. It points out that we would need an annual increase of 3.9% to meet the needs of an ageing population and an increasing number of younger adults. Seven hundred days since the social care paper was first promised is too long: when will it actually be delivered?

[Baroness Blackwood of North Oxford]

I share the noble Baroness’s impatience for progress on this. She is absolutely right that there is no point in bringing forward the proposals if they are not properly costed and funded. That is exactly why these proposals have been developed in collaboration with the long-term plan and the social care plan. We have to ensure that the right funding for social care is agreed alongside the rest of the local government settlement at the forthcoming spending review. That is partly why this process is taking the route that it is.

[Lord Laming (CB)]

My Lords, I feel sure that the noble Baroness will agree that this has become an embarrassingly long-running saga. I am sure the whole House will agree that the people who depend upon these services are the most vulnerable in our society and have such high-dependency needs that they ought to have the security of knowing that their well-being and safety is being properly attended to. Will the noble Baroness use all her influence to make sure that these people get the security and peace of mind that they deserve?

[Baroness Blackwood of North Oxford]

I am absolutely delighted to offer the noble Lord my assurance that we will work as hard as we can to deliver the most effective and most deliverable Green Paper we can. He is absolutely right that the most vulnerable people within our society depend on the effectiveness not only of social care services but the integration of social care services with our public health services and the long-term plan. That is why it is encouraging that social care sits right at the heart of the long-term plan and why it is well integrated with the other commitments within the plan to improve outcomes for major diseases and including measures to support older people, through more personalised care and stronger community and primary care services. These will improve outcomes and reduce the demand on social care, and that is exactly the kind of holistic approach that we want to see.

Tessa Jowell Brain Cancer Mission

Baroness Blackwood of North Oxford Excerpts

Monday 13th May 2019 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, with permission, I shall repeat a Statement made by my right honourable friend the Secretary of State for Health and Social Care in the other place on the Tessa Jowell brain cancer mission. The Statement is as follows:

“Mr Speaker, I would like to update the House on the significant progress that we have made in tackling brain cancer, including a new innovation that is now available across England. For far too long, tackling brain cancer has been too much in the ‘too difficult’ box. We are determined to change that.

I pay tribute to the Petitions Committee, which did so much work on this; to the Member for Mid Norfolk, who drove this subject in government as Life Sciences Minister; to the Member for Castle Point as former chair of the APPG, which brought parliamentarians together; to the Member for St Ives as the current chair of the APPG; and, of course, to Baroness Tessa Jowell, who campaigned passionately and tirelessly while battling the illness herself and sadly passed away last year.

Brain cancer is the most common cause of cancer-related death in children and young people under 19. Baroness Jowell called for all patients to benefit from 5-ALA, or ‘pink drink’ as it is otherwise known, a dye that makes cancerous cells glow under ultraviolet light, thereby making it easier for surgeons to target the right areas. Trials have shown that, when the dye is used, surgeons can successfully remove a whole tumour in 70% of cases, compared to 30% without.

I am pleased to inform the House that we have now rolled out this ground-breaking treatment across England, with the potential to save the lives of 2,000 patients every year. This is all part of the £33 billion investment that we are making in the NHS long-term plan. This medical procedure will now be expanded to every neurological centre in England. It is a fitting testament to Tessa’s memory.

It is worth pausing for a moment to remember Tessa’s courageous words urging us to rise above our differences. She said that this,

‘is not about politics but about patients and the community of carers who love and support them. It is … about the NHS but it is not just about money. It is about the power of kindness’.

Tessa represented the very best of our democracy and of our Parliament. On behalf of all those who have died, all those who have campaigned—children and adults alike—and all those seeking to do research, of which there must be more to come in future, we are acting.

I want to mention three areas in detail. The first is research. During the past year, the Government have made available an unprecedented £40 million to fund cutting-edge research of new treatments and drugs through the NIHR. This will build on the UK’s outstanding reputation for neuroscience and oncology research, and increase the quality, quantity and diversity of brain cancer research. The funding was further enhanced by Cancer Research UK committing an additional £25 million to support brain tumour research. The size of these pledges will cement the UK’s position as a leading global centre of research into brain cancer.

The second area is our NHS cancer workforce. We now have a record number of specialist cancer staff in the NHS and that number is set to grow as we put a record £33.9 billion into the NHS over the next five years. Health Education England’s cancer workforce plan and our upcoming NHS people plan will set out in detail the steps that we are taking to recruit a world-class cancer workforce. We made an additional investment of £8.6 million in the cancer workforce last year. We aim to have 300 more radiographers starting training by 2021.

The final area is empowering patients. My department has worked closely with the brain cancer mission, Jess Mills and others to ensure that patients are at the heart of all our efforts. The mission brings together government, the NHS, researchers, pharmaceutical companies and patients. Together, we are working to ensure that data is shared and disseminated so that more patients in the UK and internationally can benefit from what is learned. Due to the complexity of brain cancer, we must provide joined-up care that meets each patient’s unique needs. The NHS is focusing on improving care for brain cancer patients to ensure that they have access to dedicated out-patient clinics and consultations wherever they live.

I hope that the whole House will recognise the important progress that has been made over the past year in rising to the challenge set by Baroness Jowell and the families of those who have lost loved ones. This has been possible only through the collective efforts of patients, the NHS, charities and industry. The work has, and will continue to be, collaborative.

In her final speech in the other place last January, Tessa said:

‘I am not afraid. I am fearful that this new and important approach may be put into the “too difficult” box, but I also have such great hope’.—[Official Report, 25/1/18; cols. 1169-70.]


That hope was an inspiration to us all, and it still is. We must keep striving, and keep rising to the challenge that she and those families have set us. I commend this Statement to the House”.

My Lords, that concludes the Statement.

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[Baroness Jolly (LD)]

My Lords, I thank the Minister for repeating the Statement. I had the honour of responding to Baroness Jowell’s maiden speech on 23 May 2016. I looked it up in Hansard this morning. She recalled Seamus Heaney’s injunction to his wife:

“‘Noli timere’—‘Do not be afraid’”.—[Official Report, 23/5/16; col. 167.]

As it turned out, we did not have long to wait for her to show how fearless she could be. I responded to her maiden speech by saying that I felt sure she would make her mark very soon. Sadly, she did not have as huge an amount of time to make her mark as I had expected—but nobody who was in the Chamber for her valedictory speech in January 2018 will ever forget her demonstration of total fearlessness.

5-ALA received FDA approval for use in the USA on 3 July 2017, just over a year after Baroness Jowell joined your Lordships’ House. Use in the UK was given NICE approval on 10 July 2018, just two months after she died. I clearly welcome today’s announcement, but I have some questions for the Minister about 5-ALA and its rollout. What weight does NICE give to treatments that have received approval by the FDA? Is it usual for a treatment that is so obviously effective to wait nearly a year before being used routinely? Will it be universally available to all those who stand to benefit from it?

[Baroness Blackwood of North Oxford]

I thank the noble Baronesses, Lady Thornton and Lady Jolly, for their very important and moving contributions to this debate. I will start by responding positively to the points made by the noble Baroness, Lady Thornton; of course she is right that maintaining a strong and vibrant life sciences ecosystem is absolutely a cross-government endeavour. She is also right that the mobility of scientists, from the technical and research level up to neuroscientists and neuro-oncologists, must be the business of the whole of government. We take that as a core aspect of the life sciences strategy and shall continue to do so.

Both noble Baronesses were absolutely right to say that workforce is key. As I said in the Statement, our upcoming NHS people plan and the cancer workforce strategy will ensure that there is a holistic plan to ensure that the technical workforce—including radiologists, as I already mentioned—is in place. HEE is also leading on specific work to ensure that we recruit and train an appropriate level of neuro-oncologists. This has been identified as necessary going forward.

To make sure that we make progress, we must go forward in four specific areas: research, early diagnosis, delivering on the long-term plan commitment to see 55,000 people a year surviving cancer for five years by 2028 and, as the noble Baroness, Lady Jolly, rightly pointed out, ensuring that when those people are diagnosed they have access to the best and most innovative treatments. That is exactly why we announced the boosting of the accelerated access collaborative—to ensure that we are identifying the best and most innovative treatments and getting them through the regulatory testing and uptake systems of the NHS much more effectively than before.

We have been putting in place a number of proposals to do this, and the mission has been playing an absolutely core strategic role in bringing together key individuals across government, the NHS, charities, industry and patients. I do not think that we could ever have imagined seeing such impressive progress. We can only thank it for that, particularly for the work it has been doing in research to develop the BRAIN-MATRIX trial. It is exceptional, and the mission should be given credit for that work. Through that research we will see earlier diagnosis and delivery of the commitments and targets that we have under the long-term plan to see more people diagnosed, treated effectively and surviving cancers.

[Lord O’Shaughnessy (Con)]

My Lords, a year ago yesterday we lost somebody who was a colleague, a friend and an inspiration to us all. I do not think that any of us who were involved in the debate that Lady Jowell initiated in January last year, whether they had known her for a long time or were only just getting to know her, will ever forget the extraordinary courage and leadership that she showed that day. As my noble friend pointed out, the impact has been truly profound, including through the brain cancer mission set up in her name, of which I am proud to be a patron. I am delighted that the Government have chosen this anniversary —an unwanted one, of course—to give us an update on the very important progress that they have made.

I am delighted by the news on the pink drink, which was one of the issues that Lady Jowell highlighted that day, as well as with other progress. As well as paying tribute to my noble friend and colleagues in the department, I join other noble Lords in congratulating the brain tumour charities, Cancer Research UK, patient groups, and of course Jess and her family for keeping up pressure and momentum so that we can make a difference on this dreadful disease.

Of course, the work of curing brain cancer is one not of months but of years and even generations. While I absolutely welcome the announcements today, can my noble friend give a commitment—which I am sure she will be happy to do—that the support the Government are providing will never waver during the long periods when we have to go through research and have to change things to improve outcomes, and that that commitment will always be there for this Government and any future one?

On a specific point, it is good to hear my noble friend talking about adaptive trials through BRAIN-MATRIX, and about Health Education England training a new generation of neuro-oncologists. Is she able to give specific details about the kind of support that the Government and others are prepared to offer for those? For untreatable cancers, having highly specialised staff as well as different ways of carrying out trials is critical to keeping people alive for longer—which is of course what Tessa’s speech and the leadership she showed was all about.

[Baroness Blackwood of North Oxford]

I thank my noble friend for his comments and in particular for the leadership he showed in responding to Tessa’s call to arms to improve outcomes for those with brain cancer diagnoses. I can absolutely give him the commitment that the Government’s commitment to the mission will not waver, and there is a very good reason for this. The outcome we are already seeing is so significant; over the last 12 months there has been the launching with partners of the mission and the making available of funding that has resulted in 24 brain cancer research proposals—the highest number ever—with a further four under active consideration. In addition, progress has been made on moving towards new service and staffing models, with commitments in the long-term plan and the life sciences sector deal. This will deliver exactly what my noble friend is talking about: namely, better care and support for patients, targeted to the kind of diagnoses they have, which is exactly what the brain cancer mission has recognised, and exactly the specialist advice which government needs to tailor care for patients in the most appropriate way when they most need it.

[Lord Lansley (Con)]

My Lords, the update is most welcome. I will say two things to my noble friend. First, as part of the update, would she be able to update us on outcomes, particularly one-year and five-year survival rates, which are what we most want to see moving consistently in the right direction? Secondly, my noble friend will recall that about eight years ago we in the coalition Government agreed a programme for investment in positron emission tomography—PET—scanners. One of the particular reasons we did so was that patients in this country through the NHS were not accessing a form of radiography that would be particularly relevant for those with brain cancer, because of the minimisation of collateral damage to tissue around the tumour site. What my noble friend was saying about the identification and targeting of tumours is true not just for surgery but for radiography. Can she update us also on the availability of PET scanners through the NHS?

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question. He is absolutely right that we want to focus on outcomes. That begins with earlier diagnosis, shorter waiting times and access to treatment. However, when it comes down to it, we want to know that we have better survival rates. Cancer is a priority for the Government so that we can improve that, and the quality of care for patients. I am pleased to report to the House that survival rates are at a record high: since 2010, rates of survival from cancers have increased year on year. However, we know that there is more to do, and we will never have any measure of complacency about this. That is why in 2018 the Prime Minister rolled out a package of measures to see three-quarters of cancers detected at an early stage by 2028—the current figure is just over half. The plan is to radically overhaul screening programmes to provide new investments in state-of-the-art technologies to transform the process of diagnosis and boost R&D. My noble friend is absolutely right that one of the areas that we must focus on is ensuring that treatment has the lowest burden of side-effects possible. The proportion of cancer survivors living with long-term disabilities as a result of treatment is high, so having more targeted treatment is absolutely a priority within our cancer strategy. I will be delighted to write to my noble friend with a specific update on where we have got to with PET scanners.

[Baroness Jay of Paddington (Lab)]

My Lords, I echo noble Lords who have said what a fitting and appropriate tribute it is to Tessa that, on this anniversary of her death, we have heard this encouraging update from the Minister. It was a great sadness to me that I missed her final speech in your Lordships’ House because I was abroad, but having worked with Tessa for more than 20 years in many different roles, I found it unsurprising that she showed her characteristic determination, courage and campaigning skills, which she carried on with absolutely to her final days. It is extraordinarily good to know that her daughter, Jess Mills, carries on this work today, as my noble friend Lady Thornton said.

I make two points that I know that Tessa would have emphasised. The first is the importance of what one might call translational research, as the Minister said. I know that one problem that Tessa had as an individual was that she could not find out, except by exercising her characteristic energy and skill with the computer, what was going on. It is very important that in developing both treatment and research in these difficult areas of cancer—the glioblastoma from which she suffered being one of the most intractable—individual patients have the opportunity to know more broadly what is available.

That is why it is particularly important that the announcement today reveals not only new treatment but emphasises that it will be available in all cancer centres across the NHS, because not all of us are blessed with Tessa’s energy and ability to find things out. Particularly when people are feeling very vulnerable when they are diagnosed, their need for clear available information is paramount. It is very good to hear that that will be more available in future.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her comments and think that she has hit the nail on the head. I think I can say that Tessa’s characteristic verve is being carried on and honoured by those involved in the mission: I have been in post for a relatively short time, but I have already met the mission and Jess twice, and they have nailed me down on commitments and ensured that I follow through on commitments that my predecessor, my noble friend Lord O’Shaughnessy, had made. It helps that he is still involved in pushing them forward.

One of the key principles of the mission is that it provides a convening function, bringing together government, the NHS, charities, industry and patients in working together to identify and drive through progress on areas that need improvement. One key area that has been identified is patient care, support and communication. As the noble Baroness said, Tessa was passionate about ensuring that patients can get rapid access to new treatments and know where they may be. That is one of the principles behind the brain cancer matrix. Separately, we have introduced the accelerated access collaborative programme to try to bring in other treatments that might be complementary to patients as quickly as possible through the NHS system, recognising that the NHS, while incredibly innovative, can be low and slow at times in adopting those innovations across the system in a consistent way. We want to make that better.

NHS: Shortage of GPs and Nurses

Baroness Blackwood of North Oxford Excerpts

Wednesday 8th May 2019 Lords Chamber

[Lord Clark of Windermere (Lab)]

My Lords, I beg leave to ask a Question of which I have given private notice.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Government recognise the pressure on the NHS workforce. The forthcoming NHS people plan will set out how we will attract more people into training and keep the workforce that we have in the NHS. In 2018, Health Education England recruited a record 3,473 junior doctors into GP specialty training—a 10% increase since 2017. Demand for nursing courses is strong: the latest data, published this February, showed a 4.5% increase in the number of applicants compared with 2018.

[Lord Clark of Windermere]

My Lords, I thank the Minister for her Answer and acknowledge her long-term commitment to the National Health Service. I shall not just swap statistics with her—that is easy—but I wish the Government would not keep repeating basic statistics. She talked about an increase in the number of GPs, but we have the lowest number of GPs for more than 50 years, with patients on occasion having to wait seven weeks for an appointment. We know that there is a 40,000 shortage in the number of nurses and that, according to the interim report that the Government have received and despite all their efforts, that figure could increase to 68,500. That report states that shortages in nursing are the single biggest and most urgent problem. Instead of playing around, will the Government seriously address the drastic situation that our NHS is in? We truly survive because of the efforts of the staff.

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his Question and I echo his sentiments exactly in thanking GPs, nurses and all of our NHS workforce. Probably every noble Lord in this Chamber has a personal story of owing the NHS for personal service, as we do as a nation. That is exactly why the Government have put in a serious plan to address the challenges within the workforce. First, within the long-term plan we identified an increase in funding that is higher within general practice and community care than the wider increase in funding of £4.5 billion. Secondly, we have recruited the highest number of GP trainees ever. This is not swapping statistics, this is identifying the fact that we are being successful in recruiting into a challenging specialty. Thirdly, we are opening brand new medical schools to ensure that we have the capacity to increase training, while recognising that it takes time to grow a doctor. Fourthly, we are putting in place incentive programmes to make sure that the job is more attractive, so that we can retain those individuals.

Within the new general practice contract framework we have put funding in place for up to 20,000 more support and technical staff working in GP practices in order to relieve the pressure within that job. This will help bring down delays in getting appointments and make sure that the job is more attractive in itself. When it comes to nursing, we have put in place a pipeline, with new nursing associates and the new nursing degree apprenticeship, and we see this starting to pay off. So there is an improving picture, but there is still some way to go. We are making sure that we put in place a serious plan and we are determined to deliver on it.

[Baroness Walmsley (LD)]

My Lords, the Nuffield Trust has noted that there are fewer GPs per head in poorer areas than in wealthier areas. Health inequalities in this country are being made worse by some of the political decisions of this Government. Can the Minister say what steps the Government are taking to ensure that everyone has equal access to a GP, whatever their income and wherever they live?

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[Baroness Blackwood of North Oxford]

The noble Baroness is right that driving out variation within the NHS is one of the key commitments of the long-term plan: it can be seen as a priority throughout every commitment within it. One of the ways in which we intend to do this is through the new undergraduate medical school places; the expansion in medical schools has been targeted specifically to address that. Those medical schools will be placed in key areas—Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury—to ensure that we recruit doctors from right across the nation. That is something that I think she will welcome.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare an interest as the author of Medical Generalism, a report for the Royal College of General Practitioners some years ago. Do the Government recognise that while their moves to increase supply are admirable and welcomed by everyone, the problem is retaining staff? We have an increasing number of medical and nursing staff who, for reasons to do with taxation, their pensions and their revalidation processes, find that it is just not worth their while to carry on with the onward, uphill struggle to carry on providing services. I recently met some who have dropped off the medical register simply because the revalidation processes were just too cumbersome for them. These are good clinicians, whose skills are now being lost. Their skills are also being lost from the pool of people to teach the next generation of doctors coming through the system. These pressures are now having a knock-on effect in emergency departments, where waiting lists are going up inexorably, and we know that that is being reflected in the four-hour waiting targets. Talking to staff in emergency departments, they are routinely seeing situations that used to be unusually busy.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness, who is very expert in this area. She is absolutely right that there is no point in our bringing new trainees into the system if we do not retain the expertise and the teaching quality within the system. We can be very proud of the quality we have within the system, which is why we have put in a number of programmes to address this. We have put in a targeted, enhanced recruitment stream to attract doctors into parts of the country where there have been consistent shortages. We have put a broad offer of support for GPs to remain within the NHS, including GP Career Plus, the GP Retention Scheme, the Local GP Retention Fund and the national GP Induction and Refresher Scheme. We have also put in place a number of schemes for nurses, including a scheme that will attract nurses into specific, targeted areas, such as mental health, learning disabilities and district nursing, where we believe we should make the career more attractive. We recognise that there is more to do, and in areas such as pensions, which the noble Baroness rightly raised, we are taking that issue up with the BMA and the Treasury.

[Lord O’Shaughnessy (Con)]

My Lords, the increased numbers of staff coming through GP and nurse training are of course incredibly welcome but the truth is that we have a problem now, which is that we need more doctors and nurses practising today. One way to do that is to look around the world to recruit people, but another way is to make sure that we make the most of the resources we have through technology. Can my noble friend tell the House what the department is doing to enable us to use technological solutions to improve the efficiency of the GPs who are practising today?

[Baroness Blackwood of North Oxford]

My noble friend is absolutely right, and he has his own expertise in this area. I am pleased to be able to report that we have had an increase in recruitment of nurses and NHS workers from abroad. Compared with June 2016, we have over 5,200 more EU health and care staff working in the NHS, and we have had a 126% increase in the number of non-EU NHS workers, which shows the attractiveness of working within the NHS. But he is also right that we need to make sure that those who work in the NHS have access to the most innovative and effective tools possible, which is why, particularly within GP practice, we are launching the GP IT Futures programme. That will provide GPs with the best tools possible so that we can make their job more efficient while also allowing them to provide the best-quality care to patients.

[Baroness Thornton (Lab)]

My Lords, I think I need to declare an interest as a member of a CCG; I spend some of my time surrounded by GPs, who are utterly wonderful, and who tell me that morale is not good. The problem is that a lot of GPs are leaving because they are completely fed up with the way that they have been treated by the NHS. That has to be taken account of by the noble Baroness, Lady Harding, as part of her work in bringing forward the plan, and I know it will be.

I am afraid that it does not say much about the current lack of a workforce strategy that we are having to trawl the world to get GPs and nurses to come and work in the UK. I know that other Members of your Lordships’ House have been worried that we are taking nurses, GPs and doctors from countries where they are very much needed. Will the Minister address how to deal with the morale of GPs, as well as the ethics of the UK recruiting nurses and doctors from countries where they are needed?

[Baroness Blackwood of North Oxford]

I slightly question the premise of the noble Baroness’s question, given that I am the daughter of an English doctor and a South African nurse. This has always happened in the NHS, and it is an absolutely acceptable process. Recruitments go back and forth between nations, and that has always been the case.

To move on to the noble Baroness’s question about morale in the NHS, particularly within general practice, it is essential that that is addressed, and she is right that GPs are the bedrock of the NHS now and in the future. That is why we have announced in the long-term plan not only that we are investing an extra £4.5 billion in primary and community care, which is at a faster rate than the rest of investment within the NHS, but the new contract to develop partnerships to provide greater certainty for GPs to plan ahead and to give them the extra 20,000 support workers who can make the job within GP practice more effective and sustainable. That is also why we have announced the GP IT Futures programme to give them the tools that they need to deliver more effective services and to deliver better-quality care, and why we have announced targeted and enhanced recruitment schemes to support and retain GPs within practices, not only in hard-to-reach areas but within the pipeline. That demonstrates that the Government are completely committed to general practice and will retain that commitment as long as we are able to do so.

Atrial Fibrillation

Baroness Blackwood of North Oxford Excerpts

Tuesday 7th May 2019 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank my noble friend Lord Black for giving us all this opportunity to discuss what is not just an important issue but one that must be of incredible importance to him personally, and for sharing his story to date. As noble Lords are aware, and as we have discussed, although briefly, AF is a common heart rhythm disorder associated with debilitating consequences including heart failure, stroke, poor mental health—which we have not yet discussed—reduced quality of life, and death.

As my noble friend rightly said and others repeated, anticoagulation is an effective therapy for managing people with AF who are at risk of stroke. It can reduce the risk of stroke by up to 66%. AF increases the likelihood of stroke by five times; on average, there are 40 AF-related strokes every day in England. As my noble friend rightly indicated, PHE has been working alongside key partners to increase the proportion of patients with AF offered appropriate treatment from 74% to 89% by 2021. I will come on to the questions asked about surveillance and data.

My noble friend and other noble Lords are absolutely right that, although we have made progress on treatment, regional variation remains in the detection of AF and appropriate treatment. For that reason, a national programme was established in 2017 by NHS England and Public Health England to tackle the issue of AF-related strokes. Through this work, the 15 academic health science networks across England made it a priority to “detect, protect and perfect”—that is quite challenging to say in one sentence—AF services.

In response to questions from my noble friend Lord Black and the noble Viscount, Lord Craigavon, regarding the importance of accurately monitoring progress, a number of quality and outcomes frameworks—QOFs—measure the diagnosis and management of patients with AF. I am pleased that, based on the captured data, we can say accurately that progress has been made and that, as of last year, 84% of people with AF were appropriately managed with anticoagulation treatment; however, as the noble Viscount said, those people are only those who have been identified. It has therefore been agreed that the ambition for optimally managing AF should be increased to 90%; there is clinical consensus that this revised ambition is appropriate and achievable.

As the noble Baroness, Lady Wheeler, rightly identified, there is a role for technology to aid self-management and prevention. That is why, in July 2015, AliveCor’s KardiaMobile ECG mobile heart monitor, which allows individuals to detect, monitor and manage heart arrhythmia, joined the NHS Innovation Accelerator. Currently, 33 NHS organisations, including GP practices and acute trusts in all 15 academic health science networks, now use it with the aim to reduce the prevalence gap in AF to ensure that more people are treated appropriately to prevent AF-related strokes.

As has been mentioned, The NHS Long Term Plan, published in January 2019, sets out the ambition to prevent 150,000 heart attacks, strokes and dementia cases over the next 10 years. It includes commitments to developing and implementing an AF patient optimisation demonstrator programme, helping to case-find and optimise treatment for people with known cardiovascular disease. That is important because it will include practice pharmacists being trained in shared decision-making skills to utilise when having conversations with patients about their treatment options, which answers some of the questions asked by the noble Lord, Lord Rennard. It will also give health professionals the opportunity to work together with patients to decide on a patient’s treatment and care. SDM has been shown to improve patient experience and increase adherence to medication—a crucial issue raised by the noble Viscount, Lord Craigavon.

Clinical pharmacists, anticoagulant nurses or other appropriately qualified clinical staff will also carry out case-finding in GP records to find people with untreated AF as part of this programme, which is an encouraging part of the commitment made in the long-term plan. The programme launched on 7 May was developed in collaboration with Public Health England, the British Heart Foundation, the academic health science networks and NHS RightCare, as mentioned by the noble Baroness, Lady Wheeler. Through the programme, NHS England will invest £9 million over 18 months to case-find patients in GP records who have been diagnosed with AF but are not receiving optimal treatment. Twenty-three CCGs across England have already begun implementing the programme.

Of course, stroke prevention and treatment is a priority for the NHS. NHSE has been working closely with the Stroke Association to develop a national stroke programme to be delivered within the timeframe of the long-term plan. As the noble Baroness knows, the implementation plan will be published shortly. The programme will build on the successes of the Department of Health’s national stroke strategy and look at how to improve stroke care across the whole pathway, addressing the challenges of prevention—in this case, secondary prevention—service reconfiguration, optimising rehabilitation services, workforce development and transformative data. NHS England has engaged with cross-sector partners to support Health Education England in the development of workforce modelling for strokes. Health Education England is also looking carefully at the various components of the proposed stroke pathway and undertaking workforce modelling to articulate which workforce will be required; that will be engaged in the discussions on the spending review, as we have discussed previously in Questions. It has worked with arm’s-length bodies, charities, professional associations and academics to ensure that the required workforce is achievable over the period of the long-term plan.

The long-term plan also outlines commitments to improving vital stroke rehabilitation services. The recently established Stroke Programme Delivery Board also aims to place a strong focus on rehabilitation. Campaigns to increase awareness of stroke onset have been in place since 2009; of course, that is essential because early response is vital in avoiding disability. Public Health England has run the “Act FAST” national campaign, of which I know your Lordships will be aware. It has helped to reduce the amount of time between someone having a stroke and arriving at hospital, helping those eligible for thrombolysis and thrombectomy to access treatment in a timely way. As a result, 5,365 fewer people have become disabled due to stroke since 2009—an outcome we can all be pleased about.

I will answer some of the questions asked by the noble Baroness, Lady Wheeler, and the noble Lord, Lord Rennard, regarding regional variation. Quality of care varies greatly depending on geographic location, the day of the week and even the time of day that a patient is admitted. The NHS is working with providers to share best practice through initiatives such as that mentioned by the noble Baroness: the RightCare programme, which sets out optimal pathways for the care of stroke patients and AF patients through the collection of data in the Sentinel Stroke National Audit Programme.

My noble friend Lord Black, the noble Viscount, Lord Craigavon, and the noble Lord, Lord Rennard, all rightly linked surveillance, training and optimal treatment. CVDprevent will be the national primary care audit tool, and has been referred to by a number of noble Lords. It will automatically extract routinely held GP data covering the diagnosis and management of six high-risk conditions that cause stroke, heart attack and dementia. It will be implemented from March 2020, in response to a question asked by the noble Baroness, Lady Wheeler. The outputs will include regular national data extraction for a professionally led national audit programme which will be limited to routinely recorded primary care data. They will require no input from GPs. Analysis and reporting will identify achievement, gaps, variations, opportunity and treatment. They will also support systematic quality improvements to reduce health inequalities, a point mentioned by a number of noble Lords. They aim to improve outcomes for individuals and populations.

I also point to the primary care networks, which will be required to deliver a set of seven national service specifications. Five will start in April 2020: structured medication reviews, enhanced health in care homes, anticipatory care with community services, personalised care, and supporting early cancer diagnosis. The remaining two, which will start by 2021, comprise cardiovascular disease case finding and locally agreed action to tackle inequalities. All these will go towards answering the questions that have been raised in the debate.

I am conscious there were some questions that I have not been able to answer, and I will be happy to write on those. I hope that I have demonstrated in my response the NHS’s commitment to improving outcomes not only for people living with AF in this country but for the many more who are at risk of suffering from stroke. I cannot think of a more fitting way to close this debate than by repeating the excellent point from the CVD report referred to by the noble Viscount, Lord Craigavon: the return on investment of getting this right will be measured not just in a better quality of life for patients, important though that is, but in lives saved and life-changing disabilities averted. That is something which we must all work together to achieve.