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.

--- Later in debate ---

[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?

--- Later in debate ---

[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.

Antimicrobial Resistance

Baroness Blackwood of North Oxford Excerpts

Thursday 2nd 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 Lansley for securing a very important debate which has been filled with expertise and wisdom from all sides. I am grateful to him for saying that, if he could, he would have chosen to make this a “take note with approval” debate, which is not always the case when debating a government strategy.

My noble friend is right that antimicrobial resistance is one of the most pressing global challenges that we face in this century. Unchecked AMR threatens the achievement of many of the sustainable development goals, including those affecting health, food security, trade and labour supply. The World Bank estimates that an additional 28 million people could be forced into extreme poverty by 2050 through shortfalls in economic output unless resistance is contained.

In recognition of the threat of AMR, we published the strategy in 2013 and, as my noble friend has rightly said, we can count many significant achievements over the five years since. I pay tribute to him for the role he played in developing it before he moved on. We have seen unprecedented levels of research investment and collaboration, with £350 million having been invested since 2014. We have also reduced antibiotic use in humans by 7.3%, as he noted, and as the noble Lord, Lord Trees, who is an expert in this area, rightly pointed out, sales of antibiotics for use in animals have reduced by 40%. However, the noble Baroness, Lady Masham, said that this is of value only alongside the development of comprehensive surveillance systems, which we have also been putting in place.

Finally, resources and campaigns have been delivered for front-line staff. As the noble Baronesses, Lady Redfern and Lady Walmsley, said, they have an essential role to play in changing the culture and communicating with the public. I would like to point to a particular tool which has been developed, known as “Treat Antibiotics Responsibly Guidance, Education and Tools”. It turns into a fantastic acronym—TARGET—which I know the noble Baroness, Lady Thornton, will like. It is a toolkit of evidence-based resources to help clinicians and commissioners in England to reduce inappropriate antibiotic prescribing. Some 99% of CCGs promote this to their GP practices. I hope that responds to the question raised by the noble Baroness.

However, we must be up front about the scale of the challenge that AMR presents here at home, let alone in developing countries. As has been noted in the debate, resistance continues to increase. Between 2013 and 2017, we saw a 35% increase in resistant infections in humans here in the UK. Just as my noble friend says, this is a dynamic problem that requires a dynamic response. However, I would like to reassure the noble Baroness, Lady Masham, on her questions about Candida auris. It can establish itself within the hospital environment and be difficult to control, but currently the NHS has no persistent outbreaks. It is an uncommon fungus in the UK and our surveillance shows a low risk to patients in healthcare settings. No multi-drug resistant strains have been identified and there have been no deaths in NHS hospitals.

In order to respond to the dynamic challenge we face, the Government have recognised that no single five-year plan could deal with it, so we have set out our vision for a world in which AMR is contained and controlled by 2040 and we will continue to play our part in tackling the global problem of AMR by modelling best practice at home. Further, by supporting progress internationally through strong action to prevent infection generally, we will contain the emergence and spread of resistance. Alongside this vision we have published a five-year AMR national action plan which sets challenging five-year ambitions that will begin to fulfil the vision.

I would like to reassure the noble Baroness, Lady Thornton, on the question she raised regarding the workforce. Unlike the NHS Five Year Forward View, the NHS Long Term Plan commits to implementing the AMR national action plan which sets out to assess current and future workforce needs for strong infection prevention and control as well as antimicrobial stewardship. This should ensure that we develop the correct workforce targets. This is reassuring in terms of hoping we can achieve the priorities we have set out in the plan.

Our new plan includes a strengthened focus on infection prevention and control, renewing our commitment to halve levels of healthcare-associated Gram-negative bloodstream infections by 2023-24. It includes a world-first target to reduce the actual numbers of resistant infections, with an aim to reduce them by 10% by 2025. We will go further on our previous ambition to reduce antimicrobial prescribing, reducing it by a further 15% by 2024, strengthening stewardship programmes and raising public awareness, while ensuring rapid and timely treatment with antibiotics where it is essential to save lives. Through greater interoperability of data, we will develop real-time, patient-level prescribing and resistance data to inform antibiotic treatment, optimise life-saving treatments for serious infections and help develop new interventions to reduce AMR.

The noble Baronesses, Lady Masham and Lady Walmsley, are absolutely right that better use of diagnostic testing is essential. However, we found many challenges in this area over the last five-year period with the previous plan. We believe that, through data linkage work, by 2024 we will know which diagnostic tools and tests have been used in support of every prescription for antibiotics and will be able to target improvement. There is also further research work going on, which I will come back to.

The noble Baronesses, Lady Greengross and Lady Walmsley, and the noble Lord, Lord Trees, raised the important issue of vaccines for humans and animals, which play a key role in tackling AMR. One of the nine ambitions for change set out in our 2040 vision is to minimise infections in humans and animals. Optimising the use of effective vaccines will be critical in achieving this ambition. The national action plan includes commitments to stimulate more research into and promote broader access to vaccines. One of the ways in which we are doing this and supporting the development of the uptake of vaccines in lower and middle-income countries is through the Global AMR Innovation Fund and the UK vaccine network, as well as through our significant contributions to Gavi, the Vaccine Alliance and, more recently, through CEPI, the Coalition for Epidemic Preparedness Innovations—which, we understand, is having a significant impact on the pipeline.

My noble friend Lord Crathorne raised the question of the use of antibiotics as growth promoters. He was rather put right by the noble Lord, Lord Trees, but I will just repeat for the sake of certainty that since 2006 antibiotics for use as growth promoters have been banned in the UK and Europe, and they will continue to be.

This brings me on to a point raised by the noble Baronesses, Lady Miller and Lady Thornton, and a point of clarification on the response to Kerry McCarthy. The Government have confirmed their intention to implement their restrictions on the preventative use of antibiotics in line with EU legislation, but this will require a consultation with all interested stakeholders following the usual processes when amending domestic legislation. I hope that is a reassuring clarification. If noble Lords would like to follow up in writing, I shall be happy to respond on that.

I will respond to a follow-up point that also came from the noble Baroness, Lady Miller, and the noble Lord, Lord Trees, regarding trade agreements and AMR. I assure the House that any future trade agreements must work for consumers, farmers and businesses in the UK, and we will not water down our standards on food safety, animal welfare or environmental protection as part of any future trade deal. I hope that is a reassuring response.

I hope the noble Lord will forgive me, but following the debate I shall raise his point regarding AMR funding associated with the Agriculture Bill with the Minister and return to him.

I will now move on to the question regarding research and treatment development. Building on our research co-ordination and collaboration, we must continue to invest in research and to support the development of new, alternative treatments, vaccines and diagnostics. As noted by noble Lords from across the House, this is clearly essential if we are to make progress on the aims we have set out in what is rightly an ambitious plan.

Significantly, as my noble friends Lord Lansley and Lord Crathorne point out, the plan includes a commitment to lead the way in testing solutions that address the failure of companies to invest in the development of new antimicrobials. We are the first country in the world to announce that we will test new models that pay companies for antibiotics based primarily on a health technology assessment of their value to the NHS as opposed to the volumes that are used. This is an exciting and important step and we must fight hard to push it forward.

The noble Baroness, Lady Walmsley, asked about timelines. NICE and NHS England are leading on this complex work and a core team of experts and specialists are already in place. There is no delay in pushing forward this work. We anticipate it will take 18 months to two years to complete. The current NICE appraisal processes take about 49 to 60 weeks but this project requires a bespoke process to deal with the complexity of considering the full dimensions and value for antimicrobials. I look forward to reporting back to the House as the project continues.

We are sharing our learning with other countries and encouraging them to do the same or similar. I hope that we can push for this to be raised in international fora, as it is only when these kinds of pilots happen on a global scale that we can hope to see real progress. We hope that the data generated from this work will help other countries to think about how they value these precious drugs and how we can work with the industry to overcome market failure.

A number of noble Lords raised the question of a global fund. We have made some initial progress with the Global AMR Innovation Fund, GAMRIF, which has been set up. We are pushing at every opportunity to improve collaboration and to get support for it. However, it is a challenging picture and I hope to be able to report more progress in coming months.

On co-ordination, the national action plan was co-developed across government departments, agencies, the health family and the devolved Administrations, with an input from a wide range of stakeholders. We intend to continue in that vein as it is the only way in which we will make effective progress. The UK has played a lead role in strengthening international co-operation to tackle AMR, not least in securing the UN declaration at the General Assembly in 2016.

I pay particular tribute to the noble Lord, Lord O’Neill, for his ground-breaking early work and expertise in this area. I join others around the House who have paid tribute and expressed gratitude to Dame Sally Davies in advance of October. She has been a driving force on the global stage on this agenda. I have no doubt that, whatever happens in the autumn, her leadership will continue from Cambridge and beyond. It will be of tremendous value to the United Kingdom and everywhere else that she goes.

Whether it is getting it right with new antimicrobials and getting them through the pipeline or it is supporting the development and testing of rapid point-of-care diagnostics, the Government are clear that we want to improve the whole system. I am pleased to update the House: today I announced a new and expanded accelerated access collaborative to serve as an umbrella organisation for UK health and innovation. The new AAC will work with patients and the system to pull through the best and most cost-effective innovations, to get them to clinicians and patients faster than ever before. This includes the use of digital tools and health tech alongside the best new medicines. From new diagnostic tools to better identify people who need treatment, to improved ways of monitoring usage to ensure that patients complete treatment courses, together these innovations will help to address the growing threat of AMR.

I hope that with this information I have covered the points raised by noble Lords today. We can be proud of the work that we have done in the UK to secure AMR on the global agenda, not only as a health issue but as a “one health” issue with an enormous social and economic impact. We have invested to turn declarations into concrete actions and to support countries to develop their capacity to tackle AMR, improve global surveillance and undertake vital research and development. Through this plan we are setting out our challenge to ourselves and to other countries to continue life-preserving work to preserve antimicrobials for future generations.

In closing, I do not think that I can do better than to follow my noble friend in quoting from the IACG report to the Secretary-General:

“The challenges of AMR are complex … but they are not insurmountable”.


We should take courage from this, but should remember that our success will depend on the urgency with which we drive forward this response and the continued success in securing international collaboration. I believe that together we can achieve that.

NHS Funding: Mental Health Services

Baroness Blackwood of North Oxford Excerpts

Wednesday 1st May 2019 Lords Chamber

[Baroness Thornton (Lab)]

With his consent, I beg leave to ask the Question standing on the Order Paper in the name of my noble friend Lord Bradley. Noble Lords will know why he cannot be with us today, and the House will wish to know how much he and his family appreciate the sympathy that has been expressed.

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

My Lords, NHS England and NHS Improvement have set out their commitment to increase mental health spending by at least £2.3 billion in real terms between 2018-19 and 2023-24. In five years, this will represent over 10% of NHS England’s additional settlement. More details of how the long-term plan will be resourced will appear in the implementation framework, which is due to be published soon.

[Baroness Thornton]

I thank the noble Baroness for that Answer. Given that mental health illnesses account for 28% of the burden of illness in the NHS but receive only 13% of its funding, I find her Answer very confusing. Can she be more precise? This is not just about the number of staff required but about how much will be required to achieve parity of esteem and over what period.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness, Lady Thornton, for her question on behalf of the noble Lord, Lord Bradley. I am sure that the whole House will want to join me in sending him and his family our support at this difficult time.

The noble Baroness has asked a very important question. The mental health budget will increase by £2.3 billion by 2023-24, growing faster than the wider budget. We are using transparency to drive improvements. The mental health dashboard shows that last year, for the first time, all CCGs met the mental health investment standard, which is an encouraging sign. This builds on the work done in the five-year forward view, which delivered real improvements for patients. It delivered £247 million for liaison psychiatry, £290 million for perinatal services and £400 million for crisis resolution and home treatment teams. However, we will not rest there. The long-term plan will deliver much more for patients, including 345,000 more children and young patients to receive specialist support services. This is the ambition that we have and the ambition that we will deliver.

[The Earl of Listowel (CB)]

My Lords, I welcome the additional money and note my interest as a trustee of a mental health service for adolescents. Can the Minister assure me that highly experienced clinicians will be retained to provide vital supervision for the new people coming in at the front line—for instance, in schools? Is she concerned that there is a 1% decline in the trend for the number of child and adolescent psychiatrists, for example? Is it not crucial that we have highly experienced clinicians to supervise the new people whom the Government have in development?

[Baroness Blackwood of North Oxford]

The noble Earl is absolutely right that it is essential not only that we recruit new psychiatrists and mental health specialists to support the ambitions of the long-term plan—we have set out an ambitious plan to do so, intending to recruit 8,000 new specialists—but that we retain those within the system, who are doing an outstanding job in difficult circumstances. NHS Improvement is working with mental health trusts across the country to give them the tools that they need to do so, and I am encouraged by the progress that they have made so far.

[Baroness Tyler of Enfield (LD)]

My Lords, to help ensure that the money allocated for mental health services is indeed spent on improved mental health care and not diverted to other areas of NHS activity, will the Minister say what plans the Government have to introduce a strengthened mental health investment standard for children alongside the existing mental health standard, which focuses primarily on adults, and with meaningful sanctions imposed on CCGs that fail to meet the standard without a valid reason?

[Baroness Blackwood of North Oxford]

As usual, the noble Baroness’s expertise shines through in her question. She is right that we must ensure that the money allocated to children and young people’s mental health gets to exactly where it is intended. The dashboard is extremely valuable in tracking through the effectiveness of the funding priorities in this manner. We will be holding to account CCGs and mental health trusts in ensuring that the money allocated to trusts is spent on exactly what it is intended to be spent on.

[Baroness Redfern (Con)]

My Lords, can the Minister tell us what part of the ring-fenced mental health budget will be allocated to recruiting appropriately trained probation staff for the 39% of offenders who have mental health issues and ensuring they receive access to effective support?

[Baroness Blackwood of North Oxford]

I shall have to write to my noble friend in order to answer her question with the best accuracy possible. However, my understanding is that the ring-fenced funding will be spent on health professionals rather than probation professionals. One of the most effective measures introduced under the five-year forward view, which has delivered very effective outcomes, has been liaison services. I shall investigate the point that she has raised and come back to deliver the response that she deserves.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that continuity is what is important here? That means continuity of care and of services across the NHS, social care and family support. In the absence of any coherent plan for social care, which is needed by mental health patients almost as much as medical care, have we any hope of achieving this continuity? And if the Minister could say anything about the Green Paper, I am sure the House would be delighted.

[Baroness Blackwood of North Oxford]

The noble Baroness is right to identify the need for continuity of care and the fact that community care is essential to ensuring good mental health outcomes. That is exactly why the focus in the long-term plan is on ensuring prevention and early intervention and on targeting the support of liaison services—for example, support for mental health training in the context of schools as well as for liaison services in policing and other areas. She is right that we must endeavour to deliver on the social care Green Paper. It is imminent, and I look forward to the debates in this House when it is produced.

National Institute for Health and Care Excellence (Miscellaneous Amendments) Regulations 2018

Baroness Blackwood of North Oxford Excerpts

Wednesday 1st May 2019 Lords Chamber

[Baroness Thornton (Lab)]

I thank my noble friend for bringing this matter to the Floor of the House and for leading this short discussion. I too have many questions for the Minister but many of the questions that I would have asked have already been asked by my noble friend and the noble Baroness, Lady Jolly. It seems that our concerns are very similar. I agree with the noble Baroness, Lady Jolly, that when I read through the notes accompanying this regulation, it seemed puzzling that the consultation had produced a majority against this process, and I too was not completely convinced by the Government’s justification. That must lead to something which we can probably call cuts and wanting to save money. To want to save money with an organisation which is so integral to our NHS infrastructure and so important to ensuring the efficacy and cost benefit of and access to medicines and procedures is not a sensible way to proceed.

Some of my other questions centre around a concern about the impact that these charges will have on the jewel in the crown that is the UK-based science industry, particularly at a time when there is already such uncertainty with the dual impact of Brexit and these charges. It seems that the additional costs for a market may diminish the UK’s attractiveness for life science businesses, which has already been mentioned, and may also mean that NHS patients get access to new therapies later than those in other countries across Europe, which my noble friend also alluded to. Has there been an assessment of the impact of these charges on the UK bioindustry and its attractiveness to the international life science community, and of the UK as a location to research, develop and launch innovative medicines?

What will be the impact on patients? The UK BioIndustry Association has stated its concerns that the charges for technology appraisals could either prohibit or delay patient access to medicines in England. This could result in inequalities across the UK, as medicines may be available in Wales and Scotland, where charges for technology appraisals have not been introduced, before receiving approval for use on the NHS in England. That might disproportionately affect patients with very rare conditions, and therefore might also undermine the UK rare disease strategy to ensure equity of access across all four nations of the UK. Have the Government considered not only the financial impact but the potential impact on patient health? Do the Government have a strategy in place to mitigate delays in patient access to medicines that may come from these charges?

I join the noble Baroness, Lady Jolly, in asking whether there will be a review of the impact of this proposal, when that will take place, and when we will learn about the impact of this proposal on NICE and the NHS infrastructure. That will be important. We need to review this, because I fear that it may be a wrong decision.

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

I thank all noble Lords who have contributed and congratulate the noble Lord, Lord Hunt, on securing this debate. It is an important subject and it is right that we take time to consider it. I know that he takes a keen interest in NICE’s work from his previous role as the first Minister with responsibility for NICE, and it is a privilege to have taken on his mantle some years later.

This year marks a significant milestone for NICE, as it celebrates its 20th anniversary, during which time it has transformed the way in which decisions are made in the health and care system. I echo the comments made by the noble Baroness, Lady Thornton, who referred to NICE as a jewel in the crown of the UK life sciences ecosystem. She is absolutely right that we must ensure that we not only protect it but promote its success. Since its inception, NICE has played a vital role, not only in securing maximum value from health spending but in ensuring that patients are able to benefit from rapid access to effective new drugs and other treatments. The noble Lord, Lord Hunt, hit the nail on the head when he said that that balancing act in the health system is so challenging.

Of course, the NHS is required to fund the treatments recommended through NICE’s technology appraisals and HST evaluation programmes, so that they can be provided if a patient’s doctor says that they are clinically appropriate for the patient. Over the past 20 years, more than 80% of NICE’s recommendations have supported use of the technology assessed, meaning that many thousands of patients have benefited from rapid access to effective new treatments. A less-frequently reported statistic is that 75% of HST applications have also gone through, which is encouraging.

Recent IQVIA research has just been published which showed that, despite some of the frustrations we have with update and access—which is something we are working hard on—the UK is in fact one of the fastest countries in Europe to get products through its regulatory system. We can be very proud of that, and must protect it.

I know that your Lordships will agree not only that it is extremely important that we have a system such as NICE in place to ensure the NHS spends its money in the most effective way possible, but also that it is critical that NICE operates on a sustainable footing so that it continues to be responsive to developments in the life sciences sector, to which noble Lords all referred.

To date, as has been mentioned, NICE’s TA and HST programmes have been funded through government resources but, as is common with government bodies, it is right that NICE considers how to operate to the utmost efficiency, and that those who stand to benefit from services contribute.

This is standard procedure and a standard model for many organisations and ALBs such as NICE. It is standard for the MHRA, the HTA, the CQC and for HTAs in other countries, so we are not operating an unusual procedure here, as the noble Lord, Lord Hunt, mentioned. I was grateful for his support for the charging model.

However, recognising the need for sustainability must be balanced with the imperative to encourage innovation, and the Government and NICE believe that the most appropriate and sustainable model for NICE’s TA programmes in future is for it to levy a proportionate charge on companies that benefit directly from its recommendations. This goes right back to a recommendation of the triennial review of NICE in 2015, so long-term work has been going on in this area. Recognising the importance of getting it right, the Government consulted on the draft regulations. That consultation has been referred to by noble Lords. At that point, as part of those proposals, the Government proposed the 25% discount for small companies. The consultation also sought views on a proposal to enable NICE to recruit appeal panel members engaged in the provision of healthcare in the health services across the UK instead of just England. This has not been mentioned and I know is widely supported, but I just wanted to point out that fact, which we are very pleased about.

As was raised by the noble Baronesses, Lady Thornton and Lady Jolly, there were 78 responses to the consultation, around half of which represented views from the life sciences industry, including pharma companies, industry representatives, consultancies and medtech companies. Other responses came from patient groups, NHS organisations and individuals. Although, as has been said, the majority of respondents—62%—disagreed with the specifics of the proposal to charge companies for making recommendations, the analysis showed that just over half of respondents agreed that life sciences companies should contribute to the cost of developing NICE recommendations, which is why further work was done to develop the charging proposal but refine it.

Respondents also supported, by 59%, a mechanism for reducing the impact on small companies, but felt that the proposed 25% discount did not go far enough. Other more specific concerns were raised about the potential impact on patient access to new treatments, in particular for rare diseases, the impact on NICE’s independence, and the analysis contained in the impact assessment.

The SLSC also picked up on issues in its report, and I will address some of those in response to points raised by the noble Baronesses, Lady Thornton and Lady Jolly. The Government considered the issues raised in the consultation very carefully and carried out further analysis to feed into the final impact assessment. We concluded that it was appropriate to make two main changes to the policy in light of the consultation responses. These particularly dealt with concerns about the design of the charging with respect to SMEs. I know that noble Lords are well aware of those concerns.

There is an increased discount for small companies of 75%, to minimise barriers to the participation of small companies wishing to bring forward new products. I realise that many feel that that did not go far enough but, to address that concern, it also included the new power to enable the Secretary of State to direct NICE in specific cases to calculate charges on what it considers to be the appropriate commercial basis. This provides more flexibility for amending charges, should that be required in future, subject to consultation with stakeholders. For example, we may see different types of innovation, including devices or digital products going through TA programmes, and this provides flexibility for the Secretary of State to direct NICE to propose charges at a level appropriate to those markets. I think that responds to the point raised by the noble Lord, Lord Hunt.