Covid-19: Care Homes

Baroness Blackwood of North Oxford Excerpts

Wednesday 20th May 2020 Lords Chamber

[Baroness Blackwood of North Oxford (Con)]

My Lords, I congratulate the Government on publishing the data behind their assessment of the Roche and Abbott ELISA tests. The transparency is welcome, but given the latest evidence on how asymptomatic cases affect transmission and how challenging infection control has been in care homes, can the Minister say whether care workers and care home residents will now be prioritised for antibody as well as PCR tests to give them the best data to improve infection control?

[Lord Bethell]

My noble friend Lady Blackwood is quite right that the Roche and Abbott antibody tests are a great step forward. It shows how diagnostic technology is progressing very quickly. We are determined to use all the benefits of modern technology in the fight against Covid. Our announcements on antibody testing in the NHS, in the care service and for key workers will be announced shortly. When it is, I assure her that NHS and social care workers will be on an equal footing.

Covid-19: Contact-tracing App

Baroness Blackwood of North Oxford Excerpts

Wednesday 6th May 2020 Lords Chamber

[Lord Bethell]

My Lords, I am in touch with both the South Korean and Taiwanese Governments, and we are greatly inspired by the throughly professional way in which they have gone about epidemic management. I commend both those countries and their efforts. However, the epidemic arrived in Britain in an incredibly fulsome way. The Chief Medical Officer has been very clear that if that had happened in either of those countries, their responses would have been similar to that of Britain. I defend the Government’s response to the epidemic.

[Baroness Blackwood of North Oxford (Con)]

My Lords, one of the core principles of data protection is to gather the minimum amount of data. I understand that one reason given by the NCSC for asking for partial postcodes on registration for the app is to assist with regional healthcare planning and to monitor potential Covid flare-ups. Can the Minister explain why data from Covid tests and NHS 111, for example, would not be sufficient to keep the transmission rate down in a post-lockdown test, track and trace strategy?

[Lord Bethell]

My noble friend Lady Blackwood is entirely right. The testing and the surveillance done by testing give us powerful insight into the demographic reach of the virus and information on a very broad basis on the regional reach, but we are looking for a much more granular level of detail from the very powerful, multimillion level of detail that the app can provide. The value of those surveillance details has led us to design the app in the way we have.

Covid-19: Personal Protective Equipment

Baroness Blackwood of North Oxford Excerpts

Thursday 23rd April 2020 Lords Chamber

[Lord Bethell]

The noble Baroness asks a perfectly reasonable question. I am afraid that I do not know the individual amount off the top of my head. I can tell her that, to date, we have delivered 135 million masks, 148 million aprons, 1.3 million gowns and 485 million gloves—more than 900 million items in total. The amount that we are providing increases every day. I will not hide from the noble Baroness or the House that this is a fast-moving situation. It is my impression that the demand for PPE will soon extend to other workplace situations and increase. It would be wrong to give the impression that this is a fixed amount that we should try to hit with short-term targets.

[Baroness Blackwood of North Oxford (Con)]

Following on from my noble friend Lord Blencathra, it is vital that we explore all options to increase the sustainability of UK stocks. I understand that UVC is often used for surface sterilisation; early research suggests that it can also be used for gowns and masks, using UV sources, which are found in lots of biosafety cabinets in academic, commercial and hospital labs. If the reuse committee mentioned by the Minister has not started looking at this, can he please ask them to consider whether this is a viable option to extend the lifespan of PPE?

[Lord Bethell]

The noble Baroness is right to champion this point. The Cleveland Clinic is known to us. I will ensure that it is played into the task force that is working on both the regulations and practicalities of reuse.

Covid-19: Critical Care Capacity

Baroness Blackwood of North Oxford Excerpts

Monday 23rd March 2020 Lords Chamber

[Lord Bethell]

My Lords, I welcome the testimony of the noble Baroness and cannot help but be moved by the situation she describes. This virus has moved incredibly quickly. Hospitals are doing amazing work to adapt to the conditions that dealing with the virus requires, and everyone is learning how to do it on the job.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I welcome the reassurance that we have been given by the Minister that testing is being scaled up, especially for health workers, but surely a serological or immunity test will be the real game-changer, because it will allow us to track those who have already had the virus, even unawares, and who are safe to return to work and help the most vulnerable. It is also essential that PPE is available, especially on the front line, to ensure infection control. Can my noble friend update us on whether availability of that is improving and on the training available to ensure that it is used most effectively?

[Lord Bethell]

My noble friend Lady Blackwood is right that there are two types of test. The first is an antigen test to ensure that those in hospital, as workers or patients, do not currently carry the virus, and the second is a serological or antibody test that will confirm that a person has the antibodies and can therefore return to work, either on the front line or elsewhere. Both those tests exist, but mass production is restrained. We are working extremely hard with manufacturers around the world, and with British firms, massively to escalate our capacity.

Covid-19: Vaccine

Baroness Blackwood of North Oxford Excerpts

Thursday 19th March 2020 Lords Chamber

[Lord Bethell]

The noble Lord, Lord McNicol, is entirely right to focus on the importance of vaccines. The Government are extremely concerned that the entire public have a clear line to having confidence that they can rid themselves of the threat of the virus so that we can all get back to work and normal life. That will not be possible until we have a vaccine. If I may digress for a moment, one consideration is that, for a vaccine to work, it will have to be taken by billions; for that, it must be as safe as houses. I contrast that with the vaccine for Ebola, where the death rate was at nearly 80% and a just-about-good-enough approach could be taken. However, the coronavirus has a relatively low mortality rate and the introduction of an added risk factor into the population is something we can avoid. For those reasons, the development of a vaccine is considered to be at least a year or 18 months off. However, the noble Lord is entirely right that planning for the production of the vaccine, when it is fully developed, is front of mind for the Government.

[Baroness Blackwood of North Oxford (Con)]

My Lords, ever since John Snow discovered the link between the famous London water pump and the cholera outbreak in 1854, UK scientists and innovators have led global efforts to tackle infectious diseases. We should be very proud of that. However, many UK biotechs and healthtechs which are leading the race to fight Covid-19 are loss-leading and will struggle to raise risk capital in the current climate to maintain operations. One very simple intervention the Treasury could make would be to pay R&D tax credits in advance. This would be matched very well to each individual company and could be based simply on their most recent claims. Will the Minister look into this as a matter of urgency?

[Lord Bethell]

My noble friend has an important and exciting idea, and I am grateful to her for communicating it to me in advance of today’s Question. I have already taken the idea to Treasury colleagues. I have not had a formal response, but the idea supports a pressing and important need in the essential life sciences sector and seems to have strong merit. I hope it will go far.

Health: Maternity Care Provisions in East Kent

Baroness Blackwood of North Oxford Excerpts

Thursday 13th February 2020 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 will now repeat in the form of a Statement the Answer given to an Urgent Question by my honourable friend the Minister for Mental Health earlier today. The Statement is as follows:

“Mr Speaker, I will be setting out the situation concerning East Kent Hospitals University NHS Foundation Trust in line with the Written Ministerial Statement that was laid in Parliament this morning. The fact that I took steps to inform Parliament of this matter reflects the importance I have placed on this issue.

Before I begin, I would like to express my deepest and most heartfelt sympathies for the patients and families who have been affected. I made a Statement on 28 January about concerns regarding maternity services in East Kent Hospitals University NHS Foundation Trust. I would now like to update the House based on the reports from the independent Healthcare Safety Investigation Branch, which I refer to as HSIB from now on, and the Care Quality Commission. I requested that both HSIB and the CQC report back to me within 14 days when I instructed them to go into East Kent Trust two weeks ago and they reported to me on Monday.

HSIB has already conducted a number of investigations at the trust as part of its national maternity investigation programme. These identified a number of safety concerns, including the availability of skilled staff, particularly out of hours; access to neonatal resuscitation equipment; the speed with which patient concerns are escalated up to senior clinicians and obstetricians; along with failings in leadership and governance. As requested, the CQC carried out an unannounced inspection of the trust’s maternity service between 22 January and 5 February 2020. It has written to the trust with an overview of its findings and a full inspection report will be published in due course. The CQC received additional information from the trust this week, following its request for further assurance on triage, day care and medical staffing, and is considering this information. It is important that everyone is aware that the CQC is in regular contact with the trust and will continue to be so for the foreseeable future.

From the findings provided to me by HSIB and the CQC it is clear that the challenges at East Kent point to a range of issues—including having the right staff with the right skills in the right place; effective multidisciplinary working; clear collaborative working between midwives and doctors; good communication; and effective leadership support—but it would be wrong to speculate that there is one single cause. NHS England and NHS Improvement are working very closely with the trust and have taken some immediate actions.

First, the regional medical director and regional chief nurse are providing support to the trust. The medical director will address concerns surrounding appropriate senior medical oversight. Secondly, the regional chief nurse is providing support to the director of nursing and the head of midwifery to prioritise and focus their local maternity improvement plans to address identified safety concerns. They will also review the effectiveness of clinical governance and executive leadership support, and this will include ensuring that the trust is taking the learning from all historical cases and disseminating that learning through the trust.

The chief midwifery officer, Jacqueline Dunkley-Bent, has sent an independent clinical support team to the trust to provide assurance that all measures possible are being taken. This expert team includes a director of midwifery services from an outstanding trust, two consultant obstetricians, a consultant paediatrician and a neonatologist. She has placed the very best at the heart of the trust—on the wards, at the bedside of patients—with fresh eyes to oversee the care presently being delivered. The independent team is working with trust staff to deliver immediate improvements to care and to put in place robust and comprehensive processes to support improvement in standards over the long term. I can offer reassurance that Jacqueline Dunkley-Bent personally visited the trust two weeks ago to assess changes being put in place and that improvements are moving at pace.

Jenny Hughes, chief midwife for the south-east region, is also working with the trust directly. NHS England and NHS Improvement regional and national teams will continue to work with the trust. The trust is taking the issues seriously, is working closely with NHS England and NHS Improvement, and has created and filled several specialist midwife posts. Safety huddles, where safety issues are regularly and frequently discussed, have been embedded on both sites to anticipate problems before they occur, and multidisciplinary teams are working collaboratively.

I would like to reiterate my condolences, particularly to Harry Richford’s family and all those affected. I also thank the honourable Member for North Thanet for raising this important issue. The Government are fully committed to reducing patient harm and improving the safety of maternity services.”

[Baroness Thornton (Lab)]

I thank the Minister for that detailed Statement, which this issue definitely warrants. Given the measures that have been taken by NHS England and all the parties concerned, why has this trust not yet been put into special measures and at what point will it be? I agree with the Minister about the issue of leadership and culture in this hospital trust. I was horrified, as I am sure other noble Lords would have been, by the chief executive of this trust saying on the BBC that there had been “only” six or seven avoidable deaths since 2011. Actually, that is not true, and I think she said it because she had not read the report produced in 2015. What worries me is that there has clearly been a serious failure of leadership and culture across the whole of this trust, and that statement from the chief executive seems to symbolise that failure. How will the measures that the Government and NHS England are taking address the very serious leadership issues in this trust?

[Baroness Blackwood of North Oxford]

As I said, there has been an unannounced CQC inspection; there is also further engagement with the CQC and we await the findings of its report, which will come forward in due course. In addition, specialist teams have been sent in to ensure that there is robust leadership so that ongoing care is assured and patients can be reassured on that point. NHS England has announced that it will commission an independent review into East Kent so that there is a belt-and-braces approach to ensure the highest possible standards of care there. We can be reassured that the issues raised by the noble Baroness will be addressed and that no stone will be left unturned.

[Baroness Brinton (LD)]

I also thank the Minister for the detailed Statement, which is much appreciated, and echo the sentiments of sympathy and support to the parents of Harry Richford and the other children who have died or had their health severely impaired by the trust. It does not start just two years ago. In 2010 there was a review by NHS Eastern and Coastal Kent on maternity care; safety and quality are mentioned three times in the statement of that review. In 2012 the services were reconfigured despite many concerns of local people. In 2014 the trust was rated inadequate and put in special measures by the CQC—it left special measures in 2017. In 2015 there was an expert report by the Royal College of Obstetricians and Gynaecologists warning about many of the problems that emerged in the subsequent tragic deaths of Harry Richford and at least six other babies. And so on and so on.

The expert review said that action needed to be taken quickly. This report was not passed to the CQC. Why, given that the hospital was in special measures, was the report not handed to the CQC and why on earth was the hospital allowed to continue out of special measures after that when there were clearly still major problems? Following on from the comments of the noble Baroness, Lady Thornton, why did the chief exec and, I presume, the board not read, implement and monitor this expert review?

[Baroness Blackwood of North Oxford]

The noble Baroness raises an important question, which I am sure will be considered as part of NHS England’s independent review and the CQC’s questions around quality of leadership, but I will make a wider point for those who may be listening about the safety of maternity care in the UK. We are rightly focusing on the questions of East Kent, but for those who may be considering giving birth at the moment it is important to state that the NHS is one of the safest places in the world to give birth. Some 0.7% of births result in a stillbirth or neonatal birth. We have stated that our ambition is to halve this rate of stillbirths, neonatal and maternal deaths, and brain injuries by 2025. We have already achieved our ambition of a 20% reduction by 2020. A message of reassurance, alongside the firm actions we are taking to address the concerns raised by the noble Baroness, is appropriate and important.

[Lord Ribeiro (Con)]

My Lords, I echo the comments of the noble Baronesses, Lady Thornton and Lady Brinton, about the role of the chief executive. I watched the news last night and was horrified to hear her say that she had no knowledge of the review until 2018, yet that review was requested by the medical director of the trust in 2015. If she is unaware of what is happening in her own trust, serious questions need to be asked. In view of what the noble Baroness just said about maternity services, it is important that we send a very clear message to our midwives on the front line. They need to be supported and we need to send the message, not just to the ones in East Kent but to those throughout the UK, that they have our support.

[Baroness Blackwood of North Oxford]

My noble friend is, as ever, very wise on this. A key plank of the maternity safety strategy, launched in 2016, is a number of initiatives to improve not only clinical care but culture in maternity services. They have been designed to improve leadership and to ensure that in every trust there is a midwife, an obstetrician and a board-level maternity safety champion to spearhead improvement. It is critical that we ensure that this is delivered so that incidents such as this do not occur.

[Baroness Buscombe (Con)]

My Lords, there is no question but that our maternity services across the piece are under enormous pressure. We know that in 2017, somewhere between 30% and 40% of all babies born in the UK were born to foreign nationals. Will the Minister tell me, in broad terms, do foreign nationals, when they have babies in this country, make a financial contribution?

[Baroness Blackwood of North Oxford]

People are entitled to free NHS care if they are ordinarily resident in the UK. However, my noble friend’s wider point about the pressure on maternity services was absolutely right. That is why, in February 2018, the Government announced an additional 3,650 training places for midwives. I am pleased to say that the first 650 began their training in September 2019 to ease the pressure, and there will be 1,000 training places for each of the next three years. This should ease the pressure and address some of the concerns my noble friend raised.

[Baroness Uddin (Non-Afl)]

My Lords, I draw the Minister’s attention to one of the first advocacy schemes for maternity care, which still operates in Tower Hamlets 35 or 38 years onwards. When I was working there, I dealt with a number of cases where there were complaints from parents. Will she commend the efforts of the parents, who persisted in taking their complaints so far up? Without their knowledge, persistence and dedication, we would not have come to this point where we are seriously questioning the competence of the staff.

[Baroness Blackwood of North Oxford]

We are obviously very grateful to all those brave enough to bring their stories forward in the midst of extreme tragedy and pain. We know that it is not easy and that within the culture of the NHS, it can sometimes be extremely hard to break through the barriers of not denial, but resistance. We should pay tribute to all those who have campaigned for maternity safety. In particular, I pay tribute to my right honourable friend Jeremy Hunt, who began a lot of the work to improve maternity services when he was Health Secretary, and to James Titcombe, who led a lot of the work relating to Morecambe Bay.

[Baroness Manzoor (Con)]

Does the Minister agree that the NHS is overregulated, with lots of overlapping responsibilities between different regulators? Does she agree that we need much greater clarity so that issues such as this, with devastating impacts on people’s lives, are dealt with much more quickly and picked up much sooner, rather than individuals having to make formal complaints?

[Baroness Blackwood of North Oxford]

My noble friend makes the core point that when an issue arises, there should not be conflict between patients, the NHS and clinicians; it should be possible to resolve the situation in a straightforward way, within a culture not of blame culture but of learning. That is at the core of setting up HSIB, but this culture should go all the way from the grass roots of the NHS up to the very top. That is absolutely a part of the patient safety agenda we are trying to instil.

Wuhan Coronavirus

Baroness Blackwood of North Oxford Excerpts

Tuesday 11th February 2020 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 will now repeat a Statement made by my right honourable friend the Health Secretary regarding the ongoing situation with the Wuhan coronavirus. The Statement is as follows:

“I have laid an instrument before the House to confirm the power that we have taken to isolate those at risk of spreading the virus, and if necessary to keep them isolated as part of our belt-and-braces approach to protecting the public. The powers are proportionate and will help us slow down transmission of the virus and make it easier for NHS and public health staff to do their jobs.

The clinical advice about risks to the public has not changed and remains moderate. As of today, eight people in England have tested positive for coronavirus. All are receiving expert care from the NHS, which is well prepared and equipped to deal with this situation. Contact tracing of the first four cases has been undertaken rapidly and is now complete, while tracing for the latest four cases is ongoing. This contact tracing itself identified five of the cases—a tribute to the skill and tenacity of Public Health England staff—as well as finding five further British nationals in France who also tested positive for the virus. They are now receiving treatment, and the Foreign Office is following up with consular support.

On Sunday, 105 more British nationals and dependants from Hubei province landed safely at Brize Norton. They are now in isolation facilities at Kents Hill Park in Milton Keynes and receiving all the necessary medical attention. I pay tribute to the Foreign Office and the MoD, as well as Milton Keynes Council, Milton Keynes hospital and my own team, for their hard work and efficiency in ensuring that this all went smoothly. This is, of course, in addition to those now reaching the end of their isolation on the Wirral.

I turn to the efforts to contain the outbreak in China. The Foreign Office is advising against all travel to Hubei province and all but essential travel to mainland China. Last week we issued new advice to all travellers returning to the UK from China, Hong Kong, Macau, Malaysia, South Korea, Singapore, Taiwan and Thailand. That advice is clear: if you develop symptoms of cough, fever or shortness of breath, you should call NHS 111 and immediately self-isolate for 14 days, even if the symptoms are minor. If you have returned from Hubei, you should self-isolate and contact NHS 111, even if you have no symptoms.

My officials discussed the incubation period with the World Health Organization this morning. The current evidence shows that a 14-day incubation period remains appropriate. We will continue to monitor emerging evidence closely with our international partners.

As I said last week, dealing with this disease is a marathon, not a sprint. The situation will get worse before it gets better. We will be guided by the science. Be in no doubt: we will do everything that is effective to tackle this virus and keep people safe. We are investing £40 million in vaccine research and working with international efforts on therapeutics. Today I can announce to the House the immediate launch of a capital facility to support any urgent works the NHS needs for coronavirus response, such as the creation of further isolation areas and other necessary facilities.

Finally, there are actions that each and every one of us can take—simple but effective steps such as washing hands and using tissues. We will take all necessary precautions to keep the public safe. I commend this Statement to the House.”

--- Later in debate ---

[Baroness Brinton (LD)]

My Lords, I begin my remarks from the Liberal Democrat Benches by echoing those thanks to all staff who are involved, not just on the front line but in the large amount of planning that is going on. We would also like to thank the patients who have self-isolated in calmness, accepting what has happened and moving a long way from home, and those who after flying back from abroad have quite contentedly gone on elsewhere. The advantage of social media, television and radio is that we can hear how they are managing.

I note that the Secretary of State has declared that transmission of coronavirus is a serious and imminent threat to public health, despite the fact that the current situation remains moderate. The regulations for England only—to isolate and hold those at risk of spreading the virus—is, I hope, a last resort. So far, that has not been necessary, but we on these Benches understand that there may be occasions when it is. Will the Minister confirm that the devolved states will follow suit? We would not want Gretna Green suddenly to have a reputation for the wrong reasons, with people trying to remove themselves to somewhere that the regulations do not apply. It seems sensible in the United Kingdom to make sure that there is consistency among the four states.

What safeguards are in place for those conducting the quarantines and isolation to ensure that they are kept safe, along with the patients, and to prevent them contracting the virus?

I note also the regulation that came into force at the end of January, ensuring that no charge is to be made or recovered from overseas visitors who may have to be diagnosed with, or treated for, coronavirus. We believe that that is right, but how is this information being disseminated to healthcare bodies? I see nothing at all about it on the department’s website. The regulation appears for parliamentarians via Hansard, but I can see nothing else anywhere that might help inform hospitals and other bodies.

Today’s Statement from the Secretary of State, the department’s daily 2 pm statement, and the report from the Chief Medical Officer all talk only about those travelling from a number of Asian countries—which the Minister read out in her repeat of the Statement—and who have come from those countries in the last 14 days. This is echoed in the department’s advice to healthcare professionals. So, despite being updated daily—and the number of patients was up to date as at 2 pm today—these Statements do not reflect the fact that some of the eight UK-based cases contracted coronavirus in France, or possibly even in the UK.

Today on radio and television, we have heard a number of experts from China, from John Hopkins University and from UK universities all talking about the possibility of substantial transmission. Indeed, the department has confirmed that this is a high-consequence infectious disease, with all the concerns and constraints that go with it, which include being

“often difficult to recognise and detect rapidly … ability to spread in the community and within healthcare settings … requires an enhanced individual, population and system response to ensure it is managed effectively, efficiently and safely”.

We now have cases in York, in Brighton and its area, and in the specialist receiving hospitals in London and Newcastle, in addition to two GP surgeries in Brighton that have been closed for cleaning. There are local concerns in Brighton about a community centre, and some schools appear to be making the decision to allow children not to come in, after two people were told to self-isolate. But there does not appear to be any formal advice being offered to councils, councillors, schools, prisons and other public bodies. Can the Minister explain why the Statement seems to take no account of what is happening in the UK at the moment? What advice is being given to local councillors, schools and other bodies about early planning for their area, what they should do if a person may have coronavirus, and what happens once they are diagnosed, so that they are ready in the event that there are cases in their area?

I specifically want to mention the role of councillors here. Elected members are often at the heart of their communities, and an informed councillor can calm worries, particularly at the school gate, if they can say that they have been briefed. These days, briefings do not have to happen face to face; there are mechanisms through technology for people to be brought up to date.

Finally, in Brighton, it has been reported in the local media that a number of people with cancer and other long-term conditions are understandably worried about what they should do. They are asked to make sure that they have their annual flu jab, but at the moment there seems to be no specific advice for people regarded as vulnerable patients. Public Health England’s very helpful flow chart on the management of a suspected case runs through very sensibly what to do with the patient, but nowhere does it suggest to ask the patient whether they have any vulnerable people in their family or their contact, nor can I find any advice, anywhere at all, about what primary care doctors should be saying to vulnerable patients in their area—I am thinking particularly of Brighton, at the moment—to make sure that they feel comfortable about this.

These are concerns that could, I suspect, be resolved with effective planning. However, it seems that, at the moment, there is a bit of a lacuna, and I hope that the Minister will be able to help fill the space.

[Baroness Blackwood of North Oxford]

I thank the noble Baronesses for those important questions and, like them, I thank NHS and PHE staff for their extraordinary work over recent days, and those patients who have acted so responsibly in self-isolating. In doing so, they have slowed the transmission of coronavirus in the UK and protected many, including those who are particularly vulnerable. I also thank both Benches for their support of these regulations, which hopefully will not be needed, but should they be needed, could play a crucial role going forward.

I wish to clarify that these regulations will apply only to coronavirus. They will be in force for two years and will be triggered only in the instance of a serious or imminent threat to public health by a person not complying with public heath advice and therefore putting themselves and/or others at risk.

The noble Baroness, Lady Brinton, asked about the devolved Administrations. These regulations apply only to England, but we are in touch with the devolved Administrations, and they will consider this. Obviously, CMOs are acting in concert, and we think that the devolved Administrations will want to take this forward. The question of the scrutiny by Parliament is one for duty managers, but we have come back to the House with this issue on a number of occasions and we are very committed to keeping the House updated on this and will continue to do so.

On the point about how the NHS is being kept updated and prepared, we have announced the capital arrangements today to ensure that the NHS can be prepared for different isolation measures, but the NHS is always ready to provide world-class care, with expert teams in every ambulance service and a number of specialist hospital units that can respond to this. I am pleased to report that the latest data from PHE indicates that, in the past week, flu activity has once again decreased, against all indicators, the rate of GP consultations remains below baseline levels and the rate of ICU and HDU admissions and hospitalisations remains low, which is an encouraging background for us.

The noble Baroness, Lady Brinton, also asked about those who are vulnerable. This is factored into the NHS 111 algorithm, where we advise individuals to call should they have any concerns, as part of the public health advice. I take on board her point about those individuals who may be useful for community communications with councils, schools and others. Obviously, the first place for advice is Public Health England, but there may be activity which I do not have in my brief, so I will come back to her on this.

We have cascaded very detailed information through the NHS about coronavirus—what to look out and what actions to take—which has come from the Chief Medical Officer and those leading the response, to ensure not only immediate response and preparedness, but also on what actions can be taken by healthcare professionals to protect themselves.

The noble Baroness, Lady Thornton, asked about vaccines. She will know that we have pledged £20 million for the new vaccines to combat this. Every day that we slow down sustained transmission is a day closer to development of that vaccine. Developing a new vaccine is not necessarily a quick process; I think it will be in months rather than weeks, but we will put every effort into making sure that we can take part in that.

Finally, the noble Baroness, Lady Brinton, asked about the differential advice regarding travel from Wuhan and travel from other Asian states and about where that stands at present. The Scientific Advisory Group for Emergencies and UK Chief Medical Officers have given that advice, on those who have travelled from mainland China and the other nations that I stated versus those who have travelled from Wuhan, based on evidence now available on sustainable transmission. Should there be person-to-person transmission at a different rate, it would be kept under review and the advice would change.

I hope that I have responded to most of the questions. Should there be further questions, I am happy to respond in writing.

[Lord Campbell-Savours (Lab)]

My Lords, I do not want to overreact, but this is a very dangerous condition, and prevention starts at home. The average age in this House is 70. We therefore form part of the most vulnerable group, the group most susceptible to viral infections. Bearing in mind the pressures on Members to attend, should not the House authorities be preparing advice for us on what action should be taken to avoid cross-infection within the House, including, in the event of an infection breakout in London, the wearing of face masks on these premises, not only for self-protection but also for the protection of other people in the House?

[Baroness Blackwood of North Oxford]

The noble Lord is quite right that each of us has a role to play in preventing the spread of infection. At this point, the advice is that, if you have travelled from any of the infected areas or have been part of the contact tracing, you should self-isolate. Should you have any of the symptoms associated with coronavirus—a cough, fever or shortness of breath—you should stay indoors and call 111, even if the symptoms are mild. Outside the question of whether you have had any contact or travelled to the affected areas, the advice from the Chief Medical Officer is that effective handwashing and the “Catch It, Bin It, Kill It” concept—to use tissues when you sneeze or cough and to throw those tissues away—is the most effective way of limiting the passing on of infection, and each and every one of us has a role to play in doing that. However, I am happy to pass on to the House authorities the point the noble Lord has made and ask for communications to be sent from Public Health England with the most up-to-date information.

[Baroness Finlay of Llandaff (CB)]

My Lords, I thank the Minister for bringing the update to the House. Among all those people to whom we owe a debt, we should particularly single out the chief medical officers, led by Chris Whitty, who is an epidemiologist and therefore has an in-depth understanding of the science. We should also thank the owners and crew of, and all those on board, the “Diamond Princess”—a British-owned vessel—who are working with the Japanese authorities and doing all they can to contain the outbreak that has occurred there.

One of the difficulties—this was alluded to by the noble Baroness, Lady McIntosh, who is not in her place at the moment—is that in the early stages this is like the common manifestation of any other viral disease. Therefore, self-isolation and being responsible by staying away from people is everyone’s responsibility with all such infections. Unfortunately, some turn out to be coronavirus. Are the diagnostic kits for Covid-19, which I think is now its official name, available to adequate numbers of hospital laboratories which are under public health supervision? Are those diagnostic kits available across all four nations of the United Kingdom? Are they linked to Colindale so that there is good co-ordination of the way in which the diagnostic procedures are undertaken?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right. We are aware that there are British nationals on board the “Diamond Princess” in Japan and that six more people have tested positive for coronavirus, none of whom is a British national. We have offered consular assistance to those British nationals—we have been in touch with the “Diamond Princess”—including one who is in hospital. We obviously pay tribute to the work being done in trying to contain the situation there. I identify myself with the thanks and tribute paid to the work of the CMOs, who are doing an extraordinary job right now to make sure that the UK is prepared.

We are one of the first countries in the world to have an effective test; it is working well. Now that the protocols have been sent to the devolved Administrations, testing centres in Glasgow, Edinburgh, Cardiff and Belfast have started testing already. Labs in Cambridge, Bristol and Manchester have started testing today and Birmingham, Newcastle and Southampton will come online shortly. I hope that reassures the House about the capability already available within the NHS.

[Lord Lansley (Con)]

My noble friend’s appreciation of what is being done in contact tracing and the urgency that has been invested in that and other aspects of containment of the disease is welcome. I share the appreciation that there is across the House for that.

I am sure my noble friend agrees that the effort put in now to try to contain the virus is not disproportionate, even if it includes the powers under the new regulation, because it buys us time. She referred to buying time for research into a potential vaccine. I have not seen any reference to other antiviral treatments that might be identified and be of use. For example, if a new flu-like virus was circulating we could use our stockpiles of Tamiflu. Have any viral treatments been explored for this particular virus?

[Baroness Blackwood of North Oxford]

As ever, my noble friend is astute on this issue. Contact tracing has been hugely effective, particularly for the 1,466 passengers and 95 staff who arrived in the UK on direct flights from Wuhan between 10 and 24 January. All those have now passed through the incubation period and none of them was a confirmed case. Of the remaining cases that we have found, a number are linked to contact tracing. We should be very proud of the effectiveness of our system.

On the question of antivirals, work and research is ongoing in regard to a particular HIV retroviral which has been used in this measure. That is being considered. There are three projects which aim to advance the vaccine candidates into clinical testing as quickly as possible. We are also looking at some correspondence from both diagnostic kit manufacturers and potential end users, and we are considering whether we can also improve the diagnostic kit.

[Lord Patel (CB)]

My Lords, it is always a pleasure to correct the former Secretary of State for Health. This virus is RNA in its genetic makeup. H1N1—the previous pandemic that we were worried about when we stockpiled the antivirals—had a DNA genetic make-up. Some antivirals work better with DNA than RNA, although the Minister was correct to say that there are several antivirals currently being tested to see whether they will work against the coronavirus. As far as a vaccine is concerned, it takes a long time to develop a vaccine; when you develop one, it takes even longer to see whether it is effective.

Last time we discussed this, I said that the Government were taking a proportionate action to contain the virus in the United Kingdom. I believe that to be so even today. However, we might be on the knife edge of a pandemic. If a pandemic is declared, the whole attitude to how we contain this changes. It becomes much more draconian, to stop the movement of people, isolate the index cases and identify the contacts. Currently, asking the Members of this House to wear masks would only make the public panic and ask why we are protecting ourselves when they are not being protected. It can be a good measure, but we have to wait to see how things develop. I would like to hear reassurance from the Minister that there are plans in place, so that if this becomes pandemic, the Government will take the draconian action that is required.

We are fortunate that, apart from the Chief Medical Officer Chris Whitty, who is a first-rate epidemiologist, we have Professor Piot, who discovered the Ebola virus, and Jeremy Farrar, chief executive of the Wellcome Trust. They have better knowledge on containing pandemics than anyone else in the world; I hope the Government will use their expertise.

[Baroness Blackwood of North Oxford]

The noble Lord has demonstrated, far more eloquently than me, why we have more expertise in public health, and in particular in infectious diseases, than many other nations; we of course share our expertise through the WHO with Professor Piot, Professor Jeremy Farrar and our own Chief Medical Officer Chris Whitty. We operate using the best scientific evidence and advice from SAGE, which is currently advising the risk level of moderate. We keep that under constant review and are not complacent in any way. Through the preparations that we are putting through the NHS and all other parts of the system, we will be prepared for whatever situations might emerge should there be more sustained transmission in the UK. We will take the measures necessary to protect public health. The steps that we have taken so far have been proportionate and appropriate; they also demonstrate that the Government will act as necessary to make sure that we protect public health.

[Viscount Waverley (CB)]

My Lords, these are indeed worrying times, with self-isolation a necessary measure to control transmission. In the spirit of informing government, in the context of borders, is the Minister aware that mandatory forced isolation is contrary to provisions in the Portuguese constitution? This might become relevant when protecting our shores in future risk management efforts, to which she referred.

[Baroness Blackwood of North Oxford]

I believe there are some legal specialists in the Chamber. I note the noble and learned Lord, Lord Judge, sitting at the front on his Bench, who may be able to answer more effectively than I can. However, I believe that the regulations as they have been drawn up are legally appropriate and proportionate. As I have said, they apply only to coronavirus, are in force for only two years and are triggered only by a serious and imminent threat to public health and where a person has not complied, or will not comply, with public health advice and is therefore putting themselves and others at risk. This is well in line with other legal measures.

[Baroness Masham of Ilton (CB)]

My Lords, will the Minister give more information on people, including parliamentarians, attending conferences and functions in various parts of the world? Is there a risk of picking up coronavirus at airports and on long-haul flights? Many of your Lordships attend conferences and one noble Lord has asked me to relay this question.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

The travel advice, as it stands, is against travel to Hubei province, and against all but essential travel to China. There is no advice against other travel. People should be reassured that there is no problem there.

[Lord Hope of Craighead (CB)]

My Lords, perhaps I could follow up on that very subject. This afternoon the set of barristers’ chambers to which I belong advised any of its members who had returned from any of the named countries to self-isolate, irrespective of whether they were showing symptoms. I think that is because it is so difficult, at the beginning, for the symptoms to emerge to a point at which somebody realises that they have reached the stage of being able to transmit the disease. This set of chambers has taken rather an extreme measure; maybe others are doing the same. Do I gather that that is not yet the CMO’s advice? On the other hand, would the CMO be considering whether the advice should be not just to self-isolate if symptoms develop, but for people returning from such places to self-isolate anyway as a precaution?

[Baroness Blackwood of North Oxford]

I am sorry that I had not noticed the noble and learned Lord, Lord Hope—who is of course also an excellent legal mind— sitting right behind the noble and learned Lord, Lord Judge. We are very grateful for the precautionary measures being taken by a number of individuals and organisations. However, the advice from the Chief Medical Officer and SAGE is proportionate. At the moment, the available evidence is that transmission while asymptomatic is very unlikely. That is why the advice stands as it is: where the risk is highest and where transmission is sustained, people should self-isolate immediately on return—which means on return from Wuhan and the rest of Hubei province. On return from other areas where transmission is less sustained, people should self-isolate on the arrival of symptoms.

Health: Learning Disability and Autism Training

Baroness Blackwood of North Oxford Excerpts

Monday 10th February 2020 Lords Chamber

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

My Lords, I thank all noble Lords who took part in this short debate. In particular, I thank the noble Baroness, Lady Hollins, for her Question, which has allowed us to have this important and moving debate, and for her dedication to this issue; she said that she has been working on it for more than four decades. She has certainly gained this House’s unremitting respect for her work. In particular, I thank her for her vital work as independent chairperson for the care and treatment reviews of people with a learning disability and autistic people in long-term segregation. That work could not be more important, and her contribution in that respect is invaluable.

Noble Lords will know—they have demonstrated this—that the care and treatment of people with learning disabilities and autistic people has come under intense scrutiny in recent months, with widespread concerns about how we care for and support some of the most vulnerable in society—and rightly so. Tonight’s debate has been part of that. Everybody should receive the same high-quality care, whether or not they have a learning disability or are autistic. Despite this, as has been said, there remain serious disparities in the quality of care and support that they receive. As has also been said, evidence shows that they can experience poorer health and die sooner than the population as a whole. We must change that.

As the noble Baroness, Lady Hollins, rightly said, these disparities can arise as a result of health and social care professionals lacking the training or experience—or, sometimes, just the confidence—to deliver effective and compassionate care. I have no doubt that staff want to support everyone, including people with a learning disability or autism, to the best of their ability. Like the noble Lord, Lord Wigley, I pay tribute to Mencap’s survey for its Treat Me Well campaign, which found that almost half of staff responding thought that a lack of training on learning disability might be contributing to avoidable deaths and that two-thirds of staff wanted more training focused on learning disability. We are listening to that.

As noble Lords are aware, last year DHSC consulted on proposals for mandatory learning disability and autism training. The consultation was in response to the Learning Disabilities Mortality Review programme’s second annual report, which recommended the introduction of mandatory training. A common theme in the deaths reviewed by the programme was, as has been pointed out, the need for better training and awareness of learning disability. The same is true of autism. We published our response to the consultation in November, setting out our plan to introduce the Oliver McGowan mandatory learning disability and autism training across the health and social care system. The training is named in memory of Oliver McGowan in recognition of his family’s tireless campaigning—including a previous debate on this matter—for better training for staff.

In future, we want all health and care professionals, before starting their career or through continuing professional development—a point made by the noble Lord, Lord Addington—to undertake learning disability and autism training, covering common core elements so that we can be confident that there is consistency across education and training curricula. We are working with professional bodies and the devolved Administrations to align syllabuses and training requirements with the learning disability and autism capability frameworks at the earliest opportunity.

We have committed £1.4 million to develop and test, during 2020-21, a package of learning disability and autism training in a range of health and social settings to help us better to understand the implications of mandatory training and the associated costs before wider rollout in 2021. I assure the House that the training will involve people with lived experience at every stage throughout its design and delivery, which I know is critical to its success.

We are also clear that, to realise fully the benefits of this training, it must be mandatory. We will undertake a number of actions, recognising that different approaches will be needed for different staff groups to make sure that it is effective. These will include proposed changes to secondary legislation to ensure that providers who carry out regulated activities ensure that staff receive training that is appropriate to their roles. We will also explore options for those working in non-regulated activities.

I will just pick up on a few of the specific points raised. The first is e-learning, raised by the noble Baronesses, Lady Hollins, Lady Watkins and Lady Thornton. In the consultation on mandatory training, we heard very clearly that having a face-to-face component is important. We will consider how to build this in in an appropriate way as we develop and trial the training package. We are currently developing the specifications for trial and evaluation.

In response to the question about the timeframe from the noble Lord, Lord Addington, and the noble Baroness, Lady Thornton, the strategic oversight group met for the first time last week. We will publish invitations to tender later this month, and will then seek to appoint and sign contracts with suitable training and evaluation partners in April. We will commission and publish an evaluation of the training package by March 2021 to inform a wider rollout of mandatory training across the system. I hope that is reassuring. Of course, we will seek to learn best practice from anyone we think can help us; this will include the devolved nations, which I hope is reassuring for the noble Lord, Lord Wigley.

I will just pick up on the question raised by the noble Baroness, Lady Watkins, regarding workforce, which will of course be critical to making sure that this is effective. In addition to our new maintenance grant funding for eligible pre-registration nursing, midwifery and allied health students, we announced additional payments of £1,000 for new students who study in challenged specialisms, which would include learning disability specialisms. I think that answers the question she raised.

On the question regarding the review of the Mental Health Act raised by the noble Baroness, Lady Hollins, this was completed in December 2018 and its findings were clear that we need to modernise the Mental Health Act to ensure that patients are not detained longer than absolutely necessary. We have said we will bring forward a White Paper in the coming months. We intend to pave the way for a reform of the Act and tackle the issues raised in that review to ensure that people subject to the Act are treated with dignity and respect. The intention is to ensure that we provide more patient choice and autonomy and enable patients to set out in advance their care and treatment preferences, and also to improve the process of detention, care and treatment. I hope that is reassuring. The reason for doing it in this White Paper process is because of some of the complexities around the legislation and to ensure that there is appropriate pre-legislative scrutiny.

[Baroness Watkins of Tavistock]

I would just like to clarify that my question about funding for the maintenance support was not about whether it applies to the learning disability group but whether it will apply for all five years of intakes of this Parliament.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

It applies to all staff coming in from September, so it will apply from now on. I am happy to write and confirm the specific details if any further clarifications are necessary.

I want to reply to the very moving speech and lived experience given by my noble friend Lord Sterling. He will know that there is an autism strategy. Its intention is to address some of the important concerns he raised about improving diagnosis, helping adults with autism into work and improving access for adults with autism to the services and support they need—but obviously this does not address some of the concerns he raised about the experience of children with autism in schools and public services. That is why DHSC recently refreshed the Government’s arrangements around the autism strategy to improve its performance, to address explicitly the causes behind the gap in life expectancy that autistic people face and to make progress towards reducing it, but also to take forward a new autism strategy, which will be published in the spring, to extend the scope of the strategy to children and to deliver on one of the key commitments, which is in the long-term plan: to test and implement the most effective ways of reducing waiting times for autism diagnosis for children and young people. I hope that answers a few of the noble Lord’s questions and is reassuring.

I particularly note the very relevant points made by the noble Baroness, Lady Hollins, regarding diagnostic overshadowing and the reports by parents of children with learning disabilities and autism who feel as though they are treated as somehow less than human. As the noble Baroness and the noble Lord, Lord Addington, said, this must, and will, change.

Mandatory training, and many of the issues we have debated this evening, will play a key role in bringing about that culture change. But it will happen only through the collective commitment and work of every member of staff who takes on the training and looks for help when they do not understand how to do it, and by realising that we must have change not just in our health service and public services but within our culture as a whole. As this debate has shown, we all can and must do better in this area.

House adjourned at 7.40 pm.

Access to Palliative Care and Treatment of Children Bill [HL]

Baroness Blackwood of North Oxford Excerpts

2nd reading & 2nd reading (Hansard): House of Lords & 2nd reading (Hansard)
Friday 7th February 2020 Lords Chamber

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

My Lords, I thank all noble Lords who have taken part in what has been an important and moving debate. I particularly thank the noble Baroness, Lady Finlay. Her passion and commitment to improve the quality and experience of end-of-life care for everyone in this country are well known, both in this place and outside these walls, where her experience is known for not just the passion that she expresses but the way she has touched individuals’ lives. I also congratulate and pay tribute to my noble friend Lord Brownlow on what was an outstanding and moving maiden speech. It is quite clear that he has a great deal to contribute to this place and I look forward to his contributions in many debates to come.

Obviously, the provision of high-quality end-of-life care is an issue that each of us will care very personally about, and I therefore understand the intention of the Bill. It is the third time I have spoken on this matter in as many parliamentary Sessions. In responding, I shall address the provisions of Clause 1, and then Clause 2, which addresses a separate and equally important matter.

In common with previous Bills tabled by the noble Baroness, Lady Finlay—I would like to call her my noble friend—Clause 1 of this Bill seeks to introduce a range of measures relating to the provision of palliative and end-of-life care services, which have already been rightly tested in debate. These would create new primary legislation and amend existing legislation in Section 3(1)(c) of the National Health Service Act 2006, to create new duties on CCGs to provide some specific measures listed in the Bill.

Although I take the points raised by the noble Lord, at the moment, no other clinical area is provided for in such a detailed, prescriptive way as this Bill would create, although there are measures which were noted by the noble Baroness, Lady Hollins. As the noble Baroness, Lady Finlay, will know from responses to her previous Bills, legislating in this kind of detail on what a local commissioner must provide with regard to a clinical area is contrary to the principle of the autonomy of a clinical commissioning body, which was established in the Health and Social Care Act 2012, to determine what services it will commission based on the assessed needs of its local population. CCGs are already subject to the duty to commission health services based on local needs and palliative care is covered by this general stipulation. In addition, there is existing national commissioning and clinical guidance on the delivery of high-quality end-of-life care, which I know many in this House will be very familiar with.

Concerns have also been raised that legislating that care should be provided in a range of locations for patients—essentially, legislating for choice in end-of-life care—risks creating some tension between patients, clinicians and families, where patients cannot receive specialist palliative care in their home or care home because of their level of clinical need or the suitability of the accommodation. That may be debated further.

The Bill contains a separate provision which would mean that hospices can access drugs that would be available on the NHS on a no-cost basis, and that commissioners should pay for this. Currently, a CCG pays for a hospice resident’s medicines only, first, where it has commissioned the hospice care or, secondly, where they are prescribed by a GP and the cost has been allocated to that CCG under Schedule 12A to the NHS Act 2006. This would represent an expansion of CCGs’ liability—

[Lord Kerr of Kinlochard]

The duty as defined in Clause 1(1) would require clinical services commissioners to arrange for the provision of palliative services,

“to such extent as it considers necessary and appropriate”.

That is not a particularly specific duty in relation to anything else in the Bill. I do not quite follow the argument that if something as specific as the Bill was put into primary legislation, it would create a dangerous precedent—an anomaly, or whatever. The duty is widely expressed here and not particularly specific: they must consider it necessary and appropriate.

[Baroness Blackwood of North Oxford]

It has been seen that this duty would contradict the other legislation, as it stands, where it allows for autonomy for the CCGs. We have already expressed that we are happy to discuss this further with the noble Baroness, Lady Finlay, to explain it. On the question regarding prescription medications, I was going on to explain—

[Baroness Butler-Sloss]

I am sorry to interrupt the Minister but, following on from an earlier question, would it be possible to have a more wide-ranging discussion and invite other people to attend, so that the NHS team, plus the Minister and the Department for Health and Social Care, could meet them to discuss this? Currently, I think the Government have got it wrong.

[Baroness Blackwood of North Oxford]

Given that this discussion would be with the lead Minister for Social Care and the lawyers, I am very happy to make that commitment on their behalf. I am sure that we could drill down into the legal detail of exactly where the conflict occurs to understand that issue. Perhaps I might go on to explain some of the reasons why we think that some of the provisions have been overtaken in trying to improve palliative care, subsequent to the previous presentation of the Bill. That may be reassuring as well and might help in the debate. Would that be helpful? I will also explain the concerns on the requirement around prescriptions; that was my intent in progressing.

The issue around this representing an expansion of CCGs’ liability for the cost of medicines is that it would encompass the medicines needs of all privately funded hospice residents as well. As it is written, there is a concern. It arguably gives special treatment to one group of privately funded health service users over everybody else with some form of privately funded healthcare. This would require CCGs to fund the cost of drugs, which also risks CCGs choosing to stop funding beds through contracts. If that were to be an unintended consequence, it needs to be considered carefully. I am sure that there will be further debate on this.

This Government are committed to ensuring that we improve end-of-life care and recognise many of the issues that have been raised. They published an end of life care choice commitment in 2016, which I know has been debated previously, in response to an independent review of choice, and it sets out what everyone should expect from their care and the actions taken to reduce variation, which has also been raised here. It also sought to make more personalised care a reality. Since its publication, NHS England, health system partners and stakeholders have worked through the national End of Life Care Programme Board to provide more data, more tools and more evidence, support and guidance to local areas to highlight unwarranted variation, to improve policy development and to provide better commissioning. The end-of-life care atlas of variation, published by Public Health England, highlights variation across a broad range of measures and indicators such as place of death, admissions, the proportion of patients and identification recorded on a GP register. This allows CCGs to be benchmarked across services against one another and to draw on advice, best practice and guidance to improve service quality. This is a significant improvement and promises to be helpful.

This has led to new investment to support the NHS long-term plan, with new actions to help drive further improvement in end-of-life care and support choice. They include accelerating the rollout of personal health budgets, with up to 200,000 people, including those with palliative care needs, benefiting by 2023-24 and rolling out of training to help staff identify, and provide care for, those in their last year of life. I know that the noble Baroness, Lady Thornton, wanted some numbers on that. The latest available show that more than 600 doctors are qualified in palliative medicine—this is almost 200 more since 2010; there are 1,300 nurses and health visitors working in palliative medicine, which is over 300 more since 2010, and the people plan will have a holistic approach to how we can attract clinicians of all the different levels into the harder-to-recruit areas. We have discussed that a number of times over the Dispatch Box, so I shall not go into more detail now.

A number of Peers asked about funding. We are making £4.5 billion of new investment to fund expanded community multidisciplinary teams, providing targeted support to those identified as having the greatest risks and needs. That is important because the majority of palliative care is provided in the community, as the noble Baroness will know, and it is important that we make sure that GP and community care is properly funded. On the £25 million announced by the Prime Minister in August, this was provided to CCGs in October 2019. It has already been allocated to hospices. The 2019 manifesto set out a commitment to build and provide further support for this, which I hope reassures your Lordships. The reason that the money was provided for hospices and palliative care services was that, as was rightly said, hospices do not exist in all areas, so the intention is to make sure that we can drive down variation and improve services across the system.

In addition, we are upgrading NHS support to all care home residents with the enhanced health in care homes model rolled out across the whole country over the coming decade. We are also making end-of-life care one of the new quality improvement areas for the revised GP quality and outcomes framework to support early identification and personalised care planning. I know that the noble Lord, Lord Sheikh, asked me specifically about those who wish to die at home. We know that most patients express a preference to die at home. Currently, around 47% of patients die in hospital. This has improved since 2007, when the figure was 56%, but it is important to note that there are occasions when admission to hospital may not be preventable because, as a situation progresses, some patients may want to be in hospital as death approaches because they feel safer at that point. In other cases, the family or care giver may not be able to cope at that point, but we are working hard to improve choice.

I turn to Clause 2, relating to the treatment of children, and the issues raised by the noble Baroness, Lady Finlay, my noble friend Lord Ribeiro, the noble Lord, Lord Hunt, my noble friend Lady Stroud and a number of others. The noble Baroness, Lady Finlay, has set out proposals calling for mediation in the tragic cases where there is a disagreement in the giving or withdrawing of any form of medical treatment for a child with a life-limiting illness. Decisions around withdrawal of treatment are never easy and it is difficult for any of us to imagine the pain and suffering that families in such situations go through. At the heart of each of these difficult cases, as the noble Baroness, Lady Brinton, said, is the well-being of the child. That must remain everybody’s focus. It is important that we do all we can to ensure that families and medical experts communicate and, where possible, reach agreement on the best interests of the child. My deepest sympathies are of course with any family facing such a difficult decision and trying to navigate the challenges of our healthcare system in such a distressing moment.

Mediation can and does play a vital role in facilitating better communications and creating a space where voices on both sides of a dispute can be heard in a non-adversarial way, which is of course what we all want to achieve. It is certainly important that the legal framework is considered as part of this. The evidence shows that, unfortunately, it does not provide a solution in every dispute, particularly those most serious cases where there is a breakdown in communication or trust between the clinicians in the hospital and the parents, which may lead to animosity and lengthy court battles. It is incumbent on us all to do what we can to prevent these difficult and sad cases reaching court in the first place, which is extremely distressing for all parties—we have seen those cases.

The Government are very supportive of the many excellent mediation schemes available, including those run by charities and the private sector, and we pay tribute to those who run them. We are not sure that legislation is the answer to making sure that they exist everywhere. They are thankfully rare cases, but none the less extremely tragic. We believe that the lack of statutory prescription so far means that mediation can be tailored specifically to meet the individual needs of families and their children, clinicians and hospitals, reflecting the unique circumstances of each case. We are working with NHS England and the Nuffield Council on Bioethics to look at the effectiveness of mediation and of clinical ethics committees in managing disagreements and at how this could be improved. At this time, there does not appear to be a strong call from experts in the field to make mediation or clinical ethics committees a mandatory requirement. My honourable friend the Minister of State for Care has agreed to attend the Nuffield Council on Bioethics round-table discussion on disagreements in the care of critically ill children. This will bring together high-level health policymakers aiming to agree a set of actions reflecting what NHS leaders should do and further support the creation of healthcare environments that foster good collaborative relationships between parents and healthcare staff.

We absolutely believe that healthcare professionals have a duty to act in the best interests of their patients. When doctors and families do not agree about the best interests of a child, as in the tragic cases we have seen in recent years, the courts can be asked to make an independent judgment on the best interests of the child. We are concerned about the issues raised and that legislating in the way set out in the Bill would create a presumption that, unless it is clearly established not to be the case, the views of the parents represent the child’s best interests. There may be instances where this is not necessarily the case. This would be a significant departure from the current situation, which requires the court to make no assumptions and to consider the child’s best interests with an open mind. Establishing a default presumption would override the court’s sole focus on the interests of the child.

In almost every case of dispute, families and clinicians are able to reach agreement. The rare occasions when cases end up in court are picked up and amplified by the media. They are heartbreaking, which is perhaps why they appear more common than they are. Legislating for those rare but difficult cases would not be appropriate at this time. Our efforts are best directed at ways to avoid them in the first instance. My honourable friend the Minister of State for Care would like to offer to meet the Gard family, or representatives of the Charlie Gard Foundation, to discuss how we can focus our efforts on this important area, if that would be welcomed.

To conclude, I would like to thank the noble Baroness for raising the important issues in the Bill and every noble Lord who has contributed to this significant debate. However, I must advise that the Government have expressed their reservations and will move to oppose.

NHS: Targets

Baroness Blackwood of North Oxford Excerpts

Thursday 6th February 2020 Lords Chamber

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

My Lords, I thank all noble Lords for an expert and robust debate on a very important issue. In the time available, I shall do my best to respond to as many of the points raised as possible. I particularly thank the noble Lord, Lord Hunt, for, as ever, a robust contribution on a very important issue and for allowing us to have this debate. I also pay tribute to the noble Baroness, Lady Wilcox, for a formidable maiden speech. It is clear that she has deep personal experience and a straight-talking character, which means that she will make a considerable contribution to this place. I look forward to many future debates and interactions with her on the issues she has raised today and many others.

Like my noble friend Lord Bates, whom I can see in his place and who made an outstanding speech, I start by thanking the hard-working staff in our health and social care services. These services face unprecedented demand, with an ageing population and the challenges of winter placing a particular strain on them. In that context, the staff are doing a quite extraordinary job. As was mentioned by the noble Baroness, Lady Crawley, we all have our love letters that we can speak of, based on our own experiences. They demonstrate when the staff go far above and beyond to make sure that we come out on the other side in one piece.

I have listened very carefully to the concerns raised today about NHS performance, the pressures on our social care system and the impact on patients. Noble Lords are absolutely right to expect the Government to be restless in pursuing higher quality and in supporting the NHS so that it can be there for each and every one of us when we need it most. Today, I will outline the steps that the Government are taking to help address those concerns and will bring noble Lords up to date as much as possible.

I turn, first, to performance. As I have already mentioned, the NHS and social care system faces unprecedented demand. A number of noble Lords mentioned the figures. I will not go into too much detail as I would like to answer as many specific questions as possible. However, I should like to note that the most recent figures available for December 2019 show that there were over 2 million attendances at A&E—6.5% more than in December 2018. That means attendance by over 70,000 people every day—the highest ever for the month of December. Hospitals have also delivered 2.4 million more operations and almost 13 million more consultant-led out-patient appointments than in 2009-10. That is an extraordinary achievement.

However, I recognise, as was mentioned by the noble Lords, Lord Hunt and Lord Turnberg, the noble Baroness, Lady Pinnock, the right reverend Prelate the Bishop of Carlisle and many others, that in addition to the pressures on the health service, we are seeing increased demand in the social care system. We must put social care on a sustainable footing, with everyone being treated with dignity and respect. It is one of the biggest challenges that we face as a society. As my noble friend Lord Bates rightly said, we must resist the temptation to treat it as a political football. The Prime Minister has been clear that this Government will deliver on their promises and bring forward a plan for social care this year, as was specifically requested by the noble Baroness, Lady Brinton. I am quite sure that she will hold us to account very firmly on that commitment.

It is expected that there will be 1.5 million more over-75s in the next 10 years and we have to find a way of caring for them. As the noble Baroness, Lady Wilcox, rightly pointed out, there has also been a significant growth in the number of working-age people with disabilities who need care at a younger age. We need a system that gives every person—old and young—the dignity and security that they deserve.

The noble Baroness, Lady Wilcox, was right that these are complex questions which require not only difficult decisions to be made but the establishment of a sustainable settlement that will provide certainty for generations to come. That is why we will seek to build cross-party consensus, but we have been clear on two points: that everyone will have safety and security, and that nobody will be forced to sell their home to pay for care. The noble Baroness, Lady Thornton, asked me to predict both the Budget and the outcome of these negotiations. I am afraid that I will not be able to do that today but I am very touched by her thought that I would be able to answer those questions immediately at the Dispatch Box. However, I would like to update the House on what we have been doing to try to reduce pressures in the meantime.

To help address the increases in demand, last year we committed to £33.9 billion more funding a year by 2023-24. We are now enshrining that in law, and I know that we will have a significant debate about what that means for the NHS. As my right honourable friend the Secretary of State for Health and Social Care announced, this is a significant cash settlement for the NHS, and it means that we are already delivering on our manifesto commitments. We are also committed to delivering 40 new hospitals over the next decade, 50,000 more nurses, 6,000 more doctors in primary care and 50 million more GP appointments. As requested, I will update the House on the specific questions on that.

The noble Baroness, Lady Crawley, asked about the EU workforce. We have been clear that our priority is to ensure that the 181,000 EU staff currently working in the NHS and in social care are not only able to stay but feel welcomed and encouraged to do so. Since the referendum, we are pleased that 7,300 more EU staff are working in the NHS, including 900 more doctors. We are not only working to make sure that they are able to navigate their way through the EU settlement scheme easily and effectively; we will also introduce a new EU visa to make it easier for suitably qualified doctors, nurses and other staff to come and work in the NHS from overseas. We are working across government to make sure that this goes through smoothly.

In addition, a number of Peers, including the noble and gallant Lord, Lord Stirrup, and the noble Baroness, Lady Watkins, asked how we will go forward with the people plan, which will provide a constructive and holistic approach to our management of the framework for collective action on workforce priorities. This will be published in early 2020. It needs to take fiscal priorities into account, so there are questions around the Budget and the spending review. It will focus on growing and sustaining a well-skilled workforce across the NHS, particularly on creating healthy, inclusive and compassionate cultures. I know that this was raised by a number of Peers, including the noble Lord, Lord Turnberg.

To date, in addition, capital funding amounting to £2.4 billion has been provisionally awarded to over 150 STPs. I know that the noble Lord, Lord Hunt, has raised this on a number of occasions. This investment will modernise and transform NHS buildings and services, which the noble and gallant Lord, Lord Stirrup, asked about. The money will go towards a range of programmes across the country, including new urgent care centres, integrated care hubs that bring together primary and community services, and new mental health facilities. This money will be spent on upgrading facilities, increasing capacity so that more people can be treated and shifting emphasis towards prevention, making sure that we can deliver on the prevention Green Paper.

My right honourable friend the Prime Minister also announced a further £1.8 billion increase in NHS capital spending, which will deliver on 20 hospital upgrades so that they can come forward as soon as possible. This frees up the NHS to take forward and expand its existing plans for investment in infrastructure, and to unlock the delivery of commitments already made.

We have taken into account the questions about backlog maintenance and equivocal infrastructure asked by the noble and gallant Lord, Lord Stirrup. There has been a commitment that this will be taken into account as part of the spending review. It is recognised that, for too long, this has not been undertaken suitably strategically. I hope that that reassures him.

To respond to the noble Baroness, Lady Thornton, we have committed to growing the workforce by more than 600 doctors in general practice. NHS England and HEE are working with the profession to increase the workforce in England. This includes measures to increase recruitment, address reasons why doctors are leaving the profession and encourage them to return to practice. We have discussed this on a number of occasions. I am pleased to report that, last year, HEE recruited the highest numbers of doctors into GP training ever, at 3,540 trainees. We are moving in the right direction.

The noble Baroness, Lady Masham, rightly raised earlier diagnosis. We are committed to making sure that we drive forward on this. It is a crucial part of the long-term plan: as part of prevention, we also want to make sure that we are diagnosing earlier, reducing demand and pressures for patients and clinical trials. This is why we announced funding to replace outdated cancer diagnostics and treatment machines. Some £200 million, consisting of £100 million this year and £100 million next year, will be used to replace MRI and CT scanners or breast cancer screening machines that are more than 10 years old. I know that the Labour Front Bench wanted to be reassured about this so that we can ensure that we get earlier diagnostics and patients on the right care pathways as soon as possible.

The noble Baroness, Lady Gale, asked some specific questions about Parkinson’s. I hope to give her some helpful answers. In 2018-19, the NIHR clinical research network supported 323 dementia and neurodegeneration studies, 99 of which were new studies in this area. In addition, to address access to mental health support for people with long-term medical conditions such as Parkinson’s, we aim to increase access to psychological therapies for an additional 600,000 people each year by 2020-21. We have committed to ensuring that this will address care for patients, such as those with Parkinson’s. I hope that this answers some of the noble Baroness’s key questions.

In the short term, NHS England has prioritised funding to support performance for this winter. I know that this was raised by the noble Lord, Lord Hunt. Additional capital and revenue funding was made available to systems and trusts to support staff and bed capacity throughout the winter. This has allowed trusts to increase bed numbers and facilities to support better flow through the system. I am pleased that the NHS has reported that over 1,000 more hospital beds are open this winter than at the same time last year.

In addition, a further £240 million has been provided again this year for adult social care to help reduce delays in patients being discharged from hospital by providing social care support. The noble Baroness, Lady Brinton, was quite right to highlight the value that the better care fund has provided in integrating the links between adult social care and the NHS. She is quite right that this is a relatively short-term solution; we look forward to more sustainable long-term solutions from ICS and others. However, I am very pleased that we committed a total of £6.4 billion to the better care fund in 2019-20 and that further funding is committed for this year.

This is all in addition to winter funding that provided £145 million for hospitals last year and has gone up this year. It has also provided ambulance services with 256 new state-of-the-art vehicles and make-ready hubs, which shorten vehicle turnaround times. I know that the noble Baroness, Lady Masham, was concerned about this.

To support performance, the NHS has continued to focus on longer-term solutions. This means that, as we go on in years, we will not see the same performance challenges, transforming and improving urgent and emergency care services. The priorities are as follows.

The first is to increase the provision of same-day emergency care so that patients are seen quickly and not admitted to hospital overnight if that is unnecessary. We have seen some good progress here, with over 89% of hospitals now providing SDEC for 12 hours a day. Other priorities are: to reduce the number of patients who have unnecessary long lengths of stay of more than 21 days in hospital; to increase the number of urgent treatment centres delivering a standardised level of service to provide patients with an alternative to A&E; to continue to make improvements to the use of GPs at major A&Es, allowing less acutely ill patients to be streamed away from the emergency departments, and to consider the issues raised by the noble Baroness, Lady Watkins, about the higher training of GPs and other practitioners so that patients do not feel the need to go to A&E; and to enhance NHS 111 services so that people calling can receive a clinical assessment and be offered immediate advice.

To respond to the important point made by the noble Lord, Lord Young, about the spreading of best practice across the system, we have brought in very important measures recently—not only NHSX but Getting It Right First Time to support NHS Improvement’s work, as well as the Accelerated Access Collaborative to drive innovation and best practice across the system.

I turn to the questions about clinical waiting time standards. This review is being clinically led by Professor Stephen Powis, the national medical director of NHS England, to consider whether improvements can be made to access standards for urgent care, planned care, cancer and mental health treatment. It is not a question of abolishing or removing these waiting time standards.

I will briefly address the point made by the noble Lord, Lord Hunt, about the introduction of the four-hour waiting time and the Patient’s Charter. Let us remember that that was 15 years ago. Under this Government, last year, 1.7 million more patients were treated within four hours than in 2010, and hospitals delivered 2.4 million more operations. Let us not forget that, when the Labour Administration left office, over 18,000 people were waiting for more than 52 weeks to start elective treatment. It is now 1,400. I would like for us not to look with rose-tinted glasses and forget some of the challenges being faced then as now.

Regarding the questions on current A&E waiting times, the standard sets out a maximum four-hour wait from arrival to admission, transfer or discharge. The initial clinical review of standards report set out some key reasons why we should consider clinically whether there are better ways to deliver this care. First, the standard does not measure total waiting times or differentiate between severity of conditions. It measures a single point in what is often a complex care pathway, and there is evidence that hospital processes rather than clinical judgment are resulting in admissions or a discharge in the immediate period before a patient breaches the standard—in other words, perverse incentives.

In addition, since the introduction of the waiting time standards 15 years ago, practices in medicine and urgent care have naturally advanced, for example with the introduction of specialist centres for stroke care, urgent treatment centres, NHS 111, trauma centres, heart attack centres and acute stroke units, increased access to and use of tests in A&E and new ambulance standards, as well as the increased use of same-day emergency care to avoid unnecessary overnight admissions. This is all being led by clinicians on the best advice to improve the standard of patient care. Any changes will be reviewed only after full evaluation and clinical advice. I hope that that is reassuring for the House; I am sure that we will be robustly tested on it. I hope that it clears up some of the questions asked and responds to some of the points made by the noble Baroness, Lady Watkins.

I will close so that the noble Lord, Lord Hunt, has time to respond. I close by expressing the hope that I have reassured the House that this Government not only understand the importance of world-class health and social care provision but have made it our number one domestic priority. We are listening to the concerns raised regarding not only the quality of, and access to, NHS care but social care.

The measures I have outlined are helping to ease pressure on the health and social care system and to improve performance. The funding we have committed through legislation is intended to provide the certainty that the NHS needs to deliver the long-term plan and, with it, the world-class service that each and every one of us wants, so that clinicians, patients and the public can have confidence that they will always be able to find the right care at the right time, no matter where they live in the United Kingdom.

[Lord Young of Norwood Green]

The Minister has given a comprehensive response to a range of questions. Could she answer in writing the question on NHS apprenticeships? I would be grateful.

[Baroness Blackwood of North Oxford]

Yes.