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.

Health: Tinnitus

Baroness Blackwood of North Oxford Excerpts

Wednesday 5th February 2020 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of the impact of tinnitus on the mental health of those affected.

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

My Lords, we recognise the debilitating impact that tinnitus can have on people’s lives and that for some the condition can lead to mental ill-health, including suicidal thoughts. That is why we have commissioned NICE to develop clinical guidance on the assessment and management of tinnitus. This is expected to be published in March and will help raise much-needed understanding about the condition.

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for that Answer. Given that this condition causes enormous misery and is, we are told, incurable, and given that research has shown recently what a detrimental effect it can have on the mental health of sufferers, I have two questions for the Minister. I am very happy if she needs to write to me with the answers. First, how much is the NHS spending on research into the causes and cures of tinnitus? Secondly, if there are cures—if you google tinnitus, you will see that many products out there on social media claim to cure it—have any of these been approved? Are they in the system for approval? If so, when will they be available on prescription?

[Baroness Blackwood of North Oxford]

I am happy to pay tribute to the British Tinnitus Association, which has raised the issues this week—it is Tinnitus Week—for its research. I thank the noble Baroness for her question. I will be happy to write to her on the specifics of the tinnitus treatments. Of course, tinnitus is often linked with acoustic neuroma, hearing loss and a number of other conditions, including mental ill-health. There are some treatable causes, which GPs look for, but there can be others related to mental ill-health. The cause of tinnitus is unknown; it cannot be treated. Talking therapy will be prescribed, and a lot of those treatments are already available on the NHS and on prescription. I am happy to send that information to the noble Baroness in writing.

There is obviously research available via the NIHR. We spend more than £90 million on NIHR research, and £15 million of this is spent via biomedical research centres at Manchester, UCL and Nottingham. Nottingham undertakes specific research into deafness and hearing problems, including tinnitus and hyperacusis. If the noble Baroness would like further detail, I am happy to write.

[Lord Berkeley of Knighton (CB)]

My Lords, does the Minister endorse the views of many researchers, some of whom she has just mentioned, in their warning that listening to loud music—for example, in amplification, in front of speakers at rock concerts or in ear buds—could be an explosion waiting to happen in future generations? Secondly—this may apply to some noble Lords not yet afflicted—any slight loss of hearing should be dealt with sooner rather than later, because that research has also discovered that if you do not do something about it, it can possibly lead to dementia.

[Baroness Blackwood of North Oxford]

The noble Lord is absolutely right that contact should be made with a GP regarding hearing loss as soon as possible, that links between hearing loss and dementia have been found and that it is extremely important that we increase research in this area. That is exactly why I have asked officials to get together a round table regarding hearing loss and dementia to drive up research in this area as soon as possible.

[Baroness Brinton (LD)]

My Lords, one in 30 children suffers from tinnitus. That is one child in every average-sized class, so there are a number of such children in every school. These children often say that their tinnitus sounds like a rushing train. They find it difficult to concentrate in school and often end up with problems. Some of these children will require mental health support. Can the Minister say what the current waiting time is for a CAMHS appointment for a child or young person suffering from life-changing tinnitus? It is a chronic condition. There is already a problem with the waiting list for children and young people with acute and life-threatening conditions, but what is the waiting time for these children to get in front of a doctor?

[Baroness Blackwood of North Oxford]

We are working hard to bring down waiting times across mental health, and the noble Baroness will know that we are bringing in waiting time standards. On mental health provision for those with tinnitus, she will know that we are working to bring in improved access to psychological therapies. Ninety-five per cent of those accessing such treatments and therapies are doing so within the time available. The most important issue is making sure that those therapies are available in an accessible way. Local commissioners have to pay due regard to equality legislation and make sure they provide those services either through BSL-trained therapists or interpreters locally, if necessary.

[Lord Elton (Con)]

My Lords, having suffered from tinnitus for some 30 years, I do not share the Minister’s enthusiasm for reminding people that they have it. The most effective survival technique is learning to ignore it. Mine is a mild case. If fellow sufferers turn their mind away from it regularly and as hard as they can at the beginning, it tends to become less of a curse. As to whether it affects one’s mental abilities, I leave your Lordships to form your own conclusions.

[Baroness Blackwood of North Oxford]

My noble friend has put it rather accurately. As he said, a lot of the talking therapies available for tinnitus, which has no known cause, are ways of coping with it, some of which have proven effective. On research, we need a better understanding of causes so that we can provide better treatments for a condition that, for some, can be pervasive, pernicious and hard to ignore.

Eating Disorders: Provision of Care

Baroness Blackwood of North Oxford Excerpts

Tuesday 4th 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 noble Lords for their expert contributions. In particular, I thank the noble Baroness, Lady Parminter, for securing what has been a significant debate, and those noble Lords who spoke of their lived experience tonight. That is brave and an important contribution, both to inform policy and to let people outside this place know that there should be no stigma in speaking up. I wish to thank each and every noble Lord who has contributed tonight.

We know that eating disorders can be utterly devastating for the people suffering from these conditions and for those around them, including their families and friends. We know that they are not an aspect of vanity, as the noble Baroness, Lady Janke, said, but serious, life-threatening conditions with some of the highest mortality rates of any mental health disorder. They can have severe psychological, physical and social consequences—sometimes for a lifetime—and are more prevalent in young people but can occur at any time in life and in someone from any background. That is why we want to ensure that people have access to the right mental health support in the right place at the right time. We know that we have more work to do to ensure that we get there.

Improving eating disorder treatment services is a key priority for the Government; it is a vital part of our work on improving mental health services. As the noble Baroness, Lady Janke, rightly said, we know that the earlier an intervention is made and treatment provided, the greater the chance of recovery. That is why the Government set up the first standards to improve access to eating disorder services for children and young people, which will ensure that by 2020-21, 95% of children with an eating disorder will receive treatment within one week for urgent cases and within four weeks for non-urgent cases. We are on track to meet that commitment.

As raised first by the noble Baroness, Lady Parminter, and subsequently by others, in-patient treatment is also important, although we want it to be a last resort. That is why in 2014 we announced that we would invest £150 million to expand community-based care and why we are making good on that promise. It has resulted in 70 dedicated new or extended community services now either open or in development, which has led to faster access to eating disorder treatment in the community, with the number of children and young people accessing earlier treatment up from 5,234 in 2016-17 to 6,867 in 2017-18. The services are designed to give young people early access to services in their communities with properly trained teams. They include extended access to talking therapies, which, as the noble Lord, Lord Brooke, pointed out, are very important. In that way we can avoid extended hospital stays wherever possible.

Although eating disorders are commonly first experienced by people when they are young, conditions can continue into adulthood, as has been noted. Following the PHSO’s report, NHS England has convened a working group with NHS Improvement, Health Education England, the Department for Health and Social Care and other partners to address recommendations to take into account planning for improvements in adult eating disorder services.

As has been mentioned, there are currently 649 beds for treating eating disorders. We recognise that there is demand for extra beds, which is why we have developed a comprehensive activity dashboard—it is not very well named—which provides current and trend data regarding the use of in-patient services for adults with eating disorders. We shall use this to inform decisions regarding in-patient capacity requirements for local populations both in the short term and over the longer term to improve access.

In addition, for children and young people, the national accelerated bed programme for Child and Adolescent Mental Health Services is already supporting the delivery of care closer to home, and we hope that this is starting to improve the situation. Issues regarding geographical variation were raised by the noble Baronesses, Lady Murphy and Lady Thornton. We want to ensure that patients with eating disorders can receive treatment as close to home as possible. NHS England has recently created a review of NHS in-patient and community eating disorder services so that it can understand current provision, measure levels of geographic variation and allow the modelling of workforce implications to try to respond to those services.

I want to respond to the point raised by the noble Baronesses, Lady Hollins and Lady Brinton, as well as by others, regarding investment in mental health services. As I have already said, we have increased funding for eating disorder services, but we have also ensured that investment in mental health services must rise at a faster rate than in overall published funding. Each CCG must meet the mental health investment standard by which their 2018-19 investment in mental health rises, at a faster rate than the overall published programme of funding. CCG auditors will be required to validate their 2018-19 year-end position in meeting the mental health investment standard. In 2018-19, 100% of CCGs met that mental health investment standard. This is to ensure that we see an increase in the mental health investment standard, so that improvements can be made to access times, to the workforce and to all the other areas which have been referred to in the debate.

I would like to move on to the questions raised regarding access and waiting times for adult services. As the noble Baronesses, Lady Brinton and Lady Parminter, will know, we have brought in the eating disorder waiting time for children, but we are also trialling a four-week waiting time for adults and older people community mental health teams in local areas in order to understand how they should best be introduced. I understand the impatience for waiting time standards to be introduced immediately. Given the nature of our debate today, I ask for some understanding; we are building on a low base across the mental health system. We want to make sure that the waiting time standards we introduce are clinically appropriate, that the system is able to respond and that they are on track for delivery and sustained once brought in. I am happy to respond in a more detailed way subsequently if that is not a sufficient answer, but that is why we are bringing in the waiting time standards in that way.

On the question regarding transition that the noble Baroness, Lady Brinton, asked—rightly, given the questions identified across not only health but education and social care systems—two areas of the country with eating disorder services that are new care models, including West Yorkshire and Harrogate, are starting to make important progress in joining up young people’s and adults’ eating disorder services and improving the treatment and care received as close to home as possible. They are modelling services that, as we evaluate them, we hope could be rolled out in other parts of the country. I hope that answers the question of how we are trying to improve that.

On the question about workforce raised by a number of Peers—the noble Baronesses, Lady Thornton and Lady Hollins, and others—it is quite right that we recognise the need to recruit more mental health nurses and psychiatrists into the system. As was rightly said, there have historically been challenges in bringing in psychiatry trainees. We now have 300 more consultant psychiatrists than in 2010, so we are starting to make progress. We have focused on driving forward work to improve recruitment into psychiatry, working with the Royal College of Psychiatrists on its Choose Psychiatry campaign. To attract more junior doctors into psychiatry, the new junior doctor contract gives psychiatry trainees a £21,017 pay premium in addition to their normal pay. This is an additional £3,507 per annum for a typical six-year training programme. We also have additional support and similar additional payments in the nursing arena to attract nurses into specific specialties, because we recognise the need to do so.

In addition to this, questions were raised about prevalence. The important question was asked: how can we possibly make policy if we do not have up-to-date and accurate data on which to make that policy? As a data geek, I could not agree more. Therefore, while we have some useful data from the 2017 mental health of children and young people in England survey, which is helpful, we want to improve the information we have, so we have included—I am really sorry to use this acronym—the SCOFF eating disorder questionnaire in the 2019 health survey for England, due for publication in December 2020. We are working on securing a financial agreement for the next APMS in 2021. Content for the survey will be prioritised during the scoping phase, which I know will provide important prevalence data—something we want to see.

I have two final points regarding training and research funding, both of which are essential if we are to move forward. We certainly agree that mental health should be an integral part of medical education, and we thank the GMC for the work it has been doing to explain and illustrate by professional experience the principles of identification, self-management and referral of patients with mental health conditions. We are committed to providing the best training experience for all junior doctors. We will work with the GMC and relevant stakeholders to try to improve the training available. I know that the noble Baronesses, Lady Parminter and Lady Hollins, have been particularly involved in this. Perhaps we could take up this point afterwards.

When it comes to the questions of research raised in particular by the noble Lord, Lord Giddens, but also by the noble Lord, Lord Brooke, of course we need to understand these questions with much more granularity if we are to improve services, be more targeted with our policies and spend money more effectively. This year, we invested about £93.4 million in mental health research, which is up from last year. We are committed to having mental health research as a priority area. In particular, I was always very proud that the only biomedical research centre that focused on mental health was at Oxford Health. I was very proud to have opened that as the previous Mental Health Minister.

I am not aware of the specific research paper that the noble Lord, Lord Giddens, raised, but I am very happy to look it up after this debate and come back to him on it. When it comes to what I think he referred to as the ecological relationship between obesity and eating disorders, as a department we definitely consider that we must work very hard on making sure our prevention agenda works holistically across the entire addiction panoply. Indeed, we will be taking forward the prevention Green Paper in a way that ensures joined-up policy, not only in the department, but across government. I am very happy to follow up on the question regarding the 12-step approach.

I think I have touched on the majority of the commitments in the long-term plan, so I will not go into details because I have come to the end of my time, but I conclude by thanking all Members who contributed, in particular the noble Baroness, Lady Parminter. I hope I have reassured noble Lords about the Government’s commitment to improving eating disorder services, that we recognise the devastating impact of eating disorders and that we want to ensure that all those with eating disorders can access high-quality and vital mental health support much earlier, because we understand the impact this can have.

House adjourned at 8 pm.

Paterson Inquiry

Baroness Blackwood of North Oxford Excerpts

Tuesday 4th 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 honourable friend the Minister for Mental Health, Suicide Prevention and Patient Safety regarding the Paterson inquiry. The Statement is as follows:

“This morning, the independent inquiry into the issues raised by the disgraced surgeon Ian Paterson published its report. The inquiry was tasked with reviewing the circumstances surrounding the jailed surgeon’s malpractice that affected so many patients in the most appalling way. As the report states, between 1997 and 2011, Paterson saw 6,617 patients, of whom 4,077 underwent a surgical procedure in the independent sector; and between 1998 and 2011, Paterson saw 4,424 patients at HEFT, of whom 1,207 underwent a mastectomy.

The report contains a shocking and sobering analysis of the circumstances surrounding Ian Paterson’s malpractice. It sets out the failures in the NHS, the independent sector and the regulatory and indemnity systems. As a result of these failures, patients suffered unnecessary harm. Their testimonies in the report make harrowing and appalling reading and, as such, it is with deep regret that we acknowledge the failure of the entire healthcare system to protect patients from Ian Paterson’s malpractice and to remedy the harms.

Nothing that I say today can lessen the horrendous suffering that patients and their families experienced and continue to go through. I can only start to imagine the sense of violation and betrayal of patients who put their trust in Ian Paterson when they were at their most vulnerable. That the inquiry reports today, World Cancer Day, makes this all the more poignant, and I apologise on behalf of the Government and the NHS for what happened, not least that Ian Paterson was able to practise unchecked for so long.

I would also like to pay tribute to the bravery of all those former patients who came forward to tell their stories to the inquiry and whose anonymised accounts have been recorded in the report. I know that this will make for difficult reading, as it highlights the human cost of our failure to detect and put a stop to Ian Paterson’s malpractice. A catalogue of failings resulted in harm to thousands of patients, causing devastation to countless lives. Some of these patients were let down several times, not least by the providers and the regulatory system that should have protected them, and by the failure of the medical indemnity system to provide any kind of redress at the first time of asking.

From the outset, Bishop Graham wanted patients and their families to be central to the inquiry’s work and to be heard. It was right, therefore, that patients and their families saw the report first—early this morning, shortly before it was presented to Parliament. Two aspects of the report are particularly striking: that the various regulatory bodies failed in their main tasks; and the absence of curiosity on the part of those in positions of authority in the healthcare providers, in the face of concerns voiced by other health professionals.

The report presents a tangled set of processes. Accountability was not exercised when it should have been, and some of the problems arose from not following through on established procedures, as opposed to insufficient procedures being in place, so we must take full responsibility for what happened in the past if we are to provide reassurance to patients about their protection in the future. I am therefore grateful that the suite of recommendations based on the patient journey presents a route map to government. The recommendations are extremely sensible and we will study them in detail; I can promise the House a full response in a few months’ time. That response will need to consider the answers to some very important questions that cut right across the healthcare sector. Unequivocally, regardless of where patients are treated and how their care is funded, all patients should be confident that the care they receive is safe and meets the highest standards, with appropriate protections, and that they are supported by clinicians to make informed decisions about the most appropriate course of care.

I am also very aware that it is not the first time that regulatory failure has been highlighted in an inquiry report. We have done much to make the NHS a safer system in recent years: revalidation, a reformed CQC and the work by the Independent Healthcare Providers Network to establish a medical practitioners assurance framework to oversee medical practitioners in the independent acute sector. However, in the case of Ian Paterson, the system did not work for patients and recent events at Spire show that there are still serious problems to address.

Patient safety is a continual process of vigilance and improvement. The inquiry does not jump to a demand for the NHS and the independent sector to invent multiple new processes, but to actually get the basics right, to implement existing processes and for all professional people to behave better and to take responsibility.

Last summer, NHSE/I published a new patient safety strategy, led by the national patient safety director, Dr Aidan Fowler. It focused on better culture, systems and regulation—very sensible but familiar words; all things that today’s inquiry says were not delivered. What we need now is action across the NHS and its regulatory bodies, and the same determination to change the independent sector.

We are absolutely committed to ensuring that lessons are learned and acted on from the findings of this shocking inquiry, in the interests of enhancing patient protection and safety in both the NHS and the independent sector. For today, I apologise again on behalf of the Government and the NHS, and send my heartfelt sympathy to the patients and their families for the suffering they have endured.”

--- Later in debate ---

[Baroness Brinton (LD)]

My Lords, I echo the points just made about the speed of the Government’s reporting. It is extremely helpful that the Minister in another place apologised clearly for the failures in the system and paid tribute to the victims. I too pay tribute to them and their families for their tenacity over many years, when it was clear that something was going wrong but the people who were in a position to gather information and do something chose not to.

The Statement says:

“I can promise the House a full response in a few months’ time.”


This public inquiry has rightly taken two years—it was slightly delayed by the general election and purdah—but it was clear in 2017 what many of the issues were. The excellent report from the Centre for Health and the Public Interest published in November 2017 entitled No Safety Without Liability: Reforming Private Hospitals in England after the Ian Paterson Scandal set out in a slightly different format many of the recommendations in front of us. I am sure that the Department of Health, the NHS and the independent hospitals will have looked at those recommendations.

I ask the Minister right up front: how long will it take before recommendations come back to the House from the Government on where they want to take things? After all, we have a Bill that is almost ready to go—or perhaps, as I said yesterday on the Second Reading of the Birmingham Commonwealth Games Bill, Groundhog Day is coming around again for us. Let us use that opportunity, at the very least, to remedy the obvious shortfalls in the system.

One of our major concerns is regulation of indemnity procedures for healthcare. There are serious shortcomings that must be dealt with as soon as possible. I was extremely concerned to read in the recommendations about the arrangements private hospitals have with clinicians to carry out their own activities that are rather like self-employed contractors almost renting an out-patient desk and in-patient beds. That is similar to renting a barber’s seat but without the overseeing regulations you need when people’s lives and health are absolutely at risk. That must be managed immediately.

Independent hospitals must take responsibility for their actions, so it is good that one of the key recommendations tries to focus minds on filling the gap between responsibility and liability. The report from CHPI two years ago said that this was vital and that independent hospitals must employ doctors and healthcare professionals, because without that responsibility on their behalf they will continue to wriggle out of liabilities and choose not to monitor clinical practice, missing either ill-meaning or incompetent surgeons. That cannot happen in the NHS and trusts have to take responsibility, as they do when things come to light. This hole in the current system needs to be remedied swiftly.

The inquiry also makes the important point that boards must apologise meaningfully and as early as possible. The UK health system, whether NHS or independent, has an extremely poor record of apologising, or of even commenting at all. Worse, it often tries to bury problems, denying whistleblowers any access. I am afraid that this is part of the systematic culture exposed in this very important inquiry—one that fears liability above apology and, equally importantly, does not learn well from mistakes, especially if through malpractice.

It is shocking that patients were often not guided to the Parliamentary and Health Service Ombudsman or the Independent Sector Complaints Adjudication Service. Compare that with the Financial Ombudsman Service: financial services companies must signpost access to the ombudsman at every step of the way when people buy financial products. A financial service problem could result in a loss of money, but a medical problem could end up changing lives for ever, as in the Paterson cases, so when will the Government deal with this issue? Will there be compulsory signposting for patients and clarity over whether all independent hospitals have to sign up to an independent complaints adjudicator—preferably just one, but I understood from what the Minister said in another place that they cannot regulate the independent sector completely? Frankly, as far as healthcare is concerned, my party believes we should.

Once again, the Paterson case demonstrates the need for effective whistleblowing processes. Will the Government commit to an office of the whistleblower to, through legislation, give more protection to patients, whether they are in the NHS or the independent sector? Spire Healthcare has said that it has put more measures in place to encourage staff and patients to speak out since the Paterson case, but even the Statement refers to there still being problems in Spire Healthcare. This just demonstrates that this is not working. Paterson’s victims are very clear: we need a system within the NHS that protects patients and staff. That is equally true of the independent sector.

I end by repeating my initial question: can we please have a timetable for the Government to come back to Parliament with proposed changes, given that a Bill is waiting that could easily be amended for both Houses to attend to speedily?

[Baroness Blackwood of North Oxford]

My Lords, I thank the noble Baronesses for those very important questions on this very serious inquiry. I will try to respond to as many as I can in detail, bearing in mind that the Government are carefully considering the recommendations on an issue that deserves serious consideration.

I will reply first to the question on the Government’s responsibility for the independent sector. As I stated, patients in England have a right to safe and proper healthcare regardless of where it is provided and how it is funded. We are committed to ensuring that public and private sector providers adopt proper measures for protection of their patients, as was rightly raised by the noble Baroness, Lady Brinton. As she said, following a CQC report on acute care in the independent sector, my right honourable friend Jeremy Hunt wrote to the NHS Partners Network and chief executives, seeking their co-operation on a range of safety and quality issues, which will be followed up. Further, the independent sector has published a medical practitioner framework requiring consultants’ practising privilege to be reviewed regularly. Furthermore, the regulatory system has evolved since Paterson was practising, with fundamental standards of care, intelligence-led inspections and greater scrutiny of clinical governance as part of the well-led domain. However, this report is a rightful challenge to us to take a more strategic approach, and to regulate smarter and not harder when problems arise so that we can make sure these issues do not arise.

I would like in particular to pick up on the point made by the noble Baroness, Lady Brinton, that it is vital that the NHS has excellent directors to ensure that it can deliver the right standard of care. The Government have accepted in principle recommendations 1 and 2 of the Kark review,

“to develop specified standards of competence that all directors who sit on the board of any health-providing organisation should meet, and to create a central database of directors.”

The noble Baroness, Lady Harding, the chair of NHS Improvement, is taking this work forward as part of the people plan. This should also improve the standards available.

I must make the point that Paterson is in jail. This demonstrates that action has been taken. We have moved further from where we were. The GMC introduced revalidation in 2012 and the CQC started inspecting the independent sector in 2014. However, we will never be complacent because we recognise that there is much more to do, as the report makes clear. The staff and clinicians need to be more open, as has been stated. That is one reason why we introduced the 500 “freedom to speak up” guardians in 2015. When we speak to people, we know earlier where there are problems. As the inquiry says, we need better systems. I will go back to the national guardian, Henrietta Hughes, to ensure that she is as supported as possible in making these systems work effectively.

Regarding indemnity products, we understand how important it is, not only that patients are able to obtain compensation but that the process for assessing that compensation is easy to understand. We are considering this carefully as part of the response, and whether regulation is an appropriate means of addressing concerns about the indemnity cover of health professionals not covered by a state-backed scheme. This includes the consideration of clarity for patients seeking redress. I hope this reassures the noble Baroness.

There are widespread considerations about how cosmetic procedures not currently covered by the CQC are regulated. I hope I have answered most of the questions. We also recognise that while ISCAS is a second line of complaints system for independent patients, it may not be working for PPUs in the NHS. We will be considering that as part of our response. As for the timeframe for that response, we are looking at a three-month window, but want to ensure that we respond appropriately, carefully taking into account the points raised. As pointed out by the noble Baronesses, there are some quite knotty questions to take into account, which may require regulatory or even legislative responses. We must ensure that we get that right and respond in an appropriate timeframe.

The one further point to put into the mix is that it is still appropriate to take into account that there are many good-quality care providers in the private sector, so NHS commissioning through those providers is still appropriate. We must ensure that the regulatory system works in an appropriate manner and that, where there are concerns, people feel free to speak up and action is taken to protect any patients who may be at risk.

[Lord Ribeiro (Con)]

My Lords, as a past president of the Royal College of Surgeons, I wish to associate myself with the comments of the current president, Professor Derek Alderson. In response to the report, he said:

“The horrific experience of patients at Paterson’s hands is laid bare in today’s report. The healthcare system has failed hundreds of patients and their families, and we must learn from what went wrong. Following their thorough investigation, we welcome the inquiry’s recommendations today, designed to improve patient safety.


We have repeatedly called for the same safety standards to be enforced across both the NHS and private healthcare sector. The inquiry has also stressed this and agreed with our recommendation that a single repository of information about consultants’ practice should be created. We recommended this in our evidence to the inquiry because it allows the NHS and private sector to share information and raise any concerns about patient safety much more quickly.”


When the Bill comes before us, we will be discussing the health service safety investigation body—HSSIB. Can the Minister say whether, in the light of the Paterson inquiry, the Bill might be amended to ensure that HSSIB has the power to investigate all patient safety incidents that occur in the independent private sector as well as in the NHS, not just NHS patients referred to the private sector?

In his introduction, Bishop Graham says:

“It is wishful thinking that this could not happen again.”


Well, this week the British Medical Journal reports on an orthopaedic shoulder surgeon working in the same Spire Parkway Hospital who has had 217 patients recalled because of concerns about his practice. A solicitor for the patients involved said:

“The main concern seems to be that people were having unnecessary surgery under general anaesthetic.”


There are echoes of Paterson’s behaviour. Another recall at the same hospital suggests systemic failings. Given the outcome of the Paterson inquiry, which showed that lessons have still to be learned, how can we ensure that these lessons are learned?

[Baroness Blackwood of North Oxford]

I thank my noble friend for that question, and for his important contribution. He is of course very experienced in this area. Obviously we are looking for time in the legislative agenda to bring forward HSSIB. It is appropriate that we consider the patient safety elements of this report’s recommendations in the context of that Bill. In the previous Second Reading debate, which we look forward to repeating, we discussed the issues around the independent sector. But we will also separately, and perhaps in conjunction with that, consult on the key changes necessary to enable data on admitted patient care to be transferred from the Private Healthcare Information Network and independent providers directly to NHS Digital, which should start to take us in the direction of closing the gap, which I know that many noble Lords in the House are rightly concerned about.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare an interest as a board member of the GMC. I also chaired the Heart of England Foundation Trust from 2011 to 2014. Mr Paterson worked for the trust as well as in the private sector hospital that the Minister mentioned. I would like to add my personal apology to that of the Minister to the patients and families for the suffering that they endured. Mr Paterson was suspended shortly after I became chairman and we instituted Sir Ian Kennedy’s review. We now have a second inquiry and I pay tribute to Bishop Graham for his work. I have only had the chance to read the Statement quickly, but it seems a thorough piece of work and has many far-reaching lessons and recommendations for the health service.

I have a couple of suggestions for the Minister. First, one of the recommendations is around the way that regulators work together, or not. At the moment, legislation is rather out of date and sometimes gets in the way of collaborative working, although one should never use that as an excuse. As part of the legislative review, I wondered whether the need for reform of the whole regulatory system will be kept closely under review.

Secondly, I want to follow the Minister on this issue of NHS bodies being reluctant to own up to things that have gone wrong because of the potential legal liability. I have discussed this with bodies at the national level and they all say that that is nonsense and organisations should not fear apologising, but it is heavily in the culture of the NHS not to apologise because of potential liability. As part of the consideration of these recommendations, I suggest that the Government seriously look at giving an explicit statement to the NHS on the facts of this and encourage those working in the NHS always to be open about things that have gone wrong.

[Baroness Blackwood of North Oxford]

I thank the noble Lord for that important and knowledgeable contribution. His point about the sharing of lessons between regulators was well made. Part of the reason for proposing HSSIB is for systemic learning of lessons that might otherwise not be available because an inquiry might happen in one trust or group of trusts and lessons might not transfer across the entire system. The whole principle of HSSIB is cross-system learning. We already have evidence that that is working.

Furthermore, the principles at the heart of the patient safety agenda that my right honourable friend Jeremy Hunt put in place were to embed a culture of learning and not blame within the NHS so that apologies can be forthcoming. We have some way to go in achieving that change of culture, but the noble Lord is quite right that leadership starts from the top and having the right statements is a good start. The principles around the place of safety, the protection of whistleblowers and allowing people to come forward and say when they think that things are going wrong without fear of retribution are steps in the right direction. The right action after that is transparency and the recommendations in this report about transparency lead to the right actions being taken from that point.

Coronavirus

Baroness Blackwood of North Oxford Excerpts

Monday 3rd 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:

“On Friday, the Chief Medical Officer announced that two patients in England who are members of the same family tested positive for coronavirus. They were transferred to a specialist unit in Newcastle, where they are being cared for by expert staff. Public Health England is now contacting people who had close contact with these two confirmed cases. Close contacts will be given health advice about symptoms and emergency contact details to use, should they become unwell in the next 14 days. These tried and tested methods of infection control will ensure that we minimise the risk to the public.

On Friday, a Foreign Office-chartered aircraft carrying 83 British nationals left Wuhan for the United Kingdom, and I thank all those involved in this operation, including staff at my own department, the Foreign Office, Border Force, the Ministry of Defence and military medics, as well as all the NHS staff, officials at Public Health England and many more who have worked 24/7 on our response so far.

Yesterday, we brought back a further 11 people via France, and returned UK nationals have been transferred to off-site accommodation within the NHS at Arrowe Park Hospital on the Wirral, where they will spend 14 days in supported quarantine as a precautionary measure. I thank all the staff there who have done so much to make this possible. There, they will have access to a specialist medical team who will regularly assess their symptoms. In addition, one British national has been taken to a separate NHS facility for testing.

We will take a belt-and-braces approach that puts public protection as the absolute top priority for a virus that is increasingly spreading across the world. As of today, there are more than 17,000 diagnosed cases in mainland China, with a further 185 in other countries, including France, Germany and the United States. There have been 362 fatalities so far. The World Health Organization has now declared the situation a public health emergency of international concern, and the UK Chief Medical Officers have raised the risk in the UK from low to moderate. We are working closely with the WHO and international partners to ensure that we are ready for all eventualities.

Health Ministers from G7 countries spoke this afternoon, and we agreed to co-ordinate our evidence and response wherever possible. The number of cases is currently doubling around every five days, and it is clear that the virus will be with us for at least some months to come; this is a marathon, not a sprint. On existing evidence, most cases are mild and most people recover. Nevertheless, anyone who has travelled from Wuhan or Hubei province in the last 14 days should immediately contact NHS 111 to inform it of recent travel, and should stay indoors and avoid contact with other people, just as they would with flu, even if there are no symptoms. Anyone who has travelled to the UK from mainland China in the last 14 days and is experiencing a cough, fever or shortness of breath should self-isolate and call NHS 111, even if symptoms are mild.

We will do all we can to tackle this virus. We are one of the first countries in the world to develop a new test for the virus. Testing worldwide is being done on equipment designed right here in the UK, in Oxford, and today I am making £20 million available to the Coalition for Epidemic Preparedness Innovations to speed up development of a vaccine. I can also announce that Public Health England has sequenced the viral genome from the first two positive cases in the UK and is today making that sequence available to the scientific community. Its findings suggest that the virus has not evolved in the last month. We have also launched a public information campaign, setting out how every member of the public, including Members of this House, can help by taking simple steps to minimise the risk to themselves and their families: washing hands and using tissues when they sneeze, just as they would with flu. That goes for all of us.

We remain vigilant and determined to tackle this virus, with well-developed plans in place. I commend this Statement to the House.”

--- Later in debate ---

[Baroness Brinton (LD)]

I echo the thanks to medics, staff involved in logistics and especially the scientists working so rapidly to sequence the genome of the coronavirus. I support many of the points made by the noble Baroness, Lady Wheeler.

Our concerns are more about some of the very practical arrangements and the fact that the UK seems to be responding 24 or 48 hours behind some other countries. I note the Statement says that

“anyone who has travelled from Wuhan or Hubei province in the last 14 days should immediately contact NHS 111 to inform it of recent travel.”

It also says:

“Anyone who has travelled to the UK from mainland China in the past 14 days and is experiencing a cough, fever or shortness of breath should self-isolate”.


It is interesting that the Philippines, New Zealand, the USA, Singapore and Australia are now barring all foreign nationals from mainland China from entering their countries at all. I know that the World Health Organization is not yet saying that we should follow that, but I noticed that a report at the weekend said that about 340-odd people had come in from Wuhan just before the arrangements were put in place and that the Department of Health was now trying to track these people. Given that we now know that the disease can infect people prior to symptoms emerging, has the Department of Health been able to identify those people who arrived prior to the Government’s arrangements being put in place? Do the Government now have absolutely clear procedures to identify people coming not just from Wuhan and Hubei province but from mainland China so that they can contact them urgently if there are issues? Is everyone travelling in from China getting specific advice about who to contact and what to do?

Finally, what are the numbers of cases in regions outside Hubei? The press is reporting that at least 24 provinces, municipalities and regions in China have now told businesses not to resume work before 10 February at the very earliest. These account for 90% of exports from China. Given that many of our businesses rely on just-in-time manufacturing, I wondered whether the Government were assessing what the impact on our businesses would be if there was a gap in production and exports from China.

[Baroness Blackwood of North Oxford]

I thank the noble Baronesses for their comments and very relevant questions. The UK is of course very well prepared for these types of outbreaks. We have responded extremely well on previous occasions, so we should have confidence not only in the capability of Public Health England and the NHS to respond, but in the ability of our chief medical officers to assess the level of risk, which speaks to the point the noble Baroness, Lady Brinton, made about the pace and types of responses being put in place. This is clear medical advice based on the evidence and data available.

The advice available for travellers is obviously being kept under constant review and it has changed. Currently, there is advice against all travel to Hubei province and all but essential travel to mainland China. Essential monitoring has been put in place for all incoming flights from Hubei province, and for wider travel too. Public health officials are meeting all those flights and advice is being given as outlined in the Statement.

Rightly, a question was raised about the risk to the health workers who respond, as this is a virus that is spread by contact. Obviously, this speaks to the capabilities of NHS expert teams, who are accustomed to responding to any risk. As well as the expertise they already have, advice is being communicated from the CMO and others. The NHS expert teams are with every ambulance service and are in a number of specialist hospital units, where equipment and highly trained staff are ready to receive and care for patients with any highly infectious diseases. We have also provided an extra service on NHS 111, for public health advisers to triage people with specific queries or symptoms who have travelled from the region, so that they get to the right point. I hope that answers the question.

On the question of information to NHS staff across the system, a tripartite letter has been issued by the CMO, the NHS medical director and the director for the National Infection Service and PHE to all front-line clinical staff, so that they are aware how to respond and what steps to take when encountering patients arrived from overseas with respiratory infections. This was updated on 31 January in the light of the WHO’s declaration of PHEIC. I think we can be reassured on that point.

It is absolutely right that the evidence shows that the mortality rate of between 2% and 3% is mostly for older patients and those with pre-existing conditions. That is part of the data and the evidence which has been given to the NHS so that it knows how to provide appropriate care.

I would like to respond to the questions raised regarding the care provided for the confirmed cases. Public Health England is making good progress in identifying and contacting anyone who has been in close contact with those two confirmed cases. Thorough investigations will continue, to ensure that we take all possible actions to identify anyone who has come into close contact with them. They will be given health advice about symptoms, and emergency contact details to use if they become unwell within the 14 days. This is based on the CMO’s advice about tried and tested methods. Additionally, we are pursuing wider contact tracing across the country for all who have come in from Wuhan. We are confident in the progress that we are making.

Finally, I turn to the questions regarding vaccines. As I noted in the Statement, the Government have pledged £20 million to develop new vaccines to help to combat the world’s deadliest diseases. This will support work developing new vaccines for epidemics and includes three new programmes to develop vaccines against novel coronavirus. The project aims to advance vaccine candidates into clinical testing as quickly as possible. I cannot give an exact timeline to the noble Baroness today, but I shall endeavour to get her as much information as possible. I am sure that we shall have more discussion on these issues as we go through this, but I hope that I have answered her main questions. If I have missed anything, I will be very happy to write.

[Lord Birt (CB)]

My Lords, the Minister said that we were well prepared for this outbreak, but quite honestly it does not altogether appear so. We saw reports in the media of the first flights arriving from Wuhan. The passengers reported that there was no medical intervention and no advice offered of the kind that is in the Minister’s Statement. We are now asking people who have arrived in the last 14 days to contact the NHS immediately to inform them of recent travel, to stay indoors and to avoid contact. That advice was not offered to the first people who arrived. The delayed FCO chartered flight this week has quarantined people for 14 days, as we all know. These actions appear inconsistent. Can the Minister assure us that they are consistent and that there is some coherence and rationale behind them? There does not appear to be.

[Baroness Blackwood of North Oxford]

There is indeed. The first Urgent Question I replied to a few days ago was when we introduced the enhanced monitoring on planes, meeting each flight coming into Heathrow from Wuhan; they come in three times a week. That information and advice was given to individuals on those flights and public health officials met them from that day. If individuals came in before that day, they would not have received advice; contact tracing has been under way for those people. Subsequently, British nationals wishing to return home have been in contact with the Foreign Office and flights have been arranged to bring them home. I think that is the flight which the noble Lord is referring to. As a precautionary measure, quarantine has been arranged for those individuals for 14 days, to ensure that we manage any potential risk as effectively as possible. This is based on the advice of the Chief Medical Officer, from the data which has subsequently become available, since evidence is evolving regarding the risks associated with the Wuhan coronavirus.

[Lord Lea of Crondall (Non-Afl)]

It may seem rather indelicate at this stage to talk about the wider economic impact within China and on Chinese trade with the rest of the world, but, as was mentioned in Questions earlier, might it be useful if that dimension was included in future reports? A lot of businesspeople will be putting off trips and so on. There may need to be new lines of credit, especially at the present juncture. Of course, in China everything is coming to a halt in terms of internal transport and so forth. To show our interest in what we might call the economic and social developments in China, would it be useful to have some reporting on how the rest of the world is dealing with all these other non-medical dimensions? I think the Chinese and a lot of our businesspeople would appreciate that so that we do not jump the gun. People will be desperate to get back to business, which is not yet timely.

[Baroness Blackwood of North Oxford]

The noble Lord will not be surprised to hear that it is important to put the public health response first and foremost when it comes to a risk of this kind, and that is exactly what is happening in this case. The actions that the UK has taken in this regard have been appropriate, proportionate and commensurate with the data and evidence that have come forward, and they are based on clinical evidence. Having said that, he is absolutely right that an economic impact as a result of quarantine measures taken by China and others cannot be avoided, and it is right that we should consider the impact for UK businesses. I am sure that consideration will be given to what can be done about that.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister define what she means by mainland China? I asked a question about Hong Kong last week and I note from the Foreign Office website that the Hong Kong Government have announced that all border crossings with mainline China will close at midnight tonight, Hong Kong time, which is an excellent idea in terms of containment. I am also aware that people who work for international companies in Hong Kong have been told to work from home for a minimum of two weeks from last Friday—three days ago. What will we do about people coming to our borders from Hong Kong in the immediate future?

[Baroness Blackwood of North Oxford]

The noble Baroness asked that question last time and I did not forget. At the moment, Foreign Office travel advice is that anyone who has travelled to the UK from anywhere in China other than Wuhan or Hubei province, but not including Macau and Hong Kong, in the past 14 days and has developed symptoms should immediately self-isolate, even if symptoms are minor, and call NHS 111. Macau and Hong Kong are not included because those territories do not have evidence of sustained community transmission, as has been observed in mainland China, to date. They are therefore not currently included in the same travel advice as mainland China. However, the epidemiological situation in Hong Kong and Macau, as indeed in the rest of the region, is kept under constant review and will be considered in travel advice as we go forward, and reported to this House accordingly.

[Baroness Finlay of Llandaff (CB)]

My Lords, I am most grateful, as is everybody, to the Minister for updating us. She spoke about person-to-person transmission not having occurred in Hong Kong and those other areas. Will she confirm that to date there has been no evidence of person-to-person transmission outside China? That is, it has come from contact within China and people who have the virus leaving China. Do we have that information?

Also, in modelling for the worst-case scenario that might occur, how many negative pressure room beds do we have across the whole of the UK for those patients who develop severe acute respiratory infection and therefore have to be hospitalised and possibly ventilated in the event of this becoming severe? What evidence is there about the length of time that the virus survives on different surfaces outside the body? Because of the incubation and asymptomatic periods, when it appears that people are still infectious, there is a concern that the virus has quite a long survival time on surfaces, particularly those that may be warm and damp.

[Baroness Blackwood of North Oxford]

There were a few questions there. With regard to transmission, this is an evolving picture, so the best thing would be for me to send the most up-to-date information to the noble Baroness and put a copy in the Library, as I am sure it will be of interest to the whole House.

On ECMO beds, since April 2013, NHS England has commissioned a total of 15 adult respiratory ECMO beds from five providers in England. There is further provision in Scotland. But in periods of high demand, the capacity can be increased. For example, in the winter of 2018-19, when there was a significant risk associated with flu, the capacity was increased to over 30 beds and similar arrangements are in place for paediatric services. In addition, there are eight commissioned high-consequence infectious disease beds and around 500 infectious disease beds, and at the moment NHS England is confident that it has enough capacity, which I hope is reassuring for the noble Baroness. Obviously, we are keeping that under constant review as the situation evolves.

On the question about surfaces, that is one of the specific reasons why advice has been given regarding personal hygiene—washing hands and using tissues when sneezing—to avoid any forms of transmission that may create the kind of risks referred to by the noble Baroness.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, when the Minister repeated the Statement, she referred to the precautionary measures that people are being invited to remember when trying not to pass on infection. If I recall, the Statement said something to the effect of “as you would normally do with flu”. But does the Minister agree that that is not what people normally do with flu? People often do not take the symptoms seriously and transmit it before they have even decided to give into it themselves. I have one germane example in this context. A member of my family contracted flu a couple of months ago which became pneumonia, although fortunately not a serious case. He was advised to go to his GP and the GP referred him to A&E where he waited a long time with a lot of other people in what was clearly a highly infectious state.

Given the stringency of the measures taken to contain coronavirus, can the Minister say what wider public health lessons we might take from this in giving consistent messages to prevent people imagining that flu is a minor illness and it does not matter if you continue going to work or pass it on to other people? It does matter, and the mortality rate among vulnerable groups with flu can be quite high, as the Minister will know.

[Baroness Blackwood of North Oxford]

The noble Baroness has rightly raised this issue with me before. She is quite right that flu can and should be managed much more effectively in the community and by individuals. I think we have had an effective flu campaign this year. The flu vaccine has been offered to 25 million people. We have also extended the flu programme this year to children in year 6 to improve herd immunity and drive up its impact. We are seeing the number of those with flu declining, so we are starting to see some improvement. However, I completely recognise the noble Baroness’s point about public health lessons and improving public education on the management of infectious conditions, which we live with every winter, not just when we have an infectious situation such as this. I thank the noble Baroness for an important question.

[Lord Patel (CB)]

My Lords, in my view the measures the Government have taken are balanced so as not to cause a panic and unnecessary alarm. The important thing, though, is that the Government remain on top of developments. If the virus mutates and spreads rapidly from human to human, it will require much more draconian measures to be taken.

It has been reported that the virus transmits from human to human and to people who have not been in China, although the numbers are small. An index or measure of human-to-human transfer is known as R0. It currently stands at about 1 to 2. If it increases, that means the virus is spreading faster. Sequencing of all the known cases so far suggests that the virus has not mutated. It remains 99.98% the same sequence, including in the two patients known in the United Kingdom. I hope the Government have a strategy in place to keep on top of developments and that they will take the steps required to stop the spread.

[Baroness Blackwood of North Oxford]

I thank the noble Lord. He is right that there is a global effort to keep on top of the sequencing of the virus to track any evolution of it. As he said, the indications are that the virus has not evolved in the past month, which is encouraging. The rate of transmission is as reported. That means that the infection control measures in place, which are based on clinical evidence and the data, are proportionate and appropriate. Combined with the public health advice that has come out and the contributions each of us can make as individuals to manage the spread of infection, we believe that this is the responsible and appropriate route. However, as the noble Lord said, we will keep the developing situation under a close eye so that we can respond quickly and nimbly as the situation goes forward.

Nursing and Midwifery

Baroness Blackwood of North Oxford Excerpts

Thursday 30th January 2020 Lords Chamber

[Lord Crisp]

To ask Her Majesty’s Government what plans they have to celebrate Florence Nightingale’s bicentenary and the World Health Organization’s Year of the Nurse and the Midwife in 2020.

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

My Lords, the Government are working with the Chief Nursing Officer for England on plans to celebrate the bicentenary of Florence Nightingale and those in the nursing professions. Plans includes supporting the Nursing Now campaign across the NHS in England. The Chief Nursing Officer is also working in partnership with the Florence Nightingale Foundation to plan many activities, culminating in an international conference organised by the foundation and the Burdett Trust for Nursing in October 2020.

[Lord Crisp (CB)]

My Lords, I thank the Minister for that reply. This year is a chance to celebrate the legacy of great nurses and midwives of the past such as Florence Nightingale, notably, but also great figures such as Mary Seacole and others in this country and elsewhere. It is also a chance to celebrate today’s nurses and midwives, and thank them for what they do. In passing, I am delighted to be wearing a piece of the new nursing tartan, designed by Scottish nurses and commissioned just last month. However, this is also an opportunity to look again at nursing and midwifery, recognising how far the professions have developed in recent years and that they perform a very wide range of roles, all with customary care and compassion.

Nurses are true health professionals in their own right, no longer handmaidens to doctors—if they ever were—and have the potential in the future to do even more. With that in mind, I ask the Minister two questions. First, what plans do the Government have for investing in training and increasing the numbers of advanced nurse practitioners? Secondly, what plans do they have for reversing the decline in community nurses, school nurses and health visitors in this country, who will play such a vital role as services move more towards the community?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his important question. I am envious of his tartan and I definitely identify with his praise for nurses, who work long hours and serve the most vulnerable at the moments of their greatest need. To answer his specific questions, as part of the NHS people plan, we are committed to supporting career development for nurses, which includes supporting a diverse range of careers. An example would be the advanced practitioners within multi-professional teams. This is an important point that the noble Lord raises. We are also developing a plan for district and community nurses to work with healthcare providers, practitioners and higher education institutions. The plan will set out how we will grow the community nursing workforce, which includes mental health and learning disability nurses, and it is expected to be published later this year.

[Lord Forsyth of Drumlean (Con)]

My Lords, might my noble friend not mark this important bicentenary by enabling those nurses who have been in the profession for, say, five or 10 years to have their student loans written off, given that the cost to the taxpayer of not doing so will be greater? The write-off in 30 years’ time for the taxpayer will be £1.2 trillion in cash terms, so why not help the profession and the taxpayer by doing this now?

[Baroness Blackwood of North Oxford]

The noble Lord has made this point before and I have taken it back to the department before. He will know that we are providing additional financial support to nurses, including the maintenance grant of £5,000 in non-repayable funding, with specific targeted support of £3,000. However, I am very happy to take back his proposal once again, as we have an upcoming Budget.

[Baroness O’Neill of Bengarve (CB)]

My Lords, is the Minister aware that the Royal Statistical Society is celebrating the election of its first woman fellow, Florence Nightingale, and that nurses play a very considerable part in the collection and processing of data that matter for public health, and all our health?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

Yes, indeed. As the noble Baroness will know, Florence Nightingale was perhaps one of the earliest and most notable statisticians. She is a great role model for those young women who wish to go into STEM careers. One way in which we wish to mark this bicentenary is with the Nightingale Challenge, which calls for every employer of nurses globally to provide leadership and development training for young nurses and midwives in 2020. The aim is to have at least 20,000 nurses benefiting from it in 2020, with at least 100 employers taking part.

[Baroness Brinton (LD)]

My Lords, it is right that we have congratulated nurses and celebrate them but it is also the year of the midwife. It is important that we celebrate the progression in midwifery. Midwives are often much less publicised for the work they do within the community. What plans are there for celebrating midwifery specifically during this year?

[Baroness Blackwood of North Oxford]

We are of course conscious that we need to support midwives, especially as we look to raise standards in midwifery. Specific plans are being developed by the Chief Nursing Officer, Ruth May, which will ensure that all parts of the nursing profession, including midwives, will be focused on. These will be brought forward shortly.

[The Lord Bishop of Carlisle]

My Lords, given Florence Nightingale’s genius for exploring and combining very disparate fields of study and practice, including the worlds of healthcare and faith, will Her Majesty’s Government and the Minister join me in commending the work of parish nurses, who now bring health and healing to more than 100 communities around the country, complementing the work of both the NHS and social care agencies?

[Baroness Blackwood of North Oxford]

I absolutely agree with the right reverend Prelate on this issue. He will know that the long-term plan is committed to supporting and developing community care. Parish nurses are a key part of that, but so is the development of social prescribing, which we have committed to rolling out. I know that parish nurses work hand in hand with this programme, so I am pleased to agree with the points that the right reverend Prelate has made. We will also want to think carefully about how we can support the work that he is doing.

[Lord Clark of Windermere (Lab)]

My Lords, the Minister mentioned the reimbursement of fees, which has been reintroduced. For non-mental nurse training, is this scheme as generous as that which was discontinued a couple of years ago, or do we reimburse only about 50% of the fees?

[Baroness Blackwood of North Oxford]

The scheme is more generous than the previous scheme.

[Baroness Greengross (CB)]

My Lords, until a few years ago, community nurses looked after the whole population in the area in which they worked. Lately, they have looked after only children up to the age of about five. Is it planned for them to go back to looking after the community as a whole, which is an important part of their work?

[Baroness Blackwood of North Oxford]

The noble Baroness is very knowledgeable about this. She is right that when we strengthen community practice, it is important to have a holistic approach. That is exactly what underpins the ICS having a much more joined-up approach to social care, general practice and mental health. It is what lies behind developing a holistic people plan. Such an approach will come forward when this is published.

Wuhan Novel Coronavirus: UK Citizens

Baroness Blackwood of North Oxford Excerpts

Thursday 30th January 2020 Lords Chamber

[Viscount Waverley]

To ask Her Majesty’s Government what measures are in place to contain the Wuhan novel coronavirus (WN-CoV) in the United Kingdom and what plans are in place from British citizens returning from the China and other affected areas.

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

My Lords, the NHS is always ready to provide world-class care to patients, whether they have a common illness or an infectious disease never seen here before. As a precaution, we are asking anyone in the UK who has returned from Wuhan in the last 14 days to self-isolate. The FCO is working to make available an option for British nationals to leave Hubei province.

[Viscount Waverley (CB)]

My Lords, I thank the Minister for her response and for attending the House at short notice. It is essential that the Government be robust in their messaging and that remedial actions be taken to reduce the possibility of fear through ignorance. They should consider all eventualities, including whether, in the extreme, core elements of government should be placed in lockdown. Would the Minister study and consider replicating the helpful advice that came out of the Canadian ministry of health regarding what citizenry should do in all circumstances, with dos and don’ts?

[Baroness Blackwood of North Oxford]

I am very happy to look at the advisory from the Canadian Government. I hold in high regard the CMO from that nation, whom I have met. The action that this Government have taken in putting in place enhanced measures at ports and giving advice to nationals has been proportionate but robust. So far, we can be pleased that all of the 131 cases tested for in the UK have been negative.

[Baroness Wheeler (Lab)]

My Lords, I underline the support from these Benches for the plans for organised quarantine. Both the medical evidence on the incubation period and the limited evidence of spread from people not yet showing symptoms highlight the need for this. Keeping evacuated people together is important. We also strongly support the recognition by government that dealing with this is a top priority, and give our praise and thanks to the medical, public health and NHS staff who are working hard to ensure that preparations are in place in the UK.

Can the Minister explain a little more about the evacuation arrangements and what discussions have taken place? What discussions has the UK had with the World Health Organization on difficulties with evacuation? Can the Minister advise what action the Government are taking to ensure the safety and welfare of British nationals stranded in Wuhan due to the delay in evacuation if they are unable to board a flight as they display symptoms of the virus? Those who make it on board will have to sign contracts agreeing to the 14-day quarantine at an NHS facility on their return to make sure that they do not have symptoms of the virus. What staffing resources will be available to carry out quarantine and screening procedures? What happens if various people refuse to sign the contract? Clearly, these teams will be of great importance in preventing the spread of the virus to the UK. I look forward to the Minister’s response.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her extensive questions. We are doing everything we can to get British people in Wuhan safely back to the UK. A number of countries’ flights have been unable to take off as planned. We will continue working urgently to organise the flight to the UK as soon as possible. We are working with British nationals who wish to leave and we are developing a package for them once they arrive. The plane will have medical staff on board to assess and manage the passengers; obviously, this is on the direct advice of and with support from our Chief Medical Officer, who has specific expertise in this area. A team from Public Health England and the NHS will meet passengers, and any passengers who have developed symptoms will be assessed and transferred to NHS care, as appropriate. Asymptomatic passengers will be transferred to an isolation centre; we do not want to provide details on that at this stage. We are working with the Chinese authorities to unlock the issues to allow the plane to take off.

[Baroness Manzoor (Con)]

My Lords, more than 120,000 Chinese students study in the UK. Can my noble friend the Minister say what support and advice the Government are giving to both students and universities?

[Baroness Blackwood of North Oxford]

Public Health England is doing a superb job in providing very clear advice for all those who may be concerned—either those who have relatives in China or those who feel as though they have been exposed. I encourage anybody with concerns to look to Public Health England for the most accurate and up-to-date advice; it is updated on a very regular basis. That is the place to go for the most accurate and clinically validated advice.

[Baroness Brinton (LD)]

My Lords, the Question from the noble Viscount, Lord Waverley, asked about British citizens returning from China and other affected areas. The Minister has concentrated her replies on Wuhan and Hubei province. Yesterday, Dr Michael Ryan, the executive director of the World Health Organization Health Emergencies Programme, said:

“The whole world needs to be on alert now, the whole world needs to take action and be ready for any cases that come, either from the original epicentre or from other epicentres that become established.”


What advice is being given to people coming from other countries where there are already reported cases?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right. At the moment, there are 5,974 cases in mainland China and 6,064 cases globally, and there have been 132 deaths. It is important to understand that coronavirus is a large family of viruses, ranging from the common cold to much more severe diseases, such as MERS. The data we have puts the mortality rate at about 3%, so the risk is comparatively low compared with SARS and MERS. I just want to say that at this point.

In terms of wider travel advice, the FCO is now advising against all travel to Hubei province and all non-essential travel to China, and is advising British citizens to leave if they are able to do so. Wider public health advice for those travelling around the region can be seen on the Public Health England website. It is very clear and detailed. Any further advice on travel can be seen on the Foreign Office website. We are co-ordinating very closely; indeed, there was a COBRA meeting on this issue just yesterday.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister clarify that Public Health England is working closely with the other three public health departments in the UK and is taking the lead on this for people who are returning? Further, what is our strategy for Hong Kong, where nurses have said today that they will go on strike unless the borders between mainland China and Hong Kong are closed in order to protect the population?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right: all the public health authorities across the United Kingdom will work closely together to ensure clear co-ordination, as always happens on public health issues. On Hong Kong, we will be discussing those issues through the WHO, which met yesterday to consider whether WN-CoV should be declared a public health emergency of international concern. It did not declare a PHEIC yesterday, but it will meet again. If it does declare a PHEIC, we will of course review our recommendations. However, we should be confident about the actions that we have taken. They are measured, proportionate and based on the highest level of scientific and clinical advice available at this stage of the outbreak from the Chief Medical Officer and Public Health England. We will keep the situation under continuous review and report to the House as it develops.

[Lord Woolmer of Leeds (Lab)]

My Lords, the Minister has emphasised that the arrangements will be for British citizens. If a British citizen is married to a Chinese citizen, perhaps with children who hold British passports, will the whole family, including the Chinese citizen, be eligible to come to this country?

[Baroness Blackwood of North Oxford]

We are currently holding discussions on this point and the Foreign Secretary has made representations.

[Lord Trefgarne (Con)]

My Lords, has any progress been made in developing a vaccine against this dreadful disease?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

My noble friend has raised an important point. While the UK is one of the first countries outside China to have developed a prototype laboratory test for this novel disease, there is as yet no vaccine. The WHO is co-ordinating the research effort in this area and is producing an R&D road map. As a nation we are actively involved in this because we have particular capabilities here. We will be contributing to a co-ordinated global effort not only to improve the diagnostics but to develop vaccine capabilities.

[Lord Alton of Liverpool (CB)]

My Lords, has the Minister seen the report this morning from the AFP saying that Russia has closed its borders with China? Does that not add to the need for the World Health Organization to declare this a world health emergency? Are we in discussions with it about that?

[Baroness Blackwood of North Oxford]

I think I have already made the point that we are in constant dialogue with the World Health Organization regarding all aspects of the response to this outbreak. That dialogue includes the declaration of a PHEIC, which would include a number of different elements, and the organisation is meeting on that today.

Major Trauma Centre: Westminster

Baroness Blackwood of North Oxford Excerpts

Thursday 30th January 2020 Lords Chamber

[Baroness Masham of Ilton]

To ask Her Majesty’s Government whether they have any plans to establish a major trauma centre in the immediate vicinity of Westminster to treat casualties in the event of any terrorist attack in the area.

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

My Lords, the NHS has well-tested plans and capability for responding to a terrorist attack and treating casualties. The attacks in London and Manchester in 2017 tested our capability. London has four major trauma centres where casualties will be triaged and treated, and this will include casualties from an attack in the vicinity of Westminster.

[Baroness Masham of Ilton (CB)]

My Lords, I thank the Minister for her reply. Is she aware that thousands of people come into Westminster, including tourists from all over the world, people coming to work here, the police, demonstrators and both Houses of Parliament? Are we not a special case? Would it not be very good to have a special trauma unit at St Thomas’ Hospital? When there is a lockdown, we cannot move in Westminster.

[Baroness Blackwood of North Oxford]

My Lords, I pay tribute to all the brave members of the public, the NHS and Members of this place who so often have responded incredibly bravely when terrorist attacks occur. We owe a great debt of gratitude to all those individuals who do not think of their own lives in responding to protect others.

On the noble Baroness’s specific question about our capabilities in responding to risks that occur, we have a specific arrangement that has been put forward with the trauma network. The decision about the location of the trauma centres allows full geographic coverage while ensuring that the full package of care is available for patients when they come forward, which includes treatment for burns, orthopaedic injuries and neurosurgery. I know the noble Baroness knows there are four major trauma centres located in London at St Mary’s Hospital, St George’s Hospital, the Royal London Hospital and King’s. They are all adult and children’s major trauma centres and are all approximately three miles from Westminster.

More importantly, we have specialist ambulance capability in responding wherever an attack may occur in London. We can be very proud of the response that we have seen not only from the hazardous area response teams but from the tactical response units. Those responses have been in very short order and have meant that, although these were appalling incidents, their impact was much reduced.

[Baroness Thornton (Lab)]

My Lords, a study published in the Emergency Medicine Journal found that NHS hospitals seem in many ways unprepared for terror attacks, with half the doctors unaware of emergency plans and just over one-third aware of what to do personally if a major incident is declared. I thought the Minister’s answers were brilliant and very reassuring, but what action are the Government taking to ensure that all doctors receive education on their hospital’s major incident plan as well as an abbreviated version of their own particular role?

[Baroness Blackwood of North Oxford]

The NHS develops its plans in each hospital according to the Government’s national risk register and its planning assumptions underpin this. The security services then evaluate and publish the current threat level to the UK from terrorism and the NHS is made aware of any change to this, so that it can react accordingly. In addition, we provide training for paramedics for terrorist attacks, as I have mentioned. We have the hazardous area response team, comprising specially trained personnel to provide ambulance response to particularly hazardous or challenging environments, including following a terrorist attack. London also has the tactical response unit, which is designed to work as part of a multiagency team with police and fire services to respond to firearms incidents. In the most recent attacks, the response time for paramedics was within seven minutes. We have recently agreed to increase the number of marauding terrorist attack and chemical, biological, radiological and nuclear trainee paramedic responders, and we will have a minimum of 240 responders in each ambulance trust.

[Baroness Walmsley (LD)]

My Lords, I welcome the Minister’s reassurances. Is she aware that in London last year 265 fewer members of the public attempted CPR on people nearby whose hearts had stopped? Does that not suggest that it would be more help to the people who work in and visit this building if we invited St John Ambulance to come to us again to deliver training on CPR and wider first aid interventions?

[Baroness Blackwood of North Oxford]

As ever, the noble Baroness makes a very sensible suggestion about wider CPR training. I will take up that point.

[Lord Flight (Con)]

My Lords, with the closure of the fire stations in Victoria and across the river in Lambeth, is the Minister comfortable that the firefighting support for Westminster is adequate?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

My noble friend raises an important point. Ambulance and specialist response teams have very tried-and-tested ways of working with the fire and rescue and police services to make sure that they preserve life during potential terrorist attacks. We can be very confident in that response, especially given their performance during recent events.

[Lord Jordan (Lab)]

My Lords, London has some of the finest emergency services and best-equipped trauma centres in the world. The real problem is the deadly vacuum between the terrorist attack and the arrival of paramedics. Specialist and military experts have developed citizenAID, a free app with a proven record that gives ordinary people the ability to give life-saving first aid without prior training or equipment. Will the Government promote citizenAID nationally? London needs it now, as does the Parliamentary Estate.

[Baroness Blackwood of North Oxford]

The noble Lord makes a very sensible suggestion to look at ways in which we can encourage individuals to save lives. It may be appropriate in situations other than terrorist attacks and I am happy to look into it.

[Baroness Masham of Ilton]

My Lords, many people think that St Thomas’ has a trauma centre and are very surprised when they hear that it does not.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her comment. I think I have made the point that there is a trauma network across London to ensure full coverage for trauma across the city and enable individuals to get the best trauma service, wherever they may be.

Health: Sepsis

Baroness Blackwood of North Oxford Excerpts

Wednesday 22nd January 2020 Lords Chamber

[Lord Grade of Yarmouth]

To ask Her Majesty’s Government, further to the University of Washington’s Global Burden of Disease Report, published on 16 January, what steps they are taking to address incidents of sepsis in the United Kingdom which is ranked 132 out of 195 countries for deaths caused by sepsis.

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

My Lords, over recent years the NHS has become much better at spotting and treating sepsis quickly. This means that more people are being identified as at risk of sepsis and mortality rates are falling. While we welcome this report’s attempt to advance knowledge of worldwide deaths from infection and sepsis, we are confident in our own data, which puts UK deaths from sepsis as significantly lower than reported in the study.

[Lord Grade of Yarmouth (Con)]

I thank my noble friend for that Answer. The House will not need reminding that some 50,000 people a year die in this country from sepsis, far too many of them unnecessarily. I declare my interest as an unpaid adviser to the UK Sepsis Trust, which has done remarkable work to improve awareness. Members of the trust, including clinicians and so on, have had many meetings at different levels within the department, begging for a registry of all sepsis cases in the UK. We have had a very sympathetic hearing but it is a bit like dealing with the laundry— nothing ever comes back. Can the Government make a commitment to introduce a registry which will help greatly to improve the targeting of the right antibiotics for the right cases?

[Baroness Blackwood of North Oxford]

I thank my noble friend for this Question and I pay tribute to his work on it, and the work of the UK Sepsis Trust. I am aware of the calls for a national sepsis registry for patients. It is important that we understand the data; we are confident that it provides an accurate indication. We think that UK data is as good as it can be at the moment but that there is a clear need for better data on sepsis. The problem with the registry as proposed is that it would use retrospective data collection. We want to go beyond this with the UK’s five-year national action plan for AMR, which includes a commitment to develop the real-time patient-level data of individual patients for infection, treatment and resistance history. Work is already under way by NHS England and NHS Improvement. I hope that is the kind of answer my noble friend was looking for.

[Lord Patel (CB)]

My Lords, as a country our record for the number of deaths due to sepsis is pretty abysmal, as stated already. Most of that is due to late diagnosis of sepsis. One-third of patients die and for every hour that a diagnosis is delayed, the death rate rises by 8%. Last year, on a visit to a biotechnical company in Northern Ireland, the Secretary of State commended the development of a quick diagnostic test, which will give a result within two hours so as to start appropriate antibiotics. Will the Government make a commitment that when this molecular test is available, which is likely to be soon, it will be immediately available to the whole of the NHS?

[Baroness Blackwood of North Oxford]

The noble Lord, as always, speaks with great expertise in this area. I emphasise the work that has been ongoing to improve the picture on sepsis. Since 2015, screening for sepsis in emergency departments has improved from 52% to 89% and timely treatment for sepsis from 49% to 76%, but the noble Lord is absolutely right that we need to improve the outcomes. Early and accurate diagnosis is at the heart of this. I shall keep an eye on innovations in diagnostics. The noble Lord knows that innovation in this area is right at the heart of what I do, and I think that his proposal is very sensible.

[Baroness Thornton (Lab)]

My Lords, the Government seem to be complacent about this. I know that the Minister has given us lots of facts and statistics, but the number of deaths from sepsis in the UK is five times higher than in the country in the European Union that has the best performance. Only two EU countries have a higher number of deaths, so it is a very serious problem. Why are only 70% of acute trusts in England using the national early warning score system? Why are they not all using it?

[Baroness Blackwood of North Oxford]

I am not quite sure which data the noble Baroness was referring to. The study stated that the number of UK deaths was at 48,000. This was a modelled estimate; it was inaccurate. Our data, published by the Office for National Statistics, states that the figure is 22,341 and puts the UK’s performance at a better rate. We are not complacent in any way. This is why there has been concerted action through a number of routes not only to improve the performance in sepsis diagnosis and screening but to make sure that we raise public awareness and provide training for NHS staff. The early warning system has been introduced as the revised national early warning score. As the noble Baroness said, it is intended to improve and standardise the process of recording, identifying and responding to patients at risk. It was introduced as a CQUIN incentive and included in the 2020-21 scheme which was published yesterday. This means that it will be in every hospital across the country.

[Baroness Walmsley (LD)]

My Lords, it can be difficult to diagnose sepsis in people with learning disabilities and difficult for them to realise that they may have it. The NHS has a very good little video prepared by and for people with learning disabilities and their carers. Is there anything the Minister can do to make sure that that helpful video is disseminated more widely?

[Baroness Blackwood of North Oxford]

That is an extremely helpful and constructive proposal. If the noble Baroness would like to raise it with me outside the Chamber, I will take it up as a matter of priority.

[Lord Forsyth of Drumlean (Con)]

My Lords, does my noble friend accept that public education has an important role to play here, so that people are aware of the symptoms—following the question asked by the noble Lord, Lord Patel? Can we congratulate the BBC, those of us who are fans of “The Archers”, on the work it has done in this respect?

[Baroness Blackwood of North Oxford]

I am very happy to congratulate the BBC. I do not know that I heard “The Archers” storyline in question, but I shall make sure that I update my education in this respect. I want also to congratulate Public Health England on its national Start4Life information service for parents. It has worked with Mumsnet to make sure that awareness is spread to those most likely to need it, because those most at risk are the young, the elderly and those who have underlying conditions. Targeting the messaging at those who need it most is very important.

[Lord Winston (Lab)]

My Lords, the noble Lord, Lord Grade, raises a very important point. Can the Minister tell us what percentage of patients with sepsis have the DNA profile of the bacteria recorded?

[Baroness Blackwood of North Oxford]

The noble Lord, Lord Winston, always raises very specific questions requiring statistical answers which are not necessarily at my fingertips. I shall write to him on that point.