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?

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[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.

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?

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[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?

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[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?

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[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.

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.

Wuhan Novel Coronavirus: Threat to UK Citizens

Baroness Blackwood of North Oxford Excerpts

Wednesday 22nd January 2020 Lords Chamber

[Lord Patel]

To ask Her Majesty’s Government what is their strategy for protecting UK citizens from the threat posed by the spread of Wuhan novel coronavirus (WN-CoV).

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

My Lords, we are monitoring closely the development of this virus. Advice from Public Health England and the Chief Medical Officer is that the risk to the UK is currently low. The UK is well prepared for the emergence of novel viruses. As part of our preparedness, we have introduced enhanced monitoring of direct flights from Wuhan to the UK and updated our travel advice for Wuhan. We continue to update health workers on how to identify, treat and contain any possible cases.

[Lord Patel (CB)]

My Lords, I thank the noble Baroness for her reply and commend the Government for publishing tomorrow initial measures for controlling the spread of this virus, if it comes to the United Kingdom. This is a newly identified virus, which probably originated in animals, particularly in the seafood markets in Wuhan. None the less, it is 80% genetically identical to the SARS virus, which killed a significant number of people. We now understand that, although the Chinese have sequenced the genome of the virus, it has mutated and can now spread directly from human to human, which raises the likelihood that it will spread more widely. The initial illness can vary and is sometimes very mild, hence the case in the United States where the diagnosis was not made on arrival at the airport in Seattle by the authorities, even though they had procedures in place. Will the Government keep a watch out and update the advice depending on how the virus develops? Secondly, will there be procedures for quarantine and follow-up contact if a case is identified, particularly if the virus mutates and becomes highly virulent?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his important and timely Question. I am happy to update the House that, from today, enhanced monitoring is in place for all direct flights from Wuhan to the UK. Public health officials will meet every direct flight from Wuhan to the UK and will be on hand to provide information about symptoms. Mandarin and Cantonese speakers will be on hand and leaflets will be available in several languages. We will also roll out enhanced monitoring of all flights arriving in the UK from China. Leaflets and information will be available across all UK airports, advising travellers from China on what to do if they feel unwell. The enhanced monitoring of direct flights will obviously be kept under continuous review and expanded if necessary. The risk to the public is low and the NHS is well prepared but, to answer the noble Lord, any patients assessed for this new disease would be isolated under standard procedures if necessary. There are a number of infectious disease units around the country that would be able to respond appropriately.

[Baroness Brinton (LD)]

My Lords, it is good that the Chinese Government, and indeed our Government, are responding better than has perhaps happened in some past incidents, including over SARS. The BBC has reported today that a number of Chinese cities are now reporting that there are people with this condition. When will flights from those cities, and not just Wuhan, be monitored? Also, will there be specific traveller advice for UK citizens travelling into China who have chronic and underlying conditions that mean they may need to take more care?

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[Baroness Blackwood of North Oxford]

I have a list of the current confirmed cases, which I am happy to place in the Library—it is probably not constructive to read it out—although the numbers are changing regularly. We are keeping travel advice and the monitoring of flights in and out of other Chinese cities under constant review. The advice at the moment is against all but essential travel to Wuhan. We will keep travel to other Chinese cities under close consideration.

[Viscount Ridley (Con)]

My Lords, does my noble friend agree with one of the precepts of Darwinian medicine that there is generally a trade-off between virulence and contagiousness and that, in the world of viruses, if you want to spread by casual contact, it tends to help to keep the patient healthy and standing on their feet—as indeed I am with a cold at the moment? If this virus does spread from man to man—sorry, person to person—there is a chance that it may reduce in virulence and it is, therefore, important to keep in perspective the warnings that we give people. While we must not underreact to this, it is also important that we do not overreact and cause major disruption to the economy, as has occasionally happened with responses to previous incidences of influenza.

[Baroness Blackwood of North Oxford]

That was well put. Our view is that this is a proportionate and sensible response that is scalable and appropriate according to the evidence available. We will obviously be reviewing what is a new and emerging infection. Scientific understanding of the disease is evolving rapidly—essentially on a daily basis. We will obviously review the measures set out regularly.

It is important to set out what the symptoms are, in case anybody listening needs to understand. This is essentially a bad respiratory tract infection that could turn into pneumonia. At this stage around 2% of known cases have died. To compare mortality rates, SARS had one of 10% and Ebola 70%. That gives a level of perspective, but the picture is evolving and we will keep this under close review as the situation develops. Unsurprisingly, of course, within that context those at greatest risk are the vulnerable, the elderly or those with underlying health conditions, so the advice is to come forward if such symptoms occur.

[Baroness Thornton (Lab)]

Notwithstanding the noble Baroness’s remarks, I am pleased and reassured that the Government have implemented the measures outlined and welcome the precautionary approach taken to the arrival of passengers from the Wuhan region of China. Can she confirm that the Government have assessed whether adequate resources are available in the PHE port health teams to carry out screening procedures and any further screening procedures that might be necessary?

[Baroness Blackwood of North Oxford]

We have indeed. First, three direct flights from Wuhan arrive into Heathrow and a team of public health experts, which will include the principal port medical inspector, the port health doctor, the administrative support and team leader and a translator, will meet every direct flight from Wuhan. We believe that this is a scalable solution, which could respond to a developing health challenge. In addition, before a flight lands a message will be broadcast to passengers in several languages to encourage them to report illnesses to flight staff and the captain will be required to provide an early warning of any illnesses on the aircraft one hour before arrival, which allows a much more appropriate response on landing. We believe that this is a manageable and effective response. The NHS has a very good record of responding to similar situations, whether with Ebola or monkeypox. We can be very proud of our public health record in these areas and can be confident in how bodies will respond to this incident.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that this has come at a very difficult time, because we are the middle of the flu season and this is difficult to diagnose? Does she realise that 15 health workers have been diagnosed in China? Therefore, will all health bodies be told to be aware?

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right: there is great pressure on the NHS and we need to make sure that the appropriate information is given to the system so that there is no undue anxiety in that regard. As I said, the NHS has a tremendous record in responding to similar incidents. Clinicians in primary and secondary care have already received advice covering initial detection, investigation of possible cases, infection prevention and control and clinical diagnostics. NHS England and NHS Improvement have developed an algorithm to support NHS 111 to identify suspected cases and a central alerting system alert will be issued to the front line by the Chief Medical Officer, the medical director of Public Health England and the medical director of NHSE and NHSI to increase awareness of the situation and actions if potential cases present.

As I said to the noble Lord, Lord Patel, there are a number of infectious disease units around the country that can take suspected patients and are accustomed to responding in this way. Of course, the UK is one of the first countries outside China that has a prototype specific laboratory test for this novel disease. I want to emphasise, though, that there are no confirmed cases in the UK.

[Lord Campbell-Savours (Lab)]

My Lords, I listened closely to what the Minister said. She seemed to be referring to post-flight monitoring. Would it not be possible to have some sort of pre-flight monitoring process at the point where people depart from China? I say that as someone who has half a lung and is therefore very vulnerable.

[Baroness Blackwood of North Oxford]

As someone who has my own health condition, I share the noble Lord’s attitude to exposure to infection. The Chinese Government are taking strong measures in Wuhan to try to control the outbreak, including reports, confirmed by post in Beijing, that they are advising their own citizens against travel to and from Wuhan. Measures are in place there. We would welcome more timely sharing of epidemiological data on the spread of diseases from China via the WHO, and we are working through those routes to try to improve it. However, I made the point that, where we have the ability to do so, we seek to put in place the earliest possible control measures, including on-flight, so that by the time there are issues at the border we are able to intervene.

NHS: A&E Waiting Time Target

Baroness Blackwood of North Oxford Excerpts

Tuesday 21st January 2020 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what plans they have, if any, to change the four hour accident and emergency waiting time target.

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

My Lords, the existing standard is still in place. NHS England and NHS Improvement are reviewing access standards in four key areas, including urgent and emergency care. The Government will respond to recommendations from the review once it is concluded.

[Lord Hunt of Kings Heath (Lab)]

My Lords, in December, for 68.6% of patients the four-hour target was met, against the actual target of 95%. That is the worst month ever. The Government’s response, behind the warm words of the Minister today, is that they want to get rid of the target, yet research published last week by Cornell and the IFS shows that the current target saves at least 15,000 lives a year. The Royal College of Emergency Medicine has said that there is no viable alternative to the current target. The college says that the Government should get on with getting this target back on track. Will the Government do that?

[Baroness Blackwood of North Oxford]

The noble Lord always asks astute questions. Winter is a challenging time. Over 2 million people attended A&E last month, and we have to pay tribute to the dedicated NHS staff for seeing over 70,000 people every day—the highest number in December ever. Although we have more NHS beds open this winter than last, our A&Es have had to treat more people. The A&E waiting standard is being looked at by clinicians, who are considering whether it is appropriate, given the changes that have occurred in clinical standards. The five key reasons considered for moving away from the standard include: the standard does not measure total waiting times; the standard does not differentiate between the severity of conditions; the current standard measures a single point in an often very complex patient pathway; and there is evidence that processes, rather than clinical judgment, are resulting in admission or discharge in the period immediately before a patient breaches the standard, which is a perverse incentive. The Government will not do anything without public consultation and clinical recommendation. We will wait to see that, and no decision will be made until that comes forward.

[Baroness Fall (Con)]

My Lords, let us not get distracted from the key issue here, which is that our A&Es are under enormous pressure. One reason is that people find it very difficult to see a GP, and that is why I think we can all welcome the announcement that we will see some more GPs. When might we see some progress on the ground?

[Baroness Blackwood of North Oxford]

My noble friend is absolutely right. We need to improve access to community care to make sure that people are diverted away from inappropriate visits to A&E. We have said that we will recruit over 6,000 doctors in GP practice, and we are working on that as we speak. We are also increasing the number of GP practices within A&E so that people can be diverted into appropriate care when they go to A&E inappropriately. The evidence is that already around 10% of those attending A&E are streamed into those GP practices, and we are currently trying to increase that provision.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest in relation to the Royal College of Emergency Medicine. Do the Government recognise the data from the weekly monitoring of 50 EDs that report to the Royal College of Emergency Medicine that shows that, in the first two weeks of January this year, an average of almost 6,500 people waited more than 12 hours in emergency departments, the figure having risen from just over 3,800 in October? These long waits represent risks to the health, and indeed to the very lives, of these patients. The president of the college, Dr Katherine Henderson, has urged:

“Rather than focus on ways around the target, we need to get back to the business of delivering on it.”

[Baroness Blackwood of North Oxford]

I emphasise that the review of clinical waiting times has been ongoing since 2018. The issues this winter are being addressed with urgent action in this winter. That includes: increasing the provision of same-day emergency care, so that patients can be seen as quickly as possible and are not admitted overnight, if that is inappropriate; reducing the number of patients who have unnecessarily lengthy stays, so that beds are available for those who need to be admitted; continuing to increase the number of urgent treatment centres, with a standardised level of care, so that those who do not need it can be diverted away from A&E—there are now over 140 urgent treatment centres, which can be booked from NHS 111 in most places; increasing the number of GPs in A&E, so that patients can be streamed to appropriate care; and enhancing NHS 111, so that patients can be booked into GPs locally or diverted to pharmacists.

[Lord Clark of Windermere (Lab)]

My Lords, regarding the increase in the number of GPs, bearing in mind that the coalition Government cut the training of doctors by thousands upon thousands and that the Government have announced that they are going to increase the number of GPs by 6,000, will the Government produce a timeline of when they are going to meet that target of 6,000 extra doctors?

[Baroness Blackwood of North Oxford]

My Lords, I know that the timetables are going to come forward in the people plan, so I cannot give you that in detail today. What I can tell you is that we have announced that we are investing an extra £4.5 billion in primary and community care by 2024 to fund a good amount of this. The five-year GP contract was agreed between NHS England and the BMA last January, which makes the job much more attractive. In addition, salaried GPs will receive at least a 2% increase and there are incentives to attract them into rural areas, which are struggling the most with recruitment. We have also announced that we want to recruit staff into support services around GPs so that GPs are not focusing on administrative tasks, which has been a disincentive to recruitment over the last period.

[Baroness Brinton (LD)]

My Lords, in addition to the importance of having more GPs to help relieve pressure on the service, there is still the continuing problem of social care, where many people are ending up in A&E or being returned to hospital after a brief stay back at home, or in a home. When will the Government publish their review on social care? We need to make sure that social care is absolutely understood and refunded properly in the future.

[Baroness Blackwood of North Oxford]

The noble Baroness, Lady Brinton, is right to hold the Government’s feet to the fire on this issue. I know the strength of feeling in the House on this matter. She will know that we have provided councils with an additional £1.5 billion to make sure there is short-term funding to address the challenges. Also, of course, the better care fund has provided some winter funding to address some of the challenges. But she is right that there needs to be sustainable funding for the long term. We look forward to the SR for that. Regarding the long-term solution, the Prime Minister has been clear that he wants to bring that forward within this year.

NHS and Social Care: Staffing

Baroness Blackwood of North Oxford Excerpts

Wednesday 15th January 2020 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In so doing, I declare my interests as a nurse, as set out in the register.

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

My Lords, patient safety is paramount. We expect health and social care providers to deploy sufficient numbers of suitably qualified, skilled and experienced staff at all times. The NHS People Plan aims to ensure a sustainable overall balance between supply and demand across all staff groups. This Parliament will see the people plan deliver 50,000 more nurses by 2025, a further 6,000 doctors in general practice and 6,000 more primary care professionals, all of which will support safe staffing and better care.

[Baroness Watkins of Tavistock]

I thank the Minister for her reply and particularly commend the NHS People Plan, yet evidence suggests that urgent action is needed to address the shortages in social care as well as healthcare. Many older people with dementia are failed by our social care system, in part due to costs and the availability of suitable staff. It is vital that the Government resolve the future of social care funding. Without certainty on funding, employers cannot invest in and plan for the future workforce. Dignity in care will be achieved only with rapid, proactive planning. Can the Minister explain the potential delay to the cross-party talks about funding for social care and what approach will be taken to ensure that proper staffing in social care is available during this Parliament?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question and pay credit to the work she has done in this area. She is absolutely right that we have to make urgent progress in delivering a sustainable social care solution. In the first instance, we have given councils up to £3.9 billion of additional funding in 2019-20, and the Prime Minister has been clear that he wants to see cross-party consensus on a sustainable way forward this year. I look forward to seeing progress made as swiftly as possible and hope that we will see work across this House on it, as I know this place takes the issue very seriously. In addition, we have run a national adult social care recruitment campaign to raise the profile of adult social care and encourage applicants. This has been successful; we have seen a 23% increase in the number of vacancies advertised on the DWP’s “Findajob” platform, which is improving the situation in the short term.

[Baroness Walmsley (LD)]

My Lords, there are particular shortages of nurses in certain specialties such as children’s palliative care, children’s mental health and learning difficulties. What will the Government do to improve the situation in those very important and sensitive areas?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right that we want to target recruitment towards the areas with the greatest shortages. That is one of the reasons why, when we announced the new non-repayable funding, we also announced a top-up for targeted specialties struggling to recruit. It is also why we have announced the availability of placements which can enable nurses to develop experience in specific specialties, which make it easier to recruit and retain those nurses in very rewarding and sometimes hard to recruit specialties.

[Baroness Thornton (Lab)]

I am sure the Minister will understand why the House might be slightly sceptical of “as soon as possible” promises, given that we are still waiting for a Green Paper that was promised almost two years ago. A date would be a good idea here.

Do the Government intend to follow the example of the Welsh and Scottish Parliaments and introduce safe nursing staffing legislation? Does the Minister agree with me—and with UNISON, which has 450,000 health workers in its membership—about the ever increasing importance to the NHS of recruiting nurses from overseas? How can the Government justify increasing the health tax, which applies to overseas nationals and will surely make it harder to recruit and retain nurses? Will the Minister suggest to the Treasury that the Government should in fact drop that planned surcharge?

[Baroness Blackwood of North Oxford]

The noble Baroness will know that appropriate staffing levels are already a core part of the CQC’s registration regime and that the law already requires hospitals to employ sufficient numbers of suitably qualified, skilled and experienced staff at all times. It is also mandatory for staff to provide monthly reports on the average number of care hours per patient per day, which is considered a better measure than staff numbers. However, we recognise the proposals that have come forward regarding staff safety and legislation; they are being considered at the moment.

The NHS surcharge is being considered to make sure that it is at an appropriate level to ensure that we continue to recruit at an appropriate level. At the moment, the rate of recruitment from non-EU countries has increased significantly by more than 150%.

[The Lord Bishop of London]

My Lords, I am sure the Minister knows that safety is about not just numbers but the continuing development and supervision of nurses and midwives. Can she comment on what the Government are doing to ensure that both nurses and midwives are funded properly for clinical supervision and professional development?

[Baroness Blackwood of North Oxford]

The right reverend Prelate is quite right. Ever since the tragic events in Mid Staffordshire, the NHS and our nation have been on a journey to make sure that the NHS is one of the safest healthcare systems in the world. This is based broadly on three policy strands: better regulation; greater transparency; and a culture of learning. HSIB is part of that. We hope to move forward in putting legislation in place to ensure that there can be learning without blame, and we hope to ensure that the appropriate training is in place. The people plan, which the noble Baroness, Lady Harding, is in the process of finalising, will ensure that specific proposals on how that will be delivered come forward imminently.

[Lord O’Shaughnessy (Con)]

My Lords, the Government are to be commended for wanting to raise the number of staff in the NHS and social care. In the near term, it is equally important that we make sure that we use the staff we have as efficiently as possible, and that we give them the tools and skills to be as productive as they can, including through the use of technology. To what extent will the digital tools that already exist and are on the market feature in the people plan?

[Baroness Blackwood of North Oxford]

My noble friend is a great advocate of investment in innovation and technology—and for good reason. One of the health infrastructure plan’s key priorities is ensuring that we bring forward the data and digital transformation solutions that will enable staff to spend more time on caring and less time on administrative and repetitive tasks that could be much better undertaken by some of the digital solutions that are now available. Some of those solutions would manage rotas more effectively and others, such as those being delivered by the £200 million AI hub, will enable, for example, AI solutions in radiology and pathology, which could lead to much earlier and more effective diagnoses in areas such as cancer.

Health: Vaping

Baroness Blackwood of North Oxford Excerpts

Tuesday 14th January 2020 Lords Chamber

[Baroness Redfern]

To ask Her Majesty’s Government what assessment they have made of the effect of vaping on public health.

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

My Lords, despite reductions in smoking rates, smoking remains the leading cause of preventable death in England. E-cigarettes are not risk free but are less harmful to health than smoking tobacco. Each year, more than 50,000 additional people who would not have quit through other means quit smoking through e-cigarette use. We continue to monitor the evidence base on e-cigarettes. The next Public Health England annual review is due in February 2020.

[Baroness Redfern (Con)]

I thank the Minister for her response. Does she agree that people who vape and struggle to quit should be given the same support and access to NHS services that is offered to regular smokers?

[Baroness Blackwood of North Oxford]

The Government have consistently highlighted that quitting smoking and nicotine use completely is the best way to improve health. Although they are not risk free, research shows that e-cigarettes are effective in helping smokers to quit. That is why we committed in the long-term plan to roll out “stop smoking” services in the NHS, to support improvements even on our smoking cessation rates—smoking is now at its lowest level on record, down from 18.4% in 2013 to 14.4%.

[Lord Hunt of Kings Heath (Lab)]

My Lords, does the noble Baroness agree that, looking back over the past 10 or 20 years, apart from the ban on smoking in public places, vaping has been the most successful intervention to reduce smoking? Does she therefore agree that we need to be cautious before we rush into trying to ban or overregulate its use, as some campaigners want?

[Baroness Blackwood of North Oxford]

As I said, more than 50,000 additional people quit smoking through e-cigarette use each year. We see e-cigarettes as an effective and safer route to quitting smoking than other routes. However, we understand that, at the moment, there is no evidence on the impact of long-term vaping, which is why Public Health England continues to update and publish the evidence base on e-cigarettes annually. We will continue to monitor the impacts of that use.

[Baroness Meacher (CB)]

My Lords, modest process changes could be made to enable patients who need medical cannabis to gain access to it. This is the most effective way of reducing public use of cancer-inducing cigarettes and vaping, which I understand is not risk free, although we do not know all the results. Will the Minister agree to meet me to discuss these process changes, which really could make a big difference and save people?

[Baroness Blackwood of North Oxford]

The noble Baroness is an avid campaigner on this, and I commend her on the work she does on it. I would be delighted to meet her to discuss this, of course, but I am also pleased with the progress we have made in bringing forward clinical trials to improve the evidence base around medicinal cannabis.

[Viscount Ridley (Con)]

My Lords, my noble friend will be aware that this week sees the centenary of the prohibition amendment in the United States, a policy that resulted in disastrous health outcomes and a huge increase in criminality and was repealed within 10 years. Does she feel that history is being repeated with America’s policy of prohibiting vaping but not regulating it for product safety, resulting in a number of deaths caused by the illegal use of substances in vaping—contrasted with this country, where product safety regulation has enabled us to do safe vaping?

[Baroness Blackwood of North Oxford]

My noble friend has asked a comprehensive and pointed question. It is notable that e-cigarette use among young people in the United States has increased dramatically— 78% in high-school students and 48% in middle-school students. We have not seen that in the UK because of the very effective and tightly regulated methods we have brought in around advertising and access for under-18s, which have borne fruit. I am proud of the way in which we have managed that in the United Kingdom.

[Baroness Janke (LD)]

My Lords, is the Minister aware that smoking has again become much more normal, and indeed quite fashionable—particularly in the form of e-cigarettes, among not just smokers but young people and people who have never smoked? Does she consider that this risks growing nicotine use and dependence? If so, what is being done to monitor and evaluate in health terms the increased use of e-cigarettes?

[Baroness Blackwood of North Oxford]

I am not quite sure I agree with the fundamental hypothesis of the noble Baroness’s question. If the normalisation hypothesis were true, we would not have expected to see smoking rates continue to decline as they have. Since 2013 smoking rates have fallen from 18.4% to 14.4%, and among young people regular use is very small. It is at 2% for those who have never smoked and is very rare or less, at 0.5%, for 11 to 15 year-olds.

[Lord Brooke of Alverthorpe (Lab)]

Will the noble Baroness be good enough to check the facts and assertions made by the noble Viscount, Lord Ridley? The facts are that during prohibition in the States, health improved and did not decline. Will she check that and give him the correct facts on it? Also, will she make sure that before we make any great changes on cannabis, we look very carefully indeed at what is happening in those states in America where cannabis is freely and openly sold for recreation purposes, and check on the number of people now dying from accidents and a whole range of associated problems? True, it is raising tax, but it is also raising many social problems.

[Baroness Blackwood of North Oxford]

I assure the noble Lord that when it comes to questions around medicinal cannabis and smoking, one of the reasons the UK is successful is that we approach our policy based on the most excellent evidence base. We are world-renowned for the approach we take to using evidence and putting it into policy most effectively. We are considered the European leader in smoking policy, in particular when it comes to our most recent tobacco control plan, and we will continue to be so.

[Lord Vaux of Harrowden (CB)]

My Lords, the noble Baroness has mentioned that smoking among children is relatively low, but it is growing fast: it has more than doubled in the last four years. I strongly urge her to speak to schools. My own conversations suggest that in the last year and a half to two years it has increased more than fivefold. Does she agree that flavours such as gummy bear, twister lollipop, jelly babies, pixie tarts and unicorn milk are quite clearly aimed at children? It really is time that we looked at the rules around this.

[Baroness Blackwood of North Oxford]

The noble Lord is absolutely right: there must be no complacency when it comes to any kinds of illicit drugs or substances aimed at children. We have very active policies, led by the Home Office in partnership with the department of health, to ensure that we keep up with all these substances. On smoking and the use of e-cigarettes, my figures are slightly different from his, and I am very happy to discuss this with him after Questions.

Young Carers: Health and Well-being

Baroness Blackwood of North Oxford Excerpts

Monday 13th January 2020 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what plans they have to ensure that young carers receive the social care, family, mental health and financial support they need to ensure their own health, development and well-being.

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

My Lords, we are committed to supporting young carers to ensure that they maintain their health and well-being and have the same life chances as their peers. We will continue to carry out the commitments made in the Carers Action Plan. These aim to increase the identification, support and recognition of young carers. This year, we will publish reports on young carers identification and work on carers from seldom-heard groups.

[Baroness Wheeler (Lab)]

My Lords, there are now an estimated 800,000 young carers delivering care to family members, and there has been an alarming 83% increase in children as young as five, six and seven undertaking this role. Is it not clear that the Government’s continued failure to tackle the social care funding crisis means young carers having to undertake care and support, at great cost to their own well-being, education and mental health, that should be available in the social care system? In particular, short breaks for respite care funded by local authorities are vital for disabled children and their families, including their siblings, many of whom are young carers. What action are the Government taking to make sure that they fill the annual £434 million funding gap in local authority funding for social care for disabled children in England, identified by the Disabled Children’s Partnership?

[Baroness Blackwood of North Oxford]

The noble Baroness will know that we take with the utmost seriousness the need to put social care funding on a sustainable footing. I heard the serious debate about this that we had on Thursday in the Queen’s Speech debate, and took back the seriousness with which this place takes those issues. On carers’ leave, the Government want to combine rewarding careers and the education of young carers with being able to care, and do not want young carers to take on inappropriate levels of caring. Therefore, the Government have committed to supporting unpaid carers with a leave entitlement of one week per year, which will be taken up in the employment Bill. In addition, I take the noble Baroness’s point about respite care and I will provide her with further detail in a note.

[Lord Mackay of Clashfern (Con)]

The Minister referred to the recognition of children giving this care. What provision is there for finding out the children who are subject to caring for adults or siblings in their family?

[Baroness Blackwood of North Oxford]

I thank my noble and learned friend for his question. The Government changed the law to improve how young carers and their families are identified and supported, to simplify the legislation relating to this. In addition, in 2016 we funded the Carers Trust to develop and run the Making a Step Change project for young carers and their families. It was designed to embed best practice to champion and identify support for young carers and their families and to provide an effective and integrated way for voluntary and statutory sector partners to identify young carers. We are working even harder to make sure that GPs and other professionals do the best for young carers. NHS England has recently introduced a new framework of quality markers in when identifying carers for GP practices so that they can improve both their health and their well-being throughout the care pathway.

[Baroness Pitkeathley (Lab)]

My Lords, the noble Baroness will remember from her previous role at the Department for Health and Social Care that, when carers were consulted prior to the Carers Action Plan, 67% of young carers said that they were not receiving any support at all. Does she have any statistics to show that this situation is improving?

[Baroness Blackwood of North Oxford]

We have now delivered all 12 of the commitments and recommendations in the Carers Action Plan to improve the situation for young carers, but the noble Baroness is absolutely right that the way we will improve on that is by improving identification. As I have said, with support from the Carers Trust and the Children’s Society, we are focusing on making sure that we embed not only early identification but also the right support throughout our work with young carers. We know that we have further to go but we are determined to do so.

[Baroness Brinton (LD)]

My Lords, the Children and Families Act 2014 made a very clear link between the Department for Health and Social Care working with other government departments to ensure that young carers got support, specifically the Department for Education. Also in that Act is a young carer’s assessment that every young carer is entitled to. What are the Government doing to ensure that every school identifies such young carers and makes sure that a referral is made to other support mechanisms elsewhere, including health?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

This is a hugely important point, because obviously sometimes young carers are not necessarily identified by health professionals. In 2019 the Department for Education carried out a review of the educational outcomes of children who need or have had need of a social worker, and obviously young carers are identified in that cohort, where they represent around 3% or 16,500 of them. The department has identified the barriers that they face and the best practice needed to help leaders and front-line practitioners overcome them. Work is ongoing in how we respond to that. In addition, the DfE has worked to improve information sharing to safeguard vulnerable children, which would include carers, to make sure that they are picked up and given the support they need and thus ensure that they have the best life chances.

[Lord Watts (Lab)]

My Lords, how do the school attendance records of children who are carers compare with the average?

[Baroness Blackwood of North Oxford]

The noble Lord has asked a specific statistical question which I want to provide an accurate answer to, so I will write to him.

[Baroness Finlay of Llandaff (CB)]

My Lords, do the Government recognise that the shortage of beds which is being experienced across the NHS is having an adverse effect on the ability to provide respite admissions when young carers find that they are literally at breaking point? Funded beds in hospices, nursing homes and other places can be essential to maintaining the cohesiveness of a family unit that is under extreme strain.

[Baroness Blackwood of North Oxford]

Obviously, pressure on the wider NHS and on social care can have a knock-on effect on unpaid carers who provide an enormous and valuable contribution to our health system, and also on those who care for them. I think that many of us in this Chamber will have personal and direct experience of that. That is why we have provided an extra £33.9 billion of funding for the NHS to ease those pressures, why we are working hard to find a sustainable solution to social care reform, and why we want to make sure that we provide carers of all ages with the support they need, first through identification and later by making sure that they have joined-up support right through the system.

National Health Service Infrastructure

Baroness Blackwood of North Oxford Excerpts

Thursday 9th January 2020 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of the consequences for patient safety of the backlog of maintenance and repairs to National Health Service infrastructure.

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

My Lords, the Government recognise that the quality of infrastructure, including backlog of maintenance, can pose challenges to the efficiency, safety and quality of NHS services. That is why we have launched the Health Infrastructure Plan, which includes the biggest hospital building programme in a generation. This substantial investment will support many of the hospitals facing the biggest challenges from their estates.

[Baroness Thornton (Lab)]

I thank the Minister for her Answer. NHS Providers says that the cost of the backlog is now £6.5 billion, and last year 15,844 patient incidents and 4,810 clinical incidents were caused by estate and infrastructure failure, and there were 1,500 fires in which 34 people were injured. The backlog includes wet walls in wards preventing babies’ incubators being plugged in. This is extremely serious. Will the Government provide the necessary funding to catch up—I am not sure that it is available yet? What is the timescale for catching up with the backlog—not building necessarily the 40, or six or however many, new hospitals that have been tendered?

[Baroness Blackwood of North Oxford]

The department acknowledges that parts of the NHS estate do not meet the demands of a modern health service and that there is unmet need for capital within the NHS. That is why we announced £2.1 billion of capital for health infrastructure in August and a further £2.8 billion injection in September. This is to ensure that staff are safe to deliver the world-leading health service that they should in a modern, efficient environment. We are also going further by reforming the capital regime to establish a clearer set of capital controls and the right incentives for organisations in respect of their infrastructure. The Chancellor has also confirmed that DHSC will receive a new multi-year capital settlement in the next capital review. Backlog of maintenance across the government estate will be a key theme of the spending review.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interests in relation to emergency medicine. Will the Government undertake to look specifically at the problem for emergency departments, given that many of them do not have enough cubicle space for the number of ambulances that arrive and the number of patients who are blue-lighted in? Staff do not have enough space to take a short break from the front line of some of the most harrowing cases that they have to deal with.

[Baroness Blackwood of North Oxford]

The noble Baroness is very expert in this area, and she is absolutely right that the NHS estate must prioritise areas of most need. This is why we have put in a serious amount of investment. NHS Improvement is also conducting a backlog review to understand where the areas of greatest need are and to assist NHS trusts in prioritising capital spending over the next few months and years.

[Baroness Jolly (LD)]

My Lords, equipment such as CAT scanners also comes from this source of income. Many are now not operating properly or are out of action awaiting repair. How many days of treatment are lost each year as a result of this?

[Baroness Blackwood of North Oxford]

Data on the proportion of capital equipment that is out of action or on days lost is not currently collected and the responsibility for that is with local NHS organisations, but the Government have recently supported investment in new diagnostics. As outlined in our Health Infrastructure Plan, we have invested £200 million to deliver new state-of-the-art diagnostic machines, such as MRI machines, CT scanners and breast-scanning equipment, to 78 trusts. We recognise that we need to improve the number of scanners that are younger than the “golden rule” of 10 years old.

[Baroness Manzoor (Con)]

My Lords, I welcome the Government scrapping car parking charges, which will support people who are caring. I also welcome the new money that will be put into the infrastructure project, which is vital, as the noble Baroness, Lady Thornton, has pointed out. Can my noble friend say, however, whether AI and new technology will be used, and whether funding will be put in place to help carers and people living in their home?

[Baroness Blackwood of North Oxford]

I thank my noble friend for her question. She is absolutely right that we want to prevent people from going into hospital in the first place. We have made a £200 million investment in the AI lab to reduce the burden on doctors in the first place and to make use of the benefits of AI in diagnostics. A number of centres up and down the country are trialling this to reduce the burden on clinicians so that they can become more human and work on their caring responsibilities. We are also trialling a dementia care test bed, so that there is support for carers and so that people with dementia can remain in their own home. This is going on in Surrey and has been hugely successful; it is a very exciting development.

[Lord Crisp (CB)]

My Lords, given that the NHS is seeking to shift to being a more community and primary care-based organisation, can the Minister say more about what investment is going into community and primary care in capital terms?

[Baroness Blackwood of North Oxford]

We have been looking at providing additional funding and support to councils to meet the rising demands and to continue to stabilise the social care system. We announced access to an additional £1.5 billion of funding for adults and social care, and we will be considering this further in the spending review.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the noble Baroness will be aware that there was a spike in the incidence of flu just before Christmas; I do not know whether it has diminished, but it certainly was quite high. As a consequence, a number of people who perhaps would have much preferred not to go to hospital were forced to do so. She might like to know that, in one London hospital to which one of my family was obliged to go, the queue for A&E was out into the street. Many of those people were ill and should not have been outside in the cold. The reason for it was partly to do with availability of staff but more to do with the availability of chairs. Does she understand that hospitals need capacity beyond what their expectation might be of how many people will turn up, precisely to cope when there is a spike of this kind?

[Baroness Blackwood of North Oxford]

The noble Baroness is right that there has been a significant increase in demand over recent years. That is partly why we have secured the significant funding increase from the Treasury of £33.9 billion, which we will be enshrining in law for the first time to give certainty to hospitals. It is why we are increasing the capital investment, which will address some of the challenges that she has raised, and it is also why we have run a vigorous flu vaccination programme to prevent people from getting into that problem in the first place. We recognise that we need to reduce the demand from those going into A&E unnecessarily and to support those very hard-working staff who were in those situations over Christmas and the new year. We thank them for their hard work over that period.