Academic Health Science Centres

Baroness Blackwood of North Oxford Excerpts

Tuesday 2nd July 2019 Grand Committee

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

My Lords, I thank the noble Lord, Lord Butler, for raising this question on AHSCs. I pay tribute to his work as the former chair and now non-executive director at the King’s Health Partners AHSC and to his speech setting out some of the achievements that have been delivered. This has been a supremely expert debate, so I feel somewhat cautious in summing up. I thank noble Lords who have spoken this afternoon about their work in AHSCs, notably the noble Lords, Lord Kakkar, Lord Patel and Lord Darzi, and my noble friends Lord Prior and Lord O’Shaughnessy, who have been so instrumental in developing the system to where it is today. This is a timely debate because, as many noble Lords said, we are developing policy options for AHSCs going beyond the current designation. As noble Lords know, it is due to end in December this year. I acknowledge that this is a tense time for AHSCs, which will now be thinking about planning their future strategy. I am grateful to the noble Lord, Lord Willis, for making the point that this is a cross-party issue and that there is wide agreement across the Chamber about the importance of AHSCs. I will say at the front that there is also consensus about the need to go forward to designation; the question is how we do that.

First, in response to some of the wider points that were made in the debate, I say that the Government recognise the critical role that health research plays not only in fuelling the life sciences sector, which is one of the most productive within our economy, but in driving up the quality of diagnosis, treatment and care in the NHS. We are committed to creating the best environment for clinical research and to achieving the ambition set out not only in the life sciences strategy but in the sector deals. This is the only sector to have two sector deals, and that is because of the quality of the sector and the relationship between research, industry and the NHS, which has developed into an outstanding ecosystem in the past few years. We have to pay tribute to the role that the NHS long-term plan will play in that, due in no small part to the leadership role of my noble friend Lord Prior.

This country is a world leader in health research, with a world-class science base and three of the top 10 globally ranked universities. As my noble friend Lord Prior said, we have an extraordinary life sciences sector, and we must be as ambitious as we possibly can be in driving it forward. We are investing more than £1 billion per year through the NIHR to fund research, skills and facilities to enable high-quality research. I can answer the noble Baroness, Lady Donaghy: about £100 million of that was invested in a range of training programmes, and we have also created the NIHR training academy so that we can think about how we link that to international training.

We must ensure that we protect the valuable collaborations that we have because that ensures that we have the highest quality clinical research in the world. The commitment to increase our R&D investment from 1.7%, which has quite frankly not been good enough, to 2.4% and beyond that to 3% was hard won from the Treasury. I know that because I was one of the first to campaign on this as chair of the Science and Technology Select Committee some time ago. I will be one of the first to join noble Lords across the Committee in campaigning to drive further and faster, as we must not only have this commitment from our leadership candidates—and I am sure that others will join us in that—but keep driving forward blue-sky investment and further investment through the people, programmes, centres of excellence and the NIHR. That is how we will have an integrated health and research system which is one of the best in the world, designed to transform scientific breakthroughs into life-saving treatments.

The noble Baroness, Lady Donaghy, is right that we should be proud of what we have already achieved. Between them, the existing AHSCs cover health research and education in a wide range of clinical disciplines including mental and physical healthcare, cancer, cardiovascular and inflammatory diseases. It would not be right it we did not pay tribute to some of that today. Noble Lords have already done that. While we do not fund the AHSCs specifically, of the 20 NIHR biomedical research centres, 12 are at the heart of these six AHSCs, representing more than £700 million of NIHR investment over five years from April 2017. This significant NIHR-funded research infrastructure is key to enabling its engines for world-class excellence in early translational biomedical research.

The existing AHSCs were designated based on recommendations made by an independent panel, which we heard about from the noble Lord, Lord Darzi. On the regional spread, I am afraid that the noble Baroness, Lady Masham, will be disappointed that they can be designated only in England, not in Scotland, but it is open to the new designating committee to consider the regional spread as that goes forward.

Over the past 10 years, the six AHSCs have facilitated the strategic alignment of some of our leading NHS providers and their university partners in world-class research and health education, leading to improvements in patient care and playing an important role in driving economic growth through partnerships with industry, including life sciences companies, which is one of our key priorities. It is through this strategic alignment that these partners have secured funding. An example is the £10 million funding from UKRI for a new centre for medical imaging and AI at King’s Health Partners as part of the industrial strategy challenge fund. The noble Lord, Lord Kakkar, spoke about the success of UCL Partners, which has, among many things, been leading on the adoption of a learning health system to standardise data entry. This has allowed seven CCGs to trial and support interventions into early detection of atrial fibrillation, which is a key priority of the long-term plan, and for primary care networks. Specific examples are the ways that we are going to change healthcare for individuals. Imperial AHSC has supported North West London STP’s integrated care record to bring together the health and social care information of 2.3 million patients in the sector, enabling the identification of patient cohorts and the evaluation of service developments.

London’s three AHSCs are collaborating through the MedCity initiative to grow the life sciences cluster of London and the greater south-east, working with the Oxford and Cambridge AHSCs. In Manchester—not in the south-east—the AHSC is working with the AHSN to align research and education into the health and social care priorities of the Greater Manchester population. A single blood test-driven decision aid for patients presenting with chest pain at the emergency department is being rolled out. Since June 2016, more than 7,000 patients have been treated using this tool and the diagnosis of acute myocardial infarction was ruled out in more than 99% of cases, with patients returning home within hours of their arrival in the emergency department. This is evidence of how the AHSCs have changed clinical practice on the ground. Additional data published today by the NHIR clinical research network shows that NHS trusts which are part of the six AHSCs have undertaken more than 3,600 clinical studies and recruited 148,495 participants in 2018-19.We know that other academic health science partnerships have formed, further strengthening the health research and health education interface in London but, as my noble friend Lord O’Shaughnessy said, we must ensure that the deep research base that we have in this country is matched by a health system that embraces innovation and translates research funding into improved patient care, so that innovators can develop, test and deliver those products that patients and clinicians need and so that examples such as those I have just given can be adopted.

We know that in the past the system has been too fragmented, too complex for innovators to navigate and too slow to adopt promising technologies. That is why last summer, at my noble friend’s instigation, the department undertook an innovation landscape review, which identified the need for a system which was more joined up between healthcare partners, and for improved support for late-stage evidence and a better strategic alignment of priorities, such as how we support emerging technologies, including AI, drug discovery, mentioned by the noble Lord, Lord Kakkar, and precision medicine.

As my noble friend Lord Prior pointed out, it is also important to recognise the role of collaboration between NHS, industry and academia. During the landscape review, we found huge appetite for change and more ambition within the healthcare stakeholders who need to implement it. That is why the sector deals, the NHS long-term plan and the tech vision have all begun the process of transforming a significant part of strategy within government policy. Through the establishment of the accelerated access review and NHSX, as has been mentioned, we have started to build the necessary infrastructure effectively to support health innovation in this country. Under the expert leadership of the noble Lord, Lord Darzi, the AAC brings together senior leaders from the key government, NHS and industry partners with patient and clinician representatives to promote innovation within the NHS. Already, the AAC has made significant progress in supporting uptake.

We must agree that AHSCs and other structures must work hand in hand with AHSMs and wider innovation infrastructure to ensure that this is wired into the ARCs and will be in AHSCs. This is why I have asked the AAC to consider AHSCs, to ensure that the whole system is joined up, because that is what it is leading on. It is important that we give the AAC and the noble Lord the opportunity to build a cohesive health, research and innovation ecosystem that meets the challenges that we have set and the ambitions that we need our life sciences sector to deliver. That is why I have asked the AAC to consider AHSCs’ role within the health system as part of the boost agreement. That will ensure that the future designation of AHSCs complements the innovation support landscape, rather than adding further complexity. The AHSCs will therefore support the AAC in achieving its new objectives, including commitments to establish globally leading testing infrastructure, improving the system’s capacity to adopt innovation.

We plan to extend the existing DHSC AHSC designation until March 2020 to enable that new designation process to be held. We will announce the timescales soon. I appreciate that is not necessarily the answer that noble Lords want, but I hope that the strategic vision, the need for ambition and the purpose, which is to deliver innovation for patients which changes their quality of care and the ambition of our life sciences ecosystem is understood as the reason for that change.

Lung Health

Baroness Blackwood of North Oxford Excerpts

Monday 1st July 2019 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what steps they will take to implement the recommendations of the Taskforce for Lung Health’s five year plan for improving lung health in England.

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

My Lords, the NHS has worked closely with the Taskforce for Lung Health and the British Lung Foundation to develop a national programme for respiratory and cardiovascular disease. This will improve lung health by piloting a lung health check programme, expanding quality-assured spirometry, undertaking pharmacy medicine reviews in primary care networks and improving self-management support. In addition, access to smoking cessation interventions will be increased and a national workforce group will be established. Finally, the Government have committed to improving choice and ending variation in end-of-life care services.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the Minister for that response. She will be aware that lung disease is often underestimated as a problem; one in five of us is likely to be affected in our lifetime and priority has not really been given to it over the past few decades. Given that outcomes have hardly improved either, will she look again at the response and commit the Government to implementing the task force report in full?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for that question. He is absolutely right that respiratory illness can be extremely serious. The UK has a higher rate of respiratory deaths than any other country in the OECD; this is a clinical priority for the NHS and the Government are committed to driving it forward. We are working with the British Lung Foundation and the NHS to deliver the co-designed lung foundation’s plan and I am happy to give him that commitment now.

[The Earl of Listowel (CB)]

My Lords, the report highlights the need for prevention, including among children and young people. Will the Government look at the funding of health visitors, who can speak to mothers about smoking, and recognise that a quarter of health visitor numbers have been cut because of their dependence on local authority funding? Will they also look at school funding to ensure that all schools can make the maximum effort to protect schoolchildren from air pollution?

[Baroness Blackwood of North Oxford]

The noble Earl is absolutely right. Prevention is a core part of the plan and as well as smoking, the clean air strategy and flu vaccinations, health visitors are a crucial part of it, and will be looked at as part of the forthcoming prevention Green Paper.

[Lord Borwick (Con)]

My Lords, I declare my interest as in the register. Does my noble friend agree that air quality is vital for lung health and will she comment on the distressing fact that lung diseases are strongly correlated with poverty, and that air quality is worst in poor areas?

[Baroness Blackwood of North Oxford]

My noble friend is right that poor air quality is one of the largest environmental risks to public health in the UK. That is exactly why we brought forward the air quality strategy, which has been identified by the WHO as an example for the rest of the world to follow. But he is right that it will not work if we do not also tackle variation across the country. That is exactly what we intend to do and why we will also look at air pollution as part of the Green Paper, which is due imminently.

[Lord Rennard (LD)]

My Lords, 6.1 million people in this country still smoke. The NHS long-term plan is good at encouraging further measures to reduce the prevalence of smoking. At the same time, 50% of local authorities have had to reduce funding for smoking-cessation services, even though smokers trying to quit are four times more likely to succeed if they can benefit from such services. Is it not essential to reverse cuts in funding to Public Health England and spend money cost effectively on further advertising campaigns to reduce the prevalence of smoking among adults in this country?

[Baroness Blackwood of North Oxford]

The noble Lord is right to praise the success that we have had in smoking cessation in this country. We now have the lowest rates of smoking that we have ever had, some of which is because of the work of local authorities and PHE. He is right to identify the need to target the variation and inequalities. We are targeting this through the prevention Green Paper and we identify the need for a sustainable funding settlement through the spending review allocation.

[Baroness Thornton (Lab)]

A study of over 38,000 people with chronic obstructive pulmonary disease found that opportunities to diagnose were missed in 85% of patients in the five years before their diagnosis. My mother was probably included in that number. Will the Minister commit to introduce target case findings in general practice for people who have symptoms suggestive of COPD with follow-up care and services? How do the Government intend to eliminate the postcode lottery that exists in the quality of and access to COPD treatment?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right: COPD is the second most common lung disease in the UK. It is disturbing that around a third of people, in their first hospital admission for COPD, had not been previously diagnosed. NHS RightCare is developing a COPD pathway, which is being rolled out nationally through clinical commissioning groups, to identify the core components of an optimal service for people with COPD to ensure earlier diagnosis and better management, so that they do not experience the concerns that she has identified.

[The Lord Bishop of Carlisle]

My Lords, further to the Minister’s helpful comments about air quality, can she tell us to what extent Her Majesty’s Government are monitoring the existence of microparticles of plastic in the air, especially in our cities, and the impact they are having on lung health?

[Baroness Blackwood of North Oxford]

The right reverend Prelate raises an extremely important point on air health. While we have long-term commitments in the clean air strategy, and the other measures that have been put forward in the Green Paper and net-zero commitments, NICE has published guidance on the effect of air pollution on people with chronic respiratory and cardiovascular conditions. We also have the Committee on the Medical Effects of Air Pollutants, which advises the Government on many matters, including those the right reverend Prelate raised.

[Lord Kakkar (CB)]

My Lords, I remind noble Lords of my registered interests. Are Her Majesty’s Government satisfied that the research strategy between UKRI and the National Institute for Health Research is sufficiently well co-ordinated to ensure discovery, as well as early evaluation and adoption, of novel therapies that could manage chronic lung disease more effectively?

[Baroness Blackwood of North Oxford]

The noble Lord has raised a crucial point, which is not a surprise given his expertise in this area. We have been working with him and others to ensure that the most innovative medicines are getting to patients as quickly as possible. We announced the Accelerated Access Collaborative to identify those innovative medicines and ensure that we speed up the rate of ideation to uptake in the NHS, particularly for illnesses such as asthma. For example, smart inhalers and integrated connected devices could dramatically improve the management of that condition.

NHS Long-term Plan

Baroness Blackwood of North Oxford Excerpts

Monday 1st July 2019 Lords Chamber

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

My Lords, with permission, I will now read a Statement made by my right honourable friend the Secretary of State for Health and Social Care in the other place on the implementation of the NHS long-term plan. The Statement is as follows:

“Mr Speaker, I would like to update the House on the implementation of the NHS long-term plan and the delivery of improvements to the health service. Today marks the 100th anniversary of the Ministry of Health under the Liberal and Conservative coalition of Lloyd George. I can tell the House that on Thursday, the boards of NHS England and NHS Improvement agreed the long-term plan implementation framework.

Alongside the clinical review of standards, and the interim workforce plan, published last month, this framework is a critical step in delivering on our 10-year vision for the NHS and in transforming our health service with the record funding the Government are putting in. The document sets out the framework in which each of the 300 commitments in the long-term plan will be delivered, the 20 headline commitments and how we will monitor delivery of the plan. In the past, there have been criticisms that NHS plans have not led to full delivery, and we are determined to ensure that the LTP fulfils its potential to transform the health service. I am placing a copy of the implementation framework in the House Libraries.

I would like to draw attention to three areas, the first of which is cancer care. I would like to thank my honourable friend the Member for Basildon for his efforts in ensuring our focus on the vital indicator of cancer survival. The Prime Minister set out the ambition that three-quarters of all stageable cancers are detected at stage one or two by 2028. Early detection and diagnosis are essential to enhancing people’s chance of survival. Since 2010, rates of cancer survival have increased year on year. However, historically our survival rates have lagged behind the best-performing countries in Europe.

The implementation framework sets out our goal of measuring the one-year cancer survival rates as one of the core metrics. The one-year survival rate is how we measure our progress in achieving the ambitions set out in the NHS Long Term Plan. To realise these ambitions and ensure that we do everything we can to give people diagnosed with cancer the best chance of survival, these are the steps that the framework sets out: first, a radical overhaul of screening programmes; secondly, new state-of-the-art technology to make diagnosis faster and more accurate; thirdly, more investment in research and innovation.

From this year, we will start the rollout of new rapid diagnostic centres across the country, building on the success of a pilot scheme with Cancer Research UK, so that we can catch cancer much earlier. NHS England is further extending lung health checks, targeting areas with the lowest survival rates. Health Education England is increasing the cancer workforce, which will lead to 400 more clinical endoscopists and 300 more reporting radiographers by 2021. Because of these steps, our ambition is that 55,000 more people will survive cancer for five years, each year, from 2028. Improving the one-year survival rate is how we ensure that the NHS remains at the forefront of cancer diagnosis and treatment and continues to deliver world-class care.

The next area is mental health. The Prime Minister and her predecessor have rightly prioritised the treatment of mental health so that we can ensure that it finally gets parity with physical health. The £33.9 billion cash-terms settlement—the longest and largest cash settlement in the history of the NHS—includes a record £2.3 billion extra for the expansion of mental health services. The framework sets out how 380,000 more adults and 345,000 more children and young people will get access to mental health support. We are also introducing four-week waiting-time targets for children and young people, and testing four-week community mental health targets for adults.

The implementation framework specifically references the vital improvements to community mental health services that we all know are needed. These are adults living with serious mental disorders, including eating disorders, and those coping with substance misuse. The framework sets out how we will create a new workforce of mental health support teams to work with schools and colleges to help identify young people who need help and reach them faster. In all, it is a fundamental shift in how we treat mental illness and how the NHS will prioritise mental health services.

The third area I want to draw out is people. Three-quarters of the NHS budget goes on staff because people are the most valuable resource that we have in the NHS. We need not only the right numbers but to ensure that we have the right support for our staff. The long-term plan sets out our ambition to recruit, train and retain the right numbers of staff over the next decade. Last month, Baroness Dido Harding published her interim people plan, setting out how we will build the workforce we need and create the right culture so that doctors, nurses and other NHS staff have the time to care for patients and for themselves.

Last week, the BMA accepted, in a referendum, the new agreement with junior doctors that will improve both pay and working conditions. Thanks to the hard work of my predecessor, we are already taking steps to increase the number of clinical training places by opening five new medical schools and increasing the number of routes into nursing through apprenticeships and nursing associates. Last year, more than 5,000 nursing associates started training through apprenticeships, and this year the figure will be up to 7,500.

Those are just three of the most vital areas from a 10-year vision for the NHS. Across England, based on the implementation framework, local strategic plans are now being developed and will be brought together as part of a national implementation plan by the end of the year. All of this will be underpinned by technology.

Today sees the official opening of NHSX, the new part of the NHS which will drive digital transformation to give citizens and clinicians the technology that they need. I am delighted that NHSX has received such a warm welcome across the NHS, because it has so much potential to transform every part of health and social care for patients and for staff.

The forthcoming government spending review will settle the budgets for health education, public health and NHS capital investment, and these settlements will feed into the final implementation of this plan. As part of the SR, we will also review the current functioning and structure of the better care fund, which is rising in line with NHS revenue growth.

On this the 100th anniversary of the foundation of the Ministry of Health, this framework sets out how we will go about securing the foundations of the National Health Service into the next century and the creation of an NHS that delivers world-class care for generations to come. I commend this Statement to the House”.

--- Later in debate ---

[Baroness Jolly (LD)]

My Lords, I too thank the Minister for reading the Statement. I feel I should get out an orange flag—I am probably wearing the right colour—because, in the 1940s, Liberals were orange, not a yellowish colour. Beveridge, whose paper proposed the National Health Service, was indeed a Liberal and his proposal was for a service,

“free at the point of need”.

Anyway, I will get back to the Statement. I welcome the Secretary of State’s commitment to cancer and mental health services and workforce growth—who would not? But the Statement does not refer to the local five-year strategic plans to be completed by mid-November and rolled out thereafter. These will involve local consultation and incorporate performance trajectories and milestones across health and social care; they are truly the plans to implement the Secretary of State’s plan. The Statement mentions funding but is quiet about how much. I guess that is quite understandable given the position of the Government, who do not know who the new leader will be let alone his priorities.

The NHS is crying out for more capital: diagnostic and treatment equipment these days is big and very expensive; those of us who have been into English hospitals recently will notice that the buildings are looking sadder than they did 10, 15 or 20 years ago; and workforce shortages are mentioned. Will the Minister tell us when we can expect the NHS to be fully staffed and appropriately equipped? There is no mention of widespread regional variation in outcomes: by when will these be no more? Can the Minister explain how the areas for concentration will be managed? Will management be top-down or bottom-up, reflecting local needs?

Will the Minister also tell the House about any conversations regarding more funding for adult social care? I shall not say any more about the Green Paper. Public health services are critical to help people deal with obesity, stop smoking and become fit, so living longer, healthier lives. All these are critical matters for local authorities. The Statement barely mentions social care but, without an injection of staff and funding, it will fall, and with it the Secretary of State’s laudable visions for cancer treatment and mental health.

[Baroness Blackwood of North Oxford]

I thank the noble Baronesses for their contributions. I think the most helpful thing would be for me to talk a little about the next steps in the development of the local plans, which answer a lot of the points that have been raised.

A significant engagement exercise went into the development of the implementation framework as it stands. It identified a real desire to deliver on the total breadth of the long-term plan rather than to pick and choose, a request for systems to take into account local needs and the different starting points in order to deal with variability, and a request for help on sequencing: what they should prioritise and where they should start from.

The framework seeks to address these issues and asks the systems to develop the five-year plans, which they will implement over this period. It also sets out the approach to STPs and ICSs, which are asked to develop their strategic plans by November, covering the period from now until 2023. By the end of the year they will be aggregated as part of the national implementation plan. As has been noted, that will take into account the Government’s spending review decisions on workforce education training. Social care will be part of it, and it will also play into the upcoming publication of the prevention Green Paper and the social care Green Paper. Relevant decisions will also need to be made about public health and capital investment, as set out in the Statement.

There are key points that need to be taken into account. The NHS has been asked to ensure that these are clinically-led plans and that they are locally owned, so that communities can have meaningful input; that there is realistic workforce planning—the people plan will be part of that process; and that the plans are financially balanced, because that is the only way we can ensure genuine delivery of the long-term plan and that the concerns raised by both noble Baronesses are taken into account.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest as a past president of the BMA. It will take some years for the new workforce plan to come through. Given that the current NHS medical workforce crisis involves consultant and GP staff having to drop clinical sessions to avoid huge tax bills, what consideration is being given to abandoning the concept of annual allowance in relation to defined benefit pension schemes, and allowing tax relief to be limited by the lifetime allowance? The current situation means that people are dropping sessions. Combined with the GMC regulations around retirement and revalidation, this is forcing clinicians into permanent retirement, rather than coming back to work additional sessions, which would relieve the pressure on waiting lists in clinics, would help with teaching and supervision, and would offer experienced surgical hands in operating theatres to assist in complex operations.

[Baroness Blackwood of North Oxford]

The noble Baroness, as ever, asks a very perspicacious question. She will know that as part of the GP contract negotiations, pensions and other issues were raised, and are still under discussion. Similarly, issues around secondary care doctors are in discussions with the Treasury. These discussions are quite technical but the issues are under consideration. I am unable to give her a complete answer now, only to tell her that we are very alive to the issue and trying to find a way through.

[Lord Clark of Windermere (Lab)]

We are very keen that the Government’s attempt to have a proper plan should work. The Minister knows that the staff are working under shortages of numbers and terrible shortages of finance. The Government go on and on about promised increased finance. According to the Health Foundation, funding for the wider health budget, which includes public health, will in real terms be £1 billion less in the next financial year. Are they right?

[Baroness Blackwood of North Oxford]

It is very important to pay tribute to the extraordinary work that NHS staff are doing across the system and in the wider healthcare system—we should thank them for that. The noble Lord is right that there is great financial stress in the system. A lot of work has gone into trying to alleviate it. That is why the NHS is one of the few parts of the public health system which received a significant increase in the £22 billion increase.

As for the public health system, training and the capital and social care investment, this will be part of the SR negotiations. I am sure the noble Lord will be aware that the Department of Health and Social Care will be making a strong case for increasing those parts of the system, because we believe it needs to increase just as much as he does.

[Baroness Neville-Rolfe (Con)]

My Lords, I have two questions for my noble friend. First, I very much welcome the inclusion in the plan of a section on improving productivity. My experience is that the best way to improve productivity is the intelligent application of additional capital, and not just, to quote from page 29, “its better use”. Picking up on some of the comments already made, may I ask the Minister how the NHS will make a step change in providing or attracting, and using, capital within the system?

Secondly, a huge medium-term threat is antibiotic resistance, which gets the briefest mention on page 15. Is there a plan to nail this as part of the approach to improving the NHS?

[Baroness Blackwood of North Oxford]

I thank my noble friend for a very important question. We have just published our new plan to tackle antibiotic resistance; it is an incredibly sophisticated proposal. We have already had some success in bringing down antibiotic use in humans and animals, but there is still a significant way to go, as antibiotic-resistant infections within the system are still rising. That is why we cannot relent in our ambitions, and why it is so important that the commitment to implement that strategy is in the long-term plan and the implementation plan. Although it has a brief mention, there is a whole strategy that it refers to, and it is comprehensive, so I am optimistic about that part.

On intelligent application of capital and ensuring that it increases productivity, my noble friend is right. That is partly why there is such a focus on ensuring that there is a radical reshaping of how the NHS delivers health and care using technology: so that services and users can benefit from the advances, and so that we can have a democratisation of information, which will be one of the key ways that we will manage demand and ensure that the NHS is sustainable.

[The Lord Bishop of Carlisle]

My Lords, as a former member of the Long-Term Sustainability of the NHS Committee, I welcome the long-term plan and the Government’s response to it. I am especially glad that mental health issues will achieve financial parity with physical health issues. Does the Minister agree that research into and attention to the causes of these ever-increasing issues is as important as more spending on their treatment?

[Baroness Blackwood of North Oxford]

As ever, the right reverend Prelate is insightful in his question. He is right that although we have made a lot of progress in improving services, we were coming from a low base. One of the challenges is not understanding why there is such an increase in the challenges we face. This is why the NIHR has dramatically increased the amount of funding it provides to mental health research, and why other important organisations, such as the Wellcome Trust, are prioritising mental health research as a matter of urgency.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, does the Minister recognise that while welcoming the emphasis on mental health—as the right reverend Prelate did—the Women’s Mental Health Taskforce, which reported in December 2018, recognised that more women are becoming the real issue in mental health work, that many more women are presenting, and that many of them, particularly those who have suffered abuse and trauma, require a gendered approached? The Women’s Mental Health Taskforce recognised this as an issue for the workforce and the way women engaged with treatment, particularly that group of women. I recognise that not everything can be reflected in plans, but it would be a tragedy if that message was not communicated to localities and to those providing mental health services. Unless that happens, many women will simply be let down.

[Baroness Blackwood of North Oxford]

The noble Baroness has communicated an important message and it is one reason why we have prioritised perinatal mental healthcare. Specifically, services for young girls, who are particularly at risk of self-harm and suicide, recognise this risk. I would be interested to see the findings of the task force she mentions to ensure that those concerns are communicated.

[Baroness Masham of Ilton (CB)]

My Lords, the Statement puts importance on technology. Will the Government speed up NICE in its assessments of technology? I hear that it is taking too long.

[Baroness Blackwood of North Oxford]

The noble Baroness, Lady Masham, is right to raise the importance of this. If we want to get innovative technologies and treatments to patients as soon as possible, we must ensure that we are one of the fastest in the world at regulating and assessing those technologies. However, it is also a matter of uptake. We have dramatically improved that process but we can and must always strive to do better. This is part of my job and I will make sure that I keep working harder at it.

[Lord Ribeiro (Con)]

My Lords, I welcome the development of the five new medical schools that are going onstream. Two weeks ago, I was fortunate to be at Chelmsford when the Duke of Kent opened the Anglia Ruskin University medical school. But it is quite clear that a lot of medical graduates are leaving the profession, for whatever reason. There is also good evidence that those who come in at graduate entry last the distance a lot better than those who perhaps come in much younger. Your Lordships may ask, “Where is the evidence for that?” What efforts are being made to look into why people are giving up medicine early, and what is the possibility of increasing the number of graduate entries?

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question. The core of the work my noble friend Lady Harding is doing is to analyse recruitment and retention patterns in the health service, obviously not just among core clinicians but across the whole system, to identify best practice for improving the workplace environment to recruit and retain. I am not sure whether she has done specific work on the difference between direct entry and graduate entry but I will be happy to find out for my noble friend.

[Lord Judd (Lab)]

My Lords, with longevity still at record levels, is the Minister satisfied that in the plan for the future new doctors coming into the service get sufficient support in their training on dealing with the dying and their families, or is it often just left to them to pick it up in their professional work? The same sorts of issues arise in mental health. If you are treating mental health, of course there is often a great deal of stress within families. How far do these plans take into account family support, at the same time as the treatment of those with mental illness?

[Baroness Blackwood of North Oxford]

The noble Lord raises two hugely significant issues, which probably deserve a full debate. On clinicians and NHS systems being prepared to respond most effectively to those facing terminal illness, and their families, we have improved but there is much more to do—not just for the health service but for us all as a society. We need to become more open and comfortable with discussing that; some work has been done but more is needed. On mental health services providing support for families as well as individuals, we are still some way from where we would like to be but it is recognised as something that needs to be done.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I want to ask my noble friend the Minister about GPs’ training in mental health. I think it has been acknowledged that when parents take their children to the GP, quite often that is for a physical ailment but it turns out that the child could have a mental problem. It is difficult for GPs to pick that up, perhaps partly because of a lack of training and partly because they have only 10 minutes to see the child.

[Baroness Blackwood of North Oxford]

My noble friend raises a hugely important issue. We are seeing an improvement in the quality of training for GPs; the RCGP has been playing an important role in this, especially in raising specialist areas such as perinatal mental healthcare through the champions that it spreads through its system. We are seeing the impact on the ground, with CCGs meeting the mental health investment standard and rolling out specific access waiting times, so it is having an impact. But there is always more to do and the royal colleges have a specific role to play in raising awareness and the quality of training.

[Lord Smith of Leigh (Lab)]

My Lords, I declare an interest as chairman of the Greater Manchester Health and Social Care Partnership. There is much to welcome in this White Paper’s implementation—after all, a lot of the ideas were taken from Greater Manchester in the first place so we are pleased about that. We are particularly pleased about population health being a major factor now within government. I want to raise again two of the main issues that noble Lords have already raised. First, in deciding on local needs, if we think about only health we are missing a lot. Many times when people present with health symptoms, other social and economic issues are causing them to present. It could be loneliness or unemployment, but all these things create ill health in people and we need to think of things in the round rather than just about health. Secondly, I have a local government background, as Members know, but I must emphasise that unless we get social care right the NHS will grind to a halt. There is a real crisis in social care at the moment; it needs more money and there is no flexibility. We cannot solve the issues in the NHS unless we resolve care as well.

[Baroness Blackwood of North Oxford]

I thank the noble Lord and he is absolutely right, which is exactly why one of the core priorities in the long-term plan is the creation of integrated care systems, so that there can be a holistic approach to health while recognising that a lot of ill health is driven by social determinants. If we do not address what are often perverse incentives within healthcare systems, we will not be able to address the problems that we all know have been experienced through multiple Governments and generations. In addition, in the prevention Green Paper we have already announced a desire to bring in much more social prescribing, making it much easier for general practitioners and others within the system to address some of those wider challenges that lead to ill health and transform the system. We have already seen some fantastic pioneers of social prescribing transform the healthcare in their area, such as those in Tower Hamlets, and we want to see that thriving across the country.

Social Care: Free Personal Care

Baroness Blackwood of North Oxford Excerpts

Wednesday 26th June 2019 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what assessment they have made of the Institute for Public Policy Research’s report Social care: Free at the point of need—the case for free personal care in England, published on 23 May, and whether this matter will be addressed in the forthcoming Social Care Green Paper.

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

My Lords, we welcome the contributions made by recent reports on how social care should be funded in future, including the report by the IPPR. The Green Paper will bring forward ideas for including an element of risk pooling to help protect people from high and unpredictable costs. This Government are committed to ensuring that everyone has access to the care and support they need, and we are clear that people should continue to expect to contribute to their care.

[Baroness Wheeler (Lab)]

I thank the Minister. Age UK estimates that more than 1 million older people have died in the past two years either waiting for a care package or having been turned down and that nearly 1.3 million people have an unmet need for basic care support, such as washing, dressing and going to the toilet. Macmillan research shows that 8% of people living with cancer who have critical or substantial needs and who should qualify for council support receive no practical help at all and that 60% of their carers experience stress, anxiety and depression. I hope that when she responds the Minister will not just repeat the Government’s stock answer on so-called extra funding. The King’s Fund, the Nuffield Trust and the Health Foundation have independently identified the huge scale of government local authority social care cuts and the £2.5 billion investment needed just to keep the current system going. May I once again ask the Minister for news of the Green Paper? When is it going to be published? What is holding it up? The IPPR shows that free personal care would treble the number of older people with access to state-funded care, improve their health and well-being and save billions of pounds in hospital costs. Surely it is one of the key options for solving the current care crisis.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for an important question. She is absolutely right that the Green Paper must be a priority. It will set out our sustainable plans for reform. We have welcomed the contributions that have been made by a number of recent reports. The noble Baroness rightly pointed to the IPPR, the Joint Select Committees, the Health Foundation, the King’s Fund and the Resolution Foundation. They have made some important proposals which are being considered as part of the Green Paper’s work going forward. The noble Baroness is right that we cannot wait for that, because there are people who need improvements in care now, and that is part of what the better care fund has been set up to do—to improve the spreading of best practice and the new models of care work which have been put front and centre for the long-term plan improvements. That was introduced in 2015, and has brought in the funds required, taking the total of increased funding to £7.7 billion by 2018-19. We are looking at how we can make sure that that improves. It has brought changes across the system.

[Baroness Campbell of Surbiton (CB)]

My Lords, research carried out by the Independent Living Strategy Group, which I chair, concluded very recently that charging for the support disabled people need to go about their daily lives is unfair and counterproductive and undermines the primary purpose of the Care Act. Will the Minister tell me whether the Government have considered implementing the recommendations of the Darzi report, which called for extending the NHS’s “need, not ability to pay” principle to social care, especially for younger disabled people who have no savings and who want to save, to get a life, to get a house, to go to university and so on?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for the important point she has raised. The Government have established an interministerial group for disability chaired by the Secretary of State for DWP on exactly this point to identify barriers for those with disabilities and to drive forward co-ordinated action across government to try to address this. We are identifying organisations required to provide quality and comprehensive services based on clinical need which do not discriminate between patients on the basis of disability. I will take away the points the noble Baroness has raised because they are hugely important.

[Baroness Manzoor (Con)]

My Lords, there are examples of good social care packages across the country, but these are patchy. Can the Minister say exactly how the Government are currently disseminating good practice so that the elderly and young people who need social care packages get them now rather than in the future?

[Baroness Blackwood of North Oxford]

I thank my noble friend for her question. We should pay tribute to those who work very hard in the social care system under very challenging circumstances. Swindon, for example, has brought in a co-designed service with users and an increase in reablement of 150%, bringing an annual saving of £1.9 million to the health and care economy, while also reducing DTOC. Services and improvements such as these should be spread across the system. That is exactly what the better care fund is designed to do, and it is what the new models of care commitment within the NHS long-term plan will spread across the system so that we can improve social care for all.

[Baroness Pitkeathley (Lab)]

My Lords—

--- Later in debate ---

[Baroness Brinton]

My Lords, the IPPR report also notes that, if health and social care were truly integrated, the NHS could save £1.2 billion a year, rising to £4.5 billion by 2030, by reducing the number of admissions to hospitals and delayed transfers, as well as placing a real focus on funding care in the community. Will the new Green Paper ensure that true integration is fully addressed and that it is not just a case of adding “Social Care” to the title of the department?

[Baroness Blackwood of North Oxford]

The noble Baroness, Lady Brinton, is absolutely right. Integrating social care funding is the key priority of the social care Green Paper. It is part of the work that we are prioritising through the better care fund, but it is also part of the ICS work.

Carers: Support

Baroness Blackwood of North Oxford Excerpts

Monday 17th June 2019 Lords Chamber

[Baroness Pitkeathley]

To ask Her Majesty’s Government what proposals they have to guarantee support for family carers following the cuts made to local authority and voluntary sector support services.

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

My Lords, the Government have given councils access to £3.9 billion in dedicated funding for adult social care in 2019-20. Last June, we published the carers’ action plan, a cross-government programme of targeted work to support carers, including a £5 million carers’ innovation fund to encourage new and creative ways of doing so. We are also working with local government to ensure that carers can access the support that they deserve and promote best practice in carer breaks provision.

[Baroness Pitkeathley (Lab)]

I thank the noble Baroness for that Answer, which I listened to with great interest. I am the first to acknowledge that much progress has been made for carers in recent years, especially winning rights for them under the Carers Act. But I wonder how the noble Baroness would respond to the carer I spoke to on Friday. She is 79, recovering from cancer that has left her with severe back pain and caring for her 91 year-old partner, who has vascular dementia. Fourteen times she has asked her local authority for the assessment, to which she knows she is entitled. Fourteen times she has either been ignored or refused. Her local carers’ group, which was a support to her, has closed down because its funding has been cut. “It is no good telling me I have a right to services”, she says. “There are no services. There is only me and I am about to go under”. How does the noble Baroness respond to her?

[Baroness Blackwood of North Oxford]

The noble Baroness has raised an important point, which is that we need to provide carers with the support they need, because they do an amazing job. Unpaid care is a vital part of a sustainable health and social care system. This is why the long-term plan has put in place an ambition to ensure that we provide sustainable support across the public health system, and will ensure that we have a quality mark for primary care to highlight best practice. I am very sorry to hear about the experience of the carer in the case that the noble Baroness highlighted and would be pleased to follow this up with her directly, after today’s Question Time.

[Baroness Browning (Con)]

After decades of being a carer myself, I can say to my noble friend that it would help carers enormously for there to be an integrated approach to the carer and the person they are caring for. I cannot remember how many times I filled in a form asking what my needs are, and wrote across it, in large letters, “If the needs of the person I care for were met, my needs as a carer would be greatly reduced”. Until there is that joined-up approach in practice, carers will continue to suffer.

[Baroness Blackwood of North Oxford]

As so often, my noble friend speaks with common sense and insight. This is something that our carers innovation fund is supposed to root out, with its creative and innovative ways to drive reform and improvement through the system. That is why we brought it in, but it is also a commitment of the long-term plan. Best-practice quality marks in primary care are supposed to drive better identification and support of carers in the system. We will ensure that we see that.

[Baroness Brinton (LD)]

My Lords, 160,000 young carers have been assessed and can get support, but it is thought that there are up to 800,000 young carers. Councils have admitted to the Young Carers Trust that they cannot assess these young people at all. Some of them are doing over 50 hours of caring a week. They know that it is impacting their own physical and mental health. A third of young carers drop out of university and college. What are the Government doing to ensure that the basic funding to provide assessment for these vulnerable young people is in place, and to join up the work between social care and education?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

This is crucial. We must ensure that young carers, who are often unseen in the system, have the support that they need and are not overburdened by caring responsibilities. That is why we have been working with the Carers Trust and the Children’s Society. The Children’s Society has led a project to identify and disseminate best practice to support and enable young adult carers, between the ages of 16 and 24, to make a positive transition. Guidance and resources have been published this week, and we will ensure that this is implemented effectively. As the noble Baroness rightly says, this is a crucial part of implementing the carers action plan.

[Baroness Royall of Blaisdon (Lab)]

My Lords, one group that is desperately in need of support and respite care is the carers of children who are dying. A recent report stated that hospices for children are no longer able to help parents in those categories. They are having to shut down some of their facilities because of lack of investment. What are the Government going to do to help the families who keep these kids going, without whom the whole system will fall apart? The Government must help children’s hospices.

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right. This is an important part of the system. I noted those reports with serious concern. Significant work has been put into providing carers’ breaks and respite care within the Carers Action Plan. Local authorities are required to provide that support. We shall investigate what has happened in those instances.

[The Countess of Mar (CB)]

My Lords, the noble Baroness, Lady Pitkeathley, made it clear that what is needed is action now, not a long-term plan. What plans do the Government have to help people who are having problems now?

[Baroness Blackwood of North Oxford]

I am sorry if I have given the impression to the noble Countess that action has not been happening now. I can outline that the Government have been taking ongoing action to support carers. The Care Act 2014 introduced important new rights for carers, putting them on the same footing as those whom they care for. Through the Better Care Fund, the NHS has contributed £130 million for carers’ breaks. The Carers Action Plan, published in 2018, set out a broad, cross-government programme of work to support carers, which included 64 points which have been delivered since that time. A review will be published in July. A £5 million Carers Innovation Fund to support innovation was announced just this week and will include innovative ways to improve care for patients. This is all ongoing work which is helping carers now, but we recognise that it is not enough, because carers deserve the very best. That is why we will continue to strive to improve support for carers within the system going forward.

[Baroness Thornton (Lab)]

My Lords, according to Carers UK, 8.8 million people are carers in this country—that is up 2 million since 2011. Are the Government reviewing the funding provided in last year’s Carers Action Plan to take account of that? What discussion is the Minister’s department having with the department that funds local government? That is the nub of the problem: austerity has starved local government so that it cannot provide the right kind of care, and carers all over the country are suffering as a result.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question. Of course, £10 billion has been provided for adult social care between 2017-18 and 2020, with an extra £240 million for adult social care to reflect winter pressures and an extra £410 million to improve social care for older people, people with disabilities and children. However, the noble Baroness is absolutely right that a sustainable long-term plan for social care is part of the discussions taking place on the spending review and as part of the Green Paper planning. The consideration of dedicated employment rights and reviewing financial support for carers is part of those discussions.

People with Disabilities: Reporting Abuse

Baroness Blackwood of North Oxford Excerpts

Monday 17th June 2019 Lords Chamber

[Baroness Hussein-Ece]

To ask Her Majesty’s Government what assessment they have made of the adequacy of the support received by people with a disability when they report any form of abuse to appropriate authorities.

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

My Lords, I thank the noble Baroness for her Question. Support for people who wish to make a complaint about health services is available from the independent NHS Complaints Advocacy service. The Ask, Listen, Do programme is aimed at making giving feedback and raising concerns and complaints about education, health and social care easier for children, young people and adults with a learning disability or autism, their families and carers. We will take steps to empower independent mental health advocates to raise concerns when they know that something is not right.

[Baroness Hussein-Ece (LD)]

I thank the Minister for her response, but she will be aware that, according to the Crown Prosecution Service, disabled people and those with a learning disability are at a higher risk of crime, particularly hate crime and economic fraud, than the general population. They also experience unequal access to justice and safety.

The Mental Health Foundation last autumn produced a report which highlighted the underreporting of learning disability crimes and hate crime and it made some recommendations. Have the Government taken on board any of the recommendations aimed specifically at government and police; namely, to standardise police reporting systems so as to ensure that learning disability hate crimes are correctly recorded and adjustments made to support the victims when reporting an incident?

This week, the Government launched a task force to tackle economic fraud, but vulnerable people seem not to have been included in it. When will the Government establish good practice that is standardised to include and protect disabled people?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

The noble Baroness has raised a very important issue: she is absolutely right that those with learning disabilities are more at risk from hate crimes and less likely to report those crimes. This is exactly why a number of programmes have been introduced to support those with learning disabilities or autism to raise a complaint, such as the Ask, Listen, Do programme. I am very interested to hear about the report she mentioned: I will take that away in order to learn more about whether its recommendations can be implemented.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, during consideration of the draft domestic abuse Bill, the Joint Committee heard evidence from disabled groups about abuse in the home, sometimes from family members, sometimes from carers. I hope that the Minister’s department will join in consideration of the report of the Joint Committee, which was published last Friday, to ensure that the needs of disabled people with regard to domestic abuse are properly considered and addressed.

[Baroness Blackwood of North Oxford]

I am happy to give the noble Baroness that commitment. Domestic abuse in any situation is absolutely unacceptable and we are happy to commit to supporting her.

[Lord Sterling of Plaistow (Con)]

My Lords, a reverse of the abuse that the noble Baroness commented on was highlighted at a meeting in this House only two or three weeks ago, when we had a whole load of international psychologists around. A couple were there who said that their son, who is a lawyer but is on the spectrum, had a meltdown one Friday night. He was arrested and stayed in prison until Monday night/Tuesday morning because there was absolutely nobody around who was able to verify that he had this problem. I suggest to the Minister that one of our biggest problems is that there is not enough knowledge, by the police or by others, about how to handle such occasions.

[Baroness Blackwood of North Oxford]

I thank my noble friend for raising this matter and I am very sorry about the experience he highlighted. One of the measures that has been implemented in order to improve this situation is liaison services between police and mental health trusts to ensure that expertise is on the ground should individuals find themselves in situations such as he described. This has dramatically reduced the number of such situations. I would be very happy to write to him giving examples of where this has improved the situation.

[The Lord Bishop of Ely]

My Lords, it is important to consider also that there are various ways in which people with disability might be prevented from reporting abuse in the first place. In particular, some people with learning difficulties might not understand or recognise that they are being abused psychologically or financially. Does the Minister agree that information regarding abuse needs to be produced in accessible formats, such as easy read, and should ideally be produced in conjunction with people with disability themselves?

[Baroness Blackwood of North Oxford]

Absolutely. The right reverend Prelate makes a very sensible, common-sense point: this is exactly why work is going on between the NHS and the ombudsman to ensure that, within the NHS, there is a sensible and consistent complaints process that is accessible to all who try to make a complaint within the system, no matter their circumstances.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest as chair of the National Mental Capacity Forum. Do the Government recognise that many people are frightened of reporting any form of abuse, because of recriminations? Even when they do, they are asked for evidence of the abuse and it may be very difficult for them to provide any kind of objective evidence. Therefore, within the whole care sector we need a change in culture: we need staff to learn ways of dealing with some of the most challenging behaviours that they may face, recognising those and differentiating them from other forms of aggression, which may be drug- or alcohol-fuelled, or whatever. That requires investment, so that the CQC and other organisations, in inspecting, will look at the quality of education provided to staff at every level. It is often the lowest-paid staff who need the most education and they cannot access it.

[Baroness Blackwood of North Oxford]

As ever, the noble Baroness speaks with experience and wisdom. Speaking up and raising concerns where there has been abuse or where something has gone wrong should be straightforward and met with openness and a desire to get to the bottom of the problem. She is absolutely right that there is often a cultural barrier—a fear of aggression or recrimination. A patient or carer making a complaint should feel that they will be listened to and believed, but a staff member raising a concern should also feel that there are safe avenues for them to do so. That is why we have put in place the national guardian and the “freedom to speak up” guardian. When it comes to carers and patients, that is also why we are working with the ombudsman to ensure that there are clear routes of complaint across the whole NHS so that it is straightforward for people to make complaints and they feel that these avenues are protected for them.

Hospitals: Listeria

Baroness Blackwood of North Oxford Excerpts

Monday 17th June 2019 Lords Chamber

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

My Lords, with the leave of the House, I shall now repeat in the form of a Statement the Answer to an Urgent Question given by my right honourable friend the Secretary of State at the Department of Health and Social Care. The Statement is as follows:

“Mr Speaker, I would like to update the House on the actions that the Government are taking to protect the public following cases of listeria in hospitals linked to contaminated food. The NHS has identified nine confirmed cases of listeria in seven different hospitals between 14 April and 28 May this year, all of them linked to contaminated sandwiches from a single supplier. All of the known cases involved in-patients and, very sadly, five people have died. I would like to express my condolences to the families of those who have lost loved ones and I promise that there will be a full and thorough investigation, and severe consequences if there is any evidence of wrongdoing.

Laboratory testing indicated a link between two cases in Manchester Royal Infirmary and one case in Liverpool. Contaminated sandwiches were identified as the likely cause by Public Health England. The manufacturer, the Good Food Chain, and its supplier, North Country Cooked Meats, have withdrawn the sandwiches and voluntarily ceased supply of all products on 7 June. They are both complying with the Food Standards Agency on a full product withdrawal.

The other cases have been identified at the Royal Derby, Worthing, William Harvey in Ashford, Wexham, Leicester Royal Infirmary, and St Richard’s in Chichester. The risk to the public is very low, but any patients or members of the public with concerns should contact NHS 111, or 999 if they experience severe symptoms.

Listeria infection in healthy people may cause mild illness but is rarely fatal. However, for certain groups it can be much more serious, as we have tragically seen. The NHS, Public Health England and the Food Standards Agency have acted swiftly to identify, contain and investigate the cause of this listeria outbreak. These deaths should never have happened. People rightly expect to be safe and looked after in hospitals, and we must ensure that we take the necessary steps to restore the trust the public deserve to be able to have.

This is about ensuring not just that the food we serve in hospitals is safe—the NHS served 140 million main meals to in-patients last year—but that the food given to patients is healthy and nutritious and aids their recovery. I can inform the House that we are launching a root-and-branch review of all the food in our hospitals, both the food served and the food sold.

The Government will work with the NHS to build on the progress in three vital areas. The first area is eliminating junk food from hospitals. Since the introduction of the NHS Action on Sugar scheme, we have halved the sale of high-sugar soft drinks, and trusts are taking action to remove unhealthy food and drink and replace it with healthier alternatives. After all, hospitals are places for good health.

The second area is improving nutrition. New national standards for all healthcare food will be published this year. All patient menus will have to ensure that minimum patient nutrition standards are met.

The third area is healthier choices. We will work more closely with the Hospital Caterers Association and others to ensure that healthier food choices are available across the NHS.

The review will identify where we need to do more, where we need to do better to improve the quality of food in our hospitals and how we can help people to make healthier choices. I know this is an issue that many colleagues in the House will feel strongly about, as do the public. We will do everything we can to ensure that the food we eat in hospitals is both safe and healthy”.

[Lord Tunnicliffe (Lab)]

My Lords, I am grateful to the Minister for repeating the Answer to this Urgent Question. Our thoughts and deepest sympathies are with the families of those who have tragically died as a result of the outbreak and those who have fallen sick.

Professor Jose Vazquez-Boland, chair of infectious diseases at the University of Edinburgh, warned in the media over the weekend that:

“Pre-packed sandwiches are recurrently incriminated in the UK in listeriosis episodes”.


This is a concerning revelation, with potentially widespread implications for food packaging, storage and distribution.

Over the weekend the Health Secretary announced that he had ordered a “root-and-branch” review of hospital food. Can the Minister outline exactly what this review will entail and when it is expected to report back? Does the Minister believe the review should be industry-wide, given that the supplier, the Good Food Chain, also supplies sporting venues, businesses and universities nationwide?

[Baroness Blackwood of North Oxford]

I thank the noble Lord, Lord Tunnicliffe, for his question. The purpose of the review is to build on previous work and to implement standards for higher-quality food for NHS patients. It will take a root-and-branch approach and will follow the evidence where it can make improvements. The terms of reference are to work with the NHS and stakeholders; they are currently under development, but will be shared with Parliament as soon as they are set in place.

I can also reassure the noble Lord on the question he raised about the products. While GFC manufactures a range of products, in the consumption data gathered from case records only sandwiches were identified as having been consumed. It is therefore anticipated that the review targeted at the NHS is the right approach.

[Baroness Smith of Newnham (LD)]

My Lords, like the noble Lord, Lord Tunnicliffe, my thoughts and prayers are with the families of those who died. It is clearly right, as the Secretary of State said in his Statement, that people expect to be safe and looked after in hospitals. Yet the Answer to the Urgent Question seems to spend rather a time talking about healthy food and other wider issues. This is an urgent issue. What will happen urgently to ensure that similar situations cannot happen again? Getting rid of sugar may be important, but ensuring that listeria is not present is vital. What necessary steps will be taken to restore trust urgently? I am sure that we all welcome the Secretary of State back to his full-time job now that he has stopped trying to be leader of his party.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

I am sure that the noble Baroness would like to hear exactly how effectively Public Health England and others responded in this case. Obviously, these cases should not have occurred in the first place, but the first case occurred on 26 April. There were two cases in one hospital. The second case in a different hospital did not occur until 16 May. It took one week for Public Health England to ascertain that this was a national issue and that the cases were indeed linked. Thereafter, products were withdrawn. Very swift action was taken by Public Health England and the Food Standards Authority and a clear and concerted investigation is now under way. It will be made clear that this sort of thing cannot happen again and that there will be severe consequences for any companies that do not take careful consideration of the consequences if they do.

[Lord Patel (CB)]

My Lords, several important points come out of this tragic incident of five people dying from listeria infections. The first is how quickly we can get a diagnosis of listeria in the food products that are contaminated. Older tests take several days but there are other tests, so I ask the Minister whether rapid diagnosis tests are available. Secondly, if people are infected with listeria monocytogenes it is quite dangerous, so the death of the people concerned may be related to that infection. It is important that the food in the supply chain is tested. Some countries adopt a regulation that requires regular testing of food in the environment where food such as sandwiches is packaged. In the review that will be conducted, will we look at the possibility of such regulation?

[Baroness Blackwood of North Oxford]

I thank the noble Lord, Lord Patel. He is absolutely right that one reason why such fast action was able to be taken was that it was possible to confirm by whole genome sequencing that cases at Manchester and Liverpool were linked by an identical strain in a week. Previously, that would have taken an awful lot longer, so we can be pleased that action was taken much quicker.

In terms of lessons learned, the noble Lord is right that we need to look at how to ensure that local authorities undertake inspections and audits of sites that are approved and that we also collect samples every six months and take action on any results of concern. We must make sure that the NHS follows food safety advice from Public Health England and the Food Standards Authority. Public Health England has confirmed that serving sandwiches in hospitals—I apologise. I am going to faint.

Unpaid Carers: Support

Baroness Blackwood of North Oxford Excerpts

Thursday 13th June 2019 Lords Chamber

[Baroness Brinton]

To ask Her Majesty’s Government what steps they are taking to ensure that unpaid carers receive the support to which they are entitled.

[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 carers to provide care in ways that protect and preserve their own health and well-being. Last June, we published the Carers Action Plan, a cross-government programme of targeted work. This included a £5 million carers innovation fund, to encourage innovative and creative ways of supporting carers. We are also working with local government on a sector-led improvement programme of work focused on implementing the carers Act duties for carers.

[Baroness Brinton (LD)]

I thank the Minister for her Answer. As Carers Week draws to a close, I point out that we owe a great debt of gratitude to the 6.5 million carers in the country who save us more than £100 billion a year, given the costs that we would otherwise have to bear. The problem is that nearly three-quarters of those carers say that they suffer mental health stress as a result of their caring duties, and over 60% say that they have physical health problems. Will the overdue Green Paper on social care put sustainable funding in place to properly provide support for carers and ensure speedy access to health services for them?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important Question. I suspect that the majority of noble Lords have not only been carers themselves but have benefited from caring. I would not be standing here myself were it not for the caring support of my own family. We should pay tribute to carers up and down the country, without whom we would not have a sustainable health and care system. I assure the noble Baroness that proposals for putting in place sustainable funding to support carers, and considering their employment status, are part of the work that is going on in implementing the long-term plan and preparing the social care Green Paper. I hope that reassures her.

[Baroness Wheeler (Lab)]

My Lords, a growing number of older people are providing unpaid care while trying to manage their own health and care needs, in many cases co-caring for each other with partners, adults or children with learning difficulties. In particular, there is an alarming increase in the number of carers aged 85 and over, who are more likely than other carers to be caring round the clock, be suffering anxiety and be in poor health themselves. What are the Government doing to ensure that these carers are getting the vital social and community help they need? Are they still the priority, as was promised in the NHS five-year forward view?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question. She is absolutely right that we need to ensure that we target support at those who need it most, but that we also identify those who are carers within the community, because of the burden that we know caring can impose on the health of those who are caring. That is why the Carers Trust has been undertaking research into best practice in identifying carers and targeting support. It is also why the Department of Health and Social Care has been working with local government on a sector-led improvement programme of work focused on the implementation of the carers Act duty for carers. We have just begun phase 1 of this and we are implementing phase 2 to ensure that best practice is disseminated across the system, so we can deliver on the commitments we made within the carers plan.

[The Lord Bishop of St Albans]

My Lords, I am sure that we all want to encourage stronger family and community life, which is the very bedrock of healthy societies, but there is one group in particular that needs help and that is the 166,000 underage carers in England. Research by the Children’s Society suggests that that is just the tip of the iceberg—indeed, a huge underestimate. Many of these young people do not realise that they classify as carers: it is just what they have had to deal with. In many cases it is affecting their schooling and mental health. What are Her Majesty’s Government able to do to help and support underage carers in particular?

[Baroness Blackwood of North Oxford]

The right reverend Prelate is quite right to identify this as a crucial issue. The Government believe that children should be protected from inappropriate and excessive caring responsibilities. We changed the law to improve the way that young carers are identified, and we are supporting schools to support carers and working with the Carers Trust to identify and spread best practice. Just today, working with the Children’s Society, which he rightly says has led this project to identify and disseminate best practice, guidance and resources will be published to enable young adult carers to make positive transitions between the ages of 16 and 24. We hope that this will improve the outcomes that young carers experience.

[Baroness Manzoor (Con)]

My Lords, I am delighted by the Carers Action Plan, which is a very important piece of work for many thousands of carers in the country. Can my noble friend say exactly what progress is being made in implementing this plan and how success will be measured?

[Baroness Blackwood of North Oxford]

I thank my noble friend for this important question. The Carers Action Plan was a real step in the right direction. It has 64 action points and good progress has been made. There will be a progress report in July. Some key steps in it are promoting best practice for local authorities, clinical commissioning groups and other providers in order to give carers much-needed breaks and respite care, which can be the difference between coping and not coping; and providing carer-confident benchmarks for employers who can identify carers within their systems and give them the support they need. Of course, there is also the work I have already mentioned: the £5 million carers innovation fund to find more creative and innovative ways to support carers, who are so crucial to our health and care system.

[Lord Patel (CB)]

My Lords, does the Minister agree that any future proposals for the funding of social care need to be sustainable? Any proposal that requires the burden to fall on those who need social care or their families will not be sustainable and will therefore require contributions from wider society.

[Baroness Blackwood of North Oxford]

I completely agree with the noble Lord, Lord Patel, who is absolutely right that we must ensure that we sustainably fund social care. The Government have provided £3.9 billion more in dedicated social care funding, but we recognise that there is a need for a sustainable financial footing for social care as a whole, which is what we are working towards with the spending review. Nevertheless, carers will continue to play an important part in our healthcare system, as they do within our society. Many people consider that they are making a rewarding and important contribution within their family and community, and we must be grateful to them for that.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the implication of what the noble Baroness has just said is that the work around the Green Paper on a sustainable mechanism for funding long-term care is focused on the medium and long term. If that is so—and I think the Minister could say something about the actual remit of the work—the question then arises, what about the short term? We know that the money she talked about is a drop in the ocean compared to the money that has been taken away from social care, alongside the increasing demographic pressures. Can she tell me whether, as part of the spending review, which I assume will occur at some point, the immediate pressures are also going to be taken care of?

[Baroness Blackwood of North Oxford]

The noble Lord will know that the spending review has not yet started, so I cannot tell him what is happening in the negotiations. What I can tell him about is the work that has already gone on to improve social care funding: giving local authorities access to around £10 billion more in dedicated funding for social care from 2017-18 to 2019-20; an additional £410 million of new money to improve social care for older people, people with disabilities and children; and £240 million more for winter pressures. However, the noble Lord is absolutely right that it is no good improving the medium to long-term outlook for social care if we do not ensure that we also address the immediate challenges that it faces.

[Baroness Thomas of Winchester (LD)]

My Lords, the right reverend Prelate mentioned one group of carers. I would like to ask about those from the BME community, many of whom do not know about the benefits to which they would be entitled—the carer’s allowance, for example, and even the national insurance waivers that come with it. What are the Government proactively doing to support them?

[Baroness Blackwood of North Oxford]

This is a really important question, because the carer’s allowance has increased and is available as a non-means-tested support. I can reveal today that one of the key issues that is being looked at as part of the social care Green Paper is ensuring that financial support and employment status for carers are clearer, so that they can access all the support they are entitled to, but also to try to make things simpler.

[Lord Kirkhope of Harrogate (Con)]

I declare an interest as a former Mental Health Act commissioner. While we are talking about carers, there is a considerable number of people who are caring for members of their family who have been suffering from mental illness and are now in the community. Would my noble friend not agree that we should be more concerned to give assistance there as well, rather than merely to those who care for people with physical ailments?

[Baroness Blackwood of North Oxford]

The burden of ill health, anxiety and depression is an important issue that has been clearly identified, and it can be caused by caring for a loved one. There is specific evidence about the threshold at which the number of hours spent caring causes such challenges. My noble friend is right that we should not only identify those who are caring but signpost them clearly to the support available for carers and make sure that they can access that care easily.

National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2019

Baroness Blackwood of North Oxford Excerpts

Monday 10th June 2019 Lords Chamber

[Baroness Jolly]

My noble friend makes a very good point. The majority of people who work in the sector are care workers on the basic minimum wage, or something related to that. What we are discussing this evening is nursing care which will be paid at a union rate; nevertheless, it is stretching the sector.

The Minister knows about the shortage of nurses, and the noble Baroness, Lady Thornton, spoke about the shortage of care workers. Why do we have restrictions on agency nurses’ nursing hours of 10% of the total? Clearly, we cannot have agency nurses covering the whole thing; everyone across both health and social care frets about agency nursing and its expense over and above that of paying for directly employed people. But what is a nursing home to do if there are no salaried nurses available? Is the 10% smoothed over a month or a year? Is this realistic? How realistic is it for less than 10% of nursing hours to be delivered by the agency? This will be locally variable—relatively straightforward, perhaps, in city settings but where my noble friend and I live in Cornwall, people such as agency nurses are like hens’ teeth. This is not straightforward, and I am not convinced that it is absolutely workable.

This measure looks hurried, but I suppose any increase is welcome. I await the Minister’s response to some of the comments that I have made and those of the noble Baroness, Lady Thornton.

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

My Lords, I open with an apology for the state of my voice. I shall do my utmost to make myself heard and make it to the end of my speech. If I do not manage to answer all the points made, I shall write not only to the two noble Baronesses who have raised questions but to all those present in the debate, and will place a copy of that letter in the Library.

I would also like to identify myself with the points raised by the noble Baroness, Lady Thornton, regarding Carers Week, and to pay tribute to all those carers in this country who make tremendous sacrifices for those they care for. We should all thank them for the work they do. Our system would not cope without them; we should all be very grateful.

I turn to the questions that have been raised. NHS funded nursing care is of course an incredibly important part of the health and care system, supporting the provision of nursing care in nursing homes. The NHS funded nursing care rate plays the important role of ensuring that neither individuals nor local authorities have to pay for nursing care, which is the responsibility of the NHS. My department is seeking to ensure that nursing home providers are paid a fair rate for employing registered nurses, so that nursing care can be provided to all who need it. On the point that was just raised, it is helpful to know that the average pay for registered nurses in the independent sector has now risen from £23,400 to £29,400, so that is the benchmark we are talking about.

The noble Baroness, Lady Thornton, raised the issue of the nursing care rate for 2019-20, which my department set in regulations in April. This was done, as she said, following the LaingBuisson report into the costs of providing NHS funded nursing care to nursing home providers, after further consideration by my department. Following this work, the rate has increased by 4.7%, which is a significant increase above inflation, as has been recognised. The efficiency expectation, which is regretted in tonight’s Motion, should be seen in the context not only of this above-inflation increase but in the context of the significant increase of 40% which came in 2016-17; that is part of the picture that the efficiency expectation was put in place to address.

It is only right at a time of continued and much-needed investment into nursing home providers—ensuring they are able to employ and retain registered nurses—that the Government and the NHS also expect those providers to deliver as efficient a service as possible and value for money to the taxpayer. The 4.7% increase in the nursing care rate for 2019-20 is a far larger increase than that being seen in the vast majority of prices across the wider public sector and NHS; this is because of the priority that we have set on that rate. For example, the NHS national tariff is increasing the majority of prices in the NHS by 2.7% for 2019-20. The national tariff has also asked most NHS providers to make efficiencies of 3.1% across 2018-19 and 2019-20, and the Government believe that while still getting an above-inflation increase, nursing home providers should be able to do the same.

The LaingBuisson report provided evidence showing that many nursing home providers are already delivering nursing care more efficiently than others, so there is variability in the system. The study shows wide variation in the cost of delivering nursing care, even when factors such as region or provider size are taken into account. Efficient providers surveyed were shown to deliver an hour of NHS funded nursing care for 18% less than others. Additionally, the study showed that nursing home providers are increasing their use of agency nurses, as has been discussed. An hour of agency nursing costs 47% more to providers, and so, obviously, to the NHS. We believe that providers can work to reduce the proportion of their workload covered by agency nurses, as we have required other parts of the NHS to do, in a sustainable way.

There is a need to ensure value for money in important NHS services and to maintain their sustainability. The Government believe that efficiencies can be made in relation to the rate this year—for example, in the use of agency nurses. However, this is still within the context of a significant and above-inflation increase to the nursing care rate. That is why we think that the rate set is achievable.

The noble Baroness, Lady Thornton, also raised the important issue of the need for a long-term funding settlement for social care and financial sustainability for the sector, as she has on more than one occasion in this Chamber. The Government have already given councils access to around £10 billion of additional dedicated funding for social care over this spending review period. This includes a £240 million adult social care winter fund for 2018-19, and again for 2019-20, to help local authorities. It is the biggest injection of funding for winter pressures that councils have ever received. As a result of the measures the Government have taken, funding available for adult social care is increasing by 8% in real terms from 2015-16 to 2019-20. Councils have responded by increasing their spending on social care, so the money has gone where it was supposed to, which is always encouraging.

Local authorities were also able to increase the average fees paid for older people’s residential and nursing care by 6.4% in 2017-18, which we believe brought more stability to the market. When we look into the detail of the figures we see that, while there has been a reduction in the number of care homes, the overall number of social care beds has remained broadly constant over the last nine years, with an increase in nursing beds and care home agencies. As in any market, there will be inevitable entries and exits of care organisations, but we feel that there is some consistency. It is more reassuring than it may appear on the surface.

As we have also discussed, social care funding for future years will be settled in the spending review, where the overall approach to funding of local government will be considered in the round. We are also looking ahead to ensure that the social care system is sustainable in the longer term so that we can continue to deliver as our society ages. This is why the Government have committed to publishing a Green Paper at the earliest opportunity, setting out proposals for reform.

I hope I have answered the majority of the questions raised by the noble Baronesses. If I have failed to respond to anything, I hope they will allow me to write.

[Baroness Thornton]

I thank the Minister for that answer. I am not completely convinced about the stability of the care home sector. I think we have some major problems coming down the line. Of course, like the noble Baroness, Lady Jolly, I welcome an increase in payment for nursing staff, because that is absolutely essential. However, we have to take seriously the issue of social care staff who work in homes or a domiciliary setting. They do not get the attention or esteem they deserve, or the training they need, and they are certainly not paid sufficiently, yet we still expect them to deliver the best possible service. This statutory instrument is not the place where that can be solved, but it amplifies the challenges we face here.

On that basis, I thank the Minister for getting through that answer without completely losing her voice. We heard everything she had to say. I beg leave to withdraw the Motion.

People with Learning Disabilities

Baroness Blackwood of North Oxford Excerpts

Thursday 6th June 2019 Lords Chamber

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

My Lords, I thank the noble Baroness, Lady Thornton, for securing this serious and timely debate and I am very grateful to noble Lords for their informed contributions on a very sensitive matter. The care and treatment of people with learning disabilities and autistic people has rightly come under intense public scrutiny in recent months, with widespread concerns about how we care for and support some of the most vulnerable in society. Today’s debate provides an important opportunity to reflect on this crucial issue.

Nobody who watched the BBC’s “Panorama” programme on Whorlton Hall could have been anything but deeply shocked and disturbed by the abuse it exposed. The actions revealed by the programme, the abuse of vulnerable people in a setting where they should have been safe and well cared for, was truly appalling. We are very clear that people with learning disabilities and autistic people have the right to feel safe in their environment and to be treated with dignity and respect. As the noble Baroness, Lady Thornton, rightly said, Durham Constabulary is investigating and has so far arrested and questioned 10 members of staff about offences relating to abuse and neglect. We cannot comment on matters that might prejudice that process, but 16 members of staff have also been suspended and all patients have now been transferred out of the hospital and it is closed to new admissions. In addition, my right honourable friend the Secretary of State for Health and Social Care has asked the CQC to look in detail at its inspection and regulatory approach to Whorlton Hall to ensure that lessons are learned from what has happened in this case and in other cases that have gone before it. The CQC has commissioned independent reviews. The first is looking into how the organisation dealt with concerns raised by an inspector in a draft report prepared in 2015, as has already been mentioned; the second is a wider review of what could have been done differently or better in its regulation and inspection of Whorlton Hall between 2015 and 2019. The findings and recommendations of both reviews will be published. It is clear that opportunities to intervene were missed, and we must be open and transparent in getting to the bottom of why this happened.

The noble Baroness, Lady Thornton, and the noble Lord, Lord Hunt, mentioned the Children’s Commissioner’s report. She has also investigated the treatment of children with learning disabilities or autism in in-patient mental health hospitals. Her recently published report showed how too many children are still being admitted into secure hospitals, often a long way from their home, when they should be in their community, as well as being subject to restraint and seclusion. I will return to that in a moment. She warns that the current system of support is letting down some of the most vulnerable children in the country. We will consider her report extremely carefully.

I want to turn to points made by the noble Baroness, Lady Thornton, regarding private providers. Around half of the provision of specialist in-patient care is in the independent sector. This is carefully looked at by regulators and by the Government. At the moment, there is no evidence of a systemic difference between the quality of care and that of the NHS or voluntary providers. The care is NHS-commissioned and is subject to the same commissioner oversight, contractual provisions and regulation by the CQC. The same safeguards under the Mental Health Act also apply to protect the rights of patients. However, we keep this matter under careful review and will continue to do so.

I now turn to the important question that was raised about restrictive interventions, given the prominence they have been given in recent reports. It is important that we see a decrease in the use of such interventions. Data collection is not robust enough for us to make comparisons between years to see whether the use of restraint is rising, but it provides enough certainty for us to know that it is still used too much. We must minimise it and, where it is used, ensure that it is done safely and effectively, in line with the Positive and Proactive Care guidelines. Understandably, there is public concern about the use of restraint, prolonged seclusion and the segregation of people with mental health problems, a learning disability or autism.

In response to the case of Bethany, a young autistic woman who was held in seclusion at a hospital for far too long, my right honourable friend the Secretary of State for Health and Social Care has commissioned the CQC to undertake an in-depth thematic review of restrictive practices in health and care settings. The CQC published its interim findings and recommendations on 21 May and the Government have accepted them in full. The care of every hospital patient in long-term seclusion or segregation will be reviewed, and patients will have access to specialist independent advocates to support them and their families, as has been mentioned.

The model of care for autistic people and those with learning disabilities must be fit for purpose. We will convene an expert group to develop a new care model, taking the very best practice as the foundation. We will also strengthen the safeguards, working with the CQC to develop new regulatory arrangements for hospitals that use segregation. In addition, we will develop a new awareness-raising campaign, as has already been mentioned, so that no one will be “out of sight, out of mind”, as has too often been the case. We want to end inappropriate out-of-area placements and ensure that people are cared for as close to home as possible. Where out-of-area placements are essential, as they sometimes are for very specialist care, commissioners will need to visit children every six weeks and adults every eight weeks on site. I hope that that will improve the situation and reassure the House.

The noble Baroness, Lady Thornton, asked why the CQC registered new facilities that do not offer an appropriate model of care. The CQC has a set of stringent rules for registering the right support. It only registers a new learning disability service that meets the service model for building the right support. However, I am sure that, given the circumstances that have arisen, this will be looked at very carefully. The noble Lord, Lord Hunt, was right: given the situations that have arisen, there needs to be a holistic and systemic response.

Many of the actions that have been taken and which we have been debating began in 2014-15, and it is important that we see the progress that has been made since then. The Learning Disabilities Mortality Review Programme—the world’s only national programme looking into why people with learning disabilities die—was set up relatively recently. It has made some progress and has recommended specific steps to improve our response to those with learning disabilities in the community to ensure that they have a better quality of life. The noble Baroness, Lady Thornton, made that exact point when she talked about improved community support. That is why annual GP health checks for people with learning disabilities to help reduce recognised health inequalities is a commitment in the long-term plan, and it is why, over the next five years, national learning disability improvement standards will be implemented and will apply to all services funded by the NHS. That is one of the systemic requirements that will help to drive improvements through the system—something that I think has been missing from the response until now.

Furthermore, NHS England and NHS Digital are working to include a digital flag in the records of people with a learning disability or autism so that information can be shared across health and care records and organisations. In the NHS Long Term Plan we have committed to implement this by 2023-24. It is another systemic response that should create a significant improvement. In addition, people with a learning disability or autism, or those with the most complex needs, will have a designated keyworker. These will initially be provided to children and young people who are in-patients or at risk of being admitted to hospital. All these improvements should make a significant difference, as will the review of the autism strategy, which is well overdue.

The noble Baroness, Lady Lane-Fox, is absolutely right that augmented rather than artificial intelligence—people plus tech—has the potential to completely transform the health of this nation. I thank her for an inspirational contribution. She will be pleased to hear that we have now completed rolling out wi-fi across the GP network and that we are well on the way with the secondary care system. She is right about skills being essential to driving digital transformation across the system, and that is why we set up the NHS Digital Academy. However, we recognise that more needs to be done. Investment was one of the core elements of the Patient Capital Review. We want to drive that forward and I would very much like to hear the noble Baroness’s proposals for it.

On the Transforming Care programme, although hospital might be the right environment for a small number of people with learning disabilities or autistic people at a given point in time, everyone should have the opportunity to live in the community. When people need in-patient support, it should be for the shortest time possible, of the highest quality and delivered in the safest settings where people are free from harm and abuse. The goal of the Transforming Care programme is to reduce the number of in-patients. We have reduced the number by 22%, and we are still fully committed to reducing it by at least 35% as soon as possible during 2019-20, as set out in the NHS Long Term Plan. That remains a commitment. Local areas will be expected to use some of the growing investment in primary care and community care services to meet that commitment.

I would like to respond to the point that was made about the number of child in-patients having doubled. In part this was because, we believe, commissioners did not correctly record children in the NHS Digital figures before 2015. We are checking the data and will respond later.

The noble Lord, Lord Hunt, was absolutely right about self-training, and that is why we have consulted on proposals to introduce mandatory training. Our plans to introduce mandatory training for all relevant health and care staff will go a long way to ensuring that more people receive the safe, compassionate and informed care that they are entitled to.

We will of course continue to work with all partners across government and across the health and social care system to consider any recommendations that can improve care for people with learning disabilities and to address the shameful inequalities that they experience. Every person has a right to effective, compassionate and dignified care. If you have a learning disability, these expectations should be no different.