Health and Social Care: Malnutrition

Debate between Baroness Blackwood of North Oxford and Baroness Browning

Tuesday 5th November 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord is quite right that this is about leadership not only at board level but from the very top. It has been instructive that not only the Secretary of State but the chief executive of NHS England, Simon Stevens, have made it one of their priorities to ensure that the quality of food and food safety standards throughout the hospital and care systems should be improved. This is one of the key ways that we will drive out malnutrition from our health and care sector.

[Baroness Browning (Con)]

Could my noble friend please take a look at the frail elderly living alone at home who are not necessarily regularly seen by doctors because they do not present with symptoms? Very often, the older people get the more difficult it is, as the body starts to age, for them to absorb nutrients, even when they are eating a mixed diet. Could she take a look at that particular group, in the way that we look at people who have regular check-ups with a GP for heart problems and diabetes, to ensure that they are not just deteriorating? It is not until they deteriorate to the point where they become ill and symptomatic that people start to notice that there is a problem.

[Baroness Blackwood of North Oxford]

My noble friend is absolutely right. Evidence is on the rise that malnutrition is worse among older age groups and is both a cause and consequence of ill health. We must make sure that we are identifying and intervening as early as possible to make sure we are not leading to some of the challenges raised by the noble Baroness. That is why the malnutrition universal screening tool has been developed by the Malnutrition Advisory Group to assist those in nursing and in general practice to intervene as early as possible to prevent some of the challenges that she has identified.

Mental Disorder: Autism and Learning Disabilities

Debate between Baroness Blackwood of North Oxford and Baroness Browning

Tuesday 5th November 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for taking on the chairing of the independent panel. I cannot think of anybody better placed to do so. When it comes to her question about the detention of an individual to improve their behaviour, again, I do not think that anybody in this place or elsewhere could disagree with her. On changing the Mental Health Act, we commissioned the independent review led by Sir Simon Wessely, who is also a leader in the field. He reported in December. In its findings, the review made it clear that we need to modernise the Mental Health Act, ensure that views are respected and ensure that patients are not detained for any longer than is absolutely necessary. Sir Simon stated that there is “no clear consensus” on removing autism from the Act, and that,

“we have heard also about the many negative consequences that could arise from being outside this framework … this should be kept under review”.

Obviously, we will not respond to that immediately. There will be a White Paper by the end of the year. We will consider this carefully and we recognise the strength of feeling on this matter.

[Baroness Browning (Con)]

In support of what the noble Lord, Lord Touhig, and the noble Baroness said—we greatly welcome her chairmanship of the review—there is a very good reason for removing autism as a mental disorder: it is not a mental disorder. It is as simple as that, although it is true that people with autism, including children, will have comorbidities and will develop a mental health condition on top of their autism. I do not know whether the Minister understands my frustration, but I have been raising this issue in Parliament for nearly 28 years. The real problem is that we do not have sufficient psychiatrists who understand and can differentiate between autistic behaviour and what they believe to be psychotic behaviour. Once patients start the spiral of medication for psychosis, the autism disappears and the person disappears altogether.

[Baroness Blackwood of North Oxford]

My noble friend puts this very clearly. The Government accept completely that autism and learning disability are not mental disorders. The question is whether being excluded from the legislation would cause challenges or difficulties for those who may have autism and mental disorders. We will have to consider that carefully as we go into the process of considering a review of the Mental Health Act. As my noble friend just said, we recognise that we will have to go through a careful process. We also recognise the strong feelings—and the correct view—that autism and learning disability are not mental disorders. There is no disagreement on that point.

Carers: Support

Debate between Baroness Blackwood of North Oxford and Baroness Browning

Monday 17th June 2019 Lords Chamber

[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.

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Blackwood of North Oxford and Baroness Browning

Tuesday 26th February 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

My Lords, It is vital that those who are deprived of their liberty are provided with the information necessary for them to be able to exercise their rights. Although there is a duty to provide information in Article 5 of the European Convention on Human Rights, noble Lords have rightly flagged that the Bill should be explicit about this duty, and amended the Bill to this effect.

The Government listened to noble Lords and agreed that the Bill should be explicit on this matter. However, the amendment tabled in this place was not clear about when information should be provided; we felt that this drafting could cause some confusion for practitioners, so we tabled alternative amendments. Amendment 24 clarifies that, as soon as practicable after arrangements are proposed, the responsible body must take such steps as are practicable to ensure that the person understands the key steps and safeguards in the authorisation process. This is particularly important to ensure that people are aware of their options to challenge the authorisation. Importantly, there is also a duty to provide the same information to any appropriate person who is providing representation and support to the person. This is important in ensuring that family members and those close to the person are also provided with the necessary information to enable them to effectively provide representation and support to the person.

The duty on the responsible body is to take steps as soon as practicable to provide the person with the information. This means that this should be done as soon as possible after the responsible body is aware that arrangements are proposed. The responsible body will need to identify an appropriate person or appoint an IMCA at the earliest possible stage to provide support and representation for the person; the same principle applies for the duty to provide information. Information should be provided in the early stages of the process so that the person can make an informed decision regarding the support they receive through the process, and is able to exercise their rights. The code will provide details about how this will work in practice. We have already established a working group on the code of practice, which includes stakeholders from across the sector, ensuring that information is provided at the earliest possible point to form a part of these discussions.

Amendment 24 also introduces a general duty to publish information about the authorisation, including: the process; the circumstances in which an IMCA should be appointed; the role of the appropriate person; and the right to challenge an authorisation in court. This ensures that anyone who has an interest in the welfare of the person is subject to liberty protection safeguards authorisation, has access to the important information about a person’s rights, and is able to raise objections on behalf of the person.

Amendment 25 requires that the responsible body remind the cared-for person and any appropriate person of this information after the authorisation is granted. The information that needs to be provided to the person, and to any appropriate persons, includes details of the authorisation process, access to representation and support from an appropriate person or an IMCA, the right to request a review, and circumstances in which an AMCP will consider a case, which includes objections and the right to challenge authorisations in court.

On the matter of challenging authorisations in court, the responsible body under Article 5 of the European Convention on Human Rights has a duty to ensure that relevant cases are referred to the Court of Protection. I know that there has been a particular concern about ensuring that in very rare cases where it is not in the person’s best interests to receive support and representation, those people are enabled to challenge in the Court of Protection if they want to. In these cases, the responsible body will need to ensure that the cases are referred to the court. If it fails in this duty, it can be challenged in court.

I understand that Amendment 25A, tabled by the noble Baroness, Lady Watkins, seeks to require responsible bodies to keep a record of the decision and justification for not immediately giving a copy of the authorisation record, and if an authorisation record is not given within 72 hours, there must be a review into whether the lack of information is appropriate. I understand her desire to ensure that information about an authorisation record is provided promptly. However, we think that the drafting of the amendment would cause some issues; for example, it is not clear who is responsible for the duty to record or carry out a review. I am certainly willing to reflect on how best we can ensure that information is shared promptly, but I hope that I can reassure the noble Baroness that we will generally expect the information to be provided earlier than this, and we will set out reasonable timescales for the responsible body in the statutory code of practice. I hope that, with this reassurance, she will decide not to press her amendment.

The House has made clear its view that the Bill should be explicit about the duty to provide information. The Government have listened: these amendments outline clearly the duty to provide information at the earliest possible stage; to require, as far as possible, that the person understands the information they are being given; and to take action on it if necessary. I hope that noble Lords will accept these changes made by the House of Commons, and on that basis, I beg to move.

[Baroness Browning]

Is my noble friend able to define what the Government describe as “as soon as practicable”, which she said was going into the code of practice? Linked to that, how will it be defined for those people who will need the support of speech and language therapists, of an approved mental capacity professional or of an IMCA? It seems that we will need information to be provided at a very early stage, so that it can be considered and then decided whether there is a need for additional support. Can she give us some indication of how she is going to deal with that in the code of practice?