NHS: A&E Waiting Time Target

Baroness Brinton Excerpts

Tuesday 21st January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

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

[Baroness Brinton (LD)]

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

[Baroness Blackwood of North Oxford]

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

Young Carers: Health and Well-being

Baroness Brinton Excerpts

Monday 13th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

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

[Baroness Brinton (LD)]

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

Mental Health: Weight and Shape-related Bullying

Baroness Brinton Excerpts

Monday 22nd July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

As usual, the right reverend Prelate raises an important point. The fundamental principle of using lived experience to develop policy is an important principle within the Department of Health and across government. Most particularly, the experience of young people—those who are bullied and those who are bullying—should be taken into account. This is the only way we will get to the bottom of this problem and stamp it out once and for all.

[Baroness Brinton (LD)]

My Lords, as the co-chair of the APPG on Bullying, I have seen the reports that other noble Lords have referred to. It is good that more investment is going into mental health in the NHS, but schools still need front-line support for many bullied children. Over half of children report that bullying about their size and body image is the leading cause. What can the Government do to ensure that there really is access to front-line services for children in school?

[Baroness Blackwood of North Oxford]

As I have said, we are making sure that we bring the investment into the front line with this £2.8 million. In addition to that, all schools are legally required to have behaviour policies with measures to prevent all forms of bullying. They have the freedom to develop their own anti-bullying strategies to make sure that they are appropriate to their environment, but they are held to account by Ofsted. This is at the forefront of the Department for Education’s guidance to schools on how to prevent and respond to bullying as part of their overall behaviour policy.

NHS: Automation

Baroness Brinton Excerpts

Monday 15th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right: this is a very exciting area of ongoing work and a key part of the grand challenges which we put in place as part of the life sciences strategy, part of which is the AI and early diagnosis initiative, which aims to transform the prevention, early diagnosis and treatment of chronic diseases. NHSX’s work across government is to deliver that mission, creating an ecosystem of safe and effective development of AI and the regulatory infrastructure so patients and clinicians can be reassured that where it is introduced, it will be safe. There will be lots of research and development of those innovations. We are at an early stage of implementing them, but there are five centres of excellence across the country. I will be very happy to place a letter in the Library updating the House on progress with the AI mission and these exciting developments.

[Baroness Brinton (LD)]

My Lords, while the delivery of automation and AI has much to commend it to the NHS, CyberMDX reported last week that anaesthetic machines can be hacked and controlled from afar, including silencing alarms that would alert anaesthetists to danger. Four months ago in Israel, a cybersecurity firm demonstrated that computer virus malware could add tumours to images of scans. What protections, such as digital signatures and encryption, does the NHS now put in place, following the malware alarm two years ago, to ensure that automation and digital services cannot be attacked by malevolent forces?

[Baroness Blackwood of North Oxford]

The noble Baroness is correct to say that patients and clinicians have a right to expect their data to be held securely. Since the WannaCry attack in May 2017, we have taken steps to ensure that NHS security measures are of the highest standard. This includes £60 million to improve cyber resilience in local infrastructure, support for NHS organisations to update their Windows operating systems, procuring a new cybersecurity operations centre, and boosting the national capability to prevent, detect and respond to cyberattacks. We are also committed to achieving much greater operational visibility across all NHS digital systems. This is one of the ways in which we can respond to attacks. Lastly, we expect the highest ethical standards from all data-driven systems and that is why we have introduced the code of conduct for data-driven health and care technology. That is how we will ensure that we have some of the best AI and data-driven technologies.

Social Care: Free Personal Care

Baroness Brinton Excerpts

Wednesday 26th June 2019 Lords Chamber

[Baroness Pitkeathley (Lab)]

My Lords—

[Baroness Brinton (LD)]

My Lords—

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, it is the turn of the Liberal Democrats.

--- 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 Brinton Excerpts

Monday 17th June 2019 Lords Chamber

[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?

Unpaid Carers: Support

Baroness Brinton Excerpts

Thursday 13th June 2019 Lords Chamber

Asked by

[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.

NHS: Bullying

Baroness Brinton Excerpts

Wednesday 5th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The Interim NHS People Plan identified bullying and violence in the workplace as a key challenge that must be addressed, and identified some measures to address them. However, the noble Baroness is absolutely right that an underlying challenge is staffing, which is a major concern for the NHS workforce. The plan looks to address them in a serious and concerted way by recruiting more staff, retaining existing staff, and looking at innovative ways to entice former staff back into the NHS so that we reduce the pressure on the entire system. She will know that the plan includes commitments to recruit 40,000 more nurses over the next five years and to reduce the vacancy rate to 5% by 2028, down from the current 8%, and reiterates the commitment to recruit 5,000 more GPs on top of the 20,000 extra support staff to be recruited in the coming years.

[Baroness Brinton (LD)]

My Lords, in addition to the figures cited by the Minister at the beginning of this Question, it has also been revealed that a number of hospital trusts still use non-disclosure agreements effectively to gag people when there has been a resolution to an incident. What guidance do the Government provide to NHS England to ensure that so-called gagging clauses are used only on sensitive matters, such as any compensation payment, and absolutely not to stop whistleblowing?

[Baroness Blackwood of North Oxford]

The noble Baroness is right that non-disclosure agreements cannot cover up bullying. All staff are free to speak up. Non-disclosure agreements should not be used for that purpose in any case. The Government have been very clear on this.

Social Care: Green Paper

Baroness Brinton Excerpts

Monday 13th May 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I think that the noble Lord speaks for the whole House when he calls for consensus on social care. One reason why it is taking slightly longer to bring forward the plan is that we are doing a lot of work on consultation and collaboration to ensure that we produce a robust proposal which can command the support of the House and be delivered effectively and implemented well. The Government are committed to ensuring that everyone has access to the care and support they need, but we need to be clear that there should continue to be a principle of shared responsibility and that people should expect to contribute to their care as part of preparing for later life. The Green Paper will bring forward ideas for including an element of risk pooling in the system to help protect people from the highest costs. We look forward to support from the Opposition on those proposals.

[Baroness Brinton (LD)]

My Lords, in 2009 there was a proposal that we should all work together, cross-party, for social care, started by the then Labour Government. All three major parties signed up to it, and then one party withdrew, making it undeliverable—it was neither the Labour Party nor the Liberal Democrats. The Minister said all the warm words that we want to hear about support for health and social care integration, but the new Health for Care coalition of 19 major health organisations is very clear that, while it is doing all it can for social care services and the NHS working together, and integration is improving, it can go only so far when services are being placed under so much strain. It points out that we would need an annual increase of 3.9% to meet the needs of an ageing population and an increasing number of younger adults. Seven hundred days since the social care paper was first promised is too long: when will it actually be delivered?

[Baroness Blackwood of North Oxford]

I share the noble Baroness’s impatience for progress on this. She is absolutely right that there is no point in bringing forward the proposals if they are not properly costed and funded. That is exactly why these proposals have been developed in collaboration with the long-term plan and the social care plan. We have to ensure that the right funding for social care is agreed alongside the rest of the local government settlement at the forthcoming spending review. That is partly why this process is taking the route that it is.

Healthcare (International Arrangements) Bill

Baroness Brinton Excerpts

Report stage (Hansard): House of Lords
Tuesday 12th March 2019 Lords Chamber

[Lord Ribeiro (Con)]

My Lords, this is an enabling Bill and no more. In a letter to the chairman of the Delegated Powers and Regulatory Reform Committee on 8 March, the Minister confirmed that these powers would be used only in the exceptional circumstances of EU exit. We will discover the outcome of that tonight.

In these circumstances, the regulations’ implementing powers would be subject to parliamentary scrutiny. The assurances and clear message from our debates in Committee—when the Minister was very clear, in answer to a question from the noble Lord, Lord Brooke of Alverthorpe, that reciprocal healthcare arrangements with the United States would present significant challenges because of the different payment systems and such an arrangement was unlikely—should surely be enough to satisfy those who believe that the Government still have a cunning plan to sell the NHS to Donald Trump and others.

As I said in Committee, I believe that the implementation of our international arrangements should be phased, giving priority to our overseas territories, as has been noted; our Commonwealth partners, of which Australia and New Zealand have already been mentioned; and our important international partners, perhaps excluding Venezuela and the Galapagos Islands from that list, as suggested by the noble and learned Lord, Lord Judge.

Anything enabling this to happen should be considered seriously, given the risks of what I believe is likely to be a no-deal Brexit. I do not support these amendments and I hope that the Minister will be able to come up with suggestions for how this can be implemented to overcome some of the concerns expressed from the other side.

[Baroness Brinton (LD)]

My Lords, both the noble Lord, Lord Ribeiro, and the noble Baroness, Lady Chisholm of Owlpen, are missing the point of these amendments. While this is only an enabling Bill, it increases the scope of reciprocal health agreements with countries outside the EEA and Switzerland to include trade agreements. The noble Lords, Lord Lansley, and Lord O’Shaughnessy, at earlier stages of the Bill, raised exactly this point about setting up trade agreements. We are extremely concerned, for all the reasons given by the noble Baroness, Lady Thornton; this is the sort of large change that requires considerable consultation with the public prior to Green Papers, White Papers and bringing it through the House. We should not try to rush it through as one of the Brexit Bills, which it is, regardless of what happens over the next few days. This is one of the Bills that we were told must be passed by 29 March. Increasing the scope of the Bill means that we are moving into another area that the country, let alone this House, has not had a chance to consider.

I do not believe that reducing the scope would prevent some of the agreements already made; in fact, as the Minister has said when summing up previously, a number are already available. What it does is protect the NHS from being a bargaining tool, particularly—although not only—with the United States. Until the country has a chance to have that debate, it is important that we reduce the scope.

I endorse entirely the comments made by the noble Baronesses, Lady Thornton, and Lady Jolly, the noble and learned Lord, Lord Judge, and the noble Lords, Lord Marks and Lord Foulkes. Our task is solely to replicate the arrangements that may become out of date on 1 April; it is important that we remain focused on that.

[Lord Judd (Lab)]

My Lords, I too find this amendment imperative. The Bill as it stands has some exciting prospects, which are worth looking at, but if we are to go down that road we must recognise that the implications are highly complex and potentially demanding economically. It is quite unthinkable that we should move along that road without primary legislation that has been properly considered by a wide cross-section of Britain, including the professions. It is extraordinary to bring in exciting, challenging ideas of this kind on the back of a Bill concerned with making sure that the excellent arrangements that exist within the European Union are protected.

The most imperative words that we have heard in the remarks so far—apart from the, as usual, exemplary speech by my noble friend Lady Thornton—came from the noble and learned Lord, Lord Judge, who, with all his experience, said that this is just wrong and that we cannot pass major legislation on this basis. That is exactly how I feel. To dilute our commitment to those in the European Union and, indeed, to people from the European Union living in this country—arrangements will be reciprocal—would be very unfortunate. I hope the House will warmly endorse the amendments.

[Lord O’Shaughnessy (Con)]

My Lords, although I do not agree with it, a lot of scepticism about the scope of the Bill has been eloquently expressed at every stage of the debate on this group of amendments so far. However, I remind noble Lords of the human consequences of restricting the Bill in the way proposed by these amendments. I think we all agree in general on the benefits of reciprocal healthcare agreements—many noble Lords have paid testament to those—and we all want to see continuity of arrangements with the EEA and Switzerland. So far, so good. However, we have also debated and agreed in principle—in Committee, at Second Reading and in this group—on the desirability of having such arrangements with more countries. Indeed, the noble Lord, Lord Foulkes, talked in Committee about the opportunities of travelling to the USA, which people with long-term conditions can no longer do because they are now uninsured.

Let us be very clear what is at stake. Accepting the amendments in this group would mean that we miss out on a golden opportunity to achieve a shared goal. What are the reasons for that? I do not agree with them, but very good reasons have been given about the kind of procedure and scrutiny that ought to be applied to the new reciprocal healthcare arrangements that we may strike with countries outside the EEA and Switzerland. This is not a disagreement about the principle of having such arrangements; it is a disagreement about the process of agreeing such arrangements. However, the consequence of these amendments is not to deal with these issues by changing procedure, scrutiny and process, but instead to strike them out on principle. That does not seem to me the right approach to very well substantiated and perfectly reasonable, but ultimately procedural, concerns. By changing the Bill in this way, we will lose the opportunity to deepen relationships with key partners such as New Zealand and Australia, as my noble friend Lord Ribeiro said. We will miss out on the opportunity to give people with long-term medical conditions the chance to travel outside the EEA to visit family or to work, and for young people to broaden their experiences. We will miss out on the opportunity to deepen—

[Baroness Brinton]

Please allow me to intervene; I am afraid I cannot stand up to do so.

Is the noble Lord suggesting that by passing the Bill, existing arrangements outside the EEA and Switzerland would become null and void?

--- Later in debate ---

[Baroness Thornton]

My Lords, this is a probing amendment to Amendment 16. I am seeking reassurance about the contents of the annual report. I very much welcome the amendment moved by the noble Baroness, Lady Manzoor, which we shall be supporting.

I realise that lists are a dangerous thing to put in a Bill. In proposing her amendment, the noble Baroness covered some of these points. However, it is very important, given the powers that the Bill contains, that information—for example under Clause 2(2)(a) and (b)—must be listed in every annual report by individual countries. We feel that proposed new paragraphs (a) to (f) in our amendment need to be contained within the annual report.

This amendment seeks reassurance that the contents of this report will be consistent with the powers that the Government are seeking in the Bill.

[Baroness Brinton]

My Lords, I support the amendment moved by the noble Baroness, Lady Thornton. Without repeating our debates at previous stages of the Bill, it would be helpful to have reassurance from the Minister that the content of the list in the noble Baroness’s amendment is exactly the sort of detail we need. It is important to reassure people on exactly how any financial arrangements for healthcare will be made.

[Lord Lansley]

Further to that point, I think following the list exactly may be the most difficult thing for the Government to do. Amendment 16 sets out to commit to a report on payments. We have healthcare agreements with, for example, Australia and New Zealand where no money changes hands. As I understand the way in which these agreements work, it would be very difficult for numbers of British citizens in Australia or Australian citizens here to be collected to be reported. The noble Baroness, Lady Brinton, asked for the list to contain exactly the sort of information we need. While the list may indicate the sort of information we are looking for, if it is not available, it is not available.

[Baroness Brinton]

Under current arrangements, the National Audit Office is able to tell us exactly the costs of the reciprocal arrangements with Europe. I am therefore struggling to understand why we might not be able to do this elsewhere in future.

[Lord Lansley]

The costs are exactly what the Government are proposing to report on. The Australian agreement, for example, does not involve payments to and fro. So costs do not arise. We have mutual, reciprocal agreements about treating each other’s citizens in our domestic healthcare system.

[Baroness Brinton]

I am sorry to prolong the point but, surely, we would be clocking up those costs in the NHS, even if they were not reclaimed.

[Lord Lansley]

The Minister may wish to advise on this. I understand that we probably do not—because there is no requirement to recover the money—whereas, under an EU agreement, we collect the data because we are required to charge the Governments who are the competent authorities for those patients.

[Baroness Brinton]

I am really sorry to prolong this point but, if we are trying to make sure that new reciprocal arrangements are effective, this is exactly the sort of data collection that we should be seeking. Even if it is not used initially, the whole point is that we want to understand the costs of each arrangement.

[Lord Lansley]

I am making a simpler point: it is no good asking for information that is not collected. There is a good reason why it is not collected. Although, this might happen in future, at the moment I do not think anybody is proposing to switch the Australian and New Zealand agreements to ones where there is reciprocal reimbursement. In this case, I do not think the information is being collected.