Residential Care

Baroness Brinton Excerpts

Monday 6th February 2017 Lords Chamber

[Baroness Brinton (LD)]

My Lords, it is absolutely evident that the care homes are facing an existential problem. Their costs have increased by 30% in the last year with the introduction of the national living wage, and their profits have significantly reduced. Some 1,500 homes have closed over the last six years. There is a major problem going on, and it is not good enough to exhort local councils to pick up the gap when their funding has been severely curtailed, which is also not helping care homes. When will the Government get a grip of this very serious crisis?

[Lord O'Shaughnessy]

I am pleased that this Government have introduced the national living wage, which is supported, I believe, across this House and the other place. The noble Baroness is quite right that there is an impact on social care home providers, many of the staff of which are paid at that level. The truth is that there is a cost pressure, of course, in the social care sector—that is one of the reasons that the precept is rising quicker than it would have done otherwise—and the better care fund has been created to support more care provision in the appropriate setting that people want to have it in.

Health Workers: Training

Baroness Brinton Excerpts

Wednesday 18th January 2017 Lords Chamber

[Lord O’Shaughnessy]

There are two routes into nursing. One is the university route, and because of the changes we are making, there will be the possibility for universities to recruit up to 10,000 more nurses. That is why we are removing the cap. We have also introduced an apprenticeship route, which does not involve going to university but follows the apprenticeship route practised in other fields. That will have 1,000 places in its first instance.

[Baroness Brinton (LD)]

Data in December showed that applications for midwifery and nursing degrees and other allied health university courses in England had fallen by more than 20% since the Government’s announcement of plans to scrap the NHS bursary in favour of loans for student midwives and nurses. Given that we are already extremely short of nurses and midwives, what will the Government do, first, to reverse the removal of the bursary given that most of the courses are on the wards, learning on the job, and, secondly, to encourage the recruitment of more nurses and midwives?

[Lord O’Shaughnessy]

I thank the noble Baroness for that question. We are recruiting and creating conditions for the recruitment of more nurses. Something like 37,000 applications were turned down for those wishing to take on nursing, midwifery and allied health professional degrees in 2014-15. That was one of the reasons for removing the cap and equalising the funding arrangement that goes to nurses on other courses within higher education. That will allow universities to provide more places for trainee nurses. We are still early in the cycle and are moving to a new system. I think the UCAS applications have just closed and it is certainly true that in the past when fees were introduced by whichever Government—Labour, coalition or whoever—there was sometimes a small dip in take-up in the first year. But following that, in all those cases across the system, there was a strong rebound in interest in higher education places.

Health and Social Care

Baroness Brinton Excerpts

Thursday 24th November 2016 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I add my gratitude to that of other noble Lords to the noble Baroness, Lady Finlay, for nominating this debate on a vital matter. For me, it does not matter that we have debated this issue already this month; until the Government start to hear and understand the serious concerns, we shall be repeating it regularly.

Although most of my comments will be on social care, I want to start with a conversation I had with two nurses at St Thomas’ Hospital yesterday as I was leaving. They said to me, “You work over the road, don’t you?”. I said that I did, and they continued by saying, “We are just struggling to understand what on earth Brexit is all about. We knew during the campaign that that £350 million a week was not real, but we do not understand why people believed it”. Patients still talk to them about the extra money that the NHS is going to get. They said that they see crisis after crisis going on around them in what is an absolutely excellent hospital. I make no more comment than that, but it is clearly something that is troubling the workforce.

Others have commented on the size of the social care sector—a 1.3 million workforce. As other speakers have already outlined, struggling with the demography alone in Great Britain would put it under pressure, but it is facing a perfect storm. We need to add in the cuts to local government funding, the inability of the Government to commit to delivering Dilnot to really harmonise health and social care, and the Government’s relentless focus on reducing immigration. That is before we even start to consider the financial consequences of Brexit, as outlined yesterday by the OBR.

Independent Age and ILC UK research has looked specifically at social care workforce issues and their modelling shows that the closing off of migration will have a dramatic effect. There will be a social care workforce shortfall of 750,000 people if the Government achieve their objectives of only tens of thousands of immigrants into this country. Even under the high migration scenario, a shortfall of 350,000 is likely purely because of our ageing population. London and the south-east would be worst hit, because one in nine of the capital’s care workers are at risk of losing their right to work here.

There is a further problem in the sector of a very high turnover rate of around 25%, and an estimated vacancy rate of 5.4%, which rises to 7.7% in domiciliary care. The King’s Fund paper, Five Big Issues for Health and Social Care after the Brexit Vote notes that, immediately after the referendum,

“Bruce Keogh, NHS England’s Medical Director, and Jeremy Hunt, the Secretary of State for Health, have both publicly sought to reassure European staff working in the health service”.

They said:

“We endorse these views but would go further: providers of NHS and social care services should retain the ability to recruit staff from the EU when there are not enough resident workers to fill vacancies”.

Can the Minister provide encouragement not just to doctors, nurses and other clinical healthcare professionals but to those who absolutely fill the important jobs in the healthcare sector who have either low or no skills, such as healthcare assistants, cleaners and catering staff, so that they will also have the facility to come to work in the UK to provide vital services?

I turn to the specific experience of people in the social care system, which at the moment is really struggling with seven older people per care worker. By 2037, the projections show that that figure will almost double to 13.5 older people per care worker. That is very alarming, especially as we are relying on the care sector to relieve the pressure on hospitals. How on earth we expect the service to be able to be delivered with even fewer staff is quite extraordinary. London, as I have already mentioned, is especially reliant on migrant care workers. Nearly three out of five of its social care workforce were born abroad and, in recent years, the percentage of EEA workers has increased. Although the overall average does not look particularly large, EEA migrants now make up more than 80% of new entrants to the profession. With the turnover rates to which I have referred of one in four, the consequence of any restriction on EEA workers will be severe and rapid.

On the effect already of the pressures in the social care system, Age UK says that the number of older people in England who do not get the social care that they need now has soared to 1.2 million, up by 48% since 2010. Nearly one in eight older people are struggling with the help that they need to carry out everyday tasks, such as getting out of bed, going to the toilet, washing and getting dressed. Among that 1.2 million, nearly 700,000 do not get any help at all because, as we know, the moment there is pressure on services, the criteria for accessing help keep getting harder and harder.

My right honourable friend Norman Lamb has said that the health and social care systems are “living on borrowed time”, with more providers moving from publicly funded systems to focus entirely on private care. He said:

“The social care system always loses out in comparison with the NHS, and that’s the case even when the money was flowing”.

Under the later years of a Labour Government, there was a real disparity between the NHS and social care; in one Budget, the NHS was awarded 4% and social care just 1%. That is why the Liberal Democrats continue to call for a cross-party commission to address the problems of health and social care funding. We need to address that, and the impact of Brexit on both sectors.

The better care fund, in the coalition, was a small but helpful start, but it remains only a small contribution. Implementing Dilnot is urgent and overdue. Yesterday’s Autumn Statement failed completely to mention health and social care funding. The Alzheimer’s Society in its very helpful briefing made the very important point that, regardless of any changes in migration policies, the Government must make social care an attractive career pathway. Shortfalls in staffing are leading to social care providers failing. Already there is evidence, not just in the health and social care sector but more widely, that EU and EEA workers are leaving the UK because of the uncertainty following the referendum results. With a rapid turnover in the workforce, the consequences will be felt very quickly.

Finally, after all the doom and gloom, I wanted to end on one positive note about the diversity of social care staff. My mother, after one of her strokes, suddenly started speaking French—she had spent a lot of time in France in her childhood. The home went out of its way to find a French healthcare assistant to be moved to her ward and, as a result, she understood them and, importantly for her, someone understood her, and she was able to communicate easily. That is the social care system at its best. We need as a nation to understand that we have to resource it effectively to do its job; it cannot do it on thin air.

Adult Social Care

Baroness Brinton Excerpts

Tuesday 15th November 2016 Lords Chamber

[Baroness Brinton (LD)]

My Lords, it is good that extra money is coming into the NHS, even if it is loaded in the wrong direction at the moment. However, this Question is much more about care. The real problem at the moment is that social care is significantly starved of funding. What will the Government be doing to ensure that real cash goes into social care to help to alleviate the problems that the NHS is facing due to people remaining in hospital because there just are not the places for them to go nor the assessments for them in social care at the moment?

[Lord Prior of Brampton]

My Lords, the squeeze in social care started in 2010. Between 2010 and 2015, spending on social care declined in real terms by 12.8%. That was a significant reduction in spending when the noble Baroness’s party was in power in the coalition Government. Since then, it remains very tight in social care. As I said, we are putting more money into the NHS at the front end of this Parliament. We have introduced the 2% precept for local authorities to raise money for social care and we have put £1.5 billion into the better care fund, starting from 2017-18, which will provide more money for social care at the end of this Parliament.

NHS: Primary and Community Services

Baroness Brinton Excerpts

Monday 7th November 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I acknowledge that there is tremendous pressure in the social care system. Looking back over the last 20 years, not enough support has gone into primary, community and social care relative to what has gone into acute care. The sustainability and transformation plans are designed to bring together social care and healthcare. They are being published intermittently as I speak.

[Baroness Brinton (LD)]

My Lords, the country owes so many carers an enormous debt of gratitude for what amounts to unpaid work they are doing on behalf of the state. The NHS website says to carers:

“If someone you know is in hospital and about to be discharged, you should not be put under pressure to accept a caring role”,

or to take one if you are already doing this as their carer. It continues:

“You should be given adequate time to consider whether or not this is what you want … to do”.

The carers report has found that three out of five carers say they felt they had no choice, and of those not consulted four out of five carers said it was way too early and that there were readmissions as a result. What will the Government do to ensure effective communication between hospitals and carers truly happens, so that there are no more unprepared discharges and carers get the support they need?

[Lord Prior of Brampton]

My Lords, delayed and inappropriate discharges are clearly a huge issue for the whole health and care system. Again, this is something the STPs are designed to address. The five-year forward view is explicit in saying that there are 5.5 million carers in England and their continuation goes to the very sustainability of the NHS. The importance of care is not in dispute. The Care Act, which the noble Baroness’s party and mine put through in the last Government, recognised that so as to give them parity of esteem with those they care for. There is no question but that better communication with carers would go a long way to improving the problems we have with inappropriate discharges.

Carers over 80: Support

Baroness Brinton Excerpts

Monday 13th June 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is absolutely right. Nearly half a million people over 80 are providing more than 35 hours a week of care to their partner or loved one, which is a huge commitment and often has profound implications for their own health and well-being. We are all singing from the same hymn sheet on this and I am sure that the carers strategy coming out at the end of the year will address the particular requirements of that age group. The Government will continue to support carers’ rights. I mentioned the £186 million being given to local authorities to do that.

[Baroness Brinton (LD)]

My Lords, the Building Carer Friendly Communities research report for Carers Week last week reported that approaching half of older carers had not been offered an annual health check by their GP practices, and about half of older carers said that their GP practice had not told them where they could find help. What are the Government doing to encourage primary care to make sure that older carers get access to annual health checks and support?

[Lord Prior of Brampton]

My Lords, clearly it is essential that older people have access to at least annual check-ups from their GPs. A large part of the review that is being undertaken will be about how we signpost and inform people of the need to have these health check-ups. I am sure that will be a part of the strategy announced at the end of the year.

Learning Disabilities: Transforming Care

Baroness Brinton Excerpts

Thursday 9th June 2016 Lords Chamber

[Lord Prior of Brampton]

This is an area of healthcare about which I am least informed, so I would very much like to do that.

[Baroness Brinton (LD)]

My Lords, Sir Stephen Bubb’s update report also said that the review was going forward very slowly. The Minister has also referred to this. What is the new timetable for the full implementation of the Bubb report?

[Lord Prior of Brampton]

It is a three-year timetable. The intention is to reduce the number of in-patient hospital beds by between 35% and 50%, as I said. There will be a review at the end of the three years to see whether that can be taken further. The truth is that progress seems painfully slow until you look back to where we have come from. We have come a long way over the last 20 years, but nothing like far enough or fast enough. An old Chinese proverb says that it is better to light one candle than curse the darkness. We are making progress, but it could be quicker.

Mental Health: Ensuring Equal Access to Mental and Physical Healthcare

Baroness Brinton Excerpts

Thursday 26th May 2016 Lords Chamber

Moved by

[Baroness Brinton]

That this House takes note of the recommendations of the Five Year Forward Review for Mental Health and the case for ensuring equal access to mental and physical healthcare.

[Baroness Brinton (LD)]

My Lords, I am grateful to have this debate on the importance of mental health and look forward to hearing contributions from your Lordships.

Although attitudes are changing, some people still think that mental illness does not affect them or us, but it does. One in four of us will have a mental illness at some time in our lives. We will all have someone close to us who has experience of mental health issues—I know I have—but there is also a wider cost to society. The cost of mental illness to the economy is estimated at £105 billion a year and the employment rate of people with severe and enduring mental health problems stands at just 7%. The effect on our National Health Service is substantial, too. People with mental health illness have over three times more A&E attendances than those without, and are five times more likely to be admitted to acute service hospitals. Of particular importance is the fact that more than one-third of GP consultations are related to mental health. Nine out of every 10 people who either attempt or die by suicide already have a record of suffering from mental illness.

Between 2011 and 2014, there was a 33% rise in the number of mental health-related incidents dealt with by the police and a worrying increase in people with mental illness being held in police cells due to lack of appropriate NHS bed provision. Last November, it was reported that a 16 year-old girl was held in a secure police cell for 48 hours in Torbay because there was no acute mental health bed anywhere to be found. Imagine if that were your underage daughter, niece or granddaughter in severe distress, having committed no crime, in an alien criminal justice environment. But there was also a consequence for the acute hospital, as a nurse had to be with her the entire time, costing the hospital substantially more than the provision of an emergency bed. Sadly, this is not an isolated incident and inquest after inquest asks for action, but until there are effective weekend crisis services I fear that nothing will change.

The independent Mental Health Task Force Report, The Five Year Forward View for Mental Health, published this February, sets out the crisis in our mental health provision and makes many recommendations. The task force, chaired by Paul Farmer, also points out that this goes way beyond NHS provision. People with mental health problems need,

“to have a decent place to live, a job or good quality relationships in their local communities”,

and the wider inequalities of mental illness must also be tackled. Mental health problems affect disproportionately those living in poverty as well as black, Asian and minority ethnic people, and their involvement in the criminal justice system before they get access to health support and treatment is shocking and a shameful reflection on our society.

The report makes many recommendations but for Liberal Democrats there are some important core themes which we also had in our manifesto last year, and these remain key priorities for us. First, there needs to be comprehensive access to waiting times and standards in mental health, giving people the right to treatment in exactly the same way as for those with physical conditions. In coalition government, the Liberal Democrats introduced the first ever maximum waiting times in mental health for conditions such as depression, anxiety and psychosis. This was the first part of a vision for comprehensive waiting-time standards, championed in government by Norman Lamb MP, then Minister for mental health, who has continued his fight for these standards ever since.

Secondly, there must be 24-hour access to mental health crisis care seven days a week and this must be funded properly so that crisis resolution teams and home treatment teams can offer a real alternative to hospital admission, which is both better for the patient and, in the long run, cheaper for the NHS. The task force acknowledged the crisis care concordat joint agreement in February 2014, which describes how police, mental health services, social work services and ambulance professionals should work together to help people going through a mental health crisis.

Behind every strategy and behind the statistics there are personal tragedies. In April this year an inquest heard how 17 year-old John Partridge, a talented young musician, was allowed to discharge himself from Derriford Hospital in Plymouth because the inexperienced junior doctor had no mental health consultant to turn to for advice, and crisis mental health services for 16 to 18 year-olds were not available over the weekend. Despite his history of self-harm and attempted suicide, he was not even assessed in person. He was treated as an adult and permitted to discharge himself.

I believe that, as in physical health, there should be “never events” in mental health. In physical health the list includes operating on the wrong limb or leaving a foreign object in a patient after surgery. There is one current mental health never event, and it is important: the failure to install functional collapsible shower or curtain rails. However, the definition of mental health never events must surely be extended so that someone with a history of self-harm and attempted suicide must be seen and supported and not discharged until a senior psychiatric clinician is confident that it is the right thing to do. I hope the Minister can confirm that the “never” list will be expanded to include suicide risk immediately after leaving mental health care.

Thirdly, the practice of sending acutely ill patients long distances for treatment should be stopped as quickly as possible. In February this year it was estimated that 500 patients a month were being taken more than 30 miles, and some more than 100 miles, to the nearest available bed. Norman Lamb, my noble friends Lady Tyler and Lady Walmsley, I and many others have also made repeated requests for this practice to end. The noble Lord, Lord Crisp, who led the Commission on Acute Adult Psychiatric Care, found that there are major problems both in admission to psychiatric wards and in providing alternative care and treatment in the community. One of the commission’s key recommendations is that the practice of sending acutely ill patients long distances for non-specialist mental health treatment should be phased out by October 2017. Can the Minister confirm that the Government and the NHS will be accepting this recommendation in full and that the practice will indeed end by October next year?

I ask the Minister to update your Lordships’ House on the progress of the five-year forward view task force implementation plan. Time and funds are running out and I know that many providers are keen to hear the Government’s view. The Government’s commitment to an extra £1 billion to meet the report’s recommendations after the launch is welcome but this will not be enough to deliver the report’s recommendations. Even more worrying, it seems that the funding may come from the additional £8 billion the Government have already pledged to deliver the general five-year plan, meaning that mental health will not receive any more than it would have got on the basis of its historical and deeply inadequate share of resources—about 13% of the total NHS budget, despite accounting for around a quarter of the national burden of disease. A figure of 13% is neither parity of esteem nor parity of resource.

Worse, the report Funding Mental Health at Local Level: Unpicking the Variation, published by NHS Providers a week ago, raised serious concerns that the necessary investment is not reaching many local areas and services. This is despite recent funding commitments such as the £1.25 billion five-year CAMHS investment announced by the coalition Government in the March 2015 Budget. The report says that, “Only half”—just over half—

“of providers reported that they had received a real terms increase in funding of their services in 2015/16”.

In addition:

“Only a quarter … of providers were confident that their commissioners were going to increase the value of their contracts for 2016/17”.

There is also confusion over,

“what it means to implement parity of esteem”,

including,

“confusion over what services should be covered, and how much investment should be made”.

Furthermore:

“Over 90% of providers and 60% of commissioners were not confident that the £1 billion additional investment recommended by the mental health taskforce”—

for CAMHS—

“will be sufficient to meet the challenges faced by … services”.

At the heart of the problem is the inclusion of additional funding in the commissioner’s baseline allocations. The many competing claims on the additional money given to commissioners makes it more challenging to ensure that the funds are not diverted to other priorities but are used for the intended purpose of delivering much-needed improvements to mental health services.

These findings support a previous analysis by the BBC, which found that the £143 million investment in CAMHS was not reaching front-line services. The Mental Health Network expressed suspicions that the funding was being diverted to other services. CCGs and mental health providers have expressed support for the ring-fencing of additional resources for mental health. Some mechanism is required to ensure that funding gets through. Can the Minister inform the House which financial resources will be provided for mental health services and what guarantees there are that this funding will be ring-fenced, reach front-line services and be transparent and accountable?

One in 10 children between the ages of five and 16 suffers from a diagnosable mental health condition, and there is now substantial evidence to show that three-quarters of mental health problems start before the age of 18. It is, therefore, an absolute moral and economic responsibility for us to ensure that children and young people get the help they need as soon as possible, and in the right place and at the right time.

The Future in Mind: Promoting, Protecting and Improving our Children and Young People’s Mental Health report, launched a year ago last March, made some very clear recommendations about commissioning and improving access, about mental health support in schools and especially about ensuring that those from vulnerable and hard-to-reach backgrounds, including looked-after children, get urgent and bespoke help.

There are numerous stories about very long waiting times for referrals to CAMHS and considerable variance in different areas. The average waiting time in Gateshead is five times as long as that on Tyneside, just down the road. Some areas have referral rules that children must have “enduring suicidal ideation”—that is, they must have expressed suicidal thoughts on multiple occasions—before they are able to be seen. This is unacceptable. Children and young people need support much earlier.

In 2014, the Department for Education published statutory guidance to schools on supporting pupils with medical conditions. The guidance says:

“In addition to the educational impacts, there are social and emotional implications associated with medical conditions. Children may be self-conscious about their condition and some may be bullied or develop emotional disorders such as anxiety or depression around their medical condition”.

However, schools wanting to help their pupils who may be exhibiting mental health problems have their hands tied behind their back. Despite the continuing increase in the number of pupils across the country, the number of school nurses is reducing. Many schools see their school nurse only briefly—once a week or, worse, once a fortnight—so there cannot be effective dialogue between school nurse and staff, let alone school nurse and pupils. These cuts are continuing, especially with the cuts in public health budgets.

What are the Government doing to ensure that school nurse places are being protected? What dialogue exists between the Department of Health and the Department for Education to ensure that the vital role of schools in identifying the need for early intervention can happen?

That brings us back full-circle to the start of my contribution. First and foremost, resolving the crisis in mental health is a funding issue. Do the Government understand that all the good work done by the Mental Health Taskforce and others in identifying the problems and making recommendations to solve them will come to naught without a real-terms funding increase? Shifting money around will not do the job. Secondly, we will only solve the issues by real cross-departmental working.

What plans are there for true parity of esteem and a real cash injection into mental health services in both this year and the remainder of this Parliament? What cross-departmental working is happening at the moment? Without it, we will continue to hear of personal tragedies—lives wasted or ruined because our current mental health services are completely inadequately funded.

--- Later in debate ---

[Baroness Brinton]

My Lords, I thank everyone who has contributed to the debate, particularly to my noble friend Lord Oates for his personal story, which reminded us that strategies and data all come down to individuals. I am particularly grateful for his comments about children out of school, which is an interest that I have as well.

I am grateful to the noble Lord, Lord Crisp, for making sure that we remember that mental health issues are global, not just local, and I support his plea that DfID, too, should look at parity of esteem. I hope that the Minister will pass that on to DfID. I am grateful, too, to my noble friend Lady Tyler for her proposals for ring-fencing. I hope that the Minister will be able to address that in the reply to my noble friend. Despite the reassurances that the Minister has just given us, there is clearly real concern among providers, and even among some CCGs, that funding is not getting to front-line services. We need to be reassured that that will happen.

I am very grateful to the noble Lord, Lord Tunnicliffe, for talking about changing taboos, which is absolutely vital. We move at glacial speed on some things, and although progress is being made, if you talk to young people in particular, some major taboos are still there. Education and PHSE play an important role in helping our young people to understand how they might upset other people and in helping those young people who face difficulties to put their own experience in front of their friends and to be able to talk about it. The noble Lord, Lord Tunnicliffe, quoted Alistair Burt about rolling responses rather than one big response. I share his concern on that.

I am very grateful for the comments of the noble Lord, Lord Prior. Everybody who has taken part in this debate would completely understand that the noble Lord is certainly sympathetic to the issues about mental health, as I think is the Department of Health. But the funding issues remain, and I think we all look forward to receiving the details. Following his offer to hold the Government to account for delivering them, I also hope that he will be able to go back to the Treasury with the comments made in this debate to argue for further and specific resources. On that basis, I beg to move.

Motion agreed.

Mental Health Services

Baroness Brinton Excerpts

Thursday 28th April 2016 Lords Chamber

[Lord Prior of Brampton]

What I would say to people in the NHS is that the Government are committed to spending a lot more money—more money than has ever been spent before on mental health—so we are putting our money where our mouth is. We are the Government who signed up, with the Liberal Democrats, to putting parity of esteem in law in the 2012 Act, and we are absolutely committed to doing that. There is no ground for thinking that we are deprioritising mental health. The quality premium that NHS England uses to focus the attention of CCGs will change every year. It had mental health in it last year; it had other issues in it this year; and I hope that it will have mental health in it next year.

[Baroness Brinton (LD)]

Parity of esteem has a very specific meaning and it is good news that some extra money has been coming into mental health services but, until mental health is a real priority and there is equal funding, particularly to take pressure off the acute sector, there remains a problem. Can the Minister please confirm that mental health will continue to benefit from additional funding next year, given the priorities set out in the mental health five-year forward view? It would be really reassuring to the House to know that at least there was continuing additional funding available.

[Lord Prior of Brampton]

I assure the House that, on the funding that the Government have agreed for children’s and young people’s mental health and adult mental health—in the light of the Prime Minister’s announcement in January, but particularly in the light of Paul Farmer’s report that came out six weeks ago —we are fully committed to meeting those obligations.

Wheelchair Users

Baroness Brinton Excerpts

Thursday 21st April 2016 Lords Chamber

[Lord Prior of Brampton]

I totally agree with my noble friend that there is an absolute need for greater uniformity and standardisation. The level of variation around the country is wholly unacceptable.

[Baroness Brinton (LD)]

My Lords, the NHS guidance on the website to people seeking a powered wheelchair says:

“Each service will have a strict criteria of eligibility. Usually the NHS services do not provide powered wheelchairs … for outdoor use only”.

Some areas, including mine, say that this means you get one only if you need to use it inside your own house. This does not mean independent living. When will the criteria be changed to ensure that if a powered wheelchair is needed for work purposes it will be provided?

[Lord Prior of Brampton]

As the noble Baroness knows, the criteria are local at the moment. The point of collecting the data and developing a tariff, which takes into account assessment, the equipment and repair and maintenance, is to have local commissioning against the national standard.