Health: Pancreatic Cancer

Baroness Brinton Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

We are very clear on the need for speed in cancer treatment; that is one target that will not change, because we know its importance in all this. With pancreatic cancer, we are where we were with prostate cancer about 10 or 15 years ago, and I am glad to see that we have made great strides on that with initiatives such as the Movember campaign and the action on that. Candidly, we are not where we need to be on pancreatic cancer, and we need to adopt those sorts of awareness campaigns, as well as fast action on screening, to improve our performance.

[Baroness Brinton (LD)]

My Lords, 30 years ago cervical screening was developed and introduced; prior to that, cancer of the cervix was as impossible to detect and to find as pancreatic cancer. Will the Minister say whether research will be provided to ensure that screening for pancreatic cancer can be introduced as soon as it is confirmed, because screening was the real game-changer for cervical cancer?

[Lord Markham (Con)]

I agree that screening programmes are, without doubt, the way forward. I mentioned earlier the 73 different pancreatic cancer research studies, of which screening is a very important element, so I totally agree that that should be our top priority.

Social Care Sector: Staff Shortages

Baroness Brinton Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

I agree and have often made the point that solving this part is key to the flow and to getting people through discharge quickly, which has a knock-on impact on A&E and ambulance wait times. That is why I was delighted to hear the Chancellor recognise this specifically and mention £2.8 billion of funding in 2023-24, which will account for 200,000 new care packages in this space, as well as £4.7 billion in 2024-25 to resolve the exact problems that the noble Baroness brings up.

[Baroness Brinton (LD)]

My Lords, the Minister has now referred three times to the money that the Chancellor has said he will invest in social care from April next year. But the crisis is now and the Government’s own plan for patients says this must be resolved and there must be more social care workers immediately to help with the pressure on hospitals. What will the Government do over the next six months to ensure that there are more workers and help to relieve the problems with both discharges and A&E?

[Lord Markham (Con)]

I thank the noble Baroness. In the past few days, local authorities have been notified of the £500 million discharge fund. That funding will go out in December and January, so it is very much going out there. It is very much designed to address the issues of discharge, creating new places and helping to recruit.

Long Covid

Baroness Brinton Excerpts

Thursday 17th November 2022 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I declare my interest as a vice-chair of the All-Party Parliamentary Group on Coronavirus. I add my congratulations to the noble Baroness, Lady Thornton, on securing this important debate. She and I have spent most of the last 30 months in the parliamentary trenches of emergency Covid legislation, Statements and Questions, along with the noble Lord, Lord Bethell, and, more recently, the noble Lord, Lord Kamall. The noble Lord, Lord Markham, does not know how lucky he is to have missed those times.

The speech by the noble Baroness, Lady Thornton, eloquently set out the issues. I thank the organisations, including the Library, that have sent briefings. I also thank everyone who has spoken so far in the debate; there have been many powerful contributions from all around the House. Despite the worry of the noble Baroness, Lady Pitkeathley, that there was nothing left to say, she certainly said many things, including different things, and it is a pleasure to follow her.

I start by taking us back 100 years. The excellent book Pale Rider by Laura Spinney—which both the noble Baroness, Lady Thornton, and the noble Lord, Lord Bethell, have heard me quote repeatedly—shows evidence of excess deaths throughout the late-1920s and 1930s, after everyone thought the Spanish flu epidemic was over. But no one made the connection; all they knew was that there was excess death from cardiac and respiratory disease over a decade. Now, we understand more, of course. I have a key question for the Minister. It is already evident to me that parts of the NHS and many parts of government want to put Covid behind them. Will he undertake to make sure that we do not repeat history and stop learning from Covid, because it is not yet over, as others have said?

The authoritative and expert contribution of the noble Lord, Lord Kakkar, was really helpful. The scientific world is now publishing papers that show the consequences of Covid after that initial infection period. One in 22 will have a major cardiac event within 12 months of having caught Covid and one in five will get long Covid—as we have heard, that is over 2 million people to date. Covid damages the brain. A friend of mine in his 70s and his wife thought that he had very bad rapid onset dementia; last week, he discovered after an MRI scan that it was not dementia at all, but many micro clots in his brain, which were definitely affecting his capacity to think, speak and do physical things. That will be with him now for the rest of his life. Covid also damages the vascular system and the immune system. Variants mean that herd immunity and even one course of vaccines are no long-term solution.

Among the studies published recently is one from Washington University in St Louis. One American commentator, a scientist, says:

“We don’t know everything about long COVID yet, but what we do know is downright terrifying. But you’d never know it if you don’t seek out that information yourself … This pandemic is a mass killing AND a mass disabling event. Long COVID is going to be a defining issue of our times.”


The Americans have a reference system. The US veterans’ association provides a longitudinal study for Covid, and an article in Nature, published in May, showed that, after breakthrough SARS-Covid infection, there is considerable evidence of further and long-term problems. And the more you get Covid, the more likely you are to get long Covid or other serious consequences.

The right reverend Prelate referred to health inequalities in rural areas, and the noble Lord, Lord Brooke, referred to health inequalities for people catching Covid. Interestingly, this was also a major problem in the Spanish flu pandemic 100 years ago. We have that long tail—100 years—but have learned nothing.

My noble friend Lady Scott of Needham Market made a strong and impassioned argument for not falling into the trap of assuming that long Covid is about weakness or psychology. There are still no blood tests to identify long Covid or ME. She and the noble Baroness, Lady Meacher, made the vital connection with other post-viral conditions. Researchers this week are seeking volunteers with long Covid to take part in a study that looks at psychological factors, full stop. After all the evidence that we have heard this morning, that is breathtaking.

If noble Lords have not seen it already, Rowland Manthorpe, the excellent technology correspondent of Sky News, has a long article on the Sky website about his two-year journey with long Covid. It is very moving, including people saying that he just needed to start doing things gently and build up—not the answer. The noble Earl, Lord Clancarty, spoke of the difficulties in accessing appropriate support with GPs. At this point, the questions others have asked about definitive research become really important, but it is not just research; it is ensuring that the training for all our front-line healthcare and clinical staff understands that and they do not stick by the old thoughts.

The noble Lord, Lord Brooke of Alverthorpe, spoke about the high number of deaths in the UK. This was thought to be principally due to late lockdown in the first big wave, if we look at excess deaths, and comorbidities were key. It was not just about obesity, but obesity was among them. Significantly, people with high blood pressure, a history of heart problems or asthma also faced high death rates.

Long Covid definitely affects children too. My noble friend Lady Harris of Richmond, who cannot be in her place today, has spoken often in your Lordships House about the devastating effect that long Covid can have on children, from familial experience. The noble Baroness, Lady Taylor, referred to a young girl from the north-east and her two-year experience of long Covid. Yesterday, Hayden from Elvington in Kent, a previously fit and healthy 15 year-old, told the BBC how his life completely changed after he caught Covid in December 2020. He used to swim and play judo, but now has to use a wheelchair and is largely bed-ridden with, among other things, extreme and severe fatigue.

The noble Viscount, Lord Stansgate, referred to ivermectin. That is a longer debate for another day, but I strongly recommend he reads the one-pager that he can find online where a scientist explains why it should not be used in humans at all—in vitro, possibly; possibly even in cows; but not in humans.

The employment issues are vital. The right reverend Prelate referred to employment stats in Devon and the All-Party Group on Coronavirus also found statistics. The big issues that seemed to affect employees were that Covid-19 was often first contracted in the workplace, especially, as we heard, in professions deemed key and essential workers. As the noble Baroness, Lady Neuberger, said, 10% of those are in healthcare, so it is really shocking that the NHS is now sacking staff with long Covid and when those staff say, “But I caught it at work”, the NHS says, “You cannot prove it, end of case”. That happened to a friend of mine who was a senior midwife and it is appalling that she is now lost to the profession.

The all-party group has received many examples of healthcare professionals who were forced to work with Covid-19-positive patients with inadequate PPE. We have also heard of employers forcing them to work in unsafe conditions and offering no support for return to work, and a growing trend that those with long Covid feel physically and mentally unable to challenge dismissals or wrong PIP allocations. That is a real problem, because it means they are not getting benefits to which they are entitled.

The noble Baroness, Lady Thornton, set out the medical problems. I want to raise another issue. A number of Education Secretaries over the last 30 months have continued not to take account of Covid and long Covid in schools. That is why we have so many children with long Covid, so why are we not following the example of America, where all children are eligible for the vaccine? A colleague of mine, Councillor Oliver Patrick in Somerset, has devised a very cheap ventilator for children’s classrooms. You need only one and it costs about £100 to create, but schools are not getting support to do that and the word is certainly not getting around. So, when we have the next wave, expected in January and February, schools will once again act as a vector for Covid, and arising out of that will be long Covid.

I finish by asking the Minister some questions, some of which have already been asked. We need guidelines for employers, in both the private and public sectors, about how to manage employees who have had Covid. Will the Government undertake a compensation scheme, available to all front-line key workers who have Covid? Will the Minister look at the care system, as the noble Baroness, Lady Pitkeathley, outlined? Will the Government look at measuring, reporting and monitoring the number of people, including children, with long Covid in the UK? Finally, as the noble Baronesses, Lady Watkins and Lady Taylor, said, long Covid is a key part of Covid. Until the long Covid tail is over, Covid is not over. Will the Minister undertake to make sure that the Government act by that?

GPs: Anti-depressants and Alcohol

Baroness Brinton Excerpts

Wednesday 16th November 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend and agree. It should always be down to the GP, working closely with the patient, to decide the best form of treatment, whether talking therapies or drugs, and that is why we are quite clear in the guidance that first and foremost it has to be the local clinician who makes the decision.

[Baroness Brinton (LD)]

My Lords, the noble Baroness, Lady Blackwood, made the very important point that there are differing results with different anti-depressants and different reasons for depression. A 2007 study showed that the use of anti-depressants reduced alcohol intake in those who drank a lot while they were very depressed. However, a 2011 study showed that SSRIs and alcohol often produced disinhibition. The one thing those two studies both showed was that where the physician was able to talk to the patient and explain, the patient reduced their alcohol. When will more time be available for GPs to talk these things through properly with patients?

[Lord Markham (Con)]

We all agree that GPs are best placed to do this. I think the House is aware of our commitment to increase the number of GP appointments by 50 million, and we are well on course to meet that target. At the same time, we have the independent review of drugs by Dame Carol Black, which looks at mental health, drugs and drink and how they are closely related, to make sure we have the best advice. First and foremost, I totally agree that the best-placed person is a GP talking to their patient.

Ambulances

Baroness Brinton Excerpts

Thursday 3rd November 2022 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I declare my interest as a vice-president of the Local Government Association. I congratulate the right reverend Prelate the Bishop of London on securing this important debate and thank her for her thoughtful and knowledgeable introduction. I also echo her thanks to the House of Lords Library for its briefing and the Royal College of Nursing. It is important that we start by paying tribute to our ambulance and paramedic staff and, obviously, ambulance call handlers—as well as 111 staff, who may not automatically come into that category but are also fulfilling a very important role. All are doing the absolute best they can, despite the current circumstances. We owe them an enormous debt of gratitude.

We have had regular debates, Questions and Statements on the problems in our ambulance services for over a year now; everyone recognises that they are at breaking point. Record long ambulance waits are leaving vulnerable patients stuck outside hospitals waiting for the treatment they need. This debate rightly focuses on the part of the crisis that is very visible to everyone—ambulances queueing outside hospitals and delays in response times and handovers because A&E is full—and refers to the Government’s plan for patients.

I refer to the plan for patients because we have debated it within the last few weeks in your Lordships’ House, and most people recognise, as the plan does, that delays in the ambulance service are part of a larger problem—a “whole-systems problem” was the phrase I think the right reverend Prelate used. I will return to the detail of the plan later, but I start with some of the problems facing the ambulance service and its staff.

National standards set in 2017 said that calls are triaged into four categories depending on urgency and that all ambulance trusts must respond to 90% of category 3 calls within two hours and category 4 calls within three hours. I raise that because the targets for those categories have changed—they have lengthened.

Nationally, average ambulance wait times have more than doubled in the last two years. The British Heart Foundation, in a report published today, said that in September, average response times for category 2 calls—that is, suspected heart attacks and strokes—was 48 minutes, against the new target, set in spring this year, of 18 minutes. It used to be eight minutes before that.

I want to make a further point on category 1 and category 2 response times, because they also affect handover times and what is happening in A&E. For most levels of injury and illness, both category 1 and 2, there is what is known as the “golden hour” in which treatment must be started, particularly for strokes and suspected heart attacks. Strokes were moved into category 2 after paramedics started to be allowed to administer anti-clotting medication en route to hospital but, even with that extra time, you have to add on the queueing for hospitals. So, despite our talking about the waiting times for responses and the delays to handovers, that golden hour is constantly being eroded.

The Library briefing, to which the right reverend Prelate referred, made it plain that the situation continues to worsen. Ambulance handover delays are almost entirely caused by crowding in A&E, and that is why the plan for patients that the Government produced was discussed so heavily in your Lordships’ House. Part of the problem is that a lot of that is work that will happen in the future, not now. I want to ask the Minister what plans there are to upgrade the plan for patients, given the current crisis, because it is clear that this is unsustainable.

Today, a report in the Times on the British Heart Foundation report said that

“there had been 30,000 ‘excess’ deaths involving heart disease in England since the beginning of the pandemic.”

There is an absolute understanding that some of those are definitely due to ambulance delays. In fact, our papers are absolutely full of those reports and have been for the past six months.

The logjam could be described best in A&E as “beds and backlog”—and then there is care as well. The NHS Confederation helpfully identifies the problems of discharge and lack of capacity in the social care sector and has repeatedly, over the last year, asked the Government to help social care. Social care vacancies increased to 165,000 in July. That is a shocking increase of over 50% on the previous year, and the figure continues to rise.

It is increasingly difficult for disabled people who rely on personal assistants to recruit them. In your Lordships’ House, the noble Baronesses, Lady Campbell of Surbiton and Lady Thomas of Winchester, have repeatedly raised this. The same is true for people who need domiciliary care—that is, care in people’s homes—to keep them at home. It is increasingly difficult to recruit people to do that job. A key plank of the plan for patients is getting people home and keeping them there but that will not work without carers.

The consequences of Brexit are writ large in this sector. We know that the Government are trying to recruit from overseas, but we lost a stable workforce who returned home to Europe from the UK and have not, despite the problems of the pandemic, returned, even though they have been asked. The issue of delayed discharges therefore remains. I ask the Minister: what else on top of what was set out in the plan for patients will the Government introduce as a matter of urgency?

The broader problems in the NHS are also causing problems. From these Benches, we have highlighted for years the shortage of hospital beds compared to other OECD countries, which shows the UK at 2.3 beds per 1,000 of the population, compared to France at 5.7 and Germany at 12.6. It was a mistake to cut so many beds, especially without planning for and investing in primary care—not just GPs but all primary care healthcare professional staff and their support staff.

In August, when we were all on holiday, the Secretary of State announced that the Government would create the equivalent of 7,000 more beds through a mixture of new hospital beds, “virtual ward” spaces and initiatives to improve patient flow over the coming months. I have repeatedly asked Ministers for breakdowns of how many beds are in each of the various categories, but I still have not had an answer. There is a big difference between a bed, a virtual bed in somebody’s home, even with remote monitoring, and initiatives to improve patient flow—I am not quite sure how the latter equates to beds. It has been three months since this announcement, and we are already facing a rise in flu and other winter problems. Can the Minister please tell your Lordships’ House what that breakdown is and how many beds are in place? Specifically—I have asked him this before—can he say how many are virtual beds, because extra support is required in primary care to make those work? Will the Government undertake to fund more extra beds to stop handover delays at A&E and the backlog that goes right the way through the system?

I was very pleased to hear the right reverend Prelate refer to the importance of a workforce plan. We absolutely echo that from these Benches and have asked for one repeatedly, including during the passage of the Health and Care Bill earlier this year. This is not just about doctors and nurses, which the plan for patients relies on; it is also about other vital health care professionals such as physios, occupational therapists and speech and language therapists.

The plan for patients talks about more independent qualified prescribers in community pharmacies. This is essential to help reduce the burden on GPs. Exactly when will there be the promised increase in the number of independent qualified prescribers within community pharmacies? Will any long-term plans for providing finance and support for training and recruitment be brought forward? The plan for patients covers next year, but it is this winter that we have the problem. Above all, we need that workforce strategy.

My honourable friend Daisy Cooper MP said that Ministers should not lay the blame for these scandalous handover delays at the door of the NHS. To stop such delays, the Government need to fund the extra beds in A&E and properly fund social care. Hospitals are now running food banks for staff and staff cannot get to work because they cannot afford petrol for their cars. This is one of the reasons why staff are so concerned. This is not just about NHS staff possibly going on strike; this is an NHS cost of living strike. I hope the Minister can answer my questions.

NHS: Nurses

Baroness Brinton Excerpts

Tuesday 1st November 2022 Lords Chamber

[Lord Markham (Con)]

I totally agree. I am proud to say that we have 72,000 nurses and 9,000 midwives in training at the moment. There is no cap on the number of people who can join the programme, so that is very much the spirit of what we are trying to do. Key to that was a £5,000 grant each year for nurses to attract them into the profession. It is working.

[Baroness Brinton (LD)]

My Lords, the comment about the figures by the noble Lord, Lord Clark, was entirely accurate. The Minister gave us the truth, which is that the net increase is 9,000, whereas the manifesto promise of 2019 was for 50,000 extra. Does this explain why the Royal College of Nursing reported last week that 75% of shifts did not have the planned number of nurses? When will the NHS see 50,000 extra, on top of the 2019 figures?

[Lord Markham (Con)]

To be very clear, today, there are 29,000 extra, over the 2019 figures. That is more than half way towards the figure of 50,000. I will quite happily write to noble Lords so that they can see the figures clearly in black and white, but I can assure the House that we are talking about increases in nurse numbers. We have achieved a 29,000 increase on the 2019 levels.

Nursing: Recruitment

Baroness Brinton Excerpts

Wednesday 26th October 2022 Lords Chamber

[Lord Markham (Con)]

I would hope and trust that such a respected person would see this position as the vocation that it is and the support that they give. We accept that there are some agency workers being used in this space, because obviously, in terms of safety, we need to make sure we cover that number of people. The whole recruitment plan—which, again, we are on target to achieve—is all about making sure we have enough nurses so that we do not have to use agency workers.

[Baroness Brinton (LD)]

My Lords, following on from the question from the noble Baroness, Lady Harding, can I ask the Minister if there are plans to increase the number of student nursing places at universities and student apprenticeships over at least the next decade? While there is a short-term crisis, there is also a longer-term sustainability crisis, especially with current demographics.

[Lord Markham (Con)]

The noble Baroness is correct that this is a long-term pipeline. We have 72,000 nurses in training at the moment. To be clear, there is no cap at all on student places. We are seeking to increase them as much as possible, and we put a £5,000-a-year grant in so that trainee nurses could enjoy superior levels of financial support than other students. The fact that we have a pipeline of 72,000 shows that this is working, but that pipeline is not capped, so if we can get more people in, we definitely want to do that.

Maternity and Neonatal Services

Baroness Brinton Excerpts

Tuesday 25th October 2022 Lords Chamber

[Lord Markham (Con)]

I agree. We are putting the money into the training programmes. We have actually put £95 million on top of the £127 million investment into this area. As ever though, what is most important is outcomes not investment. Alongside the tragic instances we have seen, we have seen a reduction in stillbirth of 19% since 2010, a reduction in neonatal mortality over 24 weeks of 36%, and a reduction in maternal mortality of 17%. Alongside these tragic findings of individual trusts, we have an improving picture of maternity care overall.

[Baroness Brinton (LD)]

My Lords, in yesterday’s Statement on Dr Kirkup’s report, the Minister told us that 23 hospitals are in maternity safety support programmes—special measures—and that, while four are coming out, another 10 are due to go in. Can he assure the House that extra resources, including extra supervision, will be there to ensure that mothers and babies in those hospitals are absolutely safe?

[Lord Markham (Con)]

Yes. Resourcing the special measures programme—for want of a better name—is vital to all of us. I am pleased to see in the case of East Kent that, of the 67 special measures recommended, it has now passed 65 and the two remaining ones will be completed by the end of November.

Water Fluoridation (Consultation) (England) Regulations 2022

Baroness Brinton Excerpts

Tuesday 25th October 2022 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure to follow the noble Lord, although I do not agree with him; we debated this during the passage of the Health and Care Act through your Lordships’ House only a few months ago. I must declare that I am president of the British Fluoridation Society.

I have form, because I remember when I was secretary of the Edgware/Hendon Community Health Council in the mid-1970s, taking part in an extensive consultation exercise in the London Borough of Barnet when the then Government were encouraging the introduction of fluoridation. We had two very well attended meetings in the borough where there was a clear view in favour of fluoridating water. Unfortunately, virtually no progress has been made since then. That is why I am very glad that the Government have brought forward primary legislation, and I was very glad to hear what the Minister had to say about the intention to move ahead in the north-east. That is very encouraging and I hope that that will be the first of many such schemes.

It seems that the consultation progress that the Government have set out is entirely reasonable. We must remember that the principle is decided—it has been decided by primary legislation. The local consultations that will take place are not a reason for reopening arguments about the effectiveness of fluoridation; they are about the detailed proposals, making sure that the areas are covered correctly and that individuals can have a say about that. However, I have to say that I noted in paragraph 7.3 that in the consultation a higher weight is to be given to individuals affected by the proposals

“who reside or work in the area.”

I am sure that that is right, but I ask the Minister to agree that the highest weight has to be given to the statement by the Chief Medical Officers of all four UK countries last year that water fluoridation is both safe and effective as well as being the most cost-effective way to reduce inequalities in dental caries prevalence. That must be the principle that lies behind any consultation process. I wish these regulations all speed ahead and very much hope that the foundations for a second wave of fluoridation schemes can now be laid in the north-east.

[Baroness Brinton (LD)]

My Lords, I welcome the Minister to consequential SIs from the passage of the Health and Care Act. Some of those present will remember the long debates we had during the passage of that legislation, some of which the noble Lord, Lord Reay, has returned us to today.

I will start on water fluoridation. My points were actually about consultation, and I will return to those, but the noble Lord has a point: there are now scientific records to show that excess levels of fluoride do cause damage. There is a very good academic article entitled “Assessment of fluoride levels during pregnancy and its association with early adverse pregnancy outcomes”. It concludes that this happens mainly in developing countries where the level of fluoride is not managed. I echo the point that the noble Lord, Lord Hunt, just made, that if the four Chief Medical Officers for the four countries of the United Kingdom believe that it is safe, that should be enough for us.

Of course all care must be taken and monitoring must continue, but the other point I want to make is from a dentist in Australia, who was very supportive of Australia’s move to fluoridation a while ago. He said that the region where he lives was one of the last to add fluoride. He talks about the experience of having to give very small children repeated anaesthetics and pain relief, and the effect on them. He says:

“Since fluoridation was introduced to Geelong in 2009, my colleagues are much happier, as severe dental abscesses requiring tricky anaesthetic techniques are much less common, and tend to mainly come from areas in the region which still aren’t fluoridated.”


He goes on to say:

“The other anecdote … was that one of my colleagues who had worked in Europe for a few years went away with 3 children under the age of 6, who were the same age and social demographic as our own children. When they returned … 2 of his 3 children had needed dental treatment”


under general anaesthetic. The key point is that they went to unfluoridated places. Although I hear the concerns of the noble Lord, Lord Reay, I hope we can be reassured that everything we debated during the passage of the Health and Care Bill shows that this is being done very carefully.

During the passage of that Bill, my noble friend Lady Pinnock made a very important series of points about how to decide where to consult about fluoridation of water, given that we have so many reservoirs where water goes in lots of different directions. Often, you cannot identify each of those areas. Although it was good to hear the Minister talk about the way that consultation will happen, and it is good news that there has been broad consultation in the north-east and that there are some resources there, might the Minister comment on how it is possible for civil servants to identify the relevant areas for consultation? This was one of the reasons why we said during the passage of the Bill that there needed to be very broad consultation.

Moving on to the other statutory instrument on training on learning disabilities and autism, and on virginity testing and hymenoplasty, I signed both of those amendments during the Bill’s passage. Each time it came back I spoke to both of them. It was wonderful that the Government listened and accepted the amendments on training for health staff working with people with learning disabilities and autism. I know that this is only a technical amendment to remove the CQC, but this is a moment to thank the Government for listening to the concern of those of us who work with and know many in the learning disabled and the autistic communities, who have often found that they have been treated by people who do not understand their conditions, which makes it that much harder to communicate with them.

I will now move on to virginity testing and hymenoplasty—I welcome the Minister to the language that we have all had to learn. We were very pleased that the Government decided to support measures on this. I have one question for the Minister. He mentioned that this was about the suitability of foster parents or of their household. It is not clear how wide that household is regarded; is it literally the people who live in that house, or, as in other safeguarding issues, would it also include a member of the foster parents’ family who might be visiting that house on a regular basis and who, in any other safeguarding terms, would have to be notified? If the Minister cannot answer that today, I would completely understand, but I look forward to the answer because I have a particular interest in safeguarding. Apart from that, I support all three elements in front of us today.

[Baroness Merron (Lab)]

My Lords, I start by thanking the Minister for bringing these regulations forward today. They very much flow from the measures supported in the Health and Care Act, and we are very glad to support them.

I will first refer to the instrument dealing with fluoridation. My noble friend Lord Hunt and the noble Baroness, Lady Brinton, rightly made the point that this is not the time to reopen the whole matter as to whether fluoridation is a good thing. I feel that that has been exhausted in the debate. I am familiar with the concerns that the noble Lord, Lord Reay, has previously put before the House and which he referred to today. However, every independent review of fluoridation has confirmed its safety. As the noble Baroness, Lady Brinton, and my noble friend Lord Hunt said, the UK Chief Medical Officers back this measure, and I do not believe that they do so lightly. I hope that the noble Lord, Lord Reay, may come round to the way of thinking that explains why this measure is important in the Act and why we need the regulation today.

I have a few questions for the Minister. Regarding consultation, the necessity of taking responsibilities away from local authorities and to the Secretary of State reflects reality, because there are real difficulties when boundaries are different, yet fluoridation needs to be brought in. Also, it is important to take communities with us in this process, and the consultation measures in this regulation provide that opportunity.

Can the Minister comment on plans to extend fluoridation nationwide? What is the plan—the vision— bearing in mind that only 10% of people have fluoride in their water at present? What timeline might we be talking about? Do the Government have a target for the percentage of the UK that will benefit from fluoridation at the end of the process? I also wonder how the Government will spread awareness of the evidence of the benefits of fluoridation and gain buy-in for them, as that is extremely important.

In the course of evidence sessions in relation to the Health and Care Act we heard from experts that many families do not habitually drink water, and that many people who suffer tooth decay are now too far down the line to stave off tooth loss. It would be helpful to hear whether the department has any plans for a wraparound strategy on dental health generally.

I note from the Explanatory Memorandum that a separate impact assessment, beyond that of the Health and Care Act, has not been done for this regulation. Can the Minister comment on that? It is important to have an analysis of how the movement of powers in respect of consultation beyond local authority boundaries will play out.

East Kent Maternity Services: Independent Investigation

Baroness Brinton Excerpts

Monday 24th October 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I start by thanking Dr Bill Kirkup and his team for bringing together a report of harrowing events. This litany of failures makes for very difficult reading, and it marks another landmark for a further group of families fighting for justice who should not have had to do so. Forty-five babies could have survived had they received care at the nationally recognised standards. I am sure that the thoughts of the whole House are with the bereaved families at this extremely painful time.

This is, regrettably, yet another example of women’s voices being ignored and silenced, to the extent that some were told that they were to blame for the deaths of their babies. At a time when women are at their most vulnerable, they were let down by the very people who they were relying on to keep them safe. However, this is not a one-off: East Kent is the latest in a long line of maternity scandals, including at Shrewsbury and Telford Hospital NHS Trust and Morecambe Bay, while the upcoming review of services in Nottingham is expected to be highly critical. Dr Kirkup said that avoidable deaths happened because recommendations that had been made following reports into other scandals had not been implemented. I would be grateful if the Minister could respond to this.

We know that no woman should ever have to face going into hospital to give birth, not knowing whether she and her baby will come out alive. Those who allowed this culture of neglect and what was referred to in the report as a disturbing

“lack of kindness and compassion”

to take root must be held accountable. Can the Minister tell your Lordships’ House how this may happen?

It is shocking that there is a pattern of avoidable harm in maternity units across the country. Half the maternity units in England are failing to meet safety standards. Pregnant women were turned away from maternity wards more than 400 times last year. One in four women are unable to get the help that they need when in labour. The Government need to fully accept all the recommendations in Dr Kirkup’s review without delay. I hope the Minister will today confirm that this is the case.

In the wake of the Ockenden review, the former Health Secretary announced additional funding for maternity services to help deliver the reform that is clearly needed. Can the Minister tell your Lordships’ House how that funding has been spent and how its impact will be measured? Indeed, it would be very helpful if the Minister could bring a further report to this House on progress in the improvement of maternity services.

Underpinning the issues in maternity care and across the NHS is, of course, the workforce. But more midwives are leaving the profession than are joining it and there is now a shortage of some 2,000 midwives in England alone. Can the Minister indicate where we can find the workforce plan to get the staff needed to provide good and safe care in the short, medium and long term? It is evident that the Government must provide the staff that maternity services desperately need to provide safe care across the health service.

I am sure we were all concerned to read the Care Quality Commission’s report published just two days after Dr Kirkup’s report. It also makes sobering reading. It says that maternity services in England have deteriorated to their lowest level, services are worsening and, time and again, there are issues with the leadership and culture in maternity units.

The CQC’s chief executive said that the failings were systemic in the NHS, with two in five maternity services now ranked as requiring improvement or inadequate. This is a wholly unacceptable situation. Does the Minister share the view of the regulator that the issues in maternity services are a “national challenge”?

This CQC report shows that there has been a deterioration in maternity services overall and in relation to their safety, describing progress on improvement as “slow”. The proportion of maternity services ranked as inadequate or requiring improvement is, we see, the worst it has ever been. What actions will the Government take? Will the Minister be meeting the CQC urgently to discuss its findings? How will a major change in maternity services be brought about?

All that women and their loved ones ask for is to have confidence that they and their babies will be safe. This really is not much to ask. I hope the Government will provide the means to deliver this.

[Baroness Brinton (LD)]

My Lords, I want to start from these Benches by sending my deepest sympathies to the bereaved families and to say that we admire the parents for their campaigns over many years against the dreadful treatment by the east Kent hospitals trust for more than a decade. I echo the thanks and gratitude from the noble Baroness, Lady Merron, to Dr Kirkup and his team. Once again, he has risen to the challenge of providing a very clear picture of what has gone wrong at a hospital trust.

The trust failed to read the signals over an 11-year period. The Kirkup report puts this very bluntly and is exceptional in the way it uses evidence. Yes, there is the evidence of the voices of mothers and their families and the evidence from staff, but equally important is the use of data, especially the CESDI data from the Confidential Enquiry into Stillbirths and Deaths in Infancy. In the section headed “What happened to women and babies”, paragraph 1.16 says that

“we have not found that a single clinical shortcoming explains the outcomes. Nor should the pattern of repeated poor outcomes be attributed to individual clinical error, although clearly a failure to learn in the aftermath of obvious safety incidents has contributed to this repetition.”

This short paragraph encapsulates how failings have become cultural in the trust. Paragraph 1.19 says that

“we have found that the origins of the harm we have identified and set out in this Report lie in failures of teamworking, professionalism, compassion and listening.”

It is really worrying to have the report from the CQC of a few days ago, which echoed these exact points but more broadly across maternity services in England.

As has been mentioned, there is a wider problem. We know that. The reports on Morecambe Bay, Shrewsbury, Telford and now Nottingham, where Ms Ockenden is now working, show that systemic and cultural failures, especially with the complexity of regulators, are creating real problems. There is the idea that clinical staff will allow favouritism and the opposite of growing and supporting staff, while letting things fester and not caring to drag patients into their concerns.

Can the Minister outline the timescale for the independent working group report referred to in the Statement? The creation of the group is welcome; its main remit is to advise the maternity transformation programme in England—but by when? Is the work of the group revealing that other maternity services have problems, even if we do not know how severe they are or if they are as severe as East Kent?

In the section on the actions of the regulators on page 9, at paragraph 1.50, Dr Kirkup identified that

“the Trust was faced with a bewildering array of regulatory and supervisory bodies, but the system as a whole failed to identify the shortcomings”.

It is good that it is reported that NHS England and Innovation sought to bring about improvements, but every other trust is also facing that same complexity of different regulators. Are the Government looking at the roles of regulators and how their competing demands can be streamlined to avoid this problem?

The Commons Minister said that she would review all the recommendations and provide a full response once she has had time to consider it. I think we all appreciate that the NHS has a very large workload at the moment, but can the Minister say roughly what timescale we are looking at?

One key problem in many maternity services is with the workforce, especially midwives. Although NHS England made an exceptional grant in March of £127 million as a boost for

“safer and more personalised care”,

can the Minister say—I echo the point made by the noble Baroness, Lady Merron, which he will not be surprised to hear—where the workforce plan is for the next decade for maternity services? A year’s extra money is not going to help with training the midwives of the future and ensuring that maternity units are professionally and adequately staffed.

Dr Kirkup also criticised NHS England for firing chairs and chief execs too frequently, indulging in a blame game that reinforced the culture happening inside East Kent. It is no longer good enough to say, once again, that this must never happen again. This is the third devastating report in under seven years, and another is now being prepared in Nottingham. What will the Government do in the next three months to ensure that further appalling practice will be uncovered and dealt with immediately?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

Dr Kirkup’s report, published last week, contains some stark and upsetting findings. As mentioned, the report examined more than 200 births in east Kent between 2009 and 2020 and found that, had care been given at nationally recognised standards, 45 babies might not have lost their lives and many more families might not have experienced such distress at what should have been a time of joy. He also found a toxic culture in the trust, with a disturbing lack of kindness and compassion, and victims’ families even blamed for their devastating losses. The report underlines that the NHS needs to be better at identifying poorly performing units and at giving care with compassion and kindness, as well as team working with a common purpose and responding to challenge with honesty. I take all the findings and areas of concern extremely seriously.

I want to thank Dr Kirkup and his team; his experience has been invaluable and I know that his approach to putting families first has been welcomed. I also know that hearing the accounts of families has been a harrowing experience at times, yet, as he said, it is difficult to imagine just how hard it was for the families as they relived some of their darkest days. I am profoundly sorry to all the families who have suffered and continue to suffer from these tragedies. I pay tribute to the families who have come forward to assist the review; it is thanks to the tireless efforts, courage and determination of families in east Kent that we have been able to shine a light on maternity failings in East Kent Hospitals University NHS Foundation Trust.

Before directly addressing the recommendations, I want to put the tragic findings in the context of an improving service overall. Since 2010, stillbirths have declined by 19%, neonatal mortality over 24 weeks by 36% and maternal mortality by 17%. That is not to undermine the seriousness of the circumstances.

On the recommendations, I echo the comments already made. I know that it is top of Minister Johnson’s agenda in making sure that there are speedy, but also measured, responses. As part of that, I want to touch on some of the points made, particularly by the noble Baroness, Lady Brinton, about the use of data as part of the early warning indicators. I think we all agree that that is key to this area. This is exactly the work that the national maternity safety surveillance and concerns group was set up for: to make sure that there is methodical oversight in this area. It is in its power to recommend that people are put into the maternity safety support programme; 23 hospitals are currently in it and it is recommended that four have progressed enough to come out again, but another 10 have been identified that may need to be put into it.

It depends on how you look at it, and whether you take solace in these trusts being identified, or whether you are concerned about the number out there. Personally—I hope I echo the comments of all of us in the House—I believe it is much better that we identify them and deal with it, however uncomfortable that might be in the meantime. The lesson we have learned from these unfortunate cases, as recognised by the noble Baroness, Lady Merron, is that we have seen a failure of leadership and accountability here.

I am glad to see that, in responding, the trusts have been unequivocal in accepting unreservedly the failings on their part and have apologised wholeheartedly. As we know in these times, when dealing with these situations the first thing that has to happen is recognising that the problem exists.

I will need to write to the noble Baroness about the extra investment and how that spend is being allocated. It is very much on the agenda of Minister Johnson to look at that and at the improvements that have been made.

On the shortage of midwives, the picture as I understand it right now is that we have had a stable number of midwives—around 21,500—over the last four years. Within that, we do have the target, as mentioned, to increase it by 1,200, and that is part of the £95 million investment towards this. I accept that doing that is more than a one-year plan and needs to be part of a much larger picture.

I welcome the CQC focus on this area. It is something that we all agree needs to be an area of focus; if that makes for some uncomfortable findings then so be it. It is only when we understand those areas that we can really get on and make sure that we deal with them. I hope that we are looking to move on in these areas.

The Maternity Safety Support Programme is a force for good, and I am glad to say that, in East Kent, they have been working on the improvement plan as part of the support programme, and 65 of the 67 actions have now been completed, with the final two to be completed by the end of November. That is not to be complacent: that work should have been done a lot earlier, but I am glad to see it is being worked on now.

I have tried in these answers to respond to the questions, but I will follow up in any areas where I have not. In summary, I again thank and pay tribute to those families whose tireless determination to find the trust in telling their stories has brought us to this important point. The Government will be reviewing and considering all the recommendations from the report. We will listen, learn and act to ensure that no other family has to ever experience the same pain in the future.