(2 years, 7 months ago)
Lords ChamberMy Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.
My Lords, the coroner noted that the NHSI investigation had not used expert investigators and in some cases used only desktop research, looking at case papers, failing to interview key staff witnesses and take a longer view. Given that HSIB uses independent specialist teams and provides a safe space for staff and whistleblowers to talk, is there not a case for asking HSIB now to do its own investigation into this?
The noble Baroness raises a very important question, and it was one of the questions I asked when I was being briefed on this. Unfortunately, when HSIB was established, it did not investigate to historical cases. The future HSSIB will also not be able to investigate such cases; it will undertake only cases that are brought to it in the future.
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Lords ChamberMy Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.
My Lords, I too congratulate the noble Baroness, Lady Thornton, on her outstanding contribution in her health Front-Bench role. From these Benches, it is always a pleasure to work with her and we look forward to continuing with her in her new role. Yesterday, the CQC served the Norfolk and Suffolk mental health trust with an improvement notice, reporting that staffing levels remain unsafe, waiting lists were long and, on average, 49 people per month died within six months of contact with that trust. There are staff shortages across NHS mental health services, so can the Minister say what the Government will do to ensure that there are enough qualified mental health professionals in the NHS?
I thank the noble Baroness for the question and for repeating the fact that you can find problems in the independent sector and in NHS providers. What is really important is that we are looking at the HEE workforce plan as well as the NHS workforce plan, while working with trusts at the local level and other providers of care to ensure that we have the most appropriate staff levels to meet local conditions.
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Lords ChamberMy Lords, it is a privilege to follow the noble Baroness, Lady Campbell of Surbiton. I start by thanking the Minister for the large number of meetings during the passage of this Bill in the Lords—with some exceptions, but I will return to those shortly. It has been, for the most part, a very constructive engagement that has taken a considerable amount of the Minister’s and his officials’ time. I believe that the constructive nature of the discussions means that this Bill will leave your Lordships’ House in a better state, and more workable in practice, than when it arrived.
I will speak on Motions C, D and D1 and will leave Motions A, A1 and B to my noble friend Lady Walmsley. I pay particular tribute to her for her dedicated work on the Front Bench, which I have been unable to fulfil because of the strict rules relating to remote contributions.
On Motion C on modern slavery, I particularly thank Ministers for listening to the concerns across all parties in both Houses. Motion C addresses many of the concerns that there were about the willingness of the Government to carry out a review in order to better understand the risk of slavery, human trafficking and modern slavery in the NHS supply chain. It is, of course, only a first step. Eradication of slavery and human trafficking in health service supply chains must remain the key objective, but this will give the Government the tools they need. The publication arrangements will be transparent, and Parliament will have a chance to scrutinise it. For these reasons, these Benches will not oppose Motion C.
I turn now to Motions D and D1 on the social care cap. I start by thanking the Minister for his letter—received this afternoon—addressed to the noble Baroness, Lady Wheeler, and copied to myself and others who have attended meetings with him on the social care cap, which provided more detail on the trailblazer programme. By the way, in any other environment they would be called “pilots”, but there we go. I am struggling to see what is new about the trailblazer programme in that letter, other than one extraordinary sentence which says:
“I would be happy to arrange a further meeting with you and the policy team if you would like to discuss this in more depth”.
(2 years, 8 months ago)
Lords ChamberMy Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.
My Lords, I too commend the noble Lord, Lord Rooker, for his tireless campaign. The continuing consequences of Ministers not introducing the new legislation are that around 430 children in the UK will be born with spina bifida each year until folic acid is added to bread flour. What will the Minister—not his officials—say to the families of these babies to explain why this was just not urgent enough to put into legislation, despite the Government’s decision to do so and despite elections? Officials are not always side-tracked by elections. What will the Minister say given that those children will need continuing health support for life?
I think the noble Baroness is being a little unfair. It is quite clear that some of the delay has been due to elections, particularly when it has been necessary to consult across the devolved Administrations. Let there be no doubt. The Government are not against this; we are in favour of it. We are having to cover a number of issues—for example, the level of folic acid fortification to ensure that we add an appropriate amount without the side-effects that have been found in older people. We need to standardise the minimum levels of the existing four fortifications—calcium, iron, niacin and thiamine—and to consider exemptions from fortification for products that have minimal amounts of flour. Provisions have to be made for flour used to manufacture ingredients. We have to consider potential exemptions, for example, for micro-businesses and heritage millers. This consultation will start in earnest once the Northern Ireland elections are out of the way.
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Lords ChamberI remind the House that we have three noble Baronesses beaming in. The first is the noble Baroness, Lady Brinton.
My Lords, I declare my interests as a vice-president of the Local Government Association and vice-chair of the APPG on Adult Social Care.
I thank the Government for their Motion E relating to carers and safe discharge, which goes a considerable way to providing the reassurance that patients and their unpaid carers will be included in discharge planning. I am pleased to hear that Carers UK is working closely with the department on the guidance, and it is good to see that the guidance will be further updated when the Bill is passed and will include more mentions of carers and young carers—that is also welcome.
The guidance links to a number of background documents, such as action cards and the Home First documents, which are short, summary versions to help discharge from hospital but seem to be slightly out of step with the new provisions. So, while I am grateful for the Government’s amendment, will the Minister clarify whether these will also be updated?
I turn to Motions G, G1 and G2 on the social care cap. The Government’s changes to the care cap announced, late in the passage of the Bill in the Commons, that the amounts accrued towards the £86,000 cap are now based solely on the individual’s out-of-pocket expenses. Although individuals will still qualify for means-tested financial support if their assets fall below £100,000, in practice this will no longer act to protect people with more modest means and will simply see them contributing over a longer period. This is much more regressive and would leave poorer, older people and working-age adults with less protection from the catastrophic care costs than others who are wealthier.
I have been happy to sign previous amendments to remove the social care cap, and these Benches support Motion G1. The measures in Motion G1, especially in Amendment 80P, ensure that the original principles of the Dilnot commission recommendations are fully implemented. It is also important that the results of the trailblazer pilot schemes can be fully evaluated with an impact assessment and that Parliament has a proper opportunity to debate that review. The changes proposed by the Government just before the Bill came to your Lordships’ House are very different from those that Parliament understood right at the start of the Bill’s passage.
This is not just a problem for older people. Mencap has reminded us that the Government’s impact assessment shows that their proposals will benefit only around 10% of working-age care users and that there will be a limited impact on improving the funding spent on working-age disabled adults. It is still a disgrace that the arrangements for older people, which assume decades of working and earning, are also used for younger adults with disabilities, who we know are much more likely to be assets and savings poor and to need care and support for much longer, and who will therefore accrue much higher levels of cost than older people. These proposals from the Government are just not fit for purpose and need to be reviewed for this group of younger adults. That is why we support Motions G1 and G2.
My Lords, the noble Baroness, Lady Brinton, is taking part remotely.
My Lords, although my noble friend Lady Walmsley will be speaking from our Benches on the workforce amendments, I just want to commend the noble Baroness, Lady Cumberlege, on the eloquent speech she made on the need for proper and effective workforce planning. I support everything she said.
I will now speak to Motions D and D1 on genocide and modern slavery, having added my name to amendments at earlier stages of the Bill. I thank the Government for their Amendment 48A in Motion D. Frankly, a review of the NHS supply chains should undoubtedly happen, regardless of the Bill, but the amendment does not go nearly far enough to stop the practice of suppliers to the NHS purchasing goods where there has been a risk of slavery and human trafficking. The amendment talks only about the Secretary of State having to “mitigate the risk”. In the linguistic range of a Minister making commitments, mitigation does not hit even the halfway bar.
We need to be blunt. A very large quantity of NHS medical equipment is sourced, in whole or in part, from the People’s Republic of China. Despite the Government denying that any equipment is sourced from the Uighur region, reports have found that the UK Government have bought more than £150 million-worth of PPE from Chinese firms directly linked to abuses of Uighur rights abuses. As recently as this month, supply chain specialists revealed that the NHS continues to be supplied PPE from a company known to use Uighur forced labour programmes. Without legislation mandating transparency and due diligence, it seems very unlikely that the Government will be able to ensure that they are not sourcing goods from companies practising modern slavery.
Amendment 48B in Motion D1 in the name of the noble Lord, Lord Blencathra, goes beyond the Government’s proposals for a review by seeking to ensure that the Secretary of State must by regulation make provision to ensure that all procurement of goods and services for the health service in England avoids slavery. The UK Government have to face up to their obligations to prevent through the law any forced labour and people trafficking in UK health supply chains. From these Benches we will support Amendment 48B in Motion D1.
My Lords, I will speak in support of Motion B1 on workforce planning and Motion C1 on the Secretary of State’s powers on reconfiguration. As the noble Baroness, Lady Cumberlege, has just reminded us, there is a huge groundswell of support for the need to do proper workforce planning in the NHS, but the fact is that today we do not need to relitigate the fundamental arguments, because your Lordships have already decided, by a margin of 171 to 119 votes on 3 March, that that is indeed what is required.
Of course, if the facts change, we should change our minds. Have the facts changed since 3 March? Have we seen the long-awaited detailed workforce plan for the health and social care sector that has been promised yet suppressed for the last six years? Regrettably, we have not. Have we even had concrete commitments to the detailed, costed and quantified five, 10 and 15-year outlooks that will supposedly be forthcoming in the spring? No, we have not had commitments that those numbers will be able to be produced without fear or favour, or Treasury veto.
However, we have before us two new data points. One is the survey of 650,000 NHS front-line staff, half of whom—52%—are now telling us that they cannot do their jobs properly because of a shortage of staff in their local service. The second data point is the results of the British Social Attitudes survey, telling us that nearly half of our fellow citizens have noticed that fact; they too believe that one of the fundamental problems standing in the way of performance by the health service is the shortage of staff.
If the Government are not inclined to listen to the hundred or so organisations that have supported this amendment or, indeed, to the results of surveys of front-line staff or the public, perhaps they will listen to a commentator from the Spectator:
“The lack of workforce planning by the Government—and its continual refusal to commit to it—means satisfaction from patients and staff is likely to plummet still further.”
I do not believe the Government want that. Nobody wants that, which is why we should take this opportunity to listen to the clear message that we have been sent by patients, staff and the public.
I turn briefly to Motion C1 on the Secretary of State’s powers on reconfigurations. There is an obvious read-across between the discussion on workforce and the discussion on reconfigurations. In the real world, it is often staff shortages which give rise to concerns about the safe provision of services, hence the request for reconfigurations. In these circumstances, and coming just a few days after the Ockenden review of maternity safety, it is all the more dangerous that the new powers in Clause 40 and Schedule 6 would allow the Secretary of State to suppress changes needed to keep patients safe and to pre-empt and override the concerns of local clinicians, local patient groups, local authorities and even the Care Quality Commission.
There could be safeguards but, unfortunately, to date at least—perhaps, depending on what we do today, this will resurface after Easter—we are being asked to support the original text of the Bill, which has taken no account of any of the concerns that have been raised in both Houses during its passage. Instead, on the reconfiguration powers, today the Government are essentially praying in aid an argument not on the substance but on the merits of democratic oversight by the Secretary of State. This is despite the fact that previous Health Secretaries have managed democratically to supervise the National Health Service without requiring these new powers, despite the fact that former Health Ministers—Conservative Health Ministers, Labour Health Ministers and Liberal Democrat Health Ministers—all oppose these measures and have spoken out, including in your Lordships’ House, and despite the fact that democratically elected Health Ministers in just about every other European country have never sought and do not possess these types of powers.
If the Government want to argue Motion C on the crucible of democratic oversight, it seems that by that logic they should indeed support Motion C1 tabled by the noble Baroness, Lady Thornton, which further enhances the democratic oversight of the use of these proposed new powers, giving Parliament the ability to scrutinise these types of interventions. Therefore, for those reasons, frustratingly, perhaps, I find that we are in a position where Motions B1 and C1 are still necessary.
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Lords ChamberMy Lords, we have a remote contribution from the noble Baroness, Lady Brinton.
My Lords, I too want to join in congratulating the noble Baroness, Lady Hollins, on the Bill reaching the end of its legislative passage today. Her expertise and commitment to people with Down syndrome and other learning disabilities is well known and much respected—and not just in your Lordships’ House.
I rise to speak on behalf of some of the Peers who raised concerns about this Bill at Second Reading, particularly the noble Baroness, Lady Neville-Jones, and the noble Lord, Lord Farmer, who cannot be in their place today. I will start by saying what is good about this Bill. It has raised the profile of Down syndrome, which, speaking as someone with a nephew with Down syndrome, I say is a good thing and long overdue.
Your Lordships’ House will remember that eight of the 12 cross-party speakers noted that, if the Bill had the powers which its promoters suggest, there risks being a hierarchy of learning disability. This has already caused a split between families with learning disability, all of whom still need to fight for the limited resources to which the law says they are entitled. I am pleased to hear the noble Baroness, Lady Hollins, expressing her desire that the objectives of this Bill are extended to other people with genetic conditions and learning disabilities. I am sure that she and I—and others —will be looking to future government Bills to make a real difference to the lives of all people with learning disabilities.
I will not go through the details of the concerns we had before, because now is not the time. One of my great concerns is that the hopes of many families of people with Down syndrome have been raised beyond the powers in this Bill. I hope that the Minister will ensure that those aspirations are met, not just for people with Down syndrome but for the wider learning-disabled community. I wish this Bill well.
My Lords, I begin by extending my congratulations to the noble Baroness, Lady Hollins. I am grateful to the noble Baroness for steering the Bill to this point. I also extend a warm welcome to those who were in favour of this Bill, some of whom are in the Public Gallery. I offer my thanks to the right honourable Member for North Somerset, Dr Liam Fox, who introduced this Bill in the other place. I also want to thank everyone else who has been involved in developing this important piece of legislation.
I know that a number of concerns have been raised, and I welcomed the scrutiny of the Bill two weeks ago at Second Reading. The Government recognised some of the points that were made. Noble Lords raised important matters about the risk of discrimination and widening inequalities, as well as how the proposed guidance could be developed, scrutinised and implemented in a fair and inclusive way. We have listened closely to these concerns, and I hope to reassure noble Lords on a few points so they can be confident in their support of the Bill and the impact it will have at this stage.
The guidance is about making clearer what steps could be taken by relevant authorities to meet the unique needs of people with Down syndrome. The Bill does not remove the duties under the Equality Act 2010 for relevant authorities to assess all the needs of people to whom they provide support. Our assessment is that, to prioritise funding and resources for people with Down syndrome above other groups without proper assessment of people’s needs would be considered unlawful.
The Government will consult with a broad set of stakeholders in developing the guidance, including those with other conditions. I want to be clear that people with lived experience will be at the heart of this at each phase of its development. We will strongly encourage and support people with other genetic conditions, disabilities and protected characteristics, and their advocates, to engage with this process. It is right that we support legislation that will improve life outcomes, reduce inequalities and build a fairer society.
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Lords ChamberMy Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.
My Lords, surveys of parent carers during the pandemic by the Disabled Children’s Partnership reveal that more than 70% of disabled children were unable to access their pre-pandemic levels of therapies and health services, and many of their conditions regressed during the pandemic. How do the Government plan to use wider NHS recovery funding to meet the acute health needs of disabled children and young people?
I thank the noble Baroness for making me aware of this issue. We are aware of a number of front-line services where there is a backlog as a result of the pandemic and not being able to have face-to-face appointments. However, I will have to write to her on the specific case that she raised.
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Lords ChamberMy Lords, the noble Baroness, Lady Brinton, will make a virtual contribution.
My Lords, Public Health England says that around 246,000 people are likely to have some form of gambling addiction, but last year, only 668 people—with the most severe addiction issues—were referred to the gambling clinics because of a lack of resources. Even with the extra clinics over the next three years, will this number of clinics be able to treat the top 10% of patients, which is 24,000 people? If not, when will the service expand to help them too?
The noble Baroness makes an important point and there is recognition that we must do far more on this. That is why we held a review of the Gambling Act in the first place. As noble Lords will be aware, when the work is cross-government, the Department of Health cannot lead in this area; it can contribute when it comes to the health and addiction impacts of gambling but we are doing this in a joined-up way. The White Paper will be published soon and we are continuing to have conversations with the Department for Digital, Culture, Media and Sport on this issue.
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Grand CommitteeMy Lords, the noble Baroness, Lady Brinton, is taking part remotely. She speaks as the Front-Bench Liberal Democrat spokesman but as there are no Back-Benchers, I invite her to speak.
My Lords, I thank the Minister for his introduction. He will know that across the House there have been considerable discussions, not just in recent months but recent years, on the role of the commissioner for patient safety in various Questions, debates and Statements since the First Do No Harm report of the noble Baroness, Lady Cumberlege, was published in 2020. I join the Minister in paying tribute to her, not just for her report but for her absolute persistence in holding the Government to account to deliver as many of her recommendations as possible. I too am sorry that she cannot be with us today but I know that she is pleased that this SI has been published.
This SI specifically covers the appointment of the commissioner but, once again, government actions are happening before Parliament has had a chance to scrutinise this SI. This SI sets up the role of commissioner, but the Minister has just told us that not only is the advert out, but it is closed and an imminent announcement is due. I do not think that there is anyone who does not want the commissioner to be put in place, but once again, this seems to be putting the cart before the horse in that the SI is being dealt with after the advertisement has gone out.
However, for the first time there will be an independent commissioner whose role is to stand up for the rights of patients when they have suffered avoidable harm. The three main parts of the report of the noble Baroness, Lady Cumberlege, covered HPTs, sodium valproate and vaginal mesh but there are other issues as well, and unfortunately there will be more in the future. That is why the Minister is right to say that the creation of a learning and safety culture is absolutely vital, as is an environment in which people working inside the NHS and other organisations associated with delivering medicines and medical devices can speak without fear. That is why some of us had concerns over the initial period of appointment. While the possibility of a second term is welcome, the concerns related to that first period of setting up the commission. This is not just somebody who will walk into the job and everything will be ready to go. The difficulty is that, having established themselves in the post, they will then have to gain the confidence of everybody who they might be investigating, which can take a while. It will be quite difficult to judge whether it is appropriate to appoint them for a second term if they have had probably only about 18 months when they have been able to do the job properly.
(2 years, 8 months ago)
Grand CommitteeMy Lords, the noble Baroness, Lady Brinton, is taking part remotely. She is speaking as the Liberal Democrat Front-Bencher but, as there are no Back-Benchers to speak, I invite her to speak.
My Lords, I thank the Minister for his introduction to the Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2022, which propose three very differing amendments to existing food safety measures. He was right to start by saying that ensuring the highest levels of food safety is absolutely vital.
The Joint Committee on Statutory Instruments has pointed out that the second and third regulations come into force on the day after the day on which these amendments are made, so once again they breach the 21-day rule. It is such a shame that SIs and regulations seem always to be dealt with as emergency items, because this reduces the time available for Parliament to effectively scrutinise legislation.
The first amendment is to Article 53 of the retained general food law, to manage a problem that has arisen as a result of the Northern Ireland protocol. I note that the Explanatory Memorandum calls it a “deficiency”. It might perhaps be more honest to call it a problem of the Northern Ireland protocol and the practical effect it has had on border issues for those living in Northern Ireland—how they have to juggle the tensions of a border in the Irish Sea when third-party goods come into Great Britain via Northern Ireland and where a serious risk to human health has been identified with those goods.
It is right that the UK Government must correct regulations that are not fit for purpose, and we note that these amendments to Article 53 do not change the purpose or function of the original provision but there is now full protection for such emergency measures, regardless of where the goods have come from.
The second amendment relates to the authorisation of provisions for feed additives and for GM food and feed, which will now be through legislation, bringing them into line with other retained EU food and feed law. That is particularly welcome. There is a lot of suspicion about GM food and feed, and it is important that there is a vehicle through which it can be scrutinised carefully. Parliament is the right place for that to take place.
The third and final change is a sensible step to ensure that businesses have a slightly longer period to move from EU to UK labelling requirements, until 30 September this year. For some time, food businesses have been asking for a longer period, as well as for labelling requirements to be as close as possible to the EU requirements. The latter is not covered by this SI, but I hope that the Minister will continue to listen to UK food businesses which want to continue to sell into the EU and which must also abide by the EU labelling requirements. I thank the Government for the extension to the period during which the EU ones can be used.
The SI brings us back to the wider issues of the Northern Ireland protocol. That is obviously not on the agenda for today, but I want to say that, from these Benches, we always warned that there would be problems for goods travelling into Great Britain via Northern Ireland and for businesses there, which continue to express real concerns about the UK’s decisions and legislation between 2018 and 2020. Whether one agrees with them or not, it is good that these three corrections and amendments will at least sort out some of those minor problems.
My Lords, I am grateful to the Minister for setting out the rationale behind this eminently sensible statutory instrument, which deals with a number of significant technical issues relating to the Food Standards Agency, some of which have come about because of the Northern Ireland protocol. They need to be resolved, and from these Benches we are of course happy to support this statutory instrument.
I add that the Explanatory Memorandum is very helpful in outlining the approach that the FSA is taking. I will just pick up on a few points. First, paragraph 7.7 refers to
“An analysis of the emergency powers for”
food and feed control, which revealed that these powers could not be deployed as effectively as required. I am interested in exploring the context. It would be helpful if the Minister could advise on whether this analysis was through a hypothetical desk-based exercise, or whether the situations referred to actually occurred. For example, did goods identified as presenting a serious threat to human health enter Great Britain through Northern Ireland or did that not happen in reality?
I welcome the clarification that the GM and feed additive authorisations will be dealt with through an SI. It would be helpful if the Minister could confirm whether this will be through the negative or affirmative approach. Also, are there any implications for the Government’s longer-term strategy for GM products, given the recent statutory instrument that changed some of the rules on research and gene-edited crops?
On the issue of labelling, it would also be helpful if the Minister could comment a bit on whether he feels that the date in place is the right one. I say that because the food production sector finds itself under pressure, of course, and we want to ensure that this is a practical step.
Throughout the consultation, the National Farmers’ Union has sought clarification on the UK’s relationship with the European Food Safety Authority. The NFU has stressed the importance of the UK’s close collaboration with the EFSA on equal terms. Can the Minister comment on the Government’s intentions for their relationship with the EFSA in the context of this statutory instrument, given its importance to our food industry? I would be most grateful.
I have a final point to raise. With regard to the consultations, one observation by the sector was about the expectation that these changes to the regulations could be read through in under an hour, such that businesses, regulatory agencies and councils would be able to work out in that short period how to apply the changes to their organisations. I know that this was regarded as somewhat overoptimistic, but has any further thought been given to an assessment of just how easy it will be to work with these regulations? With those comments, I offer our support for these regulations and thank the Minister in advance for the reply that I know he will give.