Healthcare (International Arrangements) Bill

Debate between Baroness Brinton and Lord O'Shaughnessy

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

[Lord O’Shaughnessy (Con)]

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

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

[Baroness Brinton]

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

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

Brexit: Health and Social Care Workforce

Debate between Baroness Brinton and Lord O'Shaughnessy

Thursday 13th December 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord is absolutely right. The Government certainly do not hold those staff in low esteem—quite the opposite. As we know, we need increasingly to think of health and care staff as one workforce and ensure that professional paths lead through all those professions. I am sure he will be aware of the work being done by Skills for Care, which provides the overarching policy in this area, has made recommendations about pay and helped to inform our increase in the living wage, and is providing better training facilities for those staff.

[Baroness Brinton (LD)]

My Lords, in addition to the report referred to, Coram has today published its annual survey confirming that there is not enough care available for older people, with only one in five local authorities reporting enough care in the area to meet demand. As a result, more than 4.3 million people aged 75 and over are living in an area with insufficient social care. The Minister talks about discussions with the Home Office, but we also see from the report that there was a big peak of EU staff leaving, and a big reduction in nurses, dentists and allied healthcare workers coming in from the EU. This is a perfect storm, so when will the Home Office understand that we need a range of staff in this country? Secondly, can the Minister confirm when the Government’s paper on health and social care will be published?

[Lord O'Shaughnessy]

Of course, care needs are increasing—a fact that flows from having a growing and ageing population. I should point out that the Government have increased funding for social care by more than £9 billion over three years in recent Budgets, so we recognise the seriousness of the issue. We of course want to retain those staff—it is good that there were more EU staff in the NHS in June 2018 than in June 2016, and we want them to stay. As for the social care Green Paper, it will be issued shortly.

Children: Gender Dysphoria

Debate between Baroness Brinton and Lord O'Shaughnessy

Wednesday 17th October 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is right that this is an international trend; we see in many countries similar figures for people coming forward, although, frankly, some cultures deal with the issue better than others. I am sure there are international health forums—indeed, I know there are—that deal with trans health issues and I can write to her with specific details

[Baroness Brinton (LD)]

My Lords, following the comments of the noble Baroness, Lady Nicholson, will the Minister take back also the alternative view? This is an extremely complex issue—on the current consultation on gender recognition, the survey is complex, the information provided by the Government is extremely helpful and, as a result, it has informed a lot of people as well as enabling them to answer questions properly.

[Lord O'Shaughnessy]

I am happy to do so.

Adult Social Care

Debate between Baroness Brinton and Lord O'Shaughnessy

Wednesday 11th July 2018 Lords Chamber

[Lord O’Shaughnessy]

I reassure the noble Baroness that it will be addressed. When we have the consultation, there will be more opportunity to explore that.

[Baroness Brinton (LD)]

In addition to looking at funding mechanisms from abroad, will the Green Paper look at some innovative solutions, such as the projects in Holland where students live in sheltered accommodation with the elderly, improving the quality of life for the elderly and financial support for students, which is much cheaper for the state?

[Lord O’Shaughnessy]

That sounds like an excellent idea, and I would be delighted to consider it, as well as any other ideas that the noble Baroness has.

NHS and Social Care Services: Parity of Esteem

Debate between Baroness Brinton and Lord O'Shaughnessy

Thursday 5th July 2018 Lords Chamber

[Baroness Brinton (LD)]

My Lords, what advice would the Minister give to the management of organisations throughout the NHS and social care services about maintaining morale, retaining staff, promoting professional development and rewarding good work when there is often little increase in funding from local authorities, which themselves face continuing cuts in their grant from central government?

[Lord O’Shaughnessy]

I recognise that staff work under a great deal of pressure and there are two ways we can help alleviate it. One is obviously to have social care and NHS staff work more closely together, and that is a stated ambition that we all want to achieve. The other is making sure that there are more resources, both to pay people better and to make sure that there are more people. That is what we are focused on delivering.

Health and Social Care Act 2012

Debate between Baroness Brinton and Lord O'Shaughnessy

Thursday 5th July 2018 Lords Chamber

[Lord O'Shaughnessy]

That is one of the areas we need to look at to make sure that there is proper regulatory reform. It does not necessarily require legislation, primary or secondary. There are actually fewer managers in the NHS today than in 2010. We have tried to transfer responsibility to clinical staff. But if the NHS identifies any barriers, we are committed to looking at them.

[Baroness Brinton (LD)]

My Lords, the Minister has referred to the NHS five-year plan, but does he agree that that plan is worthless without a clear proposal for social care funding in the future, including on how the NHS and social care can fully integrate?

[Lord O'Shaughnessy]

I absolutely agree with the noble Baroness that they have to go hand in glove. That is why the Green Paper has been delayed, so that it can co-ordinate properly with the NHS plan. It is also important to point out that the Prime Minister was very clear in her announcement that, as a result of the settlement on social care, there would be no further pressures on the NHS.

Hospices: Impact of NHS Pay Increases

Debate between Baroness Brinton and Lord O'Shaughnessy

Monday 18th June 2018 Lords Chamber

[Lord O'Shaughnessy]

I was not aware of that proposal but I will certainly look at it and write to the noble Baroness with our response.

[Baroness Brinton (LD)]

My Lords, it is not just hospices and social enterprises that are affected by the differential in the proposed NHS scales; the existing framework in Her Majesty’s Prison and Probation Service demands formal nursing qualifications but there is no contractual obligation on private operators such as G4S, Serco and Sodexo to follow those grading scales and there is already wide disparity. What will the Government do to ensure that HMPPS follows both the pay scales and the NHS scales?

[Lord O'Shaughnessy]

It is important to reiterate that, in looking at one of the consequences of the Agenda for Change pay deal, the Government have committed to look at the impact not just on hospices but on staff who are not employed on Agenda for Change NHS contracts and to make sure that they are properly rewarded for the work they do.

Carers: Health and Well-being

Debate between Baroness Brinton and Lord O'Shaughnessy

Tuesday 12th June 2018 Lords Chamber

[Lord O’Shaughnessy]

Children’s hospices do an extraordinary job. They get less statutory funding as a percentage of their total; there are good reasons for that, both historically and to do with the type of care they provide. The Government are providing £11 million of support in 2018-19 through the children’s hospices grant to support them, in addition to funding from local clinical commissioning groups. But I will take his proposal for a palliative care strategy back to my right honourable friend the Minister for Care. I know that she is very interested in this issue.

[Baroness Brinton (LD)]

My Lords, the advice for local authorities on short breaks for carers of disabled children says on page 7 that short breaks should not just be there for those at crisis point. Given that many short break centres are now being closed across the country, removing help even at a crisis point, what are the Government doing to ensure that short breaks for children and their carers—for our most vulnerable and disabled children—will be guaranteed for the future?

[Lord O’Shaughnessy]

In addition to the £130 million in the better care fund, there is a commitment in the carers action plan to develop examples of best practice that can be spread around local authorities to make sure they all reach the highest standards. At the moment, unfortunately, only some of them are doing so.

Carers: Back Pay Liability

Debate between Baroness Brinton and Lord O'Shaughnessy

Wednesday 16th May 2018 Lords Chamber

[Lord O'Shaughnessy]

I agree with the noble Lord that there is a retrospective element to this, but it is around the clarification of the law. The Government have put a support scheme in place through HMRC to provide that support to resist, for example, enforcement notices on workers who ought to be paid in arrears. That is up and running and it has been open since September 2017. But clearly, as that continues we are also looking at whether other interventions might be necessary.

[Baroness Brinton (LD)]

My Lords, it is quite clear that the £2 billion extra for adult social care in the 2017 spring Budget had absolutely no relevance to this £400 million deficit and liability for providers, and it would be unwise for the Government to assume that it should be used for back pay. While it is wonderful that HMRC has slightly deferred payment, until the Government are able to help providers we will continue to see provider after provider going to the wall. Allied Healthcare cites £11 million as its own back pay on this issue. When will the Government help these providers?

[Lord O'Shaughnessy]

On the extra £2 billion of funding, I have not tried to link it with this; it is of course at the discretion of local authorities to use that to support the social care sector in the way they see fit. It is worth pointing out that Allied Healthcare is in this social care compliance scheme. My honourable friend the Minister for Care has written to it to express her disappointment at the approach it has outlined. Its liabilities have not crystallised yet, so it is not right for it to refuse that and she has written to it to demand clarification. However, clearly we understand that the clock is ticking and that there is an urgency to this.

NHS: Cybersecurity

Debate between Baroness Brinton and Lord O'Shaughnessy

Wednesday 2nd May 2018 Lords Chamber

[Lord O'Shaughnessy]

The PAC review found that the use of Windows XP was at the heart of the problem, as an unsupported and unpatched system. Several things have happened as a consequence. First, XP usage has gone down from 18% in 2015 to 1.7% now. We also have a customer support agreement with Microsoft now and are transitioning to Windows 10, which is of course fully supported and much more secure. We also have a system now called cursor collect. The notifications that go out, called cursor notifications, are due to be acted on within 48 hours. That exposes the fact that we did not have a way of tracking that. We now have a way of tracking that and enforcing action at trust level. So there is a much higher degree of security than there was. Of course, no security is ever perfect and our vigilance carries on.

[Baroness Brinton (LD)]

My Lords, in Scotland it is possible for your records to be transferred from one hospital to another or from your GP to your hospital without any consequences at all. One of the concerning things about the Public Accounts Committee report is the systemic failures in IT overall in NHS England. One example is where regional hospital A cannot receive data from district hospital B, even if it is a simple blood test, because they use different systems; the consultant I spoke to said that he actually advises people to use faxes. This is our NHS in the 21st century.

[Lord O'Shaughnessy]

The noble Baroness is highlighting a historic problem about interoperability between different bits of the NHS in England. That is absolutely fair enough. I would highlight two things that we are doing. First, the National Data Guardian for Health and Care has defined 10 data standards that should apply to both security and interoperability between different systems, and those now apply in all key NHS contracts, including the standard NHS contract. Secondly, we have launched a programme to appoint up to five local health and care record exemplars, which will provide interactive and interoperable data for patients for their direct care—so that the issue we have at the moment of data sometimes falling between different institutions will not happen any more.

Health: Medical Respite for Children

Debate between Baroness Brinton and Lord O'Shaughnessy

Wednesday 21st March 2018 Lords Chamber

[Baroness Brinton]

To ask Her Majesty’s Government what guidance is provided to Clinical Commissioning Groups in exercising their duty to provide medical respite care for seriously ill and disabled children, following the High Court decision of 21 February.

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

My Lords, although there is no specific statutory duty on clinical commissioning groups to offer respite care, under provisions in the National Health Service Act 2006, CCGs must ensure that they secure health services to meet the needs of disabled children to a reasonable extent. Furthermore, the statutory framework introduced in the Children and Families Act 2014 requires CCGs and local authorities to work together to support all the needs of children with a special educational need or disability.

[Baroness Brinton (LD)]

I thank the Minister for his Answer. Despite the High Court judgment in the case being brought by the amazing Nascot Lawn parents, which made it absolutely clear that the very disabled children involved are entitled to individualised NHS support, it has now emerged that the Herts Valleys CCG’s so-called assessment for each case was a five-minute pre-assessment box-ticking and that the child was not even present. The CCG is still trying to dictate its contribution to the county for the care and is not consulting the families. Can the Minister explain what steps the Government and NHS England can take to ensure that Herts Valleys CCG makes appropriate provision for each of these children, when it appears it remains determined not to?

[Lord O'Shaughnessy]

I congratulate the noble Baroness on her tenacity in raising the issue and thank her for giving me the opportunity to meet parents whose children use these services. First, it is incredibly important to be clear that there are rules for how the consultations that the judicial review said should be held should take place, and they must be abided by. More importantly, as I have just set out, there are legal obligations under the 2014 Act for joint commissioning between the CCG and the local authority. That is not one telling the other what to do; it is joint commissioning. Most important of all—the point that the noble Baroness makes—is that whenever these bodies are planning for the future, they have to keep the needs of the children in mind. That is what we, whether it is NHS England or the department, are imploring them to do through this process. Indeed, they are obliged to do that.

National Child Obesity Strategy

Debate between Baroness Brinton and Lord O'Shaughnessy

Monday 26th February 2018 Lords Chamber

[Lord O’Shaughnessy]

We have a free school meal policy in this country. Indeed, the previous Government introduced free school meals for all children up to the age of seven, I believe, so we have made a significant impact in this area. I talked about breakfast clubs, which will also help, particularly disadvantaged children.

[Baroness Brinton (LD)]

My Lords, the salt reduction strategy worked particularly well because all supermarkets came together and followed it. Two years ago, Sainsbury’s chief executive asked the Government to introduce compulsory targets for sugar reduction, but we have not seen them yet. After the first year of the sugar tax in Mexico, there was a 17% reduction in purchases by poor people and a 12% reduction across the board. It works. If the supermarkets want it, why will the Government not follow?

[Lord O’Shaughnessy]

We are making good progress in reformulation and in reducing sugar in drinks, which I have talked about, and in other foods. However, we have to look at the impact. We will look at that and if progress is not made—let us face it, obesity levels are unfortunately continuing to increase—clearly other actions will have to be taken.

Medicines and Medical Devices Safety Review

Debate between Baroness Brinton and Lord O'Shaughnessy

Thursday 22nd February 2018 Lords Chamber

[Baroness Brinton (LD)]

From the Liberal Democrat Benches, I am very grateful and thank the Minister for the Statement. I am particularly pleased about its tone, which moves on the Government’s debate with campaigners, families and clinicians about these very serious issues. It makes a break with the past.

I am particularly concerned that there should be regular assessments and updates for people with problems from Primodos and sodium valproate, because we know from our experience with thalidomide that everybody thought that everything had been sorted from the initial diagnosis of the children, but as they entered adulthood and more mature years further medical issues appeared. It will be important to recognise that we need to make sure these young people—and adults as they are now—get that protection.

The yellow card system was not available in its current format for these two drugs. One of the things that concerns me most about the Statement is the assumption that the only people involved with the yellow card are clinicians. Speaking as a patient who has been on a drug that has very serious yellow card incidents, I have been trained to recognise that if I get a side-effect I do not just go back to my hospital; I report it to the pharma company. The pharma companies are notable by their absence in this Statement. Will there be specific links back for clinicians and patients on some of the side-effects of drugs? That is easy to say for those who are formally expert patients. I absolutely accept the point made by the noble Lord, Lord Hunt, that some patients are inexpert for all the right reasons.

There needs to be a real focus on all the other health professionals that these patients come into contact with. Reporting a yellow card incident to a GP when it is very difficult to see your own GP these days means that it could quite often be missed. In the case of sodium valproate this certainly needs to include midwives and people involved in the obs and gynae departments as well. What training is to be provided for these non-specialist healthcare people to make sure that they understand, when a patient talks about a problem, that this may need to trigger a yellow card response? To that end, I welcome the proposal for an electronic yellow card. That will be extremely helpful. Printing out a yellow card, filling it in and sending it in is an absolute deterrent to it happening.

On Primodos and sodium valproate, will the longer-term effects also be covered by the Cumberlege review? It is important to have a reference back there. I am also concerned about the vaginal mesh issues, specifically those reported in the Statement. It would be useful to know what percentage of those who have had vaginal mesh implants have faced problems. It is fine to say that many have benefited. I completely accept that, but one needs to understand what the ratio is between those facing problems and those for whom it has benefited them, to understand whether a ban should be in place. What is the date for publishing the retrospective audit? It is fine to say that it will be done. I have no idea how far along the line the process is. Then there is the timescale for creating that computer database for vaginal mesh to improve clinical practice. When will it be not just commissioned, but completed and used in analysis? Will interim reports go to the noble Baroness, Lady Cumberlege, by the people doing this review if evidence emerges that she will need to take account of?

I am concerned about the idea of the creation of a patients’ champion. We already have panels and expert groups. Yet another person that patients may or may not know about, and may or may not be able to turn to, seems problematic. I urge the noble Baroness, Lady Cumberlege, to look at what is available now rather than creating yet another body.

Finally, I echo the concerns expressed by the noble Lord, Lord Hunt, about whether we should move to a public inquiry at this stage. I wonder whether the evidence that the noble Baroness, Lady Cumberlege, will undoubtedly turn up means that she may come back to Ministers and say, “Actually, this is the point at which this needs to go public”. Campaigners have highlighted for years that there are problems.

[Lord O'Shaughnessy]

I thank both noble Lords for their extensive, well-informed and probing questions; I will try to deal with all of them. I want first to take the opportunity to pay tribute to those involved in each of the three campaigns. They are almost exclusively women. A factor that needs consideration is not only that users of healthcare services are disproportionately women but that women seem to be disproportionately on the end of things when things go wrong—that issue needs investigating in itself. I have had the chance to meet not only the mesh campaigners but campaigners on sodium valproate and Primodos. They have gone to extraordinary lengths to raise these issues; they are remarkable women.

On the position relating to mesh, I have asked the MHRA and NICE as the two regulatory bodies to get in touch with their counterparts in Australia and New Zealand. There is some quite long, technical advice which I will not attempt to repeat, except to say that perhaps the simplified public view of what has happened in each of those countries is not entirely accurate. I shall certainly write to all noble Lords taking part in this debate and place a copy of that evidence in the Library. It is quite important. It is detailed, but it is well worth looking at.

I emphasise that collaboration is going on not only internationally but within the four corners of the United Kingdom. The CMOs of those four countries have met. I am meeting the Scottish Cabinet Secretary for Health—I think, next week—to talk about this specific issue and other things as well, so we are cognizant of the need for a joined-up UK approach.

On the scope of the review, it is very open. In the noble Baroness, Lady Cumberlege, we have an ideal chair: someone who has campaigned on safety issues, who is deeply knowledgeable, well respected and fiercely independent—as we know. She has the opportunity to look not just at issues around marketing, as the noble Lord, Lord Hunt, mentioned, but around the private sector. She will be able to look, too, at whether there should be public inquiries or other types of inquiry and to make recommendations. She will be able to look at pharma companies and gather evidence from wherever it is required. I want to emphasise that the review is very broad in scope. As the noble Baroness, Lady Brinton, said, we are trying to mark a break from the past. We know that we have not dealt with these things well. We are beginning to address that in the clinical and medical space in terms of medical practice; we now need to move on to medicines and devices, which is what we hope to do with this process.

On issues around the mesh, the audit and the registry, the audit is obviously retrospective. It will not be a perfect exercise, because the data is not always perfectly gathered, but it will be quite extensive in scope. It will be able to pick up not just complications associated by women, or indeed men, with having mesh but whether they have turned up in pain at another setting. We are confident that it will paint a much broader picture than we have had. The intention is to publish that in the spring. Obviously, if any interim reports relating to it come out, they will be shared with the noble Baroness, Lady Cumberlege, but clearly there needs to be robustness to them.

On the registry, this is an important moment. We have found the money to do this; it will be funded for the set-up and then for the first three years, which is the normal way in which registries are done. I do not yet have a timeline for how it will be delivered, but clearly we want to get it up and running as quickly as possible. It needs to be commissioned, but it is in everyone’s interest to do that.

Primodos presents a challenging issue, because it is not available on the market and has not been for 40 years, so it is not possible to carry out studies on what is happening to women now. However, new evidence has come to light which will also need to be considered and which was not available for the expert working group. Again, my noble friend Lady Cumberlege will be able to consider that as she looks at what needs to happen in each of those three cases.

One thing that we have to do—this moves on to the expert working group’s recommendations from the Primodos review, which is obviously very germane for women taking sodium valproate—is make sure that there is proper training for health professionals, not just in the yellow card scheme but for obstetricians in terms of their pharmacological advice and expertise. Indeed, that is one of the recommendations I will be taking forward, as was set out in the Statement. The valproate issue is very difficult, because it is an extremely effective anti-epilepsy drug but it can have very bad consequences for pregnant women and their children. I have met one of the campaigners; four or five of her children are affected and it is having a devastating impact on her life. We need to get to a position where no women of childbearing potential are using it. That needs to be done in the context of recognising that it does work for epilepsy.

Finally, I absolutely agree with the noble Lord, Lord Hunt, about meeting the groups to define the terms of reference. Again, we have learned from past experience that that has not always been done well and it is best done independently of government, with that degree of objectivity. I think that that is what this review will bring. As I say, the overall hope is that not only do we deal with the issues under each of these three headings, historical and current, but that we put in place a system that means that patients do not have to go through this tortuous process to get their concerns heard in future.

Disabled People: Social Care

Debate between Baroness Brinton and Lord O'Shaughnessy

Tuesday 20th February 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for her question. She is quite right to highlight the importance of reform for this group of people. We are talking about 250,000 people now, but that is projected to rise to 400,000 working-age adults in the next 15 years. I want to reassure her that, while the Green Paper itself is focused on care reform for older people, a parallel programme of work is going on. There is an important round table coming up which is being chaired by both the new Minister of State for Care, Caroline Dinenage, and the Parliamentary Under-Secretary for Communities and Local Government, with Mencap, Scope and others. We are giving the issue equal seriousness, as it deserves.

[Baroness Brinton (LD)]

My Lords, the charity Together for Short Lives last year put in a Freedom of Information Act request and found that one in five local authorities and one in six CCGs have absolutely no provision for respite care short breaks for the most seriously ill and disabled children. Since then we have received reports from across the country of more and more centres under threat or actually closing, such as Nascot Lawn, which I have raised in your Lordships’ House before, which is in court again tomorrow to try to save it. What is happening about this social care and nursing care provision for children? Normally, for adults, there is a negotiation between the NHS and the local authority about what is nursing and what is social care. But for these children there seems to be no such relationship; both local authorities and the NHS just point fingers at each other, and the result is children and their families not getting breaks.

[Lord O'Shaughnessy]

I am very aware of this issue. Indeed, we have had the opportunity to speak about it in specific cases. Local authorities of course are obliged to provide respite care. The noble Baroness highlights an important point about care, which seems in a way to slip between the boundaries of the two. I shall write to her about the general policy work that is going on, but I know that we need to solve this because we have children who are now living longer who before might not have lived so long and who require care, as do their families. It is essential that they get the care that they deserve.

NHS: Winter Crisis

Debate between Baroness Brinton and Lord O'Shaughnessy

Wednesday 7th February 2018 Lords Chamber

[Lord O'Shaughnessy]

I totally reject the accusation of meanness. If noble Lords look at the spending on the NHS, not only has it gone up in real terms every year while a massive fiscal retrenchment has had to take place to deal with £150 billion of borrowing bequeathed by the previous Government, but it now accounts for the highest percentage share of public spending that has ever been in place. We have found the money in difficult circumstances. We all agree that more is needed. More was found in the Budget; I am sure more will be found in the future.

[Baroness Brinton (LD)]

My Lords, in 2015 the King’s Fund warned the Government that the NHS would experience a “full-blown crisis in care” if the Government did not act early enough. That crisis has now materialised, with the additional funding announced in November’s Budget having arrived too late for hospitals struggling to cope with the accepted increase in demand from patients at that time of year. If the planning is to be published in July, when will the announcement about money to support that planning also be announced?

NHS: Clinical Negligence

Debate between Baroness Brinton and Lord O'Shaughnessy

Wednesday 31st January 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord knows more about this issue than anyone in the House, I think. The issue of reform to tort law is difficult. We have to be very careful when stepping across the idea of full compensation. It is one of the issues we are looking at. Other countries, such as Australia, have looked at this and we are considering it as part of the cross-government strategy. As I said, we will report by September this year on our plans in this area.

[Baroness Brinton (LD)]

My Lords, it is estimated that a relatively small number of clinical negligence cases end up as claims filed with the NHS. Has the NHS undertaken additional efforts to understand what factors cause certain cases to be escalated, in particular the attitude of lawyers in the NHS and trusts? How can escalation be prevented and, if so, when might the results be published?

[Lord O'Shaughnessy]

I point the noble Baroness in the direction of a five-year strategy that was published by NHS Resolution, the body that acts on behalf of what used to be the NHS Litigation Authority. The strategy looked at many issues, not only how we can prevent escalation. One of the drivers of cost is unsuccessful claims; more of those are going on. It also looked at how we can reduce incidents in the first place and learn from deaths and injury throughout the system, so that we can start to reduce the burden overall.

Social Care

Debate between Baroness Brinton and Lord O'Shaughnessy

Thursday 7th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Lord for raising that point. I apologise again for the lateness of our response to the Lords committee. What I hope is now the final version is with me for approval, and I hope it will be provided very soon.

On the Green Paper, we all want more integration between health and social care. We know that is important for the people who are increasingly using those services who are in older age, have comorbidities and are moving in and out of different settings of the time. Social care is paid for on a different basis from the NHS. That is critical. We have to get a sustainable financial basis on which we distribute social care while thinking about how it interacts with the health service. The Green Paper is trying to crack a nut that, frankly, has eluded Governments for the last 20 years.

[Baroness Brinton (LD)]

My Lords, I am grateful to the Minister for referring to Nascot Lawn. I was not going to raise it today because that is about care for severely disabled children under 18, but I want to pick up on my noble friend’s point about adult care for people with disabilities and long-term conditions. As we know, their care needs are very different from end-of-life needs. Both the current social care system and the Dilnot proposals were focused on end-of-life care, so I welcome the parallel work stream, but will it operate to exactly the same timescale and report back?

I have a further question on housing. Your Lordships’ House will remember that the recommendations of the Lords Select Committee on the Equality Act 2010 and Disability included a whole chapter on housing. It is not just about the disabled facilities grant, which is important; it is also about Building Regulations ensuring that enough of our homes are built so that, as people age and their needs change, houses can be adapted easily if need be. Will that recommendation be forwarded to the group to look at?

[Lord O'Shaughnessy]

Once again, I thank the noble Baroness for raising this issue and I am pleased that she supports the parallel work stream. I will come back to her with details on the timing—I am afraid that I do not have those with me today—but I stress the importance given to it and the fact that it is reporting to the inter-ministerial group is significant.

The noble Baroness’s question on housing goes slightly beyond my remit. I know that building regs have changed over time to encourage more homes to be built, but I will have to come back to her with more details on that point.

Health and Social Care: Falls Prevention

Debate between Baroness Brinton and Lord O'Shaughnessy

Thursday 30th November 2017 Lords Chamber

[Lord O’Shaughnessy]

I will happily do so. Dance is very popular in my household, with “Strictly Come Dancing” on the television at the moment. Debbie McGee might not be quite over 65 but she is a great advert for older people dancing. I absolutely support what the noble Lord says. I have seen the evidence on the impact that was published as part of the APPG’s work on this; it is very convincing and we will certainly let health and well-being boards know that this is exactly the kind of thing—social prescribing, if you like—that they should be looking at to prevent falls.

[Baroness Brinton (LD)]

My Lords, the Royal College of Physicians estimates that between one-quarter and one-third of falls could be prevented through assessment and intervention. NHS Improvement ran 19 projects with volunteer trusts. There is not much evidence of those pilots working closely with local authorities, which is the nature of the Question of the noble Lord, Lord Jordan. What were the results of the pilots that started in January? One of the key findings of NHS Improvement was that two-thirds of trusts were still using outdated predictor equipment which NICE has recommended against. Can the noble Lord let me know, either now or later, whether he can confirm that those predictor instruments that NICE is now saying should not be used have been withdrawn, particularly from hospitals and general practice?

[Lord O’Shaughnessy]

I do not have the specific details that the noble Baroness has asked for; I will write to her. The figures are not good; there are still around a quarter of a million falls in hospitals and mental health trusts each year, which is equivalent to the emergency admissions, so it is still a significant problem. NHS Improvement is working with the poorest-performing trusts and is reporting that those interventions have seen improvements, but we clearly need to phase out some of the poor practice that exists in order to reach higher standards.

Nurses: Tuition Fees

Debate between Baroness Brinton and Lord O'Shaughnessy

Wednesday 29th November 2017 Lords Chamber

[Lord O'Shaughnessy]

My noble friend is quite right to point out that student debt is forgiven after 30 years. The point of that is to ensure there is an equitable system, where those who earn more pay back more over the course of their working lives. It is important to point out that, with the new threshold moving up to £25,000, a nurse earning £26,000 in band 5 of the Agenda for Change pay scale would pay back £7.50 of that loan per calendar month.

[Baroness Brinton (LD)]

My Lords, with the NHS reporting that 96% of hospitals are currently failing to meet their planned number of registered nurses, and UCAS reporting a decline in student nurse applications, as the noble Lord mentioned, as well as the further news that one in four post-qualifying nurses leave in their first year, what are the Government proposing to do to change the problem of recruiting new nurses, including returning to bursaries and abolishing tuition fees altogether? Specifically, what are the Government doing right now to attract nurses into our hospitals?

[Lord O'Shaughnessy]

It is important to point out that there are 10,000 more nurses on wards than there were seven years ago. One of the things that we are trying to do is encourage nurses to return to practice—3,000 of those nurses have been on the return to practice programme. In regard to attracting them to hospitals, the main thing is that we need to train more nurses to fill those places so that we fill the demand that we know that we have from a growing and ageing population. That is why there are going to be 5,000 more funded nursing training places from 2018 onwards.

Veterans: Mental Health

Debate between Baroness Brinton and Lord O'Shaughnessy

Tuesday 7th November 2017 Lords Chamber

[Lord O'Shaughnessy]

On the first point, there have been reviews at European level to improve the packaging and the patient information leaflets about any risk that might attend taking this drug or indeed any others. Status as a veteran is now recorded in the NHS and goes into the patient record.

[Baroness Brinton (LD)]

My Lords, the mefloquine help page for veterans and current serving officers is very good at explaining the signposting, but there is no mention in Meeting the Healthcare Needs of Veterans, which has not been updated since 2011. Only 2,000 GPs out of more than 50,000 have attended the day training course on working with veterans. Can the Minister ensure that at least one GP from every surgery has training, so that he or she can advise other GPs when they are helping to serve our veterans once they are back in the civilian workforce?

[Lord O'Shaughnessy]

The noble Baroness makes a good point. As I mentioned, that training is now in the curriculum, but of course that deals with the flow of new GPs as opposed to the stock of existing GPs. I shall certainly look at that and see what more can be done to make sure that GPs have up-to-date training.

Care Homes: Hospital Discharges

Debate between Baroness Brinton and Lord O'Shaughnessy

Monday 16th October 2017 Lords Chamber

[Lord O'Shaughnessy]

The point about integration is critical. The CQC’s report from last week, which we were discussing, is all about collaboration and integration. Someone in their 80s who is experiencing care does not distinguish between different bits of it as we do bureaucratically. They want to know that there is seamless care. That is what the sustainability and transformation process is attempting to do.

[Baroness Brinton (LD)]

My Lords, I am grateful for the right reverend Prelate’s comment about the National Audit Office’s report from February, which makes it clear that 43% of the multidisciplinary team meetings in acute hospitals began immediately, which is to be encouraged, but only 20% of local authorities were invited to those early meetings. What are the Government doing to ensure that the advice from NHS Improvement about getting that earliest intervention will actually happen?

[Lord O'Shaughnessy]

The noble Baroness raises an excellent point. She may know that the better care fund—the route by which the additional money goes into social care—reviews and holds accountable local authorities and the NHS for interacting with one another to deal with delayed transfers of care. There is something called the high-impact change model, which is designed precisely to bring people together to ensure that the number of delayed transfers in care are reduced. That is compulsory as part of the funding provided.

Health and Social Care

Debate between Baroness Brinton and Lord O'Shaughnessy

Thursday 12th October 2017 Lords Chamber

[Lord O'Shaughnessy]

I join the noble Baroness in paying tribute to voluntary sector providers and volunteers, whether family members or others, who support care throughout the NHS and social care. There need to be more paid staff to meet the needs of our growing and ageing population, which is why the Secretary of State announced a 25% increase in the number of training places and more nursing associates. That is being put in place to make sure that the system, which is described in the report as stretched, has the capacity it needs to meet patients’ needs.

[Baroness Brinton (LD)]

My Lords—

--- Later in debate ---

[Baroness Brinton]

My Lords, the CQC report has shown that over the past two years there has been a reduction in beds in nursing and care homes, while the Lancet published the results of a research project in the summer showing that we will need an extra 9,000 beds per annum by 2025—that is more than 70,000 beds. What are the Government proposing to do to make it easier for more homes to be set up and run and to fund the beds we clearly need urgently, not just in 2025 but from now on?

[Lord O'Shaughnessy]

The noble Baroness will know that there has been a small reduction in the total number of residential nursing home beds, although it is a fairly flat picture over a long period of time. We have also seen an increase in the amount of domiciliary care. One of the things we need to get to the bottom of, and this is what the consultation will look at, is the imbalances that exist between the funding regimes for residential and domiciliary care. We have to get to the bottom of it, because it creates an imbalance on the provider side as well, so that we can have proper funding for the kind of care that people need regardless of whether it is in a residential nursing setting or at home.

Healthcare: Spending

Debate between Baroness Brinton and Lord O'Shaughnessy

Tuesday 4th April 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord makes the point that the NHS is operating in challenging conditions, not least because of rising demand and expectations. Notwithstanding that, there is a huge improvement in performance. More operations are being performed, there are more diagnostic tests, more people are starting cancer treatment, and people say that they have never been more satisfied with the quality and dignity of care that they are receiving. Those are the points that we need to bear in mind when we talk about the fantastic work that NHS staff do.

[Baroness Brinton (LD)]

My Lords, perhaps we can push the Minister for a clear answer on this. The average spend of G7 economies is 10.4% of their GDP in comparison with the UK’s 9.8%—a gap of £10.3 billion. The Government are proudly saying that they are putting in just under £0.5 billion this spring, with a bit more capital to follow, but what are they going to do to address that shortage, given that £10 billion could provide 10,000 extra GPs and other help in primary care?

[Lord O'Shaughnessy]

As I referred to in my previous answer, the Government have provided additional funding to the NHS—£10 billion more by 2020. It is also worth noting that since the 2015 election over £9 billion of additional funding has been found for social care, which of course has huge strains upon it, and that makes a big difference.

Social Care in England: Older People

Debate between Baroness Brinton and Lord O'Shaughnessy

Monday 20th March 2017 Lords Chamber

[Lord O'Shaughnessy]

Much more funding is now going into the social care system to reflect the additional needs of the ageing population. I am looking forwards in thinking about the extra £9 billion that will be provided. We also have over 150,000 more care workers helping people in the system, whether in residential care homes and nursing homes or at home through domiciliary care.

[Baroness Brinton (LD)]

My Lords, after the publication of the Dilnot commission report nearly six years ago, the noble Lord, Lord Lansley, in another role, and the then Chancellor congratulated the commission on its report being a valuable contribution to meeting the long-term challenge of an ageing population. A Green Paper being seen as the beginning of this process six years on is way too late. I repeat the question that I asked the noble Lord last week: can he confirm that the Treasury will specifically be involved in looking at the funding of social care in the future?

[Lord O'Shaughnessy]

The noble Baroness is quite right to point out that Dilnot was an important move. It is also fair to say that several Governments, including 13 years of a Labour Government, failed to make any significant progress on this issue. We now have a Green Paper coming forward that is, of course, looking at a sustainable and fair care system, and that must also include looking at funding.

Adult Social Care: Funding

Debate between Baroness Brinton and Lord O'Shaughnessy

Thursday 16th March 2017 Lords Chamber

[Lord O'Shaughnessy]

I will speak to the Chief Whip about taking a few days off. I thank the noble Lord for bringing that point to my attention. As he says, there are examples in the UK—in Scotland, England and Wales, and of course Northern Ireland has a joined-up system too—so clearly there are lessons to be learned from home.

[Baroness Brinton (LD)]

My Lords, following the push by Norman Lamb MP for this review that the Government have been talking about and putting into the long grass, the independent specialist group that he convened gave its interim report this morning. It makes it absolutely clear that we have to look at how the NHS and social care are paid for. Can the Minister give an assurance that the Green Paper will address those Treasury issues, as well as the issues of care and the relationship between the NHS and social care?

[Lord O'Shaughnessy]

As I have said to several noble Lords, the intention of the review is to put the adult social care system on a sustainable and long-term basis and to make sure that it is fair and transparent and that it delivers high-quality care. It will address all the issues required to do that.

Tobacco Control Plan

Debate between Baroness Brinton and Lord O'Shaughnessy

Thursday 23rd February 2017 Lords Chamber

[Lord O'Shaughnessy]

I understand the frustration at the delay in publishing the plan. That does not mean that action has not been taking place: all the action set in train under the previous plan has been taking place throughout that period. As I said, the new plan will be published shortly. I look to my noble friend Lord Ahmad, who has given several master classes in the use of words to describe “shortly” in different ways. I will save a few of those for any future Questions and stick with “shortly” for now.

[Baroness Brinton (LD)]

My Lords, the most recent report on child uptake of smoking by area shows some alarming figures of how many children start smoking every day. Given that it has been 100 days since the Government said that they would publish a new report, 67 children a day in London have taken up smoking, which makes 6,700 children in London alone. Do the Government not recognise the urgency of the plan’s publication, not just for the wider protection of our country but specifically for the most vulnerable of our children?

[Lord O'Shaughnessy]

I agree with the noble Baroness. It is worth pointing out that 8% of 15 year-olds smoke, which is obviously eight percentage points too high, but it is down from 15% in 2009, so things are moving in the right direction, although we are absolutely not complacent about it. We have taken action that is reducing the number of children who smoke. In particular, we have banned displays in small shops, which normalise that activity for children, who might be with their parents and see them—marketing is very clever at catching the eye. That is happening. As I said, we will be publishing the plan shortly and it will have reducing smoking among children as a key part.

Residential Care

Debate between Baroness Brinton and Lord O'Shaughnessy

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

Debate between Baroness Brinton and Lord O'Shaughnessy

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.