Social Care Funding (EAC Report)

Baroness Browning Excerpts

Thursday 28th January 2021 Grand Committee

[Baroness Browning (Con) [V]]

My Lords, I fully support this report. There are one or two things in some of the detail of it that I would like to see tweaked, but the thrust of it is absolutely right. This is a national scandal and it is far beyond time that the Government started to put it right. I support everybody who has said that this report should be the basis of a White Paper and not a Green Paper, because action is now needed.

I want to make merely a couple of points that are perhaps not covered in the report. I was reminded, when we were talking earlier in the debate about trusts, of the not-for-profit sector, which I believe has a lot to offer, particularly in care homes. Around the country, there are many homes that are run by trusts—we heard from the noble Lord, Lord Taylor, that new ones have been set up under trusteeships. Their great advantage is that, very often, they are small and locally based and therefore serve a particular client base. One hardship of the instability of the care home sector is that, when homes close, people often need to be moved well away from their relatives and areas where they have lived for many years. Therefore, in order to provide nationally a good mix of care that is affordable and of good quality, the not-for-profit sector could play a much bigger role than it does now. I would like us to look at that in a White Paper.

I will also pick up the funding of personal care, which many speakers have mentioned. I can see why some colleagues with a big local government interest are not very keen on this because they can see the bill. We are looking at billions; this is not a penny-on-income-tax policy. But we should look in more detail at what we mean by personal care. What does the day of somebody who needs personal care look like? It is not just about whether they can get dressed or have a meal provided by somebody in the household. Very often, particularly for those with Alzheimer’s or dementia, it is a question of not knowing what clothes to put on and perhaps dressing in the most inappropriate clothes. When it comes to food, it a matter of have they eaten or have they not? People with dementia may forget within half an hour that they have in fact eaten. Maintaining nutrition is therefore very important. This is a group of people who will wake up at 4.30 am or 5 am and think it is time to get up. They need full 24/7 care.

None of this is “medical” according to the definition of the word, but the demands and effect on carers can be quite catastrophic if those basic needs are not met. A failure in nutrition or in personal hygiene—for people who cannot look after themselves as far as their personal hygiene is concerned—can cause urinary tract infections or all sorts of problems that lead quickly to the need for doctors to be called or hospitalisation. I therefore would not underestimate the importance of personal care. It is something that must be factored in.

We have heard a lot about the political parties coming together; I agree that they will need to join together if this is to be successful, but please can we still do more to bring together social services and the NHS? In my experience as a Member of Parliament, whenever I came across a problem in this area, I would have to personally call for a case conference—and who would be sat round that table? Health, social services and the people involved with the problems. There seems to be a real lack of initiative to come forward and the reason is very simple: when you get those people round a table to sort out a problem, it costs money. They will do anything to avoid getting to the point where they have to sit round a table and commit money. I understand why—it is not easy, but we have to overcome that relationship between health and social services if this is going to work; otherwise, we will have these glass Chinese walls, where it is the responsibility of one and the other one does not want to know.

Finally—I have gone over my four minutes—not all households are one-person households. Often there are two people—two elderly people; two parents, perhaps—who need the help.

Covid-19: Vaccine

Baroness Browning Excerpts

Tuesday 12th January 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Lord alludes to a complicated dilemma that we all feel. I welcome challenge and those who query and question the basis of our policy decisions and our science. He is right: too much false information and fake news can damage trust. We have gone about the vaccine process with an approach that is as open and transparent as it can possibly be. We have sought to engage in dialogue and answer questions where there have been any. That approach has proved to be effective and it is the one we continue with.

[Baroness Browning (Con) [V]]

My husband, who is 84 years old, received his Pfizer vaccine before Christmas and his second one last week was cancelled. Is there any guarantee that, when the second jab comes, it will be the Pfizer vaccine? As I understand, there has been no research on mixing and matching these vaccines. Is there any way that the level of immunity can be tested at that three-month point?

[Lord Bethell (Con)]

The CMO has made it clear that he leans heavily towards having consistent vaccines, but it is not a requirement. Some of the immune response comes from antibodies which can be tested, but some of it is from T-cells, which are very difficult to test for. It is not possible to categorically say whether someone is immune. However, we have looked at ways to measure and understand more about the body’s immune response to develop our understanding in this area.

Care Quality Commission Report

Baroness Browning Excerpts

Tuesday 15th December 2020 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, I would be grateful to hear from the Rights for Residents campaign, which sounds like an important and valuable contribution. I reassure the noble Baroness that the numbers of those who have undergone restrictive practices who have autism or learning difficulties do not appear to have risen during the pandemic. That is not to say that the current numbers are acceptable.

[Baroness Browning (Con) [V]]

My Lords, I refer to my interests in the register. My noble friend has not mentioned—and I would like to remind him of it—that in 2009 Parliament passed the Autism Act. It is the only medically diagnosed condition, apart from mental health, considered important enough to have its own Act of Parliament. Many of the issues raised in the CQC report to do with diagnosis and failure to intervene at an early stage with appropriate and timely interventions are covered in the Autism Act. Will he ask his department to look again at that Act, which is subject to ministerial guidance, and make sure that not only is it implemented but there is sufficient funding for that Act to be put into practice?

[Lord Bethell (Con) [V]]

I am very grateful for the reminder from the noble Baroness, and I would be glad to take her recommendation back to the department and write to her on whether there are any measures that we need to put in place to ensure that we are fulfilling our commitments under the Autism Act. It was an important Act, and I suspect that we are well within the measures that it has enacted.

Face-to-Face Medical Appointments

Baroness Browning Excerpts

Thursday 19th November 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Lord makes an incredibly interesting parallel with Iceland. It is not one that I knew, but I will take care to look into it, because it is instructive and informative. He is right to say that Covid has demonstrated the power of telemedicine, and we are keen to learn that lesson. We do not want the elastic band of old practice to snap back to where it was before. To reflect the words of a noble Lord who spoke previously, there will be occasions when tele- medicine is right. The key is getting the blend correct and ensuring that the right format is used in the right circumstances.

[Baroness Browning (Con) [V]]

I quite accept that there is a role for telemedicine, but an accurate diagnosis in cases of serious disease and illness is dependent not just on the questions that the doctor asks and the observations he makes but on the ability of the patient to give accurate information. I will give the example from my family in the past few months of antibiotics prescribed for a “lung infection” that was actually a fatal pulmonary embolism. Getting that mix right is not easy; there are very many shades of grey.

[Lord Bethell (Con)]

My noble friend makes a very good point. Diagnosis is phenomenally difficult and, quite often, patients who present with seemingly one condition have something altogether different. It may be that a face-to-face appointment will be the moment when that difference is spotted and caught. She is entirely right to say that we cannot omit that format for the right circumstances, but a great many patients see their GPs very regularly. Their journeys may be onerous, uncomfortable and stressful, and telemedicine might offer them an alternative opportunity. There are others for whom speed is of the essence, and having telemedicine, particularly when it is supported by apps that provide essential information about their condition, can be an important and urgent alternative.

Hospitals and Nursing Homes: Do Not Resuscitate Notices

Baroness Browning Excerpts

Thursday 1st October 2020 Lords Chamber

Asked by

[Baroness Browning]

To ask Her Majesty’s Government what assessment they have made of the use of Do Not Resuscitate notices in hospitals and nursing homes since March.

[Baroness Browning (Con) [V]]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and refer to my interests in the register.

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

My Lords, the department is very clear that the blanket use of DNACPR and DNR is unacceptable. An agreement to a DNACPR is an individual decision and should involve the person concerned or, where the person lacks capacity, their family, carer, guardian or any other legally recognised advocate. I can inform the House that the Minister for Patient Safety and Mental Health will be writing to the Care Quality Commission requesting that it investigates and reports on DNACPR issues.

[Baroness Browning (Con) [V]]

I am grateful to my noble friend and am aware of the letters written in respect of people with learning disabilities and autism during the first phase of the Covid-19 outbreak. However, with the second wave looking as though it is on its way, my noble friend will be aware that there is still concern from charities such as Mencap and the National Autistic Society, not least because of the attitude in some areas that people who have social care support needs are rather lesser human beings than the rest of us. How will the Care Quality Commission carry out this assessment as the second wave increases?

[Lord Bethell (Con)]

My Lords, it is completely unacceptable for any group of people to have blanket DNACPR provisions apply to them. The adult social care winter plan published on 18 September reiterates that and makes the position crystal clear. The General Medical Council is providing additional support and guidance to clinicians on how to meet the needs of patients and relatives, and the Resuscitation Council UK is creating a large amount of resources to provide training. The CQC is monitoring the situation extremely carefully.

Covid-19: NHS Long-term Plan

Baroness Browning Excerpts

Tuesday 15th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the right reverend Prelate is right; health inequalities are a massive priority for the Government. Covid has demonstrated how health inequalities play out when an epidemic such as this one hits the country. That is why we put education and levelling-up on health generally as major government priorities, why we are investing in 50,000 new nurses and 40 new hospitals, and why health remains a number one priority for this Government.

[Baroness Browning (Con) [V]]

My Lords, my noble friend will be aware that the long-term plan has set an ambitious target for 2028 of 75% of cancers being diagnosed at stages 1 and 2. Does he agree that this must involve GPs, and that GPs having face-to-face consultations with patients is the only way that this target will be achieved?

[Lord Bethell (Con)]

We are enormously proud of the commitment to early intervention on cancer. This is the absolute core of our life science priorities. It is envisaged that we will have a revolution in the diagnostic capabilities of the NHS in order to hit these targets and, where necessary, face-to-face GP appointments will be made available. However, I am not sure that every single appointment needs to be face to face. One of the learnings of more than half of the 100 million consultations that took place between March and June was that telephone and video appointments can be extremely productive.

Covid-19

Baroness Browning Excerpts

Thursday 3rd September 2020 Lords Chamber

[Lord Bethell (Con)]

The right reverend Prelate is entirely right to raise this point; it is emerging as a massive concern. The idea that Covid will somehow pass through Britain and leave people untouched, a bit like simple winter flu, is beginning to prove worryingly untrue. Her anecdote from Bristol is completely consistent with what we are seeing across the piece. In particular, those who have had acute infection but also, I fear, some who have had relatively asymptomatic or low-symptom Covid have found in later weeks and months symptoms of fatigue, arrythmia, renal impact, scarring on the lungs and memory loss. These are extremely worrying symptoms. Sir Patrick Vallance, the Government Chief Scientific Adviser, is running an operation to understand what the right reverend Prelate rightly calls long Covid; we are using big data to analyse the scans we have collected from acute patients and to understand the impact of asymptomatic infection. This is an extremely worrying manifestation of Covid, one that we are acutely aware of, and we are investigating very urgently.

[Baroness Browning (Con) [V]]

My noble friend will be only too aware of the consequences of non-Covid patients’ reluctance to present themselves at hospitals and even to GPs for treatment and support. With the winter months approaching, what can he do to make sure that, at a local level, in advance of people having symptoms, they are reassured that they will be safe to approach the NHS? The idea that “it will be all right on the night” and just requires encouragement has clearly not been enough in the past and, I fear, will not be enough in the coming months.

[Lord Bethell (Con)]

My Lords, my noble friend is entirely right that confidence in attending NHS venues is hard hit by Covid. One of the inspiring and interesting things that has happened has been the switch to using telemedicine—video and telephone calls—for referrals. This has been particularly and interestingly used in mental health, where attendance at clinics is something that many patients would wisely seek to avoid, but in fact the delivery of mental health therapy through telemedicine and calls has proved to be incredibly effective and has worked very well. We are working hard, through the NHS, to try to de-weight attendance at venues, particularly big central hospitals, and move much more towards attendance in the community, or through technology, in order to give patients a choice and to increase our engagement at a time when people are fearful of going back to their GP surgeries.

Covid-19: Personal Protective Equipment

Baroness Browning Excerpts

Thursday 16th July 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, I completely share the concerns of the noble Baroness, Lady Andrews, about a second peak and we are working to prepare for that. I respect the views of the PAC and emphasise that our approach to PPE is incredibly serious. A huge amount of work has gone into it and a huge amount of progress has been made.

[Baroness Browning (Con) [V]]

Can my noble friend identify what lessons have been learnt so far from both the quantity and quality of the PPE that has been used in homes and hospitals? What action will be taken to minimise cross-infection for those who have to go into people’s domestic homes and who often work in more than one location?

[Lord Bethell [V]]

My Lords, the big lesson from Covid is that the quantity of PPE needed for a disease like this is massively more that could ever have been expected, particularly compared with our past experience. It has hit every country in the world and has hit the global supply chains incredibly hard. A benign lesson is that British manufacturers are capable of stepping up the challenge, and I salute their work. Contamination from itinerant workers was always one of the greatest challenges of the care sector, and we have put in a huge amount of work and financial resources to avoid the need for workers who move from home to home.

Hospitals: Patient Safety

Baroness Browning Excerpts

Thursday 21st May 2020 Lords Chamber

Asked by

[Baroness Browning]

To ask Her Majesty’s Government what steps they are taking to update the guidance given to hospitals about ensuring the safety of patients who do not have Covid-19 who require life-saving emergency treatment.

The Question was considered in a Virtual Proceeding via video call.

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

My Lords, despite Covid-19, the day-to-day health of the nation remains the business of the NHS. That is why the NHS has issued a new operating framework to help hospitals to continue providing essential and emergency care for patients who do not have Covid-19. This guidance is being kept under review. I have placed a copy of the framework in the Library.

[Baroness Browning (Con)]

Emergency admissions, of which we have seen many, though perhaps not enough, have resulted in people being very afraid of going into hospital, because there has been a lack of information for the general public. For example, what happens at the triage stage, what sort of PPE will people be wearing and how will they be protected? What can the Minister do to reassure the public that they will be safe and, on top of their emergency, will have the absolute minimum chance of getting Covid-19?

[Lord Bethell]

My Lords, I acknowledge that people’s concerns have led to a decline in attendance at A&E. That is why the NHS is running an “Open for business” media campaign, encouraging all patients in need of urgent or emergency medical care to seek appropriate treatment, including, where appropriate, attendance at A&E.

Mental Disorder: Autism and Learning Disabilities

Baroness Browning Excerpts

Tuesday 5th November 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for taking on the chairing of the independent panel. I cannot think of anybody better placed to do so. When it comes to her question about the detention of an individual to improve their behaviour, again, I do not think that anybody in this place or elsewhere could disagree with her. On changing the Mental Health Act, we commissioned the independent review led by Sir Simon Wessely, who is also a leader in the field. He reported in December. In its findings, the review made it clear that we need to modernise the Mental Health Act, ensure that views are respected and ensure that patients are not detained for any longer than is absolutely necessary. Sir Simon stated that there is “no clear consensus” on removing autism from the Act, and that,

“we have heard also about the many negative consequences that could arise from being outside this framework … this should be kept under review”.

Obviously, we will not respond to that immediately. There will be a White Paper by the end of the year. We will consider this carefully and we recognise the strength of feeling on this matter.

[Baroness Browning (Con)]

In support of what the noble Lord, Lord Touhig, and the noble Baroness said—we greatly welcome her chairmanship of the review—there is a very good reason for removing autism as a mental disorder: it is not a mental disorder. It is as simple as that, although it is true that people with autism, including children, will have comorbidities and will develop a mental health condition on top of their autism. I do not know whether the Minister understands my frustration, but I have been raising this issue in Parliament for nearly 28 years. The real problem is that we do not have sufficient psychiatrists who understand and can differentiate between autistic behaviour and what they believe to be psychotic behaviour. Once patients start the spiral of medication for psychosis, the autism disappears and the person disappears altogether.

[Baroness Blackwood of North Oxford]

My noble friend puts this very clearly. The Government accept completely that autism and learning disability are not mental disorders. The question is whether being excluded from the legislation would cause challenges or difficulties for those who may have autism and mental disorders. We will have to consider that carefully as we go into the process of considering a review of the Mental Health Act. As my noble friend just said, we recognise that we will have to go through a careful process. We also recognise the strong feelings—and the correct view—that autism and learning disability are not mental disorders. There is no disagreement on that point.