Social Workers: Recruitment and Retention

Baroness Butler-Sloss Excerpts

Thursday 16th May 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

My noble friend is absolutely right that social workers do vital jobs and that it is an attractive career choice. More than 4,000 students enrol in social work courses every year, and we have introduced a fast-track graduate programme that has brought 2,000 more into the social work programme. However, it will work only if we retain those within the system, so we have developed some post-qualifying standards for social workers at key stages of their career to create a consistent, practice-based career progression. In particular, we have introduced the assessed year in the workforce to provide that key level of support in the first year, so that those who experience the shock of the caseload in their first year have the support that they need to remain in the profession and develop the key skills to be able to manage that workload.

[Baroness Butler-Sloss (CB)]

My Lords, as a former family judge, I have worked very closely with social workers. Will the Minister consider the aspect of lack of respect and status? If they were given a better status, they would be much easier to recruit and retain.

[Baroness Blackwood of North Oxford]

The noble and learned Baroness makes an excellent point. Social workers play a crucial role in our society and should have the respect and status they deserve. One way in which that can be achieved is through the increasing professional standards being brought into the service. As I have said, these include key reforms such as improving leadership and providing high-quality continuous professional development, through which we seek to improve the quality of social workers’ professional lives while raising standards and recognition for the profession.

Nurses: Tuition Fees

Baroness Butler-Sloss Excerpts

Wednesday 29th November 2017 Lords Chamber

[Lord O'Shaughnessy]

I shall certainly write to my noble friend, and indeed all noble Lords, about the proportion of the write-off. Let us remember, however, why the student loans system exists. It exists because those people who earn enough over the course of their working lives end up paying more than those who do not. Therefore, if somebody has gone into nursing but has then gone on to work in another profession, earning more money and being able to pay it off, it is equitable that they pay it off. That was the policy of the Labour Government, and it has been adopted by the Conservative Government precisely on the point of equity. It is only right that the loan is written off for those who have not earned enough but, for those who have earned enough, that they pay it off.

[Baroness Butler-Sloss (CB)]

My Lords, will the Government reconsider the issue of bursaries?

[Lord O'Shaughnessy]

I obviously have not been clear enough; I thought that I had. The answer to that is that we are not considering that at the moment.

Nursing and Midwifery: Student Applications

Baroness Butler-Sloss Excerpts

Tuesday 7th February 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness makes an important point about attrition. It is one of the reasons that, within the new package of support, there is extra support for living expenses, both for mature students, who feature particularly in the case of nursing, and in cases of hardship.

[Baroness Butler-Sloss (CB)]

My Lords, has the Minister seen the fifth annual State of Maternity Services Report from the Royal College of Midwives—I attended its launch this morning—in which there are very careful data about the fact that too many midwives are aged over 50, a considerable number are over 60 and there are not sufficient to take their places? The Government should worry about this.

[Lord O'Shaughnessy]

I am grateful to the noble and learned Baroness for bringing up that issue. I have not seen the report, but I shall certainly look at it. It is true that, across the public sector, there is an issue with an ageing workforce. To some extent, that will be addressed by the fact that we will all be working until we are older. The Government will also be introducing increases to the number of training places, which was a critical reason for moving from a bursary to a fee-based system. The bursary system involved a cap; we are now able to release that cap and bring more numbers through in the training.

Mental Health: Children’s Services

Baroness Butler-Sloss Excerpts

Thursday 19th January 2017 Lords Chamber

[Lord O'Shaughnessy]

I do not think that anybody disagrees with the scale of the problem that we are dealing with, but I do not believe—and the Government do not believe—that having an NHS in which politicians can direct pots of money is the right approach. These are clinical decisions that need to be made locally. It is not true to say that there is no pressure going on—that is what NHS England is for, to make sure that CCGs are committing not just on mental health but on other health issues to spend the money and meet the targets that they are committed to meeting.

[Baroness Butler-Sloss (CB)]

Does the Minister accept that to start looking at mental health issues in secondary school is too late? There is no doubt a shortage in terms of looking at it at primary school level, but it is extremely important. The earlier that children are looked at for their problems, the better.

[Lord O'Shaughnessy]

The noble and learned Baroness may know that over the past five years I have been setting up primary free schools, with an explicit focus on developing character, well-being and resilience in young people, so I could not agree with her more—it has to start early. Indeed, it does not have to start in primary; it must start in early years and, of course, it must start with parenting and giving parents the skills that they need to teach resilience in their children.

NHS: Unsafe Hospital Discharges

Baroness Butler-Sloss Excerpts

Wednesday 15th June 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is right. Most well-run hospitals will have integrated discharge teams comprising people who work in the community, social care workers and people who work in the hospital. However, the fact is that over the last 20 years, with the benefit of hindsight, too much resource has gone into acute hospitals and not enough into primary care and community care. You cannot wish into being lots of district nurses overnight. There are some parts of the country—I will pick on Northumbria and Salford, for example—where serious integration is now going on, with hospitals also managing adult social care, GPs and community care.

[Baroness Butler-Sloss (CB)]

May I pick the Minister up on one point? He said that there were one or two examples, but my understanding is that this is right across the country.

[Lord Prior of Brampton]

The noble and learned Baroness is right, up to a point. I said one or two because the PSHO report focuses on nine individual cases. In so far as they are representative of behaviour across the country, they are important, but I want to put on record that the vast majority of hospitals the vast majority of the time are getting their discharge procedures right and are doing an outstanding job.

Access to Palliative Care Bill [HL]

Baroness Butler-Sloss Excerpts

Friday 23rd October 2015 Lords Chamber

[Baroness Butler-Sloss (CB)]

My Lords, I, too, congratulate the noble Baroness, Lady Finlay, who has led a number of wonderful campaigns to try to improve healthcare in this country.

I am a vice-president of Hospiscare, which is based at the Royal Devon and Exeter in Exeter. It looks after about 1,000 patients a year in Exeter and its environs. About 42% of the patients looked after by our hospice care die at home. Although not every patient should die at home, it is impressive how well our local community volunteers, as well as nurses, are looking after the people of that area. The bed occupancy in our hospice is generally only between 10 and 15 days at the very latter end of patients’ lives, which again is a tribute to our community nurses. We have two day centres, one new, but only 19% of the cost of keeping this going comes from a grant, so I can tell you that we are all kept pretty busy trying to raise the rest of a very substantial amount of money.

The point I want to make from this is the enormous importance of community nurses, whether the district nurses which the noble Baroness, Lady Byford, mentioned or the nurses and volunteers from the local hospice. The particular point made to me by the chief executive when I asked her what I should be saying was her concern at the inequality of provision even in our area. She estimates that another 1,700 people would benefit from help by those who are trained to recognise, assess and triage palliative care needs—not necessarily coming through the hospice, but by people who actually know how to look after those people. That is lacking.

As you can imagine, our hospice, like all the other hospices in the country, as I understand it, is enormously supportive of the Bill. I would like to raise two particular points. The first is the importance of the duty to commission. That is crucial. The other, perhaps even more important, which again was raised by the noble Baroness, Lady Byford, concerns education, training and research. They come back to the work of those on the ground identifying who needs help and helping them. I wish the Bill well.

Medical Innovation Bill [HL]

Baroness Butler-Sloss Excerpts

Friday 24th October 2014 Lords Chamber

[Lord Turnberg]

My Lords, I strongly support Amendment 2 in the name of the noble Lord, Lord Pannick, for inserting the word “reasonable” for all the cogent reasons that he has given. Amendment 3 follows on from my earlier Amendment 1, which defines “relevant condition” and does not need further discussion here. I am very pleased to see that we have the agreement of the noble Lord, Lord Saatchi, that the word “reckless” will disappear from the Bill.

[Baroness Butler-Sloss (CB)]

My Lords, I strongly support the Bill as it is drafted. I am relieved that the noble Lord, Lord Saatchi, produced a short Bill; I hope that the House does not think that it was a bad idea to suggest that a short Bill might be more attractive than a longer one. For that reason I am not at all happy about the various amendments that were in the first part of our discussions today.

I do have reservations about the words in brackets in Clause 1(1), and I take the view that the noble Lord, Lord Pannick, is probably right to say that they should be excluded.

[Baroness Finlay of Llandaff]

My Lords, I added my name to the amendment deleting “reckless” because I felt quite strongly that it detracted from the overall intention of the Bill. This is not about reckless innovation; it certainly must deter irresponsible innovation, but it is about encouraging responsible innovation. I also added my name to Amendment 3, on treatment for the “relevant conditions”, because many of these patients who are seriously ill will have multiple co-morbidities and may have many things happening to them. This Bill is aimed, as far as I have understood, at the principal condition—the condition for which patients are often desperate for some innovative treatment. It should not inadvertently allow lots of other strange things to be presented to patients to cope with many of the other co-morbidities that they may have.

My feeling about that comes particularly from my own specialty, which the House knows is palliative medicine, where we see time and again patients who are very emotionally vulnerable, psychologically fragile and potentially in despair, so they are unable to make sense of what is going on. In that state, they are quite vulnerable to people presenting all kinds of strange treatments with false claims. I will give a specific example from my own practice. We came across a group of patients on a ward who all had small crystals by their bed, and we discovered that a member of staff strongly believed that holding on to these crystals would shrink the patients’ cancers. The evidence for it was absolutely zilch; I think that the patients had paid to have the crystals given to them. That type of so-called experimentation is completely outside the scope of the Bill—and must be outside its scope. That is why it struck me that the wording about the relevant medical condition should feature in the Bill, because of the potential for exploitation otherwise.

--- Later in debate ---

[Baroness Butler-Sloss]

It seems to me that if one is going to have Amendment 6, instead of saying that it “means”, it should say that it “includes”. That would then leave open everything else that might come in as medical innovation.

[Earl Howe]

This group of amendments seeks to define innovation and the scope of the Bill. This is a uniquely difficult task as innovation is, in essence, about constant improvement, change and progression. It is essential that in the act of defining we do not inadvertently limit responsible innovation. I ask the Committee to take on board the point neatly made by my noble and learned friend Lord Mackay.

Amendment 8 to Clause 1(2) in the name of my noble friend Lord Saatchi limits the scope of the Bill to situations where a doctor departs from,

“the existing range of accepted”,

medical treatments for a condition. This will be well understood by doctors, who are best placed to know whether they are following accepted treatments. This amendment also ensures that the Bill applies only to medical treatment.

A further provision, Clause 1(4)(a), ensures that the Bill applies not to research but only to the care of individuals. This exclusion of research is sufficient to achieve the same effect as Amendment 6 in the name of the noble Lord, Lord Winston. I hope that that clarifies that point for the noble Baroness, Lady Wheeler.

The Bill’s definition of innovation allows for situations in which doctors choose to carry out no treatment in the best interests of the patient. The definition of innovation in medical treatment proposed by the noble Lord, Lord Winston, would exclude that. I hope that that point, if no other, will give him pause when he decides what to do with Amendment 6.

There is another basic point to make here. Defining innovation on the face of the Bill would restrict the application of the Bill and could risk uncertainty for doctors as to whether the protection offered by the Bill would extend to the treatment that they are proposing. It is important that the scope of the Bill is clear to the medical profession.

Moving on to Amendment 28, the Government do not believe this to be necessary. The Government are already fully committed to promoting innovation which can save and improve lives. The Committee may be aware that NHS England has a full programme of initiatives to unblock innovation and disseminate the benefits to the NHS and beyond—something that the Government fully support. These include Innovation Connect, a programme to help innovators in the health service and industry to realise their ideas, embed them into clinical practice and exploit new opportunities in international markets, NHS innovation challenge prizes to encourage, recognise and reward front-line innovation and drive the spread and adoption of these innovations across the NHS, and the NICE Implementation Collaborative, which supports work streams by providing essential support to overcome identified barriers to innovation. Those are just some examples.

My noble friend Lord Blencathra asked in particular about off-label treatments. Without repeating the answer that I gave earlier to the noble Baroness, Lady Masham, on a similar issue, the Bill sets out a series of steps which doctors can choose to take when innovating to give them confidence that they have acted responsibly and with the intention of reducing the risk to doctors of successful claims of clinical negligence. With that threat diminished, the intended effect is that doctors will be confident to innovate appropriately and responsibly. That applies in full measure to off-label treatments. I would say as an aside that the cancer drugs fund, which has enabled access to a number of novel medicines, including off-label treatments, has benefited more than 55,000 patients since September 2010. So the decision on whether to prescribe unlicensed or off-label medicines will remain a matter for the doctor or prescriber who has clinical responsibility for the patient’s care, taking into account their individual clinical circumstances.

In response to the noble Baroness, Lady Masham, about funding, I should make the simple point that the Bill does not add any extra funding for drugs. Funding may be a consideration in certain circumstances, but the Bill does not affect the situation one way or the other.

I hope that noble Lords will take into account the Government’s view that innovation is best defined as a departure from the standard range of existing medical treatments, and that on reflection the Committee will not accept Amendments 6 and 28.

Health: Transition to Adult Health Services

Baroness Butler-Sloss Excerpts

Wednesday 11th June 2014 Lords Chamber

[Earl Howe]

I think that I can reassure the noble Lord on this point. NHS England is currently developing service specifications across the range of commissioning models: specialised commissioning, CCG secondary and primary care commissioning, adolescent mental health and special educational needs, and learning disability. Those will translate examples of best practice and published outcomes into specifications for commissioning to hold providers to account for the delivery of robust transition services with measurable quality standards attached to them.

[Baroness Butler-Sloss (CB)]

My Lords, there is a particular problem with young people who have not only physical problems but very considerable mental health problems. Is a priority being given to help that group of children?

[Earl Howe]

The noble and learned Baroness is quite right, and as she well knows, this has been a long-standing issue. Our document, Closing the Gap: Priorities for Essential Change in Mental Health, which we published recently, identifies the transition from child and adolescent mental health services into adult services as a priority for action. We are supporting the work of NHS England to develop the service specification which I have just referred to. CCGs and local authorities will be able to use that specification to build excellent person-centred services that take into account the developmental needs of the young person, as well as the need for age-appropriate services.

Female Genital Mutilation

Baroness Butler-Sloss Excerpts

Thursday 7th November 2013 Lords Chamber

[Lord West of Spithead (Lab)]

My Lords—

[Baroness Butler-Sloss (CB)]

My Lords—

[The Chancellor of the Duchy of Lancaster (Lord Hill of Oareford) (Con)]

My Lords, the noble Lord, Lord West, could not see that a Cross-Bencher behind him wanted to speak.

[Baroness Butler-Sloss]

My Lords, will the Minister ensure that the police and the Crown Prosecution Service put forward far more appropriate prosecutions?

[Earl Howe]

My Lords, the Government are as frustrated as I am sure the noble and learned Baroness is by the lack of prosecutions. We welcome the Crown Prosecution Service action plan, published last year with a view to bringing successful prosecutions. The CPS guidance on FGM prosecutions provides a useful framework for prosecutors to understand how to build stronger cases with the police to bring to court. It explains how they need to be aware of the fact that where there is a victim of FGM, the local authority or social services may well have material or information to support that.

Health and Social Care Bill

Baroness Butler-Sloss Excerpts

Monday 19th March 2012 Lords Chamber

[Noble Lords]

Hear, hear!

[Baroness Butler-Sloss]

My Lords, I have not yet spoken on this Bill. Could I ask the Minister a very practical question? If the amendment of the noble Baroness, Lady Thornton, is passed, what on earth will happen to this Bill? What I understand might happen is that in due course it would be passed by the Commons but without the amendments of this House. The result of that would mean that the enormous amount of work done by everybody in this House to improve this Bill would be totally lost, and the Bill as it left the Commons would be the same Bill that went through it. Is that what we want?

[Earl Howe]

My Lords, the noble Baroness, Lady Thornton, made some very complimentary comments about me at the beginning of her remarks and I thank her for those. Therefore, it is a cause for sadness to me that we have reached this final stage of the Bill in a climate of antagonism rather than of the mutual good will that typically characterises the end of a long parliamentary process in this House. That good will is still present, but it has perhaps been temporarily overshadowed.

I am sorry that the noble Baroness, for whom I have enormous respect, has taken the unusual step of tabling this Motion. It will not surprise her to hear that I disagree utterly with her summary of what this Bill will achieve, but it is not my intention to rehearse the arguments for it all over again. I did that at Second Reading and throughout subsequent stages of the Bill, when we debated at length and in depth the detailed provisions within it.

It is disappointing, too, that this Motion, so negative in its tone and content, is the only amendment which the Official Opposition have seen fit to table on our final day of debate. It stands in marked contrast to the highly constructive approach taken to Third Reading by Peers on all Benches, and indeed to the approach of thoughtful testing and challenge to the Government which the Labour Front Bench has adopted hitherto. I believe that we have used today’s Third Reading to good and positive effect. The noble Baroness, on the other hand, has chosen today to stand aside from that approach.