GP Services in Rural Areas

Baroness Byford Excerpts

Tuesday 2nd July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is very lucky to live in such a beautiful part of the country, but she is right that rurality has a significant impact on health outcomes. It is considered as part of a number of plans. As for recruitment and retention, these have been part of the plans that the NHS has brought in, particularly for GPs. That is why we have had the recruitment and retention plan for hard-to-reach areas for GPs since 2016. We are evaluating that programme and are still considering it.

[Baroness Byford (Con)]

May I press the Minister, following the earlier Question on housing, on the need for her department to talk to the MHCLG, to ensure that when new-build housing developments come in, there is enough tie-in between health provision and housing? My understanding is that unless the number of houses is more than a certain amount, there will not be any new GP practices, thereby putting much more pressure on existing ones.

[Baroness Blackwood of North Oxford]

My noble friend is right; infrastructure must be in place before there is an expansion of development. NHS England is accountable for ensuring that patients have access to a GP practice, although the commissioning of general practices is delegated to local CCGs. It is an important planning consideration, and must be taken into account when new developments occur.

Access to Palliative Care Bill [HL]

Baroness Byford Excerpts

Friday 23rd October 2015 Lords Chamber

[Baroness Byford (Con)]

My Lords, I welcome the opportunity to speak in this Second Reading debate, so ably moved by the noble Baroness, Lady Finlay, which deals with the whole question of palliative care. Looking down the list of noble Lords taking part, I am again reminded of the depth of knowledge in this House on this and so many other subjects. My contribution will reflect on current healthcare provision that I and my family received some two years ago when my husband was taken ill. Where it was due, and in fairness, I give great credit to the service that we received, but I question, as others have and will continue to do, why you get a good experience in one place and a poor one in another one.

The noble Baroness, Lady Finlay, has given us detailed proposals to improve the current position and to stop failures. Clause 1 sets out to ensure that health and social care providers provide appropriate support to people with palliative care needs, including,

“access to pain and symptom control … support to meet their preferences in care”,

and “information regarding their condition”. I would add to that the importance of making sure that those family members involved in caring fully understand and are kept in the loop at all times, as they are the ones coping. It is an overwhelming experience to be told there is nothing more that can be done and that the end of life is drawing near.

We were lucky enough to receive great kindness from the Leicester Royal Infirmary. Doctors and nursing staff were available to give us time to talk through our options, and when the final decision was reached, my husband decided that he would like to return home to die there rather than go into a hospice. The Macmillan nurses put in a practical plan, and it happened very quickly. Two days later, my husband came back home with all the supplies that we needed and the team of carers arranged. I know from that experience how well co-ordinated our support was, but I am also too well aware that not everyone has the same experience.

In Clause 2(2)(h), the noble Baroness, Lady Finlay, wishes to,

“enable healthcare professionals to access essential medication at all times for palliative care patients being cared for in their own homes”.

Again, I cannot state how important this is. No one should be left in dreadful pain when medicines are available to ease their discomfort. The one thing that helped us as a family to see my husband’s fight against bowel cancer was the knowledge that pain could be relieved. Surely, quality of life at the end of life, and dignity in dying, is something to which we all aspire. The Bill calls for advancing education, training and research into palliative care, which is dealt with clearly in Clauses 3(1)(a) to 3(1)(d). My earlier observations reinforce the advantages that having good clinical communications and skills benefits both the patient and those caring for them.

I could not speak yesterday, as I was attending yet another friend’s funeral. I pay tribute to the work done in our care homes and, particularly, in the hospice movement. In Leicestershire we have a long-standing hospice, LOROS, and a newer one, Rainbows, which specialises in helping families with young children. Nor would I want this opportunity to go by without thanking most sincerely the Macmillan and Marie Curie nurses for the wonderful support that we had. I add to that the important link with the district nurses, who have not yet been mentioned, but may well be later. They were available 24 hours a day and always said to me, “If in the night your husband really is in trouble, pick up that phone and ring us”. So we had someone, and I wonder how many others did.

As has been said, about 350,000 deaths are expected each year, of which about 170,000 will require specialist palliative care. Some of those are young at heart, others are young children. All should have respect in the way that we deal with them in future. In yesterday’s debate, the Minister concluded that the Government were building with reference to their wish to give more control over healthcare services. The Bill of the noble Baroness, Lady Finlay, gives practical ways in which improvements could be achieved, and I am very happy to support it and wish her well.

Care Bill [HL]

Baroness Byford Excerpts

Monday 22nd July 2013 Lords Chamber

I would like the Bill to extend the PIDA requirements on employers by introducing a duty of candour for employers in health and social care, in keeping with the Francis report’s recommendations. The provisions should ensure the existence of a clear presumption of disclosure where the behaviour of employees gives rise to concerns. All staff must have a professional duty to whistleblow if they identify practice that they believe puts people they are supporting at risk of harm. Organisations must have clear whistleblowing procedures in place for when practice that puts people at risk of harm has been identified. These should stipulate that if a social worker or another care worker identifies abuse, mistreatment or neglect in any care setting, or has questions about treatment affecting anyone, whether they are supporting them directly or encounter them in the course of their work, they have a duty to draw this to the attention of managers, commissioners and managers of any provider organisation, and follow up to see if their concern has been acted upon. This would amount to a duty of candour.

[Baroness Byford]

My Lords, I have two amendments in this group. While the previous amendments have looked particularly at the risk of abuse to individuals, my amendments are to do with finance. I looked carefully through the Bill but did not see where they would fit and I therefore proposed that they be considered at this stage.

Amendment 92ZFA asks that an,

“investigation may be instigated following a complaint from a person with power of attorney for an adult having needs for care and support”.

My second amendment, Amendment 92ZFB, is an accountancy measure to ask that,

“care services shall have a duty to follow specific accounting guidelines”.

As we have heard, increasing numbers of elderly people require care and support, an increasing proportion of whom rely on someone who has power of attorney to act on their behalf, particularly in financial matters.

I am aware that a range of service providers, from banks to shops, from online businesses to public authorities, have difficulty when faced with one of these attorneys. A solicitor acting for the person in need of care sets up the power of attorney and holds all the certification. The person with the power is normally given a number of certified copies of the warrant to use in fulfilling the role. However, there seems to be conflict in the minds of many service suppliers between the need to comply with requests from the holder of power of attorney and the need to protect their original customer under the rules of the Data Protection Act. There was an example of a major chain which acknowledged a request to stop a credit/debit card and then, three years later, billed the customer for a three-year subscription. The warrant holder could not resolve the position because the enterprise would neither contact the solicitor direct nor accept a certified copy of the warrant. A number of letters and a great many telephone calls were used to remedy the situation. Then there was the example of the high street bank that lost two certified copies of a single warrant—to say nothing of the media company, the card protection company and a different bank, all of which have refused to deal with someone with power of attorney.

People in care suffering, for example, from dementia, rely heavily on those who act for them. Difficulties of the kind just outlined take a lot of time and effort to resolve. There is a high cost, too, which is particularly important when the warrant holder is neither being paid nor charging expenses. I am especially concerned about the plight of the spouses of those in care. They are often elderly, physically infirm and hard up. They are often unaccustomed to opposing the will of large organisations, nor do they necessarily know their way around officialdom. Warrant holders who are unrelated to the person in care have severe problems also, in that they may be ignored simply because they are no relation. Alternatively, how does someone with power of attorney cope with demands for family top-up fees from a care home where the managers will not accept that there is no family? Warrant holders have a statutory responsibility and must be scrupulous in their dealings. Businesses will not understand situations that create unnecessary difficulty.

My Amendment 92ZFB refers to care homes and fees. The Bill already concerns itself with the funding of care homes, and the Care Quality Commission has recently been given explicit responsibility to ensure that such homes have adequate funding to carry out their functions. My concern is with residents’ funding, to which I can find no reference in the Bill. Indeed, if I have missed it, the Minister will no doubt point me to it.

I have received complaints about how care home residents and those with power of attorney on behalf of such residents, are billed, bamboozled and in some cases bullied. Examples that I have been told about include over-invoicing which, when challenged, has resulted not in an apology and a credit note but a computer printout, without headings to any of the columns, and no possibility of agreement on the overdue balance. Requests for credit notes are ignored, and the resident or the person acting on their behalf cannot therefore maintain normal books. Mistakes by the local authority are visited upon residents in the form of extra charges that are not cancelled when the original error is corrected. The Care Quality Commission refuses to get involved, I understand, on the grounds that it has no duty to examine residents’ funding. The local authority had come upon similar problems before, but had no power to intervene. Board members of the newly constituted clinical commissioning group advised that the only thing to do was query the figures, ensure the local authority payments were up to date, and never give in.

It appears that the financial side of the care home business can be totally removed, physically and organisationally, from the home itself. No one has a duty to examine, audit or report on it. I feel that the Bill should carry that responsibility, and have a simple outline of the procedures to be followed to ensure accurate billing for services rendered, so that residents and their carers may be certain of their financial situation. At the moment it is unclear. I hope that the Minister’s response will clarify these situations, because in some cases those holding power of attorney are really at a loss to know how to resolve the situation.

[Lord Touhig]

My Lords, I speak in support of Amendment 92A, which stands in my name and that of the noble Baroness, Lady Greengross. The amendment concerns corporate responsibility for neglect. In speaking to this amendment, I acknowledge that the Bill introduces England’s first primary legislation to protect adults at risk of abuse and neglect. Similar legislation is in place in Scotland, and is in the process of being enacted in Wales.

The Bill as it stands places a duty on local authorities to investigate abuse or neglect, and introduces statutory requirements around safeguarding adults boards and safeguarding adults reviews. Substantive regulations on assessment and eligibility, published as secondary legislation, should also make provision to consider whether the person is at risk of abuse or neglect, and if this risk is sufficient to provide support.

I welcome the Government’s decision and the publication of a consultation on how to ensure that the directors of organisations are personally held to account. This may provide some redress, which our amendment seeks to secure. Given that this consultation closes in September, when the Minister responds to the amendment perhaps she could give some indication of when, in the latter stages of the Bill, the Government might decide whether they will enact some of these changes. The Government’s own consultation document acknowledges that there is a loophole in the system, allowing providers responsible for appalling failures in care to escape prosecution. This is what our amendment seeks to address. I am grateful to the noble Earl, Lord Howe, for writing to me about the Government’s consultation.

In south Wales, Operation Jasmine uncovered appalling treatment of older people in residential care. The police investigation into neglect of old people in care homes lasted more than seven years, and cost more than £11 million. Over 100 potential elderly victims were indentified; 75 police officers were involved in the inquiry, and more than 4,000 statements were taken. Yet the nursing home owner, a local GP, suffered brain damage during a violent burglary at his home in September 2012, and in March the court case against him, his company’s chief executive and their company collapsed. I understand that the company is still operating some care homes.

When I served in the other place, I saw for myself some terrible photographs of elderly people who had been neglected, and who had what I can only describe as holes in their bodies where bedsores had been left untreated. A number of people died, and the Commissioner for Older People in Wales, Sarah Rochira, said:

“I don't really know any other way of describing it other than a catalogue of failure”.

Detectives were unable to bring prosecutions for serious offences such as manslaughter and wilful neglect. The then-deputy chief constable of Gwent, Jeff Farrar, said:

“Where you are seeing people who have got pressure sores which are corroded down to the bone; people vomiting faeces they are so constipated; or so dehydrated, it is a significant cause of their death”.

Those responsible for this terrible degree of neglect should be brought to justice. At the moment they cannot be, and that is why we need an amendment of this sort. The Care Quality Commission’s report on Winterbourne View care home and the Equality and Human Rights Commission’s inquiry into home care also uncovered serious, systematic threats to the basic human rights of those receiving care services.

Amendment 92A seeks to strengthen protection by ensuring that registered providers of health and social care have duties, similar to those placed on local authorities, to report suspected abuse and to inform the safeguarding adults boards. Then, crucially, if abuse is found to have an element of corporate responsibility, where the systems or approaches taken by the care provider were a contributory factor in the abuse or neglect, a new offence is created, allowing prosecution of a registered care provider. This does not undermine the individual responsibility of staff members or the registered care provider, but would add corporate responsibility where a culture of neglect or abuse has been allowed to flourish.

Health: Active Lifestyles

Baroness Byford Excerpts

Monday 17th December 2012 Lords Chamber

[Baroness Byford]

My Lords, I am delighted to be able to speak in this debate, and I thank my noble friend Lady Heyhoe Flint for bringing the subject to our attention. I have to start by making an admission. Last night, I was very inactive. I was glued to the television, first, because of “Strictly Come Dancing” and, secondly, because of “BBC Sports Personality of the Year”. The interesting thing was that one of the people lost from “Strictly Come Dancing” was a jolly competitor. I think that she proved to everybody that you do not need to be slim and slight to be a good dancer and to have fun. Knowing that we were going to have this debate today, I said to myself what a good message it sent out. Sadly, that person did not make the final but it really was quite amazing.

The second thing that really struck home last night was the recognition of the wonderful contributions made at the Olympics this summer not only by the Olympians but particularly by the Paralympians, too. They said to the world, “Look, we might have disadvantages but we are here, we can do the best we can, and achieve”. I thought that some of the presentations and reflections on this summer were very moving. The winner was Bradley Wiggins, followed by Jessica Ennis and Andy Murray. They come from three very different sports and three different regimes.

I want to pick up on two things from the awards. The first is Martine Wright, who won the Helen Rollason Award for achieving the gold medal in the sitting volleyball competition, having lost her legs tragically in the bombing of 7/7. The second comes much closer to home: the award for unsung heroes. The winners came from Desford, not exactly my home village but it is close to me in Leicestershire. Sue and Jim Houghton were given the award for their commitment to community activity. They formed a sports centre aimed at young people, but which takes on both the young and the young at heart. I thought that this was very moving.

I move on to a recent report by the House of Lords Science and Technology Select Committee. The report, published earlier this year, questioned how robust the research and evidence base is for improving the performance of elite and non-elite athletes, and how this knowledge can be translated into treatments and preventive interventions to improve the nation’s health. The Government responded in many ways; I have picked up on two things in particular on which the Minister might like to comment. First, the Government have said that they wish to target investment to support the translation of biomedical research. Secondly, they have provided some £30 million of funding to develop the country’s first National Centre of Excellence for Sport and Exercise Medicine. These are indeed welcome commitments. However, I wish in my time to enlarge upon two other areas identified by the committee. The first was to increase grass-roots participation in sport, particularly by young people; the second was to increase community engagement to bring people together over a national event.

I am also grateful to the BMA and Bupa for the briefs which they sent, I suspect, to everybody taking part in the debate. They picked up particularly on walking, which was briefly mentioned earlier. It is a key thing that any of us can do very easily. It costs virtually no money—sole leather, maybe—and it gets people out and about in the air, giving them the chance to keep physically fit. When driving the other day, I came up behind a car in the window of which was written, “Dogs are for life, not just for Christmas”. I thought below that should have been added, “Walking is for life, not just for now”. Clearly, walking is one of the very good ways in which one can keep fit. The BMA’s study paper this year considered healthy transport, healthy living and active travel. It particularly looked at walking and cycling. Several local authorities have become aware of the need to create more cycle routes for people, and we have done so in Leicestershire too.

In 2012, Bupa produced a report titled Get Walking and Keep Walking which stated that,

“just 15 minutes a day of brisk walking can have significant health benefits, adding up to three years to life expectancy”.

Walking need not be boring; it can be fun. I suspect many of us in this Chamber have taken part in walks or runs—I do not run these days, but I do walk—to raise money for charity. The amount of money raised for charities reflects on people’s ability to get fit—one need only think of the London marathon. When I came across a walking group just this weekend when I was out walking the dog, I stopped and said hello to one man I had not met before. He said that he had just moved to the village from another area, and that it was a wonderful way to get to know people. As I found to my great interest, it is a double bonus.

I turn to the particular area of expertise of the Minister to take a few minutes to talk about the NHS. In many ways it gets a very rough passage, but many of us—including me and, recently, my husband—have reason to be very grateful for the wonderful service it provides. I will concentrate on one aspect. After a major operation, one comes out with uncertainty and a lack of confidence about what one should do and how one should do it. I give great credit to the recent work of the physiotherapists who were an enormous help to my husband after his stay in hospital. When one is very weak, the first thing they want to do is to get one up. That is quite right; up one should be. Then one starts to move around, leaning on a walking frame. For somebody who is very tall, this is not easy because their core balance is going in the wrong direction. Very quickly, they prescribed for my husband some elbow crutches. They made a huge difference. Instead of leaning forward with his weight going in the wrong direction, he was balanced on his core and able to recover much more quickly. He went from zimmer frame to elbow crutches. When he came home he was more confident; he went out and about, starting with short walks and then taking longer ones.

Often when one mentions exercise, people think of pounding away in a gym. For a lot of people, exercise is just that. They enjoy going to the gym, and I go occasionally. However, there are much simpler ways of keeping fit. When a cat or dog sits up after relaxing, it stretches. I was sorry not to be able to speak in the debate on Friday. Often as one gets older, one loses the ability to move around physically in the same way as one did when one was young. However, moving neck muscles and using very basic movements can be a help to people who are not able to get out and walk as much as they were able to in the past.

Unfortunately, we are becoming a country of very sedentary people. The young sit fascinated and do not get out and about. I totally agree with other noble Lords that the more we can do in our schools—and by linking schools to clubs, because that is where it all happens—the better. My introduction to cricket was when I attended a school in Scotland where playing cricket was the norm. I was lucky enough to be introduced to it. I never went very far with it and never became very good, but it was interesting to play another sport.

Perhaps I should have declared that for 10 years I taught tennis in schools and clubs. I am not a professional—I was what they called an associate—and I totally agree with my noble friend Lord Addington that one of the joys of sport is when a child connects. Somebody asked me if my best result was when somebody reached something. I said no, it was when they could physically connect with a ball and track its bounce and rise. There are many ways of engaging young people in activity but the most important thing for the young—or young at heart—is that it must be fun and that people must be able to enjoy it. I am very grateful to my noble friend for securing this debate and look forward to what the Minister has to say.

Abattoirs

Baroness Byford Excerpts

Monday 11th July 2011 Lords Chamber

Asked by

[Baroness Byford]

To ask Her Majesty’s Government what assessment they have made of the financial impact on small and medium-sized abattoirs of the proposed introduction of a full-cost recovery system.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, I am advised by the Food Standards Agency, which is responsible for meat hygiene controls, that following public consultation it has significantly amended its proposals for full-cost recovery. Implementation will be delayed until April 2012, staged over three years. Support will be provided for abattoirs slaughtering up to 5,000 cattle or equivalent per year. A financial impact assessment of the amended proposals is in preparation and will be published this summer.

[Baroness Byford]

My Lords, I thank the Minister for that response. Will the agency move much more towards a risk-based, proportionate regime than it has in the past? Secondly, will it consider outside—in other words, private—operators taking over the task that is currently done by state employees?

[Earl Howe]

My Lords, it is certainly the ambition of the agency to move to a more risk-based approach but, as my noble friend will know, that has considerable implications in terms of EU law and it will take some time for such an approach to be worked through. On her second question, I am aware that the agency will discuss tomorrow the findings of the Macdonald taskforce, so it is probably premature for me to say more on that point.