Public Procurement: Data Offshoring

Baroness Chisholm of Owlpen Excerpts

Tuesday 8th October 2024 Lords Chamber

[Baroness Twycross (Lab)]

The noble Baroness makes a really important point. I will speak to my noble friend Lady Merron, to make sure it is taken forward through DHSC. The Government are quite clear that government data is owned by the Government and any commercialisation should be agreed with His Majesty’s Government.

[Baroness Chisholm of Owlpen (Non-Afl)]

My Lords, obviously cybersecurity is vital for the NHS Digital app, as it is for anything. However, we know that the app is way behind, say, banking apps, which in this country are very good. Can the Minister make sure that NHS digital services are not held up by all the other stuff that is going on, because NHS apps are a vital part of NHS reform?

[Baroness Twycross (Lab)]

I think the security piece and the development piece can and should go in tandem, otherwise neither is sustainable. Three in every four people in England have already downloaded the app. This Government want to establish adoption through improved patient experience and system benefits, and to expand the services offer. This is part of making sure that more people can access the services they require.

Revised Draft Airports National Policy Statement

Baroness Chisholm of Owlpen Excerpts

Thursday 15th March 2018 Lords Chamber

Moved by

[Baroness Chisholm of Owlpen]

That this House takes note of the Revised Draft Airports National Policy Statement: new runway capacity and infrastructure at airports in the South East of England.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I start by sharing the apologies of my noble friend Lady Sugg, who is under a three-line Whip today by her mother. She is at the Palace receiving an honour, so obviously there was no way that my noble friend was going to be able to miss that today.

My noble friend and I welcome this debate on the Government’s revised draft airports National Policy Statement, or NPS. It might be helpful if I put today’s debate into context in terms of the process the Government have followed to date. The Airports Commission reported in July 2015 and, following detailed consideration of its findings and further work, the Government announced their preference for the Heathrow north-west runway scheme in October 2016. Since then, we have published a draft airports NPS and conducted two periods of public consultation, receiving over 80,000 responses in total. We are now carefully considering those responses. It is worth emphasising that we are still in a period of consideration following public consultation and no final decisions on the airports NPS have been taken. Should the Government decide to proceed, any proposed airports NPS would be laid before Parliament and an opportunity provided for debate in both Houses.

What is the purpose of the NPS? The concept of an NPS was introduced by the Planning Act 2008, which was enacted following the Heathrow terminal 5 inquiry, which lasted nearly four years. The draft airports NPS has a specific purpose. If adopted, it would provide planning guidance for the promoter of the additional runway. It sets out at a strategic level the need for development and establishes clear, high-level policies by which an application for development consent for the additional runway would be decided.

It might be helpful if I say what the draft NPS does not do. It does not give permission for a new runway. Development consent would be sought following the preparation of a more detailed design by the scheme promoter and would require public examination of the proposals in the light of the policies set out in the NPS. It is then the role of the Secretary of State, taking into account the advice of the planning inspectorate, to determine whether to grant development consent.

Clearly, there is a need for expansion. The UK currently has the third-largest aviation sector in the world—second only to the United States and China—contributing more than £22 billion to UK GDP. In 2016, UK airports handled 268 million passengers—up 7% on 2015—and 2.4 million tonnes of freight. Our airports continue to grow their business, with more passengers passing through their doors each year. Heathrow is the busiest two-runway airport in the world. Evidence shows that unless we take action, all five of London’s main airports will be completely full by the mid-2030s.

Let me set out why a new north-west runway at Heathrow is the Government’s preference for additional capacity in the south-east. Our analysis shows that a new north-west runway would deliver benefits of up to £74 billion to passengers and the wider economy over 60 years. Of the shortlisted schemes assessed by the Airports Commission, the north-west runway scheme at Heathrow delivers the greatest benefits soonest. An expanded Heathrow would offer the greatest choice and frequency of vital long-haul routes. It would secure the UK’s status as a global aviation hub, enhancing our ability to compete with other European and Middle Eastern airports. It would provide new domestic connections —moving from eight to 14 domestic routes—and greater frequency, enabling the nations and regions to benefit from onward connections to long-haul destinations.

I mentioned freight earlier. Heathrow handles more freight by value than all other UK airports combined. Heathrow has superior connections to the rest of the UK through road, rail and domestic flights. Expansion is also expected to generate up to 114,000 additional jobs in the local area by 2030, and Heathrow Airport has pledged 5,000 additional apprenticeships.

I want to emphasise that the draft NPS makes it clear that expansion at Heathrow would be allowed to proceed only if accompanied by a world-class package of compensation along with mitigation measures to reduce impacts. Without going through all the measures, let me give noble Lords a flavour of the proposals. On community compensation, the proposed package includes above-statutory levels of compensation for property owners. Heathrow Airport Limited has pledged that home owners in compulsory and voluntary purchase zones would receive 125% of unblighted market value, plus stamp duty and costs. The airport has also pledged in excess of £700 million to noise-insulate residential properties, fully insulating homes most affected and providing a contribution of £3,000 towards noise insulation for qualifying homes further from the airport. They have also promised to set aside an additional £40 million to noise-insulate schools and community buildings. The draft NPS also requires the creation of a community compensation fund worth up to £50 million per year to benefit local communities.

Moving on to environmental mitigation, as we all know, noise is a major concern for communities around Heathrow. Under the Government’s draft proposals, the scheme promoter would be expected to deliver a number of mitigating measures to reduce the impact of aircraft noise. In addition to the comprehensive noise insulation package, these are expected to include a new six and a half-hour ban on scheduled night flights. This ban would help address noise from early morning arrivals at the airport—one of the most frequently expressed concerns of local communities. Expansion would also result in more reliable periods of respite. The draft NPS makes it clear that the Government expect noise mitigation measures to limit, and where possible reduce, the impact of aircraft noise compared to the 2013 baseline assessed by the Airports Commission.

The Government have consistently made it clear that expansion at Heathrow would be allowed to go ahead only if it could be delivered in compliance with legal obligations on air quality. It is the Government’s view, based on expert analysis, that the Heathrow north-west runway scheme can be delivered in compliance with those legal obligations, with a suitable package of policy and mitigation measures. Importantly, that analysis does not take account of any of the additional measures the scheme promoter would take to address emissions. For example, the NPS proposes a public transport mode share for passengers of at least 50% by 2030, and Heathrow plans to consider a low-emission zone.

Finally, the Government have also considered the impact of the updated aviation demand forecasts on carbon emissions. Our analysis provides further support for the Airports Commission’s assessment that any of the three schemes, including the Heathrow north-west runway, could be delivered within the UK’s obligations under the Climate Change Act.

I appreciate that there are many views on airport expansion and my noble friend and I look forward to hearing them in the debate. I beg to move.

Intergenerational Fairness in Government Policy

Baroness Chisholm of Owlpen Excerpts

Thursday 26th October 2017 Lords Chamber

[Lord Wallace of Saltaire (LD)]

My Lords, this has been an excellent debate, and the speech we have just heard is a very good example of the high quality and of different experiences being brought to bear in this House. It was very good to hear the noble Lord, Lord Willetts—The Pinch was the starting point for many of my thoughts on this subject, probably some years ago now. I too was surprised by the absence of Labour speakers. I am told that Labour is a party that cares a great deal about equality, and this is one of the underlying issues to do with equality and inequality in this country. I was glad that the noble Lord, Lord Lamont, sat and listened at least to the opening speeches in view of his article in last week’s Daily Mail, in which he said that,

“the very idea of intergenerational inequality is bunk”;

indeed,

“it is one of the silliest political concepts ever conceived, and yet it has been taken up with manic enthusiasm by ... the Resolution Foundation”.

I worry about the Daily Mail, which has four pages today attacking universities and intellectuals. It is a newspaper which attacks immigrants all the time, attacked judges the other month, attacked a major international organisation, the OECD, last week and now attacks intellectuals this week. I wonder who it will go on to attack next and begin to wonder when the Conservative Government will have the courage to stand up to this hysterically reactionary newspaper and defend the concept of open debate and free speech.

The Social Mobility Commission talks about three overlapping problems of inequality in the United Kingdom: that between rich and poor, that between London and the poorest regions, and that between the old and the young. I was struck last week, on seeing a graph in the Economist on OECD figures for the gaps between the richest and the poorest regions in major countries, by how Britain stands out for the gap between London and the south-east and places such as Yorkshire and Lancashire. That is something we should also worry about, and it is why Members of this House such as me begin to go on more and more about the problems of the north and the imbalance in public spending between London and the south-east and the north.

Returning to the question of intergenerational inequality, I am glad that a number of noble Lords emphasised the extent to which growing longevity alters the nature of the equation. This House is, after all, a perfect example of that. When pensions were introduced in 1911, the average life expectancy was 57, and the pensionable age was 60. A welfare state of that sort was therefore easily affordable. When the National Health Service was introduced after the Second World War, life expectancy was a little higher—although not by too much—and there was not much you could do about people with a range of conditions for which many of us in this House have already been treated by the NHS. The situation has been changing and, as we have a higher and higher number of people in their 60s, 70s, 80s, 90s and over the age of 100, the question of intergenerational inequality is a major one. My son is now a systems biologist working on various micro-organisms which cause serious diseases, and the speed at which work in that area is developing has huge implications for longevity and medical practice and for what can be done for the elderly in the last two or three years of their lives.

We need a sober, cross-party debate. All parties in government have struggled with this in the last 20 or 30 years. I suggest there might be a very strong case for a Lords sessional committee, for example, which would discuss this question in the broadest terms, because that is one of the ways this House can throw light on difficult issues that each party finds it hard to grasp. We need to ask how we promote longer-term perspectives in government and how we deal with issues where we have to address what we are leaving to our children and grandchildren.

The Chancellor of the Exchequer talks a great deal about the need to get our public debt down so that we do not leave the debt to our children, but he does not talk enough about what sort of investments we should make so that our children will have a better life, better infrastructure, better industries and so on to inherit. I find the selling off of capital assets in the public sector to fund current spending, to hold taxes down, amazing—it was one of the things in the coalition that I most disapproved of and tried to argue against—but it has, after all, been going on for the last 30 or 40 years. There is an underlying question here about whether taxes are too low in this country for the challenges we face, for old and young, in the next 15 to 20 years. There are the questions of taxing housing assets, which we do much less than most comparable countries; of the extension of the national insurance age, which the noble Lord, Lord Balfe, mentioned; and of the costs of social care, which the Conservatives themselves raised before the election and then backed out of during it. The cost of paying for the NHS, including end-of-life care, is huge. I think it is correct to say that half of what is spent on each person by the health service is spent in the last two years of any person’s life.

The Social Mobility Commission in particular stresses the importance of early years and education up to the age of 18. My perspective on this comes from having done most of my politics in northern towns and cities. I look at younger people there without much aspiration or much help, in relatively poor schools where the savage cuts in local authority spending have meant children’s social services are no longer provided, most schools do not have nurses, obesity is a problem because of the quality of the food they eat, and they do not understand how to move from school into work and have very little idea of what sort of skills they need for the sort of work they will face. Local further education colleges have had their budgets cut, so the transition to work and training for that half or more of our 18 year-olds who do not go to university is poorly provided for. I find deep cynicism in West Yorkshire about the new apprenticeship scheme and whether it really will focus on providing skills for young people or be used to provide transitional skills for those already in work.

These people—the left-behind as the noble Lord, Lord Bird, said—are also British citizens and we will leave to our children a much more deeply divided and much less peaceful society unless we address some of their problems. This is an intergenerational issue but also a deeply important social issue. We need better apprenticeships and more effort put into local economic and industrial regeneration. The point that the noble Lord, Lord Bird, made about banks that do not spend enough time thinking about investing in local regeneration is strongly felt there. Housing—both housing to buy and a revival of social housing—is crucial, and the prospect that the impact of technological change will make their situation worse, with insecure, unskilled work and zero-hours contracts, as the noble Baroness, Lady Jenkin, said, is also a serious problem. We have to debate this issue.

One of the reasons I have been converted to the idea that we should introduce votes at 16 is that, as the proportion of our voting population who are retired rises, so it would help to redress the balance if we also increased the number of young people.

The welfare state was introduced before the First World War partly because, as government began to recruit the working classes into the Armed Forces for national security purposes, it discovered that many in the working class were underfed, unfit and uneducated, and that they therefore needed to spend state money on people we would treat as our citizens. The welfare state now benefits increasingly the middle-class retired, who live 15 years longer than the working-class retired, who benefit a great deal from the National Health Service; and the poor—

[Baroness Chisholm of Owlpen (Con)]

Time.

[Lord Wallace of Saltaire]

I apologise. This is not a sustainable basis for a peaceful and united national community. It is an issue we must address.

Housing: Availability and Affordability

Baroness Chisholm of Owlpen Excerpts

Thursday 12th October 2017 Lords Chamber

[Lord Stunell (LD)]

My Lords, I welcome this debate and thank the noble Lord, Lord Smith, for introducing it. There have been some very good contributions, not least from the noble Baroness, Lady Young, and my noble friend Lord Greaves. I am strongly tempted to follow some of the tracks they set out, but I want to pick out one or two specific points and try to take a more strategic look at some of the questions that we are facing.

First, I want to give credit to the Government. I am sure that they actually believe that we need 1 million homes; I am sure that they want 300,000 homes a year, as their manifesto stated—I have heard spokesmen over the years as diverse as Michael Gove, Grant Shapps, Gavin Barwell and of course the Minister say so repeatedly—but the fact is that it has not happened. I do not think that the Government do not get the problem that we need more homes: rather, they have not spotted the problem with the solutions that they are offering.

The most important problem, which never seems to get a proper airing, is that there is an absolute ceiling on the number of private homes which will be built by developers without subsidy. It has never exceeded 180,000 homes a year since 1945 and it has usually been significantly lower than that: you cannot get builders to build homes that they do not believe they can sell and they will not do it unless you pay them to do so. That has very little to do with planning. There are 600,000 or more planning permissions lying waiting to be built. It is much more to do with economics.

I remember, as a very junior Minister in the Department for Communities and Local Government, how much joy there was when planning permission was given for the Ebbsfleet development in Kent: 20,000 homes. Out went the press releases and the spads went wild in the media—“Another 20,000 homes for our glorious Government”. I was at the back saying, “Hang on a minute—how soon are we due to get these 20,000 homes in Ebbsfleet?” I do not know whether the Minister has the current number; I think we may have got up to 1,000 having been built so far: perhaps he can confirm that. The reason the other 19,000 have not been built despite the planning permission is that if they had been built, 19,000 empty homes would be sitting in Ebbsfleet without people buying them. We need to reflect on the fact that planning is not the bottleneck. Incidentally, I support my noble friend Lord Greaves in saying that if instead of 20,000 homes at Ebbsfleet there had been 200 sites with 100 homes on them we would have had far more homes built by now because we would have had small numbers on 200 sites rather than small numbers on one.

My second point is that affordability is very double-edged. Who actually wants cheaper homes? Do existing owners want cheaper homes? Do builders want cheaper homes? Do developers want cheaper homes? Will any party have a policy objective or a manifesto commitment to halve the value of your home? I do not think so. So the private sector will deliver what the private sector will deliver—and after that, someone else has to pay. If this Government or any Government want more houses, more homes, they have to pay.

The policy issue therefore is surely, what is the cheapest way of buying those extra homes? The Government have tried Help to Buy, which is a very good way of inflating house prices. It is, of course, a demand and not a supply-side issue and it was described quite correctly at the Tory conference as “economically illiterate” by Steve Norris. Help to Buy is not the way to go. Affordable rents have been explored—but, of course, as affordable rents become higher and higher, so the local housing allowance cost balloons as well. We now have a £30 billion LHA budget. The least central government cost looks therefore to be the lowest rent that can be managed—which would lead, of course, to a lower local housing allowance payment.

The Government followed that by putting a cap on housing association rents, which means they can no longer invest in building homes through that route. So some of these things have unintended consequences which totally defeat the purpose of the game and you come to the view very quickly that the way to go is to get local authorities to invest in council housing in the traditional way. It is not ideological; it is value for money. The Tory brand of competence and the efficient management of money may have taken a few knocks recently, but surely this point cannot have escaped them.

I make a further point about this. We talk about the housing pipeline; it is not a pipeline, it is a hosepipe. At the moment we have a model where the Government and successive Housing Ministers stand at the kitchen door like a five year-old, manipulating the tap to the hosepipe, and the construction industry stands at the far end—the business end—of the hosepipe, sometimes trying to direct an empty hose on wilting seedlings and sometimes looking down the pipe to see what is happening and getting a splash of water in its face. The fact is that we need steady, consistent investment in public sector housing in order to reach the targets we need.

Finally, I raise a different and more immediate point. Whether the target is 200,000, 250,000 or any number we care to choose, who exactly is going to build these houses? The biggest demand for homes, the most acute housing pressure, is in London and the south-east. Barratt gave evidence to the all-party group last Session that 54% of its workers in London working on its housing programme were from the EU 27. The RIBA reports that 25% of registered architects in London are from the EU 27. Estimates vary from trade to trade and function to function, but at least 30% of the construction force in London is from the EU 27—so what exactly is going to happen? Delivery of housing and of every other kind of infrastructure depends on that labour force, and I urgently say to the Government that they must give an assurance to those EU 27 workers, and to their successors, that they will be there to build the housing we need. Talk of targets and objectives—

[Baroness Chisholm of Owlpen (Con)]

My Lords, the noble Lord’s time is up, I am afraid.

Electoral Fraud

Baroness Chisholm of Owlpen Excerpts

Wednesday 29th March 2017 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

My Lords, when I was standing where my noble friend is now standing—he is doing such a fantastic job—I remember talking about pilot schemes that we planned, which I feel would help us decide the way to go. Can he reassure me that they will still take place?

[Lord Young of Cookham]

My noble friend is much missed at the Dispatch Box when questions are asked about electoral matters. We plan to go ahead in 2018 with a number of pilots to test voter identification. This is a recommendation made several times by the Electoral Commission: that when you vote, there should be some evidence that you are you say you are. We plan to pilot that next year and hope that some of the local authorities which have been identified as being at risk will apply to be part of that pilot.

Health and Social Care

Baroness Chisholm of Owlpen Excerpts

Thursday 15th December 2016 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

My Lords, I thank the noble Lord, Lord Harris, for securing a debate on this important issue and for his kind words, and those of other noble Lords, towards my noble friend Lord Prior of Brampton. I know that they will be much appreciated. I also wish that my noble friend was here but I will try to answer the questions raised and, if I fail to do so now, I will make sure that I do so in writing. I shall also try to put the department’s view.

Capturing, listening to and acting upon the views, preferences and experiences of individuals, including those mentioned by the noble Earl, Lord Listowel, and the noble Baroness, Lady Watkins, such as young people in care, those with mental health issues and all types of service users, and of communities, is crucial if we are to deliver the first-class services that people not only expect but deserve. Healthwatch England has two principal roles: first, to gather intelligence locally, which it can then feed back into the CQC and its inspections; secondly, to be the strong voice of users of care services at a national level. There is a powerful rationale for its close working relationship with the CQC. The CQC needs to hear the patient voice in the exercise of its responsibilities, while service users benefit significantly from Healthwatch being able to trigger action by the CQC where it finds that things are going wrong.

The recent changes to the accountability arrangements mean that Healthwatch England remains a statutory committee to the CQC, with its chair a CQC non-executive director. Under the new arrangements it retains a line of accountability to the Secretary of State, via the CQC chair, because the Healthwatch England chair is a Secretary of State appointment. The national director of Healthwatch England reports to the CQC chief executive on a regular basis. They continue to remain accountable to the Healthwatch England committee for delivering Healthwatch England plans. The CQC will be responsible to Parliament for the effective delivery of its statutory duties and finances, and for the delivery of the statutory functions of Healthwatch England through its framework agreement with the Department of Health. In future, the CQC will be responsible for allocating sufficient funds to Healthwatch England to deliver its role and statutory duties.

Let me stress that Healthwatch England’s important role is not changing; there is no change to the functions set out in legislation. The Healthwatch England committee will continue to set its own priorities and publish its own business plan and annual report. We expect it to continue to act as a strong, independent voice for patients and share its findings with the system. These new arrangements reflect the changed landscape since Healthwatch England was set up. The Government remain committed to strengthening the role of patients and communities, with greater focus on local leadership of the health and care system, and we have given the Care Quality Commission itself a stronger role in hearing patient views.

A big part of Healthwatch England’s role is to work with the Healthwatch network to provide leadership and support, as each local Healthwatch builds its profile and impact on local services. In answer to the question from the noble Lord, Lord Tunnicliffe, about a patchy and fragmented system, it is a priority for Healthwatch England. In fact its number one priority as set out in its business plan for 2016-17 is:

“To provide leadership, support and advice to local Healthwatch to enable them to deliver their statutory activities and be a powerful advocate for services that work for people”.

Healthwatch will continue to develop its own business plan and priorities. It will also continue to produce an annual report, which will be laid before Parliament.

This Government have a collective ambition that the people of this nation should have their voices heard, and have local health and care services designed and delivered around their local needs. Whether that be helping to set up a new local community provider of domiciliary care services in Cornwall or investigating mental health services in Birmingham, proper involvement and representation is indeed required to amplify this citizen power and to influence change. This is where local Healthwatch organisations fulfil a pivotal role. Their aims can be neatly summarised as: giving citizens greater influence over the commissioning and provision of local services; using people’s experience of services to bring about improvements locally and nationally; and providing local people with information about health and social care services, and their choices in respect of those services. I am very pleased to inform the House that these aims are now a reality for many local Healthwatch organisations up and down the country.

None the less, I am aware that there is some concern about the perceived lack of independence of local Healthwatch organisations which are funded by, and accountable to, their local authority. I do not consider that the funding and accountability arrangements for local Healthwatch organisations undermine their effectiveness or independence. We are not aware of any specific accusations that a local Healthwatch has felt unable to raise issues for fear of repercussions. Local Healthwatch organisations set their own priorities, based upon information and intelligence gathered on issues relating to local health and social care services. Their place on the local authority health and well-being boards helps to promote their independent role in representing the views and experiences of local communities.

Local authorities are well practised in commissioning organisations to deliver services that benefit communities and, at the same time, scrutinise the council. Local Healthwatch organisations also have independence in that they will be able to feed information directly to Healthwatch England, ensuring that a local voice has influence at a national level. Healthwatch England is assisting by providing leadership, support and advice to local Healthwatch organisations to enable them to deliver their statutory activities and be a powerful advocate for services that work for people.

However, the fact needs to be acknowledged that local authorities are facing challenging funding decisions. In such times, it is crucial that in fulfilling their statutory duty to commission local Healthwatch, local authorities have the freedom to ensure that their arrangements meet the needs of their local population and represent value for money. Central control of local funding decisions would diminish the voice of local communities and ignore other voluntary or partnership arrangements that a local authority may already be funding for the benefit of its population. But let me be clear on one important point: local authorities are still accountable for the funding that they allocate to local Healthwatch.

This Government are committed to transparency around local Healthwatch funding. Healthwatch England publishes figures showing how much councils are spending so that local communities can hold their councils to account. Your Lordships may have seen Healthwatch England’s report on 2016-17 local authority funding. I will say up front that the data show that some local Healthwatch organisations have large reductions in their funding. It is in the interests of local authorities and other local care system partners to have a well-performing local Healthwatch that will help to drive up the quality of local services. Those local authorities will need to demonstrate how their local Healthwatch organisations can still carry out their duties effectively. None the less, I am pleased that Healthwatch England reports that local authorities are recognising the overall value of local Healthwatch and, when compared with other council-run services, are continuing to invest. This is encouraging.

I now turn to some of the questions that were raised by noble Lords during the debate. The noble Lord, Lord Harris, talked about local Healthwatch not influencing CQC inspections. CQC actively seeks intelligence from patients, the public and staff prior to its inspections, including from local Healthwatch. The noble Lord and the noble Baroness, Lady Warwick, raised a point that I want to emphasise. Local Healthwatch has an independent voice and its statutory powers to relay patient and user voices at national level remain unchanged and unfettered.

The noble Lord, Lord Harris, also said that there is underspending and that not enough is spent on local Healthwatch. Going forward, much more of Healthwatch England’s resources will be spent on supporting local Healthwatch as this strand is being given a stronger priority by Healthwatch England. Changes to the governance and organisation of Healthwatch England reducing the duplication of, for example, corporate functions mean that Healthwatch England will be able to refocus more of its resources on its essential duties, especially on supporting local Healthwatch. It retains independence of voice and will continue to speak truth unto power, including, where necessary, to the CQC itself.

Several noble Lords, including the noble Lord, Lord Harris, spoke about problems with IT. The IT company concerned, Patient Experience Library, provides an existing service which draws together a range of reports and reviews from organisations across the country. Healthwatch England subscribes to the service rather than going to the expense and duplication of setting up a parallel system. Healthwatch England also undertakes analysis of the reports as part of its national role to understand and relay the user voice and concerns to national decision-makers. The service is a subscription service, and local Healthwatch organisations are free to decide how to spend their funds.

My noble friend Lord Lansley mentioned the independence of Healthwatch England within CQC. I agree with him that Healthwatch England is independent and acts as a rigorous scrutineer to use its place within CQC as leverage to support the voice of users. As my noble friend said, Healthwatch England has powers to challenge at national level which were not available to predecessor organisations, which puts it in a unique place to bring the voice of users to national decision-makers.

The noble Baroness, Lady Pitkeathley, made, as always, an extremely good speech on this subject. She comes with so much knowledge. She mentioned Healthwatch England’s subordination to the CQC, as did several other speakers. Local authorities are accountable for the funds they allocate to local Healthwatch organisations to ensure that they meet their statutory functions. Healthwatch England will be closely monitoring the ability of local Healthwatch organisations to deliver their statutory functions while also continuing to engage with local authorities in order to support the sustainability of local Healthwatch organisations.

The noble Baroness, Lady Masham, asked about the profile in local communities, particularly rural communities. Simon Stevens and Jim Mackey wrote a letter on 12 December to STP leaders saying how important local engagement is and that rural areas must be included in this. It is an ongoing problem which we must keep addressing.

The noble Earl, Lord Listowel, mentioned the important problem of continuity of mental health between young and old. I am going to take that back to my noble friend Lord Nash. This is a problem that keeps cropping up, and it is something we must keep bringing up. It is very important. There is no doubt that there is a problem when you leave children’s services and move on to adult life. People are definitely slipping through that net, so I will take that back.

The noble Baroness, Lady Walmsley, mentioned the experts by experience groups. CQC is strongly committed to the involvement of patients and service users in its inspections. The new contracts for experts by experience provide a more flexible and cost-effective method of engaging service users to carry out this important role. CQC is taking action to improve contract delivery, which has indeed been less than what is required in some areas of the country. Meanwhile, CQC has been very clear that there has been no diminution of the involvement of service users in the inspections programme.

The noble Lord, Lord Tunnicliffe, raised several very important questions. One was about providing analysis of information provided by CCGs. There is no analysis, but each CCG has to publish an annual report, and these reports are taken into account as part of the CCG assurance process with support provided to those not performing to a suitable standard. The noble Lord also asked whether there is a breakdown of the best and worst performances of CCGs or areas in this respect. NHS England does not do this. It focuses on supporting, not naming and shaming.

The noble Lord also asked NHS England to address poor performance in involvement. NHS England offers bespoke support according to local need. It is currently refreshing the statutory guidance for CCGs in partnership with local Healthwatch, voluntary organisations, patients and the public. He also asked about removing patient groups from the membership of the patient and public voice assurance group. I understand that this is not to be the case and that the membership of that group has been reviewed to refresh and strengthen it.

I hope I have answered all the questions, but I shall make sure that I go back and read Hansard to see what else the department needs to consider following this very important debate. Effective representation of the public voice is vital if we are to have a health and care system that meets the needs and preferences of individuals and local communities. Healthwatch England and local Healthwatch are powerful champions for this public voice and, as the noble Baroness, Lady Walmsley, said, the patient voice is vital.

Child Sexual Abuse: Football Clubs

Baroness Chisholm of Owlpen Excerpts

Thursday 15th December 2016 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

My Lords, I offer my thanks to the noble Lord, Lord Goddard, who spoke so movingly about how tragic this issue can be, and about the bravery of people who come forward, whose only wish is that this does not happen to anyone else.

This is a very important debate. It is clear from the considered and heartfelt contributions we have heard that this is an issue which strikes right to the heart of our society. It raises many important and, in some cases, uncomfortable questions. It is right that we do not shy away from any of these questions. We must look at what these recent allegations tell us about our national game and learn all that we can to ensure that children playing football and, indeed, all sports today and in the future are as safe as they can possibly be.

The noble Lord, Lord Ouseley, made an interesting point about how—thank goodness—awareness on this issue has changed over the years. I pay tribute to the former footballers who have so bravely come forward to talk publicly about the abuse they have experienced. We have seen the impact this has had, with so many people now coming forward to the police and the NSPCC helpline to talk about their experiences. It is only through people talking about abuse that we can hope to identify perpetrators, bring them to justice and ensure that no one else has to endure the suffering that child sexual abuse can cause. It is only through people talking about abuse that we can ensure victims and survivors are offered the support they may need.

As has been reported, the Football Association has launched an inquiry into its past processes, to be led by Clive Sheldon QC. This review will look at who knew what and when, and what action was, or should have been, taken. The full terms of reference for this review have been published, and the FA has given assurances that the process will be as transparent and open as possible. The child protection in sport unit will also be conducting a review of the FA’s current child protection processes to ensure that these are as robust as possible. We have seen further actions from the FA, such as the excellent video featuring Wayne Rooney and other English captains, encouraging people to speak up if they have any concerns, as the noble Lord, Lord Goddard, pointed out.

As my noble friend Lord Holmes mentioned, it would be naive to think that this is an issue that affects only football. We must be open to the possibility that this is an issue across other sports as well. To that end, the Minister for Sport has written to more than 40 sports to ask them to redouble their efforts relating to child protection. She has asked them to ensure that they have processes in place to manage non-recent allegations, and that their current child protection processes are as robust as possible. The Culture Secretary and the Home Secretary have also chaired a meeting with some of the biggest sports, the police and sports agencies to ensure that current processes are in place and as strong as they possibly can be. This demonstrates the strong cross-government co-operation on these issues. We are working with sports bodies, as a matter of urgency, to identify where systems and processes can be strengthened still further, and how government can support them in doing so. We look forward to receiving the report of the noble Baroness, Lady Grey-Thompson, on the duty of care in sport, which is looking at safeguarding issues.

Noble Lords asked several questions. The noble Lord, Lord Goddard, asked about David White being taken off a BBC programme. This is obviously a decision by BBC Radio Manchester. We applaud Mr White’s bravery in coming forward to talk about the abuse he has suffered. It is thanks to the courage shown by him that so many others have come forward. As noble Lords can imagine, I cannot comment on the details of this case. However, I understand that the BBC is saying that it made the decision on legal advice. That is all I can say at present, but at least the noble Lord has raised the issue.

My noble friend Lady Bertin referred to victims of non-statutory organisations. In January 2016, the Government announced that the £7 million funding for non-statutory organisations supporting victims and survivors of sexual abuse, including child sexual abuse, will continue in 2016-17; £4.7 million has been provided directly to police and crime commissioners to support organisations working with victims and survivors locally; £1.7 million has been allocated as an uplift to female rape support centres; and £0.6 million has been distributed directly by the Home Office to organisations working with victims and survivors of sexual abuse over a large geographic area. We have funded bids across a broad spectrum of activity, including services such as counselling, advocacy, helplines, online support, outreach, raising awareness and training. We recognise that service providers are under considerable pressure, and this funding will ensure that victims will receive the support they need, when they need it.

My noble friends Lord Holmes and Lady Bertin and the noble Lord, Lord Ouseley, all raised the issue of confidence in the FA. I think that I have more or less covered that, but we should allow the FA the opportunity to carry out its review. As I said, it has taken a number of steps to ensure the transparency and independence of the review into past practices, including through the appointment of the independent QC, Clive Sheldon, as mentioned by the noble Lord, Lord Ouseley. It has also published the terms of reference and committed to publishing any reports, where possible.

The noble Baroness, Lady Brinton, brought up the statutory responsibilities of the police and asked about amendments to the Policing and Crime Bill, on which she and I have spent long hours. I will take her comments back to the department and no doubt we will have further conversations on the subject.

I thank the noble Baroness, Lady Grey-Thompson, for the incredible work that she is doing. I know that the Minister for Sport is looking forward to receiving the noble Baroness’s report, which will be considered seriously, and I think will result in a lot of measures that we need to take forward being put in place.

As regards closing loopholes in background checks and reporting, the Government are determined to do all they can to help prevent child sexual abuse and are keen to understand where more can be done, including with background checks. The Department for Education and the Home Office carried out a joint consultation on mandatory reporting. I understand that responses are being considered at the moment, and that a response will be forthcoming shortly.

My noble friend Lady Vere talked about the speed of police investigations, and I understand her point on that. It is important to remember that the police do a fantastic job in challenging circumstances, and I know that they do everything possible to ensure that investigations are carried out as swiftly and efficiently as possible.

The noble Lord, Lord Ouseley, asked about government leadership, and I welcome his comments very much. The Home Secretary and Culture Secretary met sports bodies, including the Football Association, yesterday. The Government entirely support sports in ensuring that they have the robust processes in place to prevent child sexual abuse.

My noble friend Lord Holmes mentioned football governance. My honourable friend the Minister for Sport has had several discussions with the FA about governance, including on Monday, where she was clear that the mechanism is through compliance with the new code of governance for sport, which was published in October.

The noble Baroness, Lady Walmsley, talked about whether the Government’s response will be published. As we know, the Government launched a consultation in July on possible new measures relating to reporting and acting on child abuse and neglect, including the introduction of a new mandatory reporting duty or a new duty to act. It is important to get this right, which is why we have sought views from practitioners and professionals as well as the wider public. The consultation closed on 13 October. We are carefully considering responses and will update Parliament on the Government’s conclusions in due course. I will of course pass on to the office that the noble Baroness would like a meeting. I am sure that it can be arranged, although it will be with somebody who is far more able to answer her questions than I am.

The noble Lord, Lord Stevenson, brought up several points, which I will probably have to write to him about, as he knows. We now have a constant correspondence back and forth. We may find that quite a lot of his questions will be answered when the review led by the noble Baroness, Lady Grey-Thompson, appears shortly.

I end by saying that the protection of our children and young people is of paramount importance, and the Government will give whatever support they can to ensure people can take part in sport safely. This is ridiculous—this is probably my last debate in this House before I go to the Back Benches, and now I am getting all emotional, which is stupid. I am sorry. I will pull myself together immediately. The vast majority of people take part in sport with no experience of abuse, and likewise, most people who work in or volunteer in sport do so with people’s best interests at heart. But no abuse in sport can be tolerated, and we must do all we can to ensure that sport in this country remains something of which we can be proud.

Surrogacy

Baroness Chisholm of Owlpen Excerpts

Wednesday 14th December 2016 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

My Lords, I thank the noble Baroness for raising this important subject for debate. I also thank all noble Lords for their contributions on this highly sensitive, contentious and complex issue.

There is no doubt that surrogacy has an important role to play in our society, helping to create much-wanted families where that might otherwise not be possible. As the noble Lord, Lord Berkeley, mentioned, it enables relatives and friends to provide a truly altruistic gift to women who are not able to have a child themselves, and helps same-sex couples to have their own genetically-related children—and, of course, the UK Government recognise the value of this.

The legislation ensures that the woman who gives birth—the surrogate—is regarded as the child’s mother until legal parenthood is transferred, and that surrogacy arrangements are not legally enforceable. This is to avoid the situation of a newly-born child being taken away from its birth mother against her wishes.

Legislation sets out the criteria for a parental order to be awarded to transfer legal parenthood from the surrogate to the intended parents. These include: the requirement that genetic material of at least one of the intended parents is used to create the child; that the surrogate should be paid only for reasonable expenses; and that there is a “cooling off” period of six weeks after the birth before an application for a parental order can be made. It also provides for a six-month window after the birth for applications to be made.

These are some of the key provisions and principles that are currently in effect. However, as the noble Baroness, Lady Barker, mentioned, we all recognise that there are well-founded concerns about the struggle that surrogacy policy and legislation are facing to keep pace with 21st-century attitudes and lifestyles. This legislation is based largely on thinking and debate from the 1980s. We recognise that family structures are now much more diverse than when the policy and legislation were originally developed. The ability of intending parents to go outside the UK for surrogacy and return with a child is a particularly challenging situation.

The courts have increasingly had to address these issues when dealing with surrogacy cases and, as the noble Baroness, Lady Barker, mentioned, have expressed concerns about the legislation when doing so. Most recently, the High Court delivered a judgment in May that the legislative provision which allows couples, but not single people, to obtain parental orders is incompatible with human rights—a judgment which the Government have accepted.

Noble Lords will be aware of Surrogacy UK’s 2015 report, Myth Busting and Reform. This report reflects the views of some people who have undertaken surrogacy arrangements, either as intended parents, surrogates or supporting family members. The Government have welcomed the report’s continuing commitment to the altruistic principles of surrogacy and the important message about applying for parental orders to secure legal parenthood. It is also helpful that the report provides reassurance that the tendency towards seeking international surrogacy arrangements, although undoubtedly a concern and a challenge, is not as widespread as some have sought to portray. The Government have taken note of the changes to surrogacy legislation and policy that the report recommends.

It is worth noting that other parliamentary colleagues have exchanged correspondence with the Children and Family Court Advisory and Support Service— Cafcass—about the Surrogacy UK report. Cafcass has made a point of saying that it disagrees with the report recommendation for the introduction of pre-birth contracts to transfer legal parenthood from the surrogate mother immediately upon the birth of the child. That is an indication of the difficult and contentious ethical issues that potential review or reform of surrogacy raises.

I have listened with great interest to the points made in this debate. For some time, the Government have considered potential positive action that could be taken on surrogacy, and many of the points made tonight are therefore familiar through that consideration. Three key strands of government activity are being developed, which I will draw to the attention of the House.

First, the Department of Health intends to produce guidance on surrogacy arrangements in the UK, including best practice and clarification about the process and the legislation. This will provide authoritative information for people who are considering surrogacy. It will reflect the ground rules of the current arrangements in the UK and emphasise the benefits of undertaking surrogacy in UK-licensed clinics rather than going abroad. It will make clear the importance of seeking and obtaining a parental order to confer legal parenthood.

A project group has therefore been established to produce the guidance in close collaboration with key surrogacy organisations and other stakeholders, taking account of their input about the particular issues on which clarity and information is most needed. The aim of the project is to produce guidance on surrogacy for professionals, surrogates and intended parents to improve experiences under the current system. A number of meetings have taken place already, and good progress is being made. The intention is to complete the project and disseminate the guidance after Easter 2017.

Secondly, the Government recognise that surrogacy policy and legislation have not been significantly addressed by respective Administrations since the Surrogacy Arrangements Act was introduced in 1985. We have heard and taken account of the arguments for the need for a review. As a result—in answer to the question asked by the noble Baronesses, Lady Barker and Lady Walmsley—the Government informed the Law Commission that they fully support the commission’s proposal to include a review of surrogacy in its work programme from 2017.

The Law Commission’s consultation on its work programme concluded on 31 October and referred specifically to the Government’s support for the inclusion of a review of surrogacy. The Government have strongly encouraged all those with an interest in or views about surrogacy to respond directly to the commission, supporting the inclusion of surrogacy and setting out the particular aspects, views and issues concerning surrogacy that they consider important and wish to see covered by the review.

As I have already indicated, there are differences in opinion across the surrogacy sector about the changes that could or should be made, including some of the recommendations in Surrogacy UK’s report. It is important that we do not prejudge the positions. Having encouraged all interested parties to make their points to the Law Commission as part of the consultation process, it is now for the commission to assess the totality of views expressed in coming to a conclusion about any proposed final work programme.

The third strand of activity concerns the Government’s response to the recent High Court judgment that declared that a provision in the Human Fertilisation and Embryology Act 2008—which enables couples but not single people to obtain a parental order following surrogacy—is incompatible with the Human Rights Act. We will, therefore, update the legislation on parental orders to ensure that it is compatible with the court judgment. I can confirm that the Government will introduce a remedial order to achieve this, so that single people can apply for parental orders on the same basis as couples. The remedial order will be subject to consultation and will include transitional arrangements, which would put all single people on the same footing and allow a reasonable time period to apply. The House will recognise that there are complexities and a considerable number of consequential amendments to other pieces of legislation, so our current plan is that the remedial order will be introduced to Parliament in early 2017. This strand of work will be undertaken separately to the Law Commission’s considerations of a potential wider review of surrogacy.

I am sorry that I galloped through that, but I always feel that the 12 minutes will be up so soon that I will not have time to go through everything. That is why it sounded like a terrible gallop. However, I hope that noble Lords were able to understand the points I made rather than feeling that I read my speech parrot-fashion, which I did not want to do.

I will answer some of the questions that were raised. The noble Baroness, Lady Barker, mentioned that surrogacy should be looked at as a whole, to include all aspects of parental orders. We absolutely agree with this, and I will certainly go back to the department with consideration about improved information collection.

My noble friend Lord Faulks mentioned the case reported in today’s Times. This is an unfortunate case, but thankfully very rare. Nevertheless, that does not help the parents who are trying to deal with it at the moment. Consent is a very important principle, which underpins all the legislation concerning assisted reproduction that Parliament has agreed. Any isolated amendment to surrogacy law, such as that relating to consent, would be controversial given the range of views held about surrogacy. Parliament would expect a thorough public consultation about any proposed changes to legislation in this area. We have given this issue consideration and our preference is therefore for it to be explored through the review by the Law Commission as part of the broad policy area.

The noble Viscount, Lord Craigavon, mentioned maternity units that ask couples to exchange their babies in the car park. The Government absolutely do not support the practice of surrogate families being forced to move off NHS premises after the birth of children. Altruistic surrogacy is an alternative approach to family-building, not a form of child trafficking. The Department of Health has recently established a project group with surrogacy stakeholders to develop best-practice guidance on surrogacy for those considering entering into such arrangements and for care professionals to increase awareness and understanding of the key issues and improve the experience of those undertaking surrogacy arrangements.

The noble Lord, Lord Berkeley, talked about Patrick Trevor-Roper. That was rather extraordinary as I did my eye surgery nursing under him and he became a huge friend of mine—partly because the only bit of nursing I could not bear was eyes. Every time I went into surgery, he told me what he was doing and I watched with my eyes shut, which was not best practice. But he was certainly the most marvellous man and very much a mentor to me during my nursing training at Westminster Hospital.

The noble Lord asked whether sperm donation could be allowed with protections. There are no plans for this but I will look into the matter further and write to him.

The noble Baroness, Lady Walmsley, asked about support for an international agreement. The UK Government are willing to consider supporting an international agreement on legal parenthood, including surrogacy, to help safeguard children who travel across international borders. UK officials are currently participating in feasibility considerations with the Hague working group. However, it is important to recognise that there may be significant difficulties in preparing such an agreement due to the evolving nature of much local legislation on surrogacy and the sensitivity with which it is regarded in many countries. It would be for individual counties to determine how such an agreement might impact on issues such as nationality. Such an agreement could also be a way of minimising the risks of child trafficking.

I think that the noble Lord, Lord Hunt, asked three questions. I will need to get back to him on those if that is all right. I think that the answers are yes, yes and yes—but I do not want to say that if it is not correct. However, that is my belief.

I can give noble Lords a clear and unequivocal message that this Government recognise the value of surrogacy as a means of helping to create new families for a range of people who might not otherwise be able to have their own children. It is in that spirit of inclusiveness and equality that we look to the future and to surrogacy in the UK being updated for the 21st century. We very much welcome the significant steps that are now beginning to be made in that direction.

NHS: Congenital Heart Disease

Baroness Chisholm of Owlpen Excerpts

Wednesday 14th December 2016 Lords Chamber

[Lord Sharkey]

To ask Her Majesty’s Government how many hospitals have challenged NHS England’s recommendation that they cease to provide special surgical services for congenital heart disease.

[Baroness Chisholm of Owlpen (Con)]

My Lords, the department has not received any formal challenges to NHS England’s proposals for changes to the way that congenital heart disease services are organised. I know that there are some concerns about NHS England’s proposals but we must remember that no final decisions have been made. A service-change process is now under way that will include public consultation. NHS England will announce further details in the new year.

[Lord Sharkey (LD)]

The Royal Brompton Hospital is one of the hospitals that has those concerns. NHS England said at a recent meeting in the Commons that there were no concerns over the quality of care provided by the hospital, yet the NHS England proposals for the Royal Brompton would remove a quarter of the paediatric care beds in London when there is already a growing shortage. They would also destroy the hospital’s world-leading adult congenital heart disease programme and cost a lot of money. Given all that, can the Minister say exactly what problem the Royal Brompton proposals are aiming to solve?

[Baroness Chisholm of Owlpen]

I do not want to go into issues relating to specific hospitals but I emphasise that no decisions have been made. Where it is decided that changes need to be made, these will be managed carefully and will be carried out in partnership with current service providers, patient groups and advocates. Decisions are likely to be made in the summer but there will be no change on the ground until at least 2018. The public consultation will give everyone a chance to put forward their views and to discuss the plans further.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Baroness says that she will not discuss individual hospitals but, in the end, Ministers are accountable. Will she confirm that the reason given by NHS England is that the Brompton does not meet its specification, which insists on same-site locations for all children’s services? Can she confirm that one of the hospitals not threatened with closure has multi-site locations, and will she also confirm that the Brompton has one of the best outcomes in the country?

[Baroness Chisholm of Owlpen]

I am not going to be drawn into discussing specific hospitals and I have given my reasons for that. However, I will say that the statement made in July by the Royal College of Surgeons and the Society for Cardiothoracic Surgery said:

“We fully support these standards. NHS England must ensure that the standards are applied for the benefit of patients, by ensuring that expertise is concentrated where it is most appropriate. The proposals put forward by NHS England today should improve patient outcomes and help address the variations in care currently provided.

It is fundamentally important that specialist surgical centres are large enough and treat patients regularly enough to develop full expertise to treat all conditions. It’s vital they are properly staffed to provide on-call rotas and teams have the time to create a supportive environment where new techniques are shared and future specialists can learn”.

[Baroness Gardner of Parkes (Con)]

My Lords, I declare an interest in that I was a member of the hospital board of the Brompton for some 15 or 17 years —a long time. You have to look at this case specifically because the Brompton has been quite outstanding and does not work in complete isolation. I am a cardiac patient under the Chelsea and Westminster Hospital, and the same consultants work at both these hospitals and work fairly closely together. However, I do not think that anywhere exceeds the Brompton in standards of care for congenital heart conditions. Indeed, there are Members of this House whose children have had very successful treatment there. We cannot ignore the very special circumstances of this world-famous hospital.

[Baroness Chisholm of Owlpen]

I appreciate the concerns that noble Lords have raised and the concerns of the hospital trust. However, we must remember that no final decisions have been made and a public consultation will begin shortly. That is when all points can be raised and addressed.

[Lord Rennard (LD)]

My Lords, will the Minister agree that NHS England should review the unfair and inconsistently applied standards that may force the closure of congenital heart disease services at the Royal Brompton Hospital, putting lives and life-saving heart disease research at risk?

[Baroness Chisholm of Owlpen]

I want to share with noble Lords a little of what these standards are about. I feel quite strongly about this: it is so important, and it is the right way forward to determine where these operations should be done. The standards state:

“Each congenital cardiac surgeon must perform a minimum of 125 … congenital cardiac … surgical procedures … each year, averaged over a three-year period … Each consultant congenital interventionist must be primary operator in a minimum of 50 congenital procedures per year, averaged over a three-year period. There must be a designated lead interventionist who must be primary operator in a minimum of 100 procedures per year, averaged over a three-year period”.

This will ensure optimum outcomes for all patients.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that this debate has gone on for a long time and the insecurity is very bad for patients and for staff, and that it is not just about the Brompton hospital but about other hospitals throughout the country?

[Baroness Chisholm of Owlpen]

The noble Baroness makes a very good point. This has been fiercely debated since the publication in 2001 of the damning report into the high death rates among babies undergoing heart surgery at Bristol Royal Infirmary. The last time plans were put forward, in 2011, it led to a bitter fall-out, pitting hospitals against senior health bosses, and two years later the proposals were scrapped, with NHS bosses being told to look again. That is why we are now trying to go forward, so that we can cover both adult and children’s services.

[Lord Hunt of Kings Heath]

My Lords, may I offer some advice to the noble Baroness? It is quite clear that, in the end, the Government will not agree to the closure of the Brompton, because that has been the decision on numerous occasions since 2001. Why not just pull the consultation? It is not going anywhere, my Lords.

[Baroness Chisholm of Owlpen]

We do not yet know that it is not going anywhere. A public consultation is coming forward, and the Brompton is not the only hospital concerned; it concerns a lot of hospitals all around the country. It is fair that it should go to a public consultation. Everybody will then have a chance to put their views, and that is going to be the way forward.

[The Countess of Mar (CB)]

My Lords, does the Minister agree that as well has having surgical expertise, part of the patient’s recovery depends on having access to their friends and their family? When the NHS is deciding these things, will someone please ensure that if a hospital is a long way away from where people live, the families are given funding for travel, because many people cannot afford to do so, and, if necessary, given accommodation in the hospitals where the operations take place?

[Baroness Chisholm of Owlpen]

The noble Countess raises a good point. NHS England recognises that it may be difficult for the families involved having to travel further, which is why a number of standards will certainly address that point.

Care Quality Commission Review: Deaths in the NHS

Baroness Chisholm of Owlpen Excerpts

Tuesday 13th December 2016 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

My Lords, with the leave of the House, I shall now repeat a Statement given in the other place by Jeremy Hunt, Secretary of State for the Department of Health. The Statement is as follows:

“On 12 April this year, I asked the CQC to conduct an investigation into lessons that needed to be learned following the tragic death of Connor Sparrowhawk in 2013 at Southern Health NHS Trust. I want to start by paying tribute to his family, particularly his mother, Sara Ryan, for her persistent and determined campaigning for a proper investigation into what happened. The lesson of Mid Staffs, Morecambe Bay and, indeed, other injustices such as Hillsborough is that when families speak out we must listen. In this case, thanks to Dr Ryan’s efforts, many improvements will be made to the care of people with learning disabilities and many lives saved.

I asked the CQC to look at what happened at Southern Health NHS Foundation Trust, but also to assess more broadly what lessons there are for the NHS as a whole. Its findings make sobering reading. Among other findings, the report said that families and carers often have a poor experience of mortality investigations. They are sometimes not treated with kindness, respect and sensitivity. They can feel that their involvement is tokenistic and often question the independence of the reports.

The NHS does not prioritise learning from deaths and misses countless opportunities to learn and improve as a result. There is no single framework that sets out how local NHS organisations should identify, analyse and learn from deaths of patients in their care, or who have recently been in their care. As a result, there is inconsistency. Some NHS trusts get some elements of mortality reporting right, but not one gets all elements right. In particular, the leaders of NHS organisations, their doctors, nurses and other staff simply do not have access to the full picture of how many patients die in their care, which deaths were preventable and what needs to be learned.

I thank Professor Sir Mike Richards and his CQC colleagues for an extremely thoughtful and thorough report. I am accepting all their recommendations. From 31 March next year the boards of all NHS trusts and foundation trusts will be required to collect a range of specified information on deaths that were potentially avoidable and serious incidents, and consider what lessons need to be learned, on a regular basis. This will include estimates of how many deaths could have been prevented in their own organisation and an assessment of why this might vary positively or negatively from the national average, based on methodology adapted by the Royal College of Physicians from work by Professor Nick Black and Dr Helen Hogan.

We will require trusts to publish that information quarterly, in accordance with regulations I will lay before the House, so that local patients and the public can see whether and where progress is being made. Alongside those data, trusts will publish evidence of learning and action that is happening as a consequence of that information. They will feed the information back to NHS Improvement at a national level so that the whole NHS can learn more rapidly from individual incidents.

All trusts will also be asked to identify a board-level leader as patient safety director to take responsibility for this agenda and ensure it is prioritised and resourced in their organisation. This is likely to be the medical director. They will also be asked to appoint a non-executive director to take oversight of progress.

We will ensure that investigations of any deaths that may be the result of problems in care are more thorough and genuinely involve families and carers. More broadly, instead of the patchwork approach we have currently, all trusts will be asked to follow a standardised national framework for identifying potentially avoidable deaths, reviewing the care provided and learning from mistakes.

I have asked the NHS National Quality Board, which includes senior clinicians from all national NHS organisations, to draw up guidance on reviewing and learning from the care provided to people who die, in consultation with Keith Conradi, the new chief investigator of healthcare safety. Their guidelines will be published before the end of March next year for implementation by all trusts in the year starting next April. We will also work with the National Quality Board to ensure that much greater support is offered to bereaved families in the future.

As the report highlighted particular issues around support given to families, Health Education England will be asked to review the training for all doctors and nurses with respect both to engaging with patients and families after a tragedy and, equally importantly, maintaining their own mental health and resilience in extremely challenging situations.

Finally, because the report identified particular concerns about the treatment of people with learning disabilities, we will take two further actions. First, in acute trusts, we will ask for particular priority to be given to identifying patients with a mental health problem or a learning disability to make sure that their care responds to their particular needs and that particular trouble is taken over any mortality investigations to ensure that wrong assumptions are not made about the inevitability of death. We will also ensure that the NHS reviews and learns from all deaths of people with learning disabilities in all settings. The Learning Disability Mortality Review Programme will provide support to both families and local NHS areas to enable reporting and independent, standardised review of all learning disability deaths between the ages of four and 74.

We will ensure that there is coverage in all regions by the end of next year and will reach full national rollout by 2019. As the programme develops, all learnings will be transferred to the national avoidable mortality programme. I have today asked the LeDeR programme to provide annual reports to the Department of Health on its findings and how best to take forward the learnings across the NHS. From next year, we will become the first country in the world to publish data on avoidable deaths at a hospital-by-hospital level. So I want to address how we ensure that data published about avoidable deaths are accurate, fair and meaningful and that the process of publication rewards openness and honesty. Of course, we will work closely with CQC, NHS Improvement and senior NHS doctors and nurses to get this right, but I want to make clear to the House that I will not set any target for reducing reported avoidable deaths. Nor do I believe that it will be valid to compare numbers between hospitals, because the data depend on clinical views which may change or vary. It may surprise the House that I expect to see an increase in the number of reported avoidable deaths. This is likely to be hospitals getting better at spotting and reporting them, rather than because care is deteriorating.

We should also remember that when there is a tragedy in the NHS, there is always a second victim; namely, the doctor or nurse involved, who invariably suffers huge anguish. So let us today also give credit to all NHS front-line staff for the changes that are already taking place to improve patient safety.

The number of people experiencing the four main hospital harms are down by a third since November 2012. MRSA and C. diff rates have halved since 2010. Ten thousand more hospital nurses have been recruited since the Francis report; they are now at record numbers. A new Healthcare Safety Investigation Branch has been set up to perform speedy, no-blame inquiries into avoidable harm and death, modelled on the successful system that has operated in the airline industry for many years. And this week we conclude consultation on legislation to create a “safe space” for NHS staff to talk openly about how to improve the safety of care for patients without having to worry about litigation or professional consequences.

The culture of the NHS is changing following a number of tragedies, but this report shows that there is much progress to be made in the collecting of information about unexpected deaths, analysis of what was preventable and learning from the results. Only by implementing its recommendations in full will we honour the memory of Connor Sparrowhawk. I commend this Statement to the House”.

My Lords, that concludes the Statement.

--- Later in debate ---

[Baroness Jolly (LD)]

My Lords, I, too, thank the Minister for repeating the Statement and echo the condolences offered by the noble Lord, Lord Hunt of Kings Heath. I declare my interests as set out in the register. I am chair of a learning disabilities charity caring for adults across England.

We welcome the findings of this report but are saddened that we should need one. However, we welcome its publication and recommendations and hope that they will be taken forward and acted upon as a matter of urgency.

I am going to talk about families, governance and learning good practice from unexplained death inquiry processes. In the report, the Secretary of State said:

“The lesson of Mid Staffs, Morecambe Bay and indeed other injustices like Hillsborough is that when families speak out we must listen”.

Surely another lesson is that a trust, or even a regulated care setting run by a charity or the private sector, should reach out to the family first after the family member dies in an unexplained way. We recognise that the emphasis in the report on the importance of including and listening to families in investigations is extremely important, but is this not what common decency should require and families expect, and should this not already be happening?

The situation at Southern Health NHS Foundation Trust reflects what is known across the sector: that whether we like it or not, mental health and learning disabilities are always considered after acute and community services. As long as I can remember—and my involvement with the NHS began at the end of the 1990s—commissioners thought of them last and there was certainly nothing approaching parity of esteem. Now, at least for mental health, we have parity of esteem, and we should have processes in place that are as good and as robust as in all other NHS settings. The chair of the trust should work with the CEO to make sure this happens and a named non-executive director on the board should have ownership of the process. Sadly, this situation is nothing new. Trusts have struggled with this for years and it has to be kept on the agenda. I mean this literally as well as figuratively. It should not be relegated to a subcommittee; it should be on a full board meeting agenda by default.

I commend the processes adopted by Mersey Care NHS Foundation Trust. In such circumstances as we have been discovering, it carries out a review within days, very quickly, while all the involved staff are still in post and details are not forgotten—and, of course, families are involved.

Any good unexplained deaths investigation or complaints system should always have an element of learning built into it. This should be shared within the organisation and also within the sector, and there should be a process to make that happen. Processes currently seem to be ad hoc. Standards and definitions should be standardised into a common framework, as indicated by the report.

I have three key questions for the Minister. First, will the Government consider extending the recommendations of this report to regulated residential settings where those with a learning disability or a mental health condition are being cared for? Secondly, the report outlines the need for a national framework. Will the Minister outline who will co-ordinate the work outlined in the report and who might be involved, and indicate its expected completion date? Finally, will the framework contain recommendations about sharing good practice within the organisation and the sector?

[Baroness Chisholm of Owlpen]

My Lords, I thank noble Lords for the questions that have been raised. I particularly thank the noble Lord, Lord Hunt, for mentioning the sad death of my noble friend Lord Prior’s father. It is sad that I should have to be standing here instead of my noble friend on this occasion.

This is indeed a wake-up call. As the noble Lord, Lord Hunt, said, we have all been absolutely shocked by this report. This is a cross-party issue and something that we all need to get involved in, and I very much welcome the noble Lord’s understanding about that.

The noble Lord mentioned families and carers being equal partners, which is indeed absolutely essential to what is being brought forward. When families have a loved one in hospital, it is absolutely essential that they can be sure that if they have a concern, they will be listened to, whoever they go to. When somebody we love goes into hospital, one of the things we all feel is a sense of relief that they are now somewhere where they are going to be looked after, cared for and treated in the best possible way. If we cannot feel that that care is going to continue when we go home at night, having been with them all day, there is something very wrong with our system. We are going to make sure that that happens, and that is exactly why my right honourable friend the Secretary of State said he is determined that all the recommendations in the report will take place.

Several points were made, and I will try and get through some of them. We feel that this is not an issue of funding. Trusts already have investigations, and we will support them and make sure that best practice is followed, particularly in the training of clinical staff and in improving the way in which they investigate safety incidents. This is not about funding; this is about creating a culture where NHS trusts make sure that if somebody comes forward with a concern, they are listened to immediately. One way to help with that is the board level leader who will be put in place—a patient safety director—to take responsibility for this particular agenda. This has already been tried in the Yorkshire and Humberside region, with good feedback. It is looking at deaths and avoidability, and degrees of avoidability, and where lessons can be learned from the deaths, even if they are inevitable.

I hope that with those remarks, the noble Baroness and the noble Lord will realise that this is a wake-up call for us all and that we are going to take forward all the recommendations. It is impossible to have a timeframe for this, but we need to make sure that it is done properly and that robust actions are taken to make sure that what happened earlier on will never happen again.

[Baroness Hollins (CB)]

My Lords, I, too, commend Dr Ryan—Connor’s mother—for her persistence. The truth is that if we could get this right for people with learning disabilities, we would get it right for everyone else. Could the Minister confirm that the national mortality review for learning disability will now be permanent, just like other national mortality reviews such as the one on maternal deaths, rather than for the original three-year period for which it was established? I should declare an interest, having been involved in the tender process that led to the appointment of the Norah Fry research centre to run the national mortality review.

[Baroness Chisholm of Owlpen]

I remember the noble Baroness mentioning this once before in a debate, and I think I said then that there were absolutely no plans for this review to stop. It will certainly be carrying on. We have to ensure that all investigations for mental health patients are of a much higher quality and genuinely involve all the patients and families. We must remember that so often it is the families that know best what is wrong with the patient and how they need to be treated. It is absolutely essential that all clinicians and healthcare workers listen to what relatives or carers are saying about people with mental health or learning disabilities. They know how those people behave at home and how they need to be looked after in hospital. There has to be a joined-up approach between carers, families, clinicians, nurses and everybody who comes into contact with the patient when they go into hospital.

[Baroness Manzoor (Con)]

My Lords, changing culture is very important but culture is about having very good leadership. We need clear and greater leadership in our NHS at both clinical and management level. I am pleased to hear that the Minister has said there is going to be some emphasis in that area. With the change in culture, good data and good information systems need to be in place. I understand that there is a move within the NHS towards more locality data-sharing, rather than putting in place a national framework. Surely a national framework—an information-sharing platform—is the way forward if we are truly to understand what is happening in our NHS.

--- Later in debate ---

[Baroness Chisholm of Owlpen]

I thank my noble friend for that question. Yes, national data are important, but we also have to remember that data can vary terrifically from region to region. Of course, collecting data is absolutely vital, and there will be national data, but we also need to ensure that the data are suitable for the particular area from where they have been collected.

[Baroness Finlay of Llandaff (CB)]

My Lords, given the lamentably low involvement in investigations of families and others who loved the person who died, how will their experience be audited and monitored in future? As the Minister rightly said—I declare an interest as chairman of the National Mental Capacity Forum—such families often describe not being listened to during the period of illness prior to death, and then not being listened to around the time of death. Without auditing their experience of their involvement in investigations, there is a danger of it being tokenistic and that nothing will really change in the longer term, even though they have a great deal to offer. Will the Minister commit to involving some of the bereavement groups that might provide support and independent monitoring of people’s experiences, and undertake to catalogue centrally the reasons that emerge from such investigations? Only then will we understand if trends really are occurring across the country that need to be dealt with at national level, rather than allowing things to slip at local level.

[Baroness Chisholm of Owlpen]

The noble Baroness, who is very experienced in these areas, makes an important point. The plan is certainly to publish the information quarterly, in accordance with the regulations that the Secretary of State is going to lay before the House, so that local patients and the public can see whether and where progress is being made. Alongside those data, evidence will be published of learning and action that are happening as a consequence of that information, and the information will be fed back to the NHS Improvement regime at a national level so that the whole of the NHS can learn more rapidly from individual incidents.

[Lord Laming (CB)]

My Lords, it is right that this matter be discussed in the House with a very sombre attitude, because it is not to use exaggerated language to say that the report has some shocking elements in it, as the Minister has indicated. The way ahead has been set out, but can the Minister assure us that we have got to the bottom of why people in a caring profession have behaved in such an insensitive way to those who are grieving? That comes as a real surprise to us when it is set out in this stark way.

[Baroness Chisholm of Owlpen]

I thank the noble Lord for his question. We must also recognise that most healthcare professionals in this country are doing a fantastic job. Of course, every such incident is appalling and must be looked into, but when I was a nurse, every nurse, doctor and healthcare professional I came across was doing an incredible job, quite often in very difficult circumstances. The noble Lord is right: we must make sure that doctors and nurses are made aware of how they should conduct themselves. That is why Health Education England will be asked to review the training for all doctors and nurses on engaging with patients and families after a tragedy. Equally important is ensuring that they know how they should treat people who come into hospital with mental health issues or learning disabilities. We will be putting psychiatric assessment teams into A&E departments so that they will be able to triage these patients before they go into hospital and pass on to healthcare professionals further down the line what their needs will be.