Health and Care Bill

Debate between Baroness Chisholm of Owlpen and Baroness Walmsley

Lords Hansard - Part 1 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I support that. I am glad that the noble Baroness, Lady Thornton, introduced Amendment 34. According to the Bill as it stands, the chief executive of the ICB could be appointed only by the chair—of course with the approval of NHS England. Like many of your Lordships, I have been on a board, including being the chair of a board, and as such, I always thought it good practice to appoint my chief executive with the help and approval of my board members. As an ordinary member of a board, I cannot imagine how I would have managed the relationship with a chief executive officer who had been appointed over my head only by the chair without any consultation with me or other members. If we want to encourage collaboration, that is not the way to do it at board level.

It is inconceivable that the mechanism would work in practice in such a situation. Indeed, it is vital that all the senior people who steer the ICS, the members of the ICB, and indeed the chair and members of the ICP, must have confidence in the chief executive; the word “confidence” was so appropriately used by the noble Lord, Lord Hunt of Kings Heath. How could that be if they had no involvement whatever in the appointment? It is a simple matter of good practice and I shall be very interested to hear what the Minister can possibly find to say against it.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I know we have 10 minutes to go, but perhaps it makes sense to stop now in case noble Lords want to interject during the Minister’s speech.

NHS: Contaminated Blood

Debate between Baroness Chisholm of Owlpen and Baroness Walmsley

Thursday 20th July 2017 Lords Chamber

[Baroness Chisholm of Owlpen]

My Lords, I thank the noble Baroness for those questions. It is normal for the relevant department to sponsor an inquiry, and the Department of Health is the sponsoring department. We are listening on this, which is why the Cabinet Office has joined the discussions, and other departments may well be involved. We are absolutely committed to an independent inquiry and the Cabinet Office propriety and ethics team has been liaising with the Department of Health about this inquiry.

As regards how people can make sure that they are able to consult, we are sending letters this week, or at the beginning of next week, to all 3,500 beneficiaries of the schemes. MPs will also receive the letter. The letter will state clearly how to make contact so that people can put forward their concerns, ideas and representations.

[Baroness Walmsley (LD)]

My Lords, I welcome the fact that we are to have a proper inquiry at last and that it will be fully independent. I also welcome that the secretariat to the inquiry will be someone who has never worked at the Department of Health. However, the remit of these inquiries always has an enormous effect on the deliberations and the outcomes. Victims are concerned that the Department of Health could sign off the remit. To be seen to be completely independent, will the Minister consider which department would be more appropriate than her own for signing off the remit? Perhaps it could be the Cabinet Office.

The inquiry must have statutory powers not just to summon witnesses but to compel them to appear and to receive documents. In the debate in another place last week the Minister seemed to see two alternatives: either giving the inquiry these important statutory powers or providing a,

“Hillsborough-style panel—which would allow for a sensitive investigation of the issues, allowing those affected and their families close personal engagement”.—[Official Report, Commons, 11/7/17; col. 187.]

I do not see these as two alternatives. If the inquiry is properly constituted and the remit laid down by an independent body with the approval of the victims, it could command their trust and close personal engagement could then be achieved. However, these inquiries usually take a long time, and the victims of this scandal need help now. How will the Minister ensure that victims have access to the compensation they deserve in the short term? Will she reverse the decision made in April not to increase the compensation payments in line with inflation? Will the Minister set a date for responding to the consultation on the support scheme, which closed in April?

[Baroness Chisholm of Owlpen]

As regards the set-up of the inquiry, no final decisions on how it will be have been made. That will be taken into account following the consultations. As the noble Baroness said, there are two possible ways of doing it, either by a statutory inquiry, which involves a judge and means witnesses can be ordered to appear, or rather like the Hillsborough panel, which is more “families first” but cannot force witnesses to appear. No decision has been made. It will all be part of the consultation over the summer before a decision in September.

As for the other queries mentioned by the noble Baroness, I do not now want to go into what happened before. This Urgent Question is about how the inquiry will be set up. However, I understand the noble Baroness’s concerns about the consultation. I do not know the date yet. When I go out, if I find the date has been agreed, I will make sure I write to the noble Baroness.

Health: Obesity

Debate between Baroness Chisholm of Owlpen and Baroness Walmsley

Thursday 20th July 2017 Lords Chamber

[Baroness Chisholm of Owlpen]

We take obesity extremely seriously and have a lot of initiatives going forward such as introducing a soft drinks industry levy, which will come into effect in April. The important thing could be harnessing new technology. We need to make sure that we can get to people, particularly young people. We will work with Public Health England on good initiative ideas, and with commercial players to investigate opportunities to bring forward a suite of applications that enable consumers to make the best use of technology and data to inform their eating decisions.

[Baroness Walmsley (LD)]

My Lords, in the SACN report, the variation between different groups was seen to be quite unacceptable. For example, in the Borough of Kensington and Chelsea, the difference between different demographic groups for men was 16 years. To what does the Minister attribute this inequality and what do the Government intend to do about it?

[Baroness Chisholm of Owlpen]

It is definitely true that inequality has a part to play but it is interesting that it is due not only to funding. While I was researching this, I noticed comparative statistics on life expectancy at birth across the G7 nations. Those show no direct correlation between GDP expenditure and health outcomes. For instance, the USA spent 16.6% of its GDP on healthcare but has the lowest life expectancy at 78 years. Italy spends the least at only 9.1% of its GDP and has the second highest life expectancy at 82 years. Diet and lifestyle—which everybody has a responsibility for—go a long way in playing a part in this.

Policing and Crime Bill

Debate between Baroness Chisholm of Owlpen and Baroness Walmsley

Report: 1st sitting: House of Lords
Wednesday 30th November 2016 Lords Chamber

[Baroness Chisholm of Owlpen]

I was pointing that out as just one of the reasons why it might be—but we have to remember that, as we know, mental health is going through a huge change at the moment. As I said in a debate on Monday, I am afraid that we are going from a very low base. We have to be aware that it will take time for these places of safety to be there to ensure that we have an increased number of beds or places of safety for these people to be taken. That is part of the reason for the discrepancy.

To go back to further points raised on mental health, the noble Lord, Lord Rosser, raised an issue related to the respective changes to police powers under Sections 135 and 136 of the Mental Health Act. The noble Lord suggested that the maximum detention period should be reduced further to 12 hours. We are confident that the Bill reduces the maximum detention period by the appropriate amount—from 72 hours to 24 hours. The Government have seen evidence that the average assessment under Section 136 is conducted in under 11 hours. Furthermore, we fully support the target set by the Royal College of Psychiatrists for assessments to commence within three hours. However, there are some cases when it is not possible, due to the condition of the person detained, to conduct a meaningful assessment within 12 hours: for example, if they are intoxicated through alcohol or drugs.

The noble Lord also mentioned duties on police to consult with mental health professionals, with detainees having a right to an independent mental health advocate. The second issue concerned access to independent advice. Clause 78 requires police officers to seek advice from certain specific healthcare professionals, if practical, before making a decision to exercise their powers under Section 136. This is about supporting police officers to make the best possible decisions when they encounter a person who may be experiencing a mental crisis. This provision builds on existing good practice of police forces and local NHS services working together collaboratively, including through street triage schemes. The “if practical to do so” condition will avoid tying the hands of an officer if, in their judgment, they need to use the powers quickly to secure an individual’s safety.

On detainees’ access to advice, for example from a mental health advocate or an appropriate adult, the guidance supporting the implementation of these provisions will set out the expected support to be provided to any person detained at a place of safety under Section 135 or Section 136. Such support can, in our view, most appropriately be provided by health staff already present, rather than another person in a bespoke role, which would introduce delays and jeopardise professionals’ ability to conduct the assessment within 24 hours.

The noble Lord asked whether a person’s detention is disclosable if they subsequently apply for a disclosure and barring service check. In 2015 the Home Office published revised statutory guidance on enhanced DBS checks in relation to Section 135 and Section 136 detentions. The guidance now emphasises that the use of these powers in and of itself is unlikely to be sufficient to justify disclosure. The police are now directed to specifically factor in the behaviour of the detained person at the time, and how long they were detained. The Government’s position is that we cannot wholly rule out the possibility that there will continue to be circumstances in the future when a person’s behaviour is so extreme that it can safely be managed, at least initially, only in a police station. We are not legislating for some future point when that position will cease to be the case, which is what the amendment suggests.

I hope that, with all the things I have set out, and given our clear shared objective of doing what is in the best interests of all concerned, including their safety, I hope that the noble Baroness will be content to withdraw her amendment.

[Baroness Walmsley]

My Lords, I thank those who supported my amendment. I was fascinated by the treatise of the noble Lord, Lord Rosser, on other aspects of Sections 135 and Section 136. He is, of course, absolutely right that there is no correlation at all between the use of police cells and the rurality or urbanisation of the area concerned: absolutely none. I have always known that Merseyside is a very special place—because that is where I come from—but apparently in Merseyside there are no “exceptional circumstances”, whereas there are in other places. I cannot understand the Government’s determination to insist that there will be exceptional circumstances in other places if there are none in Hertfordshire and Merseyside.

It is quite clear that the Government are not going to move on this. However, I have to say that I welcome, of course, what the noble Baroness said about regulations. We will have to keep a very careful eye on how these work and whether they achieve our joint objective of bringing the numbers down as low as possible. I very much hope that that is exactly what will happen over the next few years. The hour being what it is, I beg leave to withdraw the amendment.

Policing and Crime Bill

Debate between Baroness Chisholm of Owlpen and Baroness Walmsley

Committee: 3rd sitting (Hansard - part one): House of Lords
Wednesday 2nd November 2016 Lords Chamber

[Baroness Walmsley]

My Lords, I thank the Minister for her reply. I have a few points to make in response but want first to apologise to the noble Lord, Lord Bradley, for not mentioning his excellent report. I congratulate him and the Government on the recommendations in the report that have been achieved on the ground. The street diversion teams are particularly good and would certainly come into play were a person found to be violent and in danger of hurting themselves or somebody else. The teams have had a fantastic effect and I look forward to their being rolled out universally.

It has been suggested that the amendment is a little premature and that we do not yet have the infrastructure in place to enable us to have a complete ban on the use of police cells. As with every other Bill, it would be perfectly possible for the Government to accept such a measure and then delay its implementation until such time as the review suggested by the noble Lord, Lord Bradley, had taken place and the extra beds had been put in place. That would not be an impediment to the Government accepting my amendment.

The noble Lord, Lord Rosser, asked what would happen if no health-based place of safety was available, the implication being that only use of a police cell was possible. Every local authority has hundreds of care homes and the lucky ones have nursing homes, too. Not all beds are occupied all the time; indeed, a recent report in the media cited instances where the contract with the family concerned stated that after the person in question had died, the family would have to carry on paying for two, three or four weeks while the home found another occupant for that room. That means that vacant rooms will be available. Some of them would be perfectly suitable for some patients, because they are acceptable and legal places of safety. If Hertfordshire and Merseyside can do it in those circumstances, then why not everywhere else?

[Baroness Chisholm of Owlpen]

Is the noble Baroness suggesting that mental health patients are able to go to care homes as places of safety?

[Baroness Walmsley]

I beg the Minister’s pardon. I should have said that there are care homes in every local authority where staff are specially trained to deal with people with mental health problems.

If Merseyside and Hertfordshire can do it, why not everywhere? Do they not have any patients who are in exceptional circumstances? I am sure they do.

On funding, the Minister suggested that the LGA was incorrect in briefing us that none of the money was going to local authorities. That is where my statement came from, and it should know.

On Amendment 191, about use of the home, it is important that somebody in a mental health crisis be able to see someone who is trained to assess and treat them as soon as possible, and as soon as would happen if they had a physical problem. They will not get that in their home. I do not believe that those choosing to take them home would be in a position to assess whether that home was really safe. Even members of the family would not know whether the home was safe, so getting their agreement is no guarantee that the home is a real place of safety. Many mental health patients have said that they would find it a serious intrusion on their privacy if the police brought them home and stood guard over them while they were there. I accept that it would be for only a short period, but to have a policeman outside the door would have a great effect on how they felt they were seen. As the noble Lord, Lord Thurlow, said, they already feel stigmatised by a link being made between mental health and criminality, which there really is not. We should therefore pursue these issues on Report. Of course, this is Committee stage, so for the moment I beg leave to withdraw the amendment.

--- Later in debate ---

[Baroness Walmsley]

Amendment 193 would ensure that people detained under Section 135 or Section 136 of the Mental Health Act 1983 have access to an appropriate adult. Such access is key to providing people in crisis access to advice while under emergency detention. It is a uniquely distressing and confusing time, as we have heard, and one where independent advice from someone with knowledge and skill who can handle the situation calmly is crucial.

At the moment detained people only have the police, who were involved in detaining them, and the person doing their mental health assessment as their key contacts. Clearly, neither of these can be seen as impartial to their situation. The person doing their assessment, although qualified, is going to be deciding what happens to them next, and so cannot really be described as impartial. There is a huge gap here, since people under most other sections of the Mental Health Act have the right to access an independent mental health advocate. People who are under arrest also have the right to access an appropriate adult. The National Appropriate Adult Network says about people detained or questioned by police:

“While both children and mentally vulnerable adults are required to have an Appropriate Adult under the PACE Codes of Practice, there is only statutory provision for children. As a result many people aged over 17 who are mentally vulnerable do not get the support that they are entitled to. This includes people with mental ill health, learning disabilities and autistic spectrum disorders”.



I recognise the concern of local authorities that they are strapped for cash, but I feel that making this provision statutory will put pressure on the Government to provide the necessary resources. The JCHR shares my concerns about this gap, as we read in its third report of the 2016-17 Session. It wrote to Mike Penning MP, then Minister for Policing and Criminal Justice. He replied on 1 July 2016 to the effect that persons detained under Sections 135 and 136 were only there in order to allow for a mental health assessment and he was keen,

“that we do not inadvertently build unintended and unnecessary delay and bureaucracy into this process or as a consequence of having to await the arrival of a formal advocate or independent representative”.

He also pointed out that the person could request the presence of a legal adviser or a relative or friend. This did not satisfy the JCHR and it does not satisfy me.

The JCHR said:

“We believe that additional safeguards are required to ensure that a person detained in a place of safety under s 135 or 136 of the Mental Health Act 1983 should have access to an ‘appropriate adult’, particularly in circumstances where they are detained in their own home”.

It drafted an amendment very similar to my Amendment 193, which I think it proposes to bring forward on Report, unless the noble Baroness can satisfy us all this evening. Given the state a person is likely to be in when they are detained, I believe it would be a breach of their human rights not to allow them the right to access an appropriate adult. I beg to move.

[Baroness Chisholm of Owlpen]

My Lords, it is absolutely right that people detained under Sections 135 or 136 should have the help and support they need to understand what is happening to them, and the current arrangements already allow for that. Detention under Sections 135 and 136 is for a short period of time and for the specific purpose of assessing the need for care and treatment, and making the necessary arrangements for its provision.

This amendment calls for each person detained to have access to an appropriate adult; an issue which was also raised by the Joint Committee on Human Rights in its report on the Bill. It is true that appropriate adults provide an incredibly valuable service, providing support and advocacy for children and vulnerable adults detained in police stations, usually when they are under arrest in connection with a criminal offence. Appropriate adults are not currently required to be provided by the police to support people detained under the Mental Health Act, nor are they trained to meet their particular needs. We must be cautious of the potentially stigmatising effects of conflating the support services provided to people suspected of an offence with those needed by people detained in connection with their mental ill health.

In the majority of cases under Sections 135 or 136, the person will be taken to health-based places of safety, where appropriate adults do not operate, rather than to police stations. In 2015-16 police stations were used in only 7% of Section 136 cases in England and Wales. The provisions in the Bill mean that police stations will be used even less than they are now; in fact, quite rarely, I expect— we hope, not at all. These rare cases require particular attention and I expect that the regulations on the use of police stations as places of safety for adults will give very clear direction about the level of support that will need to be in place.

I recognise that this amendment is about all people who are detained under Sections 135 or 136, regardless of which place of safety they are taken to. It is about supporting them, informing them and speaking for them if necessary. The Government are clear that the mental health professionals involved in the detention and assessment process are best placed to do this. Also, mandating the attendance of an appropriate adult, or some other person with a similar role, could very easily cause avoidable delays in getting on with the mental health assessment that is the proper purpose of a detention under Sections 135 or 136. Given that the Bill reduces the maximum period of detention from 72 hours to 24, it seems unhelpful to then introduce additional requirements that would, in all likelihood, impinge on that reduced period of time.

Guidance is now being developed on the changes the Bill makes to the 1983 Act. It will make clear the expectations on healthcare staff—those whom people detained under Sections 135 and 136 will encounter—to ensure that detainees have the support and advice they need while awaiting and undergoing an assessment. The Government are engaging with a wide range of experts to draw up this guidance. Current practices and the needs of people experiencing a mental health crisis will be carefully considered.

I hope I have been able to persuade the noble Baroness that mandating access to an appropriate adult is inappropriate in the context of a short Section 135 or Section 136 detention, and that, having had this opportunity to debate the issue, she will be content to withdraw her amendment.

NHS England: HIV Prevention

Debate between Baroness Chisholm of Owlpen and Baroness Walmsley

Tuesday 18th October 2016 Lords Chamber

[Baroness Chisholm of Owlpen]

The decision on which drugs to prioritise and how it should happen should surely be made by clinicians and NHS England, and not by politicians. As with all new drugs, PrEP needs to be properly assessed in relation to cost and effectiveness to see how it could be commissioned in the most sustainable and integrated way, and how it compares with other cost-effective approaches.

[Baroness Walmsley (LD)]

My Lords, if the court’s decision on the appeal upholds the original decision of the court, NHS England is clearly responsible for providing PrEP. Will the Minister emphasise to NHS England that it should be considering PrEP as a highly effective preventive measure in the same vein as the highly effective vaccinations of babies?

[Baroness Chisholm of Owlpen]

Yes, certainly if they lose their appeal, it goes back into the normal commissioning process. Of course we recognise that studies have shown that PrEP has been a success, but we also need to remember that it is a matter of how it is used. There are several ways that we have been tackling HIV until now, and PrEP is only one in a range of activities to tackle it. We need to remember that, for it to work, PrEP needs to be taken daily, and sometimes it is difficult to get this group always to take it daily.

Disability: Premature Deaths

Debate between Baroness Chisholm of Owlpen and Baroness Walmsley

Monday 17th October 2016 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

My Lords, I congratulate the noble Baroness, Lady Hollins, on securing this debate on an issue of great importance that is rightly of concern to your Lordships and indeed to the Government. I begin by paying tribute to the noble Baroness for her unfailing commitment to highlighting the inequalities, experiences and poor outcomes that people with learning disabilities and their families have faced for many years. I echo her and other noble Lords’ tributes to Lord Rix, who we are certainly going to miss enormously.

I also take this opportunity to congratulate my noble friend Lady Fall on an excellent maiden speech. My noble friend will be a great addition to this House and I greatly look forward to her contributions in the future. Also, let me thank all noble Lords for their contributions this evening.

We know that there are people young and old who die from what are often referred to as avoidable and premature deaths—which, I think we would all agree, need not happen if care, safety and the way in which people are treated were consistently good across the whole of the healthcare system. The Government are clear that the lives of people of all ages with learning disabilities matter. We are working with partner organisations, professionals and people with learning disabilities and their families to respond to issues that are important to, and have a big impact on, people’s lives.

As my noble friend Lady Rawlings mentioned in her speech, we know that people with learning disabilities experience significantly worse outcomes than the rest of the population. Our activity therefore extends beyond health and care and must also encompass the education of healthcare professionals, employment and housing. To this end, NHS England has a wide-ranging programme of work on learning disability designed to transform care and improve outcomes, driving up the quality of clinical and nursing care and reducing health inequalities. The NHS Five Year Forward View highlighted the need to improve learning disability services, with the NHS driving improvements in culture and behaviours towards people with learning disabilities.

The NHS published shared planning guidance in September with the aim of improving learning disability services, including reducing premature mortality, one of only nine “must dos” in the guidance. As my noble friend Lady Rawlings also mentioned in her speech, the clinical commissioning group improvement and assessment framework was launched in March. This Ofsted-style assessment will allow us to see how clinical commissioning groups are performing in key areas. It includes two indicators on learning disability: reliance on specialist in-patient care and the proportion of people on GP learning disability registers receiving an annual health check.

The noble Lord, Lord Hunt, and the noble Baroness, Lady Tyler, both spoke about NHS foundation trusts, and my goodness there are lessons to be learned. The Government have asked whether the issues raised in the Mazars report might be found in other providers across the country. The Care Quality Commission’s review into the investigation of deaths includes a sample of all types of NHS trusts in different parts of the country and will assess whether opportunities for the prevention of death have been missed—for example, by late diagnosis or physical healthcare problems. We expect the Care Quality Commission to publish its findings in December.

The noble Baronesses, Lady Hollins and Lady Tyler, asked what the Government were doing to provide full information on an ongoing basis on trends in the age of and causes of death of those with learning disabilities, and how those trends can be monitored. In answer, I can say that the Department of Health is working with Public Health England and NHS Digital to address the lack of reliable data, which are so important to ensuring that the right decisions can be made by healthcare professionals. A number of approaches are being considered, but the lack of progress has been frustrating. Noble Lords will be aware, however, of the wider issues surrounding the safe and secure use of health and care information, and here I cite the work undertaken by the National Data Guardian for Health and Care, Dame Fiona Caldicott, to ensure that the public can make informed choices about how their data are used. The Department of Health ran a public consultation on those proposals and is currently analysing the responses received. In addition, the department sponsored a study in this area undertaken by Public Health England, and the findings were published by the Journal of Intellectual Disability Research in July. They indicate the extent of premature mortality and its major causes.

As noble Lords have mentioned, people with learning disabilities have a life expectancy on average approximately 20 years less than other people. Public Health England also publishes a digest of the most up-to-date mortality statistics in People with Learning Disabilities in England. The 2016 edition of this will appear later this year.

The noble Baronesses, Lady Hollins and Lady Rawlings, asked whether it was time to mandate reviews into the deaths of all people with learning disabilities. Several other noble Lords mentioned this, too. In March 2015, NHS England commissioned the learning disability mortality review programme, which aims to support local and regional areas conduct reviews of deaths of people with learning disabilities and implement any recommendations and plans of action. Every NHS region is testing the review process and by March 2019 we expect every area to have established a mortality review process.

On the important matter of drugs, excessive use of psychotropic medication is known to be a specific factor in the premature death of people with a learning disability. Several royal colleges have signed a pledge to stop overmedication and have developed plans to deliver on the pledge, including issuing guidance for pre-registration nurses and psychiatrists; producing accessible information on medication for people and their families; and publishing guidance for prescribers. NHS England will also look regularly at primary-care prescribing of psychotropic drugs to monitor progress nationally.

As I mentioned earlier, the NHS mandate includes a requirement to reduce health inequalities for people with a learning disability. The noble Baronesses, Lady Redfern and Lady Hollins, mentioned annual health checks, as did the noble Baroness, Lady Walmsley. A key objective of this work is to increase the number of people on primary care registers and to ensure that as many of those people as possible get an annual health check. The ambition is for 75% of people on GP registers to receive an annual health check by 2020. Specific work under way includes: standardised letters to improve advice and guidance on health checks; pre-health check questionnaires; health check templates linked to people’s care records; and health action planning, including a focus on key issues that need to be followed up.

NHS England is working to improve how people with a learning disability access health services. This includes: developing care pathways for health conditions affecting people with a learning disability such as diabetes, epilepsy, heart disease and dysphagia; improving patient experience and outcomes; and sharing good practice to reduce variation in quality and make reasonable adjustments to services.

Education is hugely important and was mentioned by virtually every noble Lord. We have recognised that there needs to be a significant improvement in education of healthcare professionals. Health Education England, together with Skills for Health and Skills for Care, launched in July 2016 the learning disabilities core skills education and training framework, which was mentioned by several noble Lords. The framework provides the knowledge and skills needed for those delivering training to health and care professionals.

The noble Lord, Lord Addington, and the noble Baroness, Lady Hollins, mentioned the difficulties in communicating. Some universities such as St George’s, with the help of the noble Baroness, Lady Hollins, lead the way. Here, students receive training from training advisers who themselves have learning disabilities.

We are also taking steps to help people understand and access the right care and support, including by trialling the idea of “named social workers”, and, as part of the transforming care programme, establishing the role of “care and support navigators”. These will also support the aims of integrated and personalised care.

The provision of accessible information and people’s ability to communicate with staff have a key impact on their care, experiences and outcomes. In July 2015, NHS England published the accessible information standard for the NHS and social care services to help organisations identify and meet an individual’s communication and support needs.

As the noble Lord, Lord Addington, and the noble Baroness, Lady Fall, mentioned—the noble Baroness, Lady Hollins, mentioned it in the debate last Thursday on libraries and again tonight—the provision of books beyond words for those who have visual learning but difficulty with words can make a real difference. It is important that every possible healthcare professional has this at their side whenever they are dealing with people with learning disabilities.

I want to make sure that I cover all the questions, because, as always, I am running out of time.

The noble Baroness, Lady Hollins, asked what the Government are doing to improve our knowledge and understanding of the needs of this vulnerable group. GPs, under the quality and outcomes framework, have to maintain a register of their patients who have learning disabilities. The new Care Quality Commission arrangements for inspections for acute hospitals explicitly examine how patients with particular needs, such as learning disabilities or dementia, are identified. As the noble Baroness, Lady Hollins, also mentioned, the Government will regularly inform Parliament of the progress that has been made. I think the noble Baroness, Lady Tyler, also mentioned this. Public Health England’s Learning Disabilities Observatory team review each year and are covered in local and health authority joint strategic needs assessments. This team will continue, funding will continue for this team and the Secretary of State for Health reports annually to Parliament his assessment of NHS England’s progress.

The noble Baronesses, Lady Tyler and Lady Hollins, also wanted to know whether the Government can give a clear message to local authorities and special care agencies about their expectations that staff will be released to contribute to lead reviews of deaths. We agree that there should be the local capacity to undertake high-quality reviews which will yield the best possible learning. However, we have no plans to legislate to make such participation a statutory duty. There is already a strong expectation in the CQC guidelines that providers will participate in relevant clinical audits. Additionally, there is participation in the NHS England-commissioned audit and outcome review programme, which the Learning Disabilities Mortality Review programme is carrying on.

I will have to write to the noble Lord, Lord Hunt, on the 18 recommendations, if that is all right, and on the funding attitudes.

There is work in progress which will, in time, have a positive impact on the safety and quality of care.

[Baroness Walmsley]

I am sorry to interrupt, but when she is writing her letters will the Minister please also reply to my questions about learning disability nurses?

[Baroness Chisholm of Owlpen]

Yes. I am so sorry—I had the answer and I will make sure that I get it to you.

We give thanks to the noble Baroness, Lady Hollins, and people like her who keep pushing the barriers facing this vulnerable group. The Government are focused on making changes happen, stopping variation in care and championing those with learning disabilities being able to live full and happy lives, knowing that support is there when needed. Once again, I thank all noble Lords for taking part tonight. I am sorry that I have not had time to answer all the questions, but I will make sure that the letters get to noble Lords.

Severe Anaphylactic Shock

Debate between Baroness Chisholm of Owlpen and Baroness Walmsley

Thursday 26th May 2016 Lords Chamber

[Baroness Chisholm of Owlpen]

My noble friend is absolutely right: there has been a 5% increase in those suffering from allergies and half of all those affected are children. I think part of the reason for that increase in allergies being diagnosed is because diagnosis is now better. There are clinics are doing good work on making sure that allergies are well known by those who suffer from them, and that they are given treatment and advised about the right way forward in how to deal with them.

[Baroness Walmsley (LD)]

My Lords, does the Minister agree that public awareness of the dangers and what to do in the case of anaphylactic shock would help to save lives, such as in the sad case we just heard about? Does she also agree that it would be a pity if concerns about being stung prevented people keeping bees in their gardens? Bees are important pollinators and are much more interested in flowers than people. I declare an interest as a beekeeper.

[Baroness Chisholm of Owlpen]

I certainly agree with the noble Baroness about bees. Education is getting much better in making businesses aware of the dangers of anaphylactic shock and those allergens. In fact, the FSA along with the charity Allergy UK produced very good technical guidance and free online training. They also produced posters, templates and leaflets in different languages, which is particularly important for fast-food outlets. There should be no reason why food outlets are not aware of the 14 allergens of which people must be notified when they buy food.

Care Service Agencies

Debate between Baroness Chisholm of Owlpen and Baroness Walmsley

Wednesday 11th May 2016 Lords Chamber

[Baroness Chisholm of Owlpen]

PAs are an important part of the care system. They enable people to employ someone who will give them the special needs that they require, and they deserve proper pay for an important job. The national living wage was taken into account in the spending review and an extra £3.56 billion a year has been given to local authorities to help with the national living wage. The Care Act states that when calculating the personal budget, the direct payments made for the employment of a PA must be sufficient to cover all legally required costs.

[Baroness Walmsley (LD)]

Does the Minister agree that we are putting processes before payments? Is she aware of cases such as that of the lady from Bradford who is receiving both health and social care support at home for ulcerated legs? The worse leg was being treated by the district nurse; the better leg was put into support tights by her care worker, who was later dismissed because of the cuts. The nurse was not allowed to help with the better leg until it deteriorated to the point where she was permitted to dress that one too. One leg was NHS and the other was social care. Is that what the Government mean by integration?

[Baroness Chisholm of Owlpen]

Clearly not—that is not acceptable behaviour. Local authorities have an absolute duty to make sure that providers provide proper care for the people they are looking after, and there are strict regulations in place which are carried out by CQCs to make sure that that happens. If it does not, it is important for people to complain to the local authorities to make sure that proper care is given.

Food Standards Agency

Debate between Baroness Chisholm of Owlpen and Baroness Walmsley

Wednesday 10th June 2015 Lords Chamber

[Baroness Chisholm of Owlpen]

I thank the noble Lord for his question. This is a very important subject. The FSA does not charge farmers unless they are also the operators of approved premises that slaughter or cut meat; for example, if a farmer also owned and operated a slaughterhouse. As far as smaller abattoirs are concerned, discount proposals which have been looked at by the steering group would allow smaller abattoirs to benefit consistently from the highest levels of discount.

[Baroness Walmsley (LD)]

My Lords, last week the FSA announced its five-year strategy and at the same time the Chancellor announced millions of pounds-worth of departmental cuts. Can the Minister confirm that the Government are not looking for further cuts from this important arm of government, which would affect the protection of the nation’s health? Would that not be very short-sighted, and in the long term move the costs from Defra straight to the Department of Health?

[Baroness Chisholm of Owlpen]

I will have to get back to the noble Baroness with a full answer on that subject, but this is all part of the steering group consultation which, as we know, closes in two days’ time. The group has been reviewing all these items during its consultation, and we need to wait to hear what it says before we go further.

NHS: Seven-day Working

Debate between Baroness Chisholm of Owlpen and Baroness Walmsley

Monday 8th June 2015 Lords Chamber

[Baroness Chisholm of Owlpen]

My Lords, the Government are committed to improving access to GPs’ services, including delivering services seven days a week to ensure that people are able to access primary medical care when they need to. At present, £175 million, including £25 million from the £1 billion infrastructure fund, has now been invested in the GP access fund to improve access to general practice. The first wave was announced in September 2013 and the second in March this year. So there are now 57 schemes covering more than 2,500 practices, meaning that more than 80 million patients—one-third of the country—will benefit from improved access.

[Baroness Walmsley (LD)]

My Lords, in this as with many issues, one size does not fit all, so could the Minister say whether the Government are doing any research as to how their objective for a seven-day-a-week service can be delivered in different kinds of neighbourhoods? The solution for cities may not be suitable for rural areas or small towns, and there are probably many opportunities for innovation, such as near where I live in the small city of Chester, where the Countess of Chester Hospital has a GP unit. Could we not look at what the cottage hospitals and main general hospitals can do to assist general practices in providing this sort of service and keeping people out of A&E?

[Baroness Chisholm of Owlpen]

My Lords, certainly we are looking at all those ideas, and we will gather together all the data that we need before we go forward. But I feel that I should say that there are indicators for this service that cannot be measured, and one of them is quality of life. As a former nurse, at the forefront of my mind was always the question of whether my patient was getting the best care from me, from the specialist and from the hospital. In my book, a seven-day service goes towards achieving that goal.

Medical Data Sharing

Debate between Baroness Chisholm of Owlpen and Baroness Walmsley

Monday 1st June 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I associate these Benches with the words from the noble Lord, Lord Hunt, welcoming the noble Baroness and thanking the noble Earl, Lord Howe. The noble Earl and I both have new roles in this new Parliament.

When the pause that is in place at the moment comes to an end and the programme is implemented again, will the Government undertake to implement a really high-quality public information programme that is much better than the last one, which left people not knowing what their rights were or how to opt out if that was what they wanted to do? Will the Government also do some research about the efficacy of the anonymity scheme for sexual health? Unless people have confidence that anonymity works, we are going to have a lot more than 700,000 of them opting out.

[Baroness Chisholm of Owlpen]

I thank the noble Baroness. Indeed that is true. That is why these pathfinders are so important. They will start in Blackburn and Darwen and make sure that all data-collection actions are evaluated and refined. NHS England has asked the National Data Guardian, Dame Fiona Caldicott, to lead an evaluation of the pathfinder stage, and nothing will go further ahead until she is satisfied that everything is in place.