Fracture Liaison Services

Baroness Donaghy Excerpts

Wednesday 4th December 2024 Lords Chamber

[Baroness Donaghy (Lab)]

I am grateful to the noble Lord, Lord Black of Brentwood, for moving this debate so clearly and comprehensively. I hope that this is not an example of winning the argument, winning the campaign and then losing the starting gun. We need three things to happen immediately. We need that transformation fund to pump-prime fracture liaison services for the first 18 to 24 months when, as the noble Lord, Lord Black, has said, it is estimated that they will start paying for themselves. We need to allow the six integrated care boards that are ready now to begin commissioning services to go ahead, if necessary with some of that transformation fund to support them and, if necessary, before the national rollout plan.

We need clear leadership from the Government and the NHS so that there is a deliverable timetable to ensure that the half of the population not covered by fracture liaison services will be covered by 2030. Just one year’s delay will halve the total hospital bed days saved by 2029, compounding the burden on the NHS. Leadership is vital, because patients find it challenging to keep taking common osteoporosis medications, because they must be taken in a particular way and can cause side-effects. Patients do not feel better from taking them; they reduce long-term fracture risk rather than addressing any current symptoms. One GP who is extremely knowledgeable and committed in this area described how difficult it was to keep patients motivated to take their medication because of ignorance of the subject, no visible changes and the pressures in the system which mean failures to follow up. In England, only 36% of potential patients are reached.

Also, access to diagnostic services varies by region. There is a shortage of DEXA bone density scans and a shortage of radiographers. NHS England indicated that, in September 2024, 56,366 patients were waiting for a DEXA scan and 18.5% had been waiting for more than the target of six weeks. Believe it or not, that is an improvement on the 33.6% waiting more than six weeks in September last year.

I am a member of the Royal Osteoporosis Society and I believed, when I joined it 12 years ago, that we had no osteoporosis in our family. I then discovered, 18 months ago, that my only brother had been diagnosed with it. This can hit in the most unexpected circumstances. I therefore urge the Government to give some indication of when the rollout may happen and when that transformation fund might become available.

NHS: Fracture Liaison Services

Baroness Donaghy Excerpts

Monday 5th February 2024 Lords Chamber

[Lord Markham (Con)]

First, I thank my noble friend for his tireless campaigning in this space. I agree that there is a very good case to be made. Many of us will know the advantage of the fracture liaison services. A lot of studies show that you are at least 10% less likely to suffer from another fracture, so it is a vital part of the prevention programme. There is a very strong case behind it, and my noble friend can rest assured that it is something that we are really looking to progress.

[Baroness Donaghy (Lab)]

My Lords, would the Government agree to a temporary transformation fund to pump-prime the fracture liaison services? If everyone over 50 had access to a quality fracture liaison service, it would prevent 74,000 fractures, which would help people to stay in work and help to take pressure off hospital beds. Would the Minister agree that this would be investing to save?

[Lord Markham (Con)]

As I mentioned, I agree with the noble Baroness that the FLS has shown many cases of prevention. There is a good argument in terms of investment and the return on it all. That is something that we are working towards and, as the noble Baroness will know, it is part of the major conditions strategy for musculoskeletal. So it is something that we are looking to expand.

Maternity Services

Baroness Donaghy Excerpts

Thursday 25th January 2024 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, I thank my noble friend Lady Taylor for initiating this debate with her usual thoroughness and elegance. If the recommendations made by the noble Baroness, Lady Cumberlege, were all implemented, we could go home now. The noble Lord, Lord Patel, nearly made me cry. This is a very important subject, and I am glad that it is being debated. I hope that, even with all the other difficulties that the health service is faced with, the Minister will take on board the vast experience in this Chamber on this subject.

When I was a non-executive director at King’s College Hospital NHS Foundation Trust, we were fortunate to have Cathy Warwick as the lead for maternity services. Directors were kept well informed about what was happening, but I understand from various CQC reports that that good practice does not exist.

I will cover items about the pay structure and about those who experience birth trauma of a severe kind—as well as a little about the deterioration in maternity care; but that has been well covered, so I will reduce that section of my speech.

I believe that the NHS pay dispute was avoidable. The origins go back to the clumsy and arrogant stance taken by previous Health Secretaries. One Health Secretary took the junior doctors on some years ago and beat them. Ministerial memories may be short, but junior doctors have longer memories. Whether they are badly led or well led does not matter; the strength of feeling is still there.

I will refer to the Government’s consultation on creating a new pay scale for nurses and midwives. Having had experience of this, I would caution the Government against any separation for a number of reasons. The Agenda for Change pay structure, carefully negotiated over a long period of time, is underpinned by the NHS job evaluation scheme, which determines the levels at which all healthcare professionals are paid. A separation of the nurses’ pay structure would divide and rule, which is irresponsible in the long term. It would not lead to more money or more midwives, it would not help with the chronic retention problem and, most importantly, it will lead to equal pay claims and a serious risk of unplanned extra costs.

That is not a theoretical view. When I first arrived at ACAS, I was faced with over 500 equal pay claims from ACAS staff. It caused a great deal of amusement from my previous TUC General Council colleagues when they heard I got the job of chair. This was in the days of a Labour Government, so I am not making a party-political point on the subject of pay structures. The problem arose because of the break-up of the Civil Service negotiating structure and the separation of grading by government departments and non-departmental public bodies. ACAS, as an organisation, given the problem of 500 equal pay claims, was faced with sclerosis and low staff morale and risked being a laughing stock, because it was supposed to solve employment relations problems, not be the centre of them.

It was clearly a priority for the ACAS council and the new chief executive to solve. I will not go into the details of how it was done—why give away trade secrets?—but it cost us £10 million. We were given the money by government, but exactly the same amount was taken off us the following year. Subsequent redundancies cost us hundreds of staff and thousands of years of experience. Compared with the number of nurses and midwives, that cost is small beer. I urge the Government to think very carefully before they leave such chaos behind.

The Minister will no doubt be aware of the All-Party Parliamentary Group on Birth Trauma and its recent launch of a parliamentary inquiry on birth trauma. It is co-chaired by Rosie Duffield MP and Theo Clarke MP, and will be assisted by the charity Birth Trauma Association. Its stated aim is to collect evidence so that government can take practical and achievable steps to improve care and support for new mothers and their partners, and incorporate birth trauma into the women’s health strategy. The stories told by some women of their experience are horrifying, and the physical and mental trauma suffered by some are often unrecognised by the very professionals who should know better.

A relative of mine gave birth to two children and the effect on her was shattering. Her mental health did not recover for two decades. She spent months in a mental health institution after each birth. This might have happened under any circumstances, but recognition of the dangers, and the right information and preparation, might have led to a different outcome.

Recent CQC inspections reveal that maternity units are failing women; the figures have already been stated. According to the Birth Trauma Association, some women who have had a dreadful experience find that they are not listened to. They say that complaints are met with attempts to minimise the women’s trauma and deny responsibility. Frequently, the BTA was the first organisation to listen to women’s accounts and acknowledge their trauma.

A common feature is the failure to acknowledge pain levels. In a recent television drama series, two of the regular male doctor characters were challenged to take a test to experience similar levels of pain to those experienced by women in childbirth. The test went from “mild” to “severe”, and they were only half way up the painometer before they pleaded for it to stop. I know that it was a drama—although we have learned how powerful dramas can be, in different circumstances—but it clearly illustrated a point that women have been making for centuries. I should add: please do not try this at home. Will the Minister ensure that his department studies the results of the APPG inquiry when it is published and take steps to improve things?

Finally, the CQC’s 2022 maternity survey, designed to assess the quality and safety of maternity services in England, received over 20,000 responses. They showed that experiences of maternity care have, as has been said, deteriorated, particularly over the last five years. The issues of availability of staff, confidence and trust, and communications and interactions with staff have already been outlined.

I should emphasise, as did the noble Baroness, Lady Cumberlege, that the majority of respondents were satisfied, but sometimes it is now a very narrow majority. For instance, in-hospital care after birth showed that a worrying 57% of respondents said they were always able to get help, while, as my noble friend Lady Warwick said—she has already mentioned the shortage of 2,500 midwives—the Royal College of Midwives has described the impact of staff shortages on women as “stark and sobering”.

Up to now, the Government have said that they have no plans to commission a public inquiry into the future of maternity services, despite the fact that it has been suggested by the Maternity Safety Alliance and Mumsnet. Can the Minister say in what circumstances the Government would change their mind about a public inquiry?

Dementia

Baroness Donaghy Excerpts

Thursday 18th January 2024 Grand Committee

[Baroness Donaghy (Lab)]

My Lords, I thank the noble Baroness, Lady Browning, for initiating this debate. I look forward to the day when this debate is held in the main Chamber.

Losing a loved one while they are still alive is a particularly gruelling experience and any assumptions that one makes about diagnosis and care turn out to be wrong. For example, I had assumed that hospice care took place in hospices. I am not criticising the hospice movement, far from it; its development of care at home, particularly in London, is quite remarkable, and I pay tribute to St Christopher’s Hospice for its invaluable support to me. I had also assumed that there was a system; I was wrong again.

In the short time available, I will concentrate on diagnosis and a social care workforce strategy. As has been said, more than 250,000 people live with undiagnosed dementia in England alone. We have one of the lowest per capita ratios of MRI, CT and PET scanners in the OECD, behind Russia, Slovakia and Chile. Recent effective disease-modifying treatments are not yet approved or commissioned in our country, but, even if they are approved, they require early diagnosis of Alzheimer’s disease and, at present, only 2.2% of people receive the tests in the diagnosis process. Will the Minister tell us what steps the Government are taking to invest in diagnostic infrastructure for dementia? The Alzheimer’s Society has said that improvements in diagnosis should be part of a major condition strategy between the NHS and the Government to put in place a funded plan to improve rates beyond the national ambition of 66.7%, if possible. What plans do the Government have for a major conditions strategy?

My second point is about a social care workforce strategy. The care workforce pathway is a welcome step to improve career development and increase access to training, but it falls far short of a comprehensive long-term social care workforce strategy providing a trained workforce. There are 152,000 vacancies in the adult social care workforce, with 390,000 leaving their care jobs annually. Only 45% of care staff are recorded as having any level of training in dementia, and training is not mandatory. The Alzheimer’s Society has called for a minimum mandatory level of training in dementia for all care staff to tier 2 of the dementia training standards. Can the Minister say when a long-term social care workforce strategy might be available?

The Office for National Statistics identifies dementia as the UK’s biggest killer, with one in three people due to develop it. Why is it not on the front pages of newspapers? Why is it not a political priority? Why does it have the same level of obscurity that cancer had 50 years ago? Perhaps it is reduced to individual human misery and dread for the future, and those affected do not have the resilience to force the pace. Does the Minister think that the Government have any responsibility for this?

National Health Service: 75th Anniversary

Baroness Donaghy Excerpts

Thursday 30th November 2023 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, I thank my noble friend Lord Hunt of Kings Heath for initiating this debate. There are three factors which will ensure that the NHS survives, and the Minister has no control over any of them: finance, social care and decently funded local government. The NHS Confederation has said that that constitutes 80% of health needs, so we are really talking to the Minister only about the remaining 20%. The levels of funding are below those needed to serve an ageing society. It is as simple as that. The absence of long-term funding cycles prevents capital investment. The NHS Confederation states that nine out of 10 health leaders believes that underinvestment in capital is undermining their ability to tackle elective backlogs.

The Government’s complete failure to fix social care has led to acute problems around hospital discharge and an increase in human misery and fear. No sustainable system for care homes means unexpected closures for some and private equity landlords for others. Local government has more and more responsibility piled on it for less and less funding. Whatever happened to the civic pride in the Conservative Party? Without a sustainable local government service, the NHS will continue to bear the brunt of social care failings, and the population will continue to experience inequalities in treatment.

I am sure that other speakers have received numerous briefings; my noble friend Lady Taylor referred to some of them. I appreciate the trouble they have taken and thank the House of Lords Library for its background document. Even allowing for their individual advocacy, they reveal the deeply worrying state of the NHS, whether in capital spending, mental health, skills training, cancer treatments, maternity care or the virtual collapse of GP and dental services in some areas.

I will speak about osteoporosis, to which the noble Lord, Lord Lexden, has already referred. We know that there were talks between the Department of Health, the Treasury and the Royal Osteoporosis Society about funding fracture liaison services in the Autumn Statement. The Minister, Maria Caulfield, made a commitment to action by the end of the year. As the noble Lord, Lord Lexden, said, the noble Lord, Lord Evans of Rainow—who I see in his place—announced in a debate initiated by the noble Lord, Lord Black of Brentwood, that osteoporosis care would be improved, saying that the Government were

“proposing to announce, in the forthcoming Autumn Statement, a package of prioritised measures to expand the provision of fracture liaison services and improve their current quality”.—[Official Report, 14/9/23; col. GC 241.]

However, that statement was withdrawn 24 hours later.

Come the Autumn Statement, it became clear that Ministers had broken their promises to fund fracture liaison services as it contained no references to fracture liaison. NHS England has also confirmed that no expert steering group has been set up or is even in the planning stage. Osteoporosis has been excluded from the advisory groups and working groups of the Government’s major conditions strategy despite being the fourth-worst cause of disability and premature death. Failing to deliver on what was thought to be a commitment will waste £88 million on preventable fractures, including 150,000 hospital bed days. Every year, 81,000 working-age people suffer fractures due to osteoporosis, with a third quitting their job due to long-term pain and disability. If the Government honoured their promise, 74,000 fractures could be prevented in the next five years, including 31,000 life-threatening hip fractures. What plans does the Minister’s department have to honour the ministerial promises made on osteoporosis?

My direct experience in the health service is varied. I was a ward orderly in the 1960s in a Warwickshire hospital, traipsing up and down wards with a cow gown on and pulling a trolley of urine bottles—I must admit, I felt like the bee’s knees in those days. I went on to become a non-executive director at King’s College London and a champion of elder care. However, I still cannot quite get over being older than the National Health Service. I know that the Minister cannot do anything about that but, with the 20% of things he can do something about, can he improve osteoporosis care or is he effectively reduced to rifling in that trunk in the attic marked “reorganisation, reconfiguration, privatisation, efficiency gains and distance medicine”? He is a hard-working and sincere Minister who commands the respect of the House—at least this side of the House. I hope that his expertise will continue to be used in whatever happens in future.

King’s Speech

Baroness Donaghy Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, it is always a pleasure to follow the noble Baroness, Lady Browning. I found myself in the position that she has just described only last year.

I appreciated the tone of the Minister’s introduction to the debate. The gracious Speech referred to delivering on the NHS workforce plan, the first long-term plan to train the doctors and nurses that the country needs. If I had taken 13 years to produce a workforce plan, I would not want to crow about it—and if I had possibly fewer than 12 months in which to deliver it, I would expect a sceptical response.

To give equal weight to minimum service levels to prevent strikes undermining patient safety is a useful electioneering point, but it neglects the fact that most people do not blame the NHS staff for fighting their corner but they do blame this Government for bringing the health service to its knees.

I want to concentrate on two omissions in the gracious Speech relating to the health service. One omission, for which I am profoundly grateful, is that there is no major reorganisation of the health service planned. How much time, money and effort have been put into reorganisations by this Government in the last 13 years, which could have been spent on positive progress?

The second omission is any reference to osteoporosis care. If mental health is the Cinderella service, treatment for the prevention and care of osteoporosis is even further behind. I want to press the Minister on what steps the Government intend to take to end the postcode lottery, whereby some people access a world standard of care while others are fixed up and forgotten in A&E fracture clinics, leaving them at high risk of further injury.

On 14 September this year, we had an excellent debate led by the noble Lord, Lord Black of Brentwood, on improving access to and quality of services in England for people with osteoporosis and those at risk of fractures. The Minister, the noble Lord, Lord Evans of Rainow, said in his summing up:

“We are proposing to announce, in the forthcoming Autumn Statement, a package of prioritised measures to expand the provision of fracture liaison services and improve their … quality”.—[Official Report, 14/9/2023; col. GC 241.]


Some of us were pleased and, frankly, quite surprised by the positive response from the Minister to the debate. However, the following day we sank back down into the slime of low expectation and inaction when we received a “what I should have said” letter from the Minister. I should emphasise that this is not a personal attack on the noble Lord, Lord Evans of Rainow, who sent a detailed response to all those who took part in the debate and who was positive and constructive throughout—perhaps too positive for HM Treasury, which does not like what it regards as premature announcements. The letter from the noble Lord to participants said:

“I should have said ‘the Government will continue to consider options for further work to support those with osteoporosis and at risk of fractures’”.


He concluded by saying:

“I hope this clarification is of use”.

I am prepared to swallow my disappointment at the retraction and even accept that there may have been a breach of Treasury etiquette, but the real issue is whether the Treasury will fund a proposal for a package of funding to support fracture liaison services. This is currently offered to only 51% of NHS trusts in England.

If funding for the package is included in the Autumn Statement, it will be possible to free up 750,000 hospital bed days by 2028, including prevention of 31,000 life-threatening hip fractures. This is an invest-to-save measure that would free up hospital beds—1 million acute hospital bed days are taken up by hip fracture patients—and would prevent disability, or further disability. A universal fracture liaison service would reduce re-fracture levels by up to 40% and improve the chances of providing anti-osteoporosis medications. The stark and horrific fact is that two-thirds of people at risk are missing out on anti-osteoporosis medication—that is 90,000 people.

Fractures caused by osteoporosis affect half of women over 50 and one-fifth of men. They are the fourth most consequential health condition measured in disability and premature death. Hip fracture care costs £2 billion per year, and family carers give 227 hours per year to sufferers. Preventing fractures can help the economy, because 2.62 million sick days a year are caused by osteoporosis fractures, and can help levelling up, because people from lower-income households have a 25% higher risk of fractures and a higher mortality rate following hip fractures.

The Sunday Express has been running a Better Bones campaign, which has attracted widespread support. This needs some strong, visible leadership from the Government and NHS, so that everyone over 50 should have access to quality-assured services. There is already a ministerial model available, adopted in Wales from February 2023. Osteoporosis sufferers have missed out because of the short-term planning forced on the NHS. With focused funding and determined leadership, we might just catch up with the best providers.

Social Care

Baroness Donaghy Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, I thank my noble friend Lady Andrews for initiating this debate, and congratulate her on the Select Committee report. It has been said before, but the report follows other distinguished predecessors. When preparing for this debate, I pulled out my well-thumbed copy of the Dilnot report and the Economic Affairs Committee’s report—otherwise known as “Lord Forsyth’s report”—together with speeches made by my noble friend Lady Pitkeathley. Here we are again: the needs are more desperate and the achievements are less. Some 58,000 fewer older people now receive long-term care, compared with 2015-16. There will be no major development until after the general election, as the introduction of a cap on lifetime care costs and changes to the means test have now been postponed until October 2025. As has been said, these changes were contained in the Care Act 2014, yet we know that 10 years will have gone by before we even start to build a system.

Those providers in the social care industry—if they are caring and conscientious—are seeing diminishing profits and worse deficits. More than half of providers had to turn down admissions and 20% of them have closed services. Those that are less caring and conscientious are making good money out of human misery. Local government funding is half of what it was 10 years ago. What help will the Government give to providers in their remaining two years? In particular, will they continue the enhanced support for energy costs at least to assist providers to stay in business?

With no long-term policy changes in prospect, we have to turn to the short-term mitigations, with the top priority being staffing. Can the Minister tell the House whether it is correct that the Government’s promise in the social care White Paper to dedicate £500 million for

“investment in knowledge, skills, health and wellbeing and recruitment policies”

has been cut by 50%? The executive chair of the National Care Association, Nadra Ahmed, representing the independent carers, believes that the report of these cuts is correct. Martin Green, the chief executive of Care England, commenting on the rumour of cuts, said that

“it will set back social care for many years to come.”

The number of vacancies in the care sector is 165,000. The number of additional social care workers required is estimated to be 480,00 by 2035. Skills for Care has predicted that the UK will lose 430,000 carers in the next 10 years if those aged 55 and over take retirement. Hft and Care England published the 2022 Sector Pulse Check report, which covers, among other things, how the care sector is mitigating staff shortages. The “refer a friend” scheme, international recruitment and increasing use of agency staff each contains its own problems.

“Refer a friend”—a scheme where existing members of staff refer friends or relatives in exchange for financial reward—was the most popular method of recruitment, selected by 24% of respondents. In my view, this method contains real risks that suitability and skills will take second place to the loyalties of relationships. We have seen the consequences of this in various cover-ups of mistreatment of the most vulnerable. I have been a fellow of the CIPD for more than 20 years. Unless the right checks and balances are in place, the “refer a friend” scheme could be seen as a sub-optimal recruitment method.

The second method is international recruitment, used by 15% of respondents. In February 2022, the Government expanded the shortage occupation list; that was welcome but the primary barrier here is pay. The minimum wage that the Government have set for care workers employed from overseas is £10.10 per hour, which causes a disparity in pay between overseas workers and the existing workforce. Obtaining a certificate of sponsorship is bureaucratic and time-consuming, often taking up to 12 weeks. Visa applications are also an issue, with costly legal services beyond the reach of smaller providers. Even the agencies that provide these staff can no longer guarantee to provide workers, which has broader implications for the NHS. Many NHS nurses are doing extra shifts in adult social care rather than working overtime in the NHS. The report concludes that

“failure to manage this market will see nurses leave both the NHS and adult social care and become agency nurses at a few, select high-paying agencies.”

In conclusion, if you are in need of social care and money is not a worry, you can probably still receive a good experience. If you are poor, growing old will be the biggest challenge in your life at a time when you are least able to cope.

Long Covid

Baroness Donaghy Excerpts

Thursday 17th November 2022 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords, I thank my noble friend Lady Thornton for initiating this debate. I am concerned about the low level of awareness of something that affects up to 2 million people. One person said to me on Monday, “Does that mean they’re still contagious?” I am also concerned about the economic implications, particularly for the health service, whose staff were on the front line throughout the worst period. My third concern, which my noble friend Lady Thornton already raised, is about continuing government funding for research into long Covid.

On public awareness, are the Government satisfied that they are doing enough to raise the profile of the devastating effect of long Covid? Now that the newspapers and media appear to have moved on from covering Covid, the sufferers must feel like the disappeared.

I chair the mesothelioma oversight committee, which ensures that payments are made speedily and efficiently to some of the 3,000 people a year who are dying from mesothelioma. It has a low profile, but at least those diagnosed have the satisfaction of knowing that they and their families will have financial support—thanks to the noble Lord, Lord Freud, when he was the Minister.

Of course, I do not claim that long Covid is a terminal illness for most sufferers. I am grateful to and thank the noble Baroness, Lady Scott of Needham Market, for using the parallel cases of ME sufferers. Awareness, financial support and funded research are vital in all these health areas. What plans do the Government have to raise awareness and enable families to feel supported?

Secondly, on the economic and employment implications, I am aware that the National Institute for Health and Care Research is doing some research into economic evaluation, but does the noble Lord have more information about the impact on health workers? How many are affected, and in what areas? Given the number of vacancies in the health service, surely a focus on the recovery of these workers as speedily as possible would pay dividends.

The BMA said that doctors who had contracted long Covid had been let down by the Government’s failure to provide adequate support, with staff faced with a premature return to work—assuming they are physically able to—or with being unable to pay their mortgages. We know that 2,100 health and care workers lost their lives due to Covid-19, and at least 199,000 NHS workers are living with long Covid. They are seven times more likely to have had severe Covid than other workers, and much of this took place with no or inadequate PPE.

Temporary staff or locums have already lost their jobs because they did not have job security. Does the Minister know how many formal absence procedures have been initiated in the health service, and how many people have been dismissed due to long Covid? We still do not appear to know the extent of the loss to the labour market. The noble Lord, Lord Bethell, also broached this. The Resolution Foundation stated that it could be 600,000. The Institute for Fiscal Studies estimated that it was one in 10. It is clear that the majority are not getting enough help. NHS England data suggested that, up to August 2022, only 60,000 people suffering from long Covid had been assessed by an NHS specialist. If the 600,000 figure is correct, the gap is concerning.

This brings us back to the questions of awareness and profile. The patient does not know that they can get help, and the GP does not recognise the symptoms. Either way, there is a huge job to do. What role do the Government have in improving the position?

The Chief Executive of NHS England, Amanda Pritchard, said recently:

“The NHS faces the toughest winter of my career and potentially the toughest winter in its history.”


This does not sound like someone expecting adequate support from the Government.

In the paper, Our Plan for Patients, published by the DHSC in September, the then Secretary of State, Thérèse Coffey, said that

“this Government will be on your side when you need care the most.”

This sounds fine, but there is no reference to long Covid in that paper.

Finally, what assurances can the Minister give about the Government’s continuing funding for research? I am aware that the NIHR is conducting 19 studies. Ten years ago, I was an independent member of one of its sub-committees, but I no longer have that link. Many of these pieces of research are still in progress, but some themes are emerging. Mesothelioma was underresearched for decades. Will the Minister guarantee that this will not happen with long Covid?

Disabled People: Personal Assistants

Baroness Donaghy Excerpts

Wednesday 7th September 2022 Lords Chamber

[Lord Kamall (Con)]

One issue that I think noble Lords across the House agree on is a suggestion made by the noble Baroness, Lady Thornton. If we want to make sure that we have the right number of workers, we should improve training over here, but there will clearly be a skills gap in this country and therefore we need to look overseas. Sadly, as I said earlier, under the Home Office rules at the moment, individual employers do not count as sponsors. Officials in the department are having conversations with DWP to look at whether that can be rectified, or whether there is a way to find a trusted sponsor.

[Baroness Donaghy (Lab)]

My Lords, working-age people with disabilities are virtually prisoners in their own homes. We are not talking about improving skills or having conversations. When disability is supposed to be a subject where people are treated as normal citizens who want and can go out to work with sufficient support, we are looking for some answers from the Government about how they can do so. Why are the Government only having conversations, after 12 years?

[Lord Kamall (Con)]

The Government have been committed to ensuring that there is equality for disabled people, including plenty of initiatives in other sectors—transport, building new homes and offices, and retrofitting—but the issue of personal assistance is a particularly difficult one in the context of social care having been treated as a Cinderella service for years. Some of the initiatives that we are putting in place, such as the proper qualifications and recruitment from overseas, sadly do not yet apply to personal assistants because of the rules. We are looking at those barriers and hopefully will be able to tackle them.

Integration White Paper

Baroness Donaghy Excerpts

Thursday 10th February 2022 Lords Chamber

[Lord Kamall (Con)]

I respect my noble friend for his willingness to pass on the benefit of his many years of advice to me.

We do not want to get overly prescriptive. We have talked about health and well-being boards and I know that my noble friend has talked about their importance. In the papers I laid in the Library the other day, where we looked at integrated care boards and integrated care partnerships it was quite clear that, in some places where the health and well-being boards may well completely overlap with the ICPs in a smaller area, that will continue to be the place-based level. Where there is a larger system, we expect the integrated care board and integrated care partnership to work with the local place-based organisations underneath them at a more local level. That is what we have been saying all the way through. We want to make use of existing fora. In some places they will overlap and may well end up as the same thing. We will update the health and well-being board guidance in due course to reflect the implications of policies set out in the White Paper and what comes out of the Health and Care Bill when it passes.

[Baroness Donaghy (Lab)]

My Lords, mine is a simple question. We have two separate pieces of legislation on the same area. How does the Minister guarantee that we will not end up with two contradictory systems?

[Lord Kamall (Con)]

The only legislation I am aware of is the Health and Care Bill; this White Paper complements that, just as the adult social White Paper does. This is not legislation.