Covid-19: Deep Cleaning
Baroness D'Souza Excerpts(4 years, 8 months ago)
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Lord Bethell
My noble friend is quite right that measures require preparation. This Government are determined not to be caught on the hoof. In his public statements on Monday the CMO was clear that there are three areas where the modelling suggests there might be a major difference to the delay processes that the House has heard about and understands. My noble friend is also right that the safeguarding of older and vulnerable people would be a likely candidate for that. A substantial amount of time is required though, maybe 10 to 12 weeks or more. It is important that social acceptance of that kind of measure is in place before it is initiated. We are also looking at modelling the kinds of changes which would mean that those who display any symptoms might seek to socially distance themselves or that those who have been tested think about ways of putting space between themselves and their families. These are the kinds of illustrative examples that the CMO has already discussed publicly, and the Government are preparing for those kinds of scenarios at the moment.
Baroness D'Souza (CB)
My Lords, I am told on good scientific evidence that the Covid-19 virus is surrounded by a fatty skin, and that therefore the only way to deal with it effectively is by using hot water and soap. Can the Government slightly modify their advice? I am not sure that gels or cold water will have the intended effect; only hot water and soap will.
Lord Bethell
The CMO has been very clear on this important point, and I thank the noble Baroness for making it. The virus is washable. Sanitisers, cold water and soap work, but undoubtedly, hot water and soap for 20 seconds while singing a song of your choice is by far the best way of dealing with this threat.
Children and Young People: Mental Health
Baroness D'Souza Excerpts(6 years, 7 months ago)
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Lord O'Shaughnessy
I recognise the right reverend Prelate’s point about the rising demand for services. We are trying to increase the proportion of children and young people who are helped from a quarter to a third, but obviously that leaves two-thirds who will not be helped. So there is a long way to go. We are unfortunately starting from a low base; we have to bring together many new staff and teams. I agree with the right reverend Prelate that speed is of the essence, but we must also be realistic about what we can achieve.
Baroness D'Souza (CB)
My Lords, are the Government carrying out research on the causes of the increase in mental health issues in both young children and teenagers?
Lord O'Shaughnessy
The answer is yes, they are: the Green Paper has commissioned further research, and the amount of funding the National Institute for Health Research puts into this area has increased by 50% over the last seven years. However, we still do not understand the causes behind all mental illness, so this is an essential part of the strategy.
Children and Young People: Mental Health Services
Baroness D'Souza Excerpts(6 years, 8 months ago)
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Lord O’Shaughnessy
I thank the noble Baroness for those questions. On the issue of high eligibility thresholds, we are grappling with a need to expand the amount of mental health services that can be provided. Currently, about one in four children with a diagnosable mental health condition accesses NHS services. That is clearly not enough and the intention is to get that figure to one in three by 2021. Again, that is not enough but it would be progress. There is a need to move along the path, dealing first with those in the most acute trouble and then rolling out to those with less acute conditions. I agree with the noble Baroness’s point and recognise the issue. However, this cannot achieved overnight, not least because a huge number of new staff are needed to be trained in order to deliver that. We are looking at the issue of referral criteria. I should also point out to her that we have made big steps forward on waiting times and new standards for early intervention in psychosis and eating disorders. We are piloting a waiting time for access to specialist help and hope that that will start to move things along in terms of more children being seen more quickly, which is what we all want.
Baroness D’Souza (CB)
My Lords, does the Minister agree that more work needs to be done on finding out what the early warning indicators of mental health breakdown in young children are?
Lord O’Shaughnessy
I absolutely agree. This is why the changes that we are making to mental health awareness training in primary schools is critical. Most primary schools, through nurseries, take children from four—and even two or three—years old to make sure that staff can spot the signs in school and signpost to specialist services, where required.
Care Bill [HL]
Baroness D'Souza Excerpts(11 years, 1 month ago)
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The Lord Speaker
I remind your Lordships that if this amendment is agreed, I cannot call Amendments 129 to 131 by reason of pre-emption.
Baroness Masham of Ilton (CB)
My Lords, it is vital that people with mental illness have adequate aftercare. I ask the noble Lord, Lord Patel of Bradford, if his Amendment 128A would cover such cases as the tragic case of the schoolgirl who was travelling by bus to school and was killed by a person who was mentally ill. There should be more protection for the public, who are at risk from mentally ill people who are let loose in the community without adequate aftercare and supervision. It is vital that people have aftercare, otherwise we will have more and more disasters.
Health and Social Care Bill
Baroness D'Souza Excerpts(12 years, 11 months ago)
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“(5) In discharging its duty under subsection (1), the Board must publish guidance for clinical commissioning groups that includes the option to opt out and explains the extent of compliance with—
(a) the quality standards prepared by NICE under section 231 of the Health and Social Care Act 2011;(b) indicators included within the NHS Outcomes Framework; and(c) minimum standards set by the Board on patient related outcomes measures.”
The Lord Speaker (Baroness D'Souza)
My Lords, I advise the Committee that if the amendment is agreed to, Amendments 110 and 110ZA cannot be moved by reason of pre-emption.
Lord Butler of Brockwell
My Lords, with the agreement of the noble Lord, Lord Newton, I move Amendment 109A, which stands in my name and his. I can do so briefly, although the amendment is important and, I hope, helpful. I declare an interest as the chair of King's Health Partners, an academic health science centre. Part of the centre's mission is to accelerate the translation of research into patient care—getting a faster process from bench to bedside. It is in that capacity that I move the amendment.
The focus in the Bill on outcomes for patients is very welcome. It is also welcome that Clause 20 gives the Commissioning Board a duty to promote compliance with the quality standards prepared by NICE, as well as guidance published by the Secretary of State. There may be circumstances in which there are good local reasons why NHS providers should not comply with NICE guidelines. One such circumstance may be where there are innovative treatments that have been approved but with which NICE guidance has not yet caught up. We do not want the clause to stifle the introduction of such initiatives, which the creation of AHSCs is designed to promote and which are greatly in the interests of both British industry and patients. For this reason, Amendment 109A introduces an element of flexibility through a comply-or-explain regime. It will give providers the opportunity, in cases where there are good reasons why they should not comply with the NICE guidelines, to depart from them provided they can explain their non-compliance satisfactorily. That is all I need to say about the amendment. I beg to move.
Health and Social Care Bill
Baroness D'Souza Excerpts(13 years ago)
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The Lord Speaker (Baroness D'Souza)
I must advise your Lordships that if Amendment 48 is agreed to I cannot call Amendments 49 to 51 by reasons of pre-emption.
Amendment 48
Health and Social Care Bill
Baroness D'Souza Excerpts(13 years ago)
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The Lord Speaker (Baroness D'Souza)
My Lords, I would like to remind the Committee that if either Amendment 3 or Amendment 4 is agreed to, I cannot call Amendment 5 by reason of pre-emption. I call the noble Baroness, Lady Williams of Crosby.
Baroness Williams of Crosby
I apologise for the slight delay in rising to my feet—my understanding was that the Minister was proposing to start the debate by making a statement. I apologise for delaying the House. Let me say right away that I do not resile in any way from the amendment which the noble Baronesses, Lady Jay and Lady Thornton, the noble Lord, Lord Patel, and I have put down. We believe that it is important to have an absolutely solid basis by which the whole of the House and the public can understand exactly the accountabilities and responsibilities of the Secretary of State. It is therefore of great importance that this House, in this crucial Committee sitting, is able to reach a clear understanding of what those responsibilities and accountabilities are.
I very much hope that that will be possible as there are still legal questions about the particular meaning of both the amendment put forward by the noble and learned Lord, Lord Mackay of Clashfern, and the amendment put forward in the names of the noble Baroness, Lady Jay, myself and others. There are still difficulties and differences of opinion between legal voices about exactly what the forethought of those amendments is and just how clearly they lay out the responsibilities and accountability of the Secretary of State. Some Members of this House will recognise that one difficulty is that the Secretary of State is extremely anxious to avoid any further micromanagement of the health services because he believes that it would reduce professional discretion. I think that many of us sympathise with that argument.
The difficulty is that many of us also believe that the Secretary of State should have clear accountability for the very large sums involved in financing the NHS at present. We also have regard to the fact that there are certain crucial responsibilities revolving around things such as national emergencies for which we believe the public would expect the Secretary of State to be the person responsible. So on constitutional grounds, and on grounds of financial accountability and clear responsibility in certain areas of national concern, we are anxious to see that the Secretary of State retains those responsibilities. However, the possibility of drafting legislation which comprises both the issue of having no micromanagement and the issue of the crucial ultimate responsibilities of the Secretary of State has proved somewhat elusive. In that situation, I hope very much that the Government will consider pressing ahead with trying to draft acceptable legislation for Report stage, when I hope there can be broad agreement about what the responsibilities are. I cannot answer for my noble friend the Minister, of course, but I hope that he will give consideration to that request.
Perhaps I may quickly add three other considerations. The first, which I have mentioned already, is the area of legal ambiguity. I think that all Members of this House will have heard clashes of opinion about the precise meaning of the amendment before us. I regret that, and I hope the legal profession will forgive me for saying that when there is more than one lawyer in a room there is very often more than one opinion. That is exactly the situation in which we find ourselves. Secondly, many of us feel—I would certainly speak for myself and my party, and this point was raised by the noble Baroness, Lady Jay—that it is absolutely critical to look at Clauses 4 and 10 together with Clause 1, rather than trying to take them separately. They are intimately interrelated. Many of us recognise that to make a change in Clause 1 without taking on board the implications of Clauses 4 and 10 would leave us in a world of deep twilight uncertainty.
The third issue is perhaps a bigger one; perhaps it constitutes a vision that I profoundly hold. I think we all recognise that the NHS is deeply cherished in this country. It is something to which people cling, as they find themselves facing financial hardship, as one of the few certainties and areas of trust that they can rely on. However, we also know without any doubt of the essential need for change in the NHS—my noble friend the Minister and others have made this absolutely clear—if we are to be able to finance an aging population, and not least, although we often neglect this, the very welcome survival of far more people with chronic sicknesses than used to be the case even 20 years ago, all of which lays heavy responsibilities on the health service. Because of that, I for one feel strongly that the greatest prize that this House could give to the future of health services in this country would be to reach a broad political consensus on the issue, so that the NHS and other health services, as they go forward, find that they are based on a solid rock of acceptance and consensus that will carry us through many of the ups and downs that we are bound to face in the next few years.
Health and Social Care Bill
Baroness D'Souza Excerpts(13 years ago)
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“Principles of the Health Service in England
(1) Any person or body performing functions or exercising powers under this Act in relation to the Health Service in England must have regard to the principles and values outlined in the NHS Constitution.
(2) Any person or body performing functions or exercising powers under this Act in relation to the Health Service in England, or providing services as part of the Health Service in England, must provide quality, equity, integration and accountability, not the market.
(3) The primacy of patient care shall not be compromised by any structural or financial re-organisation of the Health Service in England.
(4) There must be transparency and openness wherever taxpayers’ money is being spent, and all accountable individuals and bodies should abide by the Nolan principles.
(5) “The Nolan principles” means the seven general principles of public life set out in the First Report of the Committee on Standards in Public Life (Cm 2850).
(6) Schedule (Principles of the Health Service in England) has effect.”
The Lord Speaker (Baroness D'Souza)
My Lords, I point out to the Committee that in line 8 of the amendment, there is a misprint. “Must provide quality” should be read as “must promote quality”.
Baroness Thornton
My Lords, I thank the Lord Speaker for making that correction and assure the Committee that the correct word is “promote”, not “provide”. In the context of the Bill, as noble Lords will be aware, the difference between promote and provide is a subject on which we will have many debates in the days to come. I apologise to the Committee for not having read my own amendment more carefully when it was published.
To noble Lords who are familiar with this kind of amendment, I apologise in advance. There may be some who are not; we have many new Peers with us today. Perhaps I may explain what we are doing here. The Liberal Democrats will be more familiar with this procedure because from time to time they placed this kind of amendment before the House, aiming to set a framework for the Bill in question or to give further definition of a Bill. Indeed, from time to time, they succeeded in persuading the House to support them. I know the House appreciates a good precedent. I believe that the last time there was an amendment before Clause 1 was in the Apprenticeships, Skills, Children and Learning Bill in 2009, when the Liberal Democrats and the Conservatives both put amendments down before Clause 1. Forgive me, I am not absolutely certain if either or both of them succeeded. I have a feeling that the noble Baroness, Lady Sharp, may have succeeded on that occasion.
The aim of this amendment is to set out some principles and a framework for the Bill to follow. In doing so, we have sought the widest possible genesis for this amendment, and I will explain this to the Committee in a moment. This first amendment kicks off Committee stage and concerns the principles that ought to underpin the health service in England. The amendment stresses the rights and pledges, values and principles, as outlined in the NHS constitution produced by Labour when in government. The amendment also places protection and promotion of patient care above structural or financial reorganisation. It calls for transparency and openness in decision-making, especially those decisions on funding, to ground proper accountability at the heart of our National Health Service. It seeks to set a framework around which the debate on the rest of the Bill can follow. I tabled this amendment partly because while the Government say they agree with all of these matters, at present the Bill still fails to reassure people that it delivers them. The confusion and lack of trust will be the substantive matter in many of the almost 400 amendments that have already been put down on this Bill.
At their spring conference, the Liberal Democrats made it clear that they wished to set beyond doubt that the Bill will not establish the NHS as a utility-style market based on the now outdated model that is currently failing in energy. How right the Liberal Democrats were. I share the doubts of the noble Baroness, Lady Williams, that the changes in the Bill achieve that. The need for a defining set of principles arises out of the failure of the Government to provide any reasonable explanation of what this Bill is for and what their strategy for the NHS actually is. The Government keep telling us that it has to be a different NHS so I am seeking some definition on what we can agree about and to place those principles at the front of the Bill.
We like to think of this amendment as a perfect cross-party marriage in its crafting. We have something old, something new, something borrowed and something blue. The old is the NHS constitution; although not very old, it was devised and brought about by the Labour Government and put through the House by my noble friend Lord Darzi, and we are proud of it. This is in subsection (1) of this amendment and is reflected in Amendment 52 to the schedules that list the principles of the NHS constitution, particularly with relation to patient care. I have borrowed the words of subsection (2) from the resolution that was passed at the Liberal Democrat spring conference, with the very slight addition of “integration and accountability”, which I am sure would have been there had they thought of them. I did wonder about the last three words—“not the market”—but I think everyone knows what that means. It does not mean that the NHS should not be engaged with the market, nor that there is not a place for the planned use of private and other providers within the NHS. It is there because the first Bill included a clear commitment to use competition as the main means of reforming the NHS and I think we still need to be clear that this is not the case. These Benches and the Liberal Democrats are in some agreement about this matter—at least I hope we are—and I think we should say so at the beginning of this Bill. Subsection (3) is blue, coming as it does from the coalition agreement. We will stop top-down reorganisations that get in the way of patient care. These words echo those of the Prime Minister when he said, “no top-down reorganisation”. The new, in subsection (4), is the most recent player in this Bill: the Future Forum, which has quite rightly brought the probity of the Nolan principles into this Bill.
It seems to me that only with clarity around the principles will the Government have any chance of taking the 1 million-plus staff of the NHS with them. Given the British Medical Association survey released yesterday, and GPs’ survey a week or so ago, the words of the Royal College of Nursing and many others, the Government have some way to go in persuading the staff to wholeheartedly support these changes. So I suggest that this statement of principles will help the Government in this task. It will also help the passage of this Bill. I hope that the Minister and the Committee will feel the same.