Social Care Funding (EAC Report)

Baroness Finlay of Llandaff Excerpts

Thursday 28th January 2021 Grand Committee

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare that I chair the National Mental Capacity Forum and am a Bevan Commissioner. This commendable report provides a way forward, recommending that there must be an appropriate national funding formula. That formula must be fair, recognising that areas of high costs are often in areas of less business buoyancy, meaning that the desire to make local authorities more fiscally self-reliant risks widening gaps in provision and worsening the postcode lottery.

The report was prophetic. The pandemic has shown that social care cannot be used as a pressure valve for the NHS. It has also revealed to the nation, as the report points out, that social care sector staff providing direct care are underpaid and undervalued and that their personal well-being has often been overlooked.

Personalised care has two distinct roles. One is providing all the personalised care underpinning and integrated with healthcare interventions, often delivered by health and social care staff working together. Any division based on budgets creates an artificial split, with expensive bureaucratic processes if a person’s care moves from one sector to another, either geographically or by diagnostic category.

The other role of personal social care is to support people—often working-age adults—in their own homes, to allow them to live well and contribute in our society. A key part of this role is in the prevention of healthcare problems arising. Yet this prevention role has been chronically undervalued, even though it saves avoidable expenditure from the health budget. The future of public health in social care needs much greater emphasis.

During the pandemic, some charities have instigated innovative programmes to deliver social care and support, several seeing great results in improving mobility and independence. But current funding difficulties for charities have revealed our overreliance on this sector over years.

The report highlights the workforce—without a workforce any structure will fail and there will certainly be no resilience. Will the Government urgently look again at a proper career structure with parity of esteem and of pay for those in social care? Percentage pay increases simply widen the gap between the lowest paid, who do the work with the most vulnerable, and others. Staff need their travel time between homes recognised and to be able to park on arrival. They need ongoing training and supervision, with support for their own well-being—if they feel cared for, they are better able to care for others. Those receiving social care are potentially very vulnerable, which is why a proper registration and revalidation process of social care staff would set a national standard and could provide a focus—to nurture staff, helping them feel pride in their work and more respected. Their work is highly skilled and low paid, and their indemnity needs sorting out across the sector in the long term as part of an integrated system.

Form must follow function in a fair national funding formula that recognises our duty to each other in society. In this way, we might be able to move forward. To not heed this report will worsen our problems.

Medicines and Medical Devices Bill

Baroness Finlay of Llandaff Excerpts

Report stage & Report: 2nd sitting (Hansard) & Report: 2nd sitting (Hansard): House of Lords
Thursday 14th January 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare that I am vice chair of the NICE review committee. Amendment 66, moved by the noble Lord, Lord Hunt of Kings Heath, aims to ensure early access for NHS patients to medicines and medical devices. This must also involve ensuring that results of safety and efficacy from devices in real-time use—as well as in trials—are registered, published and then considered again in real time, a process that I hope will be helped and promoted by the patient safety commissioner role.

Noble Lords will remember that in Committee I tabled, along with the noble Lord, Lord Hunt of Kings Heath, an amendment to ensure provision for the development of a new rapid provisional two-year licensing procedure. The intention behind that amendment was to ensure that patients could more quickly access potentially life-saving medicines and medical devices.

I sincerely thank the Minister and his team for meeting with me on this, and for the other meetings they facilitated. I am reassured that the approval processes from the MHRA over device development are due to be revised completely over the coming year, with improved and streamlined processes, and I hope that today the Minister can confirm this, even with a timeframe, so that we can move forward quickly.

We have a unique opportunity to develop devices and roll them out to the NHS, but it is important that approval processes do not slow down or block patient access to improvements in treatment and management over a wide range of conditions, particularly rare disorders. Evidence from real-time use is crucial, and development and improvement can become a virtuous circle when that is rapidly fed back—so we become the intellectual innovation hothouse for our future prosperity, while also benefiting our patients. The UK can then be seen as a favourable place to develop, approve and supply medicines and medical devices.

Speeding up and widening approval processes, including two-year provisional licensing that I have been advocating with the Royal College of Physicians, would ensure that developing a new device from beginning to end—taking an idea from conception to supply—all in the UK is seen as an attractive prospect. Otherwise, we continue to risk new devices beginning their innovation journey in the UK, then being taken abroad part-way through the development process and marketed back to the UK. Keeping the entire process in the UK, with different models of fast-track approvals and provisional approvals, will allow better oversight of the safety and efficacy of devices during early access, with ongoing monitoring in real-time use. That would then facilitate moving into appropriately costed long-term approval processes.

We can innovate in the UK and stop intellectual capacity being outsourced. We can protect the safety of patients while getting them access to the latest treatments. It is patients who will suffer if we do not get this right, which is why the proposals in this amendment are so important.

Covid-19: Variant

Baroness Finlay of Llandaff Excerpts

Wednesday 13th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, PHE weekly seroprevalence data suggests that antibody prevalence among blood donors aged 16-plus in England is 6.9%, which is consistent with other data that we have. The MHRA has considered this and has decided that vaccinating is just as important for those who have had Covid-19 as it is for those who have not.

[Baroness Finlay of Llandaff (CB) [V]]

How are demographic and NHS outcome data and test results from patients across the UK being collated to identify patterns suggesting further new variants, reinfections, changes in risk factors to severe disease, such as malnutrition, and planning for managing long Covid and modelling ICU provision?

[Lord Bethell (Con)]

The noble Baroness alludes to a world of analytical complexity, which is very much what we have to look forward to. The way in which this new variant has popped up and has been dramatically more transmissible presents a wholly different level of threat compared with the one that we were dealing with just six weeks ago. It is a matter of grave concern to all of us that this mutation has happened. However, I reassure noble Lords that we have very strong genomic capability in this country. Roughly 5% of all tests are analysed. It is only 5% but that is more than in most other countries, and we are putting in the analytical muscle to be able to process that data.

Medicines and Medical Devices Bill

Baroness Finlay of Llandaff Excerpts

Report stage & Report stage (Hansard): House of Lords & Report: 1st sitting & Report: 1st sitting: House of Lords
Tuesday 12th January 2021 Lords Chamber

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, I, too, welcome the Government’s amendment establishing the patient safety commissioner. This is highly significant and a great tribute to the noble Baroness, Lady Cumberlege, and her team. I should also declare an interest I must declare an interest as a member of the GMC board.

The noble Baroness’s report, First Do No Harm, is a stark and moving account of how thousands of patients were let down in a serious and life-changing way. I go back to her report because she found that the healthcare system, in which she included the NHS, private providers, regulators, professional bodies, and pharmaceutical and device manufacturers, was disjointed, siloed, unresponsive and defensive. It does not adequately recognise that patients are its raison d’être. Those are telling points, which led the noble Baroness to recommend the appointment of a patient safety commissioner, an independent and proactive public leader with a statutory responsibility to champion the value of listening to patients and promoting users’ perspectives in seeking improvements to patient safety. That is welcome and it will be essential that the person who is appointed is robust, fearless and commands wide respect. Their independence needs to be assured. I hope also that the appointment will be subject to Select Committee scrutiny and I should be glad if the Minister can comment on that.

Picking up on a point that the noble Baroness made, I should also be grateful if I could have a little more explanation about what is meant by relevant bodies, as defined in the schedule. It is clearly important that bodies with responsibilities in relation to patient safety are expected to respond to a report or recommendation made by the commissioner. Can the Minister give a broad indication of the relevant bodies? Also, in relation to the private health sector, my reading is that this is covered by the Bill and that the schedule provides for that. Can the Minister respond?

Overall, however, I commend the Minister on the Government’s response to this significant recommendation by the noble Baroness, Lady Cumberlege.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, these amendments are a testament to the incredibly hard work and perseverance of the noble Baroness, Lady Cumberlege, the Minister and the noble Baroness, Lady Penn. They have all worked hard to get to this point. The report, First Do No Harm, must be a turning point in driving up better outcomes.

I hope that in the response to these proposals it will be helpful to have reassurance that the new post will be adequately resourced, the timeframe for fulfilling the appointment is rapid, and, subsequently, regulatory requirements can be defined and relevant statutory instruments drawn up. The independence of the post-holder is crucial. The person must be able to work across all the different and varied organisations and structures that have responsibility for patients, directly or indirectly. That will require promotion to all organisations that they have a duty to co-operate and collaborate with the commissioner to ensure that early warning signals are picked up and heeded through processes that are light on bureaucracy yet rapidly responsive in order to pick up signals. We cannot have years of accumulation of distressed patients. When things start not to be right, those amber warning lights must start flashing.

I urge the Minister to ensure that the remit of the commissioner is as wide as possible. For example, the coroners’ reports that the noble Baroness, Lady Cumberlege, referred to have not had adequate enforcement by others sometimes. The reports made powerful recommendations but it was found that those responsible for enforcing them have been so slow to act that the proposals have effectively gathered dust.

In previous debates, I raised the need for the yellow card scheme to be updated—opened for easy use by patients themselves, who may wish to report adverse outcomes. The wording of the Bill that I found most helpful and welcome is the part stating that the role

“does not prevent the Commissioner considering individual cases and drawing conclusions about them for the purpose of, or in the context of, considering a general issue”.

Can the Minister make sure that the reporting mechanisms are open to patients and do not hit a hurdle when they try to report to a clinician who does not recognise the full import of they are saying?

To conclude, I reiterate my congratulations to all, particularly the noble Baroness, Lady Cumberlege, and her team, and look forward to the next phase of working with her and others as this important development moves forwards.

[Lord O'Shaughnessy (Con)]

My Lords, I join other noble Lords in expressing my sincere thanks to my noble friend the Minister for the progress that we have made. In all fairness to him, he said that since Second Reading he was listening, but we all know that it is sometimes possible to listen and not hear, let alone act. On this occasion, he heard and acted. I join other noble Lords in expressing my sincere gratitude for that.

I also pay tribute to my noble friend Lady Cumberlege. No one doubted her tenacity but it has been on display in bucketloads, and she has made the progress that her superb report deserves. More than anyone, I pay thanks to the army of campaigners; many of us have met them, and they could not help but move us with their stories. This legislation is ultimately for them and a tribute to them.

I had a close look at my noble friend the Minister’s amendment and compared it to that of my noble friend Lady Cumberlege. Clearly, there is a specific issue about where the organisation, the commissioner, should sit, but there is a precedent for doing that in the way in which the Minister suggested. I take confidence from his determination to give proper independence to the role. A lot will depend on the kind of person recruited, how they are recruited and to whom they are accountable. I should like him to say a little more about how he envisages that happening.

We also need to hear more detail on the timetable. The Minister will know that when one makes big commitments of this kind, they are staging posts—never the destination. There is still some way to go in making sure that we get there quickly. That is important, as my noble friend pointed out. However, the powers in the amendment are important to recognise. On the ability to demand information from relevant persons, as other noble Lords have said, we need to hear a little more about who they are and the consequences of non-compliance. However, they are powerful ways in which the commissioner can act and create change in the system. I have no doubt that they will be effective.

In conclusion, I make a couple of comments provided by the ABPI’s briefing. They relate to further questions around the nature of the relationship between the commissioner and the MHRA and other bodies, how the four nations of the UK will act together on patient safety, given that we are a single market, and ensuring diversity of patient voice.

I would also add one more thing to that. Patient safety is not just about finding out when medicines and devices go wrong; it is also about access to them. Will the patient commissioner have a remit to investigate these kinds of issues?

However, these questions are for tomorrow. Today, we want to recognise the progress that has been made and the amendments put down in the name of my noble friend. I thank him sincerely for them and I thank my noble friend Lady Cumberlege for her dedication to this particular cause.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, it is a great pleasure to follow the noble Lord, Lord Hunt of Kings Heath, on this very important amendment. It is an example of how, with high moral standards, the Ministers involved have been listening. With others, I wish to sincerely thank the noble Lords, Lord Bethell and Lord Ahmad of Wimbledon, and the noble Baroness, Lady Penn, who have listened to very difficult information and accepted the important responsibility we have on the world stage.

Health Protection (Coronavirus, Restrictions) (Self-Isolation and Linked Households) (England) Regulations 2020

Baroness Finlay of Llandaff Excerpts

Thursday 7th January 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB) [V]]

Today, Health Service Journal published:

“Hospitals, particularly in London and the surrounding areas, are seeing very high and rapidly growing numbers of covid-19 admissions, and are running out of options to free up beds.”


Discharge of patients to care homes has become increasingly difficult, despite beds in many care homes lying empty, as care providers fear repeating the disaster of the spring in the sector, and they are not insured to become Covid-designated homes. Will the Government provide rapid short-term indemnity, such as is provided for the NHS?

Ysbyty’r Seren in Bridgend is the busiest field hospital, operating since mid-October as a step-down unit. Today it has 72 patients. Wales has been about two weeks ahead in this second wave and important virological evidence is emerging. Is experience being sought from Wales for the Nightingale hospitals and is data from all aspects of the pandemic, including genomic testing, being rapidly shared?

Lockdowns have seen a drop in other respiratory infections, such as respiratory syncytial virus, yet sceptics are doing untold damage, endangering the lives of many, including clinical staff who are now exhausted, burnt out, seriously ill with Covid or having to isolate. As the Minister said, the new variant is highly infectious, yet many workplaces, such as factories, food processing plants and schools have remained open without any ventilation system guidance. Will the Government urgently learn from Germany and instigate ventilation guidance, support and certification of ventilation systems, establishing a rapid national standard for machines that lower viral count in the ambient air?

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) (No. 2) Regulations 2020

Baroness Finlay of Llandaff Excerpts

Wednesday 30th December 2020 Lords Chamber

[Baroness Finlay of Llandaff (CB) [V]]

Dame Deirdre Hine’s report on the 2009 influenza pandemic recommended raising public awareness and understanding about the key characteristics of a pandemic and core response measures. Yet we learned little. A failure of public communication through excessively optimistic mixed messages has led to deepening distrust. Some reporters, such as Fergus Walsh, have explained the scientific and clinical reality well, but we need clear, consistent messaging across the UK, sharing uncertainty and true risk. For example, the B.1.1.7 variant infectivity in effect adds more than 0.4 to the R number. The current reality is proving even worse than the modelling predictions for the coming months for bed shortages, overloaded services, staff infections and exhaustion. Second-time infections are now presenting, as antibodies seem to be short-lived.

Yes, the vaccine is brilliant news; it should prevent fatal infection. But infection control measures will remain essential in the long term. We do not know how long the immunity will last, whether those immunised will still get infected and be viral carriers and spreaders, nor how rapidly further mutations will develop, leading to the need for new modifications and new vaccines. Will the Government collate immunisation data from the NHS number with diagnostic data in the long term to understand the epidemiology as it evolves? Mixed messages and false hope fuel mistrust. Control will only be achieved by collaboration with the public when they understand that vaccination is not a quick fix.

Covid-19 Update

Baroness Finlay of Llandaff Excerpts

Tuesday 15th December 2020 Lords Chamber

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare that I chair the National Mental Capacity Forum. I ask the Minister to express thanks to staff in his department as they continue to work with us and the Ministry of Justice to run a rapid-response webinar on Friday, requested from primary care leads yesterday, following their pilot, to support primary care as vaccination is rolled out to care homes, where many residents have seriously impaired capacity. We aim to disseminate the latest guidance and ensure appropriate information to support understanding for consent to vaccination, including easy-read and pictorial versions of information.

[Lord Bethell (Con) [V]]

I am enormously grateful for the work that the noble Baroness, Lady Finlay, and the National Mental Capacity Forum have done during the pandemic. The issue of mental capacity and consent has been addressed in official guidance that the NHS and others have issued to medical professionals who will administer the Covid vaccine in care homes. I understand that officials at the DHSE and the MoJ are supporting the forum with the webinar planned for this Friday, and I am absolutely delighted to reaffirm the Government’s support for the forum’s work on these important areas.

Care Quality Commission Report

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Tuesday 15th December 2020 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, my noble friend makes an extremely important point. The role of families and communities in the social care provided to those with autism and learning difficulties is extremely important and will be at the centre of every recommendation that we make in response to this report.

[Baroness Finlay of Llandaff (CB) [V]]

I declare my role as chair of the National Mental Capacity Forum. Are the Government considering the separation of learning disabilities from within the Mental Health Act to drive training in early crisis recognition and de-escalation in the community, learn from good practice and pilot alternative ways of providing places of safety in a crisis? The underlying social problems need social care solutions and are not always appropriate for, or amenable to, medical intervention.

[Lord Bethell (Con) [V]]

The noble Baroness makes her point extremely well. These are exactly the kinds of questions that have been considered by Sir Simon Wessely’s review of the Act. As I said earlier, we are looking forward to publishing a White Paper on the Mental Health Act 1983 shortly, and those are exactly the kinds of issues that it will seek to address.

Covid-19 Update

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Monday 30th November 2020 Lords Chamber

[Lord Bethell (Con)]

I welcome my noble friend’s challenge. I reassure him that the testing and vaccination programmes will absolutely run alongside each other and that this has already been happening. They are collaborating very closely. The resources being provided for both are generous enough to ensure full delivery of the vaccine. The rollout of the community testing programme is a sign of the success of test and trace, but it will in no way have a negative impact on the deployment of the vaccine programme, which remains a number one priority for the Government.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, given that some people need to go to visit a relative who is dying or otherwise very distressed, will the Government instigate a system whereby these people can register that they will need to travel across boundaries? They may even need to stay over to provide care for some time, to enable a person to be cared for in their own home. Under the current situation, they risk being given a criminal record for breaching rules, and then they may have to try to defend themselves in retrospect after the person has died.

[Lord Bethell (Con)]

I thank the noble Baroness for her characteristically compassionate question. I can reassure her that there are exceptions for essential travel. The kind of scenarios that she just described would seem to me to fit into the definition of exceptional travel. I am happy to look into whether some form of registration process is necessary but, as far as I understand, that has not proved to be the case.

Covid-19: Vaccination Prioritisation

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Wednesday 25th November 2020 Lords Chamber

[Lord Bethell (Con)]

My noble friend has made the case for rough sleepers extremely well. It is one that we are deeply concerned about. When it comes to the prioritisation list, what has been published so far is an interim and indicative list. It will be reviewed, and a more detailed list will be published in time.

[Baroness Finlay of Llandaff (CB) [V]]

As the Government keep the priority list under review, will they also look at the results of the New York vaccine rollout prioritisation? Younger adults who have been shielding are often already on a list, are at high risk and have children at school or college who are also their carers. These children are already stressed, if they attend education, knowing that they risk being asymptomatic virus carriers into the home and that Covid could kill their parent or sibling.

[Lord Bethell (Con)]

I am extremely grateful to the noble Baroness for suggesting the New York precedent. It is not one that I was aware of and I will look into it. I reassure her that we are liaising with all our international partners over the vaccine rollout to ensure that we put in the best possible practice that we can.