Mental Capacity (Amendment) Bill [HL]

Baroness Garden of Frognal Excerpts

Report: 1st sitting: House of Lords
Wednesday 21st November 2018 Lords Chamber

[The Deputy Speaker (Baroness Garden of Frognal) (LD)]

My Lords, I need to inform the House that, within this group, Amendments 25 and 26 appear to be alternatives. Amendment 26 will be moved only if Amendment 25 is withdrawn or disagreed to.

[Baroness Tyler of Enfield]

My Lords, I support this group of amendments. One or two offer a slightly different definition or slightly different words but the key point for me, having moved a similar amendment in Committee, is that we have now removed the phrase “unsound mind” from the Bill. I know this is welcomed here and will be hugely welcomed by many in the sector. It means we will get rid not only of a very old-fashioned and stigmatising term but one on which there were also concerns—as I understood from my conversations with the Royal College of Psychiatrists—that it had no real clinical meaning. The term “mental disorder”—or the few more words added by other amendments—not only brings us in line with the Mental Health Act, which is good, but I am advised that it will also help to provide diagnostic clarity. That has to be a good thing too. I support this group of amendments.

--- Later in debate ---

[The Deputy Speaker]

My Lords, Amendments 16 and 16A appear to be alternatives, so Amendment 16A will be moved only if Amendment 16 is withdrawn or disagreed to.

[Baroness Meacher]

My Lords, I put my name to this amendment and I very strongly support it. Having been a Mental Health Act commissioner for many years and having visited independent hospitals as well as NHS hospitals and other establishments, I remember those independent hospitals as being the most alarming environments that I ever visited. Very often, the biggest problem was indeed the conflict of interest. People would get into those hospitals and be treated, and that was all good, but whereas in an NHS hospital the pressure all the time, from the day of arrival, is to plan the exit and aftercare in the community, once those hospitals had got the person better they had a lovely ride. The patient was there and was no trouble, no longer had symptoms and was miles—maybe hundreds of miles—from their family. They did not get visits. The conditions in which those people were held were shocking, and the degree of the deprivation of liberty was often deeply shocking. Did they go out in the grounds? Probably not. Did they go out for walks? Probably not. Any kind of a sense of liberty could be lost, not just for days, weeks or even months, but for years. We would do our tiny best, but the fact was that we might get round to one of those hospitals every two years. It was inadequate to say the least. I therefore urge the Minister to take this very seriously. We are worried about care homes, which are probably local and have the family nearby, if there is one. They can be a problem, but this is on another scale and of another degree of severity, so I strongly support this amendment and urge the Minister to consider it.

Education (Student Support) (Amendment) (No. 2) Regulations 2018

Baroness Garden of Frognal Excerpts

Monday 21st May 2018 Lords Chamber

[Baroness Garden of Frognal (LD)]

My Lords, I rise to speak briefly in support of the noble Lord, Lord Hunt, and my noble friend Lady Walmsley, who set the scene very comprehensively for us. I note that these regulations came into force on 7 May, so presumably any impact we can have on them is going to be retrospective at best.

I share the concerns about adults coming back into the nursing workforce. They will be more risk averse but by and large they are invaluable members of the nursing community, so putting them off seems extremely foolish. I also share the concerns of the noble Lord, Lord Clark, about the apprenticeship route, which obviously has got off to a very slow start. I think that the health fraternity is finding it complex working out how the apprenticeships are going to fit in. In due course degree apprenticeships may be able to take up some of the slack, but it will be a long time before that happens and certainly it will not be quick enough to solve the nursing shortfall that we are experiencing at the moment.

Equally, as the noble Lord, Lord Clark, also said, we must take into account the fact that EU nurses are leaving in droves at the moment because they find this country unwelcoming, as indeed are EU workers in a number of other sectors as well. That situation is not going to get better. I will therefore add my voice to those asking for a delay in implementing these damaging proposals until there has been time for a full impact assessment, or at least until the review of post-18 education and training has reported. The NHS is too important to be left to chance like this, and with a crisis in the nursing workforce, this is not the time to embark on measures that will do nothing but worsen the position. I urge the Minister to think again.

NHS: Association of Medical Research Charities Report

Baroness Garden of Frognal Excerpts

Thursday 27th June 2013 Grand Committee

[Baroness Sharp of Guildford]

My Lords, I am speaking today substantially in place of my noble friend Lord Willis, who, as noble Lords may know, had a heart attack two or three weeks ago. He is making very good progress and, in fact, is hoping to be back before we go into recess. However, he was anxious that somebody from our Benches should speak on this subject. My noble friend, as chair of the Association of Medical Research Charities, played a very substantial part in helping to develop this Vision document. Before that, as the noble Earl knows very well, he played a seminal role in ensuring that the Health and Social Care Act 2012 incorporated clauses that put on the Secretary of State and others in the NHS the duty to promote,

“research on matters relevant to the health service”,

and,

“the use in the health service of evidence obtained from research”.

All are agreed that the Act is a major milestone which has helped to embed research within the body of the NHS.

In many senses, I think that this vision is a natural sequel to that achievement. The AMRC, working with member charities, has attempted to put flesh on the bones of phrases that were bandied around at the time of the Bill being discussed in this House—phrases such as, “placing research at the heart of the NHS”.

As the noble Lord, Lord Turnberg, mentioned, Our vision for Research in the NHS was written after wide consultation among professionals on the one hand and patients on the other, and it is built on three key concepts that emerged from that consultation. The first is involving patients: telling them about research being undertaken, how they can find out more about that research and how they can participate if they wish and it is relevant to their care. Secondly, there is involving staff so that they understand the benefits of research, are motivated to engage with it and know how to take part in it and use its findings. Lastly, there is ensuring that the NHS is open to and about its research, and develops among its staff a group of leaders who will champion research and help embed good researchers and good research practice into the NHS.

I have just three questions for the Minister. First, there is the matter of clinical trials. As I said, one key issue is the NHS being open to research, but there is concern that it is losing its share of global clinical trials. Back in the 1980s and 1990s, when I was doing more research on the pharmaceutical industry, the UK was a favoured location for clinical trials. Many multinational companies put their research laboratories here in the UK because of that. The Science and Technology Select Committee, of which I am a member, recently made a study of regenerative medicine. In the process of taking evidence for that, we learnt that despite the recognised quality of our research, it is no longer the case that we are among the leading countries doing clinical trials. One reason cited most frequently for this was the sheer complexity of procedures, especially the number of regulatory bodies involved. I noted in reading the report that this comes up yet again:

“40% of hospital doctors polled cited difficulties navigating regulatory processes as a barrier to them taking part in medical research in the last two years”.

I know that the UK Clinical Trials Gateway has been set up to simplify procedures, but can the Minister offer us any reassurance that the situation is likely to improve, and in particular that the Health Research Authority might in time become the one-stop shop that everybody is looking for?

My second question relates to co-operation between the NHS, universities and medical schools. Yesterday I attended the lecture given by my noble friend Lord Heseltine to the Industry and Parliament Trust, and I was amused when he talked about how, in the 1970s, the public sector—the Civil Service—and private sector industry were two separate worlds that worked in their own spaces and failed to recognise the benefits of working together in such areas as regeneration. In some senses, it seems that one hits the same problems between the NHS and the world of research, particularly university and medical school research:

“Our survey of almost 400 health professionals including 130 GPs found that around half knew something about the National Institute for Health Research and the NIHR Clinical Research Network … Awareness fell to around a quarter for Academic Health Science Centres, Biomedical Research Centres and Biomedical Research Units”.

Again, we know that a lot of effort is being made to bring together and develop these academic health science networks, linking up the local NHS organisations and universities. Nevertheless, that vision raises questions as to how these networks will share best practice. Can the Minister tell us a little more about how they will function?

Finally, I raise a question that was to a large extent raised by the noble Lord, Lord Turnberg. How can CCGs embed research throughout the NHS? There is considerable scepticism as to how far the CCGs will be able to do this. To help them, the report sets out on page 31 a research charter. How far does NHS England accept that charter and how much will it encourage CCGs to take note of and follow those procedures?

[Baroness Garden of Frognal]

My Lords, I apologise for intervening, but there are no spare minutes in this debate, so it would be helpful if Back-Benchers could keep their remarks to within the six minutes.

Care Bill [HL]

Baroness Garden of Frognal Excerpts

Tuesday 21st May 2013 Lords Chamber

[Baroness Uddin]

My Lords, I come to this debate from the perspective of a professional in the social care sector, as well as with experience as a local authority councillor and, not least, as a carer for over 30 years. I agree that we are at a crossroads for our social care system. In my contribution, I shall draw on the evidence presented to us in the Joint Committee inquiry on the Promoting Independence, Preventing Crisis report, which was ably led by the all-party parliamentary groups on local government and disability. I take this opportunity to salute the work of my noble friend Lady Campbell, Anne McGuire, Heather Wheeler, and the noble Baroness, Lady Wilkins.

Much emphasis has rightly been put on the demands of our growing ageing population, and it is right that we do so, as is the fact that one in three of those who use our care services are disabled people of working age. I would like to focus on that aspect, and I make no apologies for unreservedly quoting some aspects of the inquiry, which I commend to the House.

For too long, Governments have used a sticking plaster approach and incremental improvements in dealing with adult social care, resulting in systems that are bewildering for the recipient and unwieldy for authorities to administer. So I, too, welcome the principle of adult social care reform. The Joint Committee inquiry took evidence from a long list of expert witnesses representing all sectors, all the major disability organisations and those involved in statutory provisions, as well as local authorities and academia. There was undeniable consensus, and a call for disabled people to be at the heart of social care policy reform as well as making decisions in their care. In doing so, we must not see them as passive recipients, but must uphold their human rights under the UN convention to which the United Kingdom is signatory, and embrace the fundamental principles of independence.

There are pervasive concerns that much of our provisions fall significantly short of providing dignity and choice, thus hampering independent living. Of course, the funding shortage is a reality, but we cannot allow those who may be voiceless to be sidestepped at the behest of what may be regarded as best value by locally set criteria. The evidence received by our Joint Committee points to local authorities struggling to achieve the best outcomes, resulting in raising their eligibility threshold for care provision. Many instances have been cited, implying that current eligibility criteria have led to many thousands of disabled individuals falling out of the care system altogether.

The statistics are astonishing. The Audit Commission on social care in England found with the fair access to care system in 2005 that 50% of 152 local authorities in England provide services to those with moderate needs and above but, by 2012, 84% were only providing services at the higher threshold of substantial need, with three councils now providing social care to people who fall into all four eligibility bands and only 24 councils providing care to those with moderate needs and above. The Care Bill will fail to improve the social care system for disabled people if eligibility is set so high that those in need will not receive even the basic help such as washing, dressing or getting out of the house. These changes, challenges and differences in eligibility are bound to lead to more disabled people left ineligible for care and support, contrary to the Minister’s claim that the Bill will provide compassionate and consistent care to those who need it.

The inquiry committee hopes that the Government will consider more uniformity in setting thresholds for eligibility right across the country, ensuring that the 2013 spending review will give due regard to adequate resources being made available so that the needs of disabled people are not compromised. I was surprised to hear the Minister say that legislation will not impact on the funding available. How can provision be efficiently provided, as he suggests, when the system is already stretched to its limits? Disabled people deserve to have confidence in any new care and support system, and I hope that we will be able to rectify some of these anomalies.

There is a significant body of opinion calling for prioritising the design of a new framework of eligibility, which should actively engage core stakeholders, addressing gaps highlighted already in the House today. The joint inquiry report suggests that the current fair access to care services criteria should be replaced by a system that is more objective and coherent and implemented across the country, where resource allocation is transparent and enables the disabled person and their carers to take part in the decision-making process. Worryingly, the evidence that we took suggests that there is little cohesion within various partners of care providers. This will stretch the ambition of the seamless services that the Care Bill envisages. Personalisation appears not to break down the barriers between care, housing, transport, leisure and community involvement, particularly when any person moves from one area to another. Therefore, I welcome the commitment in the Bill that continuity of care packages will not be interrupted by any move to another local authority or area. I would like to ask what mechanism will be in place to ensure a smooth transition if that happens, and whose lead responsibility it will be to manage the transition. I suppose that I am asking who will manage the “Oklahoma!” moment and who will provide the leadership.

This Care Bill is happening alongside the Government reassessing all those working-age disabled adults receiving disability living allowance and transferring recipients on to the personal independence payment. The House has voiced significant concerns to the Government, which were augmented last week by the whistleblower giving an insight to reports that individuals were not receiving even-handed services. The fact that supporting evidence given by applicants was not forwarded by the assessing company for assessors to use suggested a bias towards finding reasons to award points begrudgingly or not to award points, thereby affecting resource allocation. I have spoken to a number of carers and this is being seen by some as another cynical example of eligibility criteria being used to reset the goalposts for determining how much financial help people with disabilities require and ultimately receive.

A Member of this House recounted in a meeting last week the experience of being assessed. I hope that that respected individual will not mind my repeating what was said. The whole experience was said to have been so harrowing that the individual felt defeated by the very system which has the ambition of delivering dignity and choice through this Care Bill. I am deeply saddened that so little appears to have changed in the 30 years since I had a bitter experience with my son. Trying to access educational and social care was like asking for rain on Mars. In the end, we as a family were so defeated that we retreated into relying only on our own resources and ways and means.

I agree that reforms need to be made but they must and should be robust and intelligent in respectfully and professionally identifying genuinely deserving individuals, especially as regards those with disabilities which are difficult to understand and those with fluctuating conditions. Indeed, I have been made aware of the case of a disabled adult and her advocates who are trying to augment a personal budget. The person says that she felt bullied by a director of commissioning into accepting a package which represented best value for the authority but completely ignored her condition and needs and possibly violated her right to privacy and family life. If our society is to be judged by how we treat our weakest members, we have some distance to walk. I hope that we will be bold and ambitious enough to remember that social care must not simply be about basic survival but about supporting people to live independently. Independent living means disabled people of all ages having the same universal rights of freedom, choice, dignity and control as other citizens at home, at work, and in the community. It means having the right to obtain practical assistance and support to participate in society and live an ordinary life that others take for granted.

Your Lordships may not be surprised to learn that even in this context there is a distinct difference in the services provided to those from minority communities. It is a fact that 32% of all disabled people live in household poverty. Sadly, for minorities this figure jumps to 44% of disabled people living in household poverty. A report suggests that income for minority disabled people is 30% lower than for the general disabled population. The Equalities National Council and Scope in a report entitled Over-looked Communities, Over-due Change found that services are not fully inclusive for BME disabled people, who experience significant language and communication barriers, social isolation and stigma exacerbated by their lacking access to information and advice, including from well recognised NGOs. Many of the large NGOs operating within communities accepted that they had some way to go in addressing the needs of minority disabled people. In fact, a quarter of BME disabled people report difficulties receiving benefits and accessing independent living compared with 16% of others, indicating that additional unmet needs exist. Evidence on barriers to care shows that BME disabled people's conditions and impairments tend to escalate quickly to higher levels of need. I submit to the House that this is a costly process and that it is therefore even more important that the social care system provides effective coverage at lower care need equivalent to “moderate” within the current fair access to care needs system.

That is not all: meeting criteria and being eligible for support is not the end. An assessment determines the value of someone’s personal budget, and the resource allocation system ascribes a number of points to each eligible need which has been identified and, in referring to a table, sets out the financial value of each set of points, which then fleshes out the support plan to purchase and achieve identified independent living outcomes. Final decisions about the value of personal budgets are made by an anonymous panel of local authority social care professionals based on information provided by the disabled person, their social worker and the RAS calculation, often without ever having met the disabled person. The Sue Ryder report, The Forgotten Millions, highlights this point and found that a lack of uniformity among local authorities in allocating resources and calculating care packages for individuals is causing deep confusion and stress. A case was brought to my attention recently of a disabled adult who had all services stopped at 6 pm one evening. Apart from the legality of how and why this happened, an anonymous panel had turned down for the third time a request to increase travel by nine miles twice weekly, despite the social worker having great input from advocates on the matter. As the client had received an insufficient explanation from the social worker at 6 pm at night, she had to recall her father from business in London. He arrived at the social work offices the next day to petition the head of services as to why this had happened. Fortunately, services were immediately reinstated, with the family being offered a transfer from a direct service from the local authority to a personal budget.

Many carers claim that all these formal processes lack transparency regarding panels, their remit, obligations and decision-making. Disabled adults and their advocates are forbidden from having adequate details about the panel making the decisions. Surely transparency should be an obligation. If the objective is to provide care and support while maintaining the dignity of the individual, surely it is critical to have the individual or their representative present to ensure that their opinion is heard and valued as they are the experts on their own lives. The panel should have due regard to the contribution of disabled people in determining the nature of their care and support in any decisions that are made. Our report asks that the Government place resource allocation systems on a statutory footing through the Care and Support Bill and place new duties on councils to be transparent about these decisions. I welcome the move to put personal budgets on a statutory footing in Clause 25 of the Care and Support Bill. That should be enhanced to ensure that local authorities are transparent about decisions relating to the allocation of resources. All too often, personal budgets have care costed at one rate, with another rate available if external agencies are used.

[Baroness Garden of Frognal]

I apologise to the noble Baroness but she has been speaking for 15 minutes, which is normally the maximum time.

[Baroness Uddin]

I apologise. I am nearly finished. Anyone not associated with the care sector will become dizzy when encountering the array of acronyms and phrases such as RAS, FACS, DLA and PIP. Indeed, they are fortunate members of our society, with the ability to lead an active, fulfilled and independent life. They are fortunate enough to be able to perform everyday tasks such as getting up, washing, dressing, personal care, food preparation and eating without having to justify even the most basic daily tasks. For those members of our society who are reliant upon our care systems, this Bill represents a new hope that our social care system will enable disabled people to live an independent life which is just and equitable. I note noble Lords’ massive endorsement of the Bill and eagerly await its outcome.

Health and Social Care Bill

Baroness Garden of Frognal Excerpts

Thursday 15th December 2011 Lords Chamber

[Baroness Williams of Crosby]

I begin with an apology on behalf of my noble friend Lord Marks of Henley-on-Thames, who wants to explain to the House that he is unavoidably—

[Baroness Garden of Frognal]

With due apologies to my noble friend, it is very difficult to hear her when people are leaving the Chamber. I wonder if we might just wait for people to clear the Chamber as quickly and quietly as they can so that my noble friend may resume with her amendment.

[Baroness Williams of Crosby]

I thank my noble friend Lady Garden very much indeed for intervening. I would like to express the apologies of my noble friend Lord Marks of Henley-on-Thames for being unable to be here on this occasion. Unfortunately he has been taken ill and will probably not be in the House again before the Christmas Recess. He extends his apologies to the House and his deep regrets at being unable to be here to move this amendment. It is therefore my honour to do so on his behalf.

The first amendment amends paragraph 9(3) of Schedule 7 to the National Health Service Act 2006 to remove the requirement for a governor to be appointed by a PCT. The reason for governors being appointed by PCTs, of course, is that they were the key sub-national level of organisation under the previous National Health Service. The Act of 2006 therefore reflects that organisational structure. I submit to the House that in the new structure it is as important that the national Commissioning Board should be able to appoint at least one—and, one hopes, more—governors to the board because of the need for a clear link between the clinical commissioning groups and the boards of the foundation trusts. Our amendment requires that at least one member be appointed by the NHS Commissioning Board in the place of the PCT appointee who will no longer be able to take his place. A substantial number of NHS patients—one hopes a majority—are patients under the foundation trusts. It is therefore important that the concerns of the CCGs and of the board should be represented on foundation trust governing bodies.

I will also briefly speak to Amendments 300, 301, 302 and 303 in the same group. All relate to the decisions to be made about the mergers or dissolutions of foundation trusts. The purpose of the amendments is to add the name of the Secretary of State to those who are required to consent to either a merger or a dissolution. I shall explain very briefly why we believe this to be of great importance. Despite these amendments looking rather petty, they are not.

The Secretary of State is in a unique position to decide on the strategy of the National Health Service over the whole country. He is in an especially good position to be well-informed on the balance between demand and supply across the territory of England. If there is no requirement for him to emerge at this point as the figure who makes the ultimate decision as to whether there should be a dissolution or a merger, there is nobody else able to detect whether the needs of all patients in England are met. As the House will be aware, if a foundation trust merges and perhaps one part of that merger ceases to offer services, that may be very much in the long-term interests of the National Health Service. The noble Lord, Lord Warner, spoke eloquently on this point yesterday. Where a foundation trust is the centre of, for example, pathways in a particular chronic illness, and where it meets the hospital needs of a substantial part of an area of the country, only the Secretary of State is in a position to decide whether that foundation trust merger or dissolution will have a major impact on the health services available in that part of England.

We suggest, once again, that this is not a tactical or micromanagement issue, but a strategic one, given the significance of foundation trusts in many parts of the country. We therefore very strongly urge the Committee to agree to this amendment. We believe it is a crucial part of the strategy of running a National Health Service in England. I beg to move.

Health: Obesity

Baroness Garden of Frognal Excerpts

Monday 4th April 2011 Grand Committee

[Lord Campbell-Savours]

My Lords, I would like to intervene briefly to express some marginally politically incorrect sentiments, because I share concerns expressed by Members of the Committee about the scale of the problem of obesity nationally, which I think is huge.

[Baroness Garden of Frognal]

Perhaps the noble Lord will forgive me, but we were not notified that he had his name on the speaking list.

[Lord Campbell-Savours]

I did not know that there was a speaking list.

[Baroness Garden of Frognal]

I am afraid that there is; this is a timed debate. However, as one of the speakers has scratched, the noble Lord can speak for four minutes in the gap.

[Lord Campbell-Savours]

I intend to intervene only briefly. I support the noble Lord, Lord McColl, and congratulate him on introducing this debate. His speech is worthy of passing around our friends and colleagues because it would have made a very good after-dinner speech. Although it was amusing, it dealt with an extremely serious subject.

My noble friend Lord Patel raised the issue of calorific information on food products sold in stores and particularly in restaurants. The other week I went into a Harvester restaurant which I had never been into before. I noticed that every item on the menu had its calorific content in bold lettering, so much so that I cannot believe that people who eat in those restaurants are not aware of and do not take into account the calorific content when they order their food. I am told that in parts of the world, particularly in America, the authorities in some cities insist on calorific information being provided on all menus in restaurants.

I wonder why we cannot do something similar here in the United Kingdom. I know that the Government are not over-wedded to the principle of too much regulation, but when so much is at stake arising out of problems of obesity and their consequences for health service expenditure, why can we not grasp the nettle in this area and introduce a regulatory framework for food manufacturers whereby the general public really do have to sit down and consider what they eat daily? If we were to do that, I believe that it would certainly have some consequence for obesity.

I return to being slightly politically incorrect. There is another problem as well. Families are often simply not prepared to raise the issue internally. There is an embarrassment about fatness. People just do not want to talk about it. Even among one’s colleagues, here or anywhere, we do not talk about whether people are fat or thin. We have to get over that because a huge problem is developing, in part due to an element of political incorrectness which is reflected in how the media and the industry treat the subject.

I am sorry if I did not comply completely with the rules. Having come from the Commons, and as I normally speak only at Report, in Committee and on Third Reading, I am not used to listings during debates.