Domiciliary Home Care Support

Baroness Gardner of Parkes Excerpts

Wednesday 25th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I have huge respect for the noble Lord and his expertise in this area. I take this issue very seriously, which is why I used the opportunity in answering the noble Baroness to provide the reassurance that is in law. Local authorities need to step in to provide continuity of care with notice from the CQC, which now has a new responsibility to monitor the financial sustainability of providers and to make sure that that care is provided, whether it is delivered in-house or through contracts with other providers. That reassurance did not exist before it was introduced in the 2014 Act. It ought to provide a degree of reassurance among vulnerable people, who I accept will be anxious. That responsibility is in law.

[Baroness Gardner of Parkes (Con)]

The Minister has said that this is a matter of law. There has been a court judgment that fees should be paid to carers for time spent going between clients, which can be nearly half of their day. They may have one hour to spend with many clients. Is he aware that providers of domiciliary care—run as agencies and used by most local authorities —are not honouring that legal decision that this should be paid as part of their employment?

[Lord O'Shaughnessy]

My noble friend is right to bring up that issue. They should of course be paid. If she has any specific examples to share with me, I shall be glad to investigate.

NHS: Winter 2017-18

Baroness Gardner of Parkes Excerpts

Wednesday 18th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I am not sure how much pressure I can bring on the Chief Whip for anything, but I look forward to debating the review in whatever form we can when it comes out.

[Baroness Gardner of Parkes (Con)]

My Lords, in view of the discussions about whether people from overseas should be able to use the health service, can the Minister tell us whether any statistics are kept on any impact they would have had during this crisis, or how much of our budget would have been spent on them?

[Lord O'Shaughnessy]

I do not believe that we have specific statistics on the demand from overseas visitors during winter. I say to my noble friend that overseas visitors are most welcome to use the NHS but it is important that they pay. We are reclaiming more money than ever from overseas visitors to go into funding the NHS.

HPV Vaccinations

Baroness Gardner of Parkes Excerpts

Monday 26th March 2018 Lords Chamber

[Lord O'Shaughnessy]

The committee has to take a number of considerations into account—the public health benefits, short-term and long-term, and cost effectiveness—just as NICE does when approving medicines. It has to make a judgment about whether the incremental pound spent could be better spent across the entire health system, where, of course, there are many competing demands. But it is up to it to make that decision, and that will inform its final advice.

[Baroness Gardner of Parkes (Con)]

My Lords, is the Minister aware that oral cancer is very largely due to the papilloma virus? As a dentist, and on behalf of the dental profession, I strongly support immunisation, but there will always be people who do not attend to have it, even when it is introduced. So it is also important to be aware that dentists are usually the first people to detect oral cancer. For many years I have proposed that, when people go into accident and emergency for anything, someone should take one minute to see if there was any abnormality in the mouth which could be referred on at that stage. Could this even be included in a questionnaire when people go in for treatment? It would be a way of picking up oral cancer, which has increased by 23% in the last 10 years.

[Lord O'Shaughnessy]

My noble friend is quite right to highlight the link between HPV and oral cancer. The growing evidence base is one of the things which the JCVI is taking into consideration. There is absolutely no doubt that HPV causes around 99% of cervical cancers. The link to other cancers, such as the one my noble friend mentioned, is not quite the same and is still disputed, but it is one of the issues being considered.

Prescription Drugs: Dependence

Baroness Gardner of Parkes Excerpts

Monday 19th March 2018 Lords Chamber

[Lord O'Shaughnessy]

I completely echo the noble Baroness’s praise for the charitable sector. We have some very high-quality treatment centres in this country, provided both by the state and by charities. They do a fantastic job. In the most recently published figures, local authorities’ actual spend on funding for adults for drug misuse was about £490 million a year, so a substantial amount of money is going in. Of course, we need to make sure that it is getting to the people who are addicted to prescription drugs as well as illegal drugs.

[Baroness Gardner of Parkes (Con)]

My Lords, can the Minister explain the difference between dependence and addiction, as anyone who is on life-saving drugs is dependent upon them? Where does the definition come between that and addiction?

[Lord O'Shaughnessy]

My noble friend has just given a much better and more incisive answer than I could have given. There is a distinction; the point here is that these are drugs that people have started to take because they have needed them. I should point out one area that is not included in the review; it is not looking at cancer and terminal pain, because we need to make sure that there is appropriate pain relief for people who are in the last stages of their life.

NHS: Charitable Donations

Baroness Gardner of Parkes Excerpts

Thursday 22nd February 2018 Lords Chamber

[Lord O'Shaughnessy]

I agree with the noble Lord that it is a gift. I also absolutely understand the sentiment behind what he is saying, which is a desire for people to contribute back to the NHS not just through the tax system. It is important to point out that there are more than 250 NHS charities, with an annual income of £400 million. One of the other great gifts we have in this country is people’s willingness to donate time and money not just to the NHS but to a range of health causes. So we do provide an opportunity for that and those gifts are supported by gift aid. With regard to itemising the bill, we worry about deterrence. Many users of the most expensive health services are older people. Itemising a bill could put some of them off and that would be the wrong thing to do.

[Baroness Gardner of Parkes (Con)]

My Lords, I am pleased that the Minister has acknowledged the great contribution made by charities, but is he aware that councils are also providing a lot of care for people in need, both pre hospitalisation and post hospitalisation, but that they cannot use gift aid in any way? Will the Department of Health liaise with the Treasury to see whether there is some way that special council funds could be set up, where you could make a charitable donation? Gift aid is a great attraction. Yesterday I got a letter asking me whether I would like to give something to my council. I would not give anything unless it had gift aid—so it seems that we are missing an opportunity there.

[Lord O'Shaughnessy]

My noble friend makes an important point. Gift aid is a wonderful scheme that obviously has driven huge contributions. She is quite right that public sector bodies cannot provide the gift aid opportunity, which is why in the health sector those charities attached to hospitals exist. She makes an excellent suggestion for what councils should do and I shall take it up with my colleagues in that department.

Agency Nurses

Baroness Gardner of Parkes Excerpts

Wednesday 10th January 2018 Lords Chamber

[Lord O'Shaughnessy]

I will certainly write to the noble Earl specifically on psychiatric nurses. He will, I hope, be aware of the plan to recruit many more mental health staff as we seek to radically improve outcomes and delivery in that area.

[Baroness Gardner of Parkes (Con)]

My Lords, as a former hospital chairman, I am aware that agency staff are called in only when they absolutely have to be, when there is no other alternative. I wonder whether the National Health Service has looked at offering existing nurses in hospitals the opportunity of doing some more work out of hours, as some of them would find that convenient. There is a tendency for doctors as well as nurses to look for locum and agency jobs because they are better paid.

[Lord O'Shaughnessy]

It is that last issue that we are trying to address. One factor is that there is now an hourly rate price cap on agency spend, precisely to drill down into that issue. The reason that the number of agency staff went up was in response to the Francis review and what it said about safe staffing levels in the service. The immediate response was to deal with that through agency staff. That was expensive, of course, which is why we have had to push down those costs. Nurses have to come from somewhere, and my noble friend is quite right that using existing nurses and support from nursing banks is one way of meeting demand with better value for money.

Children: Oral Health

Baroness Gardner of Parkes Excerpts

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is right to highlight this important issue. Twice as many five to nine year-olds are admitted to hospital with tooth decay as are admitted with broken arms—that is how bad the problem is. It has improved in recent years: 75% of all five year-olds have no sign of physical decay, up from 69% in 2008. Supervised tooth-brushing is part of the “Starting Well” programme, but Public Health England and local authorities are responsible for commissioning and will look at the results to see whether it can be rolled out into general dentistry practice.

[Baroness Gardner of Parkes (Con)]

My Lords, does the Minister appreciate that in Australia and the United States there is widespread community fluoridation? Fluoride has been established as one way of preventing dental decay. I went on to Google today and found an article that states:

“With 60 Years of Data and 3000 Studies, Australia Declares Fluoride ‘Completely Safe’”.


That is supported by community water fluoridation, which means that your water authority cannot only see that the right amount is put in but will take out any oversupply above the optimum rate. The noble Baroness said that she thinks that oral health is important for children from an early age; I took my treatment antenatally for my children, who have very good teeth.

[Lord O'Shaughnessy]

My noble friend is quite right that fluoridation is effective. The 2012 Act allows local areas to choose to introduce it—with local legitimacy, which is important because this issue still stirs passions. We encourage any local area considering this—I believe that Greater Manchester is one—to look at the study my noble friend mentioned in order to see its effectiveness.

Nurses: Tuition Fees

Baroness Gardner of Parkes Excerpts

Wednesday 29th November 2017 Lords Chamber

[Lord O'Shaughnessy]

I think that the figure on shortfalls that the noble Baroness has given is not right. If one looks at the UCAS data, it shows, as I said, a small drop of around 6%, but the numbers going into training are comparable to 2014-15. She is quite right about the need for additional financial support, and there is £1,000 available for childcare support for those who need it, as well as exceptional support funds of up to £3,000.

[Baroness Gardner of Parkes (Con)]

My Lords, is the Minister aware that there was a great disincentive for people to enter nursing when it was decided that it was necessary to have university-level academic education to do it? The SENs—the state enrolled nurses—were abolished. Does he think that the apprenticeship scheme, which I understand is put forward all the time as being the replacement for that, is really working well, or is there a need to bring back that middle layer of nurses who cannot get five A-levels but can nevertheless be excellent nurses?

[Lord O'Shaughnessy]

My noble friend makes an important point. It is precisely to, if you like, recreate that route into nursing that the nursing apprenticeship and nursing associate positions have been created, and the numbers are increasing.

Greater Manchester Combined Authority (Public Health Functions) Order 2017

Baroness Gardner of Parkes Excerpts

Tuesday 7th November 2017 Lords Chamber

Yet we know that the Government are preventing Public Health England making strong interventions in the affairs of local authorities. I say to the Minister that it is all very well bringing this order—I am quite happy with the order itself—but when are the Government going to get a grip on the public health agenda? At heart, that is the issue we should really be discussing today.

[Baroness Gardner of Parkes (Con)]

I am very grateful to the noble Lord who has just spoken for setting out the fluoridation situation. I have written to the Mayor of Manchester on this very issue and sent him copies of all the Hansard replies over the years when I have asked what the difference is in health patterns between Manchester and Birmingham. The answer is always the dental situation. The general health in both the area that is fluoridated and the one that is not indicates no difference whatever. People who claim that fluoridation might be damaging to health have no foundation for that when the situation is the same in both cities.

What really alarmed me was when I read that Manchester was so desperately short of national health general anaesthetic beds for children in particular that it was having an effect on the whole bed supply, because so many children in Manchester required full clearance under general anaesthetic. It is hard to believe that it has reached a point where it is preventing other people having necessary operations. We also must not overlook the fact that those children will have been suffering considerable dental pain at the same time.

Another big pro for Manchester is that its water system is controlled by one large area, since it is large enough for that to be the case. In other local areas it might be that some very small local authority prevents the whole thing because its water would be taken into account when it was done. Greater Manchester is big enough to do this, though, and I hope it will. I am very pleased to hear that what the Minister said today is going to happen, and I am glad of the support of the Front Bench opposite.

National Health Service: Nurses

Baroness Gardner of Parkes Excerpts

Wednesday 22nd February 2017 Lords Chamber

[Lord O'Shaughnessy]

I am sorry that the noble Lord takes such a negative view of the changes we are making. There are actually 6,500 more full-time equivalent nurses and health visitors than there were in 2010. There has been a 15% increase in the number of training places and of course, through our reforms which he just mentioned, we are taking the cap off the amount of training places that can be offered.

[Baroness Gardner of Parkes (Con)]

My Lords, can the Minister tell us how the apprenticeship scheme is going, because a lot of damage was done when Tony Blair said that you had to have five A-levels to become a nurse? We hope that this apprenticeship scheme will counteract that.

[Lord O'Shaughnessy]

I am grateful to my noble friend for mentioning the nursing degree apprenticeship, which was announced at the end of last year. The first nurses should be in place from September of this year. Once established, this apprenticeship route could allow up to 1,000 additional nurses to join the NHS every year.