Health and Care Bill

Baroness Hodgson of Abinger Excerpts

Lords Hansard - Part 2 & Report stage
Tuesday 1st March 2022 Lords Chamber

I also join the noble Lord’s tribute to Lady Hollis, who was such a tremendous source of value in this House, including, as many of your Lordships will remember, the time when she was able to get the House to set aside the order about capital provision for poorer people.

[Baroness Hodgson of Abinger (Con)]

My Lords, I will be very brief. Having spoken on this in Committee, I simply thank my noble friend the Minister for bringing forward Amendment 16 to include palliative care services in the list of things required by ICBs to commission. We all agree that the end of life is one of those times when care is needed most, and I too congratulate the noble Baroness, Lady Finlay, on all her work on this, and all those who spoke in support in Committee.

This is an example of where the Government have truly listened and responded to concerns voiced on all sides of the House. They have made the most of the Bill’s unique opportunity to ensure that nobody with a terminal illness misses out on the care and support they need, both now and in the future.

[Baroness Walmsley (LD)]

My Lords, I congratulate the noble Baroness, Lady Finlay, without whom this amendment would not have been laid by the Government —although I pay tribute to the Government for listening to her. As she said, it could be game-changing—I say “could be” because unless the resources are made available for these services and for training enough of the health professionals needed to carry them out and make them available everywhere, it will not be game-changing. I would like a reassurance from the Minister that adequate resources will be made available so that, as appropriate, ICBs can carry out the duty that will be put on them.

I was horrified to hear the noble Baroness, Lady Meacher, mention a hospice with half its beds empty. I hope additional resources will be provided for hospices. I clearly remember somebody saying in Committee that you would not expect to have a coffee morning or a cake bake to treat a broken leg; you should not have to do the same sort of thing for services at the end of life. I hope the Minister will bear in mind the possibility that additional resources should go there.

We have heard that services are patchy across the country, and I suggest that the worst patchiness is in services for people dying at home. I know it is not easy to provide 24-hour services and advice to a family doing their best to try to care for somebody dying at home, but it must be done. I am afraid I know friends who have had a very bad experience of that. The person at the end of life had a bad experience, and the family have never forgotten it. As the noble Baroness, Lady Finlay, has often told us, it is possible for everybody to have a good death if the right services are provided to them. That means a good experience too for the family, who simply want to know that they have done the best and that that has been enough.

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[Baroness Hollins (CB)]

My Lords, it is a pleasure to add my name to the amendment tabled by the noble Lord, Lord McColl. I am not going to say very much in support, because the background has already been explained. Without a diagnosis, people living with dementia cannot access the community support they need.

I will add one specific group who experience dementia, which is people with Down’s syndrome. Some 60% of people with Down’s syndrome will develop Alzheimer’s by the age of 60. A lot of research on Alzheimer’s has been developed from an understanding of Down’s syndrome and the changes that take place in people’s brains. The manifesto pledged to double the funding for dementia research. The amount is interesting. It was a commitment of £800 million over 10 years for dementia research. To put that figure into context, the co-chair of the APPG on dementia, Debbie Abrahams, has stated that dementia currently costs our economy £34.7 billion each year. I therefore support this amendment requiring integrated care partnerships to include a strategy to improve both the diagnosis of dementia and dementia research, which has the potential to improve the lives of so many people in the UK.

I also added my name to the amendment in the name of my noble friend Lady Finlay. I, too, began my medical career as a GP. I therefore support my noble friend Lord Crisp’s amendments. It also has some relevance to my later practice in psychiatry. Having worked as a general practitioner in south London, I began to understand the importance of social factors in the development of mental illness and in the ability of my patients to live with whatever long-term condition they might have. As a community psychiatrist I have extensive experience of practicing medicine that addresses people’s biological, psychological and social needs, and I have been a prominent advocate of the least restrictive practices. Best practice includes facilitating robust, multidisciplinary mental health care in the community where it is a feasible alternative to treatment in hospital and, when admission is needed, helping people to be discharged back into the community at the earliest point so that their recovery can continue in the community, close to family and friends. As a mother, I advocated for effective community rehabilitation for my daughter after she become quadriplegic, which was a much better option than the nursing home care that she was initially offered.

Robust integration between multiple disciplines within health and social care is essential to ensure the high-quality, coherent, consistent and readily accessible community rehabilitation that can promote physical and mental health and help people to thrive to their full potential within communities. I am very pleased to support my noble friend’s amendment. I should declare an interest as president of the Royal College of Occupational Therapists, a profession which has a particular contribution to make in community rehabilitation.

[Baroness Hodgson of Abinger (Con)]

My Lords, before I speak to my amendment I would like to put on record that I particularly support my noble friend Lord McColl’s Amendment 62, which considers the needs of those with dementia. I also support the thrust of the amendment tabled by the noble Baroness, Lady Finlay, on better rehabilitation. Perhaps the concept of convalescence, as it used to be called, would help free acute beds and thus save money. I also support the amendments tabled by the noble Lord, Lord Crisp, to ensure that integrated care boards work with primary care and, I hope, with community nursing as well.

Amendment 177 is in my name. Much of the Bill is about the architecture of the NHS, and it is important that we get it right. However, the success of the Bill will be whether it delivers for patients. As we have discussed before, healthcare needs to be patient focused. At the moment we sadly have a system where the traditional idea of a family doctor who knows their patients is too often disappearing. Why has this been allowed to happen when we know it worked so well? We need somehow to get an element of that back. I understand that today many doctors in general practice find their role far less satisfactory, with fewer people wanting to go into general practice. I am given to understand that a large element of this has to do with the fact that fewer doctors know their patients, whereas in years gone by they would know and look after the whole family and be part of the community.

With people living ever longer, looking after older people so that they can stay healthier for longer is critical, as is ensuring that they receive the care they need and have a dignified and secure old age. This amendment would introduce a new clause that lowers from 75 to 65 the age at which every patient is assigned a named GP, which would help with prevention, an issue raised by my noble friend Lord Farmer in his amendment. The amendment would also ensure that named GPs actually have to meet and have some knowledge of each patient they are responsible for, and to communicate directly with them and their family.

I will not reiterate all the facts and figures I gave in Committee. I merely remind your Lordships that studies have shown that, quite simply, being treated by a doctor who really knows you can be life-saving. Quality care by a named GP benefits patients by delivering continuity of care and therefore better healthcare, and by keeping more people out of hospital, relieving some of the burden on the NHS.

Following the debate in Committee, I have added proposed subsection (2) to enable the role of the named GP to be “delegated” to another doctor in the practice who might be chosen and preferred by the patient. But this amendment ensures that patients will have someone who actually has some knowledge of them and whom they or their relatives can turn to for help, care and advice.

I was very disappointed that, in Committee, my noble friend the Minister failed to grasp the significant difference between current regulations, guidance and what happens in practice. I have personal proof that, as things stand, some named GPs are able to choose not to know the patients they are responsible for. This amendment seeks to positively address that.

I urge the Minister to reconsider and accept these proposed changes to the Bill. I absolutely agree with the noble Lord, Lord Hunt, that primary healthcare is incredibly important. This whole area really needs an in-depth debate because it is breaking down in some places.

[Baroness Walmsley (LD)]

My Lords, I will make just a few comments. I put my name to the amendment of the noble Lord, Lord McColl, which I will not say much about because he and the noble Baroness, Lady Hollins, have said it all.

However, I will make one point about the importance of early diagnosis. As most noble Lords will know, Alzheimer’s is a complex range of diseases, and it is very important for the patient that their doctor is able to know what sort of Alzheimer’s they have so that an appropriate set of support can be prescribed. The other very important reason is that we do not yet have a disease-modifying cure. Unless more suitable patients go forward for clinical trials, the researchers will not be able to do their research, no matter how much money the Government put forward. We know that 80% of people who put themselves forward for a dementia clinical trial have to be rejected because their disease has progressed too far. So, we really need early diagnosis so that the researchers have some chance of finding the cure that we all want.

Secondly, I will say two things about primary care. The noble Baroness, Lady Hodgson, talked about patients having to see a doctor they have never seen before within their practice. Well, now—and I would like the Minister’s answer to this—not only are people ringing up and going to a doctor in the practice whom they have never seen before; in London, they are now being referred to a completely different practice, because something like five practices share patients. I understand that that is a temporary measure during the pandemic, but could the noble Lord confirm that that is the case? Could he also confirm that it is going to end once we believe the pandemic is over, which of course it is not yet?

I shall say a few words about the amendment proposed by the noble Lord, Lord Crisp. It is vital, as he rightly said, that primary care has a role in planning the commissioning of services. As the noble Lord, Lord Hunt, said, a lot of expertise has been developed, and it must not be lost. It is vital because primary care services are the gateway for a patient to everything else in the health service; it is the first port of call for a patient and, without a referral from a GP, on the whole you cannot get to anything else.

I very much support what the noble Lord, Lord Crisp, is doing and look forward to hearing what the Minister has to say about the reasons why primary care services do not appear to be treated equally with NHS trusts and foundation trusts.