Health and Care Bill

Baroness Hollins Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

I feel sure that the Government will recognise this, and I look forward to a positive response not only to my Amendment 38 but to other amendments in this group that aim to protect the interests of mental health services across the country.

[Baroness Hollins (CB)]

My Lords, it is a pleasure to follow the noble Lord, Lord Bradley, and I support those amendments with respect to mental health. My Amendments 27 and 39 would provide for the addition of an expert in learning disability and autism on each integrated care board and ensure that the learning disability and autism lead was a person with knowledge and understanding of what good health and support look like for people with a learning disability and for autistic people.

As a starting point, this proposal has already been pledged by the Government in both the NHS long-term plan and the autism strategy, the latter stating:

“We also expect that all Integrated Care Boards, which will be established by the proposed Health and Care Bill, will focus on autism and learning disabilities at the highest level, for example by having a named executive lead for autism and learning disability.”


The reason for the Government’s firm commitment is that people with a learning disability and autistic people are among those who stand to benefit most from the integrated approach that the Bill seeks to implement. These are people whose needs frequently span health and social care systems. They are one of the largest recipient groups in terms of cost of health and social care provision and therefore a cohort with one of the greatest stakes in the effective integration of these two systems.

People with a learning disability experience huge health inequalities—very relevant to discussion on the first group of amendments today. On average, the life expectancy of men and women with a learning disability is 14 and 18 years shorter than for the general population respectively. Thirty-eight per cent of people with a learning disability die from an avoidable cause as against only 9% in the comparison population. These inequalities have been hugely exacerbated during the pandemic, with death rates of up to six times higher than among the general population, according to Public Health England. People with Down’s syndrome were identified as being at as high a risk as the over-80s. Yet they have had inappropriate DNACPRs put on their hospital records without their consent and had catastrophic reductions in care and support during the past two years, which will take years to recover from. There has been much greater reliance on family carers, who are too often dismissed as difficult by poorly trained health and social care decision-makers.

It is not learning disability and autism that are the cause; it is the situation that they are in as a result of ineffective plans and ineffective responses to their needs. Learning disability and autism, as well as foetal alcohol spectrum disorder—a much underdiagnosed and poorly understood condition but related to the groups I am speaking about—are lifelong states of being, but they are unequal states of being. Having a learning disability or being an autistic person is not like having cancer. People with learning disabilities and autistic people also get cancer; they also have a much higher prevalence of mental health problems.

The work I am overseeing for the Department of Health and Social Care places the major responsibility for inappropriate and lengthy detentions in long-term segregation under the Mental Health Act at the door of commissioners. It is a commissioning failure in the main. Some commissioners have relied on the availability of crisis admissions rather than collaborating to develop essential community services, including housing and skill support, social prescribing of meaningful activities and other innovative wellness approaches.

This is an urgent appeal to the Government to clearly signal a requirement for competent and accountable commissioning for people with a learning disability and autistic people. There is a lot of money being wasted at the moment through very poor commissioning. Please can we get it right this time?

[Baroness Bakewell (Lab)]

My Lords, before I address my Amendment 28, giving my support to my noble friend Lady Thornton, I wish to endorse the other amendments that are calling for representatives of particular groups—we just heard mention of two. I particularly endorse all those, especially as I am taking rather an oblique approach to this debate, which is not reflected in the other amendments.

Last year, there was a report in America that, increasingly, hospitals there were closing. The report said that hospitals were seen as businesses; a fifth of hospitals in America are run for profit, and globally, private equity investment in healthcare has tripled since 2015. In 2019, some $60 billion were spent on acquisitions. Globally, that includes—indeed, targets—us and the NHS. Where does that affect us? Increasing inroads are being made into the National Health Service by Centene and its subsidiary Operose, which now own 70 surgeries around this country. From Leeds to Luton, from Doncaster to Newport Pagnell, from Nottingham to Southend and many more, Centene now owns and runs for profit surgeries formerly owned and run by NHS doctors. It is now the biggest single provider of GP surgeries in this country. It has further designs on the existing fabric of the NHS, seeking to have its representatives sitting on the boards of CCGs, making decisions about the deployment of NHS funding. This is a direction of travel that needs to be monitored and checked. Safeguards must be written into the Bill against this takeover.

Why does it matter, just as long as patients have good and free treatment at the point of need? What is the reputation of Centene in America? It is not good. Indeed, it is regularly embroiled in lawsuits from either patients or shareholders, and the sums are not small. In June last year, Centene had to pay a fine of $88 million to the state of Ohio for overcharging on its Medicare department. This is one of many. Since 2000, there have been 174 recorded penalties for contract-related offences against Centene and its subsidiaries. That enterprise is now active in this country and targeting our NHS. It is not a fit company to be part of our health service. I therefore ask the Minister for safeguards to be written into the Bill against such people being represented on our boards. When I raised this at Second Reading, the Minister replied that there was no chance of us selling the NHS. We do not need to: they are buying us.

Health and Care Bill

Baroness Hollins Excerpts

Committee stage & Lords Hansard - Part 1
Tuesday 11th January 2022 Lords Chamber

The department has commissioned research and funded the National Academy for Social Prescribing and the provision of 1,000 link workers. It is not clear, however, that the department, NHS England or the Office for Health Improvement and Disparities have fully grasped the potential of creative health or that they mean to normalise creative health approaches within their vision and policies. I look forward to the Minister’s assurance that the Government do indeed intend this and will design integrated care structures to this end.

[Baroness Hollins (CB)]

My Lords, I start by declaring my interests as a past president of the Royal College of Psychiatrists and a former consultant psychiatrist and clinical academic at St George’s, University of London. I thank Mencap and the Royal College of Psychiatrists in particular for the discussions I have had with them about this group of amendments.

I will not list all my amendments and those I am supporting in this group. I say to my noble friend that this is not just a spine-stiffener; it is a reminder, because we forget about mental health. We still forget to think about it and talk about it. One of the things I often do in my career is put my hand up and say, “By the way, what about mental health?” The noble Earl, Lord Howe, will remember the debate 10 years ago; I will come back to that.

The issues covered in these amendments are not new, because the World Health Organization definition of health is about a complete state of mental, physical and social well-being. It is not just about disease and infirmity. Noble Lords may not be aware—I heard this only recently—that a psychiatrist represented the United Kingdom at the first WHO meeting, which is probably one of the reasons why mental health was included at that stage.

These amendments would require the Secretary of State and all NHS organisations to prioritise physical, mental and social well-being. The idea is simply to replicate the parity of esteem duty as introduced in the Health and Social Care Act 2012. I re-read some of my speeches on that Bill, and I can see that I was persuaded to withdraw some amendments similar to those I am speaking to today. While a significant first step, that legislation ensured only that the Secretary of State for Health and Social Care would promote parity of esteem. What we have seen since then is a better understanding of the importance of mental health and mental health services, but there is still a gulf between the financing and delivery of these two equally important services, with physical health continuing to dominate. Of course, they should not really be separate, because there is no health without mental health. Integration is fundamental; we debated that at length in 2011-12 too.

The Royal College of Psychiatrists referred me to data published by NHS Digital last year. In March 2021, there were more than 400,000 referrals to mental health services—the highest ever recorded in a calendar month, and 36% higher than the beginning of the pandemic in March 2020. The pandemic has indeed shown us the importance of good mental health for the general population, including, of course, children and young people and health and care staff.

One of my amendments is on the duty of parity of esteem, and others insert “physical and mental” in multiple places to embed the fuller meaning of “health” in the Bill. I am grateful to noble Lords who are supporting this.

I want to focus on my Amendment 99, which places the duty to ensure parity of esteem at the integrated care system level. We cannot really leave it to chance; history tells us that this would lead to a suboptimal priority for mental health services. The duty that has been in place at national level for the Secretary of State has been so valuable that we can and should replicate it at a local level. Consider a recent survey by the Royal College of Psychiatrists in which two-thirds of respondents said that their ICS had not worked towards parity of esteem effectively. Fewer than one in 10 thought that their local area was effectively promoting parity of esteem.

But if a population health-based approach is core to ICSs’ planning and decision-making, I suggest that we need stronger legislative levers to support them to address mental health. Mental health is a key population need across the country. We cannot presently meet demand. No population health approach is complete without the inclusion of mental health, and yet we consistently see the imbalances in place. The new ICSs, bringing together commissioning and provision, could be a huge opportunity to get it right—or, certainly, a lot better—for mental health.

At present, there is no assurance in the Bill that mental health will be given equal precedence with physical health in integrated care systems or even by NHS England. My proposed duty for ICSs would help to ensure parity and repeat the success of the duty on the Secretary of State in the 2012 Act—not only that, but such a duty also increases focus at service level and would make sure that ICBs are looking closely at how they are providing for people at risk of or with a mental illness.

The trouble is that it is not easy to determine the best way to achieve this. As it stands, the Bill does not address parity at all. There are other similar amendments. Would putting this duty at the local level ensure that the next step in the battle for parity of esteem will be closer to the everyday experience of people who have struggled for far too long to access mental health services? Developing good integrated care cannot be just about meeting a person’s physical health. We must think more holistically about people’s psychological and social well-being, as mentioned by the noble Lord, Lord Howarth.

Turning to the amendments tabled by my noble friend Lord Stevens, which would strengthen transparency in mental health spending, he has a unique insight into the NHS and could not be better placed to advise on what improvements are needed in funding of our mental health services, particularly in accountability and transparency. The resourcing of mental healthcare is one—admittedly, only one—indicator of whether we have a chance of meeting the need and, we hope, preventing illness developing in the first place. We know that change is needed. There have been improvements in financing mechanisms. My noble friend mentioned the mental health investment standard. This feels important in light of the most recent spending review, in which, although there was a large funding injection for the NHS, mental health seems to have lost out again.

One wonders whether anyone remembered to ask the Treasury for additional funding for mental health. Having worked in mental health for so long, perhaps I may be forgiven for suspecting that it may have been forgotten once more. Last year’s uplift for mental health due to the pressures of Covid-19 was welcome but it was non-recurrent and those pressures have not gone away. Recent estimates from different charities that I have spoken to suggest that the overall share spent on mental health could go down in the coming year. We need these amendments to the Bill to make it clear that only when the Government and the NHS genuinely have mental health at the forefront of their efforts and are truly committed to parity of esteem, even in difficult circumstances, will we make good on the purpose of the NHS when it comes to the needs of people with mental illness in our society.

[Baroness McIntosh of Pickering (Con)]

My Lords, I am delighted to speak to this group of amendments, and I associate myself very closely with the remarks of the noble Lord, Lord Stevens of Birmingham, and the noble Baroness, Lady Hollins. I declare my interest in working for the Dispensing Doctors’ Association. I speak particularly to Amendment 263, in my name and that of the noble Baroness, Lady Tyler of Enfield, and Amendment 138, in my name and those of the noble Baronesses, Lady Tyler, Lady Watkins of Tavistock and Lady Bennett of Manor Castle.

All of us are touched by knowing or learning of those who suffer from mental health problems, and I express my disappointment as well to see that there has been no parity of esteem or parity of funding between physical and mental health. I urge my noble friend the Minister, when responding, to give a commitment, in the context of the Bill, to ensure that the role of the ICS and the other bodies under the Bill will make this happen for the first time in reality.

There are particular issues, as I have seen closely, primarily as an MP but also previously as a shadow Minister. In rural areas, particularly in isolation and where there are pockets of poverty, poor mental health is suffered particularly by those on low incomes and pensioners. The farming community, especially in times of hardship, has great difficulty in communicating anxiety and mental stress. Undoubtedly, the current pandemic has taken its toll, not just in terms of self-isolation quarantine but because many businesses, particularly small businesses, have collapsed, often through no fault of those who set them up.

The background to Amendments 138 and 263 is very closely associated with that of the others in this group. I thank and pay tribute to the excellent work of Anne Marie Morris, who moved these in the other place and is chair of the All-Party Group on Rural Health. I commend her work in this regard. As has been indicated, Governments of all persuasions over recent years have spoken regularly about their desire to achieve parity of esteem between mental and physical health, including in the NHS 10-year plan. However, for this to be meaningful, there must be a legal obligation in the Bill to that effect, supported by reporting mechanisms on inputs to the mental health system, in terms of money, people trained and training places, as well as outputs resulting, including the number of mental health appointments or services made available, uptake of those appointments and the outcomes—namely, the number of patients discharged from care.

--- Later in debate ---

Amendment 5 withdrawn.

[Baroness Hollins (CB)]

My Lords, I would just like to make a comment about my amendments. I want to accept the Minister’s offer to meet and to think about the best legislative levers. I think the mood of the House is that there should be some progress on this.

House resumed. Committee to begin again not before 8.37 pm.

Health and Care Bill

Baroness Hollins Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I declare my registered interests, including my presidency of the Royal College of Occupational Therapists and the Royal Medical Benevolent Fund, and my chairmanship of the oversight panel reviewing the care of people with learning disabilities and autistic people who are being detained in long-term segregation. I plan to make five short points but, first, I welcome the encouraging maiden speech of my noble friend Lord Stevens of Birmingham, and I am glad that he highlighted the importance of mental health.

I introduced an amendment to the Health and Social Care Act 2012 with support from many noble Lords, including my noble friend Lord Patel. It committed the Government to parity for mental and physical health and illness. Some progress has been made, but not nearly enough. The Royal College of Psychiatrists suggests that there is scope to extend the commitment to mental health in the Bill across all levels of NHS organisation, including on integrated care boards. I agree.

My next point is that getting it right for people with learning disabilities would be a litmus test of how far we have made adequate and safe provision for everyone. That is what addressing inequalities is about. People with a learning disability face many barriers which contribute towards premature and avoidable mortality, including discrimination, such as the inappropriate application of “do not resuscitate” orders; or existing legal duties not being met, such as providing reasonable adjustments or meeting requirements of the Mental Capacity Act.

I support the proposed new legal duty on the CQC to assess the performance of local authorities in discharging their regulated care functions under the Care Act, as recommended by the Health and Social Care Select Committee. Mencap suggests that there should be a specific duty on ICBs to take account of the needs of people with learning disabilities. This goes further than the recommendation in the autism strategy, which is simply for a named learning disability and autism lead.

My third point is about education and research, both of which are essential to recruitment, retention and equality right across all care, well-being and health services. I will focus on education for a moment. Education is central to reducing discrimination and removing the barriers to equal access. The Government have stated their intention to introduce mandatory training in learning disability and autism for all health and social care staff. This recognises failings in existing mainstream health and social care training. Furthermore, an annual turnover of nearly one-third of all social care staff is a shocking waste of human resources. I would support meaningful training and valued career pathways, especially for direct care staff. We could learn such a lot from countries such as Germany.

If we do not plan for future generations by making children and families central to this legislation, including families with disabled children, we are letting down future generations. Beginning with the first 1,001 days, from conception to the age of two, would build the foundations needed for lifelong health and well-being.

Finally, care is not secondary to health but fundamental to it. The current system is often too mired in bureaucracy, with budget wrangling leading to poor service provision and poor outcomes. In my view, we urgently need a national care and health Bill that is genuinely integrated. It should see people of all ages as whole people whose mental and physical health and well-being cannot be divided up into packages, having been thought about and funded from within different organisational structures.

This Bill is an opportunity to bring true integration between health and social care and between mental and physical health services and to improve outcomes for everyone. We should also remember the social determinants of health, the role of the voluntary sector and the informal elements of care and well-being. I hope the Minister will consider my points as the Bill progresses, and I would welcome a discussion around supporting the amendments required to enable them.

People with Learning Difficulties and Autism: Detention in Secure Settings

Baroness Hollins Excerpts

Thursday 28th October 2021 Grand Committee

Asked by

[Baroness Hollins]

To ask Her Majesty’s Government what plans they have to prevent people with either (1) learning difficulties, or (2) autism, from being detained in secure settings when an assessment has recommended they should live in the community.

[Baroness Hollins (CB)]

My Lords, more than 2,000 autistic people and people with learning disabilities are currently detained in hospital, mostly inappropriately. Two years ago, the then Secretary of State asked me to review the care of 77 people who were at that time detained in long-term segregation. The number is now 100. My ICETR oversight panel includes people who have experienced long-term segregation themselves, family members, and experts in mental health, housing and social care. Those 77 people have all now had independently chaired education, care and treatment reviews.

We examined the first 26 of the 77 reviews in depth. What we found was profoundly shocking, and we identified several areas for urgent improvement, published in a thematic review. Typically, they had past histories of poorly commissioned education, therapy and care. There was little clinical continuity between hospital and community services, no clear therapeutic purpose for admission, and inadequate clinical assessments, with little recognition of previous trauma or its implications for mental health and behaviour. The oversight panel and NHS England have worked with the Royal College of Psychiatrists to develop a new clinical contract to try to ensure active management and therapeutic benefit.

More than half of those we reviewed were autistic people, both adults and children, but the hospitals where they lived, and those responsible for helping them move back home, lacked much understanding of the autism-friendly environment or care needed by autistic people. Most of the people reviewed were ready either to be discharged or to start a transition process back to their community.

Repeated past commissioning failures were compounded by poor commissioning responses to the ICETRs. Apathy and bureaucratic delays were part of the problem—professionals not turning up to meetings, agreed action not taken, wrangles over who pays for what. We saw interminably slow processes keeping people in situations that were at best inappropriate and all too often violated human rights. One woman had reportedly been ready for discharge for 19 years. I ask the Minister: how will Her Majesty’s Government ensure that ICETRs are being taken seriously by commissioners and that commissioners will be held accountable?

As part of our review, we gathered and published good stories of people who had managed to live happily in their communities after being discharged. We called the document Helping People Thrive, and it was written to inspire commissioners and clinicians. Mr W was one of those good stories. Prior to his discharge, he had been detained in hospital for more than 20 years, spending most of his time in what amounts to solitary confinement. Mr W has now lived in his own home for nearly three years, near his family. His home environment and care have been built around his needs. It costs no more to support him in this way than it did to detain him in hospital. Most importantly, despite still recovering from the trauma of being in the wrong environment for so many years, he is now happy.

We are pleased that our recommendations, both for senior intervention—a form of intensive case management to assist in overseeing discharge arrangements—and for the continuation of independently chaired reviews, have been supported by Her Majesty’s Government.

Some people we reviewed had social workers, advocates and families who were trying hard to move them back home, but a lack of local housing and care providers with the expertise needed was hindering their plans. A key part to successfully supporting someone in the community is the provision of good-quality housing. Sometimes commissioners are persuaded that moving the person to a single-person residence in or near the hospital is the solution, but such interim moves make it less likely that the person will ever move properly back to their own home community, and they incur continuing high fees for commissioners. How will Her Majesty’s Government ensure that there is enough housing, without months or years of delay? We must do everything we can to give people the choice to live where they want and with whom they want, just as we all do.

Sometimes, people tell us what they are unable to put into words through their behaviour. Recognising what they are trying to communicate and helping them to find a way to understand their feelings is often what enables people to move on from patterns of destructive or difficult behaviour. Good relationships with care staff are key, as shown in Dr Rebecca Fish’s recent research.

Speaking as a mother and former practising psychiatrist in this field, I believe that more attention needs to be given to really listening to people and enabling them to communicate what is troubling them, using whatever method works for them. Books Beyond Words—I declare an interest, as it is the charity I founded—creates word-free health and social stories to help people communicate their hopes and fears through the universal language of visual communication. Respond, the only specialist charity in the country offering trauma psychotherapy for autistic people and those with learning difficulties, is overwhelmed by referrals. Medication continues to be the main response to challenging behaviour. When will Her Majesty’s Government invest in widely available psychotherapy and specialist trauma therapy for people with learning disabilities and for autistic people?

Current community mental health and learning disability teams are rarely well equipped and resourced to provide the support needed for traumatised people. This deficit contributes to people’s care arrangements breaking down and to hospital admissions. If we invested in good local care, we could properly support people being discharged from hospital and prevent a new generation being admitted because of a lack of the right community support.

The social care system is nothing without the workforce. The pandemic has shone a light on the extraordinary dedication and determination of those who work in care. It is now time to address the many issues that have faced the workforce for several years, but which the pandemic has strained to breaking point. We do not currently have enough staff with the right training to ensure that people’s needs are met—staff who can empower and support that person to life their live to the fullest, who respect and value them, and can create good relationships with them.

Back in 2016, I chaired a report for Health Education England called Care Roles to Deliver the Transforming Care Programme, but little action to introduce effective training, supervision and meaningful career pathways seems to have happened. I recently visited care settings in Germany and was impressed by parity in length of training, pay, and terms and conditions for care staff, nurses, primary school teachers, occupational therapists and others. There were no staff shortages and services were much more joined-up.

How will Her Majesty’s Government ensure that care providers with expertise to support people like Mr W are available all over the country? Will they consider changing the rules, so that care workers can enter under the skilled worker immigration scheme? I hope the Minister will reassure me and the Committee that the expected reforms to the social care workforce and the promised cross-departmental strategy will tackle training as a priority. Could the noble Lord confirm whether recent recommendations from my oversight panel, and from all the other recent high-profile reports, are being taken forward in the Government’s new strategy?

Finally, I ask the noble Lord whether Her Majesty’s Government will consider making it a statutory requirement to report restrictive practices, including long-term segregation, and to publish details of commissioning organisations that still have patients in long-term segregation. Noble Lords may be surprised to know that many commissioning organisations that I have asked do not know if they have people in long- term segregation.

They could do this, for example, by making an annual report to Parliament about the numbers of autistic people and people with learning difficulties being detained in hospital, including those in long-term segregation, naming the responsible authorities, and reporting about the action being taken to develop effective care and support in the community, so that crisis admissions to hospital due to local service failures no longer happen.

We have debated this issue many times and read so many shocking reports. It is time to end scandals and tragic deaths and to give people back their lives. The new strategy needs political support. It needs resources to untangle the bureaucratic web and to reverse the perverse financial incentives that seemingly trap people in hospital. I am grateful to noble Lords for speaking in this debate and for helpful briefings from Mencap, Rightfullives, the Challenging Behaviour Foundation, the National Autistic Society and the Royal College of Psychiatrists. I look forward to hearing everybody’s contributions and the Minister’s response.

Covid-19 Update

Baroness Hollins Excerpts

Thursday 21st October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the right reverend Prelate for his advice, and for pointing out the very important role that faith communities paid played helping many people get through the lockdowns. They play an important role in this country; many people often assume that it is down to the state, but faith communities play a really important role and complement many of the things we do.

In answer to the right reverend Prelate’s specific question, it should not be seen as plan A or plan B; it is sequential. The Government would prefer that plan A works and that we vaccinate more and make sure that we reach those who have not yet been vaccinated. But if the figures, and the various factors we are looking at—scientific, but also socio-economic—suggest that we have to go to plan B, then we will. At the moment, we are hoping that plan A will work, but we are reliant on the advice that we get from the various scientific advisers that I outlined, but also the other stakeholders, to ensure that we test plan A. Hopefully, it will work, but if it does not, we will move to Plan B.

[Baroness Hollins (CB)]

My Lords, I have recently returned from Germany, where medical masks are worn indoors in settings such as shops, restaurants, theatres, conferences, churches and, of course, on public transport. To enter, you have to show a Covid green vaccination pass—the QR code is checked—or, alternatively, a same-day antigen test performed and certified in a pharmacy. It is easy, it is acceptable, it is working and people feel safe. The death rate is much lower. Will plan B provide the same security and reassurance to British citizens as I experienced in Germany by mandating face masks and green passes, and will this happen soon enough to prevent more deaths? We started the pandemic with a first lockdown that was too late; plan B may be too late.

[Lord Kamall (Con)]

I thank the noble Baroness for sharing her experiences from Germany. We are relying very much on a range of scientific advisers to tell us whether we need to move to plan B but at the moment, because we are not where we were last winter and because we have broken the link between cases, hospitalisation and deaths, we would prefer to try plan A. If we have to move to plan B, we will—on the advice of our range of scientific advisers—but there are also some concerns, as the House can imagine. I think it was Professor Mark Pennington of King’s College London who said, when assessing Covid-19 and the response to it, that you have to look at it as a complex system. When one thing happens, there might be a reaction elsewhere but also unintended consequences.

One concern we have heard about mandating face masks at the moment is: who enforces that? Do we suddenly have more police enforcing it and become a police state? Transport workers are also concerned about having to approach certain people and ask them to put their mask on in the proper place, for fear of abuse, so we have to get the balance right. We will try to stick to plan A, given that we have broken that link between cases, hospitalisations and deaths, and encourage more people to get vaccinated while reaching out to those hard-to-reach groups. But if the numbers and the various indicators are there and the scientific advice tells us to move to plan B, we will do so.

NHS Update

Baroness Hollins Excerpts

Thursday 22nd July 2021 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, I am grateful to my noble friend for highlighting this important development. The cancer drugs fund was a great success, and we are building on it with a substantial investment. The new fund will support patients with any conditions, including those with rare and genetic diseases. Dementia is one area where we are extremely interested in looking at investing further, and I hope that this would be captured, but we are waiting for recommendations from NICE and the data that it will provide before we set the right prioritisations. In terms of the date, I do not have that at my fingertips, but I would be glad to write to my noble friend with the details.

[Baroness Hollins (CB)]

My Lords, the strategy promises millions to prevent mental health crises for autistic people and to help people detained in hospital back into the community. The Written Ministerial Statement responding to my 2020 independent report about people with learning disabilities and autistic people detained in long-term segregation was laid in the other place after the Minister’s Statement had finished. My report emphasised the urgency of these strategy promises. Will the noble Lord commit to meeting me, with the Secretary of State, to discuss the full implementation of my recommendations?

[Lord Bethell (Con) [V]]

My Lords, I am enormously grateful to the noble Baroness for her hard work in this area. We are taking a range of actions to drive further, faster progress on reducing the number of autistic people and those with learning disabilities in in-patient mental health settings, including robust action by the CQC, work on our new cross-government “building the right support” delivery board, and reform of the Mental Health Act. I would be very glad to meet the noble Baroness and her colleagues to discuss these and other measures in more detail.

Social Care Reform

Baroness Hollins Excerpts

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the point made by my noble friend is entirely thoughtful and persuasive. Indeed, there may well be a role for insurance rather than any other mechanism, and it will be one of the options that those who define the policy will look at extremely carefully. The point that he makes about the desire of homeowners to pass on their homes to future generations is completely understandable and human, and one that will take into close consideration.

[Baroness Hollins (CB) [V]]

My Lords, further to my noble friend Lady Campbell’s question, will the Minister commit to mentioning working-age disabled adults every time social care reform is discussed? The needs of older people living in care homes are important, of course, but that is an easier focus for improvement. The real challenge is to improve care and support for disabled adults living in their own homes, including people with learning disabilities and autistic people.

[Lord Bethell (Con)]

I am extremely aware of the point the noble Baroness is making. A very large proportion of those in care are not elderly at all but the young and adult disabled who need some care for some condition, whether physical or mental. Their needs are paramount in these reforms. We will not forget the people the noble Baroness describes; the financial arrangements for supporting them are one of the things we absolutely want to take on in these reforms.

Social Care and the Role of Carers

Baroness Hollins Excerpts

Thursday 24th June 2021 Lords Chamber

[Baroness Hollins (CB) [V]]

My Lords, I remind the House of my interests as chairperson of the independent care, education and treatment review process for people with a learning disability or autism in in-patient settings, as president of the Royal College of Occupational Therapists, and as a carer for my adult son.

There is a growing number of households of elderly carers who may have their own health and support needs but who still support adult children with a learning disability, themselves approaching retirement age. Mencap’s survey of such carers during the pandemic found that the majority experienced significant reductions in social care, including a lack of continuity of social worker input. Knowing that parents are ageing is a reason to make plans and to have good support in place, rather than waiting for a crisis. Too many crisis admissions to residential care or hospital occur after a last surviving parent has died or following some other trauma.

Last week, some families shared their stories in a report, Tea, Smiles and Empty Promises, to mark the 10th anniversary of the BBC “Panorama” documentary which revealed the abuse and neglect of people with a learning disability and autistic people at Winterbourne View hospital. Tens of thousands of pounds are spent detaining people such as these in hospital, rather than using the money to provide community-based support. Working-aged disabled adults account for half the total social care spend in England, and of this, learning disability accounts for one-third. Is the money being spent well? The answer is mostly no.

Far too often, our social care system ignores the real needs of disabled adults of working age for skilled support to live an ordinary and decent life. They absolutely do not need to be locked up, warehoused, or kept out of sight. This debate is not just about who should pay but about the very nature and quality of the support provided.

Social care exists for a purpose: to provide personalised care that ensures well-being in line with the Care Act 2014. When it is good, it is very good, but a system based on crisis management is a failing one. Of the workforce, currently 604,000 of the 1.5 million care workers in this country are paid less than the real living wage—that is nearly half. The social care people plan framework, launched at a major summit with politicians from all parties, this afternoon, argues for a real living wage for care staff, a national register and nationally prescribed training. Does the Minister agree? I believe that the case for a social care people plan to mirror the one already in the NHS for a similar sized workforce is unassailable. The Royal College of Occupational Therapists agrees.

NHS Digital: Primary Care Medical Records

Baroness Hollins Excerpts

Tuesday 8th June 2021 Lords Chamber

[Lord Bethell (Con)]

I am grateful for the noble Lord’s anecdote. It is no coincidence that he got the text yesterday. We have energetically promoted this opportunity to patients and we are grateful to those who have engaged. He is entirely right. Patient data played a critical role in the development of the shielding list during Covid, in the recovery clinical trials programme and in the vaccine priority list. Clinical data is essential for patient safety. That is why we are modernising the system by which we access it.

[Baroness Hollins (CB) [V]]

My Lords, the choice on the opt-out preference form is either:

“I do not allow my identifiable patient data to be shared outside of the GP practice for purposes except my own care”,


or:

“I do allow my identifiable patient data to be shared outside of the GP practice for purposes beyond my own care.”


The big question is: what is identifiable? For some people with disability, mental health and/or trauma histories, data might be easily identifiable. I knew nothing of this until last week. I await with interest the noble Lord’s reply.

[Lord Bethell (Con)]

The nature of the data is very explicitly described in the documents that the noble Baroness will have referred to. If she likes, I would be very happy to send her a full set of details. Of course, many patients have engaged with the process and, like the noble Lord, Lord Young, have made the wise decision to remain enrolled in the system.

Covid-19

Baroness Hollins Excerpts

Wednesday 26th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Baroness alludes to a dilemma that we face. It is not possible to organise surge testing and have pinpoint outbreak management in 120 different areas. That is just too many and our resources do not stretch to that. Many of the outbreaks are substantial clusters. Sorry—let me phrase that better. There is a small number of very substantial clusters in the towns and cities of which noble Lords will be aware. That is where we are focusing the surge testing and surge vaccination. In the other areas, we are working with DPHs to ensure that they know the best way to target the particular behaviours of the India 2. That means that it has very high transmissibility, which requires an extremely quick reaction to school and workplace outbreaks, and within specific communities. That kind of briefing and guidance has been channelled through the Chief Medical Officer’s department and the kinds of infrastructure that I described in my answers to previous questions. The response has been extremely strong and I hope we are making some impact on the spread of the India virus, but we remain extremely vigilant.

[Baroness Hollins (CB)]

My Lords, my question is about the implementation of quarantine regulations. How many travellers have been required to repeat the 10 days required in a designated quarantine hotel for a second 10-day period, with or without a positive Covid test? What appeal arrangements are in place because public guidance does not mention any? Is there any risk of exploitation?