Covid-19: Social Care Services

Baroness Jolly Excerpts

Thursday 23rd April 2020 Lords Chamber

[Baroness Jolly (LD)]

I join other noble Lords in commending and thanking the care sector for all it does for those in its care, in care homes and in the community. I am happy to echo the opening remarks of the noble Baroness, Lady Wheeler, and thank her for instigating this debate.

The majority of care providers are private organisations, not-for-profit organisations or charities. Their income has remained pretty well constant throughout this crisis, but their costs have soared—for replacement care workers from agencies or banks to cover staff illness, and, as we heard at Questions, the new unanticipated costs of PPE. Can the Minister confirm that no provider of care will be allowed to fail in this crisis due to lack of funding to cover these and other costs?

My comments will largely be about people with learning disabilities and others who have found themselves with “DNR” on their records. We are fortunate to live in a country where life is universally valued. For the last month or so, we have seen this play out on the news, as we witness daily the efforts of our NHS and care workers struggling to save those who are in their care. Their compassion brings us to tears, and to our doorsteps on a Thursday evening. Old, young, fit or frail—it matters not. But this Covid-19 crisis has seen parents of autistic adult children receive letters from their GP practices suggesting that these children should have a “do not resuscitate” or DNR label added to their notes.

I applaud the Care Quality Commission for its condemnation of GPs across the country for categorising people who receive care in community settings as not requiring resuscitation should they fall ill with coronavirus. Let us be clear: a DNR is a clinical decision that, in perfect circumstances, involves the doctor, patient and family. NICE recommends that clinicians use the clinical frailty scale when considering patients for intensive care. It is designed to prioritise those most likely to recover from the virus, but it is not suitable for use with people who have learning disabilities, nor for people with other kinds of disabilities or conditions that affect their ability to do things independently.

Whatever the circumstances, life or death should not depend on your age, your disability, who provides your care or where you live. Does the Minister agree? Could he please persuade the department to put this message out to all care and health providers? Perhaps we can ensure that it is part of the promised Green Paper.

Coronavirus

Baroness Jolly Excerpts

Thursday 12th March 2020 Lords Chamber

[Lord Bethell]

The right reverend Prelate is entirely right to raise the question of prisons. Prisons provide an enormous challenge when it comes to the virus. The idea of prisoners living in prisons while the virus passes through such a tight-knit community concerns us enormously. I reassure him that the Ministry of Justice is looking into this carefully. It is using the experience in Italy and in China to understand how to provide for this in a humane and responsible way that preserves the security of our communities. It will publish advice on that shortly.

[Baroness Jolly (LD)]

My Lords, I declare my interest in the register. I was pleased to hear that the Secretary of State had included social care in the Statement. Could the Minister clarify what support will be offered to providers of social care to vulnerable adults with a learning disability?

[Lord Bethell]

The noble Baroness is entirely right to ask about a specific group. As yet, I do not have a clear answer on the exact demographic that she describes, but I reassure her that our understanding is that this will hit hardest the most vulnerable in our society. The entire focus of our provisions is therefore to make sure that the most vulnerable are looked after best.

Access to Palliative Care and Treatment of Children Bill [HL]

Baroness Jolly Excerpts

2nd reading & 2nd reading (Hansard): House of Lords & 2nd reading (Hansard)
Friday 7th February 2020 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I, too, support this Bill. I endorse what the noble Lord, Lord Hunt of Kings Heath, has just said and congratulate the noble Baroness, Lady Finlay, on coming so high in the ballot and getting an early slot in the parade of Private Members’ Bills. I am grateful for the many briefings that I have received. I warn the Minister that the noble Baroness, Lady Finlay, is a tenacious individual. Should the Minister decline the Committee stage, for which I have an amendment ready to go, the noble Baroness will return next year, as I am sure will many of the noble Lords speaking today. We will not let this issue drop. The response from the Government last June was unconvincing and disappointing. I fail to see how the Minister today can come up with something that will not satisfy.

As has been stated, Clause 1 of the Bill applies to palliative care and support. Midwifery services are available from the state and mandated in legislation. They are freely available to all women. It seems strange and anomalous that end-of-life services do not enjoy the same ease of access and availability of medication to treat pain and prevent suffering. Why should those of us who choose to end our lives in hospices be treated differently from those who find themselves at home or in a hospital when they die? At the end of our lives, we should all have care that is totally person-centred, not one size fits all, whatever our age, colour or creed. Hospices should have the same level of access to pharmaceutical support as settings where NHS clinicians provide care. That should be the responsibility of the local commissioning body—the CCG—as recommended by the noble Baroness, Lady Barran, when she summed up the last Second Reading debate on this Bill.

I was struck by the point made by Marie Curie that 6 million of us will die within the next 10 years. Commissioners need to face that and plan accordingly. It is not something that should just happen. It is a really big number—I think that it is something like 20,000 a day, which is an awful lot. Many of us would choose to die at home, but for many reasons that is not an option.

As a society we must think more about our deaths than we do currently. Good end-of-life care is expensive and not always available from some CCGs. That should not be the case. A good death should not be a lottery. It should be a right, not an accident of where you die. That anomaly needs sorting and I hope that the Minister will not disappoint. A clarification of the department’s thinking on this would be appreciated. If the Minister is not able to offer that now, I would be grateful if she could add it to my letter.

Clause 2 clarifies the situation when treating children with a life-limiting illness. In advance of the previous incarnation of this Bill, I had the privilege of meeting the parents of Charlie Gard, who died so tragically, in the gaze of the public in a media storm, nearly a week short of his first birthday. They were determined that no family should be put through the torment that faced them when there was an impasse between the interests of the child and parents and the clinician and hospital. There was no mediation. Noble Lords will remember the tragedy unfolding on our screens almost hour by hour. Dignity and mutual respect vanished for the dying child, his parents as helpless witnesses, and the clinicians. The Bill of the noble Baroness, Lady Finlay, remedies that, but I am sure that the Minister will tell us that it should be happening anyway. We know that and I am sure that in hindsight everyone involved in Charlie’s care knows that, too, but it could happen again unless there is legislation that states clearly how such a situation should be better handled.

I hope that the Bill is committed after this Second Reading debate, as I have an amendment ready to table. The noble Baroness knows that and believes that it sits well within her Bill—I am grateful for her endorsement today. Many organisations in their briefings have expressed concerns about Clause 2(4). My amendment would insert after Clause 2(4):

“Any medical treatment proposals put forward by any person holding parental responsibility for the child must be considered by the court, unless contrary evidence is established that the proposed treatment poses a disproportionate risk of significant harm.”


The amendment would ensure that the court is able to prevent a proposed action where it is not in the best interests of the child—in other words, when it is clearly established that the proposed action or medication would cause significant harm. Such harm should be clearly established to outweigh the harms from the alternate proposed course of action.

Fortunately, very few of us have found ourselves in the position of watching a child die. I lost a cousin before his first birthday, well over 60 years ago when I was a small child, and I still remember the impact that it had on the extended family. My mother never forgot his birthday and his parents still remember it now. We owe it to society that any palliative care that is given is properly commissioned. In the case of children receiving palliative care, mediation should be readily available in all situations where parents and clinicians fail to find a meeting of minds and the court should be able to prevent the proposed action when it is not in the best interests of the child.

I am sure that the Bill, when amended in Committee, will offer a way forward that is practical and workable and offers dignity in dying to the individual and their family. The Prime Minister has announced that £25 million will be provided to hospice and palliative care services. That must be commended but, as the noble Lord, Lord Hunt, said, a one-off is fine and dandy, but it needs to be sustained. We need to make sure that facilities remain open and that the quality of end-of-life care is improved. We eagerly await the Minister’s response. I hope that we are not disappointed.

National Health Service Infrastructure

Baroness Jolly Excerpts

Thursday 9th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is very expert in this area, and she is absolutely right that the NHS estate must prioritise areas of most need. This is why we have put in a serious amount of investment. NHS Improvement is also conducting a backlog review to understand where the areas of greatest need are and to assist NHS trusts in prioritising capital spending over the next few months and years.

[Baroness Jolly (LD)]

My Lords, equipment such as CAT scanners also comes from this source of income. Many are now not operating properly or are out of action awaiting repair. How many days of treatment are lost each year as a result of this?

[Baroness Blackwood of North Oxford]

Data on the proportion of capital equipment that is out of action or on days lost is not currently collected and the responsibility for that is with local NHS organisations, but the Government have recently supported investment in new diagnostics. As outlined in our Health Infrastructure Plan, we have invested £200 million to deliver new state-of-the-art diagnostic machines, such as MRI machines, CT scanners and breast-scanning equipment, to 78 trusts. We recognise that we need to improve the number of scanners that are younger than the “golden rule” of 10 years old.

Queen’s Speech

Baroness Jolly Excerpts

Thursday 9th January 2020 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I declare my relevant interests in the register: chair of a learning disability charity providing services for people with a learning disability and president of RoSPA.

It may surprise noble Lords to hear that there are more accidents in the home than in any other setting, and they affect the most vulnerable, so I welcome the building safety Bill. It is much needed and, I hope, an opportunity to recognise how modifying low-cost housing design features and specifications can save lives.

Naturally, following the Grenfell tragedy, there is a focus on fire safety and cladding, and this is vitally important. However, I draw attention to the fact that, for every fire-related hospital admission in England, 234 are caused by accidental falls. Indeed, falls make up 60% of total accident-related hospital admissions. Simple regulation and guidelines have the potential to ensure that tragic accidents, which most often involve infants or the elderly, are avoided and we can all feel safe in our own home. I refer the House to measures outlined in RoSPA’s Safer by Design guidelines for how this can be achieved.

I note that a new employment Bill was announced in the gracious Speech, which has the stated purpose to protect and enhance workers’ rights. However, the accompanying briefing document lacked detail about how that would apply to the most fundamental of all workers’ rights—the right to go home safe and healthy at the end of the working day. Will the Minister clarify that the Bill will contain the measures about a worker’s right to work in a safe environment that were taken out of the October EU withdrawal Bill when the December Bill was published?

There is much to be welcomed in the Government’s health plans in the Queen’s Speech. However, as with all these things, the devil will be in the detail, and I am sure that the combined expertise of this House will leave the Bills better than when they arrive. Although funding pledges enshrined in law are welcome, I regret that there is no clear plan to address issues of capital funding or public health. The Government pledge to build 40 new hospitals, but clarity is needed on the issue of funding for general infrastructure, and this includes expensive medical equipment such as CAT scanners—and, as the right reverend Prelate the Bishop of London said, we also urgently need to address the issue of staffing. The Government’s plans to introduce fast-track visas for healthcare workers are in the right direction. But the policy does not go far enough, given the scale of the current crisis facing the NHS. With more than 100,000 current vacancies and a nursing shortage of 40,000, we need urgent action. With the UK’s approaching exit from the European Union, this issue will only become more urgent.

It is important that it is made clear exactly who is responsible for the recruitment and retention of staff, and who will be held accountable if the Government fail to meet their ambitious targets. In Questions yesterday, the Minister suggested that it was the Secretary of State, but I wondered which organisation this had been devolved to.

I also urge the department to engage meaningfully in a reflection about international health worker recruitment processes. The UK has a responsibility to recruit in an ethical way. This means ensuring that our efforts in international health development and health system building are not undermined by the drain of health workers from lower-income or understaffed countries.

It is encouraging to see mental health services mentioned in the Queen’s Speech, and the rewrite of the Mental Health Act that Sir Simon Wessely has been involved in is long overdue. I would also like to see the issue of the transition from adolescent to adult services given due consideration. Mental health conditions do not recognise arbitrary age boundaries. Although such transitions are often handled well, support and continuity can be an issue. Staffing issues are also prevalent in this sector, with 10% of full-time consultant posts in psychiatry being vacant and a shortage of mental health social workers and community nurses. We also need to ensure that young people receive prompt diagnosis, so that mental health services can provide timely early support, preventing the need for crisis management later in life.

The Government’s new visas do not include staff who wish to work in social care, many of whom will fall below the Government’s £30,000 threshold for points-based immigration. How do the Government intend to address the gaps in the stretched social care workforce and ensure that work is valued? As providers of learning disability services, we often have difficult conversations with our commissioners to ensure that we can offer the service levels required by the Care Quality Commission. Local authorities are underfunded and are unable to work within their budgets for service provision. That means often that the services provided are often not up to standard. The new Government’s majority presents an opportunity to introduce reforms that have been widely recognised as necessary for years. Now is the time for action and I look forward to hearing the Government’s proposals in the very near future so that collaboration can begin.

NHS: Nurses

Baroness Jolly Excerpts

Tuesday 7th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is very expert in this area. I cannot give her specific numbers on specific recruitment from individual countries; I do not know which specific countries she is asking about. I can tell her that the recruitment of nurses from overseas non-EU territories has increased by 156% in recent years; as the daughter of a South African nurse, I can also tell her that this is a long-term pattern and has been good for the NHS. However, we must also make sure that we invest in many of those nations as we do through the overseas budget, which is part of the department’s healthcare priority. I would be happy to write to her with details.

[Baroness Jolly (LD)]

My Lords, many noble Lords will know that 2020 is the Year of the Midwife. I am delighted that the Minister was able to make an announcement on the number of midwives but I want to know by when they would be in post. I also want to know, as I am sure the House does, who is responsible for the delivery of those 50,000 new nurses.

Health: Eating Disorders

Baroness Jolly Excerpts

Tuesday 7th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

We are increasing the number of commissioned in-patient beds up and down the country, but we are doing it in a way that recognises that it is better to have earlier diagnosis—prevention of the need to admit—and ensures that we do not wait until patients are at the stage where they need admission, which is the primary aim. My noble friend is absolutely right that we need to make sure that we have the right balance between those two. At the moment, we are doing a thorough assessment, and I will be happy to write to him on that issue.

[Baroness Jolly (LD)]

My Lords, the Minister has mentioned early diagnosis and treatment, which will help save lives, yet doctors receive less than two hours’ training on this topic. What pressure can the Government bring to bear to improve training for this deadliest of mental health illnesses?

[Baroness Blackwood of North Oxford]

My Lords—[Interruption.]

I am getting some help from the other side.

The noble Baroness is quite right on this matter. It is vital that professionals are trained to look out for potential signs. Obviously, with such a deadly mental illness—

I am not sure whether to stop or carry on.

Diagnosing eating disorders is an important area of mental health practice, so Health Education England is taking forward a significant package of work at the moment to review current education and training offered to identify gaps and ensure that not only junior doctors but general practitioners and nurses have the right kind of training.

Health: Tick-borne Encephalitis

Baroness Jolly Excerpts

Tuesday 5th November 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord is quite right, and he understands this a lot better than I do. NICE published guidelines for health professionals in 2018 in an effort to ensure prompt diagnosis of Lyme disease. Obviously if it is recognised promptly and treated with antibiotics, acute Lyme disease is usually resolved without further complications. I will take away the question about the cost of the test to consider whether that has been a barrier; we have no evidence about that at this time.

[Baroness Jolly (LD)]

My Lords, raising awareness is critical, and many are completely unaware of the risk when they go out for a walk. What actions will the Government take to ensure that organisations such as national parks, national forests and the National Trust have a part to play?

[Baroness Blackwood of North Oxford]

We will run tick awareness campaigns in the spring. Material for these campaigns will include information about Lyme disease and TBE. They will be run in all areas identified as at risk as part of the surveillance campaign.

National Health Service: Pensions Tax

Baroness Jolly Excerpts

Wednesday 30th October 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord is quite right. We must make sure that we do not undermine the important benefits of the tax relief on contributions. It is one of the most expensive reliefs in the tax system, costing around £50 billion, around 60% of which was claimed by higher and additional-rate taxpayers. We will expect any review that comes forward from the Treasury to be targeted. An evidence-based approach will be adopted where there is evidence that any problems with the pension tax are affecting the delivery of front-line services, as we have found with the specific group of high-paying clinicians.

[Baroness Jolly (LD)]

My Lords, the noble Baroness will be aware that the royal colleges are all sounding alarm bells, and she is probably also aware that all our doctors serving in the Armed Forces are affected by exactly the same tax hits. The whole NHS workforce is in crisis and we really cannot afford to lose highly trained clinicians. The problem has been known to the department for some considerable time. Can she tell us exactly when the Government expect there to be a sensible, workable solution?

[Baroness Blackwood of North Oxford]

As I said in an earlier answer, we are expecting the consultation proposals to be implemented in April. However, I reassure the noble Baroness that these proposals would also apply to clinicians working in the Armed Forces and in medical schools, provided they are in the NHS pension scheme. I hope she find that encouraging.

Health Service Safety Investigations Bill [HL]

Baroness Jolly Excerpts

2nd reading (Hansard): House of Lords
Tuesday 29th October 2019 Lords Chamber

[Baroness Jolly (LD)]

My Lords, this has been an excellent debate. The noble and learned Lord, Lord Hope of Craighead, has just mentioned the issue of no blame, a theme that has run all the way through the debate. It started with the noble Lord, Lord Hunt of Kings Heath, talking about James Titcombe, who lost a child at Morecambe Bay Hospital and is insistent that there can be no learning from blame. This was echoed by the noble Baroness, Lady Finlay of Llandaff, and the noble Lord, Lord Hunt of Wirral. Another theme running through the debate was picked up by the right reverend Prelate the Bishop of London, who talked about a culture of learning. Those are the two strands: we need a culture of learning in our NHS organisations and one of no blame. I welcome the commitment to learning from incidents involving patient harm and from adverse events. I also welcome HSSIB’s independence and I was grateful for the opportunity to talk to the Bill team yesterday.

This need to learn and to share is nothing new: something similar was being done 20 years ago. The noble Lord, Lord Patel, was just talking about it, as I thought he might, and I am sure that those here today will be able to tell the House that learning from such adverse events goes back even further. We heard very moving testimony from the noble Lord, Lord Turnberg, and, with their clinical backgrounds, from the noble Lords, Lord Ribeiro and Lord Colwyn. Will the Minister expand on how this theme could actually be woven into the Bill even further?

The governance of the body is interesting. For a body that will be looking at three or four cases each month, it seems very thoroughly governed. The board of HSSIB will have a chief investigator and chair as public appointments, as well as executive appointments and non-exec directors. The Joint Select Committee recommended that the appointments of both chief investigator and chair should be subject to the scrutiny of the Commons Health and Social Care Select Committee. I welcome the suggestion of the noble Lord, Lord Hunt of Kings Heath, that senior clinicians need to be involved in this, but experienced lay members can also bring welcome independent scrutiny—this was picked up by other noble Lords. It seems an appropriate measure, so why not include it in the Bill? It is something we may return to in Committee.

This is the first time that we know what the concept of a safe space entails. To allow individuals to talk about an event, secure in the knowledge that they will not be reported to others involved, is a powerful move, and I wonder whether it will take time for participants to gain confidence. Does the Minister have any insight into what measures might be taken to help with this? An expert advisory group was set up by DHSC to look at the HSSIB, yet its recommendations were not all followed. I understand that if you make a list of recommendations you can expect that they will probably not all be followed, but it had particular concerns about the duty of candour. The noble Lord, Lord Hunt of Wirral, spoke about candour, but I think he was talking about a slightly different sort of candour to what I think of as NHS candour. Here, we refer to frank and open conversation locally between patients and clinicians, and between different clinicians. Sometimes these are very uncomfortable conversations, where something has gone wrong and you sit down and have a facilitated chat. It can be very difficult to be honest and open, but it is really important.

Professional bodies express the need and the desire for the NHS to be an open, learning body, yet the Bill does just the opposite. How does the Minister see this being resolved? The reasons that healthcare regulators will seek disclosure from the High Court are likely to be linked to the proper exercise of their public protection duties. The proposed test surrounding the interests of justice does not appear to envisage or adequately cater for such applications. I am sure we will return to this in Committee.

My noble friend Lord Scriven brought to our attention the delivery of NHS services in prisons and in conjunction with social care. I welcome that addition, but I am also not sure whether the Bill applies to NHS care for service men and women, either in the UK or overseas. That is perhaps something else that might be looked into. I am sure we will also consider in Committee whether the Bill will include patients in private hospitals whose care is being funded by the NHS, and patients being treated by clinicians who work for the NHS as well as the private sector, but whose care is being provided for privately.

Following on from the point made by the noble Lord, Lord O’Shaughnessy, it is worth noting that NHS Providers recommends in its excellent briefing that all providers registered with the CQC should be part of the HSSIB’s remit. I would support that, as a sensible suggestion that would make the situation crystal clear. Regulatory bodies are listed in Clause 2(6), but there is a very large number of people working in the NHS who are not part of a registration scheme. The most obvious are care workers, but it is also true for very skilled individuals such as clinical perfusionists. There are also other qualified technicians within the NHS who have no body with which to register. In my response to the Queen’s Speech, I expressed my concern that care workers had no organisation with which to register. Clinicians, as I have just mentioned, are not registered either, and I know that this is not an issue of their making.

Where the incident involves an unregistered member of NHS staff, with whom would the HSSIB co-ordinate the practical arrangements called for in Clause 12? Will the Government consider looking again at the issue of non-registered NHS staff? The Minister may be aware that the GMC has suggested that now would be a time to look again at regulatory reform. Can she tell us whether there are any plans to make that happen?

This Bill is about processes—the Minister said as much when she opened this debate—to determine the truth about incidents during the provision of health services where there arose extreme causes for concern and to make recommendations to avoid repetition. It involves the patient, possibly their family and the clinicians and other staff. Yet in the Bill there is no heed taken of those individuals, or their care and well-being, in what would most certainly be a stressful and difficult time.

This has been an interesting and well-informed debate, but the two most powerful speeches were those of the noble Lords, Lord Turnberg and Lord Faulks. I shall spend the next couple of weeks rereading this Bill and thinking about its future—except perhaps, just perhaps, it will not have one.