Diesel Emissions

Baroness Jolly Excerpts

Wednesday 5th December 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord is quite right that local authorities will have a critical role. The clean air strategy is supported by the Department of Health and Social Care and Public Health England, but it is Defra’s responsibility. I am not able to say any more than that at the moment, but it is clearly a very important strategy being led by the Government, and we will make sure that we support local authorities to do their bit.

[Baroness Jolly (LD)]

As the noble Lord said, local authorities are being supported by Public Health England in reducing their pollution levels. Can the Minister tell the House which local authorities are non-compliant and whether there are any sanctions for this, and what form the support from Public Health England takes?

Health: Cancer

Baroness Jolly Excerpts

Thursday 29th November 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness pinpoints some really important issues that we need to deal with. The good news is that the number of radiographers has increased by 3,500 in the last eight years, but of course we need to do more and the cancer workforce plan includes plans to recruit more specialists. Greater investment in equipment is taking place, the Prime Minister has announced investment in specialist cancer centres, and the first proton beam therapy centres in this country have now opened. Finally, AI has extraordinary benefits. It is now able to diagnose some tumours better than most expert specialists. We have made some commitments in this area through the expansion of digital pathology and radiology, and we will be doing more.

[Baroness Jolly (LD)]

My Lords, there is a complete postcode lottery for breast cancer care. It starts with appointment delays—first with the GP and then with the consultant— and then very often, as the noble Lord has said, the equipment is old and is very expensive to replace. Are there any grants that NHS England can make available to hospitals to help them purchase this equipment sooner?

[Lord O'Shaughnessy]

One reason that our cancer survival rates are not where they should be is that there is huge variation. The truth is that in some communities cancers are detected far too late as a matter of course. One way in which we are trying to address this problem is through the cancer strategy, which has provided about £600 million, £200 million of which has been to support cancer alliances in every corner of the country to make sure that we eliminate some of that variation and ensure that there is much more care for anybody suffering from cancer.

Mental Capacity (Amendment) Bill [HL]

Baroness Jolly Excerpts

Report: 2nd sitting (Hansard): House of Lords
Tuesday 27th November 2018 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I too support Amendments 29 and 86 and others in this group.

It is essential that the cared-for person and their appropriate person and/or advocate are provided with information about the reasons for the cared-for person’s detention and their rights to review and also to challenge. It is a fundamental human right under Article 5 of the ECHR. Both the Mental Health Act and the DoLS contain clear obligations to take steps to help the person understand their situation and their rights; and the DoLS set out a clear statutory list of those entitled to copies of the authorisation and the assessment.

Despite this, the Bill is silent on these rights to information. The Minister has suggested that the person could request the information by making a subject access request under the GDPR. I agree with the Joint Committee on Human Rights, which does not accept this as an adequate substitute. This misunderstands the obligation, which is a right to be informed, not a right to request information. It is highly unrealistic to expect a person subject to the LPS to think that they would know to make this request and be able to do so.

Meanwhile, the person’s family would have no obvious rights to this information unless, of course, they held a lasting power of attorney or deputyship, and most will not. At the moment, requests for personal data are managed through the MCA code’s guidance, with data being disclosed only if it is in the best interests of the person. In practice, families, and even advocates, are often shut out of decision-making and consultations about the person, and can experience obstruction in trying to access vital information like this. The Bill should be compatible with the ECHR, not on promises of what might possibly be in the code—as my noble friend Lady Barker has just stated.

The Minister has confirmed that the code of practice is statutory and that it must be followed unless there is good reason not to do so. However, this is not the main problem. In some places the code is being asked to effectively establish rights and duties instead of explaining or elaborating on them. Duties to provide information about the authorisation and clear-cut rights to obtain copies of the authorisation documentation are an important example. A code cannot be used to achieve this.

I remind the House of a recent example in which the MCA code of practice said that certain very serious decisions—such as withdrawal of artificial nutrition or hydration—could be taken only by the court of protection. Peers were reassured in Parliament that that was the case and shown a draft copy of the code of practice, which stated it clearly. However, the Supreme Court ruled this year that that was not the case in law and that the MCA code of practice not only misstated the legal situation but could not establish a duty where none had existed. Consequently, if there is a need for a hard-edged duty or right, that needs to be put into legislation, not in the code.

I therefore urge the Minister that in this Bill we must have the provisions to provide the person with information about their situation and their rights, and also clear statutory entitlements to copies of the relevant documentation for those supporting and representing them.

--- Later in debate ---

[Lord O’Shaughnessy]

My Lords—

[Baroness Jolly]

My Lords, I had not fallen asleep. We are nearly there. I put my name to Amendments 140 to 147A because they are important, although I suspect that they will not make it into the Bill. It is important to have these discussions at this stage.

In Committee, I tabled amendments on the review of the Mental Health Act and the code of practice. I still support them. The request for an equality impact assessment in Amendment 143A in the name of the noble Baroness, Lady Thornton, is the right thing to do. The amendments ask the questions but the issues are still real and important. The amendments also relate to how a future Bill could be handled. Indeed, it helps us to look back to other Bills; I cite the Care Act, for example, where a Committee of both Houses went through the Bill over a prolonged period to ensure that by the time it hit your Lordships’ House, it was worth reviewing.

The Minister has done a very good job of pulling this all together so far; Third Reading is still to come. I understand full well that he will not put any of these amendments in the Bill, but he should take seriously the concerns that they raise from Members of your Lordships’ House.

[Lord O'Shaughnessy]

I apologise for pre-empting the noble Baroness. I take the points raised in these amendments seriously, and I will attempt to deal with them as we go through. I applaud noble Lords for the contribution they have made in improving the legislation before us, but of course it is one thing getting the legislation in better order and another thing putting it into practice. I think that is what has inspired the amendments in this group. I will attempt to deal with them as comprehensively as I can and explain why we will not be accepting them in practice—as the noble Baroness, Lady Jolly, pointed out—although we are dealing with them in spirit.

Amendments 140 and 146, tabled by the noble Lord, Lord Hunt and the noble Baroness, Lady Jolly, require the Government to publish a list of every organisation we have consulted with. The noble Lord expressed concern about our response to his FOI request; as I understand it, there were some technical reasons why that did not elicit the information he was after. However, I hope the noble Lord will have seen the letter I sent following Committee, explaining that we have held over 50 engagement events since March 2017. I outlined the broad range of organisations that the Government have engaged with. That letter has been put in the Library and will be published online in due course.

I will not detain noble Lords by going through that list, but of course I am more than happy to circulate it again; indeed, it has obviously developed over time. We have engaged with care providers, a range of third-sector organisations, the royal colleges, stakeholders in local government, the NHS and the social care sector, and, critically, people who themselves have impaired capacity. That builds on three years of engagement conducted by the Law Commission in drawing up its draft Bill.

Nevertheless, I accept there is concern that we have moved too swiftly and that we have not always taken concerns on board. I know we have come in for some criticism for that, but we moved ahead with this Bill because of the urgent need for reform and because the system is not working. While I do not pretend our approach has been perfect, I and the Government feel it has been necessary to move ahead at pace.

The point I want to emphasise is that, in doing so, we have listened and acted. I am grateful to noble Lords for recognising the changes made as a consequence of challenges and ideas from them and other stakeholders. I also applaud the Bill team for responding and providing government amendments. I am pleased we have been able to move on some incredibly important topics, such as “unsound mind”, 16 and 17 year-olds, the point about IMCAs, thinking about when reviews should be considered by AMCPs, and so on.

As I said, in retrospect and as a lesson for the future, things could perhaps have been done differently. However, I believe we are in a much better place than we were at the start of the process as a consequence of our deliberations.

Amendments 141 and 147, also tabled by the noble Lord, Lord Hunt, and the noble Baroness, Lady Jolly, would require us to publish a plan to ensure that all outstanding deprivation of liberty safeguards applications are settled. The noble Lord is right to worry about this issue and give us the cautionary tale of a too-abrupt switch to a new system and the chaos that can ensue.

On commencement of the new system, existing deprivation of liberty safeguards authorisations will continue until they expire, at which point a liberty protection safeguards authorisation will need to be arranged, or the person should be provided with alternative arrangements that do not amount to a deprivation of liberty—we are seeking less restrictive care wherever possible. Given the length of time for which these authorisations exist, that will provide for a degree of staggering of the case load through the implementation of the new scheme.

On the backlog itself, many local authorities are already working to clear this. Some innovative working models have been introduced and I would be happy to write to noble Lords about them. We are working closely with the LGA and ADASS, as well as the Welsh DoLS network, to provide examples of best practice so that we can move through that backlog and into the new system. There will of course be some outstanding cases as we move from one system to another, particularly if an application is made shortly before the date the new system comes in. We will need special arrangements in place for those, but I reassure all noble Lords that we are working closely with all the people and organisations who will be responsible for implementing the new system to ensure a smooth transition.

Gosport Independent Panel

Baroness Jolly Excerpts

Thursday 22nd November 2018 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for reading out the Statement updating the House on government actions since this appalling tragedy was reported to the House in June. As the Statement says, the Gosport report was “truly shocking”, and once again our thoughts, sympathies and condolences go out to the families of the 456 patients whose lives were shortened. Those families campaigned for so many years to find out what happened. We also again pay tribute to these relatives for their courage, tenacity and persistence in seeking the truth, and to the panel, with particular thanks for the calm and compassionate leadership of the chair, Bishop James Jones, for its unstinting work in uncovering the injustice and for listening to and hearing the families’ concerns.

It is important to remind ourselves of the panel’s conclusions. First, there was a disregard for human life and a culture of shortening the lives of a large number of elderly patients. Secondly, there was an institutional regime of prescribing and administering “dangerous doses” of a hazardous combination of medication not clinically indicated or justified. Thirdly, relatives were constantly let down by those in authority in the hospital when they complained. Fourthly, senior management, the local constabulary and politicians, the coroner system, the CPS, the GMC and the NMC all failed to act in ways that would have better protected patients and relatives.

We welcome the commitment to strengthen protections for whistleblowers and for new legislation to compel NHS trusts to report annually on how concerns raised by staff have been addressed. Has a detailed programme of work for this been drawn up? When does the Minister envisage that legislation on these new powers will be introduced? However, much of the Statement today is about work in progress on the actions and measures that were announced when the report was published, and it is important that we receive regular updates in the future. In his June Statement, the Minister referred to the introduction next April of medical examiners to ensure that every death is scrutinised by either a coroner or a medical examiner, and yesterday’s Statement repeats this commitment. Can the Minister advise the House on progress on this? If they are to be employed by acute trusts, how will their independence be maintained and how will they link into the mortality reviews and the Learning from Deaths guidance? Has consideration been given to basing them in local authorities so that their remit can be extended to primary care, nursing homes and mental health and community trusts? What additional resources are being provided to fund these new posts?

When the report was published, the House welcomed the urgent establishment of a hotline and of counselling being made available to all those who had lost loved ones and were affected. Are these important provisions still available and will they continue to be provided? What further support is being provided? Also, in addition to the 456 patients given opiates without appropriate prescribing or as a result of the prescribing practices at the hospital, sadly, 200 more patients were referred to in the report whose clinical notes or medical records had gone missing. The panel considered that these patients had been similarly affected. What progress has been made by the workstream set up to further investigate this appalling situation? How many more cases have been substantiated as a result of this?

On the question of oversight of the use of opiates in the NHS, is the Minister satisfied that it is now tight enough to prevent incidents such as this happening again? We welcome the promise of a further review on how patient safety can be improved when prescribing and dispensing medicine, aimed at detecting inappropriate prescribing. Can the Minister give us further details of how this review is to be conducted, including the full remit and timescales?

In June, the Minister also promised a “fresh impetus” to moving forward on the need to streamline professional regulation following the report’s condemnation of the inadequacies of the GMC and NMC regulators who failed to act in ways that would have better protected patients and relatives. What progress has been made on this work?

Finally, we come back to the key issue of patient safety and the need to build a patient safety culture in the NHS. Does the Minister consider that additional legislation is needed to keep patients safe? Is a new independent body now required to pick up and take forward the remit of the former Patient Safety Agency, so unwisely abolished by the Government?

The Statement ends by underlining the cultural change that needs to be driven across the NHS to achieve openness, transparency and learning rather than blame and the cover-up of mistakes and incidents, and of course we agree with that. For all the awfulness of its findings, the Gosport panel report has managed to ensure that the carers and relatives of loved ones and staff have been listened to and heard. We on these Benches pledge our full support for the measures which will ensure that what happened at Gosport never happens again.

[Baroness Jolly (LD)]

My Lords, I join the noble Baroness, Lady Wheeler, in thanking the Minister for an update of this situation and I too pay tribute to the relatives and the whistleblowers in this awful scandal. I am sure that many noble Lords will remember how the Shipman scandal absolutely rocked the NHS back in the late 1990s. The learning which came out of that was meant to incorporate right across the NHS robust clinical governance structures. It is really quite ironic that the things which were put in place to deal with the Shipman case seem to have fallen apart completely as regards the particular issue of Gosport.

Whistleblowers need to be confident that there will be no danger of their being bullied. I am sure that other noble Lords will have had NHS employees ask to talk to them about whistleblowing issues. One of the saddest days I can remember was when I was sitting in the Royal Gallery talking to a very senior manager in an NHS trust who was trying to raise his concerns. In the end he resigned because he felt that he had been bullied into doing so. He was going to take his expertise elsewhere. There is learning that should come from that.

I welcome the Freedom to Speak Up initiative and the work from the National Guardian’s Office. What progress has been made in embedding the operation of that scheme? If it is still in train, when might it be embedded? What consideration has been given to a similar scheme for whistleblowers who work in the care sector? This has got the NHS sorted but, at the moment, there is no way that care workers who work in care homes or other care establishments can effectively blow the whistle.

[Lord O’Shaughnessy]

I am grateful to both noble Baronesses for their comments. I join them in expressing both my sympathy for the families of those affected and my admiration for and gratitude to Bishop Jones and his panel.

The noble Baroness, Lady Wheeler, asked a number of questions to which I will attempt to respond. First, she was right to reiterate the shocking nature of the panel’s findings and the systemic problems that were found. The noble Baroness, Lady Jolly, talked about the Shipman case. Part of the problem here is that, in some senses, people were alert for a Shipman-type event but not for a different type of event; it is almost always the case that when things go wrong, they go wrong in a different way. That is why we need a different approach from simply focusing on the actions of one person.

The noble Baroness, Lady Wheeler, asked about legislation. We are considering whether the right route would be through the draft health service safety investigations Bill, which is coming through Parliament at the moment, or other routes. Her request for regular updates is a good one; by the time we next report on such an update, I will be able to update her on the type of legislation we intend to use. I am grateful to both noble Baronesses for offering to support us through that process.

Clearly, the medical examiners’ policy is critical to making sure that we do not suffer these problems in future or that bad behaviour—you can never rule it out—is spotted and dealt with quickly. They will come in from April 2019. In the policy design, we considered whether they should be sited with local authorities but felt that they would be better sited in trusts, so they will work in trusts, there will be provisions to deal with conflicts of interest in particular, and they will report directly to a national medical examiner. That will be their reporting line, so they will have that professional responsibility.

We will support this scheme with more money—about £30 million. It will start with hospital deaths but will roll out over time to all deaths. Clearly, as was said by the noble Baroness, Lady Wheeler, interaction with the Learning from Deaths programme, which will move from acute mental health and learning disability deaths into a primary care setting, will be critical. We need to bring these programmes together; her point was well made.

We expect that the medical examiners’ system will lead to 140 more coronial inquests each year where there is suspicion of something being not quite right. That reflects both the likelihood of problems existing in the system now and the benefits that we can get from the scheme. I hope that the scheme will get strong support from all sides of the House.

Of course, support for the affected families continues; they are still going through this process and the police assessment and investigation is moving forward. We do not believe that there are further cases on this scale but we need to remain vigilant at all times, precisely as my right honourable friend the Secretary of State said yesterday. We must make sure that we do not just think that we have solved it but keep deepening our attempt to change the culture.

The noble Baroness, Lady Wheeler, asked about medicine prescribing. At this point, the intention is to have an internal review, but we would be happy to receive evidence from all parties—noble Lords, stakeholders and others—to make sure that we can improve prescribing and look for patterns of bad behaviour. E-prescribing has been rolled out across the country, which gives us the ability to investigate unusual prescribing patterns. Improved computing technology can help us to do that as well; we are talking to the MHRA about that because it is concerned with medicine safety.

The noble Baroness, Lady Wheeler, asked about professional regulation reform. The Secretary of State is aware of it. There is a long history of great support in this House for it; I am afraid that I have not got anything particular to say to her about that at this time, other than that we are aware of the support and need for reform in this area.

Finally, the noble Baroness, Lady Jolly, asked about whistleblowers. She is absolutely right that this issue is critical, which is why we are working with the business department. The good news is that speak-up guardians, as they are sometimes known, are now in place in trusts across the country. The bad news is that, despite being banned, gagging clauses are still in operation; again, my right honourable friend said that he is determined to stamp that out. I take the noble Baroness’s point about looking at the care sector; it is a good one. I will make sure that it is considered explicitly in the work that we are doing with the business department.

Once again, I thank both noble Baronesses for their support. I know that we are all determined to make a difference.

Mental Health Budget: Domestic and Sexual Violence

Baroness Jolly Excerpts

Thursday 22nd November 2018 Lords Chamber

[Lord O’Shaughnessy]

My noble friend is right: that is a really important part of the approach. It is encouraging that 88% of women would now tell someone about abuse they have suffered and that there has been a 20% increase in domestic abuse convictions since 2010. As we discussed in this House last week, we are seeking through the GP contract negotiations to abolish the fees that some GPs charge for the letters needed for referral to legal aid and other things. That is something we continue to push.

[Baroness Jolly (LD)]

My Lords, the statistics tell us that for every two women who are affected by domestic violence or abuse, there is one man. Can the noble Lord reassure the House that spending allocations reflect this?

[Lord O'Shaughnessy]

The noble Baroness is quite right. The strategy, of course, has a focus on women and men. Women are the greater victims of abuse; indeed, the more severe the abuse, the more likely it is that the victim is a woman. However, I can tell her that it is a broad strategy which encompasses both. We still have a problem, in that men are much less likely to come forward if they have been abused than women.

Health: Stroke

Baroness Jolly Excerpts

Wednesday 14th November 2018 Lords Chamber

[Lord O’Shaughnessy]

I did not know that my noble friend’s husband had had a stroke; I am grateful to her for sharing that with the House. She is right that the examples of Newcastle and Northumbria have shown that hyperacute stroke units—the centralisation of services—save lives. Closing hospitals or changing services can be controversial, but in stroke we know that it makes a big difference. It is a focus of what we need to do, and we need to take courage on that. The Act FAST campaign, which my noble friend mentioned, has been incredibly successful in making sure that we get fast action when people have a stroke. More than 5,000 fewer people have been disabled by stroke since that campaign started.

[Baroness Jolly (LD)]

My Lords, when the national stroke plan is finally published, we should expect clinical elements. I hope that we will see some lifestyle elements around protection from stroke and stroke prevention. What actions are being discussed with Public Health England on the prevention part of the plan? Can he guarantee sufficient funding for local authorities to deliver it?

[Lord O’Shaughnessy]

The noble Baroness is right about prevention. There are lots of ways that we can prevent stroke, including by reducing hypertension, obesity and other things. Of course that will be a big part of it. She will know that decisions about funding for Public Health England will be taken at the spending review.

NHS: Staff

Baroness Jolly Excerpts

Tuesday 13th November 2018 Lords Chamber

[Lord O'Shaughnessy]

I am grateful to the noble Baroness for that question. First, we have safe levels by recruiting more staff. We recognise that there is a need for it, and we are recruiting more staff in every category. The actual safe level of staffing is a trust-level issue that needs to be determined in response to the case load they have at any moment.

[Baroness Jolly (LD)]

My Lords, I understand that medical students in England could soon be fast-tracked through their studies, advancing registration by a year. This would put them on wards one year earlier, with a year’s less training than their predecessors. What is the Government’s current thinking on this? Who are they consulting? What risk analysis will be done in making this decision?

[Lord O'Shaughnessy]

The noble Baroness will understand that the safety of NHS patients, and the NHS as a whole, is paramount when considering workforce. We are looking at whether additional flexibilities can be explored, but that will only be done if we can assure ourselves and others of that safety. These issues are being considered in the workforce plan.

Vaping

Baroness Jolly Excerpts

Tuesday 13th November 2018 Lords Chamber

[Lord O'Shaughnessy]

I completely agree with my noble friend. Interestingly, ONS data shows that 48% of people said that the main reason for using an e-cigarette was as an aid to stop smoking, and just 1.5% cited the range of flavours available as their main reason.

[Baroness Jolly (LD)]

My Lords, the European tobacco products directive bans all broadcast media in the EU from advertising e-cigarettes. Will the Minister tell the House what the Government’s post-Brexit plans are?

[Lord O'Shaughnessy]

Our post-Brexit plans are the same as our pre-Brexit plans—to have a sensible policy which provides e-cigarettes to stop smoking and to make sure that they are not abused by people who should not be using them.

Antimicrobial Resistance

Baroness Jolly Excerpts

Thursday 25th October 2018 Lords Chamber

[Baroness Jolly (LD)]

My Lords, in 2016 just under 250,000 people developed multidrug-resistant TB globally, and in 2015 a report found that one-third of London boroughs exceeded the World Health Organization’s high-incidence threshold for TB. This poses a huge threat to public health. What action is being taken to get on top of this by the Department of Health, Public Health England and other agencies?

[Lord O’Shaughnessy]

The noble Baroness is quite right about the risk in London. We actually have a good TB story in this country—a 41% reduction between 2011 and 2016—but London has the highest rates in the UK. I can tell her that Public Health England and the GLA are working closely together to reduce TB. In fact there are innovative new approaches, such as UCLH’s Find & Treat mobile unit, which I myself visited last year, which is going out and finding people at the highest risk, screening them and then taking them for treatment.

Health: Flu Vaccines

Baroness Jolly Excerpts

Tuesday 23rd October 2018 Lords Chamber

[Lord O’Shaughnessy]

I am very happy to tell the House: it was on the advice of the Joint Committee on Vaccination and Immunisation, which is precisely where we get expert advice on how to act. The reason for moving to this new vaccine is the one I set out. The reason that the delivery is staggered, but to be completed by the end of November, is because it is from December into January that we have the peak of influenza in this country. The Deputy Chief Medical Officer said:

“Based on many years of surveillance in the UK it is highly unusual for widespread community flu activity to become significant or substantial before the start of September”.


It is on that clinical advice that this decision has been taken.

[Baroness Jolly (LD)]

My Lords, high-street pharmacies are offering flu jab appointments to the public, as are pharmacies in larger supermarkets. This morning I was able to book several dummy appointments online with several—just for research, noble Lords will understand. It would appear that all of those were successful, so those particular retail pharmacies have no problem providing vaccine for older people. Can the Minister tell the House whether the market for vaccines is an open market, or do GPs and the NHS get preferential treatment? We know that CCGs commission pharmacies for some of the work that they do. Is the flu vaccine included in that CCG commission? Would that tell us what proportion of the population would choose the retail route rather than the GP route?

[Lord O’Shaughnessy]

First, let me just clarify that the quotation from my last answer should have ended,

“before the start of December”.

It would be terribly alarming if it was September: it was December and I am happy to write to noble Lords with those details.

As for how the vaccine is secured, it is done on the open market. GPs and pharmacies buy it directly from the manufacturer, which in this case is Seqirus. As I have said, we have checked with the manufacturer, which has confirmed that there is adequate supply available for this country. Seqirus has, indeed, made extra supply available in response to the demand we have heard discussed today.