Chronic Lymphocytic Leukaemia: Ibrutinib

Baroness Jolly Excerpts

Thursday 7th June 2018 Lords Chamber

[Baroness Jolly (LD)]

My Lords, the NHS constitution states that patients have a legal right to,

“drugs and treatments that have been recommended by NICE for use in the NHS”.

At the moment, in England, there are many men and women who have cataracts that are deemed by NICE as being ready for operation and for replacement, but the CCGs are refusing to commission and they are having to wait longer and longer. Can the Minister shed any light on this?

[Lord O'Shaughnessy]

I am afraid I do not know—it is a slight handbrake turn on the topic. I would of course be happy to meet the noble Baroness to discuss this issue; I was not aware of it, but I will happy to investigate it for her.

Psychiatrists: Referral Fees

Baroness Jolly Excerpts

Thursday 7th June 2018 Lords Chamber

[Lord O'Shaughnessy]

If these allegations are substantiated, there must obviously be serious consequences for the doctors concerned and clearly it is right that the GMC investigates that. In terms of the noble Baroness’s overall question, there is of course local authority-commissioned alcohol and drug treatment available; it does not need to be purchased privately. More generally, in terms of mental health support, she will know that there is a commitment to recruit 21,000 more mental health staff and that, through the new mental health investment standard, CCGs have to continue increasing their mental health spending year on year.

[Baroness Jolly (LD)]

My Lords, is there any evidence to suggest that these are isolated cases or more common practice?

[Lord O'Shaughnessy]

We do not have any detail on further cases at this point. Of course we would always welcome any evidence, as would the GMC, in order to investigate that. It is important to point out that doctors are revalidated medically every year and fully revalidated every five years. In that process, they are asked to demonstrate that they have stuck by the ethical guidelines in the GMC practice and, if any evidence alights contrary to that, it would put their registration at risk.

Health Inequality: Autism and Learning Disabilities

Baroness Jolly Excerpts

Thursday 10th May 2018 Grand Committee

[Baroness Jolly (LD)]

My Lords, I too thank the noble Lord, Lord Touhig, for introducing this debate. I declare my interest as listed in the register.

People who have never been involved with learning disabilities are unclear about what they really mean. People with a learning disability will have the emotions of an adult—they can fall in love, worry, get cross and be jealous—but it is the reduced intellectual ability that affects them for their whole life. They are subject to mental health problems and early-onset dementia.

Learning disability is subject to the Equality Act and the United Nations Convention on the Rights of Persons with Disabilities. Somebody with a learning disability should be able to expect good NHS treatment. They should also expect clinicians caring for them to make reasonable adjustments. In the questions after yesterday’s Statement, I raised the issues of funding, clinician training and the provision of suitable written material, and I will not revisit them now. However, I should like to raise the issue mentioned by the noble Lord, Lord Crisp—access to NHS sight tests.

People with a learning disability are at high risk of sight problems. Adults are 10 times more likely to be visually impaired and six in 10 will need glasses. Most people think that sight tests are easy to access, but for many people with more complex needs they are not. No targeted scheme is run by the NHS or NHS England, unlike GP health checks or special dental care. For years, the same tariff of around £20 has been paid by NHS England to deliver these sight tests. This covers about half the cost of a standard high-street test, let alone the service that someone with more complex needs requires.

The outcome is that many people with learning disabilities are instead sent to use the sight-testing services at hospital eye clinics. Without any national scheme, parents are at a loss as to where to go. Half of the children in special schools have a vision problem. Around 45% of children of the age of 11 in a special school will not have had a sight test. This makes for a poorer quality of life than would otherwise be the case. Therefore, will the Minister look at whether an NHS England scheme in the community and in special schools, which four in five children with more severe learning disabilities attend, is a possibility?

As I mentioned, people with learning disabilities have rights, and this lack of appropriate treatment is an unacceptable face of discrimination. Therefore, will the Minister please investigate this and get back to us? I might also suggest that perhaps a much longer debate than this one is required on this well-ignored group.

Learning Disabilities Mortality Review

Baroness Jolly Excerpts

Wednesday 9th May 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for her questions and agree with her that it is a troubling report; it paints a troubling picture of the shockingly poor outcomes that people with learning disabilities have in terms of their mortality and morbidity. I would not disagree with her about that picture and I will come to the actions we are taking to try and address it.

On the publication, I agree with her that the timing was less than ideal. The department did not have sight of it; it was an independent report commissioned by NHS England. We are investigating that, but I agree it was not done as it should have been and we will endeavour to ensure that this does not happen again. On the areas of policy that she referred to, on out-of-area placements there is a programme called Building the Right Support, which is trying to increase the amount of care delivered in community settings, bringing people with learning difficulties, disabilities and autism out of in-patient care to more suitable care in the community. The intention is to reduce the use of in-patient beds for people in mental health hospitals by 35% to 50% between March 2015 and March 2019. It is an attempt to locate much more of that care in the community.

The noble Baroness also asked about other actions we are taking to improve outcomes. I want to focus on the annual health checks that are now available for adults and young people from 14-plus years. That is happening every year. We know the use of these checks is increasing; it has increased by 17% year on year up to 2017-18. There is a real ambition to raise that further by 64% in 2018-19 compared to 2016-17. We know this group does not always feel equipped to come forward and bring health issues to the notice of the health system. It needs extra support; it needs people to be on their side, checking in with them to make sure their issues are addressed. I think this is one way in which we will make some difference.

[Baroness Jolly (LD)]

My Lords, I declare my interest as chairman of a learning disability charity that provides services for 2,500 adults in England. This report makes for uncomfortable reading for anyone involved in the sector and it should shock the general public. We are judged by how well we as a society care for those who are weak and vulnerable. On this count, we have failed. Each year, the deaths of 1,200 people with learning disabilities are avoidable. The standard of their care is not fit for purpose. There are not enough learning disability specialist nurses in the NHS and support staff are no longer being funded to support people with a learning disability in a healthcare setting.

I have three questions for the Minister. Do either the Department of Health and Social Care or Health Education England collect figures on how many health professionals attend training in dealing with people with a learning disability? What guidance is given to staff about the provision of written material in an accessible format? Finally, once admitted, learning disabled patients lose their funding from the local authority so they have no one who knows or understands them and they are left frightened and alone. Does the Minister believe this should be the case?

[Lord O'Shaughnessy]

I thank the noble Baroness for raising excellent questions. We know that there is a need for more specialist nurses, and indeed that is one reason for the expansion of the number of nurse training places. The education and training of staff is a focus of the recommendations of this report and, equally, of the Mencap report. If noble Lords have not read that, I commend it too. Because it is a very good point, I will look into whether we are tracking the number of people who access training. Certainly there is now, and has been since 2016, an education and training framework for the care of people with learning disabilities. I believe that there is also one to follow for adults with autism, and that is welcome. However, as the noble Baroness says, it is about making sure that the staff use that training.

On the noble Baroness’s point about advocacy, I did not realise the funding issue that she raised existed. I will take that back and investigate it. I know that NHS England, the LGA and the Association of Directors of Adult Social Services have put out joint guidance on advocacy for this group of people, but I will investigate the funding point and write to her.

Health: Cancer Nurses

Baroness Jolly Excerpts

Wednesday 2nd May 2018 Lords Chamber

[Lord O'Shaughnessy]

I do not believe that nurses would have fallen into that category as nursing is named as a shortage profession in the immigration system, but I would have to check those figures and I will write to the noble Baroness.

[Baroness Jolly (LD)]

My Lords, the failure to screen nearly half a million women for breast cancer is a scandal. When it is coupled with the report of Macmillan Cancer Support, it has really been a bad few days for cancer. Immediate action is required on both counts. Is it the Government’s view that this shortage of cancer nurses is due to local budget constraints or to workforce planners’ failure to act on the demographic trend of the ageing workforce?

[Lord O'Shaughnessy]

My Lords, regarding the Statement made by my right honourable friend the Secretary of State earlier today about the errors in the breast cancer screening programme, I take this opportunity to apologise wholeheartedly and unreservedly on behalf of the Government, Public Health England and the NHS for the suffering and distress that has been caused to women by this flaw in the screening service. We will have an opportunity to discuss this at greater length tomorrow, when I will repeat the Statement.

The shortage that has been described is based on an analysis of vacancy rates. The number of cancer nurse specialists has actually increased by 1,000—that is 30%—in the last three years alone. That is a huge increase. Of course we know that we need to do more, but it is worth recognising the great steps forward that we have made in cancer treatment in this country.

The Long-term Sustainability of the NHS and Adult Social Care

Baroness Jolly Excerpts

Thursday 26th April 2018 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I join all Members in the House today in congratulating the noble Lord, Lord Patel, and his committee on an excellent report, which came with a list of three dozen recommendations. I also share the anxiety expressed by some Members of the House about the quality of the government response. To wind up this debate is difficult because it has been so rich. People have brought to it their personal experiences as clinicians, as experts and even as patients. That has made the debate very broad so I shall try to narrow my remarks to just a few areas.

When the NHS was formed, in 1948, no one could foresee a world in which people were living longer and much care was taking place outside of hospitals. To tackle the demands facing our health and social care sectors today we need still to innovate and change and to develop a patient-centred model of care. In recent years, the NHS has halved the number of hospital beds, and it is estimated that with more efficient care half of patients currently in hospital could be treated at home or within their community.

Much has been said about joint working and integrated care, and here technology can really help. I think the noble Baroness, Lady Redfern, was the first person to mention data. Having common datasets by which NHS computers can talk to social care computers was seen as part of the solution to this very problem of integration when I first became involved in the NHS, 20 years ago. As an aside, my noble friend Lord Rennard might wonder why the NHS uses a fax machine to talk to itself but apparently security is the issue: it is the most secure way of communicating between NHS establishments and regular telecoms are not up to the task. We need systems that work together to smooth the transition from primary care to hospital to social care services, and reduce cross-referrals and delays—the bumpy departures and landings to which the noble Lord, Lord Carter of Coles, referred. I hope the Minister will be able to give us some indication in his summing up of where we are with this particular piece of the integration jigsaw and other ground-breaking digital innovations.

To do all this, we need money. To have care that is oriented towards the future, we must have a properly funded and integrated framework for health and social care. This is to be seen not as government expenditure but as investment. There will be payback: in increased efficiency, better care and improved patient satisfaction. Both health and social care have suffered from ebbs and flows of funding depending on the direction of the political wind, and we must endeavour to change that. In the social care sector alone, real budgets have fallen by nearly a quarter and brought the sector to near collapse, while in the NHS hospitals are overstretched and underprepared to combat the annual winter crisis, which seems to be all year round. The noble Baroness, Lady Watkins of Tavistock, reminded us that social care involves not just old people. It includes people with a disability, whether it is a learning disability or a physical disability, and, as she mentioned, children. Both systems are in need of rescue and reform in order to serve future generations. Without proper funding levels, we cannot expect to effectively implement cost savings that would arise from the integration of care services, and we run the risk of seeing money targeted for innovation and changes to our services go towards merely keeping our NHS afloat.

At the local government level, council taxes are at the highest levels that could realistically be sustained, and the opportunity to add a discretionary amount for social care is now widely acknowledged as a flawed policy. The challenge at local government level is commissioning. A move to outcomes-based commissioning is slow to be embedded but would bring transformational change to service delivery. An example of that came in the debate today from the noble Lord, Lord Colwyn, who is a dentist. I did not expect such an example to come from the area of dentistry, but he made the point perfectly that if you commission for outcomes, you will get a better service.

Sustainability and transformation plans should prepare our system for the future and should be given the financial investment needed to see services change with the times and produce quality results for patients.

We on these Benches believe that proper NHS funding can be accomplished through bringing our health expenditure in line with other nations and by providing a ring-fenced integrated budget for health and social care that would be kept separate and defined for a 10-year period. This would allow the NHS, care providers and local communities to prepare for long-term needs, together with a plan that they can implement. It would remove short-term thinking on health and social care budgets and create a sector that is looking forward to the future instead of being occupied with daily crises.

The noble Lords, Lord Kakkar, Lord Willis, and Lord Carter, and the noble Baroness, Lady Finlay, and many others, mentioned the acute workforce shortage, which must be the single greatest threat to our health sector. To begin solving this we need to train new workers while protecting the immigration status of foreign-trained staff already here. As we come up to 70 years, we must also acknowledge our debt to the Windrush generation—the people who came from across the Commonwealth to help us set up the NHS to become what it is now.

In order to have a functional health and care service we must continue to support health and care workers, who will be absolutely critical to the way we work in any future model of care. I welcome the Government’s shift on nursing pay, but in the current climate perhaps the Chancellor might consider a further uplift.

Health and care workers feel the pressure of caring for an ageing population and have remained committed to giving their services, even in the face of long hours and stagnant wages. In the long run, however, this will not be sustainable. The health and social care workforce is facing a tremendous gap in the number of workers, which we urgently need to address.

The noble Lord, Lord Willis, mentioned nursing associates. Before this debate I was speaking to members of a delegation from Kent. They were anxious about the nursing crisis in Kent. They mentioned nursing apprenticeships and asked me whether I was aware that there were no nursing apprenticeships at all in Kent. I confessed that I was not aware of that. Can the Minister give some indication of the uptake of nursing apprenticeships, and of the number of nursing associates, in England?

It is time to consider care work as a profession, which may well include regulation. For the most part, care workers work on the basic minimum wage. They often train in their own time and at their own expense and work unsocial hours with a difficult client group. They can always go to the supermarket and work for the same number of hours with less hassle—but they do not. They have a commitment and a love of the job and, as a society, we take advantage of that. So I hope that the Green Paper, in addressing the cost of care, will look at a model where their commitment and professionalism are recognised. We can then work to attract new care workers through providing regular performance-related pay rises and flexible working conditions to those who need them. Will the Minister tell the House how his department is involving partners in the preparation of this Green Paper and who represents the voice of the care workers? I would be grateful if he told me it is not care providers.

The picture with doctors is not hugely better than that for nurses. Yesterday, many of us received information from the Royal College of Paediatricians expressing alarm at the number of doctors on duty at any time. Nearly three-quarters of all medical specialties had unfilled training posts in 2016, with the number of applications to our British medical schools decreasing for the third year in a row, and by more than 13% since 2013. Fewer trainees are moving directly into speciality training, instead choosing to take a career break. Will the Minister give an indication of the attrition rate at this stage? What remedies are being considered to keep these hugely expensive to train professionals in the UK at the early stage of their careers?

This has been an excellent debate on an excellent report. I hope that as a House we will continue—I am sure we shall—through questions and debates to understand the Government’s thinking and to influence their direction in this area.

Domiciliary Home Care Support

Baroness Jolly Excerpts

Wednesday 25th April 2018 Lords Chamber

[Lord O'Shaughnessy]

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

[Baroness Jolly (LD)]

My Lords, everyone knows that the social care sector, particularly in domiciliary and care homes, is under great stress at the moment—I declare my interests as in the register—and we look forward to the Green Paper coming up some time in the summer. I hope it takes into consideration that such homes need to pay not only wages and pensions but, for larger ones, an apprenticeship levy. Normally there would be a market for mergers but at the moment the sector is anxious about inheriting sleep-in liabilities. Can the Minister give any guidance about when these issues within the department and the Treasury will be remedied?

[Lord O'Shaughnessy]

We know that the issue of back-dated pay for sleep-ins has had an impact on this and other sectors. Two aspects of this are, first, that the Government have waived penalties for non-payment prior to July 2017; and, secondly, that there now exists an HMRC scheme that allows providers to work with HMRC and the business department to understand their liabilities and gives them a further year to pay them. That is the support we offer to any organisation affected by the changes to the taxation arrangements of sleep-ins.

Health: Online Services

Baroness Jolly Excerpts

Monday 23rd April 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for raising this important issue. She is right that the CQC report identified some serious issues among this group of online providers, which of course operate in the independent sector. She mentioned safety and safeguarding, and I would add to that. It is worth saying that there were some positive responses, in terms of 97% of the providers being caring and 90% of them responsive, so some strengths were identified as well as weaknesses. Obviously the CQC retains the ability to take regulatory action. As it sets out in the report, it has done so to ensure that standards improve, and in general they improve from one inspection to the next. However, this is of course the independent sector. We are looking at the lessons for the provision of NHS services. The biggest one of those that comes out of the report is around data sharing: to ensure a clear flow of data between an online provider and a GP, if they are different, so that any problems can be spotted early on. That is particularly important for safety.

[Baroness Jolly (LD)]

My Lords, as the Minister has just said, this is a picture of things to come. Could he give an indication of when the Government expect that GP practices would regularly be able to give an online service to the general public and their patients? What support, financially and developmentally, would they be sure to get from NHS England?

[Lord O'Shaughnessy]

On that specific point, NHS England is providing £45 million through the general practice forward view to promote online consultations. That is to ensure that they are available in general practice across the country. The noble Baroness will be aware of the GP at Hand practice, which is one practice in west London offering these services, but we are seeking to expand them, and NHS England, the CQC and others are providing regulatory support during that process.

Children: Obesity

Baroness Jolly Excerpts

Thursday 19th April 2018 Lords Chamber

[Lord O'Shaughnessy]

My noble friend is absolutely right: this is one of the many opportunities which this country will enjoy after we have left the European Union. We will have the flexibility to vary food labelling to ensure that we can use the very best, and latest techniques to encourage people to eat more healthily.

[Baroness Jolly (LD)]

My Lords, there are two components to keeping fit and losing weight. One is exercise—the example we have had is excellent—and the other, of course, is food. There are three partnerships in that: there is the department of health and the Department for Education, but parents are critical. What work has been done to involve parents in this whole issue? It is really serious, because obese children will probably be obese adults, and we know where that goes.

[Lord O'Shaughnessy]

The noble Baroness is absolutely right: parents are of course the first educators of their children and it is about them being able to set an example. I would focus on a couple of things: first, the national curriculum in schools, which is encouraging parents to get involved in understanding what good nutrition is, how to cook well and so on. The second is Public Health England’s new One You campaign, posters of which are up now, which talks about the 400, 600, 600 of calories per meal per day to encourage parents to get into good habits, because of course, if they have good habits and are well informed, their children will too.

NHS: Winter 2017-18

Baroness Jolly Excerpts

Wednesday 18th April 2018 Lords Chamber

[Baroness Jolly (LD)]

My Lords, community pharmacies are a hugely undervalued resource and could help alleviate pressure. They could do that by helping people who have already been discharged from hospital avoid readmission and by being first port of call for patients, offering advice and treatment to those with minor health conditions. Will the Minister tell the House whether the Government are having a conversation with NHS England about future commissioning of community pharmacy services?

[Lord O’Shaughnessy]

I agree with the noble Baroness that we need to beef up the role of pharmacies. Primary care is an area of investment within the five-year forward view. There are, I believe, nearly as many pharmacists as there ever have been, if not more, so their role is increasing all the time and that is part of our conversations for the future.