Carer’s Leave: Government Departments

Baroness Jolly Excerpts

Tuesday 19th July 2022 Lords Chamber

[Lord True (Con)]

My Lords, we remain committed to legislation to deliver on our commitments on employment, including on carer’s leave, as parliamentary time allows. We are aware in this context of the Private Member’s Bill on carer’s leave in another place; we will look closely at whether we can support it in this Session.

[Baroness Jolly (LD)]

My Lords, every day, many of us walk past a poster asking if we are a carer on our way into the House. ParliCare offers support to those staff who work in both Houses. Can the Minister tell the House how many carers are supported on this scheme and what form that support takes?

[Lord True (Con)]

My Lords, if the question is about arrangements in Parliament, I remind the noble Baroness that I am answering for the Executive here. As I have told the House, there are supportive arrangements in the Civil Service, but I am afraid I cannot answer specifically on the numbers in the parliamentary system.

People with Disabilities Standing for Elected Office

Baroness Jolly Excerpts

Monday 22nd March 2021 Lords Chamber

Moved by

[Baroness Jolly]

To ask Her Majesty’s Government what support they intend to provide to assist people with disabilities with the additional financial costs associated with standing for elected office.

[The Minister of State, Cabinet Office (Lord True) (Con)]

My Lords, it is the Government’s ambition to see more disabled people in public office. The Government have been clear that the responsibility for supporting disabled candidates sits with political parties and that the EnAble Fund was an interim measure to give parties time to put their own support in place. Ministers wrote to the main parties twice in 2019 to ask them how they intend to support their candidates on a long-term basis.

[Baroness Jolly (LD) [V]]

My Lords, I am grateful to the Minister for his response. I am sure he would agree that it is important that people with a disability are represented in Parliament. Can he tell the House how many MP’s have a disability, and, in the last election where financial support was given to candidates with a disability, how many candidates were supported?

[Lord True (Con)]

My Lords, I do not have all those specific figures. In relation to the EnAble Fund, 41 applicants were awarded funding and 19 were elected. Some 33 disabled candidates for the 2019 local elections received financial support through the fund, and of these 15 were elected. I will write to the noble Baroness on her other question.

European Union (Future Relationship) Bill

Baroness Jolly Excerpts

3rd reading & 2nd reading & Committee negatived & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords & 3rd reading (Hansard) & 3rd reading (Hansard): House of Lords & Committee negatived (Hansard) & Committee negatived (Hansard): House of Lords
Wednesday 30th December 2020 Lords Chamber

[Baroness Jolly (LD) [V]]

My Lords, it is a great pleasure to follow the noble Lord, Lord Judd.

The two health-related issues that I shall raise relate to our reliance on radioactive isotopes produced in the EU, to which Clauses 27 and 28 relate, and the employment of health and care workers from EU states, on which the Bill is silent.

Approximately 1 million UK patients each year rely on radioisotope procedures to diagnose or treat many conditions. These include cardiovascular imaging and cancer treatment. In addition to the TCA, the UK and the EU signed a nuclear co-operation agreement which is to define the future of the UK’s relationship with the European Atomic Energy Community, or Euratom. This is a good deal for clinicians, for researchers and, of course, for patients.

We import around 80% of the medical radioisotopes we use, most coming from the Netherlands, Belgium and France, and it will be critical that their transit is smooth and without delays, or we will not get what we pay for. These cannot be stockpiled, and as soon as they are produced they begin to decay. The longer the delay in transit, the smaller the dose of useful isotope that remains. These amendments are good for our health.

Less positively, I regret that in the Bill there is no mention of mutual professional recognition of qualifications. Will the Minister outline how this will now function, or is the idea now defunct? The EU’s policy of freedom of movement and mutual recognition of professional qualifications within the EU meant that British health workers could work across the EU, and many health and social care professionals currently working in the UK come from other EU countries. This includes 55,000 of the NHS’s 1.3 million workforce and 80,000 of the 1.3 million workers in the adult social care sector. These will not be easy to replace. A recent rough estimate of the current shortfall of nurses across all disciplines in England is 43,000. Now, EU nurses are feeling unwelcome and the number leaving the NHS to return home has grown. Are EU nationals working in our health and care sector still welcome? The Home Secretary is on record saying that we should be reliant on British staff.

Finally, I return to scrutiny. The noble Baroness, Lady Taylor of Bolton, made some powerful remarks, and her Constitution Committee’s response to the Bill makes for interesting reading. It notes the Bill’s omission of sunset provisions and disagrees with the Government on post-legislative scrutiny of the Bill, recommending that the House should decide how best to scrutinise the trade and co-operation agreement. I get the impression that today’s debate is not the end of scrutiny, only the beginning.

Covid-19: Public Health Information

Baroness Jolly Excerpts

Tuesday 8th December 2020 Lords Chamber

[Lord True (Con)]

My Lords, it is, of course, highly desirable to contain any pandemic or any threat to the welfare of our citizens. We have to deal with the situation that arises; I believe that the Government have sought to deal with it energetically. We certainly have said that we will consider the lessons learned from this pandemic.

[Baroness Jolly (LD) [V]]

My Lords, this morning I looked at the English NHS website and could not find Covid-19 information in languages other than English. I then looked at the NHS Scotland site, which had information in 12 languages, including British Sign Language. Given that this information can save lives, when do the Government anticipate making Covid-19 online information available to those living and working in England and are more comfortable reading information in their own language?

[Lord True (Con)]

My Lords, I will refer the noble Baroness’s comments about what is available on the NHS website to those responsible. The Government have enabled at least 22 languages to be accessible for Covid publicity.

Covid-19: Wedding Venues

Baroness Jolly Excerpts

Wednesday 24th June 2020 Lords Chamber

[Lord True]

My Lords, again, I understand the point. I do not want to add to my reputation for eccentricity by admitting that my wife and I delayed our marriage because the late Lord Callaghan unexpectedly delayed the anticipated election in 1978. I fully understand the frustration that many young couples face. On the noble Baroness’s wider point, wedding venues are governed in legislation, and altering it is not currently on the Government’s agenda.

[Baroness Jolly (LD) [V]]

My Lords, I understand the reasoning for yesterday’s change in advice, but clearly some of the Government’s advisers were not happy with it. In making the decision, did the Government carry out a risk analysis, and is it freely available? What will be the loss to the local economies as a result of a season of cancelled weddings? What impact will it have on the already beleaguered hospitality sector?

[Lord True]

My Lords, the announcement the Prime Minister made is fully guided by scientific advice, and I do not accept what the noble Baroness said. I remind her that this was an announcement to open up proceedings to permit weddings, so it should not provoke more cancellations—indeed, it should enable more weddings.

Covid-19: Restrictions

Baroness Jolly Excerpts

Monday 18th May 2020 Lords Chamber

[Lord True]

My Lords, I do not accept the premise of the noble Lord’s question. The advice to the shielding group is clear and is based on scientific advice that it is wise for them to avoid face-to-face contact and follow the shielding guidance. That advice is still in place and will remain so until the guidance is revised. I have told the House that the guidance is under review and that we hope that we will be able to say more during June.

[Baroness Jolly (LD)]

My Lords, a society is judged by how it treats its most vulnerable. The real policy and practice experts are the NGOs and major specialist charities. Will the Minister tell the House which of those organisations have been consulted on the impact of the restrictions on vulnerable adults and what guidance is in place to help them see family and loved ones?

[Lord True]

My Lords, I profoundly agree with the noble Baroness’s opening remark about the approach and the importance of staying in touch with all sources of expertise and advice. At present, and in the time available, I cannot give her a list of organisations of the type that she describes, but I will ensure that a letter is written to her on the matter.

Care Quality Commission Review: Deaths in the NHS

Baroness Jolly Excerpts

Tuesday 13th December 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the Minister for repeating the Statement and take this opportunity to offer my condolences to the noble Lord, Lord Prior, on the death of his father.

The circumstances of Connor Sparrowhawk’s death were shocking and I pay tribute to his family, who fought so hard for justice and to ensure that other families do not have to go through what they did. The findings of this report are a wake-up call: relatives shut out of investigations, reasonable questions going unanswered and grieving families made to feel like a pain in the neck, or that they would be dealt with better at a supermarket checkout. This is totally unacceptable and we therefore strongly welcome the recommendation of a national framework and the specific measures which the Secretary of State has outlined. I assure the Minister that we will work with her and the Care Quality Commission to support the establishment of such a framework in a timely fashion.

Families and patients clearly should not be forgotten in the process. Will the Minister pledge that families and carers will be equal partners in developing the Government’s plan for implementing the CQC’s recommendations? Does she agree that those who work in the NHS show extraordinary compassion, good will and professionalism but also that when something sadly and tragically goes wrong, it can often be the result of a number of interplaying systematic failures? A national framework will therefore provide welcome standards and guidance across the service.

Does the Minister recall that the previous Labour Government set up the National Patient Safety Agency, based on airline experience, which was responsible for monitoring patient safety incidents, including medication and prescribing error reporting? Does she also recall that the agency was scrapped under the Health and Social Care Act 2012 and will she acknowledge that this decision was a mistake? Can the Minister tell me what happened to the national reporting and learning system which the NPSA had developed to do the very work that she has outlined in the Statement today?

I was interested in the Minister’s comments about the Secretary of State not setting any targets for reducing reported avoidable deaths. I understand the reasons—it is a sensible approach—but it is one thing for the Secretary of State to say it and another for the different multilayered sections of bureaucracy to understand it. Can she assure me that the Secretary of State will make it clear to the various regulators that targets are not to be set? Equally, I agree with her point that seeing an increase in the number of reports of potentially avoidable deaths may well be a sign of care getting better rather than worse. But explaining that to the media and the public will be a challenge. Can she tell me that that will be a priority for the Government when these reports are published?

For a national framework and the proposed measures to succeed, investment will be necessary as well. Can the Minister confirm whether hospitals will receive extra funding to carry out the additional requirements that the CQC has recommended? Crucially, will this include safe staffing levels? The House will know that hospitals across England are suffering chronic staff shortages, leaving doctors and nurses overstretched. To go back to the mid-Staffordshire inquiry, Sir Robert Francis called for safe nurse staffing levels to be published by NICE. But when NICE attempted to do that, it was blocked by the Government. Will the Minister now commit to NICE publishing safe staffing levels, as recommended by the Francis report?

We saw reports over the weekend that the bed shortages in England have got so bad that seriously ill patients with eating disorders have to travel to Scotland for treatment. This is leaving some of the most vulnerable in our society hundreds of miles away from their homes. If the Government are interested in safety, does the Minister believe that this practice is safe and sustainable?

In conclusion, the CQC has called for the issues addressed in its report to be a national priority and for all those involved in delivering safe care to review the findings and publish a full report. The Opposition absolutely agree with that. Action is needed. We welcome the recommendations and we stand ready to work with the Government to ensure that these issues are no longer ignored.

[Baroness Jolly (LD)]

My Lords, I, too, thank the Minister for repeating the Statement and echo the condolences offered by the noble Lord, Lord Hunt of Kings Heath. I declare my interests as set out in the register. I am chair of a learning disabilities charity caring for adults across England.

We welcome the findings of this report but are saddened that we should need one. However, we welcome its publication and recommendations and hope that they will be taken forward and acted upon as a matter of urgency.

I am going to talk about families, governance and learning good practice from unexplained death inquiry processes. In the report, the Secretary of State said:

“The lesson of Mid Staffs, Morecambe Bay and indeed other injustices like Hillsborough is that when families speak out we must listen”.

Surely another lesson is that a trust, or even a regulated care setting run by a charity or the private sector, should reach out to the family first after the family member dies in an unexplained way. We recognise that the emphasis in the report on the importance of including and listening to families in investigations is extremely important, but is this not what common decency should require and families expect, and should this not already be happening?

The situation at Southern Health NHS Foundation Trust reflects what is known across the sector: that whether we like it or not, mental health and learning disabilities are always considered after acute and community services. As long as I can remember—and my involvement with the NHS began at the end of the 1990s—commissioners thought of them last and there was certainly nothing approaching parity of esteem. Now, at least for mental health, we have parity of esteem, and we should have processes in place that are as good and as robust as in all other NHS settings. The chair of the trust should work with the CEO to make sure this happens and a named non-executive director on the board should have ownership of the process. Sadly, this situation is nothing new. Trusts have struggled with this for years and it has to be kept on the agenda. I mean this literally as well as figuratively. It should not be relegated to a subcommittee; it should be on a full board meeting agenda by default.

I commend the processes adopted by Mersey Care NHS Foundation Trust. In such circumstances as we have been discovering, it carries out a review within days, very quickly, while all the involved staff are still in post and details are not forgotten—and, of course, families are involved.

Any good unexplained deaths investigation or complaints system should always have an element of learning built into it. This should be shared within the organisation and also within the sector, and there should be a process to make that happen. Processes currently seem to be ad hoc. Standards and definitions should be standardised into a common framework, as indicated by the report.

I have three key questions for the Minister. First, will the Government consider extending the recommendations of this report to regulated residential settings where those with a learning disability or a mental health condition are being cared for? Secondly, the report outlines the need for a national framework. Will the Minister outline who will co-ordinate the work outlined in the report and who might be involved, and indicate its expected completion date? Finally, will the framework contain recommendations about sharing good practice within the organisation and the sector?

[Baroness Chisholm of Owlpen]

My Lords, I thank noble Lords for the questions that have been raised. I particularly thank the noble Lord, Lord Hunt, for mentioning the sad death of my noble friend Lord Prior’s father. It is sad that I should have to be standing here instead of my noble friend on this occasion.

This is indeed a wake-up call. As the noble Lord, Lord Hunt, said, we have all been absolutely shocked by this report. This is a cross-party issue and something that we all need to get involved in, and I very much welcome the noble Lord’s understanding about that.

The noble Lord mentioned families and carers being equal partners, which is indeed absolutely essential to what is being brought forward. When families have a loved one in hospital, it is absolutely essential that they can be sure that if they have a concern, they will be listened to, whoever they go to. When somebody we love goes into hospital, one of the things we all feel is a sense of relief that they are now somewhere where they are going to be looked after, cared for and treated in the best possible way. If we cannot feel that that care is going to continue when we go home at night, having been with them all day, there is something very wrong with our system. We are going to make sure that that happens, and that is exactly why my right honourable friend the Secretary of State said he is determined that all the recommendations in the report will take place.

Several points were made, and I will try and get through some of them. We feel that this is not an issue of funding. Trusts already have investigations, and we will support them and make sure that best practice is followed, particularly in the training of clinical staff and in improving the way in which they investigate safety incidents. This is not about funding; this is about creating a culture where NHS trusts make sure that if somebody comes forward with a concern, they are listened to immediately. One way to help with that is the board level leader who will be put in place—a patient safety director—to take responsibility for this particular agenda. This has already been tried in the Yorkshire and Humberside region, with good feedback. It is looking at deaths and avoidability, and degrees of avoidability, and where lessons can be learned from the deaths, even if they are inevitable.

I hope that with those remarks, the noble Baroness and the noble Lord will realise that this is a wake-up call for us all and that we are going to take forward all the recommendations. It is impossible to have a timeframe for this, but we need to make sure that it is done properly and that robust actions are taken to make sure that what happened earlier on will never happen again.

Health: Birth Defects

Baroness Jolly Excerpts

Wednesday 6th November 2013 Lords Chamber

[Baroness Jolly (LD)]

I am grateful to the noble Lord for securing this debate on this very important issue, and I thank all noble Lords for this thoughtful and informative debate. The department is considering this issue very seriously. We know that approximately one in every 1,000 pregnancies is affected by a neural tube defect, which can result in miscarriage, neonatal death or lifelong disability. We also know that poor folate status is an established cause of neural tube defect-affected pregnancies, and therefore how important folic acid is for women of childbearing age. I will take your Lordships briefly through the detail of how the Government are currently taking action to reduce the risk of women having insufficient levels of folate—a risk that may result in potential neural tube defects such as spina bifida in unborn children.

It is possible to get all the folate you need from food in a healthy diet, but for women who are trying to conceive or are newly pregnant, getting enough particularly matters. That is why, since the 1990s, the Department of Health has advised women who can become pregnant to take folic acid supplements before conception and for the first 12 weeks of pregnancy, and to increase their intake of folate-rich foods. That advice is promoted as strongly as possible through all the channels we use to communicate with women and health professionals. NICE guidance ensures that health professionals are equipped with comprehensive advice on folic acid and on action to take with women who may become pregnant.

For women, advice is disseminated through a variety of sources such as the NHS Choices website, which sets out why folic acid is important for pregnancy and gives guidance on taking supplements. The Department of Health also provides funds to the charity Tommy’s to produce The Young Woman’s Guide to Pregnancy, which advises young women to take folic acid. Start4Life, a campaign to give the best start in life to nought to two year-olds, gives information on five key healthy behaviours during pregnancy, one of which is taking folic acid and vitamin D supplements. Their leaflets are written in a friendly and accessible style and are very popular with healthcare professionals as a tool to facilitate conversation with parents and expectant parents. The NHS Information Service for Patients offers to send e-mails and texts to women and their partners in the fifth week of pregnancy to remind women to take their folic acid.

Folic acid supplements are widely available and cost as little as £1 for a month’s supply, but are also available on NHS prescription. Pregnant women and women who have had a child in the previous 12 months are exempt from prescription charges, as are people on certain benefits or those who qualify through the NHS low-income scheme. We also offer free vitamin supplements containing folic acid without an NHS prescription to pregnant women and new mothers in very low-income families throughout the UK who are supported by the Healthy Start scheme. More than 150,000 pregnant women and new mothers are eligible to claim vitamins through that scheme. However, we know that some women do not take supplements, and of those that do, some start too late. That is of real concern to the Government and health professionals, and an area on which the Chief Medical Officer is keen to see action, as she set out in her recent annual report.

In 2000 the Committee on Medical Aspects of Food Policy first recommended the fortification of flour with folic acid to reduce the risk of NTD-affected births. Your Lordships will be familiar with the developments of the scientific advice since then. The Government are very grateful for the full advice which has been provided by consecutive expert committees and for the rigour and scrutiny with which the Scientific Advisory Committee on Nutrition—better known as SACN—considered the issue for its report in 2006 and its subsequent reviews of evidence. The noble Lord, Lord Rooker, will know that SACN sought to understand and clarify the risks of fortification carefully as it sought to make clear the benefits of its recommendation.

The advisory committee concluded in 2006 that mandatory fortification of flour with folic acid would reduce the risk of NTD-affected pregnancies, but that there was a potential risk to some population groups, particularly older people, including a potential increased risk of bowel cancer. In 2007, the then CMO asked SACN to further consider the evidence in this regard. In 2009, SACN’s majority view was that the new evidence did not provide a substantial basis for changing the original recommendation. However, it recommended fortification only if accompanied by a number of other actions, including restricting voluntary fortification of foods with folic acid, developing guidance on supplement use for particular population groups, and implementing measures to monitor evidence of long-term exposure to intakes of folic acid above the guideline upper limit per day.

SACN’s recommendation about monitoring and review explicitly reflected concerns around the potential for the numbers of people consuming levels of folic acid above the guideline upper limit. Health Ministers considered it prudent to ensure that all available evidence on the risk of colon cancer was peer-reviewed and in the public domain, which noble Lords referred to earlier, and the evidence was published in the Lancet this January. Following publication, Ministers confirmed earlier this year that they were taking stock of the issue. I assure the noble Lord who, as former chair of the Food Standards Agency, will understand this better than many, that because of the complexity of the issue it is essential that we weigh up carefully the risks and benefits in coming to a decision, and that we fully think through the implications of the other recommendations made by SACN. We are now doing that, and, thanks to the expert scientific committees and the consideration of this by the FSA and others, there is a wide range of evidence and advice to consider.

I pay tribute to the work of the voluntary sector, and in particular to one organisation mentioned earlier in this debate, Shine, which supports individuals and families as they face the challenges arising from spina bifida. It works tirelessly to raise awareness of the importance of folic acid and in May this year held the first ever national Folic Awareness Day.

Noble Lords have asked many questions, and I will work through them in the time I have available. However, if there are any still outstanding I will be happy to write to noble Lords after the debate. The noble Lord, Lord Rooker, asked whether we had talked to Ministers in Scotland, Wales and Northern Ireland. As noble Lords are aware, food and health policies are devolved issues and discussions on fortification outside England are for those Administrations. However, the views of those authorities will be taken into consideration by Ministers.

[Lord Rooker]

I am sorry to interrupt, but this dismissal of devolution is symptomatic of Westminster; it just does not do devolution. Rather than simply saying that it is a matter for them, it would be better to have a UK-wide policy. Is the Minister admitting that Ministers in England—this is what we are talking about here—have not discussed the matter with Ministers in Scotland, who may take their own route, as they are free to do, and that the four chief medical offices have not discussed the issue among themselves?

[Baroness Jolly]

My Lords, I am telling noble Lords what I have been briefed. I am more than happy to write to noble Lords and, if they are happy for me to do so, leave the letter in the Library for everyone to check. I will also need to respond to the noble Lord, Lord Rooker, on his question regarding terminations.

The noble Countess, Lady Mar, asked about the risks and benefits, and assessing impacts, of fortification, giving due consideration to the implications of additional recommendations by SACN. We will take into account the views of the Chief Medical Officer, who raised the issue in her annual report, and of the devolved Administrations. The other point raised by the noble Countess was on ensuring that NTDs are avoided in pregnancy and on preventing vitamin B12 masking. We need to get this right. SACN considered the amount of folic acid to recommend and also recommended developing guidance on supplement use for particular population groups, along with implementing measures to monitor evidence of long-term exposure to intakes of folic acid. We are carefully weighing the benefits and risks of SACN’s recommendations and will take account of all views.

The noble Baroness, Lady Grey-Thompson, asked what foods would be considered for fortification. Currently, breakfast cereals are voluntarily fortified with folic acid in the UK. The FSA considered other foods, including soft drinks, fruit juice, milk and chewing gum, when it made that recommendation, but the consumption rate of these products is not considered to be universal across women of child-bearing age and would therefore not be suitable for fortification. Other foods were also considered. Bread was finally decided upon as the universal food as—to answer a point raised by both noble Baronesses—it is universally consumed across the population and all socioeconomic groups: more than 90% of households eat bread. Fortification of wheat flour would also include other wheat-based products such as pizzas, pastries and biscuits.

I think I have replied to several points that were raised.

[Lord Hunt of Kings Heath]

My Lords, will the Minister write to noble Lords—clearly the Government will have to consider this—and set out a timetable on when they will come back to Parliament with an answer?

[Baroness Jolly]

That sounds eminently sensible. I am happy to write to noble Lords to give them that information. I hope that I have provided reassurance—I am not convinced that I have—that the Government are committed to reaching the right decision on the fortification of flour with folic acid, doing proper justice to the work of SACN and others and ensuring that, while seeking to deliver the benefits, we minimise the potential risks. In the mean time the Government will continue to raise awareness of the need to take folic acid supplements and are supportive of all those who are raising awareness of this issue. I thank the noble Lord for securing the debate.