Medicines and Medical Devices Bill

Debate between Baroness Jolly and Lord O'Shaughnessy

Report stage & Report: 2nd sitting (Hansard) & Report: 2nd sitting (Hansard): House of Lords
Thursday 14th January 2021 Lords Chamber

[Lord O'Shaughnessy (Con) [V]]

My Lords, it is a privilege to be able to support and put my name to the amendment in the name of my noble friend Lady Cumberlege. As has so often been the case in this Bill, where she leads, others follow, and I entirely endorse everything that she and the noble Baroness, Lady Bennett, have said. My reason for supporting the amendment is simple: as my noble friend made clear today, there are tens of thousands of women, men and their families who are suffering from the impact of licensed medicines and medical devices that have been wrongly used.

My noble friend’s landmark review gives voice to so many people who have been ignored for too long; that is what gives it such moral power and makes the force of its arguments so irresistible. Within the final report of her review is a clear recommendation for ex gratia redress schemes to be established for those affected by the HPT, mesh and valproate scandals. To my mind, this recommendation is neither radical nor extraordinary: such schemes have been set up in the past—for the victims of thalidomide and contaminated blood. Indeed, this is a common-sense proposal, and it is urgent—because the suffering of so many continues to this day, as my noble friend pointed out.

I have spoken in the past of two women—Janet Williams and Emma Murphy—whose lives, and whose children’s lives, have been changed for ever by in utero exposure to sodium valproate. They were interviewed as part of a recent Channel 4 documentary on the challenges they face in day-to-day life, the guilt they have been made to feel and their struggle to be heard. Janet and Emma’s honesty and tenacity have been an inspiration to me since I met them, and I defy anyone to watch that programme and not be moved to tears.

I was also contacted recently by another lady, who has been harmed by mesh. Her name is Susan Morgan, and, with her permission, I convey her story. She described to me being on,

“a hideous journey that was thrust upon me without consent”,

suffering grievous, painful and irreparable damage due to a mesh that can now never be removed. Sadly, she has lost nearly everything in dealing with the consequences of this terrible, avoidable injury, and she asks only that

“the burden of fear and worry be removed so that I can find some peace”.

Therefore, I ask my noble friend the Minister: are the redress schemes proposed in the review of the noble Baroness, Lady Cumberlege, under serious consideration, as my honourable friend Nadine Dorries said in the other place earlier this week? I hope so. If so, when will they be introduced? Only a robust answer will be enough to satisfy those supporting this amendment. I close by imploring my noble friend to move quickly: these victims cannot wait any longer—their pain is real, and their need is urgent. Of course, a redress scheme will not change or right every wrong that has been done to Susan, Janet, Emma and thousands like them, but perhaps it might bring them some peace.

[Baroness Jolly (LD) [V]]

Amendment 68, in the name of the noble Baroness, Lady Cumberlege, requires the Secretary of State

“to create redress schemes for those who have already suffered avoidable harm”

related to hormone pregnancy tests, sodium valproate and pelvic mesh. The Minister has told us that there will be no redress agency. The noble Lord spoke passionately about suffering without redress. A significant amount will need to be paid through NHS Resolution to the women affected by these three interventions. Who will ensure that the women affected receive proper recompense? As the noble Baroness, Lady Cumberlege, has said, they have had to pay out for travel for treatment and payment for carers, and they are seriously out of pocket for what they originally thought was standard, straightforward NHS treatment.

I fear that, if there is no scheme, the NHS will have to pay more than it would through a properly managed redress scheme. This and the previous amendment are powerful signals to the Government that they must act on this issue of redress. I hope that, in summing up, the Minister will be able to share the Government’s plans with us. If they have no plans, what would he suggest that these women should do? The noble Lord, Lord O’Shaughnessy, put the case very powerfully.

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Jolly and Lord O'Shaughnessy

Tuesday 26th February 2019 Lords Chamber

[Baroness Jolly]

My Lords, I shall speak briefly and I apologise to the House: I should have declared my interest at the beginning of this stage as a chair of an organisation caring for over 2,000 adults with learning disability or autism, or both. In Committee the noble Baroness, Lady Hollins, tabled an amendment on the provision of information for cared-for people, carers, family members and IMCAs. She is not in her place today but the noble Baroness, Lady Watkins of Tavistock, has produced a really elegant amendment and I shall support it.

On Report, I also explained why it is not sufficient to have this commitment in the code of practice. I shall not repeat that argument in detail now but it drew upon a Supreme Court ruling of earlier this year. The MCA code of practice not only misstated the legal situation but could not establish a duty where none had existed. If there is a need for a hard-edged duty or right, that needs to be put into legislation and not the code. We must have provisions in the Bill to provide the person with information about their situation and rights, along with clear statutory entitlements to copies of the relevant documentation for those supporting and representing them.

[Lord O'Shaughnessy]

My Lords, the rights to information are another good example of the positive change that this House made in the passage of the Bill. I pay tribute to the noble Baroness, Lady Watkins, and Baroness Hollis, for making that argument so persuasively. I am very grateful to my noble friend the Minister and my right honourable friend the Minister of State, Caroline Dinenage, for responding.

I completely understand the desire to create—if I can borrow a bit of terminology—a backstop for why these sorts of cases ought to be considered. It is very easy to see how in practice when perhaps a small institution is caring for people with complex needs, the definition of “practicable” could stretch over time because of urgent or important responsibilities. There is a risk that, without some kind of backstop or time limit, this is too vague. However, I have a big problem with having an arbitrary time limit. I know that the noble Baroness is not attached to any particular time, but any time is by definition arbitrary.

My concern is that if this is in primary legislation it could lead to rushed or poor record keeping if it is not, for example, possible to conclude the review, assemble all the relevant pieces of information and provide that in a readable form—bearing in mind that is not going to be just straight English language for everybody—to the appropriate person, the IMCA, and so on. We should particularly bear in mind that an appropriate person could be somebody appointed by the cared-for person who resides in another country. So there are complexities at the edge of these kinds of cases that mean that if an arbitrary limit—which any limit would be—is set out in primary legislation, it could mean that as institutions bump up against it, they just rush to get the job done rather than making sure that they take care to do the highest-quality piece of work. That is my fear, although maybe other noble Lords do not share it.

I take the point that the noble Baroness, Lady Jolly, made about whether or not—in her view, not—the guidance is the place to do it. It seems to me that it is the right place to do it, because we had not defined “practicable” and “appropriate” before. We can now derive some examples of what that would and ought to look like in normal cases, but also in edge cases. I have listened very carefully to the argument—as noble Lords know, my attitude throughout has been to listen and make sure that we can improve this Bill. However, I have concerns about putting an arbitrary limit in, for the reasons that I have set out. I hope my noble friend, as she has been asked to do by my noble friend Lady Browning, will be able to explain things to us in a bit more detail—and give us a flavour of how the statutory guidance would provide that kind of detail—to provide reassurance to noble Lords that this is not just a boundless commitment that does not have some teeth.

Healthcare (International Arrangements) Bill

Debate between Baroness Jolly and Lord O'Shaughnessy

Committee: 1st sitting (Hansard - continued): House of Lords
Tuesday 19th February 2019 Lords Chamber

[Baroness Thornton]

My Lords, I have an amendment in this group. I support the noble Lord, Lord Patel, and the noble Baroness, Lady Jolly. Clause 4 of the Bill provides the legal basis for processing personal information and data about patients to facilitate patient information and payments for reciprocal healthcare after Brexit—whether as part of an agreement with the EU, an agreement with a country outside the EU or in connection with contingency plans arising from a no-deal scenario. It also seeks to ensure that the key safeguards which should always be at the heart of systems that use and exchange patients’ sensitive personal and medical data are in place. The noble Lord, Lord Patel, is right to press this issue. It was almost the first thing that he and I spoke about when we talked about the Bill, which made me look at and ask why he and other noble Lords, particularly those in the medical profession, were very concerned about this.

At Second Reading the Minister acknowledged that there were deep concerns raised by noble Lords on data processing provisions in Clause 4, and promised to address them—but unfortunately she ran out of time on that day. We look forward to her catching up with that. We know that the noble Baroness has special expertise and experience in this field, so I look forward to hearing her talk about how she envisages the necessary robust standards, security and safeguards applying in post-Brexit healthcare deals with the EU and the rest of the world, and how those will be achieved.

In the Commons, my colleagues pressed this matter with the Minister, Stephen Hammond. He gave an assurance that the powers to access personal data would be limited, and committed at the time to provide a briefing. I wanted to raise that with the Minister—my colleagues in the Commons certainly have not received that, but I thought that she might raise it with her colleague and see what the briefing might have said. I am sure that we too would be interested to receive it.

When I raised this issue at Second Reading, I mentioned that I had been in touch with the National Data Guardian for Health and Social Care, who, as we know, has a vital role in ensuring that confidential healthcare data is used and shared appropriately in protecting the high standard of confidentiality. Pursuing that question is whether the Minister has been in touch and sought her guidance on this matter.

[Lord O’Shaughnessy (Con)]

My Lords, this has been an important discussion on an area that is, of course, of growing concern not just for people in Parliament but for the general public. Noble Lords will also know about my interest in this issue; we have had many discussions over the last few years about it. It is critical that we get this right, to allay any fears—because there are fears that attend to the use and movement of data for various purposes.

The noble Baroness, Lady Jolly, makes the point in her amendment about the Caldicott principles and so on. I was pleased from the Government’s point of view to be able to bring the National Data Guardian on to a statutory footing, as well as other measures that we took to provide that level of reassurance. My understanding is that these are all part of the scaffolding around the Data Protection Act, which is the GDPR as put into our legislation. They are a way of translating the general provisions of that into healthcare purposes. I ask the Minister to confirm that, because the Bill clearly states that the Data Protection Act is the governing piece of legislation here, it therefore follows that things such as the NDG, the principles and other things apply. They, in effect, derive from that and apply to all aspects of healthcare, including reciprocal healthcare.

[Baroness Jolly]

We are talking about exchanging health datasets, but in this world we are talking about our EU partners, the EEA and whoever else in the world we make a healthcare arrangement with. Are there mechanisms—this is a question I do not know the answer to—whereby datasets can be standardised so that any method of recording healthcare information that we might use would be recognisable to somebody in the States, Canada or France?

[Lord O’Shaughnessy]

That is an incredibly important point and it goes to the question that I was about to ask my noble friend. My reading of it is that it will not be possible for us to make reciprocal healthcare arrangements that involve the flow of data with another country unless we deem that country to be adequately complying with the GDPR. That is absolutely right and it is a high bar. It does not just provide a degree of regulatory compliance and standardisation; there are also international healthcare codes that underpin it, as the noble Baroness will know. It would be useful if my noble friend could confirm that, because it is clearly a really important point that will, in a sense, allay some of the fears that have been raised tonight about just how the powers in the Bill, once they extend beyond the European Union, Switzerland, the EEA and so on, might be used.

Health: Pancreatic Cancer Treatment

Debate between Baroness Jolly and Lord O'Shaughnessy

Wednesday 19th December 2018 Lords Chamber

[Lord O’Shaughnessy]

I am grateful to the noble Baroness for that question. Obviously, rapid diagnosis is important, but she is quite right that it needs to progress to treatment. The main way we are trying to address that issue is to increase the cancer workforce at every level—nurses, radiologists, endoscopists, oncological doctors, and others. Unless there are the staff to carry out those procedures, we will not get the outcomes that we want.

[Baroness Jolly (LD)]

My Lords, as speed is of the essence, will the Minister tell the House what work has been done to ensure that the public and GPs do not ignore often innocuous symptoms? Is he confident that there are sufficient centres of excellence across England and that they are adequately staffed to start treatment as a matter of urgency?

[Lord O’Shaughnessy]

The noble Baroness makes a very important point. I am sure that she is aware of the 14 Be Clear on Cancer campaigns that have been run over the last eight years, which are absolutely about raising the salience of these issues and making sure that people know the signs they should be looking for and can come to GPs earlier. We are seeing fewer people presenting with cancer diagnosis through emergency departments, which have the worst outcomes, and more coming through GPs. Of course, as I said, we are investing in these rapid diagnostic centres as well.

NHS: Waiting Times

Debate between Baroness Jolly and Lord O'Shaughnessy

Tuesday 18th December 2018 Lords Chamber

[Lord O'Shaughnessy]

With respect to the noble Baroness, I think I did answer the noble Lord’s Question because there are two different issues. One is the offering of private healthcare services and the second is the use of private providers to carry out NHS-funded provision—something that has been going on in the NHS for a long time and was accelerated under the last Labour Government. Of course, if private or independent providers are used to reduce waiting lists under the NHS, the NHS pays and the patient does not pay anything.

[Baroness Jolly (LD)]

My Lords, there is also a problem with the pipeline. Hospital beds are not clearing as patients recovering from surgery wait to get home or to less intensive settings. Had the Government’s Green Paper been published when it was due two years ago, NHS treatment might be available for those requiring surgery, so how long after its publication does the Minister expect the ideas in it to be fully implemented, so helping this situation to go away?

[Lord O'Shaughnessy]

Is the noble Baroness talking about delayed transfers of care? Of course, it is a major issue. We know that there needs to be better integration between health and social care. The better care fund provides that. We have seen some improvement in delayed transfers of care and the Government made an investment for further beds to come on stream this winter, to ensure that there are more beds for people and that we discharge people faster from them.

NHS: Specialist Services in Remote Areas

Debate between Baroness Jolly and Lord O'Shaughnessy

Tuesday 11th December 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right. There is an urgent need to recruit more GPs. We continue to be committed to that. I am sure she will be pleased to hear there are more GPs in training than there ever have been. We are also providing a £20,000 salary supplement to GPs who go and practise in rural areas.

[Baroness Jolly (LD)]

As the noble Baroness said, there are occasions when a patient needs to see a specialist, but travelling to access specialist services is especially difficult for those on low incomes. What is NHS England doing to advertise the healthcare travel costs scheme to patients in rural areas? Do the Government hold information on how many eligible patients are claiming?

[Lord O'Shaughnessy]

There are a number of schemes, as the noble Baroness points out. As well as the travel costs scheme, there is the low-income scheme. They are designed to help people with those kinds of costs. I do not have the specific numbers about take-up, but I shall certainly write to her with those.

Diesel Emissions

Debate between Baroness Jolly and Lord O'Shaughnessy

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

Debate between Baroness Jolly and Lord O'Shaughnessy

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]

Debate between Baroness Jolly and Lord O'Shaughnessy

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

[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.

Mental Health Budget: Domestic and Sexual Violence

Debate between Baroness Jolly and Lord O'Shaughnessy

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.

Gosport Independent Panel

Debate between Baroness Jolly and Lord O'Shaughnessy

Thursday 22nd November 2018 Lords Chamber

[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.

Health: Stroke

Debate between Baroness Jolly and Lord O'Shaughnessy

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

Debate between Baroness Jolly and Lord O'Shaughnessy

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

Debate between Baroness Jolly and Lord O'Shaughnessy

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

Debate between Baroness Jolly and Lord O'Shaughnessy

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

Debate between Baroness Jolly and Lord O'Shaughnessy

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.

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Jolly and Lord O'Shaughnessy

Committee: 3rd sitting - (Hansard): House of Lords
Monday 22nd October 2018 Lords Chamber

[Baroness Jolly (LD)]

I want to make a couple of points, but I first draw the attention of noble Lords to my interests in the register relating to learning disability. It is interesting how to read this amendment. I looked at it and thought about individuals in domestic settings, and the charity that I chair does just that. We put four or five individuals into a domestic setting. A proportion of them will have a DoLS. If noble Lords go into the house, it looks just like an ordinary home. Each resident pays rent and would consider it very much their home. Carers offer 24-hour support and locks are well and truly in evidence. Over the weekend, I asked our director of operations what proportion of the people we support were subject to DoLS, and she said thousands. It is just the norm.

I understand that the noble Baroness’s intention was to take this into a family setting where there is mum, dad and a child who may well be an adult—certainly, we see parents in their 80s caring for their children with a learning disability who may be in their late 50s or late 60s, and the parents are at their wits’ end. All that fits with this amendment so, whatever its merits, the wording needs to change but it is certainly worth pursuing.

[Lord O'Shaughnessy]

I am grateful to the noble Baronesses for leading this debate. Obviously, the bulk of the debate focused on Amendment 87C, which would exclude people residing in domestic settings, and we have discussed the merits of that approach. The noble Baroness, Lady Meacher, gave a thorough exploration of alternatives to the LPS system in a domestic setting. The noble Baroness, Lady Murphy, gave a passionate defence of the role of families in caring, which was perhaps accentuated by the noble Baroness, Lady Wilkins, talking about the need to avoid overzealous application of any new provision of deprivation of liberty safeguards. My noble friend Lady Barran talked particularly about the group of people who lack a care plan and their interaction with the care system if they go temporarily into a care home. For me, all that brought home that we have further work to do on the appropriate system that applies in a domestic setting, to put it shortly.

It was helpful that the noble Baroness, Lady Barker, told us the story about the vulnerable person. We all agree that something needs to happen in that case to check the actions of the family or help the family to do better. They may just not know what to do or be at their wits’ end—who knows? We can imagine how easy it is to fall into those situations not out of intention but out of pressure and circumstance. That debate highlighted how important it is to get that right. I absolutely want to avoid intrusion where it is not necessary, but equally we need to ensure that those people deprived of their liberty receive the proper protections due to them under Article 5 of the ECHR. This is an issue that clearly needs more work. The amendment was not designed to perfect the solution but rather to start the conversation, and it is absolutely one that we will take through with noble Lords.

I turn briefly to Amendment 83B, moved by the noble Baroness, Lady Thornton, which seeks to introduce a legal presumption that a person should give evidence in all Court of Protection proceedings. Obviously I agree with her about the importance of this issue. She called it a reasonable point and I think it more than reasonable. It is essential that in any court proceedings a person’s rights are protected and that the cared-for person has the opportunity to give evidence to the court in any case concerning the deprivation of liberty. I am happy to be able to confirm that this is already reflected in the Court of Protection rules. The court’s overriding objective under the rules is to deal with cases justly and at proportionate cost. They expressly include ensuring that the person’s interests and position are properly considered and that the parties are on an equal footing. A new set of rules was introduced less than a year ago. They include changes to ensure that a person is able to participate in proceedings. Specifically, rule 1.2 requires the court to consider in every case how best to secure the cared-for person’s participation. It sets out a range of options including the cared-for person addressing the court directly, indirectly or with support from a representative, a litigation friend or an accredited legal representative. I hope that that provides the noble Baroness with the clarification that she was looking for and that she will feel able to withdraw her amendment.

--- Later in debate ---

[Lord O'Shaughnessy]

My Lords, I am grateful to all noble Lords who have tabled amendments in this group. We have had a wide-ranging debate on areas where they would like to see various enactments, changes, reports and so on, before commencement and following implementation. I will attempt to deal with them thematically.

Amendment 86 requires that before commencement the Government must publish the code of practice and our response to the Mental Health Act review. Amendments 93 and 94 update Clause 5 to reflect this. I am happy to confirm that the Government will have published both of these before the new system commences.

Amendment 87 requires that the effectiveness of the Act is reviewed and a report laid in Parliament within a year of the Bill coming into force. As the noble Lord, Lord Touhig, just pointed out, Amendment 92 requires the Secretary of State to commission two independent reports on the operation of the new liberty protection safeguards scheme two and four years after the new system comes into force. Again, I am happy to assure noble Lords that the Government routinely conduct post-legislative scrutiny for all new Acts. The relevant guide says that within three to five years of Royal Assent the Government will be required to submit a memorandum to the relevant departmental select committee with a preliminary assessment of how the Act has worked in practice. I am happy to confirm that the Bill will receive such scrutiny and the Health Select Committee will be informed.

Amendment 87A, in the name of the noble Lord, Lord Hunt of Kings Heath, details requirements regarding a number of topics. As he pointed out, a number of these have already been addressed in our debates, including unsound mind, issues around advance consent, the availability of non-means-tested legal aid, and others. We have had a debate on the rules and guidance around IMCAs, which we are clearly going to take forward. He focused on tribunals. The Government are reviewing the courts and tribunals system but that review has not concluded. We are not proposing to change the position on the Court of Protection hearing challenges to liberty protection safeguards in the Bill precisely because there is not yet an opinion or a policy change from the Government with regard to a proposed new system. He also asked about the cost implications, which are outlined in our impact assessment, as he will know.

The noble Lord’s second amendment, Amendment 87B, seeks to make the CQC the regulator for the liberty protection safeguards. The Bill allows for bodies to be prescribed to report and monitor the scheme and it is absolutely our intention that the CQC takes on this role in England. It clearly has an important role in oversight of the new system, although we are concerned that his amendment would introduce additional layers of regulation. It should also be pointed out that the CQC is an England-only organisation; in Wales, the overseeing regulators are expected to be Healthcare Inspectorate Wales and Care Inspectorate Wales, which will both take on this role.

Amendment 87D was tabled by my noble friend Lady Barran and the noble Baroness, Lady Finlay. It would require responsible bodies to consider criteria to be published by the Secretary of State around best interests and the least restrictive option before authorisations are approved under the liberty protection safeguards. These are of course absolutely key principles of the Mental Capacity Act, and responsible bodies will have to consider them as part of any authorisation. As I have set out in previous debates, these factors already form part of the necessary and proportionate assessments, as well as other factors such as considering the wishes and feelings of the person. We will explain in the code how this assessment should be carried out and the factors that assessors should have regard to. I am grateful to my noble friend for some suggestions in that regard and I have just confirmed that the code would be published before commencement of the new scheme.

Amendment 87F, in the name of the noble Baroness, Lady Tyler, would remove the power of the Court of Protection to call for reports from local authorities and NHS bodies in cases relating to a cared-for person under the schedule. We think it is important, as I am sure she does, that the Court of Protection has access to such information but I heard the story that she told about an undue burden. I am certainly happy to commit to her that I will speak to colleagues in the Ministry of Justice to see whether there is any way that this process can be improved without removing the ability of the court to access the information it needs to make proper determinations.

Amendment 92A, in the name of the noble Lord, Lord Hunt, seeks to ensure that the liberty protection safeguards do not apply to any existing or pending DoLS authorisations. I can confirm that existing DoLS authorisations can continue until they are due for renewal or review. Clearly, depending on the final outcome of the Bill, the frequency with which those are renewed or reviewed will mean that there will be a steady stream of DoLS authorisations coming under the liberty protection safeguards in future, for those that are rolled over. Careful work will clearly need to be done with the sector to ensure that a tsunami of new authorisations does not happen but allowing for authorisations to continue under the previous system, until they can reach review or renewal, should go some way toward mitigating that risk.

Finally, Amendment 88, tabled by the noble Baroness, Lady Tyler, states that regulations should be subject to the affirmative parliamentary procedure and a consultation requirement. We have of course asked the Delegated Powers and Regulatory Reform Committee for its opinion on the regulation-making powers within the Bill and it has accepted that the negative procedure provides appropriate parliamentary oversight. As the Committee knows, we go against the DPRRC’s recommendations at our peril.

I apologise for detaining the Committee for six or seven minutes but I wanted to be thorough. I hope that I have been able to give the reassurances that noble Lords were looking for about the safeguards that we will put in place before commencement and the reviews of effectiveness to ensure that the system is working as intended. I hope that noble Lords will feel able to withdraw or not move their amendments.

[Baroness Jolly]

I thank the Minister and others who have spoken on this group. We all want to ensure that the new mental capacity Act—presumably of 2019—works and that the Department of Health and Social Care monitors its implementation. I know that we on these Benches look forward to working with the Minister and others between now and Report to ensure that the Bill is actually fit for purpose. I gently suggest that a longer time gap than is usual between Committee and Report might be needed. I guess that those conversations might need to be held with the usual channels but, in the meantime, I beg leave to withdraw my amendment.

Personal Social Care: Funding

Debate between Baroness Jolly and Lord O'Shaughnessy

Tuesday 16th October 2018 Lords Chamber

[Lord O'Shaughnessy]

I shall have to disappoint the noble Baroness: the proposals will be set out in the Green Paper and I will not give a sneak preview today.

[Baroness Jolly (LD)]

My Lords, Scotland has been giving over-65s free personal care for years now and is now running a feasibility study on extending it to under-65s. This is not the action of a Government who are unconvinced of the benefits. Will the Government consider running a trial in a defined English health community—say, the Manchester community or perhaps even Cornwall—to determine whether the benefits can be replicated south of the border; and, if not, why not?

[Lord O'Shaughnessy]

I am not sure that a trial is required; what is needed is a systematic change in the way we do things for everybody. I am interested to hear what the noble Baroness says about the under-65s. One thing I can tell the House is that the Green Paper we will publish this year will deal with adults of not only retirement age but working age. Those were two separate streams that were working in parallel, but they will be contained within the same Green Paper.

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Jolly and Lord O'Shaughnessy

Committee: 2nd sitting (Hansard): House of Lords
Monday 15th October 2018 Lords Chamber

[Lord O’Shaughnessy]

My Lords, I thank all noble Lords who have tabled amendments in this group. I am grateful for what has again been a high-quality and well-informed debate.

I want to deal with the main issue raised by the noble Baroness, Lady Jolly, at the beginning of her comments, which is the subject of the amendment in the names of the noble Lord, Lord Hunt, and the noble Baroness, Lady Thornton. The amendment would clarify in the Bill that a pre-authorisation review cannot be completed by a care home manager, who would be excluded from such a role. I am happy to assure all noble Lords that the role of care home managers in the new system is to provide the statement to the responsible body and, where necessary, to arrange assessments—as we have discussed. Their role is not to authorise arrangements. It would not be appropriate for care home managers to complete pre-authorisation reviews. I assure the Committee that we will make sure that the Bill reflects this. I hope that is at least one brick in the road towards defining the proper role for care home managers. In these amendments we are discussing the degree of independence and making sure that we minimise conflicts of interest.

A later amendment in the name of the noble Lord, Lord Hunt, and the noble Baroness, Lady Thornton, specifies that the person who completes a pre-authorisation review should also be qualified as a medical practitioner, nurse, social worker, speech therapist, occupational therapist or other profession as may be specified in regulations. I assure noble Lords that we would expect people from those professions to take on this role. That will be specified in the code of practice.

There is also a specific requirement that the pre-authorisation review be completed by somebody not involved in the day-to-day care of the person or delivering treatment to them. That is another safeguard.

Amendments in the names of the noble Baronesses, Lady Jolly, Lady Thornton, Lady Murphy, Lady Barker and Lady Finlay, would make sure that smaller NHS bodies sought external people to carry out reviews. I understand the motivation behind them, but I am concerned that they would introduce complexity and lead to delays. The issue is resolvable within the system proposed because of the independence and quality of AMCPs, or approved mental capacity professionals—referred to the by noble Baronesses, Lady Murphy and Lady Finlay. They will consider all applications to authorise a deprivation of liberty where it is reasonable to believe that the person objects to proposed arrangements, or in other complex cases. Reflecting on a point made by the noble Baroness, Lady Thornton, we may need to provide more detail and studies of the kind of cases that we are talking about or envisaging, where an AMCP would be involved in the review. I take very seriously the point made by the noble Baroness, Lady Thornton, about the consequence of that, given that the responsible body will have the legal duty to ensure that it is carried out properly. I find that reassuring because it will not be a tick-box exercise: it will need to make sure that the assessments have been carried out properly. That was one of the questions put by the noble Baroness, Lady Meacher, when she asked about the access of the responsible body to such assessments. It will mean that that body will probably err on the side of caution, but it will also mean that we will have a more proportionate system than we do now. That is to be welcomed. Those AMCPs, as has been pointed out, could be salaried professionals within a local authority; they might even be close to commissioners, but their role will be independent, just as best-interests assessors are independent, and they will be responsible to their own professional bodies. That is something in the system on which we can rely.

The noble Baroness, Lady Meacher, and other noble Lords mentioned advocacy, and I know that we will be turning to that later. It is important to state—not only as I did at the beginning of the first group about making sure that the person involved is properly consulted—that they have the right to request a review, that they have access to representation from an independent mental capacity advocate or another appropriate person, and that ultimately those responsible for their welfare and care can challenge the authorisation in the Court of Protection.

I know that there are a couple of outstanding issues. The noble Baroness, Lady Jolly, asked if we could look at fee levels and that is certainly something that I will look at. The noble Baroness, Lady Meacher, asked how IMCAs are paid for. That is currently allowed for in the Mental Capacity Act and that is not changed by this Bill, but I will write to her to clarify that.

I hope that this response—particularly about the role that care home managers will not play in preauthorisation reviews—provides reassurance that we are conscious of the need to provide that independence in the system to reduce, and indeed remove, conflicts of interest and perceptions of conflict of interest wherever possible. As ever, as has been the theme of today, I continue to want to work with all noble Lords to ensure that we determine that the system, which still has great merit, is able to respond both to the needs of the people who are being cared for and to any concerns on behalf of those people from their families and stakeholders that there are conflicts of interest. I believe that the pieces of the puzzle are coming together, but I am conscious that we need to continue working together to complete it. On that basis, I hope the noble Baroness will feel able to withdraw her amendment. I look forward to further discussions on this topic to make sure that we are able to introduce as much independence as possible into the system.

[Baroness Jolly]

I thank the Minister for his remarks. The only point I would like to make at this stage is about the use of the code. The code offers something that might not be permanent, whereas anything that goes into legislation is permanent, so I would just be wary of that. I will study Hansard carefully, but for the moment I beg leave to withdraw the amendment.

NHS: Staffing

Debate between Baroness Jolly and Lord O'Shaughnessy

Wednesday 10th October 2018 Lords Chamber

[Lord O'Shaughnessy]

I hope the noble Lord will forgive me: I do not know the specific details about psychiatrists. I know that we need to recruit more doctors, which is why there has been an increase in the number of medical training places. There are in fact around 12,000 more doctors in the NHS today than in 2010. We do have a challenge in mental health, which is to recruit not just doctors but nurses and other assistants to make sure that we can deal with the mental health cases that are sadly not being dealt with in a timely manner at the moment.

[Baroness Jolly (LD)]

My Lords, staffing shortages predate Brexit and are across all disciplines and professions. Will the Government consider looking north of the border for a solution to nursing shortages? Scotland has decided to increase the student bursary for nurses, whereas English nurses in training now get no bursary at all. Might an investment in England help attract people to the career of nursing, rather than sending the message to student nurses that they are not valued as much as those in Scotland?

[Lord O'Shaughnessy]

It is absolutely not the case that they are not valued as much as in Scotland. This country has completely different higher education funding arrangements from those in Scotland. We are taking multiple routes to increase the number of nursing staff in the NHS, including increased funding for clinical places, the nursing apprenticeship route, more retention and bringing nurses back into the profession. We are determined to increase nursing numbers.

NHS: Dangerous Waste and Body Parts Disposal

Debate between Baroness Jolly and Lord O'Shaughnessy

Wednesday 10th October 2018 Lords Chamber

[Lord O'Shaughnessy]

I can say to the noble Baroness that the NHS contracts out very large numbers of services of all kinds, and indeed has contracted out this kind of service for around 30 years. What we have here is not a market failure but a company that has broken the law, and which is therefore being pursued by the regulatory system that we have in place. That is about making sure that the Environment Agency, in this case—because it is about environmental health—is monitoring, issuing notices and raising issues as they come up, which is precisely what it has done here. But I agree with the noble Baroness that certainly there are lessons to be learned about monitoring, and we are absolutely looking at that as a consequence of this incident.

However, it is very important to state two points. No risk to public health has been established, because of the secure circumstances under which the waste—albeit way too much of it—was being kept, and there was no interruption to the provision of services, so there was no risk to patients or to hospital operations. On providing information at the earliest opportunity, we have done exactly that. As I said, no public health risk has been established, and we came to Parliament on the first day it came back, once the termination notice had been in place with a part suspension.

[Baroness Jolly (LD)]

My Lords, it is clear that this situation has gone on for some considerable time unnoticed, and it also appears that the incinerator network is not able to cope with the volume of waste generated. Will the Minister confirm that the incinerators are single use? When was the contract with HES last reviewed, and how frequent were inspections of sites? What is the timetable for being able to resume a sustainable service across all of England, and might this include new incinerators?

General Practitioners: Indemnity Scheme

Debate between Baroness Jolly and Lord O'Shaughnessy

Monday 16th July 2018 Lords Chamber

[Lord O’Shaughnessy]

I agree with the noble Baroness’s final point. Indeed, one reason for sorting out this scheme is that we know it is a barrier to people joining the profession and, unfortunately, encourages them to leave it. There is of course an urgency, but nevertheless it is a complex discussion with commercial partners. I can tell her that we are talking to GPs themselves and their representative organisations to make sure they understand what is at stake, what we intend to do and that we intend to introduce the new scheme in April.

[Baroness Jolly (LD)]

My Lords, on 1 June, a DHSC spokesperson said:

“We are continuing to work closely with key stakeholders in the development of the scheme from April 2019”—


as the Minister said. The spokesperson went on:

“We will provide a further update in the near future”.


GPs need reassurance that this will not be kicked into the long grass. What is the department’s understanding of the “near future”—is it six weeks, six months or a year?

[Lord O’Shaughnessy]

That is a very existential question. The point is that we need to introduce the scheme by April and are absolutely committed to that. There are some very big decisions to be made on the scheme design now. We have a new Secretary of State who is getting up to speed on these issues as we speak. Our intention is to make those decisions to confirm the design of the scheme and to be able to tell GPs and other stakeholders publicly as soon as possible. We are committed to the April 2019 deadline.

Health: Endoscopy and Bowel Cancer

Debate between Baroness Jolly and Lord O'Shaughnessy

Monday 2nd July 2018 Lords Chamber

[Lord O'Shaughnessy]

My noble friend is quite right to point out the potential of digital, particularly the analytical capability of artificial intelligence to look at samples. That was one reason why the Prime Minister recently pledged to have 50,000 more early cancer diagnoses by 2033—a long-term goal—precisely because the NHS is such a good place to use artificial intelligence to improve care.

[Baroness Jolly (LD)]

My Lords, after a cancer diagnosis, English patients have poorer outcomes than all but one of our European comparators. We welcome the announcement that the Minister has just made about new clinicians, but in some areas there are delays in referral, testing diagnosis and then treatment. The longest wait for treatment reported this year was 541 days. That is not good enough. How long does the Minister think we will have to wait for there to be sufficient clinicians and facilities to deliver a service that moves us significantly up the table?

[Lord O'Shaughnessy]

The noble Baroness is right to highlight the importance of waiting times. The 62-day standard is unfortunately not being hit at the moment. The NHS has pledged to get back on that standard this year. We are also piloting a faster, 28-day diagnosis standard in five areas at the moment with the idea of rolling that out so that there is a higher standard of care and fewer people have to wait longer.

Nursing and Midwifery (Amendment) Order 2018

Debate between Baroness Jolly and Lord O'Shaughnessy

Monday 25th June 2018 Lords Chamber

[Baroness Jolly (LD)]

My Lords, my contribution will be very short, as noble Lords have already said everything. We, too, welcome the role of the nursing associate. I commend the work of my noble friend Lord Willis of Knaresborough in making this happen and say to him that he can have the Front Bench if he is happy to take all that goes with it.

The noble Earl, Lord Listowel, made the point about impact. I just make one extra point. In remote locations—I live in Cornwall, but this could account for anywhere far-flung where there are hospitals and health establishments—there will be uptake from healthcare assistants who feel that they cannot leave home to train as a nurse because the distance is too great and they have family responsibilities or other commitments, but they could manage the two-year course. That would be really positive. Nursing associates would then improve in those establishments the quality, but also the skill mix, of nursing teams in areas where it is also particularly difficult to appoint.

I understand the timing of this SI. The noble Lord, Lord Clark of Windermere, said that perhaps there was still stuff to look at. It is really important that it gets on to the statute book, because we will have real live trainee nursing associates who need to register next year. Sadly, we cannot take any more time to do this, but from these Benches we really welcome the role of the nursing associate and the help it will give the NHS.

[Lord O’Shaughnessy]

My Lords, I sincerely thank every noble Lord who has spoken in the debate and engaged with these regulations so thoroughly. It has been a really important discussion about not just the new role of nursing associate but its impact on the overall health and care workforce. I am very grateful to all corners of the House for the broad welcome, albeit with questions and conditions, for the creation of this role.

I want to deal up front with the urgency of these regulations. I agree that there has been an element of rush, and I think we are all agreed on the requirement for it. But like all overnight successes, this has been a long time brewing, as the noble Lord, Lord Willis, pointed out. A lot of work has been done, and I salute, along with all noble Lords, the many people at the RCN, the NMC and others who have contributed to this, and the many people behind the scenes. It is quite right to acknowledge them. No doubt there is more work to come.

The primary debate, or part of it, revolved around the distinction between the nurse role and the nursing associate role. It is very important to be clear, as I hope I was in my speaking note, that these are distinct professions. They may all be part of the same family—there is a certain amount of semantics involved here—but they are distinct professions, which will be regulated distinctly, albeit in a joined-up way through the same regulator, which is quite right. The NMC is currently consulting on standards of proficiency. The department, with all the necessary arm’s-length bodies and others, will develop guidance for that separate profession. While nursing associates can inevitably support nurses, doctors and others, they will not just be the handmaidens to others, in the evocative phrase of the noble Lord, Lord Clark. They will be professionals in their own right.

It is also worth pointing out that, in the consultation going on at the moment on standards and proficiency, the NMC is also looking at the code of conduct and amendments to it. That consultation ends on 2 July so, again, I warmly encourage all noble Lords to contribute to that, because some of the ideas set out today could have an important role in getting that right.

The noble Baroness, Lady Thornton, asked about the financial risks involved in setting up the courses—making sure that they are properly constituted and so on. My department has a memorandum of understanding in place with the NMC to keep the costs of the set-up within agreed cost parameters. The costs of accrediting nursing associate courses are met from the annual registration fees paid by the NMC’s registrants. Therefore, the financial modelling has been investigated and we understand what we need to stick to.

Childhood Obesity Strategy

Debate between Baroness Jolly and Lord O'Shaughnessy

Monday 25th June 2018 Lords Chamber

[Lord O'Shaughnessy]

An upgrade in our grade is, I suppose, something to be welcomed. The noble Baroness is being a little unfair. The last obesity plan probably went beyond that of almost any country in the world, and this one certainly goes well beyond that. We know that we need to do more—that much is obvious from the facts—because, unfortunately, obesity continues to rise. We have taken big action through the soft drinks levy, improvements in reformulation and so on but it has not gone as far as we want. So we recognise the need to do more.

The noble Baroness referred to consultations but, if anything, you can accuse this paper of being too honest because any action requires consultation to go forward. I would not want her to be distracted by that because within it are some hard commitments. There is a commitment to voluntarism if we can make it work but, equally throughout, there is a commitment to legislate if that does not produce the right outcomes.

The noble Baroness asked about milk products. Again, if voluntary reformulation does not work, these will be considered by the Treasury as being liable for the levy on soft drinks to bring down the sugar content.

On advertising, the idea that we should have a 9 pm watershed across broadcasting is truly radical, and it is only right that we consult properly. There is a desire to do that by the end of this year, so the noble Baroness cannot accuse us of not moving quickly enough.

The Obesity Health Alliance, which counts dozens of bodies among its membership, has welcomed the plan set out today. Of course it wants us to get a move on—and we will—but it is important to note the radical change in policy to try to deal with this epidemic that we all face.

[Baroness Jolly (LD)]

My Lords, I thank the Minister for repeating the Answer to the UQ. Anything is welcome and I am at the stage where more questions are being raised than answered. A debate in this House would be useful and perhaps put some flesh on the bones. That is absolutely the wrong thing to say, but the House knows what I mean. It would give more clarity.

I wish to push the Minister a little further on the advertising issue. I appreciate that a consultation is coming up. We welcome the idea of using the watershed, but I am not clear from the Statement or from chapter 2 whether it includes all programmes before 9 pm or only programmes that are aimed at young people before 9 pm. That is an important distinction and it will be useful to know what is going to be consulted upon.

Families were mentioned in passing. I would like to know what work is to be done with families. I appreciate that there is not in this land a typical family, but we are trying to take out 500 calories a day from people’s diets and we need to point out the high calorific value not only of chips, which may seem obvious, but of pasta, rice—which everyone thinks is healthy—bread and buttered mash. There is still work to be done with families to make them understand quite what they are putting on their children’s table which seems healthy and fine.

Childhood Obesity: Yoga

Debate between Baroness Jolly and Lord O'Shaughnessy

Thursday 21st June 2018 Lords Chamber

[Lord O’Shaughnessy]

I will bring my mat.

[Baroness Jolly (LD)]

My Lords, as the Minister said, there really should be an evidence base before we pursue this too far. Does the department know whether there are sufficient teachers trained to teach children in yoga? Would there need to be appropriate safeguarding?

[Lord O’Shaughnessy]

I am afraid I do not know whether we know that. I suspect we do not. Yoga is an incredibly popular pastime for children and adults. Indeed, I think there are mother-and-baby yoga classes, which are also popular. I am sure safeguarding concerns will always be foremost when dealing with young children.

National Health Service: Assaults on Staff

Debate between Baroness Jolly and Lord O'Shaughnessy

Wednesday 20th June 2018 Lords Chamber

[Lord O’Shaughnessy]

I was delighted to meet my noble friend on this topic. I know he cares passionately about it. We have said—and I have said in this House before—that we are looking at the Scottish example with interest now that Scotland has gone ahead with it. There is a growing evidence base to demonstrate the benefits of minimum unit pricing, but we want to see what transpires in Scotland before making any decisions about whether to move ahead.

[Baroness Jolly (LD)]

My Lords, in England around 200 attacks on NHS staff occur every day, and this is nothing short of scandalous. Next week we have the Second Reading of a Private Member’s Bill, which has come from the other place, on assaulting emergency workers. Will the Minister confirm whether the Government are minded to support it—and, if not, what further action will be taken to protect health workers?

[Lord O’Shaughnessy]

I agree with the noble Baroness that it is scandalous and that we therefore want to support the Bill. I believe that it will have its Second Reading here on 29 June. I can confirm that the Government will be supporting the Bill.

Gosport Independent Panel: Publication of Report

Debate between Baroness Jolly and Lord O'Shaughnessy

Wednesday 20th June 2018 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I shall crave the indulgence of the House for a moment while I read out the first two points in the summary and conclusions of the report:

“In waiting patiently for the Panel’s Report, the families of those who died at Gosport War Memorial Hospital … will be asking: ‘Have you listened and heard our concerns, and has the validity of those concerns been demonstrated?’ … It is over 27 years since nurses at the hospital first voiced their concerns. It is at least 20 years since the families sought answers through proper investigation. In that time, the families have pleaded that ‘the truth must now come out’. They have witnessed from the outside many investigative processes. Some they have come to regard as ‘farce’ or ‘cover-up’. Sometimes they have discovered that experts who had found reason for concern had been ignored or disparaged. Sometimes long-awaited reports were not published”.


I commend my right honourable friend Norman Lamb for having a quiet word with the Secretary of State to ensure that this was moved forward.

This report makes for shocking reading. It hangs on a confusion of responsibilities between two organisations, the NHS and the police force, and there is a multitude of questions to be answered. I shall put only two questions to the Minister and hinge them on two points in the report. The first is paragraph 12.62. Health bodies felt prevented from taking action because police investigations were under way. The report points out:

“All concerned assumed not only that the police investigations took priority, but that they prevented any other investigations from proceeding”.


There is clearly a need to clarify lines of responsibility between the police and the NHS regulatory bodies when there are allegations of wrongdoing and systematic failings of this kind so that organisations simply do not pass the buck. Can the Minister assure me that this work will start?

Secondly, how will the Government take forward the call for action in paragraph 12.60? I welcome the Minister’s commitment to an independent inquiry in future in such circumstances to be carried out by the police force, but the report states that,

“the evidence … suggests that, faced with concerns amounting to allegations of unlawful killing in a hospital setting, there are clear difficulties for police investigation. It is not clear to the Panel how the police can best take forward such investigations, and how they are to know whose advice to seek from within the health service without compromising their enquiries. This is … significant if the problem concerns the practice on a ward where more than one member of a clinical team is involved. It is a need that calls for action across different authorities, rather than a matter for the police service in isolation”.

We cannot guarantee that something similar to this could not happen elsewhere—please God that it does not—but what action will be taken to ensure that there is not such a muddle and confusion in a resolution? What processes are either in place or being put in place within NHS settings and with police forces to make sure that this does not happen again?

[Lord O'Shaughnessy]

I thank the noble Baronesses, Lady Wheeler and Lady Jolly, for their very perceptive questions—as ever. First, I extend my personal sympathies to the families and join my right honourable friend in expressing our apologies on behalf of the Government and the NHS for what has happened to them and their relatives. Like the noble Baronesses have done, I pay tribute to those families and all the others who have fought so tirelessly in seeking justice. As has been acknowledged, we owe a huge debt of gratitude to Bishop Jones and his panel.

The story told in this report is of a litany of failure across many institutions, which often had very closed cultures. Unfortunately, those piled on to one another across many different agencies of government, which is what created that highly unacceptable cover-up for so long. It is about getting to the bottom of that culture. Let us face it: unfortunately these circumstances are not unique. We come across this in different parts of our society all the time, and we need to get to the heart of that closed culture to lead to a culture of accountability and transparency.

The noble Baroness, Lady Wheeler, asked some specific questions, including about the 200 additional patients without notes. Clearly, further investigation is warranted because we need to substantiate that claim. It is obviously one of the work streams that will be going forward. She asked about streamlining professional regulation, given the obvious inadequacies of the GMC and NMC regulators during this process. As my right honourable friend the Secretary of State said, every part of government needs to look to itself with great honesty about what we need to do to put in place the right environment to prevent this happening again. I think we all agree on the need to move forward to streamline professional regulation. It is not something we have yet been able to do, but the tragic news we have been discussing today gives that fresh impetus. It is clearly something we will be looking at.

Patient safety is a great passion of the Secretary of State. There were changes in the oversight of medicines, particularly opioids, after the Shipman inquiry. The noble Baroness raised some good questions about whether there is a need for an independent body, or whether in the Health Safety Investigation Branch we have that body but its remit needs to be reconsidered as part of the Bill going through. I am sure that we will be doing that.

The noble Baronesses, Lady Wheeler and Lady Jolly, asked about the issues around inquiries. One of the things that has been exposed here is that there were overlapping inquiries that were impeding each other or preventing one another moving forward. Making sure that there is a clear process for how that ought to take place when someone—a family member, a staff member, the police—has raised a concern is something we have to get to the bottom of because that bureaucratic muddle was clearly at the heart of the delay and, because of the delay, more people died unnecessarily. It is not just a case of clearing things up and making them neater; it has a massive impact on harm.

The learning from deaths programme is a big step forward. It has been taken into many bits of the health service already. It is now moving into the primary care area. Trusts are already obliged to publish deaths that ought to be in the scope of mortality reviews. From next April, all non-coronial deaths will be subject to investigation by medical examiners. That is yet another part of the patient safety environment that we need to put together.

Going beyond that, there are clearly some very challenging questions that the criminal justice authorities, coroners, the Home Office, the Department of Health and Social Care and all parts of government need to ask themselves to see whether they are really doing everything they need to do to provide a safety net to make sure that when things go wrong we find out about them quickly, we stop them and we learn from them. In the next few months, as we move towards publishing a plan for what we should do next, it is imperative that all Members of this House and the other place, who have great contributions to make in this area, feel free to engage with this process and make their recommendations to it, so that when we report we have done as thorough and comprehensive a job as we possibly can so that we can prevent these tragedies happening again in future.

Long-term Plan for the NHS

Debate between Baroness Jolly and Lord O'Shaughnessy

Tuesday 19th June 2018 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I too thank the Minister for his Statement. I welcome any increase in funding. Should the Chancellor be wondering how to pay for it, we on these Benches would be quite happy to see a 1% increase on income tax, for starters. The IFS has said that increases of close to 4% are needed for social care, as well as a funding boost for the NHS. Yet the Statement had nothing to say on this vital issue. We all know that the NHS cannot function efficiently unless social care is working well too. Many local authority leaders are indignant that the Green Paper has been moved further down the track, so when the new funding does arrive there is already a sizeable deficit to claw back. They are extremely anxious about the situation with adult social care funding being insufficient for this financial year.

What conversations have been held with the LGA, local council leaders and the Ministry of Housing, Communities and Local Government in advance of these statements? We are also dismayed about the silence on mental health, public health and community health funding. One in four of us will be affected by mental illness, there is an obesity epidemic among our children, too few health visitors, and we are critically short of psychiatric social workers. Is the Minister confident that these issues can wait until the autumn NHS plan and the Budget?

[Lord O'Shaughnessy]

I thank the noble Baronesses, Lady Thornton and Lady Jolly, for their questions. I think that our debate on the report of the Lords Select Committee on the sustainability of the NHS and social care was revealing, in that we got a hint that, while the settlement would receive a broad welcome across the House, the party opposite might not be in quite the same positive mood, and, unfortunately, we have had that confirmed today. Perhaps that might generously be described as a cautious welcome.

The noble Baroness asked about the funding of this settlement. We were very clear yesterday that it will come, effectively, from three sources: from taxation, from economic growth, and from the fact that, as we are leaving the European Union, we will not be paying annual subscriptions any more. It will be a combination of those factors that determines the spending. Indeed, the Treasury is confident in that, and it would not have signed off this deal if it had not been.

On the noble Baroness’s specific questions about the legal obligations under the NHS constitution, actually the money that was given to the NHS at the Budget was to help it to get back on target—in the case of A&E, by the end of this financial year and, for elective procedures, to halt the growth in the expansion of the waiting list. Clearly, one of the reasons for this settlement, which is set out explicitly, is to get back to those key standards, which we know are the yardsticks by which people judge their everyday experience of the NHS.

On the point about there not being enough money, there can always be arguments for more, but it is instructive that two former Health Ministers, one from the Labour Party and one from the Conservative Party—my noble friend Lord Prior and the noble Lord, Lord Darzi—set out last week that they felt that 3.5% was the right figure, which we have got very close to. We should take the suggestion of those two very experienced and knowledgeable former Health Ministers as a good yardstick for our achievement.

The noble Baroness asked about social care funding, as did the noble Baroness, Lady Jolly. The intention behind the delay in the Green Paper—which I recognise is a source of regret for people in this House and elsewhere—is to make sure that integration, which we all agree has got to be at the heart of this 10-year plan, actually happens in planning terms and policy terms as well as in announcements and delivery. That is why there is that co-ordination between the two. Again, it is worth stating that, over the current three-year period, at previous Budgets an extra £2 billion was put into the social care budget, which is rising now for the first time in a number of years, and that is obviously important as we put together that long-term solution.

Finally, let me deal with two other points. On the repair bill and the capital settlement, again at previous Budgets the Chancellor has pledged £10 billion through a number of sources towards the capital settlement for the NHS, but we are expecting the NHS, through this process, to come forward with long-term, multi-year capital proposals, because clearly that underpins so much of the transformation.

In terms of the impact on other elements of the broader health budget, mental health is included in there, including a clear commitment to deliver on parity of esteem within this period. Public health and community health will be dealt with in the next spending review process, which will be happening in the next year. Again, there are clear commitments that there will not be additional pressures, if you like, created for the NHS by what happens to the public health and social care budgets in the future. Ahead of a spending review process, that is a clear indication that there is not a desire to create trouble, if you like, in those budgets that would land at the feet of the NHS.

Chronic Lymphocytic Leukaemia: Ibrutinib

Debate between Baroness Jolly and Lord O'Shaughnessy

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

Debate between Baroness Jolly and Lord O'Shaughnessy

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.

Learning Disabilities Mortality Review

Debate between Baroness Jolly and Lord O'Shaughnessy

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

Debate between Baroness Jolly and Lord O'Shaughnessy

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.

Domiciliary Home Care Support

Debate between Baroness Jolly and Lord O'Shaughnessy

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

Debate between Baroness Jolly and Lord O'Shaughnessy

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

Debate between Baroness Jolly and Lord O'Shaughnessy

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

Debate between Baroness Jolly and Lord O'Shaughnessy

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.

HPV Vaccinations

Debate between Baroness Jolly and Lord O'Shaughnessy

Monday 26th March 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right that equality is an issue, and an equality analysis will take place. That can be completed only once we have the final advice from the joint committee. I can also promise her that we will publish that analysis, so that will be able to be scrutinised. As for legal advice, it is subject to threats of judicial review at the moment, so I cannot go any further than that, but I can promise that equality considerations are very high on the list of the issues that we are dealing with.

[Baroness Jolly (LD)]

My Lords, we welcome the decision to vaccinate gay men in England, but sex and relationships are no respecter of national borders. Has NHS England had any conversations with the NHS in Northern Ireland, Scotland or Wales to ensure that gay men are protected right across the UK?

[Lord O'Shaughnessy]

We are beginning a national rollout of the programme for men who have sex with men in terms of the provision, because of course they are not necessarily getting the indirect benefits from the girls’ immunisation programme. I do not have the details of the working relationships with the devolved Administrations, but I shall write to the noble Baroness with details.

NHS: Staff Pay

Debate between Baroness Jolly and Lord O'Shaughnessy

Wednesday 21st March 2018 Lords Chamber

[Lord O’Shaughnessy]

I thank the noble Baroness for her perhaps less than fulsome welcome for what is a fantastic deal, not least for the lowest paid staff in the NHS, some of whom will see very significant pay rises. They certainly deserve them; I do not think anyone disagrees with that. We have been able to find the additional money in the NHS budget to do this precisely because of good economic stewardship, rather than relying—as others would—on trees, magic or otherwise. That stewardship has meant that we have been able to provide the money while taking our fiscal responsibilities seriously.

The noble Baroness mentioned the joined-up staffing strategy. She is absolutely right that it is very important. I hope she knows that Health Education England has included work on the social care workforce in its draft strategy. We all understand that we need increasingly to view these workforces together—not just people such as nurses, who can work in both sectors, but carers and allied health professionals and so on. Frankly, there is more work to do on the social care workforce strategy. In the health service, we are starting from a lower base in terms of having a national picture, precisely because it is generally delivered locally. However, we are providing that strategy. I would encourage all parties who want to make sure that the strategy is joined-up to contribute their ideas, because there is a genuine willingness to make sure that we can do it.

[Baroness Jolly (LD)]

My Lords, I echo the Minister’s remarks about NHS staff working hard all year round. I welcome this agreement. The RCN and Unison must have worked very hard with the DoH to get this nailed, but the devil is in the detail and we have yet to see the detail.

Agenda for Change was implemented in 2004 when I was chair of a primary care trust. It was really difficult to get the various levels of NHS staff in the various strata. Can the Minister confirm that Agenda for Change will be revisited along with the skills and knowledge framework? The Secretary of State also talked about putting appraisal and continuous professional development at the heart of pay progression, so that may indicate that the skills and knowledge framework might need to change. On the same topic, echoing what was said just a moment ago, can the Minister shed light on whether care workers’ salaries will be included in the Green Paper on social care? At the moment, they are feeling very undervalued and underpaid.

[Lord O’Shaughnessy]

Like the noble Baroness, I think it is right to pay tribute to all the organisations involved in striking this deal. These things are never easy but it is a true partnership agreement that tries to work for everybody.

The Statement is explicit about linking pay progression with appraisals, which indeed means higher skill levels. I will write to her with the specifics of the skills and knowledge framework; I am not cognisant of that specifically, but clearly the intention is to move away from automatic progression to skill-based progression. One of the advantages of that is that it not only works for patients, but puts the onus on employers—she will see more detail of that—to make sure that there is proper professional development to help skill levels rise, so that staff can go through those gateways and progress.

Children and Young People: Mental Health Services

Debate between Baroness Jolly and Lord O'Shaughnessy

Thursday 8th March 2018 Lords Chamber

[Lord O’Shaughnessy]

I absolutely agree. This is why the changes that we are making to mental health awareness training in primary schools is critical. Most primary schools, through nurseries, take children from four—and even two or three—years old to make sure that staff can spot the signs in school and signpost to specialist services, where required.

[Baroness Jolly (LD)]

My Lords, I welcome the Minister’s Answer to the Question. I am sure that he will agree that mental health support teams will be critical in making all this work. However, CAMHS teams had huge problems in getting the workforce—and in getting it up to speed. What measures are being put in place to guarantee the resilience of these new teams?

[Lord O’Shaughnessy]

I agree that that is a challenge. There is a plan to create 21,000 new medical and allied posts by 2021, which would be the biggest expansion in mental health services that has ever taken place—certainly in this country but even in Europe. How we are going to achieve that is set out in the draft workforce strategy that Health Education England has published. A big part of that is the creation of mental health support teams in schools. That will take time—we need to be realistic—but it is an ambitious goal and we know that that support is wanted and needed.

General Practitioners: Workforce

Debate between Baroness Jolly and Lord O'Shaughnessy

Monday 5th March 2018 Lords Chamber

[Lord O’Shaughnessy]

I agree with the noble Lord: we need to crack down on agency and locum spend. That has been falling in recent years. The way we will fix this issue and the demand for general practice in a sustained way is to increase the number of GPs coming into the service, and, as I said, that is exactly what we are doing.

[Baroness Jolly (LD)]

My Lords, there should be a move to recruit newly-qualified doctors to general practice and to prevent GPs retiring earlier and earlier, but that is not as easy as it sounds. Can the Minister therefore tell the House what work has been done to enable job-sharing, so that part-time GPs balancing a family life can partner with older GPs who want a less full-time commitment?

[Lord O’Shaughnessy]

I shall have to write to the noble Baroness with the specifics on GP flexibility. However, one of the reasons that GPs take early retirement to take advantage of their pension is that it enables them to work flexibly afterwards.

Alcohol: Minimum Unit Pricing

Debate between Baroness Jolly and Lord O'Shaughnessy

Wednesday 28th February 2018 Lords Chamber

[Lord O'Shaughnessy]

My noble friend speaks with great wisdom about making sure, not just with alcohol but with other health issues around food and drink, that we have a look at making those kinds of promotions not possible.

[Baroness Jolly (LD)]

My Lords, the Minister has acknowledged that the evidence is absolutely there and that he will look at it in the near future, but when might a decision be made? How long does he need the Scotland experiment to last before he actually makes a decision?

NHS: Waiting Lists

Debate between Baroness Jolly and Lord O'Shaughnessy

Monday 26th February 2018 Lords Chamber

[Lord O'Shaughnessy]

Vacancy data is available. If it was not available on the particular footprint that the noble Lord asked for, I would point him in the direction of data published last week by NHS England on vacancies, which is always a topic of much interest in this House. Over the past three quarters, that shows a slightly improving picture, but clearly there is a lot more to do.

[Baroness Jolly (LD)]

My Lords, under the NHS constitution, no patient should have to wait more than 18 weeks for any treatment. However, there are no specific national standards for waiting times for CAMHS patients, only guidelines, except for under-18 year-olds with psychosis and those treated in the community for eating disorders. What proportion of those CAMHS patients are seen within the agreed times, when does the Minister expect we will see a significant improvement and is sufficient funding earmarked to achieve it?

[Lord O'Shaughnessy]

The noble Baroness is quite right to highlight this issue. There simply are not equivalent waiting times for CAMHS. As she mentioned, we have introduced the first waiting times for eating disorders and early intervention in psychosis. I think she will have been pleased to have seen in the Green Paper published before Christmas that a new four-week waiting time for NHS children and young people’s mental health services will be piloted. That will be rolled out in the near future.

Health: Pelvic Mesh Implants

Debate between Baroness Jolly and Lord O'Shaughnessy

Tuesday 6th February 2018 Lords Chamber

[Lord O'Shaughnessy]

My noble friend makes an excellent point. This is one procedure, and for some women it can be positive and life-enhancing. But we also know that it carries a risk of complications. That is one reason why we wanted to carry out the audit, because it will look not only at areas and procedures where there have been problems and complications but at where it has been successful, so that we can have a proper understanding of what the complication rate is and therefore what the safety concerns are.

[Baroness Jolly (LD)]

My Lords, the NICE guidelines that the Minister just referred to conclude that:

“Evidence of long-term efficacy is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research”,


as he said. But will he tell the House how confident we can now be that that is the case and that the information has been effectively disseminated? What is the mechanism for informing clinicians and women about this NICE guidance?

[Lord O’Shaughnessy]

The noble Baroness is quite right to say that it is not just about having the guidelines but making sure that clinicians follow them. Professional standards demand that clinicians do follow them, and indeed a clinician would need to be strongly justified in using mesh implants outside of the guidelines. They include things like gaining consent, providing information and registering operations that have been carried out. The guidelines are very strict and we expect clinicians to follow them.

NHS Winter Crisis

Debate between Baroness Jolly and Lord O'Shaughnessy

Monday 5th February 2018 Lords Chamber

[Lord O'Shaughnessy]

My Lords, I thank the noble Baroness for her questions. I agree with her that we are all proud of our NHS, on all sides of this House, and I am sure that we all have great pleasure in stating that through whatever means we are required to. I also join with her in paying tribute to the staff, who do such a fantastic job, often in challenging circumstances.

She asked first about urgent operations. It is clear in the guidance that they should not be cancelled when it would negatively affect patients’ outcomes. If that has happened, NHS England is investigating and reinstating those operations. The guidance is quite clear and NHS England has followed that up.

As for A&E targets, we know that they have not been achieved recently. It is important and instructive to look at the extraordinary increase, not just in winter but overall, in the number of episodes that are happening. They really are increasing at a very high rate. Demand is very high—higher than I think could have been anticipated—and it is a credit to the NHS that it has produced the performance that it has. The aim now, with funding given at the Budget, is to get us back to the four-hour target that we all agree ought to happen. That is what will be happening over the coming year.

[Baroness Jolly (LD)]

My Lords, this morning I visited a suburban hospital in London, with an almost brand new A&E unit and a well-managed winter crisis. But despite all that, it has still had to face a bed occupancy rate of 97% on several days, which is stretching its ability to make this work. Money was clearly an issue—the hospital was quite anxious about what its end of year accounts might look like. Today, the Liberal Democrats launched a report looking again at a different way of funding the NHS through the creation of an office of budget responsibility for health and care, long-term health and care funding, and a ring-fenced tax to replace national insurance. Also, there is a clear need for some sort of short-term fix, and we have suggested that £2 billion should be raised by adding a penny to our income tax. Has the Minister looked at this report and will he agree to meet with me to discuss it?

Public Health: Strength and Balance Programme

Debate between Baroness Jolly and Lord O'Shaughnessy

Thursday 18th January 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord is quite right to point out the importance of preventing falls. Around 95% of hip fractures come about through falls, at particular cost and pain to the individual, of course, but also to the wider economy as a whole. I should point out that Public Health England supports a number of activities, one of which is a partnership with Sport England that has trained 5,000 health professionals in delivering physical activities, including strength and balance work. I agree that more needs to be done at local authority level, particularly as we have an ageing population, but there is good work going on at the local level.

[Baroness Jolly (LD)]

My Lords, in parts of Cornwall there has been real success with the strength and balance programme, with a huge reduction in falls. We all know that prevention is always better and cheaper than the cure. Can the Minister tell the House what work has been done to determine how much could be saved for the NHS as a result of a total rollout of this programme and why reductions to local authority public health budgets are jeopardising such programmes?

NHS: Nurse Retention

Debate between Baroness Jolly and Lord O'Shaughnessy

Wednesday 17th January 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord speaks with great wisdom and experience. He is quite right about the need for long-term workforce planning. I hope that is why he will welcome the 10-year strategy that Health Education England is launching. It is looking at diversifying the working population—for example, through the growth in the number of nursing associate training places.

On the report, I can only apologise again for the delay. I hope that at least the noble Lord will welcome the fact that in the reshuffle the health department gained social care policy. That was one of the issues on which he wanted to promote greater integration.

[Baroness Jolly (LD)]

My Lords, in the past 12 months, more than 6,000 nurses have gone on long-term sick leave, related to stress. How are nurses being helped to cope by the occupational health departments of their employers, and do the Government acknowledge that the problem is exacerbated by a 1% cap on their pay rise?

[Lord O’Shaughnessy]

I acknowledge the importance of looking at pay, which is why it was so welcome that the issue was dealt with in the Budget, with the cap being lifted for nurses and other health professionals on Agenda for Change contracts. I agree that long-term sickness is a big concern and undoubtedly having an impact on some nurses leaving. That is why the return-to-practice programme that we have is so important. Several thousand nurses have been through it; it is about providing opportunities to come back into the profession in a supportive way for those who want to do so.

NHS: Winter Funding

Debate between Baroness Jolly and Lord O'Shaughnessy

Thursday 11th January 2018 Lords Chamber

[Lord O’Shaughnessy]

I shall certainly take that interesting idea to the new Minister for social care. The noble Baroness will be pleased to note that the number of delayed transfers of care actually fell in the run-up to winter as a result of the extra money that went into social care. However, she has put forward an excellent idea and I shall certainly take it to my new colleague.

[Baroness Jolly (LD)]

My Lords, £100 million of the money announced by the Chancellor went into primary care streaming, which is designed to keep all but the most ill out of A&E. Some £55 million of that was handed out in April and £21 million in June. Can the Minister give an indication of the impact thus far of primary care streaming and tell the House where the other £24 million went?

[Lord O’Shaughnessy]

Nine out of 10 type 1 A&E departments now have streaming in place, so the money has gone into that. However, obviously we want to get to 100% so that is where the extra funding will go, but it is already having an impact. A full quantitative evaluation will take place at the end of the winter.

Agency Nurses

Debate between Baroness Jolly and Lord O'Shaughnessy

Wednesday 10th January 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord is quite right that we need sufficient staff. He will know that when the Government came to office in 2010 difficult decisions needed to be made about the funding of all public services, because of the economic situation at the time. It is worth pointing out that, since that time, there are over 10,000 more nurses on wards, which is obviously particularly important at this time of year. In terms of the future figures, I hope he will be aware that there will be an increase in the number of training places for nursing—£5,000 a year. Indeed, Health Education England, which is responsible for workforce planning, will deliver a long-term plan to make sure that we can tackle this issue, which has been a long-standing problem for the NHS.

[Baroness Jolly (LD)]

My Lords, the Royal College of Nursing surveyed its members on this issue and two key things came out. One was that they wanted flexible working hours and the other was that they wanted the ability to choose a ward or specialty. It is clearly better for nurses to be employed by their trust rather than through an agency, so what are NHS trusts doing to accommodate nurses’ desire for flexible working patterns and a choice of where they work?

[Lord O'Shaughnessy]

On the issue of flexible working there is an important distinction between agency working and bank working. Bank working provides a degree of security and familiarity, in that the nurses employed by nursing banks often work in the same hospitals. That is one of the most important ways that we can provide the flexible working which, as the noble Baroness quite rightly said, nurses want.

NHS Winter Crisis

Debate between Baroness Jolly and Lord O'Shaughnessy

Monday 8th January 2018 Lords Chamber

[Lord O’Shaughnessy]

I am not in a position to say whether they should have a second inoculation, but there are still a number of people who have not had that inoculation. Those vaccines are available in GPs, surgeries, and we absolutely encourage all groups to have at least a first one.

[Baroness Jolly (LD)]

My Lords, it seems as if a winter crisis, year on year, is totally predictable. I cannot remember a year when there was not one, but I echo the Minister in paying tribute to those NHS staff, right across the system, who have worked flat out 24/7. Part of the problem is that the social care system and health system are not properly integrated—although I note from Twitter just now that Secretary of State Hunt has responsibility for social care, with immediate effect. Can the Minister tell me whether there are hospital beds occupied by people who no longer need them but are unable to return home? Can he give me an indication of the shortfall in accommodation or beds in the public, private and not-for-profit sectors in nursing and care homes? What gives the Government confidence that the £335 million in the autumn Budget will help, and can he give us some clarification on how that money is to be distributed?

[Lord O’Shaughnessy]

First, I join the noble Baroness by reiterating on a personal basis a tribute to the staff who have worked so hard over this period. I think we all know many of those people, and they do an extraordinary job. Social care is clearly a really important part of the picture because it is not just the flows into hospitals but the flows out. A lot of that is to do with delayed transfers of care. That is one reason why additional funding has been going in—I think it is £1 billion this year. It is important to point out that all local authorities have now signed up to plans to reduce what are called DToCs, in the jargon. DToCs have been falling, which means that there is the opportunity to get people out of hospital. That could be into a care home or residential care or it could be to their own home.

Health: Atrial Fibrillation and Stroke

Debate between Baroness Jolly and Lord O'Shaughnessy

Tuesday 12th December 2017 Lords Chamber

[Baroness Jolly (LD)]

My Lords, regular checks of the pulse rate can help indicate whether someone has atrial fibrillation. These should be carried out at the five-yearly general health check that GPs offer to those aged between 40 and 74. Could the Minister tell the House how many GP practices routinely call patients for this health check, whether they are paid to do so and how many patients take up the opportunity? I declare an interest as I am in this age range and have never been offered a health check.

[Lord O'Shaughnessy]

I too am in that age range. I am afraid I cannot tell the noble Baroness what the global figures are, but I shall write to her to do so.

Social Care

Debate between Baroness Jolly and Lord O'Shaughnessy

Thursday 7th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for her response and her questions; I will deal with them in order.

First, she asked about funding. She is quite right to point out the £2 billion of extra funding that was announced in the March Budget; of course, we have had two Budgets this year, so extra funding was included in a Budget this year. I should also point out that that was the latest tranche of additional funding, which totals over £9 billion over three years, taking into account the additional funding announced in recent financial Statements. The precise purpose of the funding is to address the fact that we have a growing and ageing population. The number of people requiring care packages is rising, and often the complexity of those packages is becoming more acute—hence the need for more funding, as we all recognise.

Experts will be fully engaged in the Green Paper, providing advice to Ministers and supporting engagement. There is no point in having such an august group and not drawing on their expertise. I do not think that there is any contradiction in the way that I have described their role. We would not want to involve those people—and they would not want to be involved—if they were not going to be listened to.

On carers, I acknowledge the delay in the carers strategy and I understand that that must be frustrating for those who have invested so much time in it. I have two things to say in response. First, it is right that the position of carers is considered in the round, with care costs. Secondly, that is why the action plan is important: it provides a staging post between now and the intention to introduce fully fledged policy proposals in due course. I am afraid that I do not have a specific date or a funding package for that, but I will write to the noble Baroness with as much detail as I can find and place a copy in the Library.

[Baroness Jolly (LD)]

My Lords, I too thank the Minister for repeating the Statement. I declare my interest as chairman of a learning disability charity, providing services to around 2,000 adults in England.

On the long-awaited Green Paper, I welcome the Government involving independent respected experts in the field, including Andrew Dilnot, Kate Barker and Caroline Abrahams. However, we are sorry that the Green Paper will not have any element of care for working-age adults when published.

I want to raise a few issues that were mentioned by the Minister in the other place in her answers to MPs. She called for all party groups to be involved and said that there could be no change without consensus. That is exactly what I wanted to hear and it makes sense. The Minister knows our views on this.

On carers, in a debate earlier this week the noble Baroness, Lady Pitkeathley, talked about the worth of carers being equivalent to the NHS budget. I also praise carers and I am delighted that they will be involved in this review, but I am somewhat disappointed, along with the noble Baroness, Lady Wheeler. They went through quite a lot of consultation for the carers strategy and there is a certain amount of irritation that they might have to revisit all this work. If they have caring responsibilities, it is not always easy for them to get to a central place. I hope some mechanism can be found to ensure that that is captured, but also to see whether anything should be changed.

The Minister also agreed that health and social care cannot be considered independent of each other—another area of agreement. Will the Government consider introducing a statutory, independent budget monitoring agency for health and care similar to the Office for Budget Responsibility? This would report every three years on how much money the system needs to deliver safe and sustainable treatment of care. It could even be the first stage in the integration of health and care.

With the delay of the Green Paper, it is unthinkable that the Government are now leaving the social care sector in this state of uncertainty. They have completely failed to address the critical crisis in social care and now there are more than a million vulnerable older people without the support they need. With a funding gap, as we heard just now, of at least £2 billion by 2020, I wonder how much worse things will have to get before the Government will act. To put that in a more balanced way, does the Minister have any sense, whatever the outcomes may be from the Green Paper, of when we might want to see some of those becoming reality? Local authorities will also tell you that they are desperate for a solution. I echo what I said before: how long does the Minister reckon we will have to wait to see something change?

[Lord O'Shaughnessy]

Again, I thank the noble Baroness for those questions. I will try to deal with them in order. As I set out in the repeat of the Statement, there will be a parallel programme for working age adults. It is important to note that that feeds into the same inter-ministerial group. I emphasise that in terms of its profile in the overall work programme. It is of course separate from social care for older people, but it is a parallel programme.

The noble Baroness is quite right about the need to build consensus. We all know how much we need sustainable reform in this sector. Governments of all hues have tried it. We really do need to get there now. I cannot give her timings at this point of course, but it is becoming urgent as our population changes.

I completely agree with the noble Baroness on carers. I pay tribute to those carers of all ages, including young ones, who take on extraordinary responsibilities and dedicate their lives to caring for others. It is an amazing thing to do. I recognise her frustrations at the delay. I hope contributing to the Green Paper should not involve much additional work, although inevitably there will need to be some updating. As I said, I will write to noble Lords to give more details about the carers action plan, which is intended to be a bridge between now and the consequences of the Green Paper and the options it lays out.

Finally, we do not agree, as the noble Baroness knows, that there is a need for such a body on health and social care. She is of course right about integration. That is why metro mayors, such as the one in Manchester, are taking on these combined responsibilities. It is why integration is built into the better care fund. This is a direction we need to push down to provide proper, holistic, wraparound care for older people.

Brexit: Health Policy

Debate between Baroness Jolly and Lord O'Shaughnessy

Wednesday 6th December 2017 Lords Chamber

[Lord O’Shaughnessy]

My noble friend gives a wonderful exposition of the values of democracy, which I wholeheartedly endorse. I should point out that the UK Government are implementing the wishes of the British people, as expressed through the referendum, and that this position was supported by the manifestos of parties that gained 80% of the vote at the most recent general election.

[Baroness Jolly (LD)]

My Lords, EU workers comprise some 5.6% of the healthcare workforce overall, including 10% of our doctors and 7% of our nurses. Most of these workers, who are not trained in the UK, are able to come and work here through the EU mutual recognition of professional qualifications directive. Can the Minister reassure the House that these reciprocal arrangements are afforded to EU and UK health professionals in perpetuity?

[Lord O’Shaughnessy]

The noble Baroness is right about the important role that EU workers play in the NHS, and I pay tribute again to the work that they do. We value them and want them to stay. We are in a position with the stock of EU workers here—and, equally, UK workers in other health systems—to recognise those qualifications. Clearly we will have to agree to continue doing that as part of the future negotiations. It has to be said that some concerns have been expressed by bodies such as the GMC about how that operates. We are working with them to make sure we get that right.

HIV Prevention Services: Public Health Funding

Debate between Baroness Jolly and Lord O'Shaughnessy

Thursday 30th November 2017 Lords Chamber

[Lord O'Shaughnessy]

First, I pay tribute to the work of the Terrence Higgins Trust and its leadership in this area in making progress in the UK in dealing with the HIV/AIDS epidemic. The delivery of open access to sexual health services is mandated for all local authorities, which are funded to do so by the public health grant. It is incredibly important to point out that over the last four years there has been a 500,000 increase in the number of attendances at sexual health clinics, and more testing and treatment is taking place. That is starting to show in the reduced number of diagnoses, as well as in other factors. It should also be pointed out that as regards looking after those suffering from the consequences of HIV/AIDS, the Care Act 2014 is extremely clear that the legal framework for social care applies to adults, including those who live with HIV.

[Baroness Jolly (LD)]

My Lords, very large populations of gay men live in metropolitan areas such as London and Manchester, but my question is about the far-flung corners of the country: the north-east, the north-west and the south-west. Can the Government be confident that young men are able to access services and have PrEP available in those sorts of areas?

[Lord O'Shaughnessy]

The noble Baroness is quite right to point out the difference. If you look at the performance in London against the UNAIDS 90-90-90 targets, you will see that they have been met. However, England as a whole is at least slightly behind on at least one of those factors—people with HIV not being diagnosed—which points to the fact that out of metropolitan areas there is more work to do, as she says. One of the ways in which local authorities meet that challenge is through offering home testing kits, which are being sent out and which are now seeing the kind of return and diagnoses levels that you would see in sexual health clinics.

Mental Health Care: Vulnerable Children

Debate between Baroness Jolly and Lord O'Shaughnessy

Tuesday 28th November 2017 Lords Chamber

[Lord O'Shaughnessy]

I can reassure the noble Lord that spending on children and young people’s mental health by CCGs, which are responsible for commissioning those services, increased by 20% between 2014-15 and 2015-16, so spending is increasing. Clearly, one of the areas in which that money is being spent is on better facilities. One of the additional changes is that about 150 new beds will be commissioned in underserved areas so that we can reduce the number of out-of-area placements, which can be quite disturbing for some of the children and young people who have to use them.

[Baroness Jolly (LD)]

My Lords, in England there are around 60,000 looked-after children, and there is evidence that some health providers are denying treatment to looked-after children if they have not yet established a permanent living situation. This is completely unacceptable. What action are the Government taking to ensure that all children’s care is addressed? Will the Minister confirm that the long-awaited Green Paper will be published this year?

[Lord O'Shaughnessy]

I ask the noble Baroness to write to me on that specific case. Of course, health services should never be withheld on such a basis; they should be provided on the basis of need, as we all know. I can confirm that the Green Paper will be published before the end of the year.

Maternal Safety Strategy

Debate between Baroness Jolly and Lord O'Shaughnessy

Tuesday 28th November 2017 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I pay credit to our midwives, who do a wonderful job all across the country, and to those who campaigned to get the report and have spoken about it—I woke up this morning to a very moving Radio 4 piece on the “Today” programme.

I also welcome the Statement from the Secretary of State. Bereaved parents certainly want an answer, and this is an ideal way of helping them to reach some sort of closure. One of the critical points that the Each Baby Counts report makes about maternity care is the importance of continuity of care both for the expectant mother and for the team in the delivery suite. Staffing is an issue, with the workforce being short by 3,500 and a third of our midwives approaching retirement. Some midwives are adopting different patterns of work or choosing to leave the profession, but temporary midwives, be they bank or agency, are not the solution. They undermine the continuity that is so critical. A perfect storm is approaching about recruitment and retention.

Will the Government reconsider some form of financial support for midwives in training? Are any other incentives being considered? Will they guarantee an NHS midwife who is an EU national a job should we leave the EU? What measures are being considered to bolster the morale of NHS midwives, because at the moment, it is really quite low?

[Lord O'Shaughnessy]

My Lords, I thank both noble Baronesses for their overall support for the important announcements made today, and join them in paying tribute to both the staff, who provide amazing care every day, which of course is the norm for most parents, and those campaigners who have campaigned so bravely to raise the profile of these issues with great success.

I shall deal with the issues raised in order. First, on legislation, it is important to point out that the Healthcare Safety Investigation Branch is up and running. Obviously, the intention is that the Bill will put it on a statutory basis, which will give it a degree of security and continuity. Draft legislation will be considered by a committee before turning it into a fully fledged Bill. Although I am not entirely sure of the timetable, I reassure the noble Baroness that we intend to have proper primary legislation following consideration of the draft Bill.

It is important to recognise that the number of staff has increased in the past few years, whether maternity nurses working in maternity services and neonatal nursing, midwives or doctors working in obstetrics and gynaecology. It is also important to recognise, first, that the number of births has risen, so there is a greater workload; and secondly, that on average births are becoming more complicated, as mothers become older, on average, and have more concomitant health problems—smoking and obesity are two of the greatest. I recognise the challenge.

I should point out that more than 6,800 midwives are in training, so there is an intention to continue growing the workforce. However, I recognise that more needs to be done to support them so that they can deliver the care. That is why the training packages announced today are so important.

In terms of learning lessons, the whole point of the rapid-resolution redress process by involving the HSIB is to provide resolution to parents so that they are satisfied while avoiding the sometimes adversarial situation that can emerge, when all that happens is that the problem is delayed for 10 years and creates great heartache for the families involved. We are trying to come up with a process that deals with it more quickly, without disadvantaging the families concerned, and means that it is easier to spread the lessons. That is why the independent HSIB investigations are so important.

Finally, I emphasise the point about the importance of continuity of care, which is referred to on page 16 of the maternity strategy. Here is a stark fact: women who receive continuity of midwife-led care are 16% less likely to lose their babies. That is about one in six, an extraordinary statistic. I understand that it does not necessarily require more staff to deliver that but it does require staff to be organised differently. That is one of the challenges that we have ahead.

Brexit: Mental Health Research Funding

Debate between Baroness Jolly and Lord O'Shaughnessy

Thursday 23rd November 2017 Lords Chamber

[Lord O'Shaughnessy]

In relation to the NIHR funding that I talked about and the specialist disease areas that receive funding, mental health is second only to cancer, so it is getting a great deal of funding. I could talk about the increase in the Medical Research Council’s budget and so on, but more funding is going in specifically to mental health research.

[Baroness Jolly (LD)]

My Lords, the UK is currently the second-largest receiver of research funding from the EU—second only to Germany—and is among the most productive places in the world in mental health research output. Does the Minister share my concern that the best will follow the money to the USA or elsewhere?

[Lord O'Shaughnessy]

As I set out in my Answer to the noble Lord, Lord Brooke, the intention is to continue our relationship with and involvement in cross-EU health projects. Other third-party countries do that, and there is no reason why that would not be the case. In terms of the workforce, which I think is what the noble Baroness was referring to, the Prime Minister has been very clear that we want to continue to attract the brightest and best to this country. Once we have left the European Union, our immigration system will be set up to do just that.

NHS: Deficit

Debate between Baroness Jolly and Lord O'Shaughnessy

Wednesday 22nd November 2017 Lords Chamber

[Lord O’Shaughnessy]

That is a completely unfair accusation and unjustified, both by the funding settlement that the NHS had and by the improved settlement today. First, deficits have been falling year on year for the past couple of years in terms of both outturn and forecast, and that is before today’s announcement on additional funding. The Chancellor today announced over £2.5 billion-worth of extra revenue funding over the next two years. That means that the actual value of the spending review settlement will end up being £11.5 billion compared with £8 billion, so I reject the idea that this Government are not funding the NHS properly.

[Baroness Jolly (LD)]

My Lords, the NHS is very nearly 70. There was some continued investment in today’s Budget, which we welcome, but we consider that it is only a sticking plaster unless we look at social care and the NHS together. If we want the NHS to continue for another 70 years, we really need to see a change. A cross-party group of MPs visited the Prime Minister and put that to her, suggesting that there needs to be an all-party conversation about this—an all-party commission. Will the Minister tell the House whether the Government are minded to pursue that and, if not, why not?

[Lord O’Shaughnessy]

As the noble Baroness pointed out, additional spending is going in. I should point out that the proportion of public spending on health has increased under this Government, so even while fiscal retrenchment has taken place, more money has been spent on health. On the idea of a cross-party convention, we talk about building a cross-party consensus on social care with the Green Paper that will come out in due course. We need to focus on action. The danger with conventions and commissions is that they just prolong the process of making decisions, whereas moving ahead with decisions on both integration in the NHS and getting consensus behind reforming social care is the way forward.

South East Coast Ambulance Service

Debate between Baroness Jolly and Lord O'Shaughnessy

Wednesday 1st November 2017 Lords Chamber

[Lord O'Shaughnessy]

My noble friend is quite right to make that point. There has been a big effort to install defibrillators in a number of public settings—they are throughout the Palace of Westminster and many other workplaces. They make a big difference to that immediate response where it is needed.

[Baroness Jolly (LD)]

My Lords, around a million calls a year are made to the South East Coast Ambulance Service and there have been many reports of technical problems with the service. According to a CQC report, the first reports of these malfunctions, which affected the recording of calls, occurred in June 2016. Does the Minister have any information on how many recordings were lost? Have the specific circumstances around any patient’s arrival to NHS premises been lost?

[Lord O'Shaughnessy]

The noble Baroness is right about the technical problems. I understand that two new systems have been put in to address those; one is a computer-aided dispatch system and the other is the moving of the emergency operating centre to new premises. That is part of the special measures investment that has been taking place to improve the quality of service.

Health: Flu

Debate between Baroness Jolly and Lord O'Shaughnessy

Monday 30th October 2017 Lords Chamber

[Baroness Jolly (LD)]

My Lords, the Minister has, quite rightly, said that community pharmacies are a really important place to seek one’s flu jab. However, the owner of Lloyds Pharmacy, Celesio UK, has announced that nearly 200 of its local chemist’s shops will cease trading. What assessment have the Government made of the potential clinical impact of this decision? What pressures will follow next winter as a result?

[Lord O'Shaughnessy]

I agree with the noble Baroness about the role of community pharmacy. It is worth bearing in mind that some 88% of people are within a 20-minute walk of a community pharmacy, which is accessible for the vast majority. There are also 20% more pharmacies than there were 12 or 13 years ago. Pharmacies have a critical role to play and are there in the community, but companies come in and out all the time.

Child and Adolescent Mental Health Services

Debate between Baroness Jolly and Lord O'Shaughnessy

Monday 30th October 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord is right about variation, sadly. We had the CQC thematic review on mental health provision at the end of last week, which showed that 80% of specialist in-patient care is good or outstanding but that that is true of only two-thirds of community care provision, with around a third either requiring improvement or inadequate. That is clearly not good enough. Patchy provision is absolutely one of the things that we need to deal with. The best way of doing that is by expanding both the number of children being treated and the size and quality of the workforce, to help us to meet our targets.

[Baroness Jolly (LD)]

According to a Guardian article last month, English CAMHS is struggling to satisfy the rapidly growing demand of referrals. We all know this. Within the past decade, 68% of admissions into hospital because of self-harm were girls under the age of 17. What are the Government doing to decrease the number of young girls inflicting self-harm?

[Lord O'Shaughnessy]

Again, this is one of the most difficult issues. Two hundred thousand people a year are admitted into the health service with self-harming injuries. Twenty per cent of young women under the age of 24 have said that they have self-harmed at some point in their lives—that is one in five. There are now NICE guidelines on self-harm and its treatment and there will be a new care pathway by 2019. However, I do not underestimate how difficult it is to crack this problem.

Medical Examiners and Death Certification

Debate between Baroness Jolly and Lord O'Shaughnessy

Wednesday 18th October 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord is quite right to highlight the pilots; indeed, early adopters have followed in their wake and have provided a much better service. The intention from April 2019 is for the service to cover the entire country, but it is most likely to start in secondary care and then move out into primary and community care.

[Baroness Jolly (LD)]

Changes to death certification are welcome and will impact on bereaved families. How were the general public involved in the consultation?

[Lord O'Shaughnessy]

I think I missed the critical word in the noble Baroness’s question. Did she ask whether the public were involved?

[Baroness Jolly]

I asked how they were consulted.

[Lord O'Shaughnessy]

There was full consultation on the proposals. We have been considering that and will respond to it.

Health: Medically Unexplained Symptoms

Debate between Baroness Jolly and Lord O'Shaughnessy

Tuesday 4th July 2017 Lords Chamber

[Lord O'Shaughnessy]

I am certainly happy to investigate CCG practice and commit to write to the joint panel to make sure it understands both the nature of the classification of the illness and the fact of the NICE guidelines. Of course, those are guidelines for clinicians; they are not mandatory in themselves.

[Baroness Jolly (LD)]

My Lords, the commissioning of mental health services has a chequered past at best, particularly when involving many agencies such as in this case. However, good commissioning practice exists. What training is available for commissioners of such complex services and what opportunities are there for sharing innovative practice?

[Lord O'Shaughnessy]

Of course, a suite of training is available for those treating illnesses such as this one, which affects about 220,000 people in England. It is not a rare disease; unfortunately, it is far too common. That treatment is there and also a number of networks exist, such as the Academic Health Science Networks, to spread innovation and best practice for treatments around the NHS.