Health and Social Care Leadership Review

Baroness Masham of Ilton Excerpts

Thursday 9th June 2022 Lords Chamber

[Baroness Masham of Ilton (CB) [V]]

My Lords, I congratulate the Government for instigating this—

[The Deputy Speaker (Baroness Fookes) (Con)]

My Lords, we appear to have had a break in service, but I think we now have the noble Baroness.

[Baroness Masham of Ilton (CB)]

It is tragic that so many babies and mothers have died when they should have been safe in hospital. What happened to the standards of care which were required? Fresh young enthusiastic people joining the NHS and those in care should be safe from bullying, harassment and discrimination. If something goes wrong with patients’ treatment and care, should there not be a duty of candour, with openness and honesty? Surely this should be incorporated in leadership education. I hope that it will be.

[Lord Kamall (Con)]

The noble Baroness is absolutely right that there should be a duty of candour. Noble Lords will remember that during the Health and Care Bill debates there was the debate around the openness of HSIB process. Here we have a difficult balance. On one hand, if someone has acted inappropriately or caused damage, you would want them to be brought to justice but, on the other hand, we know that the NHS has a culture of cover-up when things go wrong. It is great that we praise the NHS when things go well but I have heard too many stories of when things go wrong and clinicians close ranks and cover up.

Sometimes, they gaslight. I was talking about this the other day to a young official in the department and she told me about her friend, a young Afro-Caribbean female, whose baby died during birth. When she complained, the papers suddenly, magically disappeared. How can that happen? We have to make sure that there is real justice, but we have to get the right balance. HSIB makes sure that there is a safe space so people can feel free to come forward, so that we learn from that. Sometimes there may not be justice for the individual, but we can make sure that we avoid a repeat of these incidents. The Ockenden report clearly showed the role that the culture of the organisation played. We must be careful: there should not always be a focus just on numbers; we do not want to train people within the wrong culture and do more damage. We have to tackle all these issues at the same time.

GP Access

Baroness Masham of Ilton Excerpts

Tuesday 7th June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Masham of Ilton.

[Baroness Masham of Ilton (CB) [V]]

My Lords, is the Minister aware that many GPs’ surgeries made it clear during Covid-19 that they did not want patients who might have coronavirus coming to them? Does the Minister realise that many early diagnoses of seriously ill patients, including those with cancer, have been missed, putting extra pressure on everyone involved at present?

[Lord Kamall (Con)]

The noble Baroness makes an important point. Because of the focus on Covid and making sure we were keeping everyone safe, especially before we had a vaccine, precautions clearly had to be put in place. Of course, at the time it seemed eminently sensible to make sure that doctors and patients were protected. As the noble Baroness rightly highlights, the unintended consequence of this has been a backlog in seeing other patients. One of the things we are doing is making sure that, as we roll out these community diagnostic centres and modernise primary care, we can see patients in a more timely way. The GP does not necessarily have to be the first point of contact.

North East Ambulance Service

Baroness Masham of Ilton Excerpts

Monday 23rd May 2022 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, will the Government do their best to stop cover-ups, which there have been over this matter, so that this does not happen in future?

[Lord Kamall (Con)]

Absolutely. It is really important that we have a duty of candour and that people can be open. We saw this during the passage of the Health and Care Act, with HSSIB. Although there might be an initial reaction to find the culprit, or whatever the issue is, it is really important that we learn from mistakes made. It is a difficult balance, but we have to make sure that we have an open environment and culture so that people feel safe to come forward and explain what happened, and to make sure that these services learn from what went wrong. We have been absolutely clear that there is a cultural issue that has to be addressed, but also that NDAs have no place in the NHS.

Health and Care Bill

Baroness Masham of Ilton Excerpts

Consideration of Commons amendments
Tuesday 5th April 2022 Lords Chamber

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

My Lords, the final remote participant is the noble Baroness, Lady Masham of Ilton.

[Baroness Masham of Ilton (CB) [V]]

My Lords, I will speak about disputes in the critical care of children.

First, I thank and congratulate the Minister, the noble Lord, Lord Kamall, on his hard work in trying to understand the enormity of the Health and Care Bill. I also thank my noble friend Lady Finlay of Llandaff for her persistence in including the importance of palliative care in this Bill, especially dealing with the heart-rending problems when there are disputes between parents or legal guardians responsible for critically ill children and their doctors and care staff.

To understand the anxiety and fear parents have, and their wanting to do the very best for their child, they need a sympathetic doctor in charge. Some treatments are available abroad, and desperate parents sometimes know better than the doctors if they are not experienced in the very rare conditions. There is a vital need now, in this difficult time of staff shortages, to listen and help solve the problems if there are disputes.

I will understand if my noble friend thinks that today, unfortunately, a bird in the hand is worth two in the bush. I also support many of the other amendments.

Health and Care Bill

Baroness Masham of Ilton Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[The Deputy Speaker (Lord Russell of Liverpool) (CB)]

My Lords, the noble Baroness, Lady Masham, is also taking part remotely. I invite the noble Baroness to speak.

[Baroness Masham of Ilton (CB) [V]]

My Lords, I have my name to Amendment 172, and I congratulate my noble friend Lady Finlay of Llandaff on her persistence on this important matter of mediation. It is a proven way of dismantling conflicts before they reach the courts.

Over the years, there have been some tragic cases when relationships have broken down between doctors and family members. When this happens in a hospital environment, parents can feel backed into a corner, with no alternatives. Mediation gives the opportunity for the parents to give their views and to hear the doctors’ views too at the earliest stage.

Ending up in the courts costs parents, hospitals and the Government hundreds of thousands in legal fees and causes avoidable distress and concern to all those involved. The only people who win are the lawyers. Parents have to live with grief and the decisions which have been made for their child for the rest of their lives if the results are not good. They want to know that they tried everything possible to give their child the best chance.

I feel that there should be adequate training for doctors, nurses and social workers in the values of mediation so that there is a team approach to treating a child in a life-and-death situation. I hope the Minister understands the need for this amendment and will accept it.

[Baroness Stowell of Beeston (Con)]

My Lords, it is always a great privilege to follow the noble Baroness, Lady Masham of Ilton. I too have added my name to Amendment 172 and commend the noble Baroness, Lady Finlay, for the way in which she introduced it. This debate could risk sounding technical and legalistic, but it is really about redressing an imbalance of power between doctors and parents when their child is desperately sick and at risk of dying and decisions are being made about how best to care for them.

I will not repeat all that I said in Committee, but my attention was drawn to this issue just over a year ago by listening to Connie Yates describe the ordeal that she and her partner Chris endured through the courts when the Great Ormond Street Hospital doctors disagreed with their decision as parents to seek alternative treatment for their baby. Theirs may be an extreme example of what it means not to be listened to or taken seriously by highly qualified professionals who, because they know more, believe they know best, but it is all the more profound because, as parents, what they experienced was not right, and it certainly was not what they deserved.

While this kind of ordeal might be rare, the wider principle—ensuring that we are all taken seriously when we deserve to be—needs promoting with vigour by those of us who enjoy great power and privilege. We need to go out of our way to redress imbalances where we see them, because the inequalities and unfairnesses that people feel, which have driven the political realignment we have seen in recent years, will not be fixed by infrastructure projects or economic decisions alone.

Health and Care Bill

Baroness Masham of Ilton Excerpts

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

[The Deputy Speaker (Baroness Henig) (Lab)]

My Lords, the noble Baroness, Lady Masham of Ilton, is taking part remotely; I invite her to speak.

[Baroness Masham of Ilton (CB) [V]]

My Lords, I will speak to Amendments 169 and 181. I have my name down for Amendment 169 on the licencing of cosmetic procedures. During the passage of this Bill, I have had my eyes opened to just how enormous this industry is and how a great many people are putting themselves at huge risk. I have heard of some disturbing cases in which procedures with collagen have gone wrong. At a conference about plastic surgery and cosmetic procedures, one-third of the attendees were from the plastic surgery field and two-thirds from cosmetic procedures, which shows how popular this is becoming.

All Members of your Lordships’ House taking part in these amendments share the desire that these procedures should be registered and safe. I am very pleased that the noble Lord, Lord Kamall, has accepted that this matter needs addressing and making safe. I thank him and his team for the hard work that they must have gone through in producing these amendments.

Amendment 181 is a very practical and important amendment, which I could not resist supporting and speaking to. It would reduce bed-blocking—a most unfortunate problem for a busy hospital that needs all its acute beds for ill patients, and frustrating for patients who still need rehabilitation but not in acute beds. These patients cannot go home because their accommodation is not suitable for their needs; for example, they might have to use a wheelchair and they need time to get organised. One of the problems is the time that it takes to get necessary adaptations completed. Housing authorities and social services need to work together with health authorities. If suitable rehabilitation accommodation is available, it can also be used for patients who need specialised treatment that is a long distance from their home. St James’s hospital in Leeds has a hotel for such patients, and incorporated into the hospital is a Marks & Spencer food shop; this is a very valuable service. I hope that the Minister will agree that these provisions should be available throughout the country.

[Baroness Finlay of Llandaff (CB)]

My Lords, I am most grateful to the Government for tabling Amendments 153A and 157A; I will not be moving my related Amendment 169. I should declare that I am married to an academic dermatologist, and that I am vice-president of the Chartered Institute for Environmental Health.

I am very grateful to the officials with whom I have had many discussions over the issue of cosmetic procedures. These government amendments are a welcome step in the right direction, by ensuring that individuals who carry out cosmetic procedures such as Botox fillers, threads under the skin and so on will have to meet consistent safety standards. Anything that breaches the barrier function of the skin—going through the live layer of cells of the epidermis—can cause inflammation, introduce infection and cause scarring and other reactions. The government amendments are most welcome because they are broad-reaching and tackle the real problem of people doing things to other people with no proper training and in premises that are not even properly inspected and licensed.

Perhaps I could just ask the Government two questions on this. First, when we had discussions we were considering the use of the term “energy-based device” to cover all the different modalities that can be used to get different types of radiation, whether as heat or whatever, through that layer—the barrier of the epidermis. That phrase would have captured such things in future regulations. Can the Minister assure me that subsection (2)(e) of the proposed new clause will also cover forms of energy not in the wording of the amendment, such as radio frequency and ultrasound devices, which are currently in use on the high street for cosmetic skin-tightening purposes? The idea is, of course, that they produce a small amount of scarring and tighten the skin, but if that goes wrong then you have a problem.

Secondly, can the Government confirm that, in order to obtain a licence, practitioners will be required to meet the agreed standards for training and education and that, in order to maintain their licence, they will be required to undergo appraisal and report adverse events so that such events can be collated and appropriately followed up on?

Health and Care Bill

Baroness Masham of Ilton Excerpts

Lords Hansard - Part 1 & Report stage
Thursday 3rd March 2022 Lords Chamber

[The Deputy Speaker (Baroness Pitkeathley) (Lab)]

Now I invite the noble Baroness, Lady Masham, who is also speaking remotely, to speak.

[Baroness Masham of Ilton (CB) [V]]

My Lords, I speak to Amendments 80 and 168. Amendment 80 is very important and I thank the noble Baroness, Lady Cumberlege, for being so persistent. Throughout the country there is a workforce shortage in hospitals, the community and social care. At Second Reading, the noble Baroness, Lady Harding, warned that:

“Unless expressly required to do so, government will not be honest about the mismatch between the supply and demand of healthcare workers.”—[Official Report, 7/12/21; col. 1814.]


This amendment would give an independently verified assessment of the workforce numbers to meet the growing needs of the population.

Patients who have serious, rare and specialised conditions such as Guillain-Barré syndrome, spinal injuries and all sorts of conditions need expert, specialised staff and equipment so they get the treatment they need. Otherwise, their conditions can deteriorate and result in added costs to the NHS and the taxpayer. Delayed treatment also means unnecessary pain and suffering for the patients. I hope the Government realise the need for Amendment 80.

I was surprised when I received a letter from the Royal College of Surgeons of Edinburgh telling me that, along with the Royal College of Emergency Medicine, the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Physicians of Edinburgh, it was excluded by omission from participating in the process of helping trusts in England recruit much-needed consultants. I wonder what the reason for this extraordinary discrimination is. Does England think it is superior? These royal colleges have been contacted by multiple trusts in England seeking help to recruit the necessary surgeons but, unless this regulation is corrected, they cannot help in this process. This sharing of important selection is more important than ever at this difficult time.

The royal colleges of medicine in Scotland have a good reputation worldwide. I have a personal interest in this amendment, as one of my grandfathers trained as a doctor in Glasgow and one of my cousins trained in Edinburgh and is now a professor of microbiology. I hope the Government can rectify this lacuna in the regulations by accepting this amendment.

Health and Care Bill

Baroness Masham of Ilton Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 9th February 2022 Lords Chamber

[The Deputy Chairman of Committees (Lord Geddes) (Con)]

I advise the Committee that the noble Baronesses, Lady Brinton and Lady Masham of Ilton, have indicated that they wish to take part remotely. I call the noble Baroness, Lady Brinton. I am sorry, I thought it was in alphabetical order. I shall therefore call first the noble Baroness, Lady Masham.

[Baroness Masham of Ilton (CB) [V]]

My Lords, in supporting Amendment 287 I cannot think of a better person to have moved it than my noble friend Lady Finlay of Llandaff, professor of palliative care. If there is a dispute, a difference of opinion, between a parent and a child with a life-limiting illness and a doctor responsible for the child’s treatment, it can be heartbreaking. The stress and anxiety the parents can be put under can be unbearable if the doctor in charge is invincible. It is important to ensure that the views of the parents and anyone else concerned with the welfare of the child are listened to and considered.

The amendment would put mechanisms in place and highlight benefits that Charlie’s law can provide for both parents and doctors when a major difference of opinion arises. Most parents will do anything for their children in a critical situation if there is a slight hope that the treatment might work and benefit their child. Sometimes the treatment is abroad and not available in the UK. This happened to Ashya King, a young boy who had extensive surgery for an aggressive brain tumour. His parents wanted to take him to the Proton Therapy Center in Prague for treatment, but there was a dispute with Southampton hospital. At that time, there was no proton treatment in the UK. His parents took him from the hospital to Spain via France, landing up in prison in Spain and making a court appearance. This traumatic struggle hit the headlines and, in the end, young Ashya did go to the Czech Republic for treatment. How much better it would have been if there had been an agreement to save a humiliating situation for everyone.

A great deal of work and care has gone into this amendment. I thank my noble friend for all she has done, and I hope the Government will accept the amendment.

--- Later in debate ---

[The Deputy Chairman of Committees (Lord Geddes) (Con)]

My Lords, the noble Baroness, Lady Masham of Ilton, is taking part remotely. I invite her to speak.

[Baroness Masham of Ilton (CB) [V]]

My Lords, Amendment 297D is very important. Unacceptable practices of bullying and intimidation of the most vulnerable people must not take place. I thank the noble Lord, Lord Hunt of Kings Heath, for bringing this amendment to the Committee. I support it.

I congratulate “Panorama” and those who worked undercover to expose these unacceptable wrongdoings in the past in care homes, nursing homes and hospitals for residents who are very vulnerable. The programme showed one girl who was a resident and had asked to be looked after by female staff only. This did not happen, and the film showed men taunting her and seeing her get upset, as they carried on with their bullying and tormenting. All sorts of abuse has been exposed in some of the homes, which were spread across the country, such as Whorlton Hall in Barnard Castle, Winterbourne View near Bristol, Ashbourne House in Rochdale, and many, many others. This is not easy work and staff need to be well trained and suitable candidates, with patience and dedication.

During Covid-19, this situation has been a great risk. Many of the residents are a long way from home and they are very isolated. There should be independent inspections and spot checks; there should not be closed doors. There should be regular safeguarding in the regulations.

I hope that the Government will take this seriously. There should be a duty of candour so that whistleblowers are not victimised when reporting what they think is bad practice. I look forward to the Government’s reply, and I hope it will be helpful.

[The Deputy Chairman of Committees (Lord Geddes) (Con)]

My Lords, the noble Lord, Lord Howarth of Newport, is also taking part remotely. I invite the noble Lord to speak.

Health and Care Bill

Baroness Masham of Ilton Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 24th January 2022 Lords Chamber

[The Deputy Chairman of Committees (Lord McNicol of West Kilbride) (Lab)]

My Lords, we have one more noble Baroness taking part remotely. I invite the noble Baroness, Lady Masham of Ilton, to make her comments.

[Baroness Masham of Ilton (CB) [V]]

My Lords, I am very supportive of this group of amendments. There cannot be a safe, effective National Health Service without an adequate, well-trained workforce in hospitals, in care homes and for people who need care in their own homes, as well as adequate GPs and community staff.

At this time, it is more difficult than ever to recruit, as so many nurses and carers left to go back to Europe and the world has been struck by the coronavirus. Many people are off sick with the virus or isolating, and some are tired with stress and overwork. It is not helped when the relations and partners of patients have not been allowed in to help disabled and elderly patients in hospitals. They can help with feeding and giving patients extra help and support, which staff do not have the time to do.

The Royal College of Nursing says that the Bill gives

“no assurance that the system is recruiting and training enough staff to sustainably deliver health and care services.”

As has been said, there should be forward planning for the workforce. For example, the biggest barrier to improving early diagnosis of bowel cancer is long-standing staff shortages in endoscopy, pathology services and gastroenterology, with 43% of advertised posts not being filled. This is really serious. With so many posts across the country not being filled, a variety of specialties are so badly needed. There must be more training opportunities. Without adequate training, there will be no hope of filling the unfilled posts.

It would be very welcome if the Government brought some amendments on Report to help make the recruitment of staff, who are so desperately needed, more successful. Without enough staff, all the important things your Lordships have been discussing today, such as innovation and research, will be unachievable. A thriving workforce is absolutely essential.

[Lord Lea of Crondall (Non-Afl)]

My Lords, manpower planning requires a bit of definition. In my role at the TUC over many years, one of my functions was to look after all the sectoral committees. The most assiduously attended was the health services committee. As we all know, there is an enormous number of specialities in the health service.

When it comes to manpower planning, why did people not press the right button? I am afraid that there is no button to press. In 1947 Aneurin Bevan found that with the British Medical Association there was no wish or desire on the part of the doctors to be part of a structure where a button could be pressed—as might be true in a great corporation—to make sure that the plan for manpower was implemented. As we all know—I will be corrected by someone in this Committee if I have got it wrong—GPs are not appointed by the National Health Service in the way you would appoint somebody to be in charge of an oil refinery in the oil industry or whatever.

It would be useful if the Minister—and I have given notice of a question along these lines—could say what the subjects of the workforce strategy in the Bill would be. How would it be funded? What would be the timescale for introducing it? How often would it be updated? The analysis would have to include such questions as reliance on locums; anecdotally, they can prove very expensive. Will there be targets and associated timescales for the reductions in vacancies?

All of this is easier said than done. I think the remark can legitimately be made that money does not grow on trees, so how are we going to proceed on this? I do not think that everybody who advocates manpower planning is totally naive. Jeremy Hunt in the other place advocated something very much along the lines of what we are talking about now. The focus of the question was on whether five years, 10 years or some other number of years was far too long. There should be reviews every two years or on some shorter timescale.

I confess that, if I were the Minister, I would say, “You’re begging the question of whether we know what we’re talking about when we talk about manpower planning”. So I would be glad if the Minister, in giving some thought to this debate, would care to write to noble Lords—not a White Paper or anything like that—to answer specifically how this thing would work. It is an excellent initiative, and I very much welcome the fact that there is a clause in the Bill providing for this manpower planning.

Edward Argar, for the Government, said that substantial work was ongoing, and referred to a 15-year strategic framework for the health and social care workforce, so the beginnings of creative thinking in this area have gone some way. I congratulate the Government on that. I am afraid, however, that until we get Ministers to be a bit more explicit about what we are talking about, and how the workforce plan will work, this will be a missed opportunity.

In conclusion, I acknowledge that there are a number of sacred cows in this area—and unfortunately, many of those sacred cows are incompatible with each other. It would be useful if the Minister acknowledged that we are asking the right questions. That, obviously, is the necessary precondition to finding the right answers.

Health and Care Bill

Baroness Masham of Ilton Excerpts

Committee stage
Thursday 20th January 2022 Lords Chamber

[The Principal Deputy Chairman of Committees (The Earl of Kinnoull) (CB)]

My Lords, the noble Baroness, Lady Masham of Ilton, is taking part remotely. I invite her to speak now.

[Baroness Masham of Ilton (CB) [V]]

My Lords, I have put my name to Amendment 50 and will speak also to Amendment 57. I am a member of the All-Party Parliamentary Group on Osteoporosis and Bone Health. I thank the noble Lord, Lord Black of Brentwood, for leading on this cross-party amendment.

Osteoporosis is a condition which can cause much pain and debilitation to many people, mainly women. Prevention is important and this is a condition which needs treating by a fracture liaison service. This service should be available to and in easy reach of patients who can be frail and elderly and whose bones can be easily fractured.

I would like to bring to your Lordships’ attention the case of the local hospital which serves the north part of North Yorkshire, a very rural area: the Friarage Hospital, Northallerton, which, sadly, over the years has been downgraded. It used to have an excellent orthopaedic unit; the senior consultant was a brilliant surgeon who unfortunately had to go back to South Africa. He was the brightest and the best. The health service needs leaders, and both staff and patients need up-to-date equipment for satisfactory outcomes. Now there is a visiting consultant, who wanted a DEXA scanner to save his patients the long journey to James Cook University Hospital in Middlesbrough. Many of the patients are elderly and frail. Transport can be a problem. The consultant did not get his DEXA scanner, which diagnoses osteoporosis. I thank the Minister for looking into this case after I tabled a Parliamentary Question.

The problem is upgrading with new equipment. This generally goes to the large hospitals. Women’s orthopaedic wards always seem to have to fight for what they need. A good fracture liaison service, which patients can reach, helps prevention of ill health and without doubt has benefits for everyone, especially the frail and elderly. If they are to be treated in an accessible clinic, near their homes, it must have the correct equipment and well-trained staff. I think it was Winston Churchill who said, “Give them the tools and they will do the job.” The big need at the moment is finding and retaining trained, dedicated, enthusiastic staff. They are the National Health Service’s biggest asset; without them, the job will not be done.

Amendment 57, in the name of the noble Lord, Lord Farmer, follows on well from Amendment 50, and I would like to say a few words on that amendment. It requires that

“health services are available in a community setting where possible, in order to improve access.”

At the moment, weekends are becoming very difficult in rural areas, such as the one where I live. From Friday afternoon to Monday, there is no GP service. On a Sunday, a young woman I know went with an eye infection to the nearest A&E department only to be told that it was not an emergency and she should wait and go to her GP. She did so and was given some eye drops, which were not the answer. When the eye infection worsened, she rang 111. They sent an email to the GP, as the infection had spread to both eyes. She was then sent to the eye clinic at the same hospital that had sent her away from A&E. She was off work for two weeks. Only if the correct treatments are available quickly can infections be treated and days off work saved.

The correct antibiotics for infections are so important to stop resistance to drugs. We also need a first-class pathology service, with test results coming back quickly. I do not think the public always realise what an important job these services do. I hope the failing health service in rural areas can be revived, where it is desirable to have a service in the community near where people live. We need the specialist health services as well—which may be miles away from rare diseases, serious accidents and illness. Wherever the best treatment is, the relief of being treated by experts who know what they are doing is unbeatable.

Will the Minister agree that there is a lot to do to get the health service back on the road post Covid-19? We all want to see it thrive. Thank you.