Long Covid

Baroness Meacher Excerpts

Thursday 17th November 2022 Lords Chamber

[Baroness Meacher (CB)]

My Lords, I applaud the noble Baroness, Lady Thornton, for bringing forward this incredibly important debate and for her outstanding introduction to it.

Long Covid is undoubtedly a serious challenge for the NHS and, as the noble Lord, Lord Bethell, said, for the economy, and a devastation for about 1.5 million people across the country. My principal reason for speaking in this debate is a concern that, for reasons that I simply do not understand, the chronic fatigue syndrome that too often results from the Covid virus is not linked in doctors’ minds, or indeed in many other minds, to the chronic fatigue syndrome that can be triggered by other viruses, and from which more than 1.5 million people suffer and have suffered for many years.

The principal symptom of chronic fatigue syndrome, as we know, whether it is triggered by Covid or by some of the virus, is extreme physical and mental tiredness that does not go away with rest or sleep. Sufferers find it difficult to carry out everyday tasks and activities and, as others have mentioned, too often they cannot work. This applies to the 1.5 million or more people with chronic fatigue who have had it for however long—for years, in many cases—and to those with chronic fatigue from Covid. They are exactly the same.

Other symptoms, as other noble Lords have mentioned, may or may not include muscle and joint pain, headaches, flu-like symptoms or feeling dizzy or sick. Covid-triggered chronic fatigue may also include a loss of taste and smell, and that is a slightly misleading piece of the jigsaw. In the main, chronic fatigue triggered by Covid and chronic fatigue triggered by another virus are indistinguishable other than by this rather weird issue of the loss of taste and smell. Does the Minister have any evidence to suggest that these two chronic fatigues that I have mentioned are in any way distinct, other than in this little piece, which I think is just a separate element of the consequences of Covid?

As someone who will have asthma for the rest of my life as a result of Covid, I also experienced a complete loss of taste and smell for several months after Covid. I am not just being self-indulgent; there is a point to bringing this in. It seems clear that the loss of taste and smell following Covid should be regarded as separate from chronic fatigue and separate from asthma or any other post-Covid illness. The fact that post-Covid chronic fatigue sufferers may lose their taste and smell should not suggest that it is in any way different from other post-viral chronic fatigue syndromes. They are surely identical, and medical treatment and research should focus on all types of chronic fatigue syndrome, including Covid related CFS. We know there has been a lot of money devoted to research because of long Covid; it is crazy for that money and research not to include other causes of chronic fatigue. It just cannot be right.

I very strongly welcome the focus of the noble Lord, Lord Bethell, on the alarming economic consequences of long Covid. Again, the economic consequences of chronic fatigue, whether triggered by Covid or any other virus, are eye-wateringly large. Urgent attention, both medical and in research, should be given to the prevention and treatment of chronic fatigue, however it is triggered.

I raise this issue in part because in the past chronic fatigue sufferers have experienced the most unpleasant stigma from doctors and others who tended to take the view that chronic fatigue was in no sense a physical illness, just something in the mind. Clearly, post-Covid chronic fatigue syndrome is acknowledged to be a physical response to Covid with a deeply unpleasant set of symptoms. It would be very helpful if the same understanding were applied to CFS triggered by other viruses or events. I will be grateful if the Minister can respond to this point, and to the important economic concern raised by the noble Lord, Lord Bethell, in his summing up.

Primary and Community Care: Improving Patient Outcomes

Baroness Meacher Excerpts

Thursday 8th September 2022 Lords Chamber

[Baroness Meacher (CB)]

My Lords, I too applaud my noble friend Lord Patel for tabling this important debate. As he and many others have said, the NHS is broken; I really do not think that is any exaggeration. The fact is that the demand for GP services has increased over the years, as we know and as others have mentioned. It is incredible when you think about it that between 1990 and 2010 life expectancy increased by 4.2 years. People are living longer with more long-term and complex conditions. Remarkably, over 15 million people now live with at least one long-term condition. Where do these people go? To their general practitioner, so it is no surprise that they are in trouble. The effects of the pandemic are going to be with us for years. Where do all these tens of thousands of people waiting for treatments, assessments and so on go? They go to their GP, who cannot really help them, but they are desperate.

The impact of all this on GPs is colossal, made worse by the falling number of GPs, as the noble Baroness, Lady Finlay, referred to. We now have a downward spiral in primary care as GPs suffer ever greater pressure of work, ever longer days, burnout and the sense that they cannot deliver the quality of service that they wish to for their patients. A growing number are leaving the service or planning to do so—terrifying numbers of GPs are now actively engaged in the business of how and when exactly they will leave the service.

A family member is cutting their hours, as are many others, so, when we talk about the number of GPs, are we talking about full-time equivalents or are we merely talking about heads, many of whom will be working part-time? A family member GP works at a practice with 13 GPs but only three are now working full-time—he himself has cut his hours to six sessions—yet about 10 years ago I believe that all of them were working full-time. Of course, those who are working full-time are working 12 hours a day so they are literally burned out, and I watch that happen.

A common response is that GPs must employ more pharmacists and nurses. That is right, of course, but this has been happening for years and the main problem is that these people are also very hard to recruit. There are not enough of them. The big issue, raised by the noble Lord, Lord Hunt, is of course the inadequate level of prevention and preventive work within general practice even today. I must say that I feel that every general practice should have a dietician to take on the vast numbers of people in this country suffering from obesity, many of whom take up large amounts of a GP’s time. Frankly, they need to go to a dietician and get things sorted out. Perhaps that is rather a tough view but it is mine. Another specialism that I feel could take on a lot of work in a preventative capacity is psychological therapy. How many people go to their GP because they are basically a bit depressed, unhappy or whatever it is? Again, if a GP could really make sure that people’s distress was being handled, I think that would make an enormous difference.

I want to address a further point. I regard the Pulse proposal to end GP contracts and bring the vast majority of GPs into trusts as salaried doctors as foolish and potentially costly and dangerous. Too often, Governments seek to resolve the problems of the NHS through reorganisation, but this distracts all the managers from top to bottom into worrying about their own jobs, their colleagues’ jobs and so on instead of focusing on patients, and the patient focus gets lost. Personally, I would warn against revolution and say that, really, we need to deal with all these things through evolution. As I have said, a lot could be done by bringing in preventive personnel who could alleviate a lot of the problems of GPs. Employ more medical and pharmaceutical staff, psychological therapists, dieticians and nursing staff—definitely, yes.

Also, as the noble Baroness, Lady Finlay, mentioned, the Government need to sort out the pensions crisis rapidly and urgently. I hope that the Minister can give us an update today on what exactly the Government plan to do on this, because very senior and valuable doctors are leaving the NHS every day because of this problem. We cannot afford for this to be delayed at all, so please could the Minister give us some help on that one?

As a Dutch GP who came to work in the UK said recently, GPs are not the problem:

“They are knowledgeable, driven and hard working.”


He said that the NHS structure, secondary care and the media are the problem. I do not know what to make of all of that, but we need to value our GPs—that is what I take from that. We need a serious review and urgent support to ensure the sustainability of the primary care services that we value so highly. I strongly support the proposal of my noble friend Lord Patel to establish a special committee in this House to take on this work.

Integrated Care Boards

Baroness Meacher Excerpts

Monday 5th September 2022 Lords Chamber

[Baroness Meacher (CB)]

I understand from a senior ICB medical member that doctors expect general practice to be in the position that dentistry is in today in a bit of time. In other words, access to a GP will depend on the ability to pay. That is incredibly serious—it is the end of the NHS as we have known it, free at the point of delivery and need. Will the Minister take back to his colleagues the absolutely essential point that the Government must ask the ICBs to prioritise the assessment of general practice in their areas and to develop a strategy to ensure that general practice continues to be free at the point of need?

[Lord Kamall (Con)]

The noble Baroness makes the point about general practice. One thing that we are looking at, which will probably come up in the debate later in the week on the future of primary care, is the whole issue of what GPs do. There are many things they do that they do not have to do—these could be done by local partners, practice nurses, physiotherapists or social prescribing, and so on. In addition, Ministers and the NHS have been in conversation with GPs’ representatives, looking at these particular issues.

Cannabis: Medicinal Use

Baroness Meacher Excerpts

Tuesday 12th July 2022 Lords Chamber

Asked by

[Baroness Meacher]

To ask Her Majesty’s Government what plans they have to amend the Misuse of Drugs (Amendments) (Cannabis and Licence Fees) (England, Wales and Scotland) Regulations 2018 to enable general practitioners to prescribe cannabis medicines to patients whose symptoms are being substantially alleviated by such medicines currently purchased privately.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

The Government share the aim of NHS funding for licensed medicines that have proved safe and effective, rather than patients paying private subscriptions for unlicensed products that are not assured by our medicines regulator. Broadening who can prescribe these products will not achieve this. For this to happen, we need the cannabis industry to invest in clinical trials. Our medicines regulator—and the National Institute for Health and Care Research—has asked it to do so and is ready to support it when it does.

--- Later in debate ---

[Baroness Meacher (CB)]

My Lords, the Minister will be aware of Bailey Williams, aged 20, who has very severe epilepsy and was hospitalised every week throughout his childhood, until the last four years, when he has been on medical cannabis—these have been his best years. His parents are struggling financially and asked Bailey’s consultant to prescribe medical cannabis under the NHS; after all, NICE has approved this in its guidance. The answer was no, but palliative care was an option—palliative care but not a proven medicine that has done so well for this child for four years. The Minister cannot accept that situation. Will he meet MHRA, with me, to discuss the way forward? There has to be a way forward.

[Lord Kamall (Con)]

First, I thank the noble Baroness for meeting with my colleague, my noble friend Lady Penn, yesterday. When I became a Minister, the Permanent Sec recognised a potential conflict of interest, which I have been told means that I cannot meet with people about this particular issue, but I can answer this Question if I declare my interest. So I better quickly declare it: I used to work for a think tank that received some funding from the medicinal cannabis industry, and I shared a round table. That immediately ruled me out as having a conflict of interest. None the less, I am very happy to facilitate meetings with my ministerial colleagues. As the noble Baroness will be aware, there is a new ministerial colleague in place at the moment. The point remains that we have asked the industry, which makes lots of money in this area, to come forward and fund trials, but it has preferred not to do so.

Personal Protective Equipment: Waste

Baroness Meacher Excerpts

Tuesday 14th June 2022 Lords Chamber

[Lord Kamall (Con)]

We have to go back and remind ourselves of the situation in 2019 and 2020. We have to remember that, at the time, there was no vaccine and the whole market suddenly panicked—people were competing with each other to buy equipment. We heard stories of government officials sitting in factories with suitcases of cash, trying to make sure that they could buy material at the best possible prices, and at the same time we saw containers being redirected at sea and people being gazumped. We therefore made the decision at the time, without being accurately able to predict how much PPE equipment we needed—no one could have done so—to procure as much as possible.

[Baroness Meacher (CB)]

My Lords, I appreciate the very real time pressure at the beginning of the pandemic. However, a few days spent to ensure high-quality PPE through some form of competition would have saved lives. Will the Minister tell the House how many contracts were agreed through a personal contact, without any form of competition at all, in that first year?

[Lord Kamall (Con)]

The noble Baroness will recognise that I was not in post at the time, but I have been advised by officials in the department that they put feelers out to as many people as possible. Government officials, Members of the House of Lords and politicians from all parties were suggesting companies, and that was put through a process whereby the department made an assessment of whether it was able to award contracts.

Health and Care Bill

Baroness Meacher Excerpts

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

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association. I will speak very briefly from the Liberal Democrat Benches to offer our support for both the amendments in this group.

The amendment tabled by the noble Baroness, Lady Pitkeathley, Amendment 113, says that unpaid carers, including those under 18, must be properly consulted by the NHS to ensure that they are able to provide the care needed to keep patients safe. In Committee—and, more recently, at the excellent and moving round table with family carers organised by Carers UK, about which the noble Baroness, Lady Pitkeathley, just spoke—we heard evidence of hospitals discharging patients before assessments had been completed and before carers had even been told. The burden that this places on carers is totally unacceptable and unsafe. Worse still—and unsurprisingly—the home arrangements too often break down when family and unpaid carers are not a full part of the consultation process. We support the noble Baroness, Lady Pitkeathley, in this vital amendment.

The second amendment, Amendment 144, to which I have added my name, was tabled by the noble Baroness, Lady Wheeler. The amendment ensures that there are always proper social care needs assessments to ensure that both the family and unpaid carers are consulted, along with the relevant local authority; and that ICBs must have an agreement in place with the relevant parties to ensure that vulnerable people are not discharged without the right support. Some carers are themselves vulnerable people, and we need to make sure that all protections are in place for them too.

Equally importantly, it ensures reporting by the relevant authorities back to the ICB so that it can monitor discharge effectiveness. It says—as a bit of stick to go with the other carrot parts—that the ICB must pay for any

“additional costs borne by a local authority in caring for a patient whilst carrying out social care needs assessments”,

in the event that the patient has been discharged before this was completed.

There are 1.4 million unpaid carers who save the state just under £3 billion a year—and they need more than guidance. Both of these amendments will ensure that the patient and their unpaid carer are assessed and supported properly, and that the key stakeholders—the NHS, the relevant local authority and the ICB—must work together to make this happen.

[Baroness Meacher (CB)]

My Lords, I rise to support Amendment 113. I applaud the noble Baroness, Lady Pitkeathley, both on this amendment and on the years and years of commitment she has given to the support of carers.

It is extraordinary what this Government are prepared to do in this Bill. In revoking the Community Care (Delayed Discharges etc.) Act 2003, they are abolishing the “safe to discharge” test, which requires processes to have been followed to ensure that appropriate and adequate care is, or will be, in place for a patient’s discharge from hospital. The Government are proposing that carers’ rights in primary legislation should be put in statutory guidance instead.

As a member of the Delegated Powers and Regulatory Reform Committee, I am very conscious that, under this Government, secondary or delegated legislation is used more and more to concentrate power in the hands of Ministers rather than in Parliament. The only possible reason for the Government to remove carers’ rights from the Bill, and to put them into secondary legislation, is to weaken those rights. Can the Minister give any reassurance on that point? It is a very important question.

A number of us recently met with a group of so-called adult carers—teenagers and adults—and also with a group of young carers. Both of those experiences were humbling from my point of view. I will mention a couple of points that came up. One teenager rather casually mentioned that she had begun being a carer at the age of three. This is unbelievable, is it not? I forgot to ask her what she actually had to do at the age of three; it is difficult to imagine. But, whatever she had to do, the idea that she somehow had a sense of responsibility at that age is truly alarming.

The other memorable moment was when a teenager was asked, “What is the most difficult thing for you, or the biggest problem that you have as a carer?” I thought she would say that she did not have any time to play with her friends or that she had to do all sorts of boring and horrible jobs that her friends do not. But no, she did not say any of that; what she actually said was, “The biggest problem I have is that the hospital staff won’t tell me how much medication my mum needs. They say they’ve got to talk to my mum, but that’s impossible.” The selflessness implied in that is just completely extraordinary—and of course there were lots of other incredible points.

If these young carers are not consulted before their dependent relative is discharged from hospital, they may be at school or in the middle of a hockey match—it is just unimaginable that this requirement should be in any way weakened. I ask the Minister to take extreme care on this issue when going back and considering the Bill; only then can we be sure that patients are not just medically fit to be discharged from hospital, as the noble Baroness, Lady Pitkeathley, said, but are safe to be discharged—that is, carers or others are there to look after them.

BASW rightly points out that revoking a local authority’s Care Act duty to integrate care and support provision with health provision at the time of the key decision about where a person should be discharged to from hospital undermines the model of integration between social and health care staff—surely the absolute opposite of the whole objective of the Bill. I understand that discharge to assess is probably reasonable for medium and long-term care planning. However, an assess to discharge approach is even more important and should be done in hospital, from the date of admission to hospital. Where is that commitment in the Bill? I look forward to the Minister’s response.

[Baroness Hollins (CB)]

My Lords, I am very pleased to support the noble Baroness’s amendment, and my thanks go to Carers UK for its briefing. I declare an interest as a family parent carer of an adult disabled man.

Earlier in Report, community rehabilitation was debated, and Amendment 113 complements this by acknowledging the vital role that carers play in supporting people’s discharge from hospital and promoting a community-based model of care. In Committee, I promoted an amendment that sought to define carers within the Bill, as they are mentioned in three clauses. This amendment incorporates that approach, to ensure that parent and young carers are not overlooked. I cannot stress sufficiently strongly how important rights in primary legislation are for carers, who often have all the responsibility for caring but very few of the rights. They are often experts in how people like to be treated, and they can be experts in a condition that professionals may have little detailed knowledge of.

Carers UK heard from carers directly about their experiences of being shut out of the system as part of the discharge to assess process. For new carers, it was often described as bewildering; promises to contact them just did not materialise. Carers UK research found that carers were not consulted and were not given information and advice or the support that they needed to care safely and well for the person who had been discharged. For several of these people, this involved admission to longer-term intensive support or, sadly, readmission back into hospital again. The amendment would have provided the checks and balances needed to ensure that this did not happen.

Carer experience surveys are also important, and they found that carers’ experiences of accessing health and care services for themselves have either plateaued or deteriorated in the recent past. Carers are twice as likely to have ill health as a result of caring; too often, they are overlooked in policy and practice in relation to health services. This is particularly true for parents of disabled children and for young carers. The work that they do has invaluable medical and economic benefit, often at the expense of their own well-being. I therefore urge the Minister to accept the amendment.

Health and Care Bill

Baroness Meacher Excerpts

Lords Hansard - Part 1 & Report stage
Tuesday 1st March 2022 Lords Chamber

As the Minister said he would listen to the arguments, I hope he will accept this and, if not, clearly explain why. I will not move my amendment now but certainly will at some point.

[Baroness Meacher (CB)]

My Lords, I support Amendments 9, 10, 14 and 32 and will speak to my Amendment 11, which follows on quite nicely from the contribution of the noble Lord, Lord Bradley. It refers to mental health, public health and secondary care services as vital to be represented on ICBs.

As drafted, the Bill leaves the membership of ICBs very much up to local decision-making. The Minister’s Amendment 31 does not change that; it leaves it up to the ICB to decide what it should look like. My concern is that ICBs may be dominated by managers from a range of organisations, perhaps including private sector health bodies. If such ICBs are established—they are being created as we speak—the Minister’s amendment simply enables them to reproduce themselves over time. There will be a degree of transparency over time, but the amendment ignores key sectors and the need for significant clinical inputs to these boards.

Amendment 31 usefully provides an opportunity for statutory guidance to achieve important objectives. In his letter, the Minister made it clear that statutory guidance will clarify that the ICB’s annual report will cover ICB duties in relation to child safeguarding. I very strongly welcome that. Can he include mental health and public health alongside child safeguarding as very particular services that are too often neglected and really need to be represented on ICBs? If he can agree to include those key services in the statutory guidance, as he has included child safeguarding, I would be very content.

Why are these services so important? As I said in Committee, having chaired a mental health trust for nine years, I am acutely conscious of the importance of high-quality and available child mental health services in particular. Across the country at present, the scarcity of such services means that vast numbers of children with quite severe mental health problems simply never get a psychiatric service at all while they are children. These untreated children will have severe problems for the rest of their lives because of that lack of treatment. It is therefore crucial to have a psychiatrist, who will be very conscious of this, on these ICBs—any psychiatrist will be aware that you have to intervene early if children display mental health problems. That is why I feel so strongly about that; I have watched it happen over years.

Another highly significant field being neglected as ICBs are being formed is public health. As many noble Lords know, I am conscious of the huge impact that effective public health responses could have on drug addiction. Police services are increasingly aware of this and are diverting addicted young people to treatment and away from the criminal justice system. However, this approach assumes that treatment services are available in every urban area, but they are not—they have been dropped or cut. Having a public health consultant on every ICB is crucial if these difficult matters are to be properly dealt with and treatment centres are not just closed because they are inconvenient, or whatever the case may be.

The Government hope to control the growth in knife crime through punitive, serious violence reduction orders. We know from all the research in the field that they simply will not work. The Durham, West Midlands and other police services are way ahead of the game, and more and more police services are following them in showing how best to ensure that violent young people caught up in county lines gangs can be diverted into education and work and away from the criminal justice system. However, that assumes that there are treatment facilities available; otherwise it simply cannot happen. Again, please can the Minister include a public health professional consultant on the ICBs as a recommendation in the statutory guidance, as he has done for child safeguarding. I beg to move.

[Baroness Hollins (CB)]

My Lords, I will speak to Amendments 14 and 32 in my name and that of my noble friend Lady Watkins. I want to give an example from my experience; I declare an interest here as independent chair of an oversight panel, reviewing for the Department of Health and Social Care the use of long-term segregation for children and adults with learning disability and/or autism detained under the Mental Health Act. I have seen the impact of very poor and unaccountable commissioning for this group, with very costly mistakes—costly in money and in terms of lives lost and lives destroyed—because of a failure of commissioning appropriate health and social care in the community.

Some commissioners, frankly, do not have the competencies to do their commissioning job safely. I make this point because—while I appreciate the value of Amendment 31 and its requirement that ICBs would have skills, knowledge and experience, keep them under review and take action if they consider that members are failing in some way—as the noble Lord, Lord Bradley, put it, it is rather looking backwards, or marking their own homework, as I might put it, when they do not know what they do not know. This is the problem and why these amendments propose going a little further.

I welcome the Minister’s statement that ICBs will be required or expected to have the appropriate skill mix and experience necessary to deliver all their functions. I understand that the Government will issue regulations regarding fit and proper person tests, which will apply to ICBs when established, including adherence to the Nolan principles, Without the inclusion of the specific skills and expertise required, however, there will be little oversight or accountability of commissioning competence.

I would like the Minister to think again, and to commit to regulations and guidance that set out the criteria and standards that members of ICBs must possess, recognising the responsibilities that they will have and the impact of their decisions on the health and well-being of some of the most vulnerable people in our society. Commissioners take decisions of extraordinary influence; they spend large sums of public money. Civil service appointments are made in accordance with a competency framework. There is no reason why commissioners should be exempt from meeting specific eligibility criteria—and not just in the clinical sphere but in the commissioning sphere, for which there is currently no professional competency laid out.

To give another example, later this month I will be sponsoring the Second Reading of the Down Syndrome Bill, the Private Member’s Bill from the other place that will require relevant authorities, including the NHS, to take account of the specific needs of people with Down syndrome. During the Committee stage of the Down Syndrome Bill, the Minister committed to

“having a named lead on integrated care boards who will be responsible for the implementation of the guidance in practice.”—[Official Report, Commons, 2/2/22; col. 642.]

Thus, representation of learning disabilities and autism interests on ICBs would be within the context of the duty of ICBs to ensure that they have the necessary skills, knowledge and experience. Much will depend on the guidance issued by the Secretary of State under that Bill, which would fulfil similar obligations, I hope, to those of the autism strategy and the Autism Act 2009.

I reassure the Minister that I and other noble Lords recognise the challenge that the Government have in seeking to ensure that the new ICBs comprise people with the correct skills to enable the board to carry out its functions, but these amendments ask for a slightly stronger approach. I ask the Minister to assure the Chamber that guidance and regulations will address the requirement for criteria to be specified.

Health and Care Bill

Baroness Meacher Excerpts

Lords Hansard - Part 2 & Report stage
Tuesday 1st March 2022 Lords Chamber

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I too congratulate the Minister and his officials on listening to the House and the strong representations he received in Committee on this issue.

I welcome the Government’s amendment. I add my tribute to the work of the noble Baroness, Lady Finlay, as well as the many Members of this House and the campaigns of organisations such as Marie Curie in getting us to this point. It is wonderful that the symbol of Marie Curie is a daffodil, and we are here today on St David’s Day being led by the noble Baroness, Lady Finlay of Llandaff. That is very appropriate.

I disagree with the noble Lord, Lord Howarth of Newport—this is an historic moment and a huge step forward. It is the first time in the history of the NHS that there will be an explicit requirement to commission palliative care. I declare my interests as chair of the Scottish Government’s National Advisory Committee for Neurological Conditions and a trustee of the Neurological Alliance of Scotland. Many people with long-term, progressive conditions have not been able to access palliative care at an early enough point. Not only would this ensure better outcomes for patients, but it would also be a better use of NHS resources. I hope that the result of the Government’s amendment will ensure that these people get better care, including the palliative care they need. I also hope that ICBs will recognise the difference that they could make.

I welcome the opening remarks of my noble friend Lord Howe about taking the criteria set out in Amendment 17 in the name of the noble Baroness, Lady Finlay, and to which I was happy to add my name. It provides a helpful set of guidance for ICBs to follow, based on standards. I echo the question of the noble Lord, Lord Howarth, on ensuring that we have the right reporting requirements. I am grateful to hear that the Government will be developing statutory guidance to ensure that we put the necessary tools in place. However, I have been concerned to learn, in my meetings with NHS England, how—as far as I have been able to ascertain—it reports on services, rather than medicines or specific procedures. When reporting on NICE guidelines for services, NHS England seems to rely on “noise in the system” to ensure whether they know that something is happening or not. I share some noble Lords’ worry about the word “appropriate”. If we develop statutory guidance based on the criteria set out in Amendment 17, I hope that the risks that the word “appropriate” might continue to see a postcode lottery will somehow be allayed.

Finally, given that ICBs are at different stages of their development, can the Minister and the department give careful consideration to the ongoing and direct communication to ICBs regarding this duty? Will they consider writing to all ICB chairs to ensure that they are fully aware of the duty and their responsibilities?

The Government have made a very important step forward today in giving people who are facing the end of their life the reassurance they and their families need. The focus now must be on ensuring that this amendment is used to its fullest by the ICBs, so that everyone who needs palliative care will benefit.

[Baroness Meacher (CB)]

My Lords, I shall speak briefly to add my very strong support for Amendment 17, promoting the provision of specialist multiprofessional palliative care services. I also welcome, and will comment on, the Government’s Amendment 16 on the same topic. Alongside all other noble Lords, I pay tribute to my noble friend Lady Finlay for her tireless work to improve palliative care services.

It is of course most welcome that the Government have tabled an amendment in this field, but their amendment leaves it to the ICB to decide what standard and extent of palliative care services are “appropriate” to meet what they deem to be the “reasonable” requirements of their populations—the Government’s words. What do these terms mean? Does the Minister accept that the amendment does not ensure that adequate specialist palliative care services will be available across the country? That is what we all desperately want to see. I hope that, in his response, the Minister can define these terms. What do the Government mean by “appropriate” palliative care services and a “reasonable” level of such services?

As I said in Committee, it is unbelievable that the NHS provides services according to need throughout our lives, until we are dying, when of course our health needs are at their greatest. At that stage, precious hospices have to raise their own money, as others have said in the past, to finance their doctors and nurses to care for the dying. Inevitably, hospital beds lie empty. Some 50% of beds in a hospice I visited recently were empty, because it simply did not have the staff to deal with patients in those beds. Can the Minister confirm that the Government will provide statutory guidance to supplement Amendment 16 and clarify what they mean by the terms “appropriate” and “reasonable”?

As things stand, I strongly support the amendment tabled by my noble friend Lady Finlay. As we die, we should all have high-quality palliative care services. We can then expect that, when assisted dying is legalised, a reasonably small percentage of dying people will suffer unbearably, despite benefiting from top-quality services, because of course there are situations when the best possible palliative care services have done everything they possibly can and yet certain patients suffer unbearably. We need a change in the law to ensure that those patients have control over the suffering that they can reasonably tolerate.

I look forward to the Minister’s response and, as I say, hope that he will clarify the definitions of the terms used in the amendment.

[Lord Mackay of Clashfern (Con)]

My Lords, this amendment adds a new paragraph to the new Section 3(1) set out in Clause 16 and it seems clear that what Section 3(1) says refers to all that follows it:

“An integrated care board must arrange for the provision of the following to such extent as it considers necessary to meet the reasonable requirements of the people for whom it has responsibility”.


One has to look at reasonable requirements in relation to everything in that list, with the first being “hospital accommodation”. The idea that there might be some areas with no hospital access at all is absolutely ridiculous. So this is a qualification, to be fitted in as paragraph (ga).

Immediately before it is another provision, which refers to services considered

“appropriate as part of the health service”.

That seems to suggest that it is absolutely essential that the needs and reasonable requirements of people who need palliative care are met. ICBs do not need to provide palliative care for the whole community, but are required to provide it for the proportion of people expected to require it, namely those getting near the gates of death. That is a reasonable interpretation of this clause.

I believe it goes quite a long distance in the way that the noble Baroness, Lady Finlay, and others for some years have asked for. I do not think it feasible to say that nobody in an area will require palliative care—unless its inhabitants are people who live for ever, of which there are only very few. It looks to me as though this is well constructed to ensure that palliative care must be provided where people die, in the area of the integrated care board.

I entirely welcome Amendment 17 from the noble Baroness, Lady Finlay, but the crucial amendment is provided by the Government and is written in a way that will be very difficult for any care board to try to escape, because it is very clear.

Covid-19: Antiviral Pills

Baroness Meacher Excerpts

Monday 31st January 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for making me aware of this. I was not aware of this. I was told test kits were available to anyone who was considered immunosuppressed or vulnerable in advance. Given what the noble Lord has said, it is important that I investigate and write to him.

[Baroness Meacher (CB)]

My Lords, I am not aware of any medication at all for the treatment of chronic fatigue as a result of Covid. What is the relevance of the recent research into the microscopic damage to the lungs caused by Covid? Are the Government funding any research into finding medications that could cure chronic fatigue?

[Lord Kamall (Con)]

One of the interesting things about having this role is the number of different stakeholders I speak to and all the wonderful research into vaccines and antivirals for different conditions. I am not aware of any current research into the condition that the noble Baroness refers to. However, just because I am not aware, does not mean it is not happening. I will find out and write to the noble Baroness.

Health and Care Bill

Baroness Meacher Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

The measures in Clause 80, which would repeal the protections that are in place for patients before they are discharged from hospital, could benefit from reconsideration. I hope that my noble friend the Minister will meet interested Peers to discuss an alternative to this repeal of Clause 80.

[Baroness Meacher (CB)]

My Lords, I added my name to Amendment 219, and I support all the amendment in this group. In view of the number of excellent speeches that have been made, I have given up on my speech and just want to ask the Minister a question. I am sure he finds it completely unacceptable that half of carers who provide significant care for a loved one say they have not even been consulted about a discharge from hospital and two-thirds of them say that they have not been listened to about whether they are able to care for their loved one when that person might be coming out of hospital. I ask the Minister to assure the Committee that he will be able to bring back an amendment on Report on this critical issue.

[Lord Scriven (LD)]

I support in particular Amendment 217. In so doing, I draw the attention of the Committee to my interests as set out in the register, particularly as a vice-president of the Local Government Association.

I want to make three very clear points about this. First, this amendment refers to assessment; it does not refer to the package of care. The assessment is the first stage, before the social workers and before adaptation or anything else can happen, so the person leaving hospital gets a sense of independence and support to lead as independent a life as possible and to help them in their recovery. Evidence shows that the best way to start the assessment is on the day that the person is admitted. It is not about waiting for an optimal time. The assessment may change as the person progresses, but all the evidence shows that assessment should start on admission. The concept that there is an optimum point does not stand up to the evidence.

Secondly, having this framework within the Bill, with timescales and so on, does not stop local innovation, it just gives a framework for local innovation and integration to take place.

My third point is a question. I know of no condition—unless the Minister can inform the Committee of one—where starting the assessment two weeks after a person leaves hospital is in the best interests of that person; they may have to wait six, seven or eight weeks for the package of care to be put in place. Can the Minister tell us for which conditions the suitable and optimum point at which to start the assessment is after a person has left hospital?