Smoking

Baroness Merron Excerpts

Thursday 25th January 2024 Lords Chamber

[Lord Markham (Con)]

First, my understanding about New Zealand is that one of the biggest bones of contention was that it was looking to reduce the number of smoking retailers from 6,000 to 600; that is where their Bill came into difficulty. I am afraid I must disagree with my noble friend on the importance of this. It costs the economy about £17 billion a year and causes about 80,000 deaths, and 80% of people who have taken up smoking wish that they had never started. I think those are very strong reasons which I know the majority of this House is behind, and that is why I am delighted to be introducing that legislation shortly.

[Baroness Merron (Lab)]

My Lords, it has been reported that the decline in smoking has nearly ground to a halt since the pandemic, with many former smokers lapsing and many more young people now taking up smoking. Now that the smoking cessation drug cytisine is available, what is the Government’s assessment of how its availability will contribute or otherwise to the progress towards the smoke-free ambition by 2030? What plans are there to ensure its availability across the country, particularly among hard-to-reach groups of smokers?

[Lord Markham (Con)]

Hopefully, my previous answer shows that we are investing major money in cessation services. I must admit to not being that familiar with the drug the noble Baroness mentions, so I will follow up in writing to give her the details.

Maternity Services

Baroness Merron Excerpts

Thursday 25th January 2024 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I congratulate my noble friend Lady Taylor on securing this debate and setting out the issues with her customary elegance and clarity for us to build on further. As my noble friend said, all the briefings we received in preparation for this debate referred to a very worrying situation and—I shall head this off at the pass—to the fact that Covid cannot be used as an excuse because the pressures have been building for more than 10 years, which is something that I am sure the Minister will want to address.

As we heard, despite the Government and the NHS publishing various targets, programmes, strategies and action plans over the years to improve services, and having a lot of different evidence bases to call upon, and, sadly, inquiries into circumstances where things have gone tragically wrong, it is unfortunate that we find that maternity is an example of how services have deteriorated on the Government’s watch. As my noble friend Lady Armstrong said, even with all these plans, targets and so on, without proper implementation, they do not deliver improvement.

Within all of this, we know the data is important. I noticed in his response to a Written Question from the right reverend Prelate the Bishop of St Albans last month, the Minister explained that:

“The most recently published data which measures progress against”


government targets in the national maternity safety ambition

“coincided with the COVID-19 pandemic and is out of date”.

The Minister also said in his written reply that:

“The Department is working to increase the frequency and timeliness of publications”.


I am sure the whole House would agree that that would be welcome.

Does the Minister agree that it is extremely difficult to deal with any issue, including that of maternity services, without knowing the facts of the challenge? This was raised with particular regard to inequalities by my noble friend Lady Thornton and the noble Baroness, Lady Gohir.

The House will be aware of Labour’s commitment to train 10,000 more nurses and midwives every year, along with long-term workforce planning across the NHS by reviewing training and looking at creating new types of health and care professionals, drawing on a diverse skills mix. We are also committed to setting an explicit target to end the maternal mortality gap, which sees black women in the UK four times more likely to die while pregnant, giving birth or as new mothers, compared with white women. This will come partly from the aforementioned training of more midwives and health visitors but also by the incentivising of continuity of care—something referred to by the noble Baroness, Lady Cumberlege, from her experience in chairing the work that gave rise to the Better Births report. It will also come from improving course content on the presentation of illness and pain among different groups. I hope the contributions and expertise in your Lordships’ House will continue to contribute to making those commitments a reality in terms of improvement.

As we have heard a number of times in this debate, the Care Quality Commission has reported a decline in positive maternity experiences in recent years. The noble Lord, Lord Patel, described the health of maternity services as a bellwether for the health of our NHS. As we have heard, it seems that in our maternity services we are now finding that we are well behind in the maternal mortality stakes. That was not the case, but it is now. I was touched, as were other noble Lords, when the noble Lord, Lord Patel, expressed his gratitude to the thousands of mothers who allowed him to be part of their lives. I am sure that those thousands of mothers would also wish to express their gratitude to the noble Lord.

The approximately 20,000 responses to the CQC’s Maternity Survey 2022, which my noble friend Lady Donaghy referred to, showed that fewer women were being given the help they needed when they contacted a midwifery team. They were getting less help in hospital care after birth and less help with postnatal care. It also showed less confidence and trust, and a reduction in the availability of appropriate advice and support when contacting a midwife or hospital at the start of labour or while in the care of that hospital.

I thank, as have other noble Lords, the whole of the staff team who are in the provision of maternity services. As the noble Baroness, Lady Watkins, said, many of these staff go above and beyond. That is confirmed by the CQC, and rightly so. However, it is evident that there are external pressures on them that get in the way of them doing the job they need to do, and it is on this that the Government hold the levers.

The CQC has continued to raise concerns about the quality of maternity care in England over many years. In the most recent State of Care report for 2021-22, the regulator reiterates its ongoing concerns about both the safety and the ethnic inequality of maternity services, as well as the impact of poor training, poor culture and poor risk assessments on people’s care.

By September 2023, the CQC had inspected nearly three-quarters of maternity services and described the overall picture as one of a service and staff under huge pressure, warning that many patients were still not receiving safe and high-quality care. Most recently, in November 2023, around two-thirds of maternity units in England received a CQC rating of “requires improvement” or “inadequate in safety”. That compared with 55% in the previous year, so it is going in the wrong direction. I would be interested to hear the Minister’s response on this.

We have heard much in this debate, and rightly so, about maternal mortality. The latest data shows that between 2020 and 2022 it increased to levels not seen since 2003 to 2005. It is right, as noble Lords have said, that even within this extremely concerning statistic all is not uniform: the case is far worse for women who live in the most deprived areas. They are more than twice as likely to die during pregnancy, or up to one year afterwards, than women living in the least deprived areas. Between 2019 and 2021, 12% of the women who died had severe and multiple disadvantages and, as we have heard, women from black and ethnic backgrounds are three times more likely than white women to die during or up to six weeks after pregnancy, while Asian women are twice as likely.

The noble Baroness, Lady Gohir, was right to say that this broad-brush approach to definition masks the range and depth of inequalities. The noble Baroness, Lady Bull, was also right to point to the fact that inequality extends to those with a learning disability. Can the Minister say whether work is going on to produce much closer attention to the needs of groups, and to break down the nature of people within those groups, in order that we can reflect and respond to the reality of those with differing experience?

We have heard today about the tragedy of many failures within maternity services. I recall, during the many Statements that we have dealt with in this House, the expression of how devastating it is to look at these failures and to have to discuss them. Having looked recently at the independent review of maternity services at Nottingham University Hospitals NHS Trust, which is ongoing, I would say that it is staggering that it required concerned local families, MPs and others over many years to be crying out about the quality and safety of maternity services in their area. This will be the UK’s largest ever maternity services review, with around 1,700 families’ cases reportedly being examined. Donna Ockenden, who is in the lead, has said that the review will not report until September 2025 because

“no one will thank us for doing a half-baked job”.

She added that there would also be a period of family feedback, which could last until the start of 2026. This makes absolute sense, but it is worth asking why it took so long for those investigations to begin.

We have heard so much about staffing: it is absolutely key and retention is what we need. In addition, my noble friend Lady Thornton referred to the multidisciplinary training that is absolutely vital to cement the proper working practices that we need. Yet we find that so many cannot find the time to attend this training. Can the Minister say what is being done to address this?

In conclusion, the birth of a child, as we know, is a unique event. Mothers, babies and families all deserve the best. I hope that this debate and the work that may flow from it will deliver the improvements that we all need to see.

National Immunisation Programme

Baroness Merron Excerpts

Thursday 18th January 2024 Grand Committee

[Baroness Merron (Lab)]

My Lords, I add my congratulations to my noble friend Lady Ritchie, who is as we all agree a great champion for better health through greater take-up and availability of vaccines and immunisation programmes. She rightly described them as a sound investment by the NHS, and I certainly agree.

There are two main issues at play: first, the failure of already approved and recommended drugs to be included in the national immunisation programme and, secondly, the number of factors that have slowed down how long the whole process takes. It potentially takes around a decade to pass through every stage of trial and approval and two years or more for a new vaccine to reach patients post regulatory authorisation.

I am sure that we all want vaccines to be available to patients quicker and to see full account taken of patient safety and cost effectiveness. It seems to me that the way forward is to emphasise systemic options to improve availability without sacrificing the necessary safeguards.

Like other noble Lords, I am grateful to the many stakeholders who have conveyed their views to me on how to accelerate the adoption of new innovative vaccines by the national immunisation programme. Their main suggestions for tackling these damaging delays focus on ensuring that the overall system works better while adapting to additional risk, perhaps in extraordinary circumstances, such as those we saw in the Covid pandemic.

But it bears pointing out that this is against the backdrop of a step in the wrong direction, which we have heard about, such that, due to a decade of declining rates of uptake of the MMR vaccination among preschool children, for example, the UK no longer has the status of having eradicated measles, according to the World Health Organization. This is borne out by Steve Russell, whom the noble Lord, Lord Allan, referred to; he is the chief delivery officer and national director for vaccinations and screening at NHS England. He highlights a decline in vaccination-programme uptake, particularly for childhood vaccinations, in the foreword to the NHS England strategy.

I thank my noble friend Lady Twycross for bringing before us the importance of childhood vaccination. She brought it into focus by sharing her own story, for which I am sure we all thank her, but her call for evidence-based intervention and for ensuring coverage by immunisation programmes surely must be heeded. It would be helpful to hear what discussions continue to take place across government about tackling misinformation and disinformation about MMR and other vaccines, which we obviously still see proliferating on social media.

I will put a few points to the Minister about the much-needed improvement of the UK’s performance in immunisation development and delivery. We heard from my noble friend Lady Ritchie about the GSK-hosted round table, which she kindly chaired. I noticed that she described the response during the Covid-19 pandemic as “remarkable” and I endorse her comments. That response magnified the value of vaccines to individuals, health systems, society and the economy, and it is absolutely vital to embed the lessons that were learned before they are lost, as she said. So I amplify the points made by my noble friend, because it would help to hear from the Minister about what lessons the Government have learned from the pandemic, what assessment they have made of the potential value of each of those lessons and what steps are being taken, at the very least, to assess the potential benefits from continuing in that manner, but ideally to take action to embed in the system all the good practice from which we have learned.

Within this, I echo the call for pharmacies to be complimented for rising to the challenge during the pandemic. They continue to play an increasingly key role in providing advice and healthcare, including convenient and accessible vaccination services. Does the Minister consider that community pharmacies can play an even larger role in immunisation programmes by expanding the range of vaccines that they can offer, including those for shingles, RSV and pneumonia? What steps are being taken to marshal the forces of community pharmacies and expand their potential as community well-being hubs?

The second point is a predictable issue with a bearing not on safety but on bureaucracy. I am aware of the potential complexities, but what steps are the Government taking to explore the adaptation of funding mechanisms to expected new programmes in order to avoid delays and issues because of the constraints of rigid envelopes and complex approval processes? What are the general steps in the areas of improving resourcing, co-ordination and process across regulators and health-technology assessment bodies?

There is an increasing focus on the role of vaccination in fighting AMR. The JCVI has shown some willingness to consider its impact in its value-assessment criteria. I suggest to the Minister that this could be an interesting development. Given that it is newer science, it would be interesting to hear from the Government what assessment they have made of the AMR-reduction benefit from vaccines and whether they are taking any steps to explore how it can be harnessed further.

With further reference to the JCVI, I want to raise the suggestion of evolving its work to better enable the adoption of innovative vaccines. Broadly, it is important that the JCVI is continuously looking ahead. Can the Minister indicate how the Government are working with JCVI to ensure this mode of travel?

I was very interested in the argument put forward by Policy Exchange that a busy pipeline of new vaccine technologies in the coming years, including a growing number of therapeutic as well as preventative candidates, coupled with a concerning decline—as we have discussed —in the uptake of key programmes such as MMR, necessitates a fresh look at the architecture and delivery model for vaccine development and deployment. Policy Exchange’s key recommendations on delivery include boosting ministerial oversight—I am sure the Minister will have a view on that; expanding the role for community pharmacy, which we have talked about many times in our Chamber; creating a new workforce model; and piloting a local delivery model called a “vaccine collaborative”. The positive and overarching principle behind those suggestions is that of extending care further into the community. It would be helpful to get a sense of the Government’s ambition in this area and the steps they are taking to move beyond traditional delivery mechanisms to make this improvement.

As I said at the beginning, we all want an improvement in the UK’s performance in immunisation development and delivery. I look forward to hearing the Minister’s response.

Health: RSV Immunisation

Baroness Merron Excerpts

Wednesday 17th January 2024 Lords Chamber

[Lord Markham (Con)]

A DHSE team is working closely with the NHS, because that needs to be rolled out. Again, it depends on whether we go for the maternal option or do it via a different process with infants. The final answer on that will depend on the groups that are chosen; likewise, vaccinating the over-75s will more likely be in a primary care situation. When we finalise all those things, there will be a very clear plan, but there is a team in DHSE that is responsible and accountable for this.

[Baroness Merron (Lab)]

My Lords, over the past decade, we have seen the take-up of immunisation decrease. Particularly worrying is the great disparity between white Britons receiving the flu vaccine, where coverage is 83.6%, and black Britons at just 52.2%. In anticipating the RSV immunisation programme, how do the Government plan to address vaccine hesitancy, particularly in the black community?

[Lord Markham (Con)]

The noble Baroness is absolutely correct. This applies to the take-up of a whole range of vaccinations—MMR is another example, as is polio. Inner cities, including London and cities in the West Midlands, seem to be examples where take-up is quite a few percentage points lower, not just because of ethnic minorities but more because those areas have larger migrant populations, who often have not been part of the vaccination programme. Specifically to that aim, we are now publishing information in 15 languages and are trying to reach out to some harder-to-reach groups, such as ethnic minorities, the Traveller community and Orthodox Jews. There is a programme for all this, because it is a challenge. We all know that, during Covid, we talked about an R rate of 1.5. Would you believe that, for MMR, it is 13? That is just to give noble Lords an idea. It is very, very infectious.

NHS: Drug Shortages

Baroness Merron Excerpts

Wednesday 17th January 2024 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct that this so-called off-label use of these diabetes drugs for weight-loss-type treatments is causing some of the shortages she mentions. That is exactly what we have been tackling, and we have been making sure that the only way you can get the Wegovy weight-loss drug is actually on a very tightly controlled weight management programme normally run through hospitals, and not through normal GPs, exactly to get on top of that issue.

[Baroness Merron (Lab)]

My Lords, there are reports in the media today of pharmacists having to deal with frustrated and worried customers who are faced with shortages of medicines including HRT and the drugs for ADHD, diabetes and cancer. Can the Minister indicate what action is being taken to support and gather feedback from pharmacists who are dealing with such an unsatisfactory situation? What steps are being taken to ensure that, in the future, the supply system is able to cope as soon as demand for medicines increases?

[Lord Markham (Con)]

We find that each one is a different case in point. HRT is an example: we actually saw a 50% increase in demand for it over the last year, so suddenly that is quite a dislocation for the market, and you need to gear up very quickly in terms of the supply chain issues. Strep A was the example last year that we will all be familiar with; normally, it does not come until later in the year, but suddenly there was a very early outbreak in October, which caused the demand there. You find that every single drug tends to be a different case in point. There is a range of tools that they work with; it is working with the NHS, MHRA suppliers and pharmacists, and it is case by case. As I say, sometimes it is the MHRA expediting medicines to get new supply in; sometimes it is working on alternative suppliers; sometimes it is buying internationally—that is what we did in the case of strep A—and sometimes you do have to go as far as the serious shortage protocols, finding substitutes or, in extreme cases, changing doses. There is a range of programmes on it, which by and large are managing to tackle it.

National Health Service: Key Targets

Baroness Merron Excerpts

Tuesday 16th January 2024 Lords Chamber

[Lord Markham (Con)]

It is key, and I think we are all aware that a couple of years ago—this was a result of the report of the noble Lord, Lord O’Shaughnessy—we were not doing as well as we needed to be in the clinical trials area. I am glad to say that, since then, there has actually been a lot of progress towards it, so we are now hitting similar levels to comparative nations. Innovation is at the heart of everything we have done. We have some very good examples of that; I mentioned the stroke AI treatment earlier. We have just set a similar thing in terms of AI for looking at chest cancers, but it is absolutely something we need to make sure we continue to progress.

[Baroness Merron (Lab)]

My Lords, the King’s Fund has highlighted a delay to the release of additional funding to help NHS and social care services prepare for winter, which will of course only worsen the situation of missed targets and wait times for patients. Can the Minister tell the House what the reasons are for this delay and what steps are being taken to unblock the money to get it to where it is needed?

[Lord Markham (Con)]

One of the key learnings from last year, which goes back to the whole question about planning, was actually that if you put social care moneys in too late, you do not get nearly as effective spend. That is why we brought forward the £600 million discharge fund much earlier—actually, into the summer—so that local authorities and care providers could plan on that money. It is starting to make a difference. A key thing that noble Lords have heard me talk about is bed-blocking. Actually, we have seen a 10% reduction in bed-blocking since these measures have come into effect in the last few weeks. It is early days, but we are actually making progress.

NHS Winter Update

Baroness Merron Excerpts

Thursday 11th January 2024 Lords Chamber

[Baroness Merron (Lab)]

My Lords, the Government’s urgent and emergency care recovery plan promised the largest and fastest ever improvement in emergency waiting times in the NHS’s history. Yet it has not delivered in preparing the NHS for the winter, which we should remind ourselves is a season that, as sure as eggs are eggs, appears every single year. It should be no surprise to any of us, including the Government.

To take just one shortcoming, the plan talked about lowering bed occupancy rates as “fundamental”, yet in November, at the start of winter, bed occupancy was at its highest level since the start of Covid. It stood at 94.8%, a level which will surely lead to serious issues. Did the Government consider taking any additional action to lower occupancy rates? What steps will they now take to ensure that this is not simply repeated every single year?

Today, there have been a number of reports in the media, and I want to refer to two of them. We have read reports that NHS England has confirmed that the NHS is failing to meet all of its key targets: patients are waiting even longer in A&E, even longer to start routine treatment, even longer for cancer diagnosis and treatment, and even longer to be admitted to hospital or for an ambulance to arrive. This is a damning indictment. Perhaps the Minister could tell us the Government’s response to the reports of NHS England today. Also in the news, the Health Service Journal reported that trusts are being told by service commissioners for Lancashire and South Cumbria that, due to the expected deficit, they should plan for a 10% cut in contract values on top of the annual efficiency savings that they are already planning for next year. What is the Minister’s response to this worrying situation? How will it affect services, not just in winter but all year round? How many other trusts across the country are in a similar position?

I would like to pick up a matter strongly defended by the Secretary of State in the other place when this Statement was first made to Parliament—the matter of 800 new ambulances. These ambulances were promised by the Government to help NHS trusts tackle the crisis of ever-worsening response times. But freedom of information requests found that, across 10 of the 11 ambulance trusts in England, there were plans to order only 51 new ambulances. I would like to give the opportunity to the Minister to share any information that is missing from the responses from ambulance trusts that would show that the information referred to in the FOI request was mistaken in some way. Perhaps the Minister could also provide more detail on what NHS England referred to as a problem in procurement due to the impact of global supply chain pressures, and on whether and when it is expected pressure will subside, so that we will see all the promised new ambulances. What performance improvements are to be expected from the 51 new ambulances that we know have been ordered? How would this compare with the full 800 that were promised, had they been procured?

The Government’s Statement presents as a combination of somewhat selectively chosen numbers and situations that do not recognise the reality of a health service in which patients cannot get appointments with their doctors, dentistry is in crisis, and unprecedented numbers of people are having to wait unduly for surgery, cancer diagnosis and treatment, and their ambulances—and all of this while striking doctors are being blamed for the whole situation. The strike action by junior doctors has been the longest in NHS history, with trusts declaring critical incidents and A&E departments telling some patients to stay away to lessen the load. This is a situation that I am sure the Minister will tell us cannot continue, but it continues to disappoint that the Government do not see it as their responsibility to show leadership and resolve the dispute. Could the Minister advise the House of the steps the Government are now taking, or will take, to ensure that we do not see a continuation of this damaging situation?

Finally, I would be keen to hear from the Minister on an aspect of the winter health situation which was not mentioned in the Statement regarding Covid. In the run-up to Christmas, according to the Office for National Statistics, 2.5 million people were thought to have Covid. What assessment have the Government made of this increased prevalence and what impact has it had on the NHS so far this winter? What assessment have the Government made of how the impact may continue? I look forward to the Minister’s response.

[Lord Allan of Hallam (LD)]

My Lords, we should start by recognising and thanking the nearly 3 million health and care workers whom we depend on all year but who have to work especially hard during the winter months. We should also show our appreciation for the many millions more informal carers who spent the festive period looking after family and friends. That was the nice bit, but I now turn to some questions for the Government on what I thought was a predictably upbeat, “It’s all going swimmingly except for the strike” Statement; yet within it there were some significant gaps, some of which the noble Baroness, Lady Merron, pointed out.

It is notable that the Statement says nothing about primary care but instead focuses very much on hospital beds, which I will come to next. Can the Minister comment on how GP appointment waiting times remain unacceptably long in many parts of the country? This is a poor outcome both of itself and in terms of the knock-on effect it has on emergency services. I hope that the Minister can confirm that the Government have been monitoring GP waiting times during the winter months, and that he can indicate what they are doing about these.

The Government say they have added 3,000 hospital beds as part of their 5,000 target. That target was part of their response to last year’s crisis. Does the Minister have any new data on the utilisation of those beds and whether this matches up with the predictions the Government made when they set the target, and any analysis they made to come up with the 5,000 number in the first place? The Statement also highlights the 11,000 virtual beds that are now available, which instinctively seems like a positive development to me. But the important thing is how a broad range of people experience these and the health outcomes they deliver. What are the Government doing systematically to collect data about those virtual beds and whether they have been able to deliver a comparable level of care for people who are suffering during the winter pressures?

Another key area of delivering emergency care in winter is the availability of ambulances, which was rightly flagged by the noble Baroness, Lady Merron. The Minister may have seen a report in the Health Service Journal from 30 November last year, which said that in some areas there is a mismatch between the number of paramedics recruited and the number of ambulances available. It is great that the paramedics have been recruited, but if they are sitting around in the base stations because the vehicles are not there, that does not deliver the improved waiting times we are all looking for. I hope the Minister can comment on this report and whether the Government are able to deliver the vehicles in lockstep with the newly trained paramedics, which is what we all wish to see.

A further element of the response is the 111 service for less-urgent services, which, again, is not mentioned in the Statement. There are concerns about whether people are being directed to the right place—111, GPs, 999 or accident and emergency departments. Are the Government monitoring the performance of 111 in respect of flu, Covid and other winter respiratory diseases?

Finally, we have often discussed patient flow through hospital and out into the community with the Minister, who I know takes a particular interest in this. We know that some trusts are piloting systems to improve flow that could be described as like hotel booking systems that enable beds to be made available in a much more efficient and timely fashion. Will the Government compare the performance of trusts that have these systems in place with those that do not, as they go through this acute period of pressure in the winter months?

NHS App: Medical Records

Baroness Merron Excerpts

Tuesday 19th December 2023 Lords Chamber

[Lord Markham (Con)]

Clinical trials are among the key areas that are vital to the life sciences industry. We are all aware that, post-Covid, we were falling a bit behind. I am glad to say that now we have improved, so that 80% of the time we are doing the clinical responses in time. We can still do better; that should be 100% but 80% is good. Most importantly, our data is the envy of the world. Just to give noble Lords an example, about 90% of our hospital records are digitised. In Germany, it is less than 1%.

[Baroness Merron (Lab)]

My Lords, easy access to medical records on the NHS app is indeed positive and helpful to many, but of course there are parents whose abusive spouse or partner might use that sensitive clinical information to undermine legal cases of custody of dependants in the family courts. What discussions have taken place with the Ministry of Justice to assess both this risk and how to avert it?

[Lord Markham (Con)]

In terms of averting it, there are some of the measures I was talking about. For instance, with facial recognition, if anyone else is seen in the picture, it disregards it, so that you cannot have someone else holding it or holding their head in to do it. If the person’s eyes are shut—if someone is trying to do it while you are asleep—it does not work either. Those safeguards are in place, as well as multi-factor authentication, so that if anyone tries to change their details by email or whatever, it comes back to them. We have worked with user groups on this. I will come back to the noble Baroness specifically on the Ministry of Justice conversations, but we are doing a lot in this space.

In-patient Mental Health Care: Learning Disabilities and Autism

Baroness Merron Excerpts

Wednesday 13th December 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I congratulate the noble Baroness, Lady Hollins, on securing this important debate today, particularly as it comes so soon after the publication of her report, My Heart Breaks, which focuses on the fact that solitary confinement in hospital has no therapeutic benefit for people with a learning disability or for autistic people. However, I also want to congratulate her, as the noble Baroness, Lady Bull, did, on her tenacity in ensuring that this House and the Minister cannot overlook what is in fact a disgrace to our society. That disgrace is the damage caused to those with learning disabilities and/or autism, with often misunderstood and challenging behaviour, whose needs tragically continue to be unmet. The noble Baroness herself, along with many of us in this House, has made many times over the strongest of cases for reform of the Mental Health Act, which will be crucial to attending to this.

In her introduction, the noble Baroness, Lady Hollins, set out a number of disturbing statistics, which were amplified by the noble Baronesses, Lady Bull and Lady Jolly. If I had to pick out just one of those tragic statistics, it would be this: at the end of October this year, over 2,000 people with a learning disability and/or autism were in mental health hospitals, of which 210 were children. Even more shockingly, within that number, some 670—that is nearly one in three—had been in in-patient units for over five years, and the average length of stay for those in this group is 5.2 years.

The noble Baroness, Lady Bull, repeated a call I have heard a number of times before, and I would rather not keep hearing it, because, as she reminded the Minister, while this is a shocking number, it is not so large that it cannot be dealt with by a focus on it. She called, as has been called for many times in this House, for individualised plans. Can the Minister inform your Lordships’ House what progress has been made in this regard? I emphasise the point that the noble Baroness made that these are not just statistics. Every one of the people we are talking about is a real person who is part of a household, a family, a community and an organisation, and they too are very much affected.

Perhaps the key point in the debate today is, as the report of the noble Baroness, Lady Hollins, pointed out, that long-term segregation lacks any therapeutic or rehabilitative benefit for the most vulnerable in our society. I was particularly struck that the report described long-term segregation as just one part of a four-stage failure. The four failures include a lack of community-based support. We have heard a lot today, and I endorse the comments, of major failings in adult social care and the need to provide for a properly trained and rewarded social care workforce that is planned in the same way as we have in the NHS workforce plan. The second failing is where there is a failure in the hospital to provide the support needed by the individual, because without providing that there is more trauma, disorientation and restrictions for the patient. The third failure is in the use of restrictive practices, including solitary confinement. The fourth failure is a lack of clarity about responsibility for commissioning and funding the skilled support in case management that is needed, which goes back to the accountability called for in the report. I emphasise those four points to the Minister in order to ask whether this four-pronged approach will be taken in addressing the situation before us, to reduce the number of people with learning disabilities and autism in inappropriate settings.

As has been said not just today but on a number of occasions, the Government had promised to tackle this shocking ongoing scandal through the reform of the outdated and discriminatory Mental Health Act 1983, yet that was nowhere to be seen in the King’s Speech, which was the last opportunity for this Government to bring this much-needed reform forward in this Parliament. That opportunity was missed. Once again from this Dispatch Box I say that, should Labour be in government after the next election, we will bring it forward in our first King’s Speech. I hope that commitment will provide some small comfort when looking forward, because it has been devastating to all those who were so involved in developing the discussions on improving mental health care, including all the charities, the other organisations, the Joint Committee on the Draft Mental Health Bill and many others who contributed so much to the draft Bill.

It is highly unlikely that the Government will meet their target of halving the total number of people with a learning disability and/or autism in mental health hospitals by March 2024 from the 2015 levels, and analysis by Mencap, as the noble Baroness, Lady Bull, said, suggests that the target will not be met before 2029. There is no plan at all for this after next March, so I find it hard to see what change will be made.

If the Government are still committed to a reduction in the total number of people with learning disabilities and/or autism in mental health hospitals, what is the future beyond March 2024 of the Building the Right Support action plan, which previously set out these targets? The noble Lord the Minister and Minister Caulfield held a welcome meeting with noble Lords yesterday and referred to changes that might be made in the absence of government legislation. I put it to the Minister that the culture and practice reflected in a Mental Health Act that is some 40 years old are so far from what we now need that any changes must have at their heart ensuring a change of culture, as well as practice, to make any difference. It would be helpful if the Minister could give that reassurance, not just about the focus on change of culture and practice but about how this will be reported to this House, so that noble Lords can be updated and continue to take a very focused and important interest in this.

I will conclude my comments by picking up some points in a recent letter from the Minister, dated 8 December. Can he provide further detail on the pilot models of culturally appropriate advocacy that this letter said would provide tailored support to people from ethnic-minority communities being treated under the Mental Health Act? The Minister’s letter also highlighted the patient and carer race equality framework launched by NHS England. How will the Government evaluate its impact, not only on the wider scale but on how it is implemented across different mental health trusts? This is, as we always say, an important matter to debate; it is today and has been on previous occasions. I hope that the Minister will once again hear the wisdom that has been put forward and that we will have a response, in the absence of the legislation we have been promised.

Organ Donations

Baroness Merron Excerpts

Tuesday 12th December 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I pay tribute to my noble friend Lord Hunt, not just for securing this important debate and raising so many issues in a clear and methodical fashion, but for his work in taking the Bill through to fruition to become an Act. Of course, he continues to champion this very important cause, and for that, he deserves all our thanks.

Before the Organ Donation (Deemed Consent) Act came into force in 2020, it did receive cross-party support. Of course, there were concerns, but it was agreed across the parties that the previous law needed to be changed. The Act was praised as a key part of shifting the debate on the commitment to and resourcing of organ donation: an Act that would push forward thinking—that we should look beyond that legislation coming on to the statute book. As was highlighted then, and as we must highlight again now, the campaign to increase the number of organ donors did not end with the Act; it was always intended that the Act would push it forward, and that is what we are talking about tonight.

On the impact of the Act itself, the Government have already said in an Answer to a Written Question that

“it may never be possible to distinguish the true impact of opt-out legislation due to the impact”

of the pandemic. To some extent, that is completely understandable, because Covid-19 was disruptive in so many ways, but particularly with donation numbers decreasing by some 25%. However, perhaps the Minister can explain why, as time goes on and we are more distanced from the pandemic, that picture will not become clearer. Is it because Covid-19 disrupted attitudes towards organ donation, or because the disruption itself meant that processes were not put in place to correctly measure the difference? Or was something else going on? It would be helpful to understand that.

Is there a reason to believe that organ donation levels, putting the Act on one side, would not have evened out, either by now or at some point in the future. At what point should we be able to see the proper impact of the Act?

Regardless of the causes, it is, of course, as my noble friend Lord Hunt said, disappointing that the consent rate of 61% remains significantly lower than the predicted 78%, simply because there remain many more people waiting for organs than there are receiving them. In simple language, more donations are required.

Again, as my noble friend said, the latest NHS report said there were almost 7,000 people waiting for a transplant at the end of March, with almost a further 4,000 temporarily suspended from lists. This is an increase of 47% on the previous year, while the number of donors went up only 2% on the year before. This sadly means that some 439 people died who were on the active list, while a further 732 were removed from the list, mostly because they became ineligible due to deteriorating health. It is not a situation that we expected to see when the Act came in.

The noble Lords, Lord Allan and Lord Weir, spoke about families and their importance in all of this. It is interesting to note that the main reasons for families not supporting organ donation are: first, that the patient previously expressed a wish not to donate; secondly, that the family may feel that the length of time for the donation process is just too long; and, thirdly, that the family are not sure whether the patient would have agreed to donation. What is striking about that list is that none of those reasons requires further legal changes if we are seeking to improve the number of donors, especially where patients are unsure.

I think this debate has touched on that, and I would like to refer to two of the points that have already been raised. The first is about communication. During the passage of the Bill, the need for a comprehensive communications strategy and media campaign, as well as for increased resources for our healthcare structures, was raised, in order that everybody has the information they need to make what is a very important choice in an informed fashion. It would be helpful to hear from the Minister what the Government have been doing in these areas, particularly since the Act came into effect. What assessment has been made about what still needs to be done in terms of communication?

We know a number of people have said that the process is just too long. What is being done to make the process shorter and less burdensome, in order to reduce the number of people who opt out of choosing to donate organs for that reason?

The other area that has been raised in this debate and needs to be addressed is the disparities in representation in organ donation. NHS Blood and Transplant has stated that, despite an increase in the proportion of opt-in registrations from BAME donors over the past five years—with the work done to improve that engagement being praised, and we should add our praise to that—there remain under-representation and lower consent rates. So I hope the Minister can highlight what steps are being taken to deal with this continuing disparity, as well as the disparities that are so evident regionally. London has a consent rate of 51%, compared with 72% in the south-west. With the average in England and Wales being 61%, bringing regions such as London and the Midlands, with their lower consent rates, up to the average, could save lives.

Looking to the other end of the process, it is welcome that the Government announced earlier this year that they would be taking forward recommendations from the Organ Utilisation Group, to reduce the number of organs that are not properly utilised and to provide more consistency in the levels of performance and care that patients receive. While demand for organs exceeds supply, these efficiencies are especially important to tackle. So perhaps the Minister could also update your Lordships’ House on the progress in implementing these recommendations and, while I would not expect there has been any noticeable impact at this stage, what difference do the Government project that these changes will make?

For me, this debate is an important one; it keeps the issue in focus. I am sure that the Minister shares many of the concerns that have been raised this evening and I look forward to hearing his response on how we how we can work to save more lives through organ donation.