National Stroke Strategy

Baroness Oppenheim-Barnes Excerpts

Wednesday 5th July 2017 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord is quite right to highlight that issue. There is increased screening for atrial fibrillation as part of the community-based efforts to prevent the incidence of stroke, and that has been one of the factors that have reduced the incidence of stroke over the past few years.

[Baroness Oppenheim-Barnes (Con)]

My Lords, does my noble friend not agree that one of the most important issues is informing people about what is likely to cause a stroke if special care is not taken?

[Lord O’Shaughnessy]

I thank my noble friend for that question. She is quite right. That is why public health campaigns around both obesity and smoking—a cause I know the noble Lord, Lord Rennard, is also passionate about—are so important. That is why we are continuing to invest in those public health programmes that have led to the improving stroke outcomes that I have described.

Care Bill [HL]

Baroness Oppenheim-Barnes Excerpts

Tuesday 29th October 2013 Lords Chamber

[Earl Howe]

My Lords, Amendment 5 returns us to the issue of deferred payments. I begin by saying that I welcome the opportunity to debate this subject again. Unfortunately, the Government’s position on it has been fraught with misunderstandings, and I would like to take this opportunity to dispel at least some of those.

First, I remind the House that a consultation on funding reform has been running over the past three months, and it closed last Friday. During these three months, officials have travelled across the country explaining our proposals and seeking people’s views. What we have put forward so far are proposals—something for people to consider. These are not set in stone. We will listen to what we have heard through our consultation, and indeed in this Chamber, as we develop our policies over the next few months.

The purpose of this amendment, as the noble Lord, Lord Lipsey, has explained, is to ensure that anyone—even people with assets of great monetary worth in addition to their main home—can have a deferred payment agreement. I have to make it clear that if one takes this amendment literally, I disagree with that principle. I do not think the public purse should be helping people who do not need financial support to pay their care fees. This would seem a long way from the Dilnot commission’s view that deferred payments should be used to support people who,

“would be unable to afford care charges without selling their home”.

For a person with a substantial sum in their bank account or substantial liquid savings, a deferred payment agreement might be a cheap loan—a convenience, one might say—but it would not be serving its core purpose.

I hope that we can therefore agree that the principle of having an upper threshold for non-housing assets is a sound and a necessary one. If we agree that this is a sound principle, all that is left to do is agree on an amount. Our consultation sought views on that amount. The noble Lord, Lord Lipsey, asked what was wrong with an asset threshold of £118,000. From April 2016, we are extending means-tested support for people with up to £118,000 when the value of a person’s home is taken into account in the financial assessment. This determines when an individual may be eligible for local authority support with their care costs. Deferred payment agreements are designed to help people to pay for their care costs; their ability to meet these costs in the short term will be dependent on their liquid non-housing assets rather than housing wealth. I can say to the noble Lord that we are happy to consider using a threshold of £118,000 as we analyse the consultation responses. We are happy to consider a range of figures.

The noble Lord, Lord Hunt, asked why we proposed the £23,250 threshold. We were seeking to identify those people most at risk of having to sell their home to pay for their care. The reason we proposed £23,250 specifically is because it provides consistency with the threshold for means-tested support when the value of someone’s home is not taken into account, and with the principle that people with non-housing assets under that amount are likely to need state support to pay for their care costs. Indeed this is the same figure and the same reasoning that the previous Government applied in their White Paper. Therefore, from that point of view if no other, it is a little surprising to hear the noble Lord, Lord Hunt, arguing against it.

There is an interesting point about people with more than £23,250 in savings. About 60% of people entering residential care are state-supported, meaning that they have only limited assets. Of the remaining 40% who enter residential care as a self-funder, less than half have liquid savings of more than £23,250. This means that the proposed threshold of £23,250 excludes only the richest 15% of people entering residential care. By increasing the liquid savings threshold to £118,000, the scheme would be available to all but the richest 5% of people entering residential care. I hope that that is a helpful contextual analysis. However, I reiterate—particularly to the noble Lord, Lord Lipsey—that we are not wedded to the figure of £23,250. We will analyse the responses to the consultation before making any further decision.

To answer the question posed by the noble Lord, Lord Hunt, about whether the scheme will actually be cost-neutral, we intend and believe that in the long run the scheme will be cost-neutral. We have committed £330 million to fund the implementation of the cap cost system, and deferred payments to cover the initial set-up costs.

I hope that in the light of what I have said the noble Lord will, on reflection, agree that his amendment would be undesirable as drafted and that he will be content to withdraw it.

[Baroness Oppenheim-Barnes (Con)]

Before the Minister sits down, will he confirm that if a house has to be sold, after the repayment of the debt, the proceeds remain the property of the person whose house was sold? Would it be possible for the potential beneficiaries to pay the debt in advance so that the house does not have to be sold?

[Earl Howe]

My understanding is that the short answer is yes. There is no reason why potential beneficiaries should not use other moneys to pay the debt, in which case the legal charge over the house would be released by the local authority.

Medicine: Experimental Drugs

Baroness Oppenheim-Barnes Excerpts

Monday 10th June 2013 Lords Chamber

[Earl Howe]

My Lords, there is no need to think in those terms. There are many routes by which patients can access medicines lawfully and maintain their legal rights. We want to make sure that ethics and patient protection continue to be at the forefront of drug development. It would be wrong to give an indication to drug companies that they can throw caution to the winds in that sense.

[Baroness Oppenheim-Barnes]

It often takes as long as five or six years to develop a new drug. Sometimes, even after that period, when permission has been given, something is found late in the day. Therefore, does the Minister agree that we need to know what sort of period he is thinking of in accepting drugs that have not yet been approved?

[Earl Howe]

My Lords, this will very much depend on a case-by-case analysis of the drug in question. If there is a very promising new drug that is a breakthrough medicine, where there is no alternative treatment, there may be a case for considering that more favourably than a drug for which there is a readily suitable alternative. As I mentioned earlier, the menu of options available to us, such as an early access scheme for unlicensed medicines and an adaptive licensing scheme within European Union rules for licensed medicines, can perhaps be tailor-made to suit the drug in question.

Social Care Funding

Baroness Oppenheim-Barnes Excerpts

Monday 11th February 2013 Lords Chamber

[Baroness Oppenheim-Barnes]

My Lords, my noble friend may recall that when we previously discussed this problem on the Floor of your Lordships’ House, I voiced the very strong concerns that I have held for a long time. That is because when I was in another place, I faced a number of constituents in my surgery saying, “We’ve worked hard all our lives, we’ve done everything that we can do and we’ve paid for everything, and now they’re going to sell my house, whereas someone who has done nothing and saved nothing is going to get their treatment for free”. In his opening remarks, my noble friend has answered all those points, so they are extremely welcome.

On the other hand, when I raised these points with previous Governments, their reply was, “Well, the British taxpayer should not be asked to subsidise the inheritance of their future children”. I felt that that was a very harsh view to be taken, and my noble friend has put that right. This is an important step in the right direction. It may not be possible for the Minister to answer this, but if a person who has entered a care home, and made whatever provision they had to with regard to resources, unfortunately dies within a very short period, will any sort of rebate be given?

[Baroness Northover]

My Lords, I interrupt briefly to say that if noble Lords make brief contributions more of their colleagues will be able to get in this critical debate.

NHS: Public Information and Advice

Baroness Oppenheim-Barnes Excerpts

Tuesday 12th June 2012 Lords Chamber

[Earl Howe]

My Lords, there will be national focus programmes led primarily by Public Health England, but we see those as complementary to the work going on at the local level. By no means are we abandoning national campaigns. Indeed, we have seen considerable successes. In 2010-11 we invested almost £11 million to support 59 cancer awareness campaigns around the country. In 2011-12 we provided £8.5 million to support a range of cancer awareness campaigns, and this year we hope to spend even more on cancer awareness than we have in previous years.

[Baroness Oppenheim-Barnes]

My Lords, what is the reaction of the NHS to the explosive headlines appearing daily in newspapers about new cures, magic pills and other things of that nature? Surely these are being trialled for the NHS, which must be creating new demands every day as a result. Does the service have a plan to deal with this?

[Earl Howe]

The key is to make available to the public accredited sources of information because there is an awful lot of unaccredited information available. Through mechanisms such as NHS Choices and NHS Evidence, people can now see online not only what best practice looks like, but what clinical trials are available for the latest drugs and treatments. My noble friend is right; we have to direct people to the right sources of information.

Health and Social Care Bill

Baroness Oppenheim-Barnes Excerpts

Monday 13th February 2012 Lords Chamber

[Lord Faulks]

My Lords, I join the debate for the first time, conscious that I was not here in Committee. However, I read closely the debate that took place then and have also read the debates on the subject in the other place. My perspective on the issue comes from spending the past 25 years or so involved in clinical negligence cases, acting as a barrister for patients, doctors and other healthcare professionals, employed privately or by the NHS. Although the amendment is not specifically about litigation, the effect it may have on claims is important.

Much has changed in the way that healthcare professionals approach complaints and claims made against them. Where once it was difficult to obtain clear information about what had happened in some adverse event, often this is no longer the case. Similarly, where once medical professionals were inclined to close ranks, this is very far from the case now, where many current and former healthcare professionals provide opinions about the competence of their fellow professionals. In my experience, some of them are remarkably uninhibited in doing so.

Why have the changes come about? The establishment of the National Health Service Litigation Authority, which commenced its activities in November 1995, has been very much a force for good. Consistent with its aims, objectives and functions, the NHSLA has administered the schemes in a way that has done a great deal to increase public confidence that the truth can be obtained without too much difficulty. Where fault is found, the NHSLA is committed to providing proper apologies and explanations.

I pay tribute also to organisations such as AVMA, which was mentioned by the noble Baroness and which has championed the cause of the victims of medical errors and contributed to a much more effective system of litigation. It is appropriate to acknowledge also the major contribution of the civil procedure rules, which were the result of the investigation into civil procedure by the noble and learned Lord, Lord Woolf. The result is a much more open approach, with disclosure of rival opinions before trial and much greater control by the courts of this potentially vexed field of litigation.

I have a reservation concerning legal aid. The LSC, shortly to be replaced as a result of the LASPO Bill, has ensured that firms that conduct this type of litigation are franchised. I worry that with the potential disappearance of legal aid in this field we could return to a situation where those who conduct this complex litigation would not necessarily have the relevant experience. Be that as it may, matters have advanced very considerably and many experiences that were encountered by those in your Lordships’ House who in the past had to deal with constituents would not now happen on anything like the scale that they did in the past.

That is not to say that all is perfect. The duty of candour was, I think, first encapsulated in the Making Amends report in 2003 and has been championed by the former Chief Medical Officer, Sir Liam Donaldson; and, as other noble Lords have pointed out, the case of Robbie Powell has had a great deal to do with promoting the need for candour. I cannot imagine that anyone in your Lordships’ House is against candour or in favour of medical cover-ups. However, the question that the House has to consider is whether this amendment is really the right way of improving the culture when there are iatrogenic events.

There has been a considerable amount of research, mostly in the United States, about the effect of greater candour on patients’ willingness to sue, including an article in the New England Journal of Medicine in 2006 by two obscure politicians, Hillary Clinton and Barack Obama. I think it would be fair to say that the research on the issue is somewhat inconclusive. While some have clearly welcomed an earlier explanation of medical errors and have been dissuaded from litigation by a culture of openness, equally others have been encouraged to pursue cases that they might otherwise not have pursued because of the disclosure of errors by medical professionals.

The House is, of course, aware that when mistakes happen the NHS constitution requires staff to acknowledge them, apologise, explain what went wrong and put things right as quickly and effectively as possible. Professional codes of practice for doctors, nurses and NHS managers contain similar duties, and there are rights in the Data Protection Act that serve to empower patients, but the Government, as we know, intend to go further. It is a matter for consultation, but it is anticipated that there will be a contractual requirement on the part of all those engaged by commissioning bodies to have this duty of candour, which will involve openness about incidents involving at least moderate or severe harm or death, if not even minor incidents.

We must be careful not to underestimate the difficulty involved in trying to encapsulate the obligations that could be placed upon healthcare professionals. Thanks to the Compensation Act 2006, an apology is no longer to be construed as an admission of fault, but the House ought to consider, I suggest, just how difficult it may be for an individual, albeit via an organisation, to decide whether there has been an error such as to come within the scope of this amendment so as to bring about the various consequences envisaged by it. Where there has been an egregious error, such as the wrong patient being administered an injection or even the wrong limb being removed, that is one thing, but there are many cases in which there may be a suboptimal outcome and it is arguable that there was a departure from the appropriate standard of care.

I have spent a large part of my professional life listening to doctors of one sort or another giving their opinions, often contradicted by other opinions, about whether there has been fault. Even a so-called reasonable opinion, the expression used in the amendment, may not be accepted by another reasonable expert. What of the quite frequent cases where some acknowledged risk involved in a procedure has eventuated? Very often, this will just be the result of happenstance and involve no fault on anyone’s part. I am concerned about how this amendment would work in such circumstances.

I noted the observations made by the noble Lord, Lord Winston, and the noble Lord, Lord Walton, who is in his place, about this. I have often found that some doctors are almost too ready to admit mistakes when they have not made one, so anxious are they about the welfare of their patients. We should be careful that in encouraging candour we do not impose what I have to say is a not particularly coherent obligation in the form of this amendment. Surely the most important objective is to encourage candour so that it becomes embedded in the culture of the NHS. The intense difficulty in defining what that obligation should mean is far better teased out as a result of the consultation that is being undertaken rather than being imposed in the statutory form proposed.

I do not know whether those who propose this amendment intend to press it to a vote. Of course all noble Lords are in favour of candour and against cover-ups. Those who have supported this amendment have done a great deal to contribute to the continuing debate about the whole question of candour and should be congratulated on that, but I respectfully suggest that this amendment will not help patients or provide clarity for professionals and therefore will not provide any real benefit. I will oppose it.

[Baroness Oppenheim-Barnes]

My Lords, I am obliged to my noble friend Lord Faulks for provoking me into thanking him for having read the proceedings of our earlier debate on a similar amendment, in which I spoke at length about the total impossibility of someone with money and influence bringing a case against a doctor or a hospital in a situation that was completely black and white. I went into this detail only to convince those who—quite rightly—want this candour that it will not result in an “open sesame” for bringing cases in which a mistake has been made or completely bad treatment has been given.

I would also say that I wish anyone trying to deal with the General Medical Council the best of British luck, because it is not easy. It is a long process, and it involves a great deal of information being given. Even when the consultant involved has said, “I am very sorry, I have made a mistake, I have failed”, the GMC still does not find it necessary to criticise that surgeon in any way at all.

On the amendment, my noble friend the Minister was kind enough following the last debate to circulate to those who had participated a note from the NHS giving details of the steps that it takes after a mistake has been discovered: dealing with patients in counselling, apologising, all the important things that we would expect it to do. However, one thing was missing, and I hope that my noble friend will feel kind enough to grant it; it did not say that in such cases the NHS was required to circulate throughout the health service what accident had happened or what mistreatment had taken place, so that it could warn in advance that special care must be taken in the future.

[Baroness Pitkeathley]

My Lords, the noble Lord, Lord Faulks, speaks with his extensive legal experience, which I certainly could not match, but I have very extensive experience of working with patients and their families. It is in that respect that I support this amendment. I particularly support what noble Lords have said about seeking culture change in the NHS.

One thing that gets in the way of that culture change is the anxiety about why patients want candour and the truth. My experience is not that they seek redress or even want to pursue legal action—time and again any consultation with patients will show you that that is not their aim. Their aim, almost always, is to achieve closure after a distressing incident. What a patient said to me a year or so ago is typical: “I just wanted them to admit that something had gone wrong and say sorry. I knew it could not bring my brother back but it would have helped us come to terms with it”. That is what patients are seeking and that is what this amendment will help to achieve. We can all agree that if we are to achieve more culture change, we must move towards a greater degree of openness throughout the NHS.

Health and Social Care Bill

Baroness Oppenheim-Barnes Excerpts

Monday 7th November 2011 Lords Chamber

The simple principle at stake is the right of patients and their families and carers to know what has gone wrong with their care and treatment. It cannot be right that distressed, bereaved families have to resort to legal remedies for years and find out at the end of it that what they thought had happened had not happened. I have been told by patients’ families that I dealt with that it is like having a bereavement all over again. In the spirit of honesty, openness and transparency that we talk about a lot in the Bill, this proposal would ensure transparency—and, importantly, that patients and the public have complete confidence in the NHS.

[Baroness Oppenheim-Barnes]

My Lords, I intervene at this point because I have all too real personal experience that may be helpful to the movers of the amendment. When she was still a teenager, my daughter was the subject of a terrible error made during a simple investigative measure. It was covered up by all concerned, who said what a tragedy it was that such a young girl should have got this illness, which was inexplicable. Because she was a private patient, we were able to bring in other advice that led to a conclusion which was that a very serious mistake had been made. She was hospitalised for three months. She suffered several operations as a result and, when she was finally recovering, we sought in law to get some kind of satisfaction.

We were not without means or influence, but no single lawyer would take the case. They said it was not in their interests because their main clients were usually health service providers or medical providers and therefore our case was not going to be taken. The noble Lord, Lord Harris of Haringey, made the point that these people may or may not want to follow legal processes. I make the point that if that were one of the objectives of the amendment—which I hope it is not—they would have no chance whatever.

[Lord Campbell-Savours]

My Lords, I intervene briefly to do precisely what the noble Baroness has just done; namely, to draw attention to an individual case that might influence the judgment of the Committee. In a former incarnation as a Member of Parliament, I received in my post an anonymous letter from a person in the north of England, which made major allegations about a hospital in the north of England where a child had been badly brain-damaged as a result of negligence in that hospital. The letter was unsigned, as I say, and the child's name was not included. I had the task of asking around in the community to find out whether they know anyone who the child might be or whether they knew anybody in the hospital who knew about the incident that had taken place. I suspected that the letter had come from a member of staff.

After some time, I managed to identify a family. I knocked on the door and a lady answered. She said, “Yes, it was our child and the health service has basically converted our garage and put a bed in it”—for this boy who was very badly brain-damaged and remains so to this day. The family had been to lawyers and been advised that that was the best deal they could get. The reason why that happened was because there was no duty of candour and because the health service covered up what had happened. I told the family that they should go to Manchester and pick a very smart lawyer whom I knew and ask him to handle their case. It took six years, at the end of which there was a multimillion pound settlement covering a lifetime's provision of care for this child.

There are many cases of negligence in the National Health Service. I have probably spent more time in hospital in my lifetime than a large number of Members of this House put together and I have seen it myself. You hear stories in hospitals all the time when you are sitting in a bed, although some of them are not so much about negligence as stupidity. I wonder whether we are really being sufficiently transparent in the way we ensure that the information is made available to patients and their relatives. I hope that the amendment goes through.

EU: Food Labelling

Baroness Oppenheim-Barnes Excerpts

Monday 17th October 2011 Lords Chamber

Asked By

[Baroness Oppenheim-Barnes]

To ask Her Majesty’s Government whether they are supporting the new food nutritional labelling regulations approved by the European Parliament on 6 July; and, if so, why.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, we welcome the new regulation. The UK has led the way in Europe in improving nutritional information for consumers. Access to nutritional information supports consumers in choosing a balanced diet and can help in controlling calorie intake. The regulation meets our main negotiating objectives and will give the UK freedom to maintain and build on existing practice.

[Baroness Oppenheim-Barnes]

My Lords, I am a little astonished by that response. Is my noble friend aware that I have campaigned for many years in your Lordships’ House for clear, uniform food labelling on pre-packaged goods for easy comparison? The FSA produced such labelling, which I understand was approved by all five Select Committees but was rejected by the EU, which has now produced something futile, pathetic and unenforceable, to put it mildly. Does my noble friend agree that it is time for the proverbial worm to turn and to tell the EU that we do not want its version—we prefer our own?

[Earl Howe]

My Lords, I am not sure that I would accept the epithets that my noble friend has applied to this regulation. We have led the way in these negotiations. It is true that it has taken some time but we have come away with most, if not all, of our key objectives met. Nutritional information will now be displayed in a consistent manner on the back of all pre-packed foods, which is a major plus. A voluntary approach has been secured for front-of-pack nutrition labelling and for non-pre-packed foods, including those sold by caterers. It will also be made easier for alcohol companies to include energy information on their products on a voluntary basis. This will give people the information they need to make informed choices about what they eat and drink, which is the whole idea.

Reform of Social Care

Baroness Oppenheim-Barnes Excerpts

Monday 4th July 2011 Lords Chamber

[Baroness Oppenheim-Barnes]

My Lords, I was extremely pleased to hear this Statement and to hear it in the form that it has come. It must be well over 20 years since I first started writing to various Prime Ministers about the dreadful case of a constituent who had to sell his house—his life savings went into the house—to go into a care home, who said, “This cannot be fair. People who never bothered to save or to put money aside are getting the same treatment I am being charged for”.

On the other hand, and this illustrates the difficulty of the problem, the view of the taxpayers, also expressed to me, was, “Why should we have to support the inheritance of the sons and daughters of these people?”. There were two completely separate points of view that were very difficult to reconcile. As the problem becomes bigger and more urgent all the time, it is extremely brave of the Government to embark at this stage on a Statement that refers to the priority that will be given to this problem, and I welcome that very greatly.

[Earl Howe]

I thank my noble friend Lady Oppenheim-Barnes for those remarks. The House will know that her experience of these matters goes back many years. She is right; these thorny issues have been with us for a very long time and we have to get a grip on them. There is, as I made clear earlier, a clear imperative to inject certainty and predictability into the system, but there is also a need to strike a balance between the state and the individual. That principle was one that the Dilnot commission articulated—overreliance on the state would be unsustainable and arguably unfair, and overreliance on the individual presents obvious problems of a different sort. It is that balance that we need to identify.