Fracture Liaison Services

Baroness Quin Excerpts

Wednesday 4th December 2024 Lords Chamber

[Baroness Quin (Lab)]

My Lords, I join in the congratulations to the noble Lord, Lord Black of Brentwood, on initiating this debate. I know, as another long-standing member of the all-party group, how active he has been in promoting the goal of a proper system of fracture liaison services.

I remember initiating a similar debate on NHS provision for tackling osteoporosis not long after I joined your Lordships’ House, way back in October 2007. At that time, I was focusing on the patchy provision and availability of DEXA scans across the country, and highlighting the postcode lottery whereby, while you might be identified as needing access to services aimed at preventing osteoporosis, whether those services were available depended very much on where you happened to live. It is therefore very frustrating that, even now, so many years later, we are still complaining about postcode lotteries and that, in England, we still do not have the nationwide system of fracture liaison services which everyone who has spoken in this debate has favoured.

As a long-standing supporter of devolution, I also find it frustrating that England, the most populous country, has once again been lagging behind the rest of the UK. I firmly believe that if devolution is to count as a UK success, it should be a process that fosters high standards of service to all our citizens in whatever part of the UK they live. I also hope that, perhaps with the emergence of regional mayors in England, there will be a renewed effort, supported by the Government, to tackle inequalities in healthcare provisions in different regions of our country.

I accept of course that my noble friend the Minister who will reply to the debate and the Government of which she is part have been in office for only a very short period of time. I am very pleased that the current Secretary of State for Health, in already committing himself to rolling out a system of fracture liaison services across the country, fully recognises not only the benefits this will bring to NHS patients but the financial savings to the NHS in the long term through the establishment of these much-needed preventive services.

I pay warm tribute to the Royal Osteoporosis Society for the work it has done over the years in raising awareness of osteoporosis and the various ways it can be prevented and tackled. It has been particularly successful in promoting national media coverage of the issue, which in turn has increased public awareness and public consciousness of its importance.

In correspondence with me, the Royal Osteoporosis Society has made the point that fracture liaison services fit very well into the recent update on the National Health Service from the noble Lord, Lord Darzi, particularly in the three key shifts that he highlighted and deemed necessary: a move from sickness to prevention, from analogue to digital, and from emergency-based care to community-focused models. Surely it is the case that fracture liaison services offer a practical example of how we can deliver on all three of these worthwhile aims, and do so in the short term as well as the long term.

Many speeches this evening have made very telling points, and I am sure the Minister will have listened carefully to them. Like others, I look forward very much to her reply to this debate.

Covid-19: Vaccinations Administered Abroad

Baroness Quin Excerpts

Wednesday 27th October 2021 Lords Chamber

[Lord Kamall (Con)]

What we have done is look at a wide range of vaccines that are being administered worldwide and look into how we understand the vaccines that have not yet been approved by the MHRA. We are requesting trial data, for example. Only a couple of days ago, I was in a meeting with a Chilean Minister who was asking me about Sinovac, which was very important. It was very helpful that they were sharing data with the MHRA so that it could make a decision as quickly as possible.

[Baroness Quin (Lab)]

My Lords, on a recent visit to France, I found that it was very easy to transfer my English record of vaccinations to the French anti-Covid app, which I then used when going into restaurants and public buildings. This system worked well for residents and tourists alike. Yet, according to the Government’s own website, the English Covid app cannot generally even import the records from Scotland, never mind other countries. What discussions are the Government having across the UK and internationally to ensure that the pilot that he mentioned is rolled out properly and that we have a fully effective system in the future?

Covid-19: One Year Report

Baroness Quin Excerpts

Thursday 25th March 2021 Lords Chamber

[Baroness Quin (Lab) [V]]

My Lords, I welcome the chance to pay tribute to all those who have worked so hard and devotedly to care for and serve the citizens of our country over the past 12 months. This obviously includes all NHS staff, but also those working in care homes, in other public services and indeed in our local essential shops and supermarkets. I also pay tribute to the many volunteers who have helped out, particularly in vaccination centres. Having had my second jab this morning, I was so impressed by the way cheery and positive volunteers were supporting our local health services.

I welcome, too, as others have done, the success in rolling out the vaccination programme. I share, however, the concerns about how late we were initially in going into lockdown and about the failure to adequately protect people in care homes. I lost two friends for whom I had the greatest admiration and love in the distressing circumstances affecting care homes, and I know how, behind the numbers, there are terrible individual and family tragedies. I very much support the regret Motion in the name of my noble friend Lady Thornton.

I want to make two points. One is a plea to the Government, and the other is to ask the Government a specific question that I do not think has been raised so far. The plea is on behalf of borderers. I live near the Scottish borders and know how much it would help if there were better co-ordination across the UK’s devolved authorities to avoid confusion or creating unnecessary barriers. I say this fully respecting our system of devolution but simply wanting co-operation and joint decision-making to work better.

For example, at one point, with the differences between Scotland and England, I could in theory have driven more than 500 miles to Cornwall but not a few miles up the road to the Scottish borders, although the level of infection in the areas on both sides of the border was similar. Another example is the recent statement about the international travel ban. The description of what this meant, both online and in news bulletins, was far from clear as to whether it referred to England only or to the UK, yet this affects us in border areas. If you live in the far north-east of England, for example, the nearest airport for direct flights to particular destinations is often Edinburgh. Therefore, we needed to know for sure whether flights from Scotland were included, and if they were not, whether we were permitted to cross the nearby border to travel on such flights. Perhaps it is asking a bit too much to expect First Minister Nicola Sturgeon and Prime Minister Johnson to work together, but, particularly as scientific advice is shared across the UK, it should be possible to avoid such perplexing and confusing discrepancies.

Treating England as one unit, as the Minister today said, is often problematic, too, given the widely differing levels of infection and the sheer size of England’s population. For this reason, co-ordination and consultation should work at a regional level within England as well as across the UK. I salute the efforts of local authorities and their effectiveness during the pandemic and urge the Government to make even better use of them and involve them more in their vital role of delivering services on the ground.

Finally, I have a question for the Minister which I would be happy to have a reply in writing to if a response is not immediately available. I understand that the legal power of local authorities to hold virtual or hybrid meetings is to expire in May and that, in theory, meetings afterwards should therefore be fully physical. Many local authority staff are concerned about this, as it will be difficult to find venues for all meetings in rooms where social distance requirements can be met, and there may, in any case, be a need for continuing hybrid meetings for those with particular health conditions.

I should say that not only are council meetings but those bodies with local authority representation affected, which means that the issue that I am raising has wide ramifications and needs to be resolved quickly and sensitively. If new legislation is needed, it should be introduced quickly, or else existing legislation should be extended until social distancing is no longer necessary. Of course, that is something we will all be looking forward to after this difficult and extraordinary year.

Osteoporosis: Treatment

Baroness Quin Excerpts

Tuesday 9th February 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness is entirely right. There is significant regional variation in the rates of fragility fractures within the older population with the lowest incidence observed in London, the east of England and the south-east and the highest in the south-west of England, Northern Ireland and Scotland. To reduce variation in osteoporosis services in 2017, NHS England’s RightCare programme published cases studies and pathways for the management of osteoporosis and fragility fractures. The noble Baroness is right that we should have high aspirations in this matter. I am not sure that I can commit to 100%, but I will return to the department and see if we could be doing more.

[Baroness Quin (Lab) [V]]

My Lords, I do not have a specific interest to declare, but I have been a member of the All-Party Parliamentary Osteoporosis Group and fully support the Royal Osteoporosis Society. Will the Government commit themselves to some kind of timetable for the achievement of a comprehensive system such as exists in Scotland and Northern Ireland? Will they meet the Royal Osteoporosis Society and interested parliamentarians to discuss the specific issue of delays in access to treatment which have understandably emerged during the current Covid crisis?

[Lord Bethell (Con)]

My Lords, the noble Baroness is right to press me for a timetable but, unfortunately, that is not something I can commit to from the Dispatch Box today. However, I would appreciate the opportunity to meet the Royal Osteoporosis Society and will put an appointment in the diary for as soon as possible.

Brexit: Health Policy

Baroness Quin Excerpts

Wednesday 6th December 2017 Lords Chamber

Asked by

[Baroness Quin]

To ask Her Majesty’s Government what are their priorities concerning health policy in the Brexit negotiations.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O’Shaughnessy) (Con)]

As the UK leaves the European Union, the Government are committed to safeguarding the success of the health and care sectors as well as the UK as a whole. Our priority is to make sure that, whatever the outcome of the negotiations, British citizens will continue to receive world-class healthcare. We are undertaking detailed planning for all scenarios.

[Baroness Quin (Lab)]

Given the concerns expressed by the British Medical Association and others about such issues as recruitment and retention in the NHS, research, mutual recognition of qualifications, the market in pharmaceuticals and medicines and so on, do the Government agree that a full impact assessment of the effect of Brexit on this sector would be a very good idea? Since I understand some progress has been made on mutual rights between British and European Union citizens, will the Minister say whether that means that all British citizens will be able to enjoy entitlement to the European health insurance card in future?

[Lord O’Shaughnessy]

I can reassure the noble Baroness that we are meeting a range of stakeholders. Indeed, I met the BMA, which she specifically mentioned, yesterday to talk about the impact of Brexit on the workforce and other issues. I assure her that we have had extensive discussions with the NHS, doctors’ groups, nurses, industry and so on, so that we understand the consequences of a range of options and so that we make sure that ultimately patients’ health and interests are protected. The noble Baroness asked about mutual benefits. I think she was talking about reciprocal healthcare with the EHIC. We have made good progress so far in the withdrawal discussions. For example, we will continue to cover the healthcare costs of pensioners who are permanently resident abroad, and anyone abroad at the point of exit will be able to use their EHIC. That was all that the first-wave mandate allowed us to do, but as we get to the second phase, we will be able to talk about what the future looks like.

NHS: Clinical Commissioning Groups

Baroness Quin Excerpts

Wednesday 27th November 2013 Lords Chamber

[Earl Howe]

It was for very much that reason that NHS England decided last year not to interfere with the formula but to give a 2.3% real-terms uplift to all CCGs. The last thing we want to do is to take money away from areas where health outcomes are the worst.

[Baroness Quin (Lab)]

My Lords, does the Minister accept that in the north-east of England huge concern has been expressed about the initial proposals? This has been widely and repeatedly trailed in the press in the north-east. While I welcome what the Minister said about tackling health inequalities, can he give us an assurance that the most vulnerable communities and the most vulnerable people will not lose out as a result of this consultation?

[Earl Howe]

There are two elements to consider here. One is the target allocation, which is what NHS England is currently working on, and the other is the actual allocation—the money given to individual areas. The task for NHS England will be to decide how quickly or slowly to move from current allocations to the target. The key will be not to destabilise any NHS area in that process.

NHS: Spending Formula

Baroness Quin Excerpts

Tuesday 3rd July 2012 Lords Chamber

Asked by

[Baroness Quin]

To ask Her Majesty’s Government whether they intend to make changes to the formula governing levels of NHS spending in the different NHS regions in England.

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

My Lords, from 2013-14, the NHS Commissioning Board will allocate resources to clinical commissioning groups and the Department of Health will make a ring-fenced public health grant to local authorities. The Secretary of State has asked the independent Advisory Committee on Resource Allocation to develop formulae for both CCGs and local authorities. We published ACRA’s interim recommendations for local authorities on 14 June and its recommendations on CCG funding will be published in due course.

[Baroness Quin]

Is the Minister aware of the deep concern in the north-east and other parts of the north of England that if the Government, as has been rumoured, move away from using deprivation and health inequalities as an important criterion, and simply use an age criterion, areas of the north where life expectancy is lower will lose out, compared to more affluent areas in the south? This and other government-trailed proposals, such as regional public sector pay or regionalised benefits, as well as the daily reality of more job losses and more house repossessions in the north than in the south, are adding to concerns that there will be a dramatic worsening of the north-south divide. Will the Minister and his colleagues commit themselves to narrowing that divide, rather than widening it further?

[Earl Howe]

My Lords, yes. I am aware that this has been said, and it is based on a misapprehension, perhaps as a result of misunderstanding what my right honourable friend the Secretary of State said a few weeks ago. He was not suggesting that deprivation should not be a part of the future funding formula, but simply that age should continue to be the primary factor, as it currently is and should be, in the context of our intention to reduce inequalities of access to health services.

Public Bodies Bill [HL]

Baroness Quin Excerpts

Monday 28th March 2011 Lords Chamber

[Baroness Quin]

I, too, support my noble friend Lord Judd in his amendment. I was very struck by the support that, even in a very brief debate, he received throughout the Chamber with the comments of the noble Baroness, Lady Miller, the noble Lord, Lord Marlesford, who, we know, is strongly committed to the national parks, and the noble Lords, Lord Cameron and Lord Maclennan. The Government can be in no doubt about the strength of support for the national parks that clearly exists on all sides of the House.

As my noble friend told us previously, he is a vice president of the Campaign for National Parks. I am not involved in quite the same way, but I would like to thank the campaign for the briefing and information that it is always ready to send to Members of your Lordships' House.

I also thank the Government for clearly responding to some of the concerns expressed the last time that we debated this in Committee. In particular, they removed the national parks and Broads authorities from Schedules 5 and 6 to the Bill relating to the power to modify, transfer or delegate functions. Because of that, it is not surprising that the debate has focused on the continuing mention of these authorities in Schedule 3. I agree with the comments and concerns that have been expressed about this.

Obviously, mention was made of the consultation that has taken place and to which the Minister referred when we dealt with this in Committee. In Committee, he said that he and his colleagues were currently considering the responses to that consultation and were committed to announcing the outcome by the end of March. Well, the end of March is this week. Perhaps this evening the Minister might have something to say about the outcome of that consultation. At the time, he was thinking that we would probably get to this part of Report after Easter. None the less, given the interest and concern about this, we would like to know the preliminary findings of the consultation exercise.

In speaking this evening I want to reinforce the questions asked by my noble friend. The key one is why it is still felt necessary to include these organisations in Schedule 3 given the powers that Ministers already have under other legislation. Are there elements of the changes that the Government want to make that cannot be done via the legislation that already exists? We need an answer to that specific point in relation to national parks—it has been pointed out to me that perhaps the Broads legislation is somewhat different in this respect. What is not available to Ministers under the 1996 Act and other legislation mentioned by my noble friend that is already on the statute book?

We would like a list of the constitutional arrangements that the Minister feels are best dealt with in this Bill and cannot be dealt with by some other legislative instrument. Without information of that kind, what is being proposed still seems too wide, too open-ended and too vague. We are not in a clear position to judge what is in the Government's mind.

As we were reminded today, the 11th report of the Delegated Powers and Regulatory Reform Committee stated that despite the welcome changes that the Government have made in the Bill, the committee is still very concerned about the,

“exceptionally wide delegated powers which remain in clauses 1 to 5 and 13”.

Given that concern and the importance to our country of the national parks and the Broads, we should get some answers to the questions that were well raised by my noble friend and others who took part in this evening’s debate.

[The Parliamentary Under-Secretary of State, Department for Environment, Food and Rural Affairs (Lord Henley)]

My Lords, I will respond to Amendments 31 and 34 in the name of the noble Lord, Lord Greaves. I would like to say to the noble Lord, Lord Judd, that there has been no element of his legs having been broken or anything like that. Sadly, my noble friend Lord Greaves is ill. He is not here, so we wish him well and look forward to seeing him back in due course.

I will also speak to Amendments 46, 53, 57, 58 and 59. Amendments 58 and 59 are in the name of my noble friend Lord Taylor. Amendments 46, 53 and 57 are in the names of my noble friends Lord Greaves and Lord Taylor, which gives some indication of where we are coming from on those issues.

I agree totally and utterly with the noble Baroness, Lady Quin, about the strength of support on her own Benches for the national parks and the Broads authorities. That is true of all Benches throughout this House, and I reiterate it on behalf of the Government.

We had a good debate on this matter in Committee on a similar group of amendments, and on that occasion I explained the Government’s thinking in placing these bodies in Schedules 3, 5 and 6. I shall make things absolutely clear on the scope of Schedule 3 for the noble Lord, Lord Judd, who seemed to imply that the provision could be used in a slightly wider way, with matters from other clauses. We do not think that Schedule 3 could be used to go wider than it is set out, and I hope that I shall be able to cover that matter in due course. We dealt with Amendments 3, 5 and 6, which stemmed from the consultation on the governance arrangements for those bodies, which honoured a commitment in the coalition agreement—our bible—and was run in close co-operation with the national parks and Broads authorities. We asked each authority to make recommendations following consultation on the changes needed for their governance arrangements. We were clear from the start that the objective was to improve the governance arrangements of those bodies and not to remove or replace them. For that reason, they do not appear in other schedules to the Bill—not in Schedules 1 or 2, for example. Our consultation began with these words:

“The Government wishes to retain an independent authority, as currently exists, for each of the National Parks and the Broads. It intends that these authorities should continue to be the local planning authority for their areas”.

The paper then went on to raise a number of questions about what modifications or refinements of the current governance arrangements might be desirable.

In Committee, your Lordships pressed me on the sort of steps we might want to take and on why those could not be achieved without this Bill, perhaps by using powers which already exist in the Environment Act 1995 or the Natural Environment and Rural Communities Act 2006. Of course, at that time it was too early for me to be able to give concrete examples, as we were still at an early stage of evaluating the consultation. I have a slightly embarrassing admission to make, because at that stage I announced that we would have the outcome of our consultation by the end of this month. That has slipped a little, because that takes us into the period of local government elections purdah, and it will not now be until after the elections. At that stage, I still thought that Report stage might be after Easter, but one never knows quite what the Opposition will achieve in delaying government legislation. So there has been a degree of blame on all sides. But we have made significant progress in identifying what might be in our response. As a result, we have come to the conclusion that there is very little likelihood of the powers in Clauses 5 or 6—the powers to transfer functions and authorise delegation—being needed to implement any changes resulting from that consultation. For this reason, I propose to remove the national parks and Broads authorities from the schedules. That is why Schedule 6—because they are the only bodies left in that schedule—will disappear, and Amendments 46, 53, 57 and 58 have that effect. Amendment 59 is a consequential amendment that removes the reference to Clause 6 from Clause 7. Although it is clear that Clauses 5 and 6 are not required to implement necessary changes, the same is not true for Schedule 3, which deals with constitutional arrangements, so I cannot agree to the amendment moved by the noble Lord, Lord Judd.

It would not be appropriate for me to pre-empt or predict the announcement that we shall make after the May elections. However, purely by way of illustration, the House will see a number of the suggestions which national parks authorities have already made. The proposals are—dare I say it?—largely in the public domain, having featured in various board papers produced by the authorities, and elsewhere. They include, for example, the power to remove the requirement for the Secretary of State formally to appoint the members whom parish councils choose and the power to allow non-councillors to be eligible for the parish seats, or to limit the maximum time that all members may serve on a national parks authority. Any of those points, if accepted, could be delivered through Clause 3.

I appreciate that noble Lords might feel that there are other ways of dealing with these things but we think it would actually be easier and better, under the powers in the Bill, to deal with those matters in that way. I therefore hope that your Lordships will agree that it is premature to consider removing Schedule 3 at this stage and that it should continue to stand as part of the Bill. There is no sinister motive behind that; all we are proposing is a power to amend constitutions and all the usual checks and balances are available in the Bill. We want to look at what comes out of that consultation. I have given some hint of that in what has appeared in the public domain but the noble Lord, Lord Judd, will probably know even more—the noble Lord smiles—about what might come from it. I hope that he will accept that this should continue to be part of the Bill.

As I said, we are perfectly happy to remove the national parks and Broads authorities from Schedules 5 and 6, which is why we have tabled our amendments. However, it is quite right that they should remain part of Schedule 3 on the power to modify constitutions. With those assurances, I hope that the noble Lord, Lord Judd, will feel able to withdraw his amendment.