Coronavirus

Baroness Thornton Excerpts

Thursday 12th March 2020 Lords Chamber

[Baroness Thornton (Lab)]

I am grateful to the Minister for repeating the Commons Statement and updating the House this morning. I repeat my noble friend Lady Wheeler’s congratulations to him on his—slightly overdue —promotion to Minister.

Our thoughts and condolences are with the loved ones of the eight people who have, sadly, lost their lives because of this virus. Of course we also join the noble Lord in giving our best wishes to the Parliamentary Under-Secretary of State and to her staff in her department, private office and parliamentary offices, who I am sure will be worried as well. We are now learning that there may be another Health Minister and a couple of MPs self-isolating right now. I also thank the Lord Speaker for keeping us so well informed throughout.

I declare my interest as a member of a local CCG and a health and well-being committee, as in the register. Can the Minister explain what the advice is for those who work on this estate, feel ill and present symptoms, but have not, as far as they are aware, been in contact with the Parliamentary Under-Secretary, for example, or one of the MPs? Should they be tested as a matter of routine?

I also thank the Minister for the advice he has provided on the operation of Parliament. It is quite right that we continue to raise issues on behalf of the public, hold our Government to account, and send a message that we are here to both support and question. We welcome the opportunity to discuss emergency legislation, and I look forward to the Minister inviting a cross-party group of us, as we would normally have in this house, to participate in those discussions in due course.

The Minister knows that we support the actions of the Chief Medical Officer and strongly agree that we must be guided by the science. However, I press the Minister further on the epidemiology and latest medical advice about whether we should move from the containment to the delay stage and adopt further social distancing strategies. What is his response to those who suggest—the editor-in-chief of the Lancet, for example, and others in the global science community—that we are not following the epidemiology in the way we might and are placing too much emphasis on behavioural science?

There are countries taking different approaches across the world. Last night, Atlético Madrid fans arrived—and, as it turned out, celebrated—in Liverpool at a game which would not have been held in Madrid due to social distancing procedures. Can the noble Lord please explain the thinking about why we are not taking more stringent social distancing measures? I have gathered from social media, literally just now, that the Republic of Ireland has decided to close its schools.

We welcome the extra funding for the NHS and social care announced as part of the Covid-19 response fund in the Budget. It is, of course, what we all expected to happen. Are representatives of the Local Government Association and the social care organisations at the table when emergency measures and expenditure are discussed? How will this money be allocated and what will happen when it is depleted? The NHS is seeking to scale up the number of intensive care beds sevenfold. At some point, the fund will need topping up and I hope we will not have to wait until the spending review process in the summer.

The Minister knows that on these Benches we are keen to be supportive, but it is hugely disappointing and astonishing that we still have no clarity on public health funding. I spoke to a director of public health yesterday, and asked if they have their funding agreement, which starts in April. They do not. This is a matter of extreme urgency, so I ask yet again: when will the directors of public health responsible for the coronavirus multi-agency responses know what their allocations will be for the financial year starting in April?

We need to do all we can to support NHS and social care staff, so may I specifically ask about care homes? The NHS Confederation has called for the suspension of Care Quality Commission inspections. Care homes face huge challenges protecting their frail, elderly residents, and chronic staff shortages will be exacerbated by absences if staff contract the virus or need self-isolation. Does the Minister agree, given the circumstances, that the NHS Confederation’s request to suspend those inspections and scale them back is sensible?

I want to ask the Government two more questions. First, do they recognise the burden and risk that the pandemic poses to our charitable and voluntary sectors? Not only will they be expected to deliver support and care during the next few months, but many will see a massive reduction in their income. At the local level, community organisations that care and cater for many different groups, or run cultural, art and community events are all at risk. They will not be able to undertake normal fundraising events, runs, collections and so on. Has any consideration been given to the effect on this important part of our civic infrastructure and how best it can be helped to survive this too?

Secondly, in my work as a member of a CCG, I have picked up reports that communications at the moment may not be working as well as they might be. They seem to be working from the centre down but, at the local level in boroughs and towns, it is the GPs and people working at the front line who need to be absolutely clear about what is expected of them. There are numerous and growing reports that the 111 service is struggling, with delays in responding to emails and organising testing, as well as very long delays in answering the phone. I therefore raise again with the Minister that we need more clarity, more communication and greater accuracy, which I hope is going to happen very soon.

Covid-19 is now an official pandemic as designated by the World Health Organization, and we all have to do as much as we can to help to contain this virus and stop its spread. The Government have our continued co-operation because public health, well-being and safety must come first.

[Baroness Brinton (LD)]

My Lords, I echo the thanks of the Official Opposition to the team for the briefings with Chris Whitty, and indeed for the communications from the Lord Speaker and other staff in the House to keep not only Peers aware of what is going on but the wider staff in Parliament. That is absolutely vital and reassuring.

I want to pick up on the point that has been raised about whether we are in delay or not and the difficulties over the past three or four days, where both Chris Whitty and his deputy CMO have said publicly that effectively we are in delay. We know that this is a transition, not a drop-dead moment—

Coronavirus

Baroness Thornton Excerpts

Monday 9th March 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating the Statement. I shall ask three questions as quickly as I can so that as many people as possible can get in to speak.

My first question concerns vulnerable people in residential homes and the learning disabled who may be being supported, either by charities or at home by their parents. We need to include these people in the planning. I do not expect the Minister to respond to the point, but I will put it on the table. There are lots of people who have not been mentioned but need to be taken into account.

The 111 service is clearly under incredible pressure, given that it apparently took 120,000 calls in the first week of March. I want to ask the noble Lord about the training that 111 staff are receiving. If 700 new people have been taken on, how is their training being accelerated and is it being properly funded?

Finally, when the Select Committee saw Professor Whitty last week, he explained that half of all coronavirus cases in the UK are most likely to occur in just a three-week period. Based on recent trends, have the Government estimated when that peak might begin, and is the noble Lord sure that hospitals have enough bed spaces so that they are able to cope?

[Lord Bethell]

My Lords, the noble Baroness has expressed concerns about those in residential homes and people with learning difficulties. The needs of all the most vulnerable in society are paramount. There is no doubt that intense pressure will be put on social services, social care and clinical care. We are doing all we can to ensure that support is in place, which will include the mobilisation of civil society, charities and volunteers to take up some of the pressure being put on those services.

On training provision, modern call centres have very flexible working arrangements whereby staff are brought on and off contracts. Those who have already received 111 training are being brought back on to the front line. The funds for that are properly in place.

On the timing of the peak, it is impossible to say with certainty when that will be, but the CMO is crystal clear: we will do everything we can to spread it out over the summer and we will keep this House and the public up to date.

Health Protection (Coronavirus) Regulations 2020

Baroness Thornton Excerpts

Monday 9th March 2020 Grand Committee

As a final and important reminder, all of us—including noble Lords—can take actions to support the Government’s response that are simple but effective, such as washing hands and catching coughs and sneezes in a tissue. These and other precautions, including these regulations, are a necessary and proportionate response to protect public health. I commend these regulations to the House and beg to move.

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for that comprehensive explanation of the order. When I started to read the policy background, it all came flooding back to me, having sat in his position in 2008 dealing with amendments put forward to modernise the legal framework for health protection and considering what powers were needed. My first question, therefore, is, why is the 2008 Act not sufficient to cover the eventuality of this virus, when these regulations relate to the 1984 Act? It is just a technical, anorak-type question and I am interested to know the answer.

I have given the Minister notice of my other questions, the first being about the differing legal structures in the United Kingdom, particularly between England and Scotland. Where are the regulations being considered? Are they being considered? Have they already been adopted by the devolved Administrations?

Echoing the brief discussion we just had in the Chamber, a further question relates to when this becomes a serious and imminent threat. In our scrutiny, we need always to focus on whether the orders and the Bill about to come before us give too much power or just enough power to a Secretary of State.

The statutory instrument refers throughout to detention or isolation. Can the Minister explain the difference between them? Is detention where somebody is arrested and detained, and isolation where they stay in their home? What would compel them to do that? I would like that to be unpicked.

Will the measure add significantly to the workload of magistrates’ courts? Has some estimate been made of that, and will it be properly funded?

My next question is about police involvement if people will not take the precautions required of them by law. Can we be assured that the police will be protected appropriately if they have to be involved in arresting or detaining people? That goes for other people involved in incarceration of any sort, because prisons and so on are contained environments that pose their own questions and dangers.

Finally, given that we do not know how long the coronavirus outbreak will last and what will happen, is two years too long a time for these regulations? Would not one year be more sensible?

[Baroness Brinton (LD)]

My Lords, I thank the Minister for his detailed explanation of the regulations. I too have warned him in advance of an area on which I want to focus.

In general, we are content with the principles and are reassured that the Government have made it plain that the measures are a last resort when people will not co-operate and public health is seriously at risk. The points that we are raising are more about the detail of how things will work.

--- Later in debate ---

[Lord Bethell]

The noble Lord, Lord Campbell-Savours, is entirely right to press me on this. I should be honest: obviously, I am not a doctor. However, we have arranged for another briefing from the Chief Medical Officer in Room G at 4 pm tomorrow. He is the epidemiologist who can convey to the noble Lord both the extent and limits of current understanding of the virus. I have sat with him sufficiently long to have the impression that a lot of speculation, guidelines and history are associated with such viruses that we might reasonably apply to this one. However, its behaviours are not fully understood. Although the genome is broken, we do not fully understand its genetic makeup. The advice from the CMO generally is to hold back on pretending to understand things that are not yet fully explored.

[Baroness Thornton]

I say to my noble friend that I would not use the internet as my source of information on any of these issues. I would use the BBC, which has been running extra programmes—in fact, I have just received an email from the head of the World Service listing all the extra programmes that the BBC is producing which will give us lots of advice. Its website is useful. I want to put it on the record to my noble friend that I would steer clear of those sorts of discussions on the internet and look at the BBC’s websites.

[Lord Campbell-Savours]

The great majority of the British population will not go into some of the technical areas that my noble friend would go into. That is why I am trying to find a single source of information for people to be able to go to which is authoritative and gives answers, with the latest information and knowledge available, on each of the questions I have asked. I persist in believing that the Government should arrange for this information to be made part of the public debate, because it would be helpful to everyone concerned.

Health: Maternity Care Provisions in East Kent

Baroness Thornton Excerpts

Thursday 13th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for that detailed Statement, which this issue definitely warrants. Given the measures that have been taken by NHS England and all the parties concerned, why has this trust not yet been put into special measures and at what point will it be? I agree with the Minister about the issue of leadership and culture in this hospital trust. I was horrified, as I am sure other noble Lords would have been, by the chief executive of this trust saying on the BBC that there had been “only” six or seven avoidable deaths since 2011. Actually, that is not true, and I think she said it because she had not read the report produced in 2015. What worries me is that there has clearly been a serious failure of leadership and culture across the whole of this trust, and that statement from the chief executive seems to symbolise that failure. How will the measures that the Government and NHS England are taking address the very serious leadership issues in this trust?

[Baroness Blackwood of North Oxford]

As I said, there has been an unannounced CQC inspection; there is also further engagement with the CQC and we await the findings of its report, which will come forward in due course. In addition, specialist teams have been sent in to ensure that there is robust leadership so that ongoing care is assured and patients can be reassured on that point. NHS England has announced that it will commission an independent review into East Kent so that there is a belt-and-braces approach to ensure the highest possible standards of care there. We can be reassured that the issues raised by the noble Baroness will be addressed and that no stone will be left unturned.

Wuhan Coronavirus

Baroness Thornton Excerpts

Tuesday 11th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for repeating the Statement. Of course, our thoughts are with those who have been diagnosed with coronavirus and are in quarantine. I place on record these Benches’ thanks to our NHS and public health staff.

On the specific issues of quarantine arrangements, we understand the approach the Government have taken, particularly to deal with anyone who seeks to break the quarantine. We understand why the Secretary of State has invoked the regulations; he is entitled to do so under the Public Health Act, and we offer our support for that. Quarantine arrangements must be seen to be necessary, proportionate and in accordance with the law. Their enforcement, including with powers of restraint where necessary, must be fully transparent. The rights and freedoms of the quarantined evacuees must be fully understood to ensure that they are treated with dignity and respect. The media coverage so far certainly suggests that that is exactly the case.

To maintain public confidence in these arrangements, the framework must be understood and scrutinised by Parliament. With that in mind, I ask the Minister when we in this Chamber will deal with the regulations laid. The progress of this virus is rapid; there seems to be rapid change from day to day. We are due to break next week and it seems that 24 February may be too late, because it is moving so quickly. What arrangements are the Government making for us to deal with the regulations in this Chamber?

I feel that I need to declare an interest in the register: I am a member of a local clinical commissioning group. Perhaps the Minister could tell the House what clinical commissioning groups and trusts are being asked to do in terms of making plans in the coming months if this turns into a pandemic. Can she assure the House that local plans are robust and fully resourced? Are we confident that the 111 helpline has sufficient capacity to deal with increased calls? Will the community health trusts that are tasked with visiting suspected patients, and will have to visit people’s homes to carry out swab tests, be given extra resources to build up the capacity to be able to carry that out properly?

Finally, will the Minister update the House on international efforts to share research intelligence and attempts to find a vaccine, as well as the likely timescale? I understand that there is a summit of the World Health Organization today. On behalf of the Official Opposition, I thank all our NHS staff and reiterate our hope that the Secretary of State will continue to keep the House fully informed.

[Baroness Brinton (LD)]

My Lords, I begin my remarks from the Liberal Democrat Benches by echoing those thanks to all staff who are involved, not just on the front line but in the large amount of planning that is going on. We would also like to thank the patients who have self-isolated in calmness, accepting what has happened and moving a long way from home, and those who after flying back from abroad have quite contentedly gone on elsewhere. The advantage of social media, television and radio is that we can hear how they are managing.

I note that the Secretary of State has declared that transmission of coronavirus is a serious and imminent threat to public health, despite the fact that the current situation remains moderate. The regulations for England only—to isolate and hold those at risk of spreading the virus—is, I hope, a last resort. So far, that has not been necessary, but we on these Benches understand that there may be occasions when it is. Will the Minister confirm that the devolved states will follow suit? We would not want Gretna Green suddenly to have a reputation for the wrong reasons, with people trying to remove themselves to somewhere that the regulations do not apply. It seems sensible in the United Kingdom to make sure that there is consistency among the four states.

What safeguards are in place for those conducting the quarantines and isolation to ensure that they are kept safe, along with the patients, and to prevent them contracting the virus?

I note also the regulation that came into force at the end of January, ensuring that no charge is to be made or recovered from overseas visitors who may have to be diagnosed with, or treated for, coronavirus. We believe that that is right, but how is this information being disseminated to healthcare bodies? I see nothing at all about it on the department’s website. The regulation appears for parliamentarians via Hansard, but I can see nothing else anywhere that might help inform hospitals and other bodies.

Today’s Statement from the Secretary of State, the department’s daily 2 pm statement, and the report from the Chief Medical Officer all talk only about those travelling from a number of Asian countries—which the Minister read out in her repeat of the Statement—and who have come from those countries in the last 14 days. This is echoed in the department’s advice to healthcare professionals. So, despite being updated daily—and the number of patients was up to date as at 2 pm today—these Statements do not reflect the fact that some of the eight UK-based cases contracted coronavirus in France, or possibly even in the UK.

Today on radio and television, we have heard a number of experts from China, from John Hopkins University and from UK universities all talking about the possibility of substantial transmission. Indeed, the department has confirmed that this is a high-consequence infectious disease, with all the concerns and constraints that go with it, which include being

“often difficult to recognise and detect rapidly … ability to spread in the community and within healthcare settings … requires an enhanced individual, population and system response to ensure it is managed effectively, efficiently and safely”.

We now have cases in York, in Brighton and its area, and in the specialist receiving hospitals in London and Newcastle, in addition to two GP surgeries in Brighton that have been closed for cleaning. There are local concerns in Brighton about a community centre, and some schools appear to be making the decision to allow children not to come in, after two people were told to self-isolate. But there does not appear to be any formal advice being offered to councils, councillors, schools, prisons and other public bodies. Can the Minister explain why the Statement seems to take no account of what is happening in the UK at the moment? What advice is being given to local councillors, schools and other bodies about early planning for their area, what they should do if a person may have coronavirus, and what happens once they are diagnosed, so that they are ready in the event that there are cases in their area?

I specifically want to mention the role of councillors here. Elected members are often at the heart of their communities, and an informed councillor can calm worries, particularly at the school gate, if they can say that they have been briefed. These days, briefings do not have to happen face to face; there are mechanisms through technology for people to be brought up to date.

Finally, in Brighton, it has been reported in the local media that a number of people with cancer and other long-term conditions are understandably worried about what they should do. They are asked to make sure that they have their annual flu jab, but at the moment there seems to be no specific advice for people regarded as vulnerable patients. Public Health England’s very helpful flow chart on the management of a suspected case runs through very sensibly what to do with the patient, but nowhere does it suggest to ask the patient whether they have any vulnerable people in their family or their contact, nor can I find any advice, anywhere at all, about what primary care doctors should be saying to vulnerable patients in their area—I am thinking particularly of Brighton, at the moment—to make sure that they feel comfortable about this.

These are concerns that could, I suspect, be resolved with effective planning. However, it seems that, at the moment, there is a bit of a lacuna, and I hope that the Minister will be able to help fill the space.

Health: Learning Disability and Autism Training

Baroness Thornton Excerpts

Monday 10th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I declare an interest as a lay member of a CCG, and as someone who is therefore involved in the monitoring of LeDeR and other issues related to this debate.

It is a pleasure and an honour to participate in this debate initiated by the noble Baroness, Lady Hollins, who has probably done more than anyone I know to shift opinion and public policy in this area. I pay tribute to her for that. I hope she will not mind me saying that she is a great example of how expertise and persistence are such an effective combination in your Lordships’ House. This welcome debate should be seen as yet another step on that journey.

All the expert contributions tonight are important, but the theme of all of them is how to combat ignorance and ensure that there is expertise and learning on this from top to bottom of the NHS and our social care system. Like the noble Baroness, I welcome the Government’s commitment and specific inclusion of learning disability and autism as one of the clinical priorities in the long-term plan. However, I echo her questions about the introduction of mandatory training. I am grateful for the briefing we received on this, and I particularly appreciated the briefing from the Royal College of Psychiatrists, which pointed out something that we all know:

“The existence of significant co-morbidities and health inequalities for people with learning disability and autism demonstrates the need for better training across all of health and social care, including psychiatry, to improve patient outcomes and patient experience.”


I am also pleased to learn that the Royal College of Psychiatrists will soon publish its own report,

“on the psychiatric management of autism and Asperger’s syndrome in adults, which include specific recommendations for autism learning objectives within all sub-specialities of psychiatry.”

I think those are the expert’s words for what the noble Lord, Lord Addington, said: if you have met one person with autism, you have met one person with autism.

We know that last year the Government launched

“a consultation on proposals for introducing mandatory learning disability and autism training for health and social care staff”

and received a significant number of responses, including from lots of the organisations that have briefed us all prior to this debate. However, the challenge, as other noble Lords said, is significant indeed:

“There are over 1.2 million NHS staff and nearly 1.5 million adult social care staff in England”


and, as we learned, we have also to consider staff who work in Wales.

My first question is about the progress of developing and testing the learning disability and autism training pack, as well as developing guidance to employers to support them in assessing what level of training staff require. When are we likely to see that?

The noble Baroness, Lady Hollins, posed many of the questions that I thought were relevant here. Does consolidating autism training and learning disability training run the risk of not appropriately reflecting those differences? I am sure that the Minister will have an answer to that question. I echo what has already been said on e-learning, which I do not believe would be sufficient for training and learning in this area. Having been involved as a lay member of a CCG, even at that very low level one is required to undertake a lot of e-learning. We have to learn about safeguarding and conflicts of interest—it is all e-learning. I have done it all, and it is fine, but I am not sure that a huge amount of it stuck in my head. I got through, passing pretty much everything that I was asked to do, but I am not sure that that was the point. In this area, the lived experience of and learning from people who are experiencing these conditions will stick and will be much more relevant. Therefore, just e-learning and training packages will not be sufficient, as expert as the NHS is at producing these online packages for people to experience.

We have heard about powerful lived experiences, and I have been moved by some of the contributions this evening. I was also struck by the briefing from Mencap. I know that the House does not need to be reminded about life expectancy, but I was struck when Dan Scorer from Mencap said that this makes “grim reading”, and by his article in the Guardian last November about the scandalous detention of learning-disabled people.

In other words, there are some serious issues here. I echo what the noble Lord, Lord Sterling, said: we do not need more reviews; we need some action and investment.

Access to Palliative Care and Treatment of Children Bill [HL]

Baroness Thornton Excerpts

2nd reading & 2nd reading (Hansard): House of Lords & 2nd reading (Hansard)
Friday 7th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I congratulate the noble Baroness, Lady Finlay, on getting her Bill here and being persistent, which counts for a great deal in this House. I welcome all the contributions today, particularly that of the noble Lord, Lord Brownlow. I echo other noble Lords in saying I am certain that he will make a great and valuable contribution to your Lordships’ House. I also thank organisations for their briefings. Like many speakers today, I have had experience of dealing with and accessing palliative care for loved ones, in my case at least twice in the last 10 years.

It is important to focus, as this Bill does, on addressing shortcomings in end-of-life care provision by ensuring that all NHS commissioners make arrangements for general and specialist palliative care services to be available to all those who need them. At this point I probably need to draw the House’s attention to my entry in the register of interests as a member of a clinical commissioning group. We all know that there are examples of excellent end-of-life care being provided throughout the UK, but as other noble Lords have said, particularly my noble friend Lord Hunt, there is considerable and unacceptable variation between locations relating to whether people are being cared for in hospital or in the community and their medical condition. The Bill would help in addressing those variations and ensure that high-quality generalist and specialist palliative care is available to all who needed it, as it should be.

We on these Benches welcome the Bill’s ambition to place hospice provision on an equitable footing with all other healthcare services provided in a local area. We are pleased to see the Bill specifically mention hospice access to pharmaceutical services. Pain and other uncontrolled symptoms are frequently cited as the main concern about death and dying. We support the Bill’s provisions that would ensure that clinicians providing general palliative care had access to specialist palliative care advice at all times.

I am grateful for the briefing that I received from Together for Short Lives. I commend it for its wonderful and hard work in this area. I draw particular attention to the fact that it says the growing shortage of skilled children’s palliative care doctors and nurses across England has now reached crisis point so that even the good services are in jeopardy, which is leading to seriously ill children and their families missing out on crucial out-of-hours care and vital short respite breaks. It says that there are too few skilled children’s nurses to fill vacant posts in children’s hospices, with more than half of children’s hospices citing an overall lack of children’s nurses as a significant factor in the vacancy rates they are experiencing. I feel bound to ask the Minister why this clearly-needed service that should be available across the country is not being driven by the NHS and the plans outlined in the long-term plan—or is it going to be? Is it possible to take urgent action to address both adult and children’s palliative care workforce issues in the NHS people plan?

It is of course Clause 2 that raises the most concern for us, as it did for many noble Lords. I was very struck by the briefings that I received from both the BMA and Together for Short Lives expressing their concerns. I will say that everyone will welcome the Bill’s important ambition to support the resolution of differences of opinion through mediation as a non-adversarial approach, although I think the remarks by the noble Lord, Lord Balfe, were pertinent. We would welcome an accompanying commitment from the Government to properly resource mediation and ensure that it is readily accessible across the NHS, because no one wants to end up in court.

The concerns centre on the proposal in Clause 2(4) to change the way that courts consider cases when there are differences of opinion as to what treatment is in a child’s best interests. I absolutely understand how painful and difficult these issues are. The BMA says about Clause 2(4):

“We believe the current approach is preferable and does not need changing. The current approach ensures the court’s starting point and focus is on a child or young person’s best interests, taking into account all relevant factors, including the views of parents.”


Following the remarks of the noble Baroness, Lady Brinton, I think that simply has to be right.

If the current approach is to be changed, we will need to take account of a number of issues. The courts would surely have to consider the views of all those who have a parental responsibility for a child. What happens when people who hold parental responsibilities disagree on what is in the child’s best interests? How would the situation of foster carers holding parental responsibility alongside birth parents be dealt with? That may be fraught. I can see that there might be increased conflict if one person’s parental responsibility is deemed to hold more weight than others. The way the Bill is drafted could lead to one parent’s views being discounted in favour of those of another. The noble Baroness, Lady Brinton, also mentioned the Gillick competence of a 16 or 17 year-old, who may very well wish to cease medical treatment when their parents want to continue it.

Finally, what weighed heavily with me is what Together for Short Lives had to say about this:

“We have concerns that the level of proof required by this Bill to ‘clearly establish’ that ‘any medical treatment proposals put forward by any person holding parental responsibility for the child’ are not actually in a child or young person’s best interests would be too high. Parents’ views and wishes about the treatment of their children are extremely important and, where possible, should always be sought and discussed.


Where disagreements cannot be resolved and the court is approached for a view, courts frequently support parental decisions that are within the range of what could be considered in the best interests of a child. Where disagreements reach the courts, parents need to be able to access support to ensure their views and wishes are adequately represented. Whilst it is entirely understandable for parents to want to prolong their child’s life for as long as possible, we believe the court has a responsibility to ensure that children with life-limiting illnesses are not exposed to unacceptable, painful, unproven, or suboptimal treatments.


We believe that there is a greater risk of children and young people being exposed to these kinds of treatments if this new approach is adopted.”


That is very serious and has to be weighed in the balance when considering this clause.

We on these Benches offer our support to this Bill. We hope that the problems in Clause 2(4) can be resolved and look forward to the Minister’s remarks.

NHS: Targets

Baroness Thornton Excerpts

Thursday 6th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, first, I draw the House’s attention to my interests in the register. I thank my noble friend Lord Hunt for initiating this debate and all noble Lords who have participated. I particularly want to welcome and congratulate my noble friend Lady Wilcox on her maiden speech, which was a model of its kind. I was delighted when she joined us and I am very much looking forward to working with her in the future. I would also like to add my thanks to the Library, the Royal College of Surgeons, the Alzheimer’s Society, Independent Age, Age UK, the NHS Confederation, the Independent Healthcare Providers Network and many others that sent us briefings. I agree with the noble Baroness, Lady Brinton, that their analyses of the scale of the challenge and the solutions were remarkably similar.

My noble friend Lord Hunt and other speakers have set the Minister a challenging task in answering this wide-ranging debate, linking as it does priority targets, the impact of failing to deal with adult social care and the implications of that for patients in the context of what happens to primary healthcare, social care, mental health, public health and capital expenditure, which are all linked and interdependent. I agree with my noble friend Lady Crawley about how debates on the health service in the House of Lords are a love letter and a post-it note. My contribution is probably the latter.

The Government must own the effects of 10 years of austerity. They are not a brand new Government, as the Prime Minister would have us believe, but a continuation Conservative Government, and they cannot pretend that that the fact that our social care system is completely failing millions of people is a newly acquired responsibility. It is as a result of a deliberate action to starve this sector that we face NHS buildings and infra- structure which are crumbling and a danger to patient safety, that we are nowhere near parity of esteem in mental health in terms of spend or access, that public health is unable to deliver true prevention because of the cuts to local government spending, that parts of the NHS are, as the NAO reported, “seriously financially unstable” and that trusts and CCGs are building up debt.

Thus it is not surprising that, as my noble friend Lord Hunt tells us, the NHS is simply not able to meet the targets which are enshrined in the NHS constitution. While it is welcome that the long-term plan recognises that health and social care go hand in hand, we have yet to see the action and funding which will address the social care challenge. We will soon be discussing the NHS Funding Bill, which some might call window dressing. It is a testimony to a Government who must put into legislation a promise they have made to ensure that they keep it. That is a matter we will be discussing in a few weeks’ time, when there will be another opportunity for the Minister to address some of these issues.

I shall not repeat the statistics that noble Lords have adequately outlined, but at present it feels as if we are at a tipping point and the NHS is slipping back to the years before the last Labour Government, who of course made the historic investment and basically turned around the NHS to leave it in pretty good shape in 2010. However, I agree that we need to look forward, and the Government must make very good use of the resources they are already committing. Any news from the Minister about the likely outcome of the Budget and the spending review would be welcome, and some expansion on the Prime Minister’s declared intention to sort out social care would also be welcome. What exactly is his plan?

Given that I have served on a CCG for the past three years, noble Lords will not be surprised to hear that I intend to start by focusing on primary health care and its importance in future plans. I can bear witness to the tireless work of GPs and their commitment, and their staff’s commitment, to ensure that all patients receive high-quality care when they need it. I also witness the fact that front-line local healthcare is often under threat from funding being sucked out of the system by huge trusts with the push-me-pull-you funding formula that is still apparent in the system. I am pleased that there is some recognition of that in the long-term plan and that that will be reflected in the next round of NHS England’s planning process.

I echo my noble friend Lord Young’s story about his GP’s surgery. I think the Minister will recognise that, if the workforce and the funding for primary care are not sufficient and stable, the knock-on effect for acute services will be deleterious and significant. Along with the general NHS staffing crisis, there is a GP work- force crisis, and I wonder whether the Minister can update the House on how the delivery of 5,000 additional GPs and 5,000 additional staff in England is going. I am very proud of the work of the past three years in primary care delivery in Camden, with our innovative patient care-led commissioning, and I am very keen for that not to be lost in the latest reorganisation that is now under way. Clinical and lay members on CCGs all over the country are anxious that local primary care should not be lost in the creation of ICSs.

The social care system is broken, as many noble Lords, including my noble friend Lady Pitkeathley, and the noble Lord, Lord Turnberg, said. It is ignoring 1.5 million people with unmet needs, leaving carers to feel alone and unsupported in caring for their loved ones, and it is costing people their life savings. Age UK says that the social care crisis, with delayed discharges from hospital due to a lack of social care, is costing our NHS an eye-watering £500 every minute.

As a Labour and Co-operative Member of your Lordships’ House, I will take this opportunity to urge the Minister to look at a new model of social care that uses the principles of co-operation to build on the first-hand knowledge of those who rely on, receive and provide care. I urge her to read the report of yesterday’s debate in Westminster Hall, which explored this very positive proposition. It requires commissioning authorities and central government to recognise that co-operation and mutuality could provide some answers in this sector.

Thousands of people’s lives have been on pause as a result of underfunded mental health services over the last decade. My noble friend Lady Gale outlined the issues around Parkinson’s. There is a desperate need for the 19,000 new mental health workers promised in the next year. That is important not only because hundreds of thousands of people need care but because continuing not to resolve this problem has a knock-on effect on primary and secondary healthcare and social care. All these issues are interlinked.

On public health, I will say only that it really is time that there was real recognition that investment in prevention saves billions further down the line, so let us see that that actually happens. Let us not leave public health at the whim of the spending regime in local authorities whose funding has already been cut, because that is completely counterproductive.

On targets, I am concerned that the Government’s review of NHS clinical standards, including piloting the introduction of new average waiting times for elective care, is a problem. Does the Minister agree that the introduction of the 18-week target is a worthy achievement that should not be jeopardised by this review? The noble Baroness, Lady Watkins, made some very interesting points about how to reduce the pressures on, and redirect people from, accident and emergency departments through investment in GPs, primary care and minor care. She is absolutely right. However, there also needs to be an incentive to keep accident and emergency departments on their toes. We do not want to slip back to people waiting on trolleys in accident and emergency for 12 hours.

In conclusion, it is completely clear from this debate and from the briefings that we have all received that these wide-ranging issues are interlinked and inter- dependent. You cannot divorce primary care, mental health, the capital investment required, public health and secondary care from one another. That is why the long-term plan needs to be a longer-term plan and why it needs to take all these issues into account. The spending needs to be integrated so that we do not feed one side of the National Health Service while the other side—social care—puts such pressure on the system that it cannot possibly succeed. I look forward to the Minister’s response.

Health: Tinnitus

Baroness Thornton Excerpts

Wednesday 5th February 2020 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of the impact of tinnitus on the mental health of those affected.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we recognise the debilitating impact that tinnitus can have on people’s lives and that for some the condition can lead to mental ill-health, including suicidal thoughts. That is why we have commissioned NICE to develop clinical guidance on the assessment and management of tinnitus. This is expected to be published in March and will help raise much-needed understanding about the condition.

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for that Answer. Given that this condition causes enormous misery and is, we are told, incurable, and given that research has shown recently what a detrimental effect it can have on the mental health of sufferers, I have two questions for the Minister. I am very happy if she needs to write to me with the answers. First, how much is the NHS spending on research into the causes and cures of tinnitus? Secondly, if there are cures—if you google tinnitus, you will see that many products out there on social media claim to cure it—have any of these been approved? Are they in the system for approval? If so, when will they be available on prescription?

[Baroness Blackwood of North Oxford]

I am happy to pay tribute to the British Tinnitus Association, which has raised the issues this week—it is Tinnitus Week—for its research. I thank the noble Baroness for her question. I will be happy to write to her on the specifics of the tinnitus treatments. Of course, tinnitus is often linked with acoustic neuroma, hearing loss and a number of other conditions, including mental ill-health. There are some treatable causes, which GPs look for, but there can be others related to mental ill-health. The cause of tinnitus is unknown; it cannot be treated. Talking therapy will be prescribed, and a lot of those treatments are already available on the NHS and on prescription. I am happy to send that information to the noble Baroness in writing.

There is obviously research available via the NIHR. We spend more than £90 million on NIHR research, and £15 million of this is spent via biomedical research centres at Manchester, UCL and Nottingham. Nottingham undertakes specific research into deafness and hearing problems, including tinnitus and hyperacusis. If the noble Baroness would like further detail, I am happy to write.

Paterson Inquiry

Baroness Thornton Excerpts

Tuesday 4th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating the Statement made by the Health Minister in the Commons today. Two hundred and eleven former patients of Paterson, or their relatives, shared their experience with this inquiry. This report makes for harrowing and appalling reading, as the Minister said. Ian Paterson wilfully abused the trust placed in him by patients at their most vulnerable. At his hands, hundreds of women underwent extensive, life-changing operations for no medically justifiable reason. His unregulated cleavage-sparing mastectomies, in which breast tissue was left behind, meant the disease returned in many of his patients. Others had surgery they did not need and needlessly lived under the shadow of cancer for many years. This should never have been able to happen, let alone go on unchecked for so long.

As the Minister has done, I pay tribute to the courage, tenacity and persistence of many of these women and their families in exposing the injustice. I thank the panel, under the leadership of its chair, the right reverend Graham James, for uncovering the extent of Paterson’s malpractice and the systems that allowed it to continue despite repeated warnings.

The victims of Paterson’s malpractice were let down time and again by the NHS trust and an independent healthcare provider, which failed to supervise him appropriately and did not respond correctly to well-evidenced complaints about his practice, and by the wholly inadequate recall procedures in both the NHS and the private sector. The report identifies failures on the part of individuals and institutions, saying that

“a culture of avoidance and denial”

meant that those working closely with Ian Paterson did not spot his behaviour or were unwilling to challenge it. On the contrary, the report concluded that

“Paterson’s behaviour and aberrant clinical practice was excused or even favoured.”

What action does the Minister propose to support a change in the culture of the health service that encourages staff to speak up?

There is a potent example on page 130 of this report:

“The operation and awarding of practising privileges is defined in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 … Practising privileges are based on the ‘scope of practice’—that is, the procedures a consultant is competent to perform in the independent sector are based on what they undertake in the NHS … In Paterson’s case … he did not limit himself to operations he was competent to perform in the independent sector. He was undertaking operations and procedures he did not do in the NHS. Measures to monitor and limit this at Spire were inadequate.”


What has changed? Is this still the practice in the private sector? Indeed, is it still the case that private hospitals incentivise referrals from consultants who have been given shares in their private hospitals? That is what the report suggests.

Can the Minister confirm that the Government will urgently bring forward legislation to give private patients the same protection provided by the NHS, as called for by the lawyers representing hundreds of Paterson’s victims? The Centre for Health and the Public Interest has called for Paterson’s income and earnings, as well as the profits made by Spire Healthcare, to be treated as income from criminal acts, which could mean that they could be reclaimed. Can the Minister advise on whether this aspect has been referred to the CPS?

The Independent Healthcare Providers Network, which represents the sector, has already said that more needs to be done to ensure that information is shared between the NHS and private companies about their doctors. What action are the Government taking to facilitate this information sharing?

We cannot undo the awful harm that Paterson’s criminal action has caused so many, but we must act to ensure that lessons are learned and changes made so that something like this does not happen again. This report must not remain on a shelf to be forgotten, because it is clear: this was not just the act of a rogue, lone surgeon; systemic organisational failures were at fault as well. Fundamentally, it is time we addressed the question of safety in private healthcare providers and the way in which clinicians can operate in private providers with little oversight. I would be grateful if the Minister could share her thinking about this with the House.

The inquiry makes a number of recommendations about transparency and accountability, and I hope the Government mandate health bodies to implement those quickly. As the Minister said, the fight that the patients had to make for compensation was shameful.

Around a third of all private hospital income now comes from NHS procedures such as hip replacements, hernia repairs and cataract procedures, yet safety standards in the private sector often leave much to be desired. How is the NHS addressing patient safety in this regard? Apart from anything else, there are very few critical care facilities available in private hospitals, so patients are transferred to NHS hospitals when things go wrong and complications occur. I would like to know whether private hospitals can be held liable for this use of the NHS. The previous Secretary of State wrote to the private hospital sector in 2018, telling it to get its house in order on patient safety, and he was absolutely right.

If it is decided that the Government wish to legislate on this matter, I urge them to do so swiftly and bring forward proposals. I promise the Minister that she will have constructive co-operation from these Benches, so let us get on with it.

[Baroness Brinton (LD)]

My Lords, I echo the points just made about the speed of the Government’s reporting. It is extremely helpful that the Minister in another place apologised clearly for the failures in the system and paid tribute to the victims. I too pay tribute to them and their families for their tenacity over many years, when it was clear that something was going wrong but the people who were in a position to gather information and do something chose not to.

The Statement says:

“I can promise the House a full response in a few months’ time.”


This public inquiry has rightly taken two years—it was slightly delayed by the general election and purdah—but it was clear in 2017 what many of the issues were. The excellent report from the Centre for Health and the Public Interest published in November 2017 entitled No Safety Without Liability: Reforming Private Hospitals in England after the Ian Paterson Scandal set out in a slightly different format many of the recommendations in front of us. I am sure that the Department of Health, the NHS and the independent hospitals will have looked at those recommendations.

I ask the Minister right up front: how long will it take before recommendations come back to the House from the Government on where they want to take things? After all, we have a Bill that is almost ready to go—or perhaps, as I said yesterday on the Second Reading of the Birmingham Commonwealth Games Bill, Groundhog Day is coming around again for us. Let us use that opportunity, at the very least, to remedy the obvious shortfalls in the system.

One of our major concerns is regulation of indemnity procedures for healthcare. There are serious shortcomings that must be dealt with as soon as possible. I was extremely concerned to read in the recommendations about the arrangements private hospitals have with clinicians to carry out their own activities that are rather like self-employed contractors almost renting an out-patient desk and in-patient beds. That is similar to renting a barber’s seat but without the overseeing regulations you need when people’s lives and health are absolutely at risk. That must be managed immediately.

Independent hospitals must take responsibility for their actions, so it is good that one of the key recommendations tries to focus minds on filling the gap between responsibility and liability. The report from CHPI two years ago said that this was vital and that independent hospitals must employ doctors and healthcare professionals, because without that responsibility on their behalf they will continue to wriggle out of liabilities and choose not to monitor clinical practice, missing either ill-meaning or incompetent surgeons. That cannot happen in the NHS and trusts have to take responsibility, as they do when things come to light. This hole in the current system needs to be remedied swiftly.

The inquiry also makes the important point that boards must apologise meaningfully and as early as possible. The UK health system, whether NHS or independent, has an extremely poor record of apologising, or of even commenting at all. Worse, it often tries to bury problems, denying whistleblowers any access. I am afraid that this is part of the systematic culture exposed in this very important inquiry—one that fears liability above apology and, equally importantly, does not learn well from mistakes, especially if through malpractice.

It is shocking that patients were often not guided to the Parliamentary and Health Service Ombudsman or the Independent Sector Complaints Adjudication Service. Compare that with the Financial Ombudsman Service: financial services companies must signpost access to the ombudsman at every step of the way when people buy financial products. A financial service problem could result in a loss of money, but a medical problem could end up changing lives for ever, as in the Paterson cases, so when will the Government deal with this issue? Will there be compulsory signposting for patients and clarity over whether all independent hospitals have to sign up to an independent complaints adjudicator—preferably just one, but I understood from what the Minister said in another place that they cannot regulate the independent sector completely? Frankly, as far as healthcare is concerned, my party believes we should.

Once again, the Paterson case demonstrates the need for effective whistleblowing processes. Will the Government commit to an office of the whistleblower to, through legislation, give more protection to patients, whether they are in the NHS or the independent sector? Spire Healthcare has said that it has put more measures in place to encourage staff and patients to speak out since the Paterson case, but even the Statement refers to there still being problems in Spire Healthcare. This just demonstrates that this is not working. Paterson’s victims are very clear: we need a system within the NHS that protects patients and staff. That is equally true of the independent sector.

I end by repeating my initial question: can we please have a timetable for the Government to come back to Parliament with proposed changes, given that a Bill is waiting that could easily be amended for both Houses to attend to speedily?