NHS Dentistry Services

Baroness Thornton Excerpts

Thursday 11th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I am very sorry to hear of my noble friend’s experience with the Mayor of Manchester. Children’s oral health is now better than it has ever been, with more than 75% of five year-olds in England being decay-free, which we welcome. However, the number of children requiring tooth extraction remains a concern. It fell slightly between 2016 and 2017-18, which we welcome; however, we recognise that there is much more to do. That is why the NHS outcomes framework is working to ensure that we perform better, with much work being done to target improved oral health of young people, with the Starting Well core framework and Starting Well pilots in the 13 areas of greatest deprivation.

[Baroness Thornton (Lab)]

My Lords, in Portsmouth there are 20,000 patients without a dentist, due to the closure of three practices. In Cornwall, 22,000 people are on the waiting list, having to wait an average of 529 days before they get an NHS dentist. The noble Baroness is quite right that there are some serious problems to address here about access to NHS dentists. I should like to know exactly how those areas in desperate need, such as Portsmouth, will be tackled. Secondly, how many of the babies, children and young people included in those numbers currently have no dental care whatever?

[Baroness Blackwood of North Oxford]

As I said in my previous answer, children’s oral health is better than it has ever been. This is not to say that there is any complacency or acceptance of where we are. We recognise that while access has significantly improved, there are still areas where NHS England needs to do more to meet local need. NHS England is responsible for helping patients who cannot find a local dentist. Those in that situation should contact NHS England’s customer contact centre for assistance. Things that are being done to improve this include the introduction of new nationally flexible commissioning, which can help national commissioners commission a wider range of services from dental practices, and the testing of a new, reformed dental contract, which we think will make the profession more attractive for new dentists.

Restaurants: Calorie Labelling

Baroness Thornton Excerpts

Tuesday 9th July 2019 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of Diabetes UK’s Food Upfront campaign and petition; and how many businesses they estimate will be affected by the introduction of mandatory calorie labelling in restaurants.

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

My Lords, we welcome the ongoing commitment of Diabetes UK, including the Food Upfront campaign, which, together with its encouraging support for our proposals, makes a valuable contribution to improving the nation’s diets. The impact assessment published alongside our consultation last year estimates the number of businesses that will be affected under the various policy options considered. An updated impact assessment will be published when the Government publish the outcome of the consultation later this year.

[Baroness Thornton (Lab)]

I thank the noble Baroness for that Answer. It is a shame that the consultation, which ended in December, has yet to be published. Diabetes UK tells us that three out of four people want to see calorie information on restaurant, café and takeaway menus, and that nine out of 10 say that clearer food labelling will help them make healthier food choices. Diabetes UK is worried that the Government intend to limit compulsory calorie labelling to companies with 250 employees. If that is the case—I would like to know whether it is—only 520 businesses would be included out of the 168,000 eligible, rendering this meaningless. What are the Government doing in this regard and when will we see the results of the consultation?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important question. She will know that we remain committed to delivering the actions we set out in chapter 2 of the childhood obesity plan, which included the consultation on calorie labelling in the out-of-home sector. We will publish it shortly. She will also know that our ability to introduce changes to the labelling system depends on EU legislation. We are committed to exploring whatever additional opportunities we can to have food labelling in the UK display world-leading, simple nutritional information, as well as information on origin and welfare standards. We will bring that forward as soon as possible.

NHS Pensions: Taxation

Baroness Thornton Excerpts

Tuesday 9th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important Question, which she has asked before. Retaining and maximising the contribution of our highly skilled clinical workforce is crucial to the delivery of patient care. We are preparing to provide pension flexibility that appropriately balances the benefit of new flexibilities with their affordability. We have listened, and we are discussing the issue with the Treasury. As a first proposal, the consultation will set out a potential 50:50 option, offering 50% pension accrual and halved contributions. The BMA requested this as an option earlier this year and has welcomed it as a step in the right direction. The consultation will be an opportunity to listen to a range of views and will be genuinely flexible and open; we will bring it forward as a matter of urgency. I hope that that is a reassuring answer for the noble Baroness.

[Baroness Thornton (Lab)]

The briefings that I have received from the BMA and other places say that the 50:50 solution may not prevent the problem. How many people will have to wait longer for their operations before the Minister’s colleagues, the Chief Secretary to the Treasury and the Secretary of State for Health and Social Care, concentrate on their day jobs—that is, getting together and talking about how to solve this problem instead of campaigning for whoever they are campaigning for to be the leader of her party? Surely their time could be better spent sorting this problem out.

[Baroness Blackwood of North Oxford]

The noble Baroness knows that I cannot answer for the Chief Secretary to the Treasury, although I know that this issue has been raised with the candidates as part of the leadership campaign and that they see it as a priority. As I said in my Answer to the noble Baroness, Lady Finlay, we recognise that the 50:50 flexibility option does not provide unlimited flexibility for clinicians to target their own personalised level of pension growth. Other options, such as additional pension accruals to purchase individual units alongside a pension, may be considered as part of the consultation. The message going out to the sector is that we want as much flexibility as possible to try to find the right solution to meet the complex needs of the system.

Academic Health Science Centres

Baroness Thornton Excerpts

Tuesday 2nd July 2019 Grand Committee

[Baroness Thornton (Lab)]

My Lords, I join everyone in thanking the noble Lord, Lord Butler of Brockwell, for putting forward for discussion this important subject of the future of the academic health science centres. I thank the noble Baroness, Lady Masham, for asking: what about Yorkshire? I say that as a Bradfordian.

We could probably have done with at least another hour to do justice to this subject and indeed to the distinguished speakers who have taken part, such as my noble friend Lord Darzi. We have four ex-Ministers here, and then the Minister herself. It is all right; I have been in rooms like this with virtually everyone in the room knowing more than I do about the subject being talked about.

I think we would all agree that these health centres provide essential research in medicine, clinical trials, cancer treatments, mental and physical health integration and much more. At a time of such uncertainty regarding our collaboration with Europe colleagues to conduct health science research due to Brexit, it is vital that we have clarity on the next steps for the academic health science centres in the UK. I agree with the noble Lord, Lord Prior, about the lack of ambition regarding finance, funding and our position on research. I am not sure that I quite understood whether he thought that Brexit was a good or bad thing for the future of research, and I will come back to that.

I have declared in the register of interests that I am a member of the Camden Clinical Commissioning Group, so I am at the foothills of the NHS. However, I am aware of the research done by Moorfields and UCL on, for example, laser treatment for glaucoma, which is important to our CCG. The treatment is said to have had high success rates, with the research suggesting an annual saving to the NHS of £1.5 million in direct treatment costs, potentially rising to £250 million if the treatment proves beneficial for patients with later-stage glaucoma. In Camden CCG, we are proud that our area has many major research centres—Moorfields, UCL and Great Ormond Street—and regard our job as primary care commissioners as being to make sure that we co-operate with them.

I return to Brexit. One of the health science partners, the University of Cambridge, stated:

“Both the NHS and the UK life sciences industry desperately need clarity and certainty to plan successfully for Brexit, and time has almost run out”.


That was in March, but it remains true, and the Government must consider what solid solutions can be offered. If we fall out of the European Union at the end of October, that presents an enormous challenge to the centres. It makes it more important that they exist and receive sufficient funding, I agree, but the collaborations that need to be carried out across Europe and the world seem to become more difficult. I would like the Minister’s view on that.

Lung Health

Baroness Thornton Excerpts

Monday 1st July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord is right to praise the success that we have had in smoking cessation in this country. We now have the lowest rates of smoking that we have ever had, some of which is because of the work of local authorities and PHE. He is right to identify the need to target the variation and inequalities. We are targeting this through the prevention Green Paper and we identify the need for a sustainable funding settlement through the spending review allocation.

[Baroness Thornton (Lab)]

A study of over 38,000 people with chronic obstructive pulmonary disease found that opportunities to diagnose were missed in 85% of patients in the five years before their diagnosis. My mother was probably included in that number. Will the Minister commit to introduce target case findings in general practice for people who have symptoms suggestive of COPD with follow-up care and services? How do the Government intend to eliminate the postcode lottery that exists in the quality of and access to COPD treatment?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right: COPD is the second most common lung disease in the UK. It is disturbing that around a third of people, in their first hospital admission for COPD, had not been previously diagnosed. NHS RightCare is developing a COPD pathway, which is being rolled out nationally through clinical commissioning groups, to identify the core components of an optimal service for people with COPD to ensure earlier diagnosis and better management, so that they do not experience the concerns that she has identified.

NHS Long-term Plan

Baroness Thornton Excerpts

Monday 1st July 2019 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for repeating the Statement and refer the House to my interests as listed in the register.

It is 71 years this week since the Labour Party created the NHS in 1948; it will also be a Labour Government who will turn around the NHS again, as we did from 1997. As the Minister will know, I welcome the things we agree on: alcohol care teams, perinatal mental health services, a greater focus on health inequalities and enabling gambling addiction services; all Labour ideas, of course. Even today the Minister—or rather, her right honourable friend—talked about bringing hospital catering in-house, which is another Labour idea.

The Minister has focused on three important matters in this Statement, but I have some questions about other matters that it contains. I want particularly to raise the question of support for local systems. Increasing the focus on population health in the long-term plan is of course very welcome. Can the Minister explain how STPs will become ICSs by April 2021, with all ICSs—I apologise to the House for using all these acronyms—reaching “mature” status, as described in the recently published ICS maturity matrix? Will the Minister also explain how the provider and commissioner landscape will develop, with a new integrated care provider contract due to be published this summer to provide guidance on how primary care can be integrated with secondary and community services?

The long-term plan rightly has prevention at its heart. Will the Minister set out how the Government will work with local authority partners to take forward prevention activities on obesity, smoking, alcohol, sexual health, antimicrobial resistance and air pollution, including how they will use the additional targeted funding being made available to support this series of activities?

At a time when life expectancy is stalling and infant mortality rates—the rate of children not making it to their first birthday—have risen three years in a row for the first time since World War II, vital public health services that tackle inequalities have been cut by £700 million. We all know that the NHS’s ability to plan for coming years is dependent upon a well-resourced adult social care system; of course, adult social care budgets have been cut by £7 billion. Also, we still await the social care Green paper. Will the arrival of a new Prime Minister hasten or further delay further its arrival? How can system-wide reform be delivered, as aspired to in the long-term plan, under these circumstances?

On staffing issues, we have 100,000 vacancies and are short of 40,000 nurses; at the same time, bursaries have been scrapped, CPD budgets cut and the no-deal Brexit we seem to be preparing for will exacerbate the staffing crisis. I noted and welcomed the interim NHS People Plan published by the noble Baroness, Lady Harding, but when will we see a workforce plan backed up by actual cash? It cannot be delivered unless this happens. The Government talk about IT systems but give no certainty on capital investment. Hospitals are facing £6 billion-worth of repairs, with walls crumbling, ceilings falling in, pipes bursting and outdated equipment stalling. Maintenance designated to address “serious risk” has doubled to £3 billion. Will this backlog also be tackled?

I turn briefly to mental health. We know that more than 100,000 children are denied mental health treatment each year because their problems are not judged “serious” enough. Over 500 children wait more than one year for specialist mental health treatment. When the Minister talks of a fundamental shift, does she mean that the Government will ring-fence funding? Given that just 1.6% of the public health budget is spent on mental health, will the Government insist that more is spent on mental health resilience and prevention?

Finally, I want to ask about next steps. It is my understanding from the Statement that a national implementation plan to be published by the end of the year will bring together the aggregated ICS/STP plans and national activities with performance trajectories and milestones to deliver the long-term plan commitments. However, it notes that the development of the national plan is contingent on the spending review, due to the need to account for decisions on workforce, social care, public health and capital budgets. Due to the uncertainty in the current political environment, will the spending review be delayed, and will that set back the development of the national plan beyond November?

The national plan states that the NHS needs to,

“remove the counterproductive effect that general competition rules and powers can have on the integration of NHS care”.

I say Amen to that. But are the Government now willing to admit that the Health and Social Care Act of the noble Lord, Lord Lansley, has had a devastating effect on the NHS? Will the Government bring forward primary legislation to achieve the objectives set out in the long-term plan?

[Baroness Jolly (LD)]

My Lords, I too thank the Minister for reading the Statement. I feel I should get out an orange flag—I am probably wearing the right colour—because, in the 1940s, Liberals were orange, not a yellowish colour. Beveridge, whose paper proposed the National Health Service, was indeed a Liberal and his proposal was for a service,

“free at the point of need”.

Anyway, I will get back to the Statement. I welcome the Secretary of State’s commitment to cancer and mental health services and workforce growth—who would not? But the Statement does not refer to the local five-year strategic plans to be completed by mid-November and rolled out thereafter. These will involve local consultation and incorporate performance trajectories and milestones across health and social care; they are truly the plans to implement the Secretary of State’s plan. The Statement mentions funding but is quiet about how much. I guess that is quite understandable given the position of the Government, who do not know who the new leader will be let alone his priorities.

The NHS is crying out for more capital: diagnostic and treatment equipment these days is big and very expensive; those of us who have been into English hospitals recently will notice that the buildings are looking sadder than they did 10, 15 or 20 years ago; and workforce shortages are mentioned. Will the Minister tell us when we can expect the NHS to be fully staffed and appropriately equipped? There is no mention of widespread regional variation in outcomes: by when will these be no more? Can the Minister explain how the areas for concentration will be managed? Will management be top-down or bottom-up, reflecting local needs?

Will the Minister also tell the House about any conversations regarding more funding for adult social care? I shall not say any more about the Green Paper. Public health services are critical to help people deal with obesity, stop smoking and become fit, so living longer, healthier lives. All these are critical matters for local authorities. The Statement barely mentions social care but, without an injection of staff and funding, it will fall, and with it the Secretary of State’s laudable visions for cancer treatment and mental health.

Carers: Support

Baroness Thornton Excerpts

Monday 17th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I am sorry if I have given the impression to the noble Countess that action has not been happening now. I can outline that the Government have been taking ongoing action to support carers. The Care Act 2014 introduced important new rights for carers, putting them on the same footing as those whom they care for. Through the Better Care Fund, the NHS has contributed £130 million for carers’ breaks. The Carers Action Plan, published in 2018, set out a broad, cross-government programme of work to support carers, which included 64 points which have been delivered since that time. A review will be published in July. A £5 million Carers Innovation Fund to support innovation was announced just this week and will include innovative ways to improve care for patients. This is all ongoing work which is helping carers now, but we recognise that it is not enough, because carers deserve the very best. That is why we will continue to strive to improve support for carers within the system going forward.

[Baroness Thornton (Lab)]

My Lords, according to Carers UK, 8.8 million people are carers in this country—that is up 2 million since 2011. Are the Government reviewing the funding provided in last year’s Carers Action Plan to take account of that? What discussion is the Minister’s department having with the department that funds local government? That is the nub of the problem: austerity has starved local government so that it cannot provide the right kind of care, and carers all over the country are suffering as a result.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question. Of course, £10 billion has been provided for adult social care between 2017-18 and 2020, with an extra £240 million for adult social care to reflect winter pressures and an extra £410 million to improve social care for older people, people with disabilities and children. However, the noble Baroness is absolutely right that a sustainable long-term plan for social care is part of the discussions taking place on the spending review and as part of the Green Paper planning. The consideration of dedicated employment rights and reviewing financial support for carers is part of those discussions.

National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2019

Baroness Thornton Excerpts

Monday 10th June 2019 Lords Chamber

Moved by

[Baroness Thornton]

That this House regrets that the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2019, in the rate increase that the National Health Service pays to care homes to cover the costs of services, include an unrealistic “efficiency expectation” of 3.1 per cent that may lead to further shortfalls in social care funding; and further regrets that Her Majesty's Government still do not have a long-term funding package for social care, which is urgently needed to alleviate financial instability in the care home sector (SI 2019/789).

Relevant document: 47th Report from the Secondary Legislation Scrutiny Committee

[Baroness Thornton (Lab)]

My Lords, first, I declare my interests as outlined in the register.

If ever a statutory instrument were crying out to be discussed on the Floor of the House, this one must rate pretty highly for a number of reasons, not least the instability in this sector and the lack of, and disgraceful delay in bringing forward, a long-term strategy for the social care sector. I might do the parliamentary equivalent of a scream if the Minister uses the words “soon” or “imminent” with regard to the strategy.

The somewhat dry words of a statutory instrument, particularly this one, conceal a reality—the lives and security of people for whom we have a responsibility as a society, as family members and in our communities, and this is the reason for my Motion to Regret. Each threat to a care home that houses the oldest and most vulnerable people in our community means, literally, that people will die. They will die when they are moved or they will become ill from the stress of not knowing what the future holds for them or where they might end up living. They wonder whether the people who look after them will be kind and caring.

At the beginning of Carers Week, this seems an appropriate debate. Carers care for their loved ones in their home, but there are also many carers who support their loved ones in residential care when caring at home becomes impossible and too demanding, particularly for older carers.

This instrument increases the rates that the NHS pays to care homes to cover the costs of services that must be carried out by a registered nurse, called the FNC rate. As noble Lords know, accommodation and social care costs are the responsibility of either the local authority and/or the individual, subject to the outcome of a needs assessment and financial assessment.

The 4.7% increase this year is influenced by the outcome of a Supreme Court case on the Welsh FNC rate and by a subsequent review by LaingBuisson. Information about this is helpfully included in appendix 1 of the Secondary Legislation Scrutiny Committee report that goes with this statutory instrument. The rate that has been set includes a 3.1% “efficiency expectation” of nursing home providers. Given the recent reports in the press about financial instability in the care home sector, it begs the question of how realistic that assumption is. These changes took effect on 26 April 2019, rather than 1 April as is usual, and the Department of Health and Social Care published a statement on 5 April saying:

“The findings of the study were delayed, following requests to improve the robustness of the data collected and an increase to the sample size of surveyed nursing homes. With an overall budget of approximately £675m for NHS-funded Nursing Care in 2018-19, any changes to the NHS-funded Nursing Care rates have significant financial consequences for both the NHS and nursing home providers”.


The background to the additional information that the Department of Health and Social Care has provided is that in August 2017 the Supreme Court ruled against the Welsh local health boards on how they had set the FNC rate in Wales. The administration and operation of the Welsh FNC rate is separate from the rate in England. However, the basis for FNC in legislation is very similar in Wales and England, and the judgment of the Supreme Court also impacts on how the Secretary of State for Health and Social Care must set the FNC rate in England.

The Supreme Court judgment set out an expanded definition of what constitutes nursing care by a registered nurse and stated that the FNC rate should pay for the costs of everything within that definition—that is, direct and indirect time on nursing care; paid breaks; time receiving supervision; stand-by time; and time spent on providing, planning, supervising or delegating the provision of other types of care which in all the circumstances ought to be provided by a registered nurse because they are ancillary to, closely connected with, or part and parcel of the nursing care which the nurse has to provide.

That definition is being applied to the FNC rate in the context of the LaingBuisson study, which has shown that FNC costs have continued to increase at a sustained and above-inflation rate since the last full study of FNC in 2016. Since 2016, the pay component of the national tariff has been used to apply inflationary uplifts to the FNC rate, so it is believed to be appropriate to accompany this with an efficiency factor. I fail to see how that is justified.

I thank the department for that explanation. However, I looked in vain for a sign of any upgrading for the care staff who work in care homes. Of course, there is none. Why is that? When do the care staff who carry out such important and personal work get the pay, training and recognition that they deserve? When will the funding for residential care be resolved? How can the NHS long-term plan possibly be delivered if the funding of social care is not also resolved?

The truth is that the UK is running out of care home places and care home operators are collapsing. The Guardian published an article on 6 June detailing concerns about care homes collapsing under financial pressure and the impact that this is having on vulnerable people. The British Geriatrics Society has warned that,

“soon there will not be enough”,

care homes,

“to look after the growing number of vulnerable older people needing specialist care”.

More than 100 care home operators collapsed in 2018, taking the total over five years to more than 400 and sparking warnings that patients in homes that close down could be left with nowhere to go but hospitals, and we know what that means in terms of costs and bed blocking.

Three out of five MPs say that people in their constituencies are suffering because of cuts to social care, with three-quarters saying that there is a crisis in care in England. That is according to a recent poll by the NHS Confederation, which leads Health for Care, a coalition of 15 organisations. In other words, there is a rising demand for social care but the cost of care is rising far more quickly than the money that local authorities pay for it. In some cases that money is being cut and in many others it is not rising at all.

The Association of Directors of Adult Social Services has shown that councils had £700 million of social care cuts planned in 2018-19, despite growing demand. I do not see how that is consistent with the regulations before us today. Major operators to suffer financial difficulty include Four Seasons Health Care, which was put up for sale after rescue talks failed, seven years on from the high-profile collapse of Southern Cross Healthcare. It was reported that a care home which was part of Four Seasons Health Care had left a patient without medication for two days.

These are our most vulnerable members of society and we have a duty to care for and protect them. However, they are being let down by an underfunded sector that is under constant and growing strain. Care England has called for the Government to put more money into social care to avoid a shortage of beds in a sector that provides care and accommodation for more than 400,000 residents. The future of funding for the sector is due to be laid out this year in a much delayed government Green Paper intended to address a £3.5 billion shortfall expected by 2025.

So, with care homes already crumbling under the pressure of an underfunded sector, it becomes a greater concern that the increase in charges may exacerbate the existing situation. There is concern that these charges will leader to further shortfalls in social care funding. Furthermore, these regulations come at a time when there is a lack of clarity surrounding the long-term care plan, which is needed to alleviate financial instability in the care home sector. Can the Minister confirm the impacts that these regulations may have on an already struggling care home sector? How do the Government plan to keep people in appropriate care settings with the recent care home closures, and when will we see an appropriate care plan? I beg to move.

--- Later in debate ---

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

My Lords, I open with an apology for the state of my voice. I shall do my utmost to make myself heard and make it to the end of my speech. If I do not manage to answer all the points made, I shall write not only to the two noble Baronesses who have raised questions but to all those present in the debate, and will place a copy of that letter in the Library.

I would also like to identify myself with the points raised by the noble Baroness, Lady Thornton, regarding Carers Week, and to pay tribute to all those carers in this country who make tremendous sacrifices for those they care for. We should all thank them for the work they do. Our system would not cope without them; we should all be very grateful.

I turn to the questions that have been raised. NHS funded nursing care is of course an incredibly important part of the health and care system, supporting the provision of nursing care in nursing homes. The NHS funded nursing care rate plays the important role of ensuring that neither individuals nor local authorities have to pay for nursing care, which is the responsibility of the NHS. My department is seeking to ensure that nursing home providers are paid a fair rate for employing registered nurses, so that nursing care can be provided to all who need it. On the point that was just raised, it is helpful to know that the average pay for registered nurses in the independent sector has now risen from £23,400 to £29,400, so that is the benchmark we are talking about.

The noble Baroness, Lady Thornton, raised the issue of the nursing care rate for 2019-20, which my department set in regulations in April. This was done, as she said, following the LaingBuisson report into the costs of providing NHS funded nursing care to nursing home providers, after further consideration by my department. Following this work, the rate has increased by 4.7%, which is a significant increase above inflation, as has been recognised. The efficiency expectation, which is regretted in tonight’s Motion, should be seen in the context not only of this above-inflation increase but in the context of the significant increase of 40% which came in 2016-17; that is part of the picture that the efficiency expectation was put in place to address.

It is only right at a time of continued and much-needed investment into nursing home providers—ensuring they are able to employ and retain registered nurses—that the Government and the NHS also expect those providers to deliver as efficient a service as possible and value for money to the taxpayer. The 4.7% increase in the nursing care rate for 2019-20 is a far larger increase than that being seen in the vast majority of prices across the wider public sector and NHS; this is because of the priority that we have set on that rate. For example, the NHS national tariff is increasing the majority of prices in the NHS by 2.7% for 2019-20. The national tariff has also asked most NHS providers to make efficiencies of 3.1% across 2018-19 and 2019-20, and the Government believe that while still getting an above-inflation increase, nursing home providers should be able to do the same.

The LaingBuisson report provided evidence showing that many nursing home providers are already delivering nursing care more efficiently than others, so there is variability in the system. The study shows wide variation in the cost of delivering nursing care, even when factors such as region or provider size are taken into account. Efficient providers surveyed were shown to deliver an hour of NHS funded nursing care for 18% less than others. Additionally, the study showed that nursing home providers are increasing their use of agency nurses, as has been discussed. An hour of agency nursing costs 47% more to providers, and so, obviously, to the NHS. We believe that providers can work to reduce the proportion of their workload covered by agency nurses, as we have required other parts of the NHS to do, in a sustainable way.

There is a need to ensure value for money in important NHS services and to maintain their sustainability. The Government believe that efficiencies can be made in relation to the rate this year—for example, in the use of agency nurses. However, this is still within the context of a significant and above-inflation increase to the nursing care rate. That is why we think that the rate set is achievable.

The noble Baroness, Lady Thornton, also raised the important issue of the need for a long-term funding settlement for social care and financial sustainability for the sector, as she has on more than one occasion in this Chamber. The Government have already given councils access to around £10 billion of additional dedicated funding for social care over this spending review period. This includes a £240 million adult social care winter fund for 2018-19, and again for 2019-20, to help local authorities. It is the biggest injection of funding for winter pressures that councils have ever received. As a result of the measures the Government have taken, funding available for adult social care is increasing by 8% in real terms from 2015-16 to 2019-20. Councils have responded by increasing their spending on social care, so the money has gone where it was supposed to, which is always encouraging.

Local authorities were also able to increase the average fees paid for older people’s residential and nursing care by 6.4% in 2017-18, which we believe brought more stability to the market. When we look into the detail of the figures we see that, while there has been a reduction in the number of care homes, the overall number of social care beds has remained broadly constant over the last nine years, with an increase in nursing beds and care home agencies. As in any market, there will be inevitable entries and exits of care organisations, but we feel that there is some consistency. It is more reassuring than it may appear on the surface.

As we have also discussed, social care funding for future years will be settled in the spending review, where the overall approach to funding of local government will be considered in the round. We are also looking ahead to ensure that the social care system is sustainable in the longer term so that we can continue to deliver as our society ages. This is why the Government have committed to publishing a Green Paper at the earliest opportunity, setting out proposals for reform.

I hope I have answered the majority of the questions raised by the noble Baronesses. If I have failed to respond to anything, I hope they will allow me to write.

[Baroness Thornton]

I thank the Minister for that answer. I am not completely convinced about the stability of the care home sector. I think we have some major problems coming down the line. Of course, like the noble Baroness, Lady Jolly, I welcome an increase in payment for nursing staff, because that is absolutely essential. However, we have to take seriously the issue of social care staff who work in homes or a domiciliary setting. They do not get the attention or esteem they deserve, or the training they need, and they are certainly not paid sufficiently, yet we still expect them to deliver the best possible service. This statutory instrument is not the place where that can be solved, but it amplifies the challenges we face here.

On that basis, I thank the Minister for getting through that answer without completely losing her voice. We heard everything she had to say. I beg leave to withdraw the Motion.

Motion withdrawn.

People with Learning Disabilities

Baroness Thornton Excerpts

Thursday 6th June 2019 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what action they are taking to address the treatment of people with learning disabilities and complex needs in in-patient units; and what plans they have to provide adequate, alternative community support.

[Baroness Thornton (Lab)]

My Lords, the Minister will be aware that this Question was prompted by the BBC “Panorama” programme shown immediately before the Recess and the statement made by the CQC at the same time. I thank the Library, Mencap, YoungMinds, the Royal College of Speech and Language Therapists, and others for their briefings. I also thank the noble Lords taking part in this short debate.

The “Panorama” programme was shocking. You have to wonder what the owners of Whorlton Hall, Cygnet Health Care and the CQC were doing in previous years; they were certainly not looking in the direction of, or carefully enough at, the care of some of the most vulnerable people in our society. The programme revealed conduct and attitudes almost medieval in their cruelty and ignorance. The fact that it took place somewhere that should have been safe and caring is shaming for all of us. The BBC’s undercover filming appeared to show patients with learning disabilities being mocked, intimidated and restrained. We know that 10 workers have since been arrested and that the health watchdog—the CQC—has launched a review, led by David Noble, into how it handled a 2015 report raising concerns about Whorlton Hall hospital. It beggars belief that although the former Care Quality Commission inspector Barry Stanley-Wilkinson flagged up the potential abuse of patients four years earlier in an as yet unpublished report, it took an undercover programme to reveal what was going on in the home. It is even more unbelievable given that the site had at least 100 visits by official agencies in the year before the abuse was discovered.

Of course, this is not for the first time. Since the 2011 Winterbourne View abuse scandal—also revealed by a BBC “Panorama” programme—Ministers have promised repeatedly to move such people out of unsuitable secure units and into community care, yet the number of adults with autism and learning difficulties locked up in ATUs fell only slightly over the past three years, while the number of children in them has more than doubled. Last year, there were 28,880 restraint incidents in England alone.

The Transforming Care programme has taken many forms since 2012: the initial two-year targets were missed and a new lead was appointed but resigned. After two critical National Audit Office reports, two Public Accounts Committee hearings and various other reports, NHS England and partners wrote Building the Right Support. Eventually, a three-year programme for 2016-19 was announced, with three aims: to develop new community support and services; to improve the quality of care in in-patient settings; and to reduce the number of people with learning disabilities and/or autism in in-patient settings by between 35% and 50% by March 2019. The programme failed to deliver these aims. By March, at the end of the programme, bed numbers had decreased by only 19%. What is the Government’s response so far? It is true that NHS England included that target in its long-term plan. However, that has simply moved the delivery date, with NHSE now aiming to meet the target in five years’ time. That is not good enough.

It is also true that, in the meantime, the Secretary of State commissioned a CQC review of seclusion and restrictive practices in response to numerous media exposures of poor practice. The recent interim report reveals the widespread use of restraint and restrictive practices in in-patient units for people with learning disabilities and/or autism. In May 2019, a damning report from the Children’s Commissioner highlighted the shocking treatment of children in these places and the lack of community support leading to their admission. This very sorry tale reveals a lack of leadership, ability or preparedness on the part of the Government to effect real change for this most vulnerable cohort of our fellow citizens.

The truth is that, seven years on from Winterbourne View, the system continues to sanction an outdated and wrong model of care. If people are contained in institutions a long way from home, awful things seem to happen behind closed doors. Can the Minister tell the House whether the Secretary of State now takes personal responsibility for closing down institutions that provide the wrong model of care? Why does the CQC continue to register new institutions that offer inappropriate institutional care? Does the CQC need new powers? What lessons must we learn from the fact that the CQC rated this place “good”? Is this another case of whistleblowers not being listened to? How much was Cygnet Health Care charging the NHS per week for this awful abuse and neglect?

This horror came in the same week as the damning CQC report on segregation, an equally scathing report by the Children’s Commissioner and the LeDeR—the learning disabilities mortality review—report confirming the extent to which people with learning disabilities and autism are fatally failed by our system. Does the Minister accept that we are tolerating widespread human rights abuses? Surely families want not another review but action to protect their loved ones. Many of the people abused at Whorlton Hall were hundreds of miles from their families. Does the Minister recognise, and will she commit to the fact, that cutting people off from their support networks allows such abuse to carry on without anyone noticing?

The Government’s inadequate response to this matter is deeply shocking. There is agreement among experts in this field, including many health and social care professionals, that robust community support and leadership across government is needed to ensure transformation. Most recently, but still six months ago, Sir Simon Wessely’s report— Modernising the Mental Health Act: Increasing Choice, Reducing Compulsion—was published. It included a number of positive proposals meaning that children and young people would be treated in hospital only when absolutely necessary and clarifying their rights to be involved in—and challenge—decisions about their care. I agree with YoungMinds when it says that it is,

“concerned that essential reforms to improve the quality and type of support for young people with complex needs and mental health conditions could be further delayed or put at risk”.

On its behalf and that of thousands of young people and their families, I have some questions for the Minister. When will we see the Government’s response to the Wessely review recommendations? When will we see a new mental health Bill? When will the Secretary of State for Health and Social Care grasp the nettle and drive forward cross-departmental work and joined-up NHS and social care support? Only proactive and strong leadership from the top will unlock the systemic blockages stopping people from moving out of in-patient settings and back into their communities.

Mencap proposes four actions that should inform the Government’s action programme. First, it proposes increasing cross-departmental leadership, accountability and oversight through a commitment from the Secretary of State for Health and Social Care to convene and lead a new, cross-departmental ministerial group with the Minister for Children and Families and the Minister for Housing, Communities and Local Government. It states that referring the Transforming Care programme to the inter-ministerial group on disability, as the Government previously suggested, is wholly inadequate given the attention that the programme requires, so it will not be effective. Secondly, it proposes a commitment from the Secretary of State to ensure that learning takes place from the independent evaluation of the Transforming Care programme, and that this leads to new and credible implementation plans across health, social care, housing and education. Thirdly, it proposes pooled and ring-fenced funding to build high-quality, specialist support in the community. The buck-passing between health, education and social care has to end, with budgets pooled and focused on getting the right outcome for the person by intervening early so that children get the right support and adults have the right adapted housing and specialist staff support they need. Finally, it proposes co-production with families and individuals with lived experience. The regulator, specialist practitioners and commissioners should drive forward workable solutions, but not without the lived experience of children and adults with a learning disability, as well as of their families.

Finally, I have to raise the question of who owns, runs and profits from these homes. Julie Newcombe, a mother who—as she puts it—“rescued” her son and set up Rightful Lives, said:

“There is a huge conflict of interest within the private sector because heads on beds equals money in the bank, which means profit becomes the ultimate barrier to discharge”.


Last November the Mail on Sunday published an article, “Profiteers of Misery”, lifting the lid on the profits made by private companies that run establishments such as Whorlton Hall. We need to discuss and raise the issue of the conflicts of interest—with which, of course, we are very familiar through our recent consideration of the MCA Act.

Universal Health Services—whose former CEO, I think, is Simon Stevens, now the head of NHS England—is a huge US healthcare firm snapping up British psychiatric services. Its British operations are run by Cygnet Health Care, the owners of Whorlton Hall. Cygnet Health Care boasted in recent accounts of earning revenues from 220 NHS purchasing bodies and almost doubling its profits to £40.4 million in the last year. Will the David Noble inquiry look at the issues this raises—underpaid and inexperienced staff—and ascertain what the occupancy rates were and whether patients were being kept longer than was needed, ultimately to boost the profits of Cygnet and its US parent company, Universal Health Services?

Food and Feed Hygiene and Safety (Miscellaneous Amendments) (EU Exit) Regulations 2019

Baroness Thornton Excerpts

Tuesday 4th June 2019 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I congratulate the Minister on her explanation of this statutory instrument. We are of course back in the territory of whether there will a deal or no deal. Even more bizarrely, this will depend on the machinations of her party over the coming weeks and on who ends up as our Prime Minister. It is a bit surreal really, much like the parliamentary world we inhabit at the moment.

Earlier this year, as we approached the Brexit deadline of 29 March, we were regularly rushing through statutory instruments. It is just as well that the Prime Minister was able to secure a Brexit extension because, if we had left on 29 March, some of the so-called minor deficiencies that emerged with regard to food and feed safeguarding, which we are discussing today, might have turned out to be major quite quickly.

Crashing out of the EU means that the regulatory framework for food and feed, which has protected us in the UK for so many years, will cease to exist. I can see that the proposed amendments are critical to ensuring minimal disruption of food controls in the event that we leave the EU without a deal, and we on these Benches will support them. The changes seek to ensure a robust system of control which will underpin UK businesses’ ability to trade both domestically and internationally.

The first question I have concerns trichinella, a parasitic nematode worm which can be extremely serious and can cause disease in people who eat raw or undercooked meat from trichinella-infected domestic animals or game. I appreciate that this instrument provides assurance that testing requirements that ensure protection will continue after EU exit. However, is the Minister confident that we have enough capacity in this country to continue testing for that worm and its associated health risk? How quickly can the government put in place our own testing facilities? I would be grateful if the Minister could tell the House how much extra resource her department has allocated to make sure that we do not allow a loss of control in this area. I am aware that extra funding has been made available to the FSA to deal with Brexit, but the Minister could help the House by being specific about the amount of extra resource that would be available to ensure that those particular nematodes do not infect meat that might be imported into this country and eaten by people here. I am aware that the Minister in the Commons, Seema Kennedy, offered to write to my honourable friend Angela Eagle about this matter. Did she do so and can the letter be made available here?

The instrument states that facilities approved by EU member states would in future no longer be automatically approved for food imported from the UK. I repeat the question that my honourable friend Sharon Hodgson MP asked in the Commons: does the Minister know what impact that will have on supply and businesses? How long will the process be to approve facilities for food imported from the UK, and when will a list of approved facilities be available?

The instrument also includes provisions to set minimum charging rates for hygiene controls for fishery products by amending, as the noble Baroness said, the Fishery Products (Official Controls Charges) (England) Regulations 2007. Will the Minister outline what the charges will be and what impact any new set rates could have?

The Explanatory Memorandum for the statutory instrument states that functions currently undertaken by the European Commission in adopting some implementing regulations rendering applicable the controls on imported food will in future be the responsibility of the Secretary of State. Can the Minister provide information on how decisions on those controls will be made and managed? What will the arrangements be for collecting data monitoring the effectiveness of the regulations and for regularly reporting the findings? What bodies will be able to scrutinise performance and delivery? What assessment has been made of their capacity to take on that work, as my honourable friend Angela Eagle mentioned in the Commons?

Finally, what conversations has the Minister had with the devolved nations regarding this statutory instrument? Although the issues seem fairly technical, and potentially innocuous, they raise a few worries. This is about food safety, safety for consumers, consumer protection and food supply in general. Should we leave the EU European Union, a range of duties will transfer from where they have been carried out in the past for many years, in the EU, not just back to the UK but to four different bodies due to devolution, one of which is not even sitting at the moment because of what has been happening in Northern Ireland. So will the resources be available in the devolved authorities to cover these issues?

My honourable friend Angela Eagle said in the Commons:

“Despite the Minister’s attempts to engage with some of my questions, I am still not entirely sure whether this is irradiation of things such as collagen, which in specific instances is derived from animals for human consumption, or whether it is about more general irradiation of meat and vegetables that are for public consumption, which happens in the US”.—[Official Report, Commons, Third Delegated Legislation Committee, 13/5/19; col. 9.]


I agree that the answer the Minister in the Commons gave begged more questions, so let us have another go. That is probably appropriate today, when the President of the United States of America has made it clear that all our regulatory regimes will be on the table and up for negotiation, along, of course, with the NHS.

It is important to remember that the horsemeat scandal was not discovered by the enforcement processes in this country, but by testing in the Irish Republic. So we are right to be concerned that, post Brexit, things could go wrong due to weaknesses that have been created in our own enforcement system. I am looking for further reassurance from the Minister that the system we have, weakened by austerity and divided by devolution, will be robust enough to take on the extra duties that the Minister is adding through this statutory instrument.

[Baroness Walmsley (LD)]

My Lords, I too thank the Minister for outlining all the technical details of this SI. Of course, this instrument has been withdrawn from the Order Paper twice before. Some of the changes made since we originally saw it are small but crucial. We are lucky that they have been spotted, but that raises concerns for the industry that there may be others. Now that the leaving date has changed, are the Government planning on conducting additional scrutiny on the other SIs that are being rushed through this House to make sure that they are up to scratch? How do the Government intend to convey these changes to the relevant individuals and companies on whom they will impact?

I add my support to the question asked by the noble Baroness, Lady Thornton, about the capacity of the FSA. This is probably about the 16th time that we have asked the same question and we are still concerned about the capacity to replace all of the other measures.

Some of these changes reflect very recent EU law that has come into force, as the Minister mentioned, so what do the Government intend to do about any new EU law that might come into force between now and 31 October or whenever we happen to leave? Will these SI and the ones that preceded them have to be further amended if there are other changes to EU law?

The Minister mentioned that the system for minimum charging rates for hygiene controls of fishery products is somewhat out of date. Will the Government confirm whether they aim to change the pound-euro exchange rate from the 2008 level at which it is currently set? Although these charges, as we know, are rarely levied by local authorities, any change in the exchange rate, which could happen after Brexit, could have a big impact on the ability to pay of those against whom the charge is levied. We saw a big difference in the rate of the pound against the euro after the 2016 referendum, and the way in which we might, unfortunately, leave the EU, could have a similar serious effect on the exchange rate. What are the Government planning to do about those charges if there is such a big change in the exchange rate? Are they planning to bring it up to date from 10 or 11 years ago?