Obesity

Baroness Thornton Excerpts

Wednesday 18th July 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, the noble Lord, Lord McColl, is nothing if not persistent in his determination to challenge obesity. Essentially, his message to eat less is the one that he has expanded on on many occasions. I agree with him that we definitely need a national approach.

I welcome the noble Baroness, Lady Boycott, to your Lordships’ House and I congratulate her on her maiden speech. She brings great experience, not least of the media, and indeed she was a hero of mine when she edited Spare Rib. I understood slightly less well her editorship of the Daily Express, but I think that that experience will bring great weight to our debates.

There have been some excellent contributions, as ever, and pertinent questions to the Minister about the Government’s progress on their obesity strategies, particularly for childhood obesity. We have also received many excellent briefings. I particularly enjoyed the contributions of my noble friend Lord Brooke—I congratulate him on his work with the BBC—and my noble friend Lady Massey, who called for an action plan. It is fair to say that we have not cracked this one yet. I think that we are slow in having any impact in our attempts to halt the growth of obesity rates and the related, and very expensive, health and social problems that follow.

There is an even greater and more serious societal problem here which will not necessarily be resolved by the exhortation from the noble Lord, Lord McColl, to eat less, and which might be only partly resolved by the Government’s obesity strategy. We have both an obesity and an eating disorder crisis, and in my view they are different sides of the same coin. Obsessive eating and self-hate, compulsive eating and body dysmorphia are handcuffs that women, but not only women these days, place on themselves and assume they have to escape from. There are assumptions that people are weak-minded, greedy and undisciplined. When Susie Orbach wrote Fat is a Feminist Issue 40 years ago, she said that there were specific realities to the conditions of both fat and thin that we were all chasing and escaping through our eating. She was right then and she is right now. If the Minister and the noble Lord, Lord McColl, have not read FIFI, I recommend that they do so when it is reissued.

We are now 40 years on and the pressures to be thin and to have no hair on your body except on your head, or this year to have very thick eyebrows or next year none at all, are not exclusive to women. Huge damage is caused by the pressures put on our girls and boys and our men and women by social media, the media and advertising campaigns, from stereotyping of all types and the misogyny illustrated by the #MeToo campaign, and the production and advertising of high fat, salt or sugar foods. Parents are constantly fighting a battle to either afford or persuade their children into a healthy lifestyle, and sometimes both. Who would have anticipated the explosion in non-food foods that contain chemicals and sugars that do not get metabolised by the body? Who would have linked obesity to class? There is no doubt that obesity is linked to social class, being more common in the routine and semi-routine occupational groups than managerial and professional groups.

We have what you might call a perfect storm. No doubt big action is definitely required, but that has to be accompanied by a greater understanding of the nature of the problem and the challenge that we face. Can the Minister request that his right honourable friend the new Secretary of State convene a summit that seriously addresses the issue of body hatred and body image, and the factors that create it and have led to this explosion in obesity and eating disorders? I also ask that his right honourable friend address the solutions to these huge societal challenges, which cannot just be left to public health and educational policy agendas alone. It is time to look beyond the strategies that the Government are pursuing at the moment.

General Practitioners: Indemnity Scheme

Baroness Thornton Excerpts

Monday 16th July 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, the average GP paid indemnity costs that rose by 50% in a six-year period. That has had a knock-on effect of discouraging doctors from going into primary care and has been a factor in many leaving. It seems to me therefore that this is a matter of urgency, and so I am very pleased to hear that the scheme will be introduced in April next year. However, GPs are sorting out their indemnity insurance right now—they do it over the summer. What advice are the Minister and the Government giving GPs now to help them decide what the costs are? Given the shortage of GPs in this country, anything that the Secretary of State can do to encourage GPs into primary care would be a good thing.

[Lord O’Shaughnessy]

I agree with the noble Baroness’s final point. Indeed, one reason for sorting out this scheme is that we know it is a barrier to people joining the profession and, unfortunately, encourages them to leave it. There is of course an urgency, but nevertheless it is a complex discussion with commercial partners. I can tell her that we are talking to GPs themselves and their representative organisations to make sure they understand what is at stake, what we intend to do and that we intend to introduce the new scheme in April.

Mental Capacity (Amendment) Bill [HL]

Baroness Thornton Excerpts

2nd reading (Hansard - continued): House of Lords
Monday 16th July 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I am very pleased to be speaking in this Second Reading debate. Although we might be missing a few of our known experts in this rapidly organised debate, we can anticipate full participation in the next stages of the Bill. The debate thus far has been informed and passionate, as one would have expected.

The maiden speech of the noble Baroness, Lady Barran, was a model of its kind, and I welcome her to the House. She brings great experience. As someone who has been involved for 20 years in this House working on behalf of women and abused women and on domestic violence, I welcome her to our cohort of people across the House who campaign on these issues. I look forward to working with her in due course.

We have had some excellent contributions. Many noble Lords have been asking pertinent questions, starting with the ones from my noble friend Lord Touhig. The noble Baroness, Lady Meacher, was very modest. She has a lots of practical experience dealing with these issues. Just because she was not here when we worked on the original legislation does not mean that she does not have a valuable contribution to make to this. I am also pleased to see the noble Baroness, Lady Murphy, back in her place. I am glad that she managed to fly home from wherever it was to take part.

I thank the Minister and the Bill team for organising the briefing we had last week. It was a packed meeting—and quite hot, it has to be said—and it showed the level of interest that there is in this small Bill. I also thank the many organisations and individuals that have sent us their briefs and their views on the Bill, and which are, at this moment, working to see how it might be best improved—Mencap, the LGA ADSS, Age UK, VoiceAbility, Sense, Alzheimer’s Society, the Royal College of Psychiatrists and the Royal College of Speech and Language Therapists, a doctor from Cardiff University called Lucy Series, who sent me an excellent brief, the National Autistic Society and so on.

This might be a small Bill, but it is one with potentially enormous consequences. It demands proper parliamentary scrutiny and, where necessary, amendments that will make it fit for purpose on its own terms. Anything short of this will be selling short the human rights of many thousands of vulnerable people in our country. As yet, like the noble Baroness, Lady Jolly, I am not confident that the Government have made enough time available for proper consideration of this important piece of legislation. We have experts in these matters in this House. I was witness to and a participant in these discussions—not key to them, as the noble Baroness, Lady Barker, was, but I was here—and I know from those debates how complex a challenge these matters are and that it is an issue that at the same time begs absolute clarity to serve justice for our most vulnerable fellow citizens.

I hope the Minister and the Bill team will know that we will be pressing for more time to be made available and that we will be doing it with all our support. Apart from anything else, the Minister needs to address the suspicion, which I have heard whispered, that the Government are seeking to hurry or bounce this Bill through the Lords in the summer to try to avoid the detailed and essential scrutiny that it deserves and that it would receive here. I am sure that that cannot be the case, but more time would probably dispel that terrible rumour.

As we can see, the Mental Capacity (Amendment) Bill amends the Mental Capacity Act to replace the DoLS framework, which, as noble Lords know, authorises the deprivation of liberty of people who lack the mental capacity to consent to their care arrangements in hospitals, care homes or other settings. Quite rightly, DoLS has been widely criticised as excessively complex and bureaucratic, as highlighted by the noble Baroness, Lady Barran, and by the noble and learned Lord, Lord Brown, in his great speech. I was shocked to learn that 70% are behind time. That speaks for itself. Also it is costly and offers inadequate protection for human rights.

Following the Supreme Court’s ruling on Cheshire West, which offered a broader definition of the deprivation of liberty, there are now some 230,000 applications for the authorisation of DoLS in England and Wales each year—I keep hearing different figures and I am rather confused, but it is an enormous number and there is a huge backlog. Local authorities are unable to keep up with the volume of applications, leaving them, in the words of the Joint Committee on Human Rights,

“having to work out how best to break the law”.

So it is costing a huge amount of public money, that is rising, and it is not doing its job.

So this is undoubtedly a timely piece of legislation; notwithstanding some of the reservations that some noble Lords have about this, I am fairly convinced that this is an urgent matter. The question we have to address here in your Lordships’ House is whether the Bill will do the job it is asked to do.

The Law Commission was asked to review the framework between 2015 and 2017. It consulted widely and came up with the new framework, the liberty protection safeguards, which offer more flexible and less bureaucratic means of authorising deprivation of liberty, channelling resources into situations where there are conflicts or concerns about a person’s care arrangements. It also included proposed amendments to the MCA’s best interest test, highlighted by my noble friend Lord Touhig and the noble Baroness, Lady Murphy, among others, and to promote supported decision-making to bring the MCA closer in line with the requirements of the United Nations Convention on the Rights of Persons with Disabilities.

The Law Commissioner, Nicholas Paines QC, said—and the Minister quoted him—that the deprivation of liberty safeguards are failing those they were set up to protect. He went on to say:

“We’re pleased the government agrees and we stand ready to work with them to implement these reforms as soon as possible”.


I have read the Government’s response to the Law Commission report, and it seems to accept the majority of recommendations contained—it is a 24-page document and I had some time at the weekend. However, the Bill we have before us today, while having the same title as the Law Commission’s proposed scheme, appears to have removed most or some of the important safeguards it proposed, as other noble Lords mentioned. That raises some serious questions, starting with whether the Bill complies with Article 5 of the European Convention on Human Rights and whether it moves the UK further away from compliance with the CRPD, instead of closer towards it. The Bill has major implications for the human rights of hundreds of thousands of people with dementia, learning disabilities, brain injury and mental health problems.

I am disappointed that there is no accompanying equality impact assessment. Paragraphs 16.1 and 16.2 of the impact assessment refer to equality matters. Basically, what they say is that there is no need for an equality impact assessment because,

“the new system will have beneficial impacts for older and disabled people”.

Surely that is a matter for examination, not something one can assume, particularly when we look at Article 5 of the European Convention on Human Rights. It seems to me that, if that is being diluted, it is very important that we have a proper, independent equality impact assessment, so I ask whether that can be supplied.

Noble Lords have raised many other questions during this debate. How does the Bill ensure that the cared-for person and those representing them have access to the information they need to understand and exercise their rights? Do the Government plan to secure the right of the cared-for person to participate in court proceedings concerning their liberty? Should the modern legislation—this was raised by many noble Lords—include outdated and stigmatising concepts such as unsoundness of mind? The noble Baroness, Lady Browning, is completely correct when she says that the Bournewood gap has not been plugged: I absolutely agree with her remarks on that. Why have the Government not taken forward the Law Commission’s proposals to bring the MCA closer in line with the United Nations CRPD? Why have the Government not chosen to require a written record of serious decisions that can be made under Section 5 of the Mental Capacity Act 2005 or introduce stronger procedural safeguards?

Perhaps one of the most significant proposals in the Bill is that care homes assume very significant new responsibilities for the undertaking and co-ordinating of assessments, and provide information about residents who may lack mental capacity to statutory bodies. The very helpful local authority DoLS co-ordinator who has written to several noble Lords says:

“I receive application forms from care homes, train care home staff and give advice about DoLS and MCA issues. Based on these experiences, I have concerns that at present, despite honourable exceptions, care home staff do not routinely have the knowledge and skills to assess mental capacity and consider whether restrictions are proportionate”.


We need to listen to his experience, as the noble Baronesses, Lady Finlay and Lady Hollins, highlighted. We need to ask what the mandatory training is going to be. The noble Baroness, Lady Hollins, is completely right: half a day is not sufficient.

Finally, a major recommendation of the Joint Committee on Human Rights is that there must be a statutory definition of what constitutes a deprivation of liberty in this context, but the Bill does not provide such a definition. The Bill team and the Minister have emphasised their consultation process and the organisations that support the Bill. The noble Baroness, Lady Jolly, referred to these. I am sure that is true. However, my inbox, like that of many noble Lords, is full of briefings which have serious concerns about the Bill. Our job in the coming period is to ensure that those are examined. Some clear themes of concern have been mentioned by noble Lords all the way through the debate. The Minister has two choices: either he can engage with the expertise and work with us all to improve the Bill, or he and the Bill team—I hesitate to use the example of the noble Lord, Lord Callanan—could dig their heels in and resist change to their small and perfectly formed Bill. I would counsel the former path.

NHS: Equitable Access

Baroness Thornton Excerpts

Thursday 5th July 2018 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what steps they will take to ensure that National Health Service patients have equitable access to the benefits of (1) artificial intelligence, (2) genomic medicine, (3) new drugs, and (4) innovative treatments.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, the NHS was founded on the principle of universal access and we are committed to making sure that that remains. To achieve this we are establishing a genomic medicine service to provide equitable access to testing across the NHS. We have commissioned the Topol review so that our staff can maximise patient benefits from technological advances and we are accelerating access to innovation across the country by expanding the role of academic health science networks.

[Baroness Thornton (Lab)]

My Lords, happy birthday to our NHS.

[Noble Lords]

Hear, hear!

[Baroness Thornton]

I thank the Minister for his detailed Answer. My Question concerns the future in the next 70 years. One of the key barriers to ensuring that NHS patients have equitable access to genomic medicine, new drugs and innovative treatment is the pressure on the workforce and lack of protected time for the workforce to develop research and to translate new research into practice. Some 25% of medics do research in their own time. This suggests a welcome hunger for innovation, but only 0.1% of NHS money is set aside for the adoption and spread of innovation. That seems modest. With the new funding agreement and the 10-year plan in preparation, will the Government support and enable our research base and ensure the continuation of clinical trials across the EU post Brexit?

[Lord O'Shaughnessy]

I thank the noble Baroness for her Question and join the whole House in wishing many happy returns to the NHS on its 70th birthday. She asked an extremely good question: how do we make sure that the NHS is equipped for the future and that everybody can benefit from the technological advances we are seeing take place? I point her in the direction of three issues. First, the National Institute for Health Research has more than £1 billion of funding and supports the translation of research into new technology every day. It is based in the NHS and uses NHS staff. I have also recently commissioned the department to look at the money spent on innovation, which we think is around £750 million in total, to make sure that it supports the uptake of effective medicines and treatments better than it does today, and to make sure that staff have time. Finally, in response to her last question, as we set out during the passage of the withdrawal Act, we will align ourselves to the clinical trials regulation as much as possible, whatever the outcome of Brexit.

Brexit: Reciprocal Healthcare (European Union Committee Report)

Baroness Thornton Excerpts

Tuesday 3rd July 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I join other noble Lords in congratulating the EU committee on its report Brexit: Reciprocal Healthcare. I suspect it was no accident that the committee turned its attention to this matter early on in its considerations about the effects of Brexit. I congratulate the Government on turning around their response in three months. This is better than the last healthcare response, which took a year, so we should be pleased and congratulate the Minister. I thank the BMA and the Nuffield Trust for providing the most up-to-date information.

I proposed and supported amendments on these matters during the passage of the Brexit Bill most recently considered, so I looked at the record to see how it compared with the answers that the Government have given. I spotted some advances but, I am afraid, not many.

In preparing for this debate, I learned from IPSOS Mori that Brexit has now joined the NHS as the top two issues the public are most concerned with—for 46% and 44% of people respectively. Today we have a confluence; it seems that as time goes on, millions may be justified in their anxiety about both Brexit and health. We heard, as several noble Lords have mentioned —including the noble Lord, Lord Balfe, and the noble Baroness, Lady Janke—that the head of NHS England is preparing plans for the supply of medicines in the event that the UK crashes out of the EU without a deal. I suppose the first question, as reflected in this report, is what happens after the implementation period? What planning is being done for a no-deal scenario for reciprocal healthcare? Indeed, the noble Lord, Lord Ricketts, mentioned the human cost of that.

Two years for implementation is not so long. Just think how the last two years have flown since the Brexit vote, with so little progress. It is, of course, important, as other noble Lords have mentioned, that the negotiations so far have enabled the Government to achieve their aims for reciprocal healthcare in the first and implementation phases of negotiations. These include access to the European health insurance card for those visiting the EU on exit day and continued access to the S1 scheme for existing retirees living abroad. But does the Minister agree that the next phase of negotiations needs to secure ongoing access to EHIC and reciprocal healthcare arrangements, either through retention, or comparable replacement of existing reciprocal healthcare arrangements with the EU after Brexit?

Some 27 million people hold a UK-issued European health insurance card and 190,000 UK pensioners living elsewhere in the EU are registered to the S1 scheme. The Nuffield Trust has calculated that, if the 190,000 UK state pensioners signed up to the S1 scheme and, living within the EU, needed to return the UK to receive care, it would incur additional costs to health services of between £500 million and £1 billion per year.

This simultaneous increase in cost and demand would place even greater strain on the UK health and social care sector. There is some anecdotal evidence that indeed people are returning from France, Spain and elsewhere since the Brexit vote and the ensuing lack of assurance and clarity. Are the Government monitoring the numbers who are coming home already?

As reflected in this report, ending reciprocal arrangements may also require the application of existing cost recovery methods for non-EEA patients to EU and EEA patients in the UK, or the development of a new, alternative system. This could increase the complexity of the cost recovery process, so well described by the noble Lord, Lord Balfe, as well as the administrative burden on clinical staff. Does the Minister agree with the BMA’s long-standing position that doctors and clinical staff should be able to devote their attention to treating patients and not to recovering the cost of care?

If the UK loses access to these arrangements, or fails to agree comparable alternatives, it could severely impact on the healthcare arrangements of UK and EU nationals and place additional strain on our already stretched NHS. Healthcare affects all of us who travel, work and live in Europe and, just as we might legitimately expect post-Brexit that we can take for granted the supply of the most up-to-date, clinically approved medicine and remedies, we expect to continue to travel and work all over Europe and for our healthcare to be assured, without having to take out insurance. On a scale of 1 to 10, with 10 being the most likely, what is the Minister’s best estimate of this being the case post the implementation period?

The ease with which people can continue to do what they are used to doing is what will colour how people will judge whether Brexit is succeeding and whether it has been worth while. In many ways, the most important recommendations in this admirable report, most of which I agree with, are those which concern clarity and transparency. Recommendations 5 and 6 concern free movement, and recommendation 11 asks if reciprocal healthcare will be included in the objectives set out by the Government, which we hope will emerge in a White Paper, with white smoke, some time next week.

This paragraph also concerns our children and grandchildren and their ability to work across Europe, which will be curtailed, as was so well explained by the noble Lord, Lord Jay. He said we have a long way to go and he is absolutely correct. The problem is, we have a long way to go but we do not have a great deal of time. I thank noble Lords for their usual high-quality contributions and I look forward to the Minister’s reply.

Health: Endoscopy and Bowel Cancer

Baroness Thornton Excerpts

Monday 2nd July 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is right to highlight the importance of waiting times. The 62-day standard is unfortunately not being hit at the moment. The NHS has pledged to get back on that standard this year. We are also piloting a faster, 28-day diagnosis standard in five areas at the moment with the idea of rolling that out so that there is a higher standard of care and fewer people have to wait longer.

[Baroness Thornton (Lab)]

We should probably be grateful that the Minister did not choose to bring a FIT as a visual aid, as his honourable friend did on the “Andrew Marr Show” yesterday. I welcome the Government’s announcement that that test will be in introduced in England in the autumn, but will the Minister confirm that all eligible people will receive the FIT kit in the autumn rather than through a phased introduction across England? How long will that take?

[Lord O’Shaughnessy]

I will not be rummaging around in my pocket to reveal something; nobody wants to see that. My understanding is that FIT will be introduced from the autumn and the intention is to get national coverage. I do not believe that it will be achieved immediately, but I will write to the noble Baroness with the specific timeframe.

Nursing and Midwifery (Amendment) Order 2018

Baroness Thornton Excerpts

Monday 25th June 2018 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for his excellent explanation of this order, which provides the Nursing and Midwifery Council with the necessary legal powers to regulate the nursing associate profession. On these Benches, we will be supporting the order, and I thank the Nursing and Midwifery Council and the RCN for their excellent briefs.

We are ready to accept that the creation of nursing associates is a welcome addition to building capacity. Some of us who are long in the tooth—there may be one or two in the House today—will remember SRNs and SENs and wonder whether we have gone full circle to move forward. However, I accept that there is some urgency to get this on the statute book because, initially, 2,000 nursing associates were training at 35 Health Education England test sites, with a further 5,000 starts planned for this year. The first nursing associates will qualify to apply for registration with the NMC from January 2019, so I accept the urgency to implement this order.

The Minister says that the nursing associate role is a defined care role to act as a bridge between unregulated healthcare assistants and the registered nursing workforce. Now that that role has been created, we agree with the Royal College of Nursing that,

“there must be absolute clarity that the nursing associate … is not a separate profession, but a new role within the nursing family that works under the delegation of the Registered Nurse”.

It went on to ask for “urgent guidance” to be published on “the precise relationship between” nurse associates and registered nurses,

“in terms of delegation and accountability”.

I hope that the Minister has taken that on board.

It is important to recognise that this new role is not the answer to the huge workforce challenges faced by the NHS and the social care system. Last week when the Government announced their funding proposals for the NHS, and the creation of a 10-year plan, many noble Lords said—we agreed—that it would be meaningless if this does not cover healthcare workers and social care workers together, given their importance in the future of our healthcare and social care system. Given that Health Education England has had its budget slashed, that we have a huge decrease in healthcare workers from the European Union, and the soon-to-be-removed—I hope—ridiculous visa system for non-EU health workers, the fact is that more nurses are leaving the profession than joining it, and there is a demographic challenge in that one in three nurses is due to retire in the next decade. In that context there is a well-founded anxiety that nursing associates could be used as a substitute for registered nurses.

Also in that context, has this new role been thought through, or is it a quick response to nursing shortages, with unfilled nursing posts which, as we know, are at a record high? Linked to that, how do we ensure that this new role does not impact negatively on the social care workforce? The head of Health Education England has highlighted that problem.

The role of a nursing associate was created before this SI was even introduced. Has there been enough time to consider the standards and levels of training for nursing associates to be registered with the NMC? I have to say that I am comforted by two things. One is the comprehensive brief from the NMC which suggests that it is on top of this, and indeed the notes accompanying the amendment order itself. I want to raise two things with the Minister, which are on page 5 of the accompanying notes and concern the cost-benefit impact analysis and the regulation of the nursing associates. Two risks are identified:

“First, there is a financial risk that the agreed initial set up costs escalate beyond those currently agreed with NMC. Second, the unquantified costs mentioned above relating to setting up and/or amending existing nursing associate courses as well as the accreditation of education providers”.


Those risks need to be mitigated before this moves forward in an orderly fashion. Finally, I think that there is provision in the order to take account of European Economic Area nursing associates, but I understand that this is not a uniform description or role that fits the narrative across the board. Will the Minister also comment on that?

[Lord Willis of Knaresborough (LD)]

My Lords, I rise from the second Bench—I am not quite trusted to be on the front yet—

Childhood Obesity Strategy

Baroness Thornton Excerpts

Monday 25th June 2018 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for repeating the Statement. The last time we discussed childhood obesity in your Lordships’ House it centred on chapter 1 of the Government’s policy, which scored a C-minus at best among noble Lords. Today we have chapter 2, which we can probably score as a C. It offers 13 consultations, a review and a great deal of promotion.

My questions are as follows. First, does the Minister believe it is possible for voluntarism to deliver even in the generous time the Government have given themselves to reduce childhood obesity? For example, Alpro soya growing-up milk contains unnecessary fructose and sugar, but the packaging will tell you it is good for your child, particularly if your child is lactose intolerant, where there are fewer choices. Will that be on the noble Lord’s agenda for legislation or persuasion, and what would be the timeline? Secondly, given that the evidence is clear, why does the Statement not include a proposal and a timetable for legislation and regulation to ban the advertising of high fat and sugar content products on TV and social media? When will we see a draft Bill?

Long-term Plan for the NHS

Baroness Thornton Excerpts

Tuesday 19th June 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating this Statement. I also declare an interest as a member of a local clinical commissioning group.

It would indeed be churlish to say that an injection of funding into our NHS is not welcome right now. However, the 70th birthday present is an uplift in funding of below the 60-year average—from 1948, the birth of the NHS, to 2010, it is just on 4%. Of course, we would all, not least the patients and staff, welcome not having to face another winter crisis like the one we have just had. After what, I suspect, were some serious tussles within the Government about quantum, timing and explanation of where the funding will come from, the Minister and his colleagues must be a little disappointed in the headlines that have been generated so far. The IFS said, with respect to the Brexit dividend that,

“over the period, there is literally zero available”.

Sky News has done a data poll which suggests a majority of people do not believe there will be a Brexit dividend to help to boost NHS funding, a reaction made more unpalatable to the Government because the same polls show that a majority of people, 54% to 38%, say that they would be happy to pay more tax to fund the NHS, which we in the Labour Party have known for quite some time. In 2002, when the then Prime Minister Tony Blair made a commitment to massively increased funding to the NHS, he also announced an increase in national insurance to pay for it. He and then Chancellor Gordon Brown had spent two years preparing for that announcement and preparing the plans for the investment in the NHS that was necessary to turn it round from the previous 18 years of Conservative neglect and underfunding and to deliver the waiting list targets, cancer treatment targets and A&E targets which then followed. So when Theresa May says, as she did over the weekend, that Labour spent only half of the increased expenditure on patient care, that is completely misleading and plain wrong. If she means that replacing falling-down buildings and worn-out equipment, paying staff decent wages, and investing in massively increasing the number of doctors and nurses available is in some way not spending money on patient care, one has to question the right honourable lady’s understanding of what the NHS is and what it does.

Leaving aside the issue of how the £20 billion will be raised, we do indeed need to address how it can best be spent. We recognise that it will take time and planning to work out how to make the best use of this funding over 10 years. The challenge is huge because the prevailing state created by a combination of cuts for both health and social care, and the overcomplex bureaucracy of the NHS as a result of the Health and Social Care Act, make this a serious challenge. Waiting lists of 4 million last winter in the NHS were so severe it was branded a humanitarian crisis. Some 26,000 cancer patients are waiting more than 60 days for treatment. There have been billions in cuts to local government and social care.

My questions to the Minister start with three basic ones about the legal obligations of the NHS. These were also asked by my honourable friend Jonathan Ashworth. Will the waiting list for NHS treatment be higher or lower this time next year than the 4 million it is today? This time next year, will there be more or fewer patients waiting more than 60 days for cancer treatment? This time next year, will there be more than 2.5 million people waiting beyond four hours in accident and emergency or fewer—a target not met since 2015?

If the Secretary of State wants, as he says he does, to transform the health and social care system, how will he do this when every economic expert, from the Institute for Fiscal Studies to the Health Foundation, tells us that with a growing ageing population—which the Minister mentioned—increasingly living with long-term conditions, this announcement will do nothing more than see the NHS stand still? As my honourable friend Liz Kendall put it yesterday:

“We cannot put the NHS on a steady financial footing without a proper funding settlement for social care, yet the Secretary of State now says that that will not happen until the spending review, which in reality means no substantial extra money for social care until 2020 at the earliest. We cannot transform care for older people or reduce pressure on the NHS until we look at the two together”.—[Official Report, Commons, 18/6/18; col. 63]


Why are the Government still ducking that vital integration issue?

Why is the social care Green Paper delayed yet again, and how can this funding be used to mitigate the £7 billion in cuts and 400,000 people losing care support? How will the Government bring together health, social care, parity in mental health and the essential preventive work of public health, when they are scattered across different delivery bodies, often with differing commissioning regimes and accountable sometimes to different regulatory regimes? How will that be done under the proposals for the 10-year plan? Will this injection of funding ensure that we have a service with new models of care fit for the 21st century? Finally, we have a £5 billion repair bill facing our NHS right now, and outdated equipment. When will the Government start investing in the fabric and equipment of the NHS?

[Baroness Jolly (LD)]

My Lords, I too thank the Minister for his Statement. I welcome any increase in funding. Should the Chancellor be wondering how to pay for it, we on these Benches would be quite happy to see a 1% increase on income tax, for starters. The IFS has said that increases of close to 4% are needed for social care, as well as a funding boost for the NHS. Yet the Statement had nothing to say on this vital issue. We all know that the NHS cannot function efficiently unless social care is working well too. Many local authority leaders are indignant that the Green Paper has been moved further down the track, so when the new funding does arrive there is already a sizeable deficit to claw back. They are extremely anxious about the situation with adult social care funding being insufficient for this financial year.

What conversations have been held with the LGA, local council leaders and the Ministry of Housing, Communities and Local Government in advance of these statements? We are also dismayed about the silence on mental health, public health and community health funding. One in four of us will be affected by mental illness, there is an obesity epidemic among our children, too few health visitors, and we are critically short of psychiatric social workers. Is the Minister confident that these issues can wait until the autumn NHS plan and the Budget?

Hospices: Impact of NHS Pay Increases

Baroness Thornton Excerpts

Monday 18th June 2018 Lords Chamber

[Lord O'Shaughnessy]

I will certainly do everything that I can. I agree that hospices are a fantastic example of the kind of mixed economy that this country does so well, with philanthropic and public contributions, and we must make sure that both those continue.

[Baroness Thornton (Lab)]

My Lords, I am sure that the Minister will be aware that this affects not just hospices, which of course are an integral and very important part of the health service, but the pay of those who work in all the charities and social enterprises which contract with the NHS. I would like to broaden the Question slightly from hospices and ask what the Minister’s reaction is to the Royal College of Nursing, which has called on the Secretary of State to establish a non-NHS national staff council to facilitate a more integrated way of looking at the pay of all nurses and healthcare staff in health and social care settings across the piece.

[Lord O'Shaughnessy]

I was not aware of that proposal but I will certainly look at it and write to the noble Baroness with our response.