Health: Maternity Care Provisions in East Kent

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Thursday 13th February 2020 Lords Chamber

[Baroness Thornton (Lab)]

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

[Baroness Blackwood of North Oxford]

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

Health: Tinnitus

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Wednesday 5th February 2020 Lords Chamber

[Baroness Thornton]

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

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

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

[Baroness Thornton (Lab)]

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

[Baroness Blackwood of North Oxford]

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

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

Major Trauma Centre: Westminster

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Thursday 30th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

My Lords, I pay tribute to all the brave members of the public, the NHS and Members of this place who so often have responded incredibly bravely when terrorist attacks occur. We owe a great debt of gratitude to all those individuals who do not think of their own lives in responding to protect others.

On the noble Baroness’s specific question about our capabilities in responding to risks that occur, we have a specific arrangement that has been put forward with the trauma network. The decision about the location of the trauma centres allows full geographic coverage while ensuring that the full package of care is available for patients when they come forward, which includes treatment for burns, orthopaedic injuries and neurosurgery. I know the noble Baroness knows there are four major trauma centres located in London at St Mary’s Hospital, St George’s Hospital, the Royal London Hospital and King’s. They are all adult and children’s major trauma centres and are all approximately three miles from Westminster.

More importantly, we have specialist ambulance capability in responding wherever an attack may occur in London. We can be very proud of the response that we have seen not only from the hazardous area response teams but from the tactical response units. Those responses have been in very short order and have meant that, although these were appalling incidents, their impact was much reduced.

[Baroness Thornton (Lab)]

My Lords, a study published in the Emergency Medicine Journal found that NHS hospitals seem in many ways unprepared for terror attacks, with half the doctors unaware of emergency plans and just over one-third aware of what to do personally if a major incident is declared. I thought the Minister’s answers were brilliant and very reassuring, but what action are the Government taking to ensure that all doctors receive education on their hospital’s major incident plan as well as an abbreviated version of their own particular role?

[Baroness Blackwood of North Oxford]

The NHS develops its plans in each hospital according to the Government’s national risk register and its planning assumptions underpin this. The security services then evaluate and publish the current threat level to the UK from terrorism and the NHS is made aware of any change to this, so that it can react accordingly. In addition, we provide training for paramedics for terrorist attacks, as I have mentioned. We have the hazardous area response team, comprising specially trained personnel to provide ambulance response to particularly hazardous or challenging environments, including following a terrorist attack. London also has the tactical response unit, which is designed to work as part of a multiagency team with police and fire services to respond to firearms incidents. In the most recent attacks, the response time for paramedics was within seven minutes. We have recently agreed to increase the number of marauding terrorist attack and chemical, biological, radiological and nuclear trainee paramedic responders, and we will have a minimum of 240 responders in each ambulance trust.

Wuhan Novel Coronavirus: Threat to UK Citizens

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Wednesday 22nd January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

That was well put. Our view is that this is a proportionate and sensible response that is scalable and appropriate according to the evidence available. We will obviously be reviewing what is a new and emerging infection. Scientific understanding of the disease is evolving rapidly—essentially on a daily basis. We will obviously review the measures set out regularly.

It is important to set out what the symptoms are, in case anybody listening needs to understand. This is essentially a bad respiratory tract infection that could turn into pneumonia. At this stage around 2% of known cases have died. To compare mortality rates, SARS had one of 10% and Ebola 70%. That gives a level of perspective, but the picture is evolving and we will keep this under close review as the situation develops. Unsurprisingly, of course, within that context those at greatest risk are the vulnerable, the elderly or those with underlying health conditions, so the advice is to come forward if such symptoms occur.

[Baroness Thornton (Lab)]

Notwithstanding the noble Baroness’s remarks, I am pleased and reassured that the Government have implemented the measures outlined and welcome the precautionary approach taken to the arrival of passengers from the Wuhan region of China. Can she confirm that the Government have assessed whether adequate resources are available in the PHE port health teams to carry out screening procedures and any further screening procedures that might be necessary?

[Baroness Blackwood of North Oxford]

We have indeed. First, three direct flights from Wuhan arrive into Heathrow and a team of public health experts, which will include the principal port medical inspector, the port health doctor, the administrative support and team leader and a translator, will meet every direct flight from Wuhan. We believe that this is a scalable solution, which could respond to a developing health challenge. In addition, before a flight lands a message will be broadcast to passengers in several languages to encourage them to report illnesses to flight staff and the captain will be required to provide an early warning of any illnesses on the aircraft one hour before arrival, which allows a much more appropriate response on landing. We believe that this is a manageable and effective response. The NHS has a very good record of responding to similar situations, whether with Ebola or monkeypox. We can be very proud of our public health record in these areas and can be confident in how bodies will respond to this incident.

Health: Sepsis

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Wednesday 22nd January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord, as always, speaks with great expertise in this area. I emphasise the work that has been ongoing to improve the picture on sepsis. Since 2015, screening for sepsis in emergency departments has improved from 52% to 89% and timely treatment for sepsis from 49% to 76%, but the noble Lord is absolutely right that we need to improve the outcomes. Early and accurate diagnosis is at the heart of this. I shall keep an eye on innovations in diagnostics. The noble Lord knows that innovation in this area is right at the heart of what I do, and I think that his proposal is very sensible.

[Baroness Thornton (Lab)]

My Lords, the Government seem to be complacent about this. I know that the Minister has given us lots of facts and statistics, but the number of deaths from sepsis in the UK is five times higher than in the country in the European Union that has the best performance. Only two EU countries have a higher number of deaths, so it is a very serious problem. Why are only 70% of acute trusts in England using the national early warning score system? Why are they not all using it?

[Baroness Blackwood of North Oxford]

I am not quite sure which data the noble Baroness was referring to. The study stated that the number of UK deaths was at 48,000. This was a modelled estimate; it was inaccurate. Our data, published by the Office for National Statistics, states that the figure is 22,341 and puts the UK’s performance at a better rate. We are not complacent in any way. This is why there has been concerted action through a number of routes not only to improve the performance in sepsis diagnosis and screening but to make sure that we raise public awareness and provide training for NHS staff. The early warning system has been introduced as the revised national early warning score. As the noble Baroness said, it is intended to improve and standardise the process of recording, identifying and responding to patients at risk. It was introduced as a CQUIN incentive and included in the 2020-21 scheme which was published yesterday. This means that it will be in every hospital across the country.

European Union (Withdrawal Agreement) Bill

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Report: 2nd sitting (Hansard - continued) & Report stage & Report: 2nd sitting (Hansard - continued): House of Lords
Tuesday 21st January 2020 Lords Chamber

[Baroness Thornton (Lab)]

I thank the noble Baronesses, Lady Jolly and Lady Brinton, for introducing this. As they said, we are basically picking up where we left off in Committee. I was not satisfied with the answer the Minister gave about reciprocal healthcare. As noble Lords have now said, nobody really understands why, when we already have legislation that we considered and passed last March, that does not form part of the negotiation that will take place. I read the letter that the Minister sent to the noble Baroness, Lady Brinton, and it is very confusing.

I will take a more cynical view of this. A year ago, when we had in front of us the Healthcare (International Arrangements) Bill, it had in it five or six Henry VIII powers. It gave the Secretary of State the power to make a deal about healthcare with anybody in the world they might choose, without any recourse to this Parliament or any accountability. This House wisely changed that into the Bill we passed, now the Act, which does what the Government had said they would do. They said they would not add to the policy arrangements in any area. They would take up the European Union policy and translate it into a way that worked post Brexit. That Bill we had before us a year ago did not do that; it extended the powers incredibly.

I fear that we are seeing a repeat of what the Government tried to do a year ago, so I really need to know from the Minister what powers the Government may take—not what will happen between now and December, but what will happen in a year. What will it look like? Will there be any reciprocal healthcare arrangements? Will there be 27 agreements, which is what the Minister was talking to us about a year ago when we were discussing international healthcare and looking at crashing out of the European Union? What has happened to those 27 agreements? Where have they gone?

As my previous noble friend Lord Warner said—he is still my friend—it is only a matter of time until people become very anxious about this, because not only are people working all the way across Europe, but they are going on holiday all the way across Europe. At the moment, the Department of Health and Social Care’s website is really opaque. It does not give us any clarity at all about what might happen.

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

My Lords, it is always a pleasure to speak to the really important issue of reciprocal healthcare, which touches on a lot of UK and EU citizens’ lives. This House has rightly tested this issue robustly and it is right that we consider it today.

The withdrawal agreement Bill guarantees that reciprocal healthcare arrangements, including for pensioners, workers, students, tourists and other temporary EEA or Swiss visitors, will not be affected during the implementation period. During this time, there will be no change to reciprocal healthcare schemes, such as S1 and EHIC, nor to the S2 route which enables planned treatment. Importantly, I can provide assurance that the European Union (Withdrawal Agreement) Bill also guarantees lifelong, reciprocal healthcare entitlements for people so long as they remain within the scope of the citizens’ rights agreements. This includes UK nationals who will have moved to the EU before 31 December 2020, as well as EU citizens who will have become resident in the UK before this time. I hope that that explanation is clearer than my letter.

Last year, as has been mentioned, this House spent a considerable amount of time holding informed and important debates scrutinising the provisions of the then Healthcare (European Economic Area and Switzerland Arrangements) Bill. With the permission of the noble Baroness, Lady Brinton, I will call it HESA. We agreed that this was a key piece of legislation, providing the UK with options to implement any future reciprocal healthcare arrangements, subject to negotiation with the EEA states or with Switzerland after the UK leaves the EU. I understand the desire to know the outcome of these negotiations but, as they are obviously in the future, I am not able to give exact details, other than to say we want to ensure the best possible outcomes.

Following that scrutiny and the assent of Parliament…

NHS and Social Care: Staffing

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Wednesday 15th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right that we want to target recruitment towards the areas with the greatest shortages. That is one of the reasons why, when we announced the new non-repayable funding, we also announced a top-up for targeted specialties struggling to recruit. It is also why we have announced the availability of placements which can enable nurses to develop experience in specific specialties, which make it easier to recruit and retain those nurses in very rewarding and sometimes hard to recruit specialties.

[Baroness Thornton (Lab)]

I am sure the Minister will understand why the House might be slightly sceptical of “as soon as possible” promises, given that we are still waiting for a Green Paper that was promised almost two years ago. A date would be a good idea here.

Do the Government intend to follow the example of the Welsh and Scottish Parliaments and introduce safe nursing staffing legislation? Does the Minister agree with me—and with UNISON, which has 450,000 health workers in its membership—about the ever increasing importance to the NHS of recruiting nurses from overseas? How can the Government justify increasing the health tax, which applies to overseas nationals and will surely make it harder to recruit and retain nurses? Will the Minister suggest to the Treasury that the Government should in fact drop that planned surcharge?

[Baroness Blackwood of North Oxford]

The noble Baroness will know that appropriate staffing levels are already a core part of the CQC’s registration regime and that the law already requires hospitals to employ sufficient numbers of suitably qualified, skilled and experienced staff at all times. It is also mandatory for staff to provide monthly reports on the average number of care hours per patient per day, which is considered a better measure than staff numbers. However, we recognise the proposals that have come forward regarding staff safety and legislation; they are being considered at the moment.

The NHS surcharge is being considered to make sure that it is at an appropriate level to ensure that we continue to recruit at an appropriate level. At the moment, the rate of recruitment from non-EU countries has increased significantly by more than 150%.

European Union (Withdrawal Agreement) Bill

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Committee: 2nd sitting (Hansard continued) & Committee stage & Committee: 2nd sitting (Hansard continued): House of Lords
Wednesday 15th January 2020 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, let me say how much I welcome the amendment moved by the noble Baroness, Lady Brinton.

When I had the temerity to raise this issue and all the others raised by the noble Baroness on Monday at Second Reading, I sought information and assurance on a range of healthcare matters. I think we can say that I got the bum’s rush from the Minister when he answered my questions. In fact, he did not answer them at all. I hope we might fare better this evening.

The medical research sector has been clear that continued close co-operation should be a priority in the negotiations. Indeed, the Government have recognised the international nature of the life sciences sector. They are committed to aligning as closely as possible with the European Union clinical trial regulation when it comes into effect, safeguarding vital UK-EU clinical trials. Indeed, the political declaration also refers to continued co-operation with the European Medicines Agency, which would help ensure that patients in the UK have swift access to the newest medicine. However, the political declaration has no legal standing, so the noble Baroness, Lady Brinton, is quite right to repeat in the Committee the concerns expressed by the European Union Committee. As it stands at the moment, we cannot see that the European Medicines Agency will continue to benefit patients in the UK.

For some treatments, those of rare diseases, a single authorisation at EU level is vital in providing for cost-effective licensing and distribution of medicines for small populations. If the UK is outside the EU market and companies are required to pay again for separate MHRA licensing, as well as an appraisal by NICE and equivalent bodies in the devolved nations, there must be real concern that some treatments for rare diseases may become not financially viable to launch in the UK, therefore risking patient access entirely.

I know that the Minister absolutely understands all this, so it is very important that she reassures the Committee that these issues will not just be taken into account but will be part of the negotiations and will be successful.

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

My Lords, I welcome the opportunity to discuss this important issue, and I thank all noble Lords for their, as always, thoughtful and expert contributions. During the Government’s preparations for EU exit, this House has discussed on a number of occasions the great value of the UK’s life sciences industry and the importance of ensuring that it remains—as the noble Lord, Lord Warner, rightly said—one of the most productive health and life sciences sectors in the world. As noble Lords will know, this sector alone contributes over £74 billion a year to the UK economy and employs close to 250,000 people. I contest the argument that it has recently been damaged. A report just today shows our leading position in cell and gene therapies, in which ongoing UK trials represent 12% of global trials and have increased by over 45% in the last year alone. That is in the context of Brexit.

The Committee is right that this is a crucial sector to the delivery of healthcare treatments to patients across the UK and will continue to be so in future. We must get this right. I assure noble Lords that the quality and safety of patient care is paramount in the department’s and our partners’ EU exit plans. This has been visible in our extensive efforts and preparations to ensure that the supply of medicines and medical products into the UK remains uninterrupted following the UK’s departure from the EU. This led to the department’s multilayered approach to put in place in the case of a no-deal exit from the EU. It was a substantial approach, which included work to procure additional freight capacity and to ensure buffer stocks and stockpiling; working closely with industry to improve trader readiness; and collectively helping to ensure visibility in the supply chain and, therefore, much more robustly ensuring continuity of supply processes.

While no-deal planning has been stood down, there is no question but that this work will stand us in good stead going forward, given the strategic importance of the supply of medicines and medical products in all scenarios—as the noble Lord, Lord Warner, pointed out. In fact, we are finding that the learning from this work is already helping us to better manage routine shortages, which are becoming increasingly common globally.

During our preparations for EU exit, we have at all times worked closely with our delivery partners. We are committed to doing so in future. Their support, expertise and hard work have been invaluable and will remain so as we enter the next stage of negotiations.

Turning to the amendment moved by the noble Baroness, I hope noble Lords will understand that we cannot accept this proposed new clause. The amendment was originally proposed in the other place and was not accepted there. I do not want to impute motive, but following debate, the sponsor in the other place chose not to move his version of the amendment to a vote there.

I wish to reassure the Committee on some of the questions raised, because it remains our objective to work closely with our EU friends, as we do at present, to ensure that patients continue to have access to safe and effective medicines and reap the rewards of our new relationship with the EU. Our overarching aim for medicines and medical devices regulations at the end of the implementation period is underpinned by the following commitments, which I have given before: patients should not be disadvantaged, which speaks to questions raised around rare diseases in particular; innovators should be able to get products to the UK market as quickly as possible; and the UK should continue to play a leading role in promoting the health of the public. We are in a better position than some of the countries—

National Health Service Infrastructure

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Thursday 9th January 2020 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of the consequences for patient safety of the backlog of maintenance and repairs to National Health Service infrastructure.

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

My Lords, the Government recognise that the quality of infrastructure, including backlog of maintenance, can pose challenges to the efficiency, safety and quality of NHS services. That is why we have launched the Health Infrastructure Plan, which includes the biggest hospital building programme in a generation. This substantial investment will support many of the hospitals facing the biggest challenges from their estates.

[Baroness Thornton (Lab)]

I thank the Minister for her Answer. NHS Providers says that the cost of the backlog is now £6.5 billion, and last year 15,844 patient incidents and 4,810 clinical incidents were caused by estate and infrastructure failure, and there were 1,500 fires in which 34 people were injured. The backlog includes wet walls in wards preventing babies’ incubators being plugged in. This is extremely serious. Will the Government provide the necessary funding to catch up—I am not sure that it is available yet? What is the timescale for catching up with the backlog—not building necessarily the 40, or six or however many, new hospitals that have been tendered?

[Baroness Blackwood of North Oxford]

The department acknowledges that parts of the NHS estate do not meet the demands of a modern health service and that there is unmet need for capital within the NHS. That is why we announced £2.1 billion of capital for health infrastructure in August and a further £2.8 billion injection in September. This is to ensure that staff are safe to deliver the world-leading health service that they should in a modern, efficient environment. We are also going further by reforming the capital regime to establish a clearer set of capital controls and the right incentives for organisations in respect of their infrastructure. The Chancellor has also confirmed that DHSC will receive a new multi-year capital settlement in the next capital review. Backlog of maintenance across the government estate will be a key theme of the spending review.

NHS: Nurses

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Tuesday 7th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The primary responsibility for their delivery will fall to the Secretary of State and NHS England but, obviously, it falls under the NHS people plan put together by Dido Harding —my noble friend Lady Harding of Winscombe—so it will be delivered through that programme.

[Baroness Thornton (Lab)]

My Lords, can we turn to the terrible situation facing nurses in Northern Ireland? Currently, there are 2,800 nursing vacancies, nurse pay has fallen by 15% in real terms in recent years, and nurses in Northern Ireland are the lowest paid in the United Kingdom. On 18 December, members of the RCN—the Royal College of Nursing—went on strike. That is absolutely unique. They plan to take further strike action on 8 and 10 January. Does the noble Baroness agree that this crisis cannot wait for the restoration of devolved institutions and that, given that he has the locus and power to do so, the Secretary of State should sort this out?

[Baroness Blackwood of North Oxford]

The noble Baroness raises an important issue. It is under active and serious consideration but, at this point, we are unable to give specific details about it. I will come back to the House on this when I am able to do so.

Mental Disorder: Autism and Learning Disabilities

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Tuesday 5th November 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Lord for raising this very important Question today. I should like to be clear that the Government are committed to ensuring that people with learning disabilities and autistic people have the best quality of life and live a full life in the community. A lot of the work that has been done recently, including reviewing and replacing the autism strategy and doing case reviews of every individual who has a learning disability or autism and is in in-patient care, is designed to ensure that we deliver that. I shall take back to the department the noble Lord’s specific point about a hotline for families and ask what can be done.

[Baroness Thornton (Lab)]

My Lords, as my noble friend has rightly highlighted, neither autism nor learning difficulties are mental health conditions. These children should not be in wards which are likely to be noisy, bright and unpredictable. Noble Lords may have seen the report on Sky News about Jeremy, whose autistic daughter Bethany is being held in a mental health unit. He has been campaigning about her inhuman treatment for a long time—too long. He says of the proposed review: “There are 600 people whose care plan says that they should not be in hospital, and for half of them, their local authorities do not even know that”. Those are the Government’s own figures. We have had one review after another since Winterbourne View, nine years ago. I agree with Jeremy— we need action not reviews.

Worse, Matt Hancock, the Secretary of State, is apparently sitting on a report about Jeremy’s daughter and said that it will be released before Parliament rises. Can the noble Baroness ensure that Bethany’s report is released to her parents this afternoon and tell the House when we will see action, rather than reviews, for this vulnerable group of young people?

[Baroness Blackwood of North Oxford]

We absolutely agree with the noble Baroness’s point. We need to ensure that everybody who can be cared for in the community is able to be cared for. That is why we have reduced the number of people in in-patient care by 22%; we have set a target to reduce that number by 50%. We are driving that forward as quickly as possible.

On the matter of the serious incident review of Bethany’s case, we have received the report and are working to release it as soon as possible. NHS England is taking action to improve Bethany’s situation and secure an alternative, more suitable, provider in the community as quickly as possible.

Regarding the case reviews of every individual, the Government have committed to providing each patient with a date for discharge or, where that is not appropriate, with a clear explanation of why and a plan to move them closer to being ready for discharge in the community. This significant commitment from the Government should be welcomed.

Health and Social Care: Malnutrition

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Tuesday 5th November 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord is absolutely right that this is an issue which is on the rise. The causes are complex and can be clinical, social or economic, but we are committed to improving this situation. That is why we have brought in the hospital food review, to ensure the safety of the food available for patients, visitors and staff, but also to look at how we can provide the highest level of care possible for patients, which includes the quality and nutritional value of the food served to them. The review will also look at the best possible methods of screening and training staff.

[Baroness Thornton (Lab)]

My Lords, in a rich country such as ours, it is shameful that anyone does not have enough to eat. Yet over £3 billion is spent on managing malnutrition and its effects. NHS trusts already have a duty to ensure that they meet patients’ nutritional and hydration needs. However, the Campaign for Better Hospital Food has said that, despite the introduction of food standards, at least half of all hospitals are not complying and the current Government are failing to encourage progress. Labour has committed to mandatory nutritional standards being regulated. I invite the Minister to join us in supporting this sensible policy.

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right that it is critical that people have good and healthy food in hospitals. That is exactly why there are very strict food standards in hospitals and health and care settings which are already enforced by the CQC. It is also why we appointed the former head of the Hospital Caterers Association, Philip Shelley, to look at what more could be done to improve the situation with the hospital foods review, to look at the safety of food available to patients, visitors and staff, improve nutrition and make available healthier choices, and ensure that we can improve the expertise of caterers, suppliers, staff and those who work in hospitals, to ensure that we raise standards and reduce the incidence of malnutrition across the system.

Drugs: Methadone

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Monday 28th October 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

My noble friend is quite right that we have to ensure that we prevent individuals getting addicted to drugs in the first place. That is why there is a wider drugs strategy, which ensures that we take action to reduce the number of people who become addicted in the first place, why the Home Office is holding a summit in Glasgow focused on tackling the problem of drug use, and why Dame Carol Black is working on the association between drug use and violence. However, we recognise that the use of methadone is an evidence-based and effective way to reduce the harm as cost-effectively as possible, which has been proven through extensive clinical and evidence-based trials.

[Baroness Thornton (Lab)]

My Lords, the lack of local government funding for drug treatment, combined with a policy-driven emphasis on abstinence rather than harm reduction, has frequently been cited as a likely reason for the increased number of drug-related deaths. In 2016, the Advisory Council on the Misuse of Drugs advised the Government on how to reduce opioid-related deaths in the UK. Despite Ministers claiming to accept the recommendations made by the ACMD, funding for drug treatment services, including OST—opioid substitution therapy—has been cut across the UK. Can the Minister confirm that this is the case and explain why the Government are not following the advice of the ACMD?

Specific Food Hygiene (Regulation (EC) No. 853/2004) (Amendment) (EU Exit) Regulations 2019

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Wednesday 16th October 2019 Grand Committee

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

My Lords, I thank noble Lords for their consideration of the regulations. I am confident that we have the shared intention to ensure that the high standards of food and feed safety and consumer protection we enjoy in this country are maintained when the UK leaves the European Union. This instrument, and the original instrument that it amends, seek only to protect and maintain these standards. Changes are limited to minor drafting amendments to ensure that the legislation is operable on exit day. No policy changes are made through these instruments and we have no intention of making any at this point. This amends a previous EU exit SI, the Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019. Further clarity was required in setting out the authorisation process for products that can be used to remove surface contamination from products of animal origin. The clarification will ensure that the process is robust and can be applied clearly in assessing the risk of new products.

This instrument was made on 9 September under the urgent, made-affirmative procedure, which was considered appropriate to meet the deadline for the European Commission’s third country listing vote on 11 October. It needed to be in place to support the UK’s application for third country listed status with the EU. Third country listed status guarantees that the UK can continue to export animals and animal products to the EU after exit. The application was voted on by the European Commission on 11 October, and I am pleased to report that the vote was indeed in favour of accepting the UK’s application for third country listed status for products of animal origin.

I shall now talk a little about the specific detail of the minor and technical changes made by the instrument. The new instrument makes clear that the responsibility to approve substances that may be used to remove surface contamination from products of animal origin rests with the Secretary of State for Health and Social Care and the appropriate Minister in each of the devolved Administrations. Lack of clarity may affect implementation and has the potential to undermine the responsibilities for authorisation; the instrument therefore rectifies this. The measure introduces no substantive policy changes to what was successfully passed and made in Parliament in March 2019. 

Food business operators are not permitted to use any substance other than potable water or, where permitted, clean water, to remove surface contamination from products of animal origin unless this has been approved. This relates to business establishments that handle products such as meat, eggs, fish, cheese and milk and do not supply to final consumers. Currently, approval for such substances is given by the European Commission, but after EU exit this responsibility will be carried out by Ministers. The amendment to Regulation (EC) 853/2004, made by the specific food hygiene SI, is being further amended to make it absolutely clear that Ministers will be responsible for prescribing the use of any other substances and the process of consulting the Food Safety Authority is retained. That decision will be made based on rigorous, evidence-based and independent food safety advice from the FSA and the FSS.

If, after EU exit, any additional substances are proposed to be approved for this purpose, they will be subject to risk analysis by the FSA, which has established a rigorous and transparent risk analysis process for assessment and approval of any such new substances. Any requests for substance approval would be subject to thorough scientific risk assessment and risk management before being put to Ministers for the final decision. The advice provided to Ministers, and the analysis and evidence on which that advice is based, will be publicly available. All decisions to approve the use of substances to remove surface contamination from products of animal origin will be implemented by means of legislation, thus also providing opportunity for parliamentary scrutiny.

Let me be clear that neither this instrument nor the instrument it amends introduce any changes for food businesses in how they are regulated or run, and nor does it introduce an extra burden. The overall changes to the food hygiene regulations will ensure robust systems of control that will underpin UK businesses’ ability to trade both domestically and internationally.

It is also important to note that we have engaged positively with the devolved Administrations throughout the development of this instrument, and this ongoing engagement has been warmly welcomed. The Welsh Government have provided their consent and the Northern Ireland Civil Service has given its acknowledgement of this instrument. FSA officials have also been in close contact with the Scottish Government regarding these regulations. They have not yet had the opportunity to give their agreement, due to the necessity of having these regulations in place by 11 October, but we expect that to continue in a positive direction. I stress that we are still committed to the intergovernmental agreement accompanying this Act not to normally make EU exit regulations without the agreement of the devolved Administrations where the policy area is devolved in competence. However, as I explained, this is a very minor drafting change to a regulation the Scottish Government have previously agreed.

Finally, I draw noble Lords’ attention to the fact that, in line with informal communications that the FSA has had with the Joint Committee on Statutory Instruments, the agency will, in accordance with the terms of the free issue procedure, be making this instrument available free of charge to those who purchased the earlier exit SI. The Government accept that this instrument should have been made available under the free issue procedure when it was first made, but that did not happen due to an oversight. I apologise to noble Lords for that oversight and confirm that it will be corrected. The Food Standards Agency will be taking action, together with colleagues in the National Archives, to ensure that anyone entitled to a free copy of the instrument under that procedure will, where appropriate, be able to apply for a refund, or otherwise obtain a free copy of this instrument on request, in accordance with the usual terms of that procedure.  

This instrument constitutes a necessary measure to ensure that our food legislation relating to food safety continues to work effectively after exit day. I urge noble Lords to support the amendment proposed to ensure that we continue to have effective food safety and public health controls. I beg to move.

[Baroness Thornton (Lab)]

I thank the Minister for introducing these regulations. I also thank my noble friends Lord Rooker, Lady Jones and Lady Wheeler for carrying the bulk of the food standards instruments that we dealt with before the summer, when we seemed to do a great many of them. As the Minister said, these are important regulations because they address the process for approval of substances that may be used to remove surface contamination from products of animal origin.

As the noble Baroness confirmed, this SI was discussed earlier this year, but a great deal has changed since then, as we all know. We have a completely new Government, though I am pleased to see that the noble Baroness has remained in her job. What has not changed is the uncertainty over whether the UK will leave the EU in the next 15 days or so, with or without a deal, and the impact that could have. For the record, once again, we find ourselves back debating necessary statutory instruments and having to spend time and money putting through legislation in case of a no-deal Brexit.

We all agree that the safety of our food is of the utmost importance to our health and well-being. We have been fortunate to lead the world in food safety, in some areas. We have also had to learn some very hard lessons from our own food scares. We know that food safety must be protected at all costs. Therefore, I share the Government’s commitment to ensuring that there is no change in the high-level principles underpinning the day-to-day functioning of the food safety legal framework. Ensuring continuity for business and public health bodies is of the utmost importance and in the interest of the public. This has been the protection that the EU regulatory framework has afforded us in the UK.

While the Minister assures us that there is no substantive policy change, I need further reassurance. Paragraph 2.7 of the Explanatory Memorandum states:

“Following further policy deliberations, a revised approach to describing the process for approval of substances which may be used to remove surface contamination from products of animal origin is felt to be desirable”.


What does that revised approach consist of if it is not a policy change?

Why was this SI not among those we took through in March? What would have happened if we had left in March and this SI had not been on the statute book? What would have happened to this regulatory framework?

I am not convinced that the SI does not give some leeway for Ministers to approve substances that can be added to our food. I shall be interested to hear how confident the Minister is that the high standard of food safety will be maintained. What additional substances could be approved by Ministers if needed? How will that impact food safety? The safety of our food is hugely important and we cannot get this wrong, so I have made these very brief comments. I do not want to delay the Committee, but I welcome interventions from other noble Lords. We will, of course, not oppose this statutory instrument and I look forward to the Minister’s response.

Brexit: Medicine Supply and NHS Staffing

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Thursday 5th September 2019 Lords Chamber

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

My Lords, we recognise that leaving the EU could affect a wide range of areas across the health and care system. We are doing everything possible to prepare, and our plans should help to ensure that the supply of medicines remains uninterrupted. We continue to monitor staffing levels, and we are working to ensure that there will continue to be sufficient staff to deliver the high-quality services on which the public rely.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. I suspect that this Question is an appropriate one, given the debate we are going to have later. Given that the majority of the House is trying to save the Government from their foolishness of crashing out of the EU, these are very important questions because they affect people’s lives and their futures.

I have two questions. What is the department doing to sort out the fact that the Home Office is still completely failing to deliver how settled status can be offered? We are losing European staff from the NHS, including senior and experienced doctors, at a huge rate, which will mean enormous problems. Secondly, on medicines, what measures have the Government put in place to ensure that the shortage protocol does not negatively impact patient safety, and how are the Government going to prevent the UK from becoming a third-tier market for medicines and ensure that we can access medicines and new drugs in a timely fashion if we crash out of the EU?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her comprehensive questions. Regarding the EU settlement scheme, we are very pleased that there are now record levels of EU nationals working in the NHS and the social care system. We hugely value their contribution. We need them, and we want them to stay. EU nationals working in the NHS can obtain their long-term status in the UK through the EU settlement scheme, and we are supporting NHS Employers in promoting the EU settlement scheme. On 15 August, the Home Office said that 1 million people had been granted settlement status. Where there have been challenges to working through that, there is support to address it. The EU settlement scheme statistics confirm that not a single person has been refused the status that they applied for. About three-quarters of people receive that status without the Home Office needing to ask for additional evidence on the length of residence; we are checking that is working as it should.

When it comes to medicines, we continue to implement a multi-layered approach to minimise any disruptions of medicines and medical products in a no-deal scenario to ensure that patients will have access to the medicines they need. There are about 7,000 prescription-only and pharmacy-only medicines, and we have been working very closely with suppliers, asking them to hold at least six weeks of stock. The shortage protocol will be led by clinicians, to ensure that patients can access the medicines that they need and are not put at risk. Any decision about this will be made between the patient and their clinician, to ensure that it is appropriate for the care of the individual patient in question.

National Health Service: Healthcare Advice

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Tuesday 16th July 2019 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, it is exciting to contemplate the new world of communication technology and how it might help in all kinds of ways, but the noble Lord, Lord Patel, has raised some important points. The NHS-Alexa partnership has to be seen in the context of Amazon’s ambitions for our wider healthcare industry. I seek assurance. I am sure that at the moment the data is being protected, but I want to know what will happen in the future. If Amazon collects yet more data on patients raising medical concerns, what use might be made of that in the future?

I do not know how other noble Lords are getting on with their Alexa in the corner of the sitting room, but ours regularly joins in with conversations and tells us very bad jokes. My granddaughter thinks it is wonderful because she knows what noise a unicorn makes, so I am not sure, as the noble Lord said, how that plays if one is trying to have a serious discussion about a medical condition.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for that. I would be interested to know what jokes she has heard from Alexa in her family conversations. However, patients look on well-known search engines for medical advice and at the moment they may receive advice from all sorts of untested sources. NHS.uk is clinically based advice which has been approved by NHS England. The purpose of making that advice more available through the Open API, which is available through the developer system, is to ensure that that clinically based advice is more widely available and more readily searchable for patients. A reasonable point has been raised which is to ensure that the right advice reaches patients and that patients go through the right triage system, whether it is 111 or another system, but that is the intention of the programme. It will be carefully monitored and managed by NHSX, NHS England and the department.

Childhood Obesity

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Monday 15th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I absolutely agree with my noble friend. Obesity is a crisis that will not only create misery for those who will then experience increased risk of tooth decay and of diseases such as cancers, diabetes and other severe illnesses, but it will also create significant unsustainability within our health service, which we are able to prevent. Since we know the tools that we have to prevent it, we should all be working together to make sure we do.

[Baroness Thornton (Lab)]

My Lords, we know—and the noble Lord, Lord Bird, made this point—that it is the poorest children who are obese. This is largely because their parents buy food which is high in fat, sugar and salt, because it is cheaper than fresh food. It may or may not be from Waitrose, but the noble Lord makes an important point there. I have two questions for the Minister. First, is it true that two-thirds of the deadlines of the plans that have been put forward for the obesity strategy have been missed? Secondly, what is the Government’s strategy for dealing with summer hunger—those children who will not get proper meals during the summer break?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right to raise inequalities. This is exactly why chapter 2 of our plan is focused on childhood obesity trailblazer programmes, where we have identified areas of highest deprivation to provide specific support to local authorities in those areas. We have also recognised this issue around school holidays: around 50,000 disadvantaged children will be offered free meals and activities over the upcoming summer holidays, funded by £9.1 million from the Department for Education. That follows a successful programme last summer, which saw improvement, with football play sessions and cooking classes for more than 18,000 children across the country. However, the noble Baroness is right to recognise that this is a real challenge that we need to address.

NHS: Automation

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Monday 15th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

Tremendous innovations are being introduced, including in robotics and AI-based automation, particularly in diagnostics, which have the potential to transform how healthcare is delivered in the NHS, but the role of automation to carry out basic administrative and repetitive functions, and of robotics in surgical operations in particular, is due to increase over the next decade. The main purpose of this automation in health is not to replace staff with machines or to reduce the role played by humans in providing care but, rather, to enable staff to spend more time delivering personalised care. But it is also to improve the productivity of health services and systems so that we can ensure that the NHS becomes more sustainable in future.

[Baroness Thornton (Lab)]

My Lords, the noble Baroness, Lady Seccombe, made a valid point about the need for human beings to be involved in the delivery of healthcare, but the use of AI and other technology is also very exciting, as is the fact that it features so largely in the long-term plan. Are the experiments in automation taking place across the country, where are they taking place, when will we see the results and who is delivering automated healthcare and AI? Is it the NHS or are private contractors being commissioned to do this work? I accept that the Minister may not be able to answer all those questions in detail, but if she cannot, I would appreciate a letter being placed in the Library.

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right: this is a very exciting area of ongoing work and a key part of the grand challenges which we put in place as part of the life sciences strategy, part of which is the AI and early diagnosis initiative, which aims to transform the prevention, early diagnosis and treatment of chronic diseases. NHSX’s work across government is to deliver that mission, creating an ecosystem of safe and effective development of AI and the regulatory infrastructure so patients and clinicians can be reassured that where it is introduced, it will be safe. There will be lots of research and development of those innovations. We are at an early stage of implementing them, but there are five centres of excellence across the country. I will be very happy to place a letter in the Library updating the House on progress with the AI mission and these exciting developments.

NHS Dentistry Services

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

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.

NHS Pensions: Taxation

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

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.

Restaurants: Calorie Labelling

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Tuesday 9th July 2019 Lords Chamber

[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.

Lung Health

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

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.

Carers: Support

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

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

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Monday 10th June 2019 Lords Chamber

[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.

Mental Health of Children and Young Adults

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Thursday 16th May 2019 Lords Chamber

[Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank the noble Baroness, Lady Royall, for introducing this debate and giving us the opportunity to discuss such an important issue during Mental Health Awareness Week. She spoke movingly and importantly. We have had an extraordinary debate today, with many personal reflections; it is an incredibly valuable contribution to this week. I also thank those who have asked the huge range of questions which I am now tasked with trying to respond to in less than 20 minutes. I hope your Lordships will forgive me if I do not cover each one; I will write on those points I am not able to cover today.

The noble Baroness, Lady Royall, is absolutely right when she says that, unfortunately, it remains true that many young people who seek help for their mental health find it difficult to access the right support at the right time. This is wrong, and we need to work harder and faster to get it right.

I would like to start by responding to a point about data, made by the noble Lord, Lord Storey. We have recently improved the available data in two key areas, with a significant prevalence survey on mental health in young people that was done in 2018 with 9,117 children and young people aged between 2 and 19. It showed that the prevalence of mental health diagnosis has increased by 1.1% since the previous survey, and that 25.2% of young people with a diagnosable disorder report having been in contact with NHS mental health specialist services in the last year. This is important, because the previous prevalence survey was 10 years old, and during that period social media has intervened, which we expected to have had a significant effect. The CMO then did a review which created evidence-based guidelines on screen time—an important intervention. In addition, we have brought in the dashboard to track data at a local level and the implementation of various standards which we have brought in.

This is a huge improvement on the level of data and tracking that we have on mental health within the community and the performance of our mental health trusts compared to the last time I was in the post. Therefore, I would like to reassure the noble Lord on the point about data. It is not where we would like it to be, but it is still a significant step forward. I wanted to start on that, because you cannot talk about policy and where we are if you do not have the data to know about it. That is why I want to talk about where we have come to before I talk about where we need to go.

We are on track to meet the commitment to improving access that we made in the five-year forward view, and to have 70,000 more children and young people accessing treatment each year by 2020-21 compared to the 2014-15 baseline. We have introduced the first-ever access and waiting time standards for mental health services. For young people experiencing their first episode of psychosis, we have a target for early intervention to ensure that treatment begins within two weeks for more than 50%. Nationally, the NHS is exceeding this: over 75% of patients started treatment within two weeks in March 2019. We have also set a target for 95% of children and young people with eating disorders—which have been on the increase—to access treatment, with a one-week referral for urgent cases and four weeks for routine cases by next year. Nationally, we are on track to meet this, with the most recent data showing that over 82% of patients started routine treatment within four weeks. We need to pay tribute to those who work incredibly hard within the mental health system and are making some very difficult changes to achieve this, coming from what was a very low base. It is important to pay tribute to them for their achievements.

I would like to move on to some questions put to me by the noble Baroness, Lady Royall, about crisis care, before moving on to those from the noble Baroness, Lady Thornton, about out-of-area placements and the private sector. The noble Baroness, Lady Royall, is absolutely right that we need to improve access to crisis care for those young people who need it most. A commitment has been made that we will invest £400 million in 24/7 crisis resolution home treatment teams in every local area by next year, and £249 million in mental health teams in A&E departments to improve the system. The long-term plan makes a commitment to ensure timely, universal mental health crisis care for everyone, including young people, and to drive out the variability which we recognise exists for them.

We also recognise the concerns raised by the noble Baroness, Lady Thornton, about out-of-area placements. We have made a commitment that inappropriate out-of-area placements must come to an end. Where there are specialist cases, a young person will need to travel, but we want in-patient stays to be as close to home as possible and to avoid inappropriate stays. For that reason, we have introduced the accelerated bed scheme, which has already created 117 new beds, with 69 new beds on the way. This is being done to reduce variability of access to in-patient care, but we also want to reduce that care by bringing in more prevention and earlier access to lower-level care, such as that pointed out by the noble Lord, Lord Layard. I shall return to the point that he made.

We are very concerned about the recent reports of failings within mental health care, which the noble Baroness raised. She is absolutely right that all providers of NHS services, whether NHS or private, must abide by the same high standards. Where this is not the case, we are ensuring that the NHS looks into the circumstances and considers what action should be taken. Private providers play an important role in the provision of children’s mental health services, but these must be safe and of high quality. We have tough regulators to ensure that that happens.

I will move on now to the points made on early intervention by the noble Baroness, Lady Royall, and the noble Earl, Lord Listowel, who is not in place.

[Baroness Thornton]

He is there.

[Baroness Blackwood of North Oxford]

I apologise—perhaps the noble Earl is sitting low in his seat.

They are absolutely right that prevention and early intervention are crucial. We prioritised improving perinatal mental health when I was previously the Mental Health Minister for exactly that reason. The noble Earl put it so eloquently: it is vital for newborns to form that early attachment with their mother and father. We must also consider the role played by the wider family, as those on our own Benches have put it. From 2020-21, we have put in place increased access to perinatal mental health services in all areas for at least 30,000 women, backed by £365 million in funding, as part of the five-year forward view for mental health. The long-term plan will also go further, with a commitment to increase evidence-based care for women with severe perinatal mental health difficulties and a personality disorder diagnosis, to benefit an initial 24,000 women per year by 2020-21. That is reassuring, but we also need to ensure that it carries on beyond the early years and into the school years—a point made by a number of your Lordships.

I recognise the impatience surrounding the Green Paper, but I would like to clarify a few points. The commitment within the Green Paper is to have a pilot, for 25 schools in the first instance, but it is then to incentivise every school and college to identify and train a designated senior lead for mental health to create new mental health support teams in and near schools and colleges. We are starting by piloting so that we can work out what the best design is and then move it across to all schools. The idea is not to have variability but to drive it through the whole system. While I recognise the frustration with rolling out these proposals in a phased way, it is a very ambitious commitment. We need to recruit and retain a workforce numbering in the thousands for the mental health support teams alone. We cannot do that overnight, given that there are over 20,000 schools and colleges. To roll out a fifth to a quarter of these by 2022-23 is already a challenging target. We must ensure that we train that workforce in an appropriate way to meet the challenges they will face.

I will also respond to the eloquent words of the noble Baroness, Lady McIntosh, and the moving experience which she spoke of. She is right that I do not speak for the Department for Education, but the thing about being at the Dispatch Box is that I can say whatever I like; once I am up here, they cannot pull me down. As she said, I speak as a former music graduate of Somerville, and I believe strongly in the importance of the arts, and in particular music, for education and mental health. I back her entirely on its importance for social prescribing as well. I will advocate strongly for that in this role. I agree with the noble Baroness that it is extremely important that young people’s experience should be safe, inspiring and nurturing. We should all be pushing in our roles for more joy within our society.

I know that I will run out of time quite quickly, so I will move on. I would like to talk a little about the work we have been delivering for university students. This key aspect has arisen on a number of occasions, and I know that the mental health of young people in universities is vital. Noble Lords will be pleased to hear that NHS England and Universities UK are working together on a programme to support and improve mental health at universities through Universities UK’s StepChange programme, which calls on higher education leaders to adopt mental health as a strategic priority and to take a whole-institution approach to mental health. As part of this programme, the Government are actively backing the introduction of a sector-led university mental health charter, which will drive up standards in promoting student and staff mental health and well-being.

NHS England is also working closely with Universities UK through its mental health in higher education programme to improve welfare services and access to mental health services for the student population, including focusing on suicide reduction while improving access to psychological therapies. There is funding attached to this and I am happy to meet with the noble Baroness if she would like to discuss that further, as it is a vital part of the picture.

I will move on to the questions raised regarding stigma and social media, which are crucial if we are to have a preventive approach to the situation we find ourselves in. The noble Baroness, Lady Massey, and the noble Lord, Lord Bragg, spoke incisively on this issue. We are committed to eliminating the stigma around mental health and are providing £20 million in funding to the Time to Change national anti-stigma campaign, which has been hugely successful. As the noble Baroness rightly said, it involved high-profile individuals who cut through the noise that often comes at young people every day. The campaign aims to improve social attitudes towards mental health, including promoting the importance of well-being in all areas.

However, we should also think about one area that did not get aired within the debate, and that is those who face double stigma when they have a chronic condition. As I think was raised by the noble Baroness, Lady Tyler, there are those have learning disabilities and mental ill-health. It is challenging for them to navigate their way through the system. Public Health England is delivering a £15 million national health campaign called Every Mind Matters, with the aim to equip 1 million people to be better informed to look after their own mental health. This will be of huge benefit going forward.

It is important that we do not imply, in this place, that everybody who suffers from mental ill-health will end up in the criminal justice system. I do not believe that is the case.

I also point out that this Government have been committed to addressing the agenda of social media and the harms it can produce, even though it is beneficial in other areas when it is used as an effective tool. That is why the Secretary of State has not only taken this on as a personal commitment in the round tables he has held with internet companies, but we are also bringing forward the online harms White Paper. The noble Lord, Lord Haskel, was right when he said that we have to make sure this has teeth. That is why there are commitments to bring forward a new regulator under it and why the CMO brought forward recommendations on screen time.

None of this is relevant if we do not have the workforce and funding that we need. I am pleased that NHS funding for young people has increased. I was concerned to hear the noble Lord, Lord Bradley, and his comments about reduced funding. The information I have is that children’s mental health funding is increasing. It has gone up from £516 million in 2015-16 to £687.2 million in 2017-18. Planned spend next year is £727.3 million, an increase of 5.8% compared to the previous year. This will be monitored with the investment standard and dashboard. I am happy to follow this up with the noble Lord, but I believe that NHS funding for mental health is increasing and at a faster rate than overall NHS funding. We are tracking this and ensuring that local CCGs stick to that commitment. This transformative investment will ensure that more young people receive the mental health support they need.

I finally turn to the questions about suicide prevention, which was movingly spoken about by the noble Lord, Lord Giddens, and others. The noble Lord is right that we have an excellent suicide prevention strategy. It must be based on accurate data. It is challenging to ensure we have that data, but I have a great deal of confidence in Public Health England working with local authorities to ensure we raise the standards of that work. Understanding the reasons for suicide is complex. Suicides among children are relatively rare, but each is an appalling tragedy, so we must work with every ounce of our abilities to move forward and make that better.

I am proud that we recently increased the amount of research funding for mental health, by a record amount, to £74.8 million. This will play an important role in helping us understand the sources of all forms of mental ill-health, including those that drive individuals to suicide.

While I am sure that noble Lords feel there are other areas I could have covered, and would like answers to other aspects, I hope that, by pointing out the areas of rising investment today and that we are improving access and waiting times, I have communicated to you that the Government are genuinely working across all departments to ensure that we see this as a priority agenda. I have demonstrated that we understand that we still face significant challenges. While we are impatient for faster improvement, there can be no question of our commitment to a brighter, healthier and more joyful future for our children and young people.

I was deeply moved to hear the words of the noble Lord, Lord Bragg, his testimony of his own experience some years ago and how different he feels things are today. Each of us still feels frustrated by how far we still have to come and how many things we still have to deliver to give our children the services that they deserve. I cannot think of a better way to close than by repeating some of the comments that he gave in his speech. We are only as good as the way we treat the weakest among us. There is a long way to go, but we are now on the road. If we can make as much progress in the next 20 years as we have in the last 20 years, we can give young people the stigma-free lives that they deserve.

Learning Disabilities Mortality Review

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Wednesday 15th May 2019 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for repeating the Statement. I just make the obvious point that the Government have had the draft report since 1 March, and if they had published it in a reasonable time it might not have leaked.

I am sure that we can all agree that people with a learning disability have worse physical and mental health than people without a learning disability, and that the Confidential Inquiry into Premature Deaths of People with Learning Disabilities found that the average age of death from different levels of impairment was between 46 and 67 years, which is massively below the average lifespan for those without a learning disability. I look forward to the report, which the Government have told us that we will soon see.

Will the Minister now say that it is always unacceptable for learning disability to be given as a reason for not resuscitating someone? For this programme to work properly, does she agree that it needs to be resourced so that it can consider all reported cases in a timely manner? I suggest to her that many families feel that the review is the NHS marking its own homework, and that what is required here is a truly independent national body to review the premature deaths of people with learning disabilities.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important questions. On her first point, which is that the Government have had the report since March, I should like to be very clear that this is not a government report; it is an independent report from the University of Bristol. It is free to publish it when it is ready, although it was commissioned by NHS England, so the Government are not in control of the timetable for publishing it.

The noble Baroness is 100% right, however, on her point about “do not resuscitate” orders. The reports that we have heard that disabilities such as Down’s syndrome are being used by some doctors as a reason not to resuscitate are entirely unacceptable. We are taking immediate action and a letter will be sent to health professionals to make clear that that is not an acceptable reason to put in place a “do not resuscitate” order. On her last point about resourcing and the effectiveness of the LeDeR programme, progress has been made in implementing it: 15 out of 24 of the recommendations have already been completed, and in others we are making real progress. NHS England has trained more than 2,100 experts to carry out reviews, 1,500 reviews have been completed and a further 1,500 are in progress, but I have no doubt that given the situation in which we find ourselves, questions will be taken into account by NHS England and the department.

NHS: Shortage of GPs and Nurses

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Wednesday 8th May 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

My noble friend is absolutely right, and he has his own expertise in this area. I am pleased to be able to report that we have had an increase in recruitment of nurses and NHS workers from abroad. Compared with June 2016, we have over 5,200 more EU health and care staff working in the NHS, and we have had a 126% increase in the number of non-EU NHS workers, which shows the attractiveness of working within the NHS. But he is also right that we need to make sure that those who work in the NHS have access to the most innovative and effective tools possible, which is why, particularly within GP practice, we are launching the GP IT Futures programme. That will provide GPs with the best tools possible so that we can make their job more efficient while also allowing them to provide the best-quality care to patients.

[Baroness Thornton (Lab)]

My Lords, I think I need to declare an interest as a member of a CCG; I spend some of my time surrounded by GPs, who are utterly wonderful, and who tell me that morale is not good. The problem is that a lot of GPs are leaving because they are completely fed up with the way that they have been treated by the NHS. That has to be taken account of by the noble Baroness, Lady Harding, as part of her work in bringing forward the plan, and I know it will be.

I am afraid that it does not say much about the current lack of a workforce strategy that we are having to trawl the world to get GPs and nurses to come and work in the UK. I know that other Members of your Lordships’ House have been worried that we are taking nurses, GPs and doctors from countries where they are very much needed. Will the Minister address how to deal with the morale of GPs, as well as the ethics of the UK recruiting nurses and doctors from countries where they are needed?

[Baroness Blackwood of North Oxford]

I slightly question the premise of the noble Baroness’s question, given that I am the daughter of an English doctor and a South African nurse. This has always happened in the NHS, and it is an absolutely acceptable process. Recruitments go back and forth between nations, and that has always been the case.

To move on to the noble Baroness’s question about morale in the NHS, particularly within general practice, it is essential that that is addressed, and she is right that GPs are the bedrock of the NHS now and in the future. That is why we have announced in the long-term plan not only that we are investing an extra £4.5 billion in primary and community care, which is at a faster rate than the rest of investment within the NHS, but the new contract to develop partnerships to provide greater certainty for GPs to plan ahead and to give them the extra 20,000 support workers who can make the job within GP practice more effective and sustainable. That is also why we have announced the GP IT Futures programme to give them the tools that they need to deliver more effective services and to deliver better-quality care, and why we have announced targeted and enhanced recruitment schemes to support and retain GPs within practices, not only in hard-to-reach areas but within the pipeline. That demonstrates that the Government are completely committed to general practice and will retain that commitment as long as we are able to do so.

NHS Funding: Mental Health Services

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Wednesday 1st May 2019 Lords Chamber

[Baroness Thornton (Lab)]

With his consent, I beg leave to ask the Question standing on the Order Paper in the name of my noble friend Lord Bradley. Noble Lords will know why he cannot be with us today, and the House will wish to know how much he and his family appreciate the sympathy that has been expressed.

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

My Lords, NHS England and NHS Improvement have set out their commitment to increase mental health spending by at least £2.3 billion in real terms between 2018-19 and 2023-24. In five years, this will represent over 10% of NHS England’s additional settlement. More details of how the long-term plan will be resourced will appear in the implementation framework, which is due to be published soon.

[Baroness Thornton]

I thank the noble Baroness for that Answer. Given that mental health illnesses account for 28% of the burden of illness in the NHS but receive only 13% of its funding, I find her Answer very confusing. Can she be more precise? This is not just about the number of staff required but about how much will be required to achieve parity of esteem and over what period.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness, Lady Thornton, for her question on behalf of the noble Lord, Lord Bradley. I am sure that the whole House will want to join me in sending him and his family our support at this difficult time.

The noble Baroness has asked a very important question. The mental health budget will increase by £2.3 billion by 2023-24, growing faster than the wider budget. We are using transparency to drive improvements. The mental health dashboard shows that last year, for the first time, all CCGs met the mental health investment standard, which is an encouraging sign. This builds on the work done in the five-year forward view, which delivered real improvements for patients. It delivered £247 million for liaison psychiatry, £290 million for perinatal services and £400 million for crisis resolution and home treatment teams. However, we will not rest there. The long-term plan will deliver much more for patients, including 345,000 more children and young patients to receive specialist support services. This is the ambition that we have and the ambition that we will deliver.

National Institute for Health and Care Excellence (Miscellaneous Amendments) Regulations 2018

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Wednesday 1st May 2019 Lords Chamber

[Baroness Thornton (Lab)]

I thank my noble friend for bringing this matter to the Floor of the House and for leading this short discussion. I too have many questions for the Minister but many of the questions that I would have asked have already been asked by my noble friend and the noble Baroness, Lady Jolly. It seems that our concerns are very similar. I agree with the noble Baroness, Lady Jolly, that when I read through the notes accompanying this regulation, it seemed puzzling that the consultation had produced a majority against this process, and I too was not completely convinced by the Government’s justification. That must lead to something which we can probably call cuts and wanting to save money. To want to save money with an organisation which is so integral to our NHS infrastructure and so important to ensuring the efficacy and cost benefit of and access to medicines and procedures is not a sensible way to proceed.

Some of my other questions centre around a concern about the impact that these charges will have on the jewel in the crown that is the UK-based science industry, particularly at a time when there is already such uncertainty with the dual impact of Brexit and these charges. It seems that the additional costs for a market may diminish the UK’s attractiveness for life science businesses, which has already been mentioned, and may also mean that NHS patients get access to new therapies later than those in other countries across Europe, which my noble friend also alluded to. Has there been an assessment of the impact of these charges on the UK bioindustry and its attractiveness to the international life science community, and of the UK as a location to research, develop and launch innovative medicines?

What will be the impact on patients? The UK BioIndustry Association has stated its concerns that the charges for technology appraisals could either prohibit or delay patient access to medicines in England. This could result in inequalities across the UK, as medicines may be available in Wales and Scotland, where charges for technology appraisals have not been introduced, before receiving approval for use on the NHS in England. That might disproportionately affect patients with very rare conditions, and therefore might also undermine the UK rare disease strategy to ensure equity of access across all four nations of the UK. Have the Government considered not only the financial impact but the potential impact on patient health? Do the Government have a strategy in place to mitigate delays in patient access to medicines that may come from these charges?

I join the noble Baroness, Lady Jolly, in asking whether there will be a review of the impact of this proposal, when that will take place, and when we will learn about the impact of this proposal on NICE and the NHS infrastructure. That will be important. We need to review this, because I fear that it may be a wrong decision.

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

I thank all noble Lords who have contributed and congratulate the noble Lord, Lord Hunt, on securing this debate. It is an important subject and it is right that we take time to consider it. I know that he takes a keen interest in NICE’s work from his previous role as the first Minister with responsibility for NICE, and it is a privilege to have taken on his mantle some years later.

This year marks a significant milestone for NICE, as it celebrates its 20th anniversary, during which time it has transformed the way in which decisions are made in the health and care system. I echo the comments made by the noble Baroness, Lady Thornton, who referred to NICE as a jewel in the crown of the UK life sciences ecosystem. She is absolutely right that we must ensure that we not only protect it but promote its success. Since its inception, NICE has played a vital role, not only in securing maximum value from health spending but in ensuring that patients are able to benefit from rapid access to effective new drugs and other treatments. The noble Lord, Lord Hunt, hit the nail on the head when he said that that balancing act in the health system is so challenging.

Of course, the NHS is required to fund the treatments recommended through NICE’s technology appraisals and HST evaluation programmes, so that they can be provided if a patient’s doctor says that they are clinically appropriate for the patient. Over the past 20 years, more than 80% of NICE’s recommendations have supported use of the technology assessed, meaning that many thousands of patients have benefited from rapid access to effective new treatments. A less-frequently reported statistic is that 75% of HST applications have also gone through, which is encouraging.

Recent IQVIA research has just been published which showed that, despite some of the frustrations we have with update and access—which is something we are working hard on—the UK is in fact one of the fastest countries in Europe to get products through its regulatory system. We can be very proud of that, and must protect it.

I know that your Lordships will agree not only that it is extremely important that we have a system such as NICE in place to ensure the NHS spends its money in the most effective way possible, but also that it is critical that NICE operates on a sustainable footing so that it continues to be responsive to developments in the life sciences sector, to which noble Lords all referred.

To date, as has been mentioned, NICE’s TA and HST programmes have been funded through government resources but, as is common with government bodies, it is right that NICE considers how to operate to the utmost efficiency, and that those who stand to benefit from services contribute.

This is standard procedure and a standard model for many organisations and ALBs such as NICE. It is standard for the MHRA, the HTA, the CQC and for HTAs in other countries, so we are not operating an unusual procedure here, as the noble Lord, Lord Hunt, mentioned. I was grateful for his support for the charging model.

However, recognising the need for sustainability must be balanced with the imperative to encourage innovation, and the Government and NICE believe that the most appropriate and sustainable model for NICE’s TA programmes in future is for it to levy a proportionate charge on companies that benefit directly from its recommendations. This goes right back to a recommendation of the triennial review of NICE in 2015, so long-term work has been going on in this area. Recognising the importance of getting it right, the Government consulted on the draft regulations. That consultation has been referred to by noble Lords. At that point, as part of those proposals, the Government proposed the 25% discount for small companies. The consultation also sought views on a proposal to enable NICE to recruit appeal panel members engaged in the provision of healthcare in the health services across the UK instead of just England. This has not been mentioned and I know is widely supported, but I just wanted to point out that fact, which we are very pleased about.

As was raised by the noble Baronesses, Lady Thornton and Lady Jolly, there were 78 responses to the consultation, around half of which represented views from the life sciences industry, including pharma companies, industry representatives, consultancies and medtech companies. Other responses came from patient groups, NHS organisations and individuals. Although, as has been said, the majority of respondents—62%—disagreed with the specifics of the proposal to charge companies for making recommendations, the analysis showed that just over half of respondents agreed that life sciences companies should contribute to the cost of developing NICE recommendations, which is why further work was done to develop the charging proposal but refine it.

Respondents also supported, by 59%, a mechanism for reducing the impact on small companies, but felt that the proposed 25% discount did not go far enough. Other more specific concerns were raised about the potential impact on patient access to new treatments, in particular for rare diseases, the impact on NICE’s independence, and the analysis contained in the impact assessment.

The SLSC also picked up on issues in its report, and I will address some of those in response to points raised by the noble Baronesses, Lady Thornton and Lady Jolly. The Government considered the issues raised in the consultation very carefully and carried out further analysis to feed into the final impact assessment. We concluded that it was appropriate to make two main changes to the policy in light of the consultation responses. These particularly dealt with concerns about the design of the charging with respect to SMEs. I know that noble Lords are well aware of those concerns.

There is an increased discount for small companies of 75%, to minimise barriers to the participation of small companies wishing to bring forward new products. I realise that many feel that that did not go far enough but, to address that concern, it also included the new power to enable the Secretary of State to direct NICE in specific cases to calculate charges on what it considers to be the appropriate commercial basis. This provides more flexibility for amending charges, should that be required in future, subject to consultation with stakeholders. For example, we may see different types of innovation, including devices or digital products going through TA programmes, and this provides flexibility for the Secretary of State to direct NICE to propose charges at a level appropriate to those markets. I think that responds to the point raised by the noble Lord, Lord Hunt.

NHS Mandate

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Thursday 25th April 2019 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating the Answer to the Urgent Question asked by my honourable friend Jonathan Ashworth in the Commons earlier today. Why was it necessary to ask that question at all? I hope the Minister may be slightly embarrassed by the lack of courtesy in not informing Parliament of the delay in laying the mandate for NHS England before Parliament in a timely fashion. That is the first time that has happened since the Health and Social Care Act 2012 came into operation. She must also recognise that this is a very important matter. The Secretary of State appears to have ignored the statutory obligation which was much debated and discussed in your Lordships’ House before that Act was passed. Your Lordships placed huge importance on the mandate and the fact that this was how the NHS would be held to account.

Why was this deadline missed? The answer—that the NHS was busy doing the plan and such things—is not adequate. This is about accountability to Parliament. We need to discuss why targets in last year’s mandate have not been met. This is a serious omission for the mandate because it sets the objectives that the Government expect NHS England to achieve, as well as its budget. I absolutely accept that the Government are committed to the budget and the plan, but they do need to address, with some apology, the lack of accountability that this omission means.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question. I refer to the comments by Simon Stevens in the PAC yesterday, when he laid out how he sees the situation for the NHS:

“We have an agreed direction in the long-term plan … We have the budget set for the next year, and we have the NHS annual planning process … wrapped up. 2019-20 is … a transition year into stepping into the new five-year long-term plan”.


As the noble Baroness knows, planning guidance for 2019-20 was updated in January when the long-term plan was published. For all practical purposes, this document sets the decision-making for local NHS decision-makers during this year. The national implementation programme for the long-term plan, which will set the longer-term milestones for delivery of the plan until 2023-24, will be published at the end of this year. The mandate and its accountability framework is an important accountability mechanism and strategy document for the NHS. It is taking longer partly because of the close working of NHSE and NHSI and the transitional nature of this year.

It is important that this document does come out, for the purposes of strategy and accountability, but it is most important that it is got right. That is why it is taking slightly longer. I look forward to the debate this House will have when it is published. I am sure that the noble Baroness will hold us to account in the usual manner.

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Ping Pong (Hansard): House of Lords
Wednesday 24th April 2019 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, it is always a good moment when we get to this point in any legislation. It is also an opportunity for us to look at where we started in July. In July, my Chief Whip spoke to me about a really small, uncontroversial Bill that would amend the Mental Capacity Act. I am not criticising him, because that is what he had been told. The idea was that we would have the Second Reading quickly before the Summer Recess and then move straight into Committee immediately after it and get through the Bill quite quickly. It is a great testament to this House that we recognised quite quickly that it might be a small Bill but it was certainly not uncontroversial. As I said when we moved into Committee, the noble Baronesses, Lady Jolly and Lady Barker, and I were sending each other messages about this Bill when we were all poolside in different parts of Europe because we realised that we needed to understand it much better.

I do not accept the criticism that we have failed. I think we started off with a flawed Bill and that we have improved it. In a few years’ time I think we will almost certainly return to this subject, because by then we will have discovered things that have not worked out and that need to be reviewed and possibly changed. We need to thank both Ministers for listening, hearing and working to change the Bill. I particularly thank my fellow Peers for working so co-operatively and with such great expertise. It is always a pleasure when we do that and we are always at our most effective when we do so, and I have been very happy that various Members of the House have taken the lead on various issues throughout the passage of the Bill. The Minister named everybody, so I shall not do so again, but they know who they are and it has been a pleasure to work with them.

We should be pleased that we have successfully tackled what, as far as we were concerned, were certain huge issues, many of which have been mentioned by the noble Baroness, Lady Barker. They included care home managers’ powers, conflicts of interest, private hospitals, the definition of deprivation of liberty and the information provided. We should be proud that those issues have been tackled. I particularly thank the noble Lord, Lord O’Shaughnessy. I have not often been called a juggernaut but on Report he suggested that I was. I think he was expressing the opinion that in my remarks I was representing the views of the whole House and that we were definitely coming for him, as it were.

If we are to learn some lessons from this, one is possibly that the Bill team took a little while to gear up to what happens in the House of Lords and how we approach things. We talk to the stakeholders—we have a continuous dialogue with them—and that is the next group that I would like to thank. I thank all the stakeholders who came to endless meetings with us to make sure that we did our job properly, although some of them still have some major concerns.

I say to the House that what matters is what happens next. First, it seems likely that within the next year or so we will have another mental health Bill, so it is quite possible that some of the issues that we have been concerned about will re-emerge and be discussed during that process. Secondly, we will have the regulations and the code of practice. I would like to be assured that the consultation, which might not have been quite as good as it should have been at the beginning of this whole process, will absolutely inform the code of practice and the regulations that follow the implementation of this legislation.

I do not wish to threaten the Minister but, after the past eight or nine months, there is a body of commitment and passion over this issue that will certainly be watching and be interested in what happens next and will have something to say about it. Therefore, in a spirit of positiveness, we hope that we will be able to help with the next stages but we will certainly be watching them to make sure that the gains that we have made are reflected in the code of practice and the regulations.

Finally, I very much thank the Minister, who came in in the middle of the Bill. This is the second Bill that she has had to pick up and run with in your Lordships’ House. She has done it with great dignity and intelligence, and it has been a pleasure to work with her.

[Baroness Blackwood of North Oxford]

I thank noble Lords for an important moment in the passage of the Bill. I assure them that they will never have to threaten me to get me to listen to important points regarding the progression of legislation of this import. I identify myself with the comments of the noble Baroness, Lady Tyler. This is indeed a pragmatic solution to the very challenging problem of getting the right solution.

I also echo the comments of the noble Baroness, Lady Finlay, who said that this has been a bumpy ride, but it is a major decision to deprive someone of their liberty, so it is right that there has been very detailed scrutiny of the legislation. When someone is deprived of their liberty we have to ensure that it is always necessary and proportionate and, wherever possible, consistent with their wishes and feelings. I agree with her that the advocacy provisions in this Bill are stronger than in the DoLS legislation, and that it will provide greater responsiveness and flexibility than previous legislation. We can be proud as a House to have delivered that.

I am sorry to hear the concerns raised by the noble Baroness, Lady Murphy. As we proceed through the next stages of engagement over the code of practice, I hope that we shall be able to prove her wrong, in the most positive sense. We have put in place very strong measures for whistleblowing thanks to the contribution of the noble Baroness, Lady Watkins; thanks also to her work, we have strengthened the provisions for information. We have also to nail down the questions around the definition, of course, but I think it right that this is not on the face of the Bill for all the reasons that we have debated at great length in this Chamber. I will not rehearse them now but will try to answer some of the questions that I was asked.

The first is about when the code of practice will be published. Obviously, as the noble Baroness, Lady Finlay, pointed out, the department is collaborating very closely with the sector in the preparation of the code; that is already happening. We are working with many organisations and individuals. The drafting will be considered by expert reference groups and people with lived experiences, to ensure that we get the most practical and workable code of practice. The department has already convened a working group involving a wide range of stakeholders. We expect to have output from the working group by this summer. After Royal Assent, I will place a letter in the Commons Library as requested; this will contain timescales for the code of practice, including when a draft code will be published for consultation. I hope that is reassuring.

As I have said, the statutory guidance will include a suite of case studies which will demonstrate how the definition applies in different settings and scenarios. It will provide clarity and aid to practitioners. We are collaborating to ensure that it can provide clarity and lack of ambiguity and can be a real help to those using it. As the noble Baroness, Lady Tyler, said, we have made a commitment that it will provide detail about when deprivation of liberty does and does not occur. It will reflect existing case law, including the Ferreira decision, and it will set out the meaning of a deprivation of liberty in a positive framing; this should be reassuring. On the question of a review, the code can be updated at any point. This will ensure that it can reflect changes in legislation practice or case law—that is, the entire code, not just the definition. I hope that is reassuring.

I would like to respond also to some of the points made by the noble Baroness, Lady Barker. She is absolutely right regarding the questions of resourcing, the backlog and training. We are very alive to this. A further impact assessment will be done following Royal Assent and we will work with stakeholders collaboratively to take on board feedback from previous iterations. We will also ensure that the Government will provide guidance ahead of implementation. That will include steps that can be taken to help reduce the backlog.

However, we will not stop there. The Government are committed to supporting training ahead of the new system coming into force and are working with Skills for Care, Health Education England and Social Work England to deliver that. Ahead of day one, we will work with local and national networks and the Welsh DoLS network, in partnership with the LGA and ADASS, to reduce the existing backlog. Work is under way for that. Cared-for persons who have existing DoLS authorisation on day one will remain under that authorisation until it expires, after which a new application will be needed to try to manage the volume of work that will be undertaken. I hope this is reassuring. To respond to the point raised by the noble Baroness, Lady Finlay, I can assure her categorically that the code of practice will be statutory.

I hope that all this is reassuring; I think this is a great step forward and I commend the Bill to the House.

Tobacco Harm Reduction

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Tuesday 2nd April 2019 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, it is important to say that snus is snuff—let us be quite clear that we are talking about a tobacco product. It seems slightly odd that the noble Viscount should suggest that we swap one very carcinogenic product for one that might be slightly less carcinogenic and will give you only mouth and throat cancer. Will the Minister commit that the review of tobacco regulation will include an assessment of the continuing attempts by major tobacco companies to market their brand identities through advertising campaigns and sponsorship—for example, through Formula 1? Indeed, one of her colleagues recently had to write to Philip Morris, which makes Marlboro cigarettes, telling it to remove poster adverts for “healthier” tobacco products from shops around the UK.

[Baroness Blackwood of North Oxford]

Smoking remains the biggest cause of death in this country. Strict rules are in place to prevent tobacco companies promoting their products, including through sponsorship. We take the unlawful promotion of tobacco products extremely seriously and expect any organisation found to be flouting the rules to be investigated.

Health: HIV

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Monday 25th March 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble friend for that Question and pay tribute to the work of the Lord Speaker. I agree with the premise of his Question. Public Health England has attributed the success that we have had, with 92% of people with HIV now diagnosed, 98% of patients receiving treatment and 97% virally suppressed to a combination of HIV prevention, including expanded HIV testing, prompt initiation of antiretroviral therapy after diagnosis, condom provision and PrEP, all of which we will need to build on as we develop plans to achieve zero infections by 2030. He is absolutely right that these will all need to go into development of that plan.

[Baroness Thornton (Lab)]

My Lords, it is greatly to be welcomed that science is now leading us to end new transmissions by 2030. But is the Minister aware that women who are HIV-positive are four to five times more likely to develop cervical cancer? I agree with the noble Lord that there is a need for a new strategy. Will the forward plan and investment in public health recognise the need for investment in prevention and early intervention and a package of care for all women living with HIV, which includes going for regular smear tests?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question. She is absolutely right that the key to us making progress is prevention and early intervention and also understanding about any crossover consequences with other illnesses. She is also right that the key is closing the gaps now. In 2017, 43% of diagnoses were made at a late stage of HIV and, although there has been a decline, the largest group diagnosed at late stage were black African heterosexual men and women. It is important that we close those gaps. Some key projects have been working on that through the HIV Innovation Fund so when we bring forward plans for HIV 2030 it is important that we find out how we can close those gaps if we are indeed to get to zero by 2030.

Healthcare (International Arrangements) Bill

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Report stage (Hansard): House of Lords
Tuesday 12th March 2019 Lords Chamber

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

My Lords, I am grateful to the noble Baronesses, Lady Thornton and Lady Jolly, and to the noble and learned Lord, Lord Judge, the noble Lord, Lord Marks, and the noble Earl, Lord Dundee, who I am sorry could not be with us today, for giving me the opportunity to deal with the important matter of the global nature of the Bill. We have already had a good deal of debate about this during our progress on the Bill, but it is a pleasure to return to it today yet again.

It is important that the Government explain why we believe it appropriate to seek powers which are global in nature. As I mentioned in my response in Committee, the EU Home Affairs Sub-Committee of this House, which is very wise, remarked that:

“Reciprocal healthcare oils the wheel of the day-to-day lives of millions of citizens”,


and brings the,

“greatest benefit to some of the most vulnerable members of our society”.

I am grateful to noble Lords from across the House, not only in the debate today but during the progress of this Bill, who have been clear that there is widespread cross-party support for the current EU arrangements, and for providing the people who rely on these arrangements with the assurance that the Government are taking all the necessary steps to support them in these uncertain times.

We clearly all support the arrangements we have with the EU. It therefore does not seem logical to preclude the possibility of seeking new arrangements or strengthening existing ones outside the EU. Where the Government have a good policy in one place, it seems logical that we should want to extend it to others. Reciprocal healthcare agreements promote tourism and facilitate economic exchange and growth by enabling people to study, travel and work abroad without worrying about their ability to access healthcare, or the cost of doing so. As we have discussed in our debates on this issue, reciprocal healthcare arrangements are particularly important for older people, people such as me with chronic conditions, or people with disabilities, for whom access or costs can be a genuine barrier to travelling.

Reciprocal healthcare agreements enable people to travel overseas for planned treatment, which enables patient choice. One of the genuine benefits of the current EU arrangements is to enable mothers to travel to a home country to give birth close to their families and support networks. That is available only to EU citizens at the moment, not to those from other countries who live here. Our existing arrangements with the EU enable around 1,350 UK residents to receive planned treatment or maternity care in another EU member state. We do not want to be forced to limit choices only to EU countries in the future.

Reciprocal healthcare agreements can also help to support international healthcare co-operation through fostering closer working relationships between countries and states. We can be proud that the UK is a prominent voice in the global healthcare community and is a key driver in global attempts to raise standards of patient safety. We could help to further drive that agenda through developing even stronger relationships with our close partners. I have heard the concerns raised by noble Lords about the costs of these arrangements. Reciprocal healthcare agreements enable countries to reimburse one another on a fair and transparent basis. Noble Lords, particularly the noble Lord, Lord Foulkes, have queried why we cannot simply rely on waiver agreements. Fair reimbursement is the key reason why. Without this Bill, we would be restricted to waiver agreements outside the EU without a way to establish fair and transparent payment and cost-recovery mechanisms.

Agreements with other countries predate the EU and have never been limited to Europe. This is one reason why the concept of restricting the Bill to the EU does not make sense. We have agreements outside the EU now and will continue to have them in the future. The noble and learned Lord, Lord Judge, and my noble friend Lord Ribeiro raised the matter of scope—the countries which the Bill would apply to. As Clause 4 sets out, data can be shared only in accordance with the GDPR and our data protection regulations. This means that no reciprocal healthcare agreement could be reached with a country that does not meet data adequacy standards. Over and above that, as my noble friend rightly noted, this scope would be further narrowed by the need to agree reciprocal healthcare arrangements only with countries that have a compatible healthcare system. This would mean that countries such as Venezuela, raised by the noble and learned Lord, Lord Judge, would simply be out of scope for an international healthcare agreement. Safeguards built into the Bill would be in place.

I make it clear that I have heard the concerns raised at Second Reading and in Committee about the global scope of the Bill and the breadth of the delegated powers. We have taken considerable steps to address the concerns about the breadth of the powers—the root cause of the concern about the global scope. As has already been referred to, we have tabled a large package of concessions, which I worked hard to try to deliver. The first was to remove the consequential Henry VIII powers; I am taken by the terminology for this now being a “Blackwood amendment”. We have limited the ability to confer functions to public bodies. We have provided greater parliamentary scrutiny over regulations relating to data processing and greater transparency over the financial aspects of future reciprocal healthcare policy in the form of an annual report. I hope that this reassures the noble and learned Lord, Lord Judge. We have placed a statutory duty to consult the devolved Administrations where regulations make provision within devolved competence. Finally, and very significantly, we will sunset two of the three regulation-making powers at Clause 2, so that they can be exercised only for a period of five years after exit day. This final amendment means that it is not possible for the Secretary of State to set up any kind of long-term scheme to unilaterally fund mental health treatment in Arizona or hip replacements in Australia, as the DPRRC proposed. In tabling these amendments, we have limited the delegated powers and therefore the scope of what can be done under the Bill around the world. We have also provided additional parliamentary scrutiny mechanisms and greater transparency.

During the debate on Amendments 1, 2, 11, 12, 13, 27, 28 and 29, from the noble Baronesses, Lady Thornton and Lady Jolly, the noble and learned Lord, Lord Judge, and my noble friend Lord Dundee—who cannot be in his place—I have not heard any concerns raised on the fundamental principle of reciprocal healthcare in countries outside the EU. Rather, I have heard the need for reassurance that in implementing agreements with other countries we seek to appropriately cost such arrangements, protect the NHS, and ensure that those countries which we strengthen or make new agreements with have appropriate healthcare systems and are able to process data appropriately. We are firmly committed to all these principles.

When the Bill was debated in the other place, questions were raised concerning the possibility of a reciprocal agreement with Guernsey, which is something we will need to look into following EU exit. This was seen as a positive possibility of the Bill; it is just one example of how our relationships might evolve and how the Bill can offer people new opportunities which they are currently denied under our legislative framework. If the scope of the Bill is limited to matters relating only to EEA countries and Switzerland, the Government would be unable to implement a reciprocal healthcare agreement with countries such as Guernsey where we are able to reimburse one another fairly. We would also be giving up the opportunity to support people, to bring them confidence and comfort outside the EU.

As the UK considers its relationship with the rest of the world, it is appropriate to take this opportunity to consider strengthening our existing agreements while exploring possible agreements with other countries. The powers under this Bill allow us to fund healthcare overseas to support UK nationals who live in, work in, study in, want to visit or give birth in other countries, while ensuring that we also have appropriate scrutiny powers within this Bill. They also allow us to extend similar opportunities to overseas nationals to use the NHS funded by their own country, making the NHS more sustainable and fit for the future. This is what we would be giving up with these proposed amendments.

There has been much debate in this House and outside it about whether there should, in fact, be two separate Bills: one to provide for implementing agreements with EU, EEA countries and Switzerland, and the other at a later date to provide for countries outside that group. I believe that this is the intent of Amendment 4, in the name of the noble Lord, Lord Marks. That would not be an effective use of parliamentary time; it would prove a barrier to the development and implementation of policy in this area that is clearly in the interests of the people whom I have already discussed. I am also not clear how different a different implementing Bill would look, as it would simply be for the implementation of international healthcare agreements and would be rather similar, whether they are for the EU country or for a country in another part of the globe. It seems to be doing the same work twice.

With the Bill, we seek to ensure that we have an implementing mechanism for reciprocal healthcare now and into the future. While it may be appropriate in other policy areas for the Government to seek new primary powers to implement specific, individual international agreements, it is simply not the case with reciprocal healthcare agreements. These agreements are not far-reaching in nature and are very limited in subject matter: they are about reciprocal healthcare. As has already been discussed, the Government already rely on the royal prerogative to enter into these agreements with other countries. This Bill is simply a smarter implementing mechanism for these agreements.

I also have concerns that Amendment 4 risks our ability to effectively implement a future relationship with the EU. Recognising the broader benefits of reciprocal healthcare, we want a long-term relationship with the EU but, as with any area of policy, we must have flexibility as to how we negotiate with the EU and how we arrange our broader relationship with it. EU law evolves and, as we discussed in Committee, there are proposals currently before the European Parliament that would mean that elements of that model might change in the near future. This amendment would prevent the UK from implementing that evolved arrangement even if that was the desired negotiating position of the UK. If we put this on the face of the Bill, we would have no flexibility on how we would do that, including agreements already concluded with Switzerland and the EEA and EFTA states. The noble Lord himself acknowledges in his amendment that flexibility is needed, but through this amendment that flexibility would be difficult to apply in practice.

In relation to all the amendments in this group I firmly believe that, in pursuing future reciprocal healthcare policy with close partners outside the EEA and Switzerland, the Government are providing hope and opportunity to people. Our colleagues and friends in the other place overwhelmingly supported this endeavour. We have introduced significant restrictions on what this Bill can do globally. However, I regret that these amendments would prevent us from being able to look to the future and embrace an opportunity for EU exit. It would be a great shame to miss that opportunity.

I recognise the valuable contributions from many Members of the House on enhancing and improving many elements of this Bill; I thank them for the time that they have given me, but I am unable to accept these amendments. I hope noble Lords will feel able not to press their amendments on that basis.

[Baroness Thornton]

I thank the Minister for her remarks and for the attention that she has paid to this matter all the way through. Everybody appreciates that enormously. In a way, she has made my argument for me, as has the noble Lord, Lord O’Shaughnessy, because nothing in the Bill says that healthcare agreements have to be reciprocal. In a way, that proves that we do not need an international healthcare arrangements Bill: we need a European Union-EEA healthcare Bill to deal with reciprocal arrangements and do the job that we have in front of us.

I do not accept the argument put by the noble Lord, Lord O’Shaughnessy, tugging at our heartstrings, about the human consequences of this. Actually, there is nothing to stop the Government bringing forward a global healthcare Bill. I am absolutely sure that the Minister and her colleagues, with the help of the noble Lord and others, could get this into the Queen’s Speech in two months’ time, when we could have all these discussions about how it might work. He said that we do not have any disagreements in principle about this. Actually, we do not know whether we have any disagreements in principle about international healthcare because we have not had that discussion: that is the discussion we would have if we were dealing with a Bill that was being consulted upon, going through pre-legislative scrutiny and all those other things that we have been arguing need to happen if we are to have a Bill of the scope that the Minister and her party wish to have.

I thank the noble and learned Lord, Lord Judge, the noble Lord, Lord Marks, the noble Baronesses, Lady Brinton and Lady Jolly, and my noble friends Lord Foulkes and Lord Judd for their support. In particular, I thank the noble Lord, Lord Wilson, who, in his brief remarks got the argument absolutely right yet again. As I was preparing for this, I looked at the agreements we have with Australia and New Zealand, for example. These things are complicated—of course they are— and in a way that is why they deserve and need further consideration. I fear that we are not convinced by the Minister’s arguments and I would like to test the opinion of the House.

--- Later in debate ---

[Baroness Thornton]

I thank the Minister for tabling this sunset clause; she is quite right to do so. I had not thought of the question asked by the noble Lord, Lord Lansley, but it is a good one. However, we support the amendment.

[Baroness Blackwood of North Oxford]

I thank my noble friend Lord Lansley for his question. This power enables a unilateral scheme, so it does not require reciprocity and is intended to be used only in an emergency scenario where a group of individuals are in difficulty. That is why it is appropriate to sunset it in this way.

I thank the House for its support for the amendment and hope that the noble and learned Lord, Lord Judge, will withdraw his amendment on that basis. I beg to move.

--- Later in debate ---

[Baroness Thornton]

I tabled an amendment in this group. First, I join the noble and learned Lords and all noble Lords in saying thank you very much to the Government and the noble Baroness for removing these Henry VIII powers, which cause so much heartache in this House—we really do not like them at all. I tabled Amendment 21 because I should like an explanation. Given that our Constitution Committee and the Delegated Powers Committee have several times said that they find the negative procedure rampant in the Bill, and that the British Medical Association has also voiced its concern about legislation being subject to the negative resolution procedure, in the interests of accountability, I need to ask the Minister to explain to the House the justification for negative procedure throughout the Bill. Should it not be subject to the same level of scrutiny as in the European Union (Withdrawal) Act, for example?

[Baroness Blackwood of North Oxford]

I thank the noble and learned Lords for their support for our amendments to Clause 5 and the removal of the Henry VIII operation within the Bill. I shall do my best to continue in the way I have started in this House.

I thank the noble Baroness, Lady Thornton, for her Amendments 21 and 23. The Government recognise that appropriate levels of scrutiny are the hallmark of an effective and responsible parliamentary system and that the processes by which we draft, consider and test legislation must be robust. It is necessary that we look at the nature of the subordinate legislation in the Bill and balance the need for scrutiny against the appropriate use of parliamentary time.

The draft affirmative resolution offers a greater level of parliamentary scrutiny and may be appropriate for particularly significant or sensitive regulations. For example, that is why the Government have agreed that that is appropriate when amending the list of authorised persons able to process data for the purposes of reciprocal healthcare. It is important to understand that, where the UK negotiates a new comprehensive international healthcare agreement, most of the important elements setting out its terms would be included in the agreement itself rather than in the regulations, made under the Bill, that implement it. The regulations giving effect to such an agreement would be much more likely to focus on the procedural, administrative or technical details, such as the types of documents or forms to be used to administer reciprocal healthcare arrangements. Evidence tabled during the course of the Bill’s passage from the Academy of Medical Royal Colleges and the British Medical Association demonstrates that the administration for current arrangements works well. The regulations made under this Bill would be likely to simply provide for the effective and efficient administration of these arrangements.

Children: Oral Health

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Tuesday 12th March 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question; he is of course very expert in this area. We want NHS dental services to be attractive for the profession and we remain committed to reforming the dental contract, which should help, but we recognise that there are a range of reasons for contracts being handed back, whether it is retirement, a decision to concentrate on private work or, in some cases, reorganisation of the companies providing the service. It is important that NHS England works with other local dentists to ensure that patients can continue to access dental care. There is a level of concern about recruitment and retention of dentists, and those difficulties need to be addressed by NHS England in its role as the commissioner. It is continuing to ensure that it works collaboratively with the profession and the department is keeping a close eye on this.

[Baroness Thornton (Lab)]

My Lords, tooth decay is a major source of health inequalities, as the noble Baroness has acknowledged, with 33% of the most deprived five year-olds having tooth decay, compared with 13.6% of the least deprived. In some parts of the country—the north-west, the West Midlands and Yorkshire—tooth decay rose for the first time in the last 10 years. How much investment will the Starting Well Core scheme have and for how long? When will we learn from the Government whether this has provided the right kind of remedial action for the most deprived children?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question. I shall write to her on the exact amount of investment, but there are some reassuring figures coming forward: 77% of all five year-olds now have no visible decay, compared to 69% in 2008; there has been a fall in the number of extractions per 100,000 finished consultant episodes for the first time in the last decade; and more children accessed dentistry over the last year. All this is reassuring and we are committed to improving access and equality of access to dental care—that is what the Children’s Oral Health Improvement Programme Board, led by PHE, is intended to do. It brings together 20 stakeholder organisations specifically focused on oral health. There is a significant amount of activity targeting exactly the issue the noble Baroness raises.

European Qualifications (Pharmacists) (Amendment etc.) (EU Exit) Regulations (Northern Ireland) 2018

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Thursday 7th March 2019 Lords Chamber

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

My Lords, this statutory instrument has been brought forward in the absence of the Northern Ireland Assembly which, as noble Lords will be aware, is suspended. We have just debated a complementary instrument which deals with the recognition of other EEA and Swiss health and care qualifications in the UK in a no-deal scenario. My department has worked closely with Northern Ireland Civil Service officials in the development of these regulations and they are the result of positive and collaborative work between the respective departments. Noble Lords will now be familiar with the recognition arrangement for all other EEA and Swiss qualified health and care professionals across the UK, which this instrument seeks to replicate. I will therefore describe only briefly what these regulations do.

This instrument deals with the recognition of EEA and Swiss pharmacist qualifications in Northern Ireland. It has three main effects. First, like the previous set of regulations, it puts in place arrangements for the recognition of EEA and Swiss pharmacist qualifications that are currently automatically recognised. Secondly, it ensures that applications for recognition that are ongoing on exit day can be completed under the current legal arrangements. Finally, it removes a number of provisions which it is not possible or appropriate to maintain in the event of a no-deal Brexit.

The instrument puts in place new arrangements for the recognition of pharmacist qualifications that are currently automatically recognised by the Pharmaceutical Society of Northern Ireland. Such qualifications will become “relevant European qualifications”. As such, they will continue to be recognised without additional testing other than checks of language skills and whether there are concerns about their fitness to be registered.

The regulations give the PSNI a new power to stop the automatic recognition of a qualification by seeking designation of that qualification. This is not currently possible under the directive and is an important additional measure that will enhance public protection. Such a designation will be subject to the agreement of the Department of Health for Northern Ireland.

The Government have been asked whether they will set out guidance on the criteria to be applied by the PSNI when seeking the designation of a qualification. We do not intend to do so. The PSNI will be able to seek designation of any qualification that is currently automatically accepted about which they have concerns. It will be the PSNI’s responsibility to gather the evidence in support of designation. The most likely basis for designation will be that a qualification does not meet the standard of the equivalent Northern Ireland pharmacist qualification and therefore presents public safety concerns. The PSNI sets the standards for Northern Ireland pharmacist qualifications and is therefore best placed to identify if there is a case for designating a qualification as not being comparable to these standards. The arrangements for the continued recognition of automatic qualifications will be reviewed by the Secretary of State for Health and Social Care no later than two years after these regulations come into force.

Qualifications that are not covered by the automatic system are considered by the General Pharmaceutical Council, which regulates pharmacists in Great Britain. These pharmacists can practise in Northern Ireland under a memorandum of understanding between the GPhC and the PSNI. This arrangement will continue, and changes to the GPhC’s procedures in a no-deal exit have been dealt with in the previous order.

These regulations enable applications which have been made before exit day to be concluded under current arrangements as far as practically possible. The instrument also allows individuals practising under temporary and occasional status or under the European professional card to continue to do so until such registration expires. Concerns have been expressed that the removal of temporary and occasional registration will have a detrimental impact on the number of EEA and Swiss trained pharmacists practising in Northern Ireland. I do not accept this. The PSNI does not have any pharmacists registered to practise on a temporary and occasional basis and has never received an application for temporary and occasional registration in Northern Ireland.

The instrument removes obligations and administrative arrangements that no longer apply to the PSNI, operate effectively or are appropriate to maintain when the UK leaves the EU. These include the requirement to share information through the European Commission’s IMI, to which regulators will no longer have access; arrangements that allow pharmacists to practise in Northern Ireland using an EPC; and the requirement on the PSNI to set professional education and training standards that comply with standards set in the directive. This will provide the PSNI with greater flexibility to set education and training standards that meet the needs of the pharmacy profession in Northern Ireland.

These regulations put in place a system for the recognition of EEA and Swiss pharmacist qualifications in Northern Ireland if the UK exits the EU without a deal. They also ensure that applications in progress on exit day will be concluded under current arrangements as far as possible. The regulations ensure a consistent approach to the recognition of professional health and care qualifications across the UK.

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for introducing these regulations. These ones are kind of like a double whammy: there are no-deal issues to deal with and no Assembly in Northern Ireland to deal with them.

These regulations are not as complex as the other ones. However, briefings we have received about this in the last week suggest there is some confusion among pharmacists in Northern Ireland about what might happen. The Company Chemists’ Association suggests that the impact of Brexit,

“could lead to a major nationwide shortage of pharmacists available for work”.

There has reportedly been a huge drop in the number of pharmacists registering with the General Pharmaceutical Council since the Brexit vote, with registrations of pharmacists from the EEA falling by 80%—that is generally, not just in Northern Ireland. The Chief Medical Officer for England stated that our pharmacists will be on the front line if there are any shortages. It makes being a pharmacist in the next month or so a pretty daunting prospect.

Concerns are rife, despite the Government stating that they wish to keep free movement of the protected professions and recognising pharmacists’ qualifications. Can the Minister clear up the confusion between pharmacists? Some seem to be saying it will be okay; others say they will fare very badly in the event of no deal. Can assurance be given to pharmacists that their qualifications will be recognised after we exit the European Union? Can the Minister outline the impact she thinks Brexit will have on our pharmaceutical industry and our chemists? In the UK, we depend on our pharmacists as the front line, the people we go to quite often so that we do not have to bother our GP. There seems to be a lot of concern out there that our pharmacists will find themselves in some difficulty.

Brexit: Import of Radioisotopes

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Thursday 7th March 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question. This advice has come not from the Prime Minister, but from the Royal College of Radiologists. On the basis of that advice, we know that many services will be unaffected. For other services, the NHS is already working closely with suppliers to minimise the impact of changes to medical radioisotope delivery times, which are expected to be a matter of hours and easily managed by clinics. But it is appropriate that they should be given sensible and practical advice to ensure that patients are protected and that patient safety is maintained to the highest possible standards.

[Baroness Thornton (Lab)]

My Lords, in many ways this Question is the just-in-time question of healthcare. We know that our manufacturing industries, particularly the automotive industries, will be affected by Brexit because of the just-in-time nature of their work. This is the just-in-time of cancer care. If you do not have the isotopes the tests do not get done, because the delivery is timed for the morning of an appointment when patients are due to arrive at the hospital—if there is nothing to give them, they then have to go home and wait for another slot.

My question to the Minister, who has done her best to reassure us on this, is: what calculation have the Government made of the risks? Certainly, the organisations which have waved a flag about this are not trying to panic anyone; they have legitimate concerns that they may have to delay treatment and tests because of Brexit. What calculations have the Government made of the risks there would be to people’s lives from delays that may happen as a result of this lack of just-in-time?

[Baroness Blackwood of North Oxford]

I think I answered that in my response to the noble Baroness. We have assessed that we do not expect any patient harm to arise from this, and the changes to clinical pathways and practices are expected to be minor and short-lived. It is one of the reasons why we started working with industry early in the process to ensure that air freight capacity was put in place. It is also why we have been working with the Royal College of Radiologists, NHS England and the department to ensure that the guidance was put in place, so that clinics could be prepared to adapt to these changes in delivery times.

European Qualifications (Health and Social Care Professions) (Amendment etc.) (EU Exit) Regulations 2018

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Thursday 7th March 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I apologise to the noble Lord for missing out on my answers to his questions; that was most remiss of me. These SIs come into force only if there is a no-deal exit. Should there be an extension of Article 50, they would not come into force until or if there is a no-deal exit, which is obviously most undesirable and something the Government are seeking to avoid.

On the communication of the effect or implementation of these SIs, they have been developed in close collaboration and consultation with the regulators that would be impacted. They are well informed about their operation, and given that the effect of the SIs is to continue with business as usual as far as possible, we hope that that is the de minimis effect. I shall write to the noble Lord in response to his final question, as I am afraid I have forgotten what it was.

[Baroness Thornton]

My Lords, I thank the Minister for her extensive response and noble Lords for their interventions and questions on this SI. The indignation and anger of the noble Lord, Lord Deben, has been reflected right across the House. Noble Lords may not express it quite as well as he has, but it absolutely is there. We have just spent an hour and 10 minutes debating this issue. Then there are all the hours of preparation, the cost of civil servants, the cost of our time and, indeed, the worry that all this is causing, not only to us in the Chamber but to millions of people outside. As the noble Lord, Lord Deben, and others have said, the Minister has done the best she can with the hand she has been dealt and answered our questions to the best of her ability. However, this is not where any of us wants to be. On that basis, I shall withdraw my amendment.

Cannabis: Medicinal Use

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Monday 4th March 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I do not accept the characterisation that the noble Baroness has just given. UK patients are not being denied access to these medications; they are able to access medication via prescription from a doctor who is on the specialist medical register. The Government have acted fast on the review of the best clinical evidence and we are going further with forthcoming NICE guidelines and a Health Education England training package to raise even more awareness.

[Baroness Thornton (Lab)]

What troubles me about the Minister’s answer is that NHS England’s guidance says that medical cannabis can be provided only where all,

“other treatment options have been exhausted”,

and where there is, “published evidence of benefit”. We have heard lots of evidence of the benefit this afternoon but we are right to be worried about the research that is allowing that to happen. Why is it not happening quickly enough? Can the Minister describe what level of opiate addiction and which severe side-effects of other medication can be tolerated before medical cannabis is prescribed?

[Baroness Blackwood of North Oxford]

The evidence base for the quality and effectiveness of these products is limited; it is developing. This is why the Government have asked the MHRA to call for a proposal to enhance our knowledge of these medications. However, we have not waited for this; we have introduced a route via unlicensed medications which allows for doctors who are on the specialist register to prescribe for patients. This is the right route; these are the doctors who will understand the conditions mostly likely to benefit from prescription and who are able to make a judgment about the safety and efficacy of medicinal cannabis. It is the route usually used for unlicensed medications and already set up by the MHRA. We want to see more licensed products in this route, however; we call upon industry to invest in more trials and publish the results and full underpinning data to build our knowledge so that more patients are able to benefit.

Mental Health: Eating Disorders

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Monday 25th February 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble friend for that question and in particular for raising the issue of stigma. We have put £150 million and extended over 70 services into the community specifically so that services can be more accessible to young girls and boys and so that people can feel free to come forward and seek help where they need it.

[Baroness Thornton (Lab)]

It is to be welcomed that the proportion of children with an eating disorder starting urgent treatment within a week or so remains quite high in London, but it is much higher than the rest of the country, according to the data analysed by the Royal College of Psychiatrists. What will the Government do to address what looks like a postcode lottery if your child needs support and help with an eating disorder and you happen to be in Bradford?

[Baroness Blackwood of North Oxford]

I am grateful to the noble Baroness, Lady Thornton, for raising the issue of ensuring that we improve services across the country and do not have a postcode lottery. Since July, NHS England has opened up 126 beds for children and young people in areas of the greatest geographical challenge to ensure that we can address exactly that problem.

Healthcare (International Arrangements) Bill

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Committee: 2nd sitting (Hansard): House of Lords
Thursday 21st February 2019 Lords Chamber

[Baroness Thornton]

The noble Lord and I absolutely agree about that, and the noble Lord is quite right. I am not saying that one would bow to that pressure at all. Your Lordships’ House has a proud record of persuading the Government to change both statutory instruments and primary legislation with regard to the powers that they have.

I shall say one final thing. It is not the case that these issues were not raised by my honourable friends in the House of Commons; in fact, they were. Indeed, the Delegated Powers Committee’s first report on the Bill was quoted extensively in Committee in the Commons; unfortunately, the votes were not there to carry its effects through. We might think about changing that at a later stage in the Bill.

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

My Lords, I thank the noble Lord, Lord Marks, for Amendments 26, 29, 30 and 31, the noble Lord, Lord Patel, for Amendment 28, and my noble friend Lord Lansley for Amendments 37 and 39, and all noble Lords who have participated in this debate, which has been very robust.

These amendments seek to address concerns raised about the ability to make consequential changes to primary legislation using regulations under the Bill. I reassure noble Lords that the Government have been listening closely to these concerns, some of which—as the noble Lord, Lord Marks, put it—were trenchantly expressed earlier in Committee, and I want to continue these conversations as we move towards Report.

That said, I would like to take this opportunity to provide some context to the approach we have taken in the Bill. The Henry VIII powers in this Bill are not free-standing; they flow directly from the delegated powers in Clause 2(1)—which I know has also met with a little bit of disapprobation. The noble Lord, Lord Butler, recognised the importance of parliamentary scrutiny, and we do as well. We recognise the concerns over the Henry VIII powers, and the Bill has been drafted to ensure that regulations making such changes would all be subject to the affirmative procedure. The intention of including this power to make consequential changes to primary legislation is simply to ensure that healthcare agreements are implemented in an efficient and effective way.

There is a broad legislative landscape which currently implements reciprocal healthcare arrangements with the EU. It currently includes EU law, as well as domestic primary and secondary legislation. In implementing future comprehensive healthcare agreements, it may be necessary to amend different types of legislation so that we can operationalise things domestically. In the past when we have implemented international healthcare arrangements, amendments were needed to primary legislation. For example, when we implemented the EU cross-border healthcare directive in 2013, we needed to insert discrete new sections into the National Health Service Act 2006. With that specific experience in mind, we felt it was important that the Bill was able to amend primary legislation because it seemed likely that it would be necessary in order to implement future agreements, albeit in very restricted circumstances and subject to the affirmative procedure.

We can give some reassurance that this is not a stand-alone power and it will not need to be used in the vast majority of regulations made under the Bill. Our intention in including this was only to ensure that the statute book is coherent when implementing future arrangements under the Bill. I recognise that there is serious concern from noble Lords on this matter, and am grateful for their thorough scrutiny so far. I give my reassurance that the Government have listened carefully and we will welcome further discussion on this critical issue before Report.

On my noble friend Lord Lansley’s Amendments 37 and 39, it is only right that parliamentary time is allowed for regulations that need enhanced scrutiny, but it is not appropriate for all regulations. The concept of retained EU law was introduced in the European Union (Withdrawal) Act 2018. The issue of the status of retained EU law was considered during the passage of that Act, which I am sure my noble friend was involved in. As a result of those considerations, the EUWA set out bespoke rules determining how types of EU retained law might be modified. This was set out in Section 7 of and Schedule 8 to that Act, as I know the noble Lord is well aware. Crucially, the EUWA does not require that all amendments to retained direct principle EU law must be subject to the affirmative procedure. That is true both in relation to regulations made under the EUWA and regulations made under other pieces of legislation, such as this Bill. As such, I hope noble Lords will agree that it is reasonable that we should follow the rules set by the Act—which ultimately was debated and passed by this House—in order to ensure coherence. The EUWA gives flexibility for future legislation to provide for this level of parliamentary scrutiny, which is considered appropriate. That is what we have done in this Bill.

--- Later in debate ---

[Baroness Thornton]

Listening to the noble Lord, Lord O’Shaughnessy, I reflected on our debates on Tuesday. I think he is again making the argument for two Bills, but there we go. He is quite right about differentiation. I thank the noble Lord, Lord Lansley, for introducing this group of amendments, all of which seek to curb the powers of the Secretary of State under Clause 5. I shall speak to Amendment 33 in this group. It would ensure that amendments are made under the affirmative procedure. We have sought to use the affirmative procedure in the event of no deal, which would enable the Government to bring in replacement bilateral arrangements immediately. That is because we are concerned that delays under the draft procedure would leave British and EU citizens not covered by a health agreement, with serious implications.

This group of amendments points in the same direction and comes from every part of the House. They broadly agree with both the Delegated Powers Committee and the Constitution Committee reports. As noble Lords have said, the Henry VIII powers in Clause 5(3) and (4) provide for regulations to amend, repeal, revoke or retain EU law. I very much welcome the fact that the Minister said in our previous debate that she intends to consider what has been said. I will resist the temptation to quote what the Constitution Committee said about this, because I know that noble Lords have read its influential reports at length.

These powers have been mentioned by noble Lords all the way through Committee. Clauses 2 and 5 are particularly worrying, to put it mildly. What concerns me is the Government’s reaction to the legitimate concerns expressed so clearly by both those highly regarded Lords committees, on whose advice we depend for our scrutiny of legislation. They overuse the words “flexibility and capability” and argue that the Bill must be forward-looking and needs those powers to provide that flexibility and capability. I was reminded of the previous general election, when the Conservative Party coined the phrase “strong and stable”. It did not convince anybody, and I am not sure that “flexibility and capability” is convincing noble Lords as a reason for the powers. It is a good reason for what the Government want to achieve, but as a justification for the powers in the Bill, it is not compelling.

The noble Baroness now seems to have realised that in every part of the House, including on her Benches, we take these matters particularly seriously. That is not because there is a desire to stop the Government acting—absolutely not at the moment. It is because our system of checks, balances and accountability requires legislation to be subject to proper scrutiny, in order to safeguard citizens from the tendency of Governments—all Governments—to charge on and ride roughshod, implementing their wishes without let or hindrance.

I know that some officials see this as a kind of game or tussle to see what they can get away with, particularly at the moment, but as the noble Lord, Lord Wilson, wisely said on Tuesday, you cannot put these powers in because they might just be useful. Although I will resist joining the noble Lord in repeating the words of Margaret Thatcher, I agree with his sentiment that the Bill as drafted breaks all the rules of our constitutional understanding. I hope that the Minister takes that seriously because the challenge before her and the House is to amend the Bill so that it fulfils its primary function: to provide healthcare cover for millions of UK citizens and to ensure healthcare for UK citizens living and working in the European Union and European citizens living and working in the UK. In other words, it is about individuals’ lives and their health. We believe that the right amendments, like those defined in this group, will refine the Bill’s scope and give the Secretary of State appropriate powers—an achievable task.

[Baroness Blackwood of North Oxford]

My Lords, I thank my noble friend Lord Lansley for Amendments 27 and 41, the noble Baroness, Lady Thornton, for Amendment 33, my noble friend Lord Dundee and the noble Lord, Lord Foulkes, for Amendment 34 and the noble Lord, Lord Marks, for Amendments 35, 36 and 38. Each amendment speaks to concerns we have heard during the passage of the Bill to date about the breadth of the regulation-making powers and the scrutiny afforded to them.

I wish to open by saying that I listen very carefully to these concerns. I assure the noble Baroness, Lady Thornton, that I see this process as neither a game nor a tussle. The suite of measures on reciprocal healthcare we are introducing is intended entirely to reassure UK citizens living in Europe and elsewhere, and EU citizens living in the UK, that we will work hard to ensure continuity of care for them in this uncertain time and that we are looking forward and thinking about providing care in other places, as a Government should.

To assist our consideration of these issues, I thought it might be helpful to set out the intention of some of the delegated powers as drafted, as we have not yet had a chance to do so in much detail. As I indicated previously, Clause 2(1)(a) is intended to be used to set out the detail of complex payment arrangements under reciprocal healthcare deals because payments can be made in a variety of ways. For example, the UK pays France the actual cost of treatment provided, meaning that a claim for the cost of each person’s individual treatment is made to the UK, whereas in Spain we pay an average cost per person of treatment provided. In Portugal, on the other hand, we offset payments. That is why that power has been drafted in that way.

Clause 2(1)(b) provides for regulations to be made in connection with the provision of healthcare abroad outside reciprocal arrangements, allowing us to put in place complex arrangements outside a bilateral agreement in an urgent situation. That is designed specifically for an EU exit situation that may be an emergency.

Clause 2(1)(c) is needed to give effect to comprehensive healthcare agreements entered into with another country or international organisation, such as the EU. This provides the power to implement agreements in domestic legislation. We believe that it would be unworkable to produce new primary legislation to implement each agreement on an individual basis; I am sure that the House would agree.

Clause 2(2) sets outs examples of the type of provision that might be included in regulations under Clause 2(1). As we have said before, it is an illustrative list of the kinds of provisions that would already be included. I took note of the concern about conjunctives under this clause.

Clause 2(2)(a) highlights that complex healthcare agreements may include a mechanism for calculating payments and regulations but would need to specify how the cost of healthcare would be calculated between different countries.

Clause 2(2)(b) indicates that regulations may establish eligibility criteria that specify which people can access healthcare outside the UK. Establishing robust eligibility criteria is key to preventing the misuse and abuse of healthcare, as referred to already by my noble friend Lord Lansley in previous debates.

--- Later in debate ---

[Baroness Thornton]

My Lords, all these powers exist at the moment, as do all these arrangements. However, the powers being asked for in this Bill have not been needed for that. The point that was made on Tuesday is about why we look to have such huge powers when actually we have managed without them in the past.

[Baroness Blackwood of North Oxford]

For the implementation of international healthcare arrangements, these powers exist within EU legislation. At the moment we do not have the powers to implement international healthcare arrangements within domestic legislation. That is why they are being introduced.

The department believes that the negative procedure is appropriate for the use of the delegated powers to arrange the specific implementation purposes which I have laid out. That balances the appropriate level of scrutiny with the use of parliamentary time. However, I have listened closely to the discussions in the debate and I take seriously the concerns which have been raised by noble Lords, by the DPRRC and by the Constitution Committee. However, I hope that noble Lords will understand that we need to ensure that the Government have the legislative tools needed to implement the agreements we reach, especially the ones with reciprocal healthcare at EU exit. I would like to work constructively with your Lordships to further consider these issues in detail as we progress the Bill to Report, and I will make myself and officials free to discuss the breadth of the regulation-making powers further at an open session next week. I hope that with this explanation and these reassurances, my noble friend will feel able to withdraw his amendment.

GP Partnership Review

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Thursday 21st February 2019 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what steps they will take to implement the recommendations of their report GP Partnership Review: Final Report, published on 15 January.

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

My Lords, we recognise the huge contribution that general practice and the partnership model has made to patients over the lifetime of the NHS. We wish to thank Dr Watson for the report of his independent review, and we are currently considering his recommendations. We are planning to publish a formal response in due course.

[Baroness Thornton (Lab)]

I thank the noble Baroness for that Answer. The GP Partnership Review makes seven key recommendations, including: an increase in the number of GPs and funding for those roles; an expansion of the range and capacity of healthcare professionals working with GPs, such as developing the role of practice nurses; focusing on general practice in medical training; and recommendations to deal with an unsustainable workload. Those are all laudable aims. What puzzles me is the context in which these aspirations can be delivered. Some 78% of EU doctors working in the UK are not reassured by the Prime Minister’s commitment to protect the rights of EU citizens, and 35% of EU doctors are considering leaving the UK and moving to another country. The tier 2 visa cap means that 1,500 applications for healthcare workers were rejected by the Home Office last year, and indeed more GPs are retiring, leaving or going part time than are entering the profession. So is there a plan to remedy the existing shortfall and the impending shortfall, which threaten and will continue to threaten patient care and safety?

Human Fertilisation and Embryology: Frozen Eggs Storage

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Wednesday 20th February 2019 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, does the Minister realise that if a medical condition is the determining factor and has left a woman prematurely infertile, the eggs can be stored for up to 55 years, as is the case with sperm? Therefore, the science has changed. The Government need to recognise that 10 years is an arbitrary and unfair limit. If eggs can be stored for longer, surely this situation is unfair and cruel to women who wish to use those eggs after the 10-year period, for a variety of reasons. Will the Minister ask for a review of the law, and if primary legislation is needed, could it be included in the next Queen’s Speech?

[Baroness Blackwood of North Oxford]

The noble Baroness is right: the 2009 regulations were not just concerned with fertility options for people who are already adults. The 55-year limit is intended for those who become infertile through serious illness or side-effects, which can happen in childhood. I understand the concerns about the 10-year limit—there was no consensus during the 2009 review—but it is being continually reviewed and will remain under review by the department.

Healthcare (International Arrangements) Bill

Debate between Baroness Thornton and Baroness Blackwood of North Oxford

Committee: 1st sitting (Hansard): House of Lords
Tuesday 19th February 2019 Lords Chamber

[Baroness Thornton]

The Minister’s colleague in the Commons said exactly that: it was a trade Bill.

[Baroness Blackwood of North Oxford]

He may have said that, but I have clarified this point with the department, the Secretary of State, and others: that is not the case. The Bill is not about trade deals; it is about reciprocal healthcare. In addition to that, I have clarified that free trade agreements, including those to which we are currently party as EU members, contain specific wording to safeguard public services, including the NHS. As we leave the EU, the UK will ensure that future agreements have the same protections. I clarified this at Second Reading and I reiterate it now: the NHS is not and never will be for sale to the private sector, overseas or domestic. If the noble Lord, Lord Brooke, would like to follow up on the points he has raised today, I would be happy to do so outside this Chamber.

I have heard the concerns raised today and at Second Reading regarding the global scope of the powers and I will explain why the Government have drafted the Bill in this way. We believe that the reciprocal healthcare arrangements that we enjoy with EU member states are a positive and beneficial policy. This view has been supported in today’s debate, and by both Houses. It has broad public and clinical support. Indeed, the EU Home Affairs Sub-Committee of this House remarked in its Brexit: Reciprocal Healthcare report:

“Reciprocal healthcare oils the wheels of the day-to-day lives of millions of citizens”,


and the arrangements,

“bring greatest benefit to some of the most vulnerable members of our society”.

In addition, we already have reciprocal healthcare agreements with non-EU countries such as Australia and New Zealand, other European countries such as the Balkan states, and the British Overseas Territories. These often pre-date the EU and have never been limited to Europe.

[Baroness Blackwood of North Oxford]

There would be significant challenges to a reciprocal healthcare agreement with the United States, because it has a different payment system. I do not envisage one being on the cards. Having listened to the debate today, I do not believe that there is an in-principle objection to non-EU reciprocal healthcare agreements. There is, however, a concern about the nature of the powers in the Bill, to which I now turn.

As noble Lords have mentioned, Clause 1 gives the Secretary of State a new power to make payments, and to arrange for payments to be made, to fund healthcare abroad. Currently there are limited domestic powers in relation to funding healthcare abroad so at the moment non-EU healthcare agreements do not transfer money. The payment system for funding EU reciprocal healthcare is currently set out in EU law. For this reason, if we want to enter into international healthcare agreements, whether with EU or non-EU countries, we need the powers in the Bill to extend beyond 2020 or in certain no-deal scenarios. Clause 1, therefore, enables the funding of any reciprocal healthcare agreements that the UK may enter into with EU member states, non-EU states and international organisations, such as the EU, as well as unilateral funding of treatment abroad in exceptional circumstances.

In the future, detailed provisions could be given effect domestically by regulations under Clause 2(1), which we will debate in the fifth group of amendments. This approach speaks to Amendment 3, tabled by the noble Lord, Lord Marks, with whom it is always a delight to tangle in the Chamber. He has proposed that the power in Clause 1 should be used only after regulations have been laid. I completely understand the motive behind this amendment, but there is a reason why the Bill has been drafted in this way. While it is making good progress through Parliament, it is very unlikely that the Bill will achieve Royal Assent before March. With the best will in the world, it would not be possible to lay regulations using the powers in the Bill until, we estimate, at least summer 2019. In an unprecedented no-deal situation, there may be a need to use the powers before then.

The UK has recently concluded citizens’ rights agreements with the EFTA states and with Switzerland to protect reciprocal healthcare for people living in those countries on exit day, or in other specified cross-border situations. It is good news that we would have an operative agreement in those states in a no-deal scenario, as they will guarantee healthcare for those covered by the agreements. However, in that situation, it is likely that we would need to use the power in Clause 1, alongside Clause 4, to temporarily implement those agreements to share data or make healthcare payments and associated arrangements, where required under the terms of each agreement, before laying regulations to implement them more transparently at the earliest opportunity. This may also be true of other agreements we conclude before or shortly after exit day if complete reciprocity was not agreed with EU countries. If this is the case, we will make Parliament aware of it, along with our plans to legislate for these agreements.

I have heard concerns about spending public money. This is obviously closely monitored; money spent under Clause 1 would be no exception to that rule and the usual Treasury safeguards would apply. This will be debated in more detail in the seventh and eighth groups of amendments, so I will leave that until then.

I turn to Amendment 5, in the name of the noble Lord, Lord Patel. I understand completely the basis for concern about how the power to confer functions has been drafted, so it may be helpful if I explain the intent of these provisions. The current EU reciprocal healthcare agreements are implemented in partnership with a number of NHS bodies and organisations. For example, the NHS Business Services Authority has responsibility for customer services in EU reciprocal healthcare. It prints and distributes EHICs, processes claims and recovers costs. NHS England is responsible for authorising applications for the S2 route. NHS trusts are obviously responsible for identifying visitors and making sure that they are not individually charged, and for ensuring that the UK can recover costs from member states.

It is important to note that it is not just healthcare bodies that are relevant to delivering reciprocal healthcare. For example, the DWP has a role with its responsibility for pensions and social security. When we lay regulations to implement healthcare agreements, such as those currently operating, we will need to confer the relevant functions on each organisation according to the role it plays, giving it a clear legal responsibility and operating mandate. That is the purpose of these two provisions. I note the concerns raised by noble Lords on this point and am open to discussing this issue in further detail.

Finally, I shall address Amendment 44 in the names of the noble Lords, Lord Patel and Lord Kakkar, and the noble and learned Lord, Lord Judge, which would limit the legal effect of the Bill to a two-year period after exit day. I entirely recognise the rationale behind this approach, but I have some concerns about the amendment’s potential consequences. It would mean that hundreds of thousands of people who access healthcare under these arrangements would have no certainty that their healthcare could continue two years after exit day. It would also mean that it would be difficult for the Government to enter into medium and longer-term healthcare agreements. I hope noble Lords will understand that the Government cannot support an amendment that places such uncertainty on the people for whom these arrangements are intended. However, I recognise the nature of the concerns raised by noble Lords and, as we proceed through Committee and on to Report, I want to continue working with and listening to noble Lords, on an individual and party level.

For these reasons, I hope the noble Baroness will withdraw the amendment and that the noble Lords, Lord Patel and Lord Kakkar, and the noble and learned Lord, Lord Judge, will not oppose Clause 1 standing part of the Bill.

[Baroness Thornton]

I congratulate the Minister on her summing up and answers. As these things go, it was absolutely perfect. I did not agree with a lot of it, but I commend her skills.

I thank all noble Lords who have taken part in this debate. I know it has taken almost two hours, and I knew this would be a very important debate because it is about the scope of the Bill. The noble Lord, Lord Patel, was right to put down clause stand part, because it focuses the mind—of the Government, certainly—when you are facing a clause stand part. We all knew that this was probing the scope of the Bill, which was exactly right.

I say to the noble and learned Lord, Lord Judge—just keep banging on. I agree with other noble Lords that this is very important. All of us will be reading the noble and learned Lord’s remarks very carefully, because they have given us a lot of material for how we are going to take these discussions forward. The noble and learned Lord may have used the term “carte blanche Bill”. My honourable friend Justin Madders in the other place called it the Martini Bill: good “any time, any place, anywhere”. I wanted to join in with finding different ways of describing the Bill and the experience of the noble Baroness.

The noble Lord, Lord Ribeiro, was right to draw attention to the issue of no deal and to talk about the problems of the scope of this Bill. I welcome the remarks of the noble Lord, Lord Lisvane, because he has such huge knowledge of the powers that are being talked about in this Bill. With the noble Lords, Lord Cormack and Lord Wilson, he expressed enormous frustration—from enormous knowledge, power and experience—with what we are dealing with here and how unacceptable it is. I am afraid that the Minister and the noble Lords, Lord O’Shaughnessy and Lord Lansley, have not dealt with that frustration. I take one grain of hope from the fact that the noble Baroness said she was open to discussion, and that was very wise of her. We will need to have more discussions.

I am looking forward to the future amendments in the name of noble Lord, Lord Marks, but this was a very useful amendment to put into this group. The noble Baroness, Lady Brinton, is quite right to talk about changes to NHS procurement. As we know—and I declare an interest as the chair of the procurement committee for a clinical commissioning group—European rules do rule, and that is important.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

We have relatively simple agreements with these countries that do not allow for the level of complexity which we have within the EU reciprocal healthcare agreements, which allow for tourists, posted workers and UK pensioners who live in EU countries. We do not have that scale of agreements with non-EU countries. Perhaps we might like to explore that, as it has many benefits for people who go to those countries. However, that is yet to be explored and is part of the reason why we would be seeking those powers.

Perhaps I may continue to speak to the amendments in this group. The Government want to secure a wider reciprocal healthcare agreement with the EU following exit that supports a broader range of people such as those not covered by citizens’ rights when they move between the UK and the EU for leisure, work or study. We would then use the Bill to enable the UK to implement any future relationship with the EU on reciprocal healthcare from 2021. In a no-deal scenario we are attempting to prepare for any outcome.

I would like to speak to the points raised by the noble Baroness, Lady Finlay. She asked how people would be identified and for the details of implementation and communication with individuals regarding potential changes in circumstances. These issues will be addressed in quite a lot of detail in the eighth or ninth group, so if she will forgive me, I will not address them now. Regarding the points she raised around trade, I would hope that the assurances that I have offered from the Dispatch Box today and in writing in my letter at the beginning of this week will offer the assurance that she is seeking that the position I have laid out is the position of the Government and it is not going to change.

Finally, regarding her question about the devolved Administrations and our consultations with them, we are very pleased to have received a legislative consent Motion from the Scottish Government and agreement from Northern Ireland, and we are in advanced discussions with the Welsh Government. I hope to be able to report back on that point in more detail on Report and I will be happy to continue discussions with her on it.

I will go into a little more detail on our offer to the EU, EEA and Switzerland. It is to maintain reciprocal healthcare agreements so that nobody faces sudden changes to how they access healthcare. Maintaining the current arrangements as they are now is possible only with agreement from other member states. I can reassure noble Lords that we have commenced formal discussions on this issue. The two SIs we have introduced under Section 8 of the EU withdrawal Act, and which I wrote to your Lordships about, afford the UK a mechanism for ensuring that there is no interruption to healthcare arrangements after exit day in those member states which agree to maintain the current arrangements after exit day. Through these instruments, the UK can maintain current EU reciprocal healthcare arrangements for countries where we have agreed reciprocity for the transitional period lasting up to 2020. These arrangements would not apply to a member state which did not agree to maintain the current reciprocal healthcare arrangements. Importantly, the SIs also provide protection for individuals regardless of reciprocity, both here and overseas, who are in a transitional situation. This would provide additional protection for people who are, for example, in the middle of treatment.

Turning to Amendment 10, I can assure the noble Baroness, Lady Thornton, and my noble friend Lord Dundee that we want a relationship with EU member states that includes reciprocal healthcare. The fact that we have introduced this Bill is evidence of that. However, I have concerns about the amendment. First, there is good reason for the convention that one does not put negotiating terms on the face of primary legislation, because that does not allow for dynamic international relations—and we are in quite a dynamic situation at the moment. Secondly, it is important that reciprocal healthcare arrangements are consistent with wider mobility arrangements between the UK and the EU, such as the rights of different groups of people to move and work. These are areas that will also be under negotiation and may have implications for reciprocal healthcare. It is necessary that we have the flexibility to make changes in response to that.

[Baroness Thornton]

I am quite happy to accept that this may be a faulty amendment—but that is allowed in Committee. Is the Minister saying that the reason for not accepting it is that it undermines the flexibility that is needed for the broader negotiation of healthcare arrangements? Of course, this is in line with our wish to limit this to being about the European Union Brexit arrangements for healthcare. As the noble Baroness knows, that is a better way forward. Putting that into the Bill would therefore not undermine any negotiations, because that is what we want to do.

[Baroness Blackwood of North Oxford]

Under a withdrawal deal, reciprocal healthcare is protected. Under the no-deal scenario with member states agreeing to reciprocal healthcare, people would be protected under the SIs. The powers in this Bill are for asymmetrical arrangements, as it were, which may arise if member states do not want to pursue reciprocal healthcare arrangements exactly as they stand, or for the negotiation of post-2020 arrangements. It is very difficult for us to predict exactly how they will go, so putting in the Bill that we will continue with the reciprocal healthcare arrangements exactly as they are now is not realistic, given that we do not know where EU legislation will go. That is not within our power and we cannot predict it.

The amendment would mean that a future arrangement provided for under this Bill would as far as possible need to conform with and replicate the current EU, EEA and Swiss model of reciprocal healthcare as it stands at exit day. There is a lot to commend the current EU model of reciprocal healthcare. It supports people to obtain healthcare if they move between countries—EHIC—and people with long-term conditions, but the amendment would be too restrictive when we think about the future reciprocal healthcare arrangements, both in a deal and a no-deal scenario. For example, in a deal scenario it is important that future reciprocal healthcare arrangements are consistent with wider mobility arrangements between the UK and the EU, such as rights people have to travel, move and work. These areas will be under negotiation and may have implications for reciprocal healthcare. This amendment would remove our flexibility to adapt to this.

On a technical point, as I mentioned, EU law in this area evolves and under proposals currently before the European Parliament, elements of the model will soon change. This amendment would prevent the UK implementing such an evolved arrangement even if there were a desired negotiating position from the UK. In a no-deal scenario, the Bill will ensure the UK can respond to all possible scenarios and complements the approach we are taking with the withdrawal Act SIs, which I have already mentioned.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

I offer my thanks to my noble friend Lord Lansley for his Amendments 7 and 8, to the noble Baronesses, Lady Thornton and Lady Jolly, for Amendment 17, and to my noble friend Lord Dundee and the noble Lord, Lord Foulkes, for Amendments 18 and 19. I also thank all noble Lords for a good debate on this group.

Each of the amendments seeks to provide clarity about the nature of the reciprocal healthcare agreements that we are seeking to implement after exit for the people who benefit from them. I understand that these are uncertain times and that people want to know that the UK Government are doing all they can so that there are no disruptions to people’s healthcare abroad after the UK exits the EU. I hope that noble Lords can all agree that this legislation is important, as it grants the public the confidence that this Parliament is working to ensure that people can continue to access healthcare abroad.

The Government’s intention is to continue current reciprocal healthcare arrangements with countries in any exit scenario—deal or no deal—as they are now until 2020. In any exit scenario, we are committed to the principle of equal treatment—that is, that UK nationals are not treated differently from local citizens when accessing healthcare in the EU. The Government are also committed to ensuring good value for taxpayers’ money and will carefully consider the associated costs of any future reciprocal healthcare agreement that they enter into. I think that that speaks directly to the points made by my noble friend Lord Lansley.

I agree with the sentiment of my noble friend’s Amendments 7 and 8, but I suggest that requirements such as the scope of people to be included in regulations and the principle of equal treatment are matters for the healthcare agreement. Questions around who should be eligible within specific reciprocal healthcare agreements and the affordability of those agreements would naturally be part of the scrutiny of any international healthcare agreement brought before Parliament as part of the CRaG process.

I just note, again, that the purpose of the Bill is to implement those agreements, not to define their parameters, as we do not yet know how the negotiations will proceed between now and the final agreements. However, my noble friend is absolutely right when he says that questions of eligibility, the principle of equality of in-country care, the impact on the NHS and value for the taxpayer will be at the heart of the Government’s consideration as they move forward with reciprocal healthcare. It is certainly our intention to be clear and transparent about this, not least because we are discussing the personal healthcare arrangements of UK citizens. As the noble Baroness, Lady Finlay, put it, this goes to the human heart of the Bill.

In addressing the specific concerns raised by the other amendments, I shall offer reassurances about some of the specific cohorts of people mentioned in the debate. First, I shall speak directly to Amendment 17 in the names of the noble Baronesses, Lady Thornton and Lady Jolly, and spoken to by the noble Baroness, Lady Finlay, and my noble friend Lord O’Shaughnessy. I can confirm that it is the UK’s negotiation strategy to continue UK-Irish healthcare co-operation regardless of EU exit. Both the UK and Ireland are committed to continuing reciprocal healthcare rights so that UK and Irish nationals can continue to access healthcare when they live in, work in or visit the other country.

To turn to a point raised by the noble Baroness, Lady Finlay, we also want to maintain co-operation between the UK and Ireland on a range of health issues, including planned treatment. We want people to be able to live their lives as they do now and for our healthcare systems to continue supporting each other. The common travel area provides an important context for this. The CTA holds a special importance for people in their daily lives and it goes to the heart of the relationship between these islands.

To answer the point raised by the noble Baroness, Lady Jolly, about overlapping competences, two amendments have been tabled on devolution, so we will be looking at that when we reach Amendment 42 and I will deal with that matter in more detail then.

With regard to Amendments 18 and 19 tabled by my noble friend Lord Dundee and the noble Lord, Lord Foulkes, the Government are acutely aware of how reciprocal healthcare arrangements benefit UK state pensioners and those with long-term conditions. Speaking as someone with a rare condition, when I travel, I travel at risk; I am not eligible for insurance. I understand this only too personally. Therefore, I thank the noble Lord, Lord Foulkes, for rightly raising the question of how effectively we communicate with those who currently rely on reciprocal healthcare arrangements. As well as speaking from a personal perspective, I can say that the Government are very conscious that it can be difficult to get insurance. We are working with Kidney Care UK to ensure that advice is sensitive to these issues and that people have the information they need to make the best decisions. We will discuss this issue in a lot more detail when we reach the group commencing with Amendment 20, but I want to offer the noble Lord my personal thanks.

The noble Lord also referred to a letter from a friend of his. I think that that would have gone to my right honourable friend the Minister with responsibility for Brexit. However, if he has not received a response, will he please let me know?

Access to healthcare overseas is obviously vital for the groups we have mentioned. The Government are seeking to maintain reciprocal healthcare rights for pensioners and those with long-term conditions through the “in principle” withdrawal agreement in a deal scenario, and in a no-deal scenario through our discussions with member states, the two EU withdrawal Act SIs that we have introduced, and of course through the powers in this Bill.

In responding to these amendments, I hope that I have made it clear that the Government’s negotiating position is to provide for the continuation of the current reciprocal arrangements and the ease of access to healthcare that these provide, especially to the people on the island of Ireland, those with long-term illnesses and pensioners. I hope that this reassurance addresses the concerns of noble Lords and that my noble friend will feel sufficiently reassured to withdraw his amendment.

[Baroness Thornton]

Would the noble Baroness mind repeating the part of her answer that referred to overlapping competences? I would be very grateful if she could do so.

[Baroness Blackwood of North Oxford]

I simply said that two amendments on devolution have been tabled, so we will be discussing that issue in a lot of detail when we reach Amendment 42.

I hope that my noble friend will feel able to withdraw his amendment.