Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) (No. 2) Regulations 2021

Baroness Walmsley Excerpts

Tuesday 14th December 2021 Lords Chamber

The problem that we have as a House is that, in effect, the veto power on secondary legislation is so huge that we hesitate to use it. The last time we did—if I remember rightly—the Front Bench opposite threatened to abolish the House of Lords. We talk about scrutiny of secondary legislation, but the reality is that we can have these debates and we can make our contributions but the Government will take absolutely no notice. That means that we must be very careful when it comes to SIs of this kind. I support this SI, but it is draconian—there can be no doubt about it. I think that it is justified but, my goodness me, to produce it without the proper supporting documentation is a contempt of Parliament.

[Baroness Walmsley (LD)]

My Lords, before I follow up my noble friend Lady Tyler’s comments, I want to say how much I agree with the noble Lord, Lord Cormack. The way in which this has been done—I agree also with the noble Lord, Lord Hunt—is absolutely shocking; it is a contempt of Parliament. I was horrified when I read the report of the Secondary Legislation Scrutiny Committee about how bad it was and how late the sort of impact assessment—I call it a sort of impact assessment —has been produced.

Of course, we do not need an impact assessment to know what the problem at the heart of this is, apart from the compulsion element, which I understand: it is the fact that so many people are hesitant and mistrusting about having a vaccination. We also know from the work of Healthwatch, mentioned by my noble friend, that the most effective way of addressing the problems that people have with the vaccination is to have a one-to-one discussion with them so that they can say what their problems are and have them addressed. It needs to be done with a person whom they trust—somebody who they believe has some knowledge and understanding of the issues.

The difficulty with doing this at the moment is that all those people are very busy. We have the winter problems coming up; we have the omicron variant of Covid-19 increasing day by day and our NHS is on the edge of falling over. So I have a little suggestion for the Minister. There are plenty of doctors and nurses relatively recently retired who for one reason or another are reluctant to come back into the front line at the moment. However, they retain the respect of the health community. I understand from the executive summary that the total cost of replacing members of staff who are likely to leave because, whatever happens, they do not want to have a vaccine is £270 million. Could not some of that money be used to get those doctors and nurses with the knowledge and the trust of their recent fellows to have those conversations, without interrupting the staffing of hospitals, where it is bad enough at the moment, as we have lots of vacancies? We know that we cannot take all those people out to have those conversations, because it takes time and it has to be done with sensitivity and consideration. Could not some of that money be used to bring back some of those very experienced people to have those conversations and, hopefully, to reduce the number of those who absolutely will not be vaccinated and, sadly, will leave the profession?

I shall ask the Minister one more question. A few weeks ago, I asked him whether patients had the right to request that they should be treated by vaccinated staff only. Whatever the Government do, it will not all be done until April, which is months away. So there will be lots of patients treated between now and then by people who are not vaccinated. I asked the Minister whether patients had a right to request to be treated by vaccinated people only. He very kindly wrote to me, but I am afraid he was not able to give me a definitive answer. Now all the work has been done on this statutory instrument, I wonder whether things have become any clearer on that issue.

[Baroness Bennett of Manor Castle (GP)]

My Lords, a great deal of concern about procedure has been expressed from all sides of your Lordships’ House. I have nothing to add on that, except to say that I share those concerns.

I have two specific questions for the Minister. The first builds on the comments of the right reverend Prelate the Bishop of St Albans, who talked about how we have to win the argument on vaccination and the concern about unintended consequences and potentially discriminatory outcomes. When I look at the impact assessment, it is focused entirely on the care and health sectors. For example, paragraph 126 refers to

“the possibility of negative behaviour change resulting from the policy. For example, a German experiment found that vaccination requirements increased anger among individuals with existing negative vaccination attitudes and led to a decrease in uptake”.

As far as I can see, there does not appear to be in this impact assessment any consideration of impacts outside the health and care sectors. If we are creating this process, it will have impacts right across society, not just in the health and care sectors. We are talking about systems thinking here: not just what making a decision in the health and care sectors means for the health and care sectors, but what it means across the whole of society. What are the negative impacts of people in general deciding not to get vaccinated because of this?

The second point I draw from a very useful briefing from the Homecare Association. I do not think anyone else has asked this question, and I feel I should ask it for the Homecare Association. It said that it is extremely concerned about the intention to legislate rather than persuade. It is asking about a contingency plan if, indeed, the results are towards the worst end of the impact assessment. What are the Government doing to plan for this situation, when we have already had 1.5 million hours of commissioned care not delivered between August and October because of lack of availability? If this gets much worse, what plans do the Government have to fill the gaps?

Breast Screening

Baroness Walmsley Excerpts

Tuesday 14th December 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness raises a very important point; we need to tackle inequalities not just in this area but across all healthcare. One of the things we have been looking at is research into why women in certain areas do not come forward. That is why we have invested in mobile breast screening units, so that we can take screening services closer to those people who are reluctant to come forward.

[Baroness Walmsley (LD)]

My Lords, we heard the Minister’s Answer about the money that has been pledged, but the elective delivery plan promised by the end of November has not been published. Can he say when it will be published and how it will help to find and treat the just under 10,000 fewer than usual women who would have been diagnosed with breast cancer between March 2020 and October 2021?

[Lord Kamall (Con)]

The plan will be published in due course. When we look at the backlog for the breast screening programme, we see that all 77 NHS breast screening providers are now operational and screening women. Some have caught up, and others are not predicted to recover by the end of March 2022. That is why NHS England and NHS Improvement have comprehensive plans, including spending and investment.

Health and Care Bill

Baroness Walmsley Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, being asked to make a winding-up speech is a mixed blessing. There may be nothing new to say, but at least one has more than five minutes in which to say it. Like the Minister and the noble Baroness, Lady Thornton, one has to listen to the vast majority of the debate. I am sure they will join me this evening in saying what an absolute pleasure it has been. We have heard passion, compassion and expertise, all peppered with a little bit of humour—and I am right with the noble Lord, Lord Rooker, especially on the medication. It has certainly emphasised why we need your Lordships’ House: to give detailed scrutiny to Bills coming from another place. In that respect, are we not very lucky to have been able to welcome the noble Lord, Lord Stevens of Birmingham, to our ranks? I welcome him and congratulate him on his maiden speech.

When I look at a Bill like this one, I ask myself whether it will deal with the most urgent issues in the sector. So I have a little list of the questions. Will this Bill fix the crisis in social care; reduce health inequalities; ensure parity of esteem between physical and mental health; reduce the backlog of treatments while improving patient safety; improve access to primary care and reduce the demand on A&E; enable those who need social care to get it and help unpaid carers; provide the right number of qualified staff in both the NHS and social care; enable the commissioning of multi-agency pathways; improve recruitment and retention of NHS and care staff to enable them to work within safe staffing levels; enable public health to carry out prevention activities and protect us all from future pandemics; enable research and innovation to be implemented as quickly as possible and ensure that patient data is shared only in the patient’s interest and with appropriate security? Unless the answer to these 12 questions is “yes”, the Bill should either be ditched or considerably amended. It is quite clear from this evening’s debate that your Lordships are determined to do the latter.

Like the noble Lord, Lord Warner, I start with the fundamental issue of why the Government want to push these measures through at a time when the NHS is stretched beyond endurance and social care is at breaking point. Thousands of hospital beds are occupied by Covid patients; others cannot be discharged because there is not enough social care. No wonder—some care homes have had to close because they did not have enough patients to make them pay during the pandemic; others have had to close sections of beds because they cannot get enough staff. The backlog for elective treatments is not going down well enough, and both health and care staff are exhausted. GPs and pharmacists are trying to do their usual job while at the same time stepping up the vaccine programme. A White Paper on social care was published less than a week ago and another is promised next year, and it is at this time that the Government have chosen to change the structure of the health and care system.

The Minister will no doubt say that many of these changes have been requested by the health and care sector to enable them to continue to work more closely together without legislative barriers. We know that many areas have been preparing for the change for some time. That is all true, and the direction of travel is most welcome. However, winter is upon us, and services are not showing the resilience we need in preparation for it while at the same time having to prepare for these imminent changes.

The Government are taking a very big risk by asking the system to make these changes now. Can the Minister please be clear about why he is so confident that it can be done next April without the NHS and care providers taking their eye off the very heavy ball they are already carrying? None one of us wants to see a “Titanic” disaster, but the iceberg is upon us.

I move to the obvious potential benefits of the new integrated care systems, if they are set up correctly and with everything thought through. The Bill has been described as broadly permissive, and this may allow services to be arranged to suit the particular conditions of each of the 42 areas and the sub-areas between them. However, there is a danger that funding will be sucked in, as usual, to the large hospital trusts in each area and social care and community services will be left behind. From these Benches, we are particularly concerned about this. How will that be avoided? How will all the relevant interests be appropriately represented? For example, certain aspects of health such as mental health, sexual and reproductive health, as mentioned by my noble friend Lady Barker, public health and prevention services such as anti-smoking, mentioned by my noble friend Lord Rennard, and weight loss pathways, as mentioned by the noble Baroness, Lady Jenkin, may not get the attention they need right at the heart, at the ICB level, where budget decisions are made. In Committee, we will of course probe how this can be achieved. However, if representation of these services is made at the right level, there is potential for improvement.

If major changes are to be made, there is one overriding issue that must be at the heart of all ICS management, and that is addressing the health inequalities in their area. Although some parts of the country suffer more than others, no ICS will be without a group of people and neighbourhoods where health outcomes are well below the average. How does the Minister expect the ICBs to deal with this? It is not only the right thing to do but also best for the economy. People are not productive if they are not well fed, a healthy weight, active and with good mental well-being. Indeed, if the NHS is to survive financially, we need to work on prevention of ill health and avoid an older population with multi-morbidities. How much more cost effective it will be to prevent this than to pay for its effects.

Inequality also exists in the ability to pay for care, and we will probe the effects of the Government’s recent cap proposals, as my noble friend Lady Pinnock explained. Reflecting what the noble Baroness, Lady Pitkeathley, and the noble Lord, Lord Kerr of Kinlochard, said, can the Minister say where the responsibility for family and friend carers will lie under the new regime? There are millions of unpaid carers in this country, some of them still children and some very elderly themselves. The recent White Paper says very little about them, but it is somewhere in this new system that the responsibility for their welfare will lie. Where is it?

My noble friend Lady Tyler, the noble Lord, Lord Farmer, and many other noble Lords have pointed out that, at the other end of the age scale, the Bill says nothing about children and there has been no child impact assessment. I will not repeat everything that they said, but can the Minister tell us whether we will get a child impact statement? Where will the responsibility for safeguarding children lie? If it is going to the ICBs, that is a very long way from the place-based committees where all the delivery of services are made, and the current system already leaks, so we must be very careful.

My noble friends Lord Shipley and Lady Pinnock have talked about local authorities, which have numerous responsibilities for social care and public health. This Bill should be creating a partnership of equals between the ICS and local government. In Committee we will probe how local authorities can influence the distribution of budget from the ICB. Many ICSs will cover several local authorities and some authorities will cross two ICSs. How will that work? Of course, it is at local level that all the services that we are talking about will be delivered, so we will also probe the relationship and lines of accountability between the place-based committees and the ICB. In his introduction, the Minister mentioned the phrase “bottom up”. The epitome of that in this new structure is the place-based committees and the voice of the patients they represent. How will their voices be heard at an appropriate level?

The Government are hoping that the new integrated care systems will be more financially efficient than under the old regime. This may be so, but it is vital that it is not at the expense of quality. We welcome the removal of the dominance of competition in procurement, with more emphasis on quality and collaboration, but we will be watching very carefully to ensure transparency in procurement. Contracts must go to companies and service providers who are chosen on their merits and not on who they know. The ICS board, however large or small it is, must be seen to be independent and not influenced by private interests, because it will have enormous power.

Talking of power brings me to the new powers of the Secretary of State. There may be justification for some of them for accountability’s sake, but these must be tempered by appropriate limits, consultation and transparency. However, there is more than a little tension between the Government’s stated objective of being broadly permissive towards the ICSs and giving more power to the Secretary of State, especially the power to intervene at an earlier stage in local service configuration, and even to propose a new local reconfiguration himself or herself. That is going too far and is against the spirit of the Bill.

If health and care organisations and providers are to work more closely together, a lot of patient data will be exchanged. The objective is to have a common system so that information can be quickly and accurately exchanged. We will scrutinise this part of the Bill to ensure that this is always in the patient’s interest with an appropriate level of need to know, privacy and accuracy. The mandatory health services safety investigations body appears in Part 4 of the Bill.

I well remember hearing a previous Secretary of State, Jeremy Hunt, at a King’s Fund lecture several years ago, describing how it would seek to find out what went wrong without apportioning blame, so that learning could occur across the system. It struck me then, as it does now, as a very worthy objective. He said it would be based on the Air Accident Investigations Branch, which has been very successful. For it to work in the interests of patients, it must be independent and have the trust of staff. The so-called safe space in which staff can explain what happened is a very important element of this, and I would be concerned about any attempt to encroach on it. We will look at that in detail at a later stage.

I end on the most important factor of all in the delivery of health and care services: the workforce. Over the past few years, the number of vacancies has been growing and is now chronic—not helped, particularly in the case of social care, by Brexit. Safe staffing levels have been breached, and that means that patients are in danger, so we will lay amendments to ensure the provision of sufficient staff with the right level of training to ensure safe staffing levels. Planning for the provision of enough qualified staff has not been good enough, and a review of workforce planning every five years will not do. Given how quickly things can change, that is not often enough.

We will support efforts to provide more accurate predictions of need and more frequent review of the plans to provide them. We are also concerned that the focus could be on NHS staff only and that care staff will be forgotten. Does the Minister agree that they, too, need skills and career paths to ensure high-quality care and encourage recruitment and retention? We look forward to the delivery of the £500 million for this promised in the White Paper and wonder whether the Minister can say how the training will be delivered in the new integrated service. It will be one of the most important duties of the new integrated care systems.

This must not be just another NHS reform Bill. It must be about improving the health and care of the whole nation. I look forward to the Minister’s replies to these important questions.

Health and Social Care

Baroness Walmsley Excerpts

Monday 6th December 2021 Lords Chamber

[Lord Kamall (Con)]

We have to recognise that if we look at the social care system, there are an awful lot of private providers. Quite often, when we look at private providers, it is private patients who subsidise their ability to provide places for state-funded patients. In our health system overall, there will always be a mixed economy, including state provision. Lots of our GPs, for example, are partnerships—they are not state-run, some of them are co-operatives, some are even for profit. When we look at the overall health system, there will be a general balance. I am not aware of the particular case, so I thank the noble Baroness for raising it, but one of the things we are committed to is making sure that we improve services, whether they are state-funded or private, as part of the overall system of healthcare that we have in this country. Clearly, where providers are not providing a service, there will be CQC and other assessments to see whether they are fit.

[Baroness Walmsley (LD)]

My Lords, Covid-19 is absolutely rife in our schools, both primary and secondary. Teachers are in the front line. There are whole classes and even whole year groups being sent home because the teachers are off sick and they cannot even get supply teachers. A lot of teachers are under 40. Why can they not get boosters? If vaccines really are the answer, during this winter period, that would help more children to be able to stay in school and avoid disrupting their education. Will the Minister tell us about that?

Secondly, I go back to what both noble Baronesses on the Front Bench raised. Where are the social care staff going to come from? When I looked at the paper that sat behind this Statement, I noticed that there was nothing in it about changing the salary level at which visas can be offered to social care workers coming from abroad. Why not? We are desperate for social care workers. Can the Minister tell me—and if he cannot, perhaps he will write to me—what proportion of vacant posts fall below the salary level required for a visa?

[Lord Kamall (Con)]

In terms of tackling the social care workforce, there are a couple of things: £162.5 million is going on a number of different schemes to make the social care sector an attractive place to work and we are looking, longer term, at professionalisation, so that people feel valued. At the same time, the minimum wage will help lift the pay of many people in social care work, but in the longer term we want to make sure that social care is not seen as the poor relation of other parts of the health service. We want to make sure that we have professionalisation and that it is all joined up. Some of these things will not be tackled in the short term, but we have a short-term programme called Made with Care, which is aimed at targeting and recruiting people to come and work in the social care sector. We realise that we have to do the long-term things, but also to promote short-term measures to tackle the issues we have at the moment. On specific statistics, as I am sure the noble Baroness can imagine, I do not have the details at hand but I commit to write to her.

Adult Social Care

Baroness Walmsley Excerpts

Thursday 2nd December 2021 Lords Chamber

[Baroness Walmsley (LD)]

I wish the Minister good luck with his nettle grasping—I think he is going to need it. He will know that the right housing is key to enabling people to remain safely and happily in their home, yet only £300 million, a very small amount, is being promised in the White Paper to integrate housing into health and care strategies. Take, as an example, the so-called extra care units, where people can live in a flat with appropriate on-site support; that will mean only about 3,000 such units across England. Can the Minister say over what period that money is being offered? Is it three years or a different period? How many units of supported housing can be provided for that amount of money?

[Lord Kamall (Con)]

I thank the noble Baroness for raising this issue. We want to ensure that people can live in their own home for longer. We have committed a sum of money and been quite clear that practical changes can be made, such as installing stairlifts, level-access showers, wet rooms, sensors, et cetera. New technology is constantly being developed to meet people’s needs in their own home. To this end, we have committed a further £573 million per year to the disabled facilities grant, from 2022-23 to 2024-25. We are also talking to local authorities and others, looking at whether we need to increase the subsidy amount per adaptation and reconsider funding allocation to better align with local needs, as well as funding a new service to enable minor repairs and changes to people’s homes. We need to know what needs to be done, and local authorities and others can come back to us on the adaptations that they need and the best way to achieve them. We must look at best practice to make sure that, as technology develops, people can stay in their own home for longer.

Ambulance Response Times

Baroness Walmsley Excerpts

Wednesday 1st December 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness makes a very important point: we should be looking at this in a systemic way. In fact, I did my PhD in a department of system science, where you look at problems in a holistic way—rather than analysing individual problems, you look at the whole system. We found odd unintended consequences. For example, a friend forgot his inhaler, could not get one from the chemist, could not get one from the A&E and, in the end, had to call out an ambulance. There are a number of times when ambulances are called out needlessly, and that is on top of the pressures we are already facing due to Covid. We are tackling the backlog, which, hopefully, will also reduce ambulance waiting times.

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that every ambulance service in the country is currently on black alert? The problem goes both upstream, into the community, and downstream, into the hospitals and social care. What are the Government doing to decrease the number of older people being blue-lighted into A&E because they cannot get the social care services to keep them safe in their own homes?

[Lord Kamall (Con)]

The noble Baroness makes a very important point. We are all aware of the difficulties in different parts of the system. We have invested £450 million to upgrade A&E facilities in more than 120 separate NHS hospitals ahead of last winter, and this is being used to boost the physical capacity of A&E through expanded waiting areas, increasing the number of treatment cubicles, reducing overcrowding, et cetera. This is alongside an additional £1.8 million to place more hospital ambulance liaison officers at the most challenging acute trusts to help address the long delays, to reduce ambulance queueing and to get crews back on the road quickly.

New Hospitals

Baroness Walmsley Excerpts

Thursday 18th November 2021 Lords Chamber

Asked by

[Baroness Walmsley]

To ask Her Majesty’s Government what progress they have made towards their commitment of building 40 new hospitals.

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

The Government committed in October 2020 to build 40 new hospitals by 2030. We have confirmed an initial £3.7 billion to support these schemes for the first four years of the 10-year programme. This, together with eight previously announced schemes, will mean that we will have 48 new hospitals by the end of the decade. Six of the 48 new hospitals are currently in construction, including the first of the 40 new hospital schemes, and one scheme is now complete.

[Baroness Walmsley (LD)]

My Lords, as the Minister said, eight NHS capital schemes already under way when the promise was made were added to the Prime Minister’s pledge for 40 new hospitals by 2030, but now their cost overruns will have to be paid for out of the original pot of money. Can the Minister say how many of the originally promised 40 will now have to be postponed and how many are really new?

[Lord Kamall (Con)]

The Government have said that we will deliver 40 new hospitals by 2030 and in October 2020 we published the full list of the 40. This includes eight schemes that were announced by previous Governments but are to be delivered this decade and 32 new hospitals. We have also confirmed that we will identify further new hospital schemes, the process for which is ongoing, with a final decision to be made in spring 2022. This means that 48 hospitals in total are to be delivered over the decade.

Covid-19 Update

Baroness Walmsley Excerpts

Wednesday 10th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for giving me notice of his question just before we came in. I tried to get an answer as quickly as possible, and I apologise that that answer has not arrived. I want to make sure it is absolutely right and that I am certain that I do not mislead the House unintentionally.

[Baroness Walmsley (LD)]

My Lords, as we move towards 1 April, I want to raise the issue not just of the concerns of staff, which the Minister has rightly mentioned, but the concerns of patients. Could patients in a ward, an NHS clinic, primary care or any other health setting be informed as to which members of staff have not been vaccinated? Would they then have the right to politely request that they are treated only by vaccinated staff?

[Lord Kamall (Con)]

The noble Baroness makes a very interesting point and an interesting suggestion. I am not quite sure of the details absolutely on those issues—as I said, further guidance will be published. But I promise to write to her, as she so gallantly intimates or hints.

Clinical Negligence Claims

Baroness Walmsley Excerpts

Wednesday 10th November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Lord raises an important point about how we resolve a number of these issues. As many noble Lords will be aware, when the NHS does a wonderful job, we all support it but, sadly, when it does not do such a good job, there is a culture of delay, defend and deny. Sometimes it is incredibly difficult, and I have heard of people who have had terrible experiences in trying to get someone to resolve their issue. I heard of a very sad case: a young official in the department told me that a friend of hers, a young Afro-Caribbean lady, 24 years old, lost a baby and, miraculously, the papers have disappeared. They are now trying to gaslight this poor patient. It is really important that we resolve this.

In terms of the cost, NHS Resolution negotiates large-scale contracts for defendant legal services, using its position as a bulk purchaser to obtain the best expertise. NHS Resolution is looking to resolve claims promptly and most claims are often settled without court proceedings or going to trial. It is a difficult balance because while we may be concerned about the fees of the injury lawyers, they are able to shine a spotlight on the NHS delay and denial, as it were, and go further when many patients themselves or their families are in distress.

[Baroness Walmsley (LD)]

My Lords, the element of compensation in clinical negligence cases which relates to the cost of further health treatment is based on the cost of care in the private sector. Why is this so when NHS treatment is as good or better? Should not private health costs be provided only where the patient cannot get treatment on the NHS?

[Lord Kamall (Con)]

Quite often patients choose to go on the NHS and when they are unable to do so because of various factors they will go private. I wonder whether we should be giving preference. We want to treat all patients equally.

Gametes and Embryos: Storage Limit

Baroness Walmsley Excerpts

Tuesday 9th November 2021 Lords Chamber

[Lord Kamall (Con)]

The Government are still considering the responses from the technical consultation in terms of extension of storage, but as I said previously, and I hope the noble Baroness will be assured by this, we hope to bring forward legislation to enact a new policy when parliamentary time allows. If an amendment is laid, we will give it due consideration.

[Baroness Walmsley (LD)]

My Lords, accurate information about the benefits, risks and success rates of egg freezing is essential to enable women to make their own decision. What progress is being made by the Competition and Markets Authority and the Advertising Standards Authority to investigate whether the provision of information is done accurately and ethically?

[Lord Kamall (Con)]

I thank the noble Baroness for raising this very important issue, because not everyone is aware of the biological facts around fertility, particularly the decline of fertility with age. If a woman freezes her eggs in her 20s, she has a higher chance of success than if she does it in her 30s. In fact, while IVF treatment has improved over the years, the success rates of IVF are still only around 30%, so it is important that as many women and couples know as much as possible. On the detailed questions that she asked, I will write to the noble Baroness.