Health and Social Care Update

Baroness Warwick of Undercliffe Excerpts

Monday 22nd March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I simply do not recognise the characterisation that the noble Baroness has just presented. The view of our treatment of the elderly and vulnerable taken by Amnesty during the pandemic is completely inappropriate and inaccurate. Huge steps have been taken to protect those who are vulnerable and elderly. I cannot think of a country that could have done more under the circumstances. I therefore reject its analysis.

[Baroness Warwick of Undercliffe (Lab) [V]]

My Lords, this is a Statement on health and social care. I am astonished that the Minister has confined the Government’s policy on adult social care following the pandemic to a couple of sentences. He must know that most of the adult social care in this country is provided by family carers. They are regularly ignored in such Statements, but many of the 6 million carers looking after vulnerable adults, including those with learning difficulties, have been pushed to breaking point by the pandemic. Is there nothing to say to them about access to support services or respite care and nothing on carer’s allowance? Without support for these essential carers, policies such as enhanced hospital discharge, as mentioned in the Statement, will not be feasible. What is the Government’s strategy for dealing with this crisis in care?

[Lord Bethell (Con)]

My Lords, I endorse completely the noble Baroness’s remarks that we depend on the generosity, public spirit and kindness of family carers who provide an enormous amount of support for their loved ones. Without them, the system could not possibly exist and the world would be a much graver place. I recognise that many carers have been pushed very hard by the pandemic. We have put a huge amount of resource into local authorities, which are responsible for providing support for those families, and that includes the kind of respite support that the noble Baroness has rightly pointed to. I am sure that more could be done and I would welcome any correspondence on this by way of follow-up that she would like to send my way.

Dentists: Covid-19

Baroness Warwick of Undercliffe Excerpts

Thursday 11th February 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right; ventilation is a key issue. I took my daughter to the dentist this morning, and there were indeed long gaps between each appointment. I am not aware of the ventilation system she alludes to, but if the BDA would like to write to me, I would be happy to have a closer look at it.

[Baroness Warwick of Undercliffe (Lab) [V]]

My Lords, can I follow up on the Minister’s point about the new activity target imposed on dentists to reduce the backlog? It seems to have had the reverse effect. It has resulted in one of the biggest dental chains in the country instructing its dentists to focus on band 1 check- ups and reduce urgent treatments to meet the targets, reducing access for those who need it most. Other practices are reported to be doing the same. What assessment have the Government made of the impact of this target on patients who need urgent and complex treatment? Dentists have continued working, like doctors, nurses and other health professionals, in a high-risk environment during the pandemic. But their contribution seems to have been ignored. Can the Minister confirm the Government’s appreciation of the commitment of dentists and their staff during this pandemic?

[Lord Bethell (Con)]

I join the noble Baroness in paying tribute to dentists. As of 18 December, 88% of NHS dental practices were open, and that is a huge tribute to the hard work, determination and skills of dentists. She is right that they offer a spread of services; more triaging is going on, and that has successfully made a big contribution to getting through the lists. As of 13 January, 6.9 million dental patients have been triaged on the AAA service—advice, analgesics and antibiotics—but urgent dental care centres, of which there are 695, have picked up the difficult and time-consuming work for those who have an emergency need.

Cannabis Oil

Baroness Warwick of Undercliffe Excerpts

Tuesday 12th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I am grateful for the noble Baroness’s kind words, and I will indeed take that patient feedback back to the department. I reassure her that this is an area where patients have undoubtedly led the way, and clinicians have to catch up. In doing so, there will need to be a meeting of minds and regulation in areas that are open to patient interpretation. In that period, there will undoubtedly need to be compromises on all sides.

[Baroness Warwick of Undercliffe (Lab) [V]]

My Lords, the law changed over two years ago. The then Home Secretary said:

“We have now delivered on our promises … we will work with the NHS to help support specialists in making the right prescribing decisions.”


But they have not; it has been a hollow promise for terminal brain cancer sufferers such as my nephew. NHS doctors will not prescribe medical cannabis, and the BMA advises medics not to prescribe it, yet I understand that the UK is the largest producer of medical cannabis in the world. Just how many prescriptions have been issued for unlicensed cannabis medicines, other than those subject to randomised control trials, in the last 12 months?

[Lord Bethell (Con)]

My Lords, the noble Baroness is being a little unfair; Health Education England published a medicinal cannabis education package on 8 August 2019. But we cannot force clinicians to make prescriptions. That is not how the health service works. We need to work on clinical trials to put in place the correct authorisations and to give marketing authorisations for these important and promising drugs. That will require collaboration between government, the regulator and industry, and I call on industry to step up to that challenge.

Covid-19: Vaccinations

Baroness Warwick of Undercliffe Excerpts

Thursday 17th December 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the mathematics done by the noble Lord are interesting but not quite a reflection of the strategy. It is undoubtedly true that the NHS is, wisely, taking the start of the deployment with great care. This is an extremely complex vaccine to deliver, but hospital hubs, local vaccination services and vaccination centres will be rolled out around the country. The kind of ambition that the noble Lord describes—quite rightly—is exactly what we seek to deliver; we will update the House as that deployment plan rolls out.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, I want to urge early access to the vaccine for the terminally ill. On Tuesday, in response to my noble friend Lady Thornton, the Minister said that there was a powerful case but any further refinements to the priority list will “create profound operational challenges”. That is not a good enough answer for my nephew, Matthew Walton, who has stage 4 brain cancer. Surely his two young children should be able to spend their remaining time together without the additional threat of an early death, which could so easily be averted by a vaccine—unlike his cancer. Will the Minister please press this powerful case?

[Lord Bethell (Con)]

The noble Baroness makes the case extremely well; I pay tribute to her personal testimony. I looked into this matter after giving my answer to the question last week. I assure the noble Baroness that those who are terminally ill are, of course, clinically vulnerable by nature. We will ensure that those who are clinically vulnerable will get the vaccine when it is clinically appropriate to do so, which I hope brings her some reassurance.

Covid-19: People with Learning Difficulties and Autism

Baroness Warwick of Undercliffe Excerpts

Monday 5th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Baroness puts it extremely well, and it is an area we are deeply concerned about. We have commissioned Public Health England to carry out an analysis of the existing data on those who have suffered under Covid. We will be reviewing that data extremely carefully to understand the phenomenon more deeply. In the meantime, the Chancellor has announced £750 million to support the charity sector in response to the pandemic. Some of that money has been targeted specifically at charities that are supporting those with learning difficulties to ensure that they get the support that they need.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, many families really struggled to get effective support or even to know where to go to find out what is available. I understand that evidence gathered by concerned charities like Carers UK and Carers Trust shows that many family carers have had no effective support or advice since the end of March, yet they look after some of the most vulnerable in our society. Will the Minister and his colleagues at the Department of Health and Social Care meet with these organisations to discuss what could be done to improve this very sad state of affairs?

[Lord Bethell (Con)]

My Lords, I would like to pay tribute to the work of the learning disability and autism advisory group for its social care task force. Its recommendations have informed the development of the social care winter plan, which provides specific provisions for those with learning disabilities and autism. I would be very glad to meet whichever groups the noble Baroness recommends, because this is an important issue that we care about immensely and are determined to get right.

Covid-19: Social Care Services

Baroness Warwick of Undercliffe Excerpts

Thursday 23rd April 2020 Lords Chamber

[Baroness Warwick of Undercliffe (Lab)]

My Lords, I congratulate my noble friend on calling this vital debate at a very difficult time in our history and I thank her for all the work that she has done on this issue. I declare an interest as chair of the National Housing Federation, the trade body that represents not-for-profit housing associations in England.

The spread of this virus is indiscriminate, but its impact on our society’s most vulnerable people is pernicious. I pay tribute to all those who, despite the risks to themselves and their families, are still faithfully working to help those in their care. Many of us have reason to be grateful to them and their families for their sacrifice.

Like many, I have found the number of fatalities in care homes alarming and distressing. Earlier this month, reported deaths from Covid-19 in care homes quadrupled in the space of a week, and we know that this is not the full picture. We need a clear plan in place to reverse this trend.

Some 50,000 care home spaces in England are provided by not-for-profit providers, such as housing associations. They also provide 76% of all supported specialist and sheltered housing schemes for older people, people with disabilities and people with mental health needs. They support people in homelessness, hostels and domestic abuse refuges. All of these are vital components in our social care system beyond those services regulated by the CQC. All of these care settings are currently grappling with the enormous challenges that this virus brings. We should not let them be forgotten or neglected.

Accessing PPE is a significant ongoing challenge for all these workers who have daily contact with those people who are being shielded. While we quite rightly prioritise NHS staff, it must be extended to others most at risk. I welcome recent government guidance on testing in the community. I know that housing associations hope that it will stimulate greater availability of tests for their front-line staff. Those working with our older and more vulnerable population need to know that going to work will not put their safety and residents’ safety at risk. We owe it to people working in care settings to value and publicise their work and to put it on a financially secure footing, now and in the future.

The statistics on the effects of the virus on those in care homes must be a wake-up call to take action on the questions about our social care system that have dogged our country for so long. Housing associations are already mobilising for this. A root-and-branch review of how we provide care to the most vulnerable in society has never been more critical. Will the Minister commit to it now? Without it, we remain as unprepared for any future health crisis as we were for Covid-19.

Queen’s Speech

Baroness Warwick of Undercliffe Excerpts

Thursday 9th January 2020 Lords Chamber

[Baroness Warwick of Undercliffe (Lab)]

My Lords, I welcome the opportunity to take part in this debate on the humble Address. I want to talk about housing. I declare my interest as chair of the National Housing Federation, the trade body for housing associations in England.

A week after the general election, it was reported that the number of homeless households in Britain had risen to over 68,000. At Christmas, more than 135,000 children did not wake up in a safe home to call their own. Each one of these children and their families need us to act now to invest in decent, affordable and high-quality housing. Given the ambition of this Government, I am hopeful that we will see the investment needed to build the homes that will fix the housing crisis.

The election made clear that voters want to see a change in the status quo. We have seen a real shake-up in traditional heartlands. These constituencies voted for a greater amount of investment in their schools, hospitals and infrastructure. I welcome the Government’s commitment to high levels of investment in infrastructure, but this must include a bold and ambitious plan to fix the country’s housing crisis.

The morning after the election, the Prime Minister made a welcome commitment to address the concerns of utmost importance to voters who may have voted for the Conservative Party for the first time. Polling by the National Housing Federation during the election revealed that 65% of undecided voters who backed Labour in the last election and voted leave in the EU referendum support the idea of spending billions of pounds a year on new social housing. This investment would not only be the right thing to do to help millions of families in England, it is also what voters have been asking for.

In the past 20 years, many communities in the north and the Midlands have been “left behind” while cities have thrived. I welcome the Government’s plans, including regeneration, to level up the regions in England. Housing associations work as economic and social anchors in their communities. They build the vital homes we need, and, just as important, they support existing communities and empower their residents. They add £16 billion to the British economy each year and they support over 250,000 jobs distributed right across the country. Does the Minister agree that housing associations will play a key role in the Government’s aim of levelling up the regions?

But of course our drive for new homes must not detract from ensuring that existing homes are of the utmost quality and safety. It is imperative that people are safe and feel safe in their homes, and I am pleased to note two new pieces of legislation in the Queen’s Speech that will contribute to this goal. Since the tragic fire at Grenfell Tower, housing associations and indeed local authorities have worked swiftly to identify unsafe ACM cladding, and work has begun or been completed on the vast majority of these buildings in the social housing sector.

But we face failures throughout the building safety system well beyond ACM cladding, as the Hackitt review has shown. All social housing providers have made it an absolute priority to deal with safety of entire buildings, together with tenants and residents. Not surprisingly, that presents considerable financial and operational challenges. We cannot ignore the sector’s capacity to do this while continuing to build new affordable homes and investing in communities up and down the country.

The wholesale failure of the building safety system should not hamper the ability of housing associations and councils to build the affordable homes of the future. The Government’s plans to resource remediation work must take this into account. It is a complex and extensive programme of work that needs renewed strategic leadership from government. For their part, housing associations remain committed to working in partnership to get this crucial work done. Let us all be clear in our focus on what matters most of all: the safety of the people who call these buildings their homes.

I am glad that the Government have reaffirmed their commitment to the affordable homes programme. Delivering hundreds of thousands of affordable homes needs the certainty of sustained support and specific funding for building homes for social rent. Ahead of the upcoming Budget, will the Minister speak with his Treasury colleagues to ensure that the affordable homes programme is financed effectively to build the homes this country needs?

The election result will continue to be dissected, but the Government have accepted the clear message for change and a greater political focus and action on the communities that have been ignored for too long. We know that when you have a safe, quality and affordable home to live in, everything else follows—as the Minister herself quite rightly said. It is right that the Government are finally listening to these voters, and I hope that we will see the investment desperately needed to deliver the meaningful change these communities have been calling for.

Access to Medicinal Cannabis

Baroness Warwick of Undercliffe Excerpts

Tuesday 9th April 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her comments and for setting out her personal experience. She obviously has expertise in this area which few of us in the Chamber can claim. The reason NHS England has put forward is that individual clinical expertise relating to an individual patient is of the utmost importance, even where the guidance might seem to contradict that judgment. That is why in the autumn we will be bringing forward NICE guidance that will look at the most up-to-date evidence which should, we hope, be of assistance. It is also why we are bringing forward the NICE process review in order to understand what barriers may be in place and to encourage clinically appropriate prescribing and try to assist with cases such as these.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, what Mrs Emma Appleby has done—and I praise her courage—is to show that, whatever relaxation there appears to have been or modification, which we all thought was likely to produce some positive results, in fact that really is not happening. People are being denied medication, with incredibly debilitating results. I have an interest in this because I have a young family member with stage 4 terminal brain cancer. He suffers from sickness as a result of chemotherapy which nothing else is able to help. He has been refused cannabis. The consultant will not prescribe it because he feels that there is not enough information from the Department for Health and Social Care for him to feel that he is justified in doing so and he does not know what the implications might be. I understand from another consultant that the BMA is in fact advising medical professionals not to prescribe it. What is the alternative for desperate relatives? Is it to buy cannabis off the streets not knowing what the quality is and facing the prospect of a criminal conviction? Speed is of the essence here, certainly for my family member. I hope that the Minister can say a little more about the way in which this is likely to progress and the speed with which it will do so.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question and for describing her personal experience. I emphasise that we must allow clinical decision-making in this. We have tried to encourage more experience in the system by putting out guidance through NICE based on the latest evidence, by providing Health Education England with the opportunity to bring forward training to share the best quality experience, and by putting through the process review so we can bring down any inappropriate barriers in the system. I hope that encourages the noble Baroness.

Brexit: Health and Welfare

Baroness Warwick of Undercliffe Excerpts

Thursday 29th March 2018 Lords Chamber

[Baroness Warwick of Undercliffe (Lab)]

My Lords, I thank the noble Baroness, Lady Brinton, for raising such a key aspect of the impact of the EU’s withdrawal from the EU. As others noted earlier in the House, at 11 pm exactly one year from today the UK will leave the EU, but I have no doubt that we will be debating the complexities of a post-Brexit UK well beyond even the agreed 21-month transition period that will follow.

There is also no doubt that the UK’s decision to leave the EU will have many far-reaching implications for health and social care in England, and for the health of UK citizens living or travelling in EU countries. It was only when I began to look at this more closely that I realised just how many crucial issues still await clarification. There are the future arrangements regarding the European health insurance card; without EHICs, a disproportionate insurance burden will fall on the elderly and those with existing conditions. There is the question of access to healthcare for UK pensioners resident in EU countries and of cross-border co-operation in public health. I think particularly of food safety and housing, but there are many other areas. There is the continuation of the open border in Northern Ireland so that healthcare professionals can move freely to deliver vital cross-border health services. There is the damage to our research base and the international standing of our universities if they can no longer recruit and collaborate with European researchers and scientists. There is the damage to our ambitions for the UK to be a world leader in the sciences and medical research if we are not able to make good the significant loss in EU funding for R&D. There is the question of our continuing participation in the European Centre for Disease Prevention and Control, the UK losing out on clinical trials for new drugs if we are not part of the upcoming revised EU directive on clinical trials, and losing our ability to attract EU research funding or to access EU research funding sources such as Horizon 2020 and the European structural and investment funds. We do not know the extent of Brexit’s negative impact on the UK economy. Additional pressure on public finances will have a direct negative impact on the NHS and social care.

The list goes on and on, and it is depressing how little we and the country know with any degree of certainty. It is essential that health-related issues are put high on the agenda as we negotiate our future relationship with the EU. I want to focus on just a few concerns. Like the noble Baroness, Lady McIntosh of Pickering, I ask how we will maintain the NHS workforce, given its reliance on EU nationals, and how we will address the pressing issue of social care. I declare an interest as chair of the National Housing Federation. Then I will briefly consider what our withdrawal may mean for the regulation of medicines and our access to new drugs in the UK.

The freedom of movement and mutual recognition of professional qualifications that come with EU membership mean that many health and social care professionals working here are from other EU countries. A recent King’s Fund report indicated that nearly 62,000 staff, or some 5.6%, of the 1.2 million total NHS workforce in England, and 95,000, or about 7%, of the 1.3 million workers in England’s adult social care sector have come from other EU countries. A recent report by Independent Age highlights that in the first part of 2016 alone, more than 80% of all migrant care workers who moved to England to take on a social care role were from Europe. The report posits a social care workforce gap of about 1.1 million workers by 2037 in the worst-case scenario of zero net migration following Brexit. In what I suggest is a more likely low-migration scenario, the workforce gap could be more than 750,000 people. But even if there were high levels of migration and the care sector became more attractive, Independent Age puts the social care gap at 350,000 people by 2037. The implications for older and disabled people are that far fewer will be able to access the care they need to live independent, meaningful lives.

Meanwhile, the most recent figures show that the NHS has gaps in nursing, midwifery and health visitors. Although the referendum result will not have been the only factor, it is nevertheless alarming that between October 2016 and December 2017, the number of nurses and midwives from Europe leaving the Nursing and Midwifery Council’s register increased by 67% compared to the previous year, while the number joining fell by 89%. The recent commitment and clarification that EU citizens currently working in the UK and UK citizens currently working in other EU countries will be allowed to stay has, we can only hope, provided some reassurance to those individuals, but it is clearly vital that we continue to persuade as many as possible to stay and continue their valuable contribution to the health and social care workforce, while we also take measures to increase the domestic NHS workforce and the attractiveness of the social care sector to British-born workers in the longer term.

We do not have much detail on what the UK’s policy on migration will look like post Brexit beyond the intention that after March 2019, migration of EU nationals will be subject to EU law. While we await the delayed White Paper, there are many unanswered questions about our future immigration policy, some of which we explored earlier today. I am concerned in particular that in future we might mirror the current non-EU system, which is focused on high-skilled labour rather than areas of shortages. Can the Minister assure us that providers of NHS care and social care services will retain the ability to recruit staff from the EU when there are not enough resident workers to fill vacancies? I note that the Migration Advisory Committee’s interim report on European Economic Area migrants to the UK was published earlier this week, ahead of its September final report. I wonder if the Minister would agree that a way forward would be to add specific occupations to the MAC’s shortage occupation list, which currently enables employers to recruit nurses and midwives from outside the EEA. Will he also agree that the Government will need to consider urgently how both the NHS and social care can continue to recruit lower-skilled workers from the EU and elsewhere who are less likely to arrive under systems focused on encouraging higher-skilled migration?

I should add that the context for considering the impact of Brexit on our health and social care workforce is the pressing need for funding reform of social care. Local authorities are struggling to make shrinking budgets meet the demand for care, which is growing as our population ages, with increasing complexity in their needs. Can the Minister confirm that the Government’s intention in the Green Paper on social care, due later this year, will be to find a long-term solution?

I also want to take a final minute to highlight, like others, the impact that our EU withdrawal may have on the regulation of medicines and clinical trials in the UK. EU legislation ensures a consistent approach to medicines regulation across its member states, and the UK is part of the European Medicines Agency, which operates this centralised authorisation system. The EMA, of course, recently announced that it will be moving from London to Amsterdam as a result of Brexit. Currently, companies can submit a single application to the EMA to be authorised to market their products in EU, EEA and EFTA countries. As a member of the EMA, the UK has first-tier market status, giving us priority in receiving new pharmaceuticals. With Brexit, the UK is expected to leave the EMA and seek then to “work closely” with it, while increasing the capabilities of our own national Medicines and Healthcare products Regulatory Agency. The EMA currently co-operates with other countries in this way, including Canada and Switzerland. But the concern here is that losing our tier 1 status would put us at the back of the queue for new medicines. In Canada and Switzerland, these typically reach the market six months later than in the EU.

There are so many areas where we need reassurance from the Minister. I hope he will be able to provide at least some concrete answers. Can he, above all, unequivocally tell us that he will do everything in his power to ensure that health-related issues are put high on the agenda as we negotiate our future relationship with the EU?

Mesothelioma

Baroness Warwick of Undercliffe Excerpts

Thursday 27th October 2016 Grand Committee

[Baroness Warwick of Undercliffe (Lab)]

My Lords, I had always associated mesothelioma with the construction trade. It came as a complete shock that a dear friend—Sylvia, a retired maths teacher, an energetic walker and a very active grandmother—should be diagnosed with the disease. It may well have been contracted 50 years ago when she worked as a teacher in west Africa. It was even more of a shock to discover that it was a death sentence. Sylvia died a troubled and dreadful death five months later. As her husband Geoff said, “This cancer doesn’t allow for peace. There are more sorts of pain than those that can be, and were, dulled by opiates”.

What shocked me almost as much was the struggle of medical researchers to raise money to find improved treatments for the disease. The British Lung Foundation —BLF—and Mesothelioma UK have campaigned tirelessly for more research but with only limited success. Do funders regard it as a marginal cancer? Perhaps they think it will be reduced over time because products containing asbestos were banned in the UK in 1999. How have we become so complacent? Some 2,500 people in the UK are predicted to die each year of mesothelioma. The incidence is increasing, as has been mentioned, for example among schoolteachers. How have we become so blind to the immense suffering of those who contract the disease and of the families who care for them? Although we can hope that the rate will eventually decrease, no such hope is available in developing countries where asbestos continues to be used and where committed people just like my friend Sylvia will continue to work, as will countless members of the local populations.

Research is key yet the BLF’s figures show that funding is absolutely parlous compared with other cancers that kill a similar number, and even the published figures are thought to be an overestimate. I talked to the NIHR Biomedical Research Centre at UCL—I declare an interest as a member of council at UCL. UCL, along with Leicester and Barts, is doing innovative and exciting work with a small amount of funding into genomic damage which might lead to targeted new treatments. Other centres are similarly innovative. How much more could be done if they were better funded?

Companies such as Hugh James, Simpson Millar and Shield Environmental Services have donated. Insurers have helped in the past. Two which have already been mentioned, Aviva and Zurich, have increased their contribution to £1 million over two years, but the final grant is this year. The £5 million grant from the Government this year for a national centre for research is indeed welcome. I hope it will enable increased collaboration with other centres, but it will take £5 million each year to put mesothelioma on a par with other cancers, such as skin cancers, that have the same mortality levels.

A more sustainable model is required. Where is the rest of the insurance industry? Insurers are likely to pay out £11 billion in compensation to people who were exposed to asbestos in the workplace. If only a tiny fraction of this were donated to research, it would be transformational. Saving lives by donating to research could potentially save insurers millions. Will the Minister commit to some strong arm-twisting to persuade the industry to make this a comprehensive and permanent commitment, if necessary on a statutory basis?

I want to make a final point about the carers of those affected. My friend’s husband Geoff said, “Sylvia’s progress wasn’t predictable, no routine could be established, every day involved new challenges”. He was part-retired and had a pension. Supported by the GP and the district nurse, he was able to provide the care that enabled Sylvia to live and die at home as she wanted, where her dignity was preserved in a way she felt it could not have been even in the kindest institution. If he had been on a limited income and had to go out to work, how would that have been managed? Will the Minister tell us what the Government are doing to make that kind of caring an option for anyone suffering a terminal illness of this kind?