Health and Care Bill

Baroness Wheatcroft Excerpts

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

In my view, this sort of conversation ought to be available to people in the circumstances that we have discussed. I say only that this is the wrong route, and it would be better if its provision were pursued through the charitable and pastoral sector rather than through being embedded in what will inevitably be an insensitive statute.

[Baroness Wheatcroft (CB)]

I support both these amendments. I have listened to the noble Lord, Lord Moylan. In answer to his points on Amendment 203, it is highly relevant that organisations such as Marie Curie want this legislation in the Bill. Marie Curie’s nurses work tirelessly to make the end of life as gentle and congenial as possible for so many patients, but if they believe that this would help them, I would certainly support the amendment.

I agree with the noble Baroness, Lady Brinton, that in this country people are too frightened to talk about dying, and that is what we are talking about tonight—and for some it will be painful. Nevertheless, dying is a subject that nurses and those in hospitals should be empowered to feel comfortable discussing with their patients, and Amendment 203 should help with that.

It is with some trepidation that I venture to support Amendment 297, having heard the noble and learned Lord—

[Noble Lords]

Lord Mackay.

[Baroness Wheatcroft (CB)]

Yes, Lord Mackay. Your Lordships can see how nervous it makes me feel! I think that, in this particular situation, private Members’ Bills have failed, and the Government show absolutely no intention of moving on something that is so crucial to so many people. Although you have to be wary of opinion polls, it seems perfectly clear that opinion in this country has moved and that a majority of people would like not to have assisted dying made mandatory but to have the choice at the end of life of how they say farewell.

Like others, my inbox has been inundated, and I have tried to reply to one or two of those who have been opposed to the proposal from the noble Lord, Lord Forsyth. One doctor, Dr Whitehouse, a palliative care doctor, wrote to tell me that nobody had come to him whom he could not help, and it was very important that everybody should treasure their short remaining time, and palliative care would do that and assisted dying should be resisted. I wrote back to him a week ago through email—he gave me his email address—and said that I wanted to know more. I am a firm believer in palliative care; it works wonders, and it has improved hugely over the years, but I do not believe that it works in every case. I asked him whether it worked, for instance, with motor neurone disease, or whether it could cope with the incontinence which makes the end of life such a discomfort and an indignity for so many people—or did the help that could be provided mean only understanding and care, which does not necessarily deal with the indignity at all? Noble Lords will not be surprised to learn that I have not heard back from Dr Whitehouse, and neither do I expect to.

This matter polarises people, but the amendment is asking merely that Parliament should have the chance to debate a matter that is crucial to parliamentary Members and, more importantly, the constituents who vote for them. I support both amendments.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare all my interests in palliative care and as a director of Living Well Dying Well and vice-president of Marie Curie and of Hospice UK. I have two amendments in this group. I do not intend to lay out all the arguments against the amendment proposed by the noble Lord, Lord Forsyth. Indeed, the noble Lord was right that we had only three-minute speeches when we debated the Bill proposed by the noble Baroness, Lady Meacher. However, I remind the Committee that the Bill put forward in the other place by Rob Marris MP actually failed—it was voted out—and it was one that came high in the ballot, so if it had been voted in it would have progressed quite well.

Personally, I do not think this is the place for us to debate assisted dying, which would need a change in the criminal law. The procedural issues have been clearly explained by the noble and learned Lord, Lord Mackay of Clashfern. The noble Lord, Lord Forsyth, spoke about the right to die. I remind him that everybody is going to die—it is an inalienable right. What he is talking about is licensing some people to provide lethal drugs to others, against a set of criteria. I remind him that three-quarters of people in my branch of the profession—specialist palliative medicine—who look after these patients all the time, not only do not want the law to change but do not want anything to do with it in the event it changes.

The claim has been made that palliative care is not a panacea. Assisted dying is not a universal panacea either. There is a 6.9% complication rate in Oregon, which is experimenting with the fourth drug cocktail in seven years. I remind the Committee, because I have made a plea for specialist palliative care, that it is estimated that 118,000 patients each year in the UK cannot access specialist palliative care. That is why I have an amendment tabled to the Bill, which I hope the Government will look favourably on. Areas where assisted dying has happened rank low on end-of-life care compared to the UK. Areas with assisted dying have dropped in the rankings for palliative care since 2015 compared to areas which did not change the law.

Amendment 203 is well intentioned and builds on all the moves for advanced care planning that are spearheaded by specialist palliative care. I know it was drafted originally with Marie Curie’s help, because it initially discussed with me whether I would table it, but I did not and did not sign it for two reasons. First, it is imperative that such conversations begin early, are part of ongoing care and do not become a tick-box exercise which says, “Conversation offered—tick”. That risks all the dangers of what happened with the Liverpool care pathway. Sadly, I have seen all too often a patient being told, “But that’s what you said you wanted”, when their needs have changed. Much research on advanced care planning has been done by my colleagues in my team in Wales. This has now informed some of the moves that are happening. Having open conversations is something that patients want, and the clinicians trained in communication skills want to provide those openings and do.

The second reason that I was concerned about this is that excellent draft guidance on advanced care planning has been developed by NHS England and NHS Improvement, and is near to being published; I had the privilege of being consulted on the final draft. It sets out core principles that such planning must always be a voluntary process and that every effort must be made to help someone express their views and preferences. The person is central to developing and agreeing their advanced care plan with agreed outcomes that are shared in partnership with relevant professionals. They have a record of the shareable plan and are encouraged to review and revise it so that they can change their mind at any time. In addition, anyone involved can speak up if they feel that the principles are not being followed.

The very sensitive approach set out in the guidance recognises that people have different levels of preparedness for such conversations; that their perception of their illness evolves over time; and that, in the crisis of being given a diagnosis or told of disease recurrence, the views that a person expresses may subsequently change as they reframe their experience. The first step is to start with an exploration of how much the person wants to be involved, what matters to them, and the pace and language that matches the person, as well as that they are listened to and understood.

The amendment asks for a “relevant authority” to

“have regard to the needs and preferences recorded … in making decisions about the procurement of services.”

I hope that the Government can see that, by providing specialist palliative care as a core service, the type of bureaucratic delays that would be involved in procuring services would be completely replaced by a rapidly responsive specialist service that can address the person’s needs in all domains. The amendment also uses the term “relevant person”. If it were used as in the Mental Capacity (Amendment) Act, that person could turn out to be the care home manager, who may actually have competing interests and therefore is inappropriate.

A comprehensive survey of over 2,000 people by Cardiff University’s Marie Curie research department reported that people listed their top priorities towards the end of life as timely access to care at 84%, and being surrounded by loved ones at 62%. Being home was a priority for only 24%.

This is a well-intentioned amendment but it has now been replaced by the extensive consideration of the consultation and production of comprehensive guidance.

Eating Disorders

Baroness Wheatcroft Excerpts

Monday 17th January 2022 Lords Chamber

[Lord Kamall (Con)]

The question from my noble friend highlights the difficulty of dealing with such a sensitive area. You have to be very careful how you address the issue of obesity. For example, it is quite right that we want to get the rates of obesity down, because it does lead to a number of other conditions that we have discussed many times here. One thing that you have to look at, however, is the unintended consequence of any laws. One possible unintended consequence is that some of the measures to tackle obesity, such as looking at food labelling, might affect people who have eating disorders. Every time we look at the obesity strategy, therefore, we make sure that we consult charities that look after people with eating disorders to ensure that we have the right balance. We will not always get it perfectly right, but we will try our best.

[Baroness Wheatcroft (CB)]

My Lords, anorexia nervosa is one of the most pervasive of mental health disorders. It can sometimes be successfully treated only in specialist in-patient units. What plans are there to grow the number of specialist in-patient beds? In 2019, the Government promised that people would not be sent to out-of-area beds after 2021, but I do not believe that that is currently the case.

[Lord Kamall (Con)]

I am sure that the noble Baroness will appreciate that we had a strategy to tackle obesity, but some of it has been knocked back a bit by Covid and having to tackle the backlog. However, we are looking at ways to ensure that the strategy gets back on track as we emerge from lockdown and there is, we hope, less pressure on the NHS.

Calorie Labelling (Out of Home Sector) (England) Regulations 2021

Baroness Wheatcroft Excerpts

Thursday 22nd July 2021 Lords Chamber

[Baroness Wheatcroft (CB)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Bennett of Manor Castle, and her sensible comments on nutrition.

I support the amendment tabled by my noble friend Lady Bull. She is absolutely right: these regulations are misguided and will be counterproductive. If calorie labelling were an effective way of curbing obesity, sales of crisps would not have grown by 4.6% in volume last year. Neither would biscuit manufacturers have been able to enjoy a bumper year, with sales up 7.2% to almost £3 billion. Among the top 10 biscuit brands, only two failed to register growth—they were the ones in the healthier category. The best seller, McVitie’s chocolate digestive, has 86 calories. That may not sound a lot, but those prone to obesity find it hard to stop at a single biscuit.

These regulations are intended to hit in particular those who frequent fast-food outlets, but no one in Britain can be unaware that a Big Mac and fries will not win favour at Weight Watchers. In fact, together they add up to 845 calories. Throw in a caramelised frappe and you have 1,164 calories. Spelling it out on the menu will not reshape the eating habits of those intent on a quick and relatively cheap hunger fix, and it is the cheapness that is important. Obesity is strongly linked to poverty. A study of children in 2018-19 found that the incidence of childhood obesity was more than twice as high in the most deprived areas of the country as in the least.

Insisting that calorie numbers are on the menu will not deal with the obesity problem, but it will feed the problems of those suffering from eating disorders, the numbers of which are rapidly increasing. Only today it has been reported that hospitalisations of young people with eating disorders rose by 50% last year, and many more are queueing up to try to access treatment. Someone with anorexia nervosa will be as fixated on these calorie lists as a heroin addict on getting the next fix.

The regulations will make the struggle of trying to persuade an anorexic to eat something—anything—even harder than it is now. I know this because I spent many hours trying to persuade my desperately sick daughter to eat. It was sometimes easier to try to do this in a restaurant rather than at home, where she could take flight to her bedroom. As the noble Baroness, Lady Parminter, said, these trips were often very stressful for the anorexic and for all concerned.

My daughter nearly died. Had it not been for the brilliant Professor Janet Treasure and a year in hospital, she almost certainly would have done. Instead, she is a happy mother who has just produced her second child. Before making this speech, I asked if she would mind me talking about her, and she was keen that I should, because she wants to add her voice to those who counsel against insisting on this calorie labelling measure. She agrees that it would have added to the agonies of those sessions when she tried to find the least worst, in her demented view, item on the menu. Anorexics see calories as the enemy. I have been so fortunate that my daughter managed to overcome this pernicious illness, but these regulations will make it harder for others to do so while achieving very little positive.

While I realise that the Minister will not be swayed from his decision to go ahead with these regulations, may I add Lucy’s plea to that of my noble friend Lady Bull that he agrees to a timely review of their effects on everybody?

[The Deputy Speaker (Lord Brougham and Vaux) (Con)]

I now call the noble Baroness, Lady Fall. This debate is running out of time—four minutes, please.

Covid-19

Baroness Wheatcroft Excerpts

Wednesday 21st July 2021 Lords Chamber

[Baroness Wheatcroft (CB)]

My Lords, I too send my best wishes to the noble Baroness, Lady Penn. I echo the concerns of the noble Baronesses, Lady Thornton and Lady Brinton, over the contradictions over nightclubs and pubs and when we are going to insist on double vaccinations. Why not now? Why wait until September?

It is the contradictions in government policy that continue to cause concern. It is good to know that we are going to insist on vaccination for those working in care homes but why not across the NHS? Surely there is good sense in doing that.

We have lessons to learn from the treatment of Covid. We need to learn them as quickly as possible before the next emergency strikes. Sir Jeremy Farrar, the chief executive of Wellcome and a very eminent member of SAGE, has been coruscating about the failure to launch an inquiry now and to wait until March. Can the Minister explain why, when different people would be involved in conducting an inquiry, it cannot get under way immediately and report back as quickly as possible?

[Lord Bethell (Con) [V]]

My Lords, I have complete sympathy with the noble Baroness about the fast-changing nature of our response to this pandemic. However, as I have said from these Benches before, it is the virus that chops and changes and delivers us surprises. Who would have expected two or three months ago that the delta variant would have hit us as hard as it did?

We are trying to be agile and to adapt to changing circumstances. The guidelines on nightclubs and pubs will be published and when they are published, they will, I hope, be clear. The arrangements for September are being arranged right now. On mandatory vaccination in the NHS—which I think is what the noble Baroness inquired about—we have signalled our intention to consult on mandatory vaccination across the healthcare service. I hope that I will be able to share further details on that with the House at a future date.

In terms of an inquiry, of course I hear Sir Jeremy Farrar. However, I and many others are already working all the hours that God gives us on responding to this pandemic. There is no extra bandwidth for dealing with an inquiry. We are doing our best and we will look back and learn the lessons when the moment is right.

Elderly Social Care (Insurance) Bill [HL]

Baroness Wheatcroft Excerpts

2nd reading
Friday 16th July 2021 Lords Chamber

[Baroness Wheatcroft (CB)]

My Lords, the noble Lord, Lord Lilley, approaches this issue with decades of experience and genuine concern. I congratulate him on at least attempting to provide a partial answer to the problem of funding social care. His insurance scheme has superficial attractions but, as others have spelt out, a more far-reaching solution is required. As the noble Lord, Lord Davies of Brixton, said earlier, in his first speech at Downing Street the Prime Minister promised us he had an “oven-ready” solution. He may at last have decided that a new tax is the answer, but that will not deal with the fundamental flaws in the system.

I wholeheartedly support the speeches, including those of my noble friend Lord Best and the noble Baroness, Lady Altmann, that advocated doing away with the distinction between health and social care. A report of the Joseph Rowntree Foundation 25 years ago was right then and is even more so today. Most people are in care homes because they are not in good health. The pandemic has highlighted the poor health of large sections of our society. We know that the poorer parts of society have lower life expectancy and can expect to live out their final years in less good health than those at the other end of the wealth spectrum. Such inequalities would only be exacerbated by the Bill. Only 63% of our population are home owners and that proportion is shrinking.

A healthier population would have less need of care homes. There would be fewer elderly people having to spend their last years in what, for many, is a totally sterile environment—although, as we have seen, not always as sterile as some might have wished. It would be much better if people could live independent lives for longer. Today, there is talk of doctors prescribing fresh fruit and vegetables. It is sad that there is a need for them to do that, but clearly people need an improved diet. Equally, good health in older age requires exercise of the body and the mind and, in some cases, GPs are already prescribing the arts to keep people in good health. Some care homes provide a comfortable, stimulating environment. I am sure those with which the noble Baroness, Lady Verma, is associated do just that but, as the noble Lord, Lord Sikka, pointed out, too many care homes are now run by private equity, where the debt burden is such that there is little funding to provide a decent quality of care for those who live there. We need a fundamental rethink of the system.

Covid-19

Baroness Wheatcroft Excerpts

Thursday 15th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, in terms of care home staff vaccination, we are in the midst of a consultation on the subject. The noble Baroness should not necessarily pre-empt the consultation. We take into account the views of those we are consulting with. It is a measure that has caused an enormous amount of concern both here in the Chamber and with the public. It feels right that we should be consulting on a measure that ultimately protects the elderly and vulnerable.

In terms of certification, the ultimate use of certification in domestic surroundings has not been fully decided. At this stage, with the country enjoying the benefit of the vaccine, it seems right to be leaving that to businesses to decide how they wish to use it themselves.

[Baroness Wheatcroft (CB)]

My Lords, I want to follow on from the question from the noble Baroness, Lady Chakrabarti. The Government believe that passive smoking poses risks to individuals; hence they ban smoking in offices, pubs and other public places. The science has persuaded the Government that, during a pandemic, the wearing of masks in public places helps prevent individuals from passing on Covid to others, which even those who have been double vaccinated can do. In the Statement, the Government say that it is expected and recommended that masks will continue to be worn. Can the Minister explain why smoking should be governed by government diktat, but mask-wearing should be a matter of personal choice?

[Lord Bethell (Con)]

The noble Baroness makes her points extremely well. I support the ban on smoking in public places for exactly the reasons she describes. However, I do not support a mandatory, legal ban on sneezing, although I do not like people sneezing in my presence. We have to strike a balance between mandation and voluntary arrangements. We also have to choose the right people to make these decisions. Central Government cannot make every single decision on every single matter. I recognise the concern of both the public and of noble Lords in this Chamber about masks. It feels right to leave it to local decision-makers, politicians and companies to take the public with them and to enforce this measure which, I entirely agree, is of benefit to us all.

Covid-19 Update

Baroness Wheatcroft Excerpts

Tuesday 6th July 2021 Lords Chamber

[Lord Bethell (Con)]

Yes, I can reassure the noble Lord that we have in place a strong supply chain that will meet the schedule that has been outlined by my friend the Minister for Vaccinations, Nadhim Zahawi. We are also seeking to develop new vaccines, should they prove necessary—because it has been one of the surprising but reassuring aspects of our vaccination policy that a third boost is as useful and efficacious as it is. However, should another variant emerge that somehow eludes the current suite of vaccines, we have in place arrangements to develop, manufacture and distribute more.

[Baroness Wheatcroft (CB) [V]]

My Lords, the Statement is about the need for a return to normality—[Inaudible] —businesses depend for their trade on those who go to work in offices in cities and town centres, so can the Minister—[Inaudible]—and what instructions will they get about 19 July?

[Lord Bethell (Con)]

My Lords, I did not quite catch all the details, but I got the gist of the question. I reassure the noble Baroness that the return to offices and our high streets and towns is of paramount importance, and we are working on guidelines on that matter. I cannot guarantee that absolutely everything will go back to exactly what it was: we have learned lessons from the pandemic, and we want to put this country into a shape where we are resilient should another one emerge. However, it is my hope that the economy will bounce back extremely quickly, and there is good evidence that it will.

Hospital Waiting Lists

Baroness Wheatcroft Excerpts

Tuesday 29th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the publication of NHS plans around the catch-up is happening on a regular basis, and there will indeed be further communication from the NHS on this. On the use of private email, I reassure noble Lords that I have read and signed the ministerial code and I seek to uphold it in everything I do.

[Baroness Wheatcroft (CB)]

Specialist surgical hubs have been demonstrated as an effective way of dealing with surgery and would be particularly helpful in dealing with the backlog of cases. Can the Minister say what plans there are for developing specialist surgical hubs, as the Royal College of Surgeons has advocated?

Covid-19: Vaccines and Pregnancy

Baroness Wheatcroft Excerpts

Monday 14th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the up-to-date advice is this: get the vaccine. That is absolutely being promoted very widely.

[Baroness Wheatcroft (CB)]

My Lords, if the up-to-date advice is “Get the vaccine”, which is exactly what it should be, what work is being done to assess the effect on women of having Covid during their pregnancy? What is the effect on the child? Is there any research on that?

[Lord Bethell (Con)]

My Lords, the noble Baroness points to one of the challenges of longitudinal research: the babies have not been born for very long, of course. We need to do long-term studies to understand the effect. There is no evidence at all of a negative outcome but we will need to monitor that; research resources will be dedicated to looking at it.

Covid-19: Government Handling and Preparedness

Baroness Wheatcroft Excerpts

Tuesday 8th June 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, we will need to wait for the inquiry for a thorough post-mortem on what was or was not thoroughly prepared for. It is fair to say that the developed nations of the world had invested a huge amount in modern clinical medicine, yet that did not serve to prepare us for the precise circumstances of a respiratory pandemic. I pay tribute not only to those in the public health profession but to those in the military, who did so much and moved so quickly to deliver the kind of protection that this country has benefited from during the pandemic.

[Baroness Wheatcroft (CB)]

My Lords, when the pandemic hit this country, one of the reasons we were so badly hurt was the shortage of intensive care beds, the number of which had been run down progressively for many years, despite the World Health Organization pointing out the inherent dangers in that. So could the Minister say, without waiting for the inquiry, what our policy on intensive care beds is now?