Healthcare (International Arrangements) Bill

Baroness Wheeler Excerpts

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

Moved by

[Baroness Wheeler]

15: After Clause 3, insert the following new Clause—
“Annual report on the cost of healthcare agreements
(1) The Secretary of State must by the end of the period of 12 months beginning with the day on which this Act is passed and every year thereafter lay before Parliament a report setting out all expenditure and income arising over the preceding year from each healthcare agreement implemented under this Act.(2) The annual report laid under subsection (1) must include, but is not limited to—(a) all payments made by the government of the United Kingdom in respect of healthcare arrangements for healthcare provided outside the United Kingdom to British citizens;(b) all payments received by the government of the United Kingdom in reimbursement of costs of healthcare provided by the United Kingdom to all non-British citizens;(c) the number of British citizens treated under healthcare agreements outside the United Kingdom;(d) the number of non-British citizens treated under healthcare agreements within the United Kingdom;(e) any and all outstanding payments owed to or by the government of the United Kingdom in respect of the provision of healthcare outside the United Kingdom made before the passing of this Act; and(f) any and all administrative costs faced by NHS Trusts in respect of implementing healthcare agreements.(3) The information required under subsection (2)(a) and (b) must be listed by individual country in every annual report.”

[Baroness Wheeler (Lab)]

My Lords, we have pursued this matter in the Commons and this House because it is vital to be clear about how the Government will report annually to Parliament on the expenditure and income from each healthcare agreement implemented under the Act and what information will be provided. We are talking about potentially multiple and complex agreements, the costs and implications of which will not be known until the technical and operational provisions for the agreements are settled.

We have consistently been told by the Government that reporting processes are already in place. At Second Reading, the Minister assured the House that,

“all international healthcare agreements will be subject to the scrutiny route considered most appropriate by Parliament”.—[Official Report, 5/2/19; col. 1489.]

As the amendment sets out, our clear view is that a report should be produced,

“by the end of the period of 12 months beginning with the day on which this Act is passed and every year thereafter … setting out all expenditure and income”,

and the number of people treated under each healthcare agreement implemented under the Act by country. It should also detail the costs incurred by NHS trusts in administering these agreements and any outstanding payments owed to the UK.

Since it is not possible to know the detail of these healthcare agreements in advance, we cannot assess the likely costs and system implications. The detail of the impact assessment on costs is woefully inadequate. Its assessment of the annual cost of establishing reciprocal healthcare agreements of £630 million takes no account of inflation, future medical developments or fluctuations in exchange rates. Moreover, the impact assessment’s contention that the costs might even be less than the current costs is just not credible. Greater clarity on the cost of new healthcare agreements in the context of the presentation of a single report on the full range of schemes and arrangements is essential.

So far, the Government’s response has been to insist that existing reporting arrangements will provide sufficient scrutiny and detail, whether through the Public Accounts Committee, the National Audit Office, similar bodies or existing processes for reporting and scrutinising international treaties. However, none of those would provide the scrutiny and strategic overview required in the circumstances we face. The Minister has, however, provided a chink of light. In paragraph 41 of her letter to the Delegated Powers Committee, dated 30 January and published in its report of 14 February, she says that,

“the Government has heard the need for greater transparency in our administration and implementation of reciprocal healthcare arrangements”.

It also says that,

“the Government is committing to issue an annual written ministerial statement on the operation of reciprocal healthcare arrangements. This statement will be published as soon as is practicable after the end of each financial year to allow for accurate financial reporting”.

Can the Minister provide further details on this proposed statement?

For the sake of clarity and the record, the Minister commits in that letter that the statement will provide, first:

“Information on the expenditure and income of healthcare provision overseas as a whole. This would include aggregated expenditure/income for the annual year, as well as country by country sum of expenditure/ income”.


We are also promised:

“An update on the operation of arrangements. This statement could identify areas of successful operation or where arrangements are being improved to promote efficiency”.


Finally, we are promised that information will be included on:

“The strategic direction of reciprocal healthcare arrangements. This would be a statement on the future priorities for the current operation or a statement of where the UK is engaging with other countries to establish new arrangements”.


Certainly this is a step in the right direction towards the information and accountability needed, but can the noble Baroness answer some specific points concerning the Written Ministerial Statement that we have raised in our amendment?

Will it include full details of the payments made by the UK on healthcare arrangements for healthcare providers outside the UK to British citizens? Will payments received by the UK in respect of the investment costs of healthcare provided to all non-British citizens be recorded? Will the number of British and non-British citizens treated under healthcare agreements inside and outside the UK be included? Will any and all outstanding payments owed to or by the UK Government related to the provision of healthcare outside the UK be made before the passing of this Bill? Most important, as we heard in earlier amendments, can we be assured that any or all of the costs faced by NHS trusts in respect of implementing healthcare agreements will be shown, so that we can be clear not only on the costs but also that front-line staff are not having to spend additional time administering these schemes?

Our amendment would give Parliament its rightful role in scrutinising the schemes and, in particular, the Government’s delivery on collection and reimbursement. It is perfectly reasonable to expect healthcare agreements, once they have been reached, to be reported back to Parliament annually. Parliament cannot be expected to grant a blank cheque. An annual report on the costs and arrangements for the new healthcare agreements would considerably increase accountability within the systems, exploring changes in both the expenditure and the scope of healthcare provision arising from the loss of access to reciprocal arrangements after Brexit. I beg to move.

[The Earl of Dundee (Con)]

My Lords, I support Amendment 15, which proposes a new clause and has been moved by the noble Baroness, Lady Wheeler, on behalf of her noble friend Lady Thornton. As I indicated at Second Reading, in another place the Government may have slightly prevaricated on this issue by hiding behind the skirts of obvious current circumstances. While they say that the Bill should not prescribe a particular timetable for reporting back until new healthcare plans have come to light, they also claim that a number of reporting processes can anyway be deployed instead.

However, is there not a simple and necessary corollary to this? If we really want to increase confidence and transparency, why not just make sure that Parliament is given the relevant healthcare facts and figures at least once a year? If the Government should then wish to report additionally through other means, they are always free to do so.

--- Later in debate ---

[Baroness Manzoor]

I can clarify that NHS trusts are funded on the basis of existing agreements and will provide additional funding for any new agreements reached within the powers of the Bill. The same thing will apply to GPs where charges need to be made for people who are not entitled to that care and do not fall within the reciprocal arrangements that we have in place. The procedure would apply as it currently applies and such people would be charged as appropriate. If they are part of the reciprocal agreements that we have, whether bilaterally or multilaterally, such charges will not be incurred.

[Baroness Wheeler]

I thank the Minister for her response. Whichever way you look at it, it is a complex system for reporting information across a wide range of different sources. The point made by the noble Baroness, Lady Brinton, about having the information in one place as part of the ministerial Statement needs to be pursued, and I hope that the Minister will do that. I noted her agreement to discussing it or exchanging correspondence about it, but important matters need to be set out in the ministerial Statement—albeit that the information is presented elsewhere—in order to reassure and inform us about how these agreements are working. With that proviso, I withdraw the amendment.

Amendment 15 withdrawn.

Brexit: Health and Social Care Workforce

Baroness Wheeler Excerpts

Thursday 13th December 2018 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what assessment they have made of the report by the National Institute of Economic and Social Research, Brexit and the Health & Social Care Workforce in the UK, published on 6 November.

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

My Lords, the Government are determined to recruit and retain the staff that the health and social care sectors need. This will include a robust domestic recruitment drive as well as ensuring that EU staff, who play such an important role in caring for and supporting patients, are able to stay in this country. That is why on Monday 3 December, we launched the EU settlement scheme pilot for the EU workforce in health and social care.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. The Cavendish report on the current and potential staff shortages across all the key health and social care professions makes for alarming reading and shows how dependent we are on the work and dedication of EU nationals. I want to focus on social care workers. What is the Minister’s response to the Government’s Migration Advisory Committee, which says that these vital staff fall into the category of “low-skilled” and therefore do not merit preferential rights here in any post-Brexit scenario? In the past he has acknowledged the skilled, caring jobs that these staff do in community services, people’s homes, nursing homes and care homes. Does he agree that they are definitely not low-skilled? What is he doing to convince the MAC otherwise? What is the strategy for recruiting the 130,000 new social care workers that we need each year just to stand still, let alone to address the future demands of the service?

[Lord O'Shaughnessy]

I thank the noble Baroness for her question. First, we want to ensure that EU staff working in Britain are able to do so, and course that is why the EU settlement scheme pilot is so important. The social care workforce in this country has increased a lot, with a mixture of domestic and foreign staff. One of the ways in which we are increasing the attractiveness of that profession is by increasing the living wage, which has benefited so many staff in social care. Of course, many of them are highly skilled, and we want to ensure that we continue to be able to attract such skilled staff. We continue to discuss with the Home Office exactly what the right thresholds are for our future immigration system so that we do not lose out on these kinds of staff.

Diesel Emissions

Baroness Wheeler Excerpts

Wednesday 5th December 2018 Lords Chamber

[Lord O’Shaughnessy]

I absolutely agree with the noble Baroness that this is an issue of concern. It is a concern to all of us and it is certainly a concern to those of us with school-age children in urban areas, who experience the pollution every day. First, the UK has made progress on reducing pollutants, although clearly there is a long way to go, and in specific urban areas the problem is much worse than in others. Secondly, I point the noble Baroness to the clean air strategy, which will be published at the end of this year. It will contain a range of measures aimed at reducing pollution and, as a consequence, the public health damage that comes from it. I shall certainly feed in her comments about the importance of targeting these benefits on schools.

[Baroness Wheeler (Lab)]

My Lords, earlier this year the World Health Organization Science Panel reclassified diesel exhaust as a carcinogen, underlining that many cases of lung cancer could be connected to the contaminant and that exhaust could become as important a public health hazard as passive smoking. The European Public Health Alliance has pointed to the urgent need to develop research into the possible impact on other health conditions such as diabetes and dementia. Can the Minister tell the House what action is being taken in response to the WHO declaration and what research funding and programmes are in place to address the growing concerns on this issue?

[Lord O’Shaughnessy]

The noble Baroness is quite right: it is one of the biggest public health problems that we face. It is associated with around 30,000 deaths a year, and that gives us a sense of the scale of the problem. I mentioned the clean air strategy but two specific important pieces of research are also taking place. One is called the Exploration of Health and Lungs in the Environment, which is a London-based study looking at the links between pollution and children’s lung health. The Department of Health and Social Care has also commissioned a review of adverse birth outcomes and early-life effects associated with exposure to air pollution. Therefore, we take this problem seriously and are commissioning research to know not only the consequences but what to do about it.

Mental Capacity (Amendment) Bill [HL]

Baroness Wheeler Excerpts

Report: 2nd sitting (Hansard): House of Lords
Tuesday 27th November 2018 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, Amendments 49, 85 and 87, which are in my name, complement Amendment 29—which, like others, I strongly support. Information to the family and those who care deeply about the welfare of the person is the cared-for person’s safeguard against exploitation or bad care or simply having their needs ignored. It is paramount that families have a role to play in the care planning of their relatives, not least by giving them the option to stay fully informed and to object to the proposed plans if they are unsatisfied.

When an assessment happens at one point it is easy to collate all the information, get it signed off and then forget that every day until the scheduled review is a day to be lived by the cared-for person. If the conditions laid out in the authorisation are not adhered to, if the person is not empowered as much as possible to be both mentally and physically active, gradual inactivity and a slipping decline set in.

The care itself is important. Certainly, quality of care will vary between care homes and within them, but monitoring the care plan is central to ensuring that the cared-for person’s dignity is maintained. Their quality of life depends on how they are treated day in, day out, as well as whether they receive care in a way that enhances their personal dignity or, shamefully, they are treated as though they are of less worth. It is therefore imperative to ensure that the cared-for person is placed at the heart of the LPS authorisation process, which is why I want all those consulted in the initial process, as laid out in paragraph 17(2), to be able to access easily the care and support plan. Being able to apply for it is not enough; many people may not even know that they are able to apply to look at it. Relatives will notice if the care plan states that something is not happening and question why.

The care plan and authorisation record must be available to the cared-for person, enabling them to keep track of what is supposed to be happening. For those with fluctuating capacity or less severe impairments, the sense of control and empowerment that this would give is completely in line with the ethos of the Mental Capacity Act. Where the cared-for person cannot monitor their care plan, they can still know, even in their short-term memory, whether they are getting what they should get. Those with specific responsibilities for the cared-for person’s welfare—such as the nominated representative, the donee of the lasting power of attorney for health and welfare or the court-appointed deputy—must have both the authorisation statement and the accompanying care plan.

The care plan must also be provided to the care team in the cared-for person’s place of residence, because where such a place is supported living, I am concerned that those who provide support and are not on a professional register may find that they are not given all the details. I strongly support Amendment 29, introduced so clearly by my noble friend Lady Watkins. People must know what their rights are and what will happen. This will not be costly; it will be far less costly than the court cases that are likely to come if the requirement to provide information about all aspects of the process and plan is not in the Bill.

Amendment 87 deals with what to do in the event of a dispute. It requires an AMCP to be appointed to explore the reasons for the dispute and assess the situation independently. If agreement cannot be reached, independent mediation must be sought before resorting to the adversarial processes of going to court. A group of family law solicitors has been working for over a year to develop a system of mediation to be used before a court proceeding in the Court of Protection. This type of dispute, where everyone agrees that a solution must be found in the interests of the cared-for person, lends itself well to mediation; it would be swifter, cost less than any court action and be far less traumatic for all concerned. If the principle of dealing with dispute is not in the Bill, can the Minister reassure the House that it will be dealt with in the code of practice?

Before I finish, I urge the Minister to recognise the strength of feeling about people needing to be given information about their rights. If he will not accept these amendments, will he agree to bring the lead amendment in this group back as a government amendment at Third Reading? Requiring adequate information-giving must be in the Bill; it cannot be left to the code of practice, nor deferred to the Commons stages. This is one of the most essential planks in ensuring that the care that should be given is given.

[Baroness Wheeler (Lab)]

My Lords, we on these Benches strongly support the key amendments in this group. Amendment 29, to which my noble friend Lady Thornton added her name, would ensure that the responsible body has a duty to make sure that the cared-for person or the person representing them in an advocacy, professional or other capacity fully understands the rights of the cared-for person for whom deprivation of liberty is proposed, and the rights to challenge. Those rights also include specifically the rights to an independent and professional assessment, to a review of the LPS arrangements, to advocacy and support and to be able to challenge the LPS authorisation in court.

The noble Baroness, Lady Watkins, made a strong case for rights to information to be on the face of the Bill, ably following on from the interventions of the noble Baroness, Lady Hollins, during its previous stages. She spoke on the importance of this issue, particularly in respect to people with learning difficulties, and the need, wherever possible, to take steps to increase the cared-for person’s capacity to understand what is happening to them and to have as much involvement as possible to help them determine their wishes and feelings.

Gosport Independent Panel

Baroness Wheeler Excerpts

Thursday 22nd November 2018 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for reading out the Statement updating the House on government actions since this appalling tragedy was reported to the House in June. As the Statement says, the Gosport report was “truly shocking”, and once again our thoughts, sympathies and condolences go out to the families of the 456 patients whose lives were shortened. Those families campaigned for so many years to find out what happened. We also again pay tribute to these relatives for their courage, tenacity and persistence in seeking the truth, and to the panel, with particular thanks for the calm and compassionate leadership of the chair, Bishop James Jones, for its unstinting work in uncovering the injustice and for listening to and hearing the families’ concerns.

It is important to remind ourselves of the panel’s conclusions. First, there was a disregard for human life and a culture of shortening the lives of a large number of elderly patients. Secondly, there was an institutional regime of prescribing and administering “dangerous doses” of a hazardous combination of medication not clinically indicated or justified. Thirdly, relatives were constantly let down by those in authority in the hospital when they complained. Fourthly, senior management, the local constabulary and politicians, the coroner system, the CPS, the GMC and the NMC all failed to act in ways that would have better protected patients and relatives.

We welcome the commitment to strengthen protections for whistleblowers and for new legislation to compel NHS trusts to report annually on how concerns raised by staff have been addressed. Has a detailed programme of work for this been drawn up? When does the Minister envisage that legislation on these new powers will be introduced? However, much of the Statement today is about work in progress on the actions and measures that were announced when the report was published, and it is important that we receive regular updates in the future. In his June Statement, the Minister referred to the introduction next April of medical examiners to ensure that every death is scrutinised by either a coroner or a medical examiner, and yesterday’s Statement repeats this commitment. Can the Minister advise the House on progress on this? If they are to be employed by acute trusts, how will their independence be maintained and how will they link into the mortality reviews and the Learning from Deaths guidance? Has consideration been given to basing them in local authorities so that their remit can be extended to primary care, nursing homes and mental health and community trusts? What additional resources are being provided to fund these new posts?

When the report was published, the House welcomed the urgent establishment of a hotline and of counselling being made available to all those who had lost loved ones and were affected. Are these important provisions still available and will they continue to be provided? What further support is being provided? Also, in addition to the 456 patients given opiates without appropriate prescribing or as a result of the prescribing practices at the hospital, sadly, 200 more patients were referred to in the report whose clinical notes or medical records had gone missing. The panel considered that these patients had been similarly affected. What progress has been made by the workstream set up to further investigate this appalling situation? How many more cases have been substantiated as a result of this?

On the question of oversight of the use of opiates in the NHS, is the Minister satisfied that it is now tight enough to prevent incidents such as this happening again? We welcome the promise of a further review on how patient safety can be improved when prescribing and dispensing medicine, aimed at detecting inappropriate prescribing. Can the Minister give us further details of how this review is to be conducted, including the full remit and timescales?

In June, the Minister also promised a “fresh impetus” to moving forward on the need to streamline professional regulation following the report’s condemnation of the inadequacies of the GMC and NMC regulators who failed to act in ways that would have better protected patients and relatives. What progress has been made on this work?

Finally, we come back to the key issue of patient safety and the need to build a patient safety culture in the NHS. Does the Minister consider that additional legislation is needed to keep patients safe? Is a new independent body now required to pick up and take forward the remit of the former Patient Safety Agency, so unwisely abolished by the Government?

The Statement ends by underlining the cultural change that needs to be driven across the NHS to achieve openness, transparency and learning rather than blame and the cover-up of mistakes and incidents, and of course we agree with that. For all the awfulness of its findings, the Gosport panel report has managed to ensure that the carers and relatives of loved ones and staff have been listened to and heard. We on these Benches pledge our full support for the measures which will ensure that what happened at Gosport never happens again.

[Baroness Jolly (LD)]

My Lords, I join the noble Baroness, Lady Wheeler, in thanking the Minister for an update of this situation and I too pay tribute to the relatives and the whistleblowers in this awful scandal. I am sure that many noble Lords will remember how the Shipman scandal absolutely rocked the NHS back in the late 1990s. The learning which came out of that was meant to incorporate right across the NHS robust clinical governance structures. It is really quite ironic that the things which were put in place to deal with the Shipman case seem to have fallen apart completely as regards the particular issue of Gosport.

Whistleblowers need to be confident that there will be no danger of their being bullied. I am sure that other noble Lords will have had NHS employees ask to talk to them about whistleblowing issues. One of the saddest days I can remember was when I was sitting in the Royal Gallery talking to a very senior manager in an NHS trust who was trying to raise his concerns. In the end he resigned because he felt that he had been bullied into doing so. He was going to take his expertise elsewhere. There is learning that should come from that.

I welcome the Freedom to Speak Up initiative and the work from the National Guardian’s Office. What progress has been made in embedding the operation of that scheme? If it is still in train, when might it be embedded? What consideration has been given to a similar scheme for whistleblowers who work in the care sector? This has got the NHS sorted but, at the moment, there is no way that care workers who work in care homes or other care establishments can effectively blow the whistle.

Health: Stroke

Baroness Wheeler Excerpts

Wednesday 14th November 2018 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what progress they have made in developing a national plan for stroke.

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

My Lords, a stroke programme board was established in March 2018, co-chaired by NHS England’s national medical director, Professor Stephen Powis, and the CEO of the Stroke Association, Juliet Bouverie. Following this, the NHS long-term plan will include a focus on cardiovascular disease and stroke, and is set to be published before the end of this year.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. While the promise of including the national stroke plan in the full NHS long-term plan is welcome, nevertheless publishing it in its own entity after the national strategy ran out last year would surely have helped to sustain the progress and momentum since 2010, particularly in the reconfiguration of stroke services. Instead, thousands of stroke survivors say that they feel abandoned after they come out of hospital: 70% of patients are not offered a personalised care plan for their ongoing treatment, care and support; only 30% of CCGs are commissioning the vital six-month reviews of their progress and problems; one in four hospitals does not have access to stroke specialist early supported discharge at home; and, on average, stroke survivors wait 10 weeks for urgent psychological support. What action are the Government taking to ensure that CCGs tackle these problems now?

[Lord O'Shaughnessy]

I understand the noble Baroness’s frustration about the gap between the strategy and the plan but it was right to include the work undertaken on the stroke plan within a long-term plan, because clearly that covers every aspect of how the NHS is working. In the meantime, I point out to her that the NHS RightCare programme for cardiovascular disease has been set up. It is aimed specifically at dealing with some of the variation in service that she talked about. But there is good news in stroke care: not only is there less incidence than 10 years ago but 30-day mortality rates have more than halved, so there is progress which we need to build on.

If the noble Baroness and the House will allow me, I would like to use this opportunity to pay tribute to my noble friend Lord Skelmersdale, who died very recently. He was a predecessor in this role and a great champion of stroke care, both as a Minister and as chair of the Stroke Association for 10 years. I am sure that everyone in the House would offer their sincere condolences to his family and friends.

Child and Adolescent Mental Health Services

Baroness Wheeler Excerpts

Wednesday 24th October 2018 Lords Chamber

[Lord O’Shaughnessy]

I do not know the specifics on psychology graduates; I will write to the noble Baroness. If the number of nurses in mental health nurse training at the moment comes through into the profession, there will be 8,000 more mental health nurses by 2020. I am sure we will be keen to recruit them from wherever we can.

[Baroness Wheeler (Lab)]

My Lords, on the issue of 24/7 services, CQC evidence suggests that the number of children visiting A&E departments for mental health treatment has more than doubled since 2010. Earlier this year, a CQC review highlighted growing demand as children, young people, their families and carers find that they have to reach crisis point before they can get help. On top of this, the recent FOI response to the BBC’s “Panorama” programme showed that at least 1.5 million under-18s were estimated to be living in areas where there are no 24/7 child mental health services. What steps are the Government taking to join up services across health, education, local councils and the voluntary sector to ensure that these vital crisis and support services are available and funded?

[Lord O’Shaughnessy]

I recognise that there is variability across the country. Indeed, waiting times vary, which is not acceptable. That is why a new four-week waiting time standard is being trialled as part of the Green Paper I mentioned. I should also point out that new, community-based eating disorder clinics are being set up so that people do not have to go to an A&E environment and can access something that is better for them, frankly, both more easily and locally.

Personal Social Care: Funding

Baroness Wheeler Excerpts

Tuesday 16th October 2018 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what assessment they have made of the report by Independent Age, A Taxing Question: How to fund free personal social care, published in September.

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

My Lords, the Government welcome and recognise the contribution of Independent Age and other stakeholders to the important debate around social care reform. The Green Paper that is to be published later in the year will set out proposals for a sustainable social care system that strikes a fair balance between what the state and individuals pay. Reforms must be affordable and fair across the generations, including to working-age taxpayers.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. The report sums it up when it says that,

“today … accessing such support has become a game of chance: based on where you live, your social class, and your ability to pay”,

all of which was echoed in last week’s CQC state of care report, which also made it clear that any future extra funding for the NHS will just be wasted and swallowed up treating people in hospital unless there is a similar major cash injection for social care. Will the Minister confirm that all the options set out for future social care funding in the Independent Age report, particularly the strong case made for free personal social care and support for older people, are under active consideration in the social care Green Paper? How are the proposed 10-year NHS plan and the Green Paper joined together to deal with the integration lottery and fragmented care that the CQC’s local systems reviews have highlighted?

[Lord O'Shaughnessy]

I thank the noble Baroness for raising this important issue. She is quite right that extra funding is needed, which is why we have pledged £20 billion extra for the NHS and want to get this long-term funding settlement for social care. There are many proposals in the Independent Age document—nine, I think—and we are looking at a range of different options. As I said, there needs to be a fair balance between those who are working today and those who need care today, an issue that has evaded a number of Governments and which we sincerely hope to solve. On how the two plans will work together, the intention is that the long-term plan and the Green Paper will be published together around the same time and will therefore be complementary in trying to achieve the goal of integrated health and care.

Adult Social Care

Baroness Wheeler Excerpts

Wednesday 11th July 2018 Lords Chamber

[Lord O’Shaughnessy]

I absolutely agree with my noble friend. I know that she speaks from great experience. We have some good working practices now, through the better care fund, between health commissioners and local government, which is an essential part in making sure we have a sustainable system.

[Baroness Wheeler (Lab)]

Will the Minister reassure the House that the Green Paper will address the parity of esteem between mental and physical health in terms of eligibility for social care support at home? Although there is serious concern that many people suffering debilitating mental illness, particularly depression, are not receiving the basic social care support they need, it is very difficult to assess the national scale of the problem because of the very poor data on how the current eligibility criteria are applied in mental health support. How is this key issue being addressed?

[Lord O’Shaughnessy]

I reassure the noble Baroness that it will be addressed. When we have the consultation, there will be more opportunity to explore that.

Hepatitis C

Baroness Wheeler Excerpts

Monday 9th July 2018 Lords Chamber

[Lord O'Shaughnessy]

First, I applaud the noble Baroness for her work on this. We know that hepatitis C is a truly horrible disease that affects some of the most vulnerable people in our society, which is why we want to eliminate it. In terms of the NHS being geared up, we are on track to treat 70,000 people by 2020. We need to keep finding people, and, of course, they become harder and harder to find. She is quite right about the need to raise awareness. We are doing other things as well, such as reaching into hard-to-reach communities. To give one example, there is now a 100% opt-out testing offer for people entering the prison estate, which is one of the areas where hepatitis C tends to be transmitted. There is clearly a need to do more, but we are looking at how to reach those hard-to-reach communities.

[Baroness Wheeler (Lab)]

Can the Minister say a bit more about the steps the Government are taking to support the delivery of hepatitis C treatment in community settings, such as GP clinics, pharmacies, homeless shelters, substance misuse clinics and sexual health clinics? The King’s Fund estimates that spending on tackling drug misuse in adults has been cut by more than £22 million compared with last year, and funding for sexual health clinics by £30 million over the same period. How will the 2025 target for elimination of hepatitis C be met if vital education and work in these services, and the work they do in reducing reinfection rates, are not available?