Atrial Fibrillation

Baroness Wheeler Excerpts

Wednesday 4th November 2015 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I, too, congratulate the noble Lord, Lord Black, on securing this debate and pay tribute to his work highlighting the importance of early detection and effective management of AF. I also very much welcome the important walk-in clinic initiative he is promoting within Parliament, with AntiCoagulation Europe providing pulse checks to help prevent strokes and blood clots for people with AF, and hope that as many MPs, noble Lords and Parliamentary staff—if they are included—as possible will go along on 10 November.

I am also very grateful for today’s debate because it sets the scene for my own debate on 18 November on the updating of the now eight year-old national stroke strategy. The strategy runs out in April 2017 and today’s focus on AF underlines the priority it needs to have in the future strategy for preventing stroke and reducing the number of people who have strokes that could have been avoided.

As a vice-chair of the All-Party Group on Stroke, as well as being the carer of a disabled partner who had a major brain haemorrhage stroke in 2008, I am sure that noble Lords will understand why most of my remarks on AF will focus on stroke-related aspects. Better diagnosis and treatment through early detection and effective management of AF with an anticoagulant would result in the prevention of more than 4,500 strokes and 3,000 deaths across England each year. Untreated AF is a contributing factor in 20% of strokes in England, Wales and Northern Ireland, and, as we have heard, more complex disability can result from AF-related strokes.

We have heard a number of figures about the scale of the problem. The Stroke Association’s figure, cited by the noble Baroness, Lady Masham, is that an estimated 16,000 strokes could be prevented every year. The association hears many accounts from stroke recoverers about the devastating consequences of poor detection of AF, so it is worth putting on the record just two of those case histories.

David had a stroke at 62 which had a considerable impact on his life. He now has reduced mobility and this impacts on his job as an electrical engineer. David was not diagnosed with AF until after he had the stroke, and when discussing how to reduce the risk of having another stroke caused by AF, his GP seemed keen for him to take aspirin rather than an anticoagulant; that is, clot-reducing medication. However, David conducted his own research and then pressurised his GP into prescribing an anticoagulant drug.

Another stroke recoverer, Brenda, suffered a stroke thought to be caused by AF. She initially had a mini-stroke and was told by the hospital she was taken to that she had had an arrhythmia; there was no mention of AF. She went on to have a stroke 18 months later. Often AF is discovered only after patients are admitted to hospital with a stroke, and obviously by then it is too late. The Sentinel Stroke National Audit Programme found that only 28% of stroke patients known to have AF when admitted to hospital were on the anticoagulant medication they should have been on. The noble Lord, Lord Colwyn, gave this figure as 38%, I noticed.

Significant underdiagnosis and undertreatment remain, despite the incentives mentioned by noble Lords in the quality and outcomes framework, last year’s reissued NICE guidelines and the new quality standard on AF. It is imperative to address the low level of knowledge among GPs of the importance of early detection and the appropriate treatment of AF. The toolkit AF: How Can We Do Better?, developed by the Stroke Association for GPs and others in primary care, is one of a number of key actions that would lead to the increased awareness and understanding that are needed, particularly about the link between AF and stroke. Government support for NHS Improving Quality’s new GRASP-AF guidance on AF risk assessment and stroke prevention within GP practices would also make a significant difference.

How will the Government be supporting these initiatives? Does the Minister acknowledge that if swift and routine pulse checks were included as part of every GP visit, huge progress could be made and thousands of lives saved? Does he agree that the current low levels of awareness among health professionals are not conducive to developing better understanding among the public? Finally, I support the inclusion of indicators on detection and treatment of AF in the public health outcomes framework. Local health trusts need to be assessed on the efforts they are undertaking to prevent strokes and other major conditions that can arise from AF to ensure that vital opportunities to save lives are not missed.

Lyme Disease

Baroness Wheeler Excerpts

Thursday 22nd October 2015 Grand Committee

[Baroness Wheeler (Lab)]

My Lords, I, too, welcome the initiative of the noble Lord, Lord Greaves, in securing this debate, which we hope will play a helpful role in raising awareness and understanding about Lyme disease and facilitate the real progress and action that is obviously needed. Although we are talking about a relatively small patient population, it is important to underline that cases of the disease have quadrupled over the past 12 years, taking into account the latest NHS data and the fact that, as we have heard, many cases are not formally diagnosed or clear up without any treatment. It has been a comprehensive and expert debate and I look forward to the response from the Minister on the number of issues that have been raised. I do not intend to repeat them.

I also pay tribute to the work of Lyme Disease Action. Its developing work and improving relationship with the Department of Health and Public Health England is a sign of hope for the future and is to be welcomed and commended, as is its partnership with the Royal College of General Practitioners in working on, for example, online training for GPs. In particular, LDA’s help desk for patients and medics, helping to document cases, including test information, talking to laboratories about test results and offering GPs a conversation with the medical director, has led to the successful treatment of patients. Surely it is a model that needs to be taken forward across the NHS as it uses the expertise and knowledge built up by the LDA over many years and, if more widely adopted, would go some way towards addressing the lack of awareness about Lyme disease among many GPs and hospital doctors.

As we have heard, early treatment of Lyme disease is almost always successful but the best treatment in late-diagnosed cases is unknown and the resulting disability can become very severe and lasting with, frustratingly, no consensus on approach or treatment. I recently watched a DVD from the charity Canine Partners which showed how an assistance dog helped and supported a wonderful woman called Sue, who was diagnosed with Lyme disease 17 years ago and has suffered chronic fatigue, painful and stiff joints and muscle and back pain since then. I watched it because my partner had a major stroke seven years ago and he has an assistance dog, so I know first hand how helpful and vital assistance dogs can be for people with disabilities in supporting their independence. It would be good if we could all see that DVD now because it underlines the terrible cruelty of the disease for patients in the chronic state. Sue’s assistance dog is trained to wake her up in the morning because her extreme fatigue means that she has no time awareness of how long she has been sleeping; and, if she needs to rest during the day, the assistance dog is trained to keep an eye on her. It supports her in so many ways—by passing clothes to her for dressing, picking up the phone and so on. It is very good to watch that DVD, which shows the impact this terrible disease can have.

Noble Lords have commented on recent press coverage. One of the articles I read as background to this debate commented that,

“few diseases have aroused more emotional attention in the press and the public than Lyme disease”.

We saw this in the recent publicity, with the all main problems identified: the ongoing problems with diagnosis; patients going to private clinics for tests or travelling abroad to seek tests not available in the UK, or desperately searching for countries with greater knowledge and expertise on the disease than in the UK; and the firm conviction by patients that the disease can be transferred from human to human despite the strong scientific evidence so far that it cannot. These patients all felt that treatment for the disease had not worked for them and that is important. The major themes of this debate are about the overwhelming need for more data and research and I look forward to the Minister’s response on that.

On the issue of guidance for UK health professionals, I understand that there is a general acceptance by both PHE and LDA of a need for guidance for health professionals covering secondary care in particular. What discussions has the Department of Health had with PHE and NICE on this and can the Minister commit to ensuring that a work programme and timetable for such guidelines is produced in the near future?

I was interested to learn from someone who has a particular interest in the provision of specialised care—I do not have time to say why—that paediatric Lyme disease is within the scope of specialised commissioning whereas adult Lyme disease appears not to be. Can the Minister shed any light on the background and reasoning behind this situation and agree to look into the matter?

Social Care and Support: Funding

Baroness Wheeler Excerpts

Monday 19th October 2015 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what actions they propose to take to address the concerns about the availability of social care and support funding expressed in the joint statement Spending Review 2015: a representation from across the care and support sector.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, social care is a priority for this Government, which is why we have established the better care fund to join up health and social care. We recognise that there are pressures on the system and we welcome the joint spending review representations from the care and support sector in helping us to understand these fully. The representations from the sector will help inform spending review decisions. The review will be announced on 25 November.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. I emphasise that this very stark submission to government represents the collective view on the deepening social care crisis from care providers, commissioners and national organisations from across the private, public and voluntary sectors. While understanding that the Minister will not pre-empt the spending review, will he at least reassure the House that, in making the very welcome decision to introduce the national living wage from April next year, the Chancellor fully recognises the estimated additional £2.3 billion cost of this for the social care sector? Does he honestly expect councils to be able to meet this cost if the scale of cuts made over the last five years continues into the future and the Government fail to provide any substantial extra funds?

[Lord Prior of Brampton]

As regards the position of the social care sector, “fragile” is putting it kindly. It is very difficult; there is no point making any bones about that. The increase in the living wage, which is long overdue and very welcome, will add to pressures on the sector. It was made very clear in the Five Year Forward View that the future of the healthcare system is very much tied up with the future of the social care sector. The noble Baroness can be assured that we have brought that to the attention of the Treasury and we are waiting for a favourable result in November.

Social Care

Baroness Wheeler Excerpts

Thursday 15th October 2015 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, today’s CQC report calls on health and social care providers to focus on ensuring that services have the right staff and skills mix to ensure that care is always safe. Does the Minister acknowledge the impact of the funding crisis on residential care and the commission’s concern at the delay in the introduction of the care cap until 2020? Both residential and daycare have high vacancy and turnover rates and a chronic problem in recruiting and training care staff, particularly under-25s. Would it not be outrageous if the Treasury kept the £6 billion and did not use it to try to address those issues?

[Lord Prior of Brampton]

The noble Baroness raises two interesting points. There is a recruitment and a training issue involved in many care homes. This is being addressed by the Government in two ways: first, by raising the minimum wage to the national living wage so that it rises to about £9 an hour by 2020; and, secondly, by the introduction of the care certificate which came out of the Camilla Cavendish report after Mid Staffs, which should improve training in the sector. The funding of local authority-provided care is the issue on which we are awaiting the outcome of the spending round discussions.

Health: Diabetes

Baroness Wheeler Excerpts

Thursday 2nd July 2015 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I, too, congratulate my noble friend on securing this debate and on focusing on the key issue of how people with diabetes can be helped and supported to manage their condition. My noble friend has done a great service campaigning for improved diabetes care over a number of years and ensuring that this important issue remains an ongoing focus and priority for this House. As well as playing a significant role in the development of the strategy for diabetes care, he speaks from his personal experience as a diabetic and his contribution therefore is all the more valued and powerful for that.

This has been an excellent, authoritative debate and, at this stage, the stark facts relating to diabetes have been comprehensively covered by previous speakers. The 3.5 million sufferers could rise to 5 million by 2025 unless we are able to make substantial progress on achieving wider access and take-up of the education and management programmes we are discussing today. The most alarming statistics of all are that an estimated 24,000 people are dying each year when better management and care could have prevented their deaths; and that 10 million people are at risk of developing type 2 diabetes.

Like other noble Lords, I commend the excellent APPG report, Taking Control, which shows the way forward for addressing problems of access, availability and quality of diabetes education. I also pay tribute to the work of the diabetes think tank which, as we have heard, brings together key stakeholders and policymakers from the diabetes community. I was not able to attend its meeting this week but I read its pre-meeting documentation underlining the importance of the future plan for diabetes properly addressing the needs of people already living with the condition. That is really what today’s debate is about. Getting a better balance between this and action to prevent people getting diabetes is crucial and there is a wide recognition that in the past this balance has not been achieved. It stresses, for example, that repeatedly linking diabetes with obesity risks stigmatising people with type 2 diabetes and ignoring the needs of people with type 1 diabetes whose condition is not preventable.

The APPG report also underlines the importance of focusing on ensuring that everyone living with diabetes, whether type 2 or type 1, has the necessary skills and support to manage their own health and reduce the risk of devastating consequences and long-term complications. My noble friend Lord Harrison and other noble Lords have outlined the powerful case on the cost effectiveness of diabetes education and the importance of ensuring that the NICE guidelines and technical appraisal programmes on the provisions of education are adhered to. Patient education programmes help people with diabetes to understand more about their condition and to develop the skills needed to effectively self-manage their diabetes, as we have heard from noble Lords across the House.

Recent economic analysis undertaken by the York Health Economics Consortium, for example, showed that the DAFNE course for people with type 1 diabetes will pay for itself within four to five years due to the reduced complication rate expected from improved management of an individual’s diabetes. Patients with type 1 diabetes are monitoring and adjusting their treatments several times a day, making clinically significant decisions, so the absence of attending structured and ongoing education for these patients is particularly serious in terms of reducing the risk of serious complications resulting from poor management.

Noble Lords might have seen a recent feature article in the Health Service Journal which starkly brings this point home. It told of the experience of a 19 year-old student, who after a shock diagnosis of type 1 diabetes, was sent home from hospital with an injecting kit and practically no educational back-up. The result a week later was her first hypo. She said:

“The hospital wanted to see me inject myself before I went home to make sure I could do it. I was given a blood glucose monitor and a strips box, but broke it. I really felt I was on my own and I didn’t know what I was doing”.

It was not until three years later, when she moved to London, that she was offered her first structured education course.

For both type 1 and type 2 diabetes, the APPG report refers worryingly to the mountain of evidence it received from experts—including clinical staff, academics, academic health science networks and strategic clinical networks—calling for what it refers to as,

“the ongoing deadlock in the provision and uptake of diabetes education”.

GPs and hospital staff must be the advocates and champions of structured education programmes, but the APPG makes it clear that a significant culture shift in the attitudes of some GPs and other staff as to the importance and efficacy of the courses needs to take place.

These are key workforce development issues. Many doctors report concerns that aspects of training and development in the delivery of diabetes care beyond the hospital have not caught up with how diabetes care needs to be delivered today and in the future through different care models, and in settings away from hospitals and GP surgeries with multidisciplinary team involvement. For example, the APPG cites advice on identifying and using new diabetes technologies as “patchy at best”. Are the Government confident that Health Education England’s training and development strategies are able to address these key issues? Noble Lords have referred to the APPG’s concerns on the lack of emotional and psychological support and mental health issues, such as anxiety and depression, which are often experienced by people with diabetes. I look forward to the Minister’s response.

The noble Baroness, Lady Manzoor, spoke about the international perspective and particularly the key link between TB and stroke. Like her, I should like to talk briefly about diabetes and stroke in this country. Diabetes is a major risk factor for stroke and one-fifth of hospital admissions are for people with stroke, heart failure or heart attack. Having type 1 or type 2 diabetes almost doubles your risk of stroke and is a contributing factor to 20% of strokes in England, Wales and Northern Ireland. Good management of blood glucose, blood pressure and cholesterol is essential. The Cardiovascular Disease Outcomes Strategy acknowledges the common risk factors and the interlinking nature of cardiovascular disease—including coronary heart disease, stroke, hypertension and diabetes—and the fact that people with more than one CVD condition can often receive care from multiple and different teams in a disjointed way. Managing the diabetes condition in these circumstances can be particularly challenging.

I understand that NHS England is now reviewing the programme of work on CVD, but it is far from clear how they propose to take the Cardiovascular Disease Outcomes Strategy forward. How is the strategy to be implemented and how it will relate to NHS England’s prevention plans, including the National Diabetes Prevention Programme?

Support from carers, families and health professionals is key to successful self-management. People without carers or family support have especially to rely on a consistent and active two-way relationship with the health team members involved in their care. Caregivers play a key role in their family member’s diabetes management. They help the person they care for to make healthcare decisions and to stick to a care management plan. Helping carers to better understand the condition is vital. The access problems and postcode lottery situation in the local availability of education courses affects carers and family members as well as the cared for, so family-focused education is important, as are localised peer support programmes.

When researching for this debate, I saw another article about a young carer. It shows just what family members face in helping to support their loved ones. I am a carer and a trustee for our local carer support group in Elmbridge. The local community magazine reported a very moving interview with a 16 year-old carer who looks after her mother who has diabetes. She said:

“I’ve helped her from a young age, testing her blood sugar level and getting sugary snacks when she needs them. When the disease took its toll on mum’s sight, I also started shopping, cooking, collecting prescriptions. And I support her when she feels down … I love helping mum … but caring comes with responsibility and I often miss out on seeing friends. Plus if mum needs help and I have homework to do, the homework has to wait”.

The five-year forward review promises significant investment by NHS England in self-management and educational courses for people with specific conditions. I look forward to hearing from the Minister how this pledge is to be translated into addressing the challenges and problems for people with diabetes, their carers and families, as raised by the all-party group and noble Lords today.

NHS: GP Clinics

Baroness Wheeler Excerpts

Thursday 25th June 2015 Lords Chamber

[Lord Prior of Brampton]

My noble friend makes a very good point. Health Education England and NHS England have a return-to-practice scheme precisely to do as he suggests, making it easier for those who have temporarily left practice by going overseas, or taken time out, to come back to practice.

[Baroness Wheeler (Lab)]

How does the Minister see the plans for seven-day working going forward in the light of recent data showing that there is growing pressure on surgeries and that practice closures have resulted in one in four GPs now working as locums, who are increasingly forming an integral part of practice teams? Does the Minister see the new models of care and the transformation he refers to embracing these new forms of working, together with partnered and salaried GPs? We often hear the view that local and part-time working, particularly for women GPs, is one of the major causes of GP shortages.

[Lord Prior of Brampton]

The noble Baroness makes a good point. The old model, based largely around partners, often in small practices, is the one that I think will evolve over the next five years. We will certainly see many more salaried GPs coming into the workforce. The fact that there are now many more women doctors, who will wish to take time out to look after their children or for maternity leave and the like, means that the structure of general practice will change fundamentally. It may also mean more locums. I do not have a view on that particular aspect of the noble Baroness’s question.

General Practitioners

Baroness Wheeler Excerpts

Monday 22nd June 2015 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what plans they have to increase the number of general practitioners.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, my right honourable friend the Secretary of State for Health announced on Friday the first steps of a new deal for general practice. This includes working to increase the primary and community care workforce by at least 10,000, including an estimated 5,000 more doctors working in general practice. We will do this through promoting general practice as a career, increasing training places, encouraging people to return and considering how best to retain staff.

[Baroness Wheeler (Lab)]

My Lords, first, I welcome the Minister to his first Questions in the House. I thank him for his response and for whatever role he played in bringing about Friday’s announcement, ready for this Question. The Health Education England incoming chair recently told the Guardian:

“GP recruitment is what keeps me awake at night”.

Under this new package, will he have to wait until 2020 to get a decent night’s sleep or will the Government take note of the urgent call from the Royal College of General Practitioners for a clear and costed plan, and a timescale for turning it all into reality, so that we can make progress from now onwards?

[Lord Prior of Brampton]

The noble Baroness will know that NHS England recently published its Five Year Forward View, which is a five-year plan for the future. It will encourage much more care, delivered outside hospitals, in the community, and that will require larger input from general practice. I am very pleased to tell the noble Baroness that we are committed to 5,000 more doctors working in general practice.

Care Act 2014 and Children and Families Act 2014 (Consequential Amendments) Order 2015

Baroness Wheeler Excerpts

Thursday 19th March 2015 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, this order, while detailed, has a simple overarching purpose: to make amendments to primary legislation in relation to England consequent to new laws already passed by Parliament, primarily the Care Act 2014, but also to a small extent the Children and Families Act 2014, as I shall explain.

Part 1 of the Care Act 2014 is a crucial step in delivering the commitments in the Government’s White Paper Caring for Our Future: Reforming Care and Support. It takes forward the recommendations of the Law Commission to consolidate 60 years of fragmented law into a single statute, refocusing the law around the person, not the service.

The order before us today is part of the final step in this process, disapplying current legislation for England which is to be replaced by the Care Act, and changing references to that legislation in other Acts to reflect the Care Act. For example, many of the core entitlements to social care services included in the National Assistance Act 1948 are disapplied for England by this order because they are to be replaced by the overarching duty and power to meet care and support needs included in Sections 18 and 19 of the Care Act 2014.

The Department of Health and the Department for Education have worked together to ensure that carer provisions have been extended in key areas. Part 1 of the Care Act introduces improved rights for adult carers caring for adults, including to assessment and support. Sections 96 and 97 of the Children and Families Act 2014 amend the Children Act 1989 to introduce significant new rights for young carers and parent carers respectively. These new provisions will work alongside those in the Care Act 2014 for assessing adults to enable services to co-ordinate their approaches to assessment and support for young carers and the people they care for.

This consequential order therefore makes some amendments which are in consequence of the new provisions introduced by the Children and Families Act 2014. Because the previous legislation relating to carers is being replaced by a combination of provisions in these two Acts, it makes sense to deal with the necessary consequential amendments in a single order.

The order also includes some savings provisions which are necessary for the purposes of transition from the old system to the new one. Essentially the amendments in the Schedule to the primary order “turn off” the old law in England but, in respect of those currently in receipt of services, the order enables services to continue under the old law until those people move over to the new system. These savings provisions will work with separate transitional provisions, to be made by another instrument, and will ensure a smooth transition for those currently in receipt of services under the present law.

Lastly, I briefly outline how this order fits into the broader context of statutory instruments under the Care Act. Subject to parliamentary approval of this order, we will, as I have mentioned, be making a further transitional order that will complete the temporary legislative framework for local authorities and partners to move from old legislation to the Care Act. Also subject to approval of this order, we will make a commencement order to formally commence the relevant provisions in the Care Act from 1 April 2015.

We have also laid before Parliament the Care Act 2014 (Consequential Amendments) (Secondary Legislation) Order, which makes similar amendments to secondary legislation as the order before us makes to primary legislation. This is subject to the negative procedure.

I hope that this standard exercise of ensuring legislative coherence will not prove controversial, so I commend this statutory instrument to the Committee.

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for his comprehensive introduction to the order. As we have heard, it is part of the final steps of implementing the Care Act and related aspects of the Children and Families Act in respect of transition for disabled children into adulthood and on parent and young carers. Contrary to previous form on such Care Act SIs, I do not intend to raise many issues. The SI is very much a technical instrument, potentially complex and involved. However, read in connection with the 2014 statutory guidance to local authorities on implementation and transition to ensure that current services can continue under the old law until the new legal framework applies, it becomes clearer and more intelligible, even to non-lawyers such as myself.

The key imperative, which we strongly support, is for local authorities to be able to manage the transition for existing people receiving care and support services and carers before 1 April 2015 in a practical, case-by-case way. Assessments, care plans and funding arrangements and services agreed under the previous legislation continue unless circumstances have changed, and in accordance with the established review procedures to ensure that arrangements comply with the new Acts.

The Minister knows that we share local authorities’ continuing concerns over capacity and resource issues to ensure effective implementation, and I would be grateful if he could update the House on the latest stock-take survey of local authorities’ readiness and their continuing areas of concern. I understand that the joint LGA/Department of Health/ADASS programme office will continue to monitor and evaluate implementation, as well as co-ordinating the consultation on phase 2 of the Care Act implementation on the care costs cap. I hope that regular updates and information on implementation can be provided over the critical April/May period, and I would be grateful for the Minister’s reassurance on that—even if only up until 7 May.

As the Minister said, the separate transitional order setting out the detail of the circumstances in which the new order is to apply is to follow shortly, so this is especially important. The Department of Health has undertaken to circulate the draft next week via its local authority and other networks before it is formally issued, to confirm the approach for both phase 1 and phase 2 of the Care Act implementation so that it can address some of the recent detailed queries and concerns from local authorities. That is to be welcomed, as I am sure that we all agree that the local authorities need all the help and support that they can get on what is a huge and complex implementation programme.

The department has also undertaken to share the draft with us, and I am grateful for that. However, publishing the final transitional order so close to the date on which the Care Act comes into force will cause considerable difficulties to local authorities. The Minister will know that the order cannot be published until after this SI has been passed in the other place, which will take place next Wednesday. Even if it is published immediately after Commons agreement, that is exactly a week before the changes begin to be implemented and there will be no real opportunity for parliamentary comeback on such a detailed and important implementation document. I recognise that much of the order content will have already been discussed with and communicated to local authorities, but receiving the final authorisation so late in the day presents even greater implementation challenges than already faced. What steps are the Government taking to mitigate that very difficult position?

Two other key issues arise from the statutory instrument. The first is that it formally sets out the position in respect of Wales concerning the Social Services and Well-being (Wales) Act 2014 in relation to adult social care law and to children. The enforcement date of that is currently intended to be 1 April 2016, but that is rightly up to Welsh Ministers. The SI provisions underline that any provisions disapplied in England to make way for the Care Act and the Children and Families Act continue to apply in Wales until such time as Wales brings in the Welsh Act. The Explanatory Note has reassured us that full consultation has taken place with the devolved Administrations in both Wales and Scotland. It also underlines that the order does not contain any provision which changes the current law as it applies to Scotland or Wales, and we welcome those assurances.

The second issue in the SI is in the detail of the Schedule setting out the consequential amendments to existing legislation on the provision of care and support to carers in England resulting from the implementation of the Care Act and the Children and Families Act. That has obviously been a major exercise in cross-government departmental working, and we fully recognise the scale and extent of the task that the department has had to undertake. It is to be congratulated on this work. It is also timely to remind ourselves of the pioneering work described in the Law Commission’s 2008 report, which set out the agenda for the reform of social care law. We have always strongly supported the need to update, consolidate and modernise social care legislation and the key principles of the Care Act, and have been committed to working closely with Members from across the House to ensure improvements and amendments to the Act.

Can the Minister update the Committee on the issue arising from the recent report from the Joint Committee on Statutory Instruments in respect of the drafting of paragraph 95 of the Schedule? The committee has said that the amendments to the Personal Care at Home Act 2010 made by this paragraph are not comprehensive and that consequential amendments are needed. This is an important issue and the department has undertaken to remedy this omission, so will the Minister ensure that the amendments are communicated to all interested parties and organisations as soon as possible?

[Earl Howe]

I am grateful to the noble Baroness. She asked about the local authority stock take. The results of the recent stock take in relation to implementation of the Care Act for January and February reported a positive picture overall regarding local authority preparedness. Specifically, the stock take’s headline findings reported that 99% of councils say that they are very or fairly confident that they will be able to deliver the Care Act reforms from April 2015, compared to 97% of councils in stock take 2 and 90% in stock take 1. Of the four authorities which reported low confidence in stock take 2, three are now fairly confident and one is very confident; one authority has gone from fairly to not very confident.

Seventy-five per cent of councils say that they are on track in 2015-16 in their preparations for the Care Act, the remainder being slightly behind. Confidence has increased on six out of 10 proxy measures from stock take 2 to stock take 3. The exceptions are self-funders, carers’ assessment costs and information, advice and advocacy.

We have already invested more than £5 million in developing a suite of support materials, learning modules and other tools to help councils implement the Act. This is in addition to £23 million of investment in regional and local support that we have provided this year.

The noble Baroness referred to the transition order and regretted the fact that, in her view, it had been published rather late in the day. We set out the approach to transition in the statutory guidance published last October. The joint implementation programme of the Department of Health, the Local Government Association and ADASS has supported transition conversations with local authorities since that time. We do not think that anything in the transition order will have come as a surprise to local authorities.

The noble Baroness referred to the JCSI report, which pointed out that a particular consequential amendment had been omitted from the order. We accept that paragraph 95 of the Schedule to the 2015 order should have amended Section 1(2) to (5) of the Personal Care at Home Act 2010. Failure to do so was an oversight. Those subsections make some prospective amendments to Section 15 of the Community Care (Delayed Discharges etc.) Act 2003. The issue here, however, is that the 2010 Act is not yet in force and there are currently no plans to commence it. The department will ensure that if the provisions of the 2010 Act are commenced, the necessary consequential amendments to Section 1(2) to (5) will be made in the same order using the consequential amendment powers in the Care Act 2014. In summary, while we regret the missed amendment, the omission has no practical effect, and we will have ample opportunity to correct it if the relevant legislation is ever commenced.

Gender-based Violence: Screening

Baroness Wheeler Excerpts

Monday 9th March 2015 Lords Chamber

[Earl Howe]

My Lords, the provision in the Serious Crime Act on controlling behaviour is one of the ways in which we have addressed that. The noble Baroness is absolutely right: abuse can take many forms. It can be physical, sexual, emotional or psychological. Thirty per cent of this abuse starts in pregnancy, and existing abuse may get worse during pregnancy or after giving birth. In the context of health and care services, the challenge is to alert staff to all those possibilities in a way that avoids them stereotyping the person sitting in front of them.

[Baroness Wheeler (Lab)]

My Lords, more than 26,000 women in the UK received HIV care in 2013. What are the Government doing to assess the relationship between women with HIV and domestic violence, so that effective counselling, advice and support can be given to the women at greatest risk?

[Earl Howe]

My Lords, NHS England is working with the Department of Health to identify the right pathways, access to and availability of psychotherapeutic support for victims of sexual abuse and, in that context, the risk factors at play for women who have HIV. It is vital that the support services that we have and the alerts in the system are sensitive to the issue which the noble Baroness raises.

Jimmy Savile: NHS Investigations

Baroness Wheeler Excerpts

Thursday 26th February 2015 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for reading out the Statement, for early access to the two reports and for the briefing that he held this morning. The Statement rightfully acknowledges the clear failings in the security, culture and processes of many NHS organisations that meant that terrible abuse was allowed to continue unchecked over many years. As the Statement says, that abuse was horrific, caused immeasurable and often permanent damage, and betrayed the trust of vulnerable people who had reason to believe that they would be safe.

It is right for the Statement to repeat the Secretary of State’s apology made last June when the first 28 investigations into matters relating to Savile were published, and I know that I speak for the whole House when I emphasise our support for his decision to do so. I also add our gratitude and thanks to all those who have been involved in the preparation of the reports, in particular Kate Lampard and Ed Marsden for their key themes and lessons-learnt report. Through their diligence, the full scale and horror of Savile’s sickening behaviour across the NHS has been laid bare. It beggars belief that abuse on this scale, known to so many people, was allowed to go on for so long.

However, as the analysis of what happened becomes more complete, the key question and concern that will be growing in the minds of people hearing this news today is the matter of accountability and the disturbing evidence that people knew what Savile was doing but failed to act. Much of what is revealed in these reports today confirms what we already knew about a pattern of criminal behaviour in the hospitals concerned, where patients and victims were not listened to and staff felt unable or unwilling to challenge. But what changes today with the Stoke Mandeville report is that it is now no longer possible to say that although the abuse was widespread, it was not known to some of those in senior positions. Nine verbal reports and one formal complaint were made but none was acted upon.

The question why does not extend just to senior staff at the hospitals. As today’s Stoke Mandeville report says:

“From 1980 Savile’s relationship with Stoke Mandeville Hospital underwent a significant change when he was appointed by Government Ministers … to fundraise for … the new National Spinal Injuries Centre”.

As the lessons-learnt report observes:

“In appointing Savile to these roles and in allowing him the licence and free rein he had in exercising these roles ministers and/or senior civil servants either overrode or failed to observe accepted governance processes”.

That is an extremely serious finding and needs to be acted upon. While of course I do not expect the Government to respond to this today, does the Minister not accept that this finding points to the need for a more formal process of inquiry into senior people in the hospitals and at the Department of Health? This includes former Ministers who did not follow the due processes. Knowing what we do, we cannot leave this here. Victims must have accountability, and that must be our shared goal across this House.

Alongside accountability, the victims of Savile also need help now. Many people who were damaged by what happened have never recovered and continue to suffer; some victims have died. In the June Statement, the Government said they would continue to explore compensation for the victims, including the use of Savile’s estate to fund any claims. Can the Minister update the House on that work, and whether there is any value left in that estate? Will this be sufficient, or is there a need for public funding to help victims? Today’s news will again be traumatic and distressing for everyone directly affected. Can the Minister tell the House what steps are being taken to offer counselling and other support to the victims?

I turn to the lessons-learnt report. We need to stress that, while these appalling events come from a very different era, it would be a major mistake to think that they have no relevance today. As one of the report’s chilling conclusions sums up,

“the evidence we have gathered indicates that there are many elements of the Savile story that could be repeated in future”.

Even though the world was different in the 1970s and 1980s, it is impossible to read these reports without wondering how so many people could have known about what was happening but felt unable to act. It must never again be the case that a member of staff is made to feel they would be letting down the hospital if they act to report abuse.

We have welcomed and supported the action the Government are taking to support NHS whistleblowers—for example, the provisions in the Care Act which put adult safeguarding on a statutory footing—but we cannot think complacently that this will be enough in these situations. Action is needed across schools, hospitals and childcare settings. We need co-ordinated, joined-up government action in response. Does the Minister agree that introducing a mandatory requirement for people in positions of trust to report abuse should be an early legislative priority for the next Parliament, whichever party is in office?

It is also evident from the report that we need to look again at changes to the vetting and barring system. Recent changes mean that convicted sex offenders are only added to the list if they are working in professions with access to children. This means that there are thousands of sex offenders who are today not on the list but perhaps should be.

Finally, in the context that Kate Lampard identifies, of a coming era in which hospitals will be more reliant on volunteers and fundraising, and in the light of the comments in the Statement, do the Government still stand by the changes to vetting and barring, or is there a need to tighten this still further?

This report charts appalling, sickening events and places a dark cloud over the NHS. We applaud the Secretary of State and the Government for the commitment they have shown in response to these reports, and we pledge our full support to help bring about accountability and justice for the victims.