Lord Bethell (Con)

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The noble Baroness is right that research is the key. I reassure her that we are looking at ways to try to bring research forward. The issue is not with the NICE guidelines themselves; it is with getting the scientifically backed data to be able to justify the authorisations from the MHRA. We are working extremely closely with the NIHR. We are looking at the NHS, which, as the noble Baroness likely knows, does have manufacturing capability within itself for these kinds of drugs. As some noble Lords here will know, we are engaged in thoughts about how the NHS manufacturing capability can be used to mobilise clinical trials in this important area.

Lord Bethell (Con)

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The noble Baroness makes a good point, but I would put a slightly different perspective on it. Doctors have not been the most progressive group in this area; as she says, they have been caught by surprise by patients’ views. I would actually give patients the loudest voice in this particular conversation.

Lord Bethell (Con)

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My Lords, on behalf of everyone, I thank my noble friend for that powerful personal testimony. I am sure there will be many others in the Chamber or listening who have known or lived through some association with brain cancer or cancer of some kind. It is extremely gratifying that in many areas of cancer we have made enormous progress—to the extent that it is a completely treatable disease in many respects—but in the area of brain cancer, that is not true. That is not good enough and we are working on trying to find a solution. Money has been spent, but not enough. We need more focus on this.

On my noble friend’s point on supporting families, that is something that trusts work on, but it is left to the charities and support organisations to do. In all areas of illness, that is something where perhaps we could or should be doing more and I completely take on board his comments.

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

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My Lords, I start by reiterating the tributes from both noble Baronesses, Lady Thornton and Lady Brinton, to my noble friend Lady Cumberlege and her team, who have worked indefatigably on a high-quality report that does justice to this important cause. Most of all, I pay tribute to the patient groups, the specialist groups and those who campaigned on these important issues and who have brought attention and a huge amount of official focus to causes that had been overlooked for years and decades. I pay tribute to their patience, their expertise and their stamina in bringing these important causes to attention. It is entirely right that the Minister, my colleague Nadine Dorries, made an apology to those groups, and I reiterate that apology on behalf of the healthcare system to all the families affected by the report, for the time it has taken to listen and to respond to their concerns.

Both noble Baronesses referred to the culture that led to these issues being overlooked. I think that that is one of the most important learnings from this report. As Nadine Dorries said, I thought very movingly, in her speech in the House of Commons, the system has to learn to listen much more clearly. Listening must happen not just from the top but also at the level at which patients engage with the system itself. I think that trying to change that culture is one of the most important challenges facing us today. It is not just a question of bringing in punishment and retribution for those in the professional world who have failed; it is trying to create a culture where mistakes are recognised and accepted and where people address and take on board the concerns of patients themselves—and on that important cause we are hugely focused.

The noble Baroness, Lady Brinton, asked what we are doing. Already, much has been done. There has been progress in lots of areas. We already have 12 different types of patient safety function in place within the NHS: the Patient Advice and Liaison Service; commissioners of NHS services; the Parliamentary and Health Service Ombudsman; Healthwatch; the NHS Complaints Advocacy service; the CQC; the NHS Friends and Family Test; the professional regulators; the Healthcare Safety Investigation Branch; the Professional Standards Authority; the National Director of Patient Safety; and the complaint systems within individual trusts.

That patchwork quilt of patient safety and patient advocacy is an enormous function within the NHS. The report teaches us that it has not been enough to identify the major themes of failures—in this case, involving medical devices—and there has not been the patient advocacy necessary to see complaints through when they have really mattered. It is that question which we are turning to: how do we make these considerable and important efforts to put patient safety at the heart of the NHS more effective?

The noble Baroness, Lady Thornton, asked about the regulatory implementation of that response. The most important legal implementation is the registry of medical devices, which was in an amendment to the Bill on Report in the House of Commons, and it has enormous support from the Government. That registry, which is an incredibly important source of accountability and of clinical information, is the key to preventing such terrible events concerning medical devices in the future.

The report was published only last week, and it will take some time to focus on all its other recommendations. I can update the House on the specialist centres that the report quite reasonably recommended should be set up: NHS England is assessing bids from NHS providers to be specialist centres for mesh inserted for urinary incontinence and vaginal prolapse.

The noble Baroness, Lady Thornton, also asked about the MHRA regulatory review. The MHRA has begun a comprehensive and far-reaching programme of change, which will include enhancing its systems for adverse event reporting and medical device regulation. The MHRA has taken important steps to put patient advocacy at the centre of the work that it does.

There is nothing we can do today to make good the harm done in the past. However, as both noble Baronesses have rightly pointed out, there is much we can do to put patient safety at the heart of the NHS and to ensure that we have the technology, the systems and the culture to make sure that these mistakes never happen again.

Lord McColl of Dulwich (Con) [V]

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My Lords, I first thank the noble Baroness, Lady Cumberlege, for such a wonderful and constructive report, and all the members of the committee, especially Professor Sir Cyril Chantler, whom I have known for many years.

I have just two questions. Will the report encourage clinicians to consult the appropriate royal college before designing a new treatment? Secondly, after introducing a new treatment or a new operation, should the clinician be encouraged to wait for an appropriate interval to ensure that no complications occur?

Lord Bethell [V]

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The noble Lord makes an important point about Ireland. We have regular conversations with the Irish Government about the app that they are working on. It is our aspiration that the two will work together. That has not been confirmed, since neither has been launched yet, as I understand it, but it is very much at the top of our priorities.

Baroness Northover (LD)

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My Lords, I too thank the noble Baroness for securing this vital debate, and pay tribute to those working in the care sector.

Many lessons will need to be learned after this pandemic is over, but there are things we already know. We knew, for example, that a pandemic was a national threat. Epidemics have always been a global threat, but SARS showed that an epidemic could spread to all continents in the time of a plane journey.

We have long known the weaknesses in social care. Much of Beveridge’s “cradle to the grave” support was in place by the mid-20th century—free education, unemployment support, pensions and, from 1948, free healthcare—but the one huge area not covered was social care. There was report after report in the second half of the 20th century and the beginning of this one, as the noble Lord, Lord Hunt, has just made plain. Everyone agreed that health and social care needed to be seamless.

When my father was diagnosed with terminal cancer in 2007, he lived for six weeks. In the first two weeks, he was given amazing help with pain relief. The next two weeks were simply a battle between health and social care over whose responsibility he now was. Only the last two weeks of his life were spent at home, where he wished to be.

The divisions between health and social care have been shown up in lethal form in this epidemic; hence all the problems that others have mentioned—lack of co-ordination, funding, recognition, equipment and advice—and laid out so powerfully by my noble friend Lady Tyler.

There were attempts at a cross-party agreement on social care before the 2010 election, and the Minister needs to know that his party scuppered that. In the coalition, we commissioned the Dilnot report to seek more stable funding of social care and to protect people against extreme costs, as the NHS does in healthcare. Labour supported this, which was very welcome. But after the 2015 election, it was set aside.

Many of the problems that noble Lords have raised stem from the inability to integrate health and social care properly and to value both. We must indeed never be in this situation again. When we emerge, this is an area which must be urgently and radically addressed. I hope that the Minister will tell us today that he agrees.

Lord Dubs (Lab)

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I congratulate my noble friend Lady Wheeler on initiating this debate and on her very powerful speech. I should declare an interest, in that a member of my family has been in care homes over the years and now has support in his own home, so I have some experience of how these things work.

The first problem, I think, is the poor statistics on this whole sector. We are beginning to get more information together, but it seems to me that, unless we have clear statistics so that we know what the provision is, we cannot easily change policy for the better. We know that many of the problems of social care are long-standing and existed for years before the present pandemic crisis hit us, but they meant that this sector was ill prepared for the difficulties that we now face.

One example that has been often cited is the long journeys that care home workers need to take to get tested. I was told that one person had to travel from Bournemouth to either Gatwick or Chessington— 100 miles each way—to be tested. That is an impossible journey for people who are hard-pressed to get to their places of work.

We all know that social care has for too long been the underdog. Acute services have tended to get the money, albeit not enough—I would not take away a penny from acute services; I would rather put more in—but social care has still tended to be the underdog, as characterised by the very low levels of pay earned by people in the sector.

We know that there are wonderful people working in social care, we know how hard they work and we know about the wonderful long-term relationships that they establish with the people they care for—making the death of such a person even more painful. Of course we must ensure that they have security in this country, and the issue of visas must be dealt with.

Of course we need more testing, as has been said, and of course that should have happened a long time ago. I understand that residents with symptoms and those being transferred to care homes will now be tested. I wonder when that will be completed and when all workers in care homes and domiciliary care will have had the chance to be tested.

I should mention in passing that not all people in care are elderly; there are young people who need help as well, and their problems are slightly different from the needs of the elderly but are still important.

I turn to domiciliary services, which tend to be forgotten. Visits by care workers to homes where a single isolated person is on their own are crucial—not just for their health and needs but to lessen the sense of isolation. Domiciliary workers who call on people’s homes often provide their only link with the outside world. If that were to stop because of the present crisis, that would be a disaster. Of course, as a society and a country we depend very much on family members to provide care. If one falls ill, there is an even more difficult situation for the care workers who have to come in; that appears to be the difficulty at the moment. I know of one care worker who has a long journey by Tube every day to his place of work. Until recently he was given two masks per day, which was hardly enough given that he visited many people per day and per week.

In the long term, surely the social care sector needs a sustainable funding settlement so that it can look forward sensibly to the future. We have to reform the social care system, ensuring that the long-awaited Green Paper says something about it—although I suppose that is a long way away. Finally, in many health sectors there are the royal colleges—the Royal College of GPs, the Royal College of Physicians and so on. Would it not be right if social care workers, both in care homes and in the domiciliary sector, had a royal college of social care to speak for them? Would that not be a good idea? It would be able to fight their corner better than it is being fought at the moment.