Health and Care Bill
Lord Bishop of London ExcerptsThursday 13th January 2022
(2 years, 3 months ago)
Lords ChamberRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: HL Bill 71-II(b) Amendments for Committee (Supplementary to the Second Marshalled List) - (13 Jan 2022)
Baroness Tyler of Enfield (LD)
My Lords, I shall speak very briefly to Amendment 38 in the name of the noble Lord, Lord Bradley. I have huge sympathy with the intention behind this amendment. Everything that we have talked about so far on mental health has pointed to the fact that unless there is a strong mental health voice on ICBs, the whole issue of mental health funding and the priority it has will not get as strong a voice as it should. I recognise that some argue that we should not overspecify the membership of new bodies but should allow each integrated care system the flexibility to develop based on its own set of local relationships, and I do not overlook that point. However, my natural sympathy is that it is only too possible for mental health concerns to be ignored when decisions are made about resource allocation and prioritisation without a strong mental health voice around the table.
However, I think I may have a way through this. We need to look back to the discussions we had on Tuesday about the overriding importance of mental health being explicitly mentioned in the triple aims. If such an aim were in place, I think we would be hard pushed to form an ICS or an ICB without mental health representation and we might be able to argue that it is not necessary, in those circumstances, to have it in the Bill. However, if that aim is not explicit, then the argument put forward by the noble Lord, Lord Bradley, is very strong indeed.
The Lord Bishop of London
My Lords, I rose on the first day of this Committee to speak to the membership of NHS boards. I rise today for a similar reason: I think it is very difficult to stipulate the membership of boards, just as the noble Baroness has said. However, as I said with NHS boards, I say with ICB boards that I think the voice of the patient is central. Along with my role as the Government’s Chief Nursing Officer, I was director of patient experience while I was in the Department of Health. As a nurse at that time, I believed I had a patient focus. However, I learned that my default was always as a professional and that the patient needs a voice and empowerment. While I recognise the clinical voice and would always want it on the NHS board and the ICB board, it does not replace the voice of the patient and the carer.
Health and Care Bill
Lord Bishop of London ExcerptsTuesday 11th January 2022
(2 years, 3 months ago)
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Baroness Walmsley (LD)
My Lords, I wonder if I may make a slight clarification; I hope that the noble Baroness, Lady Merron, will agree with me. It is not that we believe that the people who we specify should be representatives of the sectors from which they come. Rather, given the functions of NHS England, the three of us who have signed this amendment feel that those with background knowledge of the sectors that are absolutely key to the success of NHS England should be on the board. They would be there not as representatives behaving in a unitary way, as the noble Baroness, Lady Harding, said, but having the background knowledge and information that can be shared with the rest of the board to make decisions.
The Lord Bishop of London
My Lords, I declare my background as a former government Chief Nursing Officer and non-executive director of a number of healthcare trusts. I was not going to speak, but I have listened to noble Lords’ comments today and I come down with the noble Baroness, Lady Harding, in saying that we should not stipulate what skills are required of a board too tightly. What is in front of organisations changes over time, so the chair needs to be empowered to change. However, one caveat is that it would be wise to consider having somebody on the board with a background in patients. I speak from experience as a clinical professional: we can too easily forget the patient and to see things through their eyes. Far too often, we see things through the eyes of the clinician, which is not always in the best interest of patients.
Earl Howe (Con)
My Lords, I am grateful to all noble Lords who took part in this short debate, and particularly the noble Baronesses, Lady Merron and Lady Walmsley, and the noble Lords, Lord Patel and Lord Howarth, for bringing these important issues before the Committee. As they made clear, these amendments seek to make changes to the membership and composition of the board of NHS England. Amendment 2 also outlines the conditions that should be met for the appointment process.
Like my noble friend Lady Harding, I am in sympathy with the spirit of these amendments. It is imperative that the membership of the board of NHS England is able to represent the diverse needs of patients and the populations they serve, as well as their twin functions of commissioning and holding commissioners and providers to account.
I was very much in sympathy with the principles and sentiments expressed by the noble Lord, Lord Howarth, in speaking to his Amendment 3. Executive members of the board are selected based on their expertise and ability to manage the delivery of NHS England’s functions. It is also important that non-executive members have the right skills and backgrounds to effectively support and challenge, and hold the executive to account.
I hope I can reassure noble Lords on the existing and planned board membership arrangements. We absolutely aim to ensure that the most suitably skilled and experienced candidates are appointed to the fully merged NHS England board. The legal provisions therefore need to be flexible, and I can tell the Committee that they already are. Existing provisions setting out the membership of the NHS England board in the NHS Act 2006 already provide the flexibility required for the fully merged NHS England to lead our more integrated health and care system.
I agree that robust governance arrangements are absolutely necessary to oversee public appointments, particularly to NHS England. Unlike appointments to integrated care boards, the appointments of the chair and non-executive members of NHS England are public appointments made by the Secretary of State. As your Lordships are undoubtedly aware, as public appointments, they are managed in line with the Governance Code on Public Appointments and regulated by the Commissioner for Public Appointments. These appointments are made on merit in a fair, open and transparent manner. In line with the governance code, they require due regard to be given to ensuring that they properly reflect the populations they serve, including a balance of skills, expertise and backgrounds—exactly as sought by this amendment, as I understand it. We are fully committed to the importance and value of both candidate diversity and equality of opportunity.
The commissioner works with government to encourage candidates from a diverse range of backgrounds to consider applying for public appointments. All public appointees are expected to uphold the standards of conduct set out in the Committee on Standards in Public Life’s Seven Principles of Public Life, as included in the Code of Conduct for Board Members of Public Bodies. The code sets out, clearly and openly, the standards expected from those who serve on the boards of UK public bodies and includes a clear process for managing any conflicts of interest.
The Lord Bishop of London
My Lords, I am grateful to the noble Lords who have tabled the amendments in this group. I am very aware of the expertise that exists within this Chamber. As we have heard, mental health has not always been funded in the same way as physical health. However, we have seen improvements, not least in the way we speak about our own mental well-being. We have seen a reduction in stigma and an improvement in services, but the pandemic has taught us that there is a huge unmet need around mental health, and I suspect we will not know the full impact of the pandemic for a number of years. Clearly, those groups of people requiring support around their mental health will include us and our children as well as our health and social care workers.
I am aware that in our churches, we do a lot, like other faith communities and other community groups, to support people’s mental health and enable their mental well-being to flourish, not least through our faith activities and our worship. Churches put on many activities, such as dementia cafés; we make available our outdoor spaces for people to undertake gardening to improve their mental well-being; we do walking; we reduce loneliness and isolation, to name just a few. But we are aware that we are not mental health professionals. We walk with people, often in the early stages of mental illness or while they are waiting for referral, and what those within our churches know is that the length of waiting is getting longer. The wait for access to mental health services, particularly talking therapies, has got much longer.
The noble Lord, Lord Patel, and the noble Baroness, Lady Tyler, mentioned the figures; we see the personal impact of that, as people’s lives are put into great crisis and they struggle. Not least, it brings stress to their family and friends, and it impacts on their ability to earn. As has already been said, it impacts on their physical health as well. I recognise that we have increased our determination to ensure that there is parity between physical and mental health funding but I believe we require legislative levers to make this happen. Therefore, I support particularly Amendments 5, 12 and 136 as well as Amendment 99. As we have already said, we need legislative levers at every level to address this parity. My belief is that this will contribute to not just the mental well-being of the community but its physical well-being.
Lord Crisp (CB)
My Lords, it is a great pleasure to follow the right reverend Prelate, a former esteemed colleague, and I had better follow her and the noble Lord, Lord Stevens, in declaring an interest as a former chief executive of the NHS in England—as opposed to NHS England—as Permanent Secretary at the Department of Health and as an honorary fellow of the Royal College of Psychiatrists. I support most of the amendments in this group and shall speak particularly about Amendments 5, 12 and 136, about expenditure, and Amendments 91, 92 and 99, about parity of esteem and ICSs.
The most telling comment, I think, from my noble friend Lady Hollins was when she said that mental health is too often forgotten. It is a really sad point. I am struck, when I look through the amendments we are considering today, how the legislation is trying to catch up with where we have got to as a society and how we think about health. It is obvious with mental health. I thought the great speech by the noble Lord, Lord Howarth, emphasising the role of the nonclinical—the people outside the health system and their role in health—and of salutogenesis, the creation of health, not just pathogenesis, the dealing with disease, was really impressive. The other area where this is very obvious is where we are going to come to in a bit, talking about inequalities in a later group.
This is very much part of the new agenda, but it is interesting that we still have the overhang of what I think of as the 20th-century model of healthcare, which is about the acute sector, not the primary sector; it is an NHS focus; it is about doing things to people, rather than with people; and it is about illness. This Bill is, in a way, the first health Bill of the 21st century and it is really important that it sends out some very clear messages and that so many of these amendments can be picked up to make sure those messages are sent out very clearly.
I will pick up the detail very briefly. Amendments 5, 12 and 136 from my noble friend Lord Stevens of Birmingham on measuring and increasing expenditure on mental health—or at least showing the Government’s hand and revealing what they are expecting—and, later, the monitoring of it are fundamental. However, let me put in a caveat: they are pretty blunt. They are imperfect, because they are about inputs rather than outcomes and outputs, thinking of some of the things we talked about earlier. They can also be gamed.
Also, as the noble Baroness, Lady Jones of Moulsecoomb, said, physical and mental health are not distinct; actually, most people in civil society treat mental and physical health at the same time, so there will be some arbitrary distinctions. I remind noble Lords, as we all know very well, that there is a major problem for many patients with mental health problems in trying to access help with their physical health. As Professor Sir Graham Thornicroft has said, mental health diseases are killer diseases, because people die earlier—sometimes because of that impact on physical health.
These are imperfect measures. However, I support them as a blunt instrument for offering steering and pushing the system the right way. They are a real measure that will help bring about change and they should be supported at the macro level.
Amendments 91, 92 and 99 are about achieving parity of esteem within the integrated care systems, and it is right that they are broader based, because people have to make choices at a local level about what they are doing. It is really important that the planners on those boards take full account of mental health and achieve parity of esteem across the whole spectrum, from levels of investment right the way through to ensuring that people with mental health problems can access physical healthcare when they need it. As the noble Baroness, Lady Hollins, reminded us, in 1948 the first meeting of the World Health Assembly defined health as being about
“physical, mental and social well-being”.
It is time we got back to that.
I applaud these amendments and very much hope that the Minister will indicate the Government’s support for a much bigger emphasis on mental health in supporting these and other amendments.
Public Health Grant to Local Authorities
Lord Bishop of London Excerpts(2 years, 6 months ago)
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Lord Kamall (Con)
The public health grant will be maintained in real terms over the spending review period, and we will confirm local authority allocations in due course, but this is not the only money going to public health. In addition to the grant, the Government are investing £300 million over the SR period to tackle obesity and £500 million over the SR period to improve the “best start in life” offer available to families. The NHS is spending over £1.3 billion on national public health services.
The Lord Bishop of London
My Lords, during my time as the Government’s Chief Nursing Officer for England I witnessed the unique value of public health nurses in the community. The pandemic has further highlighted the importance of such roles and the significance of a whole-system approach. Given this, will Her Majesty’s Government consider increasing funding specifically to build up or rebuild the capacity of public health nurses to tackle localised health inequalities?
Lord Kamall (Con)
The Government have allocated more money for local authorities but we think that it is best left to local authorities to decide how to spend that portion of their grant, for they are closer to the people in the communities that they serve.
Covid-19: Obesity
Lord Bishop of London Excerpts(3 years ago)
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Lord Bethell (Con)
My Lords, I completely agree with my noble friend that obesity has been a sad and tragic driver of death from Covid. Overweight people are 67% more likely to need intensive care from Covid than those who are not overweight. The list of the measures that we have in place is extensive—there are 17 in number before me—and we are not going to stop there. This is a really important project for the Government. It is not our business to shame those who are overweight, but it is our business to enable those who seek to lead fit and healthy lives to take the necessary steps to reach that objective.
The Lord Bishop of London
My Lords, the reduced use of school space during lockdown highlighted an opportunity for us to make use of school kitchens as community kitchens. This holds real potential for addressing multiple issues such as poverty, obesity, lack of food or loneliness, all at one time. Will the Government consider supporting school kitchens to become community kitchens when not in use by students in order to tackle obesity in underserved neighbourhoods where people often have limited choices in their nutritional options?
Lord Bethell (Con)
The right reverend Prelate puts the case extremely well. The community kitchen measures she describes are beyond my brief. I do not have the details to hand, but I should be glad to follow this up and write to her.
Covid-19: Update
Lord Bishop of London Excerpts(3 years ago)
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Lord Bethell (Con)
My Lords, our thoughts are with the people of India at a time when they are fighting the disease in very difficult circumstances. I acknowledge that, for families in the UK with family and business ties with India, the arrangements under the red list are extremely inconvenient, and we are doing it only because it is absolutely necessary.
The Lord Bishop of London
I am sure the Minister knows that those from deprived communities are more likely to catch Covid-19, be admitted to ITU and to die from the disease. They are also less likely to take up a vaccination. Could the Minister update us on action by the Government to ensure that Covid-19 does not continue to be a disease of poverty?
Lord Bethell (Con)
The right reverend Prelate hits the nail on the head. It is extremely sad, frustrating and hard to acknowledge the fact that those who live in deprivation are often those who are hardest hit by this awful disease. We have worked extremely hard to get the vaccine, and testing and tracing, into those communities and to support them with whatever education and community support we can. But the fact remains that this country has an unequal health outcome for too many families, and it is part of our levelling-up agenda that we try to address that. The obesity strategy is one way in which that we can do that, but there are a great many others that we need to look at.
Covid-19
Lord Bishop of London Excerpts(3 years, 6 months ago)
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Lord Bethell (Con)
My Lords, my noble friend’s observation is entirely right. In Manchester alone there have been more coronavirus infections already in October than in July, August and September combined. The average daily hospital admissions in Greater Manchester are now higher than they were on 26 March, and there are now more Covid-19 patients in Greater Manchester hospitals than in the whole of the south-west and the south-east combined. These are illustrative of one region but it is a story that has already played out in others, and we naturally fear that it will play out in others in the future.
My noble friend’s advice on the mixing of households is very perceptive. One thing with that we cannot do anything about is the kind of infection that the noble Baroness, Lady Thornton, described among her friends, where it spreads within a household. That is something that no household can reasonably fight against. However, stopping the spread of disease between different households is something that we can lean into. It requires an enormous amount of social distancing and a return to the kind of lockdown measures that we had at the beginning of this year. That is something that we are extremely anxious to avoid because it has enormous social impact, it is disruptive to our way of life, and it has an economic impact because it has implications on social distancing and on some businesses. Still, my noble friend is entirely right that that is exactly the kind of area that we will need to look at if we are to contain the spread of the virus.
The Lord Bishop of London
My Lords, from my background as a former Chief Nursing Officer, I am aware of the difficult decisions that Her Majesty’s Government are required to make, as well as of the importance at this specific time of good public health action. However, I have heard the concerns expressed by my colleagues in the north-east and the north-west of England, including some of my right reverend friends in your Lordships’ House: Covid-19 is disproportionately affecting the vulnerable and, unfortunately, so are the restrictions. There are significant concerns about their compliance with regulations that they do not feel are fair. The Government have frequently made assertions about public health behaviour and science without publishing the evidence or properly engaging with people in the communities affected. The interventions may well be right but the implementation seems to be failing. The Government must genuinely engage with, listen to and learn from people affected at a local level. Without such local buy-in, public health actions will not happen.
There is also some concern that the restrictions are impacting on those least able to manage the health and economic impact. There are concerns that movement into tier 3 will continue to exacerbate matters such as child poverty, deprivation, economic and health inequalities and poor mental health. If the perception is allowed to grow that certain sections of the economy or society can be allowed to bear the substantive weight of fresh regulations without levels of financial support, the consensus will not hold. Will the Minister reassure your Lordships’ House that, as areas move to tier 3, local voices will be listened to and everything will be done to ensure that the risk to the most vulnerable is minimised?
As I have already said in your Lordships’ House, the local public health nurse can inform top-down rules with local experience. What is being done to ensure that when the ring-fencing of funding that was passed to local government for public health comes to an end at the end of this financial year, it does not lead to further disinvestment in public health?
Lastly, faith communities, like public health nurses, are part of local populations and areas, and should be used more as experts to help leverage insights that they gain on the ground to support the public health action and interventions needed. I again encourage the Government not to neglect the whole-system approach to public health, as we work together on the challenge of Covid-19.
Lord Bethell (Con)
The right reverend Prelate puts it extremely well. We completely recognise that not only does the virus attack the most vulnerable, but those who are least fortunate bear the huge brunt of the lockdown and the measures needed to crack down on the virus. In these matters, I emphasise that it is worth stepping back and reminding ourselves that the Government are not the source of the problem; the virus is. All the Government can do is take measures to save lives, protect our healthcare service and keep our schools open. In that way, it is not right to demonise central government for taking measures.
Central government can take measures to help protect the vulnerable, and I acknowledge the right reverend Prelate’s point on this. I reassure her that we have put in place the Job Support Scheme to ensure that those affected by business closure are still paid; we have made £465 million available to help local authorities implement and enforce restrictions; we have provided £1 billion of extra funding to local authorities across the country; and we are committed to working with local authorities to allocate testing and tracing locally.
On the message the Government deliver, I recognise the phenomenon described by the right reverend Prelate, but I reassure her that there is no intent by government to make an association between poor behaviours and results. The data is there. We have published every piece of data we can and, to an extent, it does not lie. It is an uncomfortable truth, but some communities have consistently higher prevalence and infection rates. There is some responsibility on those communities to address the causes of that. It is an intent shared by government, local authorities, communities and individuals. There is no avoiding the fact that you cannot pin responsibility on any one of those four pillars.
Lastly, the right reverend Prelate is entirely right that faith communities pay an important role. I pay testimony to those faith communities in cities such as Leicester and Bolton, which have worked with us to great effect. We continue to put our relations with faith communities at the centre of our outreach to communities.
Health Protection (Coronavirus, Restrictions) (No. 2) (England) (Amendment) (No. 5) Regulations 2020
Lord Bishop of London Excerpts(3 years, 6 months ago)
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The Lord Bishop of London
My Lords, I am grateful to the Minister for the work that he and others are doing to make decisions at this very challenging time. The regulations we are debating relate to health protection restrictions and fines. However, I wonder whether our approach to public health protection and restrictions during the pandemic needs to pay more attention to a bottom-up approach of wisdom, rather than simply relying on top-down pragmatism and the push and pull of financial incentives. Last week, the right reverend Prelate the Bishop of Manchester highlighted how policies, such as fines, are out of touch with many. It has led to frustration and resentment nationwide.
Our current crisis highlights the need for a whole-systems approach to public health. We need to reinvest in our public health practitioners on the ground, working in and with communities, such as public health nurses, who understand and work with their community to ensure that health and well-being are maintained. They can provide grass-roots insights, learning the needs of local people and business owners and, therefore, how to bring about change in behaviour. In this way, rules that come down from the top are informed by real experiences from those on the ground, from the bottom up—public health professionals, with their knowledge, skills and relationships, working with people and the population to promote well-being. This approach is often seen in those countries doing far better with Covid-19 than we are.
In times as fractured as these, we must extend trust and power to those most familiar with their situations and best equipped to bring about change and rely less on disengaged push-and-pull financial incentives to influence behavioural responses. What is being done to ensure that future restrictions are better informed by local wisdom as well as science?
Covid-19: Mental Health
Lord Bishop of London Excerpts(3 years, 10 months ago)
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Lord Bethell
The noble Baroness is entirely right to focus on the Roma community, which, like many communities who are outside the mainstream, is hard hit by the results of Covid. Many such families live near me in Wiltshire. I reassure her that local authorities have continued to mobilise both digital and face-to-face mental health services in an entirely exemplary way, and I pay tribute to their hard work in this area.
The Lord Bishop of London [V]
My Lords, the Government are providing NHS staff with free access to online therapy and group counselling sessions, among other things, which is much needed and very welcome. Can the Minister say whether the same quality of care, recognition and access to mental health support is being given to parts of the social care sector such as nursing homes, care homes and home care workers, who have faced similar traumatic experiences to those of NHS staff?
Lord Bethell
The right reverend Prelate is entirely right to be focused on the support offered to both NHS and social care staff. There is considerable potential trauma in this area, and those who have been on the front line are under more pressure than one could possibly imagine. We have put in place schemes specifically targeted at both NHS and social care staff, and I reassure the right reverend Prelate that there is parity between the two sectors.
Hospitals: Patient Safety
Lord Bishop of London Excerpts(3 years, 11 months ago)
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Lord Bethell
The noble Lord raises a question about north Cumbria, which I do not know about specifically, but I reassure him that the arrangements for PPE in hospitals have been made extremely professionally and thoroughly. Billions of items of PPE are available, and training on the fitting, wearing and changing of PPE is provided for all front-line clinical, support and other staff.
The Lord Bishop of London
The report recently published by the Institute for Public Policy Research, Care Fit for Carers, found that half our healthcare workers have said that their mental health has deteriorated since the Covid-19 crisis began. What supplementary provision is being put in place to deal with the mental health needs of NHS staff?
Lord Bethell
My Lords, I acknowledge the expertise of the right reverend Prelate the Bishop of London, who, in a former life, was the Chief Nursing Officer. She raises an important point; the mental health of staff is of enormous and grave concern to the NHS, to the department and to social care. We are investing money in providing additional mental care support and are working closely with the colleges to find out how best we can provide that important support.
NHS and Social Care: Staffing
Lord Bishop of London Excerpts(4 years, 3 months ago)
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Baroness Blackwood of North Oxford
The noble Baroness will know that appropriate staffing levels are already a core part of the CQC’s registration regime and that the law already requires hospitals to employ sufficient numbers of suitably qualified, skilled and experienced staff at all times. It is also mandatory for staff to provide monthly reports on the average number of care hours per patient per day, which is considered a better measure than staff numbers. However, we recognise the proposals that have come forward regarding staff safety and legislation; they are being considered at the moment.
The NHS surcharge is being considered to make sure that it is at an appropriate level to ensure that we continue to recruit at an appropriate level. At the moment, the rate of recruitment from non-EU countries has increased significantly by more than 150%.
The Lord Bishop of London
My Lords, I am sure the Minister knows that safety is about not just numbers but the continuing development and supervision of nurses and midwives. Can she comment on what the Government are doing to ensure that both nurses and midwives are funded properly for clinical supervision and professional development?
Baroness Blackwood of North Oxford
The right reverend Prelate is quite right. Ever since the tragic events in Mid Staffordshire, the NHS and our nation have been on a journey to make sure that the NHS is one of the safest healthcare systems in the world. This is based broadly on three policy strands: better regulation; greater transparency; and a culture of learning. HSIB is part of that. We hope to move forward in putting legislation in place to ensure that there can be learning without blame, and we hope to ensure that the appropriate training is in place. The people plan, which the noble Baroness, Lady Harding, is in the process of finalising, will ensure that specific proposals on how that will be delivered come forward imminently.