Queen’s Speech

Lord Bishop of London Excerpts

Thursday 9th January 2020 Lords Chamber

[The Lord Bishop of London]

My Lords, I am grateful for the opportunity to speak during this debate on Her Majesty’s gracious Speech. I note my interests, which I have declared, and I will limit my comments purely to health and social care.

I welcome Her Majesty’s Government’s focus on the NHS: health, social care and the workforce. I also welcome the additional funding. However, we must not be misled into thinking that this is a funding bonanza; it will serve only to stabilise NHS services. Between April and September, for all nine NHS cancer targets the lowest percentage of patients was treated on time since the standards were introduced. All 118 A&E units fell below the 95% threshold in November as the NHS posted its worst performance since targets were introduced more than a decade ago. We have a long way to go simply to stabilise the status quo. Are Her Majesty’s Government confident that the action outlined will make up the ground that is required?

The NHS is only as good as its workforce, and I am glad to see the focus on recruitment, training and immigration. However, issues related to immigration must be acted on as soon as possible. The new NHS visa is welcome, but it is a limited response to the need to recruit international staff to meet pressing workforce shortages. Health workers coming to the UK still need to pay the immigration surcharge, which is set to increase to £625 per person every year, on top of £464 for a visa. I wonder whether more needs to be done.

The Her Majesty’s Government’s commitment to bring forward draft legislation to support the implementation of the NHS long-term plan is to be commended. As already mentioned, this should be based on the targeted proposals NHS England has developed. This will make it easier for NHS organisations to collaborate with not only each other but their partners in local communities to improve services for the people they serve. However, as any nurse working in a hospital today knows, too often patients, many of them vulnerable, cannot be discharged, despite being medically fit, because they have nowhere safe to go. A strategy for social care and its workforce is also needed.

The additional £1 billion is welcome, but in a sense it may give only a short-term boost to social care services for adults and children. I wonder whether it is enough to meet the rising demand for care while maintaining quality and accessibility of services. I am reassured to see that there is a cross-party approach to seeking consensus on social care reform, but it will take tremendous commitment, tenacity and creativity if the Prime Minister is going to honour his promise to fix the social care system once and for all and to bring forward meaningful proposals for reform. I look forward to lending my support to this work.

Would Her Majesty’s Government consider bringing forward proposals for health and social care integration? As the British Medical Association states:

“Challenges for Britain’s health do not end in GP surgeries or hospitals and the Government needs a credible long-term plan on how to care for people at home and in communities.”


Given the scale of the task of merely maintaining the current situation and the combined demands on healthcare needs, such a plan is increasingly important. Plans should be there to see health in its wider community context.

The diocese of London is collaborating on a pioneering project with Health Education England to place mental health students in faith communities in the Grenfell area to enable mutual learning. We need more such initiatives. They free up capacity, relieve pressure on various parts of the NHS and also contribute to the health of the community. I wonder whether more progress could be made to commission, partner and champion with local charities and churches to provide services to support the vulnerable and at-risk groups and to look at health and well-being in broader terms.

Finally, I hope that the implications of the European Union withdrawal Bill on policy and legislative business do not distract from improving the NHS, health and social care. Improving health and social care is good not just for the individual but for the nation.

Health Service Safety Investigations Bill [HL]

Lord Bishop of London Excerpts

2nd reading (Hansard): House of Lords
Tuesday 29th October 2019 Lords Chamber

[The Lord Bishop of London]

My Lords, I am grateful for the opportunity to speak at this Second Reading. I declare my interests as set out in the register. I too am grateful for briefings from the Library, the Royal College of Nursing, the Royal College of Surgeons and the Parliamentary and Health Service Ombudsman.

Like most noble Lords, I welcome the Bill’s proposal to create an independent body which will investigate serious patient safety incidents. The NHS is to be congratulated on the way in which it has sought over the years to develop as a learning organisation. Florence Nightingale said:

“Let us never consider ourselves finished nurses ... We must be learning all of our lives”.


The Bill comes as part of the wider changes which we have seen undertaken over many years. I recognise those who work day by day in the NHS seeking to do their best and to provide safe, effective and compassionate care.

At the heart of my clinical practice when I was a nurse, a manager or even the Government’s Chief Nursing Officer, and latterly a non-executive director, was my desire to improve the quality of care that people receive. I believe that that is the intention of the majority of the people who work in our NHS, but things go wrong, and when they go wrong, it is often the result of a systems failure, at the root of which is culture. The 2013 Francis report into the Mid Staffordshire NHS Foundation Trust was mentioned by the Minister. It found that misaligned goals and behaviours in a plethora of agencies led to the tragic failure in patient safety. A system failed. It failed people and their families, and the report declared that regrettably it was a preventable tragedy.

The Francis report pointed to the need to develop a culture which was more open and transparent across the healthcare system. Professor Don Berwick, an international safety expert, called on us to embrace a culture of learning, particularly of learning from mistakes, but we have to recognise that when things go wrong, there is often a place deep within us where there is a tension between seeking to learn and wanting to apportion blame. So developing a culture in which we truly seek to learn must be a steel thread which runs through everything, including this legislation.

The stated intention of this legislation is to bring about a whole-system change to how the NHS investigates and learns from healthcare error. However, as the noble Lord, Lord Hunt, said, there is concern that the current drafting fails to do that and that there seems to be a disproportionate focus on the individual person or people involved in the incident. This could be overcome by any process of investigation, starting with reviewing the wide range of the system context, the factors and the conditions in which an incident occurred, well before any discussions with individuals involved take place.

Furthermore, to bring a whole-system change means having a collective understanding of dangerous activity across the board, with NHS and non-NHS patients. I join the noble Lords, Lord Hunt and Lord O’Shaughnessy, in saying that we ought to consider powers to investigate non-NHS patient issues in the independent sector. We should do this for the benefit of not just NHS patients but the non-NHS patients in our care.

I also welcome that the HSSIB must review the criteria, principles and processes of the investigation procedure within three years of their publication and subsequently within each five-year period, but I wonder whether the criteria, principles and processes ought to be co-produced with clinical and non-clinical health service leaders. I also wonder whether they should be reviewed in consultation with not just healthcare professionals but families and patients.

The opposite of a learning culture is a culture of fear. Again, I refer to Florence Nightingale, who said:

“How very little can be done under the spirit of fear”.


Therefore, I welcome the proposals for the development of safe spaces. The present draft of the Bill, I believe, has resolved some of the concerns of the nursing profession, particularly around the concept of safe spaces, but they will be safe only if the new organisation is able to build trust, as already mentioned. Trust is built only in part by legislation; it will need to be built by those recruited, as part of the HSSIB, to implement legislation. Therefore, I hope that the Minister can reassure the House that everything is being done to ensure that people of the right character are recruited to this new body.

I know that some have asked that the prohibition on the HSSIB disclosing information held within safe spaces to the Parliamentary and Health Service Ombudsman be removed. I would be very unhappy with that. Removing this prohibition will do little to create a culture where people working in the NHS feel safe to speak up when things go wrong. However, I think that further work is required to clarify how the HSSIB relates to and co-operates with the Parliamentary and Health Service Ombudsman and with other national bodies, such as the Care Quality Commission, which hold power and responsibility for reporting on patient safety incidents and the causal factors that impact patient care.

Finally, I know that the relationship between staffing levels and patient outcomes is contested, but it strikes me that an independent body such as the HSSIB may be best placed to begin to shed light on this. I hope that the Minister will ask the new body to consider this as part of its focus.

I support many of the intentions set out in the Bill and I look forward to working with other noble Lords as it progresses through the House. I thank officials and the Minister for bringing this Bill forward for our scrutiny.

Queen’s Speech

Lord Bishop of London Excerpts

Tuesday 22nd October 2019 Lords Chamber

[The Lord Bishop of London]

My Lords, many noble Lords will know that I have a background in health, and I continue to be a great supporter of the National Health Service, so they will not be surprised when I address my comments to health and social care. In doing so, I recognise the contribution of the noble Baroness, Lady Emerton, to nursing and to this House.

I thank the Government for their work to support and strengthen the National Health Service, its workforce and its resources. However, increased investment and reform does not guarantee getting to the root of the problem. Our health and social care issue is what you might call a “village problem”. Our flourishing, mentally, physically and emotionally, occurs best in community. More than that, as Sir Michael Marmot’s research from the Institute of Health Equity indicated, our economic, social and emotional circumstances all play a part in our health and well-being.

As a Christian, I believe that every human being is created in the image of God. We are not made in isolation. We belong together in creation, which should be cherished and not simply used and consumed. This is the starting point for the Church of England’s engagement in society, nation and the world. We are most human when we know ourselves to be dependent on each other. It is therefore no surprise that when communities mobilise and environments are improved, it benefits everyone and reduces the strain on our National Health Service. Here lies, in part, the power of social prescribing. Churches have an integral part to play. The Church is a builder of and a presence in communities, and is well placed to support people as they journey through life, and in fact towards death.

Within the diocese of London, the work of the Posh Club run by St Paul’s in West Hackney is just one example. A weekly cabaret-style party for the over-60s, it combats isolation and loneliness in the community. It provides a unique way to experience connection, laughter and physical activity. Father Niall Weir, rector of St Paul’s, says:

“If there was a Posh Club in every town in the UK, I’m certain the numbers of elderly on GP waiting lists would go down hugely”.


In other words, this kind of community partnership can potentially be used to ease some of the unsustainable pressure on our National Health Service. I would be grateful to hear from the Minister what steps are being taken to ensure the deployment and distribution of social prescribing link workers, as outlined in the NHS Long Term Plan, to ensure that there is a level playing field right across all parts of this country.

What of the social care system? Some 1.3 million children—10% of all children—in England have needed a social worker in the past six years, and their prospects are not always good. For example, just 17% of them get GCSEs in maths and English. The social and economic cost of failing to help children is immense. In addition, as we heard from the noble Baroness, Lady Bakewell, the elderly are being burdened with the huge cost of their care homes, while parents struggle to pay for essential care services for their disabled children.

A great deal of thinking has been undertaken about how we might best improve adult social care funding. The Church of England has been consistent in its advocacy of integrating health and social care to ensure the most efficient and effective use of people and resources; we need to see effective integration taking place on the ground in all the communities of this country. The King’s Fund has pointed out that the NHS long-term plan is fundamentally flawed precisely because it isolates the NHS from both social care and public health. Once again, this is not merely a social care problem but a village problem.

While we are waiting for the Green Paper on reform of social care to be released, we still have the Dilnot report, published almost a decade ago. It had cross-party consensus and tackled the very issues that we still face today. It understood the value of community and the importance of shared responsibility. What plans do the Government have to revisit the Dilnot report and its recommendations?

Although I welcome the Government’s commitment to reforming the Mental Health Act, and despite the commitment made five years ago to closing the gap and the crisis care concordat, there continue to be alarming disparities in minority ethnic mental health provision. I welcome the change in legislation, but it needs to be supported by policies and practices that increase cultural competence among professionals and are developed in partnership with minority ethnic communities.

In conclusion, I remind noble Lords that health and social care depend on the wider collaboration of the community as well as internal change. To tackle the deep-seated inequalities that we face in this sector, we need to work together in partnership. Although I welcome the Government’s commitment to do more, I hope that the Minister will bear in mind the role of communities in delivering positive health outcomes and say something about how that can be done.

GP Services in Rural Areas

Lord Bishop of London Excerpts

Tuesday 2nd July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right. The digital-first proposals have been launched as a consultation so that we can work out the funding and contract changes to ensure that we get digital-first primary care right. It can mean telephone as well as video consultations, but there would also have to be physical premises in the area to provide face-to-face consultations where necessary.

[The Lord Bishop of London]

My Lords, I speak as a co-chair of the All-Party Parliamentary Group on Rural Health and Social Care. Living now in a city, I know the challenge of rural health provision, but GP services are not just about doctors. They are also about nurses and community workers. Can the Minister comment on the possibility of developing direct access training for district nurses and health visitors?

Brexit: Health and Social Care Workforce

Lord Bishop of London Excerpts

Thursday 13th December 2018 Lords Chamber

[Lord O'Shaughnessy]

Of course, care needs are increasing—a fact that flows from having a growing and ageing population. I should point out that the Government have increased funding for social care by more than £9 billion over three years in recent Budgets, so we recognise the seriousness of the issue. We of course want to retain those staff—it is good that there were more EU staff in the NHS in June 2018 than in June 2016, and we want them to stay. As for the social care Green Paper, it will be issued shortly.

[The Lord Bishop of London]

My Lords, I am grateful to the Minister for the value that he places on those working in the social care and health sector, but the National Institute of Economic and Social Research identifies that the sector is under considerable pressure, even before we consider Brexit. The Royal College of Nursing states that fewer nurses started training in our universities this year. Fifteen per cent of all our nursing roles have vacancies in London. Experience tells us that recruitment is complex. Can the Minister reassure the House that in an environment that uses the language of taking back control of our borders and controlling immigration, steps are being taken to reassure not just those within the EU but outside it that they remain a valued and essential part of our diverse health and social care sector?

[Lord O'Shaughnessy]

I am grateful to the right reverend Prelate for the opportunity to say that we value every person who works in this country in those professions. We want to ensure that they are able to stay and contribute to the health and wealth of our country. I point out we are improving both recruitment and retention not only through increases in the living wage but through changes to the Agenda for Change pay deal concluded earlier this year. It will give 1 million staff at least a 3% pay increase by the end of 2018-19, and increase the starting salary of a nurse by nearly 10% to almost £25,000 by 2021.