Health and Care Bill

Lord Bradley Excerpts

Lords Hansard - Part 1 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I must declare my interests: I am a fellow of the Royal College of Physicians, the Royal College of General Practitioners, the Academy of Medical Sciences, and the Royal College of Physicians of Edinburgh, which is affected by Amendment 168. I am an honorary fellow of the Royal College of Emergency Medicine, president of the Chartered Society of Physiotherapy and an observer on the Medical Schools Council. All those organisations have a vested interest in this amendment.

Very simply, this amendment just makes sense for the future. Without it, the cost of healthcare to the nation will rack up and never come under control. The talk about people working in the NHS is a fallacy. What matters is whole-time equivalents and the competencies of those people with whole-time equivalents. While it is absolutely right to say that it might take 15 years for somebody to come through training as a specialist, what is not understood is that, as soon as people qualify, having left their undergraduate training, they are then on the job. They are learning on the job, working incredibly hard and contributing, but they do not have the competencies developed. That is what takes a long time. The modern techniques that get things done much more quickly and that deal with more patients—laparoscopic surgery having been an example—are highly skilled, but highly efficient.

We have a shortage of 1,400 anaesthetists. Without anaesthetists, you cannot have good maternity services, you cannot operate and you cannot have good emergency services. They are absolutely essential to the whole running of secondary care. Then, of course, in primary care, we have the gaps as well, so the specialist training is really important.

As well as that, this cannot be handed over to algorithms on a computer and left to IT, because of the need for personal interaction between the clinician and the patient and their family. I do not believe that this will be replaced by AI. However, many jobs performed currently will be taken over by AI, freeing up clinicians to become even more specialist competent.

Building on the comments of the noble Baroness, Lady Harding, I remind the House that poor care overall is more expensive than good care in the long term. It is a very short-term view to think that you can provide poor care; in the long term, you really do stack up debt. Stopping workforce planning will not avoid costs at all; all it will do is move the costs from one year further into the future and create bigger problems. Although I hesitate to say it, I think it will also fuel the whole litigation culture.

Amendment 80 is absolutely essential. If it is accepted by the Government, or passed by this House, then Amendments 81 and 82 would fit very neatly into the criteria against which such reports are to be written on the workforce. I remind noble Lords who might be unaware of this that the royal colleges already collect workforce data. Verification of data collected from integrated care boards and areas will not be difficult, because you will simply see how the figures match up. The figures will be reported centrally, and planning can take place. The amendment of the noble Lord, Lord Hunt, is so straightforward; I cannot see why we want to rack up costs further by not putting it through. Vacant posts cost money, they do not save money. By putting that through, we will have more efficient appointment procedures. This is an historical anomaly which could be corrected easily.

Relying on bank staff is really dangerous. Mistakes happen much more often when staff come in who do not know the place, the team or who to call. You would never field a sports team consisting of a bunch of people brought together to play at a high level who had never played before. Yet, what we are doing in our NHS is bringing in bank staff who often do not know the hospital or the team. They do not know the strengths of the other people in the team, so they do not know to whom they can delegate. I hope that the House will approve Amendment 80 if the Government are too short-sighted to just accept it.

[Lord Bradley (Lab)]

My Lords, I rise briefly to support very strongly Amendments 80, 81 and others in the group. They have already been explained eloquently, so I will not repeat those arguments. I declare my interest as an honorary fellow of the Royal College of Speech and Language Therapists. We have already heard about their importance, as a profession, as part of the wider allied health professionals. It is always worth remembering that allied health professionals make up a third of the total workforce.

Responding to workforce planning in Committee, the Minister stated that he shares the view of the noble Baroness, Lady Finlay—from whom we have just heard—on the importance of

“integrated workforce planning across NHS and non-NHS employers … and that work is under way on it.”—[Official Report, 24/01/22; col. 102.]

Unfortunately, at that time the Minister did not set out what that work was. The response did not really give a great deal of hope regarding the long-term failings in workforce planning for allied health professionals in general and speech and language therapists in particular. We need to ensure that this is addressed. As we have heard, these amendments properly address the issue.

I draw particular attention to subsection (4) of Amendment 80, which clearly states that royal colleges must be consulted in drawing up the report which will be laid before Parliament on

“meeting the workforce needs of the health, social care and public health services in England.”

By that consultation, we should ensure that allied health professionals, and particularly speech and language therapists, are included. These professionals sometimes work directly in the NHS. Often, however, they work in other health settings and can be employed in those settings by the NHS. They might also work in settings such as education, the criminal justice system and other parts of the social care system, or in independent practice. They should all form part of the consultation to ensure that the plans which come forward on workforce planning are comprehensive in their nature and coverage. Therefore, these amendments are crucial to achieving this objective. I am sure that the Minister will want to give us that same assurance when he responds.

Health and Care Bill

Lord Bradley Excerpts

Lords Hansard - Part 1 & Report stage
Tuesday 1st March 2022 Lords Chamber

[Lord Kamall (Con)]

My Lords, with the leave of the House, I hope that noble Lords will find it helpful for me to speak early in this debate, since we believe that government Amendment 31 addresses some of the concerns raised by noble Lords. I shall, of course, listen carefully to the rest of the debate and respond in full at the end.

In speaking to Amendment 31, I thank noble Lords from across the House for the wide-ranging discussions in the Chamber on membership of ICBs. We are grateful for the discussions. Many noble Lords have offered their gratitude to the noble Baroness, Lady Walmsley, for the suggestion on the skills mix. We accept the spirit of these amendments and agree that it is important that ICBs are populated by members with the appropriate range of skills and expertise. I know that noble Lords have heard this many times, but it is also important that we do not over-prescribe, as ICBs should have the flexibility to design their boards to meet their needs, while also ensuring they have the skills and experience necessary to properly discharge their functions.

We have listened, and I hope that the amendments we have brought forward, which require ICBs to consider these skills, knowledge and experience, address those concerns while also ensuring balanced, workable boards. When the amendments refer to the necessary skills, knowledge and experience, that is in relation to the discharge of all the ICBs’ functions, including those related to mental health, children’s health, public health, public and patient involvement, engagement with the voluntary, charity and social enterprise sector, and digital innovation and integration. Therefore, these amendments would help to ensure confidence that ICBs have the necessary skills and expertise to discharge these functions, while allowing them to retain discretion in how they deliver this. This approach has been welcomed by stakeholders, including the Allied Health Professionals Federation, which represents 12 professional bodies representing allied health professionals.

The second, connected amendment would ensure that an ICB reports on how it has discharged this new duty in its publicly available annual report. This will allow public scrutiny of ICBs and create confidence that they are drawing on an appropriate range of skills, expertise and knowledge. This is in addition to governance of ICBs being clearly set out in their constitutions, which will also be published and signed off by NHS England. As I have said, I shall listen carefully to the rest of the debate, but at this stage, for these reasons, I commend these amendments to the House.

[Lord Bradley (Lab)]

My Lords, I rise to speak to this group of amendments, but particularly to move at the appropriate time my Amendment 12. Again, I declare my health interests in the register, especially as a trustee of the Centre for Mental Health and an honorary fellow of the Royal College of Speech and Language Therapists.

As we have heard, we had considerable discussion about membership of ICBs in Committee. I argued in an amendment that membership of ICBs should include a representative of a mental health trust. I also supported amendments stating that allied health professionals—who make up about a third of the health and social care workforce, within which speech and language therapists are a crucial service—should also have membership on the board. However, as we heard, the Government rejected the arguments, principally on the grounds that they made membership too prescriptive and inflexible.

--- Later in debate ---

Moved by

[Lord Bradley]

12: Schedule 2, page 145, line 30, at end insert—
“(d) at least one member with expertise and knowledge of mental health in the integrated care board’s area.”

--- Later in debate ---

[Lord Bradley (Lab)]

I wish to test the opinion of the House.

Health and Care Bill

Lord Bradley Excerpts

Lords Hansard - Part 2 & Committee stage
Monday 24th January 2022 Lords Chamber

[Lord Bradley (Lab)]

My Lords, I shall speak on this group of amendments, and I declare my health and higher education interests, as in the register—and, specifically, my honorary fellowship of the Royal College of Speech and Language Therapists. We have had some excellent speeches, and some forensic analysis, of these amendments, which are so important to ensuring that the workforce is at the centre of the reform programme under the Bill. I cannot match those contributions, so I do not intend to.

However, I would still like to support Amendments 172 and 214, in the name of the noble Baroness, Lady Finlay of Llandaff, to which I have added my name. The noble Baroness spoke eloquently to those amendments, recognising, among other things, the crucial role that allied health professionals play in the delivery of healthcare. It is worth emphasising that allied health professionals are the third largest section of the health workforce, supporting people of all ages with a range of diagnostic and therapeutic interventions both within and beyond health and social care settings. Their contribution can often be overlooked in a narrative that frequently focuses only on the role of doctors and nurses—however important those clearly are.

As we have heard, Amendments 172 and 214 are designed to address those issues. I shall comment particularly on the role of the speech and language therapy workforce; I am grateful to the Royal College of Speech and Language Therapists for its briefing on this matter. There are around 19,500 speech and language therapists in the UK, many of whom have a portfolio career and work part-time. It is estimated that about two-thirds spend at least some of their working time in the National Health Service. Those not working in, or employed by, the NHS may work for local authorities, in schools, in the justice sector—in which I have a particular interest—with speech and language therapists becoming a key part of criminal justice liaison and diversion teams, in the third sector and in independent practice.

However, as already noted, these settings are not represented in current workforce planning. This risks not enough speech and language therapists being trained to meet current and future demand. In turn, this risks people of all ages with communication and swallowing needs not being able to access the speech and language therapy they and their families desperately require. Crucially, there is already a significant backlog identified, comprising unmet need and increased demand—that increased demand exacerbated by the pandemic.

From initial discussions with speech and language therapy services, it is estimated that a minimum increase of 15% is required in this skilled workforce, whereas in recent years the profession has grown by only 1.7% net per year. Amendment 172 would mean that the duty to report by the Secretary of State would include the whole health and care workforce, not only those directly employed by the NHS in England, and Amendment 214 would ensure that workforce planning takes into account the experience and expertise of the whole social care workforce by establishing a workforce board in every ICB area.

For speech and language therapists, establishing an advisory workforce mechanism would help to address current weaknesses of workforce planning in the country. In turn, this would support better service planning and delivery, ensuring that there are sufficient speech and language therapists to meet current and future patient need. I strongly support these amendments, which recognise the value of allied health professionals across many services, who will play a crucial role in the integration of care, which is the purpose of this Bill.

Since the debate has picked up Amendment 285 on the proposal to establish an office of health and care sustainability, I add my voice in support. I was a member of the ad hoc Select Committee on the Long-term Sustainability of the NHS, so ably chaired by the noble Lord, Lord Patel. It was one of that report’s recommendations, and our key recommendation, and we will pick up that debate on another group. In the light of the comments already made on that issue, I recommend our recommendation to this Committee as we develop our thoughts on this Bill.

I hope that the Minister will give a very positive response to ensuring that the role of our allied health professionals is embedded in the plans that will come forward, crucially, on the workforce in our health and care system.

[Baroness Whitaker (Lab)]

I add my support for Amendments 172 and 214, speaking as a vice-chair of the All-Party Parliamentary Group on Speech and Language Difficulties and a patron of the British Stammering Association. These amendments, which again have the support of the Royal College of Speech and Language Therapists, would do much to safeguard the position of that now rare commodity— speech and language therapists. As has been said by both noble Lords who tabled the amendment, they do not all work in the NHS.

The view of the Department of Health and Social Care is that speech and language therapists should be added to the shortage occupation list, because the profession is facing a range of pressures, including increasing demand in mental health in particular. The NHS long-term plan identified speech and language therapy as a profession in short supply. The need for those therapists must be taken account of in workforce planning.

Similarly, Amendment 214 provides an incentive to ensure that there are enough speech and language therapists to meet current and future demand, which is just not the case at present. I remind noble Lords that meeting communication needs, as well as ensuring the ability to swallow safely—both at risk from a wide range of conditions—are an essential component of well-being, and often safety itself. I hope that the Government will look favourably on these amendments.

Health and Care Bill

Lord Bradley Excerpts

Lords Hansard - Part 2 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Earl Howe (Con)]

My Lords, I begin by thanking my noble friend Lady Morgan for raising these important matters both via this Committee and by engaging—as I understand she has recently—with my honourable friend the Minister of State for Health. I am also grateful to all other noble Lords who have spoken so powerfully and knowledgably on these issues.

There is no escaping one overarching reality in this policy area, to which the noble Baroness, Lady Thornton, has just alluded. As a Government of the whole United Kingdom, Ministers are responsible for all people of the UK; that is a given. However, while the core principles of the NHS are shared across all parts of the United Kingdom, it is the devolved Governments in Scotland, Wales and Northern Ireland who are responsible for developing their own health policies. Health is largely a devolved matter in the UK, and the commissioning and provision of health services for people in Scotland, Wales or Northern Ireland will continue to be a matter for the devolved Governments.

It will not surprise my noble friend to know that the UK Government continue to respect existing devolution settlements, so our aim is close collaboration with the devolved Administrations to deliver the best outcomes for the people across the four nations. This means that, while we are sympathetic to the spirit of these amendments, I am afraid that we cannot accept them.

I shall address the detailed issues. On Amendment 17, I agree with my noble friend that there is more we can do to align our healthcare for the good of patients across the United Kingdom. We are already exploring several projects to support the NHS to work more closely across the UK, and this includes refreshing the current memoranda of understanding between all four Governments and working with the Office for National Statistics to establish a number of UK-wide datasets. Steps like that will improve transparency and collaboration for the good of all patients across the UK. We do not believe that these steps require primary legislation, but we will keep that question under review. We will also continue to work with NHS England to ensure that a number of groups that it currently hosts, such as the rare diseases advisory group, and their specialised commissioning processes, also meet the relevant needs of the devolved Administrations.

Turning to Amendment 205, we know that choice of healthcare is an important right for patients across the UK. The NHS Constitution for England, for example, enshrines the patient’s right to informed choice. We will be preserving the important right for patients in England to choose their first elective outpatient appointment, GP and GP practice through regulations made under powers provided by the Bill. NHS England works closely with the devolved Governments, including on commissioning and ensuring access to specialised services. Requests for patients to have treatment in other nations are generally to secure continuity of care, to provide care close to patients’ support mechanisms, or because of specialist expertise.

The health services in Scotland, Wales, and Northern Ireland already have the power to contract with any NHS provider in England. As my noble friend Lord Lansley rightly pointed out, they already have in place arrangements for commissioning specialised services from English providers, including cross-border agreements, referral schemes and service-level agreements. Taking further steps, as suggested in this amendment, would place a significant burden on a smaller number of providers, particularly those along borders, with consequences for the smooth running of those health systems. From a legal perspective, such a change would be a significant impingement on a devolved competence and would require the consent of the devolved legislatures. Of course, patients matter most, but such a change would also be unlikely to greatly benefit them, since they are already served by existing arrangements.

Amendment 301 deals with data interoperability. The UK Government are committed to working with officials across the devolved Administrations to explore the benefits that healthcare data can provide while working collaboratively to respect the devolved nature of this work. As in other areas, we are looking at ways to improve collaboration on data matters and address issues with data sharing. There are commitments within the data strategy for health and social care to work across central government and the devolved Administrations to improve appropriate data linkage, thus supporting people’s health care outcomes. This builds on the work of units such as the Joint Biosecurity Centre, and the newly established UK Health Security Agency.

That work will help us to collaborate to solve public health issues, improve disease surveillance and overcome any behavioural or structural obstacles to appropriate data sharing across our respective health and social care systems. In addition, we are speaking to the Office for National Statistics about collecting data on performance and outcomes across the UK. We are pursuing this with it, working in concert with the devolved Administrations. The ONS has assured us that it does not need additional powers to gather such data.

The problems encountered by the daughter of my noble friend Lady Fraser in proving her vaccination status are being actively addressed on both sides of the border. I must concede that the problems are not fully resolved yet, but understand that a Covid status pass from Wales, Scotland or Northern Ireland will be recognised in England and vice versa.

[Lord Bradley (Lab)]

My Lords, I am sorry to interrupt, but I have been meaning to ask this question for a while. Will that also apply to students who currently study abroad and had their first vaccinations abroad, and who then come back to work in their home country? Will that be connected to the NHS app as well?

--- Later in debate ---

[Baroness Masham of Ilton (CB) [V]]

My Lords, I want to support the proposed new paragraph (h) in Amendment 37, which says,

“at least one member appointed to represent the voice of patients and carers in the integrated care board’s area.”

The patient’s voice should be heard throughout the Bill. What is the National Health Service for if not patients? Patients should be involved in planning, ensuring that patients’ and carers’ views continue to be represented. Their experience should be collected. They, with their carers, are the people who know what good, safe care is and what poor results are. I hope the patient’s voice will be involved. I am pleased that many Members already stated this in amendments last Tuesday. I hope the Government agree, and I look forward to hearing from the Minister.

[Lord Bradley (Lab)]

My Lords, I speak to my Amendment 38 and declare my health interests in the register, particularly as a trustee of the Centre for Mental Health and an honorary fellow of the Royal College of Speech and Language Therapists.

This amendment is short and simple. As its explanatory statement makes clear, it merely adds to the list of requirements for membership of an integrated care board that must be included in the ICB constitution. I believe it is essential to have a representative of mental health trusts for each ICB area, and therefore on the ICB, as it is the key strategic body for, among other things, healthcare commissioning, planning priorities and resource allocation for a local area.

Health and Care Bill

Lord Bradley Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Bradley (Lab)]

My Lords, I declare my health interests in the register. I am pleased to speak in this debate and add my congratulations to the noble Lord, Lord Stevens of Birmingham, on his excellent maiden speech.

The Government set out their laudable intentions to integrate health and social care some years ago. In 2018, they changed the name of the Department of Health to the Department of Health and Social Care. I believe that that was a step in the right direction but progress since then has been woefully slow. Recent initiatives have tended to reinforce the separation of the two services rather than their integration, and have not led to the development of seamless pathways of care centred on the needs of the individual. With this Bill strangely pre-empting a further integration White Paper, the Government seem more concerned with the architecture of the NHS, recentralising powers and decision-making to the Secretary of State than with having a genuine ambition to devolve powers to local communities to deliver efficient and effective integrated services.

Belatedly and controversially, a new clause was introduced in the Commons to set up a new funding stream for social care, but it was not clearly ring-fenced for the purpose, with most of the money initially going to support the NHS further. While that money is much needed by the NHS to tackle appalling backlogs of care, it ensures that the current crisis in social care is not addressed—particularly, as we have heard, the dire workforce situation and the failure to address funding for local authorities, where the demand on them for social care provision also remains critical.

Despite these reservations, I am sure we all want to see a system develop that genuinely addresses proper health and care integration. So much work will be done during Committee and beyond to try to improve and shape that ambition, including full scrutiny of the social care funding clauses. As a starting point today, I want briefly to raise two issues.

The first is clarity about service planning at local place level. Local services such as primary, community and many secondary care services require planning, oversight and management at local level. This Bill allows ICSs to delegate resources and responsibility to place-level entities, but there is no statutory framework for the form of local commissioning bodies or their governance and relative accountability relationships. With the abolition of clinical commissioning groups, it is unclear to me how this important function will be fulfilled in the future. I hope the Minister will be able to clarify that point later this evening.

The second issue is the structure and governance of ICSs. A dual structure is planned for ICSs, with the integrated care board and a partnership board. There is obviously a risk that ICBs will be dominated by acute trusts, with other services being relegated to the partnership board. In my view, it is essential that if, for example, parity of esteem between mental and physical health is to mean more than words, mental health trusts are recognised in statute to sit on the ICB. Similarly, it is essential that allied health professionals such as speech and language therapists and the voluntary sector are at the ICB table to ensure their voices are heard loudly and locally. Finally, how will the public voice be heard, to ensure that the best interests of the health of local populations are duly considered? I would welcome the Minister’s views on this when he winds up.

I hope the Government will listen carefully to the concerns and issues raised in our debates on the Bill in order to ensure that this is not another missed opportunity to make a proper step forward, not only in the integration of health and social care but towards early intervention and prevention programmes which tackle the root causes and determinants of ill health and health inequality, as was brilliantly articulated recently by Professor Sir Michael Marmot and his team in my home area of Greater Manchester. As Archbishop Desmond Tutu famously said:

“There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.”


That should be the guiding principle during our deliberations on this Bill.

Mental Health Act Reform

Lord Bradley Excerpts

Monday 18th January 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I have met the Race Disparity Unit and can share my noble friend’s testimony to the critical work that it does. The statistical collections managed by NHS Digital have shone a light on the extent of the disparities illustrated by Sir Simon, most notably that black people are more than 10 times more likely to be made subject to a community treatment order after discharge from hospital. That is an astounding number. We are determined to take action; we will introduce a new patient and carer race equality framework which will support NHS mental health care providers to work with their local communities to improve the ways in which patients access and experience treatment. The Race Disparity Unit will continue to play a key role.

[Lord Bradley (Lab) [V]]

My Lords, while I welcome the White Paper, it is unlikely that the legislation will be enacted until 2023. Many reforms can be made before that date to implement some of Sir Simon’s recommendations, including the development of community facilities to support people with learning disabilities and autism so as to hugely reduce the use of in-patient beds and, crucially, alternative provision to finally stop the use of prison and police custody suites as places of safety. I therefore press the Minister again to assure the House that sufficient capital funds are available within the NHS long-term plan to implement such key recommendations.

[Lord Bethell (Con)]

The noble Lord is 100% right: we can definitely start work on the recommendations of the report. As I said earlier, we have already done so: committing £400 million to end dormitories in 40 trusts. That sort of parallel processing can be done for other elements of the report. The consultation began last week, which shows our determination to get moving. Some recommendations of the report are spellbindingly obvious; we will work on them immediately. The role of police suites in safe refuge, cited by the noble Lord and by the noble Lord, Lord Winston, is exactly such an example.

Medicines and Medical Devices Bill

Lord Bradley Excerpts

Committee stage & Committee: 5th sitting (Hansard) & Committee: 5th sitting (Hansard): House of Lords
Wednesday 11th November 2020 Grand Committee

[Lord Ramsbotham (CB) [V]]

My Lords, I must declare two interests in explaining why I have put my name to the amendment—first, as co-chair of the All-Party Parliamentary Group on Speech and Language Difficulties, and secondly, as an honorary fellow of the Royal College of Speech and Language Therapists. As always, it is a great pleasure to follow the noble Baroness, Lady Thornton, and the noble Lord, Lord Hunt, both of whom know a great deal more about this subject than I do.

As I reported on Second Reading, on 12 August the Minister in the other place wrote that the Bill would allow the Government to update those professional organisations that can prescribe medicines when it was safe and appropriate to do so. This is in line with what the Minister said on Second Reading, which was quoted by the noble Lord, Lord Hunt. If the experience of dieticians, orthoptists, diagnostic radiographers and speech and language therapists is anything to go by, the role of such people has expanded considerably during the pandemic, during which there has been ever-increasing pressure on health professionals.

Prescribing responsibilities would enable allied professions to share the burden with their NHS colleagues and avoid unnecessary delay and duplication for patients. Their call for increased prescribing responsibilities is backed up by hard-pressed NHS trusts, which have identified a means of increasing their capacity. Therefore I hope that, on the basis of experience during the pandemic, the Minister will be able to announce proposals and a timetable for extending prescribing rights for certain carefully chosen health professional organisations within three months of the Bill being passed, as part of the NHS long-term improvement plan.

[Lord Bradley (Lab) [V]]

My Lords, I am pleased to support this timely amendment, which, as we have heard, would introduce a new clause to the Bill to extend prescribing rights to additional healthcare professionals. It is a consequence of the debate on Second Reading, which clearly laid out the benefits of extending prescribing rights to such allied health professionals as dieticians, orthoptists, diagnostic radiographers and speech and language therapists. I will not repeat all the advantages this would bring, because that argument has already been well made, both on Second Reading and in the speeches we have already heard this afternoon. In summary, I believe that it would help to deliver better support and more timely care for patients, reduce pressure on other health professionals, increase system efficiency and maximise the ability to respond to the Covid-19 pandemic, both now and in the predicted post-pandemic surge in the pressure on services.

Medicines and Medical Devices Bill

Lord Bradley Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Lord Bradley (Lab) [V]]

My Lords, I shall raise just one issue—that of prescribing rights, already highlighted by the noble Lord, Lord Ramsbotham. Clause 2(1)(n) deals with amendments made to provisions that govern who can supply or prescribe human medicines. As the Minister, Jo Churchill, recognised in Committee in the other place on 8 June, the provisions referred to are set out in Clause 2(2). The power gives the Government the ability to amend the rules around who can supply, administer and prescribe medicine in line with healthcare needs when it is safe and appropriate to do so. The most recent changes to prescribing responsibilities were in 2018, when legislation was amended to allow trained paramedics to act as independent prescribers.

The Minister informed the Committee that the Government had published an illustrative SI, showing how the provision could be made to permit dental hygienists to supply and administer certain medical products in the course of their professional duties. That is important, because the Government could use the opportunity presented in this Bill to extend supplementary prescribing rights training for occupational therapists and extend independent prescribing rights training to other allied health professionals, including dieticians, orthoptists, diagnostic radiographers and speech and language therapists. As the noble Lord, Lord Ramsbotham, has made clear, this could help to deliver better support and more timely care for patients; reduce pressure on other health professionals; increase system efficiency; and maximise the ability to respond to the Covid-19 pandemic now and in the predicted post-pandemic surge on services. The extension would also build on the groundwork already undertaken by NHS England’s scoping exercise over the last few years on extending prescribing rights. However, having had full consultation with professional bodies, any SIs laid must be subject to affirmative resolution in this House—and, of course, such SIs must be underpinned by efficient, robust and coherent regulation.

I support the views of the allied health professionals that there could be considerable benefits to extending these prescribing rights, including better support and more timely care for the patients they work with, enabling them to have more equitable access to treatment and reduced pressure on other stretched professionals, especially GPs. As an example of those benefits, I highlight the work of speech and language therapists. Without independent prescribing rights, speech and language therapists have to hand over a prescription to a different prescriber, such as the GP. If the prescriber is on another site, that can sometimes result in considerable delays. In addition, for those patients with eating and drinking difficulties, the current situation could increase the risk to their safety, including adverse effects such as aspirational pneumonia or reflux, with the possible increased likelihood of hospital admissions.

As noble Lords will be aware, speech and language therapists provide life-changing treatment, supporting care for children and adults who may have difficulties with communication or with eating, drinking and swallowing. They are also involved in key clinical and health pathways, including cancer, particularly head and neck cancers, learning disabilities, brain injuries, stroke and progressive neurological conditions such as dementia. Expending prescribing rights to them and allied health professionals could enable safer and more efficient patient care, and I hope that the Minister will confirm that he will support this issue as this legislation progresses though this House.

Covid-19: Mental Health

Lord Bradley Excerpts

Wednesday 1st July 2020 Lords Chamber

Asked by

[Lord Bradley]

To ask Her Majesty’s Government what action they are taking to address the impact of the COVID-19 pandemic on mental health.

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

My Lords, we have released tailored guidance to help people deal with their mental health on GOV.UK and the Every Mind Matters website. NHS mental health services have remained open for business, offering support using digital, telephone and face-to-face approaches as appropriate. We have provided £9.2 million of additional funding to charities to support adult and children’s mental health. We are working with the NHS, Public Health England and others to gather evidence and assess potential long-term impacts of Covid-19 as we plan for support for mental health through the recovery phase.

[Lord Bradley (Lab) [V]]

I refer to my interests in the register and thank the Minister for that reply. However, as he will be aware, research on the impact of the pandemic already shows that demand for mental health and well-being services is increasing substantially. Will he therefore ensure that specific funding across government is available to groups who are particularly at risk at this time, including: those who have had the virus and been treated in hospital, who suffer from high rates of PTSD; people who have been bereaved in distressing circumstances; those living and working in care homes and in our hospitals; and children, who require immediate psychological support as they return to school?

[Lord Bethell]

The noble Lord is entirely right to be focused on the potential increase in demand for mental health services, although it is an area where we have some reassurance that the explosion of mental health demand has not hit the heights that at one point we feared. None the less, we have ploughed money into mental health charities and have recruited 3,500 volunteers who are helping with the Check-in and Chat Plus process. We remain incredibly vigilant in this area, and I entirely support the focus on specific mental health issues which the noble Lord outlined.

Queen’s Speech

Lord Bradley Excerpts

Thursday 9th January 2020 Lords Chamber

[Lord Bradley (Lab)]

My Lords, declaring my interests in the register, I will briefly touch on three issues from the Queen’s Speech relating to healthcare. I also congratulate my noble friend Lady Blower on her excellent maiden speech.

First, I turn to the intention to enshrine in law the National Health Service’s multiyear funding settlement. This commitment and additional resources for the NHS are obviously always welcome, but in 2018-19 the outturn spend on mental health services was around only £12.2 billion, which is roughly £1 in every £10 of the overall NHS budget. If we are truly going to make the essential additional investment desperately needed in mental health services for both children and adults, would it not perhaps also be appropriate to enshrine in law the commitment to achieve parity of esteem and equality of access between mental health and physical health expenditure over the same funding period, rather than merely retain it as an aspiration in the NHS mandate?

Secondly, I turn to NHS investment. As pro-chancellor of the University of Salford, which has one the largest—and, dare I say, best—training departments for nurses in the country, I welcome the announcement to restore some level of bursaries for nurse training. However, I understand that there will be a delay in implementation until September this year. Universities recruit for such training at a number of points in the year, such as January and March, so it is likely that potential applicants will delay entry until September to understandably take advantage of the bursaries. However, this could further undermine the already fragile nurse workforce planning across the NHS. Will the Minister therefore consider the immediate restoration of the bursaries to ensure a more robust pipeline of nurses over the coming years and give more certainty to university recruitment?

Thirdly, I turn to the Mental Health Act and the commitment in the Queen’s Speech to continue work to reform it. Such reform is urgent following the excellent review of the current Act by Sir Simon Wessely. I strongly support two of his recommendations regarding the interface between mental health and the criminal justice system, which are similar to recommendations I made in my independent report to government some 10 years ago. First, he recommended that by 2023-24 investment in mental health services, health-based places of safety and ambulances should allow for the removal of police cells as a place of safety under the Act and ensure that the majority of people detained under police powers are conveyed to places of safety by ambulance. This is obviously subject to satisfactory and safe alternative health-based places of safety being established. I totally agree with this recommendation.

Good progress has been made in this area, with the banning of the use of police cells as places of safety for children. However, to ensure that the recommendation is implemented, we need significant further investment in, for example, crisis care assessment units away from A&E departments—they are totally the wrong environment for people in mental health crises—and liaison and diversion services. These services have now reached 100% coverage of the country but should be further enhanced by, among other things, connection to speech and language therapy services and appropriate adult support, and the rapid development of the excellent reconnect programme for rehabilitation.

His second recommendation—that NHS England should take over the commissioning of health services in police custody; again, similar to my recommendation —would significantly improve the co-ordination between mental health, learning disabilities and physical health assessment in police custody, and would be a key component in improving the quality and timeliness of crucial information about a person’s complex needs as they pass, where appropriate, along the criminal justice pathway. Again, I hope that the Minister will support these recommendations and the early introduction of the Bill in order to reform the Mental Health Act at the earliest opportunity, following diligent consideration of the complex issues through the publication of the White Paper.