Covid-19 Update
Lord Davies of Stamford Excerpts(4 years, 1 month ago)
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Lord Bethell
My noble friend is entirely right; it is a point well understood in Government. But he does slightly answer his own question, because our priority at this stage is to ensure that the medical and clinical response is right, and that the message gets across to the public about what they can and should do to protect themselves and delay the spread of this virus. I reassure him and the House that the economic impact of this virus is fully understood, and that there will be a full package of measures announced at a later date, once we have got this initial response out of the way.
Lord Davies of Stamford (Lab)
My Lords, the UK has withdrawn from the European Medicines Agency without putting anything in its place. This means that no new compound can be registered, licensed and made available for prescription in this country. The new compound might be an antiviral agent effective against coronavirus, or could equally be the vaccine which we are all waiting for. Can the Government tell the House, with urgency, what they are doing about this major gap in the provision of public health in this country?
Lord Bethell
I reassure the noble Lord that, as with the response to HIV some years ago, we will not allow any lacuna or gaps in the regulatory arrangements or any delays of the regulatory kind to stand in the way of our response to the virus.
Queen’s Speech
Lord Davies of Stamford Excerpts(4 years, 3 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, it is a great honour to open this debate on Her Majesty’s gracious Speech. I am delighted to be joined by my noble friend Lord Younger, who will, I know, brilliantly close what I am sure will be a constructive and lively debate. We will consider in detail the Government’s proposed approach to economic affairs, business and public services. The key theme linking all those areas is the overarching objective to invest in our future prosperity. Given that, I am sure that there will be unanimous support for that priority across the House, and I look forward to hearing your Lordships’ expert contributions on its implementation.
There is no question but that the gracious Speech sets out an ambitious agenda for reform. There might be some who will be tempted to give an opinion on that but I will not apologise for what is a challenging and bold approach and for a Government who are restless for opportunity and renewal. This is a Government who are re-energised, reinvigorated and refocused on the right priorities, with a driving purpose to deliver real change for British people up and down this country.
If we put aside for just one moment the small matter of Brexit, noble Lords will not be surprised to hear me say that there can be no higher priority than the NHS. It is therefore my pleasure to open this debate by updating the House on the Government’s plans for improving healthcare.
As noble Lords will no doubt be aware, we have already committed to increase NHS funding, amounting to an extra £33.9 billion in cash terms annually by 2023-24. This is the single largest commitment to the health service ever undertaken by a peacetime British Government. Furthermore, in the first 100 days of this Parliament, we will bring forward legislation to enshrine this multiyear funding settlement in law. This is the first time that a Government have delivered such a commitment in legislation and its purpose is to give unprecedented financial certainty and to allow the NHS to plan with security for years to come.
The NHS long-term plan has been drawn up by those who know the NHS best, so that we can guarantee that it is not just about money but about how we spend it effectively. It has been drawn up by health and care staff, and patients and their families, along with experts in their fields. It sets out an approach for making sure that this extra funding goes as far as possible, ensuring that every pound is invested in the things that matter most.
Supporting the NHS in delivering the long-term plan is a priority for the Government and we are carefully considering options for targeted legislation to enable this. These targeted changes will reduce bureaucracy and improve collaboration across the NHS, ensuring that it evolves to meet the challenges of prevention, integration and technology, and enabling local partners to work together to deliver a healthier nation where we can care for people throughout their lives.
A key part of this strategy is, as we have debated many times in this place, fixing our social care system, which is clearly under pressure and which, in turn, contributes to the unprecedented demand on the NHS. To meet this rising demand, we are already providing councils with access to an additional £1.5 billion for social care next year. This comprises an additional £1 billion of grant funding for both adults’ and children’s social care, and a proposed 2% to enable councils to access a further £500 million from 2020-21. Of course, this is not only about money. We are determined to find a long-term solution to meet the challenges in social care to ensure that every person is treated with dignity and offered the security that they deserve. Therefore, alongside the additional funding, we will seek to build cross-party consensus to bring forward the necessary legislation to implement social care reform. For the avoidance of doubt, we have pledged that these reforms will ensure that no one needing care will be forced to sell their home to pay for it.
Furthermore, the Government have promised to put mental health on an equal footing with physical health. As the Mental Health Act is nearly 40 years old, modernisation of this Act is critical. Therefore, we will publish a White Paper early this year, setting out the Government’s response to Simon Wessely’s independent review and our vision for wide-ranging reform. We will then bring forward a new mental health Bill to amend the Act. This work is important but it is also complex. Given our experience—in this place particularly—with the Mental Capacity Act, I think we can all agree that it is right that these long-term changes are made with care and consensus. Through these reforms, we hope and intend to empower patients and remove inequalities in our mental health system.
In my role as a Minister for Health, I have particular responsibility for promoting innovation across the industry. We all have reasons to be grateful for the medical innovations that have become available through the NHS over its 70-year history, from the first clinical trial into scurvy, to proton beam therapy and mass vaccination programmes. The Medicines and Medical Devices Bill will give us the necessary powers in UK law to update the current regulatory systems for human and veterinary medicines, clinical trials and medical devices. The Bill will enable us to cement our position as a world leader in the licensing and regulation of innovative medicines and medical devices after we leave the European Union, and will ensure that we have a regulatory system with robust standards and patient safety at its heart. The Bill is very much part of our agenda to modernise regulation, supporting early clinical trials and the production of personalised medicines but also the development of ever more sophisticated and safe medical devices.
I am proud to say that Britain is a nation of innovators, with many world-changing innovations and inventions pioneered here in the United Kingdom. The Government are committed to continuing to push the frontiers of science and technology via boosting R&D funding and developing proposals for a new, high-risk funding body to ensure that we remain at the forefront and competitive globally. We are equally ambitious in the scale of our commitment to the environment. We are the first country to legislate for long-term climate targets; we are world leaders in offshore wind and green finance; and there are now nearly 400,000 jobs in low-carbon industries and their supply chains. We will continue to lead the way in tackling climate change, encouraging new industries that will boost our productivity and growth as an early supplier of new, low-carbon technologies globally.
Our future, though, depends on the strength of our great cities. We have promised a White Paper on devolution, and I think all of us in this place agree that there is a powerful case for empowering every region and levelling up opportunity across every corner of this country. To unleash the potential across city centres in England, Scotland, Wales and Northern Ireland, we need to invest in the factors that contribute to economic growth: a strong labour market, education, land for housing, infrastructure and more.
Our labour market is in its strongest position in years, with a UK employment rate of over 76%, almost three-quarters of which is in full-time jobs, but we are committed to going even further. This Government are determined to make the United Kingdom the best place to work in the world. Through the employment rights Bill, we will continue to deliver on our pledge to bring about the greatest reform of workers’ rights in 20 years. The gracious Speech confirms the Chancellor’s promise that the national living wage will increase and that, provided economic conditions allow, it will reach two-thirds of median earnings within five years. Also, within five years, the Government plan to expand the reach of the national living wage to everyone aged 21 and over. Taken together, we expect these changes to benefit 4 million low-paid workers. As assured in our manifesto, the Government will also increase the national insurance threshold to £9,500 next year—a tax cut for 31 million people, with a typical employee paying around £100 less in 2020-21.
Record numbers of people are now working and saving for retirement, with 87% of employees saving into a workplace pension in 2018, an increase of 55% since 2012. This shows that people are preparing for their future but, even with this success, we know that we must do more. Everyone in this place has commented on this in my hearing. That is why the Pension Schemes Bill will put protection of people’s pensions at its heart and sets out the next phase of pensions reform, building on consensus across the pensions industry and the political spectrum. On a personal level, I also very much welcome the urgent review undertaken by the Department of Health and Social Care and HM Treasury into the annual allowance taper to fix the pensions system so that senior clinicians can take on extra shifts without the fear of an unexpected tax bill.
Our nation’s productivity is no more and no less than the combined talents and efforts of people up and down this country. Therefore, the next part of our plan to make Britain fit for the future is to improve the quality of our education system. Importantly, the OECD’s PISA results show that the UK already outperforms the OECD’s average for reading, maths and science, and that performance has recently improved significantly in maths. It is especially welcome that this has been driven by improvements for lower-attaining pupils. However, our work is far from finished. That is why we have announced a cash boost to schools of £2.6 billion next year, rising to an additional £7.1 billion in 2022-23. This means that per-pupil funding in every school will increase in cash terms, and it will rise higher than inflation in most schools. The settlement underlines our determination to recognise teaching as the high-value prestigious profession that it is. It ensures that pay can increase for all teachers, with teachers’ starting salaries increasing to £30,000 by 2022-23. That represents an increase of up to 25%. On further education, we have already introduced the first part of the national retraining scheme and we will invest an additional £3 billion in the National Skills Fund, which will build on existing reforms to ensure that British workers are equipped with the skills they need to thrive and prosper for a lifetime in work.
Key to ensuring a lifetime of prosperity, to recruitment and to raising the productivity of our country is building more homes and creating a fairer property market. We know that this is true. In the last year, therefore, we have delivered over 241,000 additional homes. That is the highest level in over 30 years. During this Parliament, we will implement measures to encourage shared ownership, help local families on to the housing ladder and speed up the build of affordable housing. This Government are working to deliver a rental system fit for the future, which is why we are introducing the Renters’ Reform Bill to protect tenants and support landlords to provide the good-quality homes that we know this nation needs. It is also necessary that we undertake urgent action to respond to Dame Judith Hackett’s independent review of building regulations and fire safety. Working together to learn the lessons of Grenfell, we will bring forward a building safety Bill and a fire safety Bill as soon as possible. I know that the House understands the urgency of those steps.
Turning to transport, Her Majesty’s gracious Speech contained a series of measures to tackle urban congestion and transport links—it is no good trying to boost productivity if people cannot get to work on time—both here in the UK and with trading partners around the world. Our ageing airspace system has not been updated since the 1960s, so the Air Traffic Management and Unmanned Aircraft Bill will bring forward measures to modernise airspace, making flights faster, cleaner and quieter and giving the police greater enforcement powers to effectively tackle the unlawful use of unmanned aircrafts, including drones.
Earlier this year we successfully brought home 150,000 Thomas Cook passengers stranded overseas in the largest ever peacetime repatriation. But that operation was complex and costly, so we will bring forward a number of reforms to deal with airline insolvency that will provide oversight of airlines in financial trouble and help passengers to return home speedily and efficiently. Furthermore, we are determined to protect passengers from the misery of transport strikes, so we have announced plans to keep a minimum number of services running during transport strikes, ensuring that unions can no longer hold the travelling public to ransom. We will also implement widespread reform to the rail industry, following the Williams review, to improve performance and reliability, simplify fares and ticketing and introduce a stronger railway commercial model.
This Government are steadfastly committed to a path of budget responsibility in the context of what I have outlined as an ambitious reform agenda. Our economic plan will be underpinned by a responsible fiscal strategy, investing in public services and infrastructure while keeping borrowing and debt under control. As a country we are in a strong position, not by accident but by design. The International Monetary Fund forecasts that this year the UK economy will grow faster than those of France, Germany, Italy and Japan. The deficit has reduced by four-fifths since 2009-10. We have seen the economy grow every year since 2010. There are 3.7 million more people in work now than there were in 2010, and the proportion of low-paid jobs is at its lowest in 20 years.
All this is good news that I am sure will be welcomed by every Member of this House, and thanks to this we can now invest more in growing our economy and public services. That is why this Government are proposing a step change in infrastructure investment to deliver sustainable and inclusive growth. We will implement an infrastructure revolution, helping to ensure that productivity and opportunity are spread to every part of this country. That is why the gracious Speech has confirmed plans to publish a national infrastructure strategy, which will act as a blueprint for the future of infrastructure investment across the whole of the United Kingdom. It will examine how, through infrastructure investment, we can address that most critical and pressing of challenges—decarbonisation—and set out plans to turbocharge gigabit-capable broadband rollout and improve energy and transport infrastructure.
In closing, it is my fervent belief that Her Majesty’s gracious Speech affirms our commitment to invest in an ambitious agenda and level up opportunity and quality of life in every corner of the United Kingdom. We will invest to reform education to deliver social mobility. We will invest to build homes, infrastructure and economic opportunity to help raise living standards. We will invest in our NHS to make it the most sustainable and high-quality healthcare system in the world. I know that as legislation comes forward there will be expert and challenging debates in this place in which the collective wisdom and experience of the House will be called on to the full. I also know that in this place we share a common commitment to a fairer, more innovative and prosperous Britain. I look forward to delivering on that with each and every Member in this Chamber.
Lord Davies of Stamford (Lab)
My Lords, before the noble Baroness sits down, following her remarks on the NHS, can she tell the House whether the Government propose to leave the European Medicines Agency? If so, will pharmaceutical companies registering a new compound, having gone through the procedure with the European Medicines Agency, have to replicate the process and cost by going through the same procedures here? Or will the Government accept the EMA’s registration, even though we no longer have any influence over the management, policies or strategy of the agency?
Baroness Blackwood of North Oxford
I apologise, but I think the noble Lord slightly missed his moment and I had sat down. However, I know my noble friend Lord Younger will respond in his closing remarks.
Lord Davies of Stamford
My Lords, the health service is obviously in crisis at the present time. The number of doctors and nurses is 10% below establishment. People are waiting more than two or three weeks to see their GP, which negates the very concept of general practice. Waiting times are increasing across the piece, and it now seems that the last Labour Government’s achievement in getting maximum waiting times down to 18 weeks is a long-distant memory.
When an organisation is in a crisis of this kind, I have always believed that the first thing to do is to decide whether what you are dealing with is temporary or perhaps contingent and is susceptible to solution by simple measures of some kind, including possibly throwing a lot of money at it or whether it is a problem of a longer-term, structural nature, in which case you may have to rethink the way things have been done or even the existence of long-standing and much loved institutions. I fear that the present situation of the NHS falls into the second category.
There are four fundamental contradictions at the heart of the NHS. First, every time any normal organisation that produces goods or services for the public delivers a service or increases its turnover, it gets more money. In the case of the NHS, it is the other way around: every time it delivers a service, it has less money, so we start off with a major conflict of interest—a major, perverse incentive—and what we have is in fact a rationing system rather than a health service. The second and fairly obvious contradiction is this: we all know that the cost of medicine is increasing fast because of medical technology improvements, better pharmaceuticals and so forth, and that morbidity rises with longevity. The population is living longer, so we need to have health expenditure at a rate which keeps up with those two pressures. In fact, we have it constrained within public expenditure, which fiscal policy requires should be kept down as a proportion of GDP, otherwise we will never repay any of our debts. That is a very serious contradiction.
Another contradiction is that as people get richer, they naturally want to spend more money, not less, on healthcare, just as they want to spend more money on financial services or tourism and less of their income on potatoes or bread. That is known in technical terms as income elasticity of demand for healthcare services, and is considerably more than unity. We are artificially frustrating and holding back people desire to spend more money on healthcare by channelling all the expenditure through the health service and the public expenditure system, as we do at present. That is not a sensible thing to be doing for the country.
Finally, there seem to be a lot of perverse incentives in the system but very few genuine, positive incentives. I believe that you could get considerable increases in productivity and output in the primary sector—in general practice—by remunerating doctors on a fee-per-service basis. I suggest that anybody who does not like that revolutionary suggestion spends a few hours of their time going into a general practice, declaring symptoms which obviously need medical attention and noting down how long it takes to see the doctor and what sort of reception one gets anyway by going into that surgery. Then they should get hold of a dog, go to the nearest vet and compare the reception they get there and the time they wait for it to be treated. That would be an instructive experiment; I have done it myself.
One could develop many other ideas if one had time. There are various mechanisms through which we could fund healthcare outside the public expenditure system. It is done very effectively on the continent—in France, Germany, the Netherlands and so forth—by health funds. There are something like 1,200 Krankenkassen in Germany; in France there is one large organisation, the Sécurité sociale. Of course, the continentals have 70 years’ experience of a system which is universal and compulsory. It covers everybody, as the health system does in this country, and at the same time, it has considerable popular support in those countries. I have to say that the health outcomes in those countries are considerably better in survival rates for cancer, cardiac victims, stroke victims and so forth.
It is time to look around at ideas of that sort, particularly ideas which have been tested and de-risked over time. We need to be brave enough to go in for some original thinking here. We owe it to future generations to make sure we do not have a health service that goes from one crisis to another, and simply repeats history indefinitely. That would not at all be a responsible attitude for our generation to have towards this priceless asset, which looks after the health of the nation.
Food and Feed Hygiene and Safety (Miscellaneous Amendments) (EU Exit) Regulations 2019
Lord Davies of Stamford Excerpts(4 years, 10 months ago)
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Baroness Blackwood of North Oxford
I thank the noble Baronesses for their important questions. We have been through a number of periods of scrutiny on FSA SIs between us, so I feel that we are old hands at this.
The noble Baronesses will know that leaving the EU does not change the FSA’s top priority, which is to ensure that UK food remains safe and is what it says it is. We are working hard with the FSA to ensure that the high standard of food and feed safety and consumer protection we enjoy in this country is maintained when the UK leaves the European Union. That is one of the reasons for this SI.
The noble Baroness is right to identify that this is one of the ways that we are keeping up to date with EU changes in legislation while we remain part of the European Union, but of course once we have left we will be responsible for identifying how we want to proceed and whether we want to introduce our own legislation and additional food safety standards which mirror those in the EU or whether we want to go further. That is a commitment—excuse me, I am having a Theresa May moment—that has been made before.
I shall touch first on the issue raised by the noble Baroness, Lady Thornton, at the end of her remarks about trade. I want to nail that one if I can. We have debated this before. The UK is committed to maintaining the high standards of food and feed safety which we currently enjoy. I shall repeat a line which has been used by No. 10. We have always been clear that we will not lower our food standards as part of a future trade agreement. From day one, we are committed to having a robust and effective regulatory regime in place which will mean that business can continue as normal. For most food and feed businesses there will be no change in how they are regulated and how they manage. Leaving the EU does not affect that, regardless of comments that may have been made this week.
Lord Davies of Stamford (Lab)
Can we be clear that that very important undertaking she has just given the House also applies to animal welfare standards in the European Union and currently in this country?
Baroness Blackwood of North Oxford
That is obviously not my brief, but I know that those commitments have been made from this Dispatch Box and I am very happy to give the noble Lord that commitment.
I shall move on to the important questions that were raised regarding trichinella resources. We have brought in these amendments today because we recognise the importance of maintaining standards when it comes to trichinella testing. The Food Standards Agency’s spend on trichinella testing in financial year 2018-19 was £565,000, of which £275,000 was recovered through charges for official controls. The figure includes the cost of taking samples and of the UK’s trichinella national reference laboratory. The figure is approximate and is a proportion of the total cost of official controls applied across the food industry. The UK will maintain the requirements of EU food safety legislation after leaving and will not only maintain the standards applicable to most domestic and imported food but will also ensure that UK food businesses can continue to apply controls that are widely accepted by other countries. The FSA has made a commitment that it will ensure that there are the resources required to maintain those standards and the level of testing for trichinella control after exit.
I know that I have given these statistics to the noble Baroness before, but I can reassure her once again that an extra £14 million was provided to the FSA for 2018 in order to ensure extra funding and capacity for EU exit and an extra £16 million was provided for 2019-20. This has translated into an extra 140 staff who have been recruited. More than 90% of them are already in place. That is supported by an expanded role for the independent scientific advisory committees on food. It covers risk assessment, for which the FSA has an outstanding international reputation. It was strengthened by recruiting new experts, establishing three new expert groups and expanding its access to scientific experts, who can provide scientific advice, and to other scientific services in order to meet the potential need for increased risk assessments in future. This is part of the wider priority of the FSA to ensure that it can maintain its current commitments to promoting robust food standards nationally and internationally, protect consumer interests and facilitate international trade and ensure that consumers can have confidence in the food that they buy—to know that the food is what it says it is. I hope that reassures the noble Baroness on that point.
The noble Baroness asked about official controls charges for fishery products. This was also raised by the noble Baroness, Lady Walmsley. She is absolutely right regarding the exchange rate, and that is why we are updating the provisions for these charges so that they are in line with the more sensitive DExEU and HMT guidance on amending outstanding references to euros. The instrument does two things. First, it adjusts for the fact that in the future European Union member states will become third countries for the purposes of these charges. Therefore, we can no longer offer the European Union differential treatment in terms of costs levied for hygiene controls performed on directly landed consignments of fishery products. Secondly, as I have said, it addresses the references to euros. The Government do not anticipate any increase in the extent to which these charges are levied by local authorities in England after the UK exits the EU. It is currently reported to be a very low rate. As such, we believe that food business operators in England are not expected to face any extra costs. We will expect local authorities to keep it under review, but we anticipate that it will remain low. I hope that reassures the noble Baronesses.
I hope that I answered the questions from the noble Baroness, Lady Walmsley, about the way in which risk assessment is done in my earlier answer about the increasing staffing that has become available through the increased investment in the FSA to prepare for EU exit and strengthen its risk assessment capability. On her question about how decisions are made, obviously there will be some ministerial involvement but it is important to say that maintaining the UK’s high food standards is a top priority for the Government. Part of that is to continue the long-standing commitment to openness and transparency and evidence-based decision-making from the FSA. Food safety authorities will publish the advice they provide to Ministers as well as the evidence and analysis it is based on so that stakeholders can see the basis on which decisions are made. I hope that that reassures the noble Baroness.
On the final point about devolved Administrations, raised by the noble Baroness, Lady Thornton, Scotland, Wales and Northern Ireland have provided their consent to these instruments. They have been closely involved in the development of them. The principles and rules that are set out in retained legislation and which these SIs will correct are intended to ensure the same level of food and feed safety and protection throughout the UK and the free flow of trade within it and—exactly as she said—to ensure clear lines of communication, engagement and co-operation between all four nations so we can, as has been said, pick up on any risks throughout the four nations. The FSA has a very close working relationship with the Administrations of Scotland, Wales and Northern Ireland, and we are confident that, in practice, it will be possible to make arrangements to operate a framework for food and feed safety and regulation across all four Administrations.
In conclusion, I thank noble Lords for their contributions to this debate and ask for their support.
Long-term Plan for the NHS
Lord Davies of Stamford Excerpts(5 years, 10 months ago)
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Lord O'Shaughnessy
I should not like to put any words in the mouth of my right honourable friend the Chancellor. What I do know, as was evident yesterday, is that he has committed to deliver the finances required to fulfil the plan that the NHS puts forward. Clearly, as my noble friend points out, there are a number of ways that we can do that. Polling suggests that some forms of taxation are more popular than others, and we know that technical challenges are associated with hypothecation. As I said, this is a very important and valuable conversation in which this House has a leading role to play in making sure that we get the right outcome.
Lord Davies of Stamford (Lab)
My Lords, this otherwise very welcome announcement was accompanied by quite misleading and—I hope the noble Lord will agree—deplorable PR spin about a Brexit dividend. Does he accept that the OBR, which provides the government economic statistics, has said that there is no such thing as a Brexit dividend? There is a Brexit penalty, because the reduction in tax revenue as a result of lower economic activity than would otherwise have taken place is significantly greater than the saving of our net contribution to the Union. Is it not the case that, in trying to pretend that there is a dividend, the Government have actually tried to mislead the public, and is that not something that, on reflection, the noble Lord would agree is most unfortunate?
Lord O'Shaughnessy
I would not agree with that because it is clearly the case that once we have left the European Union we will not be paying for membership of it—and it is those funds which will, in part, go towards helping us solve the funding challenge that we have set ourselves for the NHS.
Health and Social Care
Lord Davies of Stamford Excerpts(6 years, 6 months ago)
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Lord Davies of Stamford (Lab)
I shall give the Minister another chance. He did not even begin to answer the question from my noble friend Lord Hunt. Why did the Government drop Dilnot?
The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)
My Lords, we will hear from the noble Baroness, Lady Brinton.
Lord O'Shaughnessy
The noble Baroness will know that there has been a small reduction in the total number of residential nursing home beds, although it is a fairly flat picture over a long period of time. We have also seen an increase in the amount of domiciliary care. One of the things we need to get to the bottom of, and this is what the consultation will look at, is the imbalances that exist between the funding regimes for residential and domiciliary care. We have to get to the bottom of it, because it creates an imbalance on the provider side as well, so that we can have proper funding for the kind of care that people need regardless of whether it is in a residential nursing setting or at home.
Lord Davies of Stamford
Could I perhaps try again? I would like to give the Minister a chance to answer the very important question from the Lord, Lord Hunt, which he completely ignored. Why did the Government drop Dilnot?
Lord O'Shaughnessy
The Government have not dropped Dilnot. We will be consulting on both the cap and the floor in the proposals that come forward on social care funding, which build on the Dilnot proposals.
National Health Service: Nurses
Lord Davies of Stamford Excerpts(7 years, 2 months ago)
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Lord Davies of Stamford (Lab)
How many nurses currently employed in the NHS are citizens of other EU countries?
Lord O'Shaughnessy
I thank the noble Baroness for making that point. The issue of retirement ages has come up previously in Questions, and I had a look at the profiling of nursing. It similar to the profiling of other healthcare professions and other public sector professions, so there is a weighting towards older age groups, but it is not an acute problem particular to nursing. The noble Baroness is quite right that there have been reductions in the number of district nurses, but there have also been increases in other kinds of nurses, particularly health visitors offering community services. There is some overlap in the kind of services they provide.
Lord Davies of Stamford
The Minister tried to answer my question in terms of percentages, but it would be nice to have the absolute number of members of the nursing profession currently in the NHS who are citizens of other EU countries. What measures are the Government taking to reassure these nurses that their contribution is strongly valued and that we want them to remain doing the excellent job they are now doing for the health of this country?
Lord O'Shaughnessy
In answer to the noble Lord’s first question, I think the figure is 22,227 EU nationals, so I hope that satisfies him on that point. Of course, they do a fantastic job, as do all NHS and care staff, and they deserve the highest praise. The noble Lord will also know that we are keen to reassure them of their status as part of the EU negotiations, but, of necessity, that has to be a reciprocal arrangement.
Junior Doctors: Industrial Action
Lord Davies of Stamford Excerpts(7 years, 7 months ago)
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Lord Prior of Brampton
My Lords, the noble Lord makes a number of extremely good points. I am not aware of that 14% decline in applications to medical school. If that is true, it is clearly very serious. I did hear a rumour that one medical school had to use clearing to fill the number of students coming in, but overall there is still a huge demand for people who want to go to medical school and they are still recruiting people with the best academic and other qualifications. On the noble Lord’s fundamental point, we have to rebuild trust in the medical profession. It was for that reason, in the main, that the Secretary of State asked Health Education England to lead the discussions on non-contractual issues, rather than being involved with it directly himself. I am sure that is the right way to approach this issue.
Lord Davies of Stamford (Lab)
My Lords, during the previous Statement the Government were at great pains to emphasise that they are totally committed to implementing all the promises made by the Brexit campaign to the British people during the referendum. We now hear reports that the very prominent promise made to the British people during that campaign to give the NHS another £350 million a week will not be fulfilled. Why have the Government decided to renege on that particular promise?
Lord Prior of Brampton
I am not sure the Government ever made that promise. That was a promise made by the Brexit campaign. The Government have committed to putting an extra £10 billion into the NHS over the course of the Parliament, but they are certainly not in any way committed to fulfilling promises or pledges made by the Brexit campaign.
Access to Palliative Care Bill [HL]
Lord Davies of Stamford Excerpts(8 years, 6 months ago)
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Lord Davies of Stamford (Lab)
My Lords, the Bill is an excellent initiative, and I congratulate the noble Baroness, Lady Finlay, on bringing it forward. I cannot imagine that anyone would object to the substantive provisions of the Bill. Some people might think that it is too prescriptive, that it overrides local initiative and clinical commissioning groups and forces everyone into the same Procrustean bed, but there will always be a trade-off between having some local autonomy in the health service and having a national health service and avoiding a postcode lottery. If we have to err—and one does always have to err in human affairs—we should err more on the side of having a national service, because that is both what the public expect and what the consensus in this country has believed that we have, ever since the 1946 Act and the 1944 White Paper.
One of the great problems of the NHS is the complete lack of external accountability. It is a platonic system in which the experts—or supposed experts; mostly they are no doubt genuine experts—provide for the public as a whole, the hoi polloi, what they think the public need. There is no accountability and no way in which to second-guess that. In the private sector you can of course shop around and go elsewhere, but in the public sector—in the NHS—that does not work. The experiment with GP commissioning, allowing GPs supposedly to commission secondary healthcare all over the country, never worked. We do not even have the indirect democratic accountability that we now have with the police service, with elected police commissioners setting out what should be the strategy and priorities in their own area. In those circumstances, Parliament has a very important role, and an initiative like today’s Bill is a very good idea, because we are at least accountable to the public in Parliament and it is important to make sure that we set down the sort of standards and norms that the public are entitled to believe will be applied in the health service.
There is one thing that I believe should be in the Bill—and if the Bill goes forward to its next stage, as I profoundly hope that it does, I might venture an amendment of my own along these lines—which is that in this matter of palliative care, above all, the patient must be sovereign. There must be an absolute obligation or condition, so long as the patient is conscious, to explain fully the facts of the patient’s diagnosis and prognosis and the implications of any change in treatment or proposed change in treatment, and implications of any change in venue. For example, being downgraded from an intensive care bed to a general ward or acute bed will reduce considerably the chances of a successful resuscitation, if it is to be attempted. If a patient leaves a general hospital—I totally agree with the argument put forward in favour of often doing this and in favour of a hospice in the last moments of a patient’s life—the patient will be in a facility that probably does not have certain means of life support such as dialysis or ventilation. Indeed, I once asked staff in a hospice whether it had drips for providing intravenous hydration and nutrition to their patients. They looked at me rather strangely and said that they had them but they rarely used them. The implications were fairly obvious.
If I am ever in a hospice, I shall be absolutely terrified every time I receive an injection. I shall wonder whether it is the last one and it is the moment when I am going into palliative sedation, as it is euphemistically called—I tend to call it a palliative coma—from which I shall never awake. I want to be in charge and I want to know what is going on, and so long as I have breath in my body and a mind that is working I want to be able to conduct a dialogue with my clinicians. Above all, I want to be able to choose. If a patient wishes to choose to have the full apparatus of medical science apply to maximising his or her longevity, the patient should be entitled to that. If he or she wants to choose palliative sedation along the lines of the Liverpool or some other pathway, he or she should be entitled to that. If he or she wants to choose the exact moment, timing and method of his or her death, with all the legal safeguards set out in the late and much lamented Bill of my noble and learned friend Lord Falconer, in my view he or she should have that—and that is a matter that remains open, to which Parliament must return. I hope that it will, in the next Parliament.
Lord Prior of Brampton
My noble friend makes a good point. There is tension in the health service between local autonomy, local accountability and the National Health Service. There has always been this tension. We believe that in driving up standards it is best to have the local autonomy. However we must also have transparency so that we know who is falling behind and who is forging ahead. As to transparency at a clinical level, I was talking to a former president of the Royal College of General Practitioners recently—she comes from a different political background from myself—and she said that within the DNA of all doctors is a huge sense of competition: they want to deliver better care than the next-door doctor. That is true of surgeons probably more than anyone, but also true of GPs, physicians and hospitals, and increasingly it will be true of CCGs as well. My response to my noble friend is that we are embedding a much higher degree of transparency into the system and it is through that transparency that we will drive improvement by highlighting the best and the worst.
Lord Davies of Stamford
On the matter of transparency, does the Minister agree with my point that it is important that the commission should be transparent vis-à-vis the patient and that there should be a policy of full disclosure to the patient of the diagnosis, prognosis and any implications involved or deriving from changes in treatment or changes of venue from, for example, hospital to hospice or otherwise?
Lord Prior of Brampton
I accept and agree with that. One should not underestimate that even sophisticated, well-informed people put huge trust in their clinicians. How many of us, confronted with a difficult diagnosis, say, “What would you do?”. That is the question that most people put to their doctors. Of course individual choice is extremely important, but the role of the clinicians and the trust that we as patients put into them should not be underestimated.
In conclusion, let me reiterate how much we support the underlying intent of the Bill but that we do not believe that legislation is the right way to address the problems that the noble Baroness has outlined.
NHS: Five Year Forward View
Lord Davies of Stamford Excerpts(9 years, 4 months ago)
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Earl Howe
My Lords, my noble friend, as ever, has rightly identified the likelihood of greater and greater demands on our health service over the coming years. Certainly, building a non-partisan consensus is something to be desired regarding the way that we fund our health service. Having said that, I can tell my noble friend that there has been no thinking whatever on the part of Ministers to depart from the current model of funding for the NHS. We believe passionately that the NHS should be free at the point of use, regardless of ability to pay. That is one of the core principles on which the NHS has been founded since 1948 and it is paid for out of general taxation. While I take on board my noble friend’s desire to look afresh at this area, I think that we have some way to go before cross-party talks need to take place. We are clear that we can proceed on the current basis.
Lord Davies of Stamford (Lab)
The noble Earl has always taken a very serious attitude towards his ministerial responsibilities and he has just spoken about the desirability of moving to an all-party consensus on health matters. Does he not therefore rather regret, in retrospect, that the Government decided to spin this announcement, leaking it in advance of the Statement in the House of Commons and putting it about that there was £2 billion of new money for the NHS—the implication being that this was the result of more buoyant government revenues because of a higher growth rate? In fact, it is nothing of the kind as the noble Earl has now revealed to the House. It is roughly £1 billion being reallocated within the NHS budget and £1 billion being reallocated from other department budgets, including from defence where there has been underspend, which is very damaging to this country’s interest. Would it not have been better, and easier to develop a consensus in this country—to which the noble Earl quite rightly looks forward—if in fact the Government were slightly more straightforward and candid with the public over announcements of this kind?
Earl Howe
I do not think one can develop a consensus prior to a government Statement—that is probably wishing for the moon. The charge that the noble Lord levels against the Government is also, if I may say so, misplaced. We have never pretended that all the money being announced today is new money. I do not seek to suggest that, as I have already explained. As regards the timing, I think it is standard practice for key elements of the Autumn Statement to be trailed ahead of the formal announcement. However my right honourable friend the Chancellor will confirm everything we have said today in the Autumn Statement on Wednesday, and that is as it should be.
G8 Summit on Dementia
Lord Davies of Stamford Excerpts(10 years, 4 months ago)
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Lord Walton of Detchant
Does the Minister accept that much of the increased incidence of dementia is a result of the fact that many of us are living much longer than was the case in the past? Does he further agree that there is clear research evidence to suggest that continuing intellectual and physical activity, care and attention to diet, and control of blood pressure can delay the onset of dementia in many individuals, and that, as a consequence, once early dementia appears, programmes to promote such physical and intellectual activity are very valuable? In such programmes, volunteers play a very important part across the country. What are the Government doing to promote these projects?