Support for Infants and Parents etc (Information) Bill [HL]

Lord Evans of Rainow Excerpts

2nd reading
Friday 6th September 2024 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, I begin by congratulating my noble friend Lord Farmer on securing time for his Private Member’s Bill. I also pay tribute to his work over many years on family policy, preventing family breakdown, and on the welfare of children, and especially to his work on creating and growing the family hubs network, supported by Dr Samantha Callan. I also pay tribute to my right honourable friend Dame Andrea Leadsom, who has worked tirelessly on this subject. There is no doubt that my noble friend’s passion and commitment are behind the Bill today, and his belief, shared by many noble Lords, that we need to give all newborn babies the best possible start in life, no matter what their background.

The importance of the Start for Life approach cannot be underestimated. It ensures that there are welcoming family hubs, usually run by local authorities, through which new parents of newborns can access a wide range of family support services such as parenting support, help for relationships between new parents and between parents and new babies, health visitors, breastfeeding and other infant feeding services and mental health services. These services are provided by local authorities, the voluntary sector and private sector partners.

My noble friend Lord Farmer has highlighted how local authorities that receive Start for Life funding are required to publish their offer. Indeed, it is one of the conditions for local authorities receiving transformation fund money. The Bill is in some ways simple in its aim, which is to ensure that they contribute to offer Start for Life beyond the end of that fund. Of course, this will require additional funding, but in the context of some of the larger sums of billions that we debate in this Chamber, we are speaking about only £500,000 per annum across England. As with any taxpayer spending, my noble friend Lord Farmer proposes that there should be a proper procedure in the Commons to make this relatively small sum available.

It may be argued by some noble Lords that, with £500,000 here and another £500,000 there, pretty soon we are talking serious money. However, against this we need to consider the cost of family breakdown in the UK. Aside from the emotional, social, mental health and societal costs of family breakdown, the Centre for Social Justice think tank estimates that the cost to the Government and ultimately the UK taxpayer is at least £51 billion a year.

In terms of societal costs, the Centre for Social Justice also found that those who experience family breakdown when aged 18 or younger are more than twice as likely to experience homelessness, twice as likely to be in trouble with the police or spend time in prison, almost twice as likely to experience educational underachievement, and almost twice as likely when they themselves become parents to break up with the other parent of their children. They are also more likely to experience alcoholism or teenage pregnancy, suffer from mental health issues, fall into debt or experience being on benefits.

Much has been said by my noble friend Lord Farmer and noble Lords on all Benches about the importance of support for newborns and their families to give our nation’s children the very best start in life. My noble friend has committed his political life to founding and growing the network of family hubs to help parents and children of all backgrounds, and for this reason, I commend him for his equally noble work in this area.

Some noble Lords may say that we should leave this to the decisions of integrated care boards and partnerships or health and well-being boards. However, giving the best start in life to children involves far more than just being health focused. From speaking to my noble friend Lord Farmer, I understand that he believes that it is important to keep Start for Life as integrated as it currently is, with a wider remit than just health.

In preparing for this debate, my noble friend Lord Kamall contacted the office of the Minister, asking for an indication of whether the Government are inclined to support the Bill. The Government were not able to tell him whether they will do so. However, that fateful—but we hope not fatal—day for my noble friend Lord Farmer’s Bill has now arrived.

I have a few questions for the Minister. Do the Government intend to support or reject my noble friend Lord Farmer’s Bill? If the Government are not minded to support it, where do they disagree with it? If the Government are not supportive, are they considering introducing their own Bill for Start for Life? If so, what timeframe can we expect for such a government Bill, and in the meantime what will happen to the funding for the Start for Life programme?

My noble friend Lord Farmer has devoted his life to family hubs. He has made a compelling case for the Start for Life programme. I am sure that he and other noble Lords, including the Opposition Front Bench, are looking forward to the Minister’s answers to these questions.

Vaginal Mesh Implants: Compensation

Lord Evans of Rainow Excerpts

Thursday 5th September 2024 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, this has been an excellent debate. I thank my noble friends Lady Sugg, Lady Berridge and Lady Wyld, the noble Baronesses, Lady Bennett and Lady Brinton, and my noble friend Lord Mancroft, who all made very powerful points in their speeches. I congratulate my noble friend Lady Cumberlege on securing this important debate. I pay tribute to her work on this issue over many years and her leadership on the First Do No Harm report of the Independent Medicines and Medical Devices Safety Review, as well as to her team of Sir Cyril Chantler, Simon Whale and Dr Valerie Brasse, and the patient groups.

Simply put, victims have suffered as a result of two medications and one medical device. The medications are: hormone pregnancy tests such as Primodos, which were later withdrawn due to concerns over birth defects and miscarriages; and sodium valproate, the anti-epileptic drug which was later found to cause physical malformations, autism and developmental delay in children after being taken by pregnant mothers. The medical device is the pelvic mesh implants which were used to repair pelvic organ prolapse and address urinary incontinence. Their use has been linked to crippling, life-changing complications.

My noble friend Lord Kamall tells me that when he was a Minister in the department he was horrified that progress for helping the poor women who had suffered from these two medications and one medical device was far too slow. Fortunately, the then Minister, Maria Caulfield, asked the Patient Safety Commissioner to explain what the Government should do to meet the needs of individual patients who had suffered these avoidable harms.

In government, we completed four of the initial recommendations in the report of my noble friend Lady Cumberlege, and another three were in progress in March 2024. The most important of these is the setting up of nine specialist centres which can provide the support needed in terms not just of redress surgically or treatment-wise but of the support that people need to help them cope with the issues. We expect the Government to deliver financial compensation for those affected by these treatments as soon as possible.

My noble friend Lady Cumberlege has said that after “first do no harm” should come

“and now do some good”.

As other noble Lords have referenced, the Patient Safety Commissioner’s report, published earlier this year, states that

“there is a clear case for redress based on the systemic healthcare and regulatory failures”

for women and children affected by the issues in England.

There is agreement across this House that Governments of all political colours have been too slow in delivering justice and financial compensation to victims of scandals in the past. We need mention only the Post Office Horizon scandal to remind ourselves of the importance of delivering justice to those who have been wronged. When these problems come to light, it is essential that we help the victims of these scandals as quickly as possible. Too many people suffered over the Horizon scandal and too many people and families suffered due to delays in helping victims of the infected blood scandal. Likewise, too many women, children and families have suffered as a result of women being prescribed Primodos, sodium valproate and pelvic mesh implants. The Government must act urgently to help those women who have suffered, so will the Minister give an undertaking today to make this a priority?

On 23 July, my noble friend Lord Kamall submitted a Written Question to the Minister asking when the Government intend to respond to the Hughes report and when they anticipate making the first payments under the recommended redress scheme. I thank the Minister for replying within three days, saying:

“The Government is considering the recommendations of The Hughes Report, and to prevent future harm, the Medicines and Healthcare products Regulatory Agency, NHS England, and others have taken action to strengthen oversight of valproate prescribing and mesh procedures”.


My noble friend Lord Kamall followed up on 29 July to ask the Government

“by which date they expect to issue a response to the Hughes Report, and whether they plan to offer compensation as the report recommends”.

Again, the Minister responded promptly with the Answer:

“The government is carefully considering the valuable work done by the Hughes Report and will respond in due course”.


We recognise that the Government are relatively new and need time to get up to speed, but can the Minister be more specific at this stage in answering the timescale question?

My noble friend Lord Kamall tells me that when he was a Minister there were two phrases in briefings that he was not fond of. One was “at pace” and the other was “in due course”. Can the Minister give noble Lords an approximate timescale for a decision—for example, by the end of 2024, mid-2025 or indeed the end of 2025? If not, can she enlighten noble Lords on when she will be able to give an estimate of the date by which she will know the date of the Government’s response? It is vital that they give some certainty to noble Lords—and, more importantly, to the many women and children who have suffered for far too long physically, mentally and economically. I know that the noble Baroness is a formidable operator as a Minister and, to speak personally, she has our full support on this side of the House.

Palliative and End-of-life Care: Funding

Lord Evans of Rainow Excerpts

Wednesday 4th September 2024 Lords Chamber

[Baroness Merron (Lab)]

As the noble Baroness said, in 2024-25 the £25 million in funding from NHS England was distributed, for the first time, via integrated care boards. As I understand it from the previous Government, that was in line with NHS devolution. We will carefully consider the next steps on palliative and end-of-life care funding much more widely in the coming months and will take on board the comments of the noble Baroness and other noble Lords.

[Lord Evans of Rainow (Con)]

My Lords, everyone should be able to access quality palliative and end-of-life care and patient care in their local area. Under the Conservatives, we made integrated care boards legally responsible for commissioning palliative care services to meet the needs of the local population. What assessment has the Minister made of access to palliative and end-of-life care across the country? What steps will the Government take to ensure that everyone, especially those living in rural areas, can access quality end-of-life care?

[Baroness Merron (Lab)]

As the noble Lord will be aware, statutory guidance and service specifications are provided to support commissioners in ICBs to meet their duty. As I am sure the noble Lord is also aware, NHS England has developed a palliative and end-of-life care dashboard that brings all the relevant local data together and helps commissioners to understand the situation so that they can provide for their local populations. This is part of ongoing work for this new Government to see how we meet requirements to provide dignity, compassion and service at the end of life and just prior to the end of life.

Covid-19 Inquiry

Lord Evans of Rainow Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, I reflect today on the first report from the Covid-19 Inquiry—a report that is not only sobering but necessary. It marks a vital step in understanding the full impact of the pandemic on the United Kingdom and learning the lessons necessary for future crises.

I begin by expressing my gratitude to the noble and learned Baroness, Lady Hallett, and her team for their diligent and comprehensive work. The evidence presented in this report, especially from those who have suffered loss and trauma, is invaluable. Their testimonies are vital in shaping our understanding of the pandemic’s impact and informing our future strategies. The report highlights the shortcomings in our pandemic preparedness and response. These failures transcended party lines; they are failures in planning, leadership, resourcing and the ability to adapt swiftly to an unprecedented situation. We must confront these failures openly and honestly, not to cast blame but to ensure that we are better equipped to protect our citizens in the future.

Preparedness is not the responsibility of any single Government or institution. It is a shared duty that extends beyond political lines and encompasses all levels of government, public institutions and international bodies. The role of the World Health Organization and Public Health England in this pandemic must be scrutinised. Were we adequately prepared to rely on their guidance? Were these organisations equipped to offer the necessary support and leadership? It is clear from the report that the advice and recommendations from these bodies was not always as robust or adaptable as the rapidly changing situation demanded. For example, Public Health England was equipped to manage only a limited number of cases, not the extensive testing and contact tracing needed for a pandemic the scale of Covid-19. Similarly, the report cites several instances where the World Health Organization’s advice either was delayed or failed to reflect the developing reality, such as its initial denial of human-to-human transmission, the delayed declaration of a global emergency and its resistance to implementing travel restrictions.

The report also highlights a critical flaw in our previous focus on pandemic preparedness, which was largely centred on influenza, as evidenced by the Exercise Cygnus framework. While this focus was, reasonably, based on the information available at the time, the Covid-19 pandemic has emphasised the need for a broader, all-hazard approach to pandemic planning that is flexible and can adapt swiftly to unforeseen challenges. We must avoid being unprepared in the future due to an overreliance on outdated models or narrow perspectives.

Given these findings, I propose several questions to the Government. What measures are being taken to ensure that our emergency planning structures are more cohesive and comprehensive, integrating the insights and needs of devolved Administrations and local government bodies? Our response must be unified, yet flexible enough to address regional and local circumstances.

Furthermore, how do the Government intend to improve co-ordination across all levels of government and civil society? The pandemic illustrated the importance of a collaborative approach, where clear communication and co-operation are paramount. Without such co-ordination, efforts will remain fragmented and less effective.

Finally, I reiterate the importance of including a broader range of perspectives in our decision-making processes. How will the Government ensure that Ministers can access a broad spectrum of advice, including dissenting and minority viewpoints, to prevent groupthink and encourage more robust decision-making? It is crucial that we create an environment where critical thinking and diverse perspectives are not just welcome but actively encouraged.

I affirm our commitment to working with the Government and all Members of this House in the national interest. We must learn from the findings of this report and the forthcoming recommendations from the noble and learned Baroness, Lady Hallett, to strengthen our nation’s resilience and preparedness. Our collective responsibility is to ensure that we are better prepared for whatever challenges the future may hold. With this commitment, I hope that we can overcome the shortcomings highlighted in the report to emerge stronger and more prepared in the future.

With that in mind, I ask the Minister what measures are being taken to ensure that our emergency planning structures are more cohesive and comprehensive, integrating the insights and needs of devolved Administrations and local government bodies. How do the Government intend to improve co-ordination across all levels of Government and civil society? How will the Government ensure that Ministers can access a broad spectrum of advice, including dissenting and minority viewpoints, to prevent groupthink and encourage more robust decision-making?

NHS: Breast Screening Programme

Lord Evans of Rainow Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Merron (Lab)]

I am sure that the noble Lord, Lord Darzi, is listening, but if he is not I will ensure that the noble Lord’s comments are drawn to his attention. I can say to your Lordships’ House that this Government intend to transform the NHS from a late-diagnosis, late-treatment health service to one that catches illness earlier and also prevents it in the first place. It is that shift that will make the greatest change. I have been interested to see that, across all the screening programmes, something like 15 million people are invited for screening and 10 million take it up. That still leaves us with 5 million people to work on. It is important to note that the 10 million take-up figure for screening saves a considerable number of lives. We need to continue to drive up the take-up on screening, across the various cancers and not just breast cancer. As noble Lords will know, there are programmes in respect of cervical and bowel cancer, and there will be a lung cancer screening programme as well.

[Lord Evans of Rainow (Con)]

My Lords, I begin by paying tribute to the noble Baroness, Lady Morgan, for her excellent work with Breakthrough Breast Cancer and more recently with Breast Cancer Now. We are very lucky to have her in your Lordships’ House. We know that the NHS wants to shift the emphasis from cure to prevention and screening, which, whether for breast cancer or other conditions, is a vital part of prevention. The previous Conservative Government took action to drive up breast cancer screening, with new breast cancer screening units and our community diagnostic centre programme. What steps will the Government take to further increase the uptake of breast cancer screening?

[Baroness Merron (Lab)]

The measures that the noble Lord refers to did indeed assist, but as I mentioned earlier we have a stubborn problem in returning to pre-Covid rates. The improvement plan that exists sets out the priorities and the interventions, but also the monitoring of what is working and what is not. The kinds of things that are being tested and introduced now include, for example, new IT systems to enable communication with women in 30 different languages, and new IT systems that mean people know when their appointment is and are reminded of it. All these things sound quite straightforward, but they have not been in place across the country and it is important that they are. I mentioned the importance of addressing fears and embarrassment, improving information and reassurance to women, as well as more convenient times and booking systems. It is very important that we make better use of mobile screening units, so that screening is near to where women are.

NHS Continuing Healthcare

Lord Evans of Rainow Excerpts

Monday 2nd September 2024 Lords Chamber

[Baroness Merron (Lab)]

As the noble Baroness is aware, the responsibility for this lies with integrated care boards and a framework applies to both adults and children and to young people. It is for NHS England to ensure that the framework is properly applied. Certainly, the framework for children and young people has not been revisited since 2016 and we need to look at whether it is doing the job it is intended to do, because we want people to be getting the care they need. Each case is unique and complex and, as a person-centred service, that brings its own complexities. We should therefore ensure that the frameworks are applied correctly and get to the right people at the right time.

[Lord Evans of Rainow (Con)]

My Lords, I take this opportunity to warmly welcome the noble Baroness to her place; I look forward to working with her. During consideration of the Health and Care Act, the last Government committed to moving away from care homes. Are this Government also committed to allowing those needing care to be given support to live at home? What changes do they believe need to be made to the NHS continuing healthcare programme to allow them to stay at home, rather than be in care homes? The noble Baroness and I have exchanged comments about this in private, and I am very happy to discuss it again with her at a later date.

Social Care Reform

Lord Evans of Rainow Excerpts

Monday 2nd September 2024 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness raises an important point about actually making it work, but certainly the fair pay agreement is crucial to professionalising the care service and, indeed, raising the visibility of and regard for those who work in this sector, which is nearly 1.6 million people. We will be working closely, as I mentioned, with trade unions, local authorities, the sector and all those with an interest to make sure that the first ever fair pay agreement for care professionals can work and will deliver what we want, which is a stable, well-regarded and well-trained workforce.

[Lord Evans of Rainow (Con)]

My Lords, during the passage of the Health and Care Act, the previous Government came up with a compromise solution to fund healthcare for an ageing population. It was by no means perfect but it made a start, while addressing the concerns of the Treasury. The new Government have scrapped this scheme but have not yet proposed an alternative. A report from the Health Foundation claimed that Labour’s plans for social care are the most general, with a headline commitment to create a national care service but no detail about timescales or resources. Can the Minister give us any indications on the timeframe, such as “the end of 2024”—preferably a date, rather than “in due course” or “in the fullness of time”?

[Baroness Merron (Lab)]

I welcome the advice from the noble Lord and I will resist using those terms, which I am sure he will appreciate. However, as noble Lords have already understood, this is not going to be done overnight; we are talking about a 10-year vision but we will be talking about steps along the way. I think it is very important that we make progress on the national care service in the short term, because we have to build the foundations, by working with the sector and those with lived experience, to develop those new national standards. It will be work in progress and I hope that noble Lords will be patient but also press me about what progress we are making.

Vaping Products: Usage by Children

Lord Evans of Rainow Excerpts

Monday 2nd September 2024 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, I thank the noble Lord, Lord Storey, for securing this important short debate on the issue of children using vape products. He is absolutely right about the detritus left by vape products in our communities across the United Kingdom. I also say well done to the noble Lord, Lord Foster, for giving up smoking—he is an inspiration to all noble Lords who wish to do likewise.

We know that the NHS sees vaping as a pathway away from smoking cigarettes for adults, but vaping is not completely harmless and it is recommended only for adult smokers who are trying to give up smoking. According to a report from Action on Smoking and Health,

“vapes have been the most popular aid to quitting among those who have successfully stopped smoking in the last 5 years”.

While this is good news, another report from that organisation found that the proportion of children experimenting with vaping rose from 7.7% in 2022 to 11.6% in 2023. Furthermore, the World Health Organization has raised concerns about the long-term effects of nicotine on brain development in children.

As has been acknowledged by the noble Lords, Lord Bethell and Lord Naseby, and other speakers, the previous Conservative Government recognised the urgency of this issue and took important steps to tackle advertising of vapes targeted at children. But clearly there is a lot more to do.

A key finding from the previous Government’s call for evidence on vapes highlighted the appeal of flavoured vapes in attracting children to vape products. Such flavoured vapes are often displayed near sweets and other confectionery, making them easily accessible and appealing to children. Research has shown that:

“Packaging and design features of vapes … appeal to children”.


This finding led the previous Government to propose stricter regulations on packaging and display of vapes.

While it is already illegal to sell vaping products to young children, we need robust enforcement measures and trading standards need to be provided with the resources and power to seize illegal products, impose fines and ban retailers who break the law.

Beyond advertising and enforcement, schools have an important role to play in teaching students about the risks of nicotine addiction and the potential harms associated with e-cigarette use, so as we work to prevent children accessing vaping products, we must ensure that adults can continue to access vaping products as an effective pathway away from smoking.

On the Government’s wider policy, the Prime Minister recently suggested that the Government will go further, with a proposal to ban smoking by adults in outdoor spaces. This threatens the future of Britain’s pubs and clubs, and the Opposition do not support the proposal. Pubs are the lifeblood of communities across Britain but, according to reports, this measure could put the survival of one in eight pubs at risk. Pubs are a force for good, and this is the latest in Labour’s assault on small businesses. We will be holding the Government to account on their decisions. This will seriously affect the hospitality industry, which is already under strain. We must ensure that regulations are balanced and do not inadvertently harm other sectors in the economy.

Action on Smoking and Health gave oral evidence to the Health and Social Care Committee, urging that the committee recommend that the Government toughen vape regulation, including: putting vapes out of the sight and reach of children; prohibiting the promotion of e-cigarettes in shops; limiting where they can be sold; putting vapes in plain packaging to make them less appealing to children; and prohibiting sweet names, bright colours and cartoon characters. While we should consider any unintended consequences, we think that these are serious proposals that should be considered.

In conclusion, while the Opposition remain firmly committed to working with His Majesty’s Government to tackle underage vaping, will the Minister clarify the Government’s position on a number of issues? Do His Majesty’s Government support the introduction of a licensing system for retailers selling vapes to help combat illicit sales? Which of Action on Smoking and Health’s proposals do the Government support? Are the Government committed to banning cigarette smoking outdoors and will the Minister commit to coming back to the House to make a Statement on those proposals? I look forward to the Government’s response.

Homecare Medicines Services (Public Services Committee Report)

Lord Evans of Rainow Excerpts

Thursday 2nd May 2024 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I am delighted to participate in this important debate, and I regret that it is tail-end Charlie today when the report deserves much greater prominence. The only credit I can take for this excellent report is that I suggested the topic. I pay tribute to our brilliant chair and her devastating summary today, and to colleagues on the committee and to the officials, who did all the probing and heavy lifting and concluded that this is a major opportunity lost.

My personal interest is that I get two different medicines for multiple sclerosis delivered to my home. The one which sparked this inquiry is called fampridine. Most people with MS cannot lift their feet and they drag on the floor; I can trip over a dead fly on the carpet. Fampridine enables us to lift our feet by as much as 5 millimetres—that is all—but it is the difference between walking and not walking at all. To me and others, that little fact makes it a miracle drug, and I was lucky enough to get in on the trials when they started. As an aside, NICE will no longer approve it for new patients, but all those of us in the trials can keep getting it. That is grossly unjust—like many other NICE decisions.

I had excellent service until 2017, when the delivery contract was allocated to a new company; it is named in the report and I will not name it again, but it began to fail abysmally in getting the deliveries to me before the last pills ran out. I complained on many occasions and it came to a head in July 2021, when I had no delivery and no pills for 10 days. I was unable to walk—or stagger, in my case—from where I park my Ferrari at the Bar of the House even to get to this Front Bench here.

I looked up the company in Companies House, found the names of the main directors, tracked down their addresses and sent them a stinking note with my full rank and titles and a draft of my letter to Sajid Javid, the then Secretary of State, calling for the company’s contract to be terminated. The net result was that, two days later, some poor chap was dispatched on a 500-mile round trip to deliver on a Saturday my fampridine to Penrith in Cumbria.

I looked further into this company and found that the Care Quality Commission—a thoroughly useless body if ever there was one—had just published a report in May 2021 showing that over 9,885 patients had also failed to get deliveries of their drugs, and some had to be hospitalised. The CQC report gave the company an overall rating of “inadequate”. On patient safety it rated it “inadequate”, and on “Are services well led?”, it rated it “inadequate”. Therefore, with all these negative ratings, what did the CQC do? It listed all the regulatory breaches and asked the company to kindly send it a report on how it would behave better in future. As Bob Geldof might have said, “Is that it?”

That is one reason why I say that the CQC is a useless regulator, which our report also suggests—or hints at, in very strong terms. By the way, a month after the scathing CQC report, the company changed its name and pretended to be a completely different supplier altogether.

I wrote to the Secretary of State calling for the contract to be removed, but that did not happen because he was not properly in charge of it and he was not sure quite who was. I now get Rolls-Royce service from this company because of who I am and because I created a big stink, but the other 9,884 victims, who have conditions far worse than mine, might not be so well served.

When I joined the Public Services Committee, colleagues were looking for a short-term inquiry to fill a gap as we looked at suggestions for a longer inquiry. I suggested investigating the delivery of medicines at home and supplied details of my own experience. I think that initially my colleagues thought that I was perhaps exaggerating the shambles I had described, but when our excellent clerk, Samantha Kenny, looked at it, she thought that it deserved a deeper look.

My colleagues thought that there may be a bit of a mess here, and then the evidence started to come in from various patient groups such as Crohn’s & Colitis UK, and the superb report from the British Society for Rheumatology which suggested that the system was a complete shambles and cited countless examples of failure to deliver medicines on time. I think colleagues then concluded that old Blencathra was not so barking after all.

We have called the report An Opportunity Lost and that is true, but we could easily have called it “A Complete Shambles”. Those are not just our words; the Chief Pharmaceutical Officer for England told us that our inquiry had unearthed,

“a complicated picture that is quite hard to understand even when you are working in the area”.

That is a nice way of saying “a complete shambles”.

The then Minister for Health and Secondary Care, Will Quince MP, stated:

“It is certainly complicated. That is an understatement”.


That is, again, a nice euphemism for “a complete shambles”. As the noble Baroness said, the NHS has not a clue how much it costs. The National Clinical Homecare Association told us that the Treasury spends £4.1 billion per annum on homecare medicines, but the NHS told us it is only £3.2 billion. We asked the Minister—he said it was £2.9 billion. As we say, it is utterly shocking that no one in the NHS can give us an accurate figure for the billions spent on home deliveries, but then the NHS does not have a clue about how bad it is and how many patients have suffered. KPIs are a mess, as the noble Baroness explained.

We said in our report:

“Different sets of performance data are available to manufacturers and the NHS. This creates confusion and prevents effective monitoring … NHS England must develop and implement one consistent set of performance metrics”.


Performance data must be published.

The National Clinical Homecare Association told us that

“98.8% of deliveries were delivered on the day they were intended to be delivered on”.

That is a very clever form of words but quite misleading. Yes, 98.8% were delivered on the dates that the delivery company decided they were to be delivered on, but those were not the dates the doctors prescribed, which were always much earlier and before the medication for patients ran out. Part of these failures are delays in the NHS prescribing system and delays by the delivery company.

Chapter after chapter of our report highlights the failings of the system. Thus we say:

“No one—not the Government, not NHS England, not patient groups, not regulators—knows how often, nor how seriously patients suffer harm from service failures in homecare”.


Let no one misconstrue our conclusions as an attack on the private provision in the NHS. While we found myriad flaws in the provision at all levels, God help us if the NHS tried to run a courier delivery service, since that would be infinitely worse. Delivering medicines at home by couriers is eminently sensible but has to be better managed at all levels. The problems that we identified all relate to the fact that there is not one single person or NHS body in charge. Different people and organisations negotiate different contracts. There is no quality control or negotiating competence, there are no consistent KPIs to measure performance and the various regulators are all fairly useless. It seems there is no one with the power to sanction failure or cancel contracts. Worst of all, I got the feeling that the NHS rather likes it this way because when things go wrong there is no one individual or organisation to blame. They can all carry on presiding over a shambles but carry no personal responsibility for it.

I get exceptionally good medical care from the National Hospital for Neurology in Queen Square, the Royal Marsden and the Lakes Medical Practice up in Penrith, but if you want to see the general bureaucratic incompetence of the NHS and why it is failing so badly in so many areas, the bureaucratic shambles that we are reporting on here is a perfect microcosm example.

However, in the report we did not just criticise but offered solutions. Theoretically, there is a Minister in charge, but he or she has no say in the running of the system, which is delegated to the NHS. The Minister should be charge and have a very senior person reporting to them. We say:

“NHS England should designate a senior, named person with responsibility for the homecare system. That person should be given sufficient powers and resources to discharge that responsibility”.


That person’s responsibilities should include:

“Setting clear national KPIs for organisations commissioning and providing homecare medicines services … Collecting data on those KPIs, and publishing data on those KPIs in a way which supports public scrutiny of the homecare medicines system … Holding relevant bodies such as individual providers, Chief Pharmacists, the National Medical Homecare Committee and pharmacy teams to account for work on homecare medicines services … Responsibly using new powers to issue appropriate penalties to under-performing providers”.


That is essential; there must be sanctions.

The fifth recommendation is:

“Ensuring trusts or hubs procuring homecare medicines services have access to sufficient financial and expert procurement advice and information, including template legal agreement frameworks, so they are able to effectively deliver value for money services and influence the homecare medicines services market”.


As in every government department I have served in and witnessed over 40 years in Parliament, the lawyers employed by the outside commercial contractors are infinitely better than government lawyers trying to negotiate contracts; they outwit and outmanoeuvre us every time.

Finally, we said that:

“Achieving value for money and increasing transparency on homecare funding”


should be another part of their individual duties.

As the noble Baroness said, the government response accepted about 90% of what we say—that is jolly good. On that basis, let us have urgent action to implement those proposals and the remaining 10% as well.

[Lord Evans of Rainow (Con)]

My Lords, I remind the House that there is an advisory speaking time of nine minutes.

NHS: Long-term Sustainability

Lord Evans of Rainow Excerpts

Thursday 18th April 2024 Lords Chamber

[Baroness Warwick of Undercliffe (Lab)]

My Lords, it is a pleasure to follow the noble Lord, Lord Crisp, and I thank the noble Lord, Lord Patel, for providing the opportunity to consider this challenging but vital issue. I look forward to the maiden speech of my colleague, my noble friend Lady Ramsey of Wall Heath.

I shall focus my remarks on care needs, highlighting the crucial interdependence of care and the NHS. I will draw on my experience as a member of this House’s Select Committee on Adult Social Care, so ably and empathetically chaired by my noble friend Lady Andrews, whose report, A “Gloriously Ordinary Life”, was published at the end of 2022.

It is clear to me that, if we are to ensure the long-term ability of the NHS to deliver comprehensive healthcare for all, adult social care is crucial. Fundamental changes to social care funding and provision, in the form of a national long-term plan for adult social care, are a national imperative. We engage with the NHS at all points in our lives, but adult social care is often invisible and off the public agenda until we have a sudden need for it. Yet as our report noted, 10 million of us are affected by it at any one time, either because we receive care and support or because we provide paid or unpaid care. Because we are living longer and with more complex conditions, we are all increasingly likely to be one day included in that number.

Noble Lords will be aware that there is no national government budget for adult social care in England. Services are financed primarily through local authorities, bolstered by large numbers of people who fully or partly fund their own care. As the APPG on Adult Social Care highlights in its recent report Future of Care 5, this piecemeal approach means that social care is particularly vulnerable and will often be the first to lose out when—I say that advisedly—the NHS or local authorities have their budgets cut. The 29% cut in local government funding since 2010 has led to an estimated 12% drop in spending per person on adult social care services.

If we are looking at new models and systems of care and funding within the NHS, we have to change short-term emergency funding. Social care needs a long-term funding plan. As our Select Committee highlighted, improving adult social care should be seen not only as an investment in the NHS but in ourselves, as a resilient and caring society. As the quality and consistency of services has suffered, so has the pressure and demand on unpaid carers risen. Estimates suggest that there are more than 6 million unpaid carers in the UK, and the actual figure is likely to be much higher. Estimates of the value of unpaid care provided by family and friends vary between £100 billion and £132 billion a year. That is an extraordinary contribution to the health of this country and it really needs to be seen to be valued. However, as one carer who gave evidence to our report told us:

“Unpaid carers are often not even considered to be a part of the health sector and yet without them the sector would collapse”.


Despite their numbers, carers feel invisible and many are at financial, emotional and physical breaking point. Hearing the lived experiences of those who gave evidence to the Select Committee was sobering, at times even harrowing. Time and again, they told us of being unaware of what help was available, not knowing who to ask or how to access help, or of not being listened to and being put through tick-box exercises that bore no relation to their actual circumstances or needs. Time and again, these carers were falling between the gaps of a broken system, often over many years.

One parent carer told us that, while her daughter was under the age of 18, she had a central point of contact within the NHS, a paediatrician, who could project manage the different strands of specialism her daughter needed. Once she turned 18, all this fell off a cliff. The distinction made between a health need and a social care need means that unpaid carers, often family members, are on their own, battling to get information and help.

In the Select Committee report, we urged the Government to establish a commissioner for care and support who would be able to raise the profile of social care, act as a champion for older adults, disabled people and unpaid carers and accelerate a more accessible adult social care system. Sadly, this recommendation gained no traction with the Government, but, in light of the overwhelming body of evidence on the need to improve adult social care and advocate for those at the heart of adult social care of all ages, can the Minister give us any assurance that this will be revisited?

[Lord Evans of Rainow (Con)]

My Lords, I am most grateful to the noble Baroness for finishing just before five minutes were up, but she has been the only one. The excellent speech of the noble Lord, Lord Patel, finished two minutes before his allotted time. I gently remind all noble Lords to keep to their allotted time of five minutes. I know that the next speaker will keep to it because he is a perfect timekeeper.