Health: Migraines

Lord Hunt of Kings Heath Excerpts

Tuesday 24th October 2023 Lords Chamber

[Viscount Younger of Leckie (Con)]

The noble Lord makes a very good point. Those who unfortunately suffer from migraine—as we know it comes in different types, stages and forms—can call 111, go to their GP if they can get an appointment quickly or go to their local pharmacy. I hope the noble Lord will find it helpful that the NHS workforce plan, announced recently, includes £2.4 billion funding over the next five years and provides projections for the help needed for dealing with such conditions.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord’s original Question focused on the impact on the workplace. There is a lot of evidence from the Migraine Trust that employers are very unsympathetic to employees suffering from migraine. Does the Minister agree that, if the Government are to take forward a more cohesive strategy, education and working with employers to understand the impact of migraine on many of their employees may well pay dividends?

[Viscount Younger of Leckie (Con)]

The noble Lord, who has more experience in these matters than me, is quite right. My understanding is that, where an employee suffers from migraine, if the employer does not take it seriously or make certain allowances, this has a great detrimental effect on the employee. The noble Lord will know that the law says someone is disabled if they have a physical or mental impairment that has a

“substantial and long-term adverse effect”

on their

“ability to carry out normal day-to-day activities”,

including work. There is work to be done engaging more with employers to make sure they have that understanding.

Pension Schemes Bill [HL]

Lord Hunt of Kings Heath Excerpts

2nd reading (Hansard): House of Lords
Tuesday 1st November 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure to wind up for the Opposition on this important Bill. Although I may be regarded as a newcomer to pension policy I remind the House that I was a Minister at the Department for Work and Pensions from 2005 to 2007, which was a very interesting time because we had the second report of the Pensions Commission and the Government’s White Paper in response. I start by paying tribute to the commission, to the noble Lord, Lord Turner, to Mr Hills and, of course, to my noble friend Lady Drake for the outstanding work that the commission did.

I made a Statement to the House on 25 May 2006 announcing the then Government’s acceptance of the commission’s core proposals for auto-enrolment. This was welcomed by the then Opposition spokesman, the noble Lord, Lord Skelmersdale, by the Liberal Democrat spokesman, the noble Lord, Lord Oakeshott, and by my noble friends Lady Hollis, Lady Turner and Lord Lea. Earlier, my noble friend Lord Monks emphasised the importance of political consensus over auto-enrolment. I very much endorse that. It was, I believe, a major step forward and I am proud of what we did and that so many people are now enrolled in auto-enrolled schemes. Reading Hansard of that day, I think it is interesting how many noble Lords expressed concerns about the loss of public trust in pensions. Listening to our debate tonight it is clear that much more still needs to be done to regain that trust.

My noble friend Lord McKenzie suggested in his opening remarks that too much has happened in the pensions arena in recent times to damage confidence in savings and pensions, including the mis-selling of what should have been enhanced annuities and the U-turn on the secondary annuities market. As the noble Baroness, Lady Bakewell, pointed out, we have just had the call from the head of the Pensions Advisory Service for companies to be banned from cold calling pensioners because of the activities of scammers. Of course, more general underlying concerns continue about the low level of savings and the poor returns for so many savers. Added to this we have the state pension age extension.

The Minister talked about mitigation measures in his opening remarks but, as my noble friend Lady Hollis pointed out, the issue is severe, particularly for women without an occupational pension. My noble friend went on to raise the huge disparity in longevity and morbidity by socioeconomic status. My concerns have been more on the health side than the pensions side, but she is absolutely right: we cannot consider health in isolation. The plight of women, in particular, who are doubly disadvantaged—in health and wealth—deserves recognition and action. I thought that my noble friend’s critique of government policy on occupational pensions was telling and I look forward to the Minister’s response. I look forward to the Minister’s response, also, to the point made in the gap by the noble Viscount, Lord Trenchard, on the perils of early withdrawal from pension funds, and to his response to the very interesting comments of the noble Lord, Lord Flight, about valuation policy and the impact that that is having on general investment by many companies.

The continuing unease and lack of confidence in pensions and savings has, of course, been exacerbated by the events surrounding the sale of BHS and the deficit in its DB pension scheme, which has highlighted, at the least, the problem of poor corporate behaviour. This helps to identify the more general issue of the performance of the Pension Regulator, its current powers and its willingness to deploy these. Much needs to be done to ensure that savers feel safe and confident in their pensions. As millions of people are enrolled in auto-pension schemes, clearly the regulation of master trust pension schemes is essential. In this context, the Opposition welcome the Bill—we support the need to protect members from suffering financial detriment and we support the imperative of promoting good governance and a level playing field for those in the sector—but it is clear from the debate that there are concerns as to whether the statutory and regulatory provisions in the Bill are sufficient. A number of very important questions have been put to the Government tonight which I have no doubt that the Minister will respond to.

Clearly, the number one issue is whether the scheme member protection proposed in the Bill is robust. In Committee we will seek to examine this in more detail. I thought that my noble friend Lady Drake raised some very important questions that we need to tackle, including the ongoing supervision of pension pots, where we lack sight of proposed regulations, the robustness of capital adequacy and questions on restrictions being placed on the level of dividends or profits, to name but three. My noble friend Lord McKenzie and the noble Baroness, Lady Altmann, also raised the question of master trusts which have already achieved accreditation under the MT assurance scheme developed with the Institute of Chartered Accountants. Clearly, what these master trusts have achieved under accreditation overlaps with some of the provisions in the Bill. It is important to know how any potential conflicts between the accreditation scheme and the proposed regulatory scheme will be resolved.

Turning to the ability of the Pensions Regulator to do the task that is being placed upon it, my noble friend Lord McKenzie made the point that the regulation of master trusts involves extensive powers and obligations, including: dealing with authorisation; determining fit and proper persons; judging financial sustainability; deciding on the adequacy of systems; and having the power to initiate triggering events. There is considerable work for the regulator, especially at the start of the scheme, when existing trusts will have to go through the authorisation process. The noble Baroness, Lady Wheatcroft, described the regulator as overemployed and understaffed and there is a real question about whether it is going to be in a position to carry out the duties the Bill lays on it. For example, Clause 7—the fit and proper person test—is a long clause but is actually very short on what is a fit and proper person. I hope the Minister might be able to help us on this when he winds up. By implication, I think the noble Lord, Lord Stoneham, probably agrees with me when I suggest that he does not look to the football league for advice on that point.

A common theme of the debate has been the silence in the Bill—and, indeed, in the Minister’s opening remarks—on the position of members. I am indebted to ShareAction for its work on this. Clause 11, on systems and processes, is silent on the need for the members’ voice to be heard or represented in master trusts. Why is that? I echo the suggestion made by the noble Lord, Lord Stoneham, that member representation is entirely consistent with the Prime Minister’s remarks about plc board membership. There are also significant gaps on members’ communications, as my noble friend Lady Drake emphasised. Why is there no requirement for trustees to notify members unless and until a decision is made to transfer out members’ rights on wind-up schemes? Why are savers not given the right to obtain on request standardised information about what they are being charged, where their money is invested and how ownership rights are exercised? Why are pension schemes not required to hold an annual meeting for their scheme members, even if it is a virtual meeting, as suggested by the noble Lord, Lord Stoneham? Why is Clause 31 so weak on protection of members following a pause order?

The Minister spoke helpfully and extensively about the use of delegated powers and explained the rationale for the extensive use of regulations. Like my noble friend Lady Drake, I understand the need for some flexibility here but the problem is that your Lordships’ powers in relation to secondary legislation are circumscribed. It is a great pity that draft regulations are not to be published because the Government want to consult with industry first. Surely there is no reason this could not be done in parallel between Second Reading and Committee. I note also that the Minister used the word “industry”. Can he assure me that that actually means stakeholders and that pension members and their representatives will also be consulted over the draft regulations? I am sure we will want to come back to this in Committee.

My noble friend Lord Monks referred to the forthcoming review of auto-enrolment and made some very interesting observations. I know it is early days yet but it would be helpful to have from the Minister some idea of what is in the Government’s mind in relation to that review. It is absolutely essential that consensus on auto-enrolment continues.

Finally, the Opposition welcome the Bill but there remain concerns about the regulatory regime proposed. Clearly, there are gaps in the detailed provisions of the Bill, with an unacceptable use of negative regulations. There seems to be a complete absence of any reference to the role and representation of members. Having said that, we look forward to a challenging and constructive Committee.

Poverty

Lord Hunt of Kings Heath Excerpts

Thursday 14th July 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure to respond to this debate for the Opposition. I add my thanks and congratulations to the noble Baroness, Lady Sharp. She has been an extraordinary champion of further education, adult education and the skills agenda. I know that I speak for noble Lords on my side of the House when I say how much we regret her leaving but we wish her every success in the future. She certainly seems to have a very exciting agenda ahead of her. I should also say —I declare an interest as my wife is an adviser to the Education and Training Foundation—that the further education sector will be devastated that it no longer has such a powerful voice in this Chamber. It is striking how few Members of your Lordships’ House really understand this crucial sector.

The noble Lord, Lord Bird, urges us to urge the Government to refocus efforts on tackling the systematic causes of poverty. We have had a very serious debate, and he is to be congratulated. He had a slight dig at my party and, indeed, Polly Toynbee, and what he described as the analysis of the left in dealing with poverty. I thought that my noble friend Lady Lister put it well: we have been consistently concerned about tackling the root causes of poverty, but we cannot ignore the need to alleviate the poverty suffered by so many people in this country. The last Labour Government did not get it all right but they put a lot of emphasis on tackling the root causes of poverty. The Child Poverty Act 2010, which came at the end of our 13 years in government, was the culmination of many efforts.

The noble Lord talked about embracing a holistic view of budgeting, and I could not agree more. The noble Lord, Lord Mawson, set out why we need a holistic view of budgeting when he raised the wretched performance of NHS PropCo, which clearly has separate targets for financial performance from that of the National Health Service. It has almost to be forced to collaborate at local level because the targets it is given are not in its interests. The last Labour Government attempted to deal with some interdepartmental barriers by having cross-departmental targets and public service agreements. They worked to a certain extent, if not perfectly, but the current Government are not very interested in cross-departmental working. Following the decision we made that I think was a mistake, what I am most pleased about in this reshuffle is the fact that higher education is going back into the Department for Education. I welcome that move and hope that it will lead to a much more integrated approach to education than we have had in the last few years. I thought that I would get that off my mind.

We know that the child poverty figures are getting worse. My noble friend Lady Lister talked about food banks, and she is so right. People go to food banks because they have no other choice. The fact that there has been so much additional use of food banks is shameful. However, I pay tribute to the Trussell Trust, the Churches and all the other organisations that are doing such a magnificent job in keeping them going.

The right reverend Prelate the Bishop of Derby referred to the role of the Churches and the voluntary sector. He is right to say that funding constraints have made their job much more difficult. I was interested in the comment of the noble Baroness, Lady Lane-Fox, about digital skills within the charitable sector. That is an area where government could give support, as this is clearly a major challenge. The right revered Prelate also talked about extending and embracing comradeship and community. I think that my party could do with a bit of that at the moment, so we might need to approach him for further counselling and advice over the coming weeks.

The noble Lord, Lord Storey, started his speech with a wide view and then got down to what he really thinks is important—education. I embrace his wide view, but I think that health is really the issue we need to tackle. We are simply reflecting what, following the Alma-Ata declaration in the 1970s, health people used to call intersectoral co-operation. We will not be able to tackle the root causes of poverty unless we take a holistic view. The Government cannot do everything but they can drive a cross-departmental approach, and that is what we want to hear from the Minister. He will be tempted to talk from the viewpoint of his own department. Of course the DWP has a role to play but I would like to see it take a much more proactive role across government in driving forward some of the poverty eradication measures that we need.

In my humble role as a Minister in the DWP, one thing I was very proud of was the appointment of a joint tsar, as we used to call them, in the form of a national director for health, work and well-being, Dame Carol Black. That was a joint appointment between the DWP and the Department of Health. There was a recognition of the hugely close links between health, work and well-being. We need more examples of pulling things together instead of having these rigid barriers that we so regret.

On health, the Marmot review is striking. The noble Lord, Lord Crisp, and the noble Baroness, Lady Finlay, referred to it. The great variation in the length of time that people can expect to live in good health is appalling. The average difference in disability-free life expectancy is 17 years. In other words, people in poorer areas not only die sooner but spend more of their shorter lives with a disability. That is a shocking statistic.

On education, according to the ONS, 43% of people in the UK who left education without any formal qualification experienced poverty at least once between 2011 and 2014. The point made by the noble Lord, Lord Empey, about how many people still suffer from a lack of literacy skills, was very telling.

Here we come back to the noble Baroness, Lady Sharp. Given the need to embrace the skills agenda, why is further education discriminated against? Whenever there are funding reductions, why does the FE sector always take the biggest hit? The Government are very proud of their apprenticeship programme but all the evidence is that many of those apprenticeships are of very low quality and provide a poor education, and it is simply a statistic that is being chased, rather than the kind of quality that we need to see.

There are so many other issues one can talk about. The lack of affordable housing has not featured very much in our discussion, although my noble friend Lady Warwick mentioned it. The lack of affordable housing is surely one of the greatest curses we face and one of the greatest problems when it comes to alleviating poverty.

Where do we go from here? We have had brave words from our new Prime Minister. I think they were warmly welcomed all round the House and in today’s debate. My very simple question to the Minister is: how will the Government translate those words into action? How will they, as the noble Lord, Lord Crisp, said, listen to poor people and work in partnership? How are we going to embrace health and education in our poverty strategy? How will we tackle the issue of affordable homes? How will we pick up the skills agenda? How are the Government going to lead an integrated approach? These seem to be the fundamental questions, which we very much look forward to having answered in the next few minutes.

Queen’s Speech

Lord Hunt of Kings Heath Excerpts

Tuesday 14th May 2013 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, I thank the Minister for his introduction to our debate and, like him, I welcome our maiden speakers, who we all look forward to listening to later. I also refer noble Lords to my health interests as set out in the register.

With the country facing so many formidable challenges, last Wednesday’s Queen’s Speech was an opportunity for the Government to outline a positive agenda for jobs and growth, and to help hard-pressed families cope with the drastic fall in living standards, but positive change it was not. Instead, we were treated to a desperately disappointing and dispiriting programme from a Government who are out of touch, out of ideas, and out of support from a significant number of their own MPs. Nowhere is that more evident than in the subjects we are covering today: in welfare, where the welfare bill continues to rise, the universal benefits scheme is in trouble, and the Work Programme simply is not getting the long-term unemployed into work; in energy, where the dithering and discord between the Treasury and the Department for Energy and Climate Change is putting our energy supply at risk and investment in renewable and nuclear energy in jeopardy; in the environment, where the Prime Minister’s claim to lead the greenest Government ever lies in tatters; in agriculture, where the water Bill is effectively only half a Bill that fails to deal with public affordability; in culture, media and sport, where we have no communications Bill and our wonderful Olympic legacy has been squandered as schools sport provision has been woefully undermined by Mr Gove; and in education, with no plans for vocational education and the Government’s lamentable plan to weaken early years childcare ratios in total chaos.

However, nowhere is the Government’s stewardship so much in evidence in terms of failure than in the field of health and social care. The Government’s backtracking on public health is but one example. The noble Earl who is to wind up our debate later will know that the scale of health inequalities in the UK is formidable. He also knows that smoking is one of the most important contributors to ill health and early death. That is why there was such a warm welcome when reports emanated from Whitehall in the spring promising legislation to enforce plain packaging for cigarettes. Why was there no mention of the Bill in the Queen’s Speech, and why no Bill to set a minimum price for alcohol? Does the noble Earl agree with his colleague, Dr Sarah Wollaston MP, who has said that a U-turn on plain packaging would send a message that public health has been completely abandoned by the coalition?

I would also like to ask the noble Earl about the establishment of Health Education England, which is set out in the Care Bill. I note Schedule 5 to the Bill regarding the make-up of its board and would ask him whether he will ensure that there is a balance of non-executives in terms of gender and diversity. I ask him that because I was astounded to learn that all of the non-executives on the advisory board of Public Health England are men, including the chairman. I am equally astounded that my noble friend Lady Massey of Darwen, having gone through all due process, was vetoed by Ministers from joining the board. Why was that so?

We then come to the health implications of the Government’s immigration measures. They have made much of their proposals to ensure that only NHS patients who properly qualify for the NHS should get free treatment. No one would quarrel with that as a proposition, but it is clear that the Government do not have a clue how to implement their proposals, apart from forcing GPs into the role of immigration officers. The existing guidance produced by the Government on the charging of overseas patients is 90 pages long. It is one of the most incomprehensible pieces of draftsmanship that I have ever seen.

The highly respected Nuffield Trust showed in 2011 that immigrants are far less likely to use hospital services than the general population. On the Francis report and the legislation contained in the Care Bill, I certainly look forward to debating Ofsted-style ratings for NHS hospitals and I support the intention to make it a criminal offence for NHS and social care organisations to provide false or misleading information about their performance. But why is the duty of candour restricted to hospitals and other service providers? Why should commissioning bodies such as clinical commissioning groups and NHS England not have a similar duty apply to them? Mr Robert Francis called today for more honesty from the NHS. However, that means all of the NHS. I also echo some questions asked by Mr Francis. Why are the Government not providing for the ability to prosecute individual staff in the case of serious patient neglect? Why are the Government refusing to merge CQC and Monitor into a single organisation? What response does the noble Earl have to Mr Francis, who warns of the potential of a communications failure between the two organisations?

The Government claim that the Care Bill, which is probably one of the most important Bills that this House will debate in the next few weeks, will reform the way long-term care is paid for to ensure that the elderly do not have to sell their homes to meet their care bills. The Bill builds on many of the recommendations of the Law Commission’s review of adult social care legislation initiated by the previous Government and on the proposals in Labour’s White Paper before the last election. The Bill may well be a step towards a better system but the key question I put to the noble Earl is this: where is the funding to implement it? On its own, the Bill will not go anywhere near far enough in tackling the crisis that is now engulfing health and social care, openly acknowledged by the Secretary of State. We have hospitals full to bursting, discharge is becoming ever more difficult, and handovers to social services are slower and subject to more disputes. Social care and the voluntary sector are struggling to fulfil demands placed on them. On the front line, thousands of nursing posts have been lost and many services are under pressure. In social care, the recent report of the Association of Directors of Adult Social Services laid bare the scale and severity of the financial squeeze on councils: £2.7 billion stripped from adult social care services since 2010, equivalent to 20% of their care budgets, even as demand for those services continues to rise.

Ministers have today been forced to announce new measures to get the NHS and social care working together in integrated teams. However, the whole reform programme of enforced marketisation has actually encouraged the opposite—the fragmentation of services. At national level there is utter confusion as to who is in charge. We have even had NHS England arguing with the Secretary of State over the release of money to help hard-pressed accident and emergency services. The Secretary of State has finally grasped that the A&E crisis is a crisis of the whole system but NHS England persists in its foolish approach of blaming everyone but itself. How else to explain the bullying of clinical commissioning groups to fine those very same hard-pressed A&E and ambulance services? The Secretary of State itches to intervene, but his powers are limited because his predecessor and the noble Earl were adamant that they wanted to hand powers over to a quango, NHS England. No wonder Chris Hopson, chief executive of the Foundation Trust Network, described the Government’s response to the A&E problems as an “omnishambles”.

The Care Bill may well be a step towards a better system but new rights to services and support risk being meaningless as council budgets are cut to the bone and people are faced with spiralling charges. Many searching questions remain to be asked about the Government’s proposals. Can the noble Earl confirm that Andrew Dilnot warned that anything above a £50,000 cap on care costs would not provide enough protection to people with low incomes and wealth? Can he explain the rationale of persisting with a £72,000 cap? Has the noble Earl seen a paper published today by the LSE and the University of East Anglia which points out that the government proposals will provide greater benefit to relatively better off older people? What will the Government do to provide help for those of relatively low to modest means?

Dilnot hoped that the capping of care costs would lead to appropriate private insurance packages coming on to the market. Can the noble Earl tell us what discussions he has had with the ABI to stimulate such a market? Will he confirm that the cap on care payments does not include the hotel costs that a care home will charge, and that people in residential care will still need to pay up to £12,000 a year to fund their accommodation and living expenses?

Does the noble Earl accept that the national eligibility scheme will not work if it acts to restrict services for many people? Can he respond to the comments made by Age UK, which said that in the majority of councils only those assessed as having “substantial” care needs are now able to access the current system? It says that unless the Government set the proposed national eligibility criteria at the equivalent of “moderate”, hundreds of thousands of people who cannot carry out tasks such as washing, getting dressed and preparing food and laundry will be left without any help.

The contribution of carers to our society can never be overestimated. Why are there no provisions in the Bill for adults caring for children, and young carers? As Barnardo’s says, young carers represent a uniquely valuable group of people whom the Government should be ensuring receive help to address the very serious effects that caring has on their lives.

I would also welcome the noble Earl’s response to the point made by the Joint Committee in its scrutiny of the draft Bill, when it said:

“The introduction of a capped cost scheme, which will result in many more people”—

including self-funders—

“being assessed and entitled to a personal budget is likely to lead to an increase in disputes and legal challenges”.

The committee was,

“not confident that Ministers have yet fully thought through the implications for local authorities of these changes”.

Can the Minister comment?

Of course, we will explore these issues in greater detail in Committee, but however much we scrutinise the Bill it looks set to do little to help those who currently face a daily struggle to get the support they need. This is echoed by the Joint Committee, which said that,

“care and support have increasingly been rationed and restricted to those with the highest levels of need. This is ultimately self-defeating—shunting costs and reinforcing the dominance of crisis and acute care over approaches that prevent and postpone the need for formal care and support”.

The Government say they are acting to help people with care costs but the reality behind the spin is that under this Government people’s savings are being washed away. Ministers are promising to give a little in the future with one hand, while social care provision is collapsing in the other.

Above all, we need a genuinely integrated NHS and social care system, which helps older people stay healthy and live independently in their own homes for as long as possible. That is why Labour’s proposals for whole-person care are so important. This is surely one of society’s greatest challenges, which we need to tackle with urgency. In the absence of any such vision in the Queen’s Speech, it will be Labour’s mission to achieve this after the next election.