Mental Health Bill [HL]

Lord Kakkar Excerpts

Committee stage
Monday 20th January 2025 Lords Chamber

[Lord Patel (CB)]

I agree with what has been said: we need a definitive plan for how things will work out. We cannot rely on it being in five or 10 years because, as the noble Baroness, Lady Murphy, said, it then just becomes an ambition rather than a target to achieve.

I support the amendment of the noble Baroness, Lady Browning, which strongly asks that the people who look after children with autism and learning disabilities are properly assessed by properly trained and accredited people. We know that, currently, children are ending up in detention inappropriately because they are assessed to have a psychiatric condition such as schizophrenia—as the noble Baroness, Lady Browning, said—when, although they might have some psychiatric sub-condition, they fundamentally have autism or learning disability problems.

I am sorry that the noble Lord, Lord Adebowale, is not here to speak to his Amendment 150, which asks quite powerfully for a clear plan to be laid out, with resources tied to it, to achieve the ambitions there are in the Bill. I would have supported his amendment probing the Minister as to how resources will be allocated to achieve the ambitions for those targets to be met.

[Lord Kakkar (CB)]

My Lords, I support Amendment 42A in the name of the noble Baroness, Lady Browning, and I ask the Minister what justification there could be for refuting the amendment. It seems entirely appropriate, and indeed essential, that in taking such an important, far-reaching decision, one of the two registered medical practitioners who is responsible for that decision, taken at one point in the management of the natural history of disease in that individual, has the specialist skills and training to be able to make an appropriate assessment, one that will affect interventions on all future occasions for that individual.

I hope that, in addition to accepting this important principle, the noble Baroness might outline how His Majesty’s Government will go about ensuring that the development of such medical practitioners and their training is adequately resourced to ensure that, in future, as a result of the Bill being enacted, what we have seen in the past, regrettably on repeated occasions, does not remain the norm for managing patients with autism and learning disabilities.

[Earl Howe (Con)]

My Lords, I shall be very brief, because other noble Lords have already eloquently articulated the arguments that are almost self-evident about the importance of services for people with autism or a learning disability and, in particular, the importance of training all staff who may find themselves working in those fields. I agree very much with the remarks of my noble friend Lady Browning and the noble Lord, Lord Scriven, and I was particularly interested in the research mentioned by the noble Baroness, Lady Bennett of Manor Castle, which brings us into a whole new dimension, I think, in this debate.

The need to train all healthcare staff, no matter what role they perform or which part of the health service they serve in, should surely be taken as read. This should be training both in the initial identification of those with autism or a learning disability and in the skills needed to handle such individuals with the necessary sensitivity and insight. I was interested in what the noble Baroness, Lady Barker, had to say about that. The behaviour of a person who is on the autistic spectrum can be baffling to anyone who has had no experience of it, and because of that it can be open to misinterpretation. A situation of that kind carries dangers, which is why it is so necessary for healthcare staff to know how to react in a way that will make the situation better and not worse.

This is not the first time that we have debated this important topic. I believe we may be told by the Minister that mandatory training in these areas is already provided for in Section 20 of the Health and Social Care Act 2008. The provision reads:

“Regulations under this section must require service providers to ensure that each person working for the purpose of the regulated activities carried on by them receives training on learning disability and autism which is appropriate to the person’s role”.


That broad provision was inserted into the 2008 Act thanks to an amendment which your Lordships approved three years ago, during our debates on the Health and Care Act 2022.

So, a provision on training is already enshrined in law; the problem is that we have no way of knowing the extent to which it is being implemented in practice. Hence, Amendment 145 would require the Secretary of State to publish a review on mandatory training for all persons who treat patients with learning disabilities and autism under the 1983 Act and consult as necessary to determine the extent to which health service staff are actually in receipt of such training. I see this amendment as perhaps a logical partner to Amendment 152 in the name of the noble Baroness, Lady Bennett, and indeed, in his absence, to the amendment of the noble Lord, Lord Adebowale.

While the vast majority of people who provide care to people with learning disabilities and autism do so with compassion and professionalism, we have seen a number of failings in care for people with those conditions. At the same time, detention will continue to be necessary in some cases where a patient with autism or a learning disability is suffering from a separate mental health condition. In all those cases, regardless of the context in which a person presents, we need to have confidence that the people providing care have the training they need to deliver that care sensitively, and above all, capably. I would venture to say that the people who need to have most confidence in the system apart from the person receiving the care are the parents or nearest relatives of that person. Hence, I believe we need more transparency on how well the system is working than we have currently.

Incidentally, one of the things that could come out of a review of training is an opportunity to look at the current processes for whistleblowing. An important aspect of improving standards of care is to have a system of accountability that includes listening to everyone in the sector, from the most senior staff to the most junior. No one should be afraid to speak up when they see something going on that does not look right, and I should be very grateful to hear what the Minister has to say on this whole theme and on the other important issues that noble Lords have raised.

NHS Hospitals: Apheresis

Lord Kakkar Excerpts

Wednesday 9th October 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Baroness for raising that issue. I am sure it will be part of the working group’s investigations as it seeks to expand capacity to meet existing demand.

[Lord Kakkar (CB)]

I draw noble Lords’ attention to my registered interests. The Minister has identified the importance of having a framework for the adoption and standard incorporation of innovative technologies into routine care. In this regard, the long-term plan for the NHS that His Majesty’s Government are preparing is a vital element of what will happen over the next five years. Can the Minister confirm that that plan will look specifically at commissioning these innovations in such a way that life sciences innovation in our country is protected, and they get to patients quickly?

[Baroness Merron (Lab)]

Yes, I can confirm that we will be drawing on the parts of the report of the noble Lord, Lord Darzi, that refer to that. He refers to the need for innovation, to expand the use we make of life sciences and to develop that still further. That will very much form part of not just our thinking, but our doing.

NHS: Independent Investigation

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Tuesday 8th October 2024 Lords Chamber

[Baroness Merron (Lab)]

Yes, I certainly agree with my noble friend about the need for better integration. Joint training is a very practical example and will be part of how we develop the workforce, because silo working clearly is not working, as we can see in the current state of affairs, particularly if we look at the relationship between the National Health Service and the social care service. It is not seamless, and individuals are suffering for that, so I very much agree with my noble friend.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests, in particular as chairman of King’s Health Partners and of the King’s Fund. In the report by the noble Lord, Lord Darzi, a picture is clearly painted of what now represents a very serious national challenge in securing the long-term sustainability of our health service and, as the Minister has recognised, the parallel need to consider questions of how we develop a long-term strategy for the provision of social care.

On 18 April this year, in a debate in your Lordships’ House initiated by my noble friend Lord Patel on the question of the long-term sustainability of the health and care systems, there was a discussion about how one might achieve consensus—consensus among the public, consensus among the professions and political consensus to ensure that a plan might be adopted which will require very difficult decisions and great courage and commitment over a sustained period of time to deliver the kind of objective about which we all agree. How will His Majesty’s Government go about developing that consensus in addition to developing the plan that must be applied?

Inflammatory Bowel Disease

Lord Kakkar Excerpts

Monday 20th May 2024 Lords Chamber

[Lord Markham (Con)]

As described by the clinical lead in this, these really are game changers, so getting them back is key. I do not have the figures to hand as to the amount that they get a response from but, in the case of the bowel cancer screening, many of us will be aware that there has been a whole programme which has been very successful in getting those poo tests measured and responded to. We need to learn the same lessons in this area.

[Lord Kakkar (CB)]

My Lords, I draw your Lordships’ attention to my registered interests. To achieve the best outcomes for complex conditions such as inflammatory bowel disease, there is a requirement to ensure that patients are managed by properly skilled multidisciplinary teams. Is the Minister content that, with all the workforce pressures that exist, we are investing sufficiently to develop those teams to ensure the best clinical outcomes?

[Lord Markham (Con)]

The long-term workforce plan sets this out. We are getting a good response in terms of filling up the places. We have about 98% or 99% of the training places filled. The challenge is that this service, more than anything else, suffers from the highest burnout. That is the area where we are struggling to fill the places. Therefore, we are trying to ensure that this scarce resource is used by people and that this early screening test is used so that people can see who they really need to see.

NHS: Long-term Sustainability

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Thursday 18th April 2024 Lords Chamber

[Lord Kakkar (CB)]

My Lords, it is a great pleasure to follow the noble Lord, Lord Bethell, and to congratulate my noble friend Lord Patel on the thoughtful way in which he introduced this important debate. I declare my interests in the register, in particular as chairman of the King’s Fund and as chairman of King’s Health Partners.

My noble friend alluded to the report of your Lordships’ ad hoc Committee on the Long-term Sustainability of the NHS, published in April 2017, to which the Government responded in February 2018. The debate to which he referred extensively covered the questions raised in that report and the Government’s response, but, regrettably, very little has changed since. It must be recognised that we have had the global pandemic, an acute health emergency, and many other challenges, but the reality is that we have not been able to address in any meaningful measure either acute or mid-term challenges in the sustained delivery of health and care in our country, and nor have we even initiated a meaningful approach to its long-term sustainability.

We have heard in this important debate that performance, regrettably, is not where it should be in clinical outcomes. It is well recognised and sought after by all parties in all constituencies that we improve clinical outcomes. They are not as good as modern medicine would predict and could deliver. Operational delivery is poor and its trajectory in the NHS does not appear to be improving. On workforce, we have found it impossible to inspire and motivate healthcare professionals, be they clinicians, nurses or other healthcare professionals, to remain committed to the NHS and be inspired not only to serve but to innovate, undertake research and ensure that the application of that research and innovation is quickly brought to bear for the benefit of patients. More broadly, the research and innovation agenda, which our country has led for so many decades, appears to be falling behind. If that agenda is not at the centre, sustainable healthcare in our country will not be achieved.

That is not to say that there have not been many important and very well-meaning initiatives over decades to address acute problems and longer-term sustainability issues, but they have not delivered. As a result, we must ask how we are going to reach a position where we can develop a national consensus that brings together diverse political, public and professional constituencies with a common understanding and vision for the future—a consensus that is appropriately motivated and understands that what is proposed is deliverable and remains a deep-seated national commitment across the political divide?

Part of the problem may be that questions, with regard to the medium-term or long-term sustainability of health and care in our country, are projected and considered through the lens of a clinical, a delivery or an innovation problem, rather than looking more holistically at all those issues. Some of them were addressed in the previous NHS long-term plan, but they need to be considered more broadly in the context of our country’s economy and other policies, such as immigration, which need to be co-ordinated with a wider understanding of healthcare delivery needs, if we are to have a sustainable long-term plan.

I follow the fine example of my noble friend Lord Patel and ask the Minister, as well as the noble Baroness, Lady Merron, and the Liberal Benches, what approach are they going to take, for the national interest, to achieve consensus on the needs for delivering our country’s health and care? How will this consensus be delivered? In the debate on the noble Lords’ report in 2018, the idea of a royal commission was dismissed as something that was not politically acceptable and would not deliver in a short enough timeframe. Six years have passed since that debate; maybe something like a commission would have delivered the answer in that period. It is now essential that we develop a clear consensus and have the courage to adopt a long-term plan that addresses the holistic needs beyond the question of clinical care alone.

Stroke Treatment

Lord Kakkar Excerpts

Wednesday 27th March 2024 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister mentioned the importance of prevention, which of course is not only primary but secondary prevention. In that regard, for both patients with atrial fibrillation at risk of a stroke and those who have had a stroke, it is vitally important that appropriate therapies, innovations in therapeutic intervention, and broader cardiovascular risk management are provided. Is the Minister content that we have a strategy that provides those opportunities, both for primary and secondary prevention of stroke?

[Lord Markham (Con)]

The noble Lord is quite right. Many noble Lords will have heard me echo Sir Chris Whitty’s words that his major concern about the whole Covid period was that people missed out on blood pressure and cardiovascular checks, which can be early-warning indicators. That is why we see prevention as a major leg of what we are trying to do, through having blood pressure checks and inviting everyone to have their health check every five years. What we are working on, and will be bringing out shortly, is greater use of digital for health checks, to do precisely what the noble Lord says.

Cancer: Staffing

Lord Kakkar Excerpts

Thursday 14th March 2024 Lords Chamber

[Lord Markham (Con)]

First off, I completely agree about continuity of care—in any treatment, to be honest. I was just saying, in answer to a maternity question the other day, that continuity of care in the midwifery space is another vital example. On the question of learning lessons from what the noble Baroness mentioned, we have some meetings set up, so I look forward to discussing it further then.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister rightly identified an improvement in survival rates for those between their late 30s and 69 over the last 30 years. He also accepted the fact that those delivering cancer services are under a huge amount of pressure to ensure timely provision of that care. It is also essential to achieving long-term improvement in outcomes that we continue to innovate and that clinicians are provided the opportunity to participate in clinical research, which validates innovation and allows its adoption at scale and pace. Is the Minister content that we are doing enough to protect time for clinical research and participation by all healthcare professionals in those protocols to drive those advances in innovation?

[Lord Markham (Con)]

First, I completely agree on the need for and the vital importance of clinical research in all this. Providing clinicians with time does two things: it means that they get their incredibly valuable time, resources and brains on it; it also addresses the question asked earlier about retention. Of course, this is why a lot of clinicians want to be in this space, so they have time to do research as well. There are very good personal and medical reasons why they should be allowed to do that.

National Health Service: Key Targets

Lord Kakkar Excerpts

Tuesday 16th January 2024 Lords Chamber

[Lord Markham (Con)]

Staff retention, particularly of GPs, is vital. That is why we listened to the number one reason they were retiring, which was the feeling that their pensions were being adversely affected. We changed the rules in the last Budget to try to address that; it is early days, but I hear that that is starting to make progress. Primary care is the front line. That is why I am pleased that we have increased the number of appointments by more than 50 million, ahead of our manifesto target. But it absolutely needs to be a key focus.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. The long-term—and, indeed, the short and medium-term—sustainability of the NHS is critically dependent upon active engagement in research and the adoption of innovation at scale and pace. Is the Minister content that His Majesty’s Government are doing enough to ensure that the NHS is resourced to support that research and innovation agenda?

[Lord Markham (Con)]

It is key, and I think we are all aware that a couple of years ago—this was a result of the report of the noble Lord, Lord O’Shaughnessy—we were not doing as well as we needed to be in the clinical trials area. I am glad to say that, since then, there has actually been a lot of progress towards it, so we are now hitting similar levels to comparative nations. Innovation is at the heart of everything we have done. We have some very good examples of that; I mentioned the stroke AI treatment earlier. We have just set a similar thing in terms of AI for looking at chest cancers, but it is absolutely something we need to make sure we continue to progress.

Stroke Care

Lord Kakkar Excerpts

Monday 24th July 2023 Lords Chamber

[Lord Markham (Con)]

There are a number of things. For want of a better phrase, we have a tier rating for the different trusts and hospitals and they can be put into the equivalent of special measures—that is not the right term, but the noble Lord knows what I am referring to. Ultimately, the NHS and Ministers also have the ability to hire and fire, as we know that leadership is vital in all these areas.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. It is clearly important that stroke networks are properly supported to deliver clinical care efficiently and effectively but, beyond the capacity to do that, there must also be ongoing capacity to participate in further research and development and to provide the opportunity for appropriate clinical evaluation of innovations that will yet further improve outcomes for those suffering ischemic stroke. Is the Minister content that there is sufficient support for that activity in stroke networks?

[Lord Markham (Con)]

A lot of good work is being done. AI is often used to analyse brain scans very quickly in a lot of these centres that the noble Lord mentions. One of the very good things about trusts is that they have a lot of independence to develop their own initiatives, but sometimes the challenge—which I have really taken up—is getting that innovation adopted widely. I and the Secretary of State are great believers in that but, candidly, we need to work harder on it.

Stroke Rehabilitation and Community Services

Lord Kakkar Excerpts

Wednesday 22nd March 2023 Lords Chamber

[Lord Markham (Con)]

As I say, I see social prescribing as taking in a whole range of arts, music and sport. Given that that is a particular interest of my noble friend, I am happy to follow up on both arts and music.

[Lord Kakkar (CB)]

My Lords, I draw attention to my declared interests. One of the most effective ways to reduce the burden of disease associated with stroke is to intervene earlier in trying to prevent stroke. What approach do His Majesty’s Government take to screening in the community and in populations for risk factors such as heart rhythm disorders, which, once identified, might be managed appropriately and reduce the ultimate burden of stroke?

[Lord Markham (Con)]

The noble Lord makes a very good point. The House has heard me mention before that Sir Chris Whitty’s major concern right now around excess deaths is the cohort aged 50 to 65, as they missed out on three years of blood pressure and cardiovascular tests during the pandemic. With that in mind, we are looking at how we can roll out those sorts of services to the community so that they are accessible. You might not necessarily need a GP appointment, but could be tested in shopping malls and places like that, so that those things are picked up.