(1 year ago)
Lords ChamberI start by thanking the noble Baroness, Lady Morgan, for sending me a briefing in advance of this Question. She rightly and importantly highlights that cancer outcomes for prisoners are poorer than for the rest of the population, while the cost of services is greater. However, given that we will be debating the Mental Health Bill later today, I want to ask a related question. Over 30% of prisoners have a learning disability, so what steps are the Government, the NHS and the Prison Service taking to protect and care for prisoners with learning disabilities? They may be there partly as a result of their learning disability, and while in prison are often at their most vulnerable. What care is there for prisoners with learning difficulties in order to protect the public and reduce the risk of reoffending when they are released?
As the noble Lord rightly says, the Mental Health Bill is in Committee this afternoon and I know we will refer to that. Certainly, the reforms in the Bill will speed up access to specialist in-patient care and treatment, in particular by introducing a statutory 28-day time limit for the transfer of patients from prison and other places of detention to hospital. On particular needs, which may be learning disability and autism, as I know noble Lords are aware, the Mental Health Bill is very focused on ensuring that people are being cared for in the right places in the right way, and that in places of detention people are being not just held but supported and their healthcare needs met.
(1 year ago)
Lords ChamberRetention is absolutely crucial. I was looking—as I know the noble Lord also does—at the vacancy rates and they are currently running at some 131,000. However, I was interested to note that they are not actually the best measure of capacity, or lack of it, because those vacancies can reflect new roles and short-term vacancies because of anticipated staff turnover. So I have had to rein myself in when looking at the relevance of vacancy rates.
On retention, there is a whole range of factors. In the immediate, I say to the noble Lord that we are professionalising the workforce by expanding the national career structure and have developed and launched a level 2 adult social care certificate qualification.
My Lords, as the Government and the NHS introduce new workforce patterns to take account of changes, surely they should also take account of advances in technology. Recent years have seen the successful testing of virtual wards in the NHS to treat and monitor patients who can be discharged from hospital but who require further care. They can be monitored in their home, freeing up capacity in hospitals. Given this, what are the Government and NHS doing to extend virtual social care to monitor care for social care patients? It would allow them to remain in their home for longer, where they are more comfortable, and it could be one of the many ways to alleviate workforce shortages in the social care sector.
I myself have seen some tremendous examples of the use of technology in allowing people to be in the right environment for themselves and their situation. I assure the noble Lord that we are continuing to work to develop medical technology, not just getting it rolled out and applicable but developing new medtech where necessary.
Perhaps I could use this opportunity to make an allied point. We have also published new guidance on safe delegation to care staff, which I hope will also help professionalise the workforce. We are working to support that across the country. That includes, for example, having care staff taking blood pressure. These are simple but obvious measures that I think work for everybody.
(1 year ago)
Lords ChamberI am sorry to hear of the noble Baroness’s experience, which I have heard her speak of before. To me, as I said earlier, it points to the need to treat people with respect, with dignity and without making assumptions. I cannot emphasise enough the need for sensitivity and respect, which applies to everybody.
While we are talking about changing facilities, we should think about the huge difference in shops over the years. There used to be communal changing rooms, but you would be hard pushed to find them now. People have private spaces for changing and this again applies to everybody. I recognise the challenge of the NHS estate, of course, but I am talking about creative solutions and working with staff to get to where we need to be.
My Lords, the noble Baroness is absolutely right to talk about dealing with this issue very sensitively, by respecting people’s dignity and acting with compassion. However, some NHS staff and patients—the noble Baroness, Lady Fox, referred to this—have asked for single-sex provisions to protect their privacy and dignity. If the Government are planning further guidance, how do they intend to achieve that difficult trade-off and balance in potential conflicts between single-sex provisions for NHS staff and patients and the rights of individuals under the Equality Act 2010, while respecting their dignity and acting with compassion?
The noble Lord raises an interesting point. In all cases with guidance, that is always the balance we seek to reach. I am also interested in the history of this, and I am sure the noble Lord will remember that the 2019 guidance on trans patients in single-sex spaces proved somewhat controversial, if I might put it that way. The guidance was meant to be updated under the last Government, but this did not happen. I am advised that it was delayed by a dispute between the previous Government and NHS England, which also delayed proposed updates to the NHS constitution. These again were consulted on under the last Government—which was a good thing—but nothing actually happened. So all these come to us as a new Government and will be given full consideration to get us into the right place.
(1 year ago)
Lords ChamberMy Lords, I begin by echoing the comments made by my right honourable friend the shadow Secretary of State in the other place in support of all those who worked in the NHS and social care sectors over the Christmas period. They sacrificed their time, which could have been spent with their friends and families, to care for those most in need.
On the NHS app, we support the digitisation of health and care to modernise the NHS, and support digital patient records to allow joined-up health and social care to deliver better outcomes for patients and to inform patients. However, the NHS app already sends appointments and updates on treatment to some patients, while some GP surgeries prefer patients to use their own website, not the app. I would be grateful if the Minister could expand on how the updated app will differ and offer up further information to your Lordships’ House. Also, where your GP cannot see you, is the plan to allow all patients to book an appointment with another GP without having to deregister from their current practice and reregister with another practice? Will that be allowed with the updated app? One of the problems was always where there were GPs who could not see their patients but other GPs in the same area had spaces on their lists.
In the Statement, the Secretary of State said:
“We are rewarding trusts that cut waiting times fastest”,
and the carrot of “extra capital investment” is used as an incentive. This appears to make sense, but noble Lords will know that I have always been interested in potential unintended consequences. If the Government reward trusts with extra investment if they cut waiting times fastest, what will happen to those trusts that are not able to cut their lists as quickly? Will they see reduced investment, and will that simply lead to them continuing to perform poorly? What is the solution? Will hit squads—in the best possible terms—be sent in to turn them around? What other plans are there to tackle underperforming trusts which do not qualify for these extra incentives? How do the Government and NHS intend to avoid perverse incentives such as trusts prioritising certain patients over others—not necessarily based on medical needs—to cut waiting times to win this extra cash? How do we avoid that?
On social care, I appreciate the candour of the Statement in acknowledging that Governments of all colours, for decades, have not really dealt with this problem of long-term social care. As my right honourable friend the shadow Secretary of State said in the other place, we will work with the Government and the commission. However, I will put a few observations to the Minister. For decades, successive Governments have known about the ageing population, and Governments of all colours have commissioned report after report, which mostly gathered dust on the shelf. Although I have the greatest respect for the noble Baroness, Lady Casey, given that most commentators on social care agree that everything to be written about funding social care has already been written, I am curious to know what the Government expect to achieve by initiating yet another commission.
A solution was proposed in the Health and Care Act 2022. Noble Lords welcomed that we finally had a solution but disagreed on some of the details. But we had a solution to which the Treasury agreed. I remember the Opposition criticising the Government not for introducing the social care cap but for not doing it earlier, and they also suggested a number of tweaks. The incoming Government could have tweaked the numbers to address the concerns that they expressed at the time, and they could have grasped the nettle, but I am afraid that the announcement looks like yet another Government kicking the can down the road. So will the Minister write to noble Lords with the terms for the commission led by the noble Baroness, Lady Casey? This time, will the Department of Health and Social Care continue to work with the Treasury to ensure that whatever solution is finally proposed, even if it is likely not to be a new solution, has the agreement of the Department of Health and Social Care, other government departments and the Treasury? If not, it will simply find itself kicking the can down the road yet again when it comes to 2028.
My final point is on how to cut the backlog. These Benches welcome the Government continuing the policy of the last Government in opening new surgical hubs and community diagnostic centres at weekends and evenings. But, when we were in government, we found a potential workforce issue in opening community diagnostic centres at weekends and evenings. Of course, there are only so many staff who can be employed to keep these services open for longer, so have the Government made an assessment of how many staff they envisage will be available to keep these centres open for longer hours? What is the plan? Will it be a redeployment of existing staff, will existing staff be asked to work longer hours and overtime, or will they recruit new staff?
My Lords, we on these Benches welcome the Statement and can see some positives in the way forward, but we have some reservations about timescales and unintended consequences in the implementation that I would like to explore with the Minister.
On social care, we have already called for cross-party talks, as many noble Lords will know. Social care is in crisis and at a tipping point, and it is an unbearable pressure for many families. But we cannot understand why the review will take until 2028 and full implementation will probably not happen until 2029-30. It is a bit like calling the fire service when your house is on fire and asking it to attend once it is out. So what specific components of this review that are not already in the public domain have the Government already determined will take until 2028 to be dealt with? Will the review tackle all forms of social care, including continuing care and young people’s services?
The NHS elective reform plan marks a significant initiative for reducing waiting times and enhancing patient access to elective care. The plan introduces some welcome measures, but many are not new, such as the expansion of the diagnostic and surgical hubs, increased utilisation of digital platforms such as the NHS app and a commitment to meeting the 18-week referral to treatment standard by the end of this Parliament. Although these proposals are commendable, I have been of the view for many years that elective and emergency care need to be provided in different, and probably separate, ways. Several critical concerns warrant attention to ensure the plan’s success and sustainability.
A primary concern is that the plan focuses predominantly on elective care, potentially overlooking the broader health and social care ecosystem. The Nuffield Trust emphasises that, for the plan to be sustainable, there need to be concurrent reforms in social care, significant investment in community services and attention paid to the determinants of ill health, such as housing and education. The focus on throughput measures will mean that it will be focused purely on those. What outcome measures will be put in place, not just for the quantity and speed of care but for the clinical outcomes for patients?
The emphasis on meeting elective care targets should not overshadow other clinical priorities. It is critical to ensure that resources allocated to elective procedures do not detract from urgent and complex care needs. Indeed, the financial model set out in the plan on tariffs will create incentives to focus on elective cases when budgets are stretched. What measures will be put in place so that the expanded diagnostic and surgical hubs, along with the extra reported 3.5 million procedures in the independent sector, will avoid pulling staff away from urgent care and complicated patient needs? This must be based on a fully costed workforce plan, so when will that be presented?
The plan has been announced with little firm detail on funding, especially considering that the £3 billion ring-fenced for cutting waiting times this financial year will not be available from April. Will this ring-fenced scheme be reintroduced? While we welcome the thrust of this plan, there will be some unintended consequences, and we really need to see a detailed implementation plan to ensure that elective care does not overshadow emergency care and those seeking social care.
(1 year ago)
Lords ChamberThe noble Lord raises a very interesting point. It is certainly the case that those who consume ultra-processed food have around 50% of their calorific intake through that matter. Where there is not clarity is on whether the foods are unhealthy due to processing or to their nutritional content. On that, the jury is out. We need to establish that. That is the why the Government’s Scientific Advisory Committee on Nutrition has concluded that the association between UPFs and health is concerning. We need to get to the bottom of why that is.
My Lords, the Minister rightly talked about the importance of creating the right environment for people to eat healthily. Some noble Lords may have seen daytime television programmes that help families to eat healthily on a budget. The challenge has always been how we take these lessons into people’s homes. I recently spoke to BRITE Box, a local community charity which gives families the ingredients and a recipe card with instructions to help them to cook healthy meals together. This helps with not only budgeting but addressing obesity. Rather than a top-down approach from the Government, what steps are they and the NHS taking to work with existing projects such as BRITE Box to take a bottom-up, community-led approach to tackling obesity?
(1 year, 1 month ago)
Lords ChamberMy Lords, I begin by wishing the Minister and all noble Lords a happy new year. The Minister will know that most hospices are charitable, independent organisations, which the Government have recently thumped with increased costs through the rise in employer national insurance and the increase in the minimum wage, which, while welcome, also adds to costs. Will the announced increase in funding fully cover the costs that hospices will face from the rise in employer national insurance contributions and the increase in the national minimum wage? Instead of imposing extra taxes on hospices then giving them back some of the money that they will have paid due to the increase in national insurance, would it not have been better to exempt hospices and other health-related charities from the national insurance increases in the first place? Can the Minister also confirm that increasing the costs imposed on hospices and other health-related charities is not a deliberate attempt to drive out non-state providers?
(1 year, 1 month ago)
Lords ChamberMy Lords, I thank the Minister for the Statement and the right honourable Secretary of State for the careful and sensitive way in which he delivered the Statement in the other place. In line with my right honourable friend the shadow Secretary of State in the other place, from these Benches we welcome the Government’s announcement. Whatever your politics, most people believe that one of the first duties of any Government is to protect their citizens, especially our children.
As the Secretary of State said, there has been too much heat, and perhaps toxicity, around the issue of services for children experiencing gender dysphoria, so I welcome the tone with which His Majesty’s Government have approached this issue—less heat, more light—and that they continue to take an evidence-based but compassionate approach. I also take this opportunity to thank the noble Baroness, Lady Cass, for leading the review on gender services for children. The Cass review highlighted the importance of putting scientific evidence above ideology and laid out the fact that we simply do not know enough about the long-term impacts of puberty blockers on children. That is why my right honourable friend in the other place, the Member for Louth and Horncastle, when Secretary of State, banned the routine prescription of puberty blockers for gender dysphoria, and later extended that ban to private clinics.
We welcome the decision of the Government to follow the recommendations of the independent Commission on Human Medicines to extend the banning order until a safe prescribing environment can be established for these medicines. This is a common-sense approach, and allows time for more evidence to be examined to consider the holistic and long-term impacts of puberty blockers on children. The Secretary of State announced the clinical trials to gather evidence but, given understandable concerns about the risks of any clinical trial, can the Minister reassure your Lordships that these trials will have robust safeguards to ensure the well-being and safety of any children taking part, while recognising the importance of having these trials in the first place?
The Secretary of State in the other place also spoke about alternatives to puberty blockers for children suffering from gender dysphoria. As someone who takes an interest in social prescribing, I welcome the Government’s recognition that medication is not always the best solution, so will the Minister share details of some of the alternatives to puberty blockers that will be offered to children?
Finally, noble Lords will be concerned that, despite the lack of evidence, puberty blockers were prescribed to children with gender dysphoria when their safety could not be guaranteed. What steps are the Government and the NHS taking to ensure that a similar situation does not occur again and that future decisions are led by evidence? I look forward to the Minister’s responses.
My Lords, on these Benches we welcome the tone of the Secretary of State’s Statement. I have often said that there are many ways of being human. Growing up can often be a very trying time for teenagers. How much more difficult, then, for those young people with gender distress who are struggling with finding out who they are while being different from their peers, and all without adequate support? It is high time that proper services were put in place for young people struggling alone with these issues. Their families too need help to support them at this difficult time. For too long, children and young people who are struggling with their gender identity have been badly let down by a low standard of care, exceptionally long waiting lists, even by the standard of mental health waiting lists, and an increasingly toxic debate.
We always want to see policy based on the evidence. With any medical treatment, especially for children and young people, the most important thing is to follow the evidence on safety and effectiveness. It is crucial that these sorts of decisions are made by expert clinicians, based on the best possible evidence. It is also important that the results of the consultation and the advice of the Commission on Human Medicines are made public.
Some might wonder why the treatment is deemed not safe for gender dysphoria patients but safe enough for children with early-onset puberty. More transparency might clear up the confusion and give more confidence to patients and their families. However, the Secretary of State himself admits that he does not know what effect the sudden withdrawal of this treatment for young people already embarked on a course of puberty blockers will have. These are the young people with the most urgent need for other types of care in the current situation, so what clinical advice have the Government taken about the effect of withdrawing these drugs on the physical and mental state of young sufferers of gender incongruence already on the drugs, and what physical and psychological support will be offered to them?
In the current circumstances, plans for a clinical trial are welcome, but we would like to know the criteria for those eligible to participate. What assessment have the Government made of the recent Council of Europe report, which raises the ethical and rights implications of offering participation in the trial to only a small group of patients? If the only way to continue access to these drugs is through participation in the clinical trial, whose scope, length and start date have yet to be announced, this lays the Government open to accusations of coercion and breaches of human rights.
We welcome the plans for additional treatment centres in Manchester and Bristol as well as London, but can the Minister say why they will not be up and running for two years? Is it lack of funding, lack of premises or lack of sufficient therapists with the appropriate specialist training? This is a very sensitive area, so the wrong people could do more harm than good. If that is the reason, is there a plan for training up more qualified therapists in time for the opening of the regional treatment centres? I very much look forward to the Minister’s replies to these questions.
(1 year, 1 month ago)
Grand CommitteeMy Lords, I begin by thanking the noble Baroness, Lady Ramsey of Wall Heath, for securing this important debate, as well as for having some discussions before the debate so that I could better understand the issue. I am also grateful to the House of Lords Library for its briefing and to others who have sent briefings.
The noble Baroness and the noble Lord, Lord Mendelsohn, spoke passionately about their personal experiences as parents, and especially about the care that patients with allergies receive during the transition from childhood to being considered adults. I myself know family members whose children decided to go to a local university rather than go elsewhere because they knew that their local hospital had the best treatment and were not sure what the treatment would be like if they moved to another university town. Other noble Lords have alluded to a postcode lottery.
The noble Lord, Lord Scriven, said that such stories bring the statistics to life, but it is really important for us to talk about numbers. I read one report, I think by ITN, which said that 44% of adults in the UK have at least one allergy, but that includes asthma; other noble Lords have said it is one in three. Whatever the figure, it is far too high. We have seen, as the medical journal the Lancet has found, that the rate of food allergies has increased over the past decade. The noble Lord, Lord Mendelsohn, also mentioned that.
Plenty of those with allergies can continue to live normal lives, but there are an ever-increasing number of people whose allergies are debilitating. They cannot eat certain foods, and they are unable to use certain medications. They must constantly scan the list of ingredients of the food they wish to eat, either by reading the small print on labels or accessing companies’ or third-party websites, or, as the noble Baroness, Lady Keeley, said, they have to pay more for gluten-free or other foods according to their dietary requirements.
This may seem obvious, but food is one of humankind’s basic needs. It is an integral part of our daily lives, and so it is only right that we take the necessary steps to help those with allergies. It was reassuring to hear from the noble Baroness, Lady Burt, about the advice that was in her hotel room should you encounter someone suffering a severe allergic reaction. The question is how we spread that from hotel rooms to schools and more places.
The noble Lord, Lord Mendelsohn, and the noble Baroness, Lady Keeley, spoke about the sad story of Natasha Ednan-Laperouse, who tragically died in 2019 due to anaphylactic shock. Her case led to the so-called Natasha’s law, requiring all foods to carry a list of ingredients. I am proud, and I am sure that noble Lords are grateful, that swift action was taken by the previous Government. Indeed, it is a measure that has since helped countless sufferers of allergies to understand the food that they are consuming and the harms that they may cause.
We know, however, that more needs to be done. It is therefore welcome that the new Government are developing an allergy strategy. But what of the National Health Service’s role? As noble Lords will be aware, before the general election, Allergy UK published a list of steps that it wanted the new Government to take. As the noble Baroness, Lady Healy, has said, one proposal was that there should be an allergen specialist or dietician at the primary care level—the rationale behind this being that it would allow those with allergies to access specialised care, no matter where they may live. This seems a common-sense proposal, since it would enable those living with serious allergies to seek help with managing their allergies early in the process of diagnosis so that they can have a better quality of life and are not unnecessarily constrained by their allergies.
Noble Lords will also understand that there are resource constraints and that the Government of the day have to consider carefully where they allocate taxpayers’ money, given competing demands. I want to reassure the Minister that I understand from my time as a Minister the difficulties due to resource constraints and, sometimes, the practicalities of implementation, but that does not stop noble Lords asking the questions. Is this a policy idea that has been discussed within her department and with the NHS to work out its feasibility? I would be grateful for her assurances.
Like other noble Lords, I too wonder what more can be done within existing NHS structures. Some of the information is there, but how do we spread it nationally from ICB to ICB? How do we get it into schools? How do we get it beyond the hotel rooms? How do we make more people aware, so that when it is announced on a flight that nuts will not be served on a flight because someone has an allergy we avoid the collective groan and hear more understanding of those who suffer from these conditions?
Can the Minister explain what plans there are for all clinicians, including in primary care, secondary care and accident and emergency departments, as well as for other hospital employees, to be suitably trained and made aware of how to deal with patients who have serious allergies, as the noble Lord, Lord Scriven, alluded to? Has any thought been given to an allergy tsar, as the noble Lord, Lord Mendelsohn, mentioned? What safeguards are in place to ensure that no one with allergies slips through the net and is administered medication that contains ingredients they should not take? The noble Baroness, Lady Keeley, and the noble Lord, Lord Scriven, spoke about preventative strategies. What explicit preventative strategies are the Government and the NHS considering?
I know that all noble Lords are grateful to the noble Baroness, Lady Ramsey of Wall Heath, for securing this important debate and we look forward to the Minister’s responses.
(1 year, 1 month ago)
Lords ChamberAs I mentioned earlier, while 24 months is a realistic transition, not everything will wait that long. It is the case, as the noble Baroness says, that there is still advice to women who could become pregnant to take folic acid supplements, and it is important that we keep that message going. However, 50% of pregnancies are not planned, so it is not possible to prepare by taking supplements. We are looking at all ways of effectively getting the message across.
My Lords, I congratulate the Government on publishing the regulation. I pay my own tribute to the noble Lord, Lord Rooker—although he may not welcome it—for his tenacity on this particular issue. One of my frustrations when I was a Minister on this was how long the processes and consultations took. For future reference, if other supplements are to be introduced into our food, I wonder whether the department has looked at ways in which it could possibly shorten the process without compromising patient safety.
Patient safety is at the forefront of this. I do not want to look backwards, but I gently suggest that there are all sorts of reasons for delays. Still, we are where we are now, and what is important is moving ahead. We are working closely with the Chief Medical Officers across the UK. We are very much in lockstep with the devolved Governments, and I think that will also assist.
(1 year, 1 month ago)
Lords ChamberMay I express my gratitude to the Chief Whip for reminding me that there were no Prayers?
My noble friend Lady Merron is now here.
We have already made a number of commitments, but the noble Baroness is quite right to observe the excessive numbers on the waiting list. We are deeply aware of the distress and continuing difficulty that this causes for many. The noble Lord, Lord Darzi, in his independent investigation, confirmed that about 1 million people are waiting for mental health support as of April 2024. Moving to the 10-year plan will be an opportunity to put mental health services in a different place. In addition to the commitments that the noble Baroness has mentioned, we are providing access to a specialist mental health professional in every school and providing open-access Young Futures hubs.
My Lords, I am grateful to the noble Lord, Lord Alton, for organising a recent meeting with the Minister, the MHRA and some psychiatrists, who raised the issue of SSRIs and their side-effects. One concern was that patients need to be aware that one side-effect of SSRIs is to have suicidal thoughts. Therefore, I was surprised to see on the NHS website’s page on the side-effects of anti-depressants that you have to scroll down four or five pages before seeing the warning signs about suicidal thoughts. While we await the review from the MHRA which it discussed with us, will the Government and the NHS look at the advice on the website so that those who are prescribed SSRIs are clearer about the risk of suicidal thoughts?
I would be happy to look at that. However, there have been warnings on the leaflets accompanying medication for some 20 years. It is always a cause to review to ensure that it is most effective. There are at least two sides to this. One is the clinician doing their job to discuss side-effects, including on withdrawal from the medication, but it is important that patients understand it as well.