Domestic Abuse: General Practitioner Charges

Lord Kennedy of Southwark Excerpts

Thursday 15th November 2018 Lords Chamber

Asked by

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what progress they have made in the general practitioner contract negotiations for 2019–20 to end charges for the provision of evidence of domestic abuse.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, the Department of Health and Social Care has put this important issue forward as part of the general practice contract negotiations for 2019-20. While the progress of those negotiations is not discussed publicly until an agreement has been reached, I can reassure the House that the Government are committed to dealing with this issue.

[Lord Kennedy of Southwark (Lab Co-op)]

My Lords, survivors often need to provide evidence of abuse when applying for legal aid and for anonymous registration, and a letter from a GP is an acceptable form of evidence. GPs are able to charge survivors for this letter—in some cases over £150—and this is unacceptable. Can the Minister confirm, without question, that it is the official position of the Government to stop charges for these letters being made and that, either through the current negotiations or legislation, these fees will be banned?

[Lord O'Shaughnessy]

I agree with the noble Lord. I feel uncomfortable with the idea of these letters being charged for. They have been identified by the Ministry of Justice and MHCLG as barriers to accessing support for victims of domestic violence. That cannot be right, and we are seeking to end that situation. GPs are independent contractors and therefore have that freedom unless it is specifically prohibited in their contracts, and that is what we are seeking.

Grenfell Tower: Toxins

Lord Kennedy of Southwark Excerpts

Monday 15th October 2018 Lords Chamber

Asked by

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what steps they will take in response to concerns over the level of toxins found at the Grenfell Tower site and calls for survivors, firefighters and local residents to undergo immediate tests to monitor any damage to their DNA.

[Lord Kennedy of Southwark (Lab Co-op)]

My Lords, I beg leave to ask a Question of which I have given private notice.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, human biomonitoring—the measurement of chemicals in biological tissue such as blood or saliva—cannot be used to determine whether those who were exposed to contaminants in the incident 16 months ago suffered any damage. That is because results from this type of analysis provide information on total exposure over many years which could be influenced by a multitude of factors not related to a specific period of exposure. In addition, there would not be a baseline—that is, results prior to the fire—against which to compare new results. Consequently, Public Health England does not recommend human biomonitoring in this scenario, although other environmental monitoring continues to take place.

[Lord Kennedy of Southwark]

My Lords, can the noble Lord say whether it is true that Professor Anna Stec, a world-leading expert on toxicology, has privately urged Public Health England and the Department of Health to organise a range of tests to ensure that any potential health risks can be properly assessed and that Public Health England has decided not to do that until receipt of Professor Stec’s report some time next year? Is he also aware of reports of what is being called the “Grenfell cough”, which Professor Stec has said seems to indicate a high level of atmospheric contaminants?

[Lord O'Shaughnessy]

The Government are of course very concerned about all the consequences for mental and physical health that may result from the Grenfell fire. As the noble Lord will know, there has been a huge concerted effort to try to ameliorate those.

The noble Lord asked about environmental monitoring. Since summer 2017, monitoring has been ongoing, with weekly reports published by the London Air Quality Network, which is operated by King’s College London and is, therefore, at arm’s length from government. The reports provide information on the levels of particulates, asbestos and other contaminants in the air. The London Air Quality Network has found no evidence that the levels are above average for London, but monitoring continues. Public Health England is in discussions with the local authority and the local NHS trust to make sure that any signs of public health threats, from whichever area they emerge, are looked into seriously. However, we have not yet had those findings from the professor, and Public Health England is very keen to see that information as soon as possible.

Health: Hormone Pregnancy Tests

Lord Kennedy of Southwark Excerpts

Thursday 21st January 2016 Lords Chamber

Asked by

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what is the timeframe for the inquiry into the safety of hormone pregnancy tests, and when they expect the report to be published.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, an expert working group of the Commission on Human Medicines has been convened to review all available evidence on whether use of hormone pregnancy tests may have been associated with adverse outcomes in pregnancy. The group met twice in 2015 and a number of further meetings will be held in 2016. A report of the group’s findings will be published once the review is complete, which is expected before the end of the year.

[Lord Kennedy of Southwark (Lab)]

My Lords, the terms of reference of the inquiry still do not include past regulatory failures and the campaigners fear a veil of secrecy and an inability to get to the truth. What can the Minister say today to alleviate people’s fears? Will he agree to meet a delegation of campaigners and interested Peers to discuss how we can shine a light on what happened to learn the lessons of the past so that they are there for the future?

[Lord Prior of Brampton]

My Lords, this issue goes back to the 1950s, so trawling back over that period may not be that helpful. What is helpful is that we learn lessons from the past so that the existing regulatory system can learn from those errors. I am, however, very happy to meet the noble Lord and others who are interested to discuss this further, if they wish to do so.

NHS: Dermatology Services

Lord Kennedy of Southwark Excerpts

Wednesday 17th December 2014 Lords Chamber

Asked by

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what action they are taking to improve dermatology services in the National Health Service.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, we want all patients with dermatological conditions to have access to high-quality, patient-centred services wherever they live. NHS England has set national standards to ensure that the needs of patients with the rarest skin conditions are met, the National Institute for Health and Care Excellence has published clinical guidance and quality standards to drive improvement for common conditions, and we are currently investing more than £9 million in dermatology research.

[Lord Kennedy of Southwark (Lab)]

My Lords, does the noble Earl believe that we have the balance right between the training that doctors and other healthcare professionals receive and the people they have to deal with, who have conditions ranging from minor skin complaints to serious skin cancers? If we do not have the balance right, what appropriate changes have to be made to make sure that patients are provided with the best possible care?

[Earl Howe]

My Lords, the Government have mandated Health Education England to provide national leadership on education, training and workforce development. Dermatology is currently a key part of the generalist undergraduate medical curriculum and a component of GP training. The General Medical Council requires that the undergraduate medical curriculum should provide enough structured clinical placements to enable students to demonstrate the outcomes for graduates across a range of clinical specialties, including dermatology.

Care Sector

Lord Kennedy of Southwark Excerpts

Tuesday 25th November 2014 Lords Chamber

[Lord Kennedy of Southwark (Lab)]

My Lords, like other noble Lords who have spoken in this debate, I congratulate my noble friend Lady Kingsmill on securing this important debate today and on the review that she undertook into the working conditions in the care sector, which certainly deserves more attention in the media. The review is an important marker that highlights some of the most pressing issues surrounding working conditions in the care sector and how unacceptable these conditions are. It is for government to take action to deal with the worst excesses. The noble Baroness, Lady Gardner of Parkes, highlighted some of those in her contribution. My right honorable friend in the other place, Mr Andrew Smith, highlighted some of these issues in the Westminster Hall debate held on 14 November—as my noble friend Lady Andrews mentioned.

In my remarks this evening I want to talk about the working poor, the problems that they face and the fact that the care industry has lots of people working in it who can be described as working poor. Maybe some years ago it would have been suggested that poor people are those who are unemployed and have no job. We have also talked about and identified pensioners who are in poverty, but this concept of working poor and the fact that this is growing should be a matter of much regret and shame. My right honourable friend Andrew Smith quoted Winston Churchill, who spoke in the other place in 1909. He said:

“It is a serious national evil that any class of His Majesty’s subjects should receive less than a living wage in return for their utmost exertions … where you have what we call sweated trades, you have no organisation, no parity of bargaining, the good employer is undercut by the bad and the bad by the worst; the worker, whose whole livelihood depends upon the industry, is undersold by the worker who only takes up the trade as a second string … where these conditions prevail you have not a condition of progress, but a condition of progressive degeneration”.—[Official Report, 28/4/1909; Commons; col. 388.]

Things have without doubt improved since 1909, but there are unfortunately numerous examples such as those referred to in this debate where bad practice exploits workers and people are treated very badly, and it is the duty of government to protect workers from this exploitation. I would say that the Government will have to be a little more proactive in this area to convince me that this is something they are truly committed to delivering on.

Returning to the point I made about the working poor, this sector employs the vast majority of people in the private sector or in the voluntary sector, amounting to about 76% of the total workforce of approximately 1.15 million, with nearly two-thirds working in private establishments. It is a matter of much regret that the sector has high levels of non-compliance with the national minimum wage, to which my noble friend Lady Andrews referred, and I hope that the noble Earl will tell us what will be done to make good this terrible wrong.

The growth in zero hours contracts in this sector, to which my noble friend Lord McKenzie of Luton referred, is generally encouraging exploitation of workers and making life difficult and unstable. Some people may like the ability to fix their employment hours week by week or day by day but I contend that it is a significant minority. According to the latest report by the Joseph Rowntree Foundation, insecure, low-paid jobs are leaving record numbers of working families in poverty, with two-thirds of people who found work in the past year taking jobs for less than the living wage—and a large number of those jobs will be in this sector.

The living wage is calculated at £7.85 an hour nationally and £9.15 in London, which is much higher than the legally enforceable but still breached minimum wage of £6.50 per hour. While not all these issues are in the noble Earl’s area of responsibility, I hope that he can see the perfect storm of people working in a sector where the majority of staff are on low wages, the problems that that can bring in not being able to provide an income to be able to look after yourself and your family, and the reliance on the benefits system. We should add to that the housing crisis, where we have low-paid workers who are not able to get a foothold on the property ladder and are unable to get into social housing, so they are forced into the private rented sector. Then we have banks refusing to lend to people, so access to affordable forms of credit is more difficult or not available at all. People are pushed into more expensive and unsuitable forms of credit and, as I said earlier, we have the perfect storm, because these things come together: they are not in isolation.

The care worker being exploited by an unscrupulous employer and not paid even the minimum wage will be the same person who is struggling to make ends meet. They will be the same person who goes to the bank and is unlikely to get the financial products they want at an affordable price. They may also, through desperation, purchase financial products that are totally unsuitable: payday loans, logbook loans and other unsatisfactory rip-off products. They are also more likely to live in an area that does not have an abundance of free cash machines—they will pay to get their own money out—and are more likely to live in poor accommodation.

As I said, not all of those things are in the noble Earl’s immediate area of responsibility, but as a member of Her Majesty’s Government I am sure he will agree these are serious matters that a joined-up and collective approach by government needs to address. In conclusion, I look forward to the noble Earl’s response, and that of my noble friend Lord Hunt of Kings Heath.

NHS: Funding

Lord Kennedy of Southwark Excerpts

Monday 17th November 2014 Lords Chamber

Asked by

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what action they intend to take to deal with the projected funding gap for the National Health Service in England.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, NHS spending has increased in real terms by £5 billion over this Parliament, underlining the priority the Government place on the NHS. NHS England’s Five Year Forward View set out a range of future scenarios. While NHS funding beyond 2015-16 will be a matter for the next spending review, the Government believe that changes in the way that services are delivered are essential, both to moderate rapid increases in demand and to improve efficiency.

[Lord Kennedy of Southwark (Lab)]

My Lords, I first declare an interest as president of the Society of Chiropodists and Podiatrists, a small trade union professional association that has members working in the health service.

Is the noble Earl aware of the concerns of the BMA and others that the recent changes to NHS structures, particularly funding structures, actually risk worsening health inequalities? What will the noble Earl do to ensure that that does not come to fruition?

[Earl Howe]

My Lords, tackling health inequalities is one of the major tasks facing NHS England. It is built not only into its mandate but into legislation, and we expect NHS England to address it at every level—both in the acute area and in the community. It is of course up to local commissioners to prioritise their funding, but we expect to see over the next few years a shift from care in the acute sector to care in the community, both to prevent acute admissions and to ensure that people stay healthy for longer in their own homes.

NHS: Ambulance Response Times

Lord Kennedy of Southwark Excerpts

Monday 21st July 2014 Lords Chamber

Asked by

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what assessment they have made of ambulance 999 response times.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, the NHS is responding to the majority of emergency calls in less than eight minutes, despite the number of these calls having increased by almost 14% from 2011-12 to 2013-14. The NHS has been supported to ensure that urgent and emergency care services are sustainable all year round and are ready for the pressures that winter can bring. Some £18 million will be allocated directly to ambulance service commissioners with a further £10 million to ensure sustained high performance.

[Lord Kennedy of Southwark (Lab)]

My Lords, FOI disclosures indicate that, since 2010, seven out of 10 of England’s ambulance trusts have increased their spending on commercial and voluntary ambulances. In London, spending has grown from £829,000 in 2010 to £9.2 million in 2013. Does the noble Earl share the concern of the president of the College of Emergency Medicine, Dr Clifford Mann, who has said that this is an issue which is causing deep concern and is,

“incredibly wasteful and potentially dangerous”?

[Earl Howe]

My Lords, patients have the right to a high-quality urgent and emergency care service whenever they call upon it, and we expect ambulance trusts to provide that. We are aware that independent or voluntary ambulance services may be used to support NHS ambulance services because they can help manage peaks in demand. Individual NHS ambulance services have got to ensure that 999 calls are attended by staff who are properly trained and adequately equipped. Indeed, since 2011 the providers of independent ambulance services have had to register with the Care Quality Commission, which monitors, inspects and regulates all services.

NHS: Better Care Fund

Lord Kennedy of Southwark Excerpts

Thursday 3rd July 2014 Lords Chamber

Asked by

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what effect the better care fund is having on the ability of the National Health Service to provide services to patients.

[Lord Kennedy of Southwark (Lab)]

My Lords, I am delighted to have secured this debate today. We are all getting older and living longer, and that is very welcome, as medical and scientific advances make illness and diseases that would have killed us off no longer the threat to us that they were. There is still much to do, although that progress is very welcome.

However, as a consequence, we have an ageing population, which brings its own challenges: how we care for people as they live to a much older age and more people living with long-term conditions. It has long been recognised and has been an aim of Governments to deliver better integration of health and social care and improve people’s health and well-being by ensuring continuity of care while making the best use of resources.

I am sure that, in his response, the noble Earl will tell the House in some detail about the pooling of funds and the plans for local areas, including: the sharing of data and improving continuity of care; the plans for acting earlier so that people can stay healthy and independent at home; and delivering care that is centred on individual needs, with NHS and social care staff working together to deliver better outcomes for individuals.

The King’s Fund has done interesting research in this area and made some predictions about what will be the needs, how we will be living, and the pressures that that will place on the NHS. Those are important considerations in the planning that needs to be undertaken to meet the challenges ahead.

In the next 20 years, the number of people aged over 85 is expected to double. By 2030, the number of older people with care needs is expected to rise by 61%. At the same time, we expect 40% of households to be comprised of people living on their own. The number of people with dementia is expected to more than double in the next 30 years.

It is also a fact that people from the most affluent socioeconomic classes can expect to live as much as seven years longer than those from the poorest socioeconomic classes. Those and similar statistics point to increased pressure and demand on health and social care services, and government at all levels has to respond effectively to that challenge.

The better care fund is a good initiative but, as with many other things that the Government are doing in the area of health, I always have a niggling doubt whether they will put the resources in place to deliver the outcomes that we all want. I do not doubt the noble Earl’s personal commitment but as with many things in the health and social care sector, money more wisely spent at an earlier stage can deliver much better results for the patients and cost much less to the NHS.

I am a diabetic and I declare an interest as an active member of the charity Diabetes UK. I take the example of diabetic foot care and the fact that so many people have unnecessary amputations. Those could so easily be avoided; we are just not dealing with this issue. The cost to the individuals is high and traumatic. Then there is the cost to the NHS for the operations and the aftercare, and of course the projected lifespan after that, too. We need to ensure that people are able to enjoy an active and healthy life within their own communities, thereby reducing the demand for health and social care services. Well over two-thirds of patient bed days are for people with long-term conditions and a greater emphasis on self-management programmes can help to reduce unplanned hospital admissions. Ambulatory care-sensitive conditions accounted for 15.9% of all hospital admissions in England in 2009-10, with an estimated cost to the public purse of £1.42 billion. The rate of admission for those conditions in the most deprived areas was twice that in the least deprived.

Older people who are frail are a key concern for health and social care services and are at risk of sudden decline, including falling or becoming immobile. Identifying those at risk of falls and the setting-up of fracture prevention services for older people has been found to reduce hospital admissions and the need for social care, such as admission to a care home. Care co-ordination and proper case management, if well designed, has the potential to deliver better and more cost-effective care for the individual. However, as I have said, all these things have to be properly resourced to deliver the intended outcomes and savings in the future.

Just look at the whole area of emergency admissions, which can account for 70% of hospital bed days and 80% of stays of two weeks or more. A whole range of factors are at play here for hospital admissions including age, social deprivation, ethnicity and living in an urban area. A lack of alternative options then sees people being admitted to a hospital bed. That might not be the best thing for them but there is no alternative. Then on discharge, the important thing is to have a proper discharge plan in place so that people can remain at home in the long term and regain their independence.

At this point I declare that I am a member of Lewisham Borough Council, which will be involved in delivering services through the fund. The Local Government Association expressed concerns as recently as last month, warning that a larger better care fund is needed for a five-year period, with alongside that a separate transformation fund to ease the impact of these changes. It rightly expressed concern about the lack of clarity on the future of health and social care funding, which could put at risk the efforts to integrate services. The LGA is urging the Government to commit to a five-year plan, taking us to 2020. Can the noble Earl confirm whether this will in fact be delivered? If he cannot, can he tell the House why not? As I said, my worry is that the plan will falter because its provision of resources will be too short-sighted.

I have a number of questions for the noble Earl. If he can answer from the Dispatch Box that would be much appreciated. I do not expect him to do so; all I ask is that he gives a commitment to write to me afterwards and copy that to other noble Lords who speak in the debate today. I will take each question in turn. Will diabetes and diabetes foot care be prioritised as part of the better care fund? Will dementia be prioritised as part of it? Are there any plans to change the procurement rules when implementing the better care fund? What does seven-day working for social care mean? Is it correct that the health and well-being board chairs will have to sign off their local plans? What happens if the parties involved in devising a local plan cannot reach agreement? Is the better care fund’s additional allocation of funding in 2015-16 recurring or non-recurring?

In conclusion, I am delighted to have secured this debate. I look forward to the contributions of all noble Lords, including my noble friend Lord Hunt of Kings Heath and of course the noble Earl.

National Health Service: Hospital Beds

Lord Kennedy of Southwark Excerpts

Wednesday 11th June 2014 Lords Chamber

Asked by

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what is their response to the Organisation for Economic Co-operation and Development’s report on the number of hospital beds per person in the United Kingdom in comparison to Europe.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, numbers of hospital beds per person do not provide meaningful comparisons of good-quality care. Our NHS is making efficient use of its beds by judging patient demand and managing bed numbers accordingly. In the NHS, as in Europe, the number of beds has reduced because progress in medical technology is enabling more patients to be treated and discharged on the same day, and average length of hospital stay has reduced over the past decade.

[Lord Kennedy of Southwark (Lab)]

My Lords, France has twice the number of beds we have here in the UK while Germany, I think, has nearly three times as many. We are now seeing dangerous levels of overcrowding, with greater risk of infection due to beds not being cleaned properly in time. Does the Minister not see that this is very reminiscent of the previous time his party was in office and that the NHS is just not safe in their hands?

[Earl Howe]

No, in a word. First of all, it is very important to compare like with like. A number of other health systems have completely different models from our own. For example, they still have large, long-stay hospitals for people with mental health problems and older people. The NHS has a strong primary care tradition and is committed to providing care in the community. Some of the statistics that have been collated by the OECD include systems in Europe where nursing home beds are included in the figures or indeed the private sector. We are seeing healthcare infections at their lowest ever levels. There have been dramatic falls in both MRSA and C. diff infections since 2010.

Drug Companies: Medical Trials

Lord Kennedy of Southwark Excerpts

Monday 24th February 2014 Lords Chamber

Asked by

[Lord Kennedy of Southwark]

To ask Her Majesty’s Government what action they intend to take in respect of drug companies that withhold the results of medical trials.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, companies are legally required through the marketing authorisation application process to provide the relevant regulatory authority with all information for evaluation of a medicine. This includes clinical trial results which are both favourable and unfavourable. The Medicines and Healthcare products Regulatory Agency has powers to take action where particulars supporting an application are incorrect or where the company has failed to inform authorities of new information that would influence the evaluation of the benefits and risks of the product.

[Lord Kennedy of Southwark (Lab)]

My Lords, the number 1 risk on the Government’s national risk assessment for civil emergencies, ahead of both coastal flooding and a major terrorist incident, is that of pandemic influenza. Is the noble Lord concerned that Tamiflu, which is supplied for use in a flu epidemic, may not be as effective as was once thought? Is he concerned that many large-scale trials of Tamiflu have not been publicly reported?

[Earl Howe]

My Lords, during the course of last year, the Government gave detailed evidence to the Science and Technology Committee on the issue of data provision in respect of clinical trials. The committee made a number of helpful recommendations on the removal of barriers to transparency. In our formal response, we set out how we would work to achieve the aims of greater transparency. In the light of that response, the Government are looking into the recommendations of the PAC report on the stockpiling of Tamiflu and access to clinical trials data, published in January. We will give our formal response to the report next month.