Coronavirus Bill

Lord Oates Excerpts

2nd reading & 2nd reading (Hansard - continued) & 2nd reading (Hansard - continued): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Lord Oates (LD)]

As many noble Lords have noted, this Bill contains unprecedented powers, but we recognise that it comes before us in unprecedented times. Its purpose is to protect the lives of the public and to provide the National Health Service with the best chance of minimising the death toll from this virus. We owe NHS staff, the staff in our care services and all key workers who are working so hard and taking many risks to keep all of us safe, an immeasurable debt of gratitude. Among all the debts that we as a country will run up in tackling this virus, that will remain by far the greatest debt.

I support the Government in bringing forward this Bill. My noble friends and other noble Lords have set out a number of concerns about some of the measures it contains, which I share, in particular covering the duration of the powers and procedures for bringing them to an end, the variants to the social care duties of local authorities which were spoken about so powerfully by the noble Baroness, Lady Grey-Thompson, the changes to sectioning powers, the wide powers to detain people under Schedule 20, the issues around prisoner management, immigration detention, the hostile environment and data sharing. I hope that the Minister will be able to address the important questions which have been raised in these respects on all sides of the House.

Personally, I would have preferred a Bill which was of a much shorter duration—perhaps three months, as my noble friend Lord Scriven suggested—with robust arrangements for scrutiny and review, but which also contained further powers in three specific areas. The first is the powers to regulate the food supply industry, including retailers; secondly, the powers to support the self-employed and to protect renters from eviction; and thirdly, the powers to direct both supply and labour across the economy to ensure that we can meet the urgent demand for critical equipment and, going forward, for the manufacture of a vaccine, when it is discovered—hopefully, in the near future.

At the weekend, an elderly woman asked specifically that I raise with noble Lords her experience of trying to shop for essential food items last week. She went to a dedicated shopping hour for the elderly in a major supermarket in my home town of Surbiton. She had to stand in a long line of people packed close together; the majority of them not elderly. When the shop opened, the staff had no powers to prevent people who were not elderly from entering the store. As a result, she was pushed and jostled in a congested and unsafe environment as she tried to shop. She has a husband at home with underlying medical problems and she is desperate about how she can look after him and keep them both safe.

It is not enough for us all to decry the obvious selfishness and irresponsibility of those who act in this way. What this elderly lady wanted from the Government was not more censorious words but actions to enforce and protect. I therefore hope that the Government will consider introducing powers to direct food retailers and the supply chain to ensure that there are sufficient supplies in the shops, because the actions of some of these people are driven not just by greed but also by fear. They should also allow police or designated council officers to enforce dedicated shopping hours for NHS staff and the elderly and, if required, powers to require controls on the price of goods and the quantity that may be sold to individuals.

Secondly, the Bill needs to provide sufficient statutory authority for the measures that the Chancellor will need to take in the coming days and weeks—in particular, the urgent need to provide support for the self-employed. I raise the specific case of a self-employed neighbour who is working in NHS hospitals constructing the additional wards and isolation partitions needed to expand NHS capacity to deal with the crisis. He is taking risks every day by going into hospitals and yet, when this work is completed, his only recourse will be to the benefit system. That is no way to treat someone who is doing so much to ensure that the NHS is able to cope with the virus.

That is a particularly resonant case but, all over the country, as the noble Viscount, Lord Colville, highlighted, self-employed people are seeing their livelihoods disappear overnight due to government restrictions. It is right to impose those restrictions, but we must stand by the self-employed who are impacted by them just as the Chancellor stood behind those in employment. The Bill should also contain powers to introduce a rent holiday and impose a moratorium on evictions in the rented sector for rents not paid during this crisis, as the noble Lord, Lord Adonis, mentioned. We cannot have one rule for owner-occupiers and another for renters. That is the way to division, not unity.

Thirdly, the Government need greater powers to direct both supply and labour across the economy to ensure that we can meet the demand for critical equipment, testing kits, personal protection equipment, ventilators and any other equipment needed to fight this virus and protect NHS staff and other frontline workers and volunteers while we do so. Cabinet-level Ministers of supply and labour should be designated to direct this work and, in time, to ensure that we have the manufacturing capacity for the vaccine that we hope will be discovered very soon.

The Bill contains unprecedented powers that in normal circumstances this House would not dream of entertaining. But these are not normal circumstances. Therefore, with a heavy heart, a plea to the Government to shorten the duration of powers in the Bill and to review the procedures for renewal, I support the Bill and commend the hard work and dedication of Ministers and civil servants in assembling it so rapidly. Most importantly, I thank once again all our frontline NHS staff and all key workers who are working to keep us safe.

Organ Donation (Deemed Consent) Bill

Lord Oates Excerpts

2nd reading (Hansard): House of Lords
Friday 23rd November 2018 Lords Chamber

[Lord Oates (LD)]

My Lords, in speaking on this Bill, I should first declare my interest as a non-executive director of NHS Blood and Transplant, as set out in the register of Members’ interests.

There are many people who deserve credit for their role in this legislation, but as a number of noble Lords have said, the most profound recognition and honour should perhaps be given to Keira Ball and Max Johnson. Keira, as many noble Lords will know, died tragically at the age of nine in a car accident. During a time of unimaginable grief and shock, and with his wife also seriously injured, Keira’s father agreed to organ donation. Keira saved the lives of four people through that precious gift. One of those patients, as we know, was Max Johnson, who received her heart. His campaign was instrumental in inspiring this Bill that we are debating today.

As the noble Lord, Lord Hunt, stated, we also owe a huge debt to Geoffrey Robinson and Dan Jarvis, who introduced the Bill in another place. We also owe a debt to the noble Lord, Lord Hunt, who has brought this Bill before this House.

As many noble Lords have also recognised, every year hundreds of people continue to die while awaiting a transplant, due to lack of availability of organs. Hundreds more come off the transplant list because their health has deteriorated so greatly that they cannot receive a transplant. The noble Lords, Lord Lansley and Lord Ribeiro, and other noble Lords are of course absolutely right that the Bill on its own will not change that, but the experience in Wales demonstrates that such a Bill, accompanied by effective communications—and most importantly, a public debate and family conversations—can mark a profound shift. The latest figures from Wales have shown such a shift, and I pay tribute, as other noble Lords have, to my noble friend Lady Randerson for her part in that process.

Already, there has been extensive engagement from the public in England as a result of this Bill being brought forward. Over 17,000 people responded to the public consultation, a figure that is well in excess of normal response rates to government consultations. NHSBT’s ongoing public surveys indicate that over 80% of the UK population supports organ donation. As part of the consultation process, NHSBT also undertook work to seek the views of those who are most closely involved in the donation process: intensive care clinicians; clinical leads for organ donation; and specialist nurses for organ donation. Over 700 responses were received. The results show that over 76% of respondents supported the change in legislation. There are also many people who not only responded to the formal consultation but who have given further help to review and scrutinise the Bill to ensure it achieves its objectives without adverse or unintended consequences. The contribution of the faith communities has also been critical.

So the Bill has the support of the public, it has stakeholder support and it has medical and nursing support, and that support will need to be honoured by doing everything possible to make sure that every family of every single potential donor is approached and, where consent is in place, that every single organ that can be safely transplanted is transplanted. First, there is the importance of the communications strategies and campaigns, which have been spoken about already as having been important in Wales, that can raise awareness of the change in the law and encourage conversations in families, so that people have an understanding of the new legislation and also have reassurance that the decision still lies with the individual. Secondly, there is a need to ensure that the infrastructure is in place to manage the increase in donation and transplant activity. Medical and nursing teams need to be able to keep pace with the anticipated rise. Thirdly, we need to ensure that everything is done to use all organs that are donated.

It is anticipated that the change in legislation will increase the availability of organs from donors after circulatory death, from whom currently fewer organs can be successfully transplanted. Organ usage from these donors can be dramatically increased if the retrieval teams are able to use technologies that preserve the organs. For example, between February 2015 and July 2018, the introduction of machine perfusion for hearts led to 66 additional hearts being available for transplant. Service evaluations for the use of abdominal organ machine perfusion also demonstrate significant increases in the number and quality of organs that can be donated. Using these new technologies will help ensure that no potential for a safe transplanted organ is missed.

The fourth and final approach needed to deliver successful change is to continue to publicly recognise and celebrate organ donors in the way that a number of noble Lords have already mentioned. Organ donation is the last, greatest gift that anyone could possibly give. It is giving the gift of life and it must continue to be celebrated, even when this Bill is passed.

During the debate over the proposed changes to the law, a number of important issues have been raised by the public and a variety of stakeholders, particularly around family and faith. The public and stakeholders have been very clear that it is vital that the family should continue to be involved in discussions regarding organ donation after a change in the law. As the noble Lord, Lord Hunt, made clear, that must, and will, always remain the case. The next of kin of potential donors will always be approached prior to donation. If the family is not present when the patient first enters hospital, the NHS goes to great lengths to find them. That starts when the ambulance crews first arrive at the scene and continues until the next of kin can be found. If necessary, the police are asked for their help, and other records such as passport applications are checked to identify next of kin. Where there is no family, others are approached, such as friends of long standing.

Family discussion is vital for three reasons. First, it is the right thing to do. Secondly, speaking to families is necessary to determine whether their loved one would have wanted to donate, and that will continue. Thirdly, information is needed from the family regarding past medical and lifestyle information. Without this, it is much more difficult to determine whether it would be safe for retrieved organs to be transplanted.

Many noble Lords have paid tribute to the specialist nurses and highlighted their importance in this process. They are vital, and anybody who has had the privilege of speaking with them about their work will know their dedication to the very difficult job they do, in such a professional, sensitive and caring way. They ensure that, as far as possible, the family are given sufficient time to consider organ donation. NHSBT data shows that family consent rates are significantly higher if a specialist nurse is involved in the family approach.

Families are also aided by knowing whether their loved one had recorded a decision on the organ donor register. The consent rate is 92% if the family know that their loved one had recorded a decision to donate on the register. It will remain important to encourage people to register a positive decision. The family will always be asked for their views on whether any special considerations should be taken into account, including whether their loved one had a particular faith or beliefs and whether the family would like to speak to a faith leader or counsellor.

Finally, there are strict policies and protocols in place to safeguard the process, with many checks throughout the donation, retrieval and transplant process. Consent is checked on multiple occasions, by several different medical, nursing and support teams. NHS Blood and Transplant is audited and inspected on this aspect by the Human Tissue Authority.

In conclusion, it is absolutely right to say that this Bill, in itself, is not a panacea, but it is an important contribution. It will help start the debate and deliver—in the way that has been shown in Wales—profound changes, we hope, in levels of donation. I pay tribute to the noble Lord, Lord Hunt, and to all those who have brought this Bill forward. I recognise the work of officials in the Department of Health and Social Care, and the great work that has been done by the Minister in another place, Jackie Doyle-Price, and the noble Lord, Lord O’Shaughnessy. Most importantly, our tributes, thanks and recognition should go to the donors and their families, whose decisions are the gift of life. We hope that this Bill will allow far more people to benefit from such donations.

Mental Health: Ensuring Equal Access to Mental and Physical Healthcare

Lord Oates Excerpts

Thursday 26th May 2016 Lords Chamber

[Lord Oates (LD)]

My Lords, I welcome the opportunity to take part in this important debate on the Five Year Forward View for Mental Health initiated by my noble friend Lady Brinton. As my noble friend said, mental health is a topic which touches almost everyone in this country, whether through direct personal experience or through families and friends who have suffered from mental ill-health.

For much of the time when I was growing up, it was pretty much a taboo subject. Few people talked openly about mental illness; it was too often a personal burden not to be shared, understood or tackled but to be hidden away even from those closest to one. In recent years there has been a welcome shift in our attitudes, and I pay tribute to the mental health charities and the many activists and campaigners, such as Alastair Campbell, who have helped break down taboos and get mental health on the agenda, but I also pay a real and heartfelt tribute to Norman Lamb in particular who, as a Health Minister in the previous Government, strongly supported by the then Deputy Prime Minister, Nick Clegg, did so much to push the issue of mental health right up the government agenda, placing mental health literally on the front page of the Liberal Democrat manifesto.

I am pleased that the subsequent Conservative Government have reiterated their commitment to tackling the huge inadequacies that exist in mental health care today and which are highlighted in the report we are discussing, but I hope that they will commit themselves to willing the means as well as the ends. Warm words will not be enough when mental health provision remains severely under-resourced and where we need real will to ensure that the services and support that can help prevent mental illness are there and joined up.

Mental ill-health is something I have experience of both personally and through supporting people whom I care for very much who themselves suffered with mental health problems. In my teenage years and my early 20s, I suffered severely with depression and suicidal thoughts. For much of that time, I would go to sleep praying that I would not wake up in the morning, so I would not have to bear any more of the paralysing burden of despair that I felt. It is difficult to describe quite how terrifying it is to be caught in a spiral of depression, how it impacts on your physical health, how it drains all the energy from you. Back then, in the 1980s, you did not generally discuss such things: you bottled it up inside and tried to show a cheerful face to the world. I was lucky because, although I never articulated my despair directly to anyone, I had a supportive and loving family and some of the most amazing friends whose support at the bleakest moment for me saved my life and made living a better prospect than dying. Tragically, as the review sets out, that was not the case for thousands of people last year. Suicide is now the leading cause of death for men aged 15 to 49. What a terrible and tragic waste.

As we know, a wide variety of factors can lead people into mental ill-health. Adolescence in itself is a pretty confusing and difficult experience for most people. For me, it was compounded by trying to come to terms with issues about my sexuality—something I was desperately trying to hide from myself, let alone from anyone else. It was not a great time to be an adolescent coming to terms with being gay because, throughout the 1980s, the drumbeat of homophobia was beating steadily louder, culminating, just as I turned 18, in the passage of the infamous Section 28 of the Local Government Act 1988—the Government of my own country legislating in prejudice against people like me.

Almost a quarter of a century later, I was fortunate to be working in the coalition Government when, at the instigation of my noble friend Lady Featherstone, the coalition legislated for full equality via the equal marriage Act. Nick Clegg reported at the time a conversation that he had with a wonderful mutual friend who, on passing Moss Bros and seeing two grooms in the window, told Nick, “I literally felt myself walk a little taller”.

I make that diversion into that area because I think that we should all recognise that the actions of government, churches and other institutions can have profound impacts on the self-worth and mental health of individuals. I hope that organisations of all faiths, particularly the Anglican Church, of which I am a member, think about that a lot more and show the sort of leadership that it once showed in the days of Archbishop Ramsey.

I was lucky enough to come through my struggle with mental illness with the love and support of friends and family, but many people do not have the support networks that I was lucky enough to have. Too often, as the review sets out, the services that people need are not available. Just half of community mental health teams offer 24/7 crisis care. Only a minority of A&E units have 24/7 cover from mental health liaison teams. As my noble friend Lady Brinton pointed out, too many black and ethnic minority citizens access mental health care first through direct contact with the police. Care for people with eating disorders remains haphazard and often entirely inadequate, and services for young people are unco-ordinated and do not provide anything like what is required.

Over recent years, I have seen the inadequacies of service provision at close hand, in two areas—first, in the services available to those suffering from serious eating disorders, where provision can vary massively across the country and, in many cases, is so inadequate. In the experience I was aware of, there was adequate provision only because the family had the money to buy private provision. The second area is provision for adolescents suffering acute mental health problems. Many areas seem unable to have a properly joined-up approach between schools and mental teams. Children are often no longer in school because of their mental health problems. At the most basic level, there is a lack of provision for those children to continue their education, and if they fall out of education at that point, it can cause more serious problems and compound existing mental health problems.

The provision of services to help young people—in particular, talking therapies—is utterly inadequate, which can have tragic consequences. It is hard to convey the distress and anguish of parents and other family members when they are unable to gain access to services for young people struggling with terrible mental health problems. The adequate provision of mental health services requires much more effective joining up of services, but it also requires extra resources, as the review states. Yesterday, in the debate on the Queen’s Speech, the Minister, the noble Lord, Lord O’Neill, said that the Government are building our economy on low taxes. I am all for lower taxes, particularly for those on the lowest incomes—I was proud of the work of the Liberal Democrats in government in raising the personal allowance—but the taxes we raise and the taxes we levy must be sufficient to provide the services that we require in a civilised society. We have to decide what those services are and then work out how we pay for them, not the other way round. I hope that in his reply the Minister will confirm that the Government will provide the extra resources that the report identified as being required and that, as my noble friend Lady Brinton said, they are additional resources, not an accounting fix.

I hope the Minister will also commit the Government to making a reality of the commitment to provide equality of treatment for mental and physical health. To do that will mean the Government putting a huge amount of energy into this issue. It is so complex and there are so many issues to resolve that they have to champion and drive it the way that our friend Norman Lamb did in the previous Government. If the Government fail to do so, their failure will not just be about never getting round to deciding where an airport will be, or something like that; it will be much more material because it will be measured in millions of lives that are further blighted by the terrible suffering that mental illness can bring.

National Living Wage: Social Care

Lord Oates Excerpts

Thursday 5th May 2016 Lords Chamber

Asked by

[Lord Oates]

To ask Her Majesty’s Government what assessment they have made of the effect of the national living wage on providers of social care.

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

My Lords, across the sector higher productivity, staff retention and better-quality care will benefit employers and care home residents. The national living wage rewards the valuable contribution made by care workers. Out of an estimated 1.52 million adult social care jobs in England, up to 900,000 people are expected to benefit. The department continues to work in collaboration with care providers and commissioners to support effective commissioning, recruitment and retention in adult social care.

--- Later in debate ---

[Lord Oates (LD)]

I thank the Minister for his response, but it is a response rather than an answer. Is he not conversant with the BBC research published yesterday, showing that there are 5,000 care homes at risk of closure over the next three years, the recent Moore Stephens report, showing a 34% increase in care home insolvencies over the past three years, or indeed the LGA estimate of a £2.9 billion funding gap in adult social care by the end of the decade? In the face of these figures, why do the Government continue to assert the incredible proposition that it is possible to increase wage costs and regulatory burdens but not increase real-terms per capita funding? When will they end this dangerous fantasy and start addressing the serious crisis in adult social care?

[Lord Prior of Brampton]

My Lords, the increase in the minimum wage from £6.70 to a living wage of £7.20 has been universally welcomed, I think, including by most Members of this House. Care workers and people who work in care homes do an incredibly difficult job and £7.20 does not seem a small fortune to pay them. It will increase the costs for people in the care sector and there is some evidence that some care homes are closing. The figures I have are that in the past two years 2,000 beds have closed in the care sector, but during that time 600 domiciliary care agencies have opened—so I think that there is going to be a switch in the way that care is delivered from residential care to domiciliary care.