National Health Service: Assaults on Staff

Lord O'Shaughnessy Excerpts

Wednesday 20th June 2018 Lords Chamber

[Lord Clark of Windermere]

To ask Her Majesty’s Government how many attacks on NHS staff were reported in 2016-17 and 2015-16.

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

My Lords, the Government are committed to taking action against those who abuse or attack NHS staff. In 2015-16, NHS organisations, which are responsible for protecting their staff, reported 70,555 physical assaults. Of those, 52,704 were due to patients’ conditions or treatments they were receiving. Data has not been collected for 2016-17. We are reviewing with the NHS how in future information about assaults and abuse of NHS staff can help trusts promote best practice.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his Answer. Can I give him a little help with the updated figures? Has he seen the figures produced by the Health Service Journal and Unison which show a 10% increase in violence against NHS staff in the latest year? That is just unacceptable. Why did the Government in November 2017 abolish NHS Protect, which had the responsibility to protect NHS staff against violence? I know that it was replaced and that its staff, but not its functions, were transferred to the NHS Counter Fraud Authority, which focuses on fraud and protection of buildings. Will the Minister confirm that there is now no body responsible for the safety of NHS staff? I am drawn to the conclusion that this Government value property more than people.

--- Later in debate ---

[Lord O’Shaughnessy]

I have to take issue with the point the noble Lord makes. It is absolutely not the case that the Government value property more than staff. We all value the work that NHS staff do every day in very difficult conditions. That is one of the reasons that we announced our historic funding settlement at the beginning of this week. On the problem that the noble Lord raises, he is right to say that, looking back over NHS Protect’s data, starting in 2008-09, there has been a steady rise in the number of assaults on and incidents of abuse of NHS staff. Clearly that is completely unacceptable. However, there is disagreement about the reasons for that, and it is worth dwelling on that. They include not just the greater volume of patients and better reporting, but the increase in mental illness and dementia, and more severe mental illness being dealt with in hospitals rather than police cells. I do not use that as an excuse, but merely to explain that there is some uncertainty about the reasons for it. It was under NHS Protect’s aegis that this steady rise happened. It has fulfilled its function, which is to make sure that security management services are available to every NHS trust—but in the end it has to be down to every trust to take responsibility for the safety of its staff, and that is the system we are moving ahead with now.

[Baroness Finlay of Llandaff (CB)]

My Lords, given that alcohol is involved in more than 60% of assaults in the acute sector, more than 30% of assaults in the mental health sector and more than 70% of assaults in the ambulance sector, will the Minister explain why the Government have abandoned progress with the sobriety scheme pilot, which showed a very high success rate in avoiding reoffending in alcohol-fuelled crime? It would provide a tool for non-custodial sentencing where people are known to have assaulted NHS staff under the influence of alcohol.

[Lord O’Shaughnessy]

I will look into the specific issue that the noble Baroness mentions. I do not have the details in front of me. I know that all local authorities provide free, taxpayer-funded rehabilitation services for those who are suffering from alcohol addiction. I should also point out that this Government have increased progressive taxation on stronger alcohol, such as white cider, specifically to try to change people’s drinking habits and to reduce alcohol-related violence.

[Lord Ribeiro (Con)]

Following the theme of alcohol, the Minister was kind enough to meet me and members of the Alcohol Health Alliance on 30 April. We stressed that accepting a minimum unit price, as in Scotland, would do much to remove alcohol—and, particularly, cheap alcohol—from vulnerable people, some of whom are responsible for the attacks to which we are referring. When will England accept a minimum unit price and implement it?

[Lord O’Shaughnessy]

I was delighted to meet my noble friend on this topic. I know he cares passionately about it. We have said—and I have said in this House before—that we are looking at the Scottish example with interest now that Scotland has gone ahead with it. There is a growing evidence base to demonstrate the benefits of minimum unit pricing, but we want to see what transpires in Scotland before making any decisions about whether to move ahead.

[Baroness Jolly (LD)]

My Lords, in England around 200 attacks on NHS staff occur every day, and this is nothing short of scandalous. Next week we have the Second Reading of a Private Member’s Bill, which has come from the other place, on assaulting emergency workers. Will the Minister confirm whether the Government are minded to support it—and, if not, what further action will be taken to protect health workers?

[Lord O’Shaughnessy]

I agree with the noble Baroness that it is scandalous and that we therefore want to support the Bill. I believe that it will have its Second Reading here on 29 June. I can confirm that the Government will be supporting the Bill.

[Baroness Donaghy (Lab)]

I am grateful for that reply from the Minister. I have the privilege of taking the Bill through its Second Reading next week. It will create, for the first time, an aggravated offence for those who attack all emergency workers, including paramedics, nurses, doctors and all those associated with helping NHS staff in emergency work, such as St John Ambulance and other volunteers, if they are doing emergency work. So I am thankful that the Government have provided time, and I hope that we will be able to get the Bill through quickly by the summer.

[Lord O'Shaughnessy]

I salute the noble Baroness for taking it through its stages in the House of Lords. I reiterate our support for it—not just the principles behind it but the specific measures in it. Clearly it is unacceptable to assault the very people who devote their lives to serving.

National Health Service: Mental Health Funding

Lord O'Shaughnessy Excerpts

Wednesday 20th June 2018 Lords Chamber

[Lord Cotter]

To ask Her Majesty’s Government what proportion of mental health treatment is funded by the National Health Service nationally as against local funding.

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

My Lords, the Government are committed to increasing spending on mental health. In 2017-18, the NHS spent an indicative figure of £11.86 billion on mental health. Of this total, £9.97 billion was locally funded by clinical commissioning groups, with the remainder for nationally commissioned specialised services.

[Lord Cotter (LD)]

I hear what the Minister says, but parity between mental and physical health remains a concern. He knows about the facility for mental health in Weston-super-Mare and the problems associated with its future. However, I have found this problem around facilities in local areas to be widespread throughout the country. Their funding is not predominantly mainstream NHS money for mental health services, but NHS money is often used to plug holes elsewhere and local mental health units are struggling. Will the Minister address the issues of parity and funding for local mental health care?

[Lord O’Shaughnessy]

I agree with the noble Lord that we need to increase funding for local mental health services. That has been happening over the past few years; indeed, between 2015-16 and 2018-19 it has gone up by £1 billion. I turn to his point about mental health funding being used for other purposes. I want to be clear that there is NHS England guidance that that should not happen, and from this financial year all CCGs will have to meet what is called the mental health investment standard, which means that they are to increase their spending on mental health at least as much as, if not more than, their spending on physical health.

[Baroness Uddin (Non-Afl)]

My Lords, regardless of what the Minister says, does he accept that there has been a systematic destruction of voluntary organisations providing many mental health services? This has had a particular impact on survivors of domestic violence. What are the Government doing to ensure that Women’s Aid and other organisations that provide support for women suffering from and the survivors of domestic violence have funding available through the means to which he has referred?

[Lord O’Shaughnessy]

Although the particular funding the noble Baroness is talking about is a Home Office issue, I can say that £100 million is available until 2020 to support the victims of domestic violence. From the health service perspective, obviously we are increasing the amount of money spent on treating those with mental illness, regardless of the cause that gave them their illness in the first place.

[Baroness Hollins (CB)]

My Lords, does the Minister agree that more oversight is needed—not just through the mental health dashboard—of how and how well clinical commissioning groups meet the mental health investment standard, previously known as parity of esteem? Can he also explain why the mental health investment standard does not include people with learning disabilities who have mental health needs? Further, what assurances are there that clinical commissioning groups will continue with their current level of investment once the national sustainability and transformation fund finishes?

[Lord O’Shaughnessy]

I reassure the noble Baroness that there is independent audit of performance against the mental health investment standard. Anyone with mental health problems, whether they have learning disabilities or not, should certainly be included in the figures. I am alarmed by what she has said and obviously I will look into it and write to her. However, it is important to say that CCGs have been increasing their spending. In 2016-17 they were expected to deliver at least 3.7% growth in mental health spending, but the actual outturn was 6.3% growth, so that is a good story.

[The Lord Bishop of Lincoln]

My Lords, I speak for one of the most rural parts of England. Does the Minister recognise the higher level of suicide in rural areas? In part, this is due to rural isolation and the sparsity of mental health provision. What plans do the Government have to increase local and accessible provision in these areas?

[Lord O’Shaughnessy]

I agree with the right reverend Prelate that, unfortunately, that is a feature of rural communities. I understand that the MHCLG has a sparsity fund to help with that issue. Indeed, particular funding is going into support and more community-based care for those at risk of suicide and other mental illness.

[Lord Polak (Con)]

My Lords, last Thursday, I was walking past Lambeth fire station just before the minute’s silence. Together with Charles Hanks, the station manager, I stood with those brave and professional firefighters. Afterwards, I asked about ongoing support and access to counselling services. Tracey Dennison, from the fire brigade, told me today that there was a slight increase in absenteeism as the anniversary approached and the inquiry began. The Fire Fighters Charity stepped up to provide family support. Can the Minister ensure, in the sad event of another serious tragedy, that emergency capacity for immediate and ongoing counselling support is available for our brave emergency services?

[Lord O’Shaughnessy]

My noble friend is absolutely right to highlight this issue. Individually, our emergency workers did extraordinary deeds of bravery, for which we are all deeply grateful, during the Grenfell fire. In the aftermath of that fire, the north-west London mental health service was the lead trust in providing mental health support for not just the families and individuals who were victims of the fire but emergency service workers who had been through that very traumatic experience. I strongly encourage any emergency service workers who are experiencing trauma—of course, that can happen many months, indeed years, afterwards—to get in contact with mental health services.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, does the Minister agree that £1 spent today on child and adolescent mental health services is likely to save the NHS a considerable number of pounds in the future? What proportion of the money spent on mental health services is going to child and adolescent services? Will that proportion increase in the future?

[Lord O’Shaughnessy]

The noble Baroness makes an excellent point. The emerging science tells us that heading off mental illness in adolescence is critical to ensuring that it does not deepen and become more severe in later life, with great human as well as economic cost. At the moment, the mental health budget for children and young people does not reflect the burden that children and young people have, which is why the Prime Minister announced an extra £1.4 billion for children and young peoples’ services, as well as £300 million on top of that to support the plans set out in the child mental health Green Paper.

[Baroness Tyler of Enfield (LD)]

My Lords, the Minister has already referred to the mental health investment standard, but recent figures issued by the Royal College of Psychiatrists show that 15% of clinical commissioning groups are not following NHS England’s instruction to increase the proportion of their spend on mental health. What practical steps are the Government taking to ensure that all CCGs meet this standard?

[Lord O'Shaughnessy]

The noble Baroness is quite right in her figures: it was 85% compliance in 2017-18—175 of the 207 trusts. It has to be 100%. It will be independently audited and reported against. Indeed, interventions will take place if that does not happen.

Long-term Plan for the NHS

Lord O'Shaughnessy Excerpts

Tuesday 19th June 2018 Lords Chamber

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

My Lords, with permission I will repeat the Statement made yesterday in the other place by my right honourable friend the Secretary of State for Health and Social Care about the Prime Minister’s announcement of a new, long-term funding plan for the NHS. The Statement is as follows:

“The NHS was built on the principle that good healthcare should be available for everyone, whatever their background and whatever their needs. Seventy years on, it remains this country’s most valued public service—an institution that is there for every family, everywhere, at the best of times and the worst. No one in this House underestimates the importance of putting the NHS on a steady financial footing, not just for the sake of their constituents but for their own families and loved ones. That is why I am proud today that this Government have announced their commitment to a long-term funding settlement for the NHS.

From vaccinations and IVF to radiotherapy and next-generation immunotherapies, the NHS has always been at the forefront of excellence in medicine. However, as only the sixth universal healthcare system in the world, it has also come to symbolise equity both at home and abroad. Despite pressures in recent years, the Commonwealth Fund rates the NHS as the best healthcare system in the world; cancer survival rates are at a record high; stroke mortality is improving faster than almost anywhere else in the OECD; and heart disease mortality rates continue to fall. All this is thanks to NHS staff, who continue to work tirelessly day in, day out, to make it the world-class service that it truly is.

However, alongside advances in medicine, demographic pressures pose a potentially existential threat to the NHS as we know it. With the number of over-75s expected to increase by 1.5 million in the next 10 years, these pressures, far from reducing, will intensify. So in March the Prime Minister made the bold decision to commit to a 10-year plan for the NHS, backed up by a multiyear funding settlement. Since then I have been working closely with the Prime Minister and the Chancellor, and I can announce today that the NHS will receive an increase of £20.5 billion a year in real terms by 2023-24—an average of 3.4% per-year growth over the next five years. The funding will be front-loaded, with increases of 3.6% in the first two years, which means £4 billion extra next year in real terms, with an additional £1.25 billion cash to cope with specific pension pressures. Others talk about their commitment to the NHS, but this settlement makes it clear that it is this Government who deliver, and the details will shortly be placed in the Library of the House.

This intervention is only possible due to difficult decisions made by the Government, opposed by many, to get our nation’s finances back in order and our national debt falling. Some of the new investment in the NHS will be paid for by us no longer having to send annual membership subscriptions to the EU after we have left. But the commitment that the Government are making goes further, and we will all need to make a greater contribution through the tax system in a way that is fair and balanced. My right honourable friend the Prime Minister said that we will listen to views about how we do that, and my right honourable friend the Chancellor will set out the detail in due course. I pay particular tribute to the Chancellor, whose careful stewardship of the economy, alongside that of George Osborne before him, is what makes today’s announcement possible.

The British public also rightly want to know that every pound in the NHS budget is spent wisely. It is therefore critical to the success of the plan that the whole NHS improves productivity and efficiency; eliminates provider deficits; reduces unwarranted variation in the system so that people get consistently high standards of care wherever they live; gets better at managing demand effectively; and makes more effective use of capital investment. We have set the NHS five key financial tests to show how it will play its part in putting its service on a more sustainable footing, and I expect the NHS to give this work the utmost priority. The tests will be a key part of the long-term plan.

However, this is more than just a plan to get finances back on track. In its 70th year, we also want our NHS to make strides towards being the safest, highest-quality healthcare system in the world. That means making a number of improvements to the treatment and care currently offered, including getting back on track to delivering agreed performance standards, locking in and further building on the recent progress made in the safety and quality of care, and transforming the care offered to our most frail and vulnerable patients so that we prioritise prevention as much as cure. It also means transforming our cancer care, where we still lag behind France and Germany despite record survival rates. There is no family in this country that has not been touched by cancer, so the whole House will want to know how the NHS intends to make our cancer treatment and care among the best in Europe.

Many of our constituents worry about the mental health of their loved ones, families and friends. Again, I am proud of this Government’s record here: investing more in mental health than ever before and legislating for true parity as part of one of the biggest expansions of mental health provision in Europe. A critical part of the plan will be to decide what next steps will enable us to claim not just that we aspire to parity of provision with mental health but that we are actually delivering it.

For our most vulnerable citizens with both health and care needs, we also recognise that NHS and social care provision are two sides of the same coin. It is not possible to have a plan for one sector without having a plan for the other. Indeed, we have been clear with the NHS that a key plank of its plan must be the full integration of the two services. As part of the NHS plan, we will review the current functioning and structure of the better care fund to make sure that it supports that. While the long-term funding profile of the social care system will not be settled until the spending review, we will publish the social care Green Paper ahead of that. However, because we want to integrate plans for social care with the new NHS plan, it does not make sense to publish it before the NHS plan has even been drafted, so we now intend to publish the social care Green Paper in the autumn, around the same time as the NHS plan.

Finally, there are two further elements crucial to putting the NHS on a sustainable footing. Alongside the 10-year plan, we will also publish a long-term workforce plan, recognising that there can be no transformation without the right number of staff, in the right settings and with the right skills. This applies to both new and existing staff. As part of this, we will consider a multiyear funding plan for clinical training to support this aim. Similarly, we know that capital funding is critical for building the NHS services of the future and, again, we will consider proposals from the NHS for a multiyear capital plan to support the transformation plans outlined in the long-term plan.

Given the national economic situation, yesterday’s announcement is bold and ambitious. For the first time, national leaders of the NHS will develop a plan for the next decade that is clinically led, listens to the views of patients and the public and is backed by five years of core funding. We want to give the NHS the space, certainty and funds to deliver a comprehensive, long-term plan to transform health and care and to ensure that our children and grandchildren benefit from the same ground-breaking health service in the next 70 years as we all have in the first 70. That is the Government’s commitment to our NHS, and I commend this Statement to the House”.

My Lords, that concludes the Statement.

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[Baroness Jolly (LD)]

My Lords, I too thank the Minister for his Statement. I welcome any increase in funding. Should the Chancellor be wondering how to pay for it, we on these Benches would be quite happy to see a 1% increase on income tax, for starters. The IFS has said that increases of close to 4% are needed for social care, as well as a funding boost for the NHS. Yet the Statement had nothing to say on this vital issue. We all know that the NHS cannot function efficiently unless social care is working well too. Many local authority leaders are indignant that the Green Paper has been moved further down the track, so when the new funding does arrive there is already a sizeable deficit to claw back. They are extremely anxious about the situation with adult social care funding being insufficient for this financial year.

What conversations have been held with the LGA, local council leaders and the Ministry of Housing, Communities and Local Government in advance of these statements? We are also dismayed about the silence on mental health, public health and community health funding. One in four of us will be affected by mental illness, there is an obesity epidemic among our children, too few health visitors, and we are critically short of psychiatric social workers. Is the Minister confident that these issues can wait until the autumn NHS plan and the Budget?

[Lord O'Shaughnessy]

I thank the noble Baronesses, Lady Thornton and Lady Jolly, for their questions. I think that our debate on the report of the Lords Select Committee on the sustainability of the NHS and social care was revealing, in that we got a hint that, while the settlement would receive a broad welcome across the House, the party opposite might not be in quite the same positive mood, and, unfortunately, we have had that confirmed today. Perhaps that might generously be described as a cautious welcome.

The noble Baroness asked about the funding of this settlement. We were very clear yesterday that it will come, effectively, from three sources: from taxation, from economic growth, and from the fact that, as we are leaving the European Union, we will not be paying annual subscriptions any more. It will be a combination of those factors that determines the spending. Indeed, the Treasury is confident in that, and it would not have signed off this deal if it had not been.

On the noble Baroness’s specific questions about the legal obligations under the NHS constitution, actually the money that was given to the NHS at the Budget was to help it to get back on target—in the case of A&E, by the end of this financial year and, for elective procedures, to halt the growth in the expansion of the waiting list. Clearly, one of the reasons for this settlement, which is set out explicitly, is to get back to those key standards, which we know are the yardsticks by which people judge their everyday experience of the NHS.

On the point about there not being enough money, there can always be arguments for more, but it is instructive that two former Health Ministers, one from the Labour Party and one from the Conservative Party—my noble friend Lord Prior and the noble Lord, Lord Darzi—set out last week that they felt that 3.5% was the right figure, which we have got very close to. We should take the suggestion of those two very experienced and knowledgeable former Health Ministers as a good yardstick for our achievement.

The noble Baroness asked about social care funding, as did the noble Baroness, Lady Jolly. The intention behind the delay in the Green Paper—which I recognise is a source of regret for people in this House and elsewhere—is to make sure that integration, which we all agree has got to be at the heart of this 10-year plan, actually happens in planning terms and policy terms as well as in announcements and delivery. That is why there is that co-ordination between the two. Again, it is worth stating that, over the current three-year period, at previous Budgets an extra £2 billion was put into the social care budget, which is rising now for the first time in a number of years, and that is obviously important as we put together that long-term solution.

Finally, let me deal with two other points. On the repair bill and the capital settlement, again at previous Budgets the Chancellor has pledged £10 billion through a number of sources towards the capital settlement for the NHS, but we are expecting the NHS, through this process, to come forward with long-term, multi-year capital proposals, because clearly that underpins so much of the transformation.

In terms of the impact on other elements of the broader health budget, mental health is included in there, including a clear commitment to deliver on parity of esteem within this period. Public health and community health will be dealt with in the next spending review process, which will be happening in the next year. Again, there are clear commitments that there will not be additional pressures, if you like, created for the NHS by what happens to the public health and social care budgets in the future. Ahead of a spending review process, that is a clear indication that there is not a desire to create trouble, if you like, in those budgets that would land at the feet of the NHS.

[Lord Warner (CB)]

My Lords, could the Minister say something about the economic literacy of this announcement? As I understand it, the Conservative chairman of the Health Select Committee, Dr Sarah Wollaston, has said that the Brexit dividend idea is “tosh”. If we write that one out of the script, can he say something about what economic assumptions the Government are making on the growth of GDP in each of the next five years?

[Lord O'Shaughnessy]

I know that the noble Lord no longer serves the Labour Party, but he might be interested to know that the Labour leader said in February that,

“we will use the funds returned from Brussels after Brexit to invest in our public services”.

Clearly, we are not alone in believing that, once we leave the European Union—and, as a party, we are committed to leaving the European Union—we will no longer be sending subscriptions to Brussels but using them for the NHS. For further detail on the funding settlement, the noble Lord will need to wait until the Budget, when the Chancellor will outline the plans.

[Lord Ribeiro (Con)]

My Lords, I welcome this report, but note that the Statement refers to the number of over-75s increasing by 1.5 million, which will prove a challenge in the future. One of the recommendations of the long-term sustainability report was that we should look at other methods for ensuring funding. I was very pleased to hear the noble Baroness, Lady Thornton, say that the review suggests that the public are prepared to pay more towards the NHS. I suggest that if we look at the experience of Japan, where people over the age of 40 start making contributions towards their long-term care, we may well have an opportunity to resolve this problem. If the public are willing, the Government should look seriously at this in the context of social care.

[Lord O'Shaughnessy]

We have in this debate just started the lively conversation that we will be having on taxation in the next few months. Clearly there are a number of ideas; they have been voiced by Members on the Liberal Democrat and Labour Benches as well as those on my Benches and the Cross Benches. We know that there are a number of ways that this could be done; the Prime Minister has shown incredible leadership to admit that this is necessary. These are very difficult decisions: in polls, people say that they want to pay more tax but when it comes to the crunch they often feel slightly differently. True leadership is being able to take us through that situation, and that is what the Prime Minister is showing.

[Lord Clark of Windermere (Lab)]

I thank the Minister for taking the trouble to repeat the Statement made yesterday in the other place. Of course we welcome the money, but let us not get carried away. Every health trust charity believes that the increase needs to be at least 4%. Secondly, this still leaves only one country in the G7 paying less towards healthcare than we are.

May I ask the Minister three very brief questions? I saw a report saying that the training costs of doctors and nurses were not included in these figures. Is that correct? Secondly, when we pursue the Government’s concept, which is right, of bringing the NHS and social care together, hence delaying the plan, will the extra costs of social care come out of the 3.4%? Finally, when it is discovered that there is no exit bonus when we leave the EU, will the Government guarantee that that shortfall will be made up from elsewhere?

[Lord O'Shaughnessy]

The noble Lord mentions the figure of 4%. I have looked at a number of think tank reports and their assumptions on what is required. They make some very cautious assumptions of the productivity improvements that the NHS is making, based on historical performance. The improvements in productivity over the last five years are very healthy—in fact, in the last year the NHS became more productive at a rate of 1.8%. If you add that to the 3.4%, that gives an increase of more than 5% in terms of bang for your buck. It is incumbent on us during this process not only to put in more money but to make sure that we are driving those productivity gains that we have seen in the last five years. If that then gives a 5% effective increase in funding, that is what we will need to deal with the long-term pressures that the noble Lord has quite rightly highlighted.

On the three questions, there is an explicit commitment to deliver this workforce strategy that the NHS comes up with as part of its plan. On the extra costs of social care, we clearly need a social care settlement that delivers the funding for those rather than their being covered by the NHS. That is what we mean about the commitment not to create extra pressures. As I have said, the funding will come from three sources—whatever the mix, the funding will be there.

[Lord Willis of Knaresborough (LD)]

Will the Minister accept that in terms of productivity, one of the issues that is holding us back in developing things at speed is the overregulation of the whole of the health system? We have two systems regulators and seven professional regulators; we were promised in 2014 that there would be legislation to simplify the regulatory system. Can the noble Lord assure the House that we will have a bonfire of regulations and put the right regulations in place to move this agenda forward?

[Lord O'Shaughnessy]

The noble Lord speaks with great insight and makes a very important point. There is broad agreement on the need to simplify the structure of the health system but there has not to date been broad agreement on how we should do so. We are expecting in the next few months to explore the potential for the kind of streamlining that he is talking about. I hope that that can be done as a collaborative effort and, if it comes to primary legislation, that we can deliver it as a collaborative effort too.

[Lord Kakkar (CB)]

My Lords, I declare my interest as chair of University College London Partners Ltd. Although this substantial increase in funding has quite rightly been welcomed, important questions remain. It is essential that real progress is made in integrated care—integrated care between the community and secondary and tertiary sectors, and integrated care between hospitals and social care. It is vital that progress is made in the rapid adoption of innovation at scale and pace across entire health economies. It is also vital that a programme is put in place to ensure that there is a transformation of the healthcare workforce so that those who have committed themselves to being healthcare professionals can continue to be developed and serve their fellow citizens across an entire professional career. How do Her Majesty’s Government propose to achieve this? There has been much good intention and great commitment in this area over the past two decades, but we are now at a critical moment where a failure to deliver the transformation required will result in failure to achieve the long-term sustainability to which we are all committed.

[Lord O’Shaughnessy]

The noble Lord makes excellent points. It is right at this moment to applaud the wisdom and far-sightedness of the Lords Select Committee on the long-term sustainability of the health and social care system. It called for, among other things, funding of growth in line with GDP, delivering integration, a 10-year workforce strategy, a commitment to reduce variation and a joined-up Department of Health and Social Care, all of which, if we were not able to deliver it in time for our response to the report, we are delivering in short order afterwards.

One of the first ways in which we shall do it is to draw on the wisdom that resides in the NHS, in Parliament and elsewhere in the profession. In the Statement given by my right honourable friend, I point again to the commitment to take on integrated care, that being one of the tests of success. Equally, there is the commitment to transformation of the workforce, to make sure not just that we have enough people but that we have enough flexibility and digital skills, for example.

The final point, on innovation, is very close to my heart—and indeed the Secretary of State’s. We know that doing things in the same way will not deliver the standards we need. We really need a transformation in how we deliver healthcare, much greater digitalisation of the entire sector and the ability to take the amazing innovations that we develop in our laboratories and universities, such as the noble Lord’s own, and get them into use across the NHS. That is one reason why I was so delighted that we were able to announce today that the noble Lord, Lord Darzi, will be chairing our Accelerated Access Collaborative. It is hard to think of anybody more committed to this agenda than him.

[Lord Mackay of Clashfern (Con)]

My Lords, I seem to recollect that some years ago there was a royal commission on social care. Is there any wisdom to be gained from it? I do not think much action was taken on it when it reported.

[Lord O’Shaughnessy]

My noble and learned friend is quite right: these commissions do not always produce action. I realise that there is some frustration in the House over the delay to the social care Green Paper. I hope noble Lords will respect the fact that it is sometimes difficult to fight battles on many fronts. We have made some progress on the NHS and the army moves on to win the war on social care as well.

[Lord Turnberg (Lab)]

My Lords, I for one from these Benches welcome the influx of funds. We have been waiting quite a while for it so it is well received. Everyone knows, however—we have heard today—that without changes and improvement in social care, this 3.5% will go down the drain as well. It is not just that we need to do both together; we need provision for social care at the same time as, if not in front of, the influx of funds for the NHS.

[Lord O’Shaughnessy]

I agree with the noble Lord and thank him for his welcome. We all agree; indeed, the Statement sets out clearly that the two must go hand in glove. I should point out that additional money for social care in the short term was put in a previous Budget by the Chancellor—£2 billion extra over three years, a budget that is now growing. Clearly that was a short-term measure. Now we need to find that long-term settlement that goes hand in hand with the NHS and ensure that we have true service integration as well.

[Lord Hannay of Chiswick (CB)]

My Lords—

--- Later in debate ---

[Baroness Walmsley]

My Lords, first, the Statement mentions £1.25 billion cash to cope with specific pension pressures. Is that because so many doctors are retiring early, and therefore drawing their pensions early, because of the pressures of the job? I know three GPs who are retiring far too early because of those pressures, so will the NHS be able to spend some of that money to relieve those pressures? Secondly, the Statement mentions that the Government want to prioritise prevention and that the NHS should get better at managing demand effectively. There are two factors that limit its ability to do that: social care has been mentioned by many noble Lords but I would also mention prevention. Can the Minister assure us that, when we get the spending review, the amount of money that goes to local authorities co-operating with the NHS on the prevention of ill health will not just be enough to make up for the cuts they have suffered over recent years but enough to really go forward and transform prevention measures?

[Lord O'Shaughnessy]

To answer the noble Baroness’s first question, I believe that changes in actuarial calculations were the driver of that change. However, it is a technical issue and I will write to her and place a copy of the letter in the Library so that other noble Lords can see the rationale for it. Regarding her question about public health funding, obviously it is not for me to make predictions about exactly what will be in the spending review, save to say again that there was a clear commitment in the Statement that we would not create further pressures for the NHS through the settlements delivered for social care and public health.

[Lord Hannay of Chiswick]

My Lords—

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[Baroness Hollins]

My Lords, there is much concern in this House about social care. Can the Minister confirm that the now-promised social care plan will address not only the needs of older people but the needs of all vulnerable people of all ages? It is a little-known fact that the cost of meeting the needs of people with learning disabilities will soon overtake the cost of care of the growing number of older people. It is really important to address that.

[Lord O'Shaughnessy]

The noble Baroness is quite right to highlight the care for this vulnerable group of adults. As she knows, there has been a parallel work stream alongside the work for the Green Paper. Those are two allied but separate pieces of work. At this point in time I do not have a specific date for when that work will emerge into a report or a review, but I will write to her with the details because the Government agree with her that this issue is of equal importance.

[Lord Higgins (Con)]

My Lords, given the Administration’s traditional objection to the hypothecation of revenue, does my noble friend agree that the Chancellor is likely to be reluctant to say that he is putting up taxation specifically for the NHS? In any case, would it be more acceptable to the public for the money to be raised by way of an increase in national insurance contributions rather than through general taxation?

[Lord O'Shaughnessy]

I should not like to put any words in the mouth of my right honourable friend the Chancellor. What I do know, as was evident yesterday, is that he has committed to deliver the finances required to fulfil the plan that the NHS puts forward. Clearly, as my noble friend points out, there are a number of ways that we can do that. Polling suggests that some forms of taxation are more popular than others, and we know that technical challenges are associated with hypothecation. As I said, this is a very important and valuable conversation in which this House has a leading role to play in making sure that we get the right outcome.

[Lord Davies of Stamford (Lab)]

My Lords, this otherwise very welcome announcement was accompanied by quite misleading and—I hope the noble Lord will agree—deplorable PR spin about a Brexit dividend. Does he accept that the OBR, which provides the government economic statistics, has said that there is no such thing as a Brexit dividend? There is a Brexit penalty, because the reduction in tax revenue as a result of lower economic activity than would otherwise have taken place is significantly greater than the saving of our net contribution to the Union. Is it not the case that, in trying to pretend that there is a dividend, the Government have actually tried to mislead the public, and is that not something that, on reflection, the noble Lord would agree is most unfortunate?

[Lord O'Shaughnessy]

I would not agree with that because it is clearly the case that once we have left the European Union we will not be paying for membership of it—and it is those funds which will, in part, go towards helping us solve the funding challenge that we have set ourselves for the NHS.

[Lord McColl of Dulwich (Con)]

My Lords—

--- Later in debate ---

[Baroness Ludford]

My Lords, further to the question from the noble Lord, Lord Davies, is it not true that the OBR forecast budget deficit is twice our net EU contribution? We will also be making continuing payments for participation in EU programmes and agencies, let alone the £39 billion divorce Bill. Is not the Brexit dividend claim on the No. 10 website—which is a government website, not a Tory Party website—a breach of the Government’s duty to ethics, truth and accuracy?

[Lord O'Shaughnessy]

No.

[Lord McColl of Dulwich]

Does the Minister agree that the obesity epidemic is costing well over £25 billion a year? Would he consider having an all-out campaign— including every man, woman and child, every institution, school and government department—not to tell people what to do but to tell them the truth? For instance, there are 4 million people with type 2 diabetes due to overeating. If they ate less the savings would be terrific and most of them would be cured of their diabetes.

[Lord O'Shaughnessy]

My noble friend sets a tremendous personal example in this case. He is a fearless and tireless campaigner on the causes of obesity. He knows that it is our hope and intention that we will return to this topic so that we can start to reduce this plague on children and adults.

[Baroness Pitkeathley (Lab)]

My Lords, in the Statement the Minister referred to full integration between health and social care. Does he mean full integration of services, workforce and budgets? If so, is he confident that it can be done without the kinds of reorganisation that all of us dread?

[Lord O'Shaughnessy]

The noble Baroness makes a good point from her experience. There is agreement across the House—and, indeed, across both services—that there needs to be an integrated service. It is clearly not satisfactory to delineate in the way that we have done historically. How we get there will obviously be difficult. We need the NHS and local government to take the lead and to come up with proposals. If we believe that those proposals will deliver what we want without creating upheaval, it is incumbent on us all to get behind them.

[Baroness Watkins of Tavistock (CB)]

I welcome this additional contribution to the health service. However, have there been overoptimistic algorithms on improving productivity? We know that staff are currently stretched, and to expect continued productivity increases before we invest in modern technology will result in more staff leaving, and that would not be rational.

[Lord O'Shaughnessy]

The noble Baroness makes an excellent point. We know that NHS staff do a wonderful job and work incredibly hard. In talking about productivity it is wrong to think of it only in terms of getting more out of the same people. The wage bill, I think, makes up around 40% of the total NHS spend, a great deal of which is on buildings, on items and on technology. We need to use more technology so that we can deliver the productivity gains that we need.

Hospices: Impact of NHS Pay Increases

Lord O'Shaughnessy Excerpts

Monday 18th June 2018 Lords Chamber

[Lord Goddard of Stockport]

To ask Her Majesty’s Government what representations they have received from the hospice movement about the impact of the proposed increases in NHS pay; and whether voluntary hospices will also be able to access any additional funding being set aside to fund the proposed NHS pay increases.

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

My Lords, the Government received a number of written representations from hospices regarding NHS pay. The majority of NHS trade union members have now voted in favour of the Agenda for Change pay deal. This is welcome news that will help the NHS to reward, recruit and retain the staff it needs. We are now considering the impact of the agreement on non-NHS organisations such as hospices, and will consider carefully the NHS Pay Review Body’s report before making any final decisions.

[Lord Goddard of Stockport (LD)]

I thank the Minister for his reply. Would he agree that, if the Government provided direct ring-fenced funding to improve the pay and the terms and conditions of support workers and all who deliver for the NHS, that would help employers to address the significant recruitment and retention problems and, ultimately, deliver a better service, not putting at risk the vital hospice beds that would be at risk in the voluntary and charity sector?

[Lord O'Shaughnessy]

The noble Lord is quite right; the Agenda for Change pay deal obviously applies to NHS staff who are on the Agenda for Change contract. The deal was agreed and happily has been approved by the unions, precisely to reward NHS staff for the fantastic work they do, and to make sure that we can recruit and retain more. Clearly, as we go forward, for non-NHS providers, be they in social care or hospices, it is important that we do not cannibalise one workforce for the other. That is why we will look carefully at the conclusion of the pay review body’s report with regard to hospices.

[Lord Howard of Lympne (Con)]

My Lords, I declare my interest as chair of Hospice UK. Would my noble friend agree that the greater the extent to which hospices can discharge their functions, the greater the extent to which the pressure on NHS beds will be relieved? Is that not therefore a compelling reason for ensuring that a pay increase is met with regard to hospices?

--- Later in debate ---

[Lord O'Shaughnessy]

My noble friend gives a compelling reason. It is salutary to note that while around half of deaths occur in hospital, most people—about 70% to 80%—would prefer to die at home or in a hospice, which means that we need to have a thriving hospice sector. That is why it is important to make sure that it can compete on a level playing field for staff.

[Lord Blair of Boughton (CB)]

My Lords, I declare an interest as the chair of Helen & Douglas House, the first ever hospice in the world for children. When I last spoke about this subject, the Minister invited me for a meeting. I am afraid that that meeting has never been proffered since, but I am delighted to tell the House that the threat of a meeting with a Minister was enough to get the clinical commissioning group to start paying towards our hospice. However, I echo the point made by the noble Lord, Lord Howard: that a hospice that is struggling for staff, which is then presented with a pay deal only for the NHS, will struggle more. Can the Minister really consider the effect of this on hospices?

[Lord O'Shaughnessy]

I am sorry that that meeting has not taken place, and of course I am always glad to meet the noble Lord to discuss this issue. I am glad that the threat of a meeting has had the desired result, and clearly, I agree with him that we have to make sure that hospices are equally attractive places to work as is the NHS more broadly.

[Lord Judd (Lab)]

My Lords, I declare an interest as a vice-president of Hospice at Home in west Cumbria, where I live. This Question is very important. Does the Minister not agree that hospices work best when they work very closely with the health service? That is certainly the case in west Cumbria. We have become part of the co-operative provision of services and care to the community as a whole, but raising the necessary funds is a tremendous task. I hope that the Government will look very seriously at how hospices can be supported in ensuring that the nurses working for them with so much devotion are able to enjoy any improvements in the remuneration of nurses across the country.

[Lord O'Shaughnessy]

I can reassure the noble Lord that we are looking at that. Hospices work closely with local CCGs, which provide around 30% of their funding. We estimate that around 9,000 nurses work in hospices, and clearly we want to make sure that that number not only stays level but increases so that we can start to deliver the choice that we have committed to in palliative care for people.

[Lord Dobbs (Con)]

My Lords, the hospice movement helps over 200,000 patients every year, and they help not only the patients who are at that point in their lives but their relatives, leaving them with fantastic and positive experiences rather than the alternative which is available. The hospice movement is largely funded by the private sector—

--- Later in debate ---

[Lord Dobbs]

I will quickly get to that—I have a very important question. The hospice movement is largely funded by the private sector—by public subscription, not by central government. Can my noble friend use his great skills, of which we are all admirers, to make sure that nothing that the Government do undermines the hospice sector and that we find ever more imaginative and successful ways to support such a vital role?

[Lord O'Shaughnessy]

I will certainly do everything that I can. I agree that hospices are a fantastic example of the kind of mixed economy that this country does so well, with philanthropic and public contributions, and we must make sure that both those continue.

[Baroness Thornton (Lab)]

My Lords, I am sure that the Minister will be aware that this affects not just hospices, which of course are an integral and very important part of the health service, but the pay of those who work in all the charities and social enterprises which contract with the NHS. I would like to broaden the Question slightly from hospices and ask what the Minister’s reaction is to the Royal College of Nursing, which has called on the Secretary of State to establish a non-NHS national staff council to facilitate a more integrated way of looking at the pay of all nurses and healthcare staff in health and social care settings across the piece.

[Lord O'Shaughnessy]

I was not aware of that proposal but I will certainly look at it and write to the noble Baroness with our response.

[Baroness Brinton (LD)]

My Lords, it is not just hospices and social enterprises that are affected by the differential in the proposed NHS scales; the existing framework in Her Majesty’s Prison and Probation Service demands formal nursing qualifications but there is no contractual obligation on private operators such as G4S, Serco and Sodexo to follow those grading scales and there is already wide disparity. What will the Government do to ensure that HMPPS follows both the pay scales and the NHS scales?

[Lord O'Shaughnessy]

It is important to reiterate that, in looking at one of the consequences of the Agenda for Change pay deal, the Government have committed to look at the impact not just on hospices but on staff who are not employed on Agenda for Change NHS contracts and to make sure that they are properly rewarded for the work they do.

[Lord Forsyth of Drumlean (Con)]

My Lords—

--- Later in debate ---

[Lord O'Shaughnessy]

This is indeed an important day in the history of the NHS, and I am delighted that it is a Conservative Government who are making this financial commitment. I look forward to having an opportunity to repeat my right honourable friend’s Statement tomorrow, when we will have more time to discuss its benefits.

Carers: Health and Well-being

Lord O'Shaughnessy Excerpts

Tuesday 12th June 2018 Lords Chamber

[Baroness Pitkeathley (Lab)]

I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I draw attention to my interests in the register.

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

My Lords, the Government recognise and value the work that carers do and are committed to supporting carers so that they can provide care without compromising their own health and well-being. That is why, on 5 June, my department published a carers action plan, setting out a cross-government programme of support for carers. Furthermore, there will be a clear focus on carers in the forthcoming social care Green Paper.

[Baroness Pitkeathley]

I thank the Minister for that reply and for the action plan. The process was a bit protracted, as he will remember, but I am glad that the department managed to get it out in time for Carers Week. However, by its own admission it is a short-term plan only to bridge the issue of carers in the run-up to the social care Green Paper. In new research published for Carers Week, 70% of carers said that their own mental health had been adversely affected, while 60% said that their physical health had worsened, and two out of five said that they doubted their ability to go on caring unless they had more support. Given that that care is valued at £130-odd billion a year, that is a time bomb that must be addressed in the Green Paper. Can the Minister reassure the House that the needs of carers will be central to any plans for social care reform? Will he also understand that, as well as the moral imperative for supporting carers, to which I know he is personally committed, there is a very sound economic case for doing so?

[Lord O’Shaughnessy]

I thank the noble Baroness for her question and for her tenacity in pursuing me on this topic. I am glad that we were able to publish the action plan. It is appropriate during Carers Week to pay tribute to the amazing work that carers do. Yesterday, I had the opportunity to meet carers who were struggling, often against their own health needs, to care for those they love.

The action plan that we published is a two-year plan. It has some immediate actions but is not purely short-term and contains some actions for the medium term. I highlight one of those, which is important, particularly given these concerns about carers’ health and well-being: a commitment to creating equality standards for carer-friendly GPs. Carers mentioned to me yesterday how important it is for GPs to validate the fact that they are carers and signpost them in the direction of care. I can confirm that carers and support for carers will have prominence in the Green Paper.

[Lord Mackay of Clashfern (Con)]

My Lords, one of the most exciting experiences I ever had in my life was to go to a children’s hospice providing respite care for the parents of children facing an early death as a result of the onset of permanent illness. What sort of provision do we make for that?

[Lord O’Shaughnessy]

The importance of respite care is agreed by everybody. I point my noble friend to the better care fund, which provides around £130 million a year to support respite care and carers’ breaks, building on the commitment made in the Care Act 2014.

[Baroness Tyler of Enfield (LD)]

My Lords, the action plan contains a number of generalised statements about the need for health and social care professionals to have improved understanding and awareness of the needs of carers. What specific plans do the Government have to ensure that social worker training—both initial training and later professional development—contains practical guidance on how to identify carer fatigue and distress and ensure that carers receive the support to which they are entitled?

[Lord O’Shaughnessy]

The noble Baroness makes a very important point. Indeed, in the carers action plan there is a specific commitment from the department to work with local authorities to improve social work guidance in terms of spotting carers, many of whom are not even aware that they are formally designated as carers, and signposting them to the right support. There will also be an awareness-raising campaign among social workers so that they understand their duties.

[Baroness Finlay of Llandaff (CB)]

Will the Government’s action plan have a specific focus on children and adolescents who are carers, often of a single parent who may have physical and/or mental health problems? The child often carries the whole responsibility, and is sometimes also responsible for their siblings. When they have an adverse experience, such as coming home and finding their parent deteriorated or dead, they need an enormous amount of support. Therefore, the education system also needs to be involved in any strategy looking at children.

[Lord O’Shaughnessy]

The noble Baroness is quite right; it is hard to imagine what the burden must be on those young carers who are looking after parents and siblings. Young carers are explicitly mentioned in the action plan; again, I point to two commitments in that. First, there is a young carers identification project, which is working with Carers UK to make sure that we can find young carers. Secondly, the DfE has committed in its children in need review to make sure that young carers are getting the educational support they need in school and out of school to make sure that their educational outcomes do not suffer.

[Lord Touhig (Lab)]

My Lords, almost 50,000 babies, children and young people need palliative care, yet children’s hospices receive less statutory funding than adult hospices, and the lack of collaboration between support services is a major challenge. Carers and those they care for would benefit if we had a children’s palliative care strategy that was family-centred and had a holistic focus on health, education and social care. Does the Minister agree with that?

[Lord O’Shaughnessy]

Children’s hospices do an extraordinary job. They get less statutory funding as a percentage of their total; there are good reasons for that, both historically and to do with the type of care they provide. The Government are providing £11 million of support in 2018-19 through the children’s hospices grant to support them, in addition to funding from local clinical commissioning groups. But I will take his proposal for a palliative care strategy back to my right honourable friend the Minister for Care. I know that she is very interested in this issue.

[Baroness Brinton (LD)]

My Lords, the advice for local authorities on short breaks for carers of disabled children says on page 7 that short breaks should not just be there for those at crisis point. Given that many short break centres are now being closed across the country, removing help even at a crisis point, what are the Government doing to ensure that short breaks for children and their carers—for our most vulnerable and disabled children—will be guaranteed for the future?

[Lord O’Shaughnessy]

In addition to the £130 million in the better care fund, there is a commitment in the carers action plan to develop examples of best practice that can be spread around local authorities to make sure they all reach the highest standards. At the moment, unfortunately, only some of them are doing so.

Psychiatrists: Referral Fees

Lord O'Shaughnessy Excerpts

Thursday 7th June 2018 Lords Chamber

[Baroness Thornton]

To ask Her Majesty's Government what steps they will take to address concerns that psychiatrists treating patients suffering from addiction have been receiving referral fees from private clinics.

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

My Lords, the General Medical Council is the independent regulator of doctors in the United Kingdom. Its guidance is clear that doctors must not allow any financial interest to affect the way that they treat patients. The GMC is aware of the allegations in the media, will consider the evidence and, if it finds that doctors have breached its guidance, will take action. Serious or persistent failure to follow the GMC’s guidance may put a doctor’s registration at risk.

[Baroness Thornton (Lab)]

I thank the noble Lord for that Answer. Like many noble Lords, I am sure, I was alarmed to read allegations that people suffering from addiction were being used for what sounded like profiteering, which is absolutely against the rules. However, the wider issue seems to be that there is a shortage of mental health experts in the system at all levels and cuts in budgets, so there is vulnerability in the system that is being exploited. What are the Government doing to increase the number of psychiatrists and other physicians in mental health, and to increase funding given the amount lost in the mental health system?

[Lord O'Shaughnessy]

If these allegations are substantiated, there must obviously be serious consequences for the doctors concerned and clearly it is right that the GMC investigates that. In terms of the noble Baroness’s overall question, there is of course local authority-commissioned alcohol and drug treatment available; it does not need to be purchased privately. More generally, in terms of mental health support, she will know that there is a commitment to recruit 21,000 more mental health staff and that, through the new mental health investment standard, CCGs have to continue increasing their mental health spending year on year.

[Baroness Jolly (LD)]

My Lords, is there any evidence to suggest that these are isolated cases or more common practice?

[Lord O'Shaughnessy]

We do not have any detail on further cases at this point. Of course we would always welcome any evidence, as would the GMC, in order to investigate that. It is important to point out that doctors are revalidated medically every year and fully revalidated every five years. In that process, they are asked to demonstrate that they have stuck by the ethical guidelines in the GMC practice and, if any evidence alights contrary to that, it would put their registration at risk.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, as someone who has been in this area for quite some time, this exposure in the Sunday Times comes as no surprise whatever—it has been going on for many years. More importantly, is the Minister aware that there is a growing crisis in the private sector provision of alcohol and drug treatment centres? The numbers are declining and many are closing. The CQC produced a very critical report on the standards, which showed that 60% to 70% of them are failing to meet the appropriate level of performance, and that there is a distinct possibility that even less money will be available to provide for this kind of service in 2020, when the funding shifts to business rates. Is the Minister concerned about these kind of developments, and if so, would he be willing to talk to people who are equally concerned about it to try to find some way forward with better prospects for the future?

[Lord O'Shaughnessy]

I am as disturbed as the noble Lord is, not only by the stories we have seen in the press but by his view that this came as no surprise. If substantiated, from a professional perspective this is clearly a great cause of concern. I would be interested to meet him to talk about the overall support for the private sector. Clearly the CQC has a role in providing for patient safety and quality, but we need to make sure that publicly funded services are available for people recovering from alcohol and drug addiction.

[Lord Hamilton of Epsom (Con)]

My Lords, is it against the guidelines of the BMA for doctors to go to luxurious resorts on so-called conferences at places with plenty of golf courses, paid for by drugs companies?

[Lord O'Shaughnessy]

I do not know whether it is against the standards of the BMA. However, the General Medical Council is explicit in its guidance that doctors must not allow any financial interest—either the fact or the perception of it—to impact on the way they treat or refer patients, and they must declare any such conflicts or perceptions of conflicts to patients while treating them.

[The Earl of Sandwich (CB)]

Can the Minister confirm that Public Health England is now, finally, going ahead with its review of prescribed drugs and addiction to those drugs? Is he aware that the guidelines from NICE on this subject are very out of date, and will there be a parallel review of them?

[Lord O'Shaughnessy]

I can confirm that the PHE review is going ahead. I do not know whether there is a concomitant review on the NICE guidelines, and I will write to the noble Earl on that subject.

Chronic Lymphocytic Leukaemia: Ibrutinib

Lord O'Shaughnessy Excerpts

Thursday 7th June 2018 Lords Chamber

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

My Lords, the National Institute for Health and Care Excellence recommends Ibrutinib for the treatment of patients with chronic lymphocytic leukaemia who meet specified clinical criteria. NHS England is required to make funding available so that clinicians can prescribe treatments in line with NICE’s recommendations. NHS England has processes in place to transfer NICE’s recommendations into its commissioning systems, and I will be meeting both NHS England and NICE on Tuesday to seek assurance that their processes were appropriate in this case.

[Lord Forsyth of Drumlean (Con)]

My Lords, I am very grateful to my noble friend for that Answer and for his courtesy in meeting the patient support group at very short notice before the recess. What is the point of NICE if NHS England can get away with denying funding to some patients with relapsed chronic lymphocytic leukaemia, contrary to NICE guidance that Ibrutinib was an option for all patients relapsing after chemo-immunotherapy? Is my noble friend comfortable that clinicians in England, but not in Scotland or Wales, are being forced to reuse chemotherapy against their clinical judgment and at considerable risk and suffering to their patients? Is it not now time to listen to the advice set out in a letter to the Times of 18 May by our leading clinicians and bring the bean counters in NHS England to heel?

[Lord O'Shaughnessy]

First, I thank my noble friend for the question and for the opportunity to meet sufferers of this illness two weeks ago. As he and the House know, the point of NICE is to provide that expert, objective evaluation of the benefits of drugs both clinically and in terms of value for money. It has clearly made a recommendation in this case. I also know that there is concern about the discrepancy between NICE’s guidance—or, I should say, the summary in section 1 of that guidance—and NHS England’s commissioning guidance, which is narrower. It is precisely that concern about a discrepancy that we are investigating at the moment, and which will be the subject of the meeting that we are having. Once I have more information on that, I shall of course write to him and place a copy of that letter in the Library.

[Lord Patel (CB)]

My Lords, I agree with all the things that the noble Lord, Lord Forsyth of Drumlean, has said. Ibrutinib as a drug was developed after an extensive study to understand the biology of the disease, chronic lymphocytic leukaemia, which increasingly affects older people. Because it was developed following an extensive biological study, it is a targeted drug. In technological terms, it is a tyrosine kinase inhibitor. Therefore, it is more effective in the treatment of this disease and has a better outcome, and some countries have adopted this drug as the first line of treatment. We have used the guidelines that say that the first line of treatment—apart from patients who meet certain criteria, such as those with 17p deletion, who will be given the drug—will be chemotherapy. That then subjects people who have relapsed to a second toxic treatment with chemotherapy, which is wrong. For NHS England to use criteria that are completely arbitrary, except for cost, is also wrong. It should be required to produce the scientific evidence for that, and I hope that the Minister will agree.

[Lord O'Shaughnessy]

I thank the noble Lord for his question. There are two important issues here. First, on this treatment as a first-line treatment, the evidence that was put into NICE by the company itself did not propose its use as a first-line treatment, which is why it has been proposed as a second-line treatment. It is important to distinguish there. However, clearly there is this apparent discrepancy between the NICE guidelines and NHS England. I have, obviously, investigated this, subsequent to the meeting with my noble friend and sufferers. NHS England’s view is that its commissioning guidelines are consistent with the commissioning when the drug was in the cancer drugs fund, and the full NICE guidance, but I also know that that is not satisfactory to some of the patients suffering from this illness who have been in remission for three years. That is precisely what I want to get to the bottom of next week.

[The Lord Bishop of Carlisle]

My Lords, I am most grateful to the Minister for meeting some of the patients suffering from this terrible disease. Can he tell us whether anyone directly affected by blood cancer was consulted before the initial decision was made by NHS England to restrict access to Ibrutinib? Can he assure the House that NICE guidelines will not often be varied—and then only after consultation with patients?

[Lord O'Shaughnessy]

I thank the right reverend Prelate for that question. As he will know, NICE consults widely with patient groups and others in making its decisions. I am not clear at this stage whether NHS England met patient groups and others in designing its clinical commissioning guidelines, which is of course what I shall investigate next week.

[Lord Blunkett (Lab)]

First, I commend the Minister for being prepared to come to the noble Baroness Jowell’s funeral last week, which was greatly appreciated. Secondly, I commend him for his obvious commitment and detailed understanding on this particular issue that has been raised this morning. Is it not exactly the same issue as Baroness Jowell was raising, although on a very different treatment and challenge, which is that the best and most appropriate treatment should be available as quickly and easily as possible everywhere and to everyone, wherever they live?

[Lord O'Shaughnessy]

I am grateful to the noble Lord for that. I was privileged to be invited to the funeral, which was a very moving occasion for a very special lady. On his overall point, NICE approves 71% of cancer drugs that are applied for, so there is an absolute focus on making sure that the most effective cancer drugs can be brought to patients in England as soon as possible. Under the reformed cancer drugs fund, that can now happen from the point at which there is a draft guideline, which is often many months before it would otherwise be the case. That means that tens of thousands of people have been able to access cancer drugs earlier than they would ever have done before and, as a consequence, many lives have been saved.

[Baroness Jolly (LD)]

My Lords, the NHS constitution states that patients have a legal right to,

“drugs and treatments that have been recommended by NICE for use in the NHS”.

At the moment, in England, there are many men and women who have cataracts that are deemed by NICE as being ready for operation and for replacement, but the CCGs are refusing to commission and they are having to wait longer and longer. Can the Minister shed any light on this?

[Lord O'Shaughnessy]

I am afraid I do not know—it is a slight handbrake turn on the topic. I would of course be happy to meet the noble Baroness to discuss this issue; I was not aware of it, but I will happy to investigate it for her.

[Baroness Seccombe (Con)]

My Lords, can my noble friend the Minister explain why this NICE recommendation was rejected for the treatment for chronic lymphocytic leukaemia? NHSE operates a closed system whereas NICE is in direct contrast. There is no input in NHSE from patients or experts on this dreadful condition. If it is not reversed, will we not see poorer results for patients and, ultimately, higher costs for the NHS?

[Lord O'Shaughnessy]

I thank my noble friend for that question. This debate has highlighted just how passionately people care about this issue and making sure that we have good and quick access to the most effective cancer drugs. It is important to point out that, for this particular disease, Ibrutinib is available for many groups. There is clearly a concern about a potential discrepancy between the NICE guideline and the NHS commissioning guidelines. That is what I will try to get to the bottom of next week. I have to restate, however, that NHS England’s view is that its guidelines are based on the full guidance that came from NICE, not just the summary; it is that that I need to explore.

Abortion

Lord O'Shaughnessy Excerpts

Wednesday 6th June 2018 Lords Chamber

[Baroness Barker (LD)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as the chair of the All- Party Parliamentary Group on Sexual and Reproductive Health.

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

My Lords, under existing arrangements women across the United Kingdom have access to high-quality, safe abortion services. Parliament decided the circumstances under which abortion can be legally undertaken. It is accepted parliamentary practice that proposals to change the law on abortion come from Back-Bench Members and that decisions are made on the basis of free votes.

[Baroness Barker]

I thank the Minister for that Answer. Do the Government not think it is wrong that women in Northern Ireland can be coerced to continue with a pregnancy under legislation passed in 1861 by MPs, all of whom were men elected solely by men? Does he not agree that to overturn Sections 58 and 59 of the Offences against the Person Act would enable the men and women of Wales, Northern Ireland and England to determine under what circumstances women should be able to access safe, legal abortion?

[Lord O'Shaughnessy]

It has been the position of successive Governments that abortion policy and law is a devolved matter for Northern Ireland, to be decided by elected politicians in Northern Ireland on behalf of the people of Northern Ireland. That is our position: they should be the group that makes the decision.

[Baroness O'Loan (CB)]

Can the Minister confirm, given the decision by a majority of the democratically elected Northern Ireland Assembly made in February 2016—an Assembly elected by the men and women of Northern Ireland—that it does not wish to change abortion law, and given that it has been recognised since the Government of John Major that Westminster would not impose abortion on Northern Ireland, that if the Government move to decriminalise abortion in England and Wales or to direct rule in Northern Ireland, they will not impose any change in abortion law on the people of Northern Ireland, particularly at this most difficult and sensitive time?

[Lord O'Shaughnessy]

Our intention—that of the Government and the Northern Ireland Office—is to restore a power-sharing agreement and arrangement in Northern Ireland so that it will be up to the people of Northern Ireland and their elected officials to decide on abortion policy.

[Baroness Thornton (Lab)]

My Lords, the Northern Ireland Assembly is not meeting at the moment. This matter, which is the issue of the Question put by the noble Baroness, is not a devolved matter. Could the Minister give the House an indication of the Government’s response to the debate led by my honourable friend Stella Creasy in the Commons yesterday? A cross-party amendment will be tabled to the upcoming Domestic Violence Bill that will seek to decriminalise abortion across England, Wales and Northern Ireland through the repeal of Sections 58 and 59 of the Offences against the Person Act 1861. That is not a devolved matter.

[Lord O'Shaughnessy]

I merely reiterate the point that abortion policy is a devolved matter. Indeed, that has been the policy of successive Governments of all hues. Of course, it is ultimately up to Parliament to make a decision, and any move that came from Parliament would emanate from within Parliament, from the Back Benches, on the basis of a free vote, as I set out in my first Answer.

[Lord Morrow (DUP)]

My Lords, would the Minister agree with me that if, in fact, Westminster legislates on this matter, effectively devolution has been put off for a long time? Does he accept that this is a matter for the people of Northern Ireland and its elected representatives? Incidentally, the DUP is ready to go back into the Assembly tomorrow morning.

[Lord O'Shaughnessy]

I agree with the noble Lord that it is and should be a decision for the elected representatives of the people of Northern Ireland. As anyone who watched or read the transcript of the debate in the Commons yesterday will know, there is a profound disagreement about what the implications would be of repealing Sections 58 and 59 of the 1861 Act. If that were brought forward, there would be a discussion in Parliament on the consequences of that and on its interaction with the devolution settlement.

[Baroness Jenkin of Kennington (Con)]

My Lords, following yesterday’s debate in another place, the Minister for Women and Equalities said:

“With authority comes responsibility. Message from NI Secretary of State today: NI should take that responsibility. Message from the House of Commons: if you don’t, we will”.


Does my noble friend agree?

[Lord O'Shaughnessy]

The position of the Government is that this ought to be a decision for the elected representatives of Northern Ireland representing the people of Northern Ireland, which is why we are determined to restore power-sharing agreements and arrangements as soon as possible—so they can make that decision.

[Baroness Suttie (LD)]

If the Supreme Court rules tomorrow that Northern Ireland’s abortion laws are in contravention of human rights laws, will the Minister confirm that the Government will move to repeal sections of the 1861 Act and decriminalise abortion in Northern Ireland?

[Lord O'Shaughnessy]

As my right honourable friend the Secretary of State for Northern Ireland set out in her statement yesterday in the debate, we are aware of the decision coming imminently tomorrow and that both we and the Northern Ireland Executive will consider that judgment carefully.

[Lord Alton of Liverpool (CB)]

My Lords, will the Minister agree that the caricature of the people of Northern Ireland as living in some antediluvian society has to be measured against a law that has led in Great Britain to some 9 million abortions—that is one every three minutes, 20 every single hour and 600 every working day, with one in five pregnancies now ended by abortion, and abortion up to and even during birth in the case of babies with disabilities, leading to 90% of all babies with Down’s syndrome being aborted? Is that something that we have a right to export to Northern Ireland, or do we not have a belief in devolution and the right of people in Northern Ireland to make up their mind on that issue for themselves?

[Lord O'Shaughnessy]

I would not presume to make a caricature of the people of Northern Ireland in one way or another. What this debate has demonstrated is that there are deeply held beliefs in this area and, of course, there are significant consequences of decisions on abortion law in one regard or another. It has emphasised that those decisions, which are incredibly significant, ought to be made by the people whom they affect, via the elected representatives whom they put in power.

Education (Student Support) (Amendment) (No. 2) Regulations 2018

Lord O'Shaughnessy Excerpts

Monday 21st May 2018 Lords Chamber

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

My Lords, I congratulate the noble Lord, Lord Hunt, on securing this debate, and express my gratitude to all noble Lords for speaking. I always welcome the high profile that issues relating to NHS staffing receive in this House and I am always pleased to debate our approach with noble Lords, who I know are motivated by a desire to protect and promote our world-class NHS, and bring both wisdom and expertise.

I will start by explaining the overall rationale behind the reforms that the Government are making. The decision to remove bursaries for nursing, midwifery and allied health profession students and to provide them with access to the student loan system was taken by the Department of Health—as was—in the 2015 spending review. One reason for that was that this group of students had access to less money through the NHS bursary system than students in the student loan system. By moving to the loan system, these students now typically receive a 25% increase in the financial resources available to them for living costs during their time at university.

[Lord Willis of Knaresborough]

Before the Minister goes one second further, will he confirm that the bursary money was free money? They did not have to pay that back. Now they have to pay back the whole loan.

[Lord O’Shaughnessy]

If the noble Lord will let me finish, I will get to that point. Like other graduates, student nurses will be required to repay these government-funded loans only once they are in employment and earning. It is important to state that the student loan repayment terms are progressive. From April 2018, individuals will make their contribution to the system only when they are earning more than £25,000. Monthly repayments are linked to income, not to interest rates or the amount borrowed, and the outstanding debt is written off after 30 years.

I am not the Education Minister in this House, although I seem to be covering this topic not only tonight but in other forums, but it is important to underline that the reason this system was introduced into this country by a Labour Government, reaffirmed by a coalition Government and continued by a Conservative Government, is that it means that the best-earning graduates, instead of having their fees entirely paid by taxpayers, including people who have never gone to university, make a contribution to the costs incurred, whereas those who are lower-earning through their lives, including those who will perhaps never earn more than £25,000, will make no contribution. That is a more progressive system of funding than one in which everybody gets it for free, no matter how much money they make in their life.

As I said, these reforms give student nurses access to more financial support, albeit they have to pay that back if they can afford to do so later in life. It also provides a level playing field with other students. But perhaps most importantly of all, these actions released about £1 billion of funding to be reinvested in the NHS front line. As a consequence, Health Education England plans to increase the number of fully funded nurse training places by 25% from September 2018. It is important to stress that Health Education England has made that decision as an independent body to meet the need for more nurses that we all agree is there.

As the noble Lord, Lord Hunt, pointed out, this equates to around 5,000 more places each year—a major and welcome boost to our much-admired nursing workforce. My background is largely in education and I assure the noble Lord, Lord Puttnam, that we understand the urgency of this task and the parallels with education that he mentioned.

[Baroness Watkins of Tavistock]

Is that for the clinical placement funding?

[Lord O'Shaughnessy]

That is quite right. That is fully funded clinical placements—just for the sake of clarity. I thank the noble Baroness.

There is understandable concern among noble Lords, which has been expressed previously in this House, about the new system of financial support, but I want to be clear that we are giving the group of postgraduate students that we are discussing access to undergraduate maintenance and tuition fee loans, just as we do with postgraduate teachers. This represents a more generous package of support than the postgraduate master’s loan. We are also making available additional funding for childcare, travel to clinical placements and exceptional hardship funding to ensure that the students are fully supported and are able to complete their studies.

Furthermore, as many noble Lords have mentioned and as the noble Lord, Lord Hunt, and the noble Baroness, Lady Watkins, welcomed, in the debate on the regulations in the other place on 9 May, my honourable friend the Minister of State for Health set out a range of additional support that we are investigating for postgraduate nursing students. This includes specific incentives such as “golden hellos” for postgraduates who go to work in mental health—where the noble Lord, Lord Willis, was quite right that we need to attract more nursing and where there has been a shortfall—the area of learning disability and community nursing. The Government have announced £10 million to support such incentives and we are considering how this should be best delivered.

Many noble Lords have expressed concern about the drop in number of undergraduate applications to nursing courses. We acknowledge that early indications from the latest UCAS data, published in April, show that the number of students applying to study nursing has decreased from this point in the cycle last year. However, that cycle is not yet over, so we need to apply some caution.

It is also worth noting, as noble Lords have pointed out, that there is a distinction between the decline in number of applications and that in the number of students starting their courses. That was exemplified last year, which showed a 23% drop in the number of applications compared to a 3% decline in the number of acceptances. That is regrettable, but it was still the second-highest number of acceptances on record. Several noble Lords have expressed their desire for further information on how this develops. I can confirm that my department has committed to publish an update in autumn 2018 following the close of the 2017-18 application cycle.

As the noble Baroness, Lady Watkins, pointed out, there is a global challenge to recruit more nurses. We are working hard to make nursing as attractive a profession as possible. As a result of constructive dialogue over recent months, NHS Employers and the relevant trade unions began a consultation exercise on a three-year pay deal for NHS staff employed under the Agenda for Change contract. Under the plan, the starting salary of a nurse will rise to £24,907 by 2021, not only rewarding current staff for the incredible work they do but sending a clear signal to the country about how much nurses are valued.

We are boosting the attractiveness of the profession in a number of other ways, too. Nearly 4,500 nurses have started the return to practice programme and 3,000 have completed it. Across the country, NHS trusts are developing arrangements for flexible working and there is a concerted effort to tackle workplace bullying through an NHS-wide call to action. Our homes for staff programme is supporting NHS trusts to dispose of surplus land to help up to 3,000 nurses and other staff access affordable housing. I hope that gives the noble Lord, Lord Clark, some concrete examples to back up the warm words we use about supporting the nursing profession.

Several noble Lords have touched on new routes into nursing, which the Government are prioritising. The most significant innovation in this area was the announcement of a new nursing associate role in November 2016. Health Education England has already trained 2,000 nursing associates in a pilot programme and is planning to train up to 5,000 in 2018, with up to 7,500 nursing associates trained through the apprenticeship route in 2019. As well as creating a much-needed new role in its own right—I emphasise “in its own right”, as it is an augmentation to the nursing and other professions—nursing associate training offers an alternative route to becoming a registered nurse. We expect this “earn and learn” approach to be more attractive to older students, a concern which many noble Lords have raised.

To support this career path, Health Education England is developing a shortened nurse degree apprenticeship to facilitate transition from nurse associate to registered nurse, which will also automatically recognise the prior learning and experience gained in the nursing associate role. For the first time, apprentices will be able to work their way up from entry-level health work through to advanced clinical practice in nursing.

Several noble Lords expressed their concern about the apprenticeship route and the figure of only 30 nurses. The official data has been delayed and we believe that the figure is more like 250. We will be able to confirm that. It is a better start but, clearly, not yet the target that we want to reach. However, we believe that this stepped approach through the nursing associate role, giving the opportunities for a pause after two years and then to go on for two years, ought to be more attractive to employers than the current four-year commitment. This development of the nursing associate route therefore provides for a better use of the apprenticeship route.

I want to address a couple of what are perhaps misconceptions. The figure of 40,000 vacancies is used often in this House. I might be pedantic and disagree with that number—the quantum is just about right—but it is important to say that these are not empty places. They are being filled by agency and bank staff. Part of the reason for that is that people want flexibility and more pay, two of the things that we are trying to address so that we can provide more permanent contracts for those people who currently work flexibly.

The noble Lord, Lord Clark, and the noble Baroness, Lady Garden, talked about EU staff. I hope your Lordships will agree that I miss no opportunity to say from this Dispatch Box how much we value those staff and that they have just as much right to apply for settled status as anyone else in this country, provided they fit the criteria. However, it is worth pointing out that there are more EEA staff in the NHS than there were in June 2016. The one category where the figure is lower is in nursing and midwifery but the reason for that was the introduction of a more stringent language test. We are dealing with that issue, which I hope will mean that we continue to see an increase in EEA staff working in our NHS.

The noble Lord, Lord Willis, asked specific questions about the apprenticeship levy. I will need to write to him on that issue having consulted my colleagues in the Department for Education.

Turning quickly to the second point of the Motion, several noble Lords, including the noble Lord, Lord Hunt, the noble Baronesses, Lady Walmsley, Lady Watkins and Lady Garden, and others said that we should postpone the introduction of the reforms until the post-18 education and funding review has been completed. As noble Lords know, the Prime Minister launched the review earlier this year to ensure that we have a better system of higher education support that works for everyone. Many aspects of the current system work well and, as was set out in the terms of reference for the review, there are important principles that the Government believe should remain in future. One of those is that sharing the cost between taxpayers and graduates is the right approach, as I rehearsed earlier in my speech.

I take the point made by the noble Baroness, Lady Walmsley, about looking at the Welsh example. I have looked at it myself and I am sure it is something that the review would want to consider. However, it is important that we do not prejudice the work of the expert panel established to support the review or prejudge its outcomes. The fact of the review should not delay these healthcare education reforms, not least because they predate the launch of the review by some distance and already apply to the vast majority of nursing students. We believe it would do more harm than good to further delay these reforms, although it is worth underlining that any relevant reforms stemming from the review will apply equally to this group of student nurses.

In conclusion, I recognise the well-motivated concerns expressed by noble Lords during this debate. However, I hope I have been able to demonstrate that the student finance reforms that this Government have introduced have allowed both the removal of the artificial cap on nurse training places and the largest expansion of student nursing places in a single year ever seen. These two facts are not coincidental; they are inextricably linked. The latter is possible only because of the former and they form part of a wider set of workforce reforms designed to expand, train and reward our nursing profession better so that we can continue to deliver the high standards of NHS care that patients demand. On that basis, I hope the noble Lord, Lord Hunt, will feel able to withdraw his Motion.

[Lord Hunt of Kings Heath]

My Lords, I am grateful to all noble Lords who have spoken in this debate, particularly the noble Baroness, Lady Watkins, who returned early from the WHO to take part in it.

I am left, though, with huge concerns and a real puzzlement as to the Government’s approach. As the noble Lord, Lord Willis, said, faced with this huge crisis in nursing in particular but also among the other professions covered by the regulation, the Government, without any evidence base, seem to be setting out a plan to discourage older women and people from black and minority ethnic groups from entering nursing, midwifery and other professions. In the breakdown of postgraduate healthcare students, the statistics show clearly that 64% are over the age of 25, women are largely attracted to this route and there is a higher percentage of minority ethnic students. We also know from the Department for Education’s own analysis that those groups are known to be more debt-averse. So the consequence is bound to be a negative impact on the very group of people we probably most need to come into the nursing profession.

The Minister justifies that by saying that loans are higher than bursaries. That is one way of putting it but, of course, bursaries are grants and loans are loans, and the fact is that to many people a debt is a debt. I really worry about the Government, who are seeking to say, “Don’t worry, you can run up a huge debt because the chances are that you’re not going to have to repay it”. The Minister has lectured me about economic policy in the past but I have to say that this is the most extreme example of “funny money” I have ever come across. He tried to reference it back to the Labour Government, but I remind him that we never intended that the amount of fees that would have to be paid would reach anything like what they are now. We believed in a shared responsibility; the current Government believe in transferring all responsibility to students.

[Lord O'Shaughnessy]

I do not want to get into an argument about funny money and magic money trees, but it is worth pointing out that the proposal to treble student fees came from the Browne review, which was instigated by a Labour Government, and indeed the 2010 Labour manifesto committed a future Labour Government to implementing the findings of that review.

[Baroness Walmsley]

I would add that the Browne recommendations had no cap at all.

Carers: Back Pay Liability

Lord O'Shaughnessy Excerpts

Wednesday 16th May 2018 Lords Chamber

[Baroness Richardson of Calow]

To ask Her Majesty’s Government what plans they have made to assist financially with the historic back pay liability of providers of commissioned care for people with learning difficulties.

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

My Lords, the Government recognise that sleep-in liabilities are placing financial pressures on the adult social care sector and are exploring future options to minimise the impact. Any such intervention would need to be legal, proportionate, fair and necessary. To support providers now, HMRC has created the social care compliance scheme to allow participating social care providers until March 2019 to make payments to workers.

[Baroness Richardson of Calow (CB)]

My Lords, I thank the Minister for his answer and his concern, because this is a concern that is widely felt within the social care sector. I am associated with a charity called Walsingham Support, which supports adults with learning difficulties: those with brain-acquired injury, autism and complex needs. Like many other care providers, it is finding it very difficult to comply with the current exercise, which is for back-pay liability in respect of night-working. Until fairly recently, night workers who were permitted to sleep were given a flat rate and the full wage if they were required to work during the night.

--- Later in debate ---

[Baroness Richardson of Calow]

Okay.

[Lord O'Shaughnessy]

I recognise the concern expressed by the noble Baroness, which the Government share. Even though the position on the change of the status on paying sleep-in payments changed in October 2016, we understand the size of civil liabilities for some providers who, of course, are, in many cases, providing for some of the most vulnerable people in society. That is why this HMRC scheme was set up. It gives providers extra time—up to 15 months—to get their house in order, understand their liabilities and pay them. That comes to an end in March 2019, which is why we are working on looking at other interventions and talking to the European Commission about the legality and state-aid rules in relation to that. I am afraid that I cannot give her any more detail at this stage, but I can tell her that it is a priority.

[Baroness McIntosh of Pickering (Con)]

My Lords, this is particularly about the retrospective nature of this award. I contacted my noble friend, who was kind enough to take up the case of the Wilf Ward Family Trust, which provides for the care needs of young people with learning disabilities and which will be affected. Is he able to contest the retrospective nature of this decision and ensure that no similar back pay will be awarded in the future? County councils are completely incapable of making up this shortfall.

[Lord O'Shaughnessy]

I thank my noble friend for raising the issue, which we are looking into. The point here is that the change in policy has come about because of decisions made by employment tribunals and a clarification of the law, and the job of government is therefore to help providers to comply with the law. That is how the scheme has come about, and why extra support is being looked into. We are working closely with providers to try to understand the scale of the liability and how it affects organisations differently—we think that up to two-thirds are affected. We will also make sure that any intervention that might follow—I stress “might”—is proportionate, fair and legal.

[Baroness Wheeler (Lab)]

My Lords, Jeremy Hunt told MPs last week that a lot of work was going on in government on this issue to,

“understand the fragility of the current market situation”.—[Official Report, Commons, 8/5/18; col. 520.]

However, we already know that the viability of nearly 70% of the disability care sector is threatened by the sleep-in pay crisis, as last week’s survey by disability charities shows. Homes will have to be sold or more local authority contracts handed back. Is this not enough evidence of the desperate state the care sector is in and why the extra funding is needed from the Government to ensure that already low-paid staff are treated fairly and receive the money they are owed?

[Lord O'Shaughnessy]

The noble Baroness makes an important point about the attention my right honourable friend the Secretary of State is giving this. We are taking this issue seriously, and she is quite right about the number of organisations that are affected. As I said, a scheme already exists which allows providers to defer any payments, and we are investigating whether any further interventions are necessary during that period when they can defer them.

[Lord Wigley (PC)]

My Lords, I draw attention to my entry in the register of interests as a vice-president of Mencap. Is there not a taste of retrospective legislation or at least retrospective interpretation of legislation in this, something we always try to avoid? When one hears figures, as we have, of some £400 million of liability for organisations undertaking such excellent work, does this not justify the Government intervening to ensure that no such organisations suffer unduly as a result of these changes?

[Lord O'Shaughnessy]

I agree with the noble Lord that there is a retrospective element to this, but it is around the clarification of the law. The Government have put a support scheme in place through HMRC to provide that support to resist, for example, enforcement notices on workers who ought to be paid in arrears. That is up and running and it has been open since September 2017. But clearly, as that continues we are also looking at whether other interventions might be necessary.

[Baroness Brinton (LD)]

My Lords, it is quite clear that the £2 billion extra for adult social care in the 2017 spring Budget had absolutely no relevance to this £400 million deficit and liability for providers, and it would be unwise for the Government to assume that it should be used for back pay. While it is wonderful that HMRC has slightly deferred payment, until the Government are able to help providers we will continue to see provider after provider going to the wall. Allied Healthcare cites £11 million as its own back pay on this issue. When will the Government help these providers?

[Lord O'Shaughnessy]

On the extra £2 billion of funding, I have not tried to link it with this; it is of course at the discretion of local authorities to use that to support the social care sector in the way they see fit. It is worth pointing out that Allied Healthcare is in this social care compliance scheme. My honourable friend the Minister for Care has written to it to express her disappointment at the approach it has outlined. Its liabilities have not crystallised yet, so it is not right for it to refuse that and she has written to it to demand clarification. However, clearly we understand that the clock is ticking and that there is an urgency to this.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister explain what the legal liability is of commissioners who commissioned care services based on the previous costs?

[Lord O'Shaughnessy]

That is an excellent question and I will write to the noble Baroness with an answer to it.