Health: Online Services

Lord O'Shaughnessy Excerpts

Monday 23rd April 2018 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what action they are taking in response to the Care Quality Commission’s report, The state of care in independent online primary health services, published on 23 March.

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

My Lords, the online provision of primary care is a development with the potential to improve patient outcomes. However, it is important that these services are regulated and inspected properly. The CQC will continue to hold online providers to account while sharing good practice. Following its report, we are considering what further action is needed to ensure that the right balance is struck between the provision of safe, effective care and encouraging further innovation.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. We are strongly in favour of technologies and innovations that help to provide the widest possible access to primary health services, particularly when getting a timely GP appointment is so difficult for thousands of patients. The CQC inspection role is crucial but there is no disguising the serious issues to be addressed and resolved. These include checking patients’ identity, sharing information with the NHS GP and the safe prescribing of medicines. Some 43% of companies are failing to meet regulations for keeping patients safe and there are particular concerns about inappropriate prescribing of antibiotics and medicines and about managing long-term conditions. How will the Government ensure that the lessons from the first phase of the CQC inspection are learned, and will they pledge to take swift action on the problems now before the service is further rolled out?

[Lord O'Shaughnessy]

I thank the noble Baroness for raising this important issue. She is right that the CQC report identified some serious issues among this group of online providers, which of course operate in the independent sector. She mentioned safety and safeguarding, and I would add to that. It is worth saying that there were some positive responses, in terms of 97% of the providers being caring and 90% of them responsive, so some strengths were identified as well as weaknesses. Obviously the CQC retains the ability to take regulatory action. As it sets out in the report, it has done so to ensure that standards improve, and in general they improve from one inspection to the next. However, this is of course the independent sector. We are looking at the lessons for the provision of NHS services. The biggest one of those that comes out of the report is around data sharing: to ensure a clear flow of data between an online provider and a GP, if they are different, so that any problems can be spotted early on. That is particularly important for safety.

[Baroness Jolly (LD)]

My Lords, as the Minister has just said, this is a picture of things to come. Could he give an indication of when the Government expect that GP practices would regularly be able to give an online service to the general public and their patients? What support, financially and developmentally, would they be sure to get from NHS England?

[Lord O'Shaughnessy]

On that specific point, NHS England is providing £45 million through the general practice forward view to promote online consultations. That is to ensure that they are available in general practice across the country. The noble Baroness will be aware of the GP at Hand practice, which is one practice in west London offering these services, but we are seeking to expand them, and NHS England, the CQC and others are providing regulatory support during that process.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, can the Minister explain the process? If someone chooses to access an online GP service, what happens to their registration with the GP with whom they are already registered—if they are registered? Is the process clear to each patient?

[Lord O'Shaughnessy]

That is an excellent question. It is important to distinguish between the independent sector and the NHS. The CQC report was about the independent sector, so a patient would continue to be registered with their NHS GP practice and have an augmenting consultation, if you like. With GP at Hand, as it is an NHS practice, they would switch their registration. One issue that has come up is whether people have full enough information about that switching, which is one thing that NHS England is reviewing in the independent review that it has commissioned about the success or otherwise of that service.

[Lord Leigh of Hurley (Con)]

What steps are the Government taking to encourage people—I appreciate that they cannot force them—throughout the UK to use only online medical services which are registered with the CQC?

[Lord O'Shaughnessy]

This is of course the way the economy is going in general and is a great passion of the Secretary of State. Indeed, he made a commitment at the NHS Expo conference last year that, by the end of this year, every patient would have access to an NHS app online which will enable them to do things such as book consultations, see who has viewed their medical record and set their preferences about things such as blood and transplant donations. A huge stream of work is going on to ensure that those services are available to all patients in the NHS.

[Viscount Waverley (CB)]

My Lords, the Minister will be aware that Brussels is introducing the GDPR arrangement for registration of email addresses and the rest. Could he say a word about how that might impact both independent services and the National Health Service, and counsel doctors accordingly so that they do not get it wrong?

[Lord O'Shaughnessy]

That is an excellent point: the entire country is preparing for the advent of the GDPR on 25 May. We are engaged in a large programme of work with the Information Commissioner’s Office and others to ensure that everyone working in the health and care services understands their obligations and informs patients accordingly.

[Lord Winston (Lab)]

My Lords, a large number of reproductive clinics publish their wares by advertising on the London Underground, often at great cost, sometimes making claims about their treatments. If I did that as a doctor, I would be struck off the register. They get round it because they are private clinics. Is that appropriate? Does the Care Quality Commission have any involvement in this process, and should it?

[Lord O’Shaughnessy]

I would have to look at the specific clinics that the noble Lord is talking about. The subject of the report was those providing online services. One of the things it discovered was that certain regulatory issues are unique to the provision of online services, an example of which is when the data is held offshore and what that means for regulation. As the CQC says in its report, it is reviewing its regulations to make sure that it can account for the unique aspects of online provision, so that the critical aspects, whether they are about truthful advertising or other aspects, are dealt with properly.

[Lord Patel (CB)]

My Lords, as the noble Lord is aware, there is an increasing number of independent primary care practitioners. What assessment have the Government made of the impact of that on the medical workforce of the NHS?

[Lord O’Shaughnessy]

I am not specifically aware of such an evaluation, but I know that there is a need for more general practitioners, which we are all aware of, and indeed for a plan to recruit many more to the service to ensure that all patients and citizens of this country can find a GP in the NHS when they need it.

Children: Obesity

Lord O'Shaughnessy Excerpts

Thursday 19th April 2018 Lords Chamber

[Baroness Jenkin of Kennington]

To ask Her Majesty’s Government what action they are planning to reduce childhood obesity.

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

My Lords, the Government’s childhood obesity plan, launched in August 2016, focuses on the areas that are likely to have the biggest impact on preventing childhood obesity. All reports and data on progress in delivering our plan will be published and open to scrutiny. We will use this to determine whether sufficient progress has been made and whether alternative levers need to be considered.

[Baroness Jenkin of Kennington (Con)]

My Lords, I am well aware that we had a pretty comprehensive trot around the issue earlier this week but I did not have the opportunity to raise with the Minister the issue of the Daily Mile, an initiative started some six years ago in a small Scottish primary school where children were encouraged to run for 15 minutes a day, which turns out to be a mile. Since then the initiative has proliferated and now over 3,300 schools are participating. It has been independently evaluated and proven to show a massive improvement in health, well-being and academic attainment. The Scottish and Welsh Governments have written to every single primary school encouraging them to participate. Would the Minister please consider doing the same here?

[Lord O’Shaughnessy]

Following the debate that we had the other day, I looked up the Daily Mile online. It is now in 2,000 schools across the UK. My right honourable friend the Secretary of State has described it as an excellent initiative, which indeed it looks like. It certainly seems to develop good habits of physical and mental health. Writing to schools is of course a matter for the Department for Education, but I will certainly speak to my colleagues in that department to encourage schools to take this up. In the spirit of the debate of the noble Baroness, Lady Walmsley, I think it would be better to end with a quote from William at Woodfield Primary School in Wigan, who said that the Daily Mile,

“helps you with your maths, English, and you get faster each time, which makes you healthier”.

What more could you want?

[Lord Blunkett (Lab)]

My Lords, I cannot match the alliteration of the Minister but I ask him if he and his colleagues in other departments would consider an addition to the sport, to the dietary and to the drive against sugar, given the evidence of the recent review that the Government undertook into full-time social youth action in which organisations such as Volunteering Matters and City Year UK demonstrate that work by young people for young people against bullying, emotional trauma and mental health problems can have a real effect.

[Lord O'Shaughnessy]

I completely agree with the noble Lord. I believe that he chairs the National Citizen Service, which has been a massive initiative to encourage such habits in teenagers. I completely concur with him: the Government take a number of approaches to encourage youth social action, and that is something that we will continue to support.

[Baroness Redfern (Con)]

My Lords, does my noble friend agree that families need to be presented with clear information about the food they buy and how important clear labelling is? Does he agree that when the UK leaves the EU, that will give us a greater flexibility to determine what information should be presented on packaged food and how it should be displayed?

[Lord O'Shaughnessy]

My noble friend is absolutely right: this is one of the many opportunities which this country will enjoy after we have left the European Union. We will have the flexibility to vary food labelling to ensure that we can use the very best, and latest techniques to encourage people to eat more healthily.

[Baroness Jolly (LD)]

My Lords, there are two components to keeping fit and losing weight. One is exercise—the example we have had is excellent—and the other, of course, is food. There are three partnerships in that: there is the department of health and the Department for Education, but parents are critical. What work has been done to involve parents in this whole issue? It is really serious, because obese children will probably be obese adults, and we know where that goes.

[Lord O'Shaughnessy]

The noble Baroness is absolutely right: parents are of course the first educators of their children and it is about them being able to set an example. I would focus on a couple of things: first, the national curriculum in schools, which is encouraging parents to get involved in understanding what good nutrition is, how to cook well and so on. The second is Public Health England’s new One You campaign, posters of which are up now, which talks about the 400, 600, 600 of calories per meal per day to encourage parents to get into good habits, because of course, if they have good habits and are well informed, their children will too.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, does the Minister believe that within the plan there may be a greater role for the major broadcasters in this country to give a stronger lead against these problems? The BBC, in particular, has major flagship programmes which are primarily about eating, putting on weight and calories, but the same applies to the other channels. Will he join me in a conversation with the BBC to try to persuade them to produce a major flagship programme that addresses the issue, particularly with regard to children?

[Lord O'Shaughnessy]

That is rather an interesting idea and suggestion from the noble Lord. We would need to speak to colleagues in the DCMS—which I would be delighted to do. I think that broadcasters such as the BBC have traditionally played a very important and positive role in public health issues and continue to do so, and I am happy to encourage them to do so in this area, too.

[Lord Elton (Con)]

My Lords, while recognising the essential nature of sufficient exercise at all ages, in the absence of my noble friend Lord McColl of Dulwich, I again remind the House that the more you exercise, the more you eat.

--- Later in debate ---

[Lord O'Shaughnessy]

All I can say is that both my noble friends are excellent examples of slim and fit young men.

[Lord Turnberg (Lab)]

I am sure that the Minister is aware that while exercise is very good for children and adults—it improves mental and physical health—it does not do much for obesity. It is food that does the worst. It is not just sugar, it is fat, and ice cream, crisps and chocolates are so appealing to children. Ice cream has twice the calories of sugar. Will he consider how to get that message across?

[Lord O'Shaughnessy]

One thing I noticed at Easter was that Easter eggs seem to have got bigger. I was counting the calories on the Easter egg that my children had. There is a serious point there. It is about reformulation, it is not just about reduced sugar, salt and so on; it is also about smaller portion sizes, and that is a measure that we are tracking as well.

[Lord McColl of Dulwich (Con)]

My Lords, it is really me. Is the Minister aware that a recent report from Canada showed that children who were fed on whole milk for the first eight years of their life were much healthier than those not, and they were not obese? Why on earth did we ever start skimming milk when human breast milk has the same amount of fat as cows’ milk? As far as I know, we have not started skimming human breast milk yet.

[Lord O'Shaughnessy]

I am trying to imagine how that might work. The noble Lord makes an important point which he also made in a debate the other day, that our understanding of dietary needs is changing. In some ways, we are rediscovering old truths about the importance of fat and reduction of sugar. That is part of the approach that Public Health England is promoting.

NHS: Winter 2017-18

Lord O'Shaughnessy Excerpts

Wednesday 18th April 2018 Lords Chamber

[Lord Clark of Windermere]

To ask Her Majesty’s Government what assessment they have made of the effectiveness of their plans for the NHS in dealing with the pressures during the winter of 2017-18.

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

My Lords, last year the NHS started planning earlier than ever before to support delivery during the challenging winter months. Despite the NHS being extremely busy, with challenging weather conditions and flu rates at their highest level for several years, hard-working A&E staff treated more than 55,300 people within four hours per day between December and March—that is 700 more a day on average than the year before. A review of winter performance by NHS Improvement and NHS England will be published this summer.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his Answer. Of course, we are all very thankful indeed that we have got through the worst days of the winter, and we are grateful that new plans were put in place. However, I think we all know that we got through only due to the dedication and commitment of the staff in the health service at every level, and that we face dire shortages in every sector of the health service. Is the Minister aware, for example, that 800 student nurses in 20 universities have had their grants or loans cut off or reduced due to administrative errors by the Student Loans Company, and that many of them now face financial distress, with the prospect of no or reduced support for the foreseeable future? Does the Minister accept that that is preposterous when there is such a shortage? Will he therefore step in and try to sort that out, so that no student nurses suffer?

[Lord O’Shaughnessy]

I join the noble Lord in paying tribute to the dedication of staff who have taken us through what has been the worst winter for eight years. I was not aware of the particular issue he raised; I am glad he has raised it and brought it to me. I shall take it back to the department immediately after Questions to make sure that we get to the bottom of what is going on and try to fix it urgently.

[Baroness Jolly (LD)]

My Lords, community pharmacies are a hugely undervalued resource and could help alleviate pressure. They could do that by helping people who have already been discharged from hospital avoid readmission and by being first port of call for patients, offering advice and treatment to those with minor health conditions. Will the Minister tell the House whether the Government are having a conversation with NHS England about future commissioning of community pharmacy services?

[Lord O’Shaughnessy]

I agree with the noble Baroness that we need to beef up the role of pharmacies. Primary care is an area of investment within the five-year forward view. There are, I believe, nearly as many pharmacists as there ever have been, if not more, so their role is increasing all the time and that is part of our conversations for the future.

[Baroness Browning (Con)]

While my noble friend is looking at the expansion of advice from pharmacies, will he look at the same time at insurance cover for pharmacists? My understanding is that, while GPs have been very keen for pharmacists to give advice, for example, to asthma sufferers and to provide the equipment that asthma sufferers need to carry with them, they have run into difficulties in getting insurance cover to provide that level of advice.

[Lord O'Shaughnessy]

I shall certainly look into that issue. We are reviewing insurance across primary care, as my noble friend might know, and I shall look into this specific issue.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that one of the problems is the shortage of intensive care beds, which holds up operations in hospitals so that there is a queue?

[Lord O'Shaughnessy]

The noble Baroness is quite right. That is one of the reasons we have taken some big decisions over the winter, one of which is to reduce the amount of delayed discharges. I think it has been reduced by about 1,500 beds. It was also the reason behind what was undoubtedly an unpopular decision and one that we did not want to take: to suspend and postpone some elective surgeries during January. That freed up a number of beds, which helped us to cope with the emergency admissions. Happily, it has not had to be reinstated since the end of January.

[Lord Hunt of Kings Heath (Lab)]

My Lords, a huge debt is owed to the NHS for the way that it has responded to the pressures this winter. However, can I ask the Minister about elective treatments and the cancellations in January? He will know that the maximum 18-week wait target has not been met for, I think, at least two years. Given that the BMA has said that winter pressures will really never come to an end—they simply continue throughout the year—does he think that we will ever meet the 18-week target again under the current Government?

--- Later in debate ---

[Lord O'Shaughnessy]

I agree that those winter pressures are increasing. One reason that they are doing so, and throughout the year, is that we have a growing and ageing population, as we discuss a lot in this House. It is worth pointing out that the planning guidance for the NHS for 2018-19 talks about not only providing more surgeries but starting to stop the growth in waiting lists and reduce waiting times, as well as halving them for the longest waits. We are focused on this, supported by the extra money that was announced for the NHS in the Budget at the end of last year.

[Lord Laming (CB)]

My Lords, does the Minister agree that the structure of the GP service, settled decades ago at the beginning of the National Health Service, is no longer fit for the current demands on primary care services? Could that be looked at in a serious way?

[Lord O'Shaughnessy]

I think the structure of our GP service and primary care is envied around the world. It has many strengths, such as the partnership model being based in the community, but it is changing. For example, more GPs are employed in hospitals. There is a major programme of investment going into primary care, including new models of care around how GPs are structured, but the presence of primary care doctors in the community is one of the great strengths of the NHS.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I welcome the review which the Minister has announced. Does he agree that it would be beneficial if we had a debate in this House on the review when it is out, and will he commit to trying to ensure that his Chief Whip gives us the time to have such a debate?

[Lord O'Shaughnessy]

I am not sure how much pressure I can bring on the Chief Whip for anything, but I look forward to debating the review in whatever form we can when it comes out.

[Baroness Gardner of Parkes (Con)]

My Lords, in view of the discussions about whether people from overseas should be able to use the health service, can the Minister tell us whether any statistics are kept on any impact they would have had during this crisis, or how much of our budget would have been spent on them?

[Lord O'Shaughnessy]

I do not believe that we have specific statistics on the demand from overseas visitors during winter. I say to my noble friend that overseas visitors are most welcome to use the NHS but it is important that they pay. We are reclaiming more money than ever from overseas visitors to go into funding the NHS.

[Baroness Pitkeathley (Lab)]

Is the Minister aware that the pressures on the health service are compounded by the difficulties in the social care system? We are promised a Green Paper. We were promised a carers action plan in January; it is now mid-April. Will he update the House on where we are with the carers action plan?

--- Later in debate ---

[Lord O’Shaughnessy]

I know that it is still the intention of the department to publish a carers action plan, and I will write to the noble Baroness with the specific time as to when that may happen.

Children and Young People: Obesity

Lord O'Shaughnessy Excerpts

Tuesday 17th April 2018 Lords Chamber

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

My Lords, I start by congratulating the noble Baroness, Lady Walmsley, not only on securing the debate but on opening it in a way I had not previously experienced—through the voices of children. I must say that if every debate started that way, this would be both a happier place and a more informative one. I genuinely thank her for the approach that she has taken and the time that she obviously took with those children. I thank all noble Lords for their, as ever, wise and challenging contributions and will attempt to answer as many questions as I can.

I do not disagree with the characterisation of what we are discussing as an epidemic, because childhood obesity is undoubtedly one of our top public health challenges. We have heard some data about the prevalence rates, but the simple fact is that a quarter of children entering primary school start off overweight or obese—I am conscious of the distinction that my noble friend Lord Balfe makes—but that rises to a third by the time they leave. Something is happening during those years. There is also a generational aspect to this. Cancer Research UK has shown that the millennial generation is on course to be the most overweight in history. Given the lack of housing and other things they are grappling with, we must address this issue.

As my noble friend Lord Balfe said, there is some encouragement and hope in the plateauing of obesity rates: it is not a cause for despair. However, the evidence shows that, as several noble Lords have mentioned, there is a deprivation gap and this is increasing. The costs of this are mental as well as physical. My noble friend Lady Mone and the noble Baroness, Lady Benjamin, talked about the mental health impacts, including depression, that come from obesity. Other risks that we face are type 2 diabetes, heart disease and an extra likelihood of common cancers such as bowel and breast cancer. It is also a major risk factor for non-alcoholic fatty liver disease. These represent a cost, not just to individuals, but to all of us as taxpayers. The figures used today talk about a cost to the NHS of £5 billion annually. The cost to society is perhaps between five and 10 times that amount.

We all know the scale of the problem and agree that it is complex. It will not be solved overnight. The noble Baroness, Lady Thornton, spoke about the importance of urgency. We need urgency, but it will take time to see results. I am pleased that the mood of this debate is a determination to work together to solve the problem.

What have the Government been doing? As several noble Lords have referred to, we launched our childhood obesity plan in 2016, informed by the latest evidence and research in the area. At the heart of the plan is a desire to change the nature of food that children eat and make it easier for families to make healthier choices. The plan poses challenges for us all to play a role in reducing childhood obesity levels: national government, local government, business, the NHS, schools and families. Some of the key measures that have been talked about today include the soft drinks industry levy, the sugar reduction and wider reformulation programme—which I will return to—and helping children to enjoy an hour of physical activity every day.

Real progress has been made since the plan was published. The soft drinks industry levy has come into effect and PHE has formulated a comprehensive sugar reduction programme with the aim of a 20% reduction in sugar in key foods by 2020, including a 5% reduction in year one. Industry has responded to these frameworks and that gives us cause for hope. There is sometimes a sense that industry will not respond, but companies such as the makers of Lucozade and Ribena, Kellogg’s, Waitrose and Nestlé have been leading the way by removing millions of tonnes of sugar from products. Through my noble friend Lady Neville-Rolfe, I commend the action of Tesco. We enjoyed the services of Tesco Extra in the Isle of Wight over the weekend. Its offer of free fruit for children was extremely welcome; it stopped them fingering packets of Haribo and other things instead. These little things do make a difference.

We now expect almost half of all drinks that would otherwise have been in scope of the sugar levy to have been reformulated as a result. That is a cause for celebration. We know that there was scepticism about the levy when it was introduced, but I think most people would agree that it has been a success. We believe that there is a philosophical reason for acting in this way. Children do not always make their own choices and they certainly do not always make choices with a full suite of information. Government has a history of intervening to protect them; insisting on children using car seats is one example. Children need protecting from the effects of sugar and obesity, for their current and future health. It is right to act to develop good habits. I reassure noble Lords that we believe that to be the case. We do not have an ideological problem with acting in this area to tackle obesity.

An area that I thought might be touched on this evening which I want to highlight is the consumption of energy drinks. These often have a high sugar content and are linked to poor sleep. Again, this is an area where we have seen industry responding positively as regards restricting sales. I have personally seen the havoc that these drinks can wreak in schools and in diets. We are continuing to focus on this area. Therefore, these are a number of areas we are taking forward under the banner of reducing the impact of sugary soft drinks.

On the other things we are doing now, I will just step outside my brief and stress the role of schools. First, the levy is funding a doubling of the primary school PE and sport premium, and providing £100 million in 2018-19 for a new healthy pupils capital fund, with appropriate distribution for the DAs under the Barnett formula. I can reassure the noble Baroness, Lady Grey-Thompson, and other noble Lords that regardless of the income from that levy, the funding is guaranteed for the coming year; off the top of my head, I think it is £320 million. I will ask for confirmation from the DfE about what the plans are for that. However, it is not a true hypothecation, so that funding is there regardless of the income that comes in.

It is also important to say that as a consequence of the levy we are also investing £26 million in breakfast clubs. These are particularly focused in about 1,500 schools in opportunity areas, which are areas that have been targeted for government action because of poverty. An important issue that has come out of this debate, highlighted by the noble Lord, Lord Addington, the noble Baronesses, Lady Grey-Thompson and Lady Thornton, and my noble friend Lady Mone is the direct link between poverty and obesity. As I said at the beginning, the gap is still growing. We are therefore conscious, as my noble friend Lady Jenkin said, that this is an issue of social justice and that there is a need to act. The breakfast clubs have been focused in the opportunity areas because that is one way we are trying to address that issue.

We have said that schools are well-placed to support action. After a coalition policy we introduced free lunches in reception, year 1 and year 2. I have to disappoint the noble Baroness, Lady Benjamin, that at this point there are no plans to extend the free lunches for all pupils beyond those year groups, but of course children on benefits are able to get free school meals throughout their school life. We have other routes by which we can encourage good habits. I focus on PSHE, for example, and cooking classes, and in the primary curriculum lessons on healthy eating. The children of St Joseph’s had obviously taken on board many of those lessons.

One of the things we also have to do is to provide education about personal responsibility. My noble friends Lady Neville-Rolfe and Lord McColl made the point that this is about taking responsibility based on information. As a child, you are inevitably impulsive, but becoming an adult is about developing good habits, and schools have a critical role to play in this. They also have a role in educating parents, and the best schools get parents in to give them these kind of lessons to make sure that they are able to support their children as well.

The noble Baronesses, Lady Walmsley and Lady Thornton, talked about advertising. There has of course been a ban on adverts and I know that there is a call for further bans on advertising across all media. Any policy must be evidence-based. We are of course always open to that evidence, and it is important to view these kind of actions as one way in which we can help parents. I reassure noble Lords that we are keeping it under consideration. The noble Lord, Lord Berkeley, asked about swimming. It is part of the national curriculum, so I can assure him that we consider it important.

I also stress that the obesity plan is not just about school-aged children but about the early years foundation stage, when children not only learn about healthy eating—play is a key part of that. For smaller children going to formal childcare settings, that will become more part of their everyday life. We have been clear that we have considered a number of different policies, we will continue to consider other policies, and we will focus on those which will have the biggest impact on childhood obesity. I stress that we want to follow an evidence-based approach.

My noble friend Lady Jenkin talked about the work that she has been doing with the CSJ. I thoroughly commend her for that work and for the elucidation she has brought to what is happening in Amsterdam, which I believe she visited with my honourable friend the Parliamentary Under-Secretary of State for Public Health. We are trying to learn the lessons from that.

One of the opportunities that we have here concerns devolution. We recently passed a statutory instrument to give more public health powers to Manchester as part of its devo deal. Manchester is often in the lead in these kinds of issues. We see an opportunity at a city-wide level—mirroring the Amsterdam example—to get all the agencies around the table to act. Greater Manchester has introduced #GMMoving: The Plan for Physical Activity and Sport 2017-21. It involves the Greater Manchester Combined Authority, the NHS in Greater Manchester and Sport England. It is exactly that kind of partnership that we need to see more of.

Partnership working is of course at the heart of what we are doing, and I pay tribute to the many organisations that are active in this area—not just the ones that have sent briefings to noble Lords but those that are spending a great deal of money to raise the salience of these issues, such as Diabetes UK, Cancer Research UK and others.

I want to finish by touching on a couple of other issues that noble Lords have raised. The reports and data that we publish on progress will be open to scrutiny. We will be absolutely transparent in the work that we are doing, including Public Health England’s assessment of progress on the sugar reduction policy, which will be published this spring. We are also funding a new obesity policy research unit and will be publishing the details of its projects. That will give us the evidence base that we need to act.

Many other issues were raised. I thoroughly recommend Malcolm Gladwell’s “Revisionist History” podcast, which deals with a fantastic set of issues concerning how fat became the enemy and sugar the friend, and how that has driven changes in eating policy, probably for the worse. I also thoroughly recommend a book called Why We Sleep. This radically transformed my attitude towards sleep. It would not surprise me if at some point in the not-too-distant future we had a government sleep strategy—and I am not just referring to me droning on as a way of helping people to get to sleep. The consequences of poor sleep are very dramatic and, frankly, terrifying. We do need to get more sleep.

On the basis that we want to get home and get some sleep, I shall finish by saying that we are continuing to act in this area. We should focus on smoking. We have not banned it but we have had a thoroughgoing and comprehensive policy which has reduced smoking on a voluntary basis. It is that attitude that we need to take towards obesity, and the Government will continue to work on many fronts to do that. I look forward to working with all noble Lords so that we can start to reduce childhood obesity.

House adjourned at 8.47 pm.

Brexit: Health and Welfare

Lord O'Shaughnessy Excerpts

Thursday 29th March 2018 Lords Chamber

[Lord Dykes (CB)]

My Lords, it is a great pleasure to follow the speeches so far in this debate, which has been serious and solemn but also moving. I am very grateful, like others who have expressed their gratitude, to the noble Baroness, Lady Brinton, for launching this important debate.

If I may say so, without sounding in any way unctuous or sentimental, I was struck by the fact that not only are there eight noble Baronesses speaking in this debate but, just behind the Clerks’ table, we have three of the experts in this House on the National Health Service, because of both their own personal experiences and their deep knowledge of all the subjects that come within the NHS ambit. I was very moved by the description from the noble Baroness, Lady Masham, of her earlier years and how she coped with them. Those things will register, too, because the NHS is a most precious institution in this country, which the Government tamper with or undermine at their peril. People would not forget it if they did it any damage in the future.

Having said that, I am also grateful to the noble Lord, Lord Balfe, a colleague for many years, and the noble Lord, Lord Brooke, for being among the three mere males in this debate. It is an interesting reflection that women really know far more about the National Health Service than men do. That is a silly comment on my part, and I apologise for the tweets and comments that I may get on the internet from male practitioners in the NHS, saying “That’s not fair”. However, there is some connection there with the knowledge women have, given that so many women work at all levels of employment, including as technicians or the so-called unskilled. But as someone said earlier in the debate, those workers are very skilled in their work even if they are cleaners, because cleaning medical premises is a skilled job. The majority of all those people tend, I believe, to be women, including those who come from overseas.

The National Health Service is a precious institution. I was going to say that everybody in the debate is anti-Brexit except the Minister, who has to pretend to be in favour of Brexit because that is his portfolio task. I thank him for being here.

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

It is worse than that; I am in favour of it.

[Lord Dykes]

The Minister has confirmed that he is in favour of Brexit. It is nice to have the odd view given in a debate where everybody else is in favour of staying in the European Union, but I thank him for his personal efforts in this field as a Minister. I attended the meeting he held at the beginning of this week on the new death certification procedures that are coming in. We were grateful, since he is very busy. He is highly regarded in this House for the detailed and caring answers he gives to many complicated NHS questions. In that spirit, I hope that he will forgive my frivolity in referring to his official duties. We will see what happens in the future with those.

It is important for us to reflect on what is at stake here, with the damage done by this foolish decision to proceed with Brexit. There are still Ministers who are in denial psychologically about the damage already done to this country. The economy is already in the beginnings of what might even be a slight recession because of the decisions made by enterprises of one kind or another, mainly putting a halt to their long-term investment plans or transferring overseas.

I share the contempt enunciated by previous speakers—including the noble Baroness, Lady Brinton, herself—for the infamous red bus used in the pro-Brexit campaign, with Boris Johnson triumphant and chortling at the untruths written on its side; we now know that to be so. As a keen European as well as a patriotic Britisher, I am glad to say that there is now a different red bus travelling around this country with a different slogan for Europe. It is getting a tremendous reception everywhere it goes and has been a great success so far.

The NHS does millions of transactions every week. Most of them are carried out very well despite the pressures on employment, the reduction in the number of staff and so on and the huge pressure that NHS staff, doctors and specialists are experiencing because of the Government’s austerity cuts. There are millions of successful transactions every week. They are not noticed by the right-wing papers in this country, which pounce on the slightest unfortunate incident. Incidents are bound to happen, given the many different transactions that take place in our wonderful NHS. It is probably the best in the world, although there are many other good examples in smaller countries and in Scandinavia. In this country we are lumbered with six extreme right-wing newspapers—whose overseas owners do not pay UK personal taxes—with repetitive and boring editorials urging us all to be very patriotic. They always pounce, whenever they can, if something goes wrong in the health service. It is quite right for the press to follow up legitimately, but not when saying that there is something wrong with the National Health Service is propagandistic; millions of satisfied patients and customers—if I can use that word—know what it is like.

My personal experience has been twofold. I have had to go to A&E at St Thomas’ several times and I have used the European health insurance card, which other speakers in this debate have mentioned. The way St Thomas’ A&E is organised is utterly brilliant—it is fantastic. I have been there late at night when it is under huge pressure, and I pay tribute to it. There are numerous other examples of A&Es that are under very severe pressure nowadays that manage to cope. The European health insurance card is precious to so many British people and has reciprocal effects for those coming here and using our facilities. The idea that it would be in any way dented at the margin because of this foolish Brexit plan would be intolerable for many members of the public.

I apologise to the noble Baroness, Lady McIntosh of Pickering, for missing the last two minutes of her speech because I had to take an urgent phone call. I shared the pleasure of the noble Lord, Lord Balfe, at the fact that she has medical connections and connections with Hamburg. She is a great European spokesman and I thank her for what she did in the European Parliament. I know she has always been interested in the health service and therefore believes that these things matter.

Are we not lucky in this House to have the excellent Library briefing service? The document on health and welfare in the UK is outstanding, and I shall refer briefly to two items in it. I could mention its author but perhaps I should not in this parliamentary forum, because she is an official of the House; however, I thank her for the quality of the report. In the third paragraph on page four there is a reference to the December 2017 agreement that the Government reached with the EU negotiators:

“that EU citizens living in the UK before the UK withdrawal date of 29 March 2019 would have the right to remain and to apply for settled status after a period of five years. In a subsequent document, the Government proposed that EU citizens who arrived in the UK after the withdrawal date … but before the end of the subsequent transition or implementation phase should be allowed to enter the UK on the same terms as before the withdrawal date”.

I hope that will not change and that the Minister can confirm that that is the position, to reassure the many people who have been so worried about it that they have already left this country, having given good service and paid taxes as NHS workers, or in the care services in general.

Page six of the Library Note refers to the total budget. There is always the canard, the misleading reference to one of the richest countries in the EU, like Germany, France and now Italy, I believe, paying more into the EU budget—which is a very virtuous budget because it has no deficit and its receipts equal its payments—because it is wealthier than new countries coming in that need money to go to them. We now see, therefore, that an enormous amount of that money has to be deployed in the future in the health service in this country. The Government need to reassure us on this; I hope they will also have second thoughts and stop this nightmare happening at all.

--- Later in debate ---

[Lord O’Shaughnessy]

My Lords, first, I congratulate the noble Baroness, Lady Brinton, on initiating this debate and express my gratitude to her. I commend her contribution and those of all noble Lords, who have touched on many health issues. They have occasionally strayed into the kind of Second Reading speeches we may have heard a few of in the last 11 days in Committee on the EU (Withdrawal) Bill, but I think more or less everyone has retained their discipline and focused on health issues. That is absolutely right as these essential topics will be affected by our withdrawal from the European Union and we need to debate them. It is important to be as clear as possible both about what has been achieved through negotiations so far, what we intend to achieve and what the consequences of that are.

Before I get into the meat of my response, I express my particular thanks to my noble friend Lady Chisholm. She will not thank me for this, I am sure, as she is not always keen to put herself in the spotlight. However, it is her last day on the Front Bench as a Whip. As noble Lords know, she has been a great servant of the House and a great friend and support to me, and I want to place my thanks on the record.

[Noble Lords]

Hear, hear!

[Lord O’Shaughnessy]

All noble Lords clearly agree with that. I reassert and reaffirm that no one disputes the importance of health in the Brexit process. It is only right that we are all concerned with protecting and promoting our wonderful NHS in its 70th year. I take noble Lords back about nine months, when the Secretary of State set out three guiding principles to govern our future relationship with the EU on health. First, patients should not be disadvantaged in any way. Secondly, it should be no more difficult for industry and others to get medicines, devices and other treatments to those patients than it is now—of course, ideally, it should be better. Thirdly, and very importantly, the UK will continue to play a global role in public health, as it always has and will. Throughout that process, patient safety is our number one priority. I also know that it is the main priority of the Commission, from talking to the EU Health Commissioner and other Commissioners, and of the Governments of the other EU 27. We want to make sure that patients and citizens are safe throughout this process. The reason for that, of course, is that, as we all know, health is different. It is not the same as any other traded good or service. You cannot just pay a little bit more for it or take a little bit less for it, if you are undergoing a course of treatment which is essential to deal with a disease, so health is different. I think that is recognised by everybody from the Prime Minister downwards.

It is also worth saying that our regulatory system and our research staff in the NHS and elsewhere are the envy of the EU. We make an enormous contribution through agencies such as the MHRA and through the European reference networks and the GMC to patient safety. It is our very strong desire to continue making that expertise available for the benefit of EU citizens. That is why, as the Prime Minister has pointed out, we want continued collaboration with the EU 27, the Commission and the whole EU, and that is supported by those organisations. It is also widely supported by industry and charities, which are taking this message across the world, as well as Europe, for the benefit of a strong and deep future partnership.

Inevitably, the legal basis of our relationship will change but there is every reason to believe that we will strike a deal that delivers on the principles I have talked about, not least because of the progress we have made to date. As I will set out, I believe there is good cause for optimism. I know that optimism on this issue is sometimes in short supply—I think back to the last debate, which was marginally less gloomy than this one—but I cannot help but think that, as has been revealed in some speeches today, it is a prejudice about the benefits of Brexit in general that informs some of the opinions on the risks here, and I hope to alleviate some of that concern in my comments today.

It is also worth pointing out, as the noble Lord, Lord Brooke, did, that from a domestic point of view we had a very important statement from the Prime Minister about her intentions for the long-term funding and success of the NHS. I know that the Liberal Democrats like to think that they had a critical role in getting her to that point but I assure them that she is more than capable of reaching that conclusion on her own. What I cannot promise is that, whatever funding for the NHS is decided—and like the noble Lord, Lord Brooke, I hope it comes soon—we will be putting the figure on the side of a red bus. However, it will build on recent real-term increases, as well as Agenda for Change funding, to reward our wonderful NHS staff.

Inevitably, people and the workforce have been a big part of our debate today, and I want to use this opportunity, as I hope I always do, to thank and express my admiration for the approximately 150,000 EU nationals who work in our NHS and care services. As my noble friend Lady McIntosh pointed out, I have particular cause to be thankful, and other noble Lords, including the noble Baroness, Lady Masham, very movingly described their gratitude.

It is important to point out that there are more EU staff in the NHS since the referendum. That is true of every single specialty and every type of staff, apart from nurses—we know that the impact on nursing numbers has been driven in large part by the introduction of the language test—so we are continuing to welcome them. Indeed, just this week I chaired a Brexit round table with those who are interested in workforce issues. The message is going out very clearly through the Royal College of Nursing, NHS Providers and so on that we value the work that EU nationals do and their presence in our society.

I believe that noble Lords have welcomed the agreements that we have made on citizens’ rights, not only for after withdrawal but for during the implementation period. I can confirm to the noble Lord, Lord Dykes, that the more generous offer of citizenship rights during the implementation period has been agreed. Clearly, we also need to make sure that we have an immigration system that supports our shortage subjects. We have had the MAC interim report and we will have a future report. I can promise noble Lords that the department is contributing to that work to make sure that we do not run short of the staff we undoubtedly need to serve people in the health and care sector.

Nevertheless, it is true that we need to do more to grow our own. I do not agree with my noble friend Lord Balfe that that is jingoistic or narrow-minded; I think it is our obligation to the 1.5 million people who are still unemployed in this country, despite the fantastic growth in employment here. That is why we are increasing nursing midwifery places and doctor training places. I know that there is a particular concern about unskilled or low-skilled labour. This is a thorny issue, not least because it was concerns about that kind of uncontrolled labour coming through immigration that was a driver of people’s desire to vote leave—to get back control of the immigration system. Therefore, there is a balance to be had and things such as the apprenticeship route, Skills for Care and nursing associates offer us a way through.

Several noble Lords asked questions relating to issues in this area. We want to continue with mutual recognition, although, again, there are concerns about language requirements. Social care is undoubtedly an issue and we are trying to deal with that through Health Education England’s workforce strategy, covering health and care, as well as through the social care Green Paper. That of course focuses mainly on older people but there is a separate strand of work looking at, for example, adults with learning disabilities and others. This was mentioned by the noble Baronesses, Lady Masham and Lady Thomas.

In terms of our offer to Europe, my noble friend Lord Balfe talked about the GMC and sharing data on professional conduct. My understanding is that the GMC provides more professional conduct alerts to the European system than the other EU 27 countries put together—a figure provided to me by the BMA. Clearly that is a reflection not of the quality of our staff but of the rigour of our regulation. We want to continue to contribute to that. Our strong desire is to remain part of that registry so that we can share in the safety agenda across Europe.

The noble Baroness, Lady Tyler, asked about staffing in mental health. We do not need to rehearse the discussion we had yesterday about our desire to increase numbers. No Government in the EU have been more ambitious in their intentions on that. She asked specifically about the medical training initiative for psychiatrists and the length of time involved. I shall look into that issue as I understand it is a long training process.

The noble Baroness, Lady Thornton, asked about employment rights and health and safety issues emanating from the EU. These issues emanate from the EU because they concern competencies that it has taken for itself. They will be within our competence in future and, frankly, it will be our choice. That is the point of leaving the European Union. Woe betide any Government who tried to make life more difficult for staff, particularly when we are trying to recruit them. The point is that it will be in our gift and not in the gift of any other Government.

On reciprocal health work care—which, again, several noble Lords have mentioned—we have got a good achievement on both EHIC cards for people accessing planned care and for British pensioners living abroad accessing healthcare through the withdrawal agreement. I will not go into detail but I encourage noble Lords to look at that. It gives us confidence that we will be able to deliver a good outcome on continuing similar versions of the schemes. It is worth pointing out that EU countries have bilateral agreements with non-EU countries now and we had them before we entered the EU. It is a common arrangement that countries have with each other and much valued by people who are travelling abroad or looking to retire.

Another key issue that has been raised is the safety and availability of medicines. We have a fantastic regulator in the MHRA, with 30 years of knowledge as a lead regulator through the MA process and over 3,000 medicines. We will continue to play a role in the EMA during the implementation period to make sure that there is no interruption to supplies. We will support the transition of the EMA to Amsterdam. Some specific details still need to be worked out about membership of the committee, rapporteur rights and so on during that period. The noble Baroness is right, they will be less than we have at the moment, but their exact nature needs to be determined.

The big question concerns the future relationship. The Prime Minister has been admirably clear about her desire for associate membership but there is not a template we can follow for that. The MHRA makes a huge contribution to patient safety and we do not believe that the EU will want to jettison that ability. As I have said, we have a great deal to contribute not only in this area but in chemicals and airline safety. That will help not only for medicines but for blood, organs and, to some degree, medical devices.

Specifically on medical devices, there has been a good outcome on the continued flow of those during the implementation period. Two big questions remain: one is about the trading relationship we have; the other is about our regulatory environment. We have not touched much on trade but we have commissioned work on the supply chain in this area, which I have committed to share publicly once that investigation has taken place. There is, of course, a commitment from the Government for as frictionless and tariff-free trade as possible, and we have had meetings with HMRC to make sure that that can happen whatever the circumstances.

On the regulatory front, we have achieved mutual recognition of the work of notified bodies during the implementation period. Our notified bodies approve more high-risk devices than any other, so that is yet another element of our huge contribution to patient safety across the EU.

Clinical trials have been the subject of much discussion both in this Chamber and in meetings outside it. We all know that the UK is a leading centre for clinical trials. More than that, we helped to develop the Clinical Trial Regulation, which is a significant improvement on the directive that went before it. If, during the implementation period, the portal that is the final key which unlocks the door of the CTR becoming applicable is agreed, we will take part in it and continue to implement it after the implementation period.

There is of course the question of what will happen after 2021 because it is not solely in our gift to be part of this portal; it has to be a mutual decision. Again, it is our desire to continue to be part of that but it needs to be negotiated. Discussion is going on in government ahead of Report on the EU (Withdrawal) Bill so that we can give the kind of reassurances about the nature of our clinical trials environment that I know noble Lords and others are looking for. We want to make sure that we continue to increase the number of people who take part in clinical trials and have more trials in combination with EU and other countries.

Another issue that has been well covered in both the EU withdrawal Bill and discussions today is public health and the “do no harm” principle. I remind noble Lords of the principles I set out at the beginning from the Secretary of State about playing a leading role in public health, which this country has always done, whether in responding to the Ebola crisis or in domestic action on reducing smoking, drinking, sugar and salt in food and so on. We have a world-leading system that is admired around the world and that, as I said, makes a contribution to patient safety and health across the EU.

The noble Baroness, Lady Walmsley, asked about our desire to play a continued part in EU mechanisms such as ECDC, which provides surveillance, information sharing and action on antimicrobial resistance, where the UK has been in the lead. I can tell her that our desire is to continue to be part of those processes. We want to maintain our high standards. The phrase “a race to the bottom” has been used. We want the opposite: a race to the top. We will be able to say more about our intentions in this area in the coming weeks. We are, and will always remain, part of international agreements under the WHO’s auspices, as well as our own international health regulations. I make a commitment to the noble Baroness, Lady Masham, that it is our desire to continue to share data on the dangers and risks that we face—of course, diseases honour and respect no boundaries—to make sure that we can have the right information, through whatever means possible, to keep our people safe.

I want to touch on a couple of other issues. I am afraid that my noble friend Lord Balfe is quite wrong about Euratom; it does nothing to impact on the supply of medical radioisotopes. I implore noble Lords to be careful about the language they use so as not to create fear where it should not exist. We want to make sure that we have the right customs arrangements for those isotopes to come through quickly—as they do now if they come from outside the EU—and we will make sure, whether through the Euratom Observatory or the NCAs, that we agree with other countries so that we have the right level of information and, therefore, the correct supplies.

We have a world-leading research community and a leading role in Horizon 2020, which has been underpinned and underwritten by the commitment of the Prime Minister and the Chancellor to our involvement. We want to go on designing future arrangements with the EU, just as third parties and third countries do now. That would include being part of European reference networks; I believe that we lead more of those than any other country.

The noble Baroness, Lady Brinton, and the noble Lord, Lord Brooke, asked about procurement. I can tell them that we have implemented our obligations under the EU directive. The Government are absolutely committed that the NHS is, and always will be, a public service, free at the point of need. It is not for sale to the private sector, whether overseas or here. That will be in our gift and we will not put that on the table for trade partners, whatever they say they want.

Our ability to leave the EU successfully is dependent on having the right agreement with Ireland, where health services are co-commissioned. Primary care can span both borders, and there is trade in medicines and other things. I have met the Irish Health Minister to discuss these issues. We have a good working relationship and we are working hard to make sure that those cross-border issues do not disadvantage patients in the way we have talked about.

Finally, we are pushing ahead with the implementation of the falsified medicines directive that my noble friend Lady McIntosh asked about. I met SecureMed, the body implementing it, yesterday. The noble Baroness, Lady Thomas, asked about the welfare rights of disabled people and the European Social Fund. Those are policy areas for the Department for Work and Pensions, so I hope that she will forgive me if I do not answer specifically now; I will write to her.

The noble Baroness, Lady Walmsley, asked about food standards. I can promise her that they are on my radar; they were raised at a public health round table on Brexit that I held a couple of weeks ago. We want to maintain the highest standards through the FSA that we have at the moment.

I hope that I have been able to answer and, to some extent, alleviate anxieties expressed by noble Lords through the debate. I know that we will continue to have many discussions on these issues in the Chamber and privately. I hope that noble Lords also know that my door is always open to discuss these things. I want to make sure that we get the right outcome—as do all noble Lords, and I respect that.

The Government are undertaking a huge amount of preparatory work to mitigate the potential risks associated with leaving the European Union and to make sure that we can take the most advantage of the opportunities as well. I happen to be the lead Brexit Minister in the department, so I feel a very personal responsibility for getting this right. We want to continue to be global leaders in all the facets of health, as we are today. That is something that the Prime Minister has recognised—an important recognition. She said that our principle for how the UK approaches leaving the EU is to be,

“consistent with the kind of country we want to be as we leave … A country that celebrates our history and diversity, confident of our place in the world; that meets its obligations to our near neighbours and far off friends, and is proud to stand up for its values”.

Nowhere is this more important than in our commitment to continue meeting the health and welfare needs of the UK’s citizens and residents as we leave the European Union.

Children and Young People: Mental Health

Lord O'Shaughnessy Excerpts

Wednesday 28th March 2018 Lords Chamber

[Lord Cotter]

To ask Her Majesty’s Government what progress they have made in implementing the proposals for support for mental health provision for children and young people in schools, set out in the December 2017 Green Paper, Transforming children and young people’s mental health provision.

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

My Lords, following publication of the Green Paper in December, we are working across health and education to explore options for implementing the proposals, which will be informed by responses from the consultation. This includes consideration of training programmes for the designated leads and mental health support teams, delivery of the four-week waiting time pilot and criteria and processes for selecting the trailblazers. We will publish a response to the consultation in due course.

[Lord Cotter (LD)]

My Lords, I thank the Minister for his reply. As we all know, mental illness is an increasing concern. It is good that the Green Paper to which he referred has been produced. Appendix B refers specifically to schools and says that,

“68% have a designated member of staff”,

for mental health. However, does the Minister not agree that it is equally important that teachers are fully trained and involved in the process of dealing with mental health, since, unwittingly, they can exacerbate young people’s lack of confidence? For example, I heard recently of a young person who needs encouragement being told by a teacher, “Your mother did this work for you”. Teachers need training to deal with this issue.

[Lord O'Shaughnessy]

The noble Lord hits on an important point. Not only is mental illness unfortunately rising in prevalence, but it is everybody’s responsibility to try to help young people who suffer from it. That is what lies behind the proposals in the Green Paper, which contains a number of elements. He is quite right: there is additional training that will be applicable for all teachers, in mental health first aid, for example. It will also make sure that pupils understand it, changing the PHSE curriculum for more focus on mental health and well-being. That is why the designated leads are so important, because they bring that together at school level. So I agree with the noble Lord that schools have a critical role to play in dealing with this problem of mental health.

[Baroness Meacher (CB)]

My Lords, the Minister will be aware that young people with severe mental health problems can wait up to four and half months for treatment when a young person with severe physical health problems can expect to be seen within the day. Of course we all want equal treatment of these two groups. I very much welcome the Government’s plan to spend £1.25 billion extra in this area. However, does the Minister have an estimated average waiting time for young people with severe mental health problems once the £1.25 billion is in place?

[Lord O'Shaughnessy]

I do not have a specific time, but I point to two things. First, there are now waiting time standards for early intervention in psychosis and eating disorders. Those waiting time standards will become more exacting over time, but they are being met at the moment. The Green Paper also proposes a pilot of four-week waiting times for access to specialist services in the NHS. We have a long way to go—average waits are 12 weeks—so we are inevitably starting incrementally, but the ambition is that over time, we will roll that out as a nationwide ambition. However, I am afraid that I cannot give the noble Baroness a deadline.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, a lot of mental health issues among young people, including bullying and suicides, are caused by the use of social media. Is this an area that the Government should be addressing urgently?

[Lord O'Shaughnessy]

It absolutely is, and the Green Paper covers some of these issues, both in terms of providing resilience for young people themselves and getting social media to act more responsibly.

[The Lord Bishop of Ely]

My Lords, in my area, the diocese of Ely, which covers Cambridgeshire, some young people wait for up to 12 months for effective treatment, and the referral rejection rates are at the highest they have ever been—over 50% in Cambridgeshire. In many cases, voluntary sector organisations are working with us to mitigate the amount of time that children and young people have to wait. Does the Minister agree that 2025 is too long to wait until the changes proposed in the Green Paper are fully rolled out?

[Lord O'Shaughnessy]

I recognise the right reverend Prelate’s point about the rising demand for services. We are trying to increase the proportion of children and young people who are helped from a quarter to a third, but obviously that leaves two-thirds who will not be helped. So there is a long way to go. We are unfortunately starting from a low base; we have to bring together many new staff and teams. I agree with the right reverend Prelate that speed is of the essence, but we must also be realistic about what we can achieve.

[Baroness D'Souza (CB)]

My Lords, are the Government carrying out research on the causes of the increase in mental health issues in both young children and teenagers?

[Lord O'Shaughnessy]

The answer is yes, they are: the Green Paper has commissioned further research, and the amount of funding the National Institute for Health Research puts into this area has increased by 50% over the last seven years. However, we still do not understand the causes behind all mental illness, so this is an essential part of the strategy.

[Baroness Tyler of Enfield (LD)]

My Lords, given that the number of child and adolescent psychiatrists has declined by over 6% since 2013, and the number of mental health nurses by more than that, will the Government agree to consider the recommendation from the Royal College of Psychiatrists to add child and adolescent psychiatrists to the national shortage occupation list?

[Lord O'Shaughnessy]

There has undoubtedly been an impact on mental health nursing. In fact, the widest definition of the mental health and learning disability workforce according to the latest workforce stats is up by around 3,000 full-time equivalent posts. But we agree that more needs to be done. That is why there is an ambition to bring in 4,400 more mental health staff to support children and young people over the next few years. It is also reassuring to know that there are 8,000 mental health nurses in training at the moment.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister will be aware that the incidence of mental health issues in children of primary school age is growing. Whatever the causes, they are almost always amplified and exacerbated by the onset of puberty and the transition to secondary schooling. What emphasis is being put on identifying and helping to meet the unmet need in primary schools, and who is undertaking that work?

[Lord O'Shaughnessy]

That is an excellent question. A terrifying statistic is that 8,000 of those under 10 years old are suffering from severe depression. The designated leaders will be in every school; that is the ambition. We are also rolling out mental health support teams to support all schools, both primary and secondary, so I can reassure the noble Baroness that primary schools are within the scope of the plans.

[Lord Patel (CB)]

My Lords, following on from the right reverend Prelate’s question, I would like to make a plea. Will the Minister agree that the proposed mental health support team should work with the voluntary sector—particularly the children’s voluntary sector—especially in the area of palliative care, and in children’s hospices, where children are bereaved by the death of their siblings and the incidence of mental health problems is also extremely high?

[Lord O'Shaughnessy]

The noble Lord makes an excellent point, and I will make sure it is fed back into our deliberations.

HPV Vaccinations

Lord O'Shaughnessy Excerpts

Monday 26th March 2018 Lords Chamber

[Baroness Altmann]

To ask Her Majesty’s Government, in the light of the recent decision to offer HPV vaccinations to gay men, whether they plan to provide HPV vaccinations to all boys; and if so, when.

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

My Lords, following a consultation, our expert group, the Joint Committee on Vaccination and Immunisation, is reviewing the evidence for vaccinating adolescent boys against HPV. We are awaiting its final advice, and it is important not to pre-empt the decision of the joint committee.

[Baroness Altmann (Con)]

I thank my noble friend for his reply. HPV-related oral cancers are the fastest-growing type of malignancy and affect thousands of men each year. Recent studies suggest that the vaccination of boys is cost effective, and I congratulate the Government on their decision to vaccinate gay men. Does not my noble friend agree, however, that the only way in which to protect men directly is to vaccinate them before they become sexually active, as they already do in many countries, including Australia, Canada, Austria or the United States? Would he also agree that we have a duty and responsibility to protect these boys, rather than leaving them vulnerable to potentially fatal cancers when it will be too late for them to do anything about it, because we neglected them when young?

[Lord O'Shaughnessy]

My noble friend makes an important point, that vaccinations against the HPV virus brings wider health benefits beyond defending against cervical cancers. It is important to state that it is not my judgment that matters here but that of our expert group, and in its interim advice it did not recommend an extension of the HPV programme to boys as being cost effective, not least because of the high levels of immunity and uptake among girls, with the indirect benefit that that has. But that was its interim advice; the final advice is being considered at the moment, and I can tell the House that that advice and the underlying assumptions on cost benefit will be published when the decision is made.

[Baroness Wheeler (Lab)]

My Lords, last year’s interim statement referred to by the Minister mentions referring the issue of equality of access to the HPV vaccine to the Department of Health for consideration. Has that referral been made? Given that the clinical benefits of gender neutrality have been so widely advocated by top medics over a very long period, is the department treating this with urgency? When is a response expected, and has any legal advice been taken on whether the current situation of only directly protecting girls and gay men constitutes discrimination by gender or sexual orientation?

[Lord O'Shaughnessy]

The noble Baroness is quite right that equality is an issue, and an equality analysis will take place. That can be completed only once we have the final advice from the joint committee. I can also promise her that we will publish that analysis, so that will be able to be scrutinised. As for legal advice, it is subject to threats of judicial review at the moment, so I cannot go any further than that, but I can promise that equality considerations are very high on the list of the issues that we are dealing with.

[Baroness Jolly (LD)]

My Lords, we welcome the decision to vaccinate gay men in England, but sex and relationships are no respecter of national borders. Has NHS England had any conversations with the NHS in Northern Ireland, Scotland or Wales to ensure that gay men are protected right across the UK?

[Lord O'Shaughnessy]

We are beginning a national rollout of the programme for men who have sex with men in terms of the provision, because of course they are not necessarily getting the indirect benefits from the girls’ immunisation programme. I do not have the details of the working relationships with the devolved Administrations, but I shall write to the noble Baroness with details.

[Lord Patel (CB)]

My Lords, I am glad that the Minister said that the committee looking at the benefits of immunisation to boys recognises the wider benefits of immunisation for both boys and girls. However, he did say that it was not convinced about the cost effectiveness. Is that cost effectiveness merely for the cost of the programme if instituted now or the long-term benefits?

[Lord O'Shaughnessy]

The committee has to take a number of considerations into account—the public health benefits, short-term and long-term, and cost effectiveness—just as NICE does when approving medicines. It has to make a judgment about whether the incremental pound spent could be better spent across the entire health system, where, of course, there are many competing demands. But it is up to it to make that decision, and that will inform its final advice.

[Baroness Gardner of Parkes (Con)]

My Lords, is the Minister aware that oral cancer is very largely due to the papilloma virus? As a dentist, and on behalf of the dental profession, I strongly support immunisation, but there will always be people who do not attend to have it, even when it is introduced. So it is also important to be aware that dentists are usually the first people to detect oral cancer. For many years I have proposed that, when people go into accident and emergency for anything, someone should take one minute to see if there was any abnormality in the mouth which could be referred on at that stage. Could this even be included in a questionnaire when people go in for treatment? It would be a way of picking up oral cancer, which has increased by 23% in the last 10 years.

[Lord O'Shaughnessy]

My noble friend is quite right to highlight the link between HPV and oral cancer. The growing evidence base is one of the things which the JCVI is taking into consideration. There is absolutely no doubt that HPV causes around 99% of cervical cancers. The link to other cancers, such as the one my noble friend mentioned, is not quite the same and is still disputed, but it is one of the issues being considered.

[Baroness Finlay of Llandaff (CB)]

My Lords, given that the Government have recognised the importance of HPV, do they also recognise that some boys who are having a homosexual relationship will not come forward and may, therefore, be at very high risk prior to being offered immunisation? Boys also act as a reservoir for HPV among girls. There may be girls whose parents do not consent to them having immunisation but they are particularly at risk because 70% of cervical cancers are caused by HPV.

[Lord O'Shaughnessy]

Yes, of course. Among the technical issues which the JCVI has to take into account is the risk profile of boys at different ages and with different sexual behaviours.

Health: Medical Respite for Children

Lord O'Shaughnessy Excerpts

Wednesday 21st March 2018 Lords Chamber

[Baroness Brinton]

To ask Her Majesty’s Government what guidance is provided to Clinical Commissioning Groups in exercising their duty to provide medical respite care for seriously ill and disabled children, following the High Court decision of 21 February.

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

My Lords, although there is no specific statutory duty on clinical commissioning groups to offer respite care, under provisions in the National Health Service Act 2006, CCGs must ensure that they secure health services to meet the needs of disabled children to a reasonable extent. Furthermore, the statutory framework introduced in the Children and Families Act 2014 requires CCGs and local authorities to work together to support all the needs of children with a special educational need or disability.

[Baroness Brinton (LD)]

I thank the Minister for his Answer. Despite the High Court judgment in the case being brought by the amazing Nascot Lawn parents, which made it absolutely clear that the very disabled children involved are entitled to individualised NHS support, it has now emerged that the Herts Valleys CCG’s so-called assessment for each case was a five-minute pre-assessment box-ticking and that the child was not even present. The CCG is still trying to dictate its contribution to the county for the care and is not consulting the families. Can the Minister explain what steps the Government and NHS England can take to ensure that Herts Valleys CCG makes appropriate provision for each of these children, when it appears it remains determined not to?

[Lord O'Shaughnessy]

I congratulate the noble Baroness on her tenacity in raising the issue and thank her for giving me the opportunity to meet parents whose children use these services. First, it is incredibly important to be clear that there are rules for how the consultations that the judicial review said should be held should take place, and they must be abided by. More importantly, as I have just set out, there are legal obligations under the 2014 Act for joint commissioning between the CCG and the local authority. That is not one telling the other what to do; it is joint commissioning. Most important of all—the point that the noble Baroness makes—is that whenever these bodies are planning for the future, they have to keep the needs of the children in mind. That is what we, whether it is NHS England or the department, are imploring them to do through this process. Indeed, they are obliged to do that.

[Baroness Royall of Blaisdon (Lab)]

My Lords, legal obligations are all fine, and of course the Government and everybody else have to comply with them, but unless there is adequate funding for local authorities, health services and commissioning groups, it is impossible for these authorities to comply with the legislation. What are the Government going to do to ensure that enough money is available to provide respite care for these children?

[Lord O'Shaughnessy]

The noble Baroness makes an important point. That is the reason we are providing more funding, both through social care budgets and through the NHS itself. More money was found at the Budget as well, but I do not think in this case the issue is necessarily funding. It is a case of the parties involved working together, as they are obliged to do, to find the right outcome and the right solution for these children.

[Lord Blair of Boughton (CB)]

My Lords, I join the noble Baroness, Lady Brinton, in this case and declare my interest as the chair of Helen & Douglas House in Oxford, which was the first children’s hospice in the world. It covers a vast area of the Thames Valley and provides end-of-life care and respite care for children with life-limiting diseases, but the Oxfordshire CCG has completely refused to supply any funds to it. Would the Minister meet with me to discuss that situation?

[Lord O'Shaughnessy]

Yes, I would be happy to do so. I am disturbed by the picture that the noble Lord has painted. He will know, I am sure, that the Government have set out our commitment to end the variation in end-of-life care, and of course this is a co-commissioned service. I would be very pleased to meet him to investigate that.

[Baroness Hollins (CB)]

My Lords, what measures are being taken by the NHS to check that CCGs have the range of specialist expertise available to be able to make assessments individual by individual? These children’s needs are complex. From my experience, often the assessors may be expert in one area but not necessarily that of the case they are assessing.

[Lord O'Shaughnessy]

The noble Baroness is quite right. Many of the children we are talking about are receiving continuing care to meet all their needs, and delivering that is very complex. A national framework for continuing care is being revised at the moment, and it will provide the picture for the skills mix that is needed at local level to ensure that these children are properly served.

[Baroness Wheeler (Lab)]

My Lords, my question is on the specific issue of parent carers, for whom funded respite care is vital to both themselves and the children they care for. The Minister mentioned the continuing healthcare framework guidance coming into force in October, which makes clear CCGs’ responsibilities to fund respite care for parent carers and breaks for families of severely disabled children. The High Court judgment clarifies the law and makes this duty clear now. What action have the Government taken to ensure that CCGs act on the Nascot Lawn judgment now?

--- Later in debate ---

[Lord O'Shaughnessy]

The noble Baroness is quite right. Local authorities and CCGs have a number of responsibilities. We are applying pressure and making clear to all bodies that they have those responsibilities. We have of course provided funding through local authorities and CCGs for that to happen, and we expect it to.

[Lord Foulkes of Cumnock (Lab)]

My Lords, further to the question from my noble friend Lady Royall, I have great respect for the Minister but how can we believe what he says about enough money being available when health authority after health authority throughout the country says that not enough money is available and some of them are forecasting deficits? Who is right, the Minister or those who are running our health service?

[Lord O'Shaughnessy]

I do not deny for a minute that the health sector is under pressure—I have never once pretended that that is not the case. There is growing demand in all areas, whether that is children, adults or older people. We have provided more funding year on year during a difficult time of fiscal retrenchment, and indeed the Budget provided more money. Of course there is more to do, but I think that what I have said shows our commitment to funding the NHS as much as we can.

NHS: Staff Pay

Lord O'Shaughnessy Excerpts

Wednesday 21st March 2018 Lords Chamber

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

My Lords, with the leave of the House, I will repeat as a Statement the Answer to an Urgent Question given by my right honourable friend the Secretary of State for Health and Social Care in the other place. The Statement is as follows:

“Mr Speaker, the whole House will want to pay tribute to the hard work of NHS staff up and down the country during one of the most difficult winters in living memory. Today’s agreement on a new pay deal reflects public appreciation for just how much they have done and continue to do.

However, it is much more than that. The agreement that NHS trade unions have recommended to their members today is a something for something deal, which brings in profound changes in productivity in exchange for significant rises in pay. It will ensure better value for money from the £36 billion NHS pay bill, with some of the most important changes to working practices in a decade, including a commitment to working together to improve the health and well-being of NHS staff to bring sickness absence in line with the best in the public sector. We know that NHS sickness rates are around a third higher than the public sector average, and reducing sickness absence by just 1% will save around £280 million. The deal will put appraisal and personal development at the heart of pay progression, with often automatic incremental pay replaced by larger, less frequent pay increases based on the achievement of agreed professional milestones. It includes a significantly higher boost to lower paid staff in order to boost recruitment in a period when we know the NHS needs a significant increase in staffing to deal with the pressures of an ageing population.

Pay rises range from 6.5% to 29% over three years, with much higher rises targeted on those on the lowest and starting rates of pay. As part of this deal, the lowest starting salary in the NHS will increase by over £2,500, from £15,404 this year to £18,040 in 2020-21, and a newly qualified nurse will receive starting pay 12.6%—nearly £3,000—higher in 2020-21 than this year. But this deal is about retention as well as recruitment. It makes many other changes that NHS staff have been asking for—such as shared parental leave and the ability to buy and sell back annual leave—so they can better manage their work and family lives, work flexibly and balance caring commitments.

The additional funding that the Chancellor announced in the Budget to cover this deal—an estimated £4.2 billion over three years—cements this Government’s commitment to protecting services for NHS patients while also recognising the work of NHS staff up and down the country. This is only possible because of the balanced approach we are taking: investing in our public services and helping families with the cost of living while at the same time getting our debt falling. Rarely has a pay rise been so well deserved for NHS staff, who have never worked harder”.

[Baroness Thornton (Lab)]

I thank the Minister for repeating the Statement. I agree with his final statements, but never has it taken so long to get to this point of a pay increase. I do not wish to sound ungracious but the pay increase is too little, too late. The cap has meant that NHS wages have fallen by 14%. Last summer, the Prime Minister told a nurse on television that a pay rise would need a “magic money tree”; I am very glad that it seems to have been found.

The NHS is now short of 100,000 staff. In part, that must be because of this Government’s neglect of the NHS workforce. Exacerbating this situation is the chronic shortage of nursing and other staff in nursing care homes, with a 16% decrease in the number of registered nurses in the care sector since 2012. Then, there is Brexit and its damage to NHS staffing. Given that the Secretary of State now has responsibility for social care as well as health, will we see a joined-up staffing strategy for NHS and care workers? Can the Minister assure the House that, to pay for the proposed increase, the Treasury has said that it will fully match any proposed rise with new money?

[Lord O’Shaughnessy]

I thank the noble Baroness for her perhaps less than fulsome welcome for what is a fantastic deal, not least for the lowest paid staff in the NHS, some of whom will see very significant pay rises. They certainly deserve them; I do not think anyone disagrees with that. We have been able to find the additional money in the NHS budget to do this precisely because of good economic stewardship, rather than relying—as others would—on trees, magic or otherwise. That stewardship has meant that we have been able to provide the money while taking our fiscal responsibilities seriously.

The noble Baroness mentioned the joined-up staffing strategy. She is absolutely right that it is very important. I hope she knows that Health Education England has included work on the social care workforce in its draft strategy. We all understand that we need increasingly to view these workforces together—not just people such as nurses, who can work in both sectors, but carers and allied health professionals and so on. Frankly, there is more work to do on the social care workforce strategy. In the health service, we are starting from a lower base in terms of having a national picture, precisely because it is generally delivered locally. However, we are providing that strategy. I would encourage all parties who want to make sure that the strategy is joined-up to contribute their ideas, because there is a genuine willingness to make sure that we can do it.

[Baroness Jolly (LD)]

My Lords, I echo the Minister’s remarks about NHS staff working hard all year round. I welcome this agreement. The RCN and Unison must have worked very hard with the DoH to get this nailed, but the devil is in the detail and we have yet to see the detail.

Agenda for Change was implemented in 2004 when I was chair of a primary care trust. It was really difficult to get the various levels of NHS staff in the various strata. Can the Minister confirm that Agenda for Change will be revisited along with the skills and knowledge framework? The Secretary of State also talked about putting appraisal and continuous professional development at the heart of pay progression, so that may indicate that the skills and knowledge framework might need to change. On the same topic, echoing what was said just a moment ago, can the Minister shed light on whether care workers’ salaries will be included in the Green Paper on social care? At the moment, they are feeling very undervalued and underpaid.

[Lord O’Shaughnessy]

Like the noble Baroness, I think it is right to pay tribute to all the organisations involved in striking this deal. These things are never easy but it is a true partnership agreement that tries to work for everybody.

The Statement is explicit about linking pay progression with appraisals, which indeed means higher skill levels. I will write to her with the specifics of the skills and knowledge framework; I am not cognisant of that specifically, but clearly the intention is to move away from automatic progression to skill-based progression. One of the advantages of that is that it not only works for patients, but puts the onus on employers—she will see more detail of that—to make sure that there is proper professional development to help skill levels rise, so that staff can go through those gateways and progress.

[Baroness Redfern (Con)]

My Lords, in welcoming the Government’s response and the 6.5% pay rise for 1 million NHS staff, particularly in recognition of their dedication and hard work, I am pleased that the Government have recognised that the lowest full-time salaries are paid to cleaners, porters and catering staff. These groups will receive a 15% increase—£2,500—bringing their salaries up to £18,000. The fact that this is backed with new money is welcome.

[Lord O’Shaughnessy]

I thank my noble friend for making that point. It is not only about the lowest paid staff whom she has described. It is also worth dwelling on the fact that a newly qualified nurse will see a significant increase in his or her pay, which will be 12.6% higher in 2020-21. This is a package which takes account of the fact that starting salaries have been too low. We are trying to address that because it is one of the ways we can attract more people into the profession.

[Baroness Watkins of Tavistock (CB)]

My Lords, I welcome this Statement as a sign that the Government have at last recognised the effect that the pay cap has had on recruitment and retention, in particular in nursing. I hope that this pay increase will lift many nurses out of hardship and improve morale. It is a sign that the Government value NHS staff and I especially welcome the significant increase for newly qualified nurses for 2020-21. These new recruits, who commenced their training in 2017 without bursaries, will be in a far better position—comparable with other graduates in terms of starting pay—as they proceed to repay some element their salary after achieving an income of more than £25,000 a year. My only concern is that the charitable and social care sectors, which employ nurses, will need to match these salaries. How can we ensure that they will be able to do so?

--- Later in debate ---

[Lord O’Shaughnessy]

I thank the noble Baroness for her welcome for the Statement. We, along with all Members of the House, value NHS staff and this is a proper recompense after what have undoubtedly been difficult years for them. Regarding what this means for funding for charitable and social care staff—I did not address the point when the noble Baroness, Lady Jolly, asked me about it—we will obviously make sure that any staffing issues, including salaries, are part of the Green Paper discussions. They will clearly have to take into account the higher pay that is coming down the stream for these staff.

[Lord Clark of Windermere (Lab)]

My Lords, of course we welcome this, but I must say that the Minister was selling it a bit hard when he said that the Government have managed the National Health Service well when they have made cuts in training which have exacerbated the situation.

My question is a simple one. The Minister has said that the Treasury will meet all the costs. Is that an absolute assurance? I ask that because many local hospital care trusts have found that there are hidden costs. For example, the Government are pushing apprenticeships, but what they never mention is that it is the local care trust which has to pay the university thousands of pounds a year for the apprenticeship training. Will everything be covered in this pay rise?

[Lord O’Shaughnessy]

I thank the noble Lord for giving me the opportunity to provide that confirmation. In the 2017 Autumn Budget we set aside in the reserves £800 million a year, which will fund the first year of the Agenda for Change pay deal, and obviously if the members of the NHS trade unions accept the agreement, that funding will be released. The Chancellor will also provide the additional funding required to fulfil his commitment through the 2018 Autumn Budget and make available £4.2 billion over three years to fund the deal. I hope that gives the clarity the noble Lord and others seek.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, the Government have every reason to be proud of providing for this very substantial pay increase. However, can my noble friend remind NHS staff that, as would be the case for any other staff, with increased pay has to come change? There are no groups of employees in any enterprise anywhere who do not have to change, restructure or change the skill mix. Appraisal and training mean doing more and achieving greater productivity. We have a heroic mission to provide care free at the point of delivery to all. This can be achieved only with a much more positive attitude towards changing the skill mix, team working, and through the many other ways of delivering cost-effective care.

[Lord O’Shaughnessy]

My noble friend is right and she speaks from great experience. I emphasise that, as the Secretary of State has said, this is a something for something deal which will deliver greater productivity in return for higher pay. That absolutely has to be the right way of doing this. I also point out that there will be an explicit focus on improving the health and well-being of NHS staff, so that they are not only happier and more likely to stay in post, but more productive as well.

Abortion: Misoprostol

Lord O'Shaughnessy Excerpts

Tuesday 20th March 2018 Lords Chamber

[Baroness Watkins of Tavistock]

To ask Her Majesty’s Government, further to the Written Answer by Lord O’Shaughnessy on 21 January (HL5321), why there are no plans to enable women undergoing early medical abortion to take the second dose of the medication, misoprostol, at home, if they so wish.

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

My Lords, the Government’s priority is to ensure that women who require abortion services have access to safe, high-quality care. Abortions must be performed under the legal framework set by the Abortion Act 1967. We are not currently in a position to approve homes as a class of place under the Act. However, we will continue to keep this matter under review and assess further evidence as it arises.

[Baroness Watkins of Tavistock (CB)]

I thank the Minister for his Answer, but can he inform the House of the expected timeframe for the Government’s decision regarding enabling women to choose the dignity of being as comfortable as possible in their own homes when they experience medical abortion, rather than some of them suffering while travelling home from the clinic? Journeys of over two hours are not uncommon, particularly for women from rural areas. It is also worth noting that the procedure is endorsed as a safe practice by the World Health Organization.

[Lord O'Shaughnessy]

I thank the noble Baroness for her question. No timeframe has been set for any decision on a policy change. She will understand that any change of policy would need to be done cautiously, in the light of the evidence and of legal developments—for example, relating to Scotland’s decision to name homes as a place. It is on that basis that we will consider any further evidence.

[Baroness Thornton (Lab)]

My Lords, if women in Norway, France and now Scotland can take this drug at home, not in a clinical setting, with careful safeguards and support in place—I have looked at what has happened in Scotland, and there is no doubt about that at all—it is important that the Government should afford the same facility to women in England. I would like the Minister to perhaps go further than he has now and say that there will be a timetable for this to happen.

[Lord O'Shaughnessy]

In terms of the experiences in other countries, of course only the countries of the UK are operating under the auspices and obligations of the 1967 Act, which any Government would have to act under. The Scottish Government have made that decision, but the noble Baroness will know that it is subject to a dispute and that a judicial review has been brought against it by the Society for the Protection of Unborn Children, which is obviously testing the legality of the Scottish Government and their powers to act. We shall look closely at developments in these legal proceedings, as well as any other evidence that arises. Unfortunately, this is why I am not in a position to give her a timetable.

[Baroness Eaton (Con)]

My Lords, a study of 42,600 early abortions in Finland—where there is good registry data, unlike in England and Wales—found that, six weeks post abortion, complications after medical abortions were four times higher than after surgical procedures: 20% compared with 5.6%. The Royal College of Obstetricians and Gynaecologists cites one study in the UK where 53% of late medical abortions required surgical intervention. Given these facts, are Her Majesty’s Government not also concerned that so-called home abortions outside of a medical setting would compromise the health and safety of women, especially young women who may use these powerful chemicals secretly at home?

[Lord O'Shaughnessy]

This is obviously a concern. There has been an increase in women buying online the drugs necessary for medical abortions, and that is something on which we are attempting to crack down. It is worth pointing out that 90% of abortions are NHS funded and therefore provided for in that way. The noble Baroness was talking about medical abortions at a late stage; it is worth pointing out that, actually, there has been an increase in the number or percentage of abortions that are happening at an early stage, which is obviously in the interests of women’s health.

[Baroness Barker (LD)]

The noble Baroness, Lady Eaton, mixed up two completely different things. She mixed up early medical abortions and late abortions. Can the Minister confirm that a 2011 court case brought by BPAS established that the Secretary of State has the power to allow early medical abortions to happen at home? If he agrees, and if the evidence from the Scottish trial is convincing and underpinned by the decision of the Scottish courts, will the Secretary of State then undertake to look at the development of a facility for legal abortion which may well be to the benefit of thousands of women in this country, particularly those who live in rural areas?

[Lord O'Shaughnessy]

I am aware of the opinion in that judicial review. It is worth pointing out that there is still uncertainty about the legal position. This is why we will watch the developments in Scotland carefully and proceed cautiously. It would be wrong of me to prejudge either the opinions that come from the court or indeed any evidence if this scheme does get up and running in Scotland.

[Baroness Tonge (Non-Afl)]

My Lords, does the Minister agree that, up to nine weeks, it is perfectly safe for a woman to take the pills for a medical abortion? It is much better and more comfortable for her to have the consequences at home. Does he also agree that this would mean each woman would have to make half the number of appointments to get a medical abortion—a huge saving for the health service?

[Lord O'Shaughnessy]

The importance here is making sure that, under the auspices of the Act, women have access to safe and legal abortion, and that is what they have a right to do. An important point here is that, the earlier these abortions happen, the safer they are. The proportion of abortions under 10 weeks has risen from 68% to 81% in the last 10 years. At the moment, both courses of treatment for early medical abortion should take place in a clinical setting approved by the Secretary of State.

[Baroness Masham of Ilton (CB)]

My Lords, has any research been undertaken on the psychological feelings of people who have had abortions in their own homes?

[Lord O'Shaughnessy]

I am not aware of any research, but I shall ask the department to see if there is any. If there is, I shall write to the noble Baroness.

[Baroness Taylor of Bolton (Lab)]

My Lords, if the information we have just had is correct that more women, especially young women, are buying abortion drugs online, surely that proves the point that we need to improve the abortion services that we have within the NHS and the advice that is given to young women.

[Lord O'Shaughnessy]

No, I do not think it proves that. The fact that illegal drugs of all kinds are being bought online, whether they are illegal drugs or prescription drugs bought illegally, is a feature of modern life. Rates of abortion in the under-18s are falling, as is the teenage pregnancy and conception rate. Those are separate issues.

[Baroness Jenkin of Kennington (Con)]

My Lords, is my noble friend aware that, as well as in Scotland, the home use of misoprostol is common practice in the United States, Canada and multiple other European countries?

[Lord O'Shaughnessy]

Yes, I am aware of that. As I said, those countries operate under a different legal framework from ours.