Healthcare: Controlled Drugs

Lord Patel Excerpts

Thursday 14th September 2023 Grand Committee

[Lord Patel (CB)]

My Lords, it is a pleasure to follow the noble Lord, Lord Butler of Brockwell. I thank him for initiating this important debate. Like him, I hope it will result in the Government bringing in much-needed legislation to allow advanced paramedic practitioners to prescribe some of the controlled drugs in Schedules 2 to 5. I will speak briefly in support of the noble Lord. I may repeat some of what he said, but do not apologise for doing so because it is worth emphasising.

I thank the College of Paramedics and the House of Lords Library for their detailed, informative briefing on allowing paramedics to prescribe controlled medicines. I recognise the need to look at expanding prescribing by other health professionals, such as radiographers, as have been mentioned, and widening the list of drugs that can be prescribed by them. However, I shall confine my comments today to paramedics.

There is a misconception that highly trained, efficient paramedics work only in ambulances and are not allowed to prescribe and administer medicines, including some controlled drugs. Paramedics are now deployed in a whole range of healthcare settings, from emergency departments to GP practices, out-of-hours services and general and specialised wards. Some 25% of paramedics now work in wider healthcare settings. They are a versatile, experienced and valuable part of the healthcare system. There are more than 1,500 advanced paramedic practitioners, and the workforce plan recently published by the Government has the ambition to expand this workforce considerably in future.

Once qualified as an independent prescriber, a paramedic can prescribe any drugs, except controlled drugs such as morphine sulphate, as has been mentioned, Diazepam, Midazolam and codeine phosphate. Qualified paramedics can and do work independently in making the correct diagnosis. If the treatment involves giving controlled medicines, she or he has to seek assistance from another prescribing healthcare professional. This results in delay in care, disturbs the work of both professionals and increases the risk to patient safety.

I will give some real examples—the noble Lord, Lord Butler of Brockwell, already gave one such. A young man, having fallen off his bike, is brought to the emergency department by ambulance. He is in considerable pain and, after initial tests, the advanced paramedic practitioner makes a correct diagnosis of a closed tibia and fibula fracture. The advanced practitioner knows what he has to do next but is unable to prescribe morphine to alleviate the pain and has to seek assistance, disturbing the work of other clinicians, who have to leave the patient they may have been looking after to help the paramedic. This delays treatment and creates possible patient safety issues.

Another such example is a young woman, a known epileptic, who is brought by ambulance having had seizures at home. The practitioner is unable to prescribe prescribed drugs such as intravenous lorazepam to control the young woman’s epileptic seizures.

Another example is a young man with a shoulder injury who is brought in by ambulance. The paramedic makes a correct diagnosis of a dislocated shoulder and is competent to treat the patient. However, before she or he can perform the manipulation of the shoulder, they must seek the advice and assistance of another health professional to administer a mild anaesthetic such as midazolam. Being unable to prescribe and having to seek assistance means that the treatment is delayed and the young man remains in pain; this risks the dislocation causing more shoulder damage, with possible long-term effects.

Legislation, possibly introduced as a statutory instrument, as already mentioned, is urgently needed to allow highly trained, experienced advanced paramedics to prescribe some controlled medicines. Such legislation is a long time in coming. The concept of paramedics prescribing was consulted on in 2015. As the noble Lord, Lord Butler, mentioned, in 2018 legislation to approve the concept was accepted. In October 2019, the Advisory Council on the Misuse of Drugs approved the list of drugs that advanced paramedics could prescribe, which was also approved by the MHRA. Apparently, a letter was sent to the Home Office in 2019, so we have been waiting since then for the Home Office to approve and bring in the legislation.

I know that the noble Lord, Lord Sharpe of Epsom, is sympathetic to the proposals from the correspondence I have seen which others have had with him. I hope he will surprise us when he responds by telling us when the legislation will be brought forward—I hope before 7 November or soon after. Whenever it is, I cannot imagine that Parliament will do anything other than promptly approve it.

Once paramedics are able to prescribe some of the medicines in the controlled list of drugs, patients will benefit from prompt treatment, and it will free up the time of other clinicians and improve patient safety. If there is no action from the Home Office, I hope that the noble Lord, Lord Butler of Brockwell, will continue to badger the Government on a regular basis. He will have my support.

Police, Crime, Sentencing and Courts Bill

Lord Patel Excerpts

Lords Hansard - part one & Committee stage
Monday 25th October 2021 Lords Chamber

[Lord Patel (CB)]

My Lords, I support the amendments in this group in the name of the noble Baroness, Lady Brinton, to which I have added my name. The provisions in the Bill relating to serious violence introduce a new legal duty of disclosure that seriously threatens the doctor-patient relationship, especially in relation to patient confidentiality.

The Bill explicitly sets aside the common-law duty of confidentiality that I as a doctor owe to my patients. Doctors regard patient confidentiality as a fundamental ethical duty, upholding the trust that lies at the heart of the doctor-patient relationship. The Bill’s proposals that relate to disclosure of patient information threaten the common-law provision of confidentiality, the requirements of data protection laws and doctors’ ethical standards.

The General Medical Council, in guidance on professional standards, makes it clear to all doctors when and in what circumstances a doctor can release confidential patient information without a patient’s consent. This, in my view, covers the requirement for disclosure in situations of serious violence. The police having the ability to gain identifiable—I stress “identifiable”—patient information from health bodies without setting out clear reasons, which should be limited by statute, is fundamentally wrong. The Bill does not provide clear statutory arrangements that have the confidence of the medical profession, as highlighted by its regulator—the GMC—the BMA and some other health professionals, and, importantly, the data protection guardians. These bodies have raised serious concerns.

The noble Baroness, Lady Brinton, spoke eloquently and in detail on all the issues in moving her amendment, so I do not need to enlarge on that, but I support her comments. The Minister needs to set out more clearly the Government’s intention, scope and implementation of the powers in the Bill relating to access to patient data. The noble Baroness, Lady Brinton, asked some key questions that also cover some of my concerns. The issues are important. Might the Minister agree to meet the GMC, the BMA and representatives of other health professionals? I look forward to her response.

[Lord Carlile of Berriew (CB)]

My Lords, I apologise for not having taken part in the Second Reading debate, when I was unavoidably abroad for professional reasons, or in the first Committee day, when unfortunately I was recovering from coronavirus—an experience I would not recommend to any of your Lordships given my experience of it. I rise to speak having very much enjoyed the speech by my noble friend Lord Patel, because I thought he introduced an element of balance that had not quite reached the debate in the earlier moments, eloquent as the introduction from the noble Baroness, Lady Brinton, was.

I will cite two pieces of my own experience as evidence. I spent 10 years as a lay member of the General Medical Council and, during those 10 years, sat successively on the health committee and the conduct committee. The health committee is a form of conduct committee, but with an obvious emphasis, as its name indicates. We spent a great deal of our time discussing whether doctors can be fully relied upon at all times, and in particular at critical moments, to understand the limits of the duty of confidentiality. Because it is not an absolute duty; there is a balance between the private rights of the patient and the general duty of the doctor not to disclose information, and the public duty of the doctor to disclose information if there is, for example, serious danger of violence to the public. I fear that more work will be needed on the amendments being proposed at the moment if that balance is to be sustained.

My second piece of evidence relates to an inquiry I conducted in 2012 for the then Secretary of State for Education, which related to something called the Edlington case. The brief story was that two small and neglected boys, who were fractionally over the age of criminal responsibility, nearly killed another child in a wood. Fortunately, that child and their companion survived—one of them only just. In my inquiry, I looked at the sharing of information by a host of organisations—schools, general practitioners, social workers and so on. It was a clear conclusion of my report that, if key information had been shared, the child who nearly died would not have been assaulted, the two very unfortunate little brothers who committed the assault would not have spent the succeeding years of their lives in a custodial institution and the schools would have been able to create a situation in which the dreadful problems for everybody concerned did not arise. One of the key issues in that case was that the general practitioners did not fully understand the balance between their duty to the public and the rights of their patient—and near-disaster ensued.

To noble Lords moving these amendments and to the Minister, who I know listens to these debates extremely carefully, I say that this is not the time for people to take up closed positions on these matters. There is a lot of work to be done. I think my noble friend Lord Patel probably agrees with this, but I speak with great trepidation, because right in front of me are two of the most distinguished doctors in the whole country. We must ensure that, where it is necessary as a public duty, they and others need to be consulted to ensure that the balance is right and is therefore not the subject of the controversy we have been hearing about already this afternoon.

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[Baroness Hamwee (LD)]

My Lords, I am well aware that we have some of the most senior lawyers in the country in the Committee today, and very senior doctors who have grappled with these issues, so perhaps I should put my point as a question. If the legislation provides for something that a doctor “regards”, is not the concept of reasonableness implied in that proposition, so the doctor must be reasonable in what he regards?

[Lord Patel (CB)]

My Lords, I am sorry to intervene again, but it may help the debate if I address some of the issues raised. I should have mentioned in my speech—but I deliberately did not—my personal experiences when I was approached on four occasions by the police to give some information about patients. I refused, because I followed the guidance of the General Medical Council, and at no time did that threaten or harm the health of the patient nor anyone else—relatives or any members of the public. On one occasion, I voluntarily informed the police about a patient who had approached me for completely different reasons, but I had noticed that harm was being done to her and, on subsequent occasions, it became quite clear that it was becoming a serious issue. Therefore, I disclosed information to the police; again, following the GMC guidelines.

The common law may have soft edges, but if a doctor follows the common law and the guidance the GMC issues, it works. On what happens when a doctor refuses to give information, despite the fact that the patient is being harmed or that the patient may cause harm to other people, then the doctor will be wrong in his or her duty, and therefore can be overridden. That is the only point I would make.

[Lord Carlile of Berriew (CB)]

My Lords, I hesitate to be disorderly, but I was asked a direct question by the noble Baroness opposite. I think in fact it has been pretty fully answered by my noble friend Lord Patel, but the noble Baroness phrased her question in the language of judicial review, and I would just point out to her that in the real world the possibility of the judicial review of a single medical practitioner in these circumstances is not realistic in the slightest, so it would not happen. If I may say so, it is a good question but the wrong good question.

Forensic Science and the Criminal Justice System (S&T Committee Report)

Lord Patel Excerpts

Monday 26th April 2021 Grand Committee

Moved by

[Lord Patel]

That the Grand Committee takes note of the Report from the Science and Technology Committee Forensic science and the criminal justice system: a blueprint for change (3rd Report, Session 2017-19, HL Paper 333).

[Lord Patel (CB) [V]]

My Lords, it is a pleasure to move today’s debate on the Science and Technology Committee report, Forensic Science and the Criminal Justice System: A Blueprint for Change. The committee is indebted to all those who provided written and oral evidence. We held 21 oral evidence sessions, with 50 witnesses, and received 103 written submissions; I thank all who participated. I also thank the committee members, our committee clerk Donna Davidson—who, I am delighted to see, is the Table Clerk for today’s debate, and to whom goes the credit for a well-written report—our policy analyst Dr Daniel Rathbone, and our committee clerk Cerise Burnett-Stuart, who is, as always, an efficient organiser. We were also fortunate to have as our specialist adviser Professor Ruth Morgan, director of the UCL Centre for the Forensic Sciences, and professor of crime and forensic science. She is an internationally recognised expert in forensic science and its application in criminal justice systems. Her advice and knowledge contributed much to the report, and I thank her most sincerely. I am indebted to all those people.

I am also grateful, knowing her very busy schedule of legislation, to the Minister, the noble Baroness, Lady Williams of Trafford, for taking the debate today. She was kind enough to meet me and others to discuss the report following its publication. I shall say more about that later, and I thank her for listening.

Over the last 10 years there have been nine reports on forensic science and the criminal justice system, all intended to improve the service—yet adverse reports on virtually all aspects of the system continue to be made. Our report, based on the evidence we received, addresses the whole subject in a holistic way. A key aspect of it was the importance of addressing the whole forensic science system to identify the root causes of failures in the current system and to find best steps forward.

The delivery of justice depends on the integrity and accuracy of forensic science evidence and the trust that society has in it. The quality and delivery of forensic science in England and Wales is inadequate. We heard this repeatedly in our inquiry. In her 2019 annual report, the Forensic Science Regulator urged that the Government’s focus should be on

“the protection of justice rather than the protection of historic or current policies.”

One of the recurrent criticisms we heard was the lack of high-level leadership and oversight of forensic science from the Home Office and the Ministry of Justice. The strong evidence led us to recommend establishing a forensic science board, to deliver a new forensic science strategy and to take responsibility for it in England and Wales.

Budget cuts, reorganisations and exponential growth in the need for new services, such as digital evidence, have put forensic science providers under extreme pressures. The result is a forensic science market that is dysfunctional, and one which, if not properly regulated, will soon result in major forensic science providers going out of business, putting justice in jeopardy. The Government have an opportunity, following the recent much-welcomed legislation establishing the Office of the Forensic Science Regulator on a statutory basis, and with the pending appointment of a new regulator, to give the regulator resources and the function of regulating the market. I hope the Minister feels able to agree to this, but if she does not, can she say who should be responsible for regulating the market?

Structural and regulatory muddle continue to exacerbate the malaise, even now. There is no consistency in the way that the 43 police forces commission forensic services, with some doing so in-house and others contracting it out to unregulated private providers with no quality controls. Police forces also differ in which specialisms they outsource and which they keep in-house. This calls into question equitable access to evidence for defendants, and raises issues over the quality of the analysis undertaken and the evidence presented. It is urgent that the Forensic Science Regulator is given a number of statutory powers to bolster trust in the quality of forensic science provision. Will the Government use the opportunity provided by the appointment of a new regulator to give her or him these powers?

Fair access to justice for defendants is further hampered by cuts to legal aid. The defence needs to have an opportunity to commission its own forensic testing where the evidence is disputed. Further, the rapid growth of digital forensic evidence presents challenges to the criminal justice system. We were not presented with any evidence of any future strategy to deal with this. The Government have recently increased funding, but it still falls short of who will be responsible for developing a longer-term strategy.

Lack of resource and poor co-ordination of research and development in forensic science has resulted in concerns about the scientific validity of some of the forensic science evidence, particularly regarding its interpretation. It is vital that the failings identified by our report are recognised, otherwise public trust in forensic science will continue to be lost, threatening confidence in the justice system. Crimes may go unsolved, and it runs the risk of increasing the number of miscarriages of justice.

Our report was published on 1 May 2019 and the Government responded to it in July 2019. The Government’s response addressed only one part of the forensic science ecosystem, not the other key issues identified in the report. The proposals set out in the response are insufficient to address the systemic issues, and fall way short of addressing the core challenges or providing a path forward that will lead to reform across the whole of forensic science and enable the science to effectively assist the justice system.

Some things have changed since then, although not much for the better, and opportunities exist even now to address some of the failings identified in our report. Let me briefly say what has changed. One of the key pieces of good news, of course, is the establishment of the Office of the Forensic Science Regulator on a statutory basis. I thank the Minister for that. What the regulator lacks is the regulatory powers needed to drive the changes required to make the provision of forensic science in England and Wales world-class, as it once was.

There is also a need to address the level of resources required for the regulator to do his or her job. I hope the Minister can comment on that. Instead of the forensic science board recommended by the committee, the Criminal Justice Board has formed a forensic sub-group to address a forensic science reform programme to strengthen forensic science provision and address key risks and challenges. However, it is not clear how far it has progressed, what role the Government play in it and what responsibility they have for it. Despite further incidents such as a cyberattack on one of the providers of forensic services, the issue of fragility of the market is not being addressed.

The Government have put more money into the Transforming Forensics programme and launched its delivery arm, the Forensics Capability Network, but several police forces remain sceptical of its effectiveness, as evidenced by a request by the National Police Chiefs’ Council for a review. Accreditation, meeting quality standards and training still remain issues, as does inequality in the availability of forensic services to defendants, as opposed to the prosecution. As I said, cuts to legal aid threaten the financial viability of those who provide legal aid to the defence. To date, there have been some positive conversations on funding for forensic science research and development, but very little progress is being made.

Before I conclude, I have three further questions for the Minster. Where in the Government does accountability lie for provision of quality forensic services to assist the justice system? Who will be responsible for regulating the market in forensic services? How will the Government ensure that the UK remains at the forefront of research and development and forensic science methodologies, including digital forensics, foundation research and, importantly, the interpretation of forensic materials?

I end with a quotation from one of our witnesses, Professor Claude Roux, director of the Centre for Forensic Science at the University of Technology, Sydney, and president of the International Association of Forensic Scientists. Referring to all aspects of forensic services in England and Wales, he said:

“England and Wales held, essentially, the international benchmark. It was the ‘Mecca’ for forensic science … 30 years later”,


due to “an ongoing national crisis”, it

“is more of an example not to follow.”

That was not pleasant for the committee to hear. I beg to move and look forward to the Minister’s response.

[The Deputy Chairman of Committees (Lord Haskel) (Lab)]

My Lords, I remind the Committee that some Members are here in person, others are participating remotely but all Members will be treated equally. I ask Members in the Room to respect social distancing. If the capacity of the Committee Room is exceeded or other safety requirements are breached, I will immediately adjourn the Committee. If there is a Division in the House, the Committee will adjourn for five minutes.

--- Later in debate ---

[Lord Patel (CB) [V]]

My Lords, I thank the Minister for her comprehensive response. I also thank all noble Lords for their thoughtful, measured and excellent contributions. This has been one of the best debates I have heard or taken part in in recent days. In response, it is not in my nature to be confrontational, and I shall not be, and the Minister’s response showed that much of the work is in progress. She also suggested that the Government had taken note of some of our recommendations and are finding a way to take them forward. I hope that is correct, because she has heard all the contributions today, which were not only powerful but well-meaning and supportive.

I think there is a recognition that the way in which the forensic science service serves the criminal justice system needs to be looked at. If that is the message I am getting from the Minister today, I am satisfied. Of course, that gives the Science and Technology Committee an opportunity, especially as the report is now two years old, to revisit the subject—maybe in about 18 months’ time—with a short follow-up report. We may well do that, but for today I simply thank the Minister and all noble Lords who have taken part in this excellent debate.

Motion agreed.

Forensic Science Regulator Bill

Lord Patel Excerpts

2nd reading
Friday 19th March 2021 Lords Chamber

[Lord Patel (CB) [V]]

My Lords, I am pleased to support the Bill and congratulate the noble Lord, Lord Kennedy of Southwark, on bringing it to the House and the brilliant way in which he introduced it. I also congratulate the Minister, the noble Baroness, Lady Williams of Trafford. I know she has been trying hard to get such legislation on the statute book. The noble Baroness and her officials had several meetings with me and other noble Lords in late 2019, and there was a government intention to bring forward similar legislation to the Bill today, but events overtook her plans.

I accept that the Bill before us goes a long way to putting the Forensic Science Regulator’s role on the statute book, and the powers given to the regulator go a significant way to improving the delivery of proper guidance in relation to the use of forensic science in the criminal justice system, but serious gaps remain. The Science and Technology Committee which I chair identified several areas which need attention. The Bill today is a missed opportunity for the Government to address other issues in relation to forensic science and its use in the criminal justice system. The quality and delivery of forensic science in England and Wales are inadequate. In March 2019, the regulator issued a warning in a report in relation to funding and governance.

Currently, the regulator works 3.75 days a week. Is the regulator expected to be a full-time role, and what would the annual budget be? Is it expected that, as the role expands, the Home Office will increase the budget accordingly? Is the Minister able to say what role the Home Office and the Ministry of Justice will play in the governance of the forensic science service to the criminal justice system? Currently there is a lack of leadership.

What role will the regulator have in addressing the increasingly dysfunctional market of provision of forensic services? How will the statutory powers of the regulator help bolster the quality of forensic science? Research and development in forensic science is underresourced and lacks co-ordination. The UK used to be regarded as the world leader in forensic science technologies and innovation; we are now regarded as a place where not to look. Once such example is digital forensics; I hope the noble Baroness, Lady Young, may have more to say on that subject.

Today, the Second Reading of a Private Member’s Bill, is not the time to explore with the Minister the wider and important issues relating to the provision of forensic services in England and Wales. I hope that we will have that opportunity soon. However, I also hope that the statutory powers that the Bill gives to the Forensic Science Regulator will enable us to address the long-standing, deep-rooted challenges that need to be met if the provision of forensic science in this country is once again to be world leading. In conclusion, I support the Bill and wish it a speedy passage.

Immigration and Social Security Co-ordination (EU Withdrawal) Bill

Lord Patel Excerpts

Report: 2nd sitting (Hansard - continued) & Report stage & Report: 2nd sitting (Hansard - continued): House of Lords
Monday 5th October 2020 Lords Chamber

[The Earl of Clancarty (CB)]

My Lords, in moving Amendment 17, I will also speak to Amendment 25 in my name. I am grateful for the support of the noble Lord, Lord Patel, and the noble Baronesses, Lady Hamwee and Lady Bull, on Amendment 25. The amendments ask that impact assessments be carried out on the effect of the loss of free movement on areas of work, research and artistic and cultural activities in both the UK and Europe.

I will speak briefly to Amendment 17. Many of the problems and threats to livelihoods faced by the creative services—I will come on to them—are also faced by other services, which is the main reason why I tabled this amendment. I realise in retrospect that I should perhaps have been more to the point and included “services” in the amendment’s wording, but I do not see why, when one thinks of business trips abroad, the provision of services that depend on mobility should not also come directly to mind—as much as sales, for example. However, it is services—our major industrial sector—that are being forgotten by not only the Government but the media.

Last week, I attended an online meeting of a group that has been set up to address the problems facing a number of British workers, some of whom are based in the UK, some of whom are based in Europe and all of whom are self-employed and work for European clients in differing professional areas, such as IT and translation. Some of their concerns are certainly outside the scope of this Bill and will be better addressed tomorrow in the debate on the Trade Bill, but others relate directly to the loss of free movement and parallel the concerns of those in the arts, including on the need to move at short notice between the UK and the EU and between EU countries without red tape. A major worry relates to the lack of information and guidance, as well as uncertainty about what they should be doing to protect their livelihoods.

The credit for the composite Amendment 25 must go to the noble Lords, Lord Patel and Lord Clement-Jones, for their Committee stage templates, as well as to the noble Lord, Lord Hunt of Kings Heath, for eloquently moving the research and innovation amendment in Committee. I was minded to press Amendment 25 to a vote, but I will not do so, although I will listen carefully to the Minister’s reply.

Amendment 25 concerns matters of considerable importance to many outside this House and for the country as a whole, with regard to research, as leading scientists pointed out in a letter to the Prime Minister in June. The amendment is important because it is about the future of science and the arts. It is about the future of research and creativity. As much as it is about people’s livelihoods, it is also about the co-operation and the building of relationships that we have seen over decades between ourselves and the rest of Europe and which so many people working in universities, research bodies, the arts and the media do not want to see endangered more than they already have been.

This is not scaremongering. The Royal Society observes that

“the UK is now a less attractive destination for top international science talent—with 35% fewer scientists coming to the UK through key schemes”.

Yet we benefit from such expertise from Europe as much as Europe benefits from the expertise that we can offer it. The loss of free movement puts a significant part of this exchange of ideas and exchange of culture on our continent at tremendous risk. Ultimately, there will be an economic effect and an effect on our standing in the world.

In Committee, the noble Lord, Lord Hunt, concentrated his remarks on the life sciences and medical research. He said:

“It is this mixture of domestic and international talent that supports our thriving research environment.”—[Official Report, 9/9/20; col. 872.]


This is also the experience of the arts: of the visual arts, the area I most know, of music, dance, theatre and many of the other creative industries, including video games. The people we need who will enrich these industries and innovate are those who are as yet unknown. The salaries of many working in the creative industries, a large number of whom are freelancers, do not reflect the enormous contribution that the creative industries make financially to this country, which the DCMS estimated in June at £112 billion a year. These artists are the ones who make it happen. Many of them will not be earning anything like £25,600 a year—certainly not near the beginning of their careers.

There is also the huge concern about short-term work-related visits to this country for artists, which we discussed in Committee and, importantly, for UK artists visiting Europe, with the music industry in particular having an especially large number of concerns about the loss of free movement, including over touring. I will not repeat the detail of what I said on this in Committee, but I want to make one additional point. Free movement for the arts has come to something of a halt as a result of Covid, but it is instructive that interested organisations, despite the big hit that the arts are taking over Covid, in no way minimise the effects of Brexit as they understand it, even in the current crisis of the pandemic. We should not lose sight of that. In last year’s survey of 2,000 members, the Incorporated Society of Musicians found that 35% of respondents spent at least one month per year working in the EU. Europe is a significant source of work in the arts, and that loss will not be compensated for elsewhere.

We have got to the stage when concerns expressed urgently need to be addressed by the Government. In Committee the noble Lord, Lord Parkinson of Whitley Bay, mentioned the impact assessment accompanying the Bill, which liberally references the reporting of the Migration Advisory Committee, but I say to the noble Baroness that the concerns raised in these debates are hardly touched on in that document. My question to her is: how will the Government monitor the impact of the Bill on these areas and publish findings? It is clear that there is already a significant effect—and that in anticipation of the loss of free movement—in terms of both the loss of opportunity and of our confidence for the future. We need to know not just whether things are going right or wrong but how the system needs to be improved to everyone’s advantage. I beg to move.

[Lord Patel (CB) [V]]

My Lords, I speak to Amendment 25 in the name of my noble friend Lord Clancarty, to which I have added my name. In Committee, an amendment in my name was moved by the noble Lord, Lord Hunt of Kings Heath. I am grateful to him, for he did so with great skill and persuasion—as far as the House was concerned, but not the Minister. Hence my second go at it, but with the added privilege of joining the amendment of my noble friend Lord Clancarty.

The Prime Minister has the ambition to make the UK a science superpower. Really? Yes, really, and why not? We can, and the sciences are up for it. Our science and research universities are world leaders. We are innovative. Our scientists in all areas of life sciences, clinical sciences, physical sciences, animal and plant sciences and other sciences are world-class, as are our universities, which excel in technological innovations. But any country that wants to be a science superpower needs to be open, welcoming and supportive. We have been and are such a country, hence our success in attracting thousands of young scientists who currently work in our country.

However, we now want to go away from this, and the messages we are giving out are all negative. We want talent, but we want it to pay lots of money for visas, health charges, and an uncertain future. As the noble Lord, Lord Willetts, one of our respected past Ministers of Science, said in a debate on research funding of universities on 9 September this year, a post-doc wishing to come to this country for a period of three years, with three family members, would end up paying 10% of his salary in visas and health charges. How much of an incentive is that?

Immigration and Social Security Co-ordination (EU Withdrawal) Bill

Lord Patel Excerpts

Report stage & Report stage (Hansard): House of Lords & Report: 1st sitting & Report: 1st sitting: House of Lords
Wednesday 30th September 2020 Lords Chamber

[Lord Patel (CB) [V]]

My Lords, I am pleased to have added my name to this amendment in the name of the noble Lord, Lord Rosser. The greatest risk identified for health and social care in the House of Lords report The Long-term Sustainability of the NHS and Adult Social Care was the need for long-term funding arrangements for social care and, importantly, for an appropriately trained workforce for the NHS and social care. As far as social care is concerned, the Government have not addressed either, and more than three years have passed since the publication of the report. The result is that more care homes are closed and there is a massive shortage of care home staff, as has already been mentioned.

As a nation, we are getting to a point where “shameful” is the only word that can describe our failure to look after our old and frail. The pandemic has brought hardship and pain to all our citizens, but the elderly in our care homes have paid a heavy price: 30,500 excess deaths among care home residents and 4,400 more among those receiving care at home. We have failed them in many ways. We have exposed them to greater risk from the virus, we did not protect the few staff looking after them and we did not recognise their increased risk from the virus. It seems that the only people who stood by them were nurses and poorly paid care staff, the majority of whom are from overseas.

ONS figures show that social care workers are at highest risk of Covid-19 mortality. Shamefully, the United Kingdom ranks number two in the world, after Russia, for the number of deaths among healthcare workers, and the majority of them worked in social care. Some of the poorly paid and so-called unskilled paid with their lives. Many of them were not citizens of our country. We saw on our televisions poorly paid staff, many from European and other countries, working in crowded nursing homes and living in tents in the back gardens of nursing homes so that they could isolate and protect our elderly and vulnerable, who were also isolated from their families and friends.

It is estimated that we have a shortfall of approximately 122,000 care workers. So what are we saying to these dedicated, hard-working people who want to come and willingly look after our most vulnerable? We are saying, “When your visa runs out, we want you to go back to where you came from. We don’t want any more of you to come. You will not meet the unrealistic criteria we set for salaries, and the visa and health charges will be unaffordable for you as these are now our new rules. Besides, we are going to have mass unemployment, and we are going to ask all those unemployed to staff our care homes and look after our elderly. We don’t recognise that it is a task that requires some skills, compassion and a caring attitude or a feeling of vocation, as you do.”

It is time for the Home Office to review the current proposals, which do not provide a migratory route for care workers. This is a modest amendment, in that it asks for a review. All it asks is that the Government produce evidence of the impact of the legislation on the social care workforce and social care. I strongly support it, and I hope that many others will do so. It is about people whom we need—those who want the opportunity to provide compassionate care for the elderly and the frail.

I know that my namesake leads the Home Office, and we know each other, but I say to her, “Priti, on this occasion, I do not agree with you”.

[The Lord Bishop of Durham [V]]

My Lords, I speak in support of Amendment 3. First, I draw attention to my interest, as recorded in the register, of receiving support from the Refugee, Asylum and Migration Policy project.

In Committee, I spoke to an amendment that would facilitate the immigration of highly skilled people who had been forcibly displaced by war or persecution. I am glad that the Government have responded positively to that proposal, which others in this place spoke in support of.

I thank the Minister for the helpful and productive meeting that I had with her and her colleague, the Immigration Minister. I was joined by Talent Beyond Boundaries and Fragomen. I hope that she will be willing to place on the record today the Government’s commitment to developing a pilot for health workers, possibly in the education and business sectors. I and others here who are interested will be keen for her to update the House on progress in due course. Following that positive meeting and the promises made at it, I have not pressed the amendment that I tabled in Committee because of the Government’s constructive willingness to further develop the proposal, which applies to the health and social care area.

The Government, rightly, are keen to welcome those who wish to come here with the skills to support themselves and whom businesses in the UK are ready to employ. I am therefore puzzled that social care seems not to receive the attention in immigration policy that it should.

We all know that the average pay of care workers is not high. Indeed, the figures that I have seen suggest that it is typically around £17,000 per annum. This means that such workers will not qualify for a work visa, even with a reduced salary threshold. I know that the Government wish to encourage employers to increase salaries and train domestic workers, rather than allow migration to be used as a shortcut or cost-saving measure. That is welcome, although of course it will require the Minister and her colleagues to have stern conversations with their colleagues in other departments about the necessity for a better-funded care system. Such a system will also need radically better joint working between health and social care, as highlighted, for example, in the 2016 King’s Fund report, Supporting Integration Through New Roles and Working Across Boundaries.

The Migration Advisory Committee is surely right that over the long term the solution to our care crisis lies in raising wages to attract more domestic workers, rather than using migrant workers to plug the gap. Nevertheless, the MAC was also surely right to point out this week that the cliff edge of ending free movement in the middle of a global pandemic, in which care workers are very much on the front line of safeguarding our most vulnerable neighbours, friends and family, will very much increase the pressure on the system, as the MAC puts it.

Those of us who support the amendment hardly support low wages for key workers—far from it. I believe strongly in a real living wage above the national minimum wage and in care workers being appropriately recognised and rewarded for their vital work. We are concerned that the blunt treatment of social care in the new immigration system poses significant systemic problems that could include staff shortages. The impact of those shortages will be felt by the most vulnerable in our society who rely on social care. They deserve better than “fingers crossed”, which is, I am afraid, the impression that we are left with of the current approach.

I am not unused to working within institutions with byzantine processes—I am a bishop of the Church of England, for goodness’ sake, as well as in this place. Therefore, I have some sympathy with the Government’s desire to simplify the immigration system and to resist a proliferation of special routes for particular circumstances, yet simplification is not a virtue if it becomes inflexibility or bluntness in the application of rules that will exclude from coming to the UK the very people our care sector most urgently requires. The creation of a health and care visa has, of course, been welcome news, but I know that my puzzlement that social care appears not to be adequately included is shared by others.

The amendment strikes me as modest but important. It places on the Government merely a duty to publish an independent assessment of the impact of ending free movement on the social are sector. Since international workers account for one-sixth of care workers in England, we would have to be dangerously incurious not to want to know the impact that the biggest change in immigration policy in a generation has on a sector that cares for the most vulnerable among us. Such reports as we have had already from the MAC and others only confirm that there is a knotty problem still to unravel in this tangle of issues about chronic low pay and an unnecessary reliance on skilled migrant carers. I will therefore support the amendment.

Immigration and Social Security Co-ordination (EU Withdrawal) Bill

Lord Patel Excerpts

Committee stage & Committee: 1st sitting (Hansard) & Committee: 1st sitting (Hansard): House of Lords
Monday 7th September 2020 Lords Chamber

[Lord Patel (CB) [V]]

My Lords, before I speak to my Amendment 82, I want to support strongly the noble Lord, Lord Hunt of Kings Heath, who spoke with his usual passion when presenting his amendment. I hope the Minister will respond to that.

Amendment 82 can be taken in the context of the Covid-19 pandemic which has highlighted the exceptional contribution and sacrifice made by our health and social care workers every day in protecting and caring for people in the community. It has also made clear how much we depend on our international workforce. Around 29% of doctors working in NHS hospitals and almost 14% of healthcare workers overall in the United Kingdom are from overseas. International workers account for approximately one-sixth of care workers in England.

The pandemic has had a profound impact on all aspects of our health services, but I draw the attention of the House to its impact on the all-too-often overlooked sector of social care. Between March and July this year, there were 30,500 excess deaths among care home residents as well as 4,500 excess deaths among people receiving care in their home. Figures from the Office for National Statistics also show that social care workers are among the occupational groups at the highest risk of Covid-19 mortality. The United Kingdom recorded the second highest number of deaths among healthcare workers in the world, second only to Russia, and a significant number of those deaths were among social care workers. These figures highlight the immense sacrifice and heartbreak that these workers have faced while trying to do their job in a system that was already overstretched. The vital contribution they make to the health system has been overlooked and undervalued for too long.

Adult social care is facing stark recruitment and retention challenges, with an estimated 122,000 vacancies, while the demand for social care workers is expected to rise in line with the UK’s ageing population. The CQC’s State of Care report concludes that workforce shortages in adult social care are

“affected by the lack of value given to social care by society and disproportionate levels of pay.”

The pandemic should serve as a wake-up call that we need to value our social care workforce more. In a sector where one in six of the workers are from overseas, any changes to the UK immigration system that could deter or prevent those who want to work in this country are of deep concern. There is a risk of significant implications for the staffing of health and social care services, as well as the quality of care and patient safety in the future. While measures to help recruit doctors to the NHS, including the fast-track NHS visa, are welcome, the lack of any route into the UK for social care professionals is extremely concerning. The average salary for a care worker in England is between £16,400 and £18,400, which means that individuals would fail to meet even the lower salary threshold of £20,480 to enable them to trade points to be eligible to work in the United Kingdom.

The current proposals for new immigration controls risk exacerbating the current social work workforce shortages and, as a result, putting some of the most vulnerable members of our society at risk, as already mentioned. Social care staff play an integral role in the efficient and safe running of the health service, and it is vital that any future immigration system recognises this. We owe our overseas health and social care staff a huge debt of gratitude. We should do all we can to keep these dedicated workers and ensure that there are no barriers to future recruitment.

It is important to grow our domestic workforce to help to meet workforce challenges, and to improve working conditions, pay and training as part of that. However, we must also provide an entry route for overseas staff who want to join such a vital part of a healthcare system that would struggle to cope without them. There is a consensus across healthcare organisations, as well as growing support for the idea from parliamentarians right across the political spectrum, that social care needs a long-term, sustainable solution that includes better funding. In the short to medium term, the immigration system must include a migratory route that meets the needs of the social care sector, which is facing severe challenges. We now need the political will to act and reverse this public policy omission.

I therefore hope that my amendment will be supported. It is supported from outside very strongly—by the Royal College of Nursing, the British Medical Association, UNISON, Independent Age and the Royal College of Physicians. It places a duty on the Government to report on migratory options for health and social care workers ineligible for the skilled-worker route.

The amendment would require the Secretary of State to lay before Parliament a report setting out in detail the options for overseas workers excluded from the skilled-worker scheme, within a period of 30 days beginning on the day on which this Bill is passed. It would need to specify a migratory route for care workers, home workers and healthcare support workers. It is time we recognised the vast contribution of the social care workforce to our community. Showing that there is a migratory route into the UK for them would be a step towards achieving this. They have demonstrated that in low-paid jobs they provide good social care, and even die for us, as shown by Covid-19.

I had not indicated that I intend to divide the Committee today, but I look forward to the Minister’s response and I will reserve my judgment. All I can say is that the support for this amendment outside and from all sides is immense, and I hope the Minister will respond to that.

[Baroness Jones of Moulsecoomb (GP)]

My Lords, I shall speak in favour of my Amendment 93. It is obvious that many of the amendments in this group are heading towards the same sort of thing, which is protection for people of all kinds as well as holding the Government to account for what they do. I support several of the amendments that have been spoken to, and I have been moved by some of the speeches from noble Lords.

My amendment is supported by over 50 organisations from all the devolved nations, including the Health and Social Care Alliance Scotland, Macmillan Cancer Support, UNISON and the Association of Camphill Communities. Amendment 93 would require an independent evaluation of the impact of the effects of the Immigration and Social Security Co-ordination (EU Withdrawal) Bill on the health and social care sectors across the UK. This would be made after consulting the Secretary of State for Health and Social Care, the Scottish Ministers, the Welsh Ministers, the relevant Northern Ireland department, service providers, those requiring health and social care service and others. One would hope that this would be automatic with any measure that a Government introduce as they really need to know whether it is working or not.

Proposed new subsection (1) would require the Secretary of State to lay a copy of the report before both Houses of Parliament no later than one year after this Bill is passed. Proposed new subsection (8) would require a Minister of the Crown to make arrangements not later than six months after the report has been laid before Parliament, for the report to be debated and voted on in both Houses.

My amendment is necessary to safeguard the interests of the many people who rely on the contribution of EU citizens and non-EU citizens for the provision of health and social care across the four nations. This of course includes disabled people, children and young people, older people, unpaid carers and those with long-term health conditions. I should perhaps declare an interest in that I am getting older and this might apply to me in a decade or two.

Prior to the UK leaving the EU, a number of studies had highlighted the significant adverse impact of Brexit on the health and social care sectors across the UK. These studies, and the initial information about the points-based immigration system provided in the Home Office’s policy paper, The UK’s Point-Based Immigration System: Policy Statement, suggest that the ending of freedom of movement and the introduction of a points-based immigration system will potentially have a major adverse impact on the health and social care sectors across the UK. I think every speech so far has highlighted that fact.

The proposed independent evaluation that would be introduced by Amendment 93 could play a key role in supporting the health and social care sectors across the UK, helping them to address a range of concern about the proposals. These include concerns that many health and social care workers from other European countries, and from non-European countries, would not meet the proposed income threshold under this system, and that the requirement to have a job offer is unnecessarily restrictive, and will create addition administrative burdens and cost for health and social care organisations trying to recruit staff from abroad. As we have heard, there is a lack of recognition of health and social care specific skills, experience and professional qualifications in the proposed points-based system. As a result, it does not recognise the skills and experience of the workers from across the EU, and from non-EU countries, to enrich health and social care support and services here. Nor does it value the sector and its growing importance as a result of demographic changes.

There is much wrong with the Government’s immigration policy, but health and social care will feel a particularly brutal impact. This independent analysis is required so that the Government can think properly about the needs of health and social care and develop policy accordingly.

Immigration and Social Security Co-ordination (EU Withdrawal) Bill

Lord Patel Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 22nd July 2020 Lords Chamber

[Lord Patel (CB) [V]]

Before I start, I wish to say that I support the comments made by the noble Lord, Lord McConnell.

I shall focus my remarks on how immigration reform will affect science and innovation and the health and care sector. The Government have often said that they want the UK to be a science superpower. Apart from funding and international collaboration, which are crucial, this sector relies heavily on our ability to attract, recruit and retain global scientific talent. Thirty-one per cent of UK Nobel prize winners in science where born outside the UK, and 50% of CRUK-supported PhD students are from outside the UK, rising to 70% of post- doctoral researchers. In part, the Government have recognised this by introducing the global talent visa, but serious concerns remain about the rest of the system.

I will focus on two issues. First, I want to talk about the significant cost of the system for employers and researchers, early-stage researchers and technicians, who will be punished by the new rules. Even researchers gaining a Global Talent visa will face costs of over £2,500. This is 10 times the comparable cost in Germany, the US and Australia, and seven times that in France. The UK will be the most expensive scientific destination in the world. Much of this cost is also associated with health costs. The impact is even greater for those not included in the Global Talent visa due to heavy visa costs, which can be as much as £8,500, and that does not include the costs related to family, which will be above that. The points-based system further disadvantages those whose salary level does not reach £25,000, such as lab technicians—a workforce crucial to science and innovation.

Secondly, I want to refer briefly to the effect that the Bill will have on health and social care workers. The mutual recognition of professional qualifications has played a vital role in enabling EU doctors to work in the UK. The legislation would remove that recognition, which applies also to other countries, and would have a significant effect on recruitment, and not just of EU doctors.

My final comment relates to the lack of any migratory route for unregistered care staff—a point already mentioned by the noble Baronesses, Lady Greengross, Lady Kennedy and Lady Altmann. The sector is already in crisis, with an estimated 110,000 nursing vacancies in social care alone. As has already been said, the classification of social care workers as low skilled devalues their contribution and their skills.

I look forward to the Minister’s comments and the opportunity to explore these matters further in Committee.

[The Deputy Speaker (Lord Faulkner of Worcester) (Lab)]

The noble Lord, Lord Griffiths of Burry Port, has withdrawn from the speakers’ list. The next speaker is the noble Lord, Lord Roberts of Llandudno.

Pre-charge Police Bail: Time Limit

Lord Patel Excerpts

Wednesday 26th February 2020 Lords Chamber

[Baroness Williams of Trafford]

I totally recognise the point that the noble Lord makes about domestic abuse. Our proposals will ensure that bail is used in most domestic abuse and sexual offences where necessary and proportionate. The noble Lord makes a perfectly valid point.

[Lord Patel (CB)]

My Lords, the House will soon have the opportunity to debate a report on forensic science provision and the criminal justice system that the Science and Technology Committee, which I have the privilege to chair, has produced. It strongly recommends that the regulator should be put on a statutory basis. I know that the noble Baroness has just said that this is the Government’s intention, but it was not in the Queen’s Speech. When will that legislation be brought forward? Furthermore, forensic science provision, as she knows, is in dire straits, with private providers going bust all the time.

[Baroness Williams of Trafford]

My Lords, I pre-empted that the noble Lord might, rightly, bring this up. I know that it was not in the Queen’s Speech, but it is our intention to bring that legislation forward, and I shall keep him posted on its progress.

Immigration: Points-based System

Lord Patel Excerpts

Tuesday 25th February 2020 Lords Chamber

[Baroness Williams of Trafford]

My Lords, on 19 February, the Government published a new policy statement, to which noble Lords have referred. As part of this, we announced the expansion of the seasonal workers’ pilot, which raised the quota for this year from 2,500 to 10,000 places. It is not designed to meet the full labour needs of the horticultural industry; it is designed to test the effectiveness of our immigration system and to support UK growers during peak production periods, while retaining robust immigration control and ensuring that the impact on local communities and public services is kept to a minimum. It must be said that seasonal workers can stay in the UK for up to six months in any 12-month period.

[Lord Patel (CB)]

My Lords, I have made the point before, and the Government have recognised, that our science and innovation sector is world-class. That cannot be achieved without a team, and that includes a lab technician. Yet the Government, through their immigration policy, do not recognise that, although they are skilled workers, they are not paid up to £20,000. Is it not bizarre that we train our own people as lab technicians and pay them less £20,000 but we cannot accept through our immigration system somebody who is paid the same amount of money because it is less than £20,000? The same applies to computer scientists: we have a great shortage in cybersecurity of low-level, trained, skilled people who will, in due course, move up, but initially they do not earn £20,000.

[Baroness Williams of Trafford]

New entrants will receive a 30% reduction on the salary threshold that would otherwise be required for their occupation. Given that the skills level has come down to A-level, I think a new technician entrant would meet the salary threshold.