Health and Care Bill

Lord Ramsbotham Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Ramsbotham (CB)]

My Lords, when you are number 55 in a 74-strong speakers’ list, you have not got much new to say. As other noble Lords have said, there is much to be welcomed in this Bill—certainly including its intention and stated aims of integration and innovation, particularly for those who require rehabilitation.

However, as always, the devil is in the detail. I must thank Nicola Newson for an outstanding Library briefing. I also join others in congratulating my noble friend Lord Stevens of Birmingham on a superb maiden speech.

Yesterday, the Prime Minister announced in his speech that drug users were to be offered rehabilitation, but I did not hear him refer to the Bill. This is a pity, because I can think of no other form of rehabilitation that is so subject to local conditions and arrangements and therefore so natural to be included in an integrated care system along with speech and language and all the other subjects requiring rehabilitation.

As other noble Lords have pointed out, when the Bill was in the other place there was considerable concentration on workforce issues, which seem to me to be paramount. There are simply not enough doctors, nurses or other healthcare professionals to go round, particularly in the midst of a pandemic, and the future looks very worrying, particularly where replacements are concerned.

It seems to me that we will have our work cut out to try to improve the Bill, bearing in mind the fate of perfectly reasonable amendments tabled in the other place. Yet try we must, because there are too many long-term and national issues at stake.

Medicines and Medical Devices Bill

Lord Ramsbotham Excerpts

Committee stage & Committee: 5th sitting (Hansard) & Committee: 5th sitting (Hansard): House of Lords
Wednesday 11th November 2020 Grand Committee

[Lord Hunt of Kings Heath (Lab) [V]]

My Lords, I support my noble friend’s amendment and the potential for increasing prescribing responsibilities. The noble Baroness, Lady Cumberlege, was a huge champion of prescribing rights for nurses. I was able to extend that to community pharmacists and I want to see us now build on that by extending it to other professions in healthcare. Dietitians, occupational health therapists, orthoptists, radiographers and speech and language therapists all have a hugely important role to play and giving them prescribing responsibilities would help to deliver safer, better and timelier patient care.

We have seen already how dietitians have hugely expanded their role in the treatment of diabetes, gastroenterology, bariatrics, metabolic conditions and oncology. Orthoptics has seen its roles expand in stroke management and neuro-rehabilitation and neuro-ophthalmology, in particular among children with SEN and for paediatric ophthalmology. Diagnostic radiographers are increasingly performing routine interventional procedures under imaging control, while speech and language therapist roles have developed in respiratory care, ear, nose and throat services, critical care and end-of-life care. Occupational therapists have increased their advanced practitioner roles and are demonstrating a hugely beneficial impact across all areas of the NHS.

There is a problem. It has been reported that the current ability of these professions to administer medicines to support patients through patient group directions and/or patient-specific directions is apparently becoming increasingly difficult. They are either taking longer to secure or they are being more restrictive, to the detriment of patient care and safety. I ask the Minister why this is. I refer to his interesting comment on Second Reading, when he said:

“NHS England and NHS Improvement are considering across all non-medical groups, influenced by learning from the Covid-19 pandemic, where there is a need to consider undertaking formal consultation on potential amendments to prescribing responsibilities for several professional groups.”—[Official Report, 2/9/20; col. 432.]


This is very welcome—and, of course, implied in that statement is a recognition that during the past six months we have had to rely on professional and other staff adding to their responsibilities and going beyond the extra mile. By extending prescribing rights, we would be recognising that fact and recognising that many of our professionals can do more, if they are given the ability to do it.

Provided that this happens within safe bounds—and so far, prescribing for non-medics seems to have worked very successfully—we have a total win-win situation, in which patients will benefit and the professional development and satisfaction of many of our staff groups will increase. I believe that my noble friend’s intention is to give the Minister all support for charging on with the extension of prescribing rights, and I hope that she will embrace that support and get a move on.

[Lord Ramsbotham (CB) [V]]

My Lords, I must declare two interests in explaining why I have put my name to the amendment—first, as co-chair of the All-Party Parliamentary Group on Speech and Language Difficulties, and secondly, as an honorary fellow of the Royal College of Speech and Language Therapists. As always, it is a great pleasure to follow the noble Baroness, Lady Thornton, and the noble Lord, Lord Hunt, both of whom know a great deal more about this subject than I do.

As I reported on Second Reading, on 12 August the Minister in the other place wrote that the Bill would allow the Government to update those professional organisations that can prescribe medicines when it was safe and appropriate to do so. This is in line with what the Minister said on Second Reading, which was quoted by the noble Lord, Lord Hunt. If the experience of dieticians, orthoptists, diagnostic radiographers and speech and language therapists is anything to go by, the role of such people has expanded considerably during the pandemic, during which there has been ever-increasing pressure on health professionals.

Prescribing responsibilities would enable allied professions to share the burden with their NHS colleagues and avoid unnecessary delay and duplication for patients. Their call for increased prescribing responsibilities is backed up by hard-pressed NHS trusts, which have identified a means of increasing their capacity. Therefore I hope that, on the basis of experience during the pandemic, the Minister will be able to announce proposals and a timetable for extending prescribing rights for certain carefully chosen health professional organisations within three months of the Bill being passed, as part of the NHS long-term improvement plan.

[Lord Bradley (Lab) [V]]

My Lords, I am pleased to support this timely amendment, which, as we have heard, would introduce a new clause to the Bill to extend prescribing rights to additional healthcare professionals. It is a consequence of the debate on Second Reading, which clearly laid out the benefits of extending prescribing rights to such allied health professionals as dieticians, orthoptists, diagnostic radiographers and speech and language therapists. I will not repeat all the advantages this would bring, because that argument has already been well made, both on Second Reading and in the speeches we have already heard this afternoon. In summary, I believe that it would help to deliver better support and more timely care for patients, reduce pressure on other health professionals, increase system efficiency and maximise the ability to respond to the Covid-19 pandemic, both now and in the predicted post-pandemic surge in the pressure on services.

Medicines and Medical Devices Bill

Lord Ramsbotham Excerpts

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

[Lord Ramsbotham (CB) [V]]

My Lords, I declare an interest as co-chair of the All-Party Group on Speech and Language Difficulties.

On 6 May, the chief executives of the British Dietetic Association, the Royal College of Occupational Therapists, the Society of Radiographers, and the Royal College of Speech and Language Therapists, and the chair of the British and Irish Orthoptic Society collectively wrote a letter to Jo Churchill, the Minister responsible for taking the Bill through the other place, in which they appealed for extended prescribing rights, in view of the range of benefits that they would provide to patient care and the potential savings to the NHS that would result. In particular, they pointed out that such rights would result in better support and more timely care for the patients they worked with, and improved patient safety, because allied health professionals, with appropriate expertise, were often best placed to make safe medical decisions. This is particularly apposite during the problems posed by Covid-19, because patients in the community may have to wait for weeks or months for assessment or continuance of treatment.

On 10 June, I and my co-chair of the APG, Geraint Davies MP, also wrote to the Minster, welcoming her response during the processing of the Bill in the Commons, in which she said that it would give the Government powers to extend prescribing responsibilities to professional groups where it was safe and appropriate to do so. In this connection, I note the comments on delegated powers in the damning report of the Delegated Powers and Regulatory Reform Committee, published on 22 July, to which other noble Lords have already referred.

The Minister responded to our letter on 12 August, saying that the Bill will allow the Government to continue to update the professions that can prescribe medicines where it is safe and appropriate to do so, without, however, specifying which professions. To date, the professional organisations that wrote to the Minister in May have not received a reply.

All requests by professional organisations for the grant of prescribing rights will need to be subject to intense consultation before they are granted and any resulting recommendations subject to parliamentary scrutiny, as the Delegated Powers Committee points out. Will the Minister say whether that is HMG’s intention and to which professions they plan to give prescribing rights?

Mental Health Services

Lord Ramsbotham Excerpts

Tuesday 19th May 2020 Lords Chamber

[Lord Bethell]

I pay tribute to exactly the sort of charity that my noble friend’s daughter works in. They provide invaluable and often unseen benefits to society. We have already made available considerable financial support for similar such charities. If my noble friend would like to write to me with the details of the one he described, I would be glad to consider it. Undoubtedly, these charities will play an important role in dealing with mental health issues of the kind he describes during the mop-up after Covid.

[Lord Ramsbotham (CB)]

My Lords—

[The Senior Deputy Speaker (Lord McFall of Alcluith)]

I am sorry, but I think we have lost the connection. I will call the noble Baroness, Baroness Verma, and then come back to the noble Lord.

--- Later in debate ---

[The Senior Deputy Speaker]

I return to the noble Lord, Lord Ramsbotham.

[Lord Ramsbotham]

My Lords, does what the Minister has said apply to prisons and probation?

[Lord Bethell]

I pay tribute to the Prison Service, which in extremely difficult circumstances has managed to provide pastoral care and clinical segregation in our prisons in a way that has completely outperformed expectations. The effect in prisons has been profound and the mental health of prisoners is concerning. The degree of lockdown in prison cells is an awful aspect of this disease, and undoubtedly we will have to work very hard to manage and deal with the mental pressures on prisoners, which are extremely unfortunate.

Coronavirus Bill

Lord Ramsbotham Excerpts

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

[Lord Ramsbotham (CB)]

My Lords, I will raise two unconnected points in connection with the Bill. First, I admit to being very surprised to see no mention in it of prisons, which the noble and learned Lord, Lord Falconer, and the right reverend Prelate the Bishop of Rochester, have already mentioned, or of probation. Both are state-run activities and require state employees to have face-to-face contact with offenders who have been sentenced by the courts, which are mentioned, as are the police, who are responsible for the investigation of criminal acts.

I remember that, when the Prison Officers Association went on strike in 1989 and I was commanding the United Kingdom field Army, the Army was required to set up, and externally guard, two temporary prisons in existing army accommodation. When there was a suggestion that soldiers were to be required to censor prisoners’ letters, I appealed to the then Home Secretary, Lord Hurd of Westwell, that soldiers should not be put in such close contact with prisoners, to which he immediately agreed. I was therefore interested to see a report in yesterday’s Times that the Royal Navy would be called on to cover any drastic shortfalls in the number of prison officers, after the police had made it clear that they were unable to, including being responsible for delivering ready meals to prisoners in their cells.

I know that these are extraordinary times, and that extraordinary measures need to be taken, but service personnel do not have the same training as policemen or prison staff, and I appeal to the Government not to deploy Armed Forces personnel to anywhere where they will come into such close contact with convicted criminals. When I was Chief Inspector of Prisons, my deputy, who governed HMP Holloway, was faced with a strike of prison officers, and ran the prison using teachers and other volunteers already working in the prison.

No thought appears to have been given to the supervision of offenders in the community. No plans have been announced to suspend sentences or arrange other supervisors if probation staff should fall victim to the virus. All probation sentences begin with an assessment, made following a face-to-face interview, and require personal contact throughout their completion. Will work on A Draft Target Operating Model for the Future of Probation Services in England and Wales, published earlier this month, be suspended until the future is clearer? This matter will be discussed in detail in both Houses in the context of the promised royal commission on improving the effectiveness and efficiency of the criminal justice system. Unless this is carefully thought through, I am afraid that any extraordinary measures made necessary by the impact of coronavirus can only deepen the existing crisis in the delivery of probation services following the rushed and ill-thought-through transforming rehabilitation exercise.

Before making my second point, I declare an interest as co-chair of the All-Party Parliamentary Group on Speech and Language Difficulties. I realise that, compared with the other demands on NHS staff, speech and language therapists may come lower in the list. However, how do the Government plan to ensure that information about the virus and the provisions of the Bill are made accessible to those with speech, language and communication needs? Therapists, who are essential in this process, should be issued with protective equipment and added to the list of key workers.

Child and Adolescent Mental Health Services

Lord Ramsbotham Excerpts

Wednesday 24th October 2018 Lords Chamber

[Lord Ramsbotham (CB)]

My Lords, too many people in our young offender institutions are suffering from mental health problems. The Minister mentioned the likely increase in the number of nurses, but one of the problems with the young offender institutions is that there is an acute shortage of child and adolescent psychiatrists. Will he please tell the House what the situation is regarding those vital people?

[Lord O'Shaughnessy]

I hope the noble Lord will forgive me if I do not have the specific number on psychiatrists. The plans to extend the mental health workforce as a whole cover all settings, including the recruitment of a further 1,700 children and young people’s therapists. I will find out whether the young offender institutions are included in that and what the figure is for psychiatrists.

Social Care

Lord Ramsbotham Excerpts

Thursday 7th December 2017 Lords Chamber

[Lord O'Shaughnessy]

Once again, I thank the noble Baroness for raising this issue and I am pleased that she supports the parallel work stream. I will come back to her with details on the timing—I am afraid that I do not have those with me today—but I stress the importance given to it and the fact that it is reporting to the inter-ministerial group is significant.

The noble Baroness’s question on housing goes slightly beyond my remit. I know that building regs have changed over time to encourage more homes to be built, but I will have to come back to her with more details on that point.

[Lord Ramsbotham (CB)]

My Lords, sadly, the fastest-growing part of the prison population is the elderly. The lack of provision for them is one of the disgraces in the current prison system. Has the Minister considered, as part of the carers strategy, whether prisoners might be employed and trained as carers for the elderly, because that might transform the situation?

Mental Health Services: Children and Adolescents

Lord Ramsbotham Excerpts

Monday 17th July 2017 Lords Chamber

[Lord O'Shaughnessy]

Both halves.

[Lord Ramsbotham (CB)]

My Lords, can I press the Minister on the Green Paper? It is apparent that something must be produced as a matter of urgency. The much-respected Centre for Mental Health has for a long time been reporting on the inconsistency of the delivery of children’s services across the country. What is more, too many CAMHS are offputtingly clinical, formal and remote and do not relate well to children. This is something that we really must get on with, so the Green Paper is required as soon as possible.

[Lord O'Shaughnessy]

I agree completely with the noble Lord. As I have said, the Green Paper will be ready later this year. I am afraid that I cannot give him any more detail than that at this point.

NHS: Mental Health Services

Lord Ramsbotham Excerpts

Monday 14th March 2016 Lords Chamber

[Lord Prior of Brampton]

On the particular case raised by the noble Baroness, the person involved will now come out of that accommodation. I think he has been an in-patient for six months but he is now due to come out of that place fairly soon. This issue is not confined to mental health. There are too many people who, if the right resources were available outside hospital, would be much better off being treated outside an institution than they are at the moment. We are doing our best to address this general concern, raised by Paul Farmer and his task force.

[Lord Ramsbotham (CB)]

My Lords, can the Minister tell the House whether the data to be published will include the provision of services in prisons and other places of detention, including immigration removal centres?

[Lord Prior of Brampton]

My Lords, it certainly is our intention to include information about people suffering from mental health problems in prison. I will have to check into the immigration removal centres and write to the noble Lord.

National Health Service: Sustainability

Lord Ramsbotham Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Ramsbotham (CB)]

My Lords, I, too, congratulate my noble friend Lord Patel on obtaining this debate, yet again confirming his wisdom, his expertise and his commitment to an issue about which I know he cares deeply. As a mere NHS user, I hardly dare add my voice to those of the many experts who are contributing, my only qualification being that, for two years, I chaired the Hillingdon Hospitals NHS Foundation Trust, having my noble friend Lady Flather as one of my non-executive directors.

Before making two points about the sustainability of the NHS, perhaps I may share the first of two wishes. I once worked for a general who banned the use of the words “significant”, “vital” and “basic” because they were merely pejorative and signified nothing. A distinguished psychiatrist said the same, in clinical terms, about the Home Office’s use of the words “dangerous” and “severe” to qualify a personality disorder. If I could ban one word from politics it would be “change”—pejorative for doing the opposite of what the other side did, under the delusion that it is a hallmark of political virility. In fact, change for change’s sake often leads to little more than unnecessary and expensive disruption, particularly when its consequence has not been fully assessed. In the public sector, evolution is invariably a better, or more appropriate, route to improvement than revolution. The debacle following the coalition Government charging ahead with change in their pre-planned Health and Social Care Bill, before examining the books and seeing what was possible or necessary, is a classic example of what I mean. Above all, it flew in the face of the priority plea of practitioners, which is for stability.

Sustainability depends on maintaining and not squandering resources. Quite clearly, the biggest problem facing the NHS is the rising cost of meeting the physical and mental health needs of an ageing population. My first point is that affordability requires the ruthless elimination of anything unnecessary or wasteful, such as silo working when more than one ministry is involved. There are two examples from the criminal justice system. First, I hoped that prisons and probation would be represented on local health and well-being boards, resulting in improved support for offenders. Not only are they not represented on all, but fewer than 20% of clinical commissioning groups realise that they are responsible for meeting the physical and mental health needs of those undergoing supervision in the community. Secondly, expensive lack of co-operation between ministries is exemplified by the Ministry of Justice’s proposal for what it calls a “secure college”, detaining 320 children aged between 12 and 17, the vast majority of whom have mental health or emotional well-being problems, on one site in the middle of Leicestershire, while at the same time NHS England’s Children’s Mental Health and Emotional Well-Being Task Force is piloting a scheme to ensure that such children are kept in their home areas to ensure consistency of treatment. The Chancellor must be fuming.

My second point concerns senseless waste of equipment and drugs. Almost four years ago my wife had four vertebrae fractured in a car accident and had to wear a plastic body brace for some weeks. When she asked the issuing NHS hospital what she should do with it when it was no longer needed, she was told that, because they did not re-use such things in case infection was passed on, she should throw it away. In the event, she was assessed by a consultant in a private hospital, who, on hearing this, asked whether he could have it because it was worth a lot of money and could be used many more times. Only last week I tried to decline a once-prescribed box of pills which I did not need, only to be told by the pharmacist that there was no point in handing it back because, once issued, it had to be destroyed. Individually these may be small items but, aggregated across the country, they add up to a considerable sum which the NHS surely ought to be able to find ways of saving. I hope that the current work of the NHS Confederation, working with other national bodies to explore how to make savings, will demonstrate to the Government the value of an NHS-led approach to this.

One of the qualities that I most admired in the marvellous people who worked at Hillingdon was applied common sense. Sadly, common sense is often a victim of adversarial party politics. That is why my second wish, in the interests of stability and sustainability, is that in addition to the independent commission called for by my noble friend and many others, the future of the NHS should be subject to cross-party consensus.