Medicines and Medical Devices Bill

Debate between Lord Ramsbotham and Lord Hunt of Kings Heath

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.

Children and Social Work Bill [HL]

Debate between Lord Ramsbotham and Lord Hunt of Kings Heath

Report: 1st sitting: House of Lords
Tuesday 18th October 2016 Lords Chamber

[Lord Ramsbotham]

My Lords, my Amendment 29 seeks to use Clause 8 to mitigate the possible impact of provisions elsewhere in the Bill on a group of children described by the phrase,

“there being no person who has parental responsibility for the child”—

in other words, looked-after children. I refer in particular to looked-after children in custody, of whom the noble Lord, Lord Laming, in his report, estimated that there were approximately 400 at any one time, 100 of whom were on remand. Although this is not in itself a large number, it adds up to slightly less than half the numbers of children currently in custody. This ratio accentuates the need to consider their position.

Currently, all children remanded into custody are automatically granted looked-after status for the duration of their time on remand. Children in care retain this status throughout their custody. However, in Grand Committee the Minister suggested that this could be removed by other clauses in the Bill. Looked-after children in custody show greater levels of mental health needs than other incarcerated children, need greater levels of emotional and practical support, and respond less well to behavioural incentive schemes and resettlement planning. As a group, they already face problems in engaging local authority support, and it would appear to be at best counterproductive to enable local authorities to opt out of their duty to support those looked-after children who happen to be in custody. This is yet another cross-government matter, and I wonder whether the Department for Education has discussed the possible effect of this with the Ministry of Justice, which aims to reduce reoffending.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I, like my noble friend, am very grateful for government Amendment 20, which we fully support. The noble Baroness, Lady Walmsley, and my noble friend Lady King spoke eloquently about children adopted from care outside England who are now resident in England, and on the need for educational equality. We, too, very much welcome the Minister’s intention to bring forward amendments in the other place. Obviously, they will come back to your Lordships’ House in the new year.

The noble Lord, Lord Ramsbotham, made a very telling point about the particular challenges of looked-after children in custody. At heart, it is a question of whether the Minister’s department’s intention is consistent with that of the Ministry of Justice. It would be very helpful if, between now and Report, the Minister would enable some discussions to take place with the noble Lord, Lord Ramsbotham, just to make sure that there is absolute consistency, because I very much take the point that he raised.

Children and Social Work Bill [HL]

Debate between Lord Ramsbotham and Lord Hunt of Kings Heath

Wednesday 6th July 2016 Grand Committee

[Lord Ramsbotham]

My Lords, I added my name to this amendment, and entirely agree with what my noble friend has said so far. I endorse his proposal that the Wales protocol should be adopted in England as well. The number of people they put on the informed list under that protocol is interesting, as it means that most people who are likely to need to know, such as the police, health services and the director of social services, are included.

This reminded me of something that happened when I was Chief Inspector of Prisons, when the chief inspectors of constabulary, the courts services, education, probation and social services were collectively worried about the lack of information flowing around the system. We published a thematic review of what each of our particular responsibilities needed of the others, what was readily available, what was obtainable only with difficulty and what was not obtainable. We presented this to our respective Ministers, who were interested, but the tragedy was that it fell on stony ground because no one Minister was responsible for cross-governmental working to ensure that all this information was shared by those who needed it.

To the categories mentioned by my noble friend, I would just add that of unaccompanied asylum-seeking children, who are frequently moved from their port or airport of entry to local authorities all over the country in order to share the burden. We need to know where they are and what is happening to them, so the information mentioned in this amendment needs to be shared by many others—not just the directors of social services but immigration authorities and others covered in the Wales protocol. I recommend that, which is why I support my noble friend’s amendment.

[Lord Hunt of Kings Heath]

My Lords, I am very glad to wind up for the Opposition and speak in this short debate. As the noble Earl, Lord Listowel, said, there are sound reasons why out-of-area placements may occur, but they present real challenges, not least the inconsistency of approach between different local authorities and this particular problem about a multiagency response.

The noble Earl raised the issue of vulnerability to trafficking, and the noble Lord, Lord Ramsbotham, brought unaccompanied asylum seekers into consideration. I have already referred to my own concerns about the role of the National Health Service. We know that mental health services, especially child and adolescent mental health services, are inadequate and that many disturbed young people are being sent a long way from home.

The Minister in a previous debate referred to an agreement, or work, between his department and the Department of Health in establishing the care pathway. That is to be welcomed, but I would like to hear more about how he is going to make it grip when it comes to children who are being placed out of area and a long way from their homes. Has the Minister’s department had an opportunity to see how the Welsh protocol is working in Wales and whether there would be an opportunity to build on the good practice that has been developed there?

Police Reform and Social Responsibility Bill

Debate between Lord Ramsbotham and Lord Hunt of Kings Heath

Wednesday 20th July 2011 Lords Chamber

[Lord Ramsbotham]

I speak particularly to subsection (6) of the proposed new clause, which presents a very neat way out of the issues of the British Transport Police and the British Transport Policy Authority that I raised on Report. In doing so, I thank the noble Baroness, not just for the way that she has conducted this Bill through the House, but also with the speed with which she, the Secretary of State for Transport and the noble Earl, Lord Attlee, responded to the points that I made and had a meeting to discuss them. In subsection (6), it describes the police protocol as,

“a document which sets out, or otherwise makes provision about, ways in which relevant persons should … exercise, or refrain from exercising, functions so as to … encourage, maintain or improve working relationships (including co-operative working) between relevant persons, or … limit or prevent the overlapping or conflicting exercise of functions”.

That seems to be precisely at the heart of the very long delay—10 years’ delay—in bringing the jurisdiction and powers of British Transport Police constables and the definition of their chief officer’s role together with those of the Home Office police.

At Second Reading, I mentioned that there was a certain urgency in this because the transport police have a key role to play not just in anti terrorism but in the run-up to and progress of the 2012 Olympics. Therefore, as I say, something needs to be done quickly. There is a way out if you accept that the British Transport Police and the British Transport Police authority should be included in the protocol to the extent that the annual police plans, which have to be drawn up by the police and crime commissioners, should include the operations of the British Transport Police. You thus get over all the problems associated with them because they have to be resolved with the measure. For example, the licensing issue, which particularly affects transport hubs and is a matter of concern, and the proper licensing of firearms rather than requiring every constable to get an individual one, would have to be done not as separate issues but as part of a plan in every area. I was disappointed to hear that when the British Transport Police raised this at the meeting with the Secretary of State, officials said that it was inappropriate because the protocol applied only to the Home Office police. That is precisely why it presents the ideal vehicle. I hope very much that the Minister will assure the House that that approach will be followed.

[Lord Hunt of Kings Heath]

My Lords, I have an amendment in this group. I thank the noble Baroness for bringing forward her amendment. We have debated establishing a protocol and giving parliamentary endorsement to it, so that is very welcome. I also echo the remarks of the noble Baronesses, Lady Henig and Lady Harris, who expertly identified the flaws in the Bill. I very much support my noble friend’s amendment. I also support what the noble Lord, Lord Ramsbotham, said. He made a very good point. I hope that the noble Baroness will respond to him.

I have a very modest amendment in this group—Amendment 12. The noble Baroness’s amendment contains an order-making power. Essentially, the order-making power applies to the issuing, varying or replacing of a policing protocol. My reading is that that will be a negative SI. I think that it ought to be an affirmative SI. I refer the noble Baroness to the guidance given by the Delegated Powers and Regulatory Reform Committee. It states:

“A supplementary memorandum must be submitted when any Government amendment is tabled which introduces a significant new delegated power”.

I checked last night and I know that her department issued a supplementary memorandum in relation to amendments to Clause 59(2)(c), and that a two-page memorandum has been produced. However, I have not discovered a memorandum issued in relation to this amendment. I hope that the noble Baroness will clarify whether such a supplementary memorandum has been issued.

However, the real point is the following. From all the comments that have been made, right from Second Reading through to today, the importance of this protocol is not in doubt. Given that it is an order-making power, I fail to see why the noble Baroness’s amendment does not refer to an affirmative order. It ought to be an affirmative order to stress the importance of this matter. I hope that the noble Baroness will be able to give me some comfort on that.

Public Bodies Bill [HL]

Debate between Lord Ramsbotham and Lord Hunt of Kings Heath

Tuesday 11th January 2011 Lords Chamber

[Lord Ramsbotham]

My Lords, perhaps I may speak briefly to Amendment 40. I agree with the noble Lord, Lord Newton, that it would be churlish at this stage to press for a vote. I am enormously grateful for the explanation given by the noble Lord, Lord McNally, which frankly I and many other Members of the House would have welcomed before this stage. If all that information was available, why could it not have been put in the Explanatory Notes and given to us in another form? We are going to have the same sort of debate when other issues, such as the Youth Justice Board, come up for discussion. If alternative plans have already been made it would be enormously helpful to know those in advance so that we can weigh them against the bald statement in the Bill.

I listened with great care to noble Lords’ contributions, particularly that of the noble and learned Lord, Lord Mackay, whose wisdom I respect hugely and whose advice I listen to. In that spirit, it would be sensible to withdraw Amendment 40 with, I hope, discussions to follow with the possibility of resuming it later. I have read the National Audit Office report—I worked for the National Audit Office in other respects. I am not sure that it completely fills the remit, although it fills some of it. Again, this is an issue it would be sensible to look at in detail before necessarily pressing it to a vote.

[Lord Hunt of Kings Heath]

We are, of course, on Amendment 31. I beg leave to withdraw the amendment.