NHS Staff: Food Banks

Lord Trefgarne Excerpts

Tuesday 7th February 2023 Lords Chamber

[Lord Markham (Con)]

I do not think I have implied today that people are awash with cash—that has not been my tone for one moment. My tone has been one of complete understanding that we are in a difficult situation, with difficult choices to be made. We are trying to navigate our way through while bearing down on inflation, which is the priority, and making sure that our scarce resources are focused on the areas of most need. The noble Lord talks about taxes but clearly tax is one area where we want to make sure that it is as fair as possible as well. There are a number of measures and the solutions are not easy, but we are definitely mindful of the issue.

[Lord Trefgarne (Con)]

My Lords, most of the publicity we hear about the present dispute refers to percentage increases, not absolute salaries. What is the approximate salary of a junior health service employee?

[Lord Markham (Con)]

Clearly, there is a wide range with regard to that. If I was to take an average overall, we would probably be talking about the mid-£30,000s as a very broad average, but I will quite happily provide my noble friend a breakdown of those detailed figures. However, as I say, we have made sure that as a minimum everyone received at least £1,400, accepting that the lowest paid need the most protection.

Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 6) Regulations 2021

Lord Trefgarne Excerpts

Wednesday 15th December 2021 Lords Chamber

[Baroness Hayman (CB)]

My Lords, I was interested in the comments we have just heard from the noble Lord, Lord Hannan of Kingsclere, and slightly surprised at how much of his speech I agreed with—in the sense that there is a danger from a constant stream of new variants, each provoking tactical responses in our own country. Therefore, I repeat the point I made yesterday at Question Time: it is in our national self-interest to ensure not only that people in this country are protected by vaccination but that people across the world are protected, because that will protect us in the future. It will stop us having these debates every two months, six months or year, ad infinitum.

The other point I will make in response to what the noble Lord said is that he is correct that we should not make this a debate between extreme positions, where you are either 100% right or 100% wrong. I am not 100% in favour of the detail of everything that is in these three SIs—but I am 100% sure that I am going to vote for them if the noble Lord, Lord Robathan, decides to divide the House.

There is a process by which we reach compromises and balances: between the threat to health from the virus and that of not having an NHS functioning as it normally does; or between the threats to mental health from the fear of contracting the virus and those from isolation—not being able to participate and work, and all those things. How we draw those balances is a very delicate exercise and it starts, as others have said, with medical and scientific advice. That must be the rock and the foundation, but of course there is a political dimension—a value weighing-up and a judgment to be made about the comparative harms and how we get our best way through.

I will make one last point about the dangers of an extremist position—and I think that the noble Lord, Lord Robathan, actually takes an extremist position. The danger comes when, after the advice, the Government’s view and their proposals, and then parliamentary scrutiny and challenge, to get it as right as we can on balance, there is a sense in the public that the political is playing too large a part; and that a Government—this Government—will actually be deterred from taking the action that they need, and are advised, to take, and which we need them to take to protect ourselves.

Other noble Lords will have seen the streams of responses to the email of the noble Lord, Lord Robathan, from people saying, “I’m sorry I can’t be there but I’m in bed with Covid”. On public confidence, let us face it: the current public adherence, on which we all depend, to the regulations before us will be damaged by the fear that they are not based fundamentally on the science but on fears of losing political support in the very narrow environment in which we operate. That would undermine public confidence. As others have said, it is absolutely vital that we go through this process with scientific advice, government recommendations and parliamentary scrutiny, and do the best that we can in those circumstances.

[Lord Trefgarne (Con)]

My Lords, I have had the privilege of being a Member of your Lordships’ House for a very long time. I was sitting on the Benches opposite back in 1977, when my late noble friend Lord Carrington, then Leader of the Opposition, and the late Earl Jellicoe moved the cancellation of sanctions on Rhodesia. That was a mistake, and it would be a mistake to vote down the regulations today.

[Baroness Foster of Oxton (Con)]

My Lords, I saw a notice recently outside a restaurant. It read: “If you’d like to know how it feels to be in the hospitality sector during this Covid pandemic, just remember the ‘Titanic’ when it was sinking and the band played on.” Well, we are the band. Here we are, 21 months on, and it feels like we are going backwards.

Let us take a short trip down memory lane. Covid arrives, and it is March 2020. The Chinese authorities already knew that there was a problem several months before but did not decide to tell the WHO until the December—but there we are. So we go into lockdown. There are daily press conferences. There is new language: “Protect the NHS”, “Hands, face, space”, “Stay at home”, “We need to flatten the curve”. We needed to do that, but it would be for only a few weeks and it was for the greater good—quite right. “Go out once a day, but only for essential goods.” Spend hours queuing in Sainsbury’s car park, two metres apart, in the rain. “Close your businesses, do not travel, do not visit your neighbour, but it’s just for a short time.” “Don’t see your boyfriend—it’s for the greater good.” “We need to close all the schools.” “Teach your children from home.” “You won’t be able to see your loved ones in a care home, but that’s also for the greater good.” And we went with that, because it was for the greater good. But we are where we are now. Finally, it was: “You can’t see your GP if you’re ill. It is too dangerous.”

So what do we do next? We tried to comply. Of those who did not comply, some were arrested. They were arrested for sitting on a bench, having a cup of coffee. Perhaps they had already been out that day. But that was not the answer. Nevertheless, we looked ahead. I am nothing if not optimistic. There was a temporary release over summer, and, by autumn, it had started again. “But it’s okay; it’ll be fine for Christmas. The vaccines are coming, so please bear with us. It’s for the greater good.” And we did, and I am a huge supporter of the vaccine programme.

But families were still separated. Millions were home alone. Meanwhile, the economy went into freefall. Mental health issues have been raised. The number of suicides increased, and NHS waiting lists have grown and grown, with people becoming more and more ill. Then it arrived; it was the silver bullet, and it was such a relief. This vaccine programme has been fantastic; I am a huge supporter.

When the vaccine arrived we were told that, once we had got the over-70s jabbed, we would start to get back to normal. But then it was the over-60s. Then we had to wait for the over-50s, the over-40s and the over-20s. Then it was the 12 to 15s.

So, 21 months on, we were looking forward to Christmas again, but then the omicron variant arrived—talk about bad timing. “But don’t worry,” said the chairman of the South African Medical Association, Dr Angelique Coetzee, “you’re the most vaccinated country on the planet, the symptoms are mild and not one practitioner has prescribed oxygen.” But here we are. We feel as though we have been marched up the hill, as though we have taken one step forward and two steps back.

The headlines roared. Mainstream media have gone into overdrive. We have 10 cases and one death, but, as my noble friend asked, what were the causes? Did that person die of it, tragic though it is, or with it? We would like that information. There are approximately 10 cases a day. But we have also had the modelling figures. By April next year, we could have between 25,000 and 75,000 deaths, and 200,000 cases a day. They are the modelling figures, which sum up where we are. It is a very difficult situation. The question is: where will it end?

We cannot keep people in perpetual fear and we cannot knee-jerk from one day to the next. The hysteria is flooding the airwaves, and the consequences on the public are horrific. With a heavy heart, I find it difficult to support the Motions today, but I urge the Government to seriously rethink how we take this forward. I ask my noble friend to do that because, finally, coercion can never be the answer. Persuasion is much better. If we can have a frank and open discussion and hear arguments from both sides, that is how we will move forward.

Coronavirus

Lord Trefgarne Excerpts

Thursday 12th March 2020 Lords Chamber

[Lord Bethell]

The noble Lord asks a question that is on the minds of a lot of people who have been reading into the subject. The concern of the CMO is that if you bring intense social behaviour restrictions to bear on a population, you can temporarily suppress the spread of the virus. If you ask the entire population to stay at home, and close down every business, public space and event, you can suppress circulation. However, the moment you lift those restrictions, the virus spreads with a vengeance. It is often the most vulnerable who are then hit with a second peak, which can take out the provisions needed to support them. That is the CMO’s primary concern. The Government’s objective is to manage the situation so that the virus spreads in as limited a way as possible, and is spread out over time to allow medical and social care resources to be given to those who need support.

[Lord Trefgarne (Con)]

My Lords, my noble friend referred to the inevitable increased level of activity in the National Health Service. What success has been achieved in recalling recently retired NHS staff to help?

[Lord Bethell]

The recruitment of recently retired staff requires some changes to legislation, which are being studied at the moment. We look forward to bringing them to the House in the near future. I am happy to update the House on those provisions, once we have made further progress.

Wuhan Novel Coronavirus: UK Citizens

Lord Trefgarne Excerpts

Thursday 30th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

We are currently holding discussions on this point and the Foreign Secretary has made representations.

[Lord Trefgarne (Con)]

My Lords, has any progress been made in developing a vaccine against this dreadful disease?

Social Care

Lord Trefgarne Excerpts

Thursday 7th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I think that everyone in this House endorses the idea that health and social care should be better integrated. That statement is easy to make but difficult to achieve, as I think we would all agree, not least because the funding bases are very different. The NHS is taxpayer funded and free at the point of use; social care is funded on a different basis. That is one of the factors, as well as the bodies responsible for commissioning and so on. A practical way forward is to seek integration at a local level. That is happening now, for example, in Greater Manchester, which has powers over both services and is looking to integrate, and it lies at the heart of NHS England’s five-year forward view, which is about bringing services together in 44 areas, known as STP areas, to provide that level of integration. Patients do not want to have to flit through different bodies all the time. They want a sense that there is one service looking after them throughout their needs.

[Lord Trefgarne (Con)]

My Lords, perhaps I may underline the words of the noble Lord, Lord Ramsbotham, a few moments ago about the care for very elderly prisoners in our system. I have heard some shocking stories of failures in that regard. I hope that my noble friend can make some inquiries.

[Lord O'Shaughnessy]

Yes, I will certainly do so.

NHS: Accident and Emergency Services

Lord Trefgarne Excerpts

Thursday 25th July 2013 Lords Chamber

[Earl Howe]

My Lords, I do not share the noble Lord’s analysis of the problem. A&E departments are currently meeting targets, but the long-term pressures have been building up for many, many years. Over the past decade, emergency admissions have risen by 35% and an extra 1 million patients have attended A&E compared to three years ago. This is not anything recent. The Government’s reforms will, if anything, help to ease the pressure because doctors now have the freedom to provide the health services their patients really need. The action we are taking in the immediate term is to encourage doctors and all the key players in the health system to get together in urgent care boards to make sure that next winter we see a much easier picture.

[Lord Trefgarne]

My Lords, is it not the case that the problems now being faced by many A&E departments are the result of changes to GP contracts introduced by noble Lords opposite many years ago?

[Earl Howe]

My Lords, there are many factors at play here. There is no doubt that the GP contract severed the legal responsibility that individual GPs had to look after their patients out of hours. It would be idle for me to stand here and say that that has had no effect on A&E attendances. Patients are confused now about whom to contact out of hours and many turn up at A&E when perhaps they should not have done so.

Health: Hearing Loss

Lord Trefgarne Excerpts

Monday 17th December 2012 Lords Chamber

[Earl Howe]

The noble Baroness is quite right. Clinicians have found very often that patients who receive hearing aids decide, for one reason or another, not to use them. That is of course very serious; it is a waste of resources but, perhaps more importantly, it is potentially damaging to or indeed dangerous for the patient. Compliance is undoubtedly an issue. In the end, however, nobody can be forced to wear hearing aids but, once again, we believe that there is a role for audiology specialists and general practitioners in encouraging the proper use of hearing aids.

[Lord Trefgarne]

My Lords, is my noble friend aware that of all the soldiers who went south to the Falkland Islands in 1982, approximately one-third came back with permanent hearing damage? Will he ensure that the arrangements he has described will fully take into account the needs of that group of people?

[Earl Howe]

My Lords, I am grateful to my noble friend for raising a very important issue about war veterans. My department is doing a lot of work in this area. I will write to him if I have anything more specific.

Health and Social Care Bill

Lord Trefgarne Excerpts

Thursday 8th March 2012 Lords Chamber

[Lord Harris of Haringey]

My Lords, this is a complicated group of amendments. There are, I think, 50 government amendments in this group that completely change the direction of this part of the Bill. Of course, we do not have the benefit of a Committee consideration of these changes, which is unfortunate, given the nature of the changes that are envisaged.

In fact, what we are being confronted with is an almost extraordinary volte-face by the Government about how local healthwatch organisations are going to operate and proceed. As it stood, before these amendments, the Bill provided local healthwatch with a very clear structure and very clear governance. It defined membership and it defined their role. As such, the arrangements were better than LINks, better than PPI forums and, in one or two respects, better than community health councils. It was a very clear statement. There remained the problem that local healthwatches were going to be the creatures of local government without the benefit of ring-fenced money and with the potential issues around conflicts of interest concerning social care. I am reminded that on 15 October 2007, the noble Earl, Lord Howe, clearly took the view that it was inappropriate for a local authority to be host to a LINk. Presumably, the same arguments that influenced his thinking then apply on this occasion.

We have been offered guidance on conflicts but, again, it is not clear how this will work, which is something that we could have pursued perhaps in detail in Committee. The amendment refers to having regard to the guidance on conflicts, which I suspect will not necessarily be strong enough for the sorts of conflicts of interest that potentially could arise. We also have the enormous concession, to which I referred earlier, of Amendment 226ZG, which enables HealthWatch England to write a letter if it feels that something has gone wrong.

That is where we were but now the Government, without explanation or consultation, have decided that local healthwatches will no longer be statutory bodies. We are told that that is all in the name of the need for flexibility. The noble Baroness has mentioned repeatedly the briefing which took place yesterday evening, to which, incidentally, I was not invited. Even had I been, I would not have been able to attend because the meeting clashed with the regular meeting of Labour Peers, which one would think that the Government would wish to avoid. At that meeting various papers were tabled which referred to the importance of flexibility but we are not clear as to what that flexibility will deliver.

In moving the amendment the noble Baroness talked about the Government’s proposals in the Bill as creating a series of “unaccountable quangos”. I recall previous briefings which I attended with Ministers and the Bill team when it was explained that there would be guidance about how the membership of local healthwatch was going to be derived and to demonstrate that these were going to be accountable bodies and not unaccountable quangos. Somewhere along the line, in the past few weeks, there has been this amazing change of attitude, which does not seem to follow the benefit of any real explanation or consultation with those who might take an interest in it.

That underpins the amendments spoken to by the noble Baronesses, Lady Cumberlege and Lady Jolly. The noble Baroness, Lady Cumberlege, highlighted the difficulty that would arise between members and staff. The noble Baroness, Lady Jolly, talked about the importance of lay leadership. In terms of the changes, the Government are going to make it more difficult for there to be lay leadership and the role of members versus staff will be blurred still further. Indeed, the staff will be the dominant influence.

This is not a matter on which there has been consultation. I have received a note from the National Association of LINks Members, which states:

“Ministers say that they are ‘not convinced’ that LHW needs to be a stand-alone, statutory body corporate. It is not ministers who will be relying on LHW to get them a fair shake but the old, sick, vulnerable, frightened and marginalised and these, along with the rest of the patients and the public, are the ones who need to be ‘convinced’ that we have a model that will work”.

It says that it is not convinced. It points out that local healthwatch should,

“have a standard ‘platform’ of presence everywhere in England, not merely through logos, straplines and brands”—

which the Government’s amendments will make happen—

“but through a locally elected membership, a single ‘address’ and identifiable staff that it has appointed”.

It says that only:

“Statutory, body corporate status would deliver this”.

It continues:

“Government says it does not want a top-down model but it is making top-down decisions, and these fly in the face of all the evidence of the past three and a half years of LINks, all the advice of all the LINks’ members of the government’s own HealthWatch Advisory Board, of the National Association of LINks Members, all the advice of many, many LINks all over England. ‘Being heard’ has simply vanished from the national scene. The government pontificates on what it does not practise. It legislates but it does not listen”.

It suggests, although I could not possibly automatically agree, that:

“What the Government actually fears is 152 statutory LHWs, with genuine independence, with real clout and public buy-in, a separate identity, and powerful and committed membership”.

If that is the concern, where do we go from here? I am taken with the sage advice your Lordships received from the noble Earl, Lord Howe, when we debated the creation of LINks, the slightly ill-fated proposal by the previous Labour Government. The noble Earl, in his typically courteous but forceful way, said then—given these government amendments, you can simply substitute HealthWatch for LINks:

“We have come to a group of amendments most of which in their different ways relate to the same problem. I use the word ‘problem’ as the most neutral term I can readily think of for what many of us regard as a most serious and regrettable weakness in this part of the Bill; namely, the absence of even the slightest hint of a statutory identity for LINks. There is a complete lack of any descriptive reference to what a LINk might look like and practically no definition of a LINk”.

That was the noble Earl, Lord Howe, talking about the creation of LINks. Yet today he has brought forward amendments—admittedly he has delegated this to the noble Baroness, Lady Northover, who is acting as his mouthpiece on this occasion—that will do precisely what he complained that the previous Government did.

Of course he said much more than that. I will not burden the House by repeating all the remarks he made in October 2007, but if we substitute HealthWatch for LINks every time it appears, we will get the flavour. He went on to say:

“As the Bill stands there are no provisions for LINks to have any form of governance arrangements; it is left completely open as to how a LINk would be able to make decisions or authorise people to act on its behalf. This is a major issue because without some form of governance you cannot have accountability. If there are no people authorised to act on its behalf, a LINk cannot be accountable”.—[Official Report, 15/10/07; col. 567.]

He later said:

“The key issues around governance are really three: how decisions are to be made; how activities are to be undertaken; and, who is to do these things? Without those minimum requirements we would be left with a situation where someone who has joined a LINk, but who never attended any meetings or received any training or signed any code of conduct”,—[Official Report, 15/10/07; col. 568.]

could proceed in particular ways. So the lack of statutory identity was something that the noble Earl, Lord Howe, told this House was absolutely critical when we debated the creation of LINks. And he was absolutely right. I remember agreeing with him at the time and feeling that my Government had got it wrong. But this is the point. The Government have now brought forward amendments which undo all his fine words at that time and all his attempts to put this right, and that is because statutory status at the local level was what was going to give HealthWatch a cutting edge, an authority in terms of its relationships with other bodies.

The noble Earl also had a few words to say about the underlying argument that this should be delegated down. He said then, and we could say it to him now, that we were told that the Government did not want to be “prescriptive” and that it would be up to each LINk to set itself up in the way it wanted.

In June 2007, he quoted a telling Greek legend. Indeed, he may remember using this example:

“I think it was Proteus who was able to assume any shape or form that he liked. The reason why he did this was in order to avoid foretelling the future. For us debating this part of the Bill, it is almost impossible to foretell the future because neither the governance arrangements of LINks, nor their structures, nor their powers, nor even the precise scope of their activities, are set out here. In a real sense, as with Proteus, we do not know who or what we are dealing with”.

With these amendments before us today, the Government are substituting something else when we would have known what we were dealing with and where there were precise governance arrangements. But they are taking all that away and moving towards something that the noble Earl also, presciently, described in that debate, saying:

“As I understand it—the Minister may correct me—because LINks are not defined they are not classifiable as statutory bodies. We may know a LINk when we see it—although I am not completely sure about that—by virtue of the things that it does … The Bill refers to activities being ‘carried on’”.

I look at these amendments and, my goodness, Amendment 236C in the name of the noble Earl talks about,

“activities carried on for the benefits of the community in England”.

Incidentally, how a local organisation is supposed to act in the benefits of “the community in England” seems to be a very odd use of words. However, phrases such as “activities carried on” were precisely what he said then was the wrong way of going on.

The noble Earl went on to say in that June 2007 debate:

“In fact, in one way or another, there is quite a lot of carrying on in this part of the Bill. There may be a joke there somewhere but I shall refrain from trying to find it. But that nebulous form of drafting is as far as we get. It will be incumbent on us in Committee”—

we do not have the benefit of being in Committee today—to sort out this unsatisfactory regime. He continued:

“The main problem with the Bill is that because LINks”—

and you could say the same about HealthWatch now—

“have no identity or definition, they can be seen neither as bodies whose independence is guaranteed, nor as bodies which have the power to hold local health and social care commissions to account”.—[Official Report, 20/6/07; cols. 252-3.]

Those were the wise words of the noble Earl, Lord Howe, then, but he is the same noble Earl who is bringing forward amendments that create the same precisely the structure that he said was totally inappropriate then.

Let us look at what the Government are doing and I will be brief. Amendment 231B removes the statutory status. Amendment 231C removes all structure, form and governance from the Bill. Amendment 234A talks about “one set of arrangements”. It implies not just a single arrangement in any local authority area, but a set of arrangements, so it would not necessarily be one contractual arrangement: it would be a set of contractual arrangements. The word “arrangement” is in the plural.

Amendment 235C is the great catchall that tells us it is all going to be all right and that all these bodies are going to be the same in that there will be a licence to use a trademark. I am enormously reassured by that. Amendment 235D provides for subcontractors for the different functions. So what we are envisaging is that a local authority will divide up the functions of HealthWatch organisations and contract each of them to a separate organisation. Does that really make sense? Is that the strong patient voice that we were promised at local level?

In Amendments 238ZM and 238ZN there are specific references to contractors. This is essentially moving from a position where there will be a clear number of local statutory bodies delivering patient representation on behalf of their communities, with members from those communities running those organisations, because that is what the governance arrangements were before. This is essentially privatising that process, albeit by so-called social enterprises. This is privatising consumer representation.

How can contractors be representative? Yes, there is an amendment that says that these contractors will be broadly representative of the local community, but how can an enterprise itself be representative of the local community? I find this concept difficult to understand. Because we are not in Committee, we do not have the opportunity to have it explained to us fully and a chance to probe the Government.

The amendments that we talked about a few minutes ago envisaged that local healthwatch would be able to have local representation on the board of HealthWatch England. How will we have representatives from local healthwatch organisations—the arrangements that will be subcontracted for different functions to social enterprises— at the national level for HealthWatch England? Is this going to be board members of a social enterprise, charged with the effective running of that enterprise not the representation of the community? Will it be the staff? That comes back to the point about lay leadership that the noble Baroness, Lady Jolly, raised earlier.

Last night, I got an e-mail from an existing LINk member, with whom I have never previously communicated, saying:

“I’m much involved with my local LINk, which it can be argued, has already been ‘taken over’ by its Host in advance of the Privatisation of the Public’s voice when HealthWatch comes about. Lay ‘Volunteers’ have been demoted from being Members to Participants”—

there is the lay leadership of the noble Baroness, Lady Jolly—

“and our Management Committee has been redesignated as an ‘Advisory Group’”—

again, lay leadership—

“with few if any powers over anything. Expulsions have been initiated against those who don’t toe the new autocratic line—and the local authority just turns a blind eye despite appeals to the Council Leader, CEO and Portfolio holder. What hopes for a voice for the public/patient when Local Healthwatch is in place?”.

I believe that the Minister received a letter from another member of a local LINk who talks about his dedicated service. He lists at some length all the different bodies that he has sat on representing the public, then says that,

“My most precious resource—the time I have given—has, at a stroke, been set to nought”.

There is no local lay leadership in these arrangements. That is why these amendments are so sad.

We have to ask why the Government are doing this. Is it because some unit in the Cabinet Office has suddenly discovered this bit of the Health and Social Care Bill and said, “Oh, they have missed something out about the opportunity to introduce competition so let us put it in this bit of the Bill”? Or perhaps it is because Government Ministers have suddenly realised that the Bill is rather unpopular. There are some difficulties with it, the public’s perceptions of it are increasingly negative, so having proper patient representation would now be extremely dangerous.

[Lord Trefgarne]

My Lords, the noble Lord has been going on for a considerable period in connection with the government amendment. He now speaks about the Bill in general. That is really a Second Reading issue. This is Report. Could he indicate how much longer he intends to be?

[Lord Harris of Haringey]

Actually, I had finished my last sentence when the noble Lord stood up. I raised that because the question arises as to why the Government have introduced these amendments. Given the attitude to the whole Bill, one has to question their motivations. I hope that when the noble Baroness eventually—I assume—gives us her usual, extremely full exposition, she will explain precisely the motivation for this change, so as to indicate that the fears being expressed are totally misplaced.