Homecare Medicines Services (Public Services Committee Report)

Lord Willis of Knaresborough Excerpts

Thursday 2nd May 2024 Lords Chamber

[Lord Willis of Knaresborough (LD)]

My Lords, I begin by thanking again the noble Baroness, Lady Morris of Yardley, for her excellent chairmanship of a challenging inquiry. I echo her thanks to the committee clerks and staff for their inspirational work in assembling pertinent witnesses and materials for the committee.

The fact that the Government have responded positively gives hope that we will see not only significant changes to the current organisation but an opportunity to build a home medicine service that will make a profound difference to millions of future patients. I must confess, having listened to the noble Lord, Lord Blencathra, for 27 years, that when he sought the support of the committee for the inquiry, I was somewhat sceptical that this was an area of significant concern. I apologise. Not only was he right in exposing a major challenge to the NHS but, midway through the inquiry, I became a recipient of homecare medicine services, when diagnosed with pulmonary fibrosis—a serious, chronic, life-changing disease. What is more, I discovered, via the Cystic Fibrosis Trust, that 87% of its members in receipt of homecare medicines had experienced problems with home delivery. I understood then the concerns of the noble Lord, Lord Blencathra, and of the leading charities whose members are involved in the service.

I wanted to know a little bit about the service. It began in 1995, and I suspect that the noble Lord, Lord Carter, might even have been around at that time in the Government. I came across a most interesting publication by the Department of Health, which produced in 2011 a detailed review of the service entitled Towards a Vision for the Future. It is worth reading again. I am sure the Minister will have read that review, and he will be embarrassed by its conclusions, because it made exactly the same conclusions about the state of the service in 2011 as our report has done now. Thirteen years later, despite a 300% increase in patients and costs, nothing had changed or improved. I recognise that both the Minister, in discussion, and the Government, in response to the report, have accepted several of our key recommendations, but so much remains to be dealt with.

Can noble Lords imagine any business with half a million customers not knowing how much money is being spent or where it is being spent, particularly when sums from £2.9 billion to £4.1 billion are involved? Yet that remains the case. An initial response was that the service cost £3.2 billion, and then, according to the National Clinical Homecare Association, £4.1 billion, which was then reduced to £2.9 billion. The Government then said £3 billion in their response. The confusion comes because there is no accurate way to measure the cost of delivery, which prompted the committee to seek an in-depth explanation, only to be told, as Members have clearly stated, “commercial sensitivity”. In actual fact, the real reason is that there are no clear requirements to meet nationally agreed criteria for service delivery and component costs. Therefore, the critical breakdown does not exist.

The Government have accepted the need for national key performance indicators, but the idea that the National Clinical Homecare Association and the homecare providers should provide all the criteria for identifying costs is unacceptable. Could the Minister say whether the statement coming in the summer will include the National Audit Office to certify expenditure? Given that 80% of expenditure is on drugs and medicine, will the Royal Pharmaceutical Society be the lead adviser on the core national priorities to the new home medicine service leader? Speaking of the leader, could the Minister explain why, given the overwhelming role of the pharmaceutical services, the chief pharmacist was not considered as the key person to lead this service? If not them, who will it be? We would like to know.

One of our key recommendations, which was supported by the Government, is an end to the antiquated method of handwritten and fax-delivered prescriptions between consultants and providers. However, it was disappointing to read that the data systems, which are absolutely crucial to the future of the service and which are so appallingly absent at present—an issue fully accepted by the Government—will be provided by a sub-committee of the National Homecare Medicines Committee. That is not acceptable. We are in this mess because that committee, which is in league with commercial providers, failed to provide the data required to build the service in the past.

The absence of core national data seriously affects patients, who all too often have to cope with missed deliveries of drugs, sometimes forcing them back into hospital and perhaps even causing unfortunate premature deaths. We asked the NHS for statistics to see how serious this was. What was the answer? “Sorry, they’re not available”. The same answer came from the Care Quality Commission. I will not repeat what the noble Lord just said, but I plead with the Government not to get this wrong. Data is absolutely essential. What is more, if homecare is to be expanded substantially to reduce burdens in the NHS on primary and secondary care, then getting leadership, data and finance right is crucial.

This leads me to regulation, which other Members have spoken about. I know, having worked for some 10 years as a consultant to the NMC and the RCN, and having chaired the York and Humber applied research collaboration for five years, that regulation in the NHS is a major challenge, and not one that can be easily sorted out. However, we must be given a structure that integrates its work far more effectively. I totally agree that there should be a single consultant and that it should be a powerful voice. The idea that that will happen soon is, quite frankly, not realistic.

An immediate solution would be to create a lead regulator with the authority to insist on requirements from other regulators without having to seek the approval of the Secretary of State. If the CQC is to be given that task—and as the protector of patients, it should be—it must be empowered and encouraged to conduct in-depth reviews. It told us it could not do in-depth reviews unless the Secretary of State told it to do them.

That leads me finally to the patients themselves. The 2011 report concluded that,

“moving forward, patients and patient representatives should have a much greater role in design, operation and monitoring of homecare … services … Patients are at the heart of homecare medicine and should be listened to”.

Crucially, our report sought an assurance from the Government that patients and key organisations involved would at least be asked for their advice and be involved with any future policy changes, because nowhere in the Government’s response or, quite frankly, in the evidence from officials do patients take a prominent role—which is exactly the same as in the 2011 survey.

In her letter to the Minister, the chair made a special plea for this anomaly to be changed. I admire and appreciate the fabulous service that the leading charities give to patients and their families. They deserve our utmost thanks, but the Government must do more. Now is the time to put patients at the heart, not the periphery, of future discussions. I sincerely hope that, when the Minister produces what I trust will be a ground-breaking response before the Summer Recess, we will all be able to cheer from the rooftops. I live in hope.

NHS: Pay

Lord Willis of Knaresborough Excerpts

Tuesday 9th March 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, I reject the rhetoric of the noble Lord. We absolutely do support nurses, which is why we are focused on recruitment, training, culture and opportunities. It is not right to think that one pay rise represents the entire and sum contribution to the welfare of nurses. That is the response we get from nurses themselves, what the public understand, and what the Government’s guidelines are about.

[Lord Willis of Knaresborough (LD) [V]]

My Lords, could you imagine any employer, other than those of the sweatshops of the Far East, seeing their workers perform heroics to save the business and, in the process, the lives of millions of their clients, only to be rewarded by having their wages actually cut? Does the Minister agree with the Health Minister Nadine Dorries, who expressed surprise at the generosity of the Government’s offer, or with the view that a good employer would first offer a substantial bonus to its staff before taking time to negotiate a fair and sensible pay award? If we can pay a bonus to local publicans for sourcing easily obtainable files, surely a bonus to those who have saved our lives should be a no-brainer for this Government.

[Lord Bethell (Con)]

My Lords, I agree with the noble Lord on the point about heroics—we appreciate those—but I do not agree that this represents a pay cut. On the broad thrust of the noble Lord’s point, I gently remind him that millions of people are out of work off the back of this pandemic. Lots of people have had an extremely tough time and face a period of unemployment. Nurses are well paid for the job, which is a secure job, and they have other benefits. There are many people in this country who look upon professional jobs in the NHS with some envy; we should not forget that some public sector jobs are, in fact, extremely well-paid.

NHS: Staff Numbers after Covid-19

Lord Willis of Knaresborough Excerpts

Thursday 4th March 2021 Grand Committee

[Lord Willis of Knaresborough (LD) [V]]

My Lords, I will make a very brief reference to a group of NHS staff who have gone largely unnoticed during this pandemic and the debate but have been trailblazers and lifesavers in equal measure. I refer to the newest recruits in the registered healthcare workforce, nursing associates. The nursing associate register commenced two years ago, and today there are 4,036 registrants with a further 7,000 who commenced training at the height of the pandemic. Many plan to train on as registered nurses. These remarkable people, most of whom were dedicated care assistants, have risen to the greatest nursing challenge ever seen, saving patients and, indeed, the NHS. What steps are the Government taking to recognise the contribution of nursing associates and to redouble the investment in the recruitment and training of future cohorts?

[The Deputy Chairman of Committees (Baroness Watkins of Tavistock) (CB)]

I will move to the next speaker, the noble Baroness, Lady Altmann. We hope by the end of her speech to have resolved Baroness Greengross’s communication issue.

Reciprocal and Cross-Border Healthcare (Amendment etc.) (EU Exit) Regulations 2020

Lord Willis of Knaresborough Excerpts

Monday 16th November 2020 Lords Chamber

[Lord Willis of Knaresborough (LD) [V]]

My Lords, I thank the noble Baroness, Lady Ludford, and the noble Lords, Lord Greaves and Lord Bourne, for their very useful and sensible comments at the beginning of this debate. I also thank the Minister for his, as ever, very courteous and thorough explanation of the SI. It would have been wonderful if this evening he had had a road to Damascus moment, realising that, whatever new arrangements are being put in place, and no matter how complicated and effective they are, they are likely to be inferior, more costly and more inconvenient than what already exists. However, I suspect that that moment has gone. I therefore wish to seek guidance and reassurance from him on a small number of points.

The first is on cross-border healthcare. This is perhaps at its best and most innovative on the island of Ireland, where co-operation on everything from research to critical care, staff training and development has helped transform services for all residents, north and south of the border. Indeed, seeing one of my relatives in a very remote village in Donegal being offered one of the most up-to-date cancer treatments at the Altnagelvin Hospital in Derry, rather than having to travel to Dublin, was a very personal example. Another was the opportunity to address an all-Ireland nursing conference alongside Health Ministers from both sides of the border, where the discussion was on how to improve nursing services for all residents. It made me realise that cross-border healthcare was more than a political ideal; it is the bedrock of a more civilised society.

I was delighted when the Minister, in his opening remarks, mentioned that an agreement had been made with the Republic on cross-border healthcare. But are we getting exactly the same arrangements as we have now? Will they be translated into a legal document? If not, can he identify what will change for residents both in the United Kingdom and on the other side of the Irish border?

Secondly, I recognise that from 1 January UK and EU nationals who are working or studying in either the EU or the UK will be able to continue to be in receipt of the current reciprocal healthcare arrangements—I am delighted that that has been clarified again. However, most UK nationals, particularly in areas such as IT, are working as fixed-term contractors and not as permanent employees—they are not permanently in the country of their work. Will the Minister clarify whether any fixed-term contractor who currently works between the UK and the EU but is currently fulfilling a contract in the UK before returning to one in the EU will qualify for continuation of reciprocal cross-border healthcare arrangements, or will they have to be working in the EU on 1 January, as mentioned earlier?

Will EU au pairs who currently reside with UK families—their number has gone down from 90,000 to around 20,000 since the Brexit agreement—continue to receive free healthcare, should they, as is very likely, return home over the Christmas period? I realise that they will get it if they continue to stay after 1 January but, if they go home for Christmas for two or three weeks, will they then be denied that healthcare when they return to their families in the UK after Christmas?

Thirdly, I am incredibly worried about the cross-border flow of students. The noble Lord, Lord Greaves, mentioned the Erasmus programme, but it is not just that programme that has brought huge benefits to the UK, as well as to the EU over a great many years. Clearly, existing students will continue to enjoy reciprocal arrangements, provided that they continue in their course this year, but will universities—I use as an example Hull, which offers its German language undergraduates a year’s experience in Germany—as institutions have to fund health insurance? Will they pass on that cost to their students or will they be able to purchase exactly the same arrangements in some cross-border arrangement?

Finally—the noble Lord, Lord Bourne, referred to this briefly—will the Minister now, or in a note placed in the Library, say how successful the NHS has been in recovering health-related fees from non-UK residents over the past five years and what the administration costs have been as a proportion of overall recovered costs? I ask this because I have not seen anywhere assessments relating to the recovery of costs from the huge rise in claims that will be made by hospitals and other healthcare institutions when EU visitors, students and workers not currently operating in the UK do so after 1 January 2021. I am sure your Lordships would agree that it would be perverse if we had a system that costed the NHS in the UK far more than at present, simply because of the administration and bureaucracy surrounding those recharging facilities. As ever, I look forward to the noble Lord’s—as usual—courteous reply.

Covid-19 Update

Lord Willis of Knaresborough Excerpts

Thursday 12th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the capacity that we have in track and trace is growing dramatically; the number of tests we have taken is going up. It is true that testing demand does fluctuate. There was a moment when universities had a very large outbreak and there was a huge amount of demand from universities, and there may well be other reasons why testing demand goes up in the future. But I reassure the noble Lord that the capacity, speed and accuracy of testing in this country are making huge progress on a day-by-day basis, and I pay tribute to those involved in the project.

[Lord Willis of Knaresborough (LD) [V]]

My Lords, a key factor in controlling Covid-19, with or without a vaccine, is test, trace and isolation, and I fully support that. Yet the recent survey indicated that some 20% of those asked to isolate actually failed to do so, rendering the system far less effective than it should be. What is the reasoning behind the reluctance of the Government to move from PCR to lateral flow testing for the test and trace programme, following the extensive clinical evaluations by PHE and Oxford University, which found 99.6% accuracy, including on the key criterion for track and trace of detecting asymptomatic carriers? Surely, accurate 48-hour testing would enable virus-free contacts to return to normal activity quickly, rather than sitting at home for 14 days.

[Lord Bethell (Con)]

My Lords, the noble Lord is entirely right on two things, and wrong on another. He is entirely right that isolation is absolutely key—without isolation, there is no point in testing or tracing. It is true that not everyone who is asked to isolate does isolate, but we have a programme in place to try to encourage, inform and inspire people to isolate. He is entirely right that lateral flow tests offer huge advantages, in terms of the speed at which they can be used, their cost and their flexibility. But we have bought tens of millions, maybe even hundreds of millions, of these tests in recent weeks. We are deploying them in mass testing, and we have completely followed the advice and inspiration of the noble Lord in this matter in a massive way.

Covid-19: NHS Application

Lord Willis of Knaresborough Excerpts

Thursday 1st October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I cannot answer the noble Baroness’s question. There is a very good reason: the privacy arrangements of the app mean that we do not know who has downloaded it. This information is available only to those who have downloaded it. It is precisely because of those privacy arrangements that an enormous amount of trust is placed in the British people. However, I do not deny that it is frustrating that we do not have the kind of demographic insights that the noble Baroness quite reasonably asks for.

[Lord Willis of Knaresborough (LD)]

My Lords, I am delighted that this app has now been produced. Fifteen million adopters in a week is excellent news, and I genuinely congratulate the Minister on that. However, 34 countries are already using the ENX system with Bluetooth, and it is to be regretted that we are not ahead of them, but we are not. What conversations have the Government had with some of those countries to ensure that we do not repeat the mistakes that they have made on their journey? Given the importance of mass take-up—which is important before going on to talk about other things—have the Government considered discussing with Apple, Google and mobile phone suppliers such as Samsung the possibility of putting the app straight on to people’s phones at the point of sale, or point of update, with of course the option for the customer to remove it, should they wish to do so?

[Lord Bethell (Con)]

The noble Lord has made a very detailed and technical inquiry. We are studying the ENX system very closely. However, as I mentioned earlier, the secret source of the British app is the algorithm that takes the data from Bluetooth and the phone and analyses it to give the risk assessment. Our view is that that algorithm is absolutely critical. Without it, the ENX system fires off alerts to anyone who has been proximate to another Bluetooth phone that has registered a positive test, even if they have only driven past that phone on the motorway. Those are exactly the kinds of circumstances that the British public made it crystal clear to us they simply would not tolerate. Therefore, we have put an enormous investment into that algorithm. We have had an enormous amount of interest from other countries, and we are happy to share that learning with companies as we develop our intelligence on it.

Health Protection (Coronavirus, Restrictions on Gatherings) (North of England) Regulations 2020

Lord Willis of Knaresborough Excerpts

Friday 25th September 2020 Lords Chamber

[Lord Willis of Knaresborough (LD) [V]]

My Lords, I support the words of the noble Baroness, Lady Donaghy, particularly those about the Minister.

Does the Minister agree that, while Section 3(a)(ii) specifically excludes care homes, the Vivaldi 1 report made it clear that they are incredibly vulnerable to Covid-19 outbreaks as a result of staff entering the building? The risk increases particularly in areas with rising levels of infection such as West Yorkshire and East Lancashire, to which these new measures apply.

In July, SAGE recommended regular testing for staff and residents of care homes. On 3 July the Minister, Helen Whately, announced that from 6 July all staff would be tested weekly and all residents monthly, in addition to any action for an outbreak. Has any regulation ever been passed by this House to make this a legal requirement? If not, why not, and is this still government policy? Is it being monitored and, if so, by whom? Will the very welcome new testing priority system announced on Wednesday include measures to guarantee access to local testing facilities for care home staff and residents and a guaranteed 24-hour return of results, to make that priority system effective? If protecting the most vulnerable in our society is the Government’s priority, which I believe it is, surely guaranteeing the means to do so must be a priority too?

Covid-19 Update

Lord Willis of Knaresborough Excerpts

Monday 21st September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, I would be glad to talk about the weekly statistics with the noble Lord in detail, if he would like. The number of tests per day is frequently over 200,000. The number of people includes a huge amount of duplication, because some people have had more than one test. Those people are often in social care or hospitals. If a person is tested in March and goes on to be tested 20 more times, they are counted once in March and not again. That is why the number he is looking at is quite different from the daily “tested” figure.

[Lord Willis of Knaresborough (Lab) [V]]

My Lords, another statistic we seem to forget is that some 20,000 Covid-related deaths have occurred in care homes to date. Yet, as we face another massive surge, there is no guarantee that we have learned any lessons from them. I welcome the resources spent on PPE, and I hope the Minister will guarantee that no patients will be dumped into care homes as they were earlier in the year. Unless we can protect the 1.2 million social care workers, 465,000 of whom work in care homes, the same will happen again. Last Friday, as reported by the York Evening Press, a care home in York waited over seven days for 100 test results to be returned—seven days when people got more ill and faced the prospect of an early death. Unless the Minister can guarantee at the meeting tomorrow that all tests in care homes will be offered on a weekly basis and returned within 24 hours, we will be putting our whole care home sector in peril.

[Lord Bethell (Con)]

My Lords, the noble Lord, Lord Willis, does the care home sector, the NHS and those who work in them a massive disservice. There are hundreds of ways in which we have learned to deal with this disease better, such as how we use therapeutic drugs; how we store and use PPE; how we manage and protect our workforce; how we handle mental health and the entertainment of those who live in care; how we use modern technology, including television and diagnostic devices; how we transfer patients in and out of hospitals; and how we use testing. I could continue, but I think I have made my point.

Suicide

Lord Willis of Knaresborough Excerpts

Tuesday 8th September 2020 Lords Chamber

[Lord Bethell (Con)]

Yes, I am glad to provide that assurance.

[Lord Willis of Knaresborough (LD)]

My Lords, ministerial claims to have the lowest suicide rate for seven years, in the fourth report, do not accord with the latest ONS figures from 1 September this year. These show that, at 16.9 per 100,000, England has the highest suicide rate since 2000, with an increase each year since the new strategy began in 2017. Alarmingly, my own region of Yorkshire and Humber has consistently had the highest suicide rate anywhere in the United Kingdom for a decade. What steps are the Government taking to evaluate their existing strategy and produce consistent statistics? What proportion of the £25 million allocated to local suicide prevention plans has been spent in Yorkshire and Humber?

[Lord Bethell (Con)]

I remind the noble Lord that, in July 2018, the standard of proof used by coroners to determine whether a death was caused by suicide was lowered from criminal to civil. That has had a meaningful effect on the number of suicides recorded. I am afraid the numbers for Yorkshire and Humber are not available to me.

Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations 2020

Lord Willis of Knaresborough Excerpts

Thursday 3rd September 2020 Lords Chamber

[Lord Willis of Knaresborough (LD) [V]]

My Lords, does the Minister agree that it is essential that there is public buy-in for these and future regulations, and that that has not been the case? That buy-in can come only from a Government who gain credibility by having clear, unambiguous messaging and the courage at times to admit failure.

That being the case, why, when Public Health England was created by the Government and reports directly to the Secretary of State, has the Secretary of State not accepted responsibility for its failure? Why, given the consistent underperformance of his own track and trace system, has the person leading that failure now been given an even greater role in the Covid response programme? Is not a lack of government credibility the reason for the public increasingly ignoring these regulations, and not the police and local councils, which are totally frustrated because they do not have the means to enforce these confusing regulations?

The previous policy of whole-council lockdowns, often announced in the media before local officials are told, is now seen as disproportionate and unfair, but will the new regulations be any better? Where are the criteria by which local authorities need to judge their lockdown policies? What is the process for including or excluding individual businesses or leisure facilities within locked-down areas where no evidence of rising infections exist? How about dedicated local track-and-trace systems? They do not exist, but could accurately give evidence of an effective lockdown. People have to understand why they or their business are being targeted. They need criteria for action, rapid testing, swift and consistent feedback, and immediate support. Simply waving the threat of meaningless and unenforceable penalties will not do.

When will the long-awaited app—so effective in Germany, with over 15 million people using it—be available here? No doubt its failure to appear will be blamed on some hapless official to save the face of Government Ministers during this disaster.