Health: Stroke Survivors

Baroness Barker Excerpts

Thursday 28th June 2018 Grand Committee

[Baroness Barker (LD)]

My Lords, I say to the noble Lord, Lord Lingfield, that it is an absolute joy to take part in this debate with him this afternoon.

Following on from the noble Baroness’s comments, I can recount that about 20 years ago a lady called Mary Anne MacLeod Trump woke up in a hospital ward in New York following a stroke. Most of her nurses thought that she was speaking gibberish, but she was very lucky because one of her nurses was Irish and knew that she was speaking Gaelic. In fact, Mrs Trump had been born on the island of Lewis in Scotland and, unlike her son, did not routinely speak gibberish—it was just the effects of a stroke—and she recovered. The noble Baroness is quite right.

The noble Lord, Lord Lingfield, set out for us the state of stroke care in England and Wales today. However, one point is so obvious that he did not make it: we have a national health service and, consequently, we are in a uniquely good place to gather information about the detection, diagnosis and treatment of stroke and about people’s recovery from it. That is something that we often overlook but it is very important. Just in the last 10 years or so, the work that the noble Lord, Lord Darzi, has done in London in reorganising stroke services has had a measurable effect. Our National Health Service is able to measure, at scale, the effectiveness of new thrombolytic or clot-busting drugs as they come in. That is why we have a real forward steal on the rest of the world in this highly complex area.

In another place back in December, MPs talked a lot about the development of mechanical thrombectomy —I am pleased that I got that out; it is not the easiest word to say. It is a marvellous step forward in the acute treatment of stroke. The ability of surgeons to remove clots and stop further neurological damage makes an immense difference to patients and their recovery.

We are, unfortunately, able to have a 24 hours a day, seven days a week, service in only very few places. Like the noble Lord, I am very lucky to be living up the road from St George’s Hospital: we are okay. Other places are not. The ambition, surely, ought to be to make that service available at specialist neurological centres around the whole country, and easily accessible to the majority of the population as soon as possible.

A particular problem with thrombectomy is that it requires the input of several different medical disciplines, specifically surgeons and others who are not normally part of a stroke response unit. Far be it from me to accuse the NHS of territorialism, but getting surgeons to change their ways is not the easiest thing to do. I ask the Minister, therefore: will thrombectomy services be commissioned via specialist commissioning, and if the provision of the service requires redesign and redefinition—not just of the services but of the medical roles in the team—how that will happen? Does he believe, as I do, that STPs may well face a real battle to get so many people from different disciplines to change the way they work?

My understanding is that the department has not yet decided to refresh the stroke strategy; it is relying on the 2013 cardiovascular disease outcome strategy. Does the Minister believe that that is an adequate way for the department to require the NHS to look at some pretty significant changes among staff?

I also refer the Minister to the experience of some MPs who looked at provision in their local areas. They mentioned the tension between university hospitals and district general hospitals. It requires the might not just of NHS England but the department to look at this problem.

My next point is on research. We have one centre of excellence in research—certainly in thrombectomy—which I think is the University of East Anglia. It is one of several across Europe. I am a Liberal Democrat spokesperson and am therefore bound to ask what the Government are doing to make sure that, post Brexit, research and research collaboration continue? I know that the Royal Society is looking across the piece at the impact of Brexit on research, taking an unbiased and pragmatic view of it. I simply ask the Minister to tell us how the Government will keep an eye on that.

My third observation is that in 2016 Stanford University reported remarkable results from a very small-scale study—about 16 patients—on the use of stem cell therapies. These are often considered to be wonder solutions to quite an array of neurological conditions. I would not go that far: there is a lot to be done by neuroscientists before they realise the potential of stem cell therapy in all sorts of conditions, but principally such neurological diseases as Parkinson’s and possibly Alzheimer’s. If and when those trials are replicated on a larger scale and get to a further stage, where they might lead to some form of therapy, will the NHS build on its track record of work in stroke treatment by taking advantage of such developments?

On the question of rehabilitation, much of what the noble Lord, Lord Lingfield, said pointed to a system in which we have highly skilled staff but not enough of them. We have highly skilled therapists, physiotherapists and nurses—I have been in awe of the ones I have had to deal with—but we need to enable them to impart information first to care workers and secondly to family members, who are there in that golden six-week gap in which recovery can be advanced if people know what to do. To what extent are we asking our NHS acute staff, as part of their duty of care, to pass on information to carers to make sure that they can be there to assist and improvise with things which work?

What do the Government intend to do about the collection of data on post-acute service provision as part of the overall stroke strategy? The bulk of stroke recovery happens in the weeks and months afterwards.

The difference between acute provision and community provision would be that acute provision will help you deal with a physical deficiency, and a community service will help you deal with a lack of confidence. For most people, life after a stroke means living with a lifelong lack of confidence, but that can be aided, helped and treated.

We have done a lot in this country of which we should be proud, but with clever thinking we could do a lot more.

Abortion

Baroness Barker Excerpts

Wednesday 6th June 2018 Lords Chamber

Asked by

[Baroness Barker]

To ask Her Majesty’s Government, in the light of the result of the referendum to repeal the eighth amendment of the constitution of the Republic of Ireland, what assessment they have made of its impact on the ongoing criminalisation of women seeking access to abortions across the United Kingdom.

[Baroness Barker (LD)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as the chair of the All- Party Parliamentary Group on Sexual and Reproductive Health.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, under existing arrangements women across the United Kingdom have access to high-quality, safe abortion services. Parliament decided the circumstances under which abortion can be legally undertaken. It is accepted parliamentary practice that proposals to change the law on abortion come from Back-Bench Members and that decisions are made on the basis of free votes.

[Baroness Barker]

I thank the Minister for that Answer. Do the Government not think it is wrong that women in Northern Ireland can be coerced to continue with a pregnancy under legislation passed in 1861 by MPs, all of whom were men elected solely by men? Does he not agree that to overturn Sections 58 and 59 of the Offences against the Person Act would enable the men and women of Wales, Northern Ireland and England to determine under what circumstances women should be able to access safe, legal abortion?

[Lord O'Shaughnessy]

It has been the position of successive Governments that abortion policy and law is a devolved matter for Northern Ireland, to be decided by elected politicians in Northern Ireland on behalf of the people of Northern Ireland. That is our position: they should be the group that makes the decision.

Abortion: Misoprostol

Baroness Barker Excerpts

Tuesday 20th March 2018 Lords Chamber

[Lord O'Shaughnessy]

This is obviously a concern. There has been an increase in women buying online the drugs necessary for medical abortions, and that is something on which we are attempting to crack down. It is worth pointing out that 90% of abortions are NHS funded and therefore provided for in that way. The noble Baroness was talking about medical abortions at a late stage; it is worth pointing out that, actually, there has been an increase in the number or percentage of abortions that are happening at an early stage, which is obviously in the interests of women’s health.

[Baroness Barker (LD)]

The noble Baroness, Lady Eaton, mixed up two completely different things. She mixed up early medical abortions and late abortions. Can the Minister confirm that a 2011 court case brought by BPAS established that the Secretary of State has the power to allow early medical abortions to happen at home? If he agrees, and if the evidence from the Scottish trial is convincing and underpinned by the decision of the Scottish courts, will the Secretary of State then undertake to look at the development of a facility for legal abortion which may well be to the benefit of thousands of women in this country, particularly those who live in rural areas?

[Lord O'Shaughnessy]

I am aware of the opinion in that judicial review. It is worth pointing out that there is still uncertainty about the legal position. This is why we will watch the developments in Scotland carefully and proceed cautiously. It would be wrong of me to prejudge either the opinions that come from the court or indeed any evidence if this scheme does get up and running in Scotland.

NHS: Charitable Donations

Baroness Barker Excerpts

Thursday 22nd February 2018 Lords Chamber

[Lord O'Shaughnessy]

My noble friend makes an important point. Gift aid is a wonderful scheme that obviously has driven huge contributions. She is quite right that public sector bodies cannot provide the gift aid opportunity, which is why in the health sector those charities attached to hospitals exist. She makes an excellent suggestion for what councils should do and I shall take it up with my colleagues in that department.

[Baroness Barker (LD)]

Can the Minister tell the House whether integrated care trusts can have associated charities so that people can make donations not just to healthcare but to social care in their area?

[Lord O'Shaughnessy]

The noble Baroness asks a very interesting question. Clearly these are emerging organisations and most of the charities are attached to hospital trusts—although not exclusively: some are attached to primary care. None of these are yet quite in being. Once they are in being, this will be an excellent suggestion that we should take forward.

NHS and Social Care: Winter Service Delivery

Baroness Barker Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Barker (LD)]

My Lords, I thank the noble Baroness, Lady Wheeler, for the opportunity, as the noble Baroness, Lady Pitkeathley, just said, to return again to this subject. I will not make a long speech as I would like to leave as much time as possible for the debate that will follow. On behalf of my colleagues on these Benches, I wish the noble Baroness, Lady Jowell, all the very best and ask her colleagues to convey that to her.

The noble Baroness, Lady Pitkeathley, is right: we have been back to this ground so many times. In preparing for this debate, I thought back to many of the debates that we have had in the past. The origins of the problem we are looking at go back to the National Health Service and Community Care Act 1990. In that Act, for the very first time, welcome things happened: we began to break down procedures within the NHS and to cost and quantify them. But the problem was that we made them into individual units of activity, and to this day, within the NHS, the systems that join up those individual units are failing. They fail completely when they have to be matched up with the social care system, which is completely different.

Those problems were identified and partially addressed in 2003 with the Community Care (Delayed Discharges etc.) Act, when the then Minister, the noble Lord, Lord Hunt of Kings Heath, was sitting there trying to answer questions from very talented opposition spokespeople such as me. We asked him a question that he never could answer, which was why the then Government thought that the answer to the problems in the NHS was to fine social services departments. I never understood that. We still have, within the whole system of discharge, a system of penalties.

[Lord Hunt of Kings Heath (Lab)]

Perhaps I can answer the noble Baroness. Surely the point is that both local government and the NHS were being properly funded at that point. Therefore it was entirely appropriate to have a system to encourage local authorities to do the right thing.

[Baroness Barker]

The issue that I think the Government were trying to solve was one for which we have never had any evidence: that of local authorities trying to game the system. It is correct that the overall amount of funding has gone down, but we have not had evidence of people gaming the system.

We have never had a system, or even part of a system, that incentivises GPs and those in charge of social care to prepare for winter pressures, invest in programmes that will see older people through the increased incidence of illness that we know happens in winter, and avoid unnecessary admissions to A&E. What has changed in that time is that we now have better data and better information systems, but in many ways we are still failing to take all that and improve those systems. At the moment we still have ambulance services being rated on completely different systems across the country so we cannot generate data.

The Government have done some things that are very welcome. Everyone agrees that the primary care streaming system, into which they put £100 million, is a worthwhile initiative. Unfortunately, the initial evidence is that it is failing simply because it takes people from another part of the system—GPs—and locates them in hospital. What are the Government going to do to properly monitor that system in its entirety as part of an overall approach to winter pressures, to see whether it is worth more investment or whether it simply takes resources from other parts of the system?

On the question of beds, we have a national system of monitoring general and acute beds and ways of measuring the overall occupancy rate. We do not have a method of assessing the number of beds in relation to need. For example, we can open up a load more beds, as the NHS always does at times of crisis, but if there are no more staff to look after the people in those beds then we are not really addressing the need. We need to refine the measurement of this so that we have a metric along the lines of “nurses per bed per day”. That is the point at which things become really bad. I remember talking to a nurse about a patient—actually my mother—and being told that she was far too good to be in hospital and would be going home. She died two days later, which was not a surprise to any of us. I say that because it is not an uncommon experience for patients.

We have been through this time and again. The one thing that we have failed to do is incentivise GPs to work with community organisations from the summer onwards to predict the people in their area who are going to be most at risk and to put in place very low-level, simple and low-cost packages of care for them that can be there very quickly when they are discharged. The biggest cause of delayed discharge is not the absence of social care but the absence of community nurses and NHS staff available to work in the community to ensure that we do not send people home only to see them return unnecessarily into acute care.

Social Care: Sleep-in Payments

Baroness Barker Excerpts

Thursday 7th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I absolutely recognise the picture that my noble friend paints. We know the impact of the decision on backdated pay on those providers of social care of all kinds—charities, families and others. We are looking carefully at this, and there is a market analysis going on at the moment to find out the number of affected providers, the number of affected staff and the overall cost implications. Discussions are taking place with the European Commission to make sure that whatever route we take, we know it will be legally possible.

[Baroness Barker (LD)]

My Lords, these providers have been hit this year with a bill of £400 million. HMRC has given a one-month deferment of its decision, which is not enough time for them either to raise the money or to make alternative arrangements. Does the Minister agree that this can only be solved satisfactorily, without detriment to people with learning disabilities and people who are cared for, if there is a rescheduling of the liabilities? Are the Government looking, with HMRC, at drawing up a longer deferment schedule to allow them to raise the money?

[Lord O'Shaughnessy]

Again, I would point the noble Baroness in the direction of the social care compliance scheme that has been set up, which allows precisely that deferral of payments. It allows for a period of up to 15 months for assessments to take place while providers work with HMRC to provide the payment. I should also point out that although HMRC would usually levy fines in the case of underpayment of taxes after 28 days, those fines have been waived in these cases, as one would expect.

Older Persons: Care and Human Rights

Baroness Barker Excerpts

Tuesday 11th July 2017 Lords Chamber

[Lord O'Shaughnessy]

Rules affecting this House will, of course, be decided by its Members, who are probably the least likely group in the entire country to be ageist. The noble Lord is quite right to highlight this incredibly serious point. Any form of negative stereotyping or discrimination is, of course, wrong. I mentioned a couple of things that the Government are already doing and a lot is going on to counter any kind of discrimination. This Government have got more older workers into employment and are tackling the discrimination in the workplace that, unfortunately, still takes place.

[Baroness Barker (LD)]

My Lords, given the salutary experience of the general election, does the Minister now agree that the previous Conservative Government were wrong to kick the Dilnot commission recommendations into touch and that now would be the time to get that report back off the shelf, dust it down and hold proper discussions about the funding of long-term care?

[Lord O'Shaughnessy]

The noble Baroness is quite right that this is a nut we have to crack. The Government are going to begin consulting widely on proposals at the end of the year and this consultation will be on specific proposals rather than being open ended. As we have discussed in this House before, it is important that we do that in a spirit of consensus, because I do believe that there is a way forward which all parties can support.