Health and Social Care: Malnutrition

Baroness Blackwood of North Oxford Excerpts

Tuesday 5th November 2019 Lords Chamber

[Lord Aberdare]

To ask Her Majesty’s Government what assessment they have made of the prevalence and impact of malnutrition among people in health and social care settings; and what steps they are taking to prevent it.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, malnutrition is a common clinical health problem affecting all ages and all health and care settings. The Government are committed to better screening for malnutrition and improved food standards in hospitals. Hospitals and care homes must screen people for malnutrition on admission and meet high standards of nutrition care. We have announced a root and branch review of hospital food to ensure that patients receive the right nutrition and hydration.

[Lord Aberdare (CB)]

My Lords, I thank the noble Baroness for that response. Even here in the UK, malnutrition is shockingly underrecognised and undertreated. Some 3 million people live with malnutrition, including one in 10 older people. One in six patients admitted to hospital, and about 40% of those entering care homes, are malnourished or at risk. Disease-related malnutrition is estimated to cost over £20 billion a year. What steps will the Government take to improve identification and treatment of malnutrition, not just by promoting screening in care homes and GP surgeries, which I very much welcome, but also by improving the training of GPs and other health professionals on this issue?

[Baroness Blackwood of North Oxford]

The noble Lord is absolutely right that this is an issue which is on the rise. The causes are complex and can be clinical, social or economic, but we are committed to improving this situation. That is why we have brought in the hospital food review, to ensure the safety of the food available for patients, visitors and staff, but also to look at how we can provide the highest level of care possible for patients, which includes the quality and nutritional value of the food served to them. The review will also look at the best possible methods of screening and training staff.

[Baroness Thornton (Lab)]

My Lords, in a rich country such as ours, it is shameful that anyone does not have enough to eat. Yet over £3 billion is spent on managing malnutrition and its effects. NHS trusts already have a duty to ensure that they meet patients’ nutritional and hydration needs. However, the Campaign for Better Hospital Food has said that, despite the introduction of food standards, at least half of all hospitals are not complying and the current Government are failing to encourage progress. Labour has committed to mandatory nutritional standards being regulated. I invite the Minister to join us in supporting this sensible policy.

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right that it is critical that people have good and healthy food in hospitals. That is exactly why there are very strict food standards in hospitals and health and care settings which are already enforced by the CQC. It is also why we appointed the former head of the Hospital Caterers Association, Philip Shelley, to look at what more could be done to improve the situation with the hospital foods review, to look at the safety of food available to patients, visitors and staff, improve nutrition and make available healthier choices, and ensure that we can improve the expertise of caterers, suppliers, staff and those who work in hospitals, to ensure that we raise standards and reduce the incidence of malnutrition across the system.

[Baroness Janke (LD)]

My Lords, in the light of the very real pressures on care services in communities, could the Minister say what steps the Government are taking to ensure that the elderly and vulnerable living in their own homes are not suffering from malnutrition due to poverty and neglect?

[Baroness Blackwood of North Oxford]

The noble Baroness is right to raise the important issue of malnutrition in the community. We have put together a malnutrition task force, which has published a series of guides of expert advice on prevention and early identification of malnutrition in later life. These guides draw together principles of good practice and offer a framework for making sure that the situation which the noble Baroness has identified does not arise. We have also published a guide for care homes on integrating good nutrition into daily practice. This includes screening, initiating nutritional care plans and considering fortifying food and using oral nutritional supplements when appropriate.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister realise that there is a huge problem of pressure ulcers due to bad nutrition? It costs the country millions, if not billions, of pounds. Could she do something about this? It is very difficult to encourage people who do not want to eat to do so.

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right to identify some of the very significant health consequences of malnutrition. This is one of the reasons why it has been taken on board as a top priority by not only NHS England but the care system from top to bottom. The start is to have the right screening and to gather the right data so that we can identify where this needs to be improved. She is right that it needs to be integrated into nursing practice so that we not only prevent malnutrition in the first place but, where it does occur, provide the right support to put it right and the right care where there are health consequences for individuals due to clinical, social or economic problems.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I must confess to the House that I am president of the Hospital Caterers Association. Would the noble Baroness agree that there is no shortage of good advice on dealing with malnutrition and good food in the health service; nor is there a shortage of good catering professionals? The issue is trust boards that will not invest sufficiently in this area. Will she start to instruct the NHS to get serious about this if we are going to deal with this big problem?

[Baroness Blackwood of North Oxford]

The noble Lord is quite right that this is about leadership not only at board level but from the very top. It has been instructive that not only the Secretary of State but the chief executive of NHS England, Simon Stevens, have made it one of their priorities to ensure that the quality of food and food safety standards throughout the hospital and care systems should be improved. This is one of the key ways that we will drive out malnutrition from our health and care sector.

[Baroness Browning (Con)]

Could my noble friend please take a look at the frail elderly living alone at home who are not necessarily regularly seen by doctors because they do not present with symptoms? Very often, the older people get the more difficult it is, as the body starts to age, for them to absorb nutrients, even when they are eating a mixed diet. Could she take a look at that particular group, in the way that we look at people who have regular check-ups with a GP for heart problems and diabetes, to ensure that they are not just deteriorating? It is not until they deteriorate to the point where they become ill and symptomatic that people start to notice that there is a problem.

[Baroness Blackwood of North Oxford]

My noble friend is absolutely right. Evidence is on the rise that malnutrition is worse among older age groups and is both a cause and consequence of ill health. We must make sure that we are identifying and intervening as early as possible to make sure we are not leading to some of the challenges raised by the noble Baroness. That is why the malnutrition universal screening tool has been developed by the Malnutrition Advisory Group to assist those in nursing and in general practice to intervene as early as possible to prevent some of the challenges that she has identified.

Health: Tick-borne Encephalitis

Baroness Blackwood of North Oxford Excerpts

Tuesday 5th November 2019 Lords Chamber

[Lord Greaves]

To ask Her Majesty’s Government what assessment they have made of the appearance in England of a tick-borne encephalitis virus, and what plans they have to include advice about such a virus alongside that given on the tick-borne Borreliosis bacteria and associated Lyme disease.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the risk from tick-borne encephalitis virus is assessed as very low for the general public and low for those visiting, living and working in areas where infected ticks have been found. Lyme disease is the most common tick-borne infection in the United Kingdom. Tick awareness campaigns are planned for early 2020, ahead of the seasonal increase in tick activity in the UK, and will include information on tick-borne encephalitis and Lyme disease.

[Lord Greaves (LD)]

My Lords, the history of Lyme disease, a bacterial infection called Borreliosis, has been riddled over many years with mistakes of understanding, recognition, testing, diagnosis and treatment. Tick-borne encephalitis—a viral infection—has now reached the UK for the first time, having been steadily spreading westwards across Europe for several years. What are the Government doing to make sure that the mistakes that have been made—and are still being made—on Lyme disease are not made on TBE, and in particular that new instances of TBE are not mistaken for Lyme?

[Baroness Blackwood of North Oxford]

The noble Lord is right to raise this issue. We have been making sure that action is taken quickly. Tick bite avoidance is a key message in this area and is the same for TBEV as for Lyme disease. PHE has worked with local authorities and key stakeholders in the relevant areas, informing them about TBE and the tick toolkit documents and guidance, so that they can remind the public, their staff and visitors to be tick aware. Specific awareness campaigns will come forward in spring 2020. The material for these will include information on Lyme disease and TBE. In addition, there will be research programmes on TBE, to ensure that we in the UK are as aware as we can be about it. To be clear, there has been only one probable case of TBE infection diagnosed —a European visitor bitten by a tick in the UK. At the moment, this is a very low risk to anyone in the UK and a low risk to those in the areas.

[Lord Trees (CB)]

My Lords, I do not want to be alarmist but the discovery of tick-borne encephalitis virus in the UK is worrying. The tick vectors of this viral infection are widespread throughout the UK and are maintained on a variety of animal hosts, including wild deer, which are now extremely common in lowland as well as upland areas. The number of clinical cases in Europe has been steadily increasing and, while it is true that something like two-thirds of cases are non-clinical, as many as up to 10% of those affected may suffer severe neurological sequelae, especially children and—noble Lords may like to know—the elderly. I ask the noble Lord: will the Government reintroduce the mandatory tick treatment of pets imported into the UK under the pet travel scheme? Is the noble Lord satisfied that we are doing all we can in the UK, in terms of research and preventive actions with regard to biosecurity, to safeguard animal and human health in this era of climate change and globalisation?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for that question, although I generally identify as a noble Baroness. We are continuing surveillance studies for TBEV in ticks and wildlife, and we plan to monitor its prevalence, distribution, maintenance and spread in the UK to ensure oversight of the situation. We have based our understanding of the risk assessment on recent experience in the Netherlands, where TBEV was recently identified. The estimated risk there of Lyme disease from a tick bite is 1:50, while the estimated risk of TBEV from a tick bite is 1:500,000. As regards us doing enough work, we have a national contingency plan written to deal with vector-borne diseases and understanding the effect of climate change, which gives us a sense of the challenges that we face.

[Baroness McIntosh of Pickering (Con)]

My Lords, will my noble friend recognise the work of the national Encephalitis Society, which is based in Malton in North Yorkshire, of which I have the honour to be a vice-president? Will she update the House on what work has been undertaken to help doctors identify the difference between meningitis and encephalitis so that the swiftest possible treatment can be given? My husband was one of those who suffered encephalitis in his 20s; many are less fortunate and do not make the recovery that he made.

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right, and I am happy to recognise the organisation that she mentioned. In the first place, the tick toolkit and the work of PHE is in place to raise awareness, and work goes into providing advice to professionals so that early diagnosis is possible.

[Lord Winston (Lab)]

My Lords, one of the problems with Lyme disease is that the symptoms that it causes mimic a whole range of different viral infections, many of which are much more common. Does the Minister feel that the Government are doing enough to raise awareness of Lyme disease among general practitioners, and is she satisfied that the screening tests—I think that they cost around £60 a time—are sufficient?

[Baroness Blackwood of North Oxford]

The noble Lord is quite right, and he understands this a lot better than I do. NICE published guidelines for health professionals in 2018 in an effort to ensure prompt diagnosis of Lyme disease. Obviously if it is recognised promptly and treated with antibiotics, acute Lyme disease is usually resolved without further complications. I will take away the question about the cost of the test to consider whether that has been a barrier; we have no evidence about that at this time.

[Baroness Jolly (LD)]

My Lords, raising awareness is critical, and many are completely unaware of the risk when they go out for a walk. What actions will the Government take to ensure that organisations such as national parks, national forests and the National Trust have a part to play?

[Baroness Blackwood of North Oxford]

We will run tick awareness campaigns in the spring. Material for these campaigns will include information about Lyme disease and TBE. They will be run in all areas identified as at risk as part of the surveillance campaign.

[Baroness Masham of Ilton (CB)]

My Lords, how much research is the UK doing with other European countries, which may know much more about these conditions?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

As part of our surveillance work and the work of PHE, there is constant contact between the UK and other public health bodies across Europe to understand not only the risks but the most effective interventions. Two specific studies are looking at evidence of past TBEV infection in people and to understand the best interventions among the general population.

Mental Disorder: Autism and Learning Disabilities

Baroness Blackwood of North Oxford Excerpts

Tuesday 5th November 2019 Lords Chamber

[Lord Touhig (Lab)]

My Lords, I beg leave to ask a Question of which I have given private notice and declare an interest as president of the National Autistic Society.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we recognise the significance of this issue and its importance to stakeholders. The recent independent review of the Mental Health Act considered the definition of autism in the Act and recommended that the Government should keep it under review. We will respond to the review’s recommendations via the forthcoming White Paper.

[Lord Touhig]

My Lords, since 2015, there has been a 24% increase in the number of autistic people sectioned, even if they have no mental illness, because the Mental Health Act defines autism as a mental disorder. Autism is not a mental disorder. Last weekend, the Health Secretary promised to detach autism and learning difficulties from mental health legislation. That is most welcome, as is the appointment of the noble Baroness, Lady Hollins, to chair an independent panel to oversee case reviews.

However, those reviews will be conducted over a 12-month period. I press the Minister for one more step. Will the Government set up an advice hotline for families who are in despair because they have no idea where to go for help or advice as their children—and they are children—face Christmas locked up and detained by a medieval practice that deprives them of the human rights?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for raising this very important Question today. I should like to be clear that the Government are committed to ensuring that people with learning disabilities and autistic people have the best quality of life and live a full life in the community. A lot of the work that has been done recently, including reviewing and replacing the autism strategy and doing case reviews of every individual who has a learning disability or autism and is in in-patient care, is designed to ensure that we deliver that. I shall take back to the department the noble Lord’s specific point about a hotline for families and ask what can be done.

[Baroness Thornton (Lab)]

My Lords, as my noble friend has rightly highlighted, neither autism nor learning difficulties are mental health conditions. These children should not be in wards which are likely to be noisy, bright and unpredictable. Noble Lords may have seen the report on Sky News about Jeremy, whose autistic daughter Bethany is being held in a mental health unit. He has been campaigning about her inhuman treatment for a long time—too long. He says of the proposed review: “There are 600 people whose care plan says that they should not be in hospital, and for half of them, their local authorities do not even know that”. Those are the Government’s own figures. We have had one review after another since Winterbourne View, nine years ago. I agree with Jeremy— we need action not reviews.

Worse, Matt Hancock, the Secretary of State, is apparently sitting on a report about Jeremy’s daughter and said that it will be released before Parliament rises. Can the noble Baroness ensure that Bethany’s report is released to her parents this afternoon and tell the House when we will see action, rather than reviews, for this vulnerable group of young people?

[Baroness Blackwood of North Oxford]

We absolutely agree with the noble Baroness’s point. We need to ensure that everybody who can be cared for in the community is able to be cared for. That is why we have reduced the number of people in in-patient care by 22%; we have set a target to reduce that number by 50%. We are driving that forward as quickly as possible.

On the matter of the serious incident review of Bethany’s case, we have received the report and are working to release it as soon as possible. NHS England is taking action to improve Bethany’s situation and secure an alternative, more suitable, provider in the community as quickly as possible.

Regarding the case reviews of every individual, the Government have committed to providing each patient with a date for discharge or, where that is not appropriate, with a clear explanation of why and a plan to move them closer to being ready for discharge in the community. This significant commitment from the Government should be welcomed.

[Baroness Hollins (CB)]

My Lords, I declare two interests. First, I had an editorial published in the British Journal of Psychiatry last week, proposing that learning disability and autism should be removed from the Mental Health Act. Secondly, I have just agreed to chair a panel to review the cases of people with learning disability and/or autism who are in segregated care. Does the Minister agree with the treatability criterion in the Act, particularly with respect to the question of removing learning disability and autism from it? In other words, does she agree that, in detaining somebody in hospital under the Act, the excuse of doing so to improve—or with the intention to improve—their behaviour, even though their behaviour may be a reaction to inadequate social care, is an inadequate reason for detention under legislation?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for taking on the chairing of the independent panel. I cannot think of anybody better placed to do so. When it comes to her question about the detention of an individual to improve their behaviour, again, I do not think that anybody in this place or elsewhere could disagree with her. On changing the Mental Health Act, we commissioned the independent review led by Sir Simon Wessely, who is also a leader in the field. He reported in December. In its findings, the review made it clear that we need to modernise the Mental Health Act, ensure that views are respected and ensure that patients are not detained for any longer than is absolutely necessary. Sir Simon stated that there is “no clear consensus” on removing autism from the Act, and that,

“we have heard also about the many negative consequences that could arise from being outside this framework … this should be kept under review”.

Obviously, we will not respond to that immediately. There will be a White Paper by the end of the year. We will consider this carefully and we recognise the strength of feeling on this matter.

[Baroness Browning (Con)]

In support of what the noble Lord, Lord Touhig, and the noble Baroness said—we greatly welcome her chairmanship of the review—there is a very good reason for removing autism as a mental disorder: it is not a mental disorder. It is as simple as that, although it is true that people with autism, including children, will have comorbidities and will develop a mental health condition on top of their autism. I do not know whether the Minister understands my frustration, but I have been raising this issue in Parliament for nearly 28 years. The real problem is that we do not have sufficient psychiatrists who understand and can differentiate between autistic behaviour and what they believe to be psychotic behaviour. Once patients start the spiral of medication for psychosis, the autism disappears and the person disappears altogether.

[Baroness Blackwood of North Oxford]

My noble friend puts this very clearly. The Government accept completely that autism and learning disability are not mental disorders. The question is whether being excluded from the legislation would cause challenges or difficulties for those who may have autism and mental disorders. We will have to consider that carefully as we go into the process of considering a review of the Mental Health Act. As my noble friend just said, we recognise that we will have to go through a careful process. We also recognise the strong feelings—and the correct view—that autism and learning disability are not mental disorders. There is no disagreement on that point.

[Lord Addington (LD)]

My Lords, does the noble Lord—I am sorry, does the Minister agree that we are confusing disability with illness, something which has gone on for far too long? Are we going to have a programme to train people in recognising the different facets of the two and how they interact? The treatment of many people with autism has undergone is probably the best way to induce poor mental health in many of them. Can we please do something to stop that?

[Baroness Blackwood of North Oxford]

I thank the noble Lord and I recognise the challenge to my gender today. He and my noble friend are absolutely right that we must ensure that all health and social care staff have appropriate training on autism and learning disability. A number of Members of this House have campaigned long and hard to ensure that this happens. Some £1.4 million of government funding has been put in place to develop and test some new training packages and today we published the government response to the consultation on mandatory learning disability and autism training which confirms the intention to introduce mandatory training for all health and social care staff. I think that that is an excellent step forward and I am absolutely sure that this House will scrutinise it for its effectiveness. That is right, but it marks a steps forward and should be welcomed.

National Health Service: Pensions Tax

Baroness Blackwood of North Oxford Excerpts

Wednesday 30th October 2019 Lords Chamber

[Lord Balfe]

To ask Her Majesty's Government what assessment they have made of the impact on patients of doctors having to curtail their hours because of the rates of tax they would incur due to the pensions regime in the National Health Service.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Government recognise that pension tax may contribute to decisions by doctors to limit their NHS commitments. The NHS continues to work tirelessly to ensure that patients receive timely and appropriate care, so we are consulting on proposals to make the NHS pension scheme more flexible, so that doctors can continue to conduct vital NHS work while tailoring their pensions growth. The Treasury is also reviewing how the tapered annual allowance supports the delivery of public services such as the NHS.

[Lord Balfe (Con)]

I thank the Minister for her reply and draw attention to my interests in the register. This problem goes back to 2016 but, as of this week, the BMA, the doctors trade union, revealed that a recent survey showed that 42% of GPs have already reduced their hours spent caring for patients and 30% of hospital consultants have already reduced their hours. There have been similar figures from the Royal College of Physicians. Doctors are attracting massive tax bills as a result of working harder to care for their patients; indeed, half are now retiring younger. I am afraid that the appearance is of a dilatory Government where infighting between HM Treasury and the Department of Health is taking precedence over urgent action to deal with this problem. Will the Minister encourage the Government to get a move on and get this sorted out before even more patient time is lost?

[Baroness Blackwood of North Oxford]

I thank my noble friend for that very direct question. Our estimate is slightly different—that around one-third of GPs and consultants have earnings high enough to potentially be affected by the tapering of the annual allowance for tax-free pension savings. Not all clinicians are affected—it depends on the personal circumstances—but we accept that there is a need for urgent action in this area. That is why NHS employers have published guidance for short-term approaches that could have a mitigating effect on pension tax for the workforce this year and throughout the winter. We have also opened our consultation, which will close this Friday. We have already had 750 responses to it, and stakeholders are broadly supportive of the additional flexibility that has been proposed. We intend that flexibility to be available by April.

[Lord Patel (CB)]

My Lords, I apologise for asking another direct question. The results of a recent survey carried out by the Royal College of Surgeons of nearly 1,900 surgeons were that 68% of consultant surgeons are considering early retirement because of the pension tax situation, 64% have been advised to work fewer hours in the NHS and 69% have reduced the amount of time they spend working in the NHS. What effect does the Minister think that might have on surgical care?

[Baroness Blackwood of North Oxford]

The noble Lord is exactly right to raise this issue and we have taken it very seriously. I have met the president of the Royal College of Surgeons to take on board his concerns. It is exactly why we have brought forward this consultation as a matter of urgency and why the department is making strenuous representations to the Treasury, which is reviewing the operation of the annual tapered allowance, and it is why we will continue to make those representations. However, it is also why we are taking other actions around elective surgery so as to reduce the pressure on surgeons up and down the country.

[Lord Anderson of Swansea (Lab)]

My Lords, can urgent action be taken in respect of the doctors’ scheme without having an effect on other schemes of a similar nature?

[Baroness Blackwood of North Oxford]

The noble Lord is quite right. We must make sure that we do not undermine the important benefits of the tax relief on contributions. It is one of the most expensive reliefs in the tax system, costing around £50 billion, around 60% of which was claimed by higher and additional-rate taxpayers. We will expect any review that comes forward from the Treasury to be targeted. An evidence-based approach will be adopted where there is evidence that any problems with the pension tax are affecting the delivery of front-line services, as we have found with the specific group of high-paying clinicians.

[Baroness Jolly (LD)]

My Lords, the noble Baroness will be aware that the royal colleges are all sounding alarm bells, and she is probably also aware that all our doctors serving in the Armed Forces are affected by exactly the same tax hits. The whole NHS workforce is in crisis and we really cannot afford to lose highly trained clinicians. The problem has been known to the department for some considerable time. Can she tell us exactly when the Government expect there to be a sensible, workable solution?

[Baroness Blackwood of North Oxford]

As I said in an earlier answer, we are expecting the consultation proposals to be implemented in April. However, I reassure the noble Baroness that these proposals would also apply to clinicians working in the Armed Forces and in medical schools, provided they are in the NHS pension scheme. I hope she find that encouraging.

[Lord Forsyth of Drumlean (Con)]

My Lords, this is not just a problem for the NHS; it applies across the public sector—to senior people in the police, the fire service, the Army and elsewhere. It is a problem of the Government’s making. It was the Government who put a limit on the size of people’s pension pots and this is the unintended consequence. We are losing the most experienced, dedicated people. It is a false economy. My noble friend answers for the Government as a whole, not just on the health service, and it is not good enough to say that the Treasury is considering this matter. It has been brought up time and again, and it is time for the Treasury to admit that it made a mistake that is costing the public service dear.

[Baroness Blackwood of North Oxford]

As usual, my noble friend speaks with alacrity and force. It has been made quite clear by the Treasury that it will look at the impact on front-line services across the system and not just in the NHS. I am of course speaking for the Department of Health and Social Care, but where sensible evidence is brought forward by other services, it will be looked at by the Treasury in its review.

[Baroness Symons of Vernham Dean (Lab)]

My Lords, is the Minister not aware that when she speaks from that Front Bench she speaks for the entire Government, not just for the department for which she works? Anybody speaking in this House as a Minister speaks for the whole Government. The noble Lord, Lord Forsyth, is entirely right: the idea that, although we know what the problem is, there will be no implementation until the spring is unacceptable. This has to be done much sooner than that.

[Baroness Blackwood of North Oxford]

I apologise if I gave the noble Baroness the impression that there will be no action before the spring. NHS Employers has already published guidance for employers that would mitigate the effect of pension tax on their work force in this tax year. In addition, consultation is under way to allow measures to come into place in April. The Treasury is also looking at the effect of the allowance and taking further action with effect not just for NHS workers but for those who work across the public sector where there is evidence of an impact on front-line workers. I hope that that reassures the noble Baroness and the entire House.

Health Service Safety Investigations Bill [HL]

Baroness Blackwood of North Oxford Excerpts

2nd reading (Hansard): House of Lords
Tuesday 29th October 2019 Lords Chamber

Moved by

[Baroness Blackwood of North Oxford]

That the Bill be read a second time.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, it is a great honour to speak on the Health Service Safety Investigations Bill, which represents a landmark moment for safety and transparency in the NHS and is a major victory for those campaigners who have called for change. Every day, the vast majority of patients treated in the NHS receive safe, effective, world-class care. However, healthcare is complex and sadly sometimes errors occur that lead to harm. It has been estimated that more than 20,000 serious incidents and 8,000 deaths are due to problems in NHS services every year. These incidents have a devastating impact on patients, their families and staff, and cost the taxpayer up to £2.5 billion a year.

The Mid Staffordshire public inquiry and the report of the Morecambe Bay investigation highlighted the variable quality of NHS investigations into patient safety incidents. They also emphasised the many pressures that deter healthcare professionals being frank about failings in patient care and the factors that might contribute to them. In response to these findings, the Government have committed to make the NHS lead the world in providing safe, high-quality care.

In 2015, the Government accepted the central recommendation of the Public Administration Select Committee to establish an independent national body called the Healthcare Safety Investigation Branch. Such a body would conduct a small number of automatic safety investigations and identify areas of learning from healthcare incidents. Lessons have been drawn from the Air Accidents Investigations Branch—an investigative body that has been fundamental to the improvement of safety in the aviation industry.

Our Healthcare Safety Investigation Branch was established in 2016 and started operating in 2017. It currently conducts up to 30 thematic national investigations and up to 1,000 local maternity safety investigations a year. The purpose of the national investigations is not to apportion blame or liability but to share recommendations to prevent similar incidents happening again. The current investigations branch has firmly established itself within our globally renowned healthcare landscape, and is a vital component of a comprehensive plan for safety improvement in healthcare.

Let me give an example of a case that this investigation branch has taken to illustrate the recommendations and the improvement that it can give. The investigation looked into the undetected ingestion of a button or coin-cell battery in children, following an event in which, tragically, a child died after the ingestion of a coin-cell battery. Following this incident, NHS Pathways took action to ensure that NHS 111 staff were prompted to mention coin-cell batteries when asking about the ingestion of anything harmful or poisonous. In addition, the investigation branch also made a series of actionable recommendations to PHE, the Department for Business, Energy and Industrial Strategy and the Royal College of Paediatrics and Child Health. The recommendations addressed issues around the design of button batteries and public awareness about the health and safety of this product. They also focused on the recognition of the ingestion of button batteries in emergency medicine, and the role of ambulance staff concerning the urgent care of young children.

Other examples of investigations at the investigations branch have followed reference events to establish the safety risks associated with patients with special needs and to reduce the risk of prisoners with long-term, chronic conditions being moved without crucial medication. All these investigations have found system-wide solutions to system-wide problems, making this unique in the patient safety investigation system. An investigation into these cases by a local NHS trust would have been unlikely to have had the investigative ability or reach to determine what happened outside of the trust. Therefore, it is easy to see how similar incidents could happen again to other patients elsewhere in England if only local investigations had been carried out.

However, the current investigation branch is an organisational arm of the NHS Trust Development Authority, which is part of NHS Improvement. It was an important first step, but the story must not end there. It lacks independence and the necessary powers to make its investigations fully effective. The Health Service Safety Investigations Bill addresses these issues in four ways.

First, it establishes a new independent arms-length body, otherwise known as the health service safety investigations body—a snappy name. This body will continue the national thematic investigations work of the current investigations branch, focusing on a small number of significant patient safety issues where there is the greatest opportunity for learning across the NHS. This will be the first independent healthcare body of its kind in the world, leading the way in investigating for the purpose of learning, not blaming. The independence of the new body’s investigations from the NHS and Government will give the public full confidence in its investigation processes and its ability to deliver impartial conclusions and recommendations.

Secondly, the Bill will establish safe space protections, prohibiting the disclosure of information held in connection with an investigation, apart from in tightly limited circumstances, as set out in the legislation. The safe space information includes documents, equipment or other items, and is referred to as “protected material” in the Bill. The safe space provisions encourage all participants, such as NHS staff, to be completely candid in the information that they share. This will enable more thorough investigations and the development of meaningful recommendations.

Thirdly, the Bill provides for appropriate powers, so that the new body can discharge its investigative function. These include powers of entry and inspection, powers to inspect, copy or seize documents and equipment, and powers to require information from individuals or organisations, including national public bodies.

Finally, the Bill makes an amendment to the Coroners and Justice Act 2009, to provide a statutory footing for the medical examiners system in the NHS in England. This will underpin the system that is already being rolled out successfully across the country. Medical examiners will ensure that every death in England and Wales is scrutinised, either by a coroner or a medical examiner, to strengthen safeguards for the public. It will provide support to doctors by being able to provide expert advice, in turn improving the quality of the death certification process. It will also be able to provide a service for anyone who has just lost a loved one, by increasing transparency, by offering an opportunity to raise concerns, and ultimately, by avoiding unnecessary distress for the bereaved.

Overall, the medical examiner system is a key element of the NHS safety system and will ensure that any clinical issues and learning are quickly identified to improve patient safety. I take this opportunity to thank the noble Lord, Lord Hunt of Kings Heath, for his continued support over the years in implementing the medical examiner system, and of course the noble Lord, Lord Patel, for his ongoing work on patient safety and leadership in this area.

In preparation for this Bill, a Joint Committee of both Houses was appointed to conduct pre-legislative scrutiny of the Government’s draft Bill. I am grateful to the Members of this House who participated in that committee and gave the Bill such careful and thoughtful consideration. They were the noble Baroness, Lady Billingham, my noble friends Lady Chisholm and Lady Eaton, the noble Lords, Lord Elder and Lord Kirkwood of Kirkhope, and the noble Baroness, Lady Watkins. Their expertise was greatly valued by the Government. The committee made a number of recommendations and I am pleased that they were able to accept the majority. It was clear that the new body should not be able to accredit safe space investigations at a local trust level, as it was felt that this would confuse the new body’s role and make it part of a system that it is investigating. The Government have listened to this concern and removed this provision from the Bill. We consider that there are other ways to improve local investigating capability, including the provisions in the Bill for the new body to provide training and guidance.

The Government have also listened to the committee’s recommendation that the maternity investigation programme for local investigations, undertaken by the investigation branch, should not be part of the new body’s remit. We want to ensure that HSSIB focuses only on a small number of thorough, national and thematic investigations, conducted using a safe space approach to ensure the greatest opportunity for learning in the NHS. It is important to note that it will be possible under the Bill for the new body still to carry out national and thematic investigations into maternity; in fact, the current branch has conducted two national investigations relating to maternity care, which are separate from the local maternity investigations programme. I reassure the House that we will also allow the current investigations branch to continue to run the local maternity investigations programme for a period, so that it gets the maximum learning for the NHS.

A lot of recommendations were taken on board to strengthen safe space and we have defined more carefully when exemptions would apply. One recommendation which was not implemented was that the Government should make it clear that the prohibition on disclosure of safe space material applies to coroners and to the Parliamentary and Health Service Ombudsman. In response to this, the Government had extensive discussions with the Ministry of Justice, while also speaking with the Lord Chancellor and the Chief Coroner. After careful consideration, we concluded that the safe space should not interfere with the coroners’ ability to carry out their statutory functions. The Bill now provides that a coroner may request disclosure of safe space material from HSSIB, but only if it relates to a matter that is relevant to an inquest or an investigation. However, crucially, the Bill also provides that a coroner may not disclose such information in an inquest or otherwise to another person unless the coroner has obtained an order of the High Court. This ensures that participants in an HSSIB investigation still see it as a safe space. We consider that this is the most appropriate way for safe space provisions under the Bill to work alongside the powers of coroners, as set out in the Coroners and Justice Act 2009.

The Government have also decided not to accept the committee’s recommendation to extend HSSIB investigations to independently funded healthcare. We are sympathetic to this recommendation but do not want to pre-empt the findings of the Paterson inquiry, which is expected to report shortly. The Government have committed to review this recommendation once the report is published. I am sure that we will have some debate as this goes through the House.

Finally, the Joint Committee considered whether the new body’s remit should be extended to the devolved territories in Wales, Scotland and Northern Ireland and how it would be devolved across cross-border healthcare pathways. After extensive discussion with the devolved Administrations, the Government concluded that the remit of the new body will not be extended to cover the devolved nations. We want to enable co-operation between the new body and the devolved Administrations where investigations involve cross-border care pathways. We believe that the best way to achieve this is through memoranda of understanding rather than through legislation. I am sure that that point will also be ably tested as the Bill goes through the House.

Overall, the Joint Committee, the CQC, the BMA, NHS Providers and patient representatives have all welcomed the draft Bill. They have looked forward to the introduction of this legislation as soon as possible, stating that they believe HSSIB in its new form will play a vital role in improving patient safety and learning across the NHS.

Having set out the general purpose of this Bill and its broad terms, my priority today is to hear the expertise of the House, so that we can begin the robust process, as ever, of scrutinising and strengthening the Bill. I want to listen as carefully as possible and will seek to engage as fully as possible with all groups across the House, whether by party or by individual, to ensure that we deliver the HSSIB on the best possible statutory footing, so that it can deliver for patients and the NHS in a world-leading way. On that basis, I beg to move.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

My Lords, I welcome the almost unanimous support for the Bill. As ever, I am indebted to your Lordships’ House for an informed and robust debate on the measures in the Bill, and I pay tribute to everybody who has contributed today. I want to take a moment to thank my right honourable friend Jeremy Hunt for his international leadership on patient safety in recent years. I also reiterate my thanks to the Joint Committee for its thorough pre-legislative scrutiny process, which has clearly been of great benefit to the Bill and has shaped our debate today. As we can see, it has created some important changes in the Bill.

I want to take a moment to reflect on why the Bill is so important. The new Health Service Safety Investigations Body will have the powers and the independence to conduct thematic investigations into patient safety incidents that occur in the NHS, in particular not to apportion blame but to spread systematic learning and establish the trust of NHS staff, patients and the public. Until now, we have not had that on a statutory basis. The noble Baroness, Lady Finlay, and the right reverend Prelate the Bishop of London rightly said that the opposite of a learning culture is a culture of fear. With that culture of fear, we cannot make the improvements in patient safety that we need. In my view and in the view of the Government, the establishment of a safe space system—which previously has been seen only in respect of transport accident investigation bodies—is a big step forward in ensuring that the NHS can go forward and learn from its mistakes, particularly by addressing the concern that, at the moment, NHS workers do not feel that they can speak out when mistakes occur. This new body will play an important role in improving patient safety and creating that vital culture of trust and learning, which will be able to prevent serious patient incidents happening across the NHS. I believe that we have the support of the whole House in achieving that.

As ever, a wide range of issues were raised in the debate, so I will do my best to respond to them as much as I can, but I will write to noble Lords where I am not able to do so. One of the primary issues of concern was the effectiveness of the body. The best place to look for the answer to that involves looking at how well HSIB has already been performing in its pilot form within NHSI over the past year and a half. HSIB’s internal management and staff survey found that the current investigation branch was very positively received. There was an engagement rate of 91%, and 80% of staff said that they are proud to work for the organisation and want to be there in two years’ time. The responses are well above the scores of other NHS organisations, and it shows that there is more to be done and that it is progressing well.

In addition, we can measure the impact of HSIB as an organisation outside. The current investigation branch’s approach puts patients and families at the centre of its work, and I can quote from the feedback it has received. People say that they found that the “process was so supportive” in the way that it was approached and that it was,

“a great feeling that you’ve got a voice which is entirely down to the approach”,

of the current investigation branch. Another very touching response said that, “Just knowing that my mum’s death may not be in vain and may prevent similar instances from happening to other families is the best legacy that I can think of in memory of my wonderful mum. That is what she would have wanted”. That is what the HSIB has already achieved, and by putting it on a statutory footing we can ensure that it can do more and that it can do more effectively.

I want to move on to the important issue of the safe space, which was raised by a number of noble Lords, including the noble Lords, Lord Hunt of Kings Heath and Lord Turnberg, the noble Baronesses, Lady Walmsley, Lady Parminter, Lady Jolly and Lady Thornton, and my noble friends Lord O’Shaughnessy and Lady Eaton. I can do no better than to quote, as did my noble friend Lord Hunt of Wirral, from the report of the Joint Committee on the Bill:

“the primary and overriding purpose of this Bill is to put in place arrangements that will lead to learning and improvement arising from objective and comprehensive analysis of the causes of clinical mistakes and incidents, leading to better and safer outcomes for users of the healthcare system. We do not think this second principle is incompatible with obtaining justice in individual cases, which may and should be pursued by other means”.

The safe space is central to that, but it does not prevent patients and families pursuing other routes of investigation via the CQC or via the criminal courts. It is very important to understand that.

As the noble Lord, Lord Hunt of Kings Heath, said, we have to strike a balance with the safe space by including an exemption for coroners. Coroners are judicial officeholders and have an important role to play in investigating certain deaths, so we have determined that it is appropriate to allow them to access protected material where this is necessary for them to fulfil their judicial functions, but we have also determined that we should put in place tight prescriptive measures to ensure that the safe space is protected as much as possible. On that basis, if a coroner requires information under the Coroners Act 2009, they are not able to share the information without a High Court order to do so, under Clause 19, and they can disclose only if the court makes an order after deciding, in the interests of justice, that the risk of disclosure is greater than any adverse impact on current or future investigations and the Secretary of State’s ability to improve patient safety in the NHS. In addition, Clause 14 provides for a few small exemptions where HSSIB could disclose information if it was needed to help carry out an investigation, while Clause 15 provides that if it is,

“necessary to address a serious and continuing risk to the safety of any patient or to the public”.

Those are important criteria because these investigations are not supposed to pose a risk to individual patients.

The noble Baroness, Lady Parminter, raised an issue regarding the PHSO. The Government’s view is that the new body’s investigations and those of the PHSO are different types of investigation and that the prohibition would be likely to have a limited impact on the ability of the ombudsman to investigate complaints about the NHS and other health bodies. The ombudsman will still be able to obtain information from the relevant trust. In addition, HSSIB will carry out only a small number of investigations—up to 30 a year—so the view is that the impact on the work of the ombudsman will be small. However, I take on board her views and we understand the position of the ombudsman.

The noble and learned Lord, Lord Judge, asked an important question about whether HSSIB has to take into consideration patient consent in order to participate in an investigation. It is required to publish its processes for ensuring that, as far as reasonable and practicable, patients and families are involved in investigations. It would be expected to be sensitive to the circumstances of patients and their families, and we would expect it to seek consent in the vast majority of cases. The current branch has developed very good working relationships with patients and their families, and we would expect the new body to continue that. However, I shall take away the point he has raised.

The noble and learned Lord similarly raised a point regarding a fine rather than a custodial sentence for a breach of information. The sanctions regime was considered following the recommendations of the Joint Committee. We believe that criminal sanctions are appropriate, regarding the seriousness placed on non-compliance with the relevant provisions in the Bill. On his point about whether it is an appropriate sanction, I will also take that away and consider the issue he has raised.

A number of noble Lords, the noble Lords, Lord Hunt of Kings Heath and Lord Scriven, my noble friend Lord O’Shaughnessy and the noble Baroness, Lady Finlay, asked questions about the scope of HSSIB to conduct investigations. HSSIB will be an independent body. It will be able to decide its own priorities and determine what it investigates based on the referrals that it achieves on its own intelligence. It is important that it should be free to do that, but those criteria will be consulted on. There will be an opportunity for patients, the public and the NHS to contribute to that consultation. The Bill is clear, however, that HSSIB may only investigate incidents that have an effect on the safety of patients which occur in the provision of the NHS and do not involve an outcome that contributes to blame, so there are some parameters within the Bill. But the criteria of how those investigations are chosen will be set by HSSIB as an independent body.

On the question of who will be responsible for monitoring the implementation of recommendations, it is essential, if the body is to be established as effective and gain the trust of the public that it does that effectively. So the National Director for Patient Safety will chair a programme board to monitor the system response to the recommendations made by the new body. We do not believe that that needs to be set out in legislation. The Joint Committee agreed with us and agreed that HSSIB should not be responsible for enforcing its own recommendations. That is to ensure that it remains independent and does not become part of the system that is being investigated.

A number of specific questions were asked about what areas were in scope. The noble Lord, Lord Scriven, asked whether prison services were in scope. They are, providing that they are commissioned by the NHS. Indeed, HSIB has already conducted an investigation into NHS-provided prison services. The noble Baroness, Lady Hollins, asked about learning disability services, which would also remain in scope if they were funded by the NHS.

A number of noble Lords asked about staffing levels and the impact on staffing. Certainly, if the question of staffing and behavioural impact fell within the question and the terms of the investigation, that would certainly be appropriate for HSSIB to report on. The standard question is that the scope of HSSIB’s investigations and learning will extend to any patient safety incident that occurred during the provision of NHS services in England, or which occurred at a premises where such services are provided. So that would also include NHS-commissioned services in the independent sector. I will return to the independent sector in a moment.

Dentistry is also covered, which my noble friend Lord Colwyn raised, and maternity, although HSSIB does not replace the local, independent inquiries, which would be done by NHS trusts. I shall return to that in the second. On maternity services, HSSIB will focus on only a small number of thorough national investigations conducted through the safe space for maternity going forward. But we have been clear that we will allow the current investigation branch to continue to run the local maternity investigations programme for a period—the commitment is for 1,000 maternity investigations—so that we can get maximum learning for the NHS. Those will continue but they will not be part of the statutory regime.

I note the strength of feeling in the House about the independent sector and I will take that issue away with me. I answered the question in my opening remarks so I will not go into too much depth now. At the moment, the independent sector is not covered, but I take the point on board and will take it away. In addition, I note the point raised by the noble Lord, Lord Scriven, regarding social care. However, it was the Joint Committee’s recommendation that the new body should not be tasked or expected to be an investigatory body for social care. But it should be able to investigate all aspects of the healthcare pathway relating to patient safety investigation, so people should not fall through the cracks. I hope that that reassures him.

On the question of the independence of the body, which will also be critical, and responding particularly to the questions raised by my noble friends Lord O’Shaughnessy and Lord Ribeiro and the noble Lord, Lord Hunt of Kings Heath, the new body is modelled on some features of the AAIB. It will have statutory powers and carry out impartial investigations. But the AAIB sits within a department and we wanted to make sure that the new body was more independent than that and given a statutory, stand-alone role, which is why we are setting it up as a non-departmental body. It will have the powers to conduct impartial investigations and the Secretary of State may request but cannot direct the body to conduct a particular investigation. This is similar to the CQC set-up, and we think it is appropriate.

The chair and the non-executive directors will be public appointments subject to open competition. The process follows a published governance code which is independently regulated by the Commissioner for Public Appointments. This is in line with other public bodies, as is the process for the appointment of the chief investigator, which is in line with NHS England, Monitor, NICE and ALBs. The chief investigator would be appointed by the board, but would then be subject to the consent of the Secretary of State.

We are clear that the HSSIB would need to integrate and work closely with similar regulators in the space so that there is no question of duplication, which was a point of concern raised by the noble Lords, Lord Faulks and Lord Turnberg. We are reassured that that would not be the case given that the effectiveness of the HSSIB has already been demonstrated. We will make sure that it works effectively through the mutual duty of co-operation which has been set out in the Bill, a number of MoUs and the demonstration of the effective working of the body as it stands. It does not duplicate other bodies.

The National Patient Safety Agency was in many ways a forerunner, as noted by the noble Baroness, Lady Thornton, and the noble Lord, Lord Patel. I pay tribute to it for its work in that way. As noble Lords will be aware, in 2012 the decision was made to transfer the main functions of the NPSA to NHS England. Those functions now sit with NHS Improvement under Aidan Fowler. Unlike the NPSA, the new body will focus on only a small number of thematically based investigations that offer systemic learning without any blame attached and will have a statutory footing. I hope it is recognised by those who were involved in the NPSA that this is a step in the right direction.

In answer to the noble Baroness, Lady Thornton, and the noble Lord, Lord Turnberg, I say that these investigations do not replace very important local investigations. There is no intent to replace them in any way. However, there is value in national learning, as sometimes investigations which happen at trust level do not share best practice nationally. This is not a duplication on that basis.

I shall quickly move to the end of my speech, but I want to answer the question regarding the devolved Administrations asked by the noble and learned Lord, Lord Hope, and the noble Baroness, Lady Finlay. Currently the investigative branch has had positive interactions with the devolved Administrations in Scotland and Wales and has worked closely with trusts in Wales in recent investigations involving cross-border care. We think that more formal plans will be developed with the new body which will mean that other Administrations will be able to ensure that effective working can go forward. However, I take on board the concerns that were raised by the noble and learned Lord regarding Clause 25 and will ensure that it is fully tested.

There are a number of issues that I would like to go forward and raise, but I am aware that time is ticking on, that we are at the end of the day and that tomorrow may end differently. I thank everybody who has contributed today. There are some important questions that need to be resolved. As we have a little bit of time to go through it, I am sure we will be robustly tested, but ultimately the Bill is destined to play a key role in helping to prevent the recurrence of patient safety incidents and fulfilling the Government’s commitment to ensure that the NHS provides high-quality, safe care. We expect the new body outlined in the Bill and the medical examiner system to be operational from April 2021, subject to the passage of the Bill through Parliament. I heard the support of this House very loudly today.

Bill read a second time and committed to a Committee of the Whole House.

Drugs: Methadone

Baroness Blackwood of North Oxford Excerpts

Monday 28th October 2019 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask Her Majesty’s Government what plans they have to assess the regulation, and the general effectiveness, of methadone.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, methadone is a cost-effective and evidence-based opioid substitution treatment. The National Institute for Health and Care Excellence has published several pieces of guidance on drug treatment. It recommends opioid substitute treatment with either methadone or buprenorphine, delivered alongside psychosocial treatment, as the front-line treatment for heroin dependency. There are no plans to undertake any further review.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for that reply. I am disappointed that the Government are not prepared to undertake a review. I do not want methadone treatment to end, but I believe that the cost is now becoming astronomical and have sent the Minister questions about this previously. People in the industry say that it now costs £1 billion a year, yet an increasing number of people are dying from methadone and a shortage of resourcing for support and advice. We are going nowhere. They are parked in a cul-de-sac. Should we not take a look at what alternatives may be available, where that kind of money could be put to better use and give people hope, rather than just abandon them?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question. He will know that the DHSC does not collect data on the costs of supply of methadone centrally, as he has asked this question. However, I reassure him that Public Health England carried out an evidence review in 2017 on the effectiveness of drug treatment across the UK, which found that our outcomes are as good as or better than those internationally, including on effectiveness and value for money. However, we recognise the challenge of drug deaths and drug treatment across the UK and the challenge to local authorities. There will be an effective review of drugs policy, which will include Carol Black’s review of drugs.

[Lord Rennard (LD)]

My Lords, what consideration has been given to extending the Swiss model of heroin-assisted treatment, with addicts attending clinics under supervision and injecting safely, given that there is clear evidence of the success of this model in improving the health of addicts and reducing both the number of overdoses and levels of crime?

[Baroness Blackwood of North Oxford]

Heroin-assisted treatment can be an effective way of treating individuals for whom other opioid substitutes have not been effective. It is open to local areas under the existing legal framework, but given that funding decisions on drug and alcohol treatment have been devolved, it is for them to decide whether to commission HAT services based on their assessment of local need.

[Lord Watts (Lab)]

My Lords, are the Government seriously suggesting that they could be spending £1 billion but do not actually know whether they are?

[Baroness Blackwood of North Oxford]

No, the Government are suggesting that a PHE review in 2017 found that drug and alcohol treatment services are currently as good as or better than international comparators. They are cost-effective and the outcomes are good. However, we recognise that the number of deaths at the moment is too high, which is why the Home Office has commissioned a review of drugs policy by Dame Carol Black, and there will be a summit in Glasgow before the end of the year to find out what more can be done to improve these services.

[Baroness Finlay of Llandaff (CB)]

My Lords, do the Government recognise that methadone, apart from being an opioid substitute, is therapeutically a useful drug because it hits a different set of receptors from many other opioids? Each individual opioid is unique in its pharmacological profile and action, so there are real dangers in labelling methadone as only an opioid substitute. Patients who need it for symptom control can worry that they are stigmatised by being prescribed methadone, and there can be difficulties in supply therapeutically. In addition, any review of addiction and addiction services cannot look only at substituting one drug for another but must also look at the fundamental underlying drivers to the addiction that has occurred. It must give support in the long term, because these people remain at risk of returning to their addictive habits.

[Baroness Blackwood of North Oxford]

The noble Baroness in her question has outlined her expertise in this. She is quite right that the evidence base for the effectiveness of methadone is robust. It is provided for by NICE guidance and UK drug misuse and dependence treatment guidelines. Those have recently been updated in the Orange Book, which provides clinical guidance to clinicians and was published in 2017. There is also an update coming to NICE guidelines on how to manage drug dependency, which will be published in 2021. Therefore, up-to-date guidance is available for clinicians which ensures that they are able to provide both therapeutic and dependency management to those on prescription but also on withdrawal treatment. I therefore reassure the House that this is being taken extremely seriously by the Department of Health and Social Care, and by all related departments.

[Lord Forsyth of Drumlean (Con)]

My Lords, how can my noble friend say that it represents value for money if she does not know the cost? To go back to the question of the noble Lord, Lord Brooke, surely that cost has to be taken as an opportunity cost compared to other forms of treatment that do not continue with people being dependent on drugs.

[Baroness Blackwood of North Oxford]

My noble friend is quite right that we have to ensure that we prevent individuals getting addicted to drugs in the first place. That is why there is a wider drugs strategy, which ensures that we take action to reduce the number of people who become addicted in the first place, why the Home Office is holding a summit in Glasgow focused on tackling the problem of drug use, and why Dame Carol Black is working on the association between drug use and violence. However, we recognise that the use of methadone is an evidence-based and effective way to reduce the harm as cost-effectively as possible, which has been proven through extensive clinical and evidence-based trials.

[Baroness Thornton (Lab)]

My Lords, the lack of local government funding for drug treatment, combined with a policy-driven emphasis on abstinence rather than harm reduction, has frequently been cited as a likely reason for the increased number of drug-related deaths. In 2016, the Advisory Council on the Misuse of Drugs advised the Government on how to reduce opioid-related deaths in the UK. Despite Ministers claiming to accept the recommendations made by the ACMD, funding for drug treatment services, including OST—opioid substitution therapy—has been cut across the UK. Can the Minister confirm that this is the case and explain why the Government are not following the advice of the ACMD?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

We have accepted the recommendations of the ACMD and are very grateful for its advice, which is evidence-based and recommends the use of methadone. However, we recognise that services are under pressure and face a range of challenges, including the ageing cohort of drug users, which we believe is related to the increase in deaths. We are reassured by the 2017 PHE review, which, as I said, found outcomes that are as good as, or better than, international comparators, which shows that local authorities are delivering effectively even under that pressure. I am pleased, therefore, that the public health grant remains ring-fenced and will now increase in real terms. We will be focusing on how that can assist drug and alcohol services so that we can see them improve locally. This will be a particular focus for the Drug Recovery Champion, who will have an annual delivery plan and will be working with communities to improve the services available.

Healthcare: Brain Tumours

Baroness Blackwood of North Oxford Excerpts

Thursday 24th October 2019 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what steps they are taking (1) to improve access to palliative care, rehabilitation and psychosocial care for people living with a brain tumour, and (2) to provide support for their carers and families.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the NHS Long Term Plan sets a clear ambition that, where appropriate, every person diagnosed with cancer will have access to personalised care by 2021. Personalised care includes support planning based on holistic needs assessments, end-of-treatment summaries, health and well-being information and support and a cancer care review with GPs. These interventions align with the comprehensive model for personalised care and should be made available for all cancer patients, including those in need of end-of-life care.

[Baroness Wheeler (Lab)]

My Lords, International Brain Tumour Awareness Week starts on Saturday, so it is timely to remember both patients and carers. Living with a brain tumour often means coping with life-changing symptoms, such as mental and emotional health issues, communication and mobility problems. Carers also need support in adjusting to these changes in the person they care for, including coping with difficult behaviour and personality changes, disorientation and confusion. Both Marie Curie and the Brain Tumour Charity have highlighted strong concern about inadequate support for carers and the impact on the care journey that carer breakdown in these circumstances can have, often leading to emergency hospital admission. What action are the Government taking to ensure that people with brain tumours, their carers and their families receive care and support that meets their needs and wishes?

[Baroness Blackwood of North Oxford]

The noble Baroness has raised a very important issue. Obviously, the Government are working to deliver the Carers Action Plan, which retains the strategic vision of recognising, valuing and supporting carers. It includes a commitment to 64 actions across five priorities to ensure that we improve support for carers, including recognition and support, and build evidence to improve outcomes, especially in these very difficult areas. We are also working hard with the Tessa Jowell Brain Cancer Mission to ensure that we improve pathways for those with very challenging brain tumour diagnoses.

[Lord O’Shaughnessy (Con)]

My Lords, I declare an interest as a patron of the Tessa Jowell Brain Cancer Mission. The noble Baroness, Lady Wheeler, has highlighted a very important topic, because the outcomes and experiences of people with brain tumours and brain cancers are terrible and have not improved in decades. The actions my noble friend has set out are important, but it took the leadership of our late and much missed noble friend to galvanise action. Part of that action was a pledge from the Government of £40 million from the National Institute for Health Research to improve research into treatments, therapies and care for people with brain tumours. Can my noble friend update the House on what progress has been made on that and how the money is being spent?

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question and I pay tribute to his leadership on this issue. He is absolutely right that we must improve outcomes for those diagnosed with brain cancer, and one of the ways of doing so will be through earlier diagnosis. That is why the Prime Minister announced measures with the aim of seeing 75% of all cancers detected at an early stage by 2028 to save 55,000 lives a year. My noble friend is right, however, that we will deliver this only through improved research specifically targeted at brain cancers. The Government announced £40 million over five years for brain tumour research. This can be delivered only through the submission of high-quality research and I know that the Tessa Jowell mission is working to ensure that that becomes a reality.

[Baroness Jolly (LD)]

My Lords, the noble Baroness, Lady Wheeler, outlined a perfectly reasonable list of requirements and I am pleased that they all fall within the NHS long-term plan. However, “long-term” is slightly ill defined—by when will all these requirements be met?

[Baroness Blackwood of North Oxford]

We are working to deliver earlier diagnosis to improve survival of 75% of cancers by 2028. We are also working to improve the one-year survival rates of adults diagnosed since 2016 over the next 10 years. We are also making sure that we improve the commitment of the £40 million over the next five years. I hope that answers the noble Baroness’s question.

[Baroness Butler-Sloss (CB)]

My Lords, I am a vice-president of a hospice in Exeter which is raising money to provide 24-hour care at home. Does the Minister recognise how important it is for those in palliative care, particularly those with brain cancers, to be able to spend the rest of their lives—and die—at home?

[Baroness Blackwood of North Oxford]

The noble and learned Baroness is quite right that people should have a choice in end-of-life care. The long-term plan recognises that we need to improve that choice and the quality of discussions around it. That is at the heart of the drive to improve personal health budgets and help staff identify personalised care planning for end-of-life care. I hope that reassures the noble and learned Baroness that this is seen as a top priority in end-of-life care planning.

[Baroness Pitkeathley (Lab)]

My Lords, the Minister has mentioned NHS support, but she will know that by far the majority of support for carers in these circumstances comes from local authorities. How does she react to all the current research showing that not only are services diminishing for carers in local authority areas but also the number of assessments, in contradiction to obligations under the Care Act and the carers action plan?

[Baroness Blackwood of North Oxford]

The noble Baroness will know that this has been identified as a priority, not only from the call to action from carers themselves that services and systems that work for them should be improved, but also because it is one of the 64 actions in the carers action plan. It is something the Government are determined to take action on. We are concerned by the reports and taking action to improve it.

[Lord Forsyth of Drumlean (Con)]

My Lords, has my noble friend noticed that at its conference the Labour Party adopted as its policy on social care pretty well the recommendations of the all-party Economic Affairs Committee of this House? Is there now a unique opportunity for us to get a political consensus on the need to provide free personal care? The root of this problem is that access to free personal care depends on diagnosis, not need. Is it not now time for the Government to produce a White Paper and work with the Opposition to produce the consensus that everyone concerned with this matter realises needs to be achieved?

[Baroness Blackwood of North Oxford]

I first congratulate my noble friend on his leadership on this issue; it has been noted by the House and very much welcomed. He is absolutely right that leadership on social care is essential and that it is time for action on this. The Prime Minister has been clear that he wants to end the suffering in social care once and for all, and will bring forward announcements on his immediate plans for that very soon.

Queen’s Speech

Baroness Blackwood of North Oxford Excerpts

Tuesday 22nd October 2019 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I am honoured to close this final day of debate in support of the gracious Speech. As ever, debate has been robust, largely courteous, but underpinned by the extensive expertise of this House. In this age of partisan rancour, our debate has been informed by a deeply held belief that in this place, regardless of political persuasion, we are bound together by a collective responsibility to use our roles here to improve the lives of our fellow citizens. That is something to be proud of.

The topics we have debated today—education, work and pensions, culture and health—make more difference than any others to the lived experience of people across this country. That is why the past seven hours have flown by for me as I have listened with pleasure to the important contributions of 61 noble Lords. It is because of the importance of these issues and the consensus on the need for action that the Prime Minister and his Government have prioritised them over recent months and, of course, in the gracious Speech, investing £14 billion in schools over the next three years, supporting the modernisation of pensions, accelerating access to broadband—perhaps even to the home of the noble Lord, Lord Aberdare—and three new health Bills, with a commitment to work towards a further two. It is an ambitious agenda and has been fully reflected in today’s wide-ranging debate.

I will now do my best to respond to the many important points raised today, but it will be necessary, I am afraid, that the relevant Minister might have to write on a few issues that I am not able to cover in the time that is available. I begin by focusing on education. I know that the whole House is passionate about supporting investment in education and the importance of ensuring, as the noble Baroness, Lady Massey, so clearly put forward, that all children, no matter their background, can benefit from an outstanding education. As the noble Lords, Lord Storey and Lord Berkeley, and the noble Baronesses, Lady Bull and Lady McIntosh, noted, there should be a broad and varied education. As a former musician myself, noble Lords are preaching to the choir when they emphasise the value of creativity to society and its role in preparing children for the future—even its role in preparing a recalcitrant Health Minister.

As has been mentioned, the Government have announced welcomed investment in schools. I can confirm to the noble Lord, Lord Watson, that, following the funding allocation statements issued by DfE last week, all schools will be better off in three years’ time.

The noble Lord, Lord Addington, raised very important issues around special educational needs, and the Government have announced an additional £770 million of investment in 2021 for SEND education. But the whole House will appreciate that providing the best possible education is not just about money. That is why the DfE has commissioned a review of SEND education to assess what further we need to do in order to support pupils with special educational needs, so I will put forward the specific points that he raised in order to ensure they are properly considered.

The Government have also set up a cross-government hub for all disability issues in the Cabinet Office to draw together a catalysed, more effective cross-government action on these points. The DWP has increased the size of Access to Work grants by £15,000 in the last year, driving forward a 7% increase in the volume of grants made in recognition of their importance. This will support those with disabilities and special educational needs in the workplace.

A wide range of noble Lords noted the critical role of further education, with my noble friends Lord Lingfield and Lord O’Shaughnessy, and the noble Lord, Lord Aberdare, and the noble Baronesses, Lady Blackstone and Lady Garden, all drawing attention to it. Further education is at the heart of the Government’s plans for an education system that works for everyone. That is why we have announced—as has been noted—an additional £400 million of funding and a focus on improving not only the quality of teaching and learning but also its status.

Many noble Lords have welcomed an investment as well of £290 million in 20 institutes of technology to deliver higher technical education as a clear route to high-skilled, high-wage employment, but they also sought more clarity on how this will work in practice. I shall ask for those points to receive an individual response as I cannot get through all of those right now.

The noble Lord, Lord Storey, and others also raised the response to the Augar review, which is awaited. I confirm that Ministers are considering this very carefully and will respond shortly. This is a policy area that would clearly benefit from close attention in the spending review that is coming up next year.

On essay mills, I can confirm that, in the first instance, the Office for Students will engage the sector in order to eliminate the use of such organisations, but the Government do not rule out further action.

Clearly, more progress needs to be made on apprenticeships, but much progress has been made: over 1.8 million apprenticeships have started since 2015, investment annually is over £2.5 billion and over 60% of apprenticeships are of the highest industry-desired standards. I recognise the need for progress, and we are working hard on it. That is why the Secretary of State has taken the portfolio of apprenticeships as his personal responsibility, in response to the point made earlier.

I turn to work and pensions. The noble Baronesses, Lady Donaghy, Lady Watkins and Lady Sherlock, and the noble Lord, Lord Willetts, all raised universal credit and concerns about in-work poverty. I think there is a consensus that work should always pay. Universal credit is a welfare system designed to help people into work, to support those who need help and to be fair to everyone who pays for it. The DWP recognises, however, the need to continually review and improve universal credit. This year alone, the DWP has committed to running a pilot on moving to universal credit to ensure the further and safe rollout of the advantages of universal credit. I noted the question about an update on that progress and I will ensure that a note comes to the noble Baroness about that. The department has announced that it will reduce the maximum single sanction that a claimant can face from three years to six months, and the number of those sanctions has also fallen. The department has instructed work coaches to use the flexible support fund to support parents with childcare costs. It is also providing £3 billion to support transitional arrangements for claimants moving over from other benefits. Noble Lords also raised concerns about the benefits freeze being extended. I can confirm now that it will come to an end by 2020.

The noble Baroness, Lady Bryan, and a number of noble Lords mentioned the pensions Bill. I genuinely feel that pensions is an area where there has been positive progress over the past decade. The Bill now goes a step further to improve both the options available to employers and accessibility for employees, so that they can track their pension as they would their bank account.

Our debate on DCMS was particularly robust, it is fair to say. I begin with broadband rollout, which was mentioned by the noble Lords, Lord Clement-Jones and Lord Aberdare. The Government have been clear in their commitment to delivering nationwide, gigabit-capable, reliable and resilient broadband—that is not easy to say at the end of a long debate—as soon as possible. That is why the gracious Speech included the telecommunications Bill, to ensure that millions of leaseholders are not left behind as we upgrade our communications network. I am conscious of the time but I am also aware that the Second Reading is imminent, so I am sure that many of the points made by your Lordships will be answered in letter form and that there will be ample time for detailed debate and robust scrutiny, which I am sure this House will provide.

The noble Lords, Lord Clement-Jones and Lord Griffiths, and a range of Peers noted the challenge of online harms and how to regulate and respond to digital technologies that can change and evolve rapidly. The online harms White Paper was published in April. It set out the Government’s plan for world-leading legislation to make the UK the safest place in the world to be online. The public consultation has closed and the Government’s response will be published in the coming months. We will then publish a draft Bill for pre-legislative scrutiny. Let me be clear: the Government recognise that this is one of the fundamental challenges facing our society in the coming years and they are determined to address it.

I want explicitly to recognise the strength of feeling expressed by the noble Baronesses, Lady Benjamin and Lady Howe, the noble Lords, Lord Clement-Jones and Lord McNally, and other noble Lords on the issue of age verification and the pace of reform. I will confer that back to the department. The Government are clear that protecting children is at the heart of our online reform agenda and is key to wider government priorities. The issue here is making sure that those reforms are as effective as possible and do the job that they are intended to do.

Moving on to health and social care, my department was delighted to begin the year by publishing the clinically led NHS long-term plan and by securing £33.9 billion to support its implementation. On the point made by the noble Lord, Lord Smith, the plan focuses not on funnelling ever-greater funding into the health service but on ensuring sustainable and substantive reform that can support what we all want to see in the health service. As my noble friend Lord O’Shaughnessy noted, there are delicate balances to be struck on integration versus accountability, which the upcoming NHS long-term plan Bill is intended to address. That has also been clinically and NHS-led.

I follow the noble Lord, Lord Hunt, who is not in his place—

[The Earl of Courtown (Con)]

Yes he is. He is over there.

[Baroness Blackwood of North Oxford]

Sorry, he is in a different place. I follow the noble Lord in paying tribute to the noble Lord, Lord Patel, and his colleagues on the Long-Term Sustainability of the NHS Committee, which he chaired, because many of its proposals were replicated in the long-term plan.

The noble Baronesses, Lady Greengross, Lady Walmsley and Lady Massey, and my noble friend Lord Young raised the importance of prevention, primary care and tackling inequalities. These are all important agendas for the Government and for my department, which is why the Government have committed more than £4.5 billion of additional funding to support GP services and will recruit an additional 20,000 staff to work in practices.

It is also why the Government have published their prevention vision, which sets out an ambitious agenda in order to put public health at the heart of everything the department and the NHS do, including aggressive action to tackle obesity such as the sugar tax, which has proved to be a great success. I am happy to reassure my noble friend Lord Young of Cookham that this will continue to be right at the heart of our agenda. Moreover, the department is addressing the real and valid concerns about health inequalities. We have just recently finished consulting on how to improve the health of people living in the poorest communities. Reducing inequalities is a key part of the long-term plan and will be a requirement as part of our PCMs.

We have also worked closely with Defra on the introduction of the clean air strategy, which was noted by the noble Baroness, Lady Walmsley, and on antimicrobial resistance, which no one noted but I do so now, and with Henry Dimbleby on his food strategy. On this last point, while I cannot commit the Leader of the Opposition to continuing commitment on this agenda, I can certainly reassure the noble Baroness, Lady Boycott, of the Government’s ongoing commitment and I thank her for both her expertise and her work on this agenda because it is essential.

The noble Baronesses, Lady Greengross, Lady Meacher, Lady Hollins, Lady Watkins, Lady Sherlock, Lady Campbell, Lady Wheeler and Lady Bakewell, along with my noble friend Lord Young, the noble Lord, Lord Hunt, and the right reverend Prelate the Bishop of London also raised the critical issue of social care. As my noble friend Lord Willetts said, we must just get on with it, and I do not think that I can improve on what the noble Baroness, Lady Bakewell, said: “Ageing is not an option”, and nor is substantial reform in this area.

The Prime Minister was clear on the steps of Downing Street about this Government’s determination to fix the crisis in social care to ensure that every older person has dignity and security and that no one needs to sell their home to fund their care. He wants this to be a bold, once-in-a-generation reform and I can reassure the House that officials across government are working, probably at this moment, on developing ambitious proposals on top of the £17.1 billion invested in the past financial year. However, I will strongly reiterate to the Secretary of State and to the Prime Minister, as I often do, the very strong mood in this House that the time for action is now. I will also confirm that the department will consider carefully the recommendations set out by the Independent Living Strategy Group, led by the noble Baroness, Lady Campbell, and those of the Intergenerational Fairness Committee, of which the noble Baroness, Lady Greengross, is a member, as part of those considerations.

The noble Baronesses, Lady Jolly, Lady Donaghy, Lady Janke and Lady Watkins, along with the noble Lord, Lord Patel, raised the issue of NHS staffing. Having the right staff is crucial to delivering the aims and objectives of the long-term plan. To address this, we are recruiting more staff than ever before with, for example, a 25% increase in training places for medical students. We have also given a significant pay rise to more than 1 million staff and my noble friend Lady Harding is currently preparing for publication the people plan, which will set out a range of ambitious options for what more we can do to improve the situation. In answer to the noble Baroness, Lady Watkins, this will specifically consider the whole range of potential financial incentives which could support recruitment and retention. At this point I will follow other noble Lords in putting on the record my department’s deep appreciation of the noble Baroness, Lady Emerton, for her wonderful work as a champion of the nursing profession.

The noble Baronesses, Lady Jolly, Lady Hollins, Lady Sherlock, Lady Featherstone, and Lady Tyler, and my noble friends Lady Verma and Lord Kirkhope, along with the noble Lord, Lord Watson, noted the importance of getting mental health right, the reform of the Mental Health Act and the care of those with disabilities. This is not only a crucial issue but a complex area, so it is important that we get the reform right. I recognise the impatience of noble Lords to go further faster, but there is real progress to report. The Government have already accepted a number of the recommendations made in the independent review. We will publish a White Paper by the end of the year and we will set out in detail our legislative and non-legislative response. To address the immediate service challenges, the Government are also investing record amounts in NHS mental health care as well as in care for those with learning disabilities and autism. I can also report that capital will not be overlooked. Since 2017, we have recruited more than 3,000 additional staff to put in place a wide range of measures to ensure that care is provided closer to home.

The noble Lord, Lord Rennard, and my noble friend Lord O’Shaughnessy raised Brexit and the health service. In any Brexit scenario my department is committed to maintaining the very highest standards of regulation and I can assure the noble Lord, Lord Rennard, and my noble friend Lord Young of Cookham that we will remain a world leader in the regulation of tobacco and of prevention, as we have laid out in our prevention vision. Our preference remains close co-operation with the EMA as well as with our other long-term friends and partners such as the Commonwealth, as my noble friend Lord Howell mentioned.

The importance of patient safety was also raised by a number of Peers in relation to the upcoming Health Service Safety Investigations Bill. I am very much looking forward to its Second Reading next week, when I am sure we will have plenty of time to debate it and I will be held to account in every possible way—so I shall not go into detail on that now.

I will say just a word about innovation, raised by the noble Lords, Lord Patel, Lord Kakkar and Lord Bassam, who raised the importance of life sciences and innovation. We have a very strong record in this area. I am afraid I do not recognise the picture presented in the IPPR’s recent report. Turnover and employment in UK life sciences have grown notably over the last decade, and the life sciences strategy sets out a powerful vision for action, which we are delivering against assiduously. This has included £1 billion of government investment and £3 billion of leveraged industry investment. We now have substantially better partnership between the NHS, academia, government and industry, but I agree with the noble Lord, Lord Kakkar, that we have to improve on our rate of progress between ideation and adoption. Part of that is better working between all those agencies engaged in trying to deliver against that objective.

I also noted strong support from the noble Lord, Lord Patel, and others on the fast-track visa for top scientists. I will take away the sensible suggestion from the noble Baroness, Lady Bull, that this be expanded to include the cultural and creative sectors.

Finally, the noble Baroness, Lady Deech, raised the storage of gametes. I agree on the importance of this, as I think she knows, and have continued to push this matter within my department. To that end, I hope to have a positive update in the coming weeks.

I am mindful that I have only a short amount of time and the clock is counting down. In closing, I reiterate my thanks to noble Lords for their many and varied insightful contributions. Responding to a debate such as this is a challenge, given the breadth of issues we have covered, but it is also a pleasure, giving me the opportunity to engage on many issues that I do not regularly come across in my brief. As has been pointed out, we debate the gracious Speech in unprecedented political times, but my commitment to this place on behalf of the Government and the departments for whom I speak today is that we will continue to strive day in, day out to improve the lives of and the services available to people right across the United Kingdom. I know that is an ambition to which all your Lordships here today will join me in being committed.

Motion agreed nemine dissentiente, and the Lord Chamberlain was ordered to present the Address to Her Majesty.

Specific Food Hygiene (Regulation (EC) No. 853/2004) (Amendment) (EU Exit) Regulations 2019

Baroness Blackwood of North Oxford Excerpts

Wednesday 16th October 2019 Grand Committee

Moved by

[Baroness Blackwood of North Oxford]

That the Grand Committee do consider the Specific Food Hygiene (Regulation (EC) No. 853/2004) (Amendment) (EU Exit) Regulations 2019.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank noble Lords for their consideration of the regulations. I am confident that we have the shared intention to ensure that the high standards of food and feed safety and consumer protection we enjoy in this country are maintained when the UK leaves the European Union. This instrument, and the original instrument that it amends, seek only to protect and maintain these standards. Changes are limited to minor drafting amendments to ensure that the legislation is operable on exit day. No policy changes are made through these instruments and we have no intention of making any at this point. This amends a previous EU exit SI, the Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019. Further clarity was required in setting out the authorisation process for products that can be used to remove surface contamination from products of animal origin. The clarification will ensure that the process is robust and can be applied clearly in assessing the risk of new products.

This instrument was made on 9 September under the urgent, made-affirmative procedure, which was considered appropriate to meet the deadline for the European Commission’s third country listing vote on 11 October. It needed to be in place to support the UK’s application for third country listed status with the EU. Third country listed status guarantees that the UK can continue to export animals and animal products to the EU after exit. The application was voted on by the European Commission on 11 October, and I am pleased to report that the vote was indeed in favour of accepting the UK’s application for third country listed status for products of animal origin.

I shall now talk a little about the specific detail of the minor and technical changes made by the instrument. The new instrument makes clear that the responsibility to approve substances that may be used to remove surface contamination from products of animal origin rests with the Secretary of State for Health and Social Care and the appropriate Minister in each of the devolved Administrations. Lack of clarity may affect implementation and has the potential to undermine the responsibilities for authorisation; the instrument therefore rectifies this. The measure introduces no substantive policy changes to what was successfully passed and made in Parliament in March 2019. 

Food business operators are not permitted to use any substance other than potable water or, where permitted, clean water, to remove surface contamination from products of animal origin unless this has been approved. This relates to business establishments that handle products such as meat, eggs, fish, cheese and milk and do not supply to final consumers. Currently, approval for such substances is given by the European Commission, but after EU exit this responsibility will be carried out by Ministers. The amendment to Regulation (EC) 853/2004, made by the specific food hygiene SI, is being further amended to make it absolutely clear that Ministers will be responsible for prescribing the use of any other substances and the process of consulting the Food Safety Authority is retained. That decision will be made based on rigorous, evidence-based and independent food safety advice from the FSA and the FSS.

If, after EU exit, any additional substances are proposed to be approved for this purpose, they will be subject to risk analysis by the FSA, which has established a rigorous and transparent risk analysis process for assessment and approval of any such new substances. Any requests for substance approval would be subject to thorough scientific risk assessment and risk management before being put to Ministers for the final decision. The advice provided to Ministers, and the analysis and evidence on which that advice is based, will be publicly available. All decisions to approve the use of substances to remove surface contamination from products of animal origin will be implemented by means of legislation, thus also providing opportunity for parliamentary scrutiny.

Let me be clear that neither this instrument nor the instrument it amends introduce any changes for food businesses in how they are regulated or run, and nor does it introduce an extra burden. The overall changes to the food hygiene regulations will ensure robust systems of control that will underpin UK businesses’ ability to trade both domestically and internationally.

It is also important to note that we have engaged positively with the devolved Administrations throughout the development of this instrument, and this ongoing engagement has been warmly welcomed. The Welsh Government have provided their consent and the Northern Ireland Civil Service has given its acknowledgement of this instrument. FSA officials have also been in close contact with the Scottish Government regarding these regulations. They have not yet had the opportunity to give their agreement, due to the necessity of having these regulations in place by 11 October, but we expect that to continue in a positive direction. I stress that we are still committed to the intergovernmental agreement accompanying this Act not to normally make EU exit regulations without the agreement of the devolved Administrations where the policy area is devolved in competence. However, as I explained, this is a very minor drafting change to a regulation the Scottish Government have previously agreed.

Finally, I draw noble Lords’ attention to the fact that, in line with informal communications that the FSA has had with the Joint Committee on Statutory Instruments, the agency will, in accordance with the terms of the free issue procedure, be making this instrument available free of charge to those who purchased the earlier exit SI. The Government accept that this instrument should have been made available under the free issue procedure when it was first made, but that did not happen due to an oversight. I apologise to noble Lords for that oversight and confirm that it will be corrected. The Food Standards Agency will be taking action, together with colleagues in the National Archives, to ensure that anyone entitled to a free copy of the instrument under that procedure will, where appropriate, be able to apply for a refund, or otherwise obtain a free copy of this instrument on request, in accordance with the usual terms of that procedure.  

This instrument constitutes a necessary measure to ensure that our food legislation relating to food safety continues to work effectively after exit day. I urge noble Lords to support the amendment proposed to ensure that we continue to have effective food safety and public health controls. I beg to move.

[Baroness Thornton (Lab)]

I thank the Minister for introducing these regulations. I also thank my noble friends Lord Rooker, Lady Jones and Lady Wheeler for carrying the bulk of the food standards instruments that we dealt with before the summer, when we seemed to do a great many of them. As the Minister said, these are important regulations because they address the process for approval of substances that may be used to remove surface contamination from products of animal origin.

As the noble Baroness confirmed, this SI was discussed earlier this year, but a great deal has changed since then, as we all know. We have a completely new Government, though I am pleased to see that the noble Baroness has remained in her job. What has not changed is the uncertainty over whether the UK will leave the EU in the next 15 days or so, with or without a deal, and the impact that could have. For the record, once again, we find ourselves back debating necessary statutory instruments and having to spend time and money putting through legislation in case of a no-deal Brexit.

We all agree that the safety of our food is of the utmost importance to our health and well-being. We have been fortunate to lead the world in food safety, in some areas. We have also had to learn some very hard lessons from our own food scares. We know that food safety must be protected at all costs. Therefore, I share the Government’s commitment to ensuring that there is no change in the high-level principles underpinning the day-to-day functioning of the food safety legal framework. Ensuring continuity for business and public health bodies is of the utmost importance and in the interest of the public. This has been the protection that the EU regulatory framework has afforded us in the UK.

While the Minister assures us that there is no substantive policy change, I need further reassurance. Paragraph 2.7 of the Explanatory Memorandum states:

“Following further policy deliberations, a revised approach to describing the process for approval of substances which may be used to remove surface contamination from products of animal origin is felt to be desirable”.


What does that revised approach consist of if it is not a policy change?

Why was this SI not among those we took through in March? What would have happened if we had left in March and this SI had not been on the statute book? What would have happened to this regulatory framework?

I am not convinced that the SI does not give some leeway for Ministers to approve substances that can be added to our food. I shall be interested to hear how confident the Minister is that the high standard of food safety will be maintained. What additional substances could be approved by Ministers if needed? How will that impact food safety? The safety of our food is hugely important and we cannot get this wrong, so I have made these very brief comments. I do not want to delay the Committee, but I welcome interventions from other noble Lords. We will, of course, not oppose this statutory instrument and I look forward to the Minister’s response.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

I thank noble Lords for what has been, as ever on the issue of food safety and the FSA, an informed and very expert debate. While I would never dare to call the noble Lord “Grandpa Nanny Rooker”, I assure him that the value and expertise of the FSA are under no question from the Department of Health and Social Care and the Government. Experts are very much in vogue in our department, and the importance of the FSA on exit day is very much understood. That is why we have taken such care in bringing forward the statutory instruments that, as he recognised, have been crafted to ensure the highest standards of food safety on exit day, no matter what the nature of the deal. I entirely agree with him that we should ensure that we continue to value the FSA and to communicate that value publicly and privately. I should expect no less than to be held to account by him on this issue every time I come into the Chamber. His expertise shone out during his speech.

I thank the noble Baronesses, Lady Thornton, Lady Jolly and Lady Kingsmill, for their support for the statutory instrument. I shall answer some of their questions, and I welcome their commitment to join the Government’s commitment to the very highest standards for food and food safety, represented in the statutory instrument.

I reassure the noble Baroness, Lady Kingsmill, that this instrument will not have a sunset clause for the specific reason that it amends retained EU law, so any future changes, as with the other statutory instruments, will be subject to parliamentary scrutiny and control in the normal way. It is in the event of no deal, so, should the Government reach a deal with the EU, as we very much hope they will, we will repeal or amend it in accordance with that outcome. It is being put forward to reassure rather than to create any concerns, so that we can ensure that we have in our legislative framework very clear processes for the cleaning of products of animal origin.

In response to the question put forward by the noble Baroness, Lady Thornton, this issue was not missed in the original statutory instrument. It was dealt with, but it was felt that the drafting needed to be clearer. It was brought forward in a swift and made-affirmative way because we wanted to make sure that, when we went forward to the vote on the third country listing, this was part of our statutory instrument programme at that point. That is why it went through quicker than it would otherwise have done. There was no intent to be underhand or sneak it through; we just wanted to make sure that it was part of the package at that stage. That is why we are having this debate now, after the fact. With this statutory instrument, we wanted to ensure that we clarified further the process for making decisions on the approval of substances to remove surface contamination from products of animal origin, and to move beyond doubt that the decision on approvals was for Ministers and a statutory instrument, so that there would be a double question of scrutiny on the basis of clear scientific and risk advice from the FSA.

A very clear process has been set out. Currently an applicant makes a request to the European Commission following agreement from representations with member states, which will refer the application to EFSA. EFSA will carry out a scientific evaluation of both the safety of the substance and the efficacy of its use. Following the issue of EFSA’s opinion, the member states will then vote on whether the substance will be approved by the European Commission Standing Committee meeting. After EU exit, we will have a similar process, with just the Ministers, or the devolved Administration representatives, replacing the European Commission, but we will have just as strong an emphasis on scientific advice and transparency.

I have a helpful diagram, provided for me by the Food Standards Agency, which I hope it is acceptable for me to display and which I am happy to put in the Library. It demonstrates the process the FSA will go through in ensuring that there is a transparent process for gathering scientific evidence. There are several points of publication of the evidence, which would then be presented to the Minister and then be available as part of the scrutiny process for statutory instruments. I hope that this is reassuring and that there would be no question of undermining the expert advice provided to Ministers. I will place this in the Library of both Houses for assessment by your Lordships.

In answer to the question from the noble Baroness, Lady Kingsmill, regarding farmed salmon—I did not know this, so it is a helpful, educational moment for me—there will be no policy change in this area, as in any other. The treatment of farmed salmon will follow the rules as now: either clean water or seawater could be used to surface-wash salmon. I hope that is reassuring for the noble Baroness.

On chlorinated chicken, the current situation will remain. No substances other than potable water are approved to remove surface contamination from chicken carcasses, and there is no intention to change this when we leave the EU. Any change to this would have to go through the application process, which I have outlined, and would be clearly transparent to Members of this House and members of the public. It would be open to scrutiny, so I hope that is reassuring.

The noble Baroness, Lady Kingsmill, rightly raised the important issue of animal welfare in the context of chlorinated chicken. That would be considered with an application, as it is an important concern. Scrutiny would be available not only through scientific consideration and the FSA’s consideration, but also through public and parliamentary consideration. The retention of current law helps us promote the good welfare standards we already have, so I hope that is a reassuring answer.

Finally, I turn to the important question from the noble Baroness, Lady Jolly, regarding the potential for different food and feed safety standards to emerge across the UK after exit. The FSA has considered this and discussed it closely with the devolved Administrations as we have prepared very carefully with the Administrations in Scotland, Wales and Northern Ireland for the—albeit unlikely—potential no deal. There is a commitment from all the devolved Administrations to a common approach across the UK, albeit with the potential for evidence-based divergence. We are confident that, in practice, it will be possible to make arrangements to operate a framework for food and feed safety regulation across the UK. It is one of the policy areas set out in the UK Government’s published provisional policy analysis, which is subject to detailed discussions between the UK Government and the DAs to explore what common framework arrangements are needed after we have exited the EU. Officials across the different devolved Administrations have already been working over recent months and years to make sure that this is implemented effectively, so there is confidence in the FSA and FSS that this can continue effectively. I hope I have answered all the questions asked.

[Baroness Jolly]

The Minister has not answered one question; it may be that she does not have the answer at the moment. I have not seen her diagram with blobs on, but can she indicate whether there would be any element of public consultation if the Secretary of State were to consider a change?

[Baroness Blackwood of North Oxford]

The noble Baroness asks an important question. There is the opportunity for formal consultation as necessary, depending on the nature of the change. This is point 10 in the diagram and, yes, I have just been told that it is there in the SI, depending on the nature of the change that comes forward. Given that any formal advice would be available for public scrutiny, it would be evident and open should there be any need for public consultation. Given that there are implications for industry, this would be carefully managed. It is notable, and important to take into account, how carefully the FSA has managed its statutory instrument programme. It carried out a six-week consultation to prepare for its 16 SIs and managed its engagement very carefully. The impact assessment was very carefully managed, and I think this is an indication of its intention going forward. I beg to move.

Motion agreed.

Brexit: Medicine Supply and NHS Staffing

Baroness Blackwood of North Oxford Excerpts

Thursday 5th September 2019 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we recognise that leaving the EU could affect a wide range of areas across the health and care system. We are doing everything possible to prepare, and our plans should help to ensure that the supply of medicines remains uninterrupted. We continue to monitor staffing levels, and we are working to ensure that there will continue to be sufficient staff to deliver the high-quality services on which the public rely.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. I suspect that this Question is an appropriate one, given the debate we are going to have later. Given that the majority of the House is trying to save the Government from their foolishness of crashing out of the EU, these are very important questions because they affect people’s lives and their futures.

I have two questions. What is the department doing to sort out the fact that the Home Office is still completely failing to deliver how settled status can be offered? We are losing European staff from the NHS, including senior and experienced doctors, at a huge rate, which will mean enormous problems. Secondly, on medicines, what measures have the Government put in place to ensure that the shortage protocol does not negatively impact patient safety, and how are the Government going to prevent the UK from becoming a third-tier market for medicines and ensure that we can access medicines and new drugs in a timely fashion if we crash out of the EU?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her comprehensive questions. Regarding the EU settlement scheme, we are very pleased that there are now record levels of EU nationals working in the NHS and the social care system. We hugely value their contribution. We need them, and we want them to stay. EU nationals working in the NHS can obtain their long-term status in the UK through the EU settlement scheme, and we are supporting NHS Employers in promoting the EU settlement scheme. On 15 August, the Home Office said that 1 million people had been granted settlement status. Where there have been challenges to working through that, there is support to address it. The EU settlement scheme statistics confirm that not a single person has been refused the status that they applied for. About three-quarters of people receive that status without the Home Office needing to ask for additional evidence on the length of residence; we are checking that is working as it should.

When it comes to medicines, we continue to implement a multi-layered approach to minimise any disruptions of medicines and medical products in a no-deal scenario to ensure that patients will have access to the medicines they need. There are about 7,000 prescription-only and pharmacy-only medicines, and we have been working very closely with suppliers, asking them to hold at least six weeks of stock. The shortage protocol will be led by clinicians, to ensure that patients can access the medicines that they need and are not put at risk. Any decision about this will be made between the patient and their clinician, to ensure that it is appropriate for the care of the individual patient in question.

[Lord Deben (Con)]

My Lords, the Government have claimed that they have done a detailed account of what would happen if we were to leave the European Union, as far as the health service is concerned. Why have they not published that detailed account, why do we not know any of those details and why is the whole country being kept in the dark on all these issues? The Minister has the facts. Can we please have them now, so that we know what we are debating about?

[Baroness Blackwood of North Oxford]

I do not believe that the noble Lord is presenting an accurate picture of the case. We have been very clear with the public, and a lot of information has been published on the MHRA website, on GOV.UK, on nhs.uk and in a number of other places, regarding the information about the analysis of the impact of no deal on patients and on the NHS. We have been very clear about the risks that we think there may be to the supply of medicines due to temporary disruption at the border and the mitigating measures that we have taken to ensure that the supply will continue uninterrupted to patients and to the healthcare system. If the noble Lord wishes to have more information, I am sure that he would be very happy to write to me, and I will place a copy of my reply in the Library.

[Lord Clark of Windermere (Lab)]

My Lords, the noble Baroness is aware that virtually every pharmacist and every GP is experiencing dire shortages of certain medicines already. If the Government have such a good alternative plan for a no-deal Brexit, why do they not bring forward those plans to deal with the shortage that patients are facing today?

[Baroness Blackwood of North Oxford]

At any given time, there are about 100 to 150 medicine shortages within our system. There is a team specifically set up in the Department for Health and Social Care to deal with these shortages. There is no evidence whatsoever that the shortages within the medicine system at the moment are related to Brexit. I work to respond to those shortages every day. The system that we have set up to respond to the potential risks of no deal—which we do not want to happen—is prospective. We are confident that it will be able to respond to any potential border disruption on the short straits.

[Baroness Jolly (LD)]

My Lords, what proportion of our pharmaceuticals are manufactured in the UK? Have Brexit deal negotiators discussed pharmaceutical supplies and, if so, what was the outcome? How many people will be immediately affected if a no-deal Brexit is the final outcome?

[Baroness Blackwood of North Oxford]

I do not have the data for the proportion manufactured in the UK, but I can tell her that there are 7,000 prescription-only and pharmacy medicines with an EU touchpoint which we believe we need to import into the UK at the point of no deal. We have been working very closely with those suppliers, asking them to hold a six-week stock, over and above the usual buffer stock that they hold in case of a potential shortage, which they always hold a risk of. We have also put in place a number of other multi-layered mitigation measures, which include securing capacity for re-routing freight. We have also put in place a number of other measures, such as providing assurance of readiness for logistics and supply chains to meet new customs and border requirements. We have been working to ensure that we communicate that to all those along the supply chains, in the NHS system and in the pharmacy chain.