Brexit: Health and Welfare

Baroness Brinton Excerpts

Thursday 29th March 2018 Lords Chamber

Moved by

[Baroness Brinton]

That this House takes note of the effect of the United Kingdom’s planned withdrawal from the European Union on the health and welfare of United Kingdom citizens and residents.

[Baroness Brinton (LD)]

My Lords, this year the NHS is turning 70. Our universally beloved institution has transformed the health and well-being of the British people for longer than most of us have been alive—perhaps excluding Members of your Lordships’ House, where our average age is 70—and is the envy of many countries around the world. I am proud that a Liberal MP and economist, William Beveridge, wrote the report that made the proposal for a universal health system free at the point of delivery and paid for through taxes, which transformed healthcare in the United Kingdom. Beveridge understood that there needed to be widespread reforms to social welfare, first introduced by the Liberal Government in 1911, which had to address his five “giant evils” of squalor, ignorance, want, idleness and—perhaps most important to the NHS—disease. Fighting these giant evils is key to the health and welfare of UK citizens and residents.

Unlike in the United States and some other countries, the British believe that healthcare is a right, not a privilege, and we accept the opportunity to pay for it through general taxation. Recent polls show that a large number of people support the Liberal Democrat proposals for an increase in income tax to help fund the NHS, alongside reforms that are necessary for any healthcare system in the 21st century.

The NHS has a history of evolving in response to the changing needs of the nation, yet there is hardly any discussion about the effects of Brexit on our health and welfare systems. It therefore seems appropriate, on the first anniversary of triggering Article 50, for your Lordships’ House to look at these issues in some more detail. I look forward to contributions from other Members of the House who will cover specific items in detail; there is not time in the 15 minutes that I have to cover everything.

If you ask most people about Brexit and the NHS, regardless of how they voted in the referendum I suspect the first thing they would talk of is that large red bus from the leave campaign claiming that the EU costs the UK £350 million per week, which could all be invested in the NHS upon leaving the EU, while forgetting to tell us that that would remove funding from agriculture, fisheries and many other current EU projects based in the UK. Not only was this untrue—a fact checked repeatedly during the campaign by independent bodies—but there are figures to show that the cost of leaving the EU to our economy could now be equal to that £350 million per week.

Research by the Financial Times suggests the value of Britain’s output is now 0.9% lower than it would have been if the UK had not decided to leave the EU—and, guess what, that comes to just under £350 million a week. That irony is not lost on those of us who challenged the original leave campaign on its obviously fantastical claims at the time. Since then, much of the debate over the UK leaving the European Union has focused on trade, the single market and the customs union. Today, as we mark the first anniversary of the triggering of Article 50, we must start to identify some of the less visible but absolutely vital elements of Brexit that will affect the health and welfare of people in the UK.

At a time of unprecedented pressure on the NHS, it needs urgent and real investment to prevent it crumbling, so I welcome the Prime Minister’s announcements earlier this week and look forward to the detail. I hope that it can deliver the real financial help that is so desperately needed but woe betide her if it is neither real nor speedy. The Chancellor has set aside £3 billion for Brexit matters alone this year. With the chaos of where the negotiations are, who knows if that will be enough? What is clear is that people know that the NHS is in desperate need of resources. Yesterday, many hospitals across the country were still struggling with their A&E targets. Among many others, Addenbrooke’s in Cambridge was predicting 12-hour waits in A&E and had once again cancelled all non-emergency operations—and, indeed, some cancer treatments.

However, one of the lesser known pillars of protecting our NHS is also at risk with Brexit. With more and more parts of its services being put out to tender, the NHS has ultimately been protected by the EU directive on public health procurement. This directive governs the way in which public bodies purchase goods, services and works and seeks to guarantee equal access and fair competition for public contracts in EU markets. It includes specific protection for clinical services and more legal clarity on the application of procurement rules. The bottom line makes it clear that, unlike non-public services, a public body based in an EU member state can accept a contract that is not the cheapest if it fulfils the quality, continuity, accessibility and comprehensiveness of services and innovation. There is also no need to publish procurement advertisements cross-border, which, as Ministers have repeatedly said in Parliament, is a key tool to preventing mass privatisation of the NHS.

If we proceed with Brexit and leave the single market and the customs union, the NHS will lose its biggest but most invisible protector: this directive, which governs all public sector procurement in member states. It defines fair process and standards to ensure that all EU businesses, including the NHS, have fair competition for contracts. It prevents conflicts of interest through robust exclusion grounds and protects against creeping privatisation. PFI also remains a serious financial risk.

We must learn from the liquidation of Carillion and the ensuing loss of jobs that shone a light on the dangers of letting privatisation run rampant. The NHS now has more than 100 PFI hospitals, which originally cost £11.5 billion. After being privatised, they will cost the public close to £80 billion. The difference could have funded the NHS for two and a half years, but that is not all. The total PFI debt in the UK is more than £300 billion for projects worth only £55 billion. In order to protect NHS institutions from American corporations looking to buy after Brexit, we must write this EU directive into UK law. The NHS we all know is dependent on this. It is in danger. If we do not transfer the directive into UK law, there is nothing to stop the lowest bid for any service always winning wherever it might originate from and without regard for the standard of care. We know that there are many US companies already eyeing up the NHS.

As an aside, given the debate in Oral Questions about passports, the French Government have used this EU directive to ensure that French passports are made by French firms in France because they regard specialist printing as a security matter—funny, that. Despite Brexit, our Government chose not to use the same provision to print the next generation of UK passports here in the UK by a preferred UK company.

Returning to the NHS, while there was understandably concern about the TTIP agreement, it was this EU directive which provided a guarantee that US companies could not come in and cherry pick our NHS. On 18 November 2014, the noble Lord, Lord Livingston of Parkhead, answered my Question in your Lordship’s House by quoting an EU Commissioner:

“Commissioner de Gucht has been very clear:

‘Public services are always exempted ... The argument is abused in your country for political reasons’.


That is pretty clear. The US has also made it entirely clear. Its chief negotiator said that it was not seeking for public services to be incorporated. No one on either side is seeking to have the NHS treated in a different way ... trade agreements to date have always protected public services”.—[Official Report, 18/11/14; col. 374.]

That was under President Obama. I suspect matters have changed since President Trump came to power, so I am seeking unequivocal confirmation from the Minister and the Government that they will stand by their word in coalition government in 2014 and fully re-enact these procurement rules for public services in UK law to continue to protect the NHS from future trade agreements. More than that, I hope that the Government will remind the NHS of its rights under this directive; it seems that too many contracts are being let on value not quality of service.

Another key element of these procurement rules that needs to be protected is accessibility. This has meant that public money should no longer be used to introduce or maintain inaccessible structures, systems or services. It is essential for disabled people that these accessibility rules continue. I recognise that it is not without cost, but it is a core element of the EU directive and is essential for any Government who believe that all members of society need to be treated equally.

I know that many other issues affecting the health and welfare of people in the UK will be covered in the debate, and I am looking forward to hearing from noble Lords who will speak shortly. Their expertise is exceptional. I thank those from the Library and other specialist groups who have provided briefings for us. I only wish that I had time to do justice to all their recommendations, but I know that colleagues will speak far better than I could to prosecute their cause. These issues include the reduction in the number of EU workers, which is already having an impact on our hospitals and social care services from clinical to support staff, and the loss of the European Medicines Agency headquarters from London, and therefore our influence over it if we leave, which will be very serious; we may wish to join as a junior partner, but we will have lost our influence. It is also serious for London’s economy where more than 70,000 bed nights a year will be lost for tourism. Radiologists are very concerned that the extra paperwork and regulation resulting from not being a full member might disrupt supplies. Cancer treatment is so time-sensitive that delay can have a real effect. More than one quarter of clinical trials funded by Cancer Research UK involve at last one other EU country. That pan-European and international approach is crucial for paediatric and rare cancers. The UK has led or participated in the largest number of these trials for types of disease, but once we are no longer at the EU research table, what will our influence be?

Should Brexit move forward and should we leave Euratom, we would jeopardise the domestic nuclear sector, the regulation and transportation of life-saving cancer medication and research into using radioisotopes, as well as the UK’s decarbonisation initiative which will help with ozone and air quality. That is why your Lordships voted to pause leaving Euratom earlier this week. Interestingly, while pro-Brexiteers argue that membership of Euratom places us under the influence of the European Court of Justice, there has never been an ECJ case involving the UK and Euratom.

Dr John Buscombe, president of the British Nuclear Medicine Society, told a parliamentary committee that close to 1 million patients across the UK have medical imaging with radioisotopes each year, and 80% are imported into the UK from the European Union. Dr Buscombe was very concerned about the security of supply. He said:

“We have had problems with product coming in, particularly from places like Canada, where they haven’t turned up, got delayed or have the wrong paperwork”.


We must ensure that the future supply is maintained.

Moreover, what happens to UK citizens living or travelling in another EU country? Reciprocal services, starting with the well-known EHIC card, are built into our daily lives. During Brexit negotiations, and hopefully in transition, UK citizens will still be able to use the EHIC card to receive state-provided emergency medical care. However, yesterday’s excellent EU Committee report Brexit: Reciprocal Healthcare sets out the real difficulties. No deal has yet been made; no assurances have been given to ensure medical treatment for UK citizens outside the border.

As on every other Brexit issue, there is the real problem of Northern Ireland and the Republic. Joint health services, for example, allow patients to get medicine at any pharmacy north or south of the border, irrespective of the location of the GP responsible for the prescription. Ambulances on either side of the border are currently free to travel across the border to attend emergencies such as road traffic accidents and cardiac arrests. People across the island are allowed to receive radiotherapy at a new £50 million centre for cancer patients on both sides of the border at Altnagelvin Area Hospital in Derry, which opened just a year ago. Bernie McCrory, the chief officer of Co-operation and Working Together, said:

“In the past we would have had young mothers who would have declined to go to Dublin because of the time away from their children and they would have opted for radical surgery”—


instead of this specialist treatment. At Altnagelvin Area Hospital,

“we have created a pathway for patients that didn’t exist before”.

There is yet no pathway for how we manage the difficult cross-border issues in Ireland.

In conclusion, the health and welfare of UK residents will be affected by Brexit and there is much that needs to be done now to establish the rights of UK and EU citizens to strike effective deals and to recognise that the consequences of Brexit on our health and welfare might be serious. In that event, does the Minister agree that perhaps the people should have the final say? More than that, there are steps that the Government need to take now to reassure us: for example, in relation to the EU directive that I mentioned earlier. It is absolutely vital that that protection remains. I beg to move.

--- Later in debate ---

[Baroness Brinton]

My Lords, I start by thanking the Minister for his response. I will link that with the comment of the noble Lord, Lord Dykes, about the noble Baronesses’ contribution to the debate. While it was very flattering for us to be so mentioned, the Minister in particular but other noble Lords who spoke also have that in-depth knowledge. I want us to recognise that.

I will not attempt to summarise things in the very brief time I have now, but I thank all noble Lords who spoke. As I predicted, the contributions were of considerable depth and expertise, combined with experience and anecdote that demonstrated the real concern many of us have about health and welfare in the light of Brexit. The key things that stuck out for me were the problems with high-skill and low-skill recruitment in the health sector. The tier 2 limits are ridiculous. I thank the noble Lord, Lord Balfe, for his comments on Addenbrooke’s. My clinic has been delayed by a year because it has been unable to bring in the consultants it wanted from abroad. We heard about trailblazers, and the fact that young people with muscular dystrophy are flying in help from Europe because there is not the specialised care and support; that is really worrying. While I admit that the Government are trying to negotiate the rights of people to come to work here, they are not in place yet. The compelling personal testimony of my noble friend Lady Thomas and the noble Baroness, Lady Masham, was very moving. I thank them for that.

I will end on a phrase that the noble Baroness, Lady Thornton, used. She asked why we would want to be outside the EMA. I will add to that the working time directive, the ECDC, the EU directive on public procurement, Horizon 2020, medical devices and Northern Ireland border issues, all of which came up in depth during the debate. So perhaps the best note to end on would be to say that we can have the best of all worlds—and that is by remaining inside the EU.

Motion agreed.

Health: Medical Respite for Children

Baroness Brinton Excerpts

Wednesday 21st March 2018 Lords Chamber

Asked by

[Baroness Brinton]

To ask Her Majesty’s Government what guidance is provided to Clinical Commissioning Groups in exercising their duty to provide medical respite care for seriously ill and disabled children, following the High Court decision of 21 February.

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

My Lords, although there is no specific statutory duty on clinical commissioning groups to offer respite care, under provisions in the National Health Service Act 2006, CCGs must ensure that they secure health services to meet the needs of disabled children to a reasonable extent. Furthermore, the statutory framework introduced in the Children and Families Act 2014 requires CCGs and local authorities to work together to support all the needs of children with a special educational need or disability.

[Baroness Brinton (LD)]

I thank the Minister for his Answer. Despite the High Court judgment in the case being brought by the amazing Nascot Lawn parents, which made it absolutely clear that the very disabled children involved are entitled to individualised NHS support, it has now emerged that the Herts Valleys CCG’s so-called assessment for each case was a five-minute pre-assessment box-ticking and that the child was not even present. The CCG is still trying to dictate its contribution to the county for the care and is not consulting the families. Can the Minister explain what steps the Government and NHS England can take to ensure that Herts Valleys CCG makes appropriate provision for each of these children, when it appears it remains determined not to?

[Lord O'Shaughnessy]

I congratulate the noble Baroness on her tenacity in raising the issue and thank her for giving me the opportunity to meet parents whose children use these services. First, it is incredibly important to be clear that there are rules for how the consultations that the judicial review said should be held should take place, and they must be abided by. More importantly, as I have just set out, there are legal obligations under the 2014 Act for joint commissioning between the CCG and the local authority. That is not one telling the other what to do; it is joint commissioning. Most important of all—the point that the noble Baroness makes—is that whenever these bodies are planning for the future, they have to keep the needs of the children in mind. That is what we, whether it is NHS England or the department, are imploring them to do through this process. Indeed, they are obliged to do that.

National Child Obesity Strategy

Baroness Brinton Excerpts

Monday 26th February 2018 Lords Chamber

[Lord O’Shaughnessy]

We have a free school meal policy in this country. Indeed, the previous Government introduced free school meals for all children up to the age of seven, I believe, so we have made a significant impact in this area. I talked about breakfast clubs, which will also help, particularly disadvantaged children.

[Baroness Brinton (LD)]

My Lords, the salt reduction strategy worked particularly well because all supermarkets came together and followed it. Two years ago, Sainsbury’s chief executive asked the Government to introduce compulsory targets for sugar reduction, but we have not seen them yet. After the first year of the sugar tax in Mexico, there was a 17% reduction in purchases by poor people and a 12% reduction across the board. It works. If the supermarkets want it, why will the Government not follow?

[Lord O’Shaughnessy]

We are making good progress in reformulation and in reducing sugar in drinks, which I have talked about, and in other foods. However, we have to look at the impact. We will look at that and if progress is not made—let us face it, obesity levels are unfortunately continuing to increase—clearly other actions will have to be taken.

Medicines and Medical Devices Safety Review

Baroness Brinton Excerpts

Thursday 22nd February 2018 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the Minister for repeating the Statement. I should also like to thank him personally for meeting representatives from the mesh campaign group two weeks ago, which is much appreciated.

Today’s announcement is an acknowledgement that there are major issues which go back decades in areas that concern safety and a lack of proper scrutiny and research. We have heard how mesh implants have left women in permanent pain, unable to walk and unable to work. Welcome as the Statement is, the Government need to do much more to support those affected. Mesh has been suspended in Scotland and banned in other countries. The most recent interventional procedure advice from NICE on prolapses states that it should be used only for research purposes and not as a front-line treatment, but I ask the Minister whether he thinks we need to go further and suspend the use of mesh until NICE has completed its review into the safety and efficacy of the product. If the Government are not prepared to go as far as suspension, will he at least write to all trusts and indeed private hospitals to remind them that the Health and Social Care Act 2015 requires them not to cause avoidable harm? The review in itself signals that mesh is now acknowledged to cause harm.

I refer the Minister to Owen Smith’s comments in the other place; he chairs the All-Party Group on Surgical Mesh Implants. He said that:

“Lessons must be learned from the awful complications many women have experienced since undergoing mesh surgery and proper processes must be put in place to stop this happening in the future … The mesh scandal shows what can go wrong when devices are aggressively marketed to doctors and then used in patients for whom they were unsuited or unnecessary”.


Will the review chaired by the noble Baroness, Lady Cumberlege, look into that particular aspect?

The Minister mentioned in the Statement the investment of £1.1 million, part of which will go to improving clinical practice. Clearly, one should always seek to improve clinical practice, but mesh campaigners would say that the real issue is not the clinical practice but the product itself, which is not fit for purpose.

The retrospective audit is very welcome indeed, but there is a real question about whether it will capture all the women affected. I have certainly received evidence to suggest that some women suffering greatly from mesh implants are not aware of the reasons and therefore do not approach the health service. Will the Minister also say whether the mesh audit concerns only hospital statistics and records or whether it will cover GPs and primary care as well? Also, will the review extend to when men and women are affected by hernia mesh?

The Secretary of State has said that the review will not go into the science of mesh. But most studies do not use quality-of-life questionnaires, so they do not pick up the devastation of pain, lost sex lives or constant urinary infections. Studies concentrate on whether the mesh has cured the problem of prolapse or incontinence. Many studies are short-term or compare mesh to mesh. Trials should compare mesh to the old-fashioned natural tissue repair to get a proper evaluation of whether the use of these products should be continued in the future. Many trials have low numbers and any woman who has had a mesh implant can feel like a ticking time bomb, as the product can shrink or twist years down the line. No amount of surgeon training can counteract that.

Will the review extend to those with mesh bowel prolapses? Will it also look at what help the NHS needs to give to people currently affected as mesh sufferers? Obviously each country in the UK is taking a slightly different approach but, in his role as the Minister responsible, will he work with Scotland, Wales and Northern Ireland to pull together research and co-ordinated action, which would make great sense?

I hope that the noble Baroness, Lady Cumberlege, will be asked to look at whether device regulation needs to be tightened up. As the Minister knows, it is much less stringent than medicines regulation and there has been an ongoing debate about that. I hope that that will be included within her review.

On Primodos, the Minister indicated that the department would drive forward and accept the recommendations of the expert working group. But in the other place when the report was published in October, it was met with concern from all sides of the House. I hope that he will take that into account.

I am grateful that the Secretary of State has included sodium valproate in this work. The Minister will know that last year a charity found that almost one-fifth of women taking the drug still did not know the risks that this medicine could pose during pregnancy. I therefore welcome government efforts to raise awareness of the dangers of valproate. I also hope that the House can be offered an assurance that the review will gain access to medicine regulation files held in national archives, access to any valuable evidence cited in unsuccessful legal actions and access to documents and information held by pharmaceutical companies, and that all such material will be made public.

I ask the Minister to invite the noble Baroness, Lady Cumberlege, to meet victims to see whether consensus can be agreed on the terms of reference, to maintain trust and confidence in it. That would be a very valuable first step to gaining the confidence of campaigners who have worked so hard and have been gratefully acknowledged by the Secretary of State in his Statement.

[Baroness Brinton (LD)]

From the Liberal Democrat Benches, I am very grateful and thank the Minister for the Statement. I am particularly pleased about its tone, which moves on the Government’s debate with campaigners, families and clinicians about these very serious issues. It makes a break with the past.

I am particularly concerned that there should be regular assessments and updates for people with problems from Primodos and sodium valproate, because we know from our experience with thalidomide that everybody thought that everything had been sorted from the initial diagnosis of the children, but as they entered adulthood and more mature years further medical issues appeared. It will be important to recognise that we need to make sure these young people—and adults as they are now—get that protection.

The yellow card system was not available in its current format for these two drugs. One of the things that concerns me most about the Statement is the assumption that the only people involved with the yellow card are clinicians. Speaking as a patient who has been on a drug that has very serious yellow card incidents, I have been trained to recognise that if I get a side-effect I do not just go back to my hospital; I report it to the pharma company. The pharma companies are notable by their absence in this Statement. Will there be specific links back for clinicians and patients on some of the side-effects of drugs? That is easy to say for those who are formally expert patients. I absolutely accept the point made by the noble Lord, Lord Hunt, that some patients are inexpert for all the right reasons.

There needs to be a real focus on all the other health professionals that these patients come into contact with. Reporting a yellow card incident to a GP when it is very difficult to see your own GP these days means that it could quite often be missed. In the case of sodium valproate this certainly needs to include midwives and people involved in the obs and gynae departments as well. What training is to be provided for these non-specialist healthcare people to make sure that they understand, when a patient talks about a problem, that this may need to trigger a yellow card response? To that end, I welcome the proposal for an electronic yellow card. That will be extremely helpful. Printing out a yellow card, filling it in and sending it in is an absolute deterrent to it happening.

On Primodos and sodium valproate, will the longer-term effects also be covered by the Cumberlege review? It is important to have a reference back there. I am also concerned about the vaginal mesh issues, specifically those reported in the Statement. It would be useful to know what percentage of those who have had vaginal mesh implants have faced problems. It is fine to say that many have benefited. I completely accept that, but one needs to understand what the ratio is between those facing problems and those for whom it has benefited them, to understand whether a ban should be in place. What is the date for publishing the retrospective audit? It is fine to say that it will be done. I have no idea how far along the line the process is. Then there is the timescale for creating that computer database for vaginal mesh to improve clinical practice. When will it be not just commissioned, but completed and used in analysis? Will interim reports go to the noble Baroness, Lady Cumberlege, by the people doing this review if evidence emerges that she will need to take account of?

I am concerned about the idea of the creation of a patients’ champion. We already have panels and expert groups. Yet another person that patients may or may not know about, and may or may not be able to turn to, seems problematic. I urge the noble Baroness, Lady Cumberlege, to look at what is available now rather than creating yet another body.

Finally, I echo the concerns expressed by the noble Lord, Lord Hunt, about whether we should move to a public inquiry at this stage. I wonder whether the evidence that the noble Baroness, Lady Cumberlege, will undoubtedly turn up means that she may come back to Ministers and say, “Actually, this is the point at which this needs to go public”. Campaigners have highlighted for years that there are problems.

[Lord O'Shaughnessy]

I thank both noble Lords for their extensive, well-informed and probing questions; I will try to deal with all of them. I want first to take the opportunity to pay tribute to those involved in each of the three campaigns. They are almost exclusively women. A factor that needs consideration is not only that users of healthcare services are disproportionately women but that women seem to be disproportionately on the end of things when things go wrong—that issue needs investigating in itself. I have had the chance to meet not only the mesh campaigners but campaigners on sodium valproate and Primodos. They have gone to extraordinary lengths to raise these issues; they are remarkable women.

On the position relating to mesh, I have asked the MHRA and NICE as the two regulatory bodies to get in touch with their counterparts in Australia and New Zealand. There is some quite long, technical advice which I will not attempt to repeat, except to say that perhaps the simplified public view of what has happened in each of those countries is not entirely accurate. I shall certainly write to all noble Lords taking part in this debate and place a copy of that evidence in the Library. It is quite important. It is detailed, but it is well worth looking at.

I emphasise that collaboration is going on not only internationally but within the four corners of the United Kingdom. The CMOs of those four countries have met. I am meeting the Scottish Cabinet Secretary for Health—I think, next week—to talk about this specific issue and other things as well, so we are cognizant of the need for a joined-up UK approach.

On the scope of the review, it is very open. In the noble Baroness, Lady Cumberlege, we have an ideal chair: someone who has campaigned on safety issues, who is deeply knowledgeable, well respected and fiercely independent—as we know. She has the opportunity to look not just at issues around marketing, as the noble Lord, Lord Hunt, mentioned, but around the private sector. She will be able to look, too, at whether there should be public inquiries or other types of inquiry and to make recommendations. She will be able to look at pharma companies and gather evidence from wherever it is required. I want to emphasise that the review is very broad in scope. As the noble Baroness, Lady Brinton, said, we are trying to mark a break from the past. We know that we have not dealt with these things well. We are beginning to address that in the clinical and medical space in terms of medical practice; we now need to move on to medicines and devices, which is what we hope to do with this process.

On issues around the mesh, the audit and the registry, the audit is obviously retrospective. It will not be a perfect exercise, because the data is not always perfectly gathered, but it will be quite extensive in scope. It will be able to pick up not just complications associated by women, or indeed men, with having mesh but whether they have turned up in pain at another setting. We are confident that it will paint a much broader picture than we have had. The intention is to publish that in the spring. Obviously, if any interim reports relating to it come out, they will be shared with the noble Baroness, Lady Cumberlege, but clearly there needs to be robustness to them.

On the registry, this is an important moment. We have found the money to do this; it will be funded for the set-up and then for the first three years, which is the normal way in which registries are done. I do not yet have a timeline for how it will be delivered, but clearly we want to get it up and running as quickly as possible. It needs to be commissioned, but it is in everyone’s interest to do that.

Primodos presents a challenging issue, because it is not available on the market and has not been for 40 years, so it is not possible to carry out studies on what is happening to women now. However, new evidence has come to light which will also need to be considered and which was not available for the expert working group. Again, my noble friend Lady Cumberlege will be able to consider that as she looks at what needs to happen in each of those three cases.

One thing that we have to do—this moves on to the expert working group’s recommendations from the Primodos review, which is obviously very germane for women taking sodium valproate—is make sure that there is proper training for health professionals, not just in the yellow card scheme but for obstetricians in terms of their pharmacological advice and expertise. Indeed, that is one of the recommendations I will be taking forward, as was set out in the Statement. The valproate issue is very difficult, because it is an extremely effective anti-epilepsy drug but it can have very bad consequences for pregnant women and their children. I have met one of the campaigners; four or five of her children are affected and it is having a devastating impact on her life. We need to get to a position where no women of childbearing potential are using it. That needs to be done in the context of recognising that it does work for epilepsy.

Finally, I absolutely agree with the noble Lord, Lord Hunt, about meeting the groups to define the terms of reference. Again, we have learned from past experience that that has not always been done well and it is best done independently of government, with that degree of objectivity. I think that that is what this review will bring. As I say, the overall hope is that not only do we deal with the issues under each of these three headings, historical and current, but that we put in place a system that means that patients do not have to go through this tortuous process to get their concerns heard in future.

Disabled People: Social Care

Baroness Brinton Excerpts

Tuesday 20th February 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for her question. She is quite right to highlight the importance of reform for this group of people. We are talking about 250,000 people now, but that is projected to rise to 400,000 working-age adults in the next 15 years. I want to reassure her that, while the Green Paper itself is focused on care reform for older people, a parallel programme of work is going on. There is an important round table coming up which is being chaired by both the new Minister of State for Care, Caroline Dinenage, and the Parliamentary Under-Secretary for Communities and Local Government, with Mencap, Scope and others. We are giving the issue equal seriousness, as it deserves.

[Baroness Brinton (LD)]

My Lords, the charity Together for Short Lives last year put in a Freedom of Information Act request and found that one in five local authorities and one in six CCGs have absolutely no provision for respite care short breaks for the most seriously ill and disabled children. Since then we have received reports from across the country of more and more centres under threat or actually closing, such as Nascot Lawn, which I have raised in your Lordships’ House before, which is in court again tomorrow to try to save it. What is happening about this social care and nursing care provision for children? Normally, for adults, there is a negotiation between the NHS and the local authority about what is nursing and what is social care. But for these children there seems to be no such relationship; both local authorities and the NHS just point fingers at each other, and the result is children and their families not getting breaks.

[Lord O'Shaughnessy]

I am very aware of this issue. Indeed, we have had the opportunity to speak about it in specific cases. Local authorities of course are obliged to provide respite care. The noble Baroness highlights an important point about care, which seems in a way to slip between the boundaries of the two. I shall write to her about the general policy work that is going on, but I know that we need to solve this because we have children who are now living longer who before might not have lived so long and who require care, as do their families. It is essential that they get the care that they deserve.

NHS: Winter Crisis

Baroness Brinton Excerpts

Wednesday 7th February 2018 Lords Chamber

[Lord O'Shaughnessy]

I totally reject the accusation of meanness. If noble Lords look at the spending on the NHS, not only has it gone up in real terms every year while a massive fiscal retrenchment has had to take place to deal with £150 billion of borrowing bequeathed by the previous Government, but it now accounts for the highest percentage share of public spending that has ever been in place. We have found the money in difficult circumstances. We all agree that more is needed. More was found in the Budget; I am sure more will be found in the future.

[Baroness Brinton (LD)]

My Lords, in 2015 the King’s Fund warned the Government that the NHS would experience a “full-blown crisis in care” if the Government did not act early enough. That crisis has now materialised, with the additional funding announced in November’s Budget having arrived too late for hospitals struggling to cope with the accepted increase in demand from patients at that time of year. If the planning is to be published in July, when will the announcement about money to support that planning also be announced?

NHS: Clinical Negligence

Baroness Brinton Excerpts

Wednesday 31st January 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord knows more about this issue than anyone in the House, I think. The issue of reform to tort law is difficult. We have to be very careful when stepping across the idea of full compensation. It is one of the issues we are looking at. Other countries, such as Australia, have looked at this and we are considering it as part of the cross-government strategy. As I said, we will report by September this year on our plans in this area.

[Baroness Brinton (LD)]

My Lords, it is estimated that a relatively small number of clinical negligence cases end up as claims filed with the NHS. Has the NHS undertaken additional efforts to understand what factors cause certain cases to be escalated, in particular the attitude of lawyers in the NHS and trusts? How can escalation be prevented and, if so, when might the results be published?

[Lord O'Shaughnessy]

I point the noble Baroness in the direction of a five-year strategy that was published by NHS Resolution, the body that acts on behalf of what used to be the NHS Litigation Authority. The strategy looked at many issues, not only how we can prevent escalation. One of the drivers of cost is unsuccessful claims; more of those are going on. It also looked at how we can reduce incidents in the first place and learn from deaths and injury throughout the system, so that we can start to reduce the burden overall.

Social Care

Baroness Brinton Excerpts

Thursday 7th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Lord for raising that point. I apologise again for the lateness of our response to the Lords committee. What I hope is now the final version is with me for approval, and I hope it will be provided very soon.

On the Green Paper, we all want more integration between health and social care. We know that is important for the people who are increasingly using those services who are in older age, have comorbidities and are moving in and out of different settings of the time. Social care is paid for on a different basis from the NHS. That is critical. We have to get a sustainable financial basis on which we distribute social care while thinking about how it interacts with the health service. The Green Paper is trying to crack a nut that, frankly, has eluded Governments for the last 20 years.

[Baroness Brinton (LD)]

My Lords, I am grateful to the Minister for referring to Nascot Lawn. I was not going to raise it today because that is about care for severely disabled children under 18, but I want to pick up on my noble friend’s point about adult care for people with disabilities and long-term conditions. As we know, their care needs are very different from end-of-life needs. Both the current social care system and the Dilnot proposals were focused on end-of-life care, so I welcome the parallel work stream, but will it operate to exactly the same timescale and report back?

I have a further question on housing. Your Lordships’ House will remember that the recommendations of the Lords Select Committee on the Equality Act 2010 and Disability included a whole chapter on housing. It is not just about the disabled facilities grant, which is important; it is also about Building Regulations ensuring that enough of our homes are built so that, as people age and their needs change, houses can be adapted easily if need be. Will that recommendation be forwarded to the group to look at?

[Lord O'Shaughnessy]

Once again, I thank the noble Baroness for raising this issue and I am pleased that she supports the parallel work stream. I will come back to her with details on the timing—I am afraid that I do not have those with me today—but I stress the importance given to it and the fact that it is reporting to the inter-ministerial group is significant.

The noble Baroness’s question on housing goes slightly beyond my remit. I know that building regs have changed over time to encourage more homes to be built, but I will have to come back to her with more details on that point.

Health and Social Care: Falls Prevention

Baroness Brinton Excerpts

Thursday 30th November 2017 Lords Chamber

[Lord O’Shaughnessy]

I will happily do so. Dance is very popular in my household, with “Strictly Come Dancing” on the television at the moment. Debbie McGee might not be quite over 65 but she is a great advert for older people dancing. I absolutely support what the noble Lord says. I have seen the evidence on the impact that was published as part of the APPG’s work on this; it is very convincing and we will certainly let health and well-being boards know that this is exactly the kind of thing—social prescribing, if you like—that they should be looking at to prevent falls.

[Baroness Brinton (LD)]

My Lords, the Royal College of Physicians estimates that between one-quarter and one-third of falls could be prevented through assessment and intervention. NHS Improvement ran 19 projects with volunteer trusts. There is not much evidence of those pilots working closely with local authorities, which is the nature of the Question of the noble Lord, Lord Jordan. What were the results of the pilots that started in January? One of the key findings of NHS Improvement was that two-thirds of trusts were still using outdated predictor equipment which NICE has recommended against. Can the noble Lord let me know, either now or later, whether he can confirm that those predictor instruments that NICE is now saying should not be used have been withdrawn, particularly from hospitals and general practice?

[Lord O’Shaughnessy]

I do not have the specific details that the noble Baroness has asked for; I will write to her. The figures are not good; there are still around a quarter of a million falls in hospitals and mental health trusts each year, which is equivalent to the emergency admissions, so it is still a significant problem. NHS Improvement is working with the poorest-performing trusts and is reporting that those interventions have seen improvements, but we clearly need to phase out some of the poor practice that exists in order to reach higher standards.

Nurses: Tuition Fees

Baroness Brinton Excerpts

Wednesday 29th November 2017 Lords Chamber

[Lord O'Shaughnessy]

My noble friend is quite right to point out that student debt is forgiven after 30 years. The point of that is to ensure there is an equitable system, where those who earn more pay back more over the course of their working lives. It is important to point out that, with the new threshold moving up to £25,000, a nurse earning £26,000 in band 5 of the Agenda for Change pay scale would pay back £7.50 of that loan per calendar month.

[Baroness Brinton (LD)]

My Lords, with the NHS reporting that 96% of hospitals are currently failing to meet their planned number of registered nurses, and UCAS reporting a decline in student nurse applications, as the noble Lord mentioned, as well as the further news that one in four post-qualifying nurses leave in their first year, what are the Government proposing to do to change the problem of recruiting new nurses, including returning to bursaries and abolishing tuition fees altogether? Specifically, what are the Government doing right now to attract nurses into our hospitals?

[Lord O'Shaughnessy]

It is important to point out that there are 10,000 more nurses on wards than there were seven years ago. One of the things that we are trying to do is encourage nurses to return to practice—3,000 of those nurses have been on the return to practice programme. In regard to attracting them to hospitals, the main thing is that we need to train more nurses to fill those places so that we fill the demand that we know that we have from a growing and ageing population. That is why there are going to be 5,000 more funded nursing training places from 2018 onwards.