Dementia: Accident and Emergency
Baroness Brinton Excerpts(4 years, 8 months ago)
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Lord Bethell
The noble Lord is quite right to point out the delay in providing an answer on social care. That is why the Secretary of State for Health and Social Care wrote to Peers earlier this month, initiating a round of cross-party conversations and putting in the diary the beginnings of a process to pull together cross-party agreement. That cross-party agreement is essential to providing a long-term solution to this important problem.
Baroness Brinton (LD)
My Lords, I want to pick up on the point of the noble Lord, Lord Forsyth, about the lack of any extra funding for social care in the Budget. There was a reannouncement of just over £1 billion from before Christmas, but the Local Government Association states that social care generally needs about £4 billion to be able to maintain any sort of service to meet demand, which rises to £14 billion by 2030. Just saying that we are getting together to start to talk about social care problems is not enough. Where will extra money come from to remove people from hospital who do not be need to be there and to fund social care properly?
Lord Bethell
The noble Baroness is entirely right to say that this is an important issue. Short-term funding has been put in place for the best possible short-term arrangement, but this is a long-term problem that cannot be solved by any Government on their own. It requires cross-generational and cross-party agreement. That is why an important and well-organised set of engagements has been initiated. It is timetabled, and the Government have committed to action in this area.
Covid-19: Deep Cleaning
Baroness Brinton Excerpts(4 years, 8 months ago)
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Lord Bethell
The noble Lord is entirely right that cleaning is important, but the kind of deep cleaning protocols he described are not those recommended by the CMO at this stage of the epidemic. The SAGE group of statisticians and epidemiologists is modelling the outbreak of the virus very closely. Its computer models track the behaviours of the virus, the demographics of the country and the behaviours of people in different circumstances. Its focus is to try to ensure that we channel all our efforts into effective measures and do not explore red herrings or distracting policies that might prove counterproductive or distract from effective measures.
Baroness Brinton (LD)
Can the Minister assist the House? He said just now that advice was published at the end of February on how to decontaminate non-hospital environments. It is extremely difficult to find; I have not managed to find it yet. It is clearly difficult for cleaning companies to find. One company in the UK which works across a number of our cities published its own advice to its cleaners which was taken from the Singapore standards. If people cannot find this advice, how on earth do they know what the NHS wants people to do in this country?
Lord Bethell
I completely take on board the noble Baroness’s observation. I have here a copy of the regulations and I am happy to lay it in the Library. It is on GOV.UK in exactly the place you would expect to find such guidance, but I take on board the comments. We are spending millions of pounds on public information and employer advertising. More will be done to ensure that this kind of information reaches the people who need it. I will ensure that the message is heard loud and clear.
Coronavirus
Baroness Brinton Excerpts(4 years, 8 months ago)
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Lord Bethell
My Lords, the noble Baroness has expressed concerns about those in residential homes and people with learning difficulties. The needs of all the most vulnerable in society are paramount. There is no doubt that intense pressure will be put on social services, social care and clinical care. We are doing all we can to ensure that support is in place, which will include the mobilisation of civil society, charities and volunteers to take up some of the pressure being put on those services.
On training provision, modern call centres have very flexible working arrangements whereby staff are brought on and off contracts. Those who have already received 111 training are being brought back on to the front line. The funds for that are properly in place.
On the timing of the peak, it is impossible to say with certainty when that will be, but the CMO is crystal clear: we will do everything we can to spread it out over the summer and we will keep this House and the public up to date.
Baroness Brinton (LD)
My Lords, I also thank the Minister for answering the Urgent Question. Going back to my point about advice for vulnerable people, it is good to hear that advice is finally planned, but vulnerable people need that advice now. I have been saying this in your Lordships’ House for about three weeks. Will the Minister please let us know when we are going to get it?
My second question follows up on the previous one about 111. In addition to the worrying report from the woman on the “Today” programme this morning who kept not getting return calls over a three-day period, despite a high temperature, cough and many other symptoms, we also picked up on people ringing 111 with clear symptoms being told that they cannot be tested because they cannot name an individual who has been diagnosed with coronavirus. I repeat the same question: are the new call handlers being trained effectively?
Lord Bethell
The noble Baroness is absolutely right about the importance of guidance and I reassure her that an enormous amount of work is being done to draft clear guidance for employers, volunteer groups and all parts of society, which will include case studies, FAQs and detailed recommendations. That work is being guided by the CMO and senior officials at PHE.
As for 111, we look very closely at the metrics for the return of calls. Overall, the headline figures suggest that the 111 service is bearing up incredibly well under intense pressure, but I do not deny that there must be people who have had bad experiences. These pressures sometimes lead to poor results and we will keep a very careful eye on that.
Health Protection (Coronavirus) Regulations 2020
Baroness Brinton Excerpts(4 years, 8 months ago)
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Baroness Thornton (Lab)
My Lords, I thank the Minister for that comprehensive explanation of the order. When I started to read the policy background, it all came flooding back to me, having sat in his position in 2008 dealing with amendments put forward to modernise the legal framework for health protection and considering what powers were needed. My first question, therefore, is, why is the 2008 Act not sufficient to cover the eventuality of this virus, when these regulations relate to the 1984 Act? It is just a technical, anorak-type question and I am interested to know the answer.
I have given the Minister notice of my other questions, the first being about the differing legal structures in the United Kingdom, particularly between England and Scotland. Where are the regulations being considered? Are they being considered? Have they already been adopted by the devolved Administrations?
Echoing the brief discussion we just had in the Chamber, a further question relates to when this becomes a serious and imminent threat. In our scrutiny, we need always to focus on whether the orders and the Bill about to come before us give too much power or just enough power to a Secretary of State.
The statutory instrument refers throughout to detention or isolation. Can the Minister explain the difference between them? Is detention where somebody is arrested and detained, and isolation where they stay in their home? What would compel them to do that? I would like that to be unpicked.
Will the measure add significantly to the workload of magistrates’ courts? Has some estimate been made of that, and will it be properly funded?
My next question is about police involvement if people will not take the precautions required of them by law. Can we be assured that the police will be protected appropriately if they have to be involved in arresting or detaining people? That goes for other people involved in incarceration of any sort, because prisons and so on are contained environments that pose their own questions and dangers.
Finally, given that we do not know how long the coronavirus outbreak will last and what will happen, is two years too long a time for these regulations? Would not one year be more sensible?
Baroness Brinton (LD)
My Lords, I thank the Minister for his detailed explanation of the regulations. I too have warned him in advance of an area on which I want to focus.
In general, we are content with the principles and are reassured that the Government have made it plain that the measures are a last resort when people will not co-operate and public health is seriously at risk. The points that we are raising are more about the detail of how things will work.
Baroness Brinton
In the past they have been on that register, and the big concern is the move from one department to another. If I am being told that that is not the case, that is not the feedback I am getting from directors of public health. As the Minister knows, I have other concerns about the relationship between Public Health England and directors of public health, which is why I asked for clarification.
Lord Bethell
I completely understand the point of clarification. If there is information available on what proportion of directors of public health are also public health consultants, we will share it with the noble Baroness. However, the way that the regulations are drafted at the moment means that the powers in the regulations are held not by directors of public health but by public health consultants.
Baroness Brinton
I am sorry to interrupt the Minister again but the point is not about the register kept by Public Health England. My point concerns the definition of public health consultant—I am afraid that Hansard now has the relevant document, otherwise I would quote from it—and most directors of public health have to do that qualification because the job description, which is in the statutory guidance, says that they must be registered. That is my problem, and I know that it is clearly a problem for some of them as well. There is a bigger issue here. Should this become a pandemic and we see a large spike in numbers, we will need everyone qualified in public health to be able to do this, and there seems to be a problem in excluding the people at the heart of managing coronavirus within their wider communities.
Lord Bethell
The noble Baroness makes a very reasonable point. My understanding is that this decision was made not on a personnel basis but on an administrative basis. We are seeking to restrict the number of people who are able to execute these potentially quite serious powers. Having a list of available people is a legally clear and responsible way of doing things, but creating a new administrative definition goes beyond the powers of these regulations. However, I have already taken on board the noble Baroness’s points about the role of directors of public health in this epidemic. Those points have been listened to and are being followed up, and I will continue the dialogue that we already have in place on that.
The noble Baroness, Lady Thornton, asked why the 2008 powers are not sufficient. The answer is that it is mainly for practical reasons. The 2008 Section 2A powers give local councils powers but mobilising local councils to do things, sometimes at the weekend, sometimes at ports where they are not necessarily administratively present and sometimes overnight, is administratively a challenge. We found that in practice during the containment at Arrowe Park, it was really Public Health England officials on the ground who dealt with the situation and who needed these powers both in their back pocket and in their administration of the situation. That is why we have sought to do this. It is fair to say that a lessons-learned review is expected in the years to come and this will be the kind of issue that we will look at again.
The noble Baroness, Lady Thornton, asked what the difference is between detention and isolation. Although I do not have the legal definitions in front of me, my understanding is that isolation can be in someone’s house—literally holding them away from the rest of society—whereas detention involves confining someone to a place that they cannot leave, such as a police cell or a jail. Both are covered in these regulations. It is worth saying that you could, for instance, seek to isolate someone in a hotel room near the Arrowe Park facility and that would be covered.
The noble Baroness also asked about magistrates’ courts. I reassure her that MoJ colleagues were fully consulted on this and they did not see a problem. The objective was to try to create a low bar for an appeal to make the appeal process as easy and accessible as possible, recognising that these are very serious powers and we want to make them as sensitive as possible. In terms of police involvement and whether the police would wear suitable suits, they absolutely would. Police officials are highly protective of their workforce. Public Health England is working closely with the police to ensure that they have both the guidelines and the kit necessary to protect the workforce.
On the term of the regulations, I agree with the noble Baroness that two years is longer than we hope or pray this virus will continue. However, the advice from the CMO was that we cannot necessarily plan for that. Viruses sometimes last longer than expected; they can create multiple strains, and it may take time to have the lessons-learned review and to bring in new powers. That said, it is also possible that a coronavirus Bill that overtakes these regulations will be brought to the House later this month and the sunset clauses would necessarily be included in that.
Health: Maternity Care Provisions in East Kent
Baroness Brinton Excerpts(4 years, 9 months ago)
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Baroness Blackwood of North Oxford
As I said, there has been an unannounced CQC inspection; there is also further engagement with the CQC and we await the findings of its report, which will come forward in due course. In addition, specialist teams have been sent in to ensure that there is robust leadership so that ongoing care is assured and patients can be reassured on that point. NHS England has announced that it will commission an independent review into East Kent so that there is a belt-and-braces approach to ensure the highest possible standards of care there. We can be reassured that the issues raised by the noble Baroness will be addressed and that no stone will be left unturned.
Baroness Brinton (LD)
I also thank the Minister for the detailed Statement, which is much appreciated, and echo the sentiments of sympathy and support to the parents of Harry Richford and the other children who have died or had their health severely impaired by the trust. It does not start just two years ago. In 2010 there was a review by NHS Eastern and Coastal Kent on maternity care; safety and quality are mentioned three times in the statement of that review. In 2012 the services were reconfigured despite many concerns of local people. In 2014 the trust was rated inadequate and put in special measures by the CQC—it left special measures in 2017. In 2015 there was an expert report by the Royal College of Obstetricians and Gynaecologists warning about many of the problems that emerged in the subsequent tragic deaths of Harry Richford and at least six other babies. And so on and so on.
The expert review said that action needed to be taken quickly. This report was not passed to the CQC. Why, given that the hospital was in special measures, was the report not handed to the CQC and why on earth was the hospital allowed to continue out of special measures after that when there were clearly still major problems? Following on from the comments of the noble Baroness, Lady Thornton, why did the chief exec and, I presume, the board not read, implement and monitor this expert review?
Baroness Blackwood of North Oxford
The noble Baroness raises an important question, which I am sure will be considered as part of NHS England’s independent review and the CQC’s questions around quality of leadership, but I will make a wider point for those who may be listening about the safety of maternity care in the UK. We are rightly focusing on the questions of East Kent, but for those who may be considering giving birth at the moment it is important to state that the NHS is one of the safest places in the world to give birth. Some 0.7% of births result in a stillbirth or neonatal birth. We have stated that our ambition is to halve this rate of stillbirths, neonatal and maternal deaths, and brain injuries by 2025. We have already achieved our ambition of a 20% reduction by 2020. A message of reassurance, alongside the firm actions we are taking to address the concerns raised by the noble Baroness, is appropriate and important.
Wuhan Coronavirus
Baroness Brinton Excerpts(4 years, 9 months ago)
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Baroness Thornton (Lab)
I thank the Minister for repeating the Statement. Of course, our thoughts are with those who have been diagnosed with coronavirus and are in quarantine. I place on record these Benches’ thanks to our NHS and public health staff.
On the specific issues of quarantine arrangements, we understand the approach the Government have taken, particularly to deal with anyone who seeks to break the quarantine. We understand why the Secretary of State has invoked the regulations; he is entitled to do so under the Public Health Act, and we offer our support for that. Quarantine arrangements must be seen to be necessary, proportionate and in accordance with the law. Their enforcement, including with powers of restraint where necessary, must be fully transparent. The rights and freedoms of the quarantined evacuees must be fully understood to ensure that they are treated with dignity and respect. The media coverage so far certainly suggests that that is exactly the case.
To maintain public confidence in these arrangements, the framework must be understood and scrutinised by Parliament. With that in mind, I ask the Minister when we in this Chamber will deal with the regulations laid. The progress of this virus is rapid; there seems to be rapid change from day to day. We are due to break next week and it seems that 24 February may be too late, because it is moving so quickly. What arrangements are the Government making for us to deal with the regulations in this Chamber?
I feel that I need to declare an interest in the register: I am a member of a local clinical commissioning group. Perhaps the Minister could tell the House what clinical commissioning groups and trusts are being asked to do in terms of making plans in the coming months if this turns into a pandemic. Can she assure the House that local plans are robust and fully resourced? Are we confident that the 111 helpline has sufficient capacity to deal with increased calls? Will the community health trusts that are tasked with visiting suspected patients, and will have to visit people’s homes to carry out swab tests, be given extra resources to build up the capacity to be able to carry that out properly?
Finally, will the Minister update the House on international efforts to share research intelligence and attempts to find a vaccine, as well as the likely timescale? I understand that there is a summit of the World Health Organization today. On behalf of the Official Opposition, I thank all our NHS staff and reiterate our hope that the Secretary of State will continue to keep the House fully informed.
Baroness Brinton (LD)
My Lords, I begin my remarks from the Liberal Democrat Benches by echoing those thanks to all staff who are involved, not just on the front line but in the large amount of planning that is going on. We would also like to thank the patients who have self-isolated in calmness, accepting what has happened and moving a long way from home, and those who after flying back from abroad have quite contentedly gone on elsewhere. The advantage of social media, television and radio is that we can hear how they are managing.
I note that the Secretary of State has declared that transmission of coronavirus is a serious and imminent threat to public health, despite the fact that the current situation remains moderate. The regulations for England only—to isolate and hold those at risk of spreading the virus—is, I hope, a last resort. So far, that has not been necessary, but we on these Benches understand that there may be occasions when it is. Will the Minister confirm that the devolved states will follow suit? We would not want Gretna Green suddenly to have a reputation for the wrong reasons, with people trying to remove themselves to somewhere that the regulations do not apply. It seems sensible in the United Kingdom to make sure that there is consistency among the four states.
What safeguards are in place for those conducting the quarantines and isolation to ensure that they are kept safe, along with the patients, and to prevent them contracting the virus?
I note also the regulation that came into force at the end of January, ensuring that no charge is to be made or recovered from overseas visitors who may have to be diagnosed with, or treated for, coronavirus. We believe that that is right, but how is this information being disseminated to healthcare bodies? I see nothing at all about it on the department’s website. The regulation appears for parliamentarians via Hansard, but I can see nothing else anywhere that might help inform hospitals and other bodies.
Today’s Statement from the Secretary of State, the department’s daily 2 pm statement, and the report from the Chief Medical Officer all talk only about those travelling from a number of Asian countries—which the Minister read out in her repeat of the Statement—and who have come from those countries in the last 14 days. This is echoed in the department’s advice to healthcare professionals. So, despite being updated daily—and the number of patients was up to date as at 2 pm today—these Statements do not reflect the fact that some of the eight UK-based cases contracted coronavirus in France, or possibly even in the UK.
Today on radio and television, we have heard a number of experts from China, from John Hopkins University and from UK universities all talking about the possibility of substantial transmission. Indeed, the department has confirmed that this is a high-consequence infectious disease, with all the concerns and constraints that go with it, which include being
“often difficult to recognise and detect rapidly … ability to spread in the community and within healthcare settings … requires an enhanced individual, population and system response to ensure it is managed effectively, efficiently and safely”.
We now have cases in York, in Brighton and its area, and in the specialist receiving hospitals in London and Newcastle, in addition to two GP surgeries in Brighton that have been closed for cleaning. There are local concerns in Brighton about a community centre, and some schools appear to be making the decision to allow children not to come in, after two people were told to self-isolate. But there does not appear to be any formal advice being offered to councils, councillors, schools, prisons and other public bodies. Can the Minister explain why the Statement seems to take no account of what is happening in the UK at the moment? What advice is being given to local councillors, schools and other bodies about early planning for their area, what they should do if a person may have coronavirus, and what happens once they are diagnosed, so that they are ready in the event that there are cases in their area?
I specifically want to mention the role of councillors here. Elected members are often at the heart of their communities, and an informed councillor can calm worries, particularly at the school gate, if they can say that they have been briefed. These days, briefings do not have to happen face to face; there are mechanisms through technology for people to be brought up to date.
Finally, in Brighton, it has been reported in the local media that a number of people with cancer and other long-term conditions are understandably worried about what they should do. They are asked to make sure that they have their annual flu jab, but at the moment there seems to be no specific advice for people regarded as vulnerable patients. Public Health England’s very helpful flow chart on the management of a suspected case runs through very sensibly what to do with the patient, but nowhere does it suggest to ask the patient whether they have any vulnerable people in their family or their contact, nor can I find any advice, anywhere at all, about what primary care doctors should be saying to vulnerable patients in their area—I am thinking particularly of Brighton, at the moment—to make sure that they feel comfortable about this.
These are concerns that could, I suspect, be resolved with effective planning. However, it seems that, at the moment, there is a bit of a lacuna, and I hope that the Minister will be able to help fill the space.
Baroness Blackwood of North Oxford
I thank the noble Baronesses for those important questions and, like them, I thank NHS and PHE staff for their extraordinary work over recent days, and those patients who have acted so responsibly in self-isolating. In doing so, they have slowed the transmission of coronavirus in the UK and protected many, including those who are particularly vulnerable. I also thank both Benches for their support of these regulations, which hopefully will not be needed, but should they be needed, could play a crucial role going forward.
I wish to clarify that these regulations will apply only to coronavirus. They will be in force for two years and will be triggered only in the instance of a serious or imminent threat to public health by a person not complying with public heath advice and therefore putting themselves and/or others at risk.
The noble Baroness, Lady Brinton, asked about the devolved Administrations. These regulations apply only to England, but we are in touch with the devolved Administrations, and they will consider this. Obviously, CMOs are acting in concert, and we think that the devolved Administrations will want to take this forward. The question of the scrutiny by Parliament is one for duty managers, but we have come back to the House with this issue on a number of occasions and we are very committed to keeping the House updated on this and will continue to do so.
On the point about how the NHS is being kept updated and prepared, we have announced the capital arrangements today to ensure that the NHS can be prepared for different isolation measures, but the NHS is always ready to provide world-class care, with expert teams in every ambulance service and a number of specialist hospital units that can respond to this. I am pleased to report that the latest data from PHE indicates that, in the past week, flu activity has once again decreased, against all indicators, the rate of GP consultations remains below baseline levels and the rate of ICU and HDU admissions and hospitalisations remains low, which is an encouraging background for us.
The noble Baroness, Lady Brinton, also asked about those who are vulnerable. This is factored into the NHS 111 algorithm, where we advise individuals to call should they have any concerns, as part of the public health advice. I take on board her point about those individuals who may be useful for community communications with councils, schools and others. Obviously, the first place for advice is Public Health England, but there may be activity which I do not have in my brief, so I will come back to her on this.
We have cascaded very detailed information through the NHS about coronavirus—what to look out and what actions to take—which has come from the Chief Medical Officer and those leading the response, to ensure not only immediate response and preparedness, but also on what actions can be taken by healthcare professionals to protect themselves.
The noble Baroness, Lady Thornton, asked about vaccines. She will know that we have pledged £20 million for the new vaccines to combat this. Every day that we slow down sustained transmission is a day closer to development of that vaccine. Developing a new vaccine is not necessarily a quick process; I think it will be in months rather than weeks, but we will put every effort into making sure that we can take part in that.
Finally, the noble Baroness, Lady Brinton, asked about the differential advice regarding travel from Wuhan and travel from other Asian states and about where that stands at present. The Scientific Advisory Group for Emergencies and UK Chief Medical Officers have given that advice, on those who have travelled from mainland China and the other nations that I stated versus those who have travelled from Wuhan, based on evidence now available on sustainable transmission. Should there be person-to-person transmission at a different rate, it would be kept under review and the advice would change.
I hope that I have responded to most of the questions. Should there be further questions, I am happy to respond in writing.
Access to Palliative Care and Treatment of Children Bill [HL]
Baroness Brinton ExcerptsFriday 7th February 2020
(4 years, 9 months ago)
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Baroness Brinton (LD)
My Lords, I thank the noble Baroness, Lady Finlay, for bringing this Bill back with some amendments, which have undoubtedly strengthened the one that we debated in this House in June last year.
For far too long, patients across England have been victims of a system of palliative care that lacks not only consistency but the resources to help them. I join noble Lords in being delighted that the Government have announced that they will provide £25 million for hospice and palliative care services, but I am concerned that the Library briefing tells us that the purpose of this investment is to
“help keep facilities open and ‘improve’ the quality of end-of-life care”,
as that is well below the target of this Bill. The Bill seeks to absolutely mainstream palliative care throughout the country. Given the debate and the comments from expert colleagues in the House today, I am sure that if that happens, money will be saved in the acute hospital system as well. What is not to like?
Noble Lords have covered an enormous amount of ground. From the Liberal Democrat Benches I confirm that we consider virtually all the Bill to be important and correct, and it certainly needs to be found a space so that it becomes legislation. I urge the Government, and particularly the Minister, to move us forward from the statement on 29 October that the Government would work with patients, families, local authorities and voluntary sector partners to ensure equity of access to general and specialist palliative care throughout England. My grandmother often used to say, “Fine words butter no parsnips”, and the problem with that statement is that you cannot ensure that equity of access unless the resources are there to support it. Therefore, I apologise to the Minister because, once again, I am going to say that we must have the resources to enable the Government to deliver on their extremely strong words. Let us make sure that Clause 1 is enacted as fast as possible.
Your Lordships will know that I have a particular interest in palliative care services for babies, children and young people. The briefing from Together for Short Lives has a brilliant opening statement:
“If passed by parliament, this bill would help to overcome many of the barriers children and families face. This bill could also help to make sure that parents of seriously ill children and the professionals and services caring for them resolve conflicts about what is in a child’s best interests by mediation and not in court”.
Hear, hear—we on these Benches echo that, as does the British Medical Association.
The Liberal Democrats have long sought to fund palliative care and the hospice movement through NHS funding, so we are pleased to support Clause 1 in its entirety. I thank the noble Baroness, Lady Finlay, for putting back on the face of the Bill the stronger form of the legal duty for the relevant bodies—“appropriate health services”—to provide and commission palliative care and psychological supports for patients and their families. That is extremely welcome.
There is still no method of accountability to ensure that CCGs and other health bodies serve patients to the best of their ability. The situation is begging for a catalyst that will empower CCGs and hold them to account in the work that they do. Your Lordships know that I have spoken often about the position of parents with young children in Hertfordshire who need palliative care. We saw a CCG close the respite care centre 100 yards down the road from my house without making arrangements elsewhere for these children. Eighteen months after the provision closed, the alternative beds have only just opened 20 miles away in Hertfordshire, but these beds do not in any way replace the ones that were closed. The standard of variation between the lowest and highest budgets allocated for some patients by CCGs is extraordinary. No patient deserves to receive care so lacking that it is not palliative care at all.
Focusing again on children and young people, the provision in the Bill regarding pharmacies is important. However, we remember that NICE has stated that children with life-limiting conditions should be cared for by multidisciplinary teams. Together for Short Lives has found through its surveys that across England this is sometimes, rarely or never the case. It talks about a number of other facilities but there is not time this afternoon to go through them all.
However, I want to point out one absolutely chronic problem for the children who require these services that has worsened considerably over the last six months. There is a major discrepancy between the services planned and funded between 8 am and 6.30 pm from Monday to Friday, and services commissioned to provide care outside those hours. Some 93% of clinical commissioning groups commission community children’s nursing teams but only 67% provide out-of-hours care. This has resulted in parents frequently having to call an ambulance to take their child to A&E—the last place these children need to be—to have their feeding tube reinserted. This is so short-sighted; it needs to be remedied.
Nikki Lancaster, mother to Lennon, who died nearly two years ago, said:
“Nine to five, my community nurses were amazing, but come five o’clock in the evening, you’re very alone. It’s a massively overwhelming responsibility keeping a child alive. When you’re out there on your own and you’ve got no support it’s hard—emotionally hard. If you were in hospital, it would be a consultant making those decisions. When you are at home, it’s you.”
Following the death of her son Lennon, Nikki Lancaster faced the other problem that bereaved parents in receipt of benefits face: she got absolutely no benefits from the day he died because they were all linked to his care. During the passage of the parental bereavement Bill, I specifically asked the Minister to talk to DWP to make sure there was comparable provision for parents who had had to give up work to look after their chronically or terminally ill children. That has not happened. So, while we celebrate the parental bereavement Act, there is unfortunately a cohort of parents who are still being left high and dry.
Like other noble Lords, I had a problem with Clause 2(4). I am grateful to the noble Lord, Lord Balfe, for his comments about mediation, which were excellent. Before I came into the Chamber today, I was thinking, “An ACAS for the NHS and patients”; the noble Lord absolutely got that point. The noble Baroness, Lady Butler-Sloss, has taken most of the wind out of my sails but, as somebody who has been a UNICEF trustee, I point out that Article 3 of the UN Convention on the Rights of the Child says:
“In all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration.”
The problem with Clause 2(4) is that, no matter how loving the parents are, their views should not come before the interests of the children. That is why I very much welcome the family courts using children’s guardians to make sure that the voice of the child is heard, particularly in the case of very small children, who have no voice of their own.
Another, related issue, concerning teenagers, was briefly touched on. I am reminded of the importance of the Gillick competence. What do we do about teenagers, or perhaps even younger children, who could consent to and fully understand the medical treatment proposed? Which would come first—the Gillick competence or the relevant clause in the Bill? I am delighted that my noble friend Lady Jolly has proposed an amendment for Committee stage. I am not quite sure that I support it in its entirety; I do not believe that it passes my two tests of the UN Convention on the Rights of the Child and the Gillick competence. But I hope that the noble Baroness, Lady Finlay, will be open to discussing how we might best improve the Bill to ensure support and satisfaction for parents who are clearly suffering at an extraordinarily difficult time, and support for the rights of the child, which must always remain paramount.
I hope that this Bill will have further space in the Government’s schedule and, even if it does not, that it is sufficiently high up in the system. Please can the House authorities make sure that it is scheduled swiftly for Committee and subsequent stages? I hope the Minister can reassure us that there will be more than £25 million available for palliative care, and that the Government will take to heart the detail of this Bill in seeking to mainstream palliative care and ensure that it is available for absolutely everybody in this country who needs it.
NHS: Targets
Baroness Brinton Excerpts(4 years, 9 months ago)
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Baroness Brinton (LD)
My Lords, I add my thanks and congratulations to the noble Lord, Lord Hunt, for instigating this important debate and, as ever, to noble Lords for their stimulating and informative contributions. I also thank the many organisations that have sent us briefings, starting with the Library. I found the NHS Providers briefings especially helpful. It is instructive how many of those briefings cover the same concerns about the NHS and social care in England that we have reflected upon in this debate.
I echo the comment made by the noble Lord, Lord Bates, about the brilliant staff in the NHS. I want to extend that to staff in the social care sector and its volunteers, carers and patients. In recent years we have asked patients to change how they receive their healthcare, and many have adapted and responded to that well.
When I was chair of education in Cambridgeshire, I was told very clearly by my director that free school meals were a proxy indicator for children in poverty, and this House has on many occasions debated whether it is appropriate to do that and whether it is an effective proxy. As the noble Lord, Lord Hunt, said, NHS targets are a proxy for the NHS and social care performance. Whether we call them targets, access standards or some new fancy name in any government review, the most important thing from the perspective of these Benches is that they should not be scrapped. They act to make our NHS and social care sector think about and change what it is doing to achieve a better outcome.
The 3.6% increase in the NHS is welcome from the Government, but as so many have said, it is not enough. I am pleased that the Secretary of State, in another place last week at the Second Reading of the healthcare funding Bill, kept saying that this is a floor, not a cap—we will hold the Government to that. It is only a sticking plaster to get us from total emergency to perhaps being able to manage services. It provides no scope for improvement or for the large changes in technology that I know the current Secretary of State is looking for. Unless the long-term underlying problems are addressed in our health system, we will remain in crisis.
I reflect on why the Conservatives introduced the Patient’s Charter in the 1990s. As other noble Lords have said, the NHS was, frankly, in total crisis, with a lack of funding, buildings completely unfit for purpose and a burgeoning crisis in social care, with too many delayed discharges. I remember a story in Cambridgeshire of a woman being taken to Addenbrooke’s Hospital in a horse-box after a three-hour wait for an ambulance. The Patient's Charter worked. The Labour Government adapted and developed it further. I echo the many points made from the Labour Benches about the strength of those targets. Although politicians and media hold every Government to account for those targets, I do not believe that anyone thinks that they are simplistic. We understand the complexity of performance that goes on behind that. The problem is that they are consistently being missed. It is not just about lack of performance; it is about lack of resource—not only money but resource.
I really liked the four key points made by the noble Lord, Lord Hunt. I am going to focus my remarks and try to bring in what other noble Lords have said under those. Long-term planning is right. Woe betide us if we think that five years is long-term planning. It needs to be at least 20 years, and probably a quarter of a century. There is so much changing in care. The way that consultants treat people with a long-term condition such as mine has completely changed in the last five years, let alone the last 10 years. Are the resources available, whether it is staff funding or technology, to match those changes as they come? We need to ensure that it is completely fit for purpose.
Many people outside politics say that we should take the NHS away from politicians. I say no. The NHS is such a key part of our public life that the public will always come back to politicians to say, “What are you doing about it?” Let us just say that we need to tackle the issues. The noble Lord, Lord Suri, rather plaintively said that he hoped the opposition parties would come together behind the Government. I gently remind him that, in the Dilnot review, all the parties came together but the Conservatives walked away the moment a decision needed to be made. All the opposition parties will support the Government in ensuring that we work together in the future. We look to them to ensure that we have a proposal that will work.
The noble and gallant Lord, Lord Stirrup, talked about having no proper strategy. That is also a problem, but we have covered the myriad areas in the debate this morning. I think that the will is there; I know it is there among the staff, but we need to ensure that this is moved with speed to ensure that everybody understands. When I talk to senior managers in hospitals, I hear about their local strategies. I do not always see the golden thread going back to NHS England.
The noble Baroness, Lady Wilcox, made a wonderful maiden speech. I loved her phrase “not another rough draft”. It is just so pertinent. As someone else who went to the Central School of Speech and Drama—I did stage management; she trained as a teacher— I know that, no matter what you did there, you were taught to speak. Other noble Lords commented on the noble Baroness’s content; I, as a fellow alumna, congratulate her on the style of her delivery.
The funding challenge has already been covered, but it remains a persistent issue. It is vital that the funding challenge in adult social care is also addressed. We have seen the knock-on effect on the NHS of not getting adult social care right for nearly three decades. I was pleased when it was decided to make the Secretary of State the Secretary of State for Health and Social Care, but a title on its own does not do enough. The better care fund started to make progress in these areas, but it was not rolled out and is certainly not consistent.
My noble friend Lady Pinnock, who has considerable expertise in local government, talked about that perfect storm, and she is absolutely right. I welcome the comments from the right reverend Prelate the Bishop of Carlisle, and the noble Baronesses, Lady Gale and Lady Pitkeathley.
Workforce development is vital. I echo the point made by the noble Baroness, Lady Watkins, about nurse practitioners. If I hear another Member of this House say that nurses do not need to be qualified but just need to know how to care, I will grind my teeth so hard I will not have any left. I rely on my advanced nurse practitioner for advice and support in my condition, and I see nods from other noble Lords around this House. We should be developing them further in primary care because we are not going to resolve the shortage of GPs. That brings me to my other workforce point: we are not training enough doctors and other healthcare professionals. Not just this Government but Government after Government have avoided the expense of developing our doctors, in particular. That is why we continue to need people to come in from elsewhere.
We need to change the culture. The noble Lords, Lord Hunt and Lord Young, spoke about that. It is important that we do not have just little pockets of good practice. I do not understand why there is not a culture of continuous improvement in the NHS. One can go into an organisation and tell it about something wonderful that is happening elsewhere, and it is completely missed. It is more than just talking about each other. It is more than workshops. I know that NHS Improvement and NHSX are beginning to change that, but the culture changes too slowly.
Can the Minister confirm that the Government will not impose 5% cuts anywhere in the Department of Health or in local government because, if other parts of those departments are asked to take further cuts, any increase in baseline budget will become meaningless. They are way beyond saving or cutting to the bone. We are in danger of beheading the very thing the Government say they want to protect. Do the Government have any plans for a long-term strategy of at least two decades? In the meantime, a commission on adult social care is essential, as is further integration.
Let us get together, all parties, all stakeholders, to make this a national priority over the next few months. It is time to make it happen.
Health: Tinnitus
Baroness Brinton Excerpts(4 years, 9 months ago)
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Baroness Blackwood of North Oxford
The noble Lord is absolutely right that contact should be made with a GP regarding hearing loss as soon as possible, that links between hearing loss and dementia have been found and that it is extremely important that we increase research in this area. That is exactly why I have asked officials to get together a round table regarding hearing loss and dementia to drive up research in this area as soon as possible.
Baroness Brinton (LD)
My Lords, one in 30 children suffers from tinnitus. That is one child in every average-sized class, so there are a number of such children in every school. These children often say that their tinnitus sounds like a rushing train. They find it difficult to concentrate in school and often end up with problems. Some of these children will require mental health support. Can the Minister say what the current waiting time is for a CAMHS appointment for a child or young person suffering from life-changing tinnitus? It is a chronic condition. There is already a problem with the waiting list for children and young people with acute and life-threatening conditions, but what is the waiting time for these children to get in front of a doctor?
Baroness Blackwood of North Oxford
We are working hard to bring down waiting times across mental health, and the noble Baroness will know that we are bringing in waiting time standards. On mental health provision for those with tinnitus, she will know that we are working to bring in improved access to psychological therapies. Ninety-five per cent of those accessing such treatments and therapies are doing so within the time available. The most important issue is making sure that those therapies are available in an accessible way. Local commissioners have to pay due regard to equality legislation and make sure they provide those services either through BSL-trained therapists or interpreters locally, if necessary.
Paterson Inquiry
Baroness Brinton Excerpts(4 years, 9 months ago)
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Baroness Thornton (Lab)
My Lords, I thank the Minister for repeating the Statement made by the Health Minister in the Commons today. Two hundred and eleven former patients of Paterson, or their relatives, shared their experience with this inquiry. This report makes for harrowing and appalling reading, as the Minister said. Ian Paterson wilfully abused the trust placed in him by patients at their most vulnerable. At his hands, hundreds of women underwent extensive, life-changing operations for no medically justifiable reason. His unregulated cleavage-sparing mastectomies, in which breast tissue was left behind, meant the disease returned in many of his patients. Others had surgery they did not need and needlessly lived under the shadow of cancer for many years. This should never have been able to happen, let alone go on unchecked for so long.
As the Minister has done, I pay tribute to the courage, tenacity and persistence of many of these women and their families in exposing the injustice. I thank the panel, under the leadership of its chair, the right reverend Graham James, for uncovering the extent of Paterson’s malpractice and the systems that allowed it to continue despite repeated warnings.
The victims of Paterson’s malpractice were let down time and again by the NHS trust and an independent healthcare provider, which failed to supervise him appropriately and did not respond correctly to well-evidenced complaints about his practice, and by the wholly inadequate recall procedures in both the NHS and the private sector. The report identifies failures on the part of individuals and institutions, saying that
“a culture of avoidance and denial”
meant that those working closely with Ian Paterson did not spot his behaviour or were unwilling to challenge it. On the contrary, the report concluded that
“Paterson’s behaviour and aberrant clinical practice was excused or even favoured.”
What action does the Minister propose to support a change in the culture of the health service that encourages staff to speak up?
There is a potent example on page 130 of this report:
“The operation and awarding of practising privileges is defined in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 … Practising privileges are based on the ‘scope of practice’—that is, the procedures a consultant is competent to perform in the independent sector are based on what they undertake in the NHS … In Paterson’s case … he did not limit himself to operations he was competent to perform in the independent sector. He was undertaking operations and procedures he did not do in the NHS. Measures to monitor and limit this at Spire were inadequate.”
What has changed? Is this still the practice in the private sector? Indeed, is it still the case that private hospitals incentivise referrals from consultants who have been given shares in their private hospitals? That is what the report suggests.
Can the Minister confirm that the Government will urgently bring forward legislation to give private patients the same protection provided by the NHS, as called for by the lawyers representing hundreds of Paterson’s victims? The Centre for Health and the Public Interest has called for Paterson’s income and earnings, as well as the profits made by Spire Healthcare, to be treated as income from criminal acts, which could mean that they could be reclaimed. Can the Minister advise on whether this aspect has been referred to the CPS?
The Independent Healthcare Providers Network, which represents the sector, has already said that more needs to be done to ensure that information is shared between the NHS and private companies about their doctors. What action are the Government taking to facilitate this information sharing?
We cannot undo the awful harm that Paterson’s criminal action has caused so many, but we must act to ensure that lessons are learned and changes made so that something like this does not happen again. This report must not remain on a shelf to be forgotten, because it is clear: this was not just the act of a rogue, lone surgeon; systemic organisational failures were at fault as well. Fundamentally, it is time we addressed the question of safety in private healthcare providers and the way in which clinicians can operate in private providers with little oversight. I would be grateful if the Minister could share her thinking about this with the House.
The inquiry makes a number of recommendations about transparency and accountability, and I hope the Government mandate health bodies to implement those quickly. As the Minister said, the fight that the patients had to make for compensation was shameful.
Around a third of all private hospital income now comes from NHS procedures such as hip replacements, hernia repairs and cataract procedures, yet safety standards in the private sector often leave much to be desired. How is the NHS addressing patient safety in this regard? Apart from anything else, there are very few critical care facilities available in private hospitals, so patients are transferred to NHS hospitals when things go wrong and complications occur. I would like to know whether private hospitals can be held liable for this use of the NHS. The previous Secretary of State wrote to the private hospital sector in 2018, telling it to get its house in order on patient safety, and he was absolutely right.
If it is decided that the Government wish to legislate on this matter, I urge them to do so swiftly and bring forward proposals. I promise the Minister that she will have constructive co-operation from these Benches, so let us get on with it.
Baroness Brinton (LD)
My Lords, I echo the points just made about the speed of the Government’s reporting. It is extremely helpful that the Minister in another place apologised clearly for the failures in the system and paid tribute to the victims. I too pay tribute to them and their families for their tenacity over many years, when it was clear that something was going wrong but the people who were in a position to gather information and do something chose not to.
The Statement says:
“I can promise the House a full response in a few months’ time.”
This public inquiry has rightly taken two years—it was slightly delayed by the general election and purdah—but it was clear in 2017 what many of the issues were. The excellent report from the Centre for Health and the Public Interest published in November 2017 entitled No Safety Without Liability: Reforming Private Hospitals in England after the Ian Paterson Scandal set out in a slightly different format many of the recommendations in front of us. I am sure that the Department of Health, the NHS and the independent hospitals will have looked at those recommendations.
I ask the Minister right up front: how long will it take before recommendations come back to the House from the Government on where they want to take things? After all, we have a Bill that is almost ready to go—or perhaps, as I said yesterday on the Second Reading of the Birmingham Commonwealth Games Bill, Groundhog Day is coming around again for us. Let us use that opportunity, at the very least, to remedy the obvious shortfalls in the system.
One of our major concerns is regulation of indemnity procedures for healthcare. There are serious shortcomings that must be dealt with as soon as possible. I was extremely concerned to read in the recommendations about the arrangements private hospitals have with clinicians to carry out their own activities that are rather like self-employed contractors almost renting an out-patient desk and in-patient beds. That is similar to renting a barber’s seat but without the overseeing regulations you need when people’s lives and health are absolutely at risk. That must be managed immediately.
Independent hospitals must take responsibility for their actions, so it is good that one of the key recommendations tries to focus minds on filling the gap between responsibility and liability. The report from CHPI two years ago said that this was vital and that independent hospitals must employ doctors and healthcare professionals, because without that responsibility on their behalf they will continue to wriggle out of liabilities and choose not to monitor clinical practice, missing either ill-meaning or incompetent surgeons. That cannot happen in the NHS and trusts have to take responsibility, as they do when things come to light. This hole in the current system needs to be remedied swiftly.
The inquiry also makes the important point that boards must apologise meaningfully and as early as possible. The UK health system, whether NHS or independent, has an extremely poor record of apologising, or of even commenting at all. Worse, it often tries to bury problems, denying whistleblowers any access. I am afraid that this is part of the systematic culture exposed in this very important inquiry—one that fears liability above apology and, equally importantly, does not learn well from mistakes, especially if through malpractice.
It is shocking that patients were often not guided to the Parliamentary and Health Service Ombudsman or the Independent Sector Complaints Adjudication Service. Compare that with the Financial Ombudsman Service: financial services companies must signpost access to the ombudsman at every step of the way when people buy financial products. A financial service problem could result in a loss of money, but a medical problem could end up changing lives for ever, as in the Paterson cases, so when will the Government deal with this issue? Will there be compulsory signposting for patients and clarity over whether all independent hospitals have to sign up to an independent complaints adjudicator—preferably just one, but I understood from what the Minister said in another place that they cannot regulate the independent sector completely? Frankly, as far as healthcare is concerned, my party believes we should.
Once again, the Paterson case demonstrates the need for effective whistleblowing processes. Will the Government commit to an office of the whistleblower to, through legislation, give more protection to patients, whether they are in the NHS or the independent sector? Spire Healthcare has said that it has put more measures in place to encourage staff and patients to speak out since the Paterson case, but even the Statement refers to there still being problems in Spire Healthcare. This just demonstrates that this is not working. Paterson’s victims are very clear: we need a system within the NHS that protects patients and staff. That is equally true of the independent sector.
I end by repeating my initial question: can we please have a timetable for the Government to come back to Parliament with proposed changes, given that a Bill is waiting that could easily be amended for both Houses to attend to speedily?
Baroness Blackwood of North Oxford
My Lords, I thank the noble Baronesses for those very important questions on this very serious inquiry. I will try to respond to as many as I can in detail, bearing in mind that the Government are carefully considering the recommendations on an issue that deserves serious consideration.
I will reply first to the question on the Government’s responsibility for the independent sector. As I stated, patients in England have a right to safe and proper healthcare regardless of where it is provided and how it is funded. We are committed to ensuring that public and private sector providers adopt proper measures for protection of their patients, as was rightly raised by the noble Baroness, Lady Brinton. As she said, following a CQC report on acute care in the independent sector, my right honourable friend Jeremy Hunt wrote to the NHS Partners Network and chief executives, seeking their co-operation on a range of safety and quality issues, which will be followed up. Further, the independent sector has published a medical practitioner framework requiring consultants’ practising privilege to be reviewed regularly. Furthermore, the regulatory system has evolved since Paterson was practising, with fundamental standards of care, intelligence-led inspections and greater scrutiny of clinical governance as part of the well-led domain. However, this report is a rightful challenge to us to take a more strategic approach, and to regulate smarter and not harder when problems arise so that we can make sure these issues do not arise.
I would like in particular to pick up on the point made by the noble Baroness, Lady Brinton, that it is vital that the NHS has excellent directors to ensure that it can deliver the right standard of care. The Government have accepted in principle recommendations 1 and 2 of the Kark review,
“to develop specified standards of competence that all directors who sit on the board of any health-providing organisation should meet, and to create a central database of directors.”
The noble Baroness, Lady Harding, the chair of NHS Improvement, is taking this work forward as part of the people plan. This should also improve the standards available.
I must make the point that Paterson is in jail. This demonstrates that action has been taken. We have moved further from where we were. The GMC introduced revalidation in 2012 and the CQC started inspecting the independent sector in 2014. However, we will never be complacent because we recognise that there is much more to do, as the report makes clear. The staff and clinicians need to be more open, as has been stated. That is one reason why we introduced the 500 “freedom to speak up” guardians in 2015. When we speak to people, we know earlier where there are problems. As the inquiry says, we need better systems. I will go back to the national guardian, Henrietta Hughes, to ensure that she is as supported as possible in making these systems work effectively.
Regarding indemnity products, we understand how important it is, not only that patients are able to obtain compensation but that the process for assessing that compensation is easy to understand. We are considering this carefully as part of the response, and whether regulation is an appropriate means of addressing concerns about the indemnity cover of health professionals not covered by a state-backed scheme. This includes the consideration of clarity for patients seeking redress. I hope this reassures the noble Baroness.
There are widespread considerations about how cosmetic procedures not currently covered by the CQC are regulated. I hope I have answered most of the questions. We also recognise that while ISCAS is a second line of complaints system for independent patients, it may not be working for PPUs in the NHS. We will be considering that as part of our response. As for the timeframe for that response, we are looking at a three-month window, but want to ensure that we respond appropriately, carefully taking into account the points raised. As pointed out by the noble Baronesses, there are some quite knotty questions to take into account, which may require regulatory or even legislative responses. We must ensure that we get that right and respond in an appropriate timeframe.
The one further point to put into the mix is that it is still appropriate to take into account that there are many good-quality care providers in the private sector, so NHS commissioning through those providers is still appropriate. We must ensure that the regulatory system works in an appropriate manner and that, where there are concerns, people feel free to speak up and action is taken to protect any patients who may be at risk.