Mental Health: Weight and Shape-related Bullying

Debate between Baroness Brinton and Baroness Blackwood of North Oxford

Monday 22nd July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

As usual, the right reverend Prelate raises an important point. The fundamental principle of using lived experience to develop policy is an important principle within the Department of Health and across government. Most particularly, the experience of young people—those who are bullied and those who are bullying—should be taken into account. This is the only way we will get to the bottom of this problem and stamp it out once and for all.

[Baroness Brinton (LD)]

My Lords, as the co-chair of the APPG on Bullying, I have seen the reports that other noble Lords have referred to. It is good that more investment is going into mental health in the NHS, but schools still need front-line support for many bullied children. Over half of children report that bullying about their size and body image is the leading cause. What can the Government do to ensure that there really is access to front-line services for children in school?

[Baroness Blackwood of North Oxford]

As I have said, we are making sure that we bring the investment into the front line with this £2.8 million. In addition to that, all schools are legally required to have behaviour policies with measures to prevent all forms of bullying. They have the freedom to develop their own anti-bullying strategies to make sure that they are appropriate to their environment, but they are held to account by Ofsted. This is at the forefront of the Department for Education’s guidance to schools on how to prevent and respond to bullying as part of their overall behaviour policy.

NHS: Automation

Debate between Baroness Brinton and Baroness Blackwood of North Oxford

Monday 15th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right: this is a very exciting area of ongoing work and a key part of the grand challenges which we put in place as part of the life sciences strategy, part of which is the AI and early diagnosis initiative, which aims to transform the prevention, early diagnosis and treatment of chronic diseases. NHSX’s work across government is to deliver that mission, creating an ecosystem of safe and effective development of AI and the regulatory infrastructure so patients and clinicians can be reassured that where it is introduced, it will be safe. There will be lots of research and development of those innovations. We are at an early stage of implementing them, but there are five centres of excellence across the country. I will be very happy to place a letter in the Library updating the House on progress with the AI mission and these exciting developments.

[Baroness Brinton (LD)]

My Lords, while the delivery of automation and AI has much to commend it to the NHS, CyberMDX reported last week that anaesthetic machines can be hacked and controlled from afar, including silencing alarms that would alert anaesthetists to danger. Four months ago in Israel, a cybersecurity firm demonstrated that computer virus malware could add tumours to images of scans. What protections, such as digital signatures and encryption, does the NHS now put in place, following the malware alarm two years ago, to ensure that automation and digital services cannot be attacked by malevolent forces?

[Baroness Blackwood of North Oxford]

The noble Baroness is correct to say that patients and clinicians have a right to expect their data to be held securely. Since the WannaCry attack in May 2017, we have taken steps to ensure that NHS security measures are of the highest standard. This includes £60 million to improve cyber resilience in local infrastructure, support for NHS organisations to update their Windows operating systems, procuring a new cybersecurity operations centre, and boosting the national capability to prevent, detect and respond to cyberattacks. We are also committed to achieving much greater operational visibility across all NHS digital systems. This is one of the ways in which we can respond to attacks. Lastly, we expect the highest ethical standards from all data-driven systems and that is why we have introduced the code of conduct for data-driven health and care technology. That is how we will ensure that we have some of the best AI and data-driven technologies.

Social Care: Free Personal Care

Debate between Baroness Brinton and Baroness Blackwood of North Oxford

Wednesday 26th June 2019 Lords Chamber

[Baroness Brinton]

My Lords, the IPPR report also notes that, if health and social care were truly integrated, the NHS could save £1.2 billion a year, rising to £4.5 billion by 2030, by reducing the number of admissions to hospitals and delayed transfers, as well as placing a real focus on funding care in the community. Will the new Green Paper ensure that true integration is fully addressed and that it is not just a case of adding “Social Care” to the title of the department?

[Baroness Blackwood of North Oxford]

The noble Baroness, Lady Brinton, is absolutely right. Integrating social care funding is the key priority of the social care Green Paper. It is part of the work that we are prioritising through the better care fund, but it is also part of the ICS work.

Carers: Support

Debate between Baroness Brinton and Baroness Blackwood of North Oxford

Monday 17th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

As so often, my noble friend speaks with common sense and insight. This is something that our carers innovation fund is supposed to root out, with its creative and innovative ways to drive reform and improvement through the system. That is why we brought it in, but it is also a commitment of the long-term plan. Best-practice quality marks in primary care are supposed to drive better identification and support of carers in the system. We will ensure that we see that.

[Baroness Brinton (LD)]

My Lords, 160,000 young carers have been assessed and can get support, but it is thought that there are up to 800,000 young carers. Councils have admitted to the Young Carers Trust that they cannot assess these young people at all. Some of them are doing over 50 hours of caring a week. They know that it is impacting their own physical and mental health. A third of young carers drop out of university and college. What are the Government doing to ensure that the basic funding to provide assessment for these vulnerable young people is in place, and to join up the work between social care and education?

Unpaid Carers: Support

Debate between Baroness Brinton and Baroness Blackwood of North Oxford

Thursday 13th June 2019 Lords Chamber

[Baroness Brinton]

To ask Her Majesty’s Government what steps they are taking to ensure that unpaid carers receive the support to which they are entitled.

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

My Lords, we are committed to supporting carers to provide care in ways that protect and preserve their own health and well-being. Last June, we published the Carers Action Plan, a cross-government programme of targeted work. This included a £5 million carers innovation fund, to encourage innovative and creative ways of supporting carers. We are also working with local government on a sector-led improvement programme of work focused on implementing the carers Act duties for carers.

[Baroness Brinton (LD)]

I thank the Minister for her Answer. As Carers Week draws to a close, I point out that we owe a great debt of gratitude to the 6.5 million carers in the country who save us more than £100 billion a year, given the costs that we would otherwise have to bear. The problem is that nearly three-quarters of those carers say that they suffer mental health stress as a result of their caring duties, and over 60% say that they have physical health problems. Will the overdue Green Paper on social care put sustainable funding in place to properly provide support for carers and ensure speedy access to health services for them?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important Question. I suspect that the majority of noble Lords have not only been carers themselves but have benefited from caring. I would not be standing here myself were it not for the caring support of my own family. We should pay tribute to carers up and down the country, without whom we would not have a sustainable health and care system. I assure the noble Baroness that proposals for putting in place sustainable funding to support carers, and considering their employment status, are part of the work that is going on in implementing the long-term plan and preparing the social care Green Paper. I hope that reassures her.

NHS: Bullying

Debate between Baroness Brinton and Baroness Blackwood of North Oxford

Wednesday 5th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The Interim NHS People Plan identified bullying and violence in the workplace as a key challenge that must be addressed, and identified some measures to address them. However, the noble Baroness is absolutely right that an underlying challenge is staffing, which is a major concern for the NHS workforce. The plan looks to address them in a serious and concerted way by recruiting more staff, retaining existing staff, and looking at innovative ways to entice former staff back into the NHS so that we reduce the pressure on the entire system. She will know that the plan includes commitments to recruit 40,000 more nurses over the next five years and to reduce the vacancy rate to 5% by 2028, down from the current 8%, and reiterates the commitment to recruit 5,000 more GPs on top of the 20,000 extra support staff to be recruited in the coming years.

[Baroness Brinton (LD)]

My Lords, in addition to the figures cited by the Minister at the beginning of this Question, it has also been revealed that a number of hospital trusts still use non-disclosure agreements effectively to gag people when there has been a resolution to an incident. What guidance do the Government provide to NHS England to ensure that so-called gagging clauses are used only on sensitive matters, such as any compensation payment, and absolutely not to stop whistleblowing?

[Baroness Blackwood of North Oxford]

The noble Baroness is right that non-disclosure agreements cannot cover up bullying. All staff are free to speak up. Non-disclosure agreements should not be used for that purpose in any case. The Government have been very clear on this.

Social Care: Green Paper

Debate between Baroness Brinton and Baroness Blackwood of North Oxford

Monday 13th May 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I think that the noble Lord speaks for the whole House when he calls for consensus on social care. One reason why it is taking slightly longer to bring forward the plan is that we are doing a lot of work on consultation and collaboration to ensure that we produce a robust proposal which can command the support of the House and be delivered effectively and implemented well. The Government are committed to ensuring that everyone has access to the care and support they need, but we need to be clear that there should continue to be a principle of shared responsibility and that people should expect to contribute to their care as part of preparing for later life. The Green Paper will bring forward ideas for including an element of risk pooling in the system to help protect people from the highest costs. We look forward to support from the Opposition on those proposals.

[Baroness Brinton (LD)]

My Lords, in 2009 there was a proposal that we should all work together, cross-party, for social care, started by the then Labour Government. All three major parties signed up to it, and then one party withdrew, making it undeliverable—it was neither the Labour Party nor the Liberal Democrats. The Minister said all the warm words that we want to hear about support for health and social care integration, but the new Health for Care coalition of 19 major health organisations is very clear that, while it is doing all it can for social care services and the NHS working together, and integration is improving, it can go only so far when services are being placed under so much strain. It points out that we would need an annual increase of 3.9% to meet the needs of an ageing population and an increasing number of younger adults. Seven hundred days since the social care paper was first promised is too long: when will it actually be delivered?

[Baroness Blackwood of North Oxford]

I share the noble Baroness’s impatience for progress on this. She is absolutely right that there is no point in bringing forward the proposals if they are not properly costed and funded. That is exactly why these proposals have been developed in collaboration with the long-term plan and the social care plan. We have to ensure that the right funding for social care is agreed alongside the rest of the local government settlement at the forthcoming spending review. That is partly why this process is taking the route that it is.

Healthcare (International Arrangements) Bill

Debate between Baroness Brinton and Baroness Blackwood of North Oxford

Committee: 1st sitting (Hansard): House of Lords
Tuesday 19th February 2019 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I will comment on a couple of points from a political perspective. We have heard from a significant constitutional expert during the course of the last hour and a half. I thank the Minister for her letter following Second Reading and for her response at Second Reading. But what has become clear in the past hour is that for most of us who have been engaging in the debate this has clearly been a Brexit Bill. Indeed, the Minister says at the beginning of her letter:

“Although this Bill is being brought forward as a result of the UK’s exit from the EU, it is not intended to only deal with EU exit”.


However, it is one of the series of Bills that must be passed by 29 March, regardless of whether there is a deal, because we do not yet have the detail. As far as this House is concerned, it is in the list of Bills that we have been told must go through by that date. For that reason, I am afraid that I take issue with the noble Lord, Lord O’Shaughnessy, who says that it is not being rushed through. We have been waiting for this Bill and others for some time. We now have to rush it through because we are 39 days away from 29 March and time is extremely limited.

Some of the allegations that some of us made at Second Reading that this was all about future trade deals have become much clearer to us. I raised concerns then about TTIP. In her letter, the Minister appears to contradict herself. She says on page 2:

“Should the Government wish to enter into new comprehensive arrangements, this Bill provides the framework to implement these”.


Two paragraphs later she says:

“This Bill is not about negotiating new agreements, but to ensure … appropriate mechanisms … to implement them”.


It seems from everything that the noble Lords, Lord Lansley and Lord O’Shaughnessy, said that this provides the framework that will influence the Trade Bill and any future trade agreements. That is one of the most important reasons why a Bill that we understood was coming before us in order to replicate health arrangements with the EU, whatever our relationship is with it after 29 March, is now moving into a much broader political arena that deserves more than one and a half days in Committee to discuss it—let alone whatever time we are going to be allowed at Report.

I want to leave it there at this point, except to say to the noble Baroness—because I do not think there is another point at which I can do so without laying down an amendment that does not particularly have reference to the scope—that she tried to reassure me and others, both in Hansard in what she said winding up the Second Reading debate and in her letter, that the NHS was safe in the hands of this Government, and that the Government basically agree with the principle of the service of the NHS being free at the point of need. But the question that I asked has not been answered, either in her letter or in her response on the Bill. I am concerned about the replication of the EU directive on public procurement that provides many of the protections that we are seeking for the NHS in its entirety as we continue in the future.

I went on to the NHS Confederation website to look at what advice the Government were providing for the NHS in the event of a no-deal Brexit, and found that all the bullet points relating to public procurement were about emergency supplies running out. There is nothing about the intrinsic changes that are provided for in the current EU directive about not having to go out to competitive tender for certain parts of NHS procurement. We have used those as a protection over recent years, including during the coalition Government, to say that the NHS is safe in our hands. So I ask the Minister specifically if she can point me to where the replication of that EU directive on public procurement will appear before us prior to 29 March this year, because I am having trouble finding it.

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

My Lords, it is not often that one rises to speak for the first time in Committee in the presence of the head of one’s graduate college, who has just quoted Lady Thatcher at you in no uncertain terms. I am most grateful to the noble Lord, Lord Wilson, for his characteristic directness, and I promise that I shall be on my best behaviour.

I thank the noble Baronesses, Lady Thornton and Lady Jolly, for Amendments 1, 2, 12, 13, 14, 45, 46 and 47, the noble Lord, Lord Marks, for Amendment 3, the noble Lord, Lord Patel, for Amendment 5, and the noble Lords, Lord Patel and Lord Kakkar, and the noble and learned Lord, Lord Judge, for Amendment 44 and the notice of their intent to oppose Clause 1 standing part of the Bill. I am grateful to them for being clear that their intention is to strengthen, not to wreck, the Bill. I was, however, a little hurt by the noble and learned Lord, Lord Judge, stating that the role of committees of the House, particularly the Delegated Powers and Regulatory Reform Committee and the Constitution Committee, and indeed the scrutiny of this Chamber, was being dismissed or in any way taken lightly by the Government in this case.

As the noble Lord, Lord Lisvane, an old friend of mine from the other place, will know, as a former chair of a Select Committee, I could not take the scrutiny of this House more seriously, and my purpose here today is to engage seriously and effectively with the firm intention of the Bill leaving this place in a better state. Perhaps it is the optimism of a novice speaking. I welcome my noble friend Lord Cormack back from his sick bed, but believe that, given the quality of engagement in this place today, we can aspire perhaps not to quaffable wine but to more than just improving the Bill to make it applicable to the EU, the EEA and Switzerland, as the noble Lord, Lord Marks, said. We can aspire to non-EU healthcare agreements that are as valued by recipients as the EU scheme is.

Each of these amendments allows me to speak to the intent of the Bill and to the future of reciprocal healthcare arrangements after we exit the EU. As noble Lords have mentioned, although the Bill has been brought forward in response to our exiting the EU, it is not intended to deal just with that. It is designed to respond and offer certainty to those who rely on EU reciprocal healthcare, but it is more than that. It can give us the opportunity to strengthen existing reciprocal healthcare agreements with non-EU countries and to consider future additional reciprocal healthcare agreements. Given the level of public support for EU reciprocal healthcare, I would have thought that the Government seeking to strengthen global reciprocal healthcare would be a welcome move, provided, of course, that the Bill is appropriately scrutinised and strengthened.

Healthcare (International Arrangements) Bill

Debate between Baroness Brinton and Baroness Blackwood of North Oxford

Committee: 1st sitting (Hansard - continued): House of Lords
Tuesday 19th February 2019 Lords Chamber

[Baroness Brinton]

I am grateful that I am able to follow the noble Lord, Lord Lansley, because I think the point is made that this is very much a probing amendment. If the Minister gave reassurances that the contents of the amendment would be the practice followed by the Department of Health and Social Care, many of us would be reassured.

We spoke earlier about kidney patients on dialysis, but let me give another illustration of a family very close to me, who have a two year-old who requires an overnight ventilator. If they want to go anywhere outside the EEA, the cost of medical insurance for a small child on an overnight ventilator is more than the flights for the entire family—so they go to Europe. At the moment, they cannot book their summer holiday because their insurers say that they do not know or understand the arrangements, and of course we have no idea whether there will be any reciprocal arrangements. Families such as this will want access to advice very speedily if we are in the unfortunate position of a no-deal Brexit. By the way, following the collapse of the Malthouse compromise, I gather that the EU has said today that it is much more convinced that there will be a no-deal Brexit. Let us hope that it is wrong.

Although I understand the concerns of the noble Lord, Lord Lansley—the noble Baroness, Lady Thornton, may have different views—it would be good to have reassurance from the Minister that many of the things proposed in these amendments are exactly what the department will do and that it will be able to reassure the House and the wider public in the next few weeks.

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

I am very grateful to the noble Baroness, Lady Thornton, for Amendments 20 and 21. As the noble Baroness, Lady Brinton, has just said, I very much hope that I can reassure the Committee on these points. The noble Baroness is absolutely right that within the broader debate on the Bill, where noble Lords have valid concerns, we cannot forget that the Bill is being brought forward to protect individuals. These points were also raised earlier, by the noble Baroness, Lady Finlay, and the noble Lord, Lord Foulkes.

Speaking first to Amendment 20, I wholeheartedly agree with the spirit of the noble Baroness’s amendment. It is absolutely right that the Government provide individuals with relevant, timely information relating to their healthcare access after EU exit. The Government have already taken steps to inform individuals of what could happen to reciprocal healthcare in a deal or no-deal scenario. As a matter of course, we will continue to provide up-to-date information to individuals as soon as it becomes available.

The Government have issued advice via GOV.UK and NHS.UK to UK nationals living in the EU, UK residents travelling to the EU and EU nationals living in the UK. The advice provided on these websites explains how the UK is working to maintain reciprocal healthcare arrangements, but this depends on negotiations as they proceed. It also sets out options on how people might access healthcare under local laws in the member state they live in if we do not have a deal or a bilateral agreement in place, and what people can do to prepare, although we are determined that this will not happen. These pages will be updated as information becomes available. Our advice to people travelling abroad must continue to be to purchase travel insurance, which we already recommend, even though I recognise the challenge for those who have long-term conditions—in this debate, I have already expressed the challenge I myself experience.

[Baroness Brinton]

The Minister may recall that I pointed out at Second Reading that the Liberal Democrats had done some mystery shopping for travel insurance. It is not just about insurance for people who have special medical needs. Most of the insurers approached said they could not yet provide anything, because their insurance amounts would be based on whatever the final outcome is. Most of them, including very large insurers, were not prepared to tell potential travellers that they would cover them at all. The situation is much more serious and affects more than a handful of people with difficult medical conditions.

[Baroness Blackwood of North Oxford]

I am aware. This is a really challenging point. That is one of the reasons why we are determined to get the powers in the Bill, those in the SI and the best possible reciprocal healthcare arrangements through. That is one of the reasons why I am working so hard to make sure that we can strengthen the Bill as much as possible.

In addition to the point I just made, the Government are in constant dialogue with system partners throughout the health and social care system, including NHS England and NHS trusts, to ensure that the UK is prepared whatever the outcome of EU exit. I know noble Lords just had a debate on this on the previous group of amendments, so I will not take up too much time on it now. Looking to our expat communities in the EU, the DHSC and the FCO are working together to ensure that embassies and consular services can provide individuals with relevant information and support regarding their healthcare entitlements after EU exit, especially those who might need individual and specialised support.

I fully support the spirit of the amendment that the noble Baroness, Lady Thornton, tabled. I will ensure that we continue to take those actions to provide individuals with the information that they need. I hope that she has been reassured by this. If the noble Baroness, Lady Brinton, has any further concerns on this point I would be very happy to meet her and discuss detailed ways in which we can improve the service we are providing, given the situation in which we find ourselves.

Amendment 21 suggests using the Bill to offer financial support for British citizens to help them with healthcare costs should the UK leave the EU without a deal and without other agreements in place. It is important that I am clear about what support the Government can realistically offer, and why we are unable to go quite as far as the noble Baroness proposes.

The Government’s intention is to continue current reciprocal healthcare arrangements with member state countries in any scenario as they are now until 2020. However, healthcare for UK nationals who live in or visit other countries is ultimately for the individuals themselves or foreign authorities. We recognise that the UK can play an important supporting role by brokering reciprocal healthcare agreements, which we very much hope and intend to do. We have made very clear and generous offers to all countries in the EU and EEA, and Switzerland, to maintain reciprocal healthcare arrangements for the transitional period, and we will be negotiating for the period after that. This means maintaining reciprocal healthcare rights for pensioners, workers, students, tourists and other visitors in line with the current arrangements, including, as we have already debated, reimbursement of healthcare costs until 2020. But this depends on decisions by member states. People’s access to healthcare could change; we must be honest and open about that. Naturally, there is concern about what this will mean and what should be done. This is an uncertain situation and I very much appreciate that it will be difficult for people. I hope I can be a little bit reassuring about the actions we have already taken.

The 27 EU member states are all countries with universal healthcare coverage. In general, people would have good options for obtaining healthcare, providing they take the appropriate steps. After exit, and should there be no bilateral agreements in place, which we do not expect, the vast majority of UK nationals who live or work in the EU would still have good options for accessing healthcare. Depending on the country, it will generally be possible to access healthcare through legal residency, current or previous employment, joining a social insurance scheme, or contributing a percentage of income, as other residents need to. Less frequently—we have looked into this—people may need to purchase private insurance. People who return to the UK will also be able to use the NHS.

We recognise that this means a change and, in some circumstances, additional expense for UK nationals living abroad. It is to avoid this that we are offering not only to continue existing reciprocal agreements but to consider expanding our reciprocal healthcare arrangements outside the EU.

Speaking directly to the noble Baroness’s amendment, the Government will not be able to unilaterally fund healthcare for all UK citizens who live in or visit the EU. There are good reasons for this. It would be a new scheme that would cater for hundreds of thousands of people in up to 30 countries. It would place huge financial and administrative burdens on NHS bodies, assuming they made payments promptly and in-year. The technical challenges, including the risk of fraud, would be considerable. It would make it less likely that individuals would take the steps they need to, even if they were able to. It would undermine our approach with member states in negotiating reciprocal agreements. We do not think that is the right approach, but I reassure the noble Baroness that while these are difficult decisions and we cannot accept her amendment, we are taking important steps in addition to the reciprocal agreement negotiations that I have discussed.

We have mentioned the statutory instruments under the withdrawal Act that, in a no-deal scenario, can fund healthcare for people who are in the middle of treatment on exit day for up to one year. That assumes that the member state is willing to treat them and accept reimbursement; we have been discussing this. They would also enable some residents to recover costs if they are charged.