Health and Social Care: Malnutrition

Baroness Janke Excerpts

Tuesday 5th November 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

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

[Baroness Janke (LD)]

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

[Baroness Blackwood of North Oxford]

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

Queen’s Speech

Baroness Janke Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Baroness Janke (LD)]

It is a great pleasure to follow the noble Baroness, Lady Bakewell. As a former council leader, I am very familiar with some of the issues she raised here today, but I shall confine my remarks to the worsening conditions of the least well off in our country. They deserve consideration, although sadly they are not a priority of the Government in the gracious Speech. There is ample evidence that conditions are getting worse for the poorest, whether in the form of research and reports, or in the daily experiences of children, families and individuals. Reports from the UN rapporteur, the Joseph Rowntree Trust, the Children’s Commissioner, the Child Poverty Action Group and a host of others provide shaming testimony in a country that once led the world in the social welfare of its citizens.

The gracious Speech makes reference to unlocking the full potential of children, yet we hear that teachers are buying food, clothing and equipment out of their own pockets for children who are too ashamed to come to school because their families cannot afford clothes and basic needs. The number of children attending food banks in the last year has doubled. Some 4.1 million children are in poverty, and 70% of them are from families where at least one parent works. Single parents, of whom 90% are women, are twice as likely to be in poverty as married couples. Half the children in one-parent families are in poverty. Furthermore, as far as housing is concerned, there has been a surge in homelessness, which was up by 320,000 in November 2017. Rough sleeping has shot up by 15% in a year; this is because of the paring back of housing benefit and the freezing of local housing allowance.

Nearly 50% of those in poverty—6.9 million—are from families where someone has a disability. On this I support the speech of the noble Baroness, Lady Campbell, and some of the examples she gave us. The crisis in PIP assessments whereby 75% of appeals are upheld requires attention. Even if the Government were concerned only with finance it would be sensible to look at a better way of doing this; in terms of the suffering it inflicts on people who already have to face financial penalties in various forms, it is just unforgivable. Families with disabilities are projected to lose £11,000 a year by 2021-22, more than a third of their income.

Indications also show that the worst off and most vulnerable will suffer more under Brexit. I understand from talking to those involved that very little assessment of this has been done, yet already the depreciation of the pound, rising prices and inflation are making things very difficult for those on fixed income. Unless the full uprating of benefits and low incomes takes place, there will be a crisis and the poorest and most vulnerable will not be protected. Indebtedness has already reached pre-2008 levels, yet little appears to have been done in terms of emergency support.

The gracious Speech states:

“My government will bring forward measures to protect individuals, families and their homes”.


The Government really need to look at the evidence of how they are protecting families and their homes. The two-child limit and the four-year benefits freeze both directly affect children. If what people are saying about the effect of Brexit is right, emergency payments would be indispensable, but they are going to be lost. In the past they have prevented families falling into destitution; they need to be reinstated. The sanctions imposed by the Government are a source of destitution and debt and are particularly damaging to people with disabilities or health conditions such as heart disease.

Payments to young people of £250 per month are not enough to live on for those who do not have supportive homes. Split payments need to be made so that abused women are not kept under the control of their abuser. As the noble Lord, Lord Willetts, has already mentioned, the disincentives to work, the effect of sanctions and flexible working need to be thoroughly investigated and action needs to be taken.

There is ample evidence of the worsening lives of the poor and vulnerable. Our priorities must be to build an effective social safety net nationally and locally, to address the issues that lead to low pay and insecure employment and to ensure that measures are in place for the least well-off, the least protected and the most vulnerable so that they do not slip through the holes of an insufficient safety net and drift into destitution and poverty.

Children: Oral Health

Baroness Janke Excerpts

Tuesday 12th March 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is exactly right, in that improving children’s oral health is a wider picture: it is about not just access to dentistry but a preventive approach, which is a core government priority. This is exactly why we introduced the children’s obesity plan, one aspect of which is a consultation on advertising. Proposals on that will be brought forward shortly.

[Baroness Janke (LD)]

My Lords, what is the Government’s assessment of the number of children receiving dental care from Dentaid, a peripatetic charity that provides emergency care in third-world countries? Does she consider this an acceptable way of safeguarding children’s oral health, and what will she do about children’s lack of access to NHS dentists in many parts of the country?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question. I shall have to write to her about access via Dentaid, which I was not aware of; it is a very important point. We are committed to driving down inequality of access and are pleased that the number of young people accessing dentists has increased. One of the key measures in reducing inequality is the Starting Well Core programme, which has targeted areas of highest need, and its performance is encouraging. However, she is absolutely right: we must drive out inequality of access to children’s dentistry and the Government are committed to doing that.

Brexit: Reciprocal Healthcare (European Union Committee Report)

Baroness Janke Excerpts

Tuesday 3rd July 2018 Lords Chamber

[Baroness Janke (LD)]

My Lords, it is a privilege to speak to this report. I pay tribute to the noble Lord, Lord Jay, and to his diplomatic skills in putting such a positive face on yet another report on Brexit, which again faces us with very worrying findings. I also thank the committee members and staff for their contributions; the staff provided us with very high-quality support.

In the words of one of our witnesses, Raj Jethwa, director of policy at the BMA,

“the best situation is one in which you are able to replicate or mirror as closely as possible the current reciprocal arrangements”.

So for many people it is a something of a “mad riddle”—to quote another recent discussion of Brexit—to understand quite how so much time, money and effort are being devoted to achieving something as close as possible to what we have already. Worse still, having taken part in this inquiry, I realise that lots of people simply have no idea of the risks ahead in healthcare post Brexit.

I add my thanks to the Minister, who has clearly attempted to reassure us and has put quite a lot of time into doing so. As such, I do not doubt his motives in any way; I am sure he wants to achieve the best possible solution. The report, however, provides us with a clear picture of the enormous benefits that have accrued to us as members of the EU.

There are the four routes to healthcare in the EU. First, the European health insurance card allows freedom of movement and access to healthcare wherever we might be. For holidaymakers and workers alike, there is no problem in accessing care or medicine. Secondly, the S1 scheme for people who live in the EU provides a simple, easy, accessible system. I am old enough to have lived in Europe before the EU. The system that existed before was so complicated and difficult that many people came home to the UK to get treatment where they could, rather than try to access it in Europe. Thirdly, there is the S2 scheme, which entitles British people to be referred to a specialist provider for treatment. Fourthly, the parent’s right directive gives British people the right to access high-quality treatment in the EU, particularly that which is unavailable in their own country, and to have the cost reimbursed. We often find that cheaper treatment for UK residents can be found in the EU than in the NHS. The average cost per pensioner has recently been calculated at €4.173 in Spain, as against £4.396 under the NHS, so there is even a savings benefit.

The noble Lord, Lord Ribeiro, spoke about Northern Ireland. I, too, was particularly moved to hear of the improvements and not just the peace dividend but the health dividend that has resulted from cross-border working, close co-provision and co-planning and, on an island as sparsely populated as Ireland, the absolute need to access high-quality healthcare, which had not been available before. The noble Lord also talked about children waiting four years for ear, nose and throat treatment, with all the ensuing difficulties that that entailed for their development. So there are enormous benefits.

I welcome the joint report, which tells us that the Government want the common travel area to continue, and the assurances that there will be no hard border. However, this gives rise to quite a few questions. I am sure that many people I know are unaware that the EHIC system is even at risk, but if it does not exist after March, can the Minister tell us about some of the issues that people will face over insurance? In the report, the insurance industry tells us that it is not completely prepared for a major impact of this kind after Brexit. How can families deal with this? What will the cost be for pensioners and people with long-standing illnesses? How will they be able to afford insurance and how much more will their holiday cost?

If we are to keep the common travel area—I understand that, as people say, nothing is agreed until everything is agreed—how will it happen? How exactly will this work with the red line of no freedom of movement and with the Government saying, as the Minister said yesterday, that there will be no barrier between Ireland and the EU? People need confidence; they need to understand what is going to happen and they need to make their own plans.

We heard Simon Stevens on “The Andrew Marr Show” on Sunday saying that the NHS is now planning contingencies for a no-deal scenario. This was one of the things we were assured: that there will not be a no-deal scenario. However, when we hear that the NHS is planning for this, it must raise all sorts of worries. The Government need to come clean with people, let them know what the risks are and let them understand what we are facing. All these things take time to resolve. They cannot be changed overnight or a magic wand easily waved so that everything will be as it was before. People need to know this. There is a huge lack of trust as these effects seem to come out slowly and have to be dragged out, whereas if people were able to understand that there were these risks, they could make their own plans for them. As the clock ticks, we can see that there is an urgent need for the Government to lead and reveal their plans; to make clear the extent of the shortfall in healthcare; and to let members of the public know what they can expect in terms of healthcare after March and after Brexit.

Dental Care

Baroness Janke Excerpts

Thursday 1st February 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness might send me her book so I can get her ideas on reaching adults with learning difficulties. Most adults with significant learning difficulties are likely to be on a range of benefits. That means that their dental care is free, if not for all, I suspect, then for some. She is absolutely right to point to sugar. We now have the sugar levy, which has had a really big impact. About 50% of drinks that would have been affected have been reformulated to either reduce or remove the application of that levy. That is a really good impact. On her point on advertising, we have very tough advertising rules in this country, including the banning of advertising of sweet drinks, sugary products and so on in children’s media. That is one of the reasons why we are seeing some hopeful signs on, for example, the number of extractions falling in primary care year on year.

[Baroness Janke (LD)]

My Lords, is the Minister aware that 41.5% of children have not visited the dentists for the year up to September 2017 and that many of these children are in the poorest communities of the country, many of which, as the noble Baroness, Lady Kennedy, said, are now dependent on charity for dental care? What action will he take to ensure that all children have proper access to NHS dentistry, wherever they live throughout the country?

[Lord O'Shaughnessy]

The noble Baroness is right. About 59% of children have seen a dentist in the last two years, but of course that leaves 41% who have not. I have to say that that is an improving picture. On her two particular issues, there is NHS England’s Starting Well programme, which is targeted on 13 local authorities that have the worst oral health outcomes for children. The range is really quite dramatic from one area to the next. It has also developed a core offer to help every local authority commission better dental health for children.