Health: Tick-borne Encephalitis

Baroness Jolly Excerpts

Tuesday 5th November 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

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

[Baroness Jolly (LD)]

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

[Baroness Blackwood of North Oxford]

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

National Health Service: Pensions Tax

Baroness Jolly Excerpts

Wednesday 30th October 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

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

[Baroness Jolly (LD)]

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

[Baroness Blackwood of North Oxford]

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

Health Service Safety Investigations Bill [HL]

Baroness Jolly Excerpts

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

[Baroness Jolly (LD)]

My Lords, this has been an excellent debate. The noble and learned Lord, Lord Hope of Craighead, has just mentioned the issue of no blame, a theme that has run all the way through the debate. It started with the noble Lord, Lord Hunt of Kings Heath, talking about James Titcombe, who lost a child at Morecambe Bay Hospital and is insistent that there can be no learning from blame. This was echoed by the noble Baroness, Lady Finlay of Llandaff, and the noble Lord, Lord Hunt of Wirral. Another theme running through the debate was picked up by the right reverend Prelate the Bishop of London, who talked about a culture of learning. Those are the two strands: we need a culture of learning in our NHS organisations and one of no blame. I welcome the commitment to learning from incidents involving patient harm and from adverse events. I also welcome HSSIB’s independence and I was grateful for the opportunity to talk to the Bill team yesterday.

This need to learn and to share is nothing new: something similar was being done 20 years ago. The noble Lord, Lord Patel, was just talking about it, as I thought he might, and I am sure that those here today will be able to tell the House that learning from such adverse events goes back even further. We heard very moving testimony from the noble Lord, Lord Turnberg, and, with their clinical backgrounds, from the noble Lords, Lord Ribeiro and Lord Colwyn. Will the Minister expand on how this theme could actually be woven into the Bill even further?

The governance of the body is interesting. For a body that will be looking at three or four cases each month, it seems very thoroughly governed. The board of HSSIB will have a chief investigator and chair as public appointments, as well as executive appointments and non-exec directors. The Joint Select Committee recommended that the appointments of both chief investigator and chair should be subject to the scrutiny of the Commons Health and Social Care Select Committee. I welcome the suggestion of the noble Lord, Lord Hunt of Kings Heath, that senior clinicians need to be involved in this, but experienced lay members can also bring welcome independent scrutiny—this was picked up by other noble Lords. It seems an appropriate measure, so why not include it in the Bill? It is something we may return to in Committee.

This is the first time that we know what the concept of a safe space entails. To allow individuals to talk about an event, secure in the knowledge that they will not be reported to others involved, is a powerful move, and I wonder whether it will take time for participants to gain confidence. Does the Minister have any insight into what measures might be taken to help with this? An expert advisory group was set up by DHSC to look at the HSSIB, yet its recommendations were not all followed. I understand that if you make a list of recommendations you can expect that they will probably not all be followed, but it had particular concerns about the duty of candour. The noble Lord, Lord Hunt of Wirral, spoke about candour, but I think he was talking about a slightly different sort of candour to what I think of as NHS candour. Here, we refer to frank and open conversation locally between patients and clinicians, and between different clinicians. Sometimes these are very uncomfortable conversations, where something has gone wrong and you sit down and have a facilitated chat. It can be very difficult to be honest and open, but it is really important.

Professional bodies express the need and the desire for the NHS to be an open, learning body, yet the Bill does just the opposite. How does the Minister see this being resolved? The reasons that healthcare regulators will seek disclosure from the High Court are likely to be linked to the proper exercise of their public protection duties. The proposed test surrounding the interests of justice does not appear to envisage or adequately cater for such applications. I am sure we will return to this in Committee.

My noble friend Lord Scriven brought to our attention the delivery of NHS services in prisons and in conjunction with social care. I welcome that addition, but I am also not sure whether the Bill applies to NHS care for service men and women, either in the UK or overseas. That is perhaps something else that might be looked into. I am sure we will also consider in Committee whether the Bill will include patients in private hospitals whose care is being funded by the NHS, and patients being treated by clinicians who work for the NHS as well as the private sector, but whose care is being provided for privately.

Following on from the point made by the noble Lord, Lord O’Shaughnessy, it is worth noting that NHS Providers recommends in its excellent briefing that all providers registered with the CQC should be part of the HSSIB’s remit. I would support that, as a sensible suggestion that would make the situation crystal clear. Regulatory bodies are listed in Clause 2(6), but there is a very large number of people working in the NHS who are not part of a registration scheme. The most obvious are care workers, but it is also true for very skilled individuals such as clinical perfusionists. There are also other qualified technicians within the NHS who have no body with which to register. In my response to the Queen’s Speech, I expressed my concern that care workers had no organisation with which to register. Clinicians, as I have just mentioned, are not registered either, and I know that this is not an issue of their making.

Where the incident involves an unregistered member of NHS staff, with whom would the HSSIB co-ordinate the practical arrangements called for in Clause 12? Will the Government consider looking again at the issue of non-registered NHS staff? The Minister may be aware that the GMC has suggested that now would be a time to look again at regulatory reform. Can she tell us whether there are any plans to make that happen?

This Bill is about processes—the Minister said as much when she opened this debate—to determine the truth about incidents during the provision of health services where there arose extreme causes for concern and to make recommendations to avoid repetition. It involves the patient, possibly their family and the clinicians and other staff. Yet in the Bill there is no heed taken of those individuals, or their care and well-being, in what would most certainly be a stressful and difficult time.

This has been an interesting and well-informed debate, but the two most powerful speeches were those of the noble Lords, Lord Turnberg and Lord Faulks. I shall spend the next couple of weeks rereading this Bill and thinking about its future—except perhaps, just perhaps, it will not have one.

Healthcare: Brain Tumours

Baroness Jolly Excerpts

Thursday 24th October 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

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

[Baroness Jolly (LD)]

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

[Baroness Blackwood of North Oxford]

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

Queen’s Speech

Baroness Jolly Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I refer to my interests in the register. I am going to be talking about Bills and what I call missing measures—or perhaps that is my wish list. We welcome the healthcare Bills in the Queen’s Speech. The Health Service Safety Investigations Bill seems sensible, and I look forward to a departmental briefing before Second Reading. The Mental Health Act was passed in 1983 and updated in 2007. Sir Simon Wessely has carried out his consultation on the Act, which should finish by the end of this year, and we look forward to the White Paper and subsequent Bill. The Medicines and Medical Devices Bill may well be critical in the event that we leave the EU. There will be a Bill to deliver the long-term plan, which will be interesting because it will have to enact some kind of reverse surgery on the Health and Social Care Act 2012, undoing some of the stuff that was done and putting other bits together. With apologies to St Matthew, what has been joined together may be very difficult to rend asunder; we shall see. With all these Bills the devil will be in the detail, and I am sure the Minister will understand that we will not hesitate to hold the Government’s feet to the fire where we think it necessary.

Everyone in the UK is thankful for the NHS, values it and understands how important its success is, but it is struggling, as we see in the parlous state of our cancer survival rates and one of the worst rates of depression in the EU. Some 1.4 million people this year did not receive any social care support, meaning that they went without a bath, help getting dressed in the morning or help with food, which puts a huge strain on family carers. The noble Baroness, Lady Bakewell, spoke about the need of elderly people for personal contact and how good it is for their well-being and mental health. Our workforce is in crisis as never before, with shortages of nurses, care workers and doctors, GPs and consultants across most specialities. The latter are particularly affected by the pension issue mentioned by the noble Baroness, Lady Donaghy. Can the Minister tell us whether the Treasury is close to resolving this issue?

For the past few years, we have watched as the Government have repeatedly cut public health funding. In the UK, a wealthy first-world country, life expectancy is decreasing for the first time ever. That statement should shame us all. It is not something that we should ignore, and the Government should not be surprised if there is a campaign to increase or at least sustain funding for health and social care.

Several areas vital to the future of health in this country are being sidelined at the moment. First, the state of mental health services is a scandal. We welcome the commitment to a new mental health Act, but it will not be worth the paper it is written on unless we can do something urgently about the workforce and local access to services for both adults and children. It is a sign of the times that a wonderful new residential facility for 12 children in Cornwall had to be funded by a local charity. The NHS did not have the funding locally to do it, but it is a brilliant facility.

For most of us, our first point of contact with the NHS is the local GP, but many feel unable to diagnose mental health conditions, so we need to improve mental health training for all GPs and health staff. Many long-term physical conditions have free prescriptions: I hold my hand up as being in receipt of that. Have the Government looked at replicating this for the most mentally unwell, where the condition is enduring? I know that for many there is a worry every month about which medications they feel they must have and which they feel they can do without. That is a scandal, too. While she was Prime Minister, Mrs May promised a Green Paper on social care. Many noble Lords referred to this and it was referred to in the Queen’s Speech. We all know that the only way to secure the future of social care is through a cross-party commission on social care funding. All parties have agreed to sit around a table, yet the promised Green Paper is hidden in the long grass. Two Prime Ministers have promised to sort this out, but we are still waiting.

We need to ensure that the quality of social care, both for our elderly and for those with disabilities, is excellent. The people who care for them, whether a family carer or a professional, need recognition and support. I gently remind the House that adult social care concerns vulnerable older people and disabled people of working age—that is often forgotten. I would welcome more ambitious targets on reducing life expectancy inequality for people with learning disabilities. Can the Minister confirm whether work to achieve this is in hand? On public health, we need to keep working with manufacturers to reduce sugar and to ensure that there is minimum unit pricing for alcohol. This is not the nanny state; it is, as the noble Lord, Lord Young of Cookham, put it, “benign paternalism”. I think that is far nicer. Over the past 20 years or so, the public have continued to eat too much of what is not good for them, and the taxpayer picks up the bill for NHS care for their type 2 diabetes, stroke, heart disease and cancer.

Our dedicated workforce determines everything within the health and social care system; nothing will succeed if there are not trained staff right across the system.

The NHS is not universally a good employer, with flexible working and mental health support. Many junior doctors do not even qualify for shared parental leave. The unresolved contract issues need to be sorted. Pharmacists are key to improving community healthcare right across the country, but services are not being commissioned from them. Many of us have friends or family who have been looked after by care workers on the minimum wage. I would like to see in the next Queen’s Speech some legislation to require care work to be a profession and care workers to be registered.

This debate should be in praise of the NHS and social care. Most noble Lords present will have a reason to be grateful to NHS or care workers who have gone the extra mile, whether in A&E, specialist services or a late night attendance at home. I would like to express all our thanks for the hundreds and thousands of friends and family carers who have gone unnoticed in the Queen’s Speech, who give up their jobs and lives to care for someone who can no longer care for themselves. Although she is not in her seat, I am sure that the noble Baroness, Lady Pitkeathley, would remind us that they save the state the equivalent of the whole annual NHS budget. I also applaud the carer’s credit of the noble Baroness, Lady Drake.

Like others, I am sorry that the noble Baroness, Lady Emerton, is not in her place. When I was new here, she was hugely helpful and gave me much advice about dealing with both health policy and noble Lords. She was a formidable nursing leader, made a DBE when I was in my 30s—which seems a really long time ago now—and will probably remain the only nurse to have a building named after her. I hope she is better soon.

I must praise the voluntary sector in both health and social care, the professional bodies and our world-leading think tanks. They carry out research and act as beacons for good treatment and health and social care policy, and thus improve care of patients and the professionalism of health and care workers. I also echo the words of the right reverend Prelate the Bishop of London in applauding the work of faith groups and local charities in health and social care delivery. This has been a wide-ranging debate, and we have learned much about the challenges of other disciplines. I eagerly await the Minister’s response.

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

Baroness Jolly Excerpts

Wednesday 16th October 2019 Grand Committee

[Baroness Jolly (LD)]

My Lords, I do not intend to detain the Committee for very long. The Minister has outlined the instrument clearly and the noble Baroness, Lady Thornton, has raised some pertinent issues but I too would appreciate some clarification. The briefing that I received from the FSA says:

“The new instrument makes clear that the responsibility to approve any additional substances which may be used to remove surface contamination from products of animal origin rests with the Secretary of State for Health and Social Care, in England, and the appropriate Minister in each of the Devolved Administrations”.


This raises a few questions and I have some that I would be grateful if the Minister could answer, or at least get back to the Committee about.

I wonder whether we could have different outcomes in each country of the union. Would this impact on, for example, the sales of Welsh lamb into England? If we can operate slightly differently in Wales and make different decisions there from those in England, could there be an issue with that? I also wonder who the Secretary of State will take evidence from in making his or her decision in this matter. What public consultation will be carried out in advance of a decision? Finally, we have already heard chlorinated chicken being raised but could the Minister assure us that this is just an English measure? Can she assure us that there will be no English chlorinated chicken on English dinner plates?

[Lord Rooker (Lab)]

My Lords, I should like to raise a few points and I suppose I ought to declare an interest, as between 2009 and 2013 I chaired the Food Standards Agency. I will not go into any detail about the regulations but they are really about Ministers’ powers. It is a Minister I want to talk about because it seems that we now have another Secretary of State who does not like the FSA. The Minister here may shake her head but wait until I have finished, please.

The noble Lord, Lord Lansley, did not like the FSA and sought to abolish it in 2010 but was prevented. Labour Ministers did not like the FSA either; that is the point. That is why it was set up, but now we have a Minister openly attacking the FSA in the public prints. He talked about action on “best-before zealotry” after the Prime Minister said that mouldy jam was okay: “Just scrape the top off, it’s okay”. Sod the toxins that have got into the rest of the jar and can cause major food poisoning. The Prime Minister and the Secretary of State were obviously better qualified than the medics who give the advice. The Secretary of State also weighed in when he said back in February, “I want a new chief executive at the FSA”, and he got one—did he not?—when the previous one left in June or July. I do not criticise that. I am sure it was perfectly ordered and all fine. However, he is starting to speak out on matters related to food safety. He has piled in about the “government body’s line”—referring to the FSA, a non-ministerial department—on beef burgers. He is very unhappy about the FSA’s interventions on food safety and wants it to go back to its “original purpose”.

These regulations are quite good, in a way, because they are essentially about surface contamination. But I invite the Minister and the Secretary of State to go and read Hugh Pennington’s report about the south Wales outbreak of E. coli 0157 in September 2005. A butcher provided meat then to schools in four local authorities; 157 people fell ill and, regrettably, Mason Jones, aged five, died. The butcher went to jail. It was all about the contamination and cross-contamination, and Hugh Pennington did a major report for the whole of the country. It did not relate just to Wales or that incident, as he had of course done others as well. That was about surface contamination, so surface contamination is not unimportant.

The Secretary of State said that if beef patties—beefburgers—were served rare, that was perfectly all right. I have some news for him: that is the whole point. I know that there is dispute between some scientists on this, but if you chop up meat, part of it will have been the outer part of the meat, the bit that can get contaminated. If you then mix it all together and do not cook it properly, it is highly likely that somewhere in the middle of the product will be meat that could be contaminated but has not been cooked. That is the great thing: cooking gets rid of most of the problems, whether E. coli or salmonella.

We have had cases in recent years where people have been seriously ill. It is not just a UK issue; there was the death of a young boy in France, who died 5 years after eating rare burgers from a Lidl supermarket. It is not unimportant.

My noble friend mentioned CJD. When I led a debate on the ban on beef on the bone—the most controversial debate I have ever led—it was at 10 pm in the House of Commons, everyone had had a good dinner and I came along as Grandpa Nanny Rooker saying that we need to ban beef on the bone. It was pretty acrimonious. What silenced the House was that during the day—this was in 1998 and I am not a doctor —I had asked: what happens to people who get CJD? What are the symptoms? During my conversation with three or four medics, it transpired that when those identified as having CJD—there is no final figure, but there are well over 100—were operated on to check the situation in the brain, the medical instruments had to be destroyed. They could not be sterilised. That really put the House of Commons to bed. It suddenly dawned on us that this was serious.

We may not have some of those issues now—heaven forbid that we do—but we must learn lessons from the past. It is so easy to say, “We haven’t had any problems; we will relax the rules because we have too much regulation”.

Just before I left the FSA—I am not sure of the date because I have not checked, but it was either 2012 or 2013—we were lobbied intensively by industry to allow animal protein to be fed to animals. We had a long board discussion about it, which is all on the record. One beauty of the FSA is that it is open and transparent. We came down 100% against allowing animal protein.

This Secretary of State is obviously amenable to industry, given how he has been bellyaching that the FSA is doing too much and should stick to its original purpose. There are attempts to restore that procedure, because it is a cheaper way to do it. I understand the pressure from industry. I and others were lobbied—submissions were made—to go back to it, saying, “We will follow the rules; we will not mix it up with anything else”, but everybody spoke on the record and the FSA board unanimously said that we were not going down that road, because we were still worried about what had happened.

We understand that this Secretary of State does not like what is happening at the FSA. I have not spoken to anybody on the board, by the way, but I assume that it is bold enough and has enough backbone to follow the rules and the law that set it up in the first place. I warn the Secretary of State that if he ever comes to this House trying to change Section 1 of the FSA Act, it will not go through. I am certain of that, because there is no excuse for watering down.

Ministers do not like it when things go wrong. They love to pull the levers when things are okay, because they are Ministers and they want to do this and announce the other. That is the thing they do not like about the FSA. My caveat—not a warning—to them is that they need to have officials and scientists front up the media when things go wrong. If Ministers start interfering when things are not going wrong, it might be that one day they will end up in the spotlight themselves. They will be the Minister who has taken health and food risk decisions. They will carry the can. There is no need for that. That is what the FSA has been set up for—not to carry the can, but to be the public guardian. That is its main function.

I have looked at various of the Secretary of State’s musings. It is probably unfair of me; I have probably not seen all the good things that he has said about the FSA. In fact, I have not found anything good that he has said about it, but I have found a few things that are negative. I thought that this would be an opportunity to put on record that we are watching him, because when things go wrong people will start opening the books and saying, “Who’s responsible for this?” It was the same when the horsemeat issue broke. I was in Northern Ireland at the time and so was the chief executive. It broke overnight.

When things go wrong, you start to say, “Hang on, who’s responsible for which bit here?” You can test these things out, but when things go wrong that is when people open the book. When things are going okay and we do not have major outbreaks, you can always say, “We can relax. We’re being too tough on industry. We want less regulation and to free up the market”. On food safety, however, the FSA’s staff have spent the best part of 20 years rebuilding British people’s confidence in their food supply. It is very important that we do not put that at risk. I fully accept that the regulations and the statutory instruments that the Government have provided for Brexit fully conform to all that. I have no problems with any of them. I have absolute confidence in what Ministers are planning.

However, the vulnerability is in the meat plants in particular. It is a closed industry. I think there is only one plc in the meat industry, which might be Morrisons, because it has a vertically integrated system—at least it used to; I am not up-to-date these days. Generally, it does not advertise on its factories, “By the way, we kill animals here so you can have your meat”. It is a very closed industry, but when you go to abattoirs for pigs, sheep and cattle you see the care and attention that has to take place for live cattle, some of which might be dirty cattle—the vets are there to stop that; a clean cattle policy is supposed to operate—from live animals at the beginning to the end product for the table. It is vital that that process is looked after. There are people in that industry who will seek to cut corners. I will not give examples; it would be unfair because they are out of date. But the fact is that it is a closed industry and it does not expose itself. I understand why. A few documentaries so that people understand where meat comes from might be helpful, but nobody has ever had the courage to do it.

It is in the industry’s interest that it resists any ministerial temptation to cut corners, because industry would be the loser. The beef ban lasted until 2006. It was the last thing that I did as a Northern Ireland Minister. I did not go to Brussels; I am one of those who has hardly ever been there. I went there to serve Northern Ireland beef on the day that the beef ban was lifted. Traders were over there doing deals to restore their past links. The last few years of the beef ban were purely political. There was nothing scientific or health-based about it whatever. We in this country know far more about CJD and BSE than anybody else simply because we have gone through it. We had reports galore. The fact is that industry suffers economically, and then the country suffers as well.

I wanted to put those few pointers on record so that someone could say to the Secretary of State, “By the way, it’s probably not a good idea to keep rubbishing the FSA, because people are watching what you are saying”.

[Baroness Blackwood of North Oxford]

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

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

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

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

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

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

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

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

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

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

[Baroness Jolly]

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

[Baroness Blackwood of North Oxford]

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

Sexually Transmitted Infections: England

Baroness Jolly Excerpts

Thursday 5th September 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord will agree that this Government have shown significant commitment to the roll-out of PrEP since the start of the PrEP impact trial in October 2017. Over half of the 26,000 places have been filled, which is welcome progress. The trial is scheduled to continue until autumn 2020 and work is now starting to consider future commissioning for PrEP after the trial has ended.

[Baroness Jolly (LD)]

My Lords, as the noble Lord, Lord Black, said, there is good news. Walking into the House this morning through Lambeth, I saw posters telling us that HIV is on the way out, but to be aware of STIs. What proportion of the Chancellor’s money announced yesterday will be allocated to local authorities delivering public health and what guidance is given to local authorities on developing sexual health services by Public Health England?

[Baroness Blackwood of North Oxford]

We will need to confirm the distribution of the grant in due course. I am sure that will be the subject of questions as we go forward. As for the guidance that comes from Public Health England, in developing its plans, local systems work in close partnership with directors of public health to respond to local health needs and deliver on the commitments for the long-term plan. Public Health England works very closely with those directors of public health.

Brexit: Medicine Supply and NHS Staffing

Baroness Jolly Excerpts

Thursday 5th September 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

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

[Baroness Jolly (LD)]

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

[Baroness Blackwood of North Oxford]

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

Personal Healthcare Budgets: Sheffield

Baroness Jolly Excerpts

Wednesday 4th September 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord has asked a very important question and I am pleased that the Prime Minister has followed through on his commitment to improve the situation for local authorities and for social care, not only by increasing funding for social care by £1 billion today but by increasing funding for local authorities. This is a welcome change for local authorities, which need to ensure that they can fund the commitments that we have. In addition to the letter that I shall place in the Library, I shall be happy to follow up on the specific challenge that the noble Lord raised regarding Sheffield following Questions.

[Baroness Jolly (LD)]

My Lords, personal healthcare budgets and payments from the Independent Living Fund can offer an individual freedom and choice, but will the Minister tell the House what advocacy support accompanies these payments, so that members of the public can be well informed and choose the best providers for their needs?

[Baroness Blackwood of North Oxford]

Personal health budgets play a really important role, not only in supporting individuals to have personalised care but by making sure that we can seek support from social prescribing and community care, just as the noble Baroness mentioned. These plans are designed not only between the general practitioner and the supporter, but with the patient; therefore, the right information is provided to the patient in an open and transparent manner so that they can ensure they get the right care. It is important to note that those in receipt of this care have an 87% satisfaction that they are receiving the care they want in a much more effective way than they were before.

Adult Social Care

Baroness Jolly Excerpts

Thursday 25th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Lord for the work he has done on this issue. It is very much welcomed. He will know that, as one of his first statements, the Prime Minister said that his job was to,

“protect you or your parents or grandparents from the fear of having to sell your home to pay for the costs of care”.

This was one of the first points he made. The noble Lord will also know that one of the Government’s long-term principles is that there must be a level of personal responsibility for social care in England, as well as the safety net that supports significant numbers of people today. However, we accept that there will need to be a significant amount of funding as part of the spending review commitment. That is being considered at the moment and will be coming forward imminently.

[Baroness Jolly (LD)]

My Lords, the sustainability of adult social care is at severe and immediate risk. We too welcome the Prime Minister’s words yesterday. Could the Minister confirm that he will commit to continuing with the precept, and the social care grant or the improved better care fund after 2019-20? Otherwise, how can councils plan their finances for 2020-21? What assurances do councils have that any future funding will be protected for the adult social services budget and not be part of the overall spending at the councils’ discretion?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right that the better care fund has been considered a great success. It is an important part of the integration proposals between health and social care, which the Government and the NHS are committed to. It is under review to see how it can work better. That will conclude later this year so that certainty can be given to local councils, which I hope she welcomes. On market instability, I reassure her that the overall number of social care beds has remained more or less constant over the past nine years. There are also over 3,700 more home care agencies now—so, while there will inevitably be some exits from the market, we are more reassured than we would otherwise have been.