GP Access

Baroness Jolly Excerpts

Tuesday 7th June 2022 Lords Chamber

[Lord Kamall (Con)]

There are indeed a number of challenges. One is that many GPs are nearing retirement age and some are worried that their pension will be affected if they carry on working. Also, as an IPPR report recently said, the nature of illness and patient expectations have changed but the model of care has remained the same throughout. We expect five-minute appointments with referrals, but what we need in primary care is a much more networked model, with GPs, nurses, mental health officials, pharmacists, link workers and charities providing a joined-up service so that it does not always have to be the GP.

[Baroness Jolly (LD)]

My Lords, since 2016 the number of GPs in Devon has fallen by 7%, whereas the number of patients has increased by 14%. When does the Minister expect the 2016 GP/patient ratio to be the norm?

[Lord Kamall (Con)]

I apologise, I did not exactly get the nature of the noble Baroness’s question, but I understand about some issues in Devon. Clearly, there are areas of the country where there is more of a challenge. One solution being looked at is how we make sure that doctors are trained close to areas where there are shortages. Research has shown in some cases that people tend to stay in the area in which they were trained, and we have opened new medical schools. However, that will not be an overnight solution as we have to wait for doctors to be trained. Some solutions will be short-term and some will be long-term.

Down Syndrome Bill

Baroness Jolly Excerpts

2nd reading
Friday 18th March 2022 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I support the noble Baroness, Lady Hollins, and all that she has said today and, indeed, all of her work. I should be brief—only a few minutes—but the alternative, more in-depth look at this would take rather longer than the powers that be would allow. I would like to thank Dr Fox for the time he spent in the briefing, which was very helpful.

In the standard way, I have no interests to declare. But in a rather sort of non-Parliament way, I have two interests that have informed the way I think about this area and this debate. Like many others, when I was much younger, I had contact with a family member—my cousin, Daniel—who had Down’s syndrome. Like many people with Down’s syndrome, he sadly died as a child when he was six, leaving my uncle and aunt totally bereft. But I can certainly remember him as a happy, cheerful child who is very much missed by the family.

Secondly, for three years I was chair of one of England’s larger providers of services for people with a learning disability. There, I began to understand the issues about the care of an adult with Down’s syndrome and the many areas to be considered in their care. Although not interests in the parliamentary way, these two points have coloured what I want to say about this Private Member’s Bill.

This, of course, in the main is an excellent Bill—clear, concise and with the main bases covered. Thinking about the relevant authorities, we should consider the services delivered by the Department of Health and Social Care, the DfE and the Ministry of Housing, Communities and Local Government—which now goes under the somewhat snappier title of the Department for Levelling Up, Housing and Communities.

I wonder if the Minister could tell the House what areas he thinks the Department of Health and Social Care would have to augment, were this Bill to be passed? Would the Minister tell the House what conversations he has had with officials about this Private Member’s Bill? What changes would need to be made in the unlikely event that it finds its way on to the statute book? We all know it will not, but for the 40,000 people who have Down’s syndrome and their families and carers, could the Minister tell me when was the last “in the round” look that the department made of services for and care of people with Down’s syndrome? When did that last take place? Who is responsible in Whitehall for ensuring they are appropriate? Is Down’s syndrome treated separately from learning disability, or are decisions made about those with learning disabilities taken as all right for those with Down’s syndrome?

One of the things that my time chairing a learning disability provider organisation taught me was that those we supported really valued being involved in decision-making. I discovered that meeting the needs of someone with Down’s syndrome was best done by involving the individuals in the decisions being made about them, along with parents and family. The Bill is silent in its guidance about involving the person with Down’s syndrome in decisions about how they live, with whom and where. We often fail to do this and, were this Bill ever to reach Committee, I would like to lay an amendment which would ensure that people with Down’s syndrome—or any of the other learning disabilities—could say, with their hand on their heart, that “No decision is ever made about me without me.” We would not fail to involve people with a physical disability in legislation relating to them. The Secretary of State should make a provision to involve people with Down’s syndrome—or any other learning disability—in any guidance written by the department.

Integration White Paper

Baroness Jolly Excerpts

Thursday 10th February 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for raising the issue of mental health and parity of esteem, not only here but in our debates on the Health and Care Bill, and for our continuing conversations. We hope that we will be able to find a solution to make sure that mental health has parity of esteem. In previous Bills, health has meant physical and mental health, but I recognise the mood of the House when noble Lords ask for it to be stated explicitly somewhere, even in the triple aim. We are looking at solutions for that. He is absolutely right that it is not just about physical health; it is about mental health, about well-being, about tackling inequalities and about disparities. However, we cannot do that from here. We have to make sure that the place-based organisations, working in partnership with integrated care systems, really understand what is happening locally and are best placed to do that.

[Baroness Jolly (LD)]

My Lords, I welcome the White Paper. How will adults with a learning disability and their carers see a difference in their care and support as a result of it?

[Lord Kamall (Con)]

That is a really important issue. A single point of responsibility will make sure that these things do not fall between the cracks. It ensures that physical health, mental health and well-being all come together. A number of noble Lords have spoken about social prescribing, for example, and where that has been tried and where it might not work in other places. It is important that by talking about integration we get people thinking about integration at the place-based and the system level, but also that we can learn from good examples of what works elsewhere. That is what we hope to see. Sometimes, you just have to put in on the tin and say, “Think in an integrated way.”

NHS Dentistry

Baroness Jolly Excerpts

Monday 31st January 2022 Lords Chamber

[Lord Kamall (Con)]

We are looking at long-term reform and are in conversations with the BDA, especially around looking at the current UDA system and understanding its complexities. We have a number of different plans for dentistry, looking not only looking at its contracts but at recruitment and retention of people locally and from overseas, where it is ethical to do so.

[Baroness Jolly (LD)]

My Lords, at present, very few dentists in Cornwall take NHS patients at all. There is very poor public transport and travel distances to access a dentist are invariably more than 20 miles. When does the Minister anticipate patients in Cornwall—and in Devon, as we heard—being able to access NHS dentistry?

[Lord Kamall (Con)]

The briefing I have is that, if you are unable to access an NHS dentist, you should be able to access one at one of the 700 urgent dental care centres or ring 111 for advice. If that is not happening, I hope noble Lords will write to me, so I can look into it.

Ambulance Queues: Health Outcomes

Baroness Jolly Excerpts

Thursday 13th January 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord raises a very important point. One of the things the NHS is looking at in more detail, and something we will discuss in forthcoming debates on the Health and Social Care Bill, is how we move a system culturally to not only treat patients once they are ill or need treatment, and work in terms of prevention and encouraging healthier lifestyles. When patients are kept too long in hospital, they can lose certain facilities such as muscle function, so we need to look at prevention as opposed to just treatment. Getting the right balance is something that the NHS and the Department of Health and Social Care are looking at closely.

[Baroness Jolly (LD)]

My Lords, as a result of Covid’s impact, many A&E departments have reconfigured their internal infrastructure and their working practices. Could the Minister tell the House how best practice is being disseminated to other NHS trusts? What support, financial and otherwise, have trusts received to do this?

[Lord Kamall (Con)]

Given that it was identified that there were particular pressures on 29 trusts across 35 sites, extra resources have been targeted and teams have made site visits to work out, for example, the flows in those hospitals, and to make sure that they deal not only with the immediate issues that those departments face but also with the wider system issues. For example, as I have mentioned, sometimes patients cannot get hold of doctors and go to A&E as a substitute because they want a face-to-face appointment. We are looking at a number of those wider issues. We announced £55 million of winter funding for all ambulance services and have boosted staff numbers by 700, including for the availability of the ambulance fleet, through a £4.2 million investment to improve times. We have also invested nearly £2 million to support the well-being of front-line staff during these pressures; they have experienced increased pressures, so we must make sure we look after them as well.

Folic Acid

Baroness Jolly Excerpts

Tuesday 13th July 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, it is not only its importance for maternity services that is on my mind. It is also the recently announced office for health promotion, which will lead the national effort to improve and level up the health of the nation in the round by tackling obesity, improving mental health and promoting physical activity. This important initiative should be seen in the context of that important strategy. I completely endorse the ambition expressed by the noble Lord.

[Baroness Jolly (LD)]

My Lords, why does the Minister tease the House? He says that fortification should happen, so there is no disagreement, but it does not happen. In June, just over two weeks ago, he said that

“we are committed to following the science and are totally persuaded by it … I reassure noble Lords that this remains a priority for the Government.”—[Official Report, 23/6/21; col. 221.]

Since that Question, 50 more babies will have been born with neural tube defects. This will not do. Has the Minister sought the view of the new Secretary of State? Could he share it with the House?

[Lord Bethell (Con)]

I look forward with great enthusiasm to my monthly updates to the House on this important initiative. We are moving as quickly as the machinery of government allows us to. Taking along all the nations is an important aspect, but, quite fairly, it requires consultation with and the engagement of the devolved assemblies, which is why we have written to them and are engaging with them accordingly. I am also pleased to share with the noble Baroness that we are actively engaged with Defra, which is undertaking a wider review of bread and flour regulations. We will be aligning its fortification plans with this measure in due course.

Social Care and the Role of Carers

Baroness Jolly Excerpts

Thursday 24th June 2021 Lords Chamber

Moved by

[Baroness Jolly]

That this House takes note of social care provision in the United Kingdom, and the role of carers in that provision.

[Baroness Jolly (LD)]

My Lords, it is a great pleasure to open this debate on social care. I am sure it will be rich and varied, and that the Minister will struggle to sum up the points made in the time he is given. I am sure we will welcome a letter from him with his responses to our more trying queries. This debate also doubles as my health and care swansong, as I now move to defence.

I start by putting on record my, and our, utmost thanks to all those who work in social care systems, from carers to cleaners and caterers, to management in care homes and domiciliary care, and those who provide so much care for friends and family, expecting nothing in return.

I want to cast our minds back to the time of the coalition, when the Liberal Democrats made reform of social care an absolute priority, and the Dilnot commission provided a framework for us to fix the inherent unfairness in how social care is funded and provided. Cross-party talks were promising and it felt as though progress was being made. Not so. Later, both Prime Ministers May and Johnson said that they would sort it. But somewhere along the way this issue has been pushed into the long grass again and again, despite two Conservative Prime Ministers pledging to make it a priority. Of course, Covid has not helped.

So will it be Dilnot, Forsyth or something completely different? How will it be funded? We have seen, over the last year, what is possible when resources and energy are mobilised to address a crisis. We know that this an issue exercising the Chancellor. I want to be clear: what is happening in social care is a crisis, and we need to approach it as such.

Looking at the sector since the onset of Covid, we see that the Government have provided significant short-term support to help care providers through Covid-19, but it is vital that the Department of Health and Social Care now sets out how it will help providers move beyond it. The costs of the pandemic and the dramatic fall in care home occupancy, from around 90% at the start of the pandemic to 80% in February this year, puts many providers at risk of failing. In response, the Government provided short-term funding through local authorities and the infection control fund. This support has stabilised the market and kept most providers from falling over. However, the department does not have a strong grip on the variable levels of support that individual providers received, and there have been some reports of providers struggling to access some of the additional funding. The commitments around extra funding and free PPE—personal protective equipment—until the end of next March are welcome, but the department does not yet have a road map outlining how long extra funding and support will be in place. Can the Minister tell us please?

The Care Quality Commission warns that ongoing support is likely to be required in 2021-22 if care home admissions remain low or costs are inflated. Can the Minister tell the House whether the Department of Health and Social Care, working with the Ministry of Housing, Communities and Local Government, has an assessment process in place to determine how much support providers need in the short to medium term to deal with Covid-19 and lower occupancy in care homes?

I want to address the role of carers, both paid and unpaid. For those who work in social care, it is time for parity to become a reality. This relates to a number of issues. As I am sure carers themselves would say if they were here, the first issue is pay. Noble Lords will remember the outrage over a mere 1% pay rise for some of our NHS workers earlier this year, but the reality is that this is something our social carers can only dream of. Of course, the sector is far more fragmented, and much of it private, but the Government need to be ambitious in providing a fair, living wage to our social carers for all the hours that they work. This means leading the way on developing a framework that outlines what social care staff should be paid.

Secondly, along with pay, our carers need recognition and career progression. During the first stage of the pandemic, on Thursday nights, we all went outside and clapped to support all the NHS workers and care workers who were doing their very best. But care work, as many of us know, can be immensely rewarding and challenging in equal parts. Our workers need to know that their skills are valued and there is space for them to grow and progress in their career. We know that retention is an issue, when pay matches that in a supermarket. Greater recognition and regulation are needed. In both Wales and Scotland, care work is acknowledged as a profession. Would the Minister explain why care workers in England are not regulated and their pay derisory? What is stopping their recognition and regulation in England, as for those working in Wales and Scotland?

Turning now to unpaid carers, I draw on family experience, which is typical. For five years, my brother was my mother’s carer. He was able to get out of the house and shop when her carers came to get her up or get her ready for bed. His main breaks came when I got back at weekends, or when she went into a care home while we all went on holiday. Caring for a loved one is hard work, particularly when dementia is involved.

A Carers UK report found that, during the pandemic, 72% of carers have had no breaks from their caring role, with an average of 25 hours of support lost each month. Caring for someone can be a 24/7 job, and more. Research suggests that a third of unpaid carers now feel unable to manage their role. What assessment have the Government made of the impact on unpaid carers of the closure of respite care during the pandemic?

Will the Minister tell the House when the Government last looked at the issue of family carers? Family carers deserve breaks, so will the Minister commit to making sustainable funding available, to ensure that respite and day care centres can provide these much-needed breaks? If we fail to do this, we risk seeing an increase in burnout and mental health problems among carers, many of whom are old. This will lead to a vicious circle, where we find ourselves asking the question: who cares for the carers? Many day centres were run by organisations such as Age UK and funded by local authorities, but that funding was pulled five or six years ago by stretched local authorities. We cannot continue to rely on the unpaid labour of women—it is most frequently women—to prop up a social care system that is not sustainable or fit for purpose.

The devolved nations have instituted occupancy guarantees where they are falling, due sadly to the deaths of residents and hesitancy of individuals to move into care settings during the pandemic. In England, occupancy rates have fallen 7% to below 80%. Will the Government follow the example of Scotland, Wales and Northern Ireland and intervene with this short-term measure before wider reforms of funding and provision are announced? If not, I fear there will be no social care system left to reform.

The issue of indemnity for care homes has also been raised in this House many times. This comes back again to the theme of parity. As we hope to enjoy more freedoms over the next few months, these need to be extended to homes, with visits from family and friends and trips out. However, homes will not be able to provide these experiences if they are not adequately insured. Will the Minister please agree to look into this issue as a matter of urgency?

Looking to the future, our current model of care provision is unfair and unsustainable. Funding is one obvious issue. With the sector so fragmented, cuts to local authorities and a postcode lottery, we need to find consensus on how to fund the system. Government funding for local authorities fell by 55% in the decade between 2010 and 2020. Where there are cuts, we now see self-funders picking up the tab, but also subsidising the care of others in the care homes they live in. This is not fair, nor is it sustainable.

Workforce planning is another issue. We need to commit to a 10-year workforce plan that will adequately fill vacancies but also allow care providers to aim higher, providing continuity of care and allowing relationships to develop, to the benefit of both staff and those receiving care. The ideas have all been laid out and opposition parties are ready to work with the Government on the solution. What are we waiting for?

Through Covid-19, the Government provided significant short-term support to help providers. It is vital that the Department of Health and Social Care now sets out how it will help providers to move beyond it. The costs of Covid-19 and the dramatic fall in care home occupancy, from around 90% at the start of the pandemic to 80% by February 2021, puts many providers at risk of failing. In response, the Government provided short-term funding through local authorities and the infection control fund. This support has stabilised the market and kept most providers from failure. They are very grateful but still fear for the future. However, the department does not have a strong grip on the variable levels of support that individual providers received, and there have been some reports of providers struggling to access some of that additional funding.

Commitments around extra funding and free PPE until the end of March 2022 are welcome, but the department does not have a map out. The Care Quality Commission warns that

“ongoing support is likely to be required … if care home admissions remain low or costs remain inflated.”

It recommends that the Department of Health and Social Care, working with the Ministry of Housing, Communities and Local Government, should assess and outline by the end of July—next month—how much support providers need in the short to medium term to deal with Covid-19 and lower occupancy in care homes. Can the Minister outline how this work is progressing?

For several years, I was the chairman of one of the large charities that provide residential care for people with one learning disability or more. We cared for more than 1,000 people across England. Local government pays their fees and essentially what they get is a roof over their heads, full bed and board and care. More often than not, their homes are in large semis in residential parts of town with access to public transport. Supported people are in receipt of benefits, and the older ones a pension. This helps them to save for an annual holiday. They use their buying power to go out in the evening with their carers for a pizza, to the bowling alley or to a film. A day at the seaside is a favourite. Many are helped to find local jobs. Some of the large coffee chains will pay and train people with a learning disability to work the espresso machine, make milkshakes and clear tables. Job placements are carefully chosen and it is rare that the arrangement fails due to lack of commitment. The skill set and temperament that is required to care for someone with a learning disability is very different from what we expect from the carers of older people.

Many of us have seen at first hand the work of care homes, carers in our locality or those caring for family or friends. Many of us have seen people with a learning disability out with their friends enjoying themselves. All that points to dedicated carers in that sector. I know that there will be much expertise and wisdom in this debate today; I look forward to hearing noble Lords’ contributions and the Minister’s responses. I beg to move.

--- Later in debate ---

[Baroness Jolly (LD)]

My Lords, this debate has been as far reaching, well informed, well supported and inspirational as I expected. The message is absolutely clear. The Minister has probably has it, but I would be grateful if he would pull together all our thoughts—I do not think there has been any disagreement across the House on any of these issues—and tell his right honourable friend the Secretary of State that this is what needs to happen and ask him to go and chat to his friend the Prime Minister.

As I said at the beginning, this is my swansong. I say for those noble Lords who might not take part in health debates regularly that there is a sort of core team of “healthies”, and I will miss working with them. I will miss the camaraderie that exists in the core health and care community, and I look forward to working with an all-party defence team. That might take a bit more work to make it all-party, but we will work at it. I thank the Minister very much for his time.

Motion agreed.

Osimertinib Cancer Treatment

Baroness Jolly Excerpts

Tuesday 18th May 2021 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness is entirely right to be concerned about the backlog of oncological diagnostics. It is of grave concern to all of us. That is why the NHS has massively prioritised the tests she described. We are working extremely hard to get through the backlog. GPs are extremely focused on identifying those most at risk and those who are late for their tests are being followed up with great energy and endeavour. I pay tribute particularly to the role of NHS D, which is using the kind of data gains that we made during the pandemic to mobilise all the technology we can to get the right people into tests at the right time.

[Baroness Jolly (LD)]

I am really pleased that this drug can now be used as I understand that it is something of a wonder drug. That is good news. Are there any other drugs that might fall foul of the Northern Ireland protocol? Will the Minister update the House on the current problems in Northern Ireland with over-the-counter medicines such as Strepsils and others that appear to have fallen foul of the protocol?

Eating Disorder Services: Referrals

Baroness Jolly Excerpts

Monday 17th May 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Baroness is entirely right that community eating disorder services are critical. They are the backbone of our measures to address these difficult cases. But money for the treatment of eating disorders comes from many different pots. During 2021, a total of 10,695 children and young people started treatment, which is up from 8,034 children in the year before. So, clearly, resources are getting through to cope with a large number of people, and that is an encouraging sign.

[Baroness Jolly (LD)]

Is the Minister confident that all referrals to a community eating disorder specialist can be managed without excessive travel on the part of the individual and their family and that, where necessary, local in-patient services are available right across England?

[Lord Bethell (Con)]

The noble Baroness refers to a perennial issue in any national health service, which is the inevitable concentration of expertise in some hubs where there is particular specialist knowledge. But she is entirely right that we should try to avoid excessive travel. That is why community eating disorder services are so important, because they bring the treatment as close as possible to the people who are suffering.

Care Home Occupancy Rate

Baroness Jolly Excerpts

Wednesday 28th April 2021 Lords Chamber

[Lord Bethell (Con)]

My Lords, NHS minutes are published as a routine matter, of course. I would be happy to write to the noble Lord with a link to the right minutes.

[Baroness Jolly (LD) [V]]

Given the reluctance, post pandemic, to going into care homes, one would expect more vulnerable people to require support at home, and this is delivered in part using local authority funding. What advice is being given to the sector by Her Majesty’s Government, and what measures are being taken to ensure that this need can be met?