Abortion

Baroness Thornton Excerpts

Wednesday 6th June 2018 Lords Chamber

[Lord O'Shaughnessy]

Our intention—that of the Government and the Northern Ireland Office—is to restore a power-sharing agreement and arrangement in Northern Ireland so that it will be up to the people of Northern Ireland and their elected officials to decide on abortion policy.

[Baroness Thornton (Lab)]

My Lords, the Northern Ireland Assembly is not meeting at the moment. This matter, which is the issue of the Question put by the noble Baroness, is not a devolved matter. Could the Minister give the House an indication of the Government’s response to the debate led by my honourable friend Stella Creasy in the Commons yesterday? A cross-party amendment will be tabled to the upcoming Domestic Violence Bill that will seek to decriminalise abortion across England, Wales and Northern Ireland through the repeal of Sections 58 and 59 of the Offences against the Person Act 1861. That is not a devolved matter.

[Lord O'Shaughnessy]

I merely reiterate the point that abortion policy is a devolved matter. Indeed, that has been the policy of successive Governments of all hues. Of course, it is ultimately up to Parliament to make a decision, and any move that came from Parliament would emanate from within Parliament, from the Back Benches, on the basis of a free vote, as I set out in my first Answer.

Health Inequality: Autism and Learning Disabilities

Baroness Thornton Excerpts

Thursday 10th May 2018 Grand Committee

[Baroness Thornton (Lab)]

My Lords, I congratulate my noble friend on introducing this important debate, made particularly poignant by the learning disabilities mortality review, which we discussed yesterday. I also congratulate all noble Lords on sticking to the time limit, on being succinct and on being informative and moving in their remarks. I also thank the National Autistic Society, Mencap and SeeAbility for their briefings.

I was going to talk about eye care because I was so taken by the brief that we got on that. SeeAbility points to a gap and I hope that the Minister will be able to assist with that. The National Autistic Society quite rightly wanted to know when the autism pathway will be progressed. That has been mentioned by many noble Lords and I echo that. It is important also that the department looks at whether the Transforming Care programme meets the needs of autistic people and takes action to ensure that it does. Given that the Government are reviewing the Mental Health Act, will the Minister commit to look explicitly at how the Act works for autistic people?

I shall finish with something also to do with eyes. Desmond’s story, which came from the National Autistic Society or Mencap, is worth reading into the record:

“My learning disability means I grasp things more slowly and I need people to communicate clearly. Normally I go to my local hospital for my eye care—they are good with me. But in 20113 they referred me to another hospital to get an operation. That is where the problems began. I had a new doctor looking at my eye before the operation and he didn’t explain anything to me about what would happen. In the past, the hospital staff sedated me for operations on my eyes. I thought this would happen again. But instead, the doctor immediately started operating on me, while I was still awake. I was scared, and they were telling me not to close my eyes. It was a horrible feeling. I didn’t have a chance to explain what would make me feel more comfortable. There was no-one to talk it through and no time for the doctors to get to know me. I wish the doctors could have told me what was happening and why—it’s what anyone should expect. I hope staff get better training in the future to make sure they communicate better with people with a learning disability”.

Learning Disabilities Mortality Review

Baroness Thornton Excerpts

Wednesday 9th May 2018 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for repeating that briefing. He may find that the decision about the date of the publication was actually that of NHS England and, frankly, publishing it on the Friday before a bank holiday is either incompetent or shameful. However, seven years after the Winterbourne View scandal and five years since the avoidable death of Connor Sparrowhawk, the findings of this review show a much worse picture than previous reports about the early deaths of people with learning difficulties. One in eight of the deaths reviewed so far show there to have been abuse, neglect and delay in treatment and gaps in care. Women with a learning disability are dying 29 years younger, and men 23 years younger, than the general population; 28% of the deaths reviewed had occurred before the age of 50, compared with just 5% in the general population. This is a terrible situation.

I would like to ask the Minister two questions. First, almost one in 10 of the people who have died have been in out-of-area placements, without the support of family, friends, or any local, familiar community support. The Government have repeatedly said that such placements must be avoided, so will the Minister tell the House what action is being taken to ensure that government statements and guidance on this matter are being followed? Secondly, will the Minister expand on the last part of the Statement, and tell us what action the Government are taking to address the alarming gap in life expectancy of people with learning difficulties?

[Lord O'Shaughnessy]

I thank the noble Baroness for her questions and agree with her that it is a troubling report; it paints a troubling picture of the shockingly poor outcomes that people with learning disabilities have in terms of their mortality and morbidity. I would not disagree with her about that picture and I will come to the actions we are taking to try and address it.

On the publication, I agree with her that the timing was less than ideal. The department did not have sight of it; it was an independent report commissioned by NHS England. We are investigating that, but I agree it was not done as it should have been and we will endeavour to ensure that this does not happen again. On the areas of policy that she referred to, on out-of-area placements there is a programme called Building the Right Support, which is trying to increase the amount of care delivered in community settings, bringing people with learning difficulties, disabilities and autism out of in-patient care to more suitable care in the community. The intention is to reduce the use of in-patient beds for people in mental health hospitals by 35% to 50% between March 2015 and March 2019. It is an attempt to locate much more of that care in the community.

The noble Baroness also asked about other actions we are taking to improve outcomes. I want to focus on the annual health checks that are now available for adults and young people from 14-plus years. That is happening every year. We know the use of these checks is increasing; it has increased by 17% year on year up to 2017-18. There is a real ambition to raise that further by 64% in 2018-19 compared to 2016-17. We know this group does not always feel equipped to come forward and bring health issues to the notice of the health system. It needs extra support; it needs people to be on their side, checking in with them to make sure their issues are addressed. I think this is one way in which we will make some difference.

Breast Cancer Screening

Baroness Thornton Excerpts

Thursday 3rd May 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the noble Lord for repeating that Statement and say to him that, along with millions of other people in this country, I am looking at my older relatives and wondering if any of them were caught by this. I do not think I am alone in that. As a woman of my age, it is important to say that we absolutely depend on the screening process to take care of us, to be invited for the smears and breast cancer screening and to be warned and told. So this is a massive public health failure—I think that we would all agree about that.

The noble Lord is quite right: there are a great many questions that he has mentioned that need to be answered. I appreciate his candour in questioning why this problem was not picked up, because eight years is a long time for an error of this magnitude to go undetected. Did the department receive any warnings in that time? Is there any record of how many women raised concerns that they had not received the appropriate screening? Were there any opportunities to change this mistake that were missed? We on these Benches indeed welcome the establishment of a national inquiry. Will the inquiry be hosted and staffed by the Department of Health or by another department? In the interests of transparency, I hope that Public Health England’s analysis from this year will be put in the Library, so that we can see what was identified as the problem with the algorithm. The noble Lord says that NHS England will take steps to expand capacity of screening services. Can he say a little more about that? Where are those extra resources going to be found and how will they provide extra screening?

The reason that this is so terrible in many ways is that we all know that the screening rates were falling; we have known that for years. The proportion of women aged between 50 and 70 taking up routine breast screening invitations fell to 71% in 2016-17; in London, I understand it is about 64%, so this is very serious indeed. In a way, I hope that the inquiry will address how we can make sure that those warnings are heeded and will allow questioning to take place of the whole process, which should be escalated to the right level in the Department of Health. There is an enormously wide range of variation in screening rates, which I hope the inquiry will also address. It seems that the fact that there is such a wide variation is also connected with things such as kit and staff—yesterday we were discussing the understaffing at various levels in the National Health Service. So beyond the problems identified by the Minister today, what more are the Government doing to make sure that screening rates rise again so that cancer care for patients is the best it can possibly be?

We are all concerned—this has cast a shadow that will bring fear and anxiety to millions of people. I know that all Members on all sides of the House who want to see cancer prevented will see this as an issue which we will all join in helping to resolve.

[Baroness Maddock (LD)]

My Lords, I am sure that all of us in this House are considerably concerned about those older women who at the moment are suffering acute anxiety because of what happened, and not only them but their families. It would appear that this was a software error. As I understand it, the same situation has not occurred in Wales, although the health service there appears to be on the same system. Can the Minister tell us a little more about that?

The Minister said that past notes will be looked at. How long does it take to get notes from the archive? Not all notes are held with GPs, and hospitals sometimes archive historic records. Are there enough current NHS staff to look at this, or will we need to take on new staff? That leads me on to another point about speed being of the essence. Depending on the uptake, as has already been alluded to, there may be a need to get women in this cohort X-rayed quickly and at scale. I know that we have had a shortage of radiologists; do we have enough to meet this need?

There is a wider issue, already referred to by the noble Baroness, Lady Thornton, of the lowering of the take-up rate. One thing that has come to my notice because of where I live and from talking to other people, is that if you happen to be unable to take up the appointment in the travelling van that comes round, you are often referred to a hospital. Sometimes that works and sometimes it does not—it can be a long way to go. However, when one of my colleagues asked whether she could have it done when she was here in London and have the X-ray emailed to her, she was told that that was not possible. Can the Minister look at that? While on technology, perhaps the problem of not detecting this is connected with the fact that we have become so reliant on technology that we think it is looking after things and so people do not personally ask the questions they need to.

I hope that the Minister will give us a bit more information about other steps that the Government are taking to try to help improve the take-up rate of screening. Unfortunately, this episode will cause some people to lose faith in the system, and we need to do something about that. Can he also say what his department will do to raise awareness, particularly among women over 70, so that they can continue to be checked?

I hope that the House will indulge me if I take this opportunity to thank those in the health service who have served me with my breast cancer. I may or may not have been one of these people; I self-referred when I was 70 because I had been through the screening process and had been looking out for signs that I had been warned of, so that is one very good thing. I had excellent service at the Royal Victoria Infirmary in Newcastle, which has been rated as outstanding after an inspection, and I was fortunate enough to be able to have chemotherapy down the road in my local hospital in Berwick. The two nurses who run that are absolutely fantastic. So I am very fortunate, and I know that that is what happens in my part of the country. I therefore thank the National Health Service for helping me, and I look forward to hearing from the Minister.

Health: Cancer Nurses

Baroness Thornton Excerpts

Wednesday 2nd May 2018 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of the impact of the shortage of more than 400 specialist cancer nurses reported by Macmillan Cancer Support.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, we welcome Macmillan Cancer Support’s report, which acknowledges the fact that the number of specialist cancer nurses has increased by nearly 1,000 full-time equivalent posts, or by 30%, since 2014. There is more to do, however, and Health Education England is working closely with Macmillan and the cancer alliances, so that we can achieve our aim that every cancer patient has access to a specialist cancer nurse by 2021.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. The census also pointed to the facts that there are vacancy rates as high as 15% for chemotherapy nurses in some areas, that the proportion of specialist cancer nurses who are over 50 years old continues to climb, and that almost one in 10 specialist cancer nurses comes from the European Union. We know that there has been a cliff edge for recruitment from the European Union. I want to ask two questions. First, will the Minister assure the House that this census will be used by the Department of Health and Social Care, Health Education England and the cancer alliances to inform their strategic workforce planning? Secondly, will he explain what steps the department has taken to assess the level of funding required to deliver the recommendations contained in the Cancer Workforce Plan, including the long-term strategy?

[Lord O'Shaughnessy]

The noble Baroness is quite right that the Macmillan report highlights some challenges around vacancy rates and the age profile of cancer nurse specialists. It was explicitly set out in the cancer workforce strategy that it would have a phase 2 of planning once the census had been published. This census has been published, so there is an absolute commitment by Health Education England to work with Macmillan and the cancer alliances to bottom out how many more staff are required to meet the standard that we have set out—for every patient to see a cancer nurse specialist by 2021—and how many extra people we would need to recruit for that, and therefore to deliver the funding that would enable that to happen.

The Long-term Sustainability of the NHS and Adult Social Care

Baroness Thornton Excerpts

Thursday 26th April 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I first congratulate the noble Lord, Lord Patel, and his committee both for the excellent report we have been discussing and for persisting in pushing the Government to respond—a response, I think, which merits a C-plus perhaps, although my noble friend Lord Hunt thinks that is generous, and was late and could do better.

I declare an interest as a member of a CCG. In that part of my life, I am what noble Lords might call “up close and personal” with the results of the reforms of the noble Lord, Lord Lansley. I witness a great deal of great work, often in spite of the heavy hand of NHS England and our swingeing QIPP. In many ways, the report gladdens my heart.

I thank all noble Lords for their contributions, particularly my noble friends Lord Hunt and Lady Wheeler. As I said, the report is excellent and there is much that we can agree about in it. As the noble Baroness, Lady Finlay, said, it is a birthday present to the NHS from the noble Lord, Lord Patel, and the House of Lords—or perhaps it brings a new dawn to the NHS, as my noble friend Lady Pitkeathley put it.

I was struck by many excellent contributions today, such as that of the right reverend Prelate and his comments about an office for health and care sustainability. That idea is definitely worthy of consideration, and the recommendation did not deserve the dismissive response it received. I think that I would support it, but only if we can get rid of some of the other bodies that this report suggests are not necessary. My noble friend Lord Turnberg and other noble Lords have urged the Minister to be bold and think the unthinkable. I definitely look forward to him doing so.

In his plea to integrate academic medicine into our hospitals, my noble friend Lord Winston told me something that I did not know, as he always does. It often shocks me when I realise that what he is saying is true. I look forward to the Minister’s response to what he had to say.

The noble Baroness, Lady Finlay, and my noble friend Lord Carter made powerful contributions about the workforce in their different ways.

The noble Lords, Lord Kakkar, Lord Willis and Lord Saatchi, and the noble Baroness, Lady Tyler, talked about cross-party consensus. I need to respond to them. If I might put it like this—certainly to the noble Lord, Lord Kakkar—we could look at this in a different way. There is a great deal of agreement on many matters that we discuss. We all agree about the need for a preventative, not an illness-based, NHS. We all agree about patient safety, primary care and many other matters. Indeed, we in this House spend our lives finding agreement on how to proceed and what we might do.

The best way I can put it is that this problem is about trust. It is not only we on these Benches who struggle with trusting this Government. That lack of trust is based on solid experience of things such as the Dilnot report, but the state of the NHS is also the single biggest issue vexing Conservative voters, with more than seven out of 10 of them citing their concern in January this year. Notwithstanding my noble friend Lord Turnberg’s support for the Secretary of State, fewer than four out of 10 Conservative voters thought that the Secretary of State should keep his job. The polling shows, as did the last election, that there is a problem with trusting this Government on the NHS.

The noble Lord, Lord Willis, should remember that his party was decimated in 2015, partly because of that trust. It is a problem that all political parties face in this country. It is to do with not just this issue, but the way we run our country. We need to contemplate and think about that issue, because it is obviously a very important one regarding how we proceed and build consensus about our National Health Service.

My intention is to speak about social care and the crucial issue of integration, which is so central to this report. As the report indicates, all the investment we might want to put into the health service will not work if we do not also deal with social care. I know from personal experience, both as a carer for my mother and as a CCG member, how complex it is to achieve integration, but there are, as many noble Lords said, examples of really great integration programmes going on at local level, with local leadership and innovation. My question to the Minister is: how can the system learn from that? Many of us have posed that question over many years. How can we replicate the systems that work?

Today, we see the announcement from the think tank the IPPR, which now seeks also to address the issues of the long-term future of our health and social care system, led by my former boss and noble friend Lord Darzi and the noble Lord, Lord Prior, also a former Minister, whose contribution about the fragmentation of the NHS I completely agree with. We should welcome this report and the consideration because it is being led by two very experienced former Ministers. I am sure it will look at the huge challenges that the health and social care system faces: the re-emergence of rationing and waiting times on the rise; deteriorating finances, with the zigzag that the noble Lord, Lord Warner, talked about on funding; demoralised staff, referred to by my noble friend Lord Carter; and all the issues that come with Brexit.

As many noble Lords have said, the future of the NHS and of social care are inextricably linked. A sustainable NHS is predicated on a sustainable social care system. My noble friend Lord Rea said that even better than I could. These are enormous questions about how the health and social care system can succeed in an age of rising demand and take advantage of new technology, and how to truly integrate health and social care systems.

How can we deliver parity of esteem for patients receiving support for mental health problems and join up health and care around those patients, as my noble friend Lord Bradley explained with great eloquence? If I have a particular criticism of the Government’s response, it is that it was not robust enough at all on mental health.

Next year we will celebrate the 70th anniversary of the founding of the NHS. The health and social care system deserves a secure future that gives us confidence that it will celebrate its centenary in a little more than 30 years from now. The noble Baroness, Lady Watkins, is right: we need to take a 30-year perspective on this.

I need to comment on the idea of a royal commission. The Government have promised us a Green Paper. Since the royal commission on social care and long-term funding for older people first reported in 1999, we have seen 12 consultations and four independent reviews. With the Government undertaking yet another consultation and producing yet another Green Paper, the question is whether it will lead to action. Some £1 million was spent on the Dilnot review, only for the Government to delay the introduction of its recommended care cap before shelving it indefinitely. The Government are wasting time and public money on consultations. How can we have confidence that a royal commission will be any different? I do not think we can, or that we can wait for a royal commission to be established. I say to the noble Lord, Lord Saatchi, that we on these Benches would take some convincing that this is a sensible way forward.

We should be calling for social care to be placed on an equal footing with the NHS, rather than being an adjunct. We need care and health operating as one—locally led, focused on prevention and person-centred. It is social care that keeps people out of hospital in the first place and takes the pressure off the NHS. Delayed discharges are a good example of this, as was explained by the noble Baroness, Lady Greengross.

Are the Government going to give equal priority to social care and mental health? Will the Minister answer the questions, posed by many noble Lords, from the excellent Age UK briefing? It asks when the social care Green Paper will be published; how the Government will ensure that older people in care are consulted properly; and whether the Government will undertake—as my noble friend Lady Pitkeathley and other noble Lords outlined—to make sure that people understand what the cost of social care will be to their families.

In conclusion, the Government should return to this report and take a better look at it. This is one of those occasions where we should give them back their homework and say, “Have another go at this”, because the report is full of great suggestions and recommendations and the response is not great. The long-term sustainability of the NHS and adult social care deserves a great response.

NHS: Artificial Intelligence

Baroness Thornton Excerpts

Tuesday 24th April 2018 Lords Chamber

[Lord O’Shaughnessy]

My Lords, I thank my noble friend for his question and congratulate him and the rest of the committee on the excellent report, AI in the UK: Ready, Willing and Able?, which has a substantial chapter on AI’s application in healthcare. The potential to transform every element of health and care is susceptible to artificial intelligence. A couple of areas outside the clinical setting that I would highlight are workforce planning and triaging patients between different forms of care. As for support, in addition to the items in my first Answer, I highlight the work of the Topol review, which is designed to make sure that staff are fully equipped and trained to take advantage of these technologies as they come through the system, rather than letting them sit with a few early adopters and not becoming more widespread in the NHS.

[Baroness Thornton (Lab)]

My Lords, it is quite clear that the use of big data and AI will have transformative outcomes for patients. There are at least two challenges. The first is investment, which the Minister has already mentioned. What framework of accountability and transparency is in place to deal with that level of investment? How will we know whether it is being sensibly invested? The second is safeguarding and protecting data, and I use my local hospital as an example. A partnership between Google DeepMind and the Royal Free Hospital trust resulted in a breach of the Data Protection Act and the personal data of more than 1.6 million patients was transferred to the Google subsidiary as part of the creation of Streams, an app to diagnose and detect acute kidney injury—which we would, of course, all support. This suggests inexperienced procurement and negotiation skills in the NHS and the potential for the Googles of this world to run rings round them, to all our detriment. What are the Government doing to safeguard patients and their data?

[Lord O’Shaughnessy]

The case the noble Baroness highlighted brings to the fore both the potential benefits and risks. There are tremendous benefits in having personalised healthcare, and we all want to see that delivered. At the same time, if data is not used safely and securely we lose the public’s trust. If we do not have that trust, we will not be able to get the changes that we want. The Government respect the decisions made by the Information Commissioner and National Data Guardian in their judgments about poor practice at the Royal Free. I am pleased to say that the hospital has responded well to these. We are doing a couple of things to make more systematic changes. First is implementing the proper data standards of the GDPR in one month’s time. We will also make sure that National Data Guardian’s 10 data standards are written into every NHS contract so that, when it comes to procurement, there is understanding about the kind of things they should and should not be doing to safeguard data.

Children and Young People: Obesity

Baroness Thornton Excerpts

Tuesday 17th April 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the noble Baroness, Lady Walmsley, for initiating this debate and for her patience—she has got it at last. I thank all noble Lords for their contributions, and I thank the many organisations that have sent us briefings about this important subject: the LGA, the BMA, Diabetes UK, Cancer Research UK, the Faculty of Dental Surgery, the Daily Mile and the Obesity Health Alliance. As other noble Lords have mentioned, we also received one late today from the Advertising Association, which seemed to make the argument that there is no need to have a ban on high-fat, salt and sugar advertising before the watershed at 9 pm because there is no evidence that it would have any impact. As someone who proposed a Private Member’s Bill about 10 years ago saying exactly the opposite to that, I am afraid that, like the noble Baroness, I was not in sympathy with that argument. I am sorry if I have left anyone out of the thanks for all the briefings that we have received. This amount of interest seems to be a sign that people recognise that there is a health emergency that our children and young people face.

The House of Commons Select Committee March 2017 follow-up to its 2015 report tracked the action, or inaction, of government in tackling the problem of child obesity. It commented on the Government’s child obesity plan that was published in 2016, which, like many noble Lords here, we found disappointingly modest, given the proposals of the 2015 Select Committee. It showed a lack of urgency that I am afraid is still apparent.

I am not going to repeat all the facts that many noble Lords have mentioned, but the fact that 30% of our children are overweight or obese and many will remain that way into adulthood is not good. And yet, in 2016 UNICEF estimated that 10% of children in the UK are living in severe food insecurity, which means that they do not have enough to eat. Frank Field’s Hungry Holidays report estimated that as many as 3 million children could be at risk of going hungry over the school holidays. I am sure that your Lordships will recall that at a recent teachers’ conference we heard reports of grey-faced hungry children turning up at school who cannot learn because they have not eaten.

Food poverty and obesity coexist in some of our most deprived communities. Children living in the most deprived areas are more than twice as likely to be affected by obesity as those living in the least deprived areas. Families from deprived communities have the poorest diets, as noble Lords have mentioned, high in saturated fat and low in fruit, vegetables and fibre.

Can the Minister assure the House that the Government are taking a comprehensive approach to this issue, which is also about how to support parents to make the right choices, the right decisions? It is about ensuring that children can still have access to free school lunches. It is about looking at how families can afford decent food. As the noble Lord, Lord Storey, said, it is about Sure Start centres, it is about providing support in the communities where children are most at risk. If I may add, it is also about not selling off school playgrounds.

I was struck by the briefing we received from the LGA, because since the responsibility for delivering public health transferred to councils in 2015, local government has spent more than £1 billion tackling child and adult obesity and physical inactivity. Against a backdrop of reductions to the public health budget, councils report a 50% increase in spend in the years between 2013 and 2017 on childhood obesity and a 60% increase on childhood physical inactivity in the same period.

Surely it is counterproductive to continue to cut public health budgets in this context. Public Health England’s sugar reduction programme should be extended to include salt, saturated fat and overall calories. Is the Minister prepared to ensure that compliance with these targets should be regularly monitored and backed by meaningful sanctions for companies failing to make progress?

As many noble Lords have mentioned, the Government should close existing loopholes to restrict children’s exposure to junk food marketing across all the media to which they are exposed. The rules currently apply to only 26% of children’s viewing times and still allow adverts for food and drink high in fat, sugar and salt to be shown during family viewing time—between 6 and 9 pm—when the number of children watching TV is at its highest. These rules are failing to protect our children. They deserve to be protected from exposure to adverts for food and drink that we know can influence their food preferences, choices and intake.

The noble Baroness, Lady Mone, made a great speech about what needs to be done, but the point about her analogy with seatbelt usage is that we needed legal compulsion to make people wear seatbelts because they would not do it voluntarily and the car industry was not going to install them unless the law made it comply. If we are to follow that analogy, perhaps some lessons need to be learned about compulsion.

We need a comprehensive strategy that tackles all those issues. If we fail to have that, we fail a generation of children and young people, to great personal cost to them and great public cost. The noble Baroness, Lady Jenkin, hit the nail on the head when she said that political leadership is what is required.

Brexit: Health and Welfare

Baroness Thornton Excerpts

Thursday 29th March 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I congratulate the noble Baroness, Lady Brinton, on initiating this debate and, of course, on its timing—the 70th anniversary of the NHS, and one year from Brexit. I thank all those who have taken part. They have taken a break from their Easter egg hunting to be here this morning.

I think the Minister is aware—if he was not, he certainly is now, as the noble Lord, Lord Dykes, said, from the serious and solemn nature of the debate—that, one year away from leaving the EU, we are discussing health and care issues that affect every person in the UK. They affect those from the EU who live and work here; those from the UK who work in the EU; those of us who go on holiday; those who retire to the EU; those who use medicines of any sort, including over-the-counter purchases; those, and their families, who have rare diseases—in fact, all of us. It is a long list of issues. So when the noble Lord, Lord Callanan, talked about, as he puts it, a “snapshot” of the EU law transferring in a year’s time, I can only wonder whether even the widest-lens panoramic view camera will be able to capture all the issues that will need attention if only in the health and social care arena.

As my noble friend Lady Warwick put it, uncertainty is still the problem. I spoke about uncertainty on Second Reading of the European Union (Withdrawal) Bill—thankfully, we finished the Committee stage yesterday—and every speaker in this debate has talked about uncertainty and lack of clarity. We have talked about workforce issues, reciprocity of health and social care, the licensing of medicines and clinical devices; clinical trials, research and infectious disease control, which the noble Baroness, Lady Walmsley, mentioned; food regulation, which I agree is vital in this matter; Euratom and European network references; and indeed, as my noble friend Lord Brooke said, concerns about the trade deals that are to follow Brexit and how we will move forward on those.

I shall focus on two main issues which I think bring into focus the whole challenge facing the UK in the years to come, beginning with workforce issues. A substantial proportion of UK health and safety regulations and workers’ rights originate from the EU and provide important protections for healthcare workers and their patients. As we know, the employment environment for NHS staff, including nurses and healthcare assistants, links directly to patient outcomes and patient safety. We need to ensure that nurses, midwives and doctors working in the UK from elsewhere in the EU are made to feel welcome and that their families and futures are secure, and that our NHS staff can benefit from access to medical staff from all over the EU, as we do now. These are vital workforce issues. We know that there has been a drop in the number of midwives and nurses applying to work in our NHS already. The BMA says that EU nationals—highly-skilled doctors and researchers—will choose to leave the UK because of continued uncertainty in the Brexit negotiations. In other words, 45% of EEA doctors are considering leaving the UK. This will not help with rebuilding the NHS, which we need to do now.

The working time regulations provide a framework to reduce fatigue within our nursing workforce, and put critical safeguards in place. These include compensatory rest and controls on working time, to address the health and safety effects of shift working patterns. We strongly supported their adoption in the 1990s and their subsequent updating. Fatigue, long working hours, lack of rest breaks and poorly managed shift rotas are a risk factor that again impact on the health of nursing staff and on patient safety. It is essential that the working time directive stays in place, as currently drafted.

The Royal College of Nursing and other royal colleges wrote to the Prime Minister asking for clarity on this matter in 2017. In response, the Prime Minister did not reassure them that the working time directive was a negotiating objective and priority for the UK Government, so can the Minister give that guarantee now? With one year to go until Brexit, we are calling on the Government to be louder and clearer in reassuring the tens of thousands of EU nurses, carers and doctors working across the UK, not only on their right to stay here, but how desperately the NHS and social care system needs them to stay, and how much we welcome them.

Turning to clinical trials, I thank Cancer Research UK, Genetics Alliance UK, and others for the briefs they have sent to noble Lords about this matter. As the Minister is aware, the EU clinical trials regulation—CTR—replaces the existing clinical trials directive, and will reform the governance of clinical trials across the EU. It was adopted in 2014, with the UK’s full support. However, due to a technical delay with the set-up of the portal and the database, it will come in after 2019, rather than later this year. As a result, it will not be covered by the EU (Withdrawal) Bill and automatically be converted into UK law. The noble Lord, Lord Callanan, keeps referring to “snapshots” but it will be off the edge of that snapshot.

It is important that the UK adopts and aligns with the CTR, as it will harmonise the regulation of clinical trials taking place across Europe, making it easier for cross-border research collaboration. We need action from the UK Government that an agreement will be reached to align the clinical trials regulation and remain aligned until after the end of the transition period. Let us take rare diseases as an example, which can be written across the whole of medicine development and clinical trials. Patients affected by genetic or rare conditions often have few or no effective treatments available to them. There are over 6,000 known rare diseases, yet only about 140 medicines licensed in the EU for those rare conditions.

The EU’s medicines regulator, the European Medicines Agency—EMA—has created the largest single supranational regulatory environment, covering a population of 500 million people. Why would we want to be outside that regime; why would we want to put at risk those with rare diseases, particularly children? The Minister needs to reassure the House that this will not happen. Losing the leverage that comes from being in the single market, and therefore this regime, means that the incentives of the centralised process could be the difference between UK patients being able to access a new treatment for a rare disease or not, or it could cause major delays. It looks like we might already be losing that leverage.

Can the Minister confirm that the UK has now been informed that it can no longer be the lead assessor in clinical trials and that the UK has been removed from every EU medicine committee? Can he also explain to the House the implication of this action? When the Prime Minister talks about associate membership, can the Minister explain whether that exists at present, whether it is in the negotiations and whether it means that those things that are already happening will be reversed?

European reference networks are equally important as they have the potential to revolutionise the care and treatment of patients with rare diseases. Without the UK’s involvement, those patients in the UK and, indeed, the rest of Europe will lose out. Will the Brexit negotiations include provisions for the NHS to continue to take part in ERNs so that we can ensure that families with rare diseases are not disadvantaged?

These are huge and vital matters to be solved for the whole population of the UK. If the Minister senses a whiff of panic, he would be correct. One noble Lord after another, including the two from his own Benches, has explained the consequences of not sorting this out, not resolving it and not giving clarity and assurances in these vital areas, so I hope that he will be able to do so now.

NHS: Staff Pay

Baroness Thornton Excerpts

Wednesday 21st March 2018 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for repeating the Statement. I agree with his final statements, but never has it taken so long to get to this point of a pay increase. I do not wish to sound ungracious but the pay increase is too little, too late. The cap has meant that NHS wages have fallen by 14%. Last summer, the Prime Minister told a nurse on television that a pay rise would need a “magic money tree”; I am very glad that it seems to have been found.

The NHS is now short of 100,000 staff. In part, that must be because of this Government’s neglect of the NHS workforce. Exacerbating this situation is the chronic shortage of nursing and other staff in nursing care homes, with a 16% decrease in the number of registered nurses in the care sector since 2012. Then, there is Brexit and its damage to NHS staffing. Given that the Secretary of State now has responsibility for social care as well as health, will we see a joined-up staffing strategy for NHS and care workers? Can the Minister assure the House that, to pay for the proposed increase, the Treasury has said that it will fully match any proposed rise with new money?

[Lord O’Shaughnessy]

I thank the noble Baroness for her perhaps less than fulsome welcome for what is a fantastic deal, not least for the lowest paid staff in the NHS, some of whom will see very significant pay rises. They certainly deserve them; I do not think anyone disagrees with that. We have been able to find the additional money in the NHS budget to do this precisely because of good economic stewardship, rather than relying—as others would—on trees, magic or otherwise. That stewardship has meant that we have been able to provide the money while taking our fiscal responsibilities seriously.

The noble Baroness mentioned the joined-up staffing strategy. She is absolutely right that it is very important. I hope she knows that Health Education England has included work on the social care workforce in its draft strategy. We all understand that we need increasingly to view these workforces together—not just people such as nurses, who can work in both sectors, but carers and allied health professionals and so on. Frankly, there is more work to do on the social care workforce strategy. In the health service, we are starting from a lower base in terms of having a national picture, precisely because it is generally delivered locally. However, we are providing that strategy. I would encourage all parties who want to make sure that the strategy is joined-up to contribute their ideas, because there is a genuine willingness to make sure that we can do it.