NHS: Targets
Baroness Thornton Excerpts(4 years, 9 months ago)
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Baroness Thornton (Lab)
My Lords, first, I draw the House’s attention to my interests in the register. I thank my noble friend Lord Hunt for initiating this debate and all noble Lords who have participated. I particularly want to welcome and congratulate my noble friend Lady Wilcox on her maiden speech, which was a model of its kind. I was delighted when she joined us and I am very much looking forward to working with her in the future. I would also like to add my thanks to the Library, the Royal College of Surgeons, the Alzheimer’s Society, Independent Age, Age UK, the NHS Confederation, the Independent Healthcare Providers Network and many others that sent us briefings. I agree with the noble Baroness, Lady Brinton, that their analyses of the scale of the challenge and the solutions were remarkably similar.
My noble friend Lord Hunt and other speakers have set the Minister a challenging task in answering this wide-ranging debate, linking as it does priority targets, the impact of failing to deal with adult social care and the implications of that for patients in the context of what happens to primary healthcare, social care, mental health, public health and capital expenditure, which are all linked and interdependent. I agree with my noble friend Lady Crawley about how debates on the health service in the House of Lords are a love letter and a post-it note. My contribution is probably the latter.
The Government must own the effects of 10 years of austerity. They are not a brand new Government, as the Prime Minister would have us believe, but a continuation Conservative Government, and they cannot pretend that that the fact that our social care system is completely failing millions of people is a newly acquired responsibility. It is as a result of a deliberate action to starve this sector that we face NHS buildings and infra- structure which are crumbling and a danger to patient safety, that we are nowhere near parity of esteem in mental health in terms of spend or access, that public health is unable to deliver true prevention because of the cuts to local government spending, that parts of the NHS are, as the NAO reported, “seriously financially unstable” and that trusts and CCGs are building up debt.
Thus it is not surprising that, as my noble friend Lord Hunt tells us, the NHS is simply not able to meet the targets which are enshrined in the NHS constitution. While it is welcome that the long-term plan recognises that health and social care go hand in hand, we have yet to see the action and funding which will address the social care challenge. We will soon be discussing the NHS Funding Bill, which some might call window dressing. It is a testimony to a Government who must put into legislation a promise they have made to ensure that they keep it. That is a matter we will be discussing in a few weeks’ time, when there will be another opportunity for the Minister to address some of these issues.
I shall not repeat the statistics that noble Lords have adequately outlined, but at present it feels as if we are at a tipping point and the NHS is slipping back to the years before the last Labour Government, who of course made the historic investment and basically turned around the NHS to leave it in pretty good shape in 2010. However, I agree that we need to look forward, and the Government must make very good use of the resources they are already committing. Any news from the Minister about the likely outcome of the Budget and the spending review would be welcome, and some expansion on the Prime Minister’s declared intention to sort out social care would also be welcome. What exactly is his plan?
Given that I have served on a CCG for the past three years, noble Lords will not be surprised to hear that I intend to start by focusing on primary health care and its importance in future plans. I can bear witness to the tireless work of GPs and their commitment, and their staff’s commitment, to ensure that all patients receive high-quality care when they need it. I also witness the fact that front-line local healthcare is often under threat from funding being sucked out of the system by huge trusts with the push-me-pull-you funding formula that is still apparent in the system. I am pleased that there is some recognition of that in the long-term plan and that that will be reflected in the next round of NHS England’s planning process.
I echo my noble friend Lord Young’s story about his GP’s surgery. I think the Minister will recognise that, if the workforce and the funding for primary care are not sufficient and stable, the knock-on effect for acute services will be deleterious and significant. Along with the general NHS staffing crisis, there is a GP work- force crisis, and I wonder whether the Minister can update the House on how the delivery of 5,000 additional GPs and 5,000 additional staff in England is going. I am very proud of the work of the past three years in primary care delivery in Camden, with our innovative patient care-led commissioning, and I am very keen for that not to be lost in the latest reorganisation that is now under way. Clinical and lay members on CCGs all over the country are anxious that local primary care should not be lost in the creation of ICSs.
The social care system is broken, as many noble Lords, including my noble friend Lady Pitkeathley, and the noble Lord, Lord Turnberg, said. It is ignoring 1.5 million people with unmet needs, leaving carers to feel alone and unsupported in caring for their loved ones, and it is costing people their life savings. Age UK says that the social care crisis, with delayed discharges from hospital due to a lack of social care, is costing our NHS an eye-watering £500 every minute.
As a Labour and Co-operative Member of your Lordships’ House, I will take this opportunity to urge the Minister to look at a new model of social care that uses the principles of co-operation to build on the first-hand knowledge of those who rely on, receive and provide care. I urge her to read the report of yesterday’s debate in Westminster Hall, which explored this very positive proposition. It requires commissioning authorities and central government to recognise that co-operation and mutuality could provide some answers in this sector.
Thousands of people’s lives have been on pause as a result of underfunded mental health services over the last decade. My noble friend Lady Gale outlined the issues around Parkinson’s. There is a desperate need for the 19,000 new mental health workers promised in the next year. That is important not only because hundreds of thousands of people need care but because continuing not to resolve this problem has a knock-on effect on primary and secondary healthcare and social care. All these issues are interlinked.
On public health, I will say only that it really is time that there was real recognition that investment in prevention saves billions further down the line, so let us see that that actually happens. Let us not leave public health at the whim of the spending regime in local authorities whose funding has already been cut, because that is completely counterproductive.
On targets, I am concerned that the Government’s review of NHS clinical standards, including piloting the introduction of new average waiting times for elective care, is a problem. Does the Minister agree that the introduction of the 18-week target is a worthy achievement that should not be jeopardised by this review? The noble Baroness, Lady Watkins, made some very interesting points about how to reduce the pressures on, and redirect people from, accident and emergency departments through investment in GPs, primary care and minor care. She is absolutely right. However, there also needs to be an incentive to keep accident and emergency departments on their toes. We do not want to slip back to people waiting on trolleys in accident and emergency for 12 hours.
In conclusion, it is completely clear from this debate and from the briefings that we have all received that these wide-ranging issues are interlinked and inter- dependent. You cannot divorce primary care, mental health, the capital investment required, public health and secondary care from one another. That is why the long-term plan needs to be a longer-term plan and why it needs to take all these issues into account. The spending needs to be integrated so that we do not feed one side of the National Health Service while the other side—social care—puts such pressure on the system that it cannot possibly succeed. I look forward to the Minister’s response.
Health: Tinnitus
Baroness Thornton Excerpts(4 years, 9 months ago)
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Baroness Thornton
To ask Her Majesty’s Government what assessment they have made of the impact of tinnitus on the mental health of those affected.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, we recognise the debilitating impact that tinnitus can have on people’s lives and that for some the condition can lead to mental ill-health, including suicidal thoughts. That is why we have commissioned NICE to develop clinical guidance on the assessment and management of tinnitus. This is expected to be published in March and will help raise much-needed understanding about the condition.
Baroness Thornton (Lab)
My Lords, I thank the Minister for that Answer. Given that this condition causes enormous misery and is, we are told, incurable, and given that research has shown recently what a detrimental effect it can have on the mental health of sufferers, I have two questions for the Minister. I am very happy if she needs to write to me with the answers. First, how much is the NHS spending on research into the causes and cures of tinnitus? Secondly, if there are cures—if you google tinnitus, you will see that many products out there on social media claim to cure it—have any of these been approved? Are they in the system for approval? If so, when will they be available on prescription?
Baroness Blackwood of North Oxford
I am happy to pay tribute to the British Tinnitus Association, which has raised the issues this week—it is Tinnitus Week—for its research. I thank the noble Baroness for her question. I will be happy to write to her on the specifics of the tinnitus treatments. Of course, tinnitus is often linked with acoustic neuroma, hearing loss and a number of other conditions, including mental ill-health. There are some treatable causes, which GPs look for, but there can be others related to mental ill-health. The cause of tinnitus is unknown; it cannot be treated. Talking therapy will be prescribed, and a lot of those treatments are already available on the NHS and on prescription. I am happy to send that information to the noble Baroness in writing.
There is obviously research available via the NIHR. We spend more than £90 million on NIHR research, and £15 million of this is spent via biomedical research centres at Manchester, UCL and Nottingham. Nottingham undertakes specific research into deafness and hearing problems, including tinnitus and hyperacusis. If the noble Baroness would like further detail, I am happy to write.
Paterson Inquiry
Baroness Thornton Excerpts(4 years, 9 months ago)
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Baroness Thornton (Lab)
My Lords, I thank the Minister for repeating the Statement made by the Health Minister in the Commons today. Two hundred and eleven former patients of Paterson, or their relatives, shared their experience with this inquiry. This report makes for harrowing and appalling reading, as the Minister said. Ian Paterson wilfully abused the trust placed in him by patients at their most vulnerable. At his hands, hundreds of women underwent extensive, life-changing operations for no medically justifiable reason. His unregulated cleavage-sparing mastectomies, in which breast tissue was left behind, meant the disease returned in many of his patients. Others had surgery they did not need and needlessly lived under the shadow of cancer for many years. This should never have been able to happen, let alone go on unchecked for so long.
As the Minister has done, I pay tribute to the courage, tenacity and persistence of many of these women and their families in exposing the injustice. I thank the panel, under the leadership of its chair, the right reverend Graham James, for uncovering the extent of Paterson’s malpractice and the systems that allowed it to continue despite repeated warnings.
The victims of Paterson’s malpractice were let down time and again by the NHS trust and an independent healthcare provider, which failed to supervise him appropriately and did not respond correctly to well-evidenced complaints about his practice, and by the wholly inadequate recall procedures in both the NHS and the private sector. The report identifies failures on the part of individuals and institutions, saying that
“a culture of avoidance and denial”
meant that those working closely with Ian Paterson did not spot his behaviour or were unwilling to challenge it. On the contrary, the report concluded that
“Paterson’s behaviour and aberrant clinical practice was excused or even favoured.”
What action does the Minister propose to support a change in the culture of the health service that encourages staff to speak up?
There is a potent example on page 130 of this report:
“The operation and awarding of practising privileges is defined in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 … Practising privileges are based on the ‘scope of practice’—that is, the procedures a consultant is competent to perform in the independent sector are based on what they undertake in the NHS … In Paterson’s case … he did not limit himself to operations he was competent to perform in the independent sector. He was undertaking operations and procedures he did not do in the NHS. Measures to monitor and limit this at Spire were inadequate.”
What has changed? Is this still the practice in the private sector? Indeed, is it still the case that private hospitals incentivise referrals from consultants who have been given shares in their private hospitals? That is what the report suggests.
Can the Minister confirm that the Government will urgently bring forward legislation to give private patients the same protection provided by the NHS, as called for by the lawyers representing hundreds of Paterson’s victims? The Centre for Health and the Public Interest has called for Paterson’s income and earnings, as well as the profits made by Spire Healthcare, to be treated as income from criminal acts, which could mean that they could be reclaimed. Can the Minister advise on whether this aspect has been referred to the CPS?
The Independent Healthcare Providers Network, which represents the sector, has already said that more needs to be done to ensure that information is shared between the NHS and private companies about their doctors. What action are the Government taking to facilitate this information sharing?
We cannot undo the awful harm that Paterson’s criminal action has caused so many, but we must act to ensure that lessons are learned and changes made so that something like this does not happen again. This report must not remain on a shelf to be forgotten, because it is clear: this was not just the act of a rogue, lone surgeon; systemic organisational failures were at fault as well. Fundamentally, it is time we addressed the question of safety in private healthcare providers and the way in which clinicians can operate in private providers with little oversight. I would be grateful if the Minister could share her thinking about this with the House.
The inquiry makes a number of recommendations about transparency and accountability, and I hope the Government mandate health bodies to implement those quickly. As the Minister said, the fight that the patients had to make for compensation was shameful.
Around a third of all private hospital income now comes from NHS procedures such as hip replacements, hernia repairs and cataract procedures, yet safety standards in the private sector often leave much to be desired. How is the NHS addressing patient safety in this regard? Apart from anything else, there are very few critical care facilities available in private hospitals, so patients are transferred to NHS hospitals when things go wrong and complications occur. I would like to know whether private hospitals can be held liable for this use of the NHS. The previous Secretary of State wrote to the private hospital sector in 2018, telling it to get its house in order on patient safety, and he was absolutely right.
If it is decided that the Government wish to legislate on this matter, I urge them to do so swiftly and bring forward proposals. I promise the Minister that she will have constructive co-operation from these Benches, so let us get on with it.
Baroness Brinton (LD)
My Lords, I echo the points just made about the speed of the Government’s reporting. It is extremely helpful that the Minister in another place apologised clearly for the failures in the system and paid tribute to the victims. I too pay tribute to them and their families for their tenacity over many years, when it was clear that something was going wrong but the people who were in a position to gather information and do something chose not to.
The Statement says:
“I can promise the House a full response in a few months’ time.”
This public inquiry has rightly taken two years—it was slightly delayed by the general election and purdah—but it was clear in 2017 what many of the issues were. The excellent report from the Centre for Health and the Public Interest published in November 2017 entitled No Safety Without Liability: Reforming Private Hospitals in England after the Ian Paterson Scandal set out in a slightly different format many of the recommendations in front of us. I am sure that the Department of Health, the NHS and the independent hospitals will have looked at those recommendations.
I ask the Minister right up front: how long will it take before recommendations come back to the House from the Government on where they want to take things? After all, we have a Bill that is almost ready to go—or perhaps, as I said yesterday on the Second Reading of the Birmingham Commonwealth Games Bill, Groundhog Day is coming around again for us. Let us use that opportunity, at the very least, to remedy the obvious shortfalls in the system.
One of our major concerns is regulation of indemnity procedures for healthcare. There are serious shortcomings that must be dealt with as soon as possible. I was extremely concerned to read in the recommendations about the arrangements private hospitals have with clinicians to carry out their own activities that are rather like self-employed contractors almost renting an out-patient desk and in-patient beds. That is similar to renting a barber’s seat but without the overseeing regulations you need when people’s lives and health are absolutely at risk. That must be managed immediately.
Independent hospitals must take responsibility for their actions, so it is good that one of the key recommendations tries to focus minds on filling the gap between responsibility and liability. The report from CHPI two years ago said that this was vital and that independent hospitals must employ doctors and healthcare professionals, because without that responsibility on their behalf they will continue to wriggle out of liabilities and choose not to monitor clinical practice, missing either ill-meaning or incompetent surgeons. That cannot happen in the NHS and trusts have to take responsibility, as they do when things come to light. This hole in the current system needs to be remedied swiftly.
The inquiry also makes the important point that boards must apologise meaningfully and as early as possible. The UK health system, whether NHS or independent, has an extremely poor record of apologising, or of even commenting at all. Worse, it often tries to bury problems, denying whistleblowers any access. I am afraid that this is part of the systematic culture exposed in this very important inquiry—one that fears liability above apology and, equally importantly, does not learn well from mistakes, especially if through malpractice.
It is shocking that patients were often not guided to the Parliamentary and Health Service Ombudsman or the Independent Sector Complaints Adjudication Service. Compare that with the Financial Ombudsman Service: financial services companies must signpost access to the ombudsman at every step of the way when people buy financial products. A financial service problem could result in a loss of money, but a medical problem could end up changing lives for ever, as in the Paterson cases, so when will the Government deal with this issue? Will there be compulsory signposting for patients and clarity over whether all independent hospitals have to sign up to an independent complaints adjudicator—preferably just one, but I understood from what the Minister said in another place that they cannot regulate the independent sector completely? Frankly, as far as healthcare is concerned, my party believes we should.
Once again, the Paterson case demonstrates the need for effective whistleblowing processes. Will the Government commit to an office of the whistleblower to, through legislation, give more protection to patients, whether they are in the NHS or the independent sector? Spire Healthcare has said that it has put more measures in place to encourage staff and patients to speak out since the Paterson case, but even the Statement refers to there still being problems in Spire Healthcare. This just demonstrates that this is not working. Paterson’s victims are very clear: we need a system within the NHS that protects patients and staff. That is equally true of the independent sector.
I end by repeating my initial question: can we please have a timetable for the Government to come back to Parliament with proposed changes, given that a Bill is waiting that could easily be amended for both Houses to attend to speedily?
Eating Disorders: Provision of Care
Baroness Thornton Excerpts(4 years, 9 months ago)
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Baroness Thornton (Lab)
My Lords, I congratulate the noble Baroness, Lady Parminter, on securing this debate and on her moving opening remarks, as well as all other noble Lords who have participated in the debate today on this important and growing challenge.
As we have heard today, eating disorders are complex mental illnesses. I absolutely agree with my noble friend Lord Brooke that we need to see progress. I spent a few minutes looking on my iPad to see whether I had answered the debate in 2013 from this Dispatch Box. I am sure that I would have remembered if I had, and indeed, I did not—one of my colleagues dealt with that issue. But it is remarkable that that debate very much reflected the things that have been said this evening, and it is a bit depressing that we still need to make some progress today.
The thing about eating disorders is that you can develop one no matter your age, gender or background. Some examples of eating disorders have been mentioned: bulimia, binge eating, anorexia and obesity. There is no single cause of this, as noble Lords have said; it can be very complex, and people might not have all the symptoms for any one eating disorder. I echo the thanks expressed by other noble Lords to the General Medical Council and Beat in particular for their information about this matter.
The General Medical Council noted at one of the round tables that it organised on this in November 2019 that there is a lack of eating disorder specialists in the UK. There are only 70 posts, mostly in child and adolescent mental health, with some in adult, and approximately 15% of posts are vacant. Coupled with the lack of beds and the stories that noble Lords have recounted, that makes this situation very serious indeed.
We know that there is an important link between obesity, mental health and eating disorders. My noble friend Lord Giddens definitely expressed this eloquently and in greater depth, but this relationship is often neglected. Awareness of this is neglected as well, as several noble Lords said. Medical training across the board does not adequately recognise the seriousness of this condition.
I think we all welcome that the NHS long-term plan and related initiatives which emphasise mental health provide a unique opportunity to make progress on improvements to eating disorder services and the relationship with education and training. For example, I am pleased to hear that the General Medical Council is now working with the Faculty of Eating Disorders Psychiatry and other key stakeholders. That is some comfort, but I was very disturbed by the contribution by the noble Baroness, Lady Hollins, when she addressed the workforce situation; she posed some serious questions to the Minister.
In December 2017, the Parliamentary and Health Service Ombudsman published Ignoring the Alarms: How NHS Eating Disorder Services are Failing Patients. The report made five recommendations for improvements in NHS eating disorder services. Indeed, the Public Accounts Committee went on to say that this was important and needed to be acted on. We all know, as noble Lords have said, that collaboration is needed at both service level—as the PHSO report highlighted in terms of, for example, handover and continuity of care—and at system-wide level with regulators, commissioners and others working jointly to identify and implement improvements. The PHSO also recommended a public health campaign, which would help to raise awareness of the impact of this condition. Is that likely to happen?
Noble Lords will know that a Guardian investigation established that coroners in England and Wales have served a prevention of future deaths notice in at least 12 cases, identifying problems that have been mentioned tonight, including a lack of staff or beds. Coroners were so alarmed by these failings that they sent official warnings to 11 trusts that provided care for people with anorexia and bulimia between 2013 and 2019. Grace Freeman, a policy and campaigns officer for the mental health charity Mind, said that the cases were a
“shocking reminder of the poor quality of care too many young people receive from mental health services, particularly those living with eating disorders.”
The noble Baroness, Lady Parminter, made a plea, saying that science and research needs investment to provide the evidence base that the Government want, to make sure that eating disorders are dealt with with the seriousness they deserve. For example, there is no official data on deaths due to eating disorders; at a recent inquest, a doctor said cases were not being properly recorded by the NHS. As we know, suicide is one of the biggest risk factors for people with the condition, with between one-fifth and one-third of patients taking their own lives.
As far as I, aged 67, can see, if I develop an eating disorder, it depends on where I live but I would not be eligible for treatment in one of the 49 adult eating disorder clinics in England and Wales. According to an investigation by the “Victoria Derbyshire” programme, three have a cut-off age of 65, with older patients referred to general geriatric mental health units, which are likely to be unable to provide the same level of tailored care as would be required.
Finally, I agree with the noble Baroness, Lady Brinton, that it is awful that our clinicians face rationing treatment for eating disorders. It is completely unacceptable. This condition requires more investment, more choice and more money being available to combat it.
Major Trauma Centre: Westminster
Baroness Thornton Excerpts(4 years, 9 months ago)
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Baroness Blackwood of North Oxford
My Lords, I pay tribute to all the brave members of the public, the NHS and Members of this place who so often have responded incredibly bravely when terrorist attacks occur. We owe a great debt of gratitude to all those individuals who do not think of their own lives in responding to protect others.
On the noble Baroness’s specific question about our capabilities in responding to risks that occur, we have a specific arrangement that has been put forward with the trauma network. The decision about the location of the trauma centres allows full geographic coverage while ensuring that the full package of care is available for patients when they come forward, which includes treatment for burns, orthopaedic injuries and neurosurgery. I know the noble Baroness knows there are four major trauma centres located in London at St Mary’s Hospital, St George’s Hospital, the Royal London Hospital and King’s. They are all adult and children’s major trauma centres and are all approximately three miles from Westminster.
More importantly, we have specialist ambulance capability in responding wherever an attack may occur in London. We can be very proud of the response that we have seen not only from the hazardous area response teams but from the tactical response units. Those responses have been in very short order and have meant that, although these were appalling incidents, their impact was much reduced.
Baroness Thornton (Lab)
My Lords, a study published in the Emergency Medicine Journal found that NHS hospitals seem in many ways unprepared for terror attacks, with half the doctors unaware of emergency plans and just over one-third aware of what to do personally if a major incident is declared. I thought the Minister’s answers were brilliant and very reassuring, but what action are the Government taking to ensure that all doctors receive education on their hospital’s major incident plan as well as an abbreviated version of their own particular role?
Baroness Blackwood of North Oxford
The NHS develops its plans in each hospital according to the Government’s national risk register and its planning assumptions underpin this. The security services then evaluate and publish the current threat level to the UK from terrorism and the NHS is made aware of any change to this, so that it can react accordingly. In addition, we provide training for paramedics for terrorist attacks, as I have mentioned. We have the hazardous area response team, comprising specially trained personnel to provide ambulance response to particularly hazardous or challenging environments, including following a terrorist attack. London also has the tactical response unit, which is designed to work as part of a multiagency team with police and fire services to respond to firearms incidents. In the most recent attacks, the response time for paramedics was within seven minutes. We have recently agreed to increase the number of marauding terrorist attack and chemical, biological, radiological and nuclear trainee paramedic responders, and we will have a minimum of 240 responders in each ambulance trust.
Health: Sepsis
Baroness Thornton Excerpts(4 years, 10 months ago)
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Baroness Blackwood of North Oxford
The noble Lord, as always, speaks with great expertise in this area. I emphasise the work that has been ongoing to improve the picture on sepsis. Since 2015, screening for sepsis in emergency departments has improved from 52% to 89% and timely treatment for sepsis from 49% to 76%, but the noble Lord is absolutely right that we need to improve the outcomes. Early and accurate diagnosis is at the heart of this. I shall keep an eye on innovations in diagnostics. The noble Lord knows that innovation in this area is right at the heart of what I do, and I think that his proposal is very sensible.
Baroness Thornton (Lab)
My Lords, the Government seem to be complacent about this. I know that the Minister has given us lots of facts and statistics, but the number of deaths from sepsis in the UK is five times higher than in the country in the European Union that has the best performance. Only two EU countries have a higher number of deaths, so it is a very serious problem. Why are only 70% of acute trusts in England using the national early warning score system? Why are they not all using it?
Baroness Blackwood of North Oxford
I am not quite sure which data the noble Baroness was referring to. The study stated that the number of UK deaths was at 48,000. This was a modelled estimate; it was inaccurate. Our data, published by the Office for National Statistics, states that the figure is 22,341 and puts the UK’s performance at a better rate. We are not complacent in any way. This is why there has been concerted action through a number of routes not only to improve the performance in sepsis diagnosis and screening but to make sure that we raise public awareness and provide training for NHS staff. The early warning system has been introduced as the revised national early warning score. As the noble Baroness said, it is intended to improve and standardise the process of recording, identifying and responding to patients at risk. It was introduced as a CQUIN incentive and included in the 2020-21 scheme which was published yesterday. This means that it will be in every hospital across the country.
Wuhan Novel Coronavirus: Threat to UK Citizens
Baroness Thornton Excerpts(4 years, 10 months ago)
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Baroness Blackwood of North Oxford
That was well put. Our view is that this is a proportionate and sensible response that is scalable and appropriate according to the evidence available. We will obviously be reviewing what is a new and emerging infection. Scientific understanding of the disease is evolving rapidly—essentially on a daily basis. We will obviously review the measures set out regularly.
It is important to set out what the symptoms are, in case anybody listening needs to understand. This is essentially a bad respiratory tract infection that could turn into pneumonia. At this stage around 2% of known cases have died. To compare mortality rates, SARS had one of 10% and Ebola 70%. That gives a level of perspective, but the picture is evolving and we will keep this under close review as the situation develops. Unsurprisingly, of course, within that context those at greatest risk are the vulnerable, the elderly or those with underlying health conditions, so the advice is to come forward if such symptoms occur.
Baroness Thornton (Lab)
Notwithstanding the noble Baroness’s remarks, I am pleased and reassured that the Government have implemented the measures outlined and welcome the precautionary approach taken to the arrival of passengers from the Wuhan region of China. Can she confirm that the Government have assessed whether adequate resources are available in the PHE port health teams to carry out screening procedures and any further screening procedures that might be necessary?
Baroness Blackwood of North Oxford
We have indeed. First, three direct flights from Wuhan arrive into Heathrow and a team of public health experts, which will include the principal port medical inspector, the port health doctor, the administrative support and team leader and a translator, will meet every direct flight from Wuhan. We believe that this is a scalable solution, which could respond to a developing health challenge. In addition, before a flight lands a message will be broadcast to passengers in several languages to encourage them to report illnesses to flight staff and the captain will be required to provide an early warning of any illnesses on the aircraft one hour before arrival, which allows a much more appropriate response on landing. We believe that this is a manageable and effective response. The NHS has a very good record of responding to similar situations, whether with Ebola or monkeypox. We can be very proud of our public health record in these areas and can be confident in how bodies will respond to this incident.
NHS and Social Care: Staffing
Baroness Thornton Excerpts(4 years, 10 months ago)
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Baroness Blackwood of North Oxford
The noble Baroness is quite right that we want to target recruitment towards the areas with the greatest shortages. That is one of the reasons why, when we announced the new non-repayable funding, we also announced a top-up for targeted specialties struggling to recruit. It is also why we have announced the availability of placements which can enable nurses to develop experience in specific specialties, which make it easier to recruit and retain those nurses in very rewarding and sometimes hard to recruit specialties.
Baroness Thornton (Lab)
I am sure the Minister will understand why the House might be slightly sceptical of “as soon as possible” promises, given that we are still waiting for a Green Paper that was promised almost two years ago. A date would be a good idea here.
Do the Government intend to follow the example of the Welsh and Scottish Parliaments and introduce safe nursing staffing legislation? Does the Minister agree with me—and with UNISON, which has 450,000 health workers in its membership—about the ever increasing importance to the NHS of recruiting nurses from overseas? How can the Government justify increasing the health tax, which applies to overseas nationals and will surely make it harder to recruit and retain nurses? Will the Minister suggest to the Treasury that the Government should in fact drop that planned surcharge?
Baroness Blackwood of North Oxford
The noble Baroness will know that appropriate staffing levels are already a core part of the CQC’s registration regime and that the law already requires hospitals to employ sufficient numbers of suitably qualified, skilled and experienced staff at all times. It is also mandatory for staff to provide monthly reports on the average number of care hours per patient per day, which is considered a better measure than staff numbers. However, we recognise the proposals that have come forward regarding staff safety and legislation; they are being considered at the moment.
The NHS surcharge is being considered to make sure that it is at an appropriate level to ensure that we continue to recruit at an appropriate level. At the moment, the rate of recruitment from non-EU countries has increased significantly by more than 150%.
National Health Service Infrastructure
Baroness Thornton Excerpts(4 years, 10 months ago)
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Baroness Thornton
To ask Her Majesty’s Government what assessment they have made of the consequences for patient safety of the backlog of maintenance and repairs to National Health Service infrastructure.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, the Government recognise that the quality of infrastructure, including backlog of maintenance, can pose challenges to the efficiency, safety and quality of NHS services. That is why we have launched the Health Infrastructure Plan, which includes the biggest hospital building programme in a generation. This substantial investment will support many of the hospitals facing the biggest challenges from their estates.
Baroness Thornton (Lab)
I thank the Minister for her Answer. NHS Providers says that the cost of the backlog is now £6.5 billion, and last year 15,844 patient incidents and 4,810 clinical incidents were caused by estate and infrastructure failure, and there were 1,500 fires in which 34 people were injured. The backlog includes wet walls in wards preventing babies’ incubators being plugged in. This is extremely serious. Will the Government provide the necessary funding to catch up—I am not sure that it is available yet? What is the timescale for catching up with the backlog—not building necessarily the 40, or six or however many, new hospitals that have been tendered?
Baroness Blackwood of North Oxford
The department acknowledges that parts of the NHS estate do not meet the demands of a modern health service and that there is unmet need for capital within the NHS. That is why we announced £2.1 billion of capital for health infrastructure in August and a further £2.8 billion injection in September. This is to ensure that staff are safe to deliver the world-leading health service that they should in a modern, efficient environment. We are also going further by reforming the capital regime to establish a clearer set of capital controls and the right incentives for organisations in respect of their infrastructure. The Chancellor has also confirmed that DHSC will receive a new multi-year capital settlement in the next capital review. Backlog of maintenance across the government estate will be a key theme of the spending review.
Queen’s Speech
Baroness Thornton Excerpts(4 years, 10 months ago)
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Baroness Thornton (Lab)
My Lords, it is an honour and privilege to speak at the end of this day’s debate—indeed, this three-day debate—on the gracious Speech. The large list of topics and the large number of speakers proves that we could have done with one more day. I am grateful to my noble friend for his opening address, which covered some of the long list of Bills covered by this debate. I will do my best to be coherent on some of the others. It was a pleasure to be present at the maiden speech of my noble friend Lady Blower, who brings a lifetime of public service, education and trade unionism. I for one am very excited that she has joined our Benches and look forward to working with her.
This was a veritable pot-pourri of speeches, some more fragrant than others. Possibly the noble Lord, Lord Bates, wins the prize for the most fragrant. On this side of the House, I felt that I needed to start by joining the noble Baronesses, Lady Howe and Lady Benjamin, the noble Lord, Lord Clement-Jones, the noble Viscount, Lord Colville, and my noble friend Lord Griffiths in talking about child safety on the internet, because we were delighted to hear the Government renew their pledge to make the UK the safest place in the world to go online. However, I am pretty sure it is in respect of the Government’s pledges about making the internet safer and a better place for children that a number of noble Lords are most keen to see early progress; they have said so. I am not alone in feeling intensely disappointed about what happened with the implementation—or non-implementation—of Part 3 of the Digital Economy Act 2017. Those are the provisions which would have allowed this country to become the first in the democratic world to restrict access to online commercial pornographic sites by introducing an age-verification regime, as we have with great success for online gambling. I was particularly pleased to see in one of the background briefing notes that in a review of gambling legislation the Government were going to address loot boxes, for example, which are a modern scandal, deceitfully costing children and their families a great deal of money. Here I pay tribute to the excellent work done by the Gambling Commission and Parent Zone, which have done so much to draw attention to the matter. What is the timescale now for online child safety?
The Queen’s Speech and the Conservative Party manifesto contained a number of announcements on specific areas of public spending, particularly those to do with economic affairs. I agree with the noble Lord, Lord Fox, that we look in vain for an energy strategy or an industrial strategy, but 14 million people in this country are locked in poverty. That is the context in which we must address the economic affairs of this country, as was extremely well described in terms of regulation and everything else by various noble Lords, not least the noble Baroness, Lady Kramer, with her usual expertise in these areas.
I want to talk about the inaction of dealing with the fact that three in four children in poverty have a working parent. Despite the record employment that the Government trumpet at every available opportunity, the proportion of children in poverty with working parents has now reached an all-time high of 72%. Two decades ago, it was barely half that. These changes have very little to do with universal credit, for good or ill, because it is not yet being received by enough people to show up strongly in the figures. But given that the national living wage has increased each year and that employment has risen across the UK, why are so many families getting swept into poverty?
Nothing that I have heard so far in the debate from the Government or in the Queen’s Speech acknowledges that one of the richest nations in the world is so unequal and so failing its children and their future. My noble friend Lord Hain was completely correct in his economic analysis and I will not repeat it, except to say that I would like to know what the Minister thinks is in the Speech that will address those inequalities and that problem, which faces so many millions of our children.
It is true that Brexit has been a huge distraction from domestic problems such as poverty and, to become the compassionate country that we all want the UK to be, we have to address the underlying drivers of poverty in a sustained and strategic way. The Minister needs to explain how these policies will address those issues.
The record so far is not encouraging. There is a crisis of low pay and stagnating wages. The 2019 spending round was a one-off election gimmick, which did little to reverse a decade of austerity. The recent figures by the Society of Motor Manufacturers and Traders, for example, show that car sales fell to a six-year low in 2019, with the chief executive stating that Brexit uncertainty remains the biggest threat to the industry—and I could go on. In fact, all these things were so much better explained by the noble Baroness, Lady Bull. I am not sure that the revolutionary proposal about responsible capitalism of the noble Lord, Lord Hodgson, will bring us the answer that we need.
I turn to the proposals on housing and building safety. The fire at Grenfell Tower exposed a broken system for fire safety checks and controls, and the Government have been off the pace on almost every front in their response. We need a £1 billion fire safety fund to address these problems. When will that be available?
People who rent from private landlords are at the sharp end of the housing crisis, and the number has risen rapidly since 2010 to more than 11 million people. We need legislation with new rights across the board for private renters—rent controls, open-ended tenancies and binding legal minimum standards. What plans do the Government have to allow tenants to hold rogue landlords to account?
My noble friend Lady Drake wisely made the link between financial resilience and household well-being. Any intention by the Government to support home ownership should be welcomed across the House, but what steps will the Government take to increase housebuilding, particularly in those towns and cities where it is most in demand?
The Government mention English devolution. As they aim for full devolution across England, there will be occasions when communities oppose the powers that they are offered. I would like to know from the Minister quite how they intend to deal with that in their devolution settlement. I would also like some assurance that, when the Government proceed with this, extensive consultation will exist.
I was not going to mention transport because it has been covered, but I will mention buses because most of us catch buses. But they are under threat almost everywhere in the country except London, and there is a good reason for that. I would like to know what the transport policies of the Government will be to address the remedial action our bus services need, particularly in rural areas.
On health and social care, we welcome the emphasis the Government have put on the NHS. We have an NHS funding Bill. We have the health safety investigative Bill, which we have already had the Second Reading of but will probably have it again in the future. We have the medicines and medical devices Bill. We have the long-term plan and proposals about mental health and social care. But, today, the NHS recorded its worst accident and emergency waiting times in England since the current targets began in 2004, so we have a mountain to climb.
I do not remember the last Labour Government feeling the need to pass a law to force themselves to invest in the NHS. I find that a slightly bizarre proposition. I do not understand, if the Government are forcing themselves to invest in the NHS, why they are not doing the same for, for example, education, social care or mental health. I know that some people in the country have problems with the credibility of the Prime Minister and the Government, but I did not think that the Government had the same problems themselves.
The Minister made an extravagant claim about the amount of expenditure being put into the NHS. She claimed that it was the largest since the world began, but the truth is that that much was spent between 2004-05 and 2009-10. I will allow that it is the biggest investment under a Tory Administration in this century.
The point has been made by many noble Lords that the Government are under scrutiny. They are under scrutiny over social care and the National Health Service, and they will have to deliver. The noble Lord, Lord Warner, and my noble friends Lord Hunt, Lord Dubs, Lady Pitkeathley and Lord Bradley mentioned social care and the investment that needs to be made there. I will not repeat all that, but it is interesting that the noble Lord, Lord Forsyth, the Institute and Faculty of Actuaries, Carers UK, the LGA and Peers across the House all agree about the need to get social care sorted. I hope the Government have heard that from this debate.
I close by mentioning the work of your Lordships’ House in the coming months and years. We know from the reaction of Conservative-led Governments in the past few years that carrying out our role of scrutiny, revision, examination and testing of legislation has sometimes brought an overreaction—that is the best way I can put this—from Governments who have threatened to do things to us as a consequence of our proposals. I place on record that the Government should expect us to do our job here diligently. They are likely to find this place a fertile ground for seeking amendments and concessions. I urge the Benches opposite not to be cowed or distracted from proper parliamentary scrutiny by the political, administrative and constitutional reforms being floated by this Government already. This starts on Monday, when I hope that the Government and the Benches here honour, for example, my noble friend Lord Dubs’s amendment concerning child refugees, and that this House sticks to its commitment on this. I agree with the noble Lord, Lord Bichard. I look forward to the Minister’s response.