Health and Care Bill

Baroness Wheeler Excerpts

Lords Hansard _ Part 1 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, my noble friend has returned with his amendment on the need for an expert-led review on the 40 year-old Vaccine Damage Payments Act, and I am pleased that the meeting he sought with the Ministers has taken place. The amendment is a timely reminder for all of us that while the vaccination programme against Covid has been hugely successful, for a small group of people suffering very serious adverse effects and deteriorating health as a result of having the vaccination, the experience has been devastating, as the noble Baroness, Lady Brinton, underlined. The current legislation dealing with compensation arrangements is not fit for purpose: in the words of my noble friend, it offers too little, too late and to too few people. I hope the Minister acknowledges the need to meet and engage with the families of those affected, and that he looks urgently at the ways in which claims under the current system can be speeded up, and he also accepts the need for the review of the scheme and the next steps that have to be taken on this.

My noble friend has also added his name to Amendment 180 from the noble Baroness, Lady Cumberlege, on her unrelenting campaign for separate compensation schemes to meet the cost of care and support for the victims highlighted in her First Do No Harm report. Once again, we have heard convincing and forceful contributions from the noble Baronesses, Lady Cumberlege and Lady Brinton, which we on these Benches strongly support, calling for an independent redress agency for the three patient groups covered by the First Do No Harm report. The Government’s positive response to another key aspect of the First Do No Harm report, to improve patient safety for the future, including establishing the patient safety commissioner, is a welcome and necessary development. But the redress agency needs to be there to provide care and support for the thousands of women who suffered, and whose needs will not be met by the healthcare system, social care support or social security benefits support.

I hope the Minister has considered the matter carefully since Committee, and will report positively to the House on the ongoing discussions and progress which will ensure the strongest recompense possible for the people we are concerned about.

[Earl Howe (Con)]

My Lords, I will turn first, if I may, to the amendment in the name of the noble Lord, Lord Hunt of Kings Heath, on the Vaccine Damage Payment Scheme, and start by thanking him for his campaigning on this issue, and for the informative debates we have had today and in Committee.

As we discussed in Committee, since the NHS Business Services Authority took over responsibility for the Vaccine Damage Payment Scheme from the Department for Work and Pensions in November 2021, we have started to find ways to improve the operation of the scheme. The most important thing the NHS Business Services Authority is looking do to is to improve the claimant journey on the scheme, and that means making engagements with claimants more personalised, as well as giving claimants access to more general support. The crucial part of this drive is to reduce response times, which the authority knows has been a cause of dissatisfaction, particularly during Covid; in other words, the whole process is being modernised.

The NHS Business Services Authority has done its best to hit the ground running. Since taking over in November, it has already contacted all applicants to update them on their cases and it has also allocated additional resource to the operation of the scheme. I can assure the noble Lord that the department will further engage with the NHS Business Services Authority to ensure that these service improvements, greater digitisation in particular, really do make headway. There is already regular dialogue on this.

With all this enhanced activity happening, I do not think this is right time to establish an independent review into the VDPS. As the noble Lord will know, reviews take significant time and they carry substantial costs to the organisation, not just financial but in terms of leadership focus and energy. Instead, we think it is a better use of resources to focus on making the changes that we know need to happen; that is, to improve the claimant’s journey, and to modernise the process for claimants, as well as scaling up the capacity of the VDPS. We will keep the progress on these under regular scrutiny, and I am sure we will report regularly to this House as we do so.

I will address the noble Lord’s three key questions. First, I should be happy to facilitate a meeting with representatives of the families, and my honourable friend Maria Caulfield, who is the Minister with direct responsibility for the scheme, will be pleased to see them. Secondly, as I have already indicated, reducing response times is one of the NHS Business Services Authority’s key objectives. Thirdly, the noble Lord asked whether the Government would undertake a review of the scheme. I simply remind the noble Lord that the scheme has been revised many times since its inception, which shows that it is reviewed regularly as a matter of course, but perhaps it is worth my making the point that the VDPS is not a compensation scheme; nor is it designed to cover all expenses associated with severe disablement, which are catered for from the public purse in other ways. I hope that is helpful to the noble Lord, and that on the basis of those assurances he will feel able to withdraw his amendment.

Before I address the detail of Amendment 180, I would like to again put on record my thanks to my noble friend Lady Cumberlege for her continued commitment to the issues she has so powerfully spoken about, and the diligence and dedication of the IMMDS team, and the brave testimonies of those who contributed to the IMMDS review. As my noble friend knows, the Government have accepted the majority of the report’s nine strategic recommendations and 50 actions for improvement, and are taking forward work to improve patient safety. This includes establishing specialist mesh removal centres, the ninth of which opens in Bristol this month, and work to improve the care pathways for children and families affected by medicines during pregnancy.

We remain committed to delivering improvements in patient safety across the board. We are focusing government funds on initiatives that directly improve future safety. For this reason, the Government have already published their decision that redress schemes will not be established for people affected by hormone pregnancy tests, sodium valproate or pelvic mesh. I realise that was a disappointing decision for my noble friend, and I am always very sorry to disappoint her, but, for the reasons I have given, I ask her not to move Amendment 180 when it is reached.

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[Lord Clement-Jones (LD)]

My Lords, I rise briefly to support Amendment 165, in the name of the noble Lord, Lord Hunt, and thank him for putting it forward. Self-care has an important role to play in supporting people to manage their own health needs, and also in alleviating an unsustainable demand on GP and A&E services. As the noble Lord described, prior to the coronavirus pandemic there were some 18 million GP appointments and 3.7 million visits to A&E every year for conditions which people could have looked after themselves or sought advice from a pharmacist. It is estimated that this was costing the NHS in the region of £1.5 billion a year.

During the coronavirus, again as the noble Lord described, surveys have shown a much greater willingness among members of the public to self-care for these self-treatable conditions. But it is vital that appropriate policies are put in place to ensure that, as we emerge from the pandemic, people who can self-care continue to do so. It is evident now that self-care can help address many of the challenges we face in the NHS today, but to do so we need to address some of the system barriers to self-care, as described in this amendment, and unlock the important behavioural shifts that enabled people to self-care during the pandemic.

In particular, I will highlight how the NHS can make much better use of digital technologies and community pharmacists to enable people to self-care. We need to make better use of the technologies that the NHS has embraced over the course of the pandemic, such as the Covid-19 symptom checker on the NHS website. The digital triaging technology should be used to support the expansion of the community pharmacist consultation service to enable people to follow an algorithm online to get a referral for a consultation with a local pharmacist. It is critical, if we are to optimise the role of pharmacists—I am a big supporter of community pharmacists—that we give them the digital tools and information they need to support people. At present, a pharmacist cannot routinely record the advice or medication they give people, despite receiving training. The NHS must address the question of interoperability in IT systems, so that pharmacists can have access to read and to input into people’s medical records and enable pharmacists to be a core part of an individual’s primary healthcare team.

6.15 pm

The pandemic has highlighted how quickly the NHS and patients can adopt technological and digital changes. Realising the Potential: Developing a Blueprint for a Self Care Strategy for England, a document launched last October, is an excellent blueprint for this. A whole range of organisations, including NHS clinical commissioners, the RCN, pharmacy organisations, the Self Care Forum and, of course, the PAGB, have worked together to develop this blueprint for a comprehensive national self-care strategy to support the introduction of self-care policies throughout the NHS in England. It contains policy proposals and case studies, in particular in relation to digital technologies, which set out how the NHS can fully embed self-care and pharmacy into primary care.

I hope the Minister today will outline how the Government are ensuring that the NHS can adopt these proposals, which learn from the pandemic, and will expand them to support individuals to enable self-care.

[Baroness Wheeler (Lab)]

My Lords, we had a good debate in Committee on the issue of self-care and the management of health conditions, particularly on its importance as a key part of the primary care pathway. This was underlined in diabetes care and, as I also emphasised, in the care and treatment of people with rare diseases, most of whom are living with lifelong conditions. As vice-chair of the Specialised Healthcare Alliance of charities supporting this key group of patients, I know that they often do not feel sufficiently supported in terms of care and support and health and system information, and with physical and daily living.

As the two noble Lords have stressed, the Health Foundation’s research on the effective self-management by patients has shown a significant reduction in the need for emergency admissions to hospital and in A&E attendances, and fewer GP appointments. In this context, Amendment 165 makes a great deal of sense. If patients with, for example, rare diseases receive appropriate support to manage their less intensive care needs, then promoting self-care has the potential to help them prevent their conditions from deteriorating, to improve their lives and to reduce demands on the NHS, as the noble Lords have stressed.

We therefore strongly support the need for the development of a national self-care strategy, starting with awareness raising among primary and secondary children on how to self-care, and with appropriate staff and management training of healthcare professionals. Improved technologies, as underlined by the noble Lord, Lord Clement-Jones, especially those developed during the pandemic, will have a key role in broadening access to effective self-care and ensuring the better support from primary and community pharmacists that we all want to see. I hope the Minister will respond positively to this amendment.

[Baroness Penn (Con)]

My Lords, I thank the noble Lord, Lord Hunt, for bringing forward a debate on this issue. I reassure him and other noble Lords that the Government absolutely agree that supporting people to maintain their health and well-being and to manage self-treatable conditions is a vital part of delivering a comprehensive health service. Indeed, much of what the amendment seeks to achieve is already government policy. However, I do not agree that requiring the Secretary of State to prepare a single national strategy would add value. Instead, we are threading self-care through a wide range of work, reflecting the range of areas that it impacts upon.

A good deal of work is already under way. The community pharmacy contractual framework for 2019 to 2024 five-year deal sets out how community pharmacy will support the NHS long-term plan. Community pharmacies, which provide easy access to the NHS, are already required to support patient self-care, signpost to other parts of the NHS and local services as necessary, and help people to live healthily.

I am especially aware of the interest the Proprietary Association of Great Britain has shown in this area. The Department of Health and Social Care officials have met with it to discuss its blueprint for a self-care strategy in England and will continue to engage with it about further supporting self-care throughout our healthcare system.

We do not think placing an additional duty on the Secretary of State would be the right way to support this work, as it would take it out of the NHS long-term plan, where it belongs as part of a holistic approach to the provision of a health service. It could risk making it more disjointed rather than integrated in its approach, but noble Lords made a really important point about demand on our health service and the role that self-care has in this. Prevention was a key theme of a speech by my right honourable friend the Secretary of State last week and, clearly, elements of self-care and prevention go hand in hand with each other, particularly in the use of new technology.

Noble Lords also made an important point about how we can use self-care, particularly at community pharmacies, to reduce pressure on GPs and A&E departments. All community pharmacies are required, as I said, to provide support for self-care. To ensure that people get directed to the right support for their health needs, we have introduced referral systems from NHS 111 and GPs to pharmacies for advice and treatment for minor illnesses. We are also exploring expanding referrals from other settings, including urgent treatment centres and A&E to community pharmacies.

I hope that gives noble Lords some reassurance that we place an importance on self-care, as part of our health service. That will only increase in future and work is under way in multiple areas of the health service to do that. I hope, therefore, that the noble Lord is able to withdraw his amendment.