(9 months, 2 weeks ago)
Lords ChamberI do not have an answer in my pack to that specific question, but the noble Lord raises a very good point. It is very important that we bring more specialist skills into primary care, and GP practices are exactly the right place, but I will come back to the noble Lord on that specific point.
My Lords, what assessment have the Government made of the number of general practitioners required to meet the needs of the population and for training purposes by the year 2030?
We are working with NHS England to increase the general practice workforce in England but, as the population grows, with the amount of building that goes on throughout the country, it is the responsibility of local authorities. There are two ways to do this: they can apply for capital funding for new GP practices; or they can apply through Section 106 agreements through local authorities. It is for the regions and for local authorities to plan ahead on that front.
(9 months, 3 weeks ago)
Lords ChamberMy Lords, I had the privilege of knowing Igor for just short of 40 years. We first met in that bitter industrial dispute, the miners’ strike of 1984 to 1985, in the raft of litigation: I was in one case for the National Union of Mineworkers, and he was for the Union of Democratic Mineworkers. The bitterness between the two can be imagined. Out of court he was charm itself, such an easy man to deal with. We co-operated as barristers should, for the benefit of our clients and, of course, the court. But in court—my word—he was a lethal advocate, as has already been said and, indeed, as your Lordships know from his interventions in this House.
I also had the privilege of appearing before him several times in the Court of Appeal in some leading cases that time does not permit a discussion of. He was a wonderful judge: courteous, charming, attentive, concise and, of course, just—as one would expect. Before I met him in this House, I also had dealings with him in another context: I was one of the founders of an organisation called the Free Representation Unit, which arranges young barristers to represent people who would not otherwise be represented in employment tribunals, social security tribunals and so on. Igor was its patron and an ardent supporter. Those qualities demonstrated to me things that I saw so many times when he spoke in this House: his humanity, his empathy for those less fortunate than ourselves, and his respect for the rule of law. I am pleased to say that last night we had an event marking the 51st anniversary of the founding of the FRU and a minute’s silence for Igor. We will miss him, and I will miss him.
My Lords, I am probably the last speaker, as time is running out. My tribute is very personal. Igor treated me as if I were his confidant, not just about his health but about other things, and we spoke regularly. I last spoke to him last Saturday. He had come out of hospital at the time. He regarded me as a friend, and it was a great privilege. He gave me the impression that I was his personal friend. That is the memory that I will keep of Igor. I shall miss my friend.
(1 year, 7 months ago)
Lords ChamberMy Lords, I thank the noble Baroness, Lady Verma, for securing this debate, congratulate the noble Earl, Lord Minto, on his maiden speech and look forward to the maiden speech of the noble Baroness, Lady Foster, very much.
I will make brief comments about developing a science and innovation relationship with India, an emerging strong economy, which like all developed economies will soon be an even stronger science and innovation country. The UK has an ambition to be a science superpower, and in some areas like life sciences we probably already are. While I support the hopes that we will re-join as members of Horizon Europe, it is right that we develop associations in science, research and innovations globally, if we are to meet our ambition of being a global science superpower.
The Science Minister recently announced during a visit to Japan a £119 million global collaboration fund for science and business. I hope this signals a wish to develop science collaboration not only with countries such as Japan, but even more so with countries such as India, particularly as we share common values and traditions including education in science. Another advantage is language, as English is commonly spoken and taught in India, particularly in the teaching of science. India has strong research institutions. Nationally, it excels in areas such as space science, computer science and nuclear science, to mention but a few.
I recently met the new high commissioner of India to the UK, Mr Vikram Doraiswami, who is very enthusiastic about establishing a UK-India science link. I hope that our Foreign, Commonwealth and Development Office will show the same enthusiasm. We have a model that we can follow: I have been privileged to be a member of the UK-Israel Science Council, of which the noble Lord, Lord Winston, who is not in his place, is a joint chair. It was established over a decade ago by our then-ambassador to Israel, Matthew Gould, and its continuing success, after over a decade, is due to his foresight. It is a highly successful scheme of science collaboration and exchange of scientists, and is worth duplicating. The success is primarily because of the efforts of our embassy in Israel, and I hope that we can duplicate that with our high commission in India.
Government support is essential: importantly, though, that support has meant that nearly all the funding has come from donations from people in the UK and Israel who have affiliations to both countries. I note that several speakers in today’s debate have associations and affiliations with both India and the UK.
As the UK develops stronger trade ties with India, it is an opportune time to have such ties for science and innovation. The Foreign, Commonwealth and Development Office can play an important part. If his time allows, I would be pleased to meet the Minister to acquaint him further about how UK-Israel science collaboration works, and how it could be replicated with India and the UK, and I would hope to have a subsequent informal meeting with the India high commissioner. I have no doubt that the UK science community will be very supportive of developing a UK-India science council that could provide the exchange of scientists with common interests.
(2 years, 7 months ago)
Lords ChamberMy Lords, in this rather large group of amendments, I shall take us from catering to my Amendment 242 on professional regulation. I thank the noble Baroness, Lady Finlay, for adding her name. I draw your Lordships’ attention to my registered interests, in particular as chief executive of Cerebral Palsy Scotland. I am involved with the employment of regulated allied health professionals.
Clause 142 gives the Secretary of State far-ranging powers to alter the professional regulatory landscape, with the potential to make significant changes to how certain health and care professions may be regulated, including the power to remove professions from, or bring professions into, statutory regulation.
The UK model of regulation for healthcare is rigid, complex and needs to change to better protect patients, to support our health services and to help the future workforce meet future challenges. The case for reform has been acknowledged.
Whether a health and care profession falls under regulation is a major decision affecting not only the professions themselves but employers, patients and service users who place their trust in those professionals. My Amendment 242 is a probing one. I want to explore some of the issues that will be particularly important for the Government to consider as and when they might seek to use these extended powers.
I want first to thank my noble friend the Minister and the Bill team for the time they have taken so far to discuss the issues around my amendment. We are all agreed on the importance of encouraging greater collaboration between regulators, with the ability to share data and intelligence, but I remain to be convinced that the legislation is being used to reduce regulatory silos, which is crucial to reducing regulatory failures in the future.
I want to be clear that I am not advocating for a single super regulator, which would be a step in the wrong direction, not to mention complicated, disruptive and expensive. I would rather harness the best elements of professional regulation and give the regulators the tools to work more closely together and share best practice more consistently.
I accept that work is being done in the department on various regulatory reform initiatives. These are all important, but it strikes me that they are all focused on individual regulators and amend specific operational issues, rather than looking at the landscape as a whole and what could be achieved.
We have sadly seen all too many reviews and inquiries which have identified regulatory silos as a key factor in why something went terribly wrong. My noble friend Lady Cumberlege’s First Do No Harm report highlights the issue starkly, but the Paterson inquiry, the Sir Robert Francis report on Mid Staffs, the Shipman inquiry and others have all underscored the value of greater collaboration between regulatory bodies, sharing data and intelligence as well as adopting shared professional standards. Reducing and removing silos is also good for professionals and employers, with benefits in terms of intra-professional learning and for professional and patient safety.
I am grateful to the Health and Care Professions Council for its briefing, but I was concerned to note something which regulators have stressed to me: that due to their tightly defined duties, they have often been forced to resort to informal memorandums of understanding to try to make the system work better. That is piecemeal and inefficient— frankly, I would be extremely disappointed if the Minister in his response was to rely on such MoUs to fix the issue.
Do not the powers in this Bill offer a chance to look at things differently: a whole system regulatory approach rather than a set of silos? Amendment 242 identifies some principles and considerations that I believe the Government would find beneficial in developing this more collaborative landscape.
Maintaining regulatory independence is crucial. The Government have rightly recognised this in other legislation recently, but I would welcome confirmation from the Minister that this remains a cornerstone of any future regulatory reform proposals. I would be grateful for reassurance that no regulatory reform would be undertaken by the UK Government without working with the devolved Administrations to ensure that it worked for all parts of the UK.
I particularly want to highlight the benefits of multi-profession regulation, which, as the CEO of an organisation that relies on a range of expert allied health and care professionals registered with the HCPC, I see at first hand, supporting improvements across professions that are increasingly interconnected. As the Minister is aware, the HCPC regulates 15 professions, so is able to utilise common frameworks and outcome-based standards. This approach could, and should, be spread among all the professional regulators.
This is particularly important as the Government, NHS England and NHS Improvement seek to create a more flexible workforce with an ability to move between professions, work as multidisciplinary teams and support career progression. From my own experience, I know that this is positive, but we need our regulatory system to keep up with innovations in delivery. Can my noble friend the Minister therefore tell us about how we can harness the benefits of multi-profession regulation and how he anticipates this will influence the Government’s thinking in terms of reform? Collaboration and the development of a system-wide approach to overcome fragmentation and silos is critical to the future success of regulation. It is an enabler of better care, and a collaborative structure would generate considerably higher and richer levels of data.
Finally, this holistic approach would offer an opportunity to create consistent criteria for making decisions about which professions may be brought into or taken out of regulation. Could the Minister put it on record today that the issues in the amendment are principles that would govern the future use of the powers within Clause 142, that they are all principles that the Government are actively considering and that no decisions on regulatory change would be taken if the criteria set out in this amendment were not met? Once again, I thank him and his team for his engagement so far, and I look forward to his response today. I hope we can continue discussions between now and Report.
My Lords, I rise to speak to Amendment 243 in the name of the noble Baroness, Lady Merron, and Amendment 264 in the name of the noble Lord, Lord Hunt of Kings Heath.
Yesterday I was chastised—wrongly, in my view—for speaking at length. Such boldness requires training in speaking up, confidence in being right and using authority. The comments came from a government Whip, who happens to be a registered nurse. As a doctor, I am used to that. When a nurse speaks up, patient safety improves, health equity improves, collegial relationships are stronger—again, as a doctor I can vouch for that—and healthcare systems improve. This is because of their training. Not recognising legally the status that the title of “nurse” brings to those that are highly trained and qualified and on a nursing council register is wrong.
We all know what a nurse is; a nurse is highly trained, highly competent, can do the job well and is on a nursing register. Anybody else is not a nurse. It is right, therefore, that we recognise this and give it a legal status. Furthermore, the NHS and health providers should not employ anyone as a nurse who does not meet the above criteria. I understand that last year there were 195 advertisements for nurses in the NHS which did not say that the qualification of being registered was necessary. In my view, that is wrong. I strongly back this amendment, and I look forward to the contribution of my noble friend Lady Watkins.
Turning to Amendment 264 on the appointment of consultants in surgery, I am a fellow of the Royal College of Surgeons of England, the Royal College of Surgeons of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow, so I speak on behalf of all surgical colleges. Let me give your Lordships an example: there is a surgical post empty in Birmingham. A highly qualified person, who was well-trained in Scotland and holds a fellowship of the Royal College of Surgeons of Edinburgh, is a key candidate for application but cannot be appointed because the Royal College of Surgeons of England cannot provide an assessor. On the other hand, there is a surgical vacancy in Glasgow, and the top candidate is a fellow of the Royal College of Surgeons of England but can be appointed without a Royal College of Surgeons of England assessor being there. That is a total anomaly.
A person can be appointed who is fully trained in Scotland, is a fellow of the Royal College of Surgeons of Edinburgh, works in Cambridge, applies in Cambridge, but you cannot have an assessor from the Royal College of Surgeons of Edinburgh. In all other specialties—the Royal Colleges of Obstetricians and Gynaecologists, of Ophthalmologists, of Radiologists, of Psychiatrists, of Anaesthetists, and in public health—the assessor can come from any part of the United Kingdom. This anomaly can be stopped very easily. I agree with the noble Lord, Lord Hunt of Kings Heath, that it is not a big deal; just change it in legislation. I do not know who opposes it.
My Lords, it is a pleasure to follow the noble Lord, Lord Patel, on the term “nurse”, which is protected in law at the moment only for those who are a “registered nurse”. This means that anyone can describe themselves as a nurse, as the noble Baroness, Lady Wheeler, outlined. They can even describe themselves as a nurse if they have no qualifications or experience—or, perhaps more seriously, have just been struck off the register. As somebody who was a member of the forerunner to the Nursing and Midwifery Council, I can say that we do not strike people off the register lightly, so the risks of such people being at large and describing themselves as nurses are serious. For this reason, a petition was created calling for the title “nurse” to be protected further in UK law.
In the initial response by the Government to the petition, recognition was given that the protection of professional titles
“provides assurance to the public that someone using that title is competent and safe to practise.”
The response references a consultation by the Department of Health and Social Care on professional regulation, Regulating Healthcare Professionals, Protecting the Public. In the Nursing and Midwifery Council response to this consultation, the nursing regulator recognised issues around the limitations of “nurse” not being a protected title and said it did not think that its current powers are sufficient,
“given that they are primarily based around titles that are not widely understood by the public or used by the professions.”
This amendment is designed to ensure that there are sufficient regulatory levers to be able to protect the public in the future.
Nurses on the NMC register find it difficult to understand why the Government are reluctant to protect the title. As part of the statutory regulations of the Health and Social Care Act 2012, it was mandated that registered nurses would be part of the clinical commissioning group governing body. In Regulation 11 of the National Health Service (Clinical Commissioning Groups) Regulations 2012, the CCG governing body is required to include at least one registered nurse within its membership. This created a statutory commissioning role for nursing leaders in England that will be lost should this not be required within integrated care boards’ executive membership. Please can the Minister explain whether guidance will include a recommendation that there should be a registered nurse as part of the executive team on integrated care boards?
My Lords, the Minister suggested that, to have any changes in the appointment of surgeons, the department would have to consult first. I assume that the only body it would need to consult is the Royal College of Surgeons, which I understand is sympathetic to the change. If that is the case, it is a simple matter, so can it not be consulted before Report?
If it is as straightforward as the noble Lord suggests, I will see if that can be done.
(2 years, 7 months ago)
Lords ChamberMy noble friend makes a very good point. As I alluded to earlier, HMRC and BEIS are working very hard in conjunction with the lenders to recover as much as we possibly can. I reiterate that the figures, as noble Lords will tell me, are big. We have paid out altogether more than £400 billion to support the economy. It is fair to say that to that extent it has been a great success, because the economy is in very good shape.
My Lords, I listened to the debate yesterday, in which the noble Lord, Lord Agnew, indicated that some lenders were failing on fraud. Can the Minister say which lenders are failing on fraud?
I do not accept the premise that lenders are failing on fraud, and, of course, the noble Lord, Lord Patel, will know that I am not in a position to name individual lenders. However, lenders continue to work closely with the Government on counterfraud, including recovering £1.2 million on facilities identified as fraudulent so far. It is important that lenders are held accountable for taxpayers’ money, and all lenders continue to be subject to a robust audit process by the British Business Bank.
(2 years, 7 months ago)
Lords ChamberI am afraid I do not have an answer to that question, so I will go back to the department to try to find out, and will provide that information to the noble Lord.
My Lords, I thank the noble Baroness the Leader of the House for repeating the Statement. Could she confirm that we will still continue with the vaccination of 12 to 15 year-olds? The JCVI recommends that the over-5s are also vaccinated. Now that the MHRA has approved the drug Paxlovid, which has been found to be highly effective in trials at reducing serious illness by 89%, do the Government have plans to purchase such drugs for those who might catch Covid in future?
As the noble Lord will be aware, we have already purchased more antivirals than anywhere else in Europe, so we are on the front foot on this and will continue to be so. As new drugs become available, I am sure we will continue to do that. The noble Lord is absolutely right: we will be continuing to vaccinate those aged between 12 and 15. In England alone, we have already delivered over 1.7 million doses to that age group, and we are continuing to work on increasing take-up—for example, through repeat offers, ensuring information is translated into appropriate languages, and collaborating with leading social media platforms to direct young people and their parents to trusted sources of information.
(2 years, 7 months ago)
Lords ChamberMy Lords, I am glad to see the noble Lord, Lord Hunt, in his place. I welcome him back and am pleased to hear that things are good with his family. As he mentioned, in 2012 I led on the amendment arguing for Healthwatch to be made independent. I did not succeed—it was defeated by 22 votes—but we had a coalition Government at the time, so I did not stand much chance anyway. I will try again today.
My name is attached to all the amendments in this group. They are the key amendments relating to local and national Healthwatch, and they address public and patient involvement in the Bill. The Bill says a lot about how patients will be centre stage in the whole reorganisation, so it is important that the patient voice be heard. How will we do that?
Amendment 220 is about the independence of Healthwatch England in statute and its ability to get the information about health services it will need to do its job. The Government’s genuine aspiration to establish an effective system of public involvement requires that Healthwatch England be strengthened by making it truly independent. In fact it deserves it; it has grown into its role and proved its worth. Healthwatch England should provide a national vehicle to drive standards of health and social care and identify areas of poor practice. It has a very special mission that is quite different from that of the regulator, the CQC, of which the Government want Healthwatch England to be a committee. Healthwatch England should be the voice of the people, the voice to which the Secretary of State listens, working in close collaboration with the CQC but also able to hold it to account.
Healthwatch England should be the voice of the abused patient—of the forgotten person with dementia on the second floor of a nursing home, of the child with a learning disability who is getting poor care on a children’s ward, of the people waiting for excessive periods for emergency care in an A&E department. When a local Healthwatch or member of the public raises their voice because of a persistent local problem, as occurred in Mid Staffordshire, Healthwatch England must hear it and respond immediately. To do so, it needs to be independent.
Embedding Healthwatch England in the CQC is a fundamental error, as the noble Lord, Lord Hunt of Kings Heath, said. Calling it “a committee” is a fundamental error: it diminishes its power and influence. The only people who think a committee is important are the people who sit on it. Having sat on so many of them, I might agree. It has been argued that locating Healthwatch England within the CQC puts it at the centre of regulation, where it can have real power and influence. However, it cannot have power and influence if it is a committee of the regulator. To have power and influence it needs independence and the ability to challenge the regulator, and to have influence with every local authority in England. It must be seen to be independent, not just called independent. Being independent and being seen to be so requires Healthwatch England to be run by a board that has public trust and confidence, meets in public and speaks to the public, not the board of the CQC.
With the development of the ICS, it is even more important that Healthwatch England is an independent voice of patients and the public. I agree with the noble Lord, Lord Hunt of Kings Heath.
(3 years, 3 months ago)
Lords ChamberOn 26 January last year, I was surprisingly granted a PNQ to ask the Government about their plans for dealing with a virus that was spreading in China. I did not know at that stage that we would have a pandemic still raging in our country today, with the new variants. I have not been in the Chamber since 11 March last year and I yearn to get back. Physical presence, with all the procedures and business that we run in the Chamber, has a different atmosphere and the ability to scrutinise the Government and hold them to account.
Before I say more, I thank, most enormously, all the staff, both in the offices and the digital services, who have helped establish our ability to work virtually and in hybrid. I was chosen to be one of the early adopters, so I was a sort of guinea pig to test the system. Therefore, I learned a lot at the beginning and I thank enormously the staff who work in digital services, particularly —I would like to name him—Mr Avi Dussaram who, not surprisingly, was awarded an honour in the last Birthday Honours List. He was brilliant at explaining to us early adopters how the system would work and at developing it so that we could use it. So I thank all the staff.
This has already been a long debate and I see that the Chamber is emptier than it was. At this stage, I cannot tell how many might be listening virtually, so I will be brief. First, I will comment on the working of committees virtually. It is obvious that many noble Lords feel that the committees work well virtually and that it is easier to get witnesses. My experience as the chairman of the Science and Technology Committee is not the same; we have always managed to get witnesses and the interaction physically of the committee with witnesses has been more helpful than doing it virtually. When a witness does not agree with the evidence being given by another witness, you can tell from the body language and are then able to ask a supplementary and get better evidence. I agree that it is easier to get witnesses from overseas and, when we return after Whitsun, my committee will be listening to witnesses from the west coast of America, Germany and the United Kingdom at the same time. So I have a slightly different view of how the committees work, but I accept that the House will have to decide. It may be that a flexible way of working that the committees design will be better.
The list for Questions, and I have taken part in many Questions, does work, except when the Minister gives a 30-second answer to avoid a question being asked. They do that many times. There are times when numbers nine and 10 on the list miss out, and the Leader of the House may well remember when I had to ask a question in 10 seconds, otherwise number 10 would have missed out.
I will comment on the workings of a Grand Committee in which I took part. It worked better due to the Ministers —the noble Lord, Lord Bethell, and the noble Earl, Lord Howe—having several meetings outside the Committee at the time. As a result, not many votes were called on Report. Otherwise, it is very difficult to hold government to account in the way we used to in Grand Committees and at the Committee stage of Bills.
In conclusion, the digital voting system works and I hope we can retain it in some form, but it will have to be for people who are present on the estate. For Questions, having listed questioners works, and I hope we will keep this form.
Lastly, I hope the noble Lord, Lord Cormack—I agree with what he had to say—will not call a vote. Today is a day for discussion and getting opinions, but I agree with him that it should be the House that makes the final decision.
(3 years, 3 months ago)
Lords ChamberMy Lords, the threat of SARS-CoV-2 causing a pandemic was first highlighted in this House on 22 January 2020. From the early days of scientific uncertainty related to the virus and its transmission, which possibly helped to drive much of the policy of managing the pandemic, science helped to identify drug treatments, sequence the changing genome and develop vaccines. Does the Leader of the House agree that the proposed inquiry should include as part of its terms of reference the UK’s scientific ability to help manage and, importantly, prevent future pandemics, including the surveillance of likely emerging infections? The WHO independent panel report published on 12 May makes the same point.
I thank the noble Lord. I am sure that many of the issues that he raises will be part of the inquiry, but it will be up to the inquiry to determine its terms of reference, the scope of requests for evidence and who to call for evidence. We are clear that it will be a thorough examination, so I am sure the issues that the noble Lord talks about will be considered.
(3 years, 4 months ago)
Lords ChamberMy Lords, I begin by joining others in expressing my deepest condolences to Her Majesty the Queen and all the members of the Royal Family.
My abiding memory of His Royal Highness Prince Philip, Duke of Edinburgh, is his kindness shown to me and my wife Helen. That kind nature was evident every time I had the privilege to meet him. I also have fond memories of conversations when I was enlightened by his vast and deep knowledge of many subjects, like on the occasion he gave me a lesson on lighthouses, on which he was very knowledgeable. As you would expect, there were also times when he would take a delight in teasing me and, as I learned, waiting to see how I would respond. And he enjoyed it if you returned the compliment.
Every year His Royal Highness the Duke of Edinburgh presided over the Royal Society of Edinburgh’s gold medal awards. On one such occasion I did a citation for Sir David Lane, who discovered P53, a cancer gene. At that time he was working at Dundee University, where I was chancellor. Later, His Royal Highness congratulated me on my citation, but noble Lords can guess what was coming next. He asked: “Do you understand any of it?” I should have said, “Of course I do”, but being taken aback and trying to be polite I said, “Some of it, your Highness, but not all.” He was then interested in my role as chancellor at Dundee University. When I said that I had just attended four days of graduation ceremonies, he paused, looked at me and said, “You attended four days of graduation ceremonies?” I said yes. He said, “You’re a mug to stand doing that for four days.” He was of course chancellor of Edinburgh University at the time.
On subsequent occasions I learned not just to take it, but to try to give some back. I had to be quick-witted. I think I did win once, and then only just. He was a person I would look forward to meeting at every opportunity I was offered, for I knew that I would be enriched and be treated like a friend, with kindness, even to be teased, all in good humour. The last occasion I had the privilege to meet him was a cold wet July afternoon in the grounds of Holyrood Palace in Edinburgh. Despite many people being around him, he made sure that I had an opportunity to have a brief conversation with him—a reflection of his kind nature and ability to make you feel important. When I inquired after his health, he just said, “I’m not liking the cold any more.” Soon after that, he retired from public service.
The most reverend Primate the Archbishop of Canterbury is reported to have said that the Duke of Edinburgh lived life with the hand he was dealt. The Hindu scripture Bhagavad Gita says:
“It is better to live your own destiny imperfectly than to live an imitation of somebody else’s life with perfection.”
The Duke of Edinburgh lived his own destiny, not imperfectly. The text goes on to say that one should live a life with purity, strength, discipline, honesty, kindness and integrity—qualities and virtues that His Royal Highness Prince Philip, the Duke of Edinburgh, had in plenty. With them he enriched us all.