Lords Chamber
12:41
Baroness Anderson of Stoke-on-Trent (Labour)
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Baroness Anderson of Stoke-on-Trent (Labour)
Campbell, who I was delighted to see in your Lordships House last week and is definitely on the road to recovery. Lady Featherstone, who has ensured that we have a human voice always. And of course, lady, as their resolve in seeking justice for the victims of this scandal cannot be understated, and their generosity of time to make sure that I am fully abreast of such issues has been incredibly, personally beneficial. I'd also like to thank my opposite number, Lady Phin, for how constructive we have worked together on these issues to deliver for a community that needs to be that rightly has limited faith and trust in government after their experiences, and it is the onus on all of us in your Lordships' House to make sure that they know that we are listening to them.
My Lords, I'm going to look in detail at the comments of the noble Baroness Lloyd Brinton. Obviously, as she highlighted, they were very specific questions. I think it may be useful for us actually to have a meeting with officials, which I will invite all of those who have participated today to to attend. But I will also reflect on the points. I'm right in advance of the meeting. My Lords, we're here today first and foremost to debate the regulations, and I will prioritise the issues raised on the regulations in my response.
I'm aware of the other points that have been raised, and I'll do my best to address those too. But obviously I will reflect on Hansard if I've missed any of them. In terms of the specific points that have been raised, I'd like to start by the points raised by the noble Lady Baroness Finlay. These are incredibly important points, and she did worry me when she raised in advance. When she gave me the detail in advance. And I had worried that there was a gap that we had missed.
So to clarify for the record, I think it would be very useful. Someone infected as a child would receive injury, social impact, autonomy, care, and basic financial loss awards in the same way as an adult. They do not receive an additional financial loss award for the years where they were aged under 16. However, they will still receive an additional financial loss award for the years where they were or will be aged 16 or over, and I hope that gives a level of reassurance.
And with regards to the heartbreaking situation of when an infected child had passed away, a bereaved parent, a parent would receive injury, social impact and autonomy. Awards based on the infection and infection severity that that child had. This will not change based on how old their child was when they passed away. The awards to parents are higher where their child's infection has caused, or is expected to cause an early death in the future. This includes those infected with HIV or level three, four and five hepatitis infections.
They would also be the likely beneficiary of their child's estate under the under the law of intestacy. All such would likely be the recipient of whatever injury, social impact, autonomy, care and financial loss awards are due to the child's estate, so there is still a level of compensation, but I will make sure that I also write to the noble Lady so she has a copy in writing as well as from Hansard. I just want to touch on prioritisation because I think that is helpful in the context of what we're talking about it, our prioritising those nearing the end of their lives because community members and representatives have highlighted how important it is for these people to start their compensation claim.
Nearing the end of life means a person has been told by a doctor or medical professional that they might have less than 12 months to live. This could be due to any medical illness or condition. It does not need to be caused directly by an infection from contaminated blood. With regards to previous payments.
**** Possible New Speaker ****
Intervene. The noble Lady has said that this is the case for those who are infected victims. those who are infected victims. Will the same rules be applied to affected victims who are nearing the end of their life, because many the end of their life, because many of them are. Many are dying now.
**** Possible New Speaker ****
of them are. Many are dying now. As I believe that to be the case, I will confirm to the noble Lady in I will confirm to the noble Lady in writing, given the issues that we're talking about, and I would not want to mislead anybody, but I believe that is also because approach for affected estate as well. With regards to previous payments that have been made, they are all pre the 31st of March ex-gratia. Only payments from the 31st of March count towards compensation calculations.
No payments from an r r compensation. But I will again in our conversations and reflecting on Hansard, write to the noble Lady in terms of the special category mechanism. Now noble Lady asked very specific points about the system, but I want to confirm, while I recognise the level of community concern about how the scheme considers and recognises the impacts captured by the special category mechanism, the matter of how the scheme recognises and compensates people for the impacts that make someone eligible for SCM is part of the public consultation and further regulations.
The consultation proposes that anyone currently receiving special category, mechanism or equivalent payments through the Infected Blood Support Screen schemes would now be automatically eligible for a Severe Health Condition Award. Everyone who receives SCM payments should have been contacted by ICA already, as part of the cohort of infected people registered with a support scheme. I hope that gives a level of reassurance, but I'm aware the noble Lady asked for more specific questions about that and I will revert. Moving on to inheritance tax.
Well, the noble Lady will appreciate that. Such was the statement from the Chancellor that no such meeting was required because the Chancellor there were private conversations happened about this. Reflecting on both the conversation about the issues raised in your Lordships' House and in the other place about how important this was. Representations were made and the Chancellor reflected that in the budget. And I am very, very pleased that she did so. So there was no such meeting in terms of a meeting that I had offered, but proved to be unnecessary.
I hope nobody could appreciate that it now proved to be unnecessary. In terms of the inheritance tax. Though raised by the noble Lady Baroness Finn, I think it would be helpful if I can just outline what we've actually agreed to. I know that the issue of inheritance tax policy has been widely raised by noble, by many members of your Lordships' House and in the community, and was of huge concern. Compensation payments made under the scheme will be exempt from income, capital gains and inheritance tax.
This is in line with tax exemptions for the first and second interim payments. At the budget. The government announced that further updates to Inheritance Tax disregard will be made to ensure that infected blood compensation payments are relieved from inheritance tax in cases where the original infected or affected person eligible for compensation has sadly died before the compensation is paid. I know this was an important issue for many members of the community, and I'm pleased that the government has been able to listen and make this change.
The changes mean inheritance tax credit will be automatically applied to the estate of the first beneficiary of the infected or affected person's estate, for example, this would mean that the children of a bereaved partner who inherits their infected partner's estate and then dies would not face an inheritance tax charge on the compensation they inherit. This will apply to compensations made before or after the 26th of November, 2025. The government has also made changes to the rules on gifting compensation payments. The change means that the first living recipients of compensation payments will have two years in which to give some or all of their compensation payment, without an inheritance tax charge.
This applies to gifts of compensation made on or after the compensation made on or after the 4th of December, 2025. Noble Lady Baroness Finn also raised the fact that no one should fall through the cracks. Noble Lady is absolutely right. It is working with those affected and infected to build an evidence base where where people are struggling to. And I think noble Lords would appreciate that as we move from the infected who are claiming to the effective, who have claims that some of the evidence base is going to become more challenging, and it is right that the that the case handlers are working will work with people to help support their evidence efforts.
With regard to the Tyrone Urch review, we're still reflecting and I look forward to discussing on the recommendations and working and talking to colleagues to see what support, because many of the recommendations were for them. I will report back in due course and to confirm these are the changes to these regulations will not slow us down. Where there are enhancements that have been made, those will be retrospectively applied to those people who've already received compensation without them having to come forward again.
And we don't believe that anything we're proposing at this point will slow anything down. With regard to the clear plan, noble Lords are aware that over the earlier this year I went to visit it. I met with their comms team. I think we can all agree that there have been significant communication challenges from during this process. I personally think having seen some of their new materials that they're using and the fact that they are using the different level of basic English standard now, as opposed to a level of science that that has made this much more accessible.
My Lords, we are talking about a number of people who have different experiences and personal and different personal circumstances. Comms is always going to be a challenge, but I want to put on record my thanks for both the women who are and they are overwhelmingly women who are answering the calls at the first instance, who are providing huge support, and for the the handlers that are based at ICA who are doing a very, very good job, having built an organisation from scratch since May last year to deliver over £2 billion of compensation, there is a long way to go, but I believe that they are on track.
My Lords, these regulations will action several of the inquiry's recommendations and bring them into force as quickly as we have been able to. But I am very clear that this is not the end of the process. These regulations are only one part of the government's response to the inquiry's additional report. The consultation that is currently away does not close until the 22nd of January, and I encourage all of those impacted by the scandal to respond, to ensure that your voice is part of those helping to guide us forward, and if there are problems in people being able to access the consultation, then please let us know.
And we will. And we are. We
**** Possible New Speaker ****
are making other mitigations, but if there are specific challenges, I would want to hear them. Thank you.
**** Possible New Speaker ****
Thank you. Absolutely clear. The comment I was making was not about the consultation, which is a written one. It was about the fact that nobody with lived experience was invited to attend the round table
**** Possible New Speaker ****
meetings. Looking at the detail. But that has now been resolved.
**** Possible New Speaker ****
But that has now been resolved. Okay, I will explore. I will speak to officials and look to see what's actually happened. Many of the points raised today are subject to the consultation. I look forward to discussing these in more detail response. In the meantime, I hope the changes we are making today with these regulations demonstrate that we are fully committed to ensuring that justice is finally brought to a group of people who have waited far too long. My Lords, I beg to move here.
My Lords, I'm going to look in detail at the comments of the noble Baroness Lloyd Brinton. Obviously, as she highlighted, they were very specific questions. I think it may be useful for us actually to have a meeting with officials, which I will invite all of those who have participated today to to attend. But I will also reflect on the points. I'm right in advance of the meeting. My Lords, we're here today first and foremost to debate the regulations, and I will prioritise the issues raised on the regulations in my response.
I'm aware of the other points that have been raised, and I'll do my best to address those too. But obviously I will reflect on Hansard if I've missed any of them. In terms of the specific points that have been raised, I'd like to start by the points raised by the noble Lady Baroness Finlay. These are incredibly important points, and she did worry me when she raised in advance. When she gave me the detail in advance. And I had worried that there was a gap that we had missed.
So to clarify for the record, I think it would be very useful. Someone infected as a child would receive injury, social impact, autonomy, care, and basic financial loss awards in the same way as an adult. They do not receive an additional financial loss award for the years where they were aged under 16. However, they will still receive an additional financial loss award for the years where they were or will be aged 16 or over, and I hope that gives a level of reassurance.
And with regards to the heartbreaking situation of when an infected child had passed away, a bereaved parent, a parent would receive injury, social impact and autonomy. Awards based on the infection and infection severity that that child had. This will not change based on how old their child was when they passed away. The awards to parents are higher where their child's infection has caused, or is expected to cause an early death in the future. This includes those infected with HIV or level three, four and five hepatitis infections.
They would also be the likely beneficiary of their child's estate under the under the law of intestacy. All such would likely be the recipient of whatever injury, social impact, autonomy, care and financial loss awards are due to the child's estate, so there is still a level of compensation, but I will make sure that I also write to the noble Lady so she has a copy in writing as well as from Hansard. I just want to touch on prioritisation because I think that is helpful in the context of what we're talking about it, our prioritising those nearing the end of their lives because community members and representatives have highlighted how important it is for these people to start their compensation claim.
Nearing the end of life means a person has been told by a doctor or medical professional that they might have less than 12 months to live. This could be due to any medical illness or condition. It does not need to be caused directly by an infection from contaminated blood. With regards to previous payments.
**** Possible New Speaker ****
Intervene. The noble Lady has said that this is the case for those who are infected victims. those who are infected victims. Will the same rules be applied to affected victims who are nearing the end of their life, because many the end of their life, because many of them are. Many are dying now.
**** Possible New Speaker ****
of them are. Many are dying now. As I believe that to be the case, I will confirm to the noble Lady in I will confirm to the noble Lady in writing, given the issues that we're talking about, and I would not want to mislead anybody, but I believe that is also because approach for affected estate as well. With regards to previous payments that have been made, they are all pre the 31st of March ex-gratia. Only payments from the 31st of March count towards compensation calculations.
No payments from an r r compensation. But I will again in our conversations and reflecting on Hansard, write to the noble Lady in terms of the special category mechanism. Now noble Lady asked very specific points about the system, but I want to confirm, while I recognise the level of community concern about how the scheme considers and recognises the impacts captured by the special category mechanism, the matter of how the scheme recognises and compensates people for the impacts that make someone eligible for SCM is part of the public consultation and further regulations.
The consultation proposes that anyone currently receiving special category, mechanism or equivalent payments through the Infected Blood Support Screen schemes would now be automatically eligible for a Severe Health Condition Award. Everyone who receives SCM payments should have been contacted by ICA already, as part of the cohort of infected people registered with a support scheme. I hope that gives a level of reassurance, but I'm aware the noble Lady asked for more specific questions about that and I will revert. Moving on to inheritance tax.
Well, the noble Lady will appreciate that. Such was the statement from the Chancellor that no such meeting was required because the Chancellor there were private conversations happened about this. Reflecting on both the conversation about the issues raised in your Lordships' House and in the other place about how important this was. Representations were made and the Chancellor reflected that in the budget. And I am very, very pleased that she did so. So there was no such meeting in terms of a meeting that I had offered, but proved to be unnecessary.
I hope nobody could appreciate that it now proved to be unnecessary. In terms of the inheritance tax. Though raised by the noble Lady Baroness Finn, I think it would be helpful if I can just outline what we've actually agreed to. I know that the issue of inheritance tax policy has been widely raised by noble, by many members of your Lordships' House and in the community, and was of huge concern. Compensation payments made under the scheme will be exempt from income, capital gains and inheritance tax.
This is in line with tax exemptions for the first and second interim payments. At the budget. The government announced that further updates to Inheritance Tax disregard will be made to ensure that infected blood compensation payments are relieved from inheritance tax in cases where the original infected or affected person eligible for compensation has sadly died before the compensation is paid. I know this was an important issue for many members of the community, and I'm pleased that the government has been able to listen and make this change.
The changes mean inheritance tax credit will be automatically applied to the estate of the first beneficiary of the infected or affected person's estate, for example, this would mean that the children of a bereaved partner who inherits their infected partner's estate and then dies would not face an inheritance tax charge on the compensation they inherit. This will apply to compensations made before or after the 26th of November, 2025. The government has also made changes to the rules on gifting compensation payments. The change means that the first living recipients of compensation payments will have two years in which to give some or all of their compensation payment, without an inheritance tax charge.
This applies to gifts of compensation made on or after the compensation made on or after the 4th of December, 2025. Noble Lady Baroness Finn also raised the fact that no one should fall through the cracks. Noble Lady is absolutely right. It is working with those affected and infected to build an evidence base where where people are struggling to. And I think noble Lords would appreciate that as we move from the infected who are claiming to the effective, who have claims that some of the evidence base is going to become more challenging, and it is right that the that the case handlers are working will work with people to help support their evidence efforts.
With regard to the Tyrone Urch review, we're still reflecting and I look forward to discussing on the recommendations and working and talking to colleagues to see what support, because many of the recommendations were for them. I will report back in due course and to confirm these are the changes to these regulations will not slow us down. Where there are enhancements that have been made, those will be retrospectively applied to those people who've already received compensation without them having to come forward again.
And we don't believe that anything we're proposing at this point will slow anything down. With regard to the clear plan, noble Lords are aware that over the earlier this year I went to visit it. I met with their comms team. I think we can all agree that there have been significant communication challenges from during this process. I personally think having seen some of their new materials that they're using and the fact that they are using the different level of basic English standard now, as opposed to a level of science that that has made this much more accessible.
My Lords, we are talking about a number of people who have different experiences and personal and different personal circumstances. Comms is always going to be a challenge, but I want to put on record my thanks for both the women who are and they are overwhelmingly women who are answering the calls at the first instance, who are providing huge support, and for the the handlers that are based at ICA who are doing a very, very good job, having built an organisation from scratch since May last year to deliver over £2 billion of compensation, there is a long way to go, but I believe that they are on track.
My Lords, these regulations will action several of the inquiry's recommendations and bring them into force as quickly as we have been able to. But I am very clear that this is not the end of the process. These regulations are only one part of the government's response to the inquiry's additional report. The consultation that is currently away does not close until the 22nd of January, and I encourage all of those impacted by the scandal to respond, to ensure that your voice is part of those helping to guide us forward, and if there are problems in people being able to access the consultation, then please let us know.
And we will. And we are. We
**** Possible New Speaker ****
are making other mitigations, but if there are specific challenges, I would want to hear them. Thank you.
**** Possible New Speaker ****
Thank you. Absolutely clear. The comment I was making was not about the consultation, which is a written one. It was about the fact that nobody with lived experience was invited to attend the round table
**** Possible New Speaker ****
meetings. Looking at the detail. But that has now been resolved.
**** Possible New Speaker ****
But that has now been resolved. Okay, I will explore. I will speak to officials and look to see what's actually happened. Many of the points raised today are subject to the consultation. I look forward to discussing these in more detail response. In the meantime, I hope the changes we are making today with these regulations demonstrate that we are fully committed to ensuring that justice is finally brought to a group of people who have waited far too long. My Lords, I beg to move here.
12:53
Short debate: Plans to publish a strategy for a wheelchair provision by NHS and social care services
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Short debate: Plans to publish a strategy for a wheelchair provision by NHS and social care services
The question is that this motion be agreed to. As many as of that opinion will say content. Contrary, not content. The contents have it. not content. The contents have it. We move now to the next business question for short debate strategy for wheelchair and community for wheelchair and community equipment provision Lord Hunt of Kings Heath.
12:53
Lord Hunt of Kings Heath (Labour)
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Lord Hunt of Kings Heath (Labour)
My Lords, I'm very grateful to noble Lords who taking part in this debate, and I particularly want to welcome the noble Baroness Gerada who is making her maiden speech. She has, of course, been a She has, of course, been a absolutely brilliant president and chair of the Royal College of GPS. chair of the Royal College of GPS. But if I can say so, more than that, an excellent GP and brilliant champion of primary care and the NHS, and it's a pleasure to welcome her to this debate.
I shall also inform the House of my patronage of the Wheelchair Alliance and also the Healthcare Supply Association, and my daughter Philippa works for backup, which supports people with spinal injury. My Lords, the provision of wheelchair and community equipment in this country for disabled people is, to put it quite bluntly, a disgrace. The nub of the problem was described in The Guardian on the 2nd of December by the distinguished academic doctor, Paul Sager. He was paralysed in a climbing accident and described how inconsiderate, illogical and incompetent many of the current wheelchair providers are.
He talked about the bureaucratic barriers, organisational inflexibilities and patchiness of the services he encountered. I thought particularly telling for me were the words of a physiotherapist he quoted, who had been working with people with spinal cord injury for more than 20 years. Many of her clients are discharged from hospital, she said, in heavy manual wheelchairs that an able bodied person would struggle to push frequently. They're the wrong type or size and at the very least are uncomfortable often, she said, people who have impaired functions in their upper limbs cannot push these wheelchairs themselves and become effectively housebound, in some cases confined to their bed.
Sometimes they develop complications from poorly prescribed wheelchairs, and it lands them back in hospital on average, she added, people wait at least ten months after discharge before being assessed, let alone getting the wheelchair that is right for them. Unbelievably, some local wheelchair services apparently refused to assess a patient until they have left hospital. So much, my Lords, for integrated care, which I thought integrated care boards were established to actually achieve. Now, Doctor Sage's experience, of course, is not unusual.
The Wheelchair Alliance has produced convincing evidence to show how inconsistent and under-resourced wheelchair services are. Over 50% of providers come from the private sector, and there are real worries regarding the financial frailty of many of them. With a system that prioritises lowest initial cost over long term value and reliability, there are no consistent national standards, no independent regulation, few clear paths for users seeking repairs, reporting thoughts or making complaints. As a result, many disabled people experience long waiting times, delays in hospital discharge, loss of independence, social inclusion and tragically avoidable deterioration in health and well-being.
My Lord, it's the same dismal picture with community equipment embracing hoists, scrap rails, harnesses, medical beds and a wide range of essential medical products. The all party Group for Access to Disability Equipment has recently reported on the systematic crisis in the sector. 60% 63% of carers, 55% of equipment users feel that services are getting worse, not better, and the all party group concluded the system's inconsistent, underinvested, fragmented and lacking leadership. Now, government policy is that local authorities and integrated care boards are share responsibility for community equipment.
In practice, this means a fragmented, inconsistent delivery equipment providers describe a landscape in which every authority works differently without alignment or accountability, so the consequence is a postcode lottery, with 74% of equipment providers aware of patients experiencing delayed hospital discharge due to unavailability of community equipment. And I would argue, and I'm looking forward to Baroness Brinton speech later on this, I would argue that community equipment is almost the silent crisis at the root of the challenges we face in providing community and social care.
And the tragedy is it would be so easy to sort this out if there was a will to do it now, my Lords, in April, the government published the Wheelchair Quality Framework to assist integrated care boards and will share service providers deliver high quality provision. I have read it. It's welcome. But my Lords, the problem is, first of all, its guidance. It lacks binding universal standards, does not guarantee equitable provision across all of the country. It does not address systematic under-investment.
It does not mandate robust data reporting. It lacks external oversight or performance management. And so there is no statutory legally guaranteed entitlement, ensuring that every person in need receives the right wheelchair or community equipment in a timely fashion. My Lords, what is required? I am absolutely convinced that we need a national strategy, underpinned by the appointment of a national clinical director, accountable to Ministers and backed up by strong performance management and the remit of the director, should embrace community equipment as well as wheelchairs.
Miles what that needs to be underpinned by a vision, a national, comprehensive vision of what a high quality wheelchair and community equipment provision should look like, and the government should embrace the report of the all party group on access to Disability equipment by introducing a dedicated national strategy for community equipment and wheelchair provision. Users must be around the top table with a real input into policy, a nationally defined eligibility and quality standard for wheelchairs and community equipment uniform across all regions, and removing the current postcode lottery, a legally guaranteed entitlement to appropriate equipment for all those assessed as needing them.
A long term funding model that accounts for rising costs of equipment, manufacturing, maintenance, energy, staff and supply chain resilience, and a simple, user friendly service for wheelchair users and carers to report issues, requests, papers, make complaints or feedback and be heard on procurement. We need to shift from lowest cost procurement to value based procurement, which is happening, my Lords, in general procurement, it ought to be extended to wheelchairs and community equipment and my Lords for community equipment itself.
National training standards for clinicians, commissioners, OTS, other professionals and suppliers involved in equipment provision. I don't think anyone in this debate is going to argue that wheelchair and community equipment is absolutely woeful. The tragedy, as I've said before, is that it's so easily sorted. If the government were prepared to say we're going to sort it, we're going to have a national, we're going to do what I've suggested in relation to have national leadership. And I lost so many of the issues in community care, and the blockages would be dealt with if this were really taken seriously.
We all know what happens. It's not regarded as at all serious by either the NHS or local authorities and many, many people suffer as a result. My Lords, I beg to move.
I shall also inform the House of my patronage of the Wheelchair Alliance and also the Healthcare Supply Association, and my daughter Philippa works for backup, which supports people with spinal injury. My Lords, the provision of wheelchair and community equipment in this country for disabled people is, to put it quite bluntly, a disgrace. The nub of the problem was described in The Guardian on the 2nd of December by the distinguished academic doctor, Paul Sager. He was paralysed in a climbing accident and described how inconsiderate, illogical and incompetent many of the current wheelchair providers are.
He talked about the bureaucratic barriers, organisational inflexibilities and patchiness of the services he encountered. I thought particularly telling for me were the words of a physiotherapist he quoted, who had been working with people with spinal cord injury for more than 20 years. Many of her clients are discharged from hospital, she said, in heavy manual wheelchairs that an able bodied person would struggle to push frequently. They're the wrong type or size and at the very least are uncomfortable often, she said, people who have impaired functions in their upper limbs cannot push these wheelchairs themselves and become effectively housebound, in some cases confined to their bed.
Sometimes they develop complications from poorly prescribed wheelchairs, and it lands them back in hospital on average, she added, people wait at least ten months after discharge before being assessed, let alone getting the wheelchair that is right for them. Unbelievably, some local wheelchair services apparently refused to assess a patient until they have left hospital. So much, my Lords, for integrated care, which I thought integrated care boards were established to actually achieve. Now, Doctor Sage's experience, of course, is not unusual.
The Wheelchair Alliance has produced convincing evidence to show how inconsistent and under-resourced wheelchair services are. Over 50% of providers come from the private sector, and there are real worries regarding the financial frailty of many of them. With a system that prioritises lowest initial cost over long term value and reliability, there are no consistent national standards, no independent regulation, few clear paths for users seeking repairs, reporting thoughts or making complaints. As a result, many disabled people experience long waiting times, delays in hospital discharge, loss of independence, social inclusion and tragically avoidable deterioration in health and well-being.
My Lord, it's the same dismal picture with community equipment embracing hoists, scrap rails, harnesses, medical beds and a wide range of essential medical products. The all party Group for Access to Disability Equipment has recently reported on the systematic crisis in the sector. 60% 63% of carers, 55% of equipment users feel that services are getting worse, not better, and the all party group concluded the system's inconsistent, underinvested, fragmented and lacking leadership. Now, government policy is that local authorities and integrated care boards are share responsibility for community equipment.
In practice, this means a fragmented, inconsistent delivery equipment providers describe a landscape in which every authority works differently without alignment or accountability, so the consequence is a postcode lottery, with 74% of equipment providers aware of patients experiencing delayed hospital discharge due to unavailability of community equipment. And I would argue, and I'm looking forward to Baroness Brinton speech later on this, I would argue that community equipment is almost the silent crisis at the root of the challenges we face in providing community and social care.
And the tragedy is it would be so easy to sort this out if there was a will to do it now, my Lords, in April, the government published the Wheelchair Quality Framework to assist integrated care boards and will share service providers deliver high quality provision. I have read it. It's welcome. But my Lords, the problem is, first of all, its guidance. It lacks binding universal standards, does not guarantee equitable provision across all of the country. It does not address systematic under-investment.
It does not mandate robust data reporting. It lacks external oversight or performance management. And so there is no statutory legally guaranteed entitlement, ensuring that every person in need receives the right wheelchair or community equipment in a timely fashion. My Lords, what is required? I am absolutely convinced that we need a national strategy, underpinned by the appointment of a national clinical director, accountable to Ministers and backed up by strong performance management and the remit of the director, should embrace community equipment as well as wheelchairs.
Miles what that needs to be underpinned by a vision, a national, comprehensive vision of what a high quality wheelchair and community equipment provision should look like, and the government should embrace the report of the all party group on access to Disability equipment by introducing a dedicated national strategy for community equipment and wheelchair provision. Users must be around the top table with a real input into policy, a nationally defined eligibility and quality standard for wheelchairs and community equipment uniform across all regions, and removing the current postcode lottery, a legally guaranteed entitlement to appropriate equipment for all those assessed as needing them.
A long term funding model that accounts for rising costs of equipment, manufacturing, maintenance, energy, staff and supply chain resilience, and a simple, user friendly service for wheelchair users and carers to report issues, requests, papers, make complaints or feedback and be heard on procurement. We need to shift from lowest cost procurement to value based procurement, which is happening, my Lords, in general procurement, it ought to be extended to wheelchairs and community equipment and my Lords for community equipment itself.
National training standards for clinicians, commissioners, OTS, other professionals and suppliers involved in equipment provision. I don't think anyone in this debate is going to argue that wheelchair and community equipment is absolutely woeful. The tragedy, as I've said before, is that it's so easily sorted. If the government were prepared to say we're going to sort it, we're going to have a national, we're going to do what I've suggested in relation to have national leadership. And I lost so many of the issues in community care, and the blockages would be dealt with if this were really taken seriously.
We all know what happens. It's not regarded as at all serious by either the NHS or local authorities and many, many people suffer as a result. My Lords, I beg to move.
13:01
Lord Shinkwin (Conservative)
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Lord Shinkwin (Conservative)
My Lords. the noble Lord Hunt of Kings Heath, and I thank him firstly for securing this important debate. Secondly, for his work on improving health outcomes, which he has been involved with for probably far longer than he cares to remember. And thirdly, for choosing to champion wheelchair services in which I should declare an interest as a user. I trust his noble friend. The Minister will bear in mind the noble Lords tenacity in her response, which we look forward to hearing as we do the maiden speech of Baroness Baroness Gerada.
None of us will ever forget the trepidation with which we each faced the prospect of addressing the Lordships House for the first time. There may be issues which divide us, but the nerve wracking experience and making our own maiden speech say it into each member's memory surely unites us. I have no doubt that we will all be rooting for her. May Lords are referred to the Lord's tenacity. It's much needed, not least because, as he very helpfully outlined, the absence of a strategic approach on wheelchair services will be costing the NHS an awful lot of money, money it cannot afford to waste.
So in a little time I have now put three questions to the noble Baroness Minster. She'll no doubt be familiar with the finding of the Appg for Access to Disability Equipment Support that the Community and Medical Equipment system is, to quote in crisis with the Wheelchair Alliance's recent report, Wheelchair Provision How to Drive Effective Change, which details the costly consequences of inadequate and inconsistent provision which the Lord Lord Hanson mentioned, including delays in hospital discharge, loss of independence, social isolation was the inevitable impact on mental health and, of course, avoidable deterioration in health and wellbeing, a point the noble Lords made in his excellent speech.
So would she agree with me that that is the avoidable? And would she further agree that it is? If it is avoidable, then we are putting our nose to spite our face. If we allow ICBs to misrepresent as a saving what is actually in the strategic big picture, a completely false economy which is costing the NHS and indeed the taxpayer far too much money. And my third and last question is this Frontier Economics setting out a few reports, the value of the wheelchair estimated the potential value.
I would say saving that high quality wheelchair provision to provide wheelchair users and crucially, society. Will she undertake to put that thinking at the heart of any strategy? My Lords, the current situation is untenable because it does not make economic sense. That is why the noble Lords call for a strategy deserves to be heard and deserves to be acted upon urgently.
None of us will ever forget the trepidation with which we each faced the prospect of addressing the Lordships House for the first time. There may be issues which divide us, but the nerve wracking experience and making our own maiden speech say it into each member's memory surely unites us. I have no doubt that we will all be rooting for her. May Lords are referred to the Lord's tenacity. It's much needed, not least because, as he very helpfully outlined, the absence of a strategic approach on wheelchair services will be costing the NHS an awful lot of money, money it cannot afford to waste.
So in a little time I have now put three questions to the noble Baroness Minster. She'll no doubt be familiar with the finding of the Appg for Access to Disability Equipment Support that the Community and Medical Equipment system is, to quote in crisis with the Wheelchair Alliance's recent report, Wheelchair Provision How to Drive Effective Change, which details the costly consequences of inadequate and inconsistent provision which the Lord Lord Hanson mentioned, including delays in hospital discharge, loss of independence, social isolation was the inevitable impact on mental health and, of course, avoidable deterioration in health and wellbeing, a point the noble Lords made in his excellent speech.
So would she agree with me that that is the avoidable? And would she further agree that it is? If it is avoidable, then we are putting our nose to spite our face. If we allow ICBs to misrepresent as a saving what is actually in the strategic big picture, a completely false economy which is costing the NHS and indeed the taxpayer far too much money. And my third and last question is this Frontier Economics setting out a few reports, the value of the wheelchair estimated the potential value.
I would say saving that high quality wheelchair provision to provide wheelchair users and crucially, society. Will she undertake to put that thinking at the heart of any strategy? My Lords, the current situation is untenable because it does not make economic sense. That is why the noble Lords call for a strategy deserves to be heard and deserves to be acted upon urgently.
13:05
Lord Rennard (Liberal Democrat)
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Lord Rennard (Liberal Democrat)
Yeah. Well said, well said. >> My Lords. I declare my interest. >> As the conference. Chair of the National Association of Equipment Providers for the last five years. Providers for the last five years. Before that, for ten years I was director of communications for the British Healthcare Trades Association, representing manufacturers and suppliers of wheelchairs and assistive technology, upholding industry standards, promoting innovation, and supporting purchasers and users who are code of practice. My personal interest began as a teenager, pushing my mother in a second hand wheelchair bought through an advert in the Liverpool Echo.
There was no assessment, training or support in the 1970s. Much has improved in the 50 years since then. Yet the Wheelchair Alliance report in December 2023 showed that wheelchair provision was varying very widely. They said then that whilst wheelchair users in some areas receive an excellent service, users in other areas may experience significant delays. Inappropriately tailored equipment, a lack of training and or a slow response to breakdowns. The report also showed how high quality provision can improve lives and deliver financial benefits.
Wheelchairs are not just medical devices, they're gateways to independence, inclusion, work, education and activity. Poor provision restricts life chances, limits employment and can harm the health of carers. Pressures in wheelchair services are mirrored across community equipment, from hoists and specialist beds to bathing aids and home adaptations. The problems are systemic, not just localised. The Appg for Access to Disability Equipment found the delays are driven by staff shortages, particularly of occupational therapists, supply chain and recycling constraints, and wide inconsistencies between local authorities.
At the root of this crisis is weak oversight and blurred accountability between local authorities and integrated care boards, driving wide regional variation. The provision is fragmented and inconsistent, so I also hope that the government will now drive forward a national strategy with clear structures for provision. I agree with the Wheelchair Alliance that all integrated care boards must adopt the quality framework for wheelchair provision and the model service specification when commissioning services. I also support the call by the Appg for Access to Disability Equipment for a dedicated national strategy for Community equipment, alongside a dedicated DHSC Minister to oversee delivery.
This would ensure that needs are appropriately and fairly met everywhere. I welcome the government's wheelchair quality framework, but it doesn't go nearly far enough and I also welcome increased use of personalised budgets. But providers and users both really need to understand these budgets to ensure real choice and best provision, giving users more control over their daily lives. Fundamentally, what we need to address is balancing the costs of the provision of wheelchairs and community equipment with long term benefits, including preventing accidents, reducing the need for healthcare intervention, future enabling people with disabilities to work, pay taxes and reduce their dependency on benefits, whilst at the same time significantly increasing emotional well-being for many families.
There was no assessment, training or support in the 1970s. Much has improved in the 50 years since then. Yet the Wheelchair Alliance report in December 2023 showed that wheelchair provision was varying very widely. They said then that whilst wheelchair users in some areas receive an excellent service, users in other areas may experience significant delays. Inappropriately tailored equipment, a lack of training and or a slow response to breakdowns. The report also showed how high quality provision can improve lives and deliver financial benefits.
Wheelchairs are not just medical devices, they're gateways to independence, inclusion, work, education and activity. Poor provision restricts life chances, limits employment and can harm the health of carers. Pressures in wheelchair services are mirrored across community equipment, from hoists and specialist beds to bathing aids and home adaptations. The problems are systemic, not just localised. The Appg for Access to Disability Equipment found the delays are driven by staff shortages, particularly of occupational therapists, supply chain and recycling constraints, and wide inconsistencies between local authorities.
At the root of this crisis is weak oversight and blurred accountability between local authorities and integrated care boards, driving wide regional variation. The provision is fragmented and inconsistent, so I also hope that the government will now drive forward a national strategy with clear structures for provision. I agree with the Wheelchair Alliance that all integrated care boards must adopt the quality framework for wheelchair provision and the model service specification when commissioning services. I also support the call by the Appg for Access to Disability Equipment for a dedicated national strategy for Community equipment, alongside a dedicated DHSC Minister to oversee delivery.
This would ensure that needs are appropriately and fairly met everywhere. I welcome the government's wheelchair quality framework, but it doesn't go nearly far enough and I also welcome increased use of personalised budgets. But providers and users both really need to understand these budgets to ensure real choice and best provision, giving users more control over their daily lives. Fundamentally, what we need to address is balancing the costs of the provision of wheelchairs and community equipment with long term benefits, including preventing accidents, reducing the need for healthcare intervention, future enabling people with disabilities to work, pay taxes and reduce their dependency on benefits, whilst at the same time significantly increasing emotional well-being for many families.
13:09
Lord Harries of Pentregarth (Crossbench)
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Lord Harries of Pentregarth (Crossbench)
I'd like to thank the noble Lord, >> I'd like to thank the noble Lord, Lord hunt for introducing this debate, which I think is of very great importance indeed. I am the main carer for my wife, who is very severely disabled, and I've calculated that we probably need at least nine pieces of equipment in order to lead any kind of reasonable life. She has a hospital bed to stop her having sores, a hoist to get her out of bed, a commode wheelchair to wheel her to the stairlift, a turner to actually get her onto the chairlift, a chairlift to take her downstairs, another turner to get her onto the commode lift, and the commode lift to take her into the bathroom, in addition to a lifting wheel chair.
In addition, of course, special amputations in the in the bathroom with rails, and so on. A powered wheelchair and a wheelchair. Because we can only get into the GP with a small handrail, at least three ramps in order to get her out of the house. My Lords, we are very fortunate. This is a good story. We have what we want in order to rid a a decent life, partly provided and partly purchased ourselves. But it brings to my mind the nightmare, the total nightmare of people who do not have that equipment or equipment breaks down and they're not able to get emergency help in order to, to, to, to mend it.
And as we've already heard from the noble Lord Wharton and other people, there is very widespread dissatisfaction with people who need equipment because of frustrations and, and delays and, and bureaucracy. And I won't repeat those figures, but I was particularly moved and I think perhaps others have been moved also by the story of Reece Porter, who had cerebral palsy, and who was without essential equipment, including a hoist and home adaptations for two years, my Lord, for two years.
And during this time, apparently his parents had to help him use a commode seat in his bedroom and drag him into the family bathroom on a towel once a week, putting them all at risk of injury. And when he needed surgery, there was no immediate help to have a hoist in order to to get him out of bed. To do do that. This equipment for Reece and countless others is critical not only to support day to day activities, but also to ensure essential medical treatment can take place, avoiding further complications.
My Lords, such delays are not just occasional. The crisis impacting community equipment causing months, sometimes years of delay for assessment and medical kit is systematic rather than down to individual actors. And the main reason, as we've already heard, my Lord, but it is worth repeating, is that there is a lack of national oversight. Statutory responsibilities have left, or local authorities and ICBs, which is creating inconsistent and patchy provision. And moreover, confusion over who ultimately is responsible for this essential service.
Moreover, my Lords, the situation is likely to get worse with an ageing population and the rise of chronic health conditions, the demand for mobility aids of various kinds is going to increase, and it's vitally important for the government to act now before the situation deteriorates even further. So I'd like to ask the Minister, in the light of the APPG, for access to disability equipments, finding that there is no national strategy, no coherent commissioning framework and no single accountable Minister for Community equipment, will the government now commit to developing a national strategy for both community equipment and wheelchair services, overseen by a named Minister with clear responsibility for delivery?
In addition, of course, special amputations in the in the bathroom with rails, and so on. A powered wheelchair and a wheelchair. Because we can only get into the GP with a small handrail, at least three ramps in order to get her out of the house. My Lords, we are very fortunate. This is a good story. We have what we want in order to rid a a decent life, partly provided and partly purchased ourselves. But it brings to my mind the nightmare, the total nightmare of people who do not have that equipment or equipment breaks down and they're not able to get emergency help in order to, to, to, to mend it.
And as we've already heard from the noble Lord Wharton and other people, there is very widespread dissatisfaction with people who need equipment because of frustrations and, and delays and, and bureaucracy. And I won't repeat those figures, but I was particularly moved and I think perhaps others have been moved also by the story of Reece Porter, who had cerebral palsy, and who was without essential equipment, including a hoist and home adaptations for two years, my Lord, for two years.
And during this time, apparently his parents had to help him use a commode seat in his bedroom and drag him into the family bathroom on a towel once a week, putting them all at risk of injury. And when he needed surgery, there was no immediate help to have a hoist in order to to get him out of bed. To do do that. This equipment for Reece and countless others is critical not only to support day to day activities, but also to ensure essential medical treatment can take place, avoiding further complications.
My Lords, such delays are not just occasional. The crisis impacting community equipment causing months, sometimes years of delay for assessment and medical kit is systematic rather than down to individual actors. And the main reason, as we've already heard, my Lord, but it is worth repeating, is that there is a lack of national oversight. Statutory responsibilities have left, or local authorities and ICBs, which is creating inconsistent and patchy provision. And moreover, confusion over who ultimately is responsible for this essential service.
Moreover, my Lords, the situation is likely to get worse with an ageing population and the rise of chronic health conditions, the demand for mobility aids of various kinds is going to increase, and it's vitally important for the government to act now before the situation deteriorates even further. So I'd like to ask the Minister, in the light of the APPG, for access to disability equipments, finding that there is no national strategy, no coherent commissioning framework and no single accountable Minister for Community equipment, will the government now commit to developing a national strategy for both community equipment and wheelchair services, overseen by a named Minister with clear responsibility for delivery?
13:13
Baroness Gerada (Crossbench)
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Baroness Gerada (Crossbench)
Here are. >> Here are. >> My Lords. I rise for the first time with gratitude, humility and, if I'm honest, a certain amount of surprise until I remember how hard it is to see a GP these days and having me in the house at the solves that problem. It's though a great honour, of course, to stand here, particularly in such a significant debate that concerns dignity, fairness and independence. I thank the noble Baroness, Lady Kennedy of the Shaws and Lord Patel of Bradford, who so kindly introduced me.
I also thank the staff of this House for their warm welcome, for their patience with my many questions and for their kindness. So a little bit about me. I have Maltese heritage and I was born in Nigeria where my father worked as a doctor. My parents arrived in this country in the early 1960s as proud citizens of the Commonwealth. They taught me that success rests on courage, hard work and a commitment to the quiet dignity of public service.
My father became a general practitioner in the NHS. His surgery was the front room of our home. Patients have therefore been part of my life from a very early age. As a young girl, dad would take me to home visits to the community still bearing the scars of the Second World War. Through him, I learnt what general practice truly involves not merely medicine, but community, continuity and compassion, and that the measure of a doctor lies in not just what he knows, but in how he or she cares.
I have now worked in the NHS for more than 50 years, beginning as a Saturday girl in our local pharmacy in 1990. After completing my training in psychiatry, I became a GP in Kennington and I have lived and worked in a community I serve ever since. Being well known in the area has its advantages. I recall my bicycle being stolen during a home visit the next day. It was returned to the surgery with a note reading sorry doc, it won't happen again.
Of course, it can never happen when I visit this house, as my little Brompton has two armed policemen guarding it every day. Thank you officers. My patients have included the great, the good and given that I work in the Division bell occasionally the difficult. My very first patient was a young woman who suffered a stillbirth. Decades later, I look after her children and now their children. To that continuity seems lives unfold across time, gives general practice its unique moral and social power.
It allows us to see people as whole human beings, not as isolated organs or diagnoses. We are interpreters of experience, translators of suffering and witnesses of change. We observe how illness is linked with housing, with poverty, with work, and the myriad pressures of everyday life. This is not the soft end of medicine. It is its foundation, the undramatic, continuous care that underpins the entire National Health Service. GPS carry out more than 300 million patient consultations every year.
80% of all NHS contacts, for less than 10% of its budget. Most of our encounters end without referral or admission or prescription. When general practice thrives, the whole system does. It prevents illness, supports self-care, protects hospitals from becoming overwhelmed, and saves money. And where the story of our NHS begins anew every day. My Lords, it is a privilege to be amongst the very few GPS admitted to this noble House. And now that I have completed my my maiden speech, my first surgery is tomorrow, ten minutes only.
And only one problem allowed. My Lords, thank you very much. It's a great honour to listen to Baroness Gerada, and to have enjoyed a small sample of the immense knowledge that she
I also thank the staff of this House for their warm welcome, for their patience with my many questions and for their kindness. So a little bit about me. I have Maltese heritage and I was born in Nigeria where my father worked as a doctor. My parents arrived in this country in the early 1960s as proud citizens of the Commonwealth. They taught me that success rests on courage, hard work and a commitment to the quiet dignity of public service.
My father became a general practitioner in the NHS. His surgery was the front room of our home. Patients have therefore been part of my life from a very early age. As a young girl, dad would take me to home visits to the community still bearing the scars of the Second World War. Through him, I learnt what general practice truly involves not merely medicine, but community, continuity and compassion, and that the measure of a doctor lies in not just what he knows, but in how he or she cares.
I have now worked in the NHS for more than 50 years, beginning as a Saturday girl in our local pharmacy in 1990. After completing my training in psychiatry, I became a GP in Kennington and I have lived and worked in a community I serve ever since. Being well known in the area has its advantages. I recall my bicycle being stolen during a home visit the next day. It was returned to the surgery with a note reading sorry doc, it won't happen again.
Of course, it can never happen when I visit this house, as my little Brompton has two armed policemen guarding it every day. Thank you officers. My patients have included the great, the good and given that I work in the Division bell occasionally the difficult. My very first patient was a young woman who suffered a stillbirth. Decades later, I look after her children and now their children. To that continuity seems lives unfold across time, gives general practice its unique moral and social power.
It allows us to see people as whole human beings, not as isolated organs or diagnoses. We are interpreters of experience, translators of suffering and witnesses of change. We observe how illness is linked with housing, with poverty, with work, and the myriad pressures of everyday life. This is not the soft end of medicine. It is its foundation, the undramatic, continuous care that underpins the entire National Health Service. GPS carry out more than 300 million patient consultations every year.
80% of all NHS contacts, for less than 10% of its budget. Most of our encounters end without referral or admission or prescription. When general practice thrives, the whole system does. It prevents illness, supports self-care, protects hospitals from becoming overwhelmed, and saves money. And where the story of our NHS begins anew every day. My Lords, it is a privilege to be amongst the very few GPS admitted to this noble House. And now that I have completed my my maiden speech, my first surgery is tomorrow, ten minutes only.
And only one problem allowed. My Lords, thank you very much. It's a great honour to listen to Baroness Gerada, and to have enjoyed a small sample of the immense knowledge that she
13:18
Baroness Lane-Fox of Soho (Crossbench)
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Baroness Lane-Fox of Soho (Crossbench)
will bring to this house. It is, however, somewhat ironic that I am being asked to talk about her in a time limited debate, when it's time limited debate, when it's clear possible to fill a whole hour with her public achievements and contributions to public life. As we contributions to public life. As we heard, Baroness Gerada qualified as a doctor in 1983, trained in psychiatry in the Maudsley in psychiatry in the Maudsley in Bethlehem and then as a GP in South London, her career has consistently sat at the intersection of general practice and mental health, including addiction, gambling, harm and, critically, the well-being of the healthcare workforce itself.
From 2008 to 22, she founded and led the NHS Practitioner Health Service, now the largest confidential mental health and addiction service for health professionals in the world, supporting 50,000 clinicians across England and Scotland. From 2019 to 25, she co-chaired the NHS Assembly, helping to bridge policy, policy and patient experience at a national level. Ever the entrepreneur, it seems she also co-developed Econsult, now used by around a third of GP practices, and she continues to lead the primary care gambling service and serves as patron of Doctors in Distress.
And as if this was not all enough, she has been Chair and president of the Royal College of General Practitioners, only the second woman to hold both roles. But before I end, I must mention perhaps her most remarkable career high her stint as a stand up comedian. In the show, she co-wrote 50 Minutes to Save the NHS, which should perhaps have been a clue as to how effective she would be in a time limited debate on an important subject. Baroness Gerada brings not only expertise but wit to this House, and I have no doubt she'll make an important and exceptional contribution.
We often file wheelchair and community equipment services under health or social care. In reality, they are ought to be part of our national employment infrastructure. When services fail, people don't just lose mobility, they lose their ability to contribute. The numbers tell this story starkly. Only around 53% of working age disabled people are in employment, compared with 82% of non-disabled people. And it's even wider for young disabled people. As a recent House of Lords report on the transition to work made clear, 1.2 million of people rely on a wheelchair and many more on other pieces of equipment.
So when these systems fail, we're not just talking about inconvenience, we're talking about large parts of the labour market losing the tools that make work possible for many disabled people, daily life and work depend on reliable access to the right equipment, wheelchair seating, mobility aids, home adaptations, assistive tech when systems slip. When assessments take months, repairs take weeks. The consequences are immediate. Parliamentary inquiries have described these failures as systemic. As we've heard charities report people stuck at home with unsafe chairs or unable to start new jobs because their equipment simply hasn't arrived.
Services designed to enable independence become gatekeepers to your ability to work. This is an economic cost. We rarely acknowledge if someone is unable to work purely because essential equipment is delayed or incorrect, the ripple effect hits every public budget. They're less likely to earn, less likely to pay tax to progress in their career, more likely to draw on welfare, and likely to need avoidable support. Independent assessments show that timely wheelchair provision provides substantial net fiscal benefits over a lifetime. This is not charity.
It's investment in people, productivity and public finances. So what can we do? I would like to offer that the private sector has a bigger role than it realises. Many employers have disability inclusion strategies, but too often the effort stops at the workplace door. Rarely do companies engage with the upstream systems that determine whether someone can physically get to work. Access to equipment, responsiveness of service providers, or the basic accessibility of buildings and bathrooms. Employers can change that. They can partner with local social care services.
They can use procurement to demand guarantee, repair times, loan equipment, or minimum quality standards. They can appoint a senior sponsor for end to end online accessibility, responsible for everything from recruitment to evacuation plans. They can embed requirements for accessibility and rapid occupational therapy assessments in their HR processes. They can also use their data tracking how many dates slip because equipment isn't in place, how many job offers fall away, how many days of work are lost to broken or missing equipment? They can work with unions to help work into disabled staff networks and design no detriment policies.
When external equipment failures prevent people from working, government and commissioners must stop treating equipment services as a marginal welfare line, they are essential. Economic infrastructure outcomes should be judged not just clinically, but in terms of employment, education and participation. Services should publish transparent data on waiting times for the assessments, delivery and repair broken down by age, region and employment status. At a minimum, we must know how many working age disabled people are being delayed or denied work because of delays to equipment.
Access to work should be fully integrated with NHS wheelchair and community equipment pathways. Leaders such as Sara Weller, a non-exec at BT, have long been arguing that disability inclusion must mean more than good intentions. It means designing systems that work from end to end. This is the core point. Mobility, accessibility and equipment are not optional extras for many disabled people. They are the foundation that makes employment possible. I learned this the hard way when I was in a wheelchair for a year, but before my own experience, I learned from another lane-fox who terrorised the halls of this building in her electric wheelchair.
My great aunt Felicity Lane-fox. If we're serious about closing the disability employment gap, boosting productivity and unlocking talent, we must put disability equipment services in our growth strategy,
**** Possible New Speaker ****
not marooned on the edge of the health system. Thank you. My Lords. I'm delighted to be the first conservative to.
**** Possible New Speaker ****
the first conservative to. Congratulate the noble Baroness, Lady Garrard, on an excellent maiden speech. As one would expect from such a distinguished doctor, and how wise of her to speak today and how wise of her to speak today and not step into the maelstrom of assisted dying tomorrow. Although, of course, there will be plenty more days and plenty of opportunity more days and plenty of opportunity for her to give a view. As a former distinguished president of the Royal College of General Practitioners, of course, we shall also expect her to single handedly save the NHS and solve the serious
From 2008 to 22, she founded and led the NHS Practitioner Health Service, now the largest confidential mental health and addiction service for health professionals in the world, supporting 50,000 clinicians across England and Scotland. From 2019 to 25, she co-chaired the NHS Assembly, helping to bridge policy, policy and patient experience at a national level. Ever the entrepreneur, it seems she also co-developed Econsult, now used by around a third of GP practices, and she continues to lead the primary care gambling service and serves as patron of Doctors in Distress.
And as if this was not all enough, she has been Chair and president of the Royal College of General Practitioners, only the second woman to hold both roles. But before I end, I must mention perhaps her most remarkable career high her stint as a stand up comedian. In the show, she co-wrote 50 Minutes to Save the NHS, which should perhaps have been a clue as to how effective she would be in a time limited debate on an important subject. Baroness Gerada brings not only expertise but wit to this House, and I have no doubt she'll make an important and exceptional contribution.
We often file wheelchair and community equipment services under health or social care. In reality, they are ought to be part of our national employment infrastructure. When services fail, people don't just lose mobility, they lose their ability to contribute. The numbers tell this story starkly. Only around 53% of working age disabled people are in employment, compared with 82% of non-disabled people. And it's even wider for young disabled people. As a recent House of Lords report on the transition to work made clear, 1.2 million of people rely on a wheelchair and many more on other pieces of equipment.
So when these systems fail, we're not just talking about inconvenience, we're talking about large parts of the labour market losing the tools that make work possible for many disabled people, daily life and work depend on reliable access to the right equipment, wheelchair seating, mobility aids, home adaptations, assistive tech when systems slip. When assessments take months, repairs take weeks. The consequences are immediate. Parliamentary inquiries have described these failures as systemic. As we've heard charities report people stuck at home with unsafe chairs or unable to start new jobs because their equipment simply hasn't arrived.
Services designed to enable independence become gatekeepers to your ability to work. This is an economic cost. We rarely acknowledge if someone is unable to work purely because essential equipment is delayed or incorrect, the ripple effect hits every public budget. They're less likely to earn, less likely to pay tax to progress in their career, more likely to draw on welfare, and likely to need avoidable support. Independent assessments show that timely wheelchair provision provides substantial net fiscal benefits over a lifetime. This is not charity.
It's investment in people, productivity and public finances. So what can we do? I would like to offer that the private sector has a bigger role than it realises. Many employers have disability inclusion strategies, but too often the effort stops at the workplace door. Rarely do companies engage with the upstream systems that determine whether someone can physically get to work. Access to equipment, responsiveness of service providers, or the basic accessibility of buildings and bathrooms. Employers can change that. They can partner with local social care services.
They can use procurement to demand guarantee, repair times, loan equipment, or minimum quality standards. They can appoint a senior sponsor for end to end online accessibility, responsible for everything from recruitment to evacuation plans. They can embed requirements for accessibility and rapid occupational therapy assessments in their HR processes. They can also use their data tracking how many dates slip because equipment isn't in place, how many job offers fall away, how many days of work are lost to broken or missing equipment? They can work with unions to help work into disabled staff networks and design no detriment policies.
When external equipment failures prevent people from working, government and commissioners must stop treating equipment services as a marginal welfare line, they are essential. Economic infrastructure outcomes should be judged not just clinically, but in terms of employment, education and participation. Services should publish transparent data on waiting times for the assessments, delivery and repair broken down by age, region and employment status. At a minimum, we must know how many working age disabled people are being delayed or denied work because of delays to equipment.
Access to work should be fully integrated with NHS wheelchair and community equipment pathways. Leaders such as Sara Weller, a non-exec at BT, have long been arguing that disability inclusion must mean more than good intentions. It means designing systems that work from end to end. This is the core point. Mobility, accessibility and equipment are not optional extras for many disabled people. They are the foundation that makes employment possible. I learned this the hard way when I was in a wheelchair for a year, but before my own experience, I learned from another lane-fox who terrorised the halls of this building in her electric wheelchair.
My great aunt Felicity Lane-fox. If we're serious about closing the disability employment gap, boosting productivity and unlocking talent, we must put disability equipment services in our growth strategy,
**** Possible New Speaker ****
not marooned on the edge of the health system. Thank you. My Lords. I'm delighted to be the first conservative to.
**** Possible New Speaker ****
the first conservative to. Congratulate the noble Baroness, Lady Garrard, on an excellent maiden speech. As one would expect from such a distinguished doctor, and how wise of her to speak today and how wise of her to speak today and not step into the maelstrom of assisted dying tomorrow. Although, of course, there will be plenty more days and plenty of opportunity more days and plenty of opportunity for her to give a view. As a former distinguished president of the Royal College of General Practitioners, of course, we shall also expect her to single handedly save the NHS and solve the serious
13:25
Lord Blencathra (Conservative)
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Lord Blencathra (Conservative)
problems of general practice moving patients into hospital care. And so we all look forward to hearing from her again. I also congratulate the noble Lord Lord Hunt of Kings Heath for securing this debate and his excellent contribution. NHS wheelchair provision has been widely criticised for inconsistency, widely criticised for inconsistency, long delays and poor suitability of equipment costs are driven up by inefficiencies and the false inefficiencies and the false economy of supplying inadequate wheelchairs. A cost effective strategy would focus on on standardising services, improving assessments and investing in fit for purpose equipment to reduce downstream health and social costs.
Now, one of the key criticisms of NHS wheelchair provision. First a postcode lottery. Services vary significantly across regions, leading to inequitable, inequitable access. Second, long waiting times, delays in assessment and delivery leave users without mobility support for months. Third, poor suitability of equipment. Many wheelchairs provide a heavy, cumbersome or not tailored to users daily lives, forcing some to buy their own. And fourth, limited user involvement assessments often fail to consider lifestyle needs, reducing independence and social participation, and fifth or sixth
Now, one of the key criticisms of NHS wheelchair provision. First a postcode lottery. Services vary significantly across regions, leading to inequitable, inequitable access. Second, long waiting times, delays in assessment and delivery leave users without mobility support for months. Third, poor suitability of equipment. Many wheelchairs provide a heavy, cumbersome or not tailored to users daily lives, forcing some to buy their own. And fourth, limited user involvement assessments often fail to consider lifestyle needs, reducing independence and social participation, and fifth or sixth