Foetal Sentience Committee Bill [HL]

Baroness Barker Excerpts

2nd reading
Friday 22nd March 2024 Lords Chamber

[Baroness Barker (LD)]

My Lords, I wish to put on record that although my noble friend and I have very different views, as a matter of principle I defend her right to make her views known, and I hope she will understand why I respectfully disagree with her. I absolutely agree with the noble Baroness, Lady Kennedy of The Shaws: she is spot on. This Bill is part of a far wider anti-gender, anti-LGBT attack on human rights, a campaign which is international and largely but not exclusively put forward by national Conservatives and Christian nationalists.

The noble Lord, Lord Moylan, in his introduction said two things, both of which I think have subsequently been shown to be not true. This Bill is neither modest, nor not about abortion. It is far from that. It is unprecedented government interference in the ethics and practices of abortion care. It seeks to circumvent expert clinical guidelines, not because of another body of clinical evidence but because of an ideological disagreement with the conclusions of the work of the Royal College of Obstetricians and Gynaecologists. I should say to noble Lords opposite that the RCOG is duty-bound to provide evidence-based clinical guidelines, and to think that it would do so without talking to anaesthetists and other relevant professionals is to do that college a great disservice.

This Bill is focused solely on the foetus and says nothing about the rights of women. It is from the same stable that has brought similar legislation about in American states such as Arizona, Kansas and North Carolina, and it absolutely is a precursor to further legislation which will limit and outlaw abortion in full. Setting up a committee in this way, which has no remit to consider the rights of women or their experiences and healthcare, speaks volumes about the real motivation behind this legislation. I have to say to noble Lords opposite, and on the Cross Benches, who have repeatedly drawn parallels with the use of analgesia in animal scientific experimentation that they have ignored the fact that in this Bill we are talking about foetuses that are carried in the bodies of women—who are sentient beings capable of expressing not only their own healthcare needs but those of others.

This has been presented as being a method by which we can get to objective evidence. It is nothing of the sort. This is about setting up a committee to consider selective evidence—evidence that, I put it to the noble Lord, will inevitably lead towards a diminution of women’s rights. Far from being humane, the Bill has considerable scope for unintended consequences. The threats to women, not just during pregnancy but during childbirth, were this to go ahead, are considerable. We have already seen that throughout the United States, in states where these sorts of measures have been introduced.

I put it to you that this Bill does pretty well the opposite of what has been claimed for it. It is actually about picking and choosing selective evidence in order to lead down a path, as has happened in Alabama, towards the complete abolition of abortion. It is a Trojan horse. I really hope that we will not be fooled, and that we will put this in the context of that wider campaign against women’s rights and human rights.

[Baroness Smith of Newnham (LD)]

How does my noble friend account for the disparity between the views of the BMA and of the Royal College of Obstetricians and Gynaecologists?

[Baroness Barker (LD)]

It is not uncommon for health professionals to have different views and for their views to develop over time. However, I would much rather listen to either of those than to a hand-picked political committee making political decisions on what should really be a health matter.

This is a Trojan horse, and I really hope we will see through it. I thank the noble Lord, Lord Moylan, for unveiling, yet again, a little bit more of this wider campaign against women’s rights and human rights. He has done us a service.

Sexual and Reproductive Healthcare

Baroness Barker Excerpts

Tuesday 19th March 2024 Lords Chamber

Asked by

[Baroness Barker]

To ask His Majesty’s Government what assessment they have made of the current level of provision for sexual and reproductive healthcare in England and the case for a workforce plan in this sector.

[Baroness Barker (LD)]

My Lords, I thank all noble Lords and the Minister. Their participation at this late stage is very much appreciated. I also thank the British Association for Sexual Health and HIV, the British HIV Association, the Terrence Higgins Trust and the National AIDS Trust for their briefings for this debate. I draw the House’s attention to my role as co-chair of the All-Party Parliamentary Group on HIV/AIDS and the All-Party Parliamentary Group on Sexual and Reproductive Health. My ongoing involvement in those APPGs reflects my very strongly held belief since I was a young woman that giving people, particularly young people, scientifically correct and fully inclusive sex and relationship education information not only protects them and enables them to study, work and live their lives to their full potential but benefits the whole of society in terms of health and economics.

I want to have this debate because sexual and reproductive healthcare in the UK is in a crisis. That is not me saying that but the Local Government Association, the British HIV Association and the British Association for Sexual Health and HIV—that is, those on the front line trying to hold these services together and make them work. Data from the UK Health Security Agency shows that demand for SRH services has been increasing year on year and hit a record high in 2023, with no signs of abating this year. That increasing demand has not been mirrored in an increase in resources and staffing. The recent Local Government Association report showed that services throughout the UK are at breaking point, with people being turned away from services, which are often open for very minimal times due to a lack of capacity.

Due to the deterioration in numbers of people trying to be genitourinary medicine physicians in the UK, there is a real possibility that very soon we will be without adequately trained experts in out-patient management of complex and complicated STIs. That is worrying for us all. There are huge issues about recruitment, training and staff that can be traced back to commissioning changes that were made under the Health and Social Care Act 2012. Those reforms, which put public health back into local government, were right in principle; public health and prevention and surveillance of disease should start not in the NHS but in communities, where people live. The problem was that this reform coincided with a plummeting of local government finance and, consequently, the commissioning of services has been so severely depleted that services have deteriorated to the point where we have reached the highest levels of cases of gonorrhoea since the 1920s and the highest rates of syphilis since 1948.

The high rate of those diseases, and the lack of capacity for people to be seen in SRH services, has resulted in people presenting late and with levels of infection so high that they may have irreversible harm that could have been treated properly had they been seen earlier.

There has also been a resurgence in neonatal syphilis in the UK—something that we thought was history is now back. We have significant neonatal morbidity. In addition, reduced NHS service capacity has reduced the access to preventive SRH services, including vaccinations and the provision of HIV PrEP, both of which are critical to reducing future transmissions of STIs. In some areas of the UK, particularly outside London, there has been a disproportionate effect, as small clinics have been hit more than others.

It is important to understand in this debate that there are two types of specialists who deliver the majority of SRH and out-patient HIV care in the UK: first, GUM clinics, and HIV physicians who are trained in medicine and specialise in STI and HIV diagnosis and management; and, secondly, community sexual and reproductive health specialists, who train predominantly in women’s healthcare and who specialise in the gynaecological and reproductive care of women across their life course. Most provision of specialist contraception and training of other healthcare workers in contraception, and the leadership of systems across secondary and primary care, is done by community SRH consultants.

Dame Lesley Regan has done tremendous work in the development of the women’s hubs. I ask the Minister whether the Government plan to build on that work to make those into one-stop shops for women, where they can have their reproductive and sexual health issues dealt with all at once.

HIV treatment is different—HIV services are open-access and anybody can come into them—but there is a huge problem in the HIV workforce. Not only is there huge demand; there are so few consultant specialists around to help other staff to train and develop that we are now having a real problem recruiting trainees into genitourinary medicine. That means that those services are becoming ever more fractured, and there is a knock- on effect back to general practice and to pharmacies, which simply do not have the specialist knowledge and training to deal with those more complex cases.

Nurses and allied healthcare professionals are doing much more than they did a year ago, but they cannot deal with the sorts of complex cases that are now being presented to them. We have an inadequate number of consultant specialists working in the field and that is having an adverse effect on training.

Commissioning arrangements are at the root of the problem in all of this. No one is taking responsibility for ensuring that the next generation of doctors and nurses in sexual health services are being trained. No local authority has a training plan and there is no cohesion nationally to drive accountability where it fails. Services that offer no training and education are inherently cheaper and those are the ones being commissioned more and more—for short-term gain for cash-strapped councils, but with long-term harm to public health.

I ask the Minister to address three critical issues: first, making sure that all sexual health medical training posts are 100% funded through NHS England in the same way that posts in primary care oncology and public healthcare are funded; secondly, that NHS England is accountable on its plan to ensure improved recruitment, with the publication of a corresponding action plan to deliver improved recruitment in sex and reproductive health; and, thirdly, that no service is allowed to operate without a GUM consultant within it, no matter how much it depends on lesser-qualified staff.

It is worrying that we are going back to levels of sexually transmitted diseases that we thought were a thing of the past. It is deeply frustrating, because we now have the medicines to deal with these cases, and we know there are new technologies and ways of delivering services that could make the system so much more efficient. If we had nationwide home testing kits for HIV, if we had a greater use of pharmacies for the management of people with HIV in their local areas, rather than them having to go to specialist clinics for ongoing treatment, we could be making great progress. In this field, as in many other parts of medicine, were staff to have the time to sit and think through the ethics and potential of the use of AI, we could make huge strides forward in these public health matters. As it is, these services are stretched to breaking point.

I want the Minister to answer two simple questions. First, what are the Government going to do to stop the crisis and the downward spiral of stretched services relying on staff who are not sufficiently well trained? Secondly, what have the Government made of the lessons that can be learned from the GP recruitment crisis and the opportunities to apply those to increasing recruitment and retention in urinary medicine and HIV, including fully funding training posts? We need to get this workforce back up to the levels we know we can manage in order to deal with a crisis which need not have occurred in the first place.

Cancer: Staffing

Baroness Barker Excerpts

Thursday 14th March 2024 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend and totally agree that GPs are the front line of our medical services. We are trying to do everything we can to make sure that they feel valued and are retained. The recent change to the pension law was all about addressing that very point, answering GPs’ number 1 concern in order to keep them. Their hard work has seen a 25% increase in the cancer referral rate: we treated 3 million people, up 600,000, over the last year, thanks to their work and the expansion in the diagnostic centres we have set up.

[Baroness Barker (LD)]

My Lords, does the Minister agree with us on these Benches that there should be a statutory two-month period between diagnosis and access to appropriate treatment for any cancer patient? In order to achieve that, there needs to be further investment in radiography training and an equitable distribution of trainee radiographers and qualified radiographers across the country. How will the Government ensure that that happens?

[Lord Markham (Con)]

As I mentioned, that was very much the big feature of the discussion that I had with the president of the Royal College of Radiologists just the other day. We have been growing the number of radiographers by about 3% every year, which is a good rate, and we look to increase that even further. The CDCs are about that. However, the actual demand is increasing by about 5% every year. Clearly, as well as recruitment, we need to make sure that we have effective diagnosis, and this is where the field of AI is very exciting. The radiographers are 100% behind it, because they really see the revolutionary effect it is bringing.

NHS: Neurology Care

Baroness Barker Excerpts

Monday 26th February 2024 Lords Chamber

[Lord Markham (Con)]

Yes, that is precisely what I was referring to: the progressive neurological condition toolkit is all about the pathways for that integrated approach to it all. Again, there are 15 million people affected—I think this statistic was mentioned earlier—and one in five deaths come from related conditions, so making sure we have that integration with palliative care as well as the other services is key.

[Baroness Barker (LD)]

My Lords, neurological conditions require diagnosis by a specialist. Thereafter, the individuals need the input of people from all the different disciplines of the NHS. At the moment, the expectation to manage that falls upon GPs, and they cannot manage it. The key people who can are specialist nurses, and we have a severe deficit of specialist nurses for several neurological conditions. Can the Minister say how that deficit is to be addressed by the workforce plan?

[Lord Markham (Con)]

I thank the noble Baroness. Yes, the point about epilepsy nurses was made very clear to me just half an hour ago, and I quizzed both the national clinical director of neurology and Professor Stephen Powis on that subject this morning. I was assured that the next stage of the long-term workforce plan goes into that level of detail. I have made a commitment to the House to share some of that data, so we can make sure that it really is covered properly.

Sexually Transmitted Infections

Baroness Barker Excerpts

Tuesday 5th December 2023 Lords Chamber

[Lord Markham (Con)]

Overall, we spend £3.5 billion on public health. I do not have the breakdown of the advertising within that, but I will happily follow up with that. That is a small increase over the last year. Education is key to all this. Part of the reason for the increase in sexually transmitted diseases is that people used to use condoms because they were scared about two things: pregnancy and HIV infection. As both those risks have gone down, so has the use of condoms, which has resulted in the higher level of sexually transmitted diseases—so education is key.

[Baroness Barker (LD)]

My Lords, in 2022 the rate of STIs went up by 22% and, at the same time, the public health budget has been reduced by 29%. The strain on those services is now intolerable. Is it not time to have a proper, real increase in that budget?

[Lord Markham (Con)]

The figures are slightly misleading because, of course, that was in comparison to a Covid year, when there was much less testing. In fact, if you look at it versus pre-pandemic figures, the numbers are 16% down compared with 2019; that is the real comparison we should look at here. At the same time, I think we would all agree that £3.5 billion is a big investment in this space. It has gone up slightly over the past year but, as I mentioned earlier, education is also key in this space.

Mental Health Act 1983

Baroness Barker Excerpts

Tuesday 21st November 2023 Lords Chamber

[Lord Markham (Con)]

We are all agreed on the intent behind what we were trying to do with the Bill. On learning difficulties and autism, the most important thing we are trying to do is to make sure that the CQC, within 48 hours of a person being put into segregation, is investigating and doing an independent review on whether that is the best place for them. Like the noble Baroness, I share the feeling—we all think it—that it is much better that they are treated in the community, where they can be.

[Baroness Barker (LD)]

My Lords, mental health legislation relies on good data; we do not have good enough data about the detention of people from different groups. Does the Minister agree with the committee that a step forward that could be taken now is the appointment of a responsible person in each organisation with a duty to record not only the detention of people under the Mental Health Act but the demographic data surrounding it?

[Lord Markham (Con)]

Yes. The data, and fundamentally understanding what is beneath it, is key to all this. We have put an executive lead on each trust board to look at exactly these sorts of issues, including the data, so I am happy to take that forward.

Autism: In-patient Care in Mental Health Hospitals

Baroness Barker Excerpts

Tuesday 14th November 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness for her report and the meeting that we had to follow it up. Probably the best way forward on this is that a lot of things we are doing and can do can be done absent the Bill. I should be happy to sit down with her and talk through what we can do and where we can go further to make sure that everything that we were trying to put into legislation we can effectively make happen anyway, because we are all agreed as a House absolutely on the direction of travel in which we want to go.

[Baroness Barker (LD)]

My Lords, what is being done to change the commissioning systems and contracts that currently incentivise providers of medium and long- term secure accommodation to keep people in hospital, rather than equip them to go back into the community?

[Lord Markham (Con)]

I will come back in more detail on the contractual arrangements, but the point that the noble Baroness raises on making sure that there are no perverse incentives to do that has to be right. The now CQC-led reviews that we have agreed to put in place as part of continuing the recommendations of the noble Baroness, Lady Hollins, happen frequently. In the case of adults, there is a review every six months, if appropriate, and, in the case of children, every three months to make sure that every step of the way we ask whether this is really the right place for them to be.

King’s Speech

Baroness Barker Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Barker (LD)]

My Lords, a gracious Speech is a helpful indicator of a Government’s position and their intended programme for the coming years. This speech is quite clear: it is a series of individual bits and pieces with not a strategy in sight. That is something we should pay a great deal of attention to when we think about the run-up to the next election because we are desperate for a Government who will take seriously the issues facing all our public services, addressing the growing demands on them and the likelihood that there will be fewer resources in real terms to provide them.

I spent the last two years in various Select Committees of your Lordships’ House—one on social care, one on scrutinising the mental health Bill and one, which is about to conclude, on the integration of community and primary care. Across those three pieces of work, there have been a number of recurrent themes.

The most fundamental to this is the need for an informed public debate about sharing personal data. Our personal data will be the basis on which the future of health and public services is built. At the moment, we have a great deal of confusion, not least on the part of practitioners, about the status of data protection laws and the importance of public health. Time and again in those different committees, we heard frustration on the part of practitioners, service planners and patients at the utter impossibility of getting data on individuals, or even at a community level, in a manner that is timely and makes for the effective and efficient provision of services.

I wonder whether the Minister will take from this the urgent need to revisit the Caldicott principles and update them in the light of technological information advances, and to begin the process of having a public debate about the ethics and principles of sharing data. In that way, we might move quickly towards an improved performance of public services, particularly health and social care, based on the resources that we have at the moment.

It is regrettable and a great shame that the Government have turned their back on the widespread consensus on how mental health law should be reformed that has developed since Sir Simon Wessely produced his report. Nevertheless, a great deal of work has been done, which will be there waiting for an incoming Government to do it.

There are three things that the current Government should do now, which do not require legislative change. First, there should be mandatory training for all mental health professionals in the recognition and diagnosis of autism and learning disabilities. That would stop the inappropriate treatment of people with learning disabilities and autism, which sometimes not only leads to them being inappropriately detained at length under mental health legislation but results in them going into the criminal justice system when they should not.

Secondly, with a number of long-term conditions such as Parkinson’s disease, there is a great incidence of mental illness. I wonder whether the Minister will look at the major conditions strategy and the need to make sure that practitioners, in certain physical conditions, understand the mental health aspects of those conditions.

Finally, when we worked on the mental health Bill, we looked time and again at the disproportionate effect of mental health legislation on people from black and brown communities. They are far more likely to be detained inappropriately than other groups. We were told by all the people to whom we spoke that one thing that would have a direct impact on that is the introduction of an electronic system of advance choice documents. Advanced work is being done on that, based on work done in the field of palliative care by people at South London and Maudsley, the psychiatrists at Guy’s and so on. It needs only the Minister’s department to swing in behind the work already being done for pilots to be rolled out, ready for an incoming change in the legislation.

Let us be honest: none of us can see a time when local authorities will suddenly have new, massive amounts of money to put into social care. It is already underfunded and is subsidised by individuals. The one key thing that the Government could do is make sure that local government retains the requirement to give people assessments of their needs and to tell them what is available to them, wherever they choose to get their help from. Funding those independent assessments, and not leaving it to providers of services, is the one critical thing that might make a difference to the increasing number of people who will be living in the community with long-term conditions and really need help to stay in their homes—which I hope will be built to a lifetime standard in the future, so that people can stay in their home whatever the tenure of the home in which they live, whether rented or private.

I take the opportunity to say one final thing: King’s Speeches are about Governments’ priorities and choices. When the Government can find the time to license pedicabs but cannot be bothered to bring in a ban on conversion therapy, the lesbian and gay community understands the message. We get it: we are not safe while this Government continue to be in office. It is absolutely time that they went.

National Health Service: Major Conditions Strategy

Baroness Barker Excerpts

Monday 18th September 2023 Lords Chamber

[Lord Markham (Con)]

The strategy tries to provide a road map for how we want to do this. It starts with prevention, which I think we are all agreed on, then early diagnosis, quality treatment and then living or dying well with that condition. It is a philosophy: the idea is that we get it right in these six major areas with 60% morbidity, and then we roll it out across the board in all other areas. It is a way of treatment, really—a way of looking at the whole problem, centred around whole patient needs, that we will roll out to other conditions as well.

[Baroness Barker (LD)]

My Lords, if this is to become a reality rather than an aspiration it will require a huge increase in the number of community nurses. How do the Government think that will happen when the main incentives and career development for nurses lie within the acute sector?

[Lord Markham (Con)]

My Lords, the noble Baroness is absolutely correct. That is set out in the long-term workforce plan: a move much more upstream to prevention and primary care, of which community nurses will be a key part. The recruitment is in place for it all. Yes, a lot of people might see the action as being in the acute sector, but a lot of people really enjoy working in the community as part of their lifestyle. The hope and expectation is that it will appeal to a lot of people in those areas as well.

Social Care

Baroness Barker Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness Barker (LD)]

My Lords, I have had the privilege of being a member of the Adult Social Care Committee, chaired by the noble Baroness, Lady Andrews, and I am now a member of the Select Committee on the Integration of Primary and Community Care, chaired by the noble Baroness, Lady Pitkeathley, so I have come to think of the noble Baroness, Lady Shephard, as my partner in crime on both of those, as we question a series of professionals coming in to try to tell us just how bad the situation is currently.

We are having this discussion in the run-up to a general election, nearly a decade on from the passing of the Care Act and more than two decades on from the royal commission on the future of long-term care, and I suspect we are no nearer a resolution now than we were then. But I think it is important, as we are in the run-up to a general election, to make a few recommendations to all those people in political parties who are drawing up their manifestos.

The first is that there needs to be an update of the Dilnot commission proposals. We need a realistic assessment of the needs of older people and adults with disabilities for long-term care and the extent to which that can be funded by individuals’ capital assets. A crucial element of that assessment has to be the availability and cost of trained skilled staff, because that is a huge issue in the sector. For the first time, a further element needs to be the number of people ageing without children—that is a phrase which covers a number of different circumstances. We have now got to the point where Secretaries of State for Health admit openly that we have a health and social care system predicated on the fact that the majority of care, and management of care, will be done by families. There are at least 1 million people who do not have children, and it is children we are talking about. We do not even record the number of men who do not have children; we do not have that basic data, and yet we are expecting them to manage care. Unless and until we do that, there will be a profound effect on those people when they come to moments of crisis, such as hospital discharge. We need the Government to start to really look at this issue.

The second recommendation is that we need, as a matter of urgency, the development of legislation, policy and protocols that governing the use of, and access to, data of health and social care users. Currently, we have a system in which the sharing of information just between the departments of an acute hospital is utterly random, and between the different parts of the health and social care system, between acute and community health, and social care and local authorities, is non-existent. We talk about care pathways, but they are rapidly becoming a fictional idea. I defy anybody—a professional, a user or a carer—to know what a care pathway is and how to get from one place to another. Unless and until we sort this, we will have an ineffective, expensive mess: duplication of services on the one hand and lack of access to basic services on the other.

My third point is that, as regulators of health and social care—particularly the CQC as it goes into the new single assessment framework—look at these new integrated care systems, they need to specify who is responsible not just for a single episode of care but for care pathways. We have not begun to see that yet, and it is fundamental to our ability to build a system which works in the long term.

I suspect, in the run-up to the election, there will be calls from some people to say that we ought to take care away from local authorities; that for the sake of efficiency, we either put everything under the NHS, or outsource much more to the voluntary sector, charities and faith groups because they will make better use of limited resources. I would caution against that. Local authorities have a public equality duty and access to population data, and to data about individuals within their areas. I think it is crucial that we stick with them.

Finally, as president of the National Association of Care Catering, I want to make a plug for meals on wheels: old-fashioned, much denigrated, but an absolute lifeline to people. I had the privilege of being an undercover meals-on-wheels volunteer a couple of years ago—I said I was a trainee; I do not think most of them would have given me the job. The immense value of low-tech services to older people cannot be overestimated. We really should make sure that those services which give great value are maintained for older people.