Adult Social Care

Baroness Brinton Excerpts

Wednesday 11th July 2018 Lords Chamber

[Lord O’Shaughnessy]

I reassure the noble Baroness that it will be addressed. When we have the consultation, there will be more opportunity to explore that.

[Baroness Brinton (LD)]

In addition to looking at funding mechanisms from abroad, will the Green Paper look at some innovative solutions, such as the projects in Holland where students live in sheltered accommodation with the elderly, improving the quality of life for the elderly and financial support for students, which is much cheaper for the state?

[Lord O’Shaughnessy]

That sounds like an excellent idea, and I would be delighted to consider it, as well as any other ideas that the noble Baroness has.

NHS and Social Care Services: Parity of Esteem

Baroness Brinton Excerpts

Thursday 5th July 2018 Lords Chamber

[Baroness Brinton (LD)]

My Lords, what advice would the Minister give to the management of organisations throughout the NHS and social care services about maintaining morale, retaining staff, promoting professional development and rewarding good work when there is often little increase in funding from local authorities, which themselves face continuing cuts in their grant from central government?

[Lord O’Shaughnessy]

I recognise that staff work under a great deal of pressure and there are two ways we can help alleviate it. One is obviously to have social care and NHS staff work more closely together, and that is a stated ambition that we all want to achieve. The other is making sure that there are more resources, both to pay people better and to make sure that there are more people. That is what we are focused on delivering.

Health and Social Care Act 2012

Baroness Brinton Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord O'Shaughnessy]

That is one of the areas we need to look at to make sure that there is proper regulatory reform. It does not necessarily require legislation, primary or secondary. There are actually fewer managers in the NHS today than in 2010. We have tried to transfer responsibility to clinical staff. But if the NHS identifies any barriers, we are committed to looking at them.

[Baroness Brinton (LD)]

My Lords, the Minister has referred to the NHS five-year plan, but does he agree that that plan is worthless without a clear proposal for social care funding in the future, including on how the NHS and social care can fully integrate?

[Lord O'Shaughnessy]

I absolutely agree with the noble Baroness that they have to go hand in glove. That is why the Green Paper has been delayed, so that it can co-ordinate properly with the NHS plan. It is also important to point out that the Prime Minister was very clear in her announcement that, as a result of the settlement on social care, there would be no further pressures on the NHS.

Hospices: Impact of NHS Pay Increases

Baroness Brinton Excerpts

Monday 18th June 2018 Lords Chamber

[Lord O'Shaughnessy]

I was not aware of that proposal but I will certainly look at it and write to the noble Baroness with our response.

[Baroness Brinton (LD)]

My Lords, it is not just hospices and social enterprises that are affected by the differential in the proposed NHS scales; the existing framework in Her Majesty’s Prison and Probation Service demands formal nursing qualifications but there is no contractual obligation on private operators such as G4S, Serco and Sodexo to follow those grading scales and there is already wide disparity. What will the Government do to ensure that HMPPS follows both the pay scales and the NHS scales?

[Lord O'Shaughnessy]

It is important to reiterate that, in looking at one of the consequences of the Agenda for Change pay deal, the Government have committed to look at the impact not just on hospices but on staff who are not employed on Agenda for Change NHS contracts and to make sure that they are properly rewarded for the work they do.

Carers: Health and Well-being

Baroness Brinton Excerpts

Tuesday 12th June 2018 Lords Chamber

[Lord O’Shaughnessy]

Children’s hospices do an extraordinary job. They get less statutory funding as a percentage of their total; there are good reasons for that, both historically and to do with the type of care they provide. The Government are providing £11 million of support in 2018-19 through the children’s hospices grant to support them, in addition to funding from local clinical commissioning groups. But I will take his proposal for a palliative care strategy back to my right honourable friend the Minister for Care. I know that she is very interested in this issue.

[Baroness Brinton (LD)]

My Lords, the advice for local authorities on short breaks for carers of disabled children says on page 7 that short breaks should not just be there for those at crisis point. Given that many short break centres are now being closed across the country, removing help even at a crisis point, what are the Government doing to ensure that short breaks for children and their carers—for our most vulnerable and disabled children—will be guaranteed for the future?

[Lord O’Shaughnessy]

In addition to the £130 million in the better care fund, there is a commitment in the carers action plan to develop examples of best practice that can be spread around local authorities to make sure they all reach the highest standards. At the moment, unfortunately, only some of them are doing so.

Carers: Back Pay Liability

Baroness Brinton Excerpts

Wednesday 16th May 2018 Lords Chamber

[Lord O'Shaughnessy]

I agree with the noble Lord that there is a retrospective element to this, but it is around the clarification of the law. The Government have put a support scheme in place through HMRC to provide that support to resist, for example, enforcement notices on workers who ought to be paid in arrears. That is up and running and it has been open since September 2017. But clearly, as that continues we are also looking at whether other interventions might be necessary.

[Baroness Brinton (LD)]

My Lords, it is quite clear that the £2 billion extra for adult social care in the 2017 spring Budget had absolutely no relevance to this £400 million deficit and liability for providers, and it would be unwise for the Government to assume that it should be used for back pay. While it is wonderful that HMRC has slightly deferred payment, until the Government are able to help providers we will continue to see provider after provider going to the wall. Allied Healthcare cites £11 million as its own back pay on this issue. When will the Government help these providers?

[Lord O'Shaughnessy]

On the extra £2 billion of funding, I have not tried to link it with this; it is of course at the discretion of local authorities to use that to support the social care sector in the way they see fit. It is worth pointing out that Allied Healthcare is in this social care compliance scheme. My honourable friend the Minister for Care has written to it to express her disappointment at the approach it has outlined. Its liabilities have not crystallised yet, so it is not right for it to refuse that and she has written to it to demand clarification. However, clearly we understand that the clock is ticking and that there is an urgency to this.

NHS: Cybersecurity

Baroness Brinton Excerpts

Wednesday 2nd May 2018 Lords Chamber

[Lord O'Shaughnessy]

The PAC review found that the use of Windows XP was at the heart of the problem, as an unsupported and unpatched system. Several things have happened as a consequence. First, XP usage has gone down from 18% in 2015 to 1.7% now. We also have a customer support agreement with Microsoft now and are transitioning to Windows 10, which is of course fully supported and much more secure. We also have a system now called cursor collect. The notifications that go out, called cursor notifications, are due to be acted on within 48 hours. That exposes the fact that we did not have a way of tracking that. We now have a way of tracking that and enforcing action at trust level. So there is a much higher degree of security than there was. Of course, no security is ever perfect and our vigilance carries on.

[Baroness Brinton (LD)]

My Lords, in Scotland it is possible for your records to be transferred from one hospital to another or from your GP to your hospital without any consequences at all. One of the concerning things about the Public Accounts Committee report is the systemic failures in IT overall in NHS England. One example is where regional hospital A cannot receive data from district hospital B, even if it is a simple blood test, because they use different systems; the consultant I spoke to said that he actually advises people to use faxes. This is our NHS in the 21st century.

[Lord O'Shaughnessy]

The noble Baroness is highlighting a historic problem about interoperability between different bits of the NHS in England. That is absolutely fair enough. I would highlight two things that we are doing. First, the National Data Guardian for Health and Care has defined 10 data standards that should apply to both security and interoperability between different systems, and those now apply in all key NHS contracts, including the standard NHS contract. Secondly, we have launched a programme to appoint up to five local health and care record exemplars, which will provide interactive and interoperable data for patients for their direct care—so that the issue we have at the moment of data sometimes falling between different institutions will not happen any more.

Brexit: Health and Welfare

Baroness Brinton Excerpts

Thursday 29th March 2018 Lords Chamber

Moved by

[Baroness Brinton]

That this House takes note of the effect of the United Kingdom’s planned withdrawal from the European Union on the health and welfare of United Kingdom citizens and residents.

[Baroness Brinton (LD)]

My Lords, this year the NHS is turning 70. Our universally beloved institution has transformed the health and well-being of the British people for longer than most of us have been alive—perhaps excluding Members of your Lordships’ House, where our average age is 70—and is the envy of many countries around the world. I am proud that a Liberal MP and economist, William Beveridge, wrote the report that made the proposal for a universal health system free at the point of delivery and paid for through taxes, which transformed healthcare in the United Kingdom. Beveridge understood that there needed to be widespread reforms to social welfare, first introduced by the Liberal Government in 1911, which had to address his five “giant evils” of squalor, ignorance, want, idleness and—perhaps most important to the NHS—disease. Fighting these giant evils is key to the health and welfare of UK citizens and residents.

Unlike in the United States and some other countries, the British believe that healthcare is a right, not a privilege, and we accept the opportunity to pay for it through general taxation. Recent polls show that a large number of people support the Liberal Democrat proposals for an increase in income tax to help fund the NHS, alongside reforms that are necessary for any healthcare system in the 21st century.

The NHS has a history of evolving in response to the changing needs of the nation, yet there is hardly any discussion about the effects of Brexit on our health and welfare systems. It therefore seems appropriate, on the first anniversary of triggering Article 50, for your Lordships’ House to look at these issues in some more detail. I look forward to contributions from other Members of the House who will cover specific items in detail; there is not time in the 15 minutes that I have to cover everything.

If you ask most people about Brexit and the NHS, regardless of how they voted in the referendum I suspect the first thing they would talk of is that large red bus from the leave campaign claiming that the EU costs the UK £350 million per week, which could all be invested in the NHS upon leaving the EU, while forgetting to tell us that that would remove funding from agriculture, fisheries and many other current EU projects based in the UK. Not only was this untrue—a fact checked repeatedly during the campaign by independent bodies—but there are figures to show that the cost of leaving the EU to our economy could now be equal to that £350 million per week.

Research by the Financial Times suggests the value of Britain’s output is now 0.9% lower than it would have been if the UK had not decided to leave the EU—and, guess what, that comes to just under £350 million a week. That irony is not lost on those of us who challenged the original leave campaign on its obviously fantastical claims at the time. Since then, much of the debate over the UK leaving the European Union has focused on trade, the single market and the customs union. Today, as we mark the first anniversary of the triggering of Article 50, we must start to identify some of the less visible but absolutely vital elements of Brexit that will affect the health and welfare of people in the UK.

At a time of unprecedented pressure on the NHS, it needs urgent and real investment to prevent it crumbling, so I welcome the Prime Minister’s announcements earlier this week and look forward to the detail. I hope that it can deliver the real financial help that is so desperately needed but woe betide her if it is neither real nor speedy. The Chancellor has set aside £3 billion for Brexit matters alone this year. With the chaos of where the negotiations are, who knows if that will be enough? What is clear is that people know that the NHS is in desperate need of resources. Yesterday, many hospitals across the country were still struggling with their A&E targets. Among many others, Addenbrooke’s in Cambridge was predicting 12-hour waits in A&E and had once again cancelled all non-emergency operations—and, indeed, some cancer treatments.

However, one of the lesser known pillars of protecting our NHS is also at risk with Brexit. With more and more parts of its services being put out to tender, the NHS has ultimately been protected by the EU directive on public health procurement. This directive governs the way in which public bodies purchase goods, services and works and seeks to guarantee equal access and fair competition for public contracts in EU markets. It includes specific protection for clinical services and more legal clarity on the application of procurement rules. The bottom line makes it clear that, unlike non-public services, a public body based in an EU member state can accept a contract that is not the cheapest if it fulfils the quality, continuity, accessibility and comprehensiveness of services and innovation. There is also no need to publish procurement advertisements cross-border, which, as Ministers have repeatedly said in Parliament, is a key tool to preventing mass privatisation of the NHS.

If we proceed with Brexit and leave the single market and the customs union, the NHS will lose its biggest but most invisible protector: this directive, which governs all public sector procurement in member states. It defines fair process and standards to ensure that all EU businesses, including the NHS, have fair competition for contracts. It prevents conflicts of interest through robust exclusion grounds and protects against creeping privatisation. PFI also remains a serious financial risk.

We must learn from the liquidation of Carillion and the ensuing loss of jobs that shone a light on the dangers of letting privatisation run rampant. The NHS now has more than 100 PFI hospitals, which originally cost £11.5 billion. After being privatised, they will cost the public close to £80 billion. The difference could have funded the NHS for two and a half years, but that is not all. The total PFI debt in the UK is more than £300 billion for projects worth only £55 billion. In order to protect NHS institutions from American corporations looking to buy after Brexit, we must write this EU directive into UK law. The NHS we all know is dependent on this. It is in danger. If we do not transfer the directive into UK law, there is nothing to stop the lowest bid for any service always winning wherever it might originate from and without regard for the standard of care. We know that there are many US companies already eyeing up the NHS.

As an aside, given the debate in Oral Questions about passports, the French Government have used this EU directive to ensure that French passports are made by French firms in France because they regard specialist printing as a security matter—funny, that. Despite Brexit, our Government chose not to use the same provision to print the next generation of UK passports here in the UK by a preferred UK company.

Returning to the NHS, while there was understandably concern about the TTIP agreement, it was this EU directive which provided a guarantee that US companies could not come in and cherry pick our NHS. On 18 November 2014, the noble Lord, Lord Livingston of Parkhead, answered my Question in your Lordship’s House by quoting an EU Commissioner:

“Commissioner de Gucht has been very clear:

‘Public services are always exempted ... The argument is abused in your country for political reasons’.


That is pretty clear. The US has also made it entirely clear. Its chief negotiator said that it was not seeking for public services to be incorporated. No one on either side is seeking to have the NHS treated in a different way ... trade agreements to date have always protected public services”.—[Official Report, 18/11/14; col. 374.]

That was under President Obama. I suspect matters have changed since President Trump came to power, so I am seeking unequivocal confirmation from the Minister and the Government that they will stand by their word in coalition government in 2014 and fully re-enact these procurement rules for public services in UK law to continue to protect the NHS from future trade agreements. More than that, I hope that the Government will remind the NHS of its rights under this directive; it seems that too many contracts are being let on value not quality of service.

Another key element of these procurement rules that needs to be protected is accessibility. This has meant that public money should no longer be used to introduce or maintain inaccessible structures, systems or services. It is essential for disabled people that these accessibility rules continue. I recognise that it is not without cost, but it is a core element of the EU directive and is essential for any Government who believe that all members of society need to be treated equally.

I know that many other issues affecting the health and welfare of people in the UK will be covered in the debate, and I am looking forward to hearing from noble Lords who will speak shortly. Their expertise is exceptional. I thank those from the Library and other specialist groups who have provided briefings for us. I only wish that I had time to do justice to all their recommendations, but I know that colleagues will speak far better than I could to prosecute their cause. These issues include the reduction in the number of EU workers, which is already having an impact on our hospitals and social care services from clinical to support staff, and the loss of the European Medicines Agency headquarters from London, and therefore our influence over it if we leave, which will be very serious; we may wish to join as a junior partner, but we will have lost our influence. It is also serious for London’s economy where more than 70,000 bed nights a year will be lost for tourism. Radiologists are very concerned that the extra paperwork and regulation resulting from not being a full member might disrupt supplies. Cancer treatment is so time-sensitive that delay can have a real effect. More than one quarter of clinical trials funded by Cancer Research UK involve at last one other EU country. That pan-European and international approach is crucial for paediatric and rare cancers. The UK has led or participated in the largest number of these trials for types of disease, but once we are no longer at the EU research table, what will our influence be?

Should Brexit move forward and should we leave Euratom, we would jeopardise the domestic nuclear sector, the regulation and transportation of life-saving cancer medication and research into using radioisotopes, as well as the UK’s decarbonisation initiative which will help with ozone and air quality. That is why your Lordships voted to pause leaving Euratom earlier this week. Interestingly, while pro-Brexiteers argue that membership of Euratom places us under the influence of the European Court of Justice, there has never been an ECJ case involving the UK and Euratom.

Dr John Buscombe, president of the British Nuclear Medicine Society, told a parliamentary committee that close to 1 million patients across the UK have medical imaging with radioisotopes each year, and 80% are imported into the UK from the European Union. Dr Buscombe was very concerned about the security of supply. He said:

“We have had problems with product coming in, particularly from places like Canada, where they haven’t turned up, got delayed or have the wrong paperwork”.


We must ensure that the future supply is maintained.

Moreover, what happens to UK citizens living or travelling in another EU country? Reciprocal services, starting with the well-known EHIC card, are built into our daily lives. During Brexit negotiations, and hopefully in transition, UK citizens will still be able to use the EHIC card to receive state-provided emergency medical care. However, yesterday’s excellent EU Committee report Brexit: Reciprocal Healthcare sets out the real difficulties. No deal has yet been made; no assurances have been given to ensure medical treatment for UK citizens outside the border.

As on every other Brexit issue, there is the real problem of Northern Ireland and the Republic. Joint health services, for example, allow patients to get medicine at any pharmacy north or south of the border, irrespective of the location of the GP responsible for the prescription. Ambulances on either side of the border are currently free to travel across the border to attend emergencies such as road traffic accidents and cardiac arrests. People across the island are allowed to receive radiotherapy at a new £50 million centre for cancer patients on both sides of the border at Altnagelvin Area Hospital in Derry, which opened just a year ago. Bernie McCrory, the chief officer of Co-operation and Working Together, said:

“In the past we would have had young mothers who would have declined to go to Dublin because of the time away from their children and they would have opted for radical surgery”—


instead of this specialist treatment. At Altnagelvin Area Hospital,

“we have created a pathway for patients that didn’t exist before”.

There is yet no pathway for how we manage the difficult cross-border issues in Ireland.

In conclusion, the health and welfare of UK residents will be affected by Brexit and there is much that needs to be done now to establish the rights of UK and EU citizens to strike effective deals and to recognise that the consequences of Brexit on our health and welfare might be serious. In that event, does the Minister agree that perhaps the people should have the final say? More than that, there are steps that the Government need to take now to reassure us: for example, in relation to the EU directive that I mentioned earlier. It is absolutely vital that that protection remains. I beg to move.

--- Later in debate ---

[Baroness Brinton]

My Lords, I start by thanking the Minister for his response. I will link that with the comment of the noble Lord, Lord Dykes, about the noble Baronesses’ contribution to the debate. While it was very flattering for us to be so mentioned, the Minister in particular but other noble Lords who spoke also have that in-depth knowledge. I want us to recognise that.

I will not attempt to summarise things in the very brief time I have now, but I thank all noble Lords who spoke. As I predicted, the contributions were of considerable depth and expertise, combined with experience and anecdote that demonstrated the real concern many of us have about health and welfare in the light of Brexit. The key things that stuck out for me were the problems with high-skill and low-skill recruitment in the health sector. The tier 2 limits are ridiculous. I thank the noble Lord, Lord Balfe, for his comments on Addenbrooke’s. My clinic has been delayed by a year because it has been unable to bring in the consultants it wanted from abroad. We heard about trailblazers, and the fact that young people with muscular dystrophy are flying in help from Europe because there is not the specialised care and support; that is really worrying. While I admit that the Government are trying to negotiate the rights of people to come to work here, they are not in place yet. The compelling personal testimony of my noble friend Lady Thomas and the noble Baroness, Lady Masham, was very moving. I thank them for that.

I will end on a phrase that the noble Baroness, Lady Thornton, used. She asked why we would want to be outside the EMA. I will add to that the working time directive, the ECDC, the EU directive on public procurement, Horizon 2020, medical devices and Northern Ireland border issues, all of which came up in depth during the debate. So perhaps the best note to end on would be to say that we can have the best of all worlds—and that is by remaining inside the EU.

Motion agreed.

Health: Medical Respite for Children

Baroness Brinton Excerpts

Wednesday 21st March 2018 Lords Chamber

Asked by

[Baroness Brinton]

To ask Her Majesty’s Government what guidance is provided to Clinical Commissioning Groups in exercising their duty to provide medical respite care for seriously ill and disabled children, following the High Court decision of 21 February.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, although there is no specific statutory duty on clinical commissioning groups to offer respite care, under provisions in the National Health Service Act 2006, CCGs must ensure that they secure health services to meet the needs of disabled children to a reasonable extent. Furthermore, the statutory framework introduced in the Children and Families Act 2014 requires CCGs and local authorities to work together to support all the needs of children with a special educational need or disability.

[Baroness Brinton (LD)]

I thank the Minister for his Answer. Despite the High Court judgment in the case being brought by the amazing Nascot Lawn parents, which made it absolutely clear that the very disabled children involved are entitled to individualised NHS support, it has now emerged that the Herts Valleys CCG’s so-called assessment for each case was a five-minute pre-assessment box-ticking and that the child was not even present. The CCG is still trying to dictate its contribution to the county for the care and is not consulting the families. Can the Minister explain what steps the Government and NHS England can take to ensure that Herts Valleys CCG makes appropriate provision for each of these children, when it appears it remains determined not to?

[Lord O'Shaughnessy]

I congratulate the noble Baroness on her tenacity in raising the issue and thank her for giving me the opportunity to meet parents whose children use these services. First, it is incredibly important to be clear that there are rules for how the consultations that the judicial review said should be held should take place, and they must be abided by. More importantly, as I have just set out, there are legal obligations under the 2014 Act for joint commissioning between the CCG and the local authority. That is not one telling the other what to do; it is joint commissioning. Most important of all—the point that the noble Baroness makes—is that whenever these bodies are planning for the future, they have to keep the needs of the children in mind. That is what we, whether it is NHS England or the department, are imploring them to do through this process. Indeed, they are obliged to do that.

National Child Obesity Strategy

Baroness Brinton Excerpts

Monday 26th February 2018 Lords Chamber

[Lord O’Shaughnessy]

We have a free school meal policy in this country. Indeed, the previous Government introduced free school meals for all children up to the age of seven, I believe, so we have made a significant impact in this area. I talked about breakfast clubs, which will also help, particularly disadvantaged children.

[Baroness Brinton (LD)]

My Lords, the salt reduction strategy worked particularly well because all supermarkets came together and followed it. Two years ago, Sainsbury’s chief executive asked the Government to introduce compulsory targets for sugar reduction, but we have not seen them yet. After the first year of the sugar tax in Mexico, there was a 17% reduction in purchases by poor people and a 12% reduction across the board. It works. If the supermarkets want it, why will the Government not follow?

[Lord O’Shaughnessy]

We are making good progress in reformulation and in reducing sugar in drinks, which I have talked about, and in other foods. However, we have to look at the impact. We will look at that and if progress is not made—let us face it, obesity levels are unfortunately continuing to increase—clearly other actions will have to be taken.