Mental Health: Advertising and Body Image

Baroness Brinton Excerpts

Thursday 30th June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

We have a remote contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, the Children’s Society’s Good Childhood Report 2021 shows that one in seven girls and one in eight boys is particularly unhappy about their appearance. Young people who are not happy with their lives at 14 are more likely than others to have symptoms of mental health issues by 17, including instances of self-harm and suicide attempts. Despite the Government’s promises of future funding for mental health support for schools and CAMHS, it is clear that young people are not getting that initial front-line support that they need now. How soon will there be mental health counsellors in every secondary school?

[Lord Kamall (Con)]

When we look at mental health in children and body image, we see that it varies not only among age groups but within age groups. We have identified concerns about poor body image as a risk factor that leads to mental health conditions, but it is not necessarily a mental health condition in itself. We have to look at how much of this was already present in the playground before the age of social media, with people being called nicknames for their appearance. However, that has been amplified by social media. We are working with social media companies and others to find the most effective solution.

Draft Mental Health Bill

Baroness Brinton Excerpts

Tuesday 28th June 2022 Lords Chamber

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely.

[Baroness Brinton (LD) [V]]

My Lords, from these Benches we would also like to thank Sir Simon Wessely for his report. We welcome reform to the outdated Mental Health Act and we are pleased to see that the Wessely review is finally being implemented by the Government, even if they are not accepting all the recommendations. The Liberal Democrats pledged in 2019 to implement all the recommendations of Sir Simon’s review, including bringing forward the necessary investment to modernise and improve patient settings and ambulances. We will apply the principle of “care, not containment” to mental health, while ensuring an emergency bed is always available if needed. Sadly, that has not been the case in recent years.

The Statement talks of the Mental Health Act 1983 and how it was designed to protect those who presented a risk to themselves or to others, but it has long been unfit for purpose, with some practices adding more distress to those already struggling with mental health conditions. I am sure most of us have seen that with our families and friends, because everybody knows somebody who has had mental health problems. For too long, people from ethnic minority groups, as well as autistic people and those with learning disabilities, have been unfairly detained under this Act and it has caused huge distress and damage, not only to the individuals themselves but to their families too.

Shockingly, black people are more than four times more likely to be detained under the Act and more than 10 times more likely to be subject to a community treatment order. The noble Baroness, Lady Merron, said it is important to eliminate racism in mental health and criminal justice system interventions for those with mental health problems. This is long overdue. It is or has been, frankly, institutional racism, and it is time that it is dealt with very quickly.

That people with learning disabilities and those who are autistic are being detained under the Act even when they do not suffer from any mental health conditions is appalling. The Statement says that the Bill will change this, but can the Minister assure us that the Government are serious about tackling these issues and will have no cause to delay this Bill again? While pre-legislative scrutiny is important, it should not lead to further delays in getting the Bill on the statute book next year.

It is good that the Statement announces £150 million over the next three years to bolster mental health services, especially to support people in crisis and avoid their having to attend A&E, which is not good for them and not good for A&E either, but I ask the Minister, since it is not clear from the Statement: is this entirely new money, or is it coming out of the mental health budget that was announced?

It is good that patient safety will be enhanced, but what is being proposed to bring much of the elderly and decrepit mental health building stock up to date and suitable for the 21st century? Some of the buildings are not just unsafe; they are actually not very pleasant places to be either.

The cost of living crisis continues to have a significant impact on families and the demand for mental health services for parents with young families is increasing, but the support to deliver these services is simply not keeping pace with demand, with nurses reporting cuts to funding and staff shortages. What plans does the Minister have in place to improve access to mental health services for new parents?

The Statement mentions the important proposals to give patients more control over their care and treatment. This is vital. We in the disabled community say that there should be nothing about us without us, and that is true too for those with mental health issues. The proposal for the nominated person to be chosen by the patient is a great step forward too, but that may well be hard for family members not selected as the nominated person, who may be excluded from any information about their family member’s mental health or progress, or as my honourable friend Daisy Cooper MP said yesterday, may not even know which part of the country their family member is staying in. This is part of the navigation of a future which is important to get right for the patient, while making sure that close family members who are worried about their loved ones are not cut out of the information loop entirely. Perhaps the Minister can give us some indication of how this trickly situation could be navigated.

The Government have said that they are accepting most of the recommendations of the Wessely review, but I add my concern to that expressed by the noble Baroness, Lady Merron: why have some not been accepted? Having said that, we accept the Wessely review and look forward to the pre-legislative scrutiny and the opportunity to discuss this Bill in detail when it comes into Parliament.

Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022

Baroness Brinton Excerpts

Tuesday 28th June 2022 Lords Chamber

[The Deputy Speaker (Lord Brougham and Vaux) (Con)]

The noble Baroness, Lady Brinton, will be taking part remotely and I call her now.

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for his introduction to this Order and the noble Lord, Lord Hunt of Kings Heath, for explaining his amendment. First, as others have said, it is important to recognise the contribution pharmacists in our health service have made for many years—long before the NHS was created. Too often we talk about clinical and health care professionals and do not raise the vital contribution made by pharmacists. Covid-19 has really demonstrated in a number of ways that they are not only a cornerstone of the NHS and our healthcare system. In the pandemic, and lockdown especially, they also stepped up, took on extra responsibilities and became a new frontline service for people concerned about minor symptoms that they would normally have taken to their GPs, while their GPs were overrun with many more serious cases, including Covid cases.

I too thank the PSNC for the pharmacy advice audit it sent through earlier this week. We now know that nearly a quarter of a million consultations a week—that is 65 million informal healthcare consultations a year—are still being carried out in community pharmacy because patients are unable to access another part of the healthcare system. We should not forget, either, that the pharmacy database was used as the basis for the NHS app because it already had direct links with GP records, prescriptions and vaccinations that were delivered by pharmacists in their pharmacies.

Turning to the SI, which clarifies the governance of, and sets out the roles of, responsible pharmacists and superintendent pharmacists, the brief summary by the Secondary Legislation Scrutiny Committee raises some key issues. The Minister is right: although there are only three paragraphs, its report is certainly worth reading. It says in paragraph 14:

“several proposals were not popular with respondents to the consultation exercise on the grounds that they may reduce patient safety, particularly provisions allowing Superintendent Pharmacists to cover more than one firm and Responsible Pharmacists to cover more than one pharmacy or to operate remotely. We also note significant levels of distrust from the profession that the regulator, the General Pharmaceutical Council … would be able to set standards and rules appropriately.”

Worryingly, the committee goes on to say:

“We found the response of the Department of Health and Social Care … to these concerns, as set out in the Explanatory Memorandum, unconvincing.”


In the next paragraph, it says:

“In supplementary material, DHSC told us that to counter the concerns the GPhC will be required to consult on any proposed rules, which will provide the profession with an opportunity for scrutiny and comment. In addition, any changes to professional rules made … would need to be made by a statutory instrument following the negative resolution procedure in Parliament.”


Although this extra information to the Secondary Legislation Scrutiny Committee is reassuring, I still want to ask the Minister what the timescale is likely to be before such an instrument is laid before Parliament for scrutiny, explaining those concerns outlined by the committee and how they will be alleviated.

I thank the General Pharmaceutical Council for its briefing, which sets out the safeguards in the draft order to consult on the rules and report back. I know we look forward to seeing the detailed responses to the consultation and how they might affect the resulting resolution. With any change in responsibility, trust is absolutely critical, and this is on top of the increase in community consultations and referrals to other parts of the healthcare system that pharmacists throughout the UK are now carrying out. This is the real change already happening in our primary care system that Ministers say we should be looking for, and the public have taken to it.

The All-Party Pharmacy Group notes that the new demands on pharmacists have been coupled with a real-terms decrease in funding over the last eight years. Despite their desire to help, many pharmacies have had to limit or reduce their offerings and, as the noble Lord, Lord Hunt, has said, some pharmacies are closing. It is in this context that the noble Lord has brought forward his amendment, asking your Lordships’ House to consider that

“the Order does not make provision about the wider workforce challenges facing the community pharmacy sector”.

Diabetic Prevention Programme

Baroness Brinton Excerpts

Thursday 23rd June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

The noble Baroness, Lady Brinton, is contributing remotely.

[Baroness Brinton (LD) [V]]

My Lords, the observational study by academics of the 2018-19 wave of the NHS diabetes prevention programme, published by BMC Health Services Research, observed disengagement within sessions when patients reported that information was difficult to understand, and when there were very large group sizes and problems with session scheduling. This is all before Covid. Problems with the course will inevitably make patients more likely to drop out but 50% is shocking. Now that this diabetes prevention programme has been rolled out across England, have these specific problems been addressed?

[Lord Kamall (Con)]

The noble Baroness makes an important point about what we have to learn from these programmes. In many of these programmes we are in a process of discovery. You try things—some will work and some will not. Those which do not work, we want to learn the lessons from. Clearly, the length of the programme, nine months, has put some people off and led to the dropout rate. We are looking at shorter programmes, digital access and self-assessment, and at community-led initiatives rather than top-down government initiatives. To give another example, I met someone at a meeting yesterday who told me that his mosque in Accrington was running healthier-diet programmes for worshippers. We need to see a lot more of those programmes as well.

Social Care: Adults

Baroness Brinton Excerpts

Wednesday 22nd June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the noble Baroness, Lady Brinton, is participating remotely.

[Baroness Brinton (LD) [V]]

My Lords, I go back to the previous question: this ADASS survey shows that almost 170,000 hours of homecare a week could not be delivered for the first three months of this year, because of a shortage of care workers. This is a sevenfold increase on the previous year. The changes proposed to the social care system will not increase the rates of pay for social care workers, at the moment, to make it attractive to others, who can work in hospitality. But there is a dire need for people now. What will the Government do right now to help solve this crisis?

[Lord Kamall (Con)]

As the noble Baroness will acknowledge, some of the problems have been in evidence for a long time. Sometimes, we are tackling the legacy of this neglect of the social care system. At the same time, we have to remember that many social care providers are not run by the state; they are private providers. Following the People at the Heart of Care White Paper, we want to make sure that, first, we encourage better conditions for workers. We also want to make sure that local authorities determine a fair rate of pay based on local market conditions. We have seen an increase in the national living wage, which means care workers will get an increase. But we are looking at all this as part of the overview of the social care landscape.

Nursing: Staffing

Baroness Brinton Excerpts

Thursday 16th June 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I congratulate my noble friend Lady Tyler on securing this important and timely debate and her excellent introduction to it. Its content is perhaps no surprise to many of us who have spoken so far. Our nursing workforce continues to face unbelievable pressures in their day-to-day roles. Supported by many other clinical and non-clinical NHS staff, nurses say that the NHS must staff for safety and for effective care.

The right reverend Prelate the Bishop of London spoke movingly from her own experience and deep knowledge of the issues that nurses face. I pay tribute to all of our NHS staff, who face the most severe difficulties at the moment. The Government seem to have glossed over these in their post-pandemic policy of, “Let’s just move on”. I hope that the Minister will respond to the questions raised by other noble Lords.

The RCN report rightly looks at the impact on its members, and it makes harrowing and concerning reading, especially on the lack of enough staff on duty on a regular basis, as well as the personal comments of those who have left through burnout. The Royal College of Emergency Medicine’s Beds in the NHS report shows that the NHS needs 13,000 extra staffed beds—the emphasis on “staffed” is important.

The pandemic was an emergency, but long before 2020 we were well below the OECD average for staffed hospital beds, and some of us have been raising concerns about staffing and beds for well over a decade. The current OECD data, which covers 2017-20, shows that the UK has 2.4 beds per 1,000 inhabitants; France has 5.8 and Germany has 7.8, while Korea and Japan have over 12. To repeat, the UK has 2.4—we have lost 25,000 hospital beds since 2010. Of course, in referring to hospital beds, we mean staff as well.

The pandemic has shown us the consequences of having bed occupancy at 95% early in 2020, but the underlying problems remain. The front line of this crisis in hospitals is the ambulance services and A&E departments, but we delude ourselves if we look at only the data. The workforce is absolutely critical, and many noble Lords have spoken about how important it is to plan properly for our nursing workforce. They have mentioned the Health and Care Act and the Government’s apology for workforce planning, including their assertions that they may not publish the workforce plans in full. I echo the questions seeking to understand why that is the case.

Nurses’ role has changed greatly over the last 40 years, and their high level of education and training means that the skills they offer can help to take the burdens off doctors and other clinicians, who bore them alone in the past. Specialist nurse practitioners have transformed the lives of many with long-term conditions—I include myself in that. Community nurse roles have also changed, but their current workload means that their real benefit of having time to talk to, listen to and understand the needs of their patients at home, and then to be able to signpost extra help or resolution, is under real pressure.

So it is good that the Government have increased the number of nurse training places, but it is less good that it is still not enough, given the number of retirements and staff leaving through burnout. The King’s Fund report on the NHS workforce makes this point very strongly, noting how much the UK will have to rely on international nurses. The noble Lord, Lord Lilley, made some interesting points on international recruitment. He has specific concerns about 4,000 nurses coming from poor countries, and he is absolutely not alone in that. But there are some more ethical overseas arrangements: my local trust, West Hertfordshire Hospitals NHS Trust, had an arrangement with hospitals in the Philippines whereby newly qualified nurses would come for a period, usually of five years, to gain some extra qualifications and then return home highly qualified. Even so, while they are away, their country does not have the skills for which it trained them.

Have the Government achieved their targets, set out in their elective recovery plan, which pledged to recruit 10,000 international nurses by April 2022, and are they encouraging the type of partnership that I just described? As my noble friend Lady Tyler said, retention is absolutely vital too. What plans do the Government have to tackle retention? This is about pay, the work environment, bullying, discrimination, more leadership and support for ethnic-minority staff facing discrimination and bias, all of which we have had reports on in recent months.

The noble Baroness, Lady Bennett, made an important point about the gender construction of nursing and, indeed, care. She is right that we undervalue and underpay those in caring nursing roles. That too needs to be re-evaluated, not just by government but by society. We should not have health staff caring for people’s personal needs while on the minimum wage. There is also pressure on nurses with a lack of doctors, so we need to note that the Secretary of State for Health and Social Care has acknowledged that the manifesto pledge to have 6,000 more GPs in England by 2024-25 is not on track. Similarly, the NHS target to fund 26,000 additional roles to ease the pressure on general practice is unlikely to be achieved by that same date. That pressure causes further pressure on our nurses.

Cancer targets are still being missed every month, and waiting times remain sky high. The NHS does not think that it can get them down in the next year, despite the Government promising performance returning to pre-pandemic levels by spring 2023.

Finally—news hot off the press—today there is monthly data for May on trusts achieving the target of waiting four hours or less in A&E. The average for achieving four hours or less is now 60%. The worst three are my own local hospital, West Herts; Barking, Havering and Redbridge; and Torbay and south Devon, which achieved between only 31% and 37%. Those figures alone are shocking, but what sits behind them is a shortage of nurses, doctors and other healthcare staff writ large. I hope that the Minister can respond to these concerns and ensures that we will have a nursing profession that is fully staffed, fully trained and fully supported, as they do their absolutely vital job in our NHS.

Defibrillators

Baroness Brinton Excerpts

Wednesday 15th June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, I call the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, 12-year-old Oliver King died suddenly of sudden arrhythmic death syndrome, a condition that kills 12 young people under 35 every week. The Oliver King Foundation has been campaigning for a defibrillator in every school. Last September, the Secretary of State for Education said this should happen. The DfE has been working with the NHS to make this possible, but the NHS Supply Chain website says that, in December last year, only 3,200 were advantageously procured for schools to then purchase. Can I ask the Minister: is the NHS expanding its procurement to enable all 22,000 schools to be able to purchase defibrillators now and not just when the school is rebuilt?

[Lord Kamall (Con)]

The noble Baroness raises an important point: while we require defibrillators to be purchased when a school is refurbished or built, one of the things we are looking at is how we can retrofit this policy. We are talking to different charity partners about the most appropriate way to do this. What we have to recognise is that it is not just the state that can do this; there are many civil society organisations and local charities that are willing to step up and be partners with us, and we are talking to all of them.

Vaccinations

Baroness Brinton Excerpts

Wednesday 15th June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, the shingles vaccine is available in the UK only to those aged between 70 and 79, whereas in the USA it is automatically available to everyone over 50. NICE data says that shingles is much more prevalent in those with a weakened immune system, yet they are not offered it until they are 70, resulting in severe cases of shingles, possible sight loss and other serious consequences which could have been mitigated by an early vaccine. Can the Minister say when Shingrix, the shingles vaccine suitable for the immunocompromised will be automatically offered to this group of patients?

[Lord Kamall (Con)]

I thank the noble Baroness for that question. I am afraid I will have to write to her with the details.

Health and Social Care Leadership Review

Baroness Brinton Excerpts

Thursday 9th June 2022 Lords Chamber

[The Deputy Speaker (Baroness Fookes) (Con)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely and I now invite her to speak.

[Baroness Brinton (LD) [V]]

My Lords, from these Benches we also thank all the staff in the NHS and social care sectors, and specific thanks go to General Sir Gordon Messenger and Dame Linda Pollard for this excellent report. We too support the recommendations in the report.

The Liberal Democrats believe our NHS is in desperate need of support. We need to remember that there are well over 100,000 NHS staff vacancies—and an equally worrying number in the social care sector—and we are concerned about the impact of these vacancies on patient safety.

With millions now waiting for treatment and waiting times increasing, it is more important than ever that the Government address the workforce crisis facing health and social care. We have just come this afternoon from debating two key issues in Grand Committee that the NHS faces: managing RSV and other respiratory infections, and managing neurological conditions.

The two sectors have serious staff shortages in clinical health and that is replicated right across the NHS. After a gruelling couple of years, many staff are considering leaving or retiring early. The Government need to get a grip on this workforce crisis and seriously start planning for the long term, giving the crisis the attention it deserves. I too echo the question from the noble Baroness, Lady Merron, about when the workforce planning draft will first be presented to Parliament. It is urgently needed.

This leadership report is blunt. It highlights the current absence of accepted standards and structures for the managerial cohort within the NHS and says that it has

“long been a profession that compares unfavourably to the clinical careers in the way it is trained, structured and perceived”.

And that is not just inside the NHS. Far too many people—even Ministers—slam managers as unseen, expensive bureaucrats. This report calls that out, as well as recognising that consistent standards and improvement are needed. That is welcome.

The recommendation for a new national entry-level induction for all who join health and social care, as well as national career programmes for managers right across the sector, is very welcome, but what plans do the Government have now for the interim? The crisis is with us—we see it every night on the television news—and the benefits of training and culture change will take some time to bear fruit.

The executive summary advocates a step change in the way the principles of equality, diversity and inclusion are embedded as the personal responsibility of every leader and every member of staff. It goes on to say that good practice is by no means rare but it is not consistent throughout the NHS, and it raises particular concerns about the experience of those with disabilities or race-protected characteristics. We agree with the report’s proposals that EDI should become a universal indicator of how the system is working.

The fourth recommendation in the report on the simplified standard appraisal system is also welcomed, alongside consistent management standards and consistent accredited training. The talent management recommendations are also excellent.

We welcome any measures that seek to improve the way the NHS works, such as the Government’s pledge to build more hospitals, but many of our senior NHS managers struggle with failing buildings that, rather like our Parliamentary Estate, need urgent repair or replacement—but until then they have to try to make them safe. My own local hospital, Watford General, is a case in point. With that in mind, will the Minister please tell us how he proposes to unblock the delays to meet his Government’s pledge of 40 new hospitals by 2030?

Yesterday, the Secretary of State likened the NHS to the now-defunct video store Blockbuster, saying that the country has a

“Blockbuster healthcare system in the age of Netflix”

and that things would change by 2030. To date, only six projects that predate the Prime Minister’s premiership have started construction, despite the Government’s 2019 election pledge that 40 would be built by 2030.

A core theme of the report is collaboration. It reports pockets of excellent practice but also pockets of stuck and poor practice. The report is clear that a real culture change is needed now. In some parts of the NHS there is still an “ignore if not invented here” approach that must be challenged and changed.

Leadership is indeed key to a well-functioning health service, but having enough staff to care for patients is critical to reducing waiting times and improving patient outcomes. Ministers seem keen only on tinkering with leadership programmes. They seem to be ignoring the huge number of vacancies in the NHS and recently refused to write workforce planning and projections into law. So what additional steps will they take to increase the number of doctors and GPs working in our health service in the next nine months? Workforce shortages across the health and social care sector are leading to long wait times and poor outcomes.

Our NHS leaders have done a sterling job steering the NHS through the pandemic and now they are trying to tackle record-breaking waiting times. Leadership is pivotal to the success of any organisation, and the example set by the head of the organisation plays a huge part in that success.

It is a shame that the report focuses only on the NHS and not on the department, because it is important that we remember that two areas over which the Secretary of State’s predecessor, Matt Hancock, had power were PPE and test and trace, both of which were extremely badly handled in leadership terms. Does the Minister agree that leadership starts with Ministers? In an exchange between the Secretary of State and General Sir Gordon Messenger published yesterday, the Secretary of State said, “Leadership is critical”.

Finally, the most welcome chapter of the report is the final one, chapter 4, on implementation. The authors set out a clear route map for making this happen through the establishment of the review implementation office. I note that, yesterday, the Secretary of State said that he accepted all the recommendations. From these Benches, we will hold him to account for the resources necessary for the review implementation office to deliver them.

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

My Lords, I thank the noble Baronesses for their questions and for their general welcome for the tone of the Messenger report. I also pay tribute, as did the noble Baronesses, to Sir Gordon Messenger and Dame Linda Pollard for their combination of leadership skills as well as clinical and medical knowledge. I pay tribute too to the number of people who were consulted across the system who fed into the report.

I shall try to address some of the questions that were asked. The Messenger report looked at both health and social care. It was interesting that reference was made to reports being published but nothing being acted on. I think we can be proud that, for the first time, we are now aiming, as is set in law following the passing of the Health and Care Act, for a properly integrated health and care system. We can now work to that properly across the system.

In December 2021, the Government published their strategy for the adult social care workforce in the People at the Heart of Care: Adult Social Care Reform White Paper. Our strategy aims to create a well-trained and developed workforce, a healthy and supported workforce, and a sustainable and recognised workforce. Work that has already started includes the review of the existing workforce and the voluntary register to look at the workforce landscape and the various qualifications. We also want to look at how we make sure that the workforce is professionalised and that people feel attracted to it as a career. The strategy is backed up by an historic investment of at least £500 million for new measures over three years—noble Lords will be aware of that.

Both noble Baronesses raised workforce planning. During the debates on the Health and Care Bill, I made it quite clear that where we disagreed with some of the amendments was on the frequency of the reports that was called for. Let me be quite clear about what we are doing in terms of workforce. First, we have the Health Education England strategic framework to support long-term planning. The department commissioned HEE to review and renew the long-term strategic framework for the health and regulated social care workforce—the right skills and the right values and behaviours to deliver world-leading services. The work is nearing its final stages and will be published before the Summer Recess.

Building on this, we have also commissioned NHS England and NHS Improvement to develop a long-term plan for the workforce for the next 15 years, including long-term supply projections. We will share the key conclusions of this work as soon as it is ready. Section 41 of the Health and Care Act 2022 gives the Secretary of State a duty to publish a report at a minimum of every five years describing the NHS workforce planning and supply system. The report provided for in that section will increase the transparency and accountability of the workforce planning process. On top of this, rather than everything simply being top down—the person in Whitehall or Westminster telling local services what to do—there is also the bottom-up planning, at trust level and ICS level, looking at the right workforce and skills mixes required on the boards and in the services to deliver the right services to patients.

The noble Baroness referred to the North East Ambulance Service. This highlights why this report was so badly needed. My right honourable friend the Secretary of State for Health and Social Care said yesterday in the other place that he was very concerned by what he has heard about the ambulance service and that he is not satisfied with the review that has already been done. He said that we need a much broader and more powerful review; he will have more to say about this very shortly.

We welcome the report. We have rightly said, as both noble Baronesses have said, that we welcome all the recommendations. To ensure that these are delivered as quickly as possible and with the right impact, an implementation plan co-created across the whole health and social sector is required. This report will therefore be followed by a plan with clear timelines and deadlines for delivery.

I am grateful to both noble Baronesses for raising the issue of discrimination and lack of diversity. It is interesting that our public services post war were rescued by immigrants from Commonwealth countries—from Africa, Asia and the Caribbean—yet, amazingly, we do not see them at the top of these organisations. Why is that? Frankly, we must move away from this position of white people stopping black and Asian people from being promoted and fobbing them off as “diversity officers”. They do not want to be diversity officers. We are good enough to be leaders and we must ensure that this is instilled right through our health and social care system, not just at the bottom level but all the way up. That will be the test of true diversity and true openness to equality.

There has been some positive movement towards tackling discrimination. The NHS people plan established a set of robust and comprehensive initiatives thought to imbed equality, diversity and inclusion. The recruitment and promotion practices have been overhauled and there will be named equality champions, but we must ensure that this is not just fobbing off. We need to see more diversity right at the top of our health and care system.

If I have not answered the noble Baronesses, I will write to them.

NHS: Respiratory Syncytial Virus Infections

Baroness Brinton Excerpts

Thursday 9th June 2022 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, I congratulate the noble Baroness, Lady Ritchie, on securing this important, and for me very personal, debate. As she outlined, RSV is a common respiratory virus that affects large numbers, mainly of children younger than five, but also some elderly and immunocompromised people. The burden of RSV includes not only ill health for children but the emotional and practical burdens of the affected families and carers and the impact that that has on productivity in the economy, alongside the costs of providing healthcare.

I found the key findings from a very interesting report by RAND published earlier this year, which did a desktop review of recent literature and published data on RSV in the UK. It approximated the annual healthcare costs of having RSV at £80 million. That equates to a mean cost of £97 to the NHS per child under five with RSV. Just over £40 million of that is due to productivity loses, £1.5 million is due

“to out-of-pocket costs incurred by parents/carers, and the remaining nearly £65 million to healthcare costs.”

Estimates suggest that each year 33 children under five die from RSV. While most cases of RSV have very short-term impacts, some children may face long-term respiratory issues later in their life.

Children born prematurely account for nearly 20% of the total cost burden of RSV in the under-fives. My twin granddaughters were born very early. The smaller of the two, Amelia, was 700 grams when she was born and at that point 30% of her lung tissue was dead. She was very unwell for the first few weeks of her life; we were lucky that she survived. Once she was home, within two or three days she picked up an infection, which transpired later to be bronchiolitis. It presented with all the traditional things you hear from Public Health England. Two parents were at home with premature twins and one was suddenly finding breathing very difficult. All the signs you are told to look for were already evident in her and 999 was used.

The Evelina Hospital was absolutely brilliant. My granddaughter remained in and out of hospital for the next year of her life; she was about three months old when this happened. The intensity to which the disease took over was extraordinary, on top of her underlying prematurity problems. She was in PICU—the premature intensive care unit—for some time and then did a step down to the next tier of ward. She then spent months on the lovely Snow Leopard ward—in the old days we would have called it a community hospital, but it is inside the Evelina—where the focus is very much on helping the families to understand the consequences of their child’s problems.

That was where I learned as a grandmother how to put on her ventilator every night, which she needed until she was three. I learned how to put on her heart monitor, because she also had heart problems, and to spot the signs of any infection, including future infections of influenza or anything else. Her skin was very pale and blue a lot of the time. I do not believe she was immunised with the monoclonal antibody, but she certainly had a substantial amount of medication as well. The most useful thing my son and daughter-in-law saw was how it was managed and how they could manage it and help her and themselves in the future.

Now, this bouncy six-year-old girl still has lung damage; you cannot revive dead lung tissue. She still cannot run around the way her twin sister does, but without the care of that extended paediatric team she probably would not be with us today. She is a shark expert, a budding oceanographer and absolutely determined to live her life to the full. The cost of her bronchiolitis was certainly in the upper economic numbers provided by the RAND desktop survey. But the benefit to the family is absolutely inestimable—in the support of the hospital and a large range of healthcare professionals who made it possible for her to go home. There were considerable difficulties, but she did.

She has a baby brother, born a year before Covid. His experience of RSV earlier this year, aged two, was very different. He has absolutely no problems. His experience was a very heavy cold with some croup and minor bronchiolitis. He saw the GP, but no more. His parents were very relaxed, while all their friends whose children were having RSV like that were getting very worried—but that is life when you have had a child who has had quite a severe illness.

RSV is with us and will be with us. As the noble Baroness, Lady Ritchie, said, as Covid starts to lift, we must expect to see more of it as small children mix with each other, as it is extremely infectious. She is right to be concerned about the overprescription of antibiotics. For some it is necessary but it needs to be checked. What is really clear from Public Health England’s guidance is that families can help themselves; they can recognise the symptoms of RSV and do what I did as a mother with my eldest child, who had quite severe croup, which is to make sure that there is lots of humidity in the atmosphere—with the kettle boiling away to make sure that there is steam in the room to help the bronchioles open and ensure that your child is protected.

However, it is not just about parents. Unfortunately, far too many GPs, community nurses and childcare staff do not recognise RSV either. I hope that one of the things we can ask of the Minister is to hear that that will change, and that this illness will be part and parcel of normal paediatric training. For some children, RSV is extremely serious, and the cost to the NHS and the families of those children—let alone to their long-term future—can be severe.