Health and Care Bill

Baroness Grey-Thompson Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Morris of Yardley (Lab)]

My Lords, I support the comments of the noble Lord, Lord Moynihan. I do not want to repeat points that have been made at this late hour, but I wish to emphasise that the arguments about the importance of sport and well-being do not need to be made again. Everybody from all parties, right across the House, understand their importance and the consequences of not getting them right. The good will has been there for years, but the ability to transform it into effective action has not, and lots of well-intentioned efforts in the past have come to naught. That is what is driving the committee that met under the chairmanship of the noble Lord, Lord Willis, and I agree with the questions that have been asked.

For me, it is a case of not relying on a cross-departmental committee to run this project. It has not worked in the past, and there is no reason to think that it would work in the future. Is there seniority? Is there someone with clout who can bang heads together? Is there someone for whom it is a very important part of their job, and who knows they will be held accountable? I agree with the noble Lord, Lord Moynihan, that the Health Promotion Taskforce does seem to offer hope. Clarity on that—letting us know about its leadership, and the presenting to Parliament of an annual report for discussion—would allay many of our concerns. I look forward to hearing the Minister’s response.

[Baroness Grey-Thompson (CB)]

My Lords, I draw your attention to my interests: I am chair of ukactive, and I have a number of interests in this area. I also sat on the Lords Select Committee.

I too am not going to rehearse the arguments we gave in Committee, but all the names added to this amendment have been involved in this space for many years. We have all been through various iterations of this, and we should be talking about physical literacy and physical activity, and slightly less about sport. That might be surprising considering my background, but as the noble Lord, Lord Moynihan, said, we have an obesity crisis and a generation of young people who are more likely to die before their parents, and there are a number of conditions that can be treated. Frankly, we have been tinkering at the edges of this for way too long. There have been programmes and lots of initiatives that have had some success, but if we are serious about the NHS and the health of the nation, we have to do things in a different way. I feel like I have been talking about this for about the last 30 years—the noble Lord has had a slightly longer time in sport than I have—but I will be interested to hear the Minister’s response in order to understand how we can genuinely make a change and stop going round in circles on this important issue.

[Lord Addington (LD)]

My Lords, the last shall probably be quickest on this. We have all, as is agreed, said that we need to do something that is coherent. This has not been coherent. We have had committees that met once every full moon, provided everybody had had tea of the right quality that day; thus was their infrequency. Nobody was prepared to ensure that something that was inconvenient for one department was done to ensure that another department fulfilled it. There just was not anything. The Olympics did not manage to make them work together. We need coherent leadership and a price to be paid—accountability—for not doing it. If the Minister can give us that, we will have taken a major step forward. I would of course prefer the amendment that has been tabled, but I will take half a loaf any day over no bread. Can the Minister assure us that there will be leadership and that a price will be paid, publicly paid, for not doing it? Without that, as we know, this will merely become a report with somebody else saying, “They should have had a meeting about it some time”. Let us bin this. I am fed up with making that speech, even though it does usually get me out of a lot of trouble.

Health and Care Bill

Baroness Grey-Thompson Excerpts

Lords Hansard - Part 2 & Committee stage
Monday 31st January 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise very briefly, since I attached my name to Amendment 289, in the name of the noble Baroness, Lady Greengross. She set out the reason for the need for this service, but I just want to say explicitly—particularly given the next group of amendments—that I do not believe that independent providers, for-profit providers at least, would be the way of doing this, given the many problems that we have seen in social care, which are highlighted in the next group.

We still have, in some places at least, community hospitals and facilities in communities. These are things that ideally would be developed by the community for the community, being run for public good not private profit.

[Baroness Grey-Thompson (CB)]

My Lords, I speak in support of Amendment 289 in the names of my noble friends Lady Greengross, Lady Watkins, Lady Finlay and the noble Baroness, Lady Bennett of Manor Castle.

Reading the words of the amendment reminded me of the speech that my noble friend Lady Campbell of Surbiton gave in your Lordships’ Chamber on 29 November 2012—col. 274 in Hansard. She talked movingly about a young man, a wheelchair user who had to remain in hospital four months longer than he should have because of a lack of accessible accommodation —a travesty. One can only imagine the impact on the mental health and well-being of someone in this situation. Sadly, many more now know what this feels like.

Although the situation we are in now is somewhat different, I hope that the Minister will be able to give due consideration to the needs of disabled people, in relation to accessibility—for example, regarding toilets, showers, and specialist equipment—but also to the support networks that disabled people may require, while ensuring that appropriate and knowledgeable people are able to support their rehab. This is vital so that many disabled people are not marooned.

While I have been in your Lordships’ Chamber tonight, I have been sent some data on the work carried out by Dr Elizabeth Williamson about the mortality rates of those on the learning disability register over the last 18 months; these rates are, quite frankly, shocking. I need some time to go through the data in detail and digest it. I will write to the Minister to explore this further but, at a quick glance, the data gives me cause for significant concern and means that careful implementation of the amendments in this group will be very important to protect and support disabled people.

Going back to the amendment, a disabled person’s ability to return home may or may not be more complicated than for a non-disabled person during this time but a longer stay than necessary could have a significant impact on someone’s mental health and well-being, especially if not properly supported, and could even hamper their long-term physical recovery, which, in turn, would put more pressure on the NHS.

Health and Care Bill

Baroness Grey-Thompson Excerpts

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, I want to react very briefly to one comment that has been made in debate tonight, which is the issue flagged by my noble friend Lady Wheatcroft. It is something that is continually raised in the wider debate on assisted dying and it is the issue of incontinence being seen as so inherently tragic that people should use it as a reason to want to end their lives. It is considered an important subject; we have an all-party group on it.

Personally, I find it really difficult because I am incontinent and I have never once felt undignified by it. I cannot believe that I am the only person in the House, or, indeed, in the Chamber tonight, who is incontinent and I will happily discuss the many solutions for sorting out this problem. What I see is that people are scared to talk about it, because they think it is something that we should never discuss. I have many solutions for this. I intermittently catheterise; I use indwelling catheters; I have lots of options available to me if those do not work—medication and lots of options on surgery. There is nothing undignified about being incontinent if we support it properly.

[Lord Aberdare (CB)]

My Lords, both these amendments reflect a desire to give people a greater say over the final weeks of their lives. As a strong believer in patient choice, which is, after all, a very central part of this Bill, I am greatly attracted by and supportive of my noble friend’s Amendment 203.

As several noble Lords have said, we are not very good at thinking about, planning for and managing death, despite Benjamin Franklin’s observation that it is one of only two certainties in this world, along with taxes. This amendment would give people diagnosed with a terminal illness the possibility of some degree of agency in their final days. That seems to me a wonderful idea, but it does of course raise questions about who such discussions would be with, and what qualifications might be needed by the people offering them. So, while I support the amendment, I would want to know more about the practicalities of delivering it, hopefully without having to create a whole new regulated profession of mortality consultants. I hope therefore that the Minister will respond positively to my noble friend’s suggestion of discussions on how the amendment might work; I will be interested to hear his response.

On Amendment 297, which I also support, I make only two brief points. First, I very much agree with what everybody has said that tonight is not the time to be discussing the merits of assisted dying; that is not what this amendment is about. Many Members on both sides of the argument have made it clear that Parliament needs to decide this issue, and the amendment from the noble Lord, Lord Forsyth, seeks to find a way of making that possible. I feel the same sort of alarm as my noble friend Lady Wheatcroft in finding myself on the opposite side to that of the noble and learned Lord, Lord Mackay, but, with the greatest respect, I think he himself said we were waiting for a decision from Parliament before the Government could act on this. In that case, there has to be some way or process for making such a decision happen. That is exactly what the noble Lord, Lord Forsyth, is trying to produce with this amendment. No doubt there are ways of improving how that is done, maybe by giving more time to my noble friend Lady Meacher’s Bill. This responsibility is Parliament’s to resolve, and I cannot believe that, in this great Parliament, we cannot find a way of doing it.

Covid-19 Regulations: Assisted Deaths Abroad

Baroness Grey-Thompson Excerpts

Tuesday 10th November 2020 Lords Chamber

[Lord Bethell (Con)]

Well, this is an extremely complex issue. As the noble Baroness alluded to, there is a wide variety of issues at stake, including values issues, questions of faith and, as she rightly said, questions of personal choice. There are the components here for an important national debate. I acknowledge the comments of several noble Lords already that we are approaching the moment when that debate seems more relevant than it has ever done. When that debate takes place, certainly personal choice will be an important part of it.

[Baroness Grey-Thompson (CB) [V]]

What advice did the Secretary of State, Matt Hancock, have from the Director of Public Prosecutions in relation to the official guidance? The response on travelling to Dignitas suggests assisting suicide is an urgent act and encourages the suicide of those with disabling conditions. Some 25 years on from the Disability Discrimination Act, and with the rise in post-Covid mental health problems, this is particularly inappropriate, as data from other countries shows that the major driver for seeking assisted suicide is the fear of being a burden, and other social factors.

[Lord Bethell (Con)]

In direct answer to the noble Baroness’s question, I am not sure whether any advice was given by the DPP, because there has been no change in the law. Nothing we have done here changes in any way either the 1961 Act or the advice of the DPP. So, from that point of view, the consultation is not necessary. What we have sought to do is clarify travel guidance in a way that does not change the application of the law in the country.

Covid-19: Social Care Services

Baroness Grey-Thompson Excerpts

Thursday 23rd April 2020 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, I draw attention to my interests in the register, in that I am a vice-president of the LGA. The Care and Support Alliance has reported thousands of people getting in touch with its members over this very issue. The questions I raised at Second Reading of the Coronavirus Bill are still valid and I will be writing to the Minister, because of our three-minute time limit today. To help proceedings, I have nine questions.

There is still a lack of adequate PPE for disabled people and their carers. One young disabled woman reported that she was verbally abused for not having adequate PPE available, even though it is difficult to obtain. Another young woman struggling with PA support was told that she should just go and live in a care home. My first question is: now that care home deaths are being reported, are HMG changing their strategy for this sector? A really serious danger is that some disabled people may be forced to move back to their families, which could be toxic or abusive, because that could appear safer than a care home.

Secondly, for transparency, will HMG report deaths in the community so that the true overall death figure is accurate; if not, why not?

Thirdly, HMG said that the delivery target was 100,000 coronavirus tests a day by the end of April. Is this on target and how many more need to be done? Was this a logistics aim or a medical aim? Will the Minister confirm that disabled people will not be excluded from testing?

Fourthly, will HMG review the carer’s allowance? Unpaid carers are also in a precarious position.

Fifthly, will HMG urgently review the guidance on direct payments? It is confusing and families are at breaking point trying to manage working from home.

However, my biggest concern is that, as I understand it, eight areas have switched on the Care Act easements. I can find the names of six: Sunderland, Middlesbrough, Warwickshire, Staffordshire, Birmingham and Solihull. So, sixthly, as a matter of urgency, can the Minister confirm that these six are correct? It was reported in the Law Society Gazette this morning—but has now been removed—that the other two are Croydon and Hertfordshire, although Hertfordshire has said that it has not triggered easement. This is very confusing for everybody. Can the Minister confirm which areas have triggered easement?

Seventhly, can he explain how these areas have apparently reached crisis point, such that they cannot carry out their duties to disabled people, but nowhere else has? Or are there more than eight?

Eighthly, how are disabled people expected to get advice if they do not know what law their local area is applying?

Finally, ninthly, does the Minister accept that HMG should publish regularly the full list of areas that have switched on Care Act easements and, if they are not prepared to do so, can he explain why not?

Coronavirus Bill

Baroness Grey-Thompson Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Tuesday 24th March 2020 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. I am trustee of the British Institute of Human Rights and a vice-president of the LGA, among others.

We are in challenging times, with a significant number of noble Lords not in their usual place. With a Bill of this magnitude, the Chamber would normally be full. I strongly support the comments made by the noble Lord, Lord Newby, that this has proved more than anything that we need to find more modern ways of working, especially when we have had no time to discuss the Bill outside the Chamber. Even more so, the review point for this Bill is incredibly important.

I sincerely thank the House staff who are here today and the NHS and front-line staff for what they are doing. For me, it was a big, personal decision to be here today, especially with the release of the clinical frailty scale. Many would see me, as a wheelchair user, as being no higher than number 7 on that scale. I am delighted that NICE yesterday confirmed that the clinical frailty scale would not be used for certain groups, including those with learning disabilities and cerebral palsy, but many disabled people are still very worried by the Bill. Decisions will be taken by someone else about our usefulness in the next few months that we will have no control over. I am starting to worry that disabled people might be seen as expendable during this pandemic. There is a real fear that this will graduate towards a move to register disabled people and that that will be used to decide future provision.

There is a need for part of this emergency Bill; however, the draconian measures outlined made it a personal necessity for me to be here today. This is a health and social care obliteration Bill by a different name. Alan Benson captured many views when he said that we have been fighting for rights for 30 years and now it is about survival. Inclusion London has said that, “buried deep” in the Bill is

“the complete removal of social care responsibilities, for at least two years.”

I apologise because I will ask the Minister a series of questions. I will email them to his department because there are many. I will also cover presentations and questions that have been sent to me by other noble friends.

What will happen to those stuck in the PIP decision appeal process while we are going through these difficult times?

What will be done to look after or support victims of domestic violence, who we know will be at greater risk?

What specific measures will be put in place for the emergency registration of healthcare professionals for those over 65, some of whom may be considered vulnerable?

What about unpaid carers and child carers? What about the self-employed? There will be additional pressure on them at this time that will be impossible to step back from.

When the Prime Minister and Her Majesty’s Government make announcements on TV, will they commit to having a British Sign Language interpreter so that everybody can understand what is going on?

The Bill is a temporary suspension of most of the duties contained in the Care Act 2014. Is this any more than just a cost-saving exercise? If local authorities are no longer required to meet care needs under the Care Act, will the Minister explain why local authorities would carry out any assessments at all if they did not have to? How will they prioritise?

In yesterday’s debate in another place, a human rights safeguard was raised numerous times. The Government stated that they considered the Bill to be compatible with human rights. However, the analysis was released late on Friday 20 March, after the Bill was laid before Parliament on 19 March, and while some of the analysis is welcome, some of the most worrying clauses have simply not been dealt with. Will the Minister explain what analysis has been done about the unintended consequences on the NHS at this difficult time of removing social care or prioritising health over social care?

Will the Minister advise how social care is guaranteed, because, as I understand it, there is no human right to social care or a positive obligation under the European Convention on Human Rights to meet care needs? Are people to be protected from inhumane or degrading treatment within the provisions of Article 3 or perhaps Articles 8 or 14? I would like to understand that. How will the Secretary of State ensure that social care is protected and what support will be given to decision-makers such as social workers to ensure that they identify and avoid breaches? Given that human rights training is not mandatory, is that something that could be considered?

What happens when a disabled child turns 18 and their adult social care package is unavailable? Does provision just stop?

My noble friend Lady Hollins, who is unable to be in her place, asked me to raise the following questions, which are really important for disabled individuals. If we look to home care for disabled people, what provision are Her Majesty’s Government putting in place for European care workers who have not been able to return to the UK? What personal protective equipment will be made available for carers? Can Her Majesty’s Government look at parking charges, so that carers who do not want to use public transport are able to drive? Will there be extra funding for disabled employers or home care agencies to enable them to pay an additional income premium or quarantine payment? What about carers who have to self-isolate in their employer’s home to ensure they do not put their disabled employer at risk? How will care agencies or disabled employers fund these periods of advisory self-isolation? Will the Government require local authorities to keep a record of those who have had their support reduced or cut, so that their support packages can be reinstated when this emergency is over?

What about people with dementia? Can the Government assure us that they will not be discharged to inappropriate care homes without staff who have had dementia training? Can the Government give a financial guarantee to families living with dementia—that they will not be retrospectively charged for inappropriate care home placements once the pandemic is over?

The St John Ambulance contacted me this morning. It said that it is ready and wants to help and would very much welcome a call with the Minister. What about paid leave and access to emergency volunteering certificates for it?

The changes to the Mental Health Act are just as concerning. Does the Minister consider it proportionate for individuals to be sectioned by only one medical professional, who is no longer required to be acquainted with the individual? I hope no amendments will be tabled that amend other major pieces of legislation. This is a time for unity, not for introducing other far-reaching changes on highly contested issues.

At different times, in-patients in mental health care facilities may face increased restraint and seclusion. The powers in this Bill could lead to a deterioration in an individual’s conditions where carers or families cannot manage, leading to individuals being admitted to an in-patient unit in crisis. No one should be admitted because of a failure of social care. Can the Minister assure the House that, should the powers in this Bill be activated and as a consequence should people be admitted to in-patient settings because of a failure of care, an independent care and treatment review will be carried out as soon as this emergency has ended, and not just for people detained in long-term segregation? The Bill’s provision to relax the measures around NHS continuing healthcare assessments could see some of these people discharged from hospital without the right support, putting them at additional risk of readmission. Delays to NHS continuing healthcare assessments will undermine this programme of work.

Like many others, I have huge sympathy for what the Government are trying to do right now, but a Bill of this magnitude will be life-changing for disabled people. I look forward to hearing the Minister’s response.