Historical Forced Adoption
Baroness Wheeler Excerpts(3 weeks ago)
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Baroness Smith of Basildon (Lab)
My Lords, I thank the noble Lord and the noble Baroness for their comments and their welcoming of the Statement. The noble Lord is quite right: the apology is the start of a process. I think we all agree that everyone has waited too long for this.
Whenever I read about this or speak to women I know who have been affected, I always go back to that frightened young woman who finds that she is pregnant, and society and, often, her family are not willing to support her. Society as a whole was complicit in this, in the way that we, as a whole, treated women who were single, young, scared and did not know where to turn. The very organisations they thought could help them were the ones they suffered most at the hands of. We have just to hear these stories. I think we all felt quite emotional hearing some of those tales; just imagine living through them. The noble Baroness and the noble Lord are right to pay tribute to those women and the adoptees for what they went through.
There are a number of issues to address. The noble Baroness talked about behavioural change in public sector employees. It was not just public sector employees; this was across society. I remember speaking to one lady who told me that her relationship with her mother never recovered because her mother allowed her—indeed, forced her—to go into a home. The repercussions have gone through family life through generations. There is nothing you can do or say that can change the hurt that has been done, but we can try to do something to make a difference.
The noble Lord is right to challenge us on records. Records are held in different formats by different organisations across the country. Bringing them together will be quite something to achieve. To get them in one place is crucial.
The noble Lord asked about compensation and redress. We are led by those who have been affected. There are three big things in this package of support. One is improving access to and safeguarding adoption records, getting them into one place so that they can be accessed. There is also expanding access to specialist services, including mental health services, but also to reconnection services to help those who want to trace their families, and improving access to NHS services. This is not about individual compensation. We are seeking to give the people the support they need. I do not think there is any money in the world that can address the hurt and problems that have been caused by this.
The noble Baroness asked what the support is. Some of it is in place already. FamilyConnect is already expanding the use of the national advice line, because there is no point having information available if it is not easy to access. We are funding intermediary services —in effect, we are funding family-finding services for historical adoption cases, because people need support and help to navigate their way around the information. The more we can get it into one place, the easier it will be to access. Also, through FamilyConnect, we will have a national peer and support group offer, for the support to be there.
On trauma services in the NHS, the noble Lord references a specific kind of trauma. We will get this through guidance in the NHS and specific tools to recognise the experience of those affected by historical forced adoptions, so that clinicians can better understand the impact, because it impacts different people in different ways. We need to give clinicians that information and set up a range of support that may be relevant. There needs to be consistency of care through GP services.
Something that has always been a problem for those who are forced adoptees is knowing the family medical history, because that will be so important. They may have a medical condition later in life, and knowing their family’s medical history beforehand is crucial. We are going to give the option of a marker and of putting that marker, as the person wishes, on their NHS record so that clinicians can take it into account.
All this has to be led by and have strong input from those who are directly affected. We can all stand here and say what we think is appropriate but, if you are part of the cohort, whether you are a mother or an adoptee, you will know how you have been affected and you need to lead on what is needed.
Another important part is testimonials, so that people who want to tell their story, either to be acknowledged personally or to do so privately, can be recorded. Look at the mood in this House: when I read out the Statement, we felt the temperature lower. Anyone who heard it in the House of Commons last week will have seen an unusual degree of support across the House, particularly when women gave their personal stories. To be able to do that and bring people together is important. The testimonials are an important way forward.
This is the start of a process to recognise the hurt, apologise for the state’s role in it and do whatever we can to try to bring all the measures I have spoken about into being as quickly as possible. There will be absolutely no delay. I do not think that was what the noble Baroness was hinting at. She will know from the tone of the Statement and the work that went on before it was brought forward that there is a determination across government to ensure that we do what we can now to address this and try to give some redress for the problems and wrongs of the past.
Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)
My Lords, before we move on, I remind the House that the next 20 minutes are reserved for questions from Back-Benchers only. I know the whole House will appreciate these rules being adhered to, to ensure that as many noble Lords as possible get a suitable opportunity to ask questions to the Lord Privy Seal.
Draft Conversion Practices Bill
Baroness Wheeler Excerpts(3 weeks, 6 days ago)
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The Deputy Leader of the House of Lords (Lord Collins of Highbury) (Lab)
I thank the noble Lords for their questions. I am acutely aware that there is a consensus across this House. There are no bipartisan divides here. The previous Government were committed to the principle of this legislation, and I welcomed it at the time. So, irrespective of what the noble Baroness says, there is consensus and there is concern. At the end of the day—I agree with the noble Baroness here—we can all agree that no one should face abuse just because of who they are, and our draft Bill is about protecting LGBT+ people from serious physical and psychological harm.
The Galop anti-abuse charity has for many years supported people who have suffered abuse. It is only reflecting the evidence that has been given to it. We must be clear that we are talking about victims of severe abuse here. One case of this abuse is one too many, which is why we are criminalising it. So let us not say that we are getting this out of proportion.
The noble Lord, Lord Scriven, addressed the fact that there are gaps in the existing law that mean we cannot prosecute offences properly with domestic abuse legislation. For example, on coercive control, the legislation is designed for someone who has a relationship with an intimate partner, and it would not capture an offence committed by someone they did not know. There are many other examples of gaps in the law that need to be addressed.
Secondly, the noble Baroness missed an important point: for the first time, we will have a clear definition in law of conversion practice. As with other offences, such as upskirting or non-fatal strangulation, a definition is important to help victims understand what has happened to them and be able to come forward, and for prosecutors to build a case. I am confident that there is a need to legislate in this area.
On the points that both noble Lords raised about parents and legislation, I want to be absolutely clear that this Government and this law will not dictate how people raise their children. Our measures are not intended to infringe on the right of parents to bring up their children in line with their beliefs or core values. We are absolutely clear that the ban must be balanced and targeted so as not to impinge on legitimate healthcare or the range of broader support that those exploring their sexual orientation or gender identity might seek or receive. I also stress that this draft Bill is not about regulating medical care. We understand how important it is that people get the medical support they need, depending on their particular needs and circumstances. This is a matter for the DHSC and the NHS.
I and Minister Bailey in the other place have been clear right from the beginning about the importance of the pre-legislative scrutiny. I very much welcome the fact that the Liaison Committee has agreed to this. It will be scheduled and the usual channels will bring forward calls for participation in that committee fairly shortly. That will hopefully be a great opportunity to reassure people about what are genuine questions and concerns that we should not be afraid to deal with. Many people in this House know and have met people who have experienced the abuse defined in this Bill, so I hope that through the pre-legislative scrutiny we can all come together and return to the consensus that we have had on dealing with this terrible abuse.
Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)
My Lords, I gently remind noble Lords that this next session of 20 minutes is for Back-Bench questions only. We will start with the Conservatives and then work our way around.
Antisemitism on University Campuses
Baroness Wheeler Excerpts(4 months, 1 week ago)
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Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)
We will hear from the Lib Dems. Thank you.
Lord Palmer of Childs Hill (LD)
I had not intended to speak, but when I listen to the Minister linking over and again the problems in the Middle East with antisemitism, I am disappointed. They are two separate things. There is an incredible rise in antisemitism where Jews cannot go around in the street wearing a head covering or a Star of David—a Magen David. That is the problem. The Minister talks about confusion because of events in the Middle East, but it is not the same thing. Zionism can mean different things to different people. The Zionism I believe in is that there should be a homeland for the Jews. After the events of October 2023, there has to be a homeland for the Jews. That is my Zionism. It has nothing to do with treatment of Palestinians, because Palestinians have rights as well. The Minister constantly muddles up the two in his reply. Antisemitism in this country needs to be handled and I want to know what the Government are going to do about it.
Alaa Abd el-Fattah
Baroness Wheeler Excerpts(1 year, 1 month ago)
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Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)
My Lords, can we hear from the noble Baroness, please?
Baroness Altmann (Non-Afl)
My Lords, as a mother, my heart goes out to the mother of Alaa Abd el-Fattah, Laila Soueif. I cannot imagine the pain that she and her family are going through. Given that the Egyptian Parliament is about to go into recess for Eid and that there may be little extra chance to have the time to negotiate bilaterally, would not some extra pressure give more comfort to the family? Given the bilateral talks that have been had at the highest level, are there any signs of progress at all that can give any such comfort?
Ukraine: UK-USA Discussions
Baroness Wheeler Excerpts(1 year, 4 months ago)
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Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)
My Lords, we will hear from the Liberal Democrats.
Baroness Smith of Newnham (LD)
My Lords, the Minister said it is vital that the United Kingdom and our European allies stay in marked support of Ukraine. Does he believe that the United States still gives that vital support to Ukraine? Very often it does not look like that under Donald Trump.
Restoration and Renewal
Baroness Wheeler Excerpts(4 years ago)
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Baroness Wheeler (Lab)
My Lords, I thank the noble Baroness the Leader for moving the Government’s Motion and for her introduction to the joint report of the House of Commons and House of Lords Commissions. I also thank my noble friend Lord Blunkett for moving his important amendment on the key principles of accessibility and public engagement going forward, and I thank the noble Baroness for her reassurances to him in her speech.
As the House will know, my noble friend Lady Smith has long been a passionate advocate for the visionary, strategic and structured management and delivery of the programme for the restoration of the Palace as set out in the 2019 Act, and she will sum up for us later. She and I worked closely on the then Bill on behalf of these Benches, and I note that many other noble Lords who were also heavily involved in that, and who are highly committed advocates, are also speaking today. They will share our deep frustration at the position we are now in. Nevertheless, we have obligations to meet and we must move forward.
Under the 2019 Act, we all thought we had established restoration and renewal governance structures and accountability that were vital to the safe and efficient execution and delivery of such a huge and complex project. By passing the Act, MPs and noble Lords accepted the necessity for the arm’s-length sponsor body to oversee the entire project, provide the expertise needed and avoid the constant political interference, changing objectives and moving goalposts that was greatly feared would happen under an in-house delivery alternative. It also meant full acceptance of the extensive analysis and costings that had been undertaken, showing clear evidence of the overwhelming safety, security, logistical and practical reasons why full decant of both Houses to alternative venues during the works was absolutely necessary and the only viable and realistic option in terms of overall costs and minimising project delivery timescales.
Sadly, the argument for a continued presence—primarily of MPs—and remaining in the building, like latter day Miss Havishams, has still not been laid to rest. A decision on whether to decant is not now to be made until after the intrusive survey work is completed and there is greater understanding of the condition of the House and the work that needs doing.
We also know that persistent attempts to revisit the basis and scope of the programme began pretty much as soon as the sponsor board started its work. The Lords’ spokesperson on the body, the noble Lord, Lord Best, who I am pleased to see is in his place and will be speaking later, has made clear his view that it has been hampered from the outset by political interference and has not been allowed to get on with the job Parliament gave it to do.
However, despite the regrettable changes to the established managerial and delivery structures and our disappointment at the stage we are now at, the House will know that, yesterday, the Commons supported this joint report produced by the two commissions. We strongly urge our Members in a free vote to support it today. We recognise that the joint report is now the only show in town—the only way to keep moving forward the vital restoration work that must take place on this wonderful building. It is the only opportunity we now have to try to make sure that the urgent and vital works that are needed are proceeded with in as coherent and managed a programme as possible, and the only way to get the essential House of Commons buy-in.
It is of considerable comfort that the joint report fully acknowledges the huge challenges and scale of the work that has to be done and outlines the key initial priorities of essential work that must be addressed to prevent the building falling into even further decay: on fire and safety; building services; asbestos elimination; and on the building’s stonework and framework.
The noble Baroness has set out the new structures and arrangements under the joint report, and I will not repeat the details. The sponsor body is disbanded, and the much-reduced numbers of expert staff that we have succeeded in retaining from it will be transferred to the new joint department of the two Houses. We will have a new in-house client body, advised by an independent panel of experts.
The Public Accounts Committee’s report on what has or has not taken place since the passing of the 2019 Act, and on the new mandate—surprisingly not referred to by the noble Baroness the Leader—raises a slew of key questions for her on how it will all work. I will come back to those later.
First, I pay tribute to the role played by our representatives on the sponsor body and draw the attention of noble Lords to their contributions in last year’s Grand Committee debate in November, on the parliamentary sponsor body’s 2020-21 annual report and accounts, led by the noble Lord, Lord Best. I commend it to noble Lords. It is a master class in the management of major renewal and construction management, with contributions from the noble Lord, Lord Best, and from my noble friend Lord Carter of Coles and the noble Lord, Lord Deighton, both of whom have extensive experience of managing and delivering large-scale construction and building projects —on NHS pricing and procurement in the case of my noble friend Lord Carter, and on the 2012 Olympics in the case of the noble Lord, Lord Deighton. The detailed analysis of the sponsor body’s accounts by our Finance Committee chair, the noble Lord, Lord Vaux, was particularly insightful and informative in the light of the PAC’s subsequent observations.
My noble friend Lord Carter and the noble Lord, Lord Vaux, are both speaking today, but it is worth placing on record the view of the noble Lord, Lord Deighton, that full decant is
“the only truly viable option which would produce the best value for money for the taxpayer.”—[Official Report, 16/11/21; col. GC 58.]
He also stressed the inescapable fact that for any total budget for renovation, three-quarters of the costs would be for the necessary core engineering work—a key factor that the Government must remember when the key priority areas are being planned and budgeted for.
My noble friend Lord Carter warned that:
“Without a decision, or if the decision is to kick the can down the road, we will be faced with a catastrophe at some point.”—[Official Report, 16/11/21; col. GC 64.]
This is a warning that we have heard many times and which no doubt will be repeated today. It is reinforced in the escalating media coverage on the state of the Palace, such as in the recent Observer article, “Britain’s Notre Dame?”, with some very graphic pictures of the decaying basement and antiquated engineering and plumbing works.
The steady but extremely slow-moving work of the sponsor body on the intrusive surveys and drilling down into the buildings and courtyards has urgently to be stepped up so that the maximum work can be achieved over the Summer Recess. I serve on the Services Committee, under the excellent chairpersonship of my noble friend Lord Touhig. We have spent a great deal of time over the past two years combing through detailed sponsor body reports on the urgent works needed and the proposed surveys—what they will cover, how they will work and what they are designed to find. My noble friend Lord Blunkett will be pleased to hear that this included ensuring that all the accessibility issues while the work takes place are fully addressed.
Can the noble Baroness the Leader assure the House that the surveys are going ahead at full steam on the priority areas of work over the summer, so that we know what we are starting with and the viable costs? The PAC report calls for this particularly in respect of determining what the asbestos removal plan should be and the safety of remaining in the Palace while these works take place.
The PAC report makes for some pretty sober reading, recognising of course the realities of the post-Covid financial environment. However, it contains no real surprises to most of us: the colossal sums wasted; the loss of the critical professional skills built up by the sponsor body to develop the business case for the programme funding and undertake the specialist construction and technical work; and the delay and prevarication that has resulted in the start date for major works being pushed back by many years, up to 48 or even 76 years under some worse-case scenarios. The PAC pulls no punches on these issues and on the increasing risks that the delays have caused.
Can the Minister comment on three of the issues that it raised? First, the PAC calls for a clear plan and structure on how the short-term risks to value for money and to avoid nugatory expenditure and further health and safety incidents will be managed. What timescales are envisaged for this extremely urgent area of work? Secondly, given the lack of time to consider other options for going forward and why the 2019 Act structures have not worked, how will the performance and governance lessons be learned in the delivery phase for the new arrangements? Thirdly, how will transparency and accountability to Parliament be managed in the future? What are the plans to report regularly to Parliament and its various committees on progress, potential costs and risks? How will the independent expert advice needed to support decision-making be truly independent and objective?
In conclusion, and despite the many unanswered questions from the Public Accounts Committee and that I am sure that will be asked by noble Lords today, I come back to where I started. The joint commission report on a new mandate, and the Motion before the House, must be approved. It is the only way forward to meet our obligations and to preserve and develop this wonderful building—the only show in town. Comfort can be drawn from the joint report’s undertaking to start the safety-critical works as soon as possible. There are definite signs of optimism in the first stage engagement survey of 20,000 members of the public, which shows strong support for the preservation and renovation of the Palace as the heart and centre of our democracy. This is a very welcome development and it must not be squandered.
Her Majesty the Queen’s Platinum Jubilee
Baroness Wheeler Excerpts(4 years, 2 months ago)
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Baroness Wheeler (Lab)
My Lords, I am very pleased to contribute to today’s debate. I have heard with great interest the range of contributions from noble Lords paying tribute to Her Majesty in celebration of the forthcoming Platinum Jubilee weekend. As usual in your Lordships’ House, as varied as the speeches have been, they have gelled together extremely well to paint a full picture of Her Majesty’s remarkable life and work.
A number of noble Lords have related their own memorable and moving experiences of meeting the Queen. Although I have not had that privilege, my own memory is of being a young working-class child living in south London in the post-war early 1950s and celebrating the Queen’s Coronation Day, with my own Coronation dress, Coronation mug and Coronation doll—but not a beer mug, as the noble Lord, Lord Newby, recollected. I was also convinced that I saw the Queen’s carriage go along the street I lived in. However, unless the carriage passed down the Old Kent Road and Camberwell Green on its way from Buckingham Palace to Westminster Abbey, that memory is obviously a mistaken one.
I remember all of us sitting around a very crackly wireless and listening to the Coronation. What was clear to me, even at that young age, was the strong and solid support that the monarchy enjoyed among working-class communities struggling to recover from the devastation of the Second World War. The young princess shortly to become Queen provided people with hope for the future and, as we have heard, has succeeded during her long reign in retaining and building respect, trust and admiration across the UK among our diverse communities and nations.
We have heard much today about the Queen’s famous work ethic. In the short time available, I would like to underline this in respect of her unique role in supporting charities. As we celebrate her long reign, recent research by the Charities Aid Foundation has shown that she is among the world’s greatest supporters of charities, helping to raise more than £1.4 billion. Clearly, she has ensured that the Royal Family maintains this as an essential part of its work. The Queen is a patron of 519 charities, including Cancer Research, the British Red Cross and Barnardo’s; her wider family supports 2,215 charities in Britain, rising to nearly 3,000 worldwide.
The Queen is a patron of one of the excellent charities I am involved in: the Stroke Association. Her role as patron is greatly valued and appreciated by the association. I have been a strong supporter of its work since joining your Lordships’ House in 2010 and as a carer of a disabled adult stroke recoverer. Stroke strikes every five minutes in the UK and 100,000 people have strokes each year. It is a leading cause of death and adult disability in the UK, with more than two-thirds of people suffering a stroke leaving hospital with a disability.
The Queen’s sister, Princess Margaret, died of a stroke after having had several previously. The Princess Margaret Fund for stroke research was established in her name. It provides a unique opportunity for people who care about stroke to invest in areas of stroke research that have the greatest potential to change our understanding of this disease and develop new life-saving treatments. Stroke research is vital to drive improvements in care and treatment but has been historically underfunded, receiving only a fraction of the research investment in other comparable life-threatening conditions. Annual research per stroke patient in the UK is £48 but it is £241 for cancer, so there is a great deal of catching up to do.
Stroke is a complex condition. A wide range of healthcare professionals are involved across the stroke care pathway, from GPs, primary care, ambulance paramedics, hospital doctors, specialists, nurses and support staff through to key rehabilitation specialists. The Stroke Association is campaigning vigorously to ensure that acute staff shortages in many areas of the stroke pathway can be addressed, in particular for the game-changing acute treatment for many strokes of thrombectomy to be available to all who would benefit from it. Thrombectomy is an extremely cost-effective treatment that reduces the chances of disabilities such as paralysis, blindness and aphasia. So watch out for the association’s July campaign on this vital issue, of which I feel certain Her Majesty would fully approve.
I too am very much looking forward to the jubilee celebrations and I pay tribute to all those who have worked so hard and played such a vital part in designing, planning and organising the exciting and imaginative events and initiatives taking place up and down the country. The one I especially commend is the inspirational Queen’s Green Canopy, inviting us to plant a tree for the jubilee. As well as inviting the planting of new trees, the QGC highlights 70 unique and irreplaceable ancient woodlands across the UK. We have seen how hundreds of families, especially children and children’s groups, have taken up the challenge to plant trees, with special environmental and horticultural projects running alongside the canopy initiative to encourage young people in particular to get involved and to think about taking up careers in this important work through such initiatives as the Junior Forester Award. The BBC’s excellent “Countryfile” programme has played a key role in building understanding of how crucial trees are for people and nature and for encouraging communities in all parts of the UK to be a part of the Green Canopy. The need both to protect our existing wood stock and to increase the percentage of the UK under tree cover could not be more important to the future of our planet. Having the Green Canopy as an inspirational and core part of the jubilee celebrations reinforces this crucial message.
Finally, I stress that I am particularly pleased and honoured to be attending the National Service of Thanksgiving to celebrate the Platinum Jubilee at St Paul’s Cathedral next weekend. I am looking forward to what will be a very memorable occasion.
Health and Care Bill
Baroness Wheeler ExcerptsWednesday 16th March 2022
(4 years, 4 months ago)
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Baroness Wheeler (Lab)
My Lords, my noble friend has returned with his amendment on the need for an expert-led review on the 40 year-old Vaccine Damage Payments Act, and I am pleased that the meeting he sought with the Ministers has taken place. The amendment is a timely reminder for all of us that while the vaccination programme against Covid has been hugely successful, for a small group of people suffering very serious adverse effects and deteriorating health as a result of having the vaccination, the experience has been devastating, as the noble Baroness, Lady Brinton, underlined. The current legislation dealing with compensation arrangements is not fit for purpose: in the words of my noble friend, it offers too little, too late and to too few people. I hope the Minister acknowledges the need to meet and engage with the families of those affected, and that he looks urgently at the ways in which claims under the current system can be speeded up, and he also accepts the need for the review of the scheme and the next steps that have to be taken on this.
My noble friend has also added his name to Amendment 180 from the noble Baroness, Lady Cumberlege, on her unrelenting campaign for separate compensation schemes to meet the cost of care and support for the victims highlighted in her First Do No Harm report. Once again, we have heard convincing and forceful contributions from the noble Baronesses, Lady Cumberlege and Lady Brinton, which we on these Benches strongly support, calling for an independent redress agency for the three patient groups covered by the First Do No Harm report. The Government’s positive response to another key aspect of the First Do No Harm report, to improve patient safety for the future, including establishing the patient safety commissioner, is a welcome and necessary development. But the redress agency needs to be there to provide care and support for the thousands of women who suffered, and whose needs will not be met by the healthcare system, social care support or social security benefits support.
I hope the Minister has considered the matter carefully since Committee, and will report positively to the House on the ongoing discussions and progress which will ensure the strongest recompense possible for the people we are concerned about.
Earl Howe (Con)
My Lords, I will turn first, if I may, to the amendment in the name of the noble Lord, Lord Hunt of Kings Heath, on the Vaccine Damage Payment Scheme, and start by thanking him for his campaigning on this issue, and for the informative debates we have had today and in Committee.
As we discussed in Committee, since the NHS Business Services Authority took over responsibility for the Vaccine Damage Payment Scheme from the Department for Work and Pensions in November 2021, we have started to find ways to improve the operation of the scheme. The most important thing the NHS Business Services Authority is looking do to is to improve the claimant journey on the scheme, and that means making engagements with claimants more personalised, as well as giving claimants access to more general support. The crucial part of this drive is to reduce response times, which the authority knows has been a cause of dissatisfaction, particularly during Covid; in other words, the whole process is being modernised.
The NHS Business Services Authority has done its best to hit the ground running. Since taking over in November, it has already contacted all applicants to update them on their cases and it has also allocated additional resource to the operation of the scheme. I can assure the noble Lord that the department will further engage with the NHS Business Services Authority to ensure that these service improvements, greater digitisation in particular, really do make headway. There is already regular dialogue on this.
With all this enhanced activity happening, I do not think this is right time to establish an independent review into the VDPS. As the noble Lord will know, reviews take significant time and they carry substantial costs to the organisation, not just financial but in terms of leadership focus and energy. Instead, we think it is a better use of resources to focus on making the changes that we know need to happen; that is, to improve the claimant’s journey, and to modernise the process for claimants, as well as scaling up the capacity of the VDPS. We will keep the progress on these under regular scrutiny, and I am sure we will report regularly to this House as we do so.
I will address the noble Lord’s three key questions. First, I should be happy to facilitate a meeting with representatives of the families, and my honourable friend Maria Caulfield, who is the Minister with direct responsibility for the scheme, will be pleased to see them. Secondly, as I have already indicated, reducing response times is one of the NHS Business Services Authority’s key objectives. Thirdly, the noble Lord asked whether the Government would undertake a review of the scheme. I simply remind the noble Lord that the scheme has been revised many times since its inception, which shows that it is reviewed regularly as a matter of course, but perhaps it is worth my making the point that the VDPS is not a compensation scheme; nor is it designed to cover all expenses associated with severe disablement, which are catered for from the public purse in other ways. I hope that is helpful to the noble Lord, and that on the basis of those assurances he will feel able to withdraw his amendment.
Before I address the detail of Amendment 180, I would like to again put on record my thanks to my noble friend Lady Cumberlege for her continued commitment to the issues she has so powerfully spoken about, and the diligence and dedication of the IMMDS team, and the brave testimonies of those who contributed to the IMMDS review. As my noble friend knows, the Government have accepted the majority of the report’s nine strategic recommendations and 50 actions for improvement, and are taking forward work to improve patient safety. This includes establishing specialist mesh removal centres, the ninth of which opens in Bristol this month, and work to improve the care pathways for children and families affected by medicines during pregnancy.
We remain committed to delivering improvements in patient safety across the board. We are focusing government funds on initiatives that directly improve future safety. For this reason, the Government have already published their decision that redress schemes will not be established for people affected by hormone pregnancy tests, sodium valproate or pelvic mesh. I realise that was a disappointing decision for my noble friend, and I am always very sorry to disappoint her, but, for the reasons I have given, I ask her not to move Amendment 180 when it is reached.
Lord Clement-Jones (LD)
My Lords, I rise briefly to support Amendment 165, in the name of the noble Lord, Lord Hunt, and thank him for putting it forward. Self-care has an important role to play in supporting people to manage their own health needs, and also in alleviating an unsustainable demand on GP and A&E services. As the noble Lord described, prior to the coronavirus pandemic there were some 18 million GP appointments and 3.7 million visits to A&E every year for conditions which people could have looked after themselves or sought advice from a pharmacist. It is estimated that this was costing the NHS in the region of £1.5 billion a year.
During the coronavirus, again as the noble Lord described, surveys have shown a much greater willingness among members of the public to self-care for these self-treatable conditions. But it is vital that appropriate policies are put in place to ensure that, as we emerge from the pandemic, people who can self-care continue to do so. It is evident now that self-care can help address many of the challenges we face in the NHS today, but to do so we need to address some of the system barriers to self-care, as described in this amendment, and unlock the important behavioural shifts that enabled people to self-care during the pandemic.
In particular, I will highlight how the NHS can make much better use of digital technologies and community pharmacists to enable people to self-care. We need to make better use of the technologies that the NHS has embraced over the course of the pandemic, such as the Covid-19 symptom checker on the NHS website. The digital triaging technology should be used to support the expansion of the community pharmacist consultation service to enable people to follow an algorithm online to get a referral for a consultation with a local pharmacist. It is critical, if we are to optimise the role of pharmacists—I am a big supporter of community pharmacists—that we give them the digital tools and information they need to support people. At present, a pharmacist cannot routinely record the advice or medication they give people, despite receiving training. The NHS must address the question of interoperability in IT systems, so that pharmacists can have access to read and to input into people’s medical records and enable pharmacists to be a core part of an individual’s primary healthcare team.
6.15 pm
The pandemic has highlighted how quickly the NHS and patients can adopt technological and digital changes. Realising the Potential: Developing a Blueprint for a Self Care Strategy for England, a document launched last October, is an excellent blueprint for this. A whole range of organisations, including NHS clinical commissioners, the RCN, pharmacy organisations, the Self Care Forum and, of course, the PAGB, have worked together to develop this blueprint for a comprehensive national self-care strategy to support the introduction of self-care policies throughout the NHS in England. It contains policy proposals and case studies, in particular in relation to digital technologies, which set out how the NHS can fully embed self-care and pharmacy into primary care.
I hope the Minister today will outline how the Government are ensuring that the NHS can adopt these proposals, which learn from the pandemic, and will expand them to support individuals to enable self-care.
Baroness Wheeler (Lab)
My Lords, we had a good debate in Committee on the issue of self-care and the management of health conditions, particularly on its importance as a key part of the primary care pathway. This was underlined in diabetes care and, as I also emphasised, in the care and treatment of people with rare diseases, most of whom are living with lifelong conditions. As vice-chair of the Specialised Healthcare Alliance of charities supporting this key group of patients, I know that they often do not feel sufficiently supported in terms of care and support and health and system information, and with physical and daily living.
As the two noble Lords have stressed, the Health Foundation’s research on the effective self-management by patients has shown a significant reduction in the need for emergency admissions to hospital and in A&E attendances, and fewer GP appointments. In this context, Amendment 165 makes a great deal of sense. If patients with, for example, rare diseases receive appropriate support to manage their less intensive care needs, then promoting self-care has the potential to help them prevent their conditions from deteriorating, to improve their lives and to reduce demands on the NHS, as the noble Lords have stressed.
We therefore strongly support the need for the development of a national self-care strategy, starting with awareness raising among primary and secondary children on how to self-care, and with appropriate staff and management training of healthcare professionals. Improved technologies, as underlined by the noble Lord, Lord Clement-Jones, especially those developed during the pandemic, will have a key role in broadening access to effective self-care and ensuring the better support from primary and community pharmacists that we all want to see. I hope the Minister will respond positively to this amendment.
Baroness Penn (Con)
My Lords, I thank the noble Lord, Lord Hunt, for bringing forward a debate on this issue. I reassure him and other noble Lords that the Government absolutely agree that supporting people to maintain their health and well-being and to manage self-treatable conditions is a vital part of delivering a comprehensive health service. Indeed, much of what the amendment seeks to achieve is already government policy. However, I do not agree that requiring the Secretary of State to prepare a single national strategy would add value. Instead, we are threading self-care through a wide range of work, reflecting the range of areas that it impacts upon.
A good deal of work is already under way. The community pharmacy contractual framework for 2019 to 2024 five-year deal sets out how community pharmacy will support the NHS long-term plan. Community pharmacies, which provide easy access to the NHS, are already required to support patient self-care, signpost to other parts of the NHS and local services as necessary, and help people to live healthily.
I am especially aware of the interest the Proprietary Association of Great Britain has shown in this area. The Department of Health and Social Care officials have met with it to discuss its blueprint for a self-care strategy in England and will continue to engage with it about further supporting self-care throughout our healthcare system.
We do not think placing an additional duty on the Secretary of State would be the right way to support this work, as it would take it out of the NHS long-term plan, where it belongs as part of a holistic approach to the provision of a health service. It could risk making it more disjointed rather than integrated in its approach, but noble Lords made a really important point about demand on our health service and the role that self-care has in this. Prevention was a key theme of a speech by my right honourable friend the Secretary of State last week and, clearly, elements of self-care and prevention go hand in hand with each other, particularly in the use of new technology.
Noble Lords also made an important point about how we can use self-care, particularly at community pharmacies, to reduce pressure on GPs and A&E departments. All community pharmacies are required, as I said, to provide support for self-care. To ensure that people get directed to the right support for their health needs, we have introduced referral systems from NHS 111 and GPs to pharmacies for advice and treatment for minor illnesses. We are also exploring expanding referrals from other settings, including urgent treatment centres and A&E to community pharmacies.
I hope that gives noble Lords some reassurance that we place an importance on self-care, as part of our health service. That will only increase in future and work is under way in multiple areas of the health service to do that. I hope, therefore, that the noble Lord is able to withdraw his amendment.
Health and Care Bill
Baroness Wheeler ExcerptsFriday 4th February 2022
(4 years, 5 months ago)
Lords ChamberRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: HL Bill 71-VIII(a) Amendment for Committee - (3 Feb 2022)
Baroness Walmsley (LD)
My Lords, I certainly support these three amendments so ably introduced by the noble Lord, Lord Hunt, and the noble Baroness, Lady Cumberlege. The beauty of their presentations is that they not only outlined the terrible suffering that can be caused by the things we are discussing but came up with very reasonable solutions to make the situation better. That is what we always try to do in your Lordships’ House.
My noble friend Lord Storey put down Amendment 297E in this group. Because he was unable to make it today, I do not intend to speak to it. I do not think that would be appropriate in case he wishes to bring it back on Report. I think he would be happy to support all three of the other amendments, in particular Amendment 268 from the noble Lord, Lord Hunt.
I was interested to hear the noble Baroness, Lady Hodgson of Abinger, say just now that clinical negligence costs £2.26 billion per year. That is about the same as the whole budget of the Ministry of Justice and, as a result, hardly anybody can get legal aid these days. That is a very good reason why we should look carefully at the performance of NHS Resolution. There is clearly no incentive for the NHS lawyers to get things through quickly, because they are being paid anyway. The fact is that there is no equality of arms; I have said this on this subject before. It should be a principle of justice in this country that there is equality of arms, but in this case there is not—so I very much support the noble Lord, Lord Hunt.
Baroness Wheeler (Lab)
My Lords, this is an important group and there is little to add to the expert contributions on the amendments, which have been spoken to so comprehensively. We have always championed the need for patients’ voices to be heard and listened to in the care and treatment they receive, and are doing so in pressing for the patient voice to be properly embedded in the new structures established under the Bill.
When appalling safety incidents occur, such as those so graphically spelled out in the First Do No Harm report from the noble Baroness, Lady Cumberlege, we need not only to ensure that there are effective systems to make sure that victims receive the care, treatment and proper financial compensation needed but to enable the NHS to acknowledge and learn from what has happened, both to prevent further harm and to promote future patient safety.
In opening this group, my noble friend Lord Hunt made a strong case for an urgent, expert-led review of the 40 year-old Vaccine Damage Payments Act in the light of major developments and growth in vaccine usage and, of course, huge gains in population health and ill-health protection as a result. But the small numbers of individuals and their families who sustain serious injury or adverse reactions to vaccines—now to the fore as a result of the highly successful Covid vaccination programme—need legislative protection and a scheme that is up to date, fit for purpose, properly resourced and based on compensation levels and criteria that fully reflect the needs of today’s victims.
I am sure the noble Lord, Lord Storey, would have made an equally strong case for the repeal of the NHS Redress Act, a slightly younger 16 year-old scheme for adverse health incidents, which is out of date and also not fit for purpose.
The noble and learned Lord, Lord Mackay, led an expert and informed debate in Grand Committee last December on the NHS clinical negligence scheme and its ever-escalating costs, which is reflected today in my noble friend Lord Hunt’s Amendment 268 and its call for a major review of the scheme, including consideration of the Law Reform (Personal Injuries) Act and repealing its Section 2(4).
Health and Care Bill
Baroness Wheeler ExcerptsWednesday 26th January 2022
(4 years, 6 months ago)
Lords ChamberRead Full debate Health and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: HL Bill 71-VI(a) Amendments for Committee (Supplementary to the Sixth Marshalled List) - (26 Jan 2022)
Baroness Wheeler
“(4A) The indicators of quality set by the Commission under subsection (4) must include—(a) whether national standards in the care of people with rare and less common conditions are being met;(b) whether the views of patients with rare and less common conditions are being represented;(c) whether people with rare and less common conditions have access to a named clinical nurse specialist.”Member’s explanatory statement
This amendment would require integrated care boards to be assessed by the Care Quality Commission on the provision of care for people with rare and less common conditions, in particular.
Baroness Wheeler (Lab)
My Lords, Amendment 164 heads this wide-ranging group and probes how the proposed Care Quality Commission rating system for ICBs’ work in practice, with a particular focus on rare and less common conditions, although this debate is more broadly relevant to all aspects of the CQC’s role.
Amendments 178 and 240 from the noble Lord, Lord Sharkey, to which I have added my name, also relate to people with rare diseases and their access to innovative medicines and medicinal products, and the general need for awareness-raising about those conditions among health and social care staff. I remind the Committee of my role as vice-chair of the Specialised Healthcare Alliance. The noble Lord will speak to those amendments later.
The group also covers amendments on wider care and safety issues that impact on patients, including ensuring that liothyronine T3 is available to patients when it is prescribed by a doctor and the regulation of healthcare and associated professions. This includes safeguards to apply under the Secretary of State’s power to alter the professional regulatory framework; protecting the use of the title “nurse”; hospital food standards for patients and training for staff; reviewing the surgical consultants’ appointment process; and licensing aesthetic non-surgical cosmetic procedures in registering cosmetic surgery practitioners.
The noble Lords who have their names to these amendments will speak to them, so I will leave them to it and concentrate on my rare disease issues and the matters that our Front Bench team have added their names to. Returning to the CQC, and following on from the previous debate on Clause 26, on the amendment tabled by the noble Lord, Lord Lansley, regarding the role of the Secretary of State in setting objectives and priorities, overall, we welcome the extension of the CQC’s remit to ICBs but now need to understand how it will work in practice.
As it stands, the Bill establishes an overarching framework under which the CQC will need to determine for itself the quality indicators against which it will assess ICBs. My amendment raises the issues about the quality indicators relevant to those with rare and less common conditions. If the purpose of the rating system is to protect patients, it must help to ensure that national standards of patient care, where they exist, are being met. Under the NHS’s plans to jointly commission or delegate commissioning responsibility for specialised services to ICBs, set out in NHS England’s Integrating Care paper, an important assurance given is that specialised services will
“continue to be subject to consistent national service specifications and evidence-based policies determining treatment eligibility.”
Will the CQC ensure that services organised by ICBs are organised in line with these national specifications?
Moreover, people with rare diseases are concerned that if services are to be commissioned in some way by ICBs in future, rather than just NHS England, their voices may be lost. NHS England’s specialised commissioning team meets regularly with representatives of the rare disease community, including the SHCA, and it is important that ICBs can hear their views too. How will this happen and how will the CQC rating system act to ensure that this happens?
Finally, one of the key asks of patients with rare diseases to help deliver continuity in their care is that they have access to a named clinical nurse specialist, which is commonplace for patients with more common conditions. That continuity of care is an important marker of quality. Will the CQC rating system help to deliver it?
Beyond these questions are broader ones. If the bulk of the CQCs work will continue to focus on inspecting providers, can the Minister explain how it will ensure that its ICB ratings are not unnecessarily duplicative, given that providers will form part of ICBs? Also, the CQC looks at whether services are safe, effective, caring, responsive and well led. Given that the first three of these should continue to be the primary concern of those providing care, rather than of the ICBs organising it, how will the CQC ensure that the new rating system clarifies rather than dilutes this accountability? How will the CQC’s work align with the wider performance management of ICBs undertaken by NHS England? How specialised services will operate is a complex area and I am happy for the Minister to write to me on some of the specifics of my questions.
As I said, I will speak briefly to other amendments in this group, to which Labour Front-Benchers have added their names. Amendment 243, tabled by my noble friend Lady Merron, covers the important issue of the protection of the title “nurse”, and is supported by three respected medical and healthcare professionals whose contributions I look forward to. The recent Health Service Journal survey found hundreds of roles that do not require Nursing and Midwifery Council registration but use “nurse” in the job title. While “registered nurse” is a title protected by the NMC, “nurse” is not. The term may be used by anyone in the UK to offer professional advice and services, and people with no nursing qualifications or experience, or who have been struck off the professional register, may use it.
Obviously, this is worrying and even dangerous—a dangerous trend which potentially compromises patients’ health. What progress is being made on the Government’s review of healthcare professional regulation following their consultation last year? Surely we must follow the example of other countries, such as France and Australia, in giving the consistently most trusted profession in the UK the recognition and protection that it deserves.
My noble friend Lady Thornton has added her name to Amendment 258, from my noble friend Lord Hunt, to the welcome new Clause 145, on hospital food standards. It underlines the importance of investment in the food served to patients in hospital and other care and treatment settings. It is welcome because it specifies food quality and standards and stresses the importance of recognising staff skills, experience and training, as well as ensuring investment in NHS kitchens and catering equipment to ensure that the highest standards can be maintained.
On Amendment 266 from my noble friend Lady Merron, we seek to give the Secretary of State power to introduce a licensing regime for aesthetic non-surgical cosmetic procedures and to introduce an offence of practising without a licence. This area is crying out for regulation. The Department of Health’s own report has said that non-surgical interventions which can have major and irreversible adverse impacts on health and well-being are almost entirely unregulated. We fully recognise that this is also a highly complex policy area. However, I understand that noble Lords concerned about this issue had constructive and positive discussions yesterday with the Minister, and I look forward to the Minister updating the House on the scope and discussions of the Government’s ambition in this important area.
Finally, I offer my strong support for my noble friend Lord Hunt’s Amendment 176, which seeks to ensure that the general powers of the Secretary of State to direct the functions of NHS England include ensuring that when T3 is prescribed to patients with hyperthyroidism, the drug is made available to them. My noble friend rightly raises this issue at every opportunity, and I hope the Minister will have a bit of good news for him today and tell us that some real progress has been made. It is clear that many thyroid patients would benefit hugely from the declassification of T3 as a high-cost drug, back to a drug that is routinely prescribed in primary care. It is much cheaper now, and the many patients who were taken off the drug and continue to be denied it need to have it restored. The Government must ensure that the now updated NICE guidelines which reflect this new position are implemented consistently across the new NHS structures, rather than repeat the record of the nearly 50% of CCGs which failed to ensure that the drug is properly prescribed.
I will leave it at that, and I look forward to the debate.
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)
I remind the Committee that both the noble Baronesses, Lady Brinton and Lady Masham, will be contributing remotely. I call the noble Baroness, Lady Brinton.
Lord Kamall (Con)
If it is as straightforward as the noble Lord suggests, I will see if that can be done.
Baroness Wheeler (Lab)
My Lords, I thank noble Lords for their many expert and very informative contributions. It has been a fascinating debate on a number of issues.
On specialised care services and rare diseases, I note the Minister’s comments and thank him for some of his reassurances, but there were some issues that he did not cover, particularly in relation to my noble friend’s Amendment 178. However, I welcome the dialogue that is taking place on these issues, and the recognition of their complexity, and am very hopeful that that will continue. We will take stock to see if anything else needs to come back on Report. I also thank my noble friend Lady Pitkeathley for her support on this issue.
In the general debate, noble Lords will, I am sure, follow up on the points that they made, as the noble Lord, Lord Patel, just did. I thought the contributions of my noble friend Lord Hunt and the noble Baroness, Lady Barker, on the hospital food situation, really drove home the importance of this issue. We must make progress on it and move forward.
On the title “nurse”, strong support was expected and we certainly got it from across the House. I hope that progress can be made. The issue will not go away, as the Minister knows, and neither will the determination of my noble friend Lord Hunt to pursue the issue of the availability of T3 for thyroid patients. We hope that progress can be made on that, because again it is a situation that a must be addressed.
The noble Baronesses, Lady Masham and Lady Brinton, and other noble Lords made valuable points on the vital need for a licensing regime for non-surgical cosmetic procedures, again underlining the need for urgent, step-by-step progress, and demonstrating in particular why the current situation is unacceptable. Progress can be made. As the noble Lord, Lord Lansley, pointed out, it was seen in the recent Private Members’ Bill on Botox fillers. We need progress to be made, and steadily.
Finally, on the reference to when the review of the regulatory system will be completed—the noble Baroness, Lady Walmsley, also raised this—the issue was about timescales. We know there is a review. We are told that KPMG is on the case and has delivered its report, but we need timescales and action as soon as possible.
With those comments, I beg leave to withdraw my amendment.