Care Home Staffing

Lord Allan of Hallam Excerpts
Thursday 18th January 2024

(4 months, 2 weeks ago)

Lords Chamber
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Lord Allan of Hallam Portrait Lord Allan of Hallam (LD)
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My Lords, as the Minister has likely anticipated, 2024 is going to be a year when we keep hassling him for a long-term workforce plan for social care. Assuming he is not going to announce the imminent publication of one, can I at least ask him to commit to commissioning and publishing an independent report into the potential impact of the visa changes described by the noble Baroness, Lady Pitkeathley? The Government are of course entitled to make it harder to get visas, but they should be upfront and transparent about the downstream effects.

Lord Markham Portrait Lord Markham (Con)
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The Home Office has made an impact assessment of that. It thinks it will impact about 20,000 staff; we recruited about 100,000 last year. The main thing is that, by making sure that only CQC-registered bodies are able to recruit in this way, we are trying to make sure it is done in the correct, ethical manner by high-quality providers, which I think we would all agree is the right approach.

Dementia

Lord Allan of Hallam Excerpts
Thursday 18th January 2024

(4 months, 2 weeks ago)

Grand Committee
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Lord Allan of Hallam Portrait Lord Allan of Hallam (LD)
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My Lords, I am grateful to the noble Baroness, Lady Browning, for this debate. There are some repeated themes to our questions and debates that we need because these are complex challenges affecting millions of people that require a hard slog and real attention to detail. I have learned a lot about the specific challenges and solutions from all the speakers in the debate.

I will first return to some of the issues raised in the Oral Question on social care today. The noble Baroness, Lady Donaghy, rightly flagged it is not just the number of care workers, but their skills, which are quite different for carers who have to deal with people with dementia. I hope the Minister will talk, as he did earlier, about the Government’s intention to upskill care workers.

On the numbers, it is important that much of this care will be delivered in the home, over the long term, yet the skills care data shows that vacancy rates are higher in the domiciliary sector than in care homes. They are still running at over 10% and are barely improving. Does the Minister agree that we need to make social care roles more attractive, which must involve decent salaries that increase as skill levels increase? Is he concerned about the acute problems in the domiciliary sector? The numbers suggest that the Government’s actions to date have not had the same effect there that they may have had in care homes.

Another key issue that I want to raise is around long-term conditions generally and specifically dementia. There is a lot of discussion about who pays for these services and which budget they come from. The noble Baroness, Lady Berridge, highlighted this with a very graphic example. The questions are about who pays, where the budgets sit and, critically in this area, self-pay, which was referred to by the noble Lord, Lord Warner. These questions are still wide open; they have not been resolved. No one can say, hand on heart, that they understand what the long-term path is when someone has a diagnosis, who is going to pay for their care and how that will be resolved over the long term.

The split between the NHS and local authorities has long been recognised as an issue. Integrated care boards have been highlighted as the solution that bridges that divide. Can the Minister say how this is going for dementia services? Are there now examples of real pooling of resources for patient-focused services, which is the promise of the integrated care board? The noble Lord, Lord Weir, talked about the example of Northern Ireland, and my fear is that people are already queuing up to see the integrated care boards fail and that they will be booking another reorganisation of the NHS in England.

The example of Northern Ireland given by the noble Lord, Lord Weir, was very telling: he said that no one would go back. I hope that we do not go back; I am not wishing for that outcome. However, unless we see real pooling of resources, real patient focus and a genuine overcoming of this crazy divide where some public money is in Pot A and some in Pot B, we will not have made the progress that we needed. I hope the Minister agrees that dementia services in particular are a prime example of a test case on whether ICBs can deliver the promise that was in the legislation.

NHS: Drug Shortages

Lord Allan of Hallam Excerpts
Wednesday 17th January 2024

(4 months, 2 weeks ago)

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Lord Markham Portrait Lord Markham (Con)
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I thank the noble Lord for my proposed promotion. My noble friend Lord Moylan has also raised pancreatic cancer a number of times. To be absolutely honest, this is one of those cases where we are on a journey. I think we have got on top of certain areas, such as prostate cancer, about which we have increased awareness to ensure we get detection early on, but we do not detect pancreatic cancer early enough and, unfortunately, it is then often too late. We are working on something to try to correct that. The noble Lord is quite right to bring it up, and I am happy to write to him to tell him exactly what we are doing.

Lord Allan of Hallam Portrait Lord Allan of Hallam (LD)
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My Lords, I hope the Minister will revisit his department’s response to the Times today, which comes across as quite dismissive of genuine difficulties that many people across the country have with access to medicines. I encourage the Government to offer a service where people can report their individual experiences of shortages so that they can be aggregated into real-time public reports about what is happening across the country. If he wants an example of what this could look like, he could look at Downdetector, which does something similar for access to internet services.

Lord Markham Portrait Lord Markham (Con)
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I quizzed the team on exactly that Times newspaper report today, because like the noble Lord, they were saying that they did not recognise the numbers that the British Generic Manufacturers Association had produced. I wanted to understand why, and asked the team to sit down with them, and understand the differences, because one side or the other must be right. They are absolutely doing that, and will report back; I will be happy to update the House on the results of that.

Health: RSV Immunisation

Lord Allan of Hallam Excerpts
Wednesday 17th January 2024

(4 months, 2 weeks ago)

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Lord Markham Portrait Lord Markham (Con)
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As I mentioned, the tender is in place with a view to rolling it out in the autumn. Whether we go for the maternal vaccination or the infant one will depend on the communication plan, but I can assure my noble friend that a communication plan will be part of this ground-breaking rollout. Only one other public health rollout like this has happened in the world—in Galicia, Spain—so I am proud to say that we will be top of the list.

Lord Allan of Hallam Portrait Lord Allan of Hallam (LD)
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My Lords, during the pandemic, we learned the value of having a clearly identifiable owner of a new vaccination programme. Can the Minister tell us who the owner of the RSV vaccination programme is so that, in a year’s time, we can come back here either to congratulate them on a successful rollout next winter or to hold them accountable if it has not happened?

National Health Service: Key Targets

Lord Allan of Hallam Excerpts
Tuesday 16th January 2024

(4 months, 2 weeks ago)

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Lord Markham Portrait Lord Markham (Con)
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The noble Baroness is correct: staff numbers have gone up but, for a number of reasons that we are exploring, output has not gone up by the same amount. It is a key point, and I think all noble Lords agree that making sure we are getting value for money out of the service is important. We are engaged in a productivity study to discover the reasons right now.

Lord Allan of Hallam Portrait Lord Allan of Hallam (LD)
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My Lords, back in 2013, the Government set a target for the NHS to become paperless by 2018, which they later extended to 2020 when the target seemed too ambitious. This may come as something of a surprise to the millions of people who continue to have regular paper-based interactions with the NHS. Could the Minister tell the House when he now expects the target for the NHS becoming fully digital to be met? Would he agree that it is now even more important that we achieve it than when it was first set over a decade ago?

Lord Markham Portrait Lord Markham (Con)
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I definitely agree that it is more important, and that is why I am pleased that we have made such progress. If we look at one area in terms of hospital records being available and doctors’ records to patients, that has gone up since the beginning of the year from about 1% of GPs to about 90% today. About 90% of all our hospital records are now digitised, compared to less than 3% in Germany. We have made massive progress, and it is key to all of the reform and to improving productivity across the NHS.

NHS Winter Update

Lord Allan of Hallam Excerpts
Thursday 11th January 2024

(4 months, 3 weeks ago)

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Baroness Merron Portrait Baroness Merron (Lab)
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My Lords, the Government’s urgent and emergency care recovery plan promised the largest and fastest ever improvement in emergency waiting times in the NHS’s history. Yet it has not delivered in preparing the NHS for the winter, which we should remind ourselves is a season that, as sure as eggs are eggs, appears every single year. It should be no surprise to any of us, including the Government.

To take just one shortcoming, the plan talked about lowering bed occupancy rates as “fundamental”, yet in November, at the start of winter, bed occupancy was at its highest level since the start of Covid. It stood at 94.8%, a level which will surely lead to serious issues. Did the Government consider taking any additional action to lower occupancy rates? What steps will they now take to ensure that this is not simply repeated every single year?

Today, there have been a number of reports in the media, and I want to refer to two of them. We have read reports that NHS England has confirmed that the NHS is failing to meet all of its key targets: patients are waiting even longer in A&E, even longer to start routine treatment, even longer for cancer diagnosis and treatment, and even longer to be admitted to hospital or for an ambulance to arrive. This is a damning indictment. Perhaps the Minister could tell us the Government’s response to the reports of NHS England today. Also in the news, the Health Service Journal reported that trusts are being told by service commissioners for Lancashire and South Cumbria that, due to the expected deficit, they should plan for a 10% cut in contract values on top of the annual efficiency savings that they are already planning for next year. What is the Minister’s response to this worrying situation? How will it affect services, not just in winter but all year round? How many other trusts across the country are in a similar position?

I would like to pick up a matter strongly defended by the Secretary of State in the other place when this Statement was first made to Parliament—the matter of 800 new ambulances. These ambulances were promised by the Government to help NHS trusts tackle the crisis of ever-worsening response times. But freedom of information requests found that, across 10 of the 11 ambulance trusts in England, there were plans to order only 51 new ambulances. I would like to give the opportunity to the Minister to share any information that is missing from the responses from ambulance trusts that would show that the information referred to in the FOI request was mistaken in some way. Perhaps the Minister could also provide more detail on what NHS England referred to as a problem in procurement due to the impact of global supply chain pressures, and on whether and when it is expected pressure will subside, so that we will see all the promised new ambulances. What performance improvements are to be expected from the 51 new ambulances that we know have been ordered? How would this compare with the full 800 that were promised, had they been procured?

The Government’s Statement presents as a combination of somewhat selectively chosen numbers and situations that do not recognise the reality of a health service in which patients cannot get appointments with their doctors, dentistry is in crisis, and unprecedented numbers of people are having to wait unduly for surgery, cancer diagnosis and treatment, and their ambulances—and all of this while striking doctors are being blamed for the whole situation. The strike action by junior doctors has been the longest in NHS history, with trusts declaring critical incidents and A&E departments telling some patients to stay away to lessen the load. This is a situation that I am sure the Minister will tell us cannot continue, but it continues to disappoint that the Government do not see it as their responsibility to show leadership and resolve the dispute. Could the Minister advise the House of the steps the Government are now taking, or will take, to ensure that we do not see a continuation of this damaging situation?

Finally, I would be keen to hear from the Minister on an aspect of the winter health situation which was not mentioned in the Statement regarding Covid. In the run-up to Christmas, according to the Office for National Statistics, 2.5 million people were thought to have Covid. What assessment have the Government made of this increased prevalence and what impact has it had on the NHS so far this winter? What assessment have the Government made of how the impact may continue? I look forward to the Minister’s response.

Lord Allan of Hallam Portrait Lord Allan of Hallam (LD)
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My Lords, we should start by recognising and thanking the nearly 3 million health and care workers whom we depend on all year but who have to work especially hard during the winter months. We should also show our appreciation for the many millions more informal carers who spent the festive period looking after family and friends. That was the nice bit, but I now turn to some questions for the Government on what I thought was a predictably upbeat, “It’s all going swimmingly except for the strike” Statement; yet within it there were some significant gaps, some of which the noble Baroness, Lady Merron, pointed out.

It is notable that the Statement says nothing about primary care but instead focuses very much on hospital beds, which I will come to next. Can the Minister comment on how GP appointment waiting times remain unacceptably long in many parts of the country? This is a poor outcome both of itself and in terms of the knock-on effect it has on emergency services. I hope that the Minister can confirm that the Government have been monitoring GP waiting times during the winter months, and that he can indicate what they are doing about these.

The Government say they have added 3,000 hospital beds as part of their 5,000 target. That target was part of their response to last year’s crisis. Does the Minister have any new data on the utilisation of those beds and whether this matches up with the predictions the Government made when they set the target, and any analysis they made to come up with the 5,000 number in the first place? The Statement also highlights the 11,000 virtual beds that are now available, which instinctively seems like a positive development to me. But the important thing is how a broad range of people experience these and the health outcomes they deliver. What are the Government doing systematically to collect data about those virtual beds and whether they have been able to deliver a comparable level of care for people who are suffering during the winter pressures?

Another key area of delivering emergency care in winter is the availability of ambulances, which was rightly flagged by the noble Baroness, Lady Merron. The Minister may have seen a report in the Health Service Journal from 30 November last year, which said that in some areas there is a mismatch between the number of paramedics recruited and the number of ambulances available. It is great that the paramedics have been recruited, but if they are sitting around in the base stations because the vehicles are not there, that does not deliver the improved waiting times we are all looking for. I hope the Minister can comment on this report and whether the Government are able to deliver the vehicles in lockstep with the newly trained paramedics, which is what we all wish to see.

A further element of the response is the 111 service for less-urgent services, which, again, is not mentioned in the Statement. There are concerns about whether people are being directed to the right place—111, GPs, 999 or accident and emergency departments. Are the Government monitoring the performance of 111 in respect of flu, Covid and other winter respiratory diseases?

Finally, we have often discussed patient flow through hospital and out into the community with the Minister, who I know takes a particular interest in this. We know that some trusts are piloting systems to improve flow that could be described as like hotel booking systems that enable beds to be made available in a much more efficient and timely fashion. Will the Government compare the performance of trusts that have these systems in place with those that do not, as they go through this acute period of pressure in the winter months?

Lord Markham Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
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I wish everyone a happy new year and share in the thanks given by noble Lord, Lord Allan—and, I am sure, the noble Baroness, Lady Merron—for the hard work all the staff put in over the Christmas period. We have done a lot of work to prepare for this winter, and that was based on expanding supply. I will go into more detail in answering the questions so far, but that included the 5,000 additional beds, of which 4,000 are currently in place. It included the 11,000 virtual wards and 800 new ambulances, and again, I will answer some of the specific questions about the utilisation of those. It included the £600 million for adult social care discharge and the 141 CDCs, with 6 million more diagnostic tests, and the 50,000 increase in nurses—as well as mental health.

Of course, there have also been 50 million more primary care appointments since 2019, to answer the point made by the noble Lord, Lord Allan. That was accompanied by extensive planning, as I have seen. We have really tried to learn a lot of lessons from last year and get ahead of the curve with earlier plans, putting key management support teams in place to provide help in the areas where it is most needed. Everything is underpinned by a stronger technology infrastructure, digitalisation and the patient flow systems.

We are really trying to get ahead, so we brought forward the flu and Covid vaccines, so that, hopefully, we can make the situation better. I will not say that it is anything more than early days, or that one swallow makes a summer, but there are some promising early signs. On ambulance handovers, we have seen a 20% reduction in lost hours. The figure for category 2 response times is 45 minutes; it is still too long, but it is half that for this time last year. As for patient flow and the use of the system, we have seen a 10% reduction in so-called bed blocking, partly because of the flow mechanisms and partly as a result of early investment in the discharge fund.

All that is against the background of increased activity—and, of course, the strikes. To date, they have cost us 1.3 million lost appointments, 113,000 most recently. I say to the noble Baroness, Lady Merron, that we have tried to behave in a reasonable manner. We have reached agreements with all the other professions—the nurses, physicians, consultants and specialist doctors—and we have shown leadership, alongside the unions, in doing so. In contrast with that reasonable behaviour, the 35% pay demand is not reasonable, and nor is planning strike action at the busiest time of the year. Coming out only twice, when you have been asked 40 times by NHS trusts to act on patient safety, is also not reasonable behaviour. We want to resolve this issue. We have shown a capacity to resolve it in other areas, and we have shown leadership. I ask the BMA and junior doctors to come forward with reasonable expectations, and let us resolve this right now.

I have a polite suggestion to make. I thought that the noble Baroness, Lady Merron, might raise the issue of NHS targets. People know that I am a reasonable person, and the last thing I am going to do is say that all is rosy in the garden, but we are showing some solid improvement. I am definitely not happy with the fact that the England targets for a four-hour wait and 62-day cancer care were last met in July 2015. But I note that they have never been reached in Wales, which Labour has been running. In Wales, the 62-day cancer care target was last reached in 2010. Also, if you are in Wales, you are much more likely to be on a waiting list: 21% of the population are on a waiting list, compared with 13% here. In Wales, you are likely to wait five weeks longer, on average; and 50% of the time, you will wait for more than four hours in A&E, compared with 40% in England.

The England results need to be better, and we are working to make them better, but I politely suggest that the Opposition might want to look at where they are running the NHS and see what they can do to improve that, because on every standard you see a poorer performance from the Labour action in Wales. That is what all the evidence tells us.

I will try to answer some of the specific points. On ambulances, 300 new vehicles have been delivered to date. There is an issue with one supplier, but we are confident that the 800 new vehicles will be delivered. It is those, alongside the paramedics, that are allowing us to address ambulance wait times and bring them down. The 111 number is now on the app and is really directing traffic; it is up 8% versus last year, so, again, we are seeing real improvements. I think I mentioned that patient flow is improving as well.

On Covid, bringing forward the vaccinations has been helpful in terms of prevention. While we would all accept that 2.5 million is a large number, if we look at the number of beds being taken up by Covid and flu this year, we can see that it is half the number that it was last year. It is still a big number, but it is half what it was. We are in the early stages and a lot more work is needed, but one reason we are starting to see these improvements is that we have tried to get ahead of the curve with those vaccinations.

As regards virtual wards, so far we have about 70% utilisation of those. We need to collect the data; noble Lords have heard me say before that the results from virtual wards in places such as Watford and elsewhere show good results in terms of both satisfaction and, most importantly, not returning to hospital. Where people have gone into a virtual ward rather than just going home, there has been a reduction of as much as 50% in people having to return to hospital environments. So we are seeing results.

In terms of primary care, as I mentioned, we have seen 50 million more appointments take place. Pharmacy First, which will be introduced shortly, is a key way of expanding that supply still further. So I say politely that, yes, there is a lot more work that will need to be done, but we really have expanded supply. We have put plans in place, and the early signs are promising. I hope, like all of us, that we will see far more of this and I look forward to updating the House as the season progresses.

NHS App: Medical Records

Lord Allan of Hallam Excerpts
Tuesday 19th December 2023

(5 months, 2 weeks ago)

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Asked by
Lord Allan of Hallam Portrait Lord Allan of Hallam
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To ask His Majesty’s Government what measures they have put in place to mitigate the risk of people being coerced into showing their confidential medical records to third parties as records become universally available through the NHS app.

Lord Markham Portrait The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
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The Government want people to have access to their own records. For most, online record access is beneficial but for a minority, having access could cause harm or distress. In many cases, practices can identify these patients and ensure that safeguarding processes are in place. Furthermore, to access the NHS app, users must prove their identity through the NHS log-in and, before entering their record, are advised what to do if they are being pressurised to share their information.

Lord Allan of Hallam Portrait Lord Allan of Hallam (LD)
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My Lords, the design goals for the NHS app should be to make it as easy and frictionless as possible for legitimate users to access the system, while making it as difficult and frictionful as possible for people trying to gain unauthorised access. But there is a natural tendency to focus on the first part of this equation as developers believe in the systems they build and find it hard to put themselves in the shoes of the cunning and resourceful attackers who will try to break them. Given this dynamic, can the Minister confirm that the NHS has a red team tasked with trying to identify all possible vectors of attack on the NHS app, and that the requisite resources will be put into mitigating any risks that they identify?

Lord Markham Portrait Lord Markham (Con)
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The noble Lord is absolutely correct on getting that balance right between the two; that is why the NHS has a safeguarding reference group on exactly this, which has been putting in protections as well as messaging patients, telling them to be aware and that they have the opportunity to redact their records if they are concerned. There are other features, such as multi-factor authentication and making sure that, for log-in with facial ID, you cannot have anyone else in the picture, to ensure that people are not being coerced. So, there are a number of measures in place, but I completely agree that we need to keep them under review with user groups checking all the way.

Organ Donations

Lord Allan of Hallam Excerpts
Tuesday 12th December 2023

(5 months, 3 weeks ago)

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Lord Allan of Hallam Portrait Lord Allan of Hallam (LD)
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My Lords, I am very grateful to the noble Lord, Lord Hunt, which takes me back more than a decade to when I worked at Facebook. That may seem like a weird connection, but back in those days when Facebook was connecting people for social good—before we went on to destroy democracy—one of the programmes we ran was encouraging the uptake of organ donor registers. There were people connecting on the social media platform to arrange donations and we extended that and said that it was great to use our platform to get out there and encourage people to sign up. There was a slight flaw in that this was all designed from the US perspective, where of course it is an opt-in register that you sign up to when you get your driving licence. That worked for the US because nearly everyone has a driving licence, but when we tried to roll it out across the world I had to tell colleagues that the US model is not always present. We started to look at the variation across different systems and recognised that there was opt-in, opt-out and 99 different varieties of organisational structures for organ donation.

Fast forwarding to where we are now, the law has certainly moved on since those days, not least thanks to the efforts of the noble Lord and others who took through the law change in England. As he pointed out, a lot of those shifts in the law are predicated on assumptions about an uplift that will happen. He cited the figures, which I also saw, that there would a shift from 61% of people consenting to donation to 78%, yet the numbers show us that it has not happened and that the change has been much less dramatic.

Of course, Covid intervened, so the data we have, for England in particular, is not especially helpful and will not be for a little while as we get back to more of a “business as usual” situation. But there is really interesting data from other countries. Part of the fascination of being a spokesperson in this place is that it does encourage you to learn and read about things that you did not understand before, and to take that curiosity.

I found a fascinating 2021 paper from an academic called Harriet Etheredge in the Risk Management and Healthcare Policy publication, which I recommend, if noble Lords have not read it. She goes through the difference between opt-out and opt-in systems in a very readable and accessible way. The short version of her summary is that a shift to opt-out is not the silver bullet many people hope it will be. Rather, she concludes that actual rates of donation—which is what we are concerned about at the end of the day, not the rates of who has opted in or out; it is ultimately about the number of organs that end up being donated—relate to many other factors in a country’s healthcare system. She says it is very much about looking at specific local barriers and building local trust.

I want to build on the comments of the noble Lord, Lord Hunt, and to address the specific barriers in England in particular—that is what we are talking about in this debate—thinking about what builds trust in England.

The data in the House of Lords Library note, which was again helpfully supplied for this debate, tends to reinforce the view that it is not all about opt-in or opt-out. It tells us that the top-rated countries are the United States and Spain, the United States being an opt-in country. In the paper, Spain is described as not pure opt-out; it is seen as an opt-out country but in fact it is more of a hybrid model. Again, as the noble Lord, Lord Hunt, described, the Spanish example is very instructive because it is not necessarily the register that has got Spain to those levels. Academics suggest that it took Spain 10 years from moving to the hybrid opt-out model to get to those high rates. It got there by investing in the transplant services and in family counselling in particular, in order to get ahead of the moment when a decision is made. When you know someone is likely to be a donor, you start the conversation with the family at that stage, so that when the decision has to be made, a lot of the work has already been done and people have a much greater level of understanding.

Harriet Etheredge does, in passing, talk about the hard opt-out model whereby families cannot overrule— I think that was introduced in Brazil—but suggests that there was a significant backlash. So, there are major concerns about a model whereby families cannot overrule if there has not been an express wish. That is worth considering. I can instinctively see why it does not take many negative stories about families who really object to being overruled for the whole system to fall into disrepute; that was certainly the situation in Brazil.

The paper looks at other national situations. Harriet Etheredge highlighted Singapore, which is interesting because it is ethnically, religiously and culturally very diverse. Referring again to the comments of the noble Lord, Lord Hunt, there may be some really interesting lessons to learn from Singapore. It has an advanced healthcare system, but people’s social attitudes are quite diverse. For example, it has a large Islamic community, which has traditionally been more sceptical about and had more concerns about organ donation. Singapore has managed to work through those, and there may be something important for us there.

The importance of education and trust in the system cannot be overstated. That is particularly true for the families. We can educate ourselves, as potential donors, but the other critical parties are the families who are sitting around us if ever it comes to the point when that donation may be about to be made. Perhaps we do not focus enough effort on educating families about how they should approach that situation. They are in an incredibly distressed state at the deathbed of a relative, and that is the time to finish the conversation about organ donation, not start it. A lot of education upfront would be very useful.

It is essential to have staff who have the time to do this very labour-intensive work; again, the noble Lord, Lord Hunt, talked about blood and transplant services. It is incredibly labour-intensive to sit with people for perhaps hours as they say, “Yes. No. Yes. No”, going backwards and forwards, as we all might do in that situation. That is not something our NHS is traditionally geared up to do; it is more a case of “make a decision and move on”. Co-ordination is also labour-intensive; it is very on/off, and it requires many hours of people’s time. I will be interested to hear from the Minister where this fits into the workforce plan, given that we need this particular skillset and capacity.

The other key flag raised relates to transparency and accountability. If we are going to have public consent, there needs to be some understanding of the system as a whole, not just individual decisions. We can see how trust can be lost, given the range of stories we read every day about organ harvesting, unfair access to transplants, failed transplants and so on. We need to be mindful of that: for people to buy into the system, they have to see that the benefits outweigh the negatives. We all understand why, in many cases, the negatives are more newsworthy, but I do worry that trust is lost. Every time there is an organ harvesting story, we may say that that has nothing to do with the NHS and organ transplanting, but people out there start to associate transplants with something dark and negative, rather than positive and life-giving. I will be interested to hear how the Government intend to address that.

It would be unwise to assume that everybody will always see transplants as a priority. This touches on the points made by the noble Lord, Lord Weir. A double lung transplant, for example, requires a huge amount of resource. Probably all of us involved in this debate believe that we need to make that investment, and that it is a valid one for the NHS. But in order for people to understand the system as a whole, the Government need to keep repeating why investing in transplants—which will benefit a small number of individuals compared to other services that will benefit many more people—is critical and deserves to happen.

The noble Lord, Lord Hunt, set out six brilliant areas of focus, and I hope the Minister is able to work through those and, in his usual fashion, give us some meaty responses.

Adult Social Care: Staffing

Lord Allan of Hallam Excerpts
Tuesday 12th December 2023

(5 months, 3 weeks ago)

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Lord Markham Portrait Lord Markham (Con)
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I share the noble Baroness’s concern about the speed of deployment. At the same time, it is fair to say that we are developing a whole new set of social care qualifications, which we think we can all agree are key to this. We are also developing a whole new payment mechanism, because there are 17,000 independent providers and we need a mechanism to allow payment. It is a complex programme, but I agree that we need to do everything we can to speed it up.

Lord Allan of Hallam Portrait Lord Allan of Hallam (LD)
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My Lords, a key part of the equation for long-term social care sustainability is charging reform, yet the National Audit Office report points out that the Government have scrapped their charging reform programme board and have no overarching social care programme in place. Can the Minister confirm where responsibility for charging reform now sits, and whether we can expect any progress in this critical area in 2024?

Lord Markham Portrait Lord Markham (Con)
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Charging reform is still part of the Government’s commitment. At the same time, I think we all recognise that, largely as a result of the pandemic, we had to stabilise the social care situation first. That is what the £8.1 billion in funding has been all about and what the investment and recruitment have been for—so that we can stabilise first. I am glad to say that we are reaching a more stable footing. For the first time, staffing went up over last year and, likewise, the number of people in social care went up. We have to stabilise before we move on to the reform. I think we would all agree that the speed of reform needs to be a bit quicker, but it is sensible that we stabilise the situation first.

Strikes (Minimum Service Levels: NHS Ambulance Services and the NHS Patient Transport Service) Regulations 2023

Lord Allan of Hallam Excerpts
Wednesday 6th December 2023

(5 months, 4 weeks ago)

Lords Chamber
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Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (GP)
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My Lords, in speaking after the noble Baroness, Lady Merron, I must respectfully disagree with and indeed correct her on one point. I do not now accept that your Lordships’ House does not have the responsibility, in exceptional circumstances that I have set out before, to act to stop statutory instruments that should not go through. However, your Lordships will be pleased to know that I will not rehearse all the arguments I referenced in my earlier speech.

I also correct the noble Baroness on her suggestion that there has to be a Labour Government to protect the rights of working people. We have to get rid of the Conservative Government, but other options are available. The see-saw of politics that we have had for the past century has not served this country well, and its people are increasingly aware of that fact.

I am aware of the desire to move quickly to a vote, so I will be brief, but I will pick up a point from the Minister. Again, it is important in this debate to reference the briefing from the Royal College of Nursing, which stresses that the regulations seek to make trade unions responsible for breaking their own strikes. As the Royal College of Nursing makes clear, the Government had claimed this is not about nurses, but there are nurses working for the services that we are now talking about. It seems so long ago that we were all standing on doorsteps clapping, cheering and banging pots for our nurses and other medical workers who were putting their lives on the line. Look where we are now.

The RCN briefing also makes the important point, as the Joint Committee on Human Rights noted, that the minimum service level requirements may impact more severely on certain protected groups—most obviously women in respect of nursing. This is a gendered attack on the freedom of members of the RCN. As the RCN says, and as others have said before, this whole approach makes strikes more likely, not less likely.

In a recent survey of RCN members, 83% of nursing staff said that the staffing levels on their most recent shift were not sufficient to meet the needs of patients safely and effectively. I, and I think all medical workers, strongly believe in minimum service levels. We need to have them every day, and the Government have not created a situation in which that is possible.

For the avoidance of doubt—we want to move on to other votes—I am not planning to divide the House on this but, in the meantime, to allow the debate, I beg to move.

Lord Allan of Hallam Portrait Lord Allan of Hallam (LD)
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My Lords, it is good that this instrument applies only to ambulance trusts in England. That is the last time I will use the word “good” in association with this statutory instrument, but it certainly reflects a lot of feedback, particularly by the noble and learned Lord, Lord Thomas of Cwmgiedd, and others, that we had during the debate on the primary legislation, when we felt we had to remind the Government that the health service is devolved and that it was inappropriate to seek to interfere too far. It was interesting to hear the Minister say that the Government have made an offer of assistance to the Governments in Wales and Scotland in respect of giving them these wonderful minimum service levels. I would love to be a fly on the wall for those conversations, which I am sure are very short.

I turn to the substance of the requirements. The people running local health services are like watchmakers looking after very complex mechanisms with many different moving parts. From time to time, we work with those professionals on health and care legislation that provides tools for them to tune and improve their services. What is before us today is not such an instrument but rather reflects that the Government have decided unilaterally to give local health authority managers a hammer, because that is what the Government think they need. Yet the feedback we have had from all those who work in the National Health Service, as cited by the noble Baroness, Lady Merron, is that they clearly believe that this is the wrong tool for the job. Given that feedback, it seems quite likely that many trusts will choose not to use the powers to issue work notices. If that is the case, perhaps little harm will ultimately have been done other than wasting parliamentary time on creating the law and the regulations.

But there is a worrying scenario, which we explored during the legislative process, that was not sufficiently addressed—where trusts that do not want to issue work notices nevertheless feel compelled to use them for legal reasons. I would like the Minister to come back to this today and provide some more compelling assurances. If an ambulance trust, after the passing of these regulations, wishes not to use this mechanism but instead to negotiate voluntary agreements, as the Minister said that he would like them to do, will it truly be free to make that choice? If politicians want to urge trusts to use the hammer of work notices that they have given them, that is one thing. They can deal with the political pressure. But if, by declining to use these notices, they will expose themselves to new legal risks, that is much more problematic. Trusts may then feel that they have to use the hammer, even where they believe it will cause more damage, because they cannot risk being sued for not doing so. Can the Minister give a clear guarantee that his department has looked into this thoroughly and determined that trusts will continue to be able to use their best judgment on what will cause least harm to the communities they serve?

Where a trust has exercised its judgment not to issue work notices and things go wrong, as inevitably may happen from time to time, for a variety of reasons, we need to know that the trust will not face action either from the department or from any other third party. Absent that assurance, the safe option may be to issue the work notices, for the trust to take the hammer to the watch, whether or not it thinks it is a good idea. This is the crucial point. If we are to believe the Minister’s reassuring words, that this will still create the scope for trusts to negotiate voluntary agreements and they will not have to issue these work notices, we need to know that the department has looked at this and can give us that kind of copper-bottomed guarantee, rather than simply saying it will not be a problem.

Lord Woodley Portrait Lord Woodley (Lab)
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My Lords, I declare an interest as a former leader of Unite the Union, which represents ambulance workers and other NHS staff up and down our country. My noble friend Lady Merron has powerfully laid out the arguments against the draconian regulations we are considering today. I will emphasise three points in the short time that I have now.

First, these regulations are entirely unnecessary. Trade unions already agree life and limb cover during strike action—noble Lords know that. These arrangements work well, giving confidence and flexibility if workers are needed to leave the picket line to respond to emergencies. We have always done that. Central to the NHS disputes over the past year are the unsafe staffing levels due to poor pay and retention. Why are the Government so keen on minimum staffing levels on strike days but do not care what happens when staff are not striking?

Secondly, these regulations will simply poison industrial relations between employers and workers, as all the impact assessments have shown us. When you deprive somebody of their ability to strike after a ballot, how can you be surprised when this causes widespread anger and resentment? Without being able to take effective strike action, workers will of course seek new ways to put pressure on employers, including work to rule and overtime bans. With all good faith gone, disputes will drag on and become even more bitter. Forcing workers to cross their own picket lines, with unions made to take so-called reasonable steps to enforce this, is undoubtedly a recipe for disaster. Mark my words: when the first worker is sacked for refusing to cross their picket line, there will be a major escalation of industrial action. Is that what the Government really want?

Finally, these measures are just the latest in a long line of union-busting legislation from this Government. It is a disgrace that they continue to attack workers’ rights when they promised an employment Bill to make Britain the best place to work in Europe. Instead, they are trying again to repeal the ban on using agency staff to break strikes, despite the High Court ruling that said it was unfair, unlawful and irrational.

In this place, we are privileged to be able to hold the Government to account and to help protect people from greed and exploitation. I urge noble Lords to stand up for the hard-pressed workers of this country, already suffering from a cost of living catastrophe not of their making, and to vote down these vindictive, destructive and, above all, counterproductive measures.