Brexit: Health Policy

Lord Foulkes of Cumnock Excerpts

Wednesday 6th December 2017 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness is right about the important role that EU workers play in the NHS, and I pay tribute again to the work that they do. We value them and want them to stay. We are in a position with the stock of EU workers here—and, equally, UK workers in other health systems—to recognise those qualifications. Clearly we will have to agree to continue doing that as part of the future negotiations. It has to be said that some concerns have been expressed by bodies such as the GMC about how that operates. We are working with them to make sure we get that right.

[Lord Foulkes of Cumnock (Lab)]

My Lords, could the Minister remind us what the effect of Brexit has been on the location of the European Medicines Agency?

[Lord O’Shaughnessy]

The European Medicines Agency will be moving to Amsterdam.

Older Persons: Human Rights and Care

Lord Foulkes of Cumnock Excerpts

Thursday 16th November 2017 Lords Chamber

Moved by

[Lord Foulkes of Cumnock]

That this House takes note of the human rights of older persons, and their comprehensive care.

[Lord Foulkes of Cumnock (Lab)]

My Lords, I am grateful to the Labour group in this place for giving me the opportunity of leading off in this debate on an issue which has concerned me for many years.

First, I must declare an interest. It is not my age—a lot of us might have to do that, although not the Minister, of course. I am the chair of Age Scotland, the charity concerned with all aspects of concern to older people in Scotland. As the noble Baroness, Lady Greengross, knows, in the 1970s I used to be director of Age Concern Scotland. When I was first made a trustee of Age Scotland, Brian Sloan, the chief executive, said that he remembered that, but that I had more of a vested interest in it now—rather cheeky, but he was right: I have a vested interest in it now.

I am grateful for all the submissions that we have received—I think noble Lords will also have received them—from Age UK, Age International, the Local Government Association, Independent Age and many others. I also commend the House of Lords’ Library for its excellent briefing; it really is good at this kind of briefing. All of this underlines the importance of this issue.

This debate is to look at older persons in the context of human rights, not just care and compassion—although that is important; we all need care and compassion and we must not forget that. But it is in the context of human rights that we are looking at the subject today, because it will affect us all. Assuming we avoid the grim reaper, everyone will be moving into older age. The United Nations has looked at this in the human rights context for some time, since its Second World Assembly on Ageing in 2002. The UN set up an open-ended working group—it is a pity in some ways that it is open-ended.

The Council of Europe has also been looking at this. My report, which is the basis of our debate today, was adopted unanimously by the Council of Europe Parliamentary Assembly in May this year. I thank the staff who helped me to produce that report; I could not have done it without them. The Council of Europe has been looking at the subject in this context since 1996, when it adopted the European Social Charter on the rights of old to social protection. All of that is good, but the problem is that little or nothing is done about it. All these things are agreed and adopted, but then they have to go to national Governments to be implemented which, I am afraid, does not always happen—indeed, it happens very seldom.

On 11 July, as the Minister will recall, I had an Oral Question about this. He noted it and followed on with—I was going to say the usual platitudes but, since I like the Minister, I will say the usual good and nice words that someone had written for him. I am hoping that we get better today; he has had longer to think about it and I am ever the optimist. Even in the Library earlier on, he asked me what kind of reply I would like, so I gave him a hint.

Let me outline some of the issues. First, there is the demographic challenge, which underlies all this. As Independent Age said, just to give one statistic:

“there will be nearly 16 million people aged 65 and over”,

in Britain by 2030. The number of those aged 80-plus is going up even faster and the number of centenarians is set to double. That indicates that the size of the problem is growing day by day, week by week, year by year.

A key aspect of the report which must be taken account of to ensure that, as the numbers go up, individuals are not disadvantaged but get a decent life is, first, the need for an adequate income. This is central to everything. Maintaining the triple lock is vital—and so far, so good. But when I heard my noble friend Lady Sherlock say earlier on that, because we have the triple lock, pensioners are lucky compared with some others, I worry. There is an attempt sometimes from Governments to divide and rule and to say that pensioners are okay compared with families with young children. It is not true for most pensioners, who are not all that much better off. It is this divide and rule that worries me. It occurs to me—we all saw the Panama papers—that if those with their fortunes hidden away in the Isle of Man, Bermuda or the Cayman Islands were to pay their fair share of taxes, there would be enough to provide decent incomes for people at every stage of their lives.

The second issue is appropriate housing, close to amenities. Instead, older people are often in cold houses, isolated from amenities. Age UK argued very effectively in its submission that older people want comfortable and attractive housing alternatives that promote healthy and active lifestyles. That saves money in the longer term.

I was really disappointed recently to see in Edinburgh—my home town now—more and more student houses being built, almost ghettoes of student houses. One thing that we recommend in the report is more intergenerational provision: housing for older people and younger people, including students, in the same area. I saw that in Denmark and it was working very well. They can help each other, so it can be mutually beneficial. The other type of intergenerational provision that I saw when I was preparing this report were day centres for older people combined with children’s nurseries. Not only was it good to have older people mixing with young people and vice versa, but the staff were helping each other out and learning from each other. Intergenerational provision must be looked at a great deal more.

This brings me to the central issue of social care, both residential and domiciliary. We must all recognise and acknowledge that most of it is, and will continue to be, provided by families as they look after relatives. But they need more and more help—they need respite care and domiciliary support. The scandal of less than 15-minute home care visits must end. There must be decent visits to look after older people living alone. We need proper home help services, district nurses and, above all, chiropody—it seems like a small thing, but if older people do not have proper chiropody and podiatry services, they cannot get around. It is vital. When old people are in residential homes, they must be looked after by properly trained staff. Age UK also makes some recommendations on that.

Now we come to my central point: we need a charter of rights for older people. That is what the UN said, and the submission that Age International sent to us all endorses it. For example, care in older people’s homes needs proper inspection by properly trained staff. Age UK has made recommendations on that subject as well. There are examples of abuse, such as what we saw on the Channel 4 documentary on Haringey. We only get to know about that when a whistleblower tells us about it—whereas if there were more frequent regular inspections without notice, as is advocated, and stiffer penalties for people breaking the rules, we might be treating old people better.

Let us look at abuse in a wider context. Far too much abuse, by relatives for example, is hidden, and we do not know about it. Sometimes—let us be honest—there is coercion, in relation to the drafting of wills and things like that. There is also abuse by commercial interests, especially now—the telephone calls and internet activities aimed at people who are not necessarily as clued up as younger people are, and can be taken advantage of.

In relation to social care, one of the difficulties we experience is bed-blocking. Beds that ought to be available for acute care in the NHS are being used by older people who should have been out of them some time ago, but the social care is not available—a package has not been devised. That is why the report recommends the integration of health and social care administration. At present, there are silos of NHS care and social care, with the money in their own budgets. In Scotland people are trying to bring health and social care together; in theory it is happening, but in practice it is not working on the ground. Some of the old traditions and patterns need to be broken down. That is another key issue that emerges from the report and the recommendations.

That brings me to another issue that needs to be included in the charter: an end to age discrimination. It is astonishing that age discrimination still takes place. It was supposedly outlawed in the Equality Act 2010, but although fairly strong action is taken on gender and race discrimination, that does not happen with age discrimination. One of the submissions tells us that the Royal College of Surgeons and Age UK examined the possibility that older patients may be discriminated against regarding access to surgery in England. Their first report, published in 2012, found that elective surgical treatment rates declined for the over-65s, in spite of this age group’s increased need for health interventions. The doctors say, “I’m sorry, you’re just too old. It’s not worth spending the money on you, because you’ll be dead soon.” It is outrageous that such discrimination should take place, and it must end now. I hope that the Government will pick that up.

Of course, not all older people are frail and dependent. We need to acknowledge that. I have talked a lot about those who are, but many are active, and promoting active ageing is included in the report. We need to encourage active ageing, and volunteering. Older people can and do volunteer, and they should be encouraged to do so more, partly to help even older people, but also to help younger people. They should also be encouraged to get about. I was interested in the Local Government Association’s submission about transport, which said that long-term underfunding for concessionary fares and free transport was about £200 million. Yet the best thing ever for getting older people active, and out and about—I advocated this myself when I was a councillor—is free transport. People travel from Glasgow up to Orkney, and down to the south of Scotland. That is keeping them out of old people’s homes and out of hospital, and making them less of a burden on the welfare state.

That is all included in the report, and I hope that we will get a positive response from the Minister. He may well challenge me and say, “If there was a Labour Government, what would happen?”. He is entitled to do that but, if he looks at our manifesto for the last election, he will see that we proposed substantial increases in social care funding and a lot of the things included in the report. Sometimes I get told off for bringing politics into the House of Lords; I am not sure why, because we are here as part of the legislature. A general election may or may not be around the corner, but older people cannot wait for a Labour Government to come to power before some of these improvements get under way.

I hope the Minister will indicate that the work that has been put in by all the organisations that I mentioned, the Council of Europe and the United Nations in identifying the problem and indicating the solution will at least be picked up to some extent by this Government. If it is, I for one—I was going to say I would die happy—will continue to live in increasing happiness.

--- Later in debate ---

[Lord Foulkes of Cumnock]

My Lords, in replying very briefly to the debate, I first apologise for not having moved the Motion properly at the start. Noble Lords gave me the kind of look that made me feel very guilty. I also apologise to my noble friend on the Front Bench for not welcoming her. I was going to say that the noble Baroness, Lady Thornton, and I go back a long time together, but she is very young in comparison. Still, as fellow co-operators, we have worked closely together and I am delighted that she is on the Front Bench again.

It has been a fantastic debate. I am very pleased with so many excellent speeches, which were almost unanimous, if not quite. Like my noble friend Lord Sawyer, I welcomed the contribution of the noble Lord, Lord Balfe, who was looking after the workers again. I should also have mentioned but forgot—perhaps I should have declared another interest—that my son works in this sector. He is relatively low paid and he works very hard indeed; I know care workers work very hard.

I also found the speech of the noble Baroness, Lady Cavendish, encouraging and helpful. She is right about the Care Quality Commission; it is doing a job, but it could do better. There could be more frequent and incisive unannounced inspections. The fact that there are problems shows that it is not yet working. However, she is certainly on the ball, as it were, in getting it moving in the right direction.

I was grateful for the wisdom of my noble friend Lord Haskel and for the experience of my noble friend Lord Cashman in the LGBT sector. He also did a tremendous job on this as an MEP. My noble friend Lady Massey normally champions children and I see her as chair of the children’s committee in the Council of Europe—it is nice to have her move into this area as well. My noble friend Lord Rea and I used to work together in international development many years ago; it is wonderful to have him make such an eloquent speech in support.

It was also good to get such overwhelming support from the noble Baroness, Lady Thomas, from the Liberal Democrat Front Bench, and I appreciate it. Sometimes I can be a wee bit critical of the Liberal Democrats, but certainly not on this occasion. It was fantastic support. As the noble Baroness, Lady Greengross, said, she and I have also been working together for a number of years; it is nice to be working with her on the same subject again.

I am afraid I did not agree with the noble Lord, Lord Lipsey. I think he is falling into the trap of those people who want to divide and rule us. We will have the debate on universality versus means testing outwith this Chamber—we have a lot of debates outwith this Chamber—but when 1% of people in this country own 50% of the wealth, it is not the poor who should be fighting each other over who is a little better off than the rest. There are people who can afford to pay more in taxation; we will have to have that debate on another occasion.

I come to the Minister. I must say—and I say it with his boss present—that he is one of the Ministers for whom I have the greatest respect. He treats this House with great respect and answers Questions at Question Time properly; not every Minister does that. He does it very well and he listens carefully to what is said. I have been a junior Minister, too, admittedly in the other place, and I know it gives you a little more power, but you are always constrained by Secretaries of State, Prime Ministers and so on. But within that constraint, he has been helpful. I did not see the announcement about the Green Paper on social reform because we were all busy preparing for this debate. However, it is a welcome development. I do not normally welcome things from this Government but it is welcome. The way the Minister described it made it sound sensible, and it is encouraging. Let us say that it is a step in the right direction, but there are many more steps to take.

I should have said earlier that it is nice to see my noble friend Lord Pendry here. He had hoped to participate in the debate but I know he was called into hospital. However, I am glad that he has been discharged and is with us at the end of the debate.

I thank the Minister for that helpful response. I can only assure him that, as I said, the noble Baroness, Lady Greengross, and I have been going on about this for a long time, and some of us will keep banging on until we get more, and better. Our concern is to make sure that every old person lives in dignity, in some degree of comfort, and enjoys their last years as much as they enjoyed their early years.

Motion agreed.

Mental Health Services: Children and Adolescents

Lord Foulkes of Cumnock Excerpts

Monday 17th July 2017 Lords Chamber

[Lord O'Shaughnessy]

I know that the noble Countess feels passionately about this issue, but she will know that it is only right for me to say that we need to be guided by evidence that is collected in clinical reviews. A review is being carried out by NICE at the moment and we shall wait to see the results of that before deciding what needs to happen as a consequence in terms of the kinds of treatments that are appropriate for those suffering from ME.

[Lord Foulkes of Cumnock (Lab)]

My Lords, the Minister has answered both this Question and indeed the previous one in his usual effective manner. However, I wonder if he could tell us on behalf of which half of the Cabinet he is speaking.

Older Persons: Care and Human Rights

Lord Foulkes of Cumnock Excerpts

Tuesday 11th July 2017 Lords Chamber

Asked by

[Lord Foulkes of Cumnock]

To ask Her Majesty's Government whether they intend to implement the recommendations of the report Human rights of older persons and their comprehensive care, adopted by the Parliamentary Assembly of the Council of Europe on 30 May 2017.

[Lord Foulkes of Cumnock (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I refer noble Lords to my entry in the register of interests.

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

My Lords, first, I congratulate the noble Lord on leading the production of this report. The Government are pleased to note its publication and look forward to contributing to the response. This Government’s ambition is to make the UK a good place for everyone to grow old, and we have put in place a programme of reforms across health, care, housing and other services to support older people to live independent and fulfilling lives.

[Lord Foulkes of Cumnock]

My Lords, I have no doubt at all about the Minister’s sincerity on this, but he will know that in the last few weeks Age UK, the Care Quality Commission, the King’s Fund and the Local Government Association have all produced reports showing problems and failings in the provision of services for older people in the United Kingdom. Will Her Majesty’s Government now discuss with civil society the implementation of the recommendations contained in the report?

[Lord O'Shaughnessy]

I certainly pay tribute, as the noble Lord does in the foreword of the report, to the growing trend towards strengthening the protection of older persons’ human rights. He is also right to highlight today and in the report that there are still widespread negative stereotypes. The Government are proud to lead the world in tackling age discrimination, and we published in February a strategy called Fuller Working Lives on that purpose. We are taking many actions to fulfil the requests in his report; one particular one that I would focus on from a health perspective is the fact that, by 2020, all medical curricula will include training for geriatrics, so there will be that additional support throughout the entire NHS.

National Stroke Strategy

Lord Foulkes of Cumnock Excerpts

Wednesday 5th July 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is of course right that the strategy had that galvanising effect. As I said, it has been superseded by a broader cardiovascular strategy, which is leading to some of the improvements that I have discussed. The other thing to focus on is the fact that stroke is now being included in the new urgent and emergency care standards that are being introduced, which will ensure, and indeed require, that all stroke patients are seen within 14 hours by consultants who are stroke specialists. That is precisely about ironing out some of the discrepancies in actual practice that happen across the country.

[Lord Foulkes of Cumnock (Lab)]

My Lords, although I would hesitate to disagree with the noble Lord, Lord McColl, and his very helpful obesity advice, I fear that he is completely wrong in relation to public expenditure on the NHS in Scotland. If he had read today’s Scottish edition of the Times, he would know that it is being slashed in Scotland and that Scotland is facing problems in the health service even greater than those in the rest of the United Kingdom. Could the Minister apportion the blame? Is it the United Kingdom Government not giving enough money to Scotland, or is it the Scottish Government getting their priorities wrong—or maybe both?

[Lord O'Shaughnessy]

Can I first say how slim the noble Lord is looking? I do not think that it is a case of apportioning blame. All health systems, not just in the UK but around the world, are facing pressure from an ageing and growing population and from the incidence of lifestyle diseases. We are all trying to deal with them as best we can.

Adult Social Care: Funding

Lord Foulkes of Cumnock Excerpts

Thursday 16th March 2017 Lords Chamber

[Lord O'Shaughnessy]

As I said to the noble Baroness, Lady Pitkeathley, the Green Paper has a wide remit. It is trying to provide a comprehensive solution to social care funding, which has unfortunately eluded many Governments. In doing so, it naturally needs to look particularly at the interaction between health and social care. For many people now there is no particular distinction between those as they follow their journey, as it were, through the health and care system. The important thing is that the care is joined up and is of high quality.

[Lord Foulkes of Cumnock (Lab)]

My Lords, is the Minister aware that he does not need to go as far as Germany and Japan to find good examples of this? Could he go up to Scotland, in particular to Ayrshire, and talk to Ian Welsh, the chair of the NHS health and social care partnership? That is a very good example of two bodies working together under a joint budget and joint administration. If the Minister were to take a few days off and go up there, I think he would find it very valuable.

[Lord O'Shaughnessy]

I will speak to the Chief Whip about taking a few days off. I thank the noble Lord for bringing that point to my attention. As he says, there are examples in the UK—in Scotland, England and Wales, and of course Northern Ireland has a joined-up system too—so clearly there are lessons to be learned from home.

Southern Health NHS Foundation Trust

Lord Foulkes of Cumnock Excerpts

Tuesday 3rd May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, this goes back to the culture of the trust. It is important that members of the public or Healthwatch have a right to go in and visit facilities, and that they are welcomed there, but that they do not go native at the same time—that they are truly independent, looking at it from the patients’ perspective. Healthwatch has an important part to play, and the relationship that it has locally with the CQC inspection team is very important.

[Lord Foulkes of Cumnock (Lab)]

My Lords, I am slightly perplexed. Why is it that, once again, it is only because an Urgent Question was tabled and agreed by the Speaker that Parliament knows all the details and is able to hold the Government to account? If, as the Minister says, the Government are so concerned about it, why did they not volunteer a Statement?

[Lord Prior of Brampton]

My Lords, the CQC report is in the public domain, as are all the CQC reports. To be honest with your Lordships, I am not technically sufficiently aware of the procedures of the House to know why it did not automatically come to the House but, as I say, I am here today.

Health: Adult Psychiatric Care

Lord Foulkes of Cumnock Excerpts

Monday 22nd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, that is a very hard question to answer. The talking therapies, for example, seem to be effective in about 50% of the cases, and whether they are effective is clearly a clinical decision. As for other standards, we tend to rely, as the noble Baroness will know, on proxies such as waiting times and the four-hour standard, which the noble Lord recommended in his report. We are considering the introduction of a four-hour waiting-time standard for people suffering from psychotic problems, in the same way as we have for physical health.

[Lord Foulkes of Cumnock (Lab)]

My Lords, can I give the Minister an easy question? What discussions has he or any of his colleagues in the Department of Health had with his counterparts in the Scottish Administration to exchange experience and ideas?

[Lord Prior of Brampton]

My Lords, I am not aware that we have had any discussions in the Scotland Office. However, there is no doubt that in Scotland they are approaching quality improvement extremely effectively. I had a recent meeting with people who have been involved in that, so I can assure the noble Lord that, at that level, if we can learn things from what they are doing in Scotland, we will do so.

Social Care and Support: Funding

Lord Foulkes of Cumnock Excerpts

Monday 19th October 2015 Lords Chamber

[Lord Prior of Brampton]

I think that the only word of comfort I can give is that in the long run we will have a well-funded social care sector and a well-funded NHS only if we have a successful and productive economy, and we will have a successful and productive economy only if we can get government borrowing back to where it needs to be and so can begin to eliminate the government deficit.

[Lord Foulkes of Cumnock (Lab)]

My Lords, does the Minister not realise that he is not just a disinterested observer in this matter? He has admitted a 10% reduction, he has said that the sector is “fragile”, and then he says that we have to wait until the settlement in November. What are he and his colleagues doing about saying to the Treasury, “This is a fragile sector. This is a sector that needs more money. This is a sector that is alarming many, many Members of the House of Lords”, and getting those messages over to the Government?

[Lord Prior of Brampton]

What we are saying is that we have to fundamentally transform the health and social care sector so that it is fit for the kinds of patients living in today’s society, not those living in, frankly, 1948.

NHS: GP Clinics

Lord Foulkes of Cumnock Excerpts

Thursday 25th June 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness—

[Lord Foulkes of Cumnock (Lab)]

Has a very good point.

[Lord Prior of Brampton]

The main thrust of the legislation was to put GPs more in control of the delivery and structuring of local healthcare.