Healthcare: Brain Tumours

Debate between Baroness Blackwood of North Oxford and Baroness Wheeler

Thursday 24th October 2019 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what steps they are taking (1) to improve access to palliative care, rehabilitation and psychosocial care for people living with a brain tumour, and (2) to provide support for their carers and families.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the NHS Long Term Plan sets a clear ambition that, where appropriate, every person diagnosed with cancer will have access to personalised care by 2021. Personalised care includes support planning based on holistic needs assessments, end-of-treatment summaries, health and well-being information and support and a cancer care review with GPs. These interventions align with the comprehensive model for personalised care and should be made available for all cancer patients, including those in need of end-of-life care.

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[Baroness Wheeler (Lab)]

My Lords, International Brain Tumour Awareness Week starts on Saturday, so it is timely to remember both patients and carers. Living with a brain tumour often means coping with life-changing symptoms, such as mental and emotional health issues, communication and mobility problems. Carers also need support in adjusting to these changes in the person they care for, including coping with difficult behaviour and personality changes, disorientation and confusion. Both Marie Curie and the Brain Tumour Charity have highlighted strong concern about inadequate support for carers and the impact on the care journey that carer breakdown in these circumstances can have, often leading to emergency hospital admission. What action are the Government taking to ensure that people with brain tumours, their carers and their families receive care and support that meets their needs and wishes?

[Baroness Blackwood of North Oxford]

The noble Baroness has raised a very important issue. Obviously, the Government are working to deliver the Carers Action Plan, which retains the strategic vision of recognising, valuing and supporting carers. It includes a commitment to 64 actions across five priorities to ensure that we improve support for carers, including recognition and support, and build evidence to improve outcomes, especially in these very difficult areas. We are also working hard with the Tessa Jowell Brain Cancer Mission to ensure that we improve pathways for those with very challenging brain tumour diagnoses.

Personal Healthcare Budgets: Sheffield

Debate between Baroness Blackwood of North Oxford and Baroness Wheeler

Wednesday 4th September 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

Personal health budgets play a really important role, not only in supporting individuals to have personalised care but by making sure that we can seek support from social prescribing and community care, just as the noble Baroness mentioned. These plans are designed not only between the general practitioner and the supporter, but with the patient; therefore, the right information is provided to the patient in an open and transparent manner so that they can ensure they get the right care. It is important to note that those in receipt of this care have an 87% satisfaction that they are receiving the care they want in a much more effective way than they were before.

[Baroness Wheeler (Lab)]

My Lords, NHS continuing healthcare is supposed to provide a lifeline when older people and their families are at their most vulnerable and face sky-high costs as the result of chronic health conditions. However, this system is confusing and the rules arbitrary, resulting in a significant postcode lottery. Since 2015 more than 4,000 adults have died while awaiting a decision on their care to be made. What action are the Government taking to ensure that every person in need gets the support they need promptly, regardless of where they live?

[Baroness Blackwood of North Oxford]

One of the actions we have taken today is increasing funding to local authorities to relieve some of the pressures on them, increasing real-terms spending on public health, and also £1 billion for social care. In addition to that, there is a clear impetus from the long-term plan to increase personal health budgets, which are a very important aspect of the solution, because it will lead to an integration of spending and an integrated assessment of NHS care and social care. This is a real gap within the solutions for those who receive this support, which is why we want to make sure that we roll this out much faster than we have before. There is a commitment to have 200,000 people on personal health budgets and we are ahead of our ambitions on that.

Adult Social Care

Debate between Baroness Blackwood of North Oxford and Baroness Wheeler

Thursday 25th July 2019 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what assessment they have made of the Association of Directors of Adult Social Services Budget Survey 2019 on the state of adult social care.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we recognise many of the issues highlighted by ADASS. People of all ages are now living longer, sometimes with complex care needs. Social care funding for future years will be settled in the spending review, where the overall approach to funding local government will be considered in the round. Meanwhile, we have given local authorities access to up to £3.9 billion for more dedicated funding for adult social care this year, and a further £410 million is available for adult and children’s services.

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[Baroness Wheeler (Lab)]

My Lords, the ADASS survey results provide yet more evidence of the ongoing crisis in social care caused by persistent underfunding and a fragile and failing care market. As the report says, there are planned cuts of £700 million to adult social care budgets in the current financial year and there have been cumulative cuts of £8 billion since 2010. On the last day of our current Session, can the Minister update the House on the timing of the social care Green Paper, which has been delayed six times and is now two years overdue? Given this inexcusable delay and the widespread consensus across social care about what needs to be done, why can the Government not commit to publishing a White Paper with actual proposals? Has the Lords Economic Affairs Committee report calling for £15 billion of extra funding, to include free personal care for people needing basic washing and dressing support, not done the Government’s job for them?

[Baroness Blackwood of North Oxford]

I share the noble Baroness’s impatience on this issue and I agree with the overall conclusions of the ADASS report that older and disabled people need dignified, high-quality care and support. When properly resourced it does work, and as a nation we must make this an immediate priority. That is why I very much welcomed the incoming Prime Minister’s statement that,

“we will fix the crisis in social care once and for all with a clear plan ... To give every older person the dignity and security they deserve”.

He will make it a priority of the incoming Government and there will be an imminent announcement from the incoming Health Secretary. As I do not know whether I will be part of the department, I am afraid that I cannot commit to this, but I am sure that whoever is in this place when that comes forward will be very happy to do so.

Mental Health: Weight and Shape-related Bullying

Debate between Baroness Blackwood of North Oxford and Baroness Wheeler

Monday 22nd July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness has a record of raising this important issue. The Government recognise that poor body image is not only a common problem but is associated with mental ill health. Approximately 70% of adolescent girls and 45% of adolescent boys want to change their body, weight or shape. As she rightly points out, in the most extreme cases, that can lead to eating disorders, depression or even feeling suicidal. The Government have delivered a broad programme of body image work over the past six years. We believe that more work can be done but we are working hard to make sure that we expand our eating disorder community care work for children and young people over the next few years. I welcome continuing the debate to see what more can be done.

[Baroness Wheeler (Lab)]

My Lords, the latest Barnardo’s report, Overcoming Poverty of Hope, showed that 69% of young people,

“feel they will have worse ‘overall happiness and mental health’ compared to their parents’ generation”,

with one young person saying that social media is “massive for mental health” because of the,

“unrealistically high expectations of body image and lifestyles”.

On top of that, the report found that,

“young people with additional life challenges, such as young carers and care leavers are more susceptible to the negative impacts of social media as they are more likely to experience social isolation”.

What are the Government doing to work with mental health charities, such as YoungMinds, and young carers to address this situation?

[Baroness Blackwood of North Oxford]

The noble Baroness is right that children exposed to persistent bullying risk experiencing these problems. This is related to the experience of face-to-face bullying, but exposure on social media can also cause the problem. That is why the Department for Education is providing over £2.8 million of funding between September 2016 and 2020 to four anti-bullying organisations—Internet Matters, the Diana Award, Anti-Bullying Alliance and the Anne Frank Trust—to support schools to tackle bullying. Of course, all schools must have in place an anti-bullying policy, which Ofsted regulates.

Asthma

Debate between Baroness Blackwood of North Oxford and Baroness Wheeler

Wednesday 3rd July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question. I have met with Asthma UK on this issue. As an asthmatic myself, I understand the challenges of keeping up with medication, especially when in the middle of an exacerbation. At the moment, we do not intend to review the prescription charges list. However, there are some exemptions in the prescription list, and we have committed to work with Asthma UK to ensure that those who are eligible for low-income exemptions and for the pre-payment charge are accessing them and to look at any other ways in which we can help those who need life-saving medication.

[Baroness Wheeler (Lab)]

My Lords, I am sure that the Minister will know about the recent shocking report from the BMA describing the UK health system as complacent about the risks of asthma. It comments on and documents some of the tragic deaths of young children who would still be alive if their chronic asthma had been properly cared for. It shows a sorry litany of absence of a proper asthma plan across primary and secondary care and failure to refer children suffering repeated attacks to a specialist respiratory team or to optimise medical management of the condition. Some clinicians and staff are unaware of national treatment guidelines, prescribing advice or recommendations from the national review of asthma deaths. What is the Government’s response to this? Why has only one of the NRAD recommendations been implemented since 2014? Why are the remaining 18 still to be acted on to try to stop these unnecessary and untimely deaths?

[Baroness Blackwood of North Oxford]

The noble Baroness will have heard in my opening remarks that we have put treating asthma and respiratory diseases as a key priority within the NHS Long Term Plan precisely because we recognise that we need to improve our performance on respiratory diseases. Working with Asthma UK, we have identified that one of the key challenges in improving performance has been the identification of those with severe asthma and providing them with an appropriate care plan. That is exactly why we are pleased that a new NICE quality standard, QOF and the RightCare programme are in place; these should help to improve referrals and outcomes for patients as is desperately needed.

Social Care: Free Personal Care

Debate between Baroness Blackwood of North Oxford and Baroness Wheeler

Wednesday 26th June 2019 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what assessment they have made of the Institute for Public Policy Research’s report Social care: Free at the point of need—the case for free personal care in England, published on 23 May, and whether this matter will be addressed in the forthcoming Social Care Green Paper.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we welcome the contributions made by recent reports on how social care should be funded in future, including the report by the IPPR. The Green Paper will bring forward ideas for including an element of risk pooling to help protect people from high and unpredictable costs. This Government are committed to ensuring that everyone has access to the care and support they need, and we are clear that people should continue to expect to contribute to their care.

[Baroness Wheeler (Lab)]

I thank the Minister. Age UK estimates that more than 1 million older people have died in the past two years either waiting for a care package or having been turned down and that nearly 1.3 million people have an unmet need for basic care support, such as washing, dressing and going to the toilet. Macmillan research shows that 8% of people living with cancer who have critical or substantial needs and who should qualify for council support receive no practical help at all and that 60% of their carers experience stress, anxiety and depression. I hope that when she responds the Minister will not just repeat the Government’s stock answer on so-called extra funding. The King’s Fund, the Nuffield Trust and the Health Foundation have independently identified the huge scale of government local authority social care cuts and the £2.5 billion investment needed just to keep the current system going. May I once again ask the Minister for news of the Green Paper? When is it going to be published? What is holding it up? The IPPR shows that free personal care would treble the number of older people with access to state-funded care, improve their health and well-being and save billions of pounds in hospital costs. Surely it is one of the key options for solving the current care crisis.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for an important question. She is absolutely right that the Green Paper must be a priority. It will set out our sustainable plans for reform. We have welcomed the contributions that have been made by a number of recent reports. The noble Baroness rightly pointed to the IPPR, the Joint Select Committees, the Health Foundation, the King’s Fund and the Resolution Foundation. They have made some important proposals which are being considered as part of the Green Paper’s work going forward. The noble Baroness is right that we cannot wait for that, because there are people who need improvements in care now, and that is part of what the better care fund has been set up to do—to improve the spreading of best practice and the new models of care work which have been put front and centre for the long-term plan improvements. That was introduced in 2015, and has brought in the funds required, taking the total of increased funding to £7.7 billion by 2018-19. We are looking at how we can make sure that that improves. It has brought changes across the system.

Unpaid Carers: Support

Debate between Baroness Blackwood of North Oxford and Baroness Wheeler

Thursday 13th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important Question. I suspect that the majority of noble Lords have not only been carers themselves but have benefited from caring. I would not be standing here myself were it not for the caring support of my own family. We should pay tribute to carers up and down the country, without whom we would not have a sustainable health and care system. I assure the noble Baroness that proposals for putting in place sustainable funding to support carers, and considering their employment status, are part of the work that is going on in implementing the long-term plan and preparing the social care Green Paper. I hope that reassures her.

[Baroness Wheeler (Lab)]

My Lords, a growing number of older people are providing unpaid care while trying to manage their own health and care needs, in many cases co-caring for each other with partners, adults or children with learning difficulties. In particular, there is an alarming increase in the number of carers aged 85 and over, who are more likely than other carers to be caring round the clock, be suffering anxiety and be in poor health themselves. What are the Government doing to ensure that these carers are getting the vital social and community help they need? Are they still the priority, as was promised in the NHS five-year forward view?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question. She is absolutely right that we need to ensure that we target support at those who need it most, but that we also identify those who are carers within the community, because of the burden that we know caring can impose on the health of those who are caring. That is why the Carers Trust has been undertaking research into best practice in identifying carers and targeting support. It is also why the Department of Health and Social Care has been working with local government on a sector-led improvement programme of work focused on the implementation of the carers Act duty for carers. We have just begun phase 1 of this and we are implementing phase 2 to ensure that best practice is disseminated across the system, so we can deliver on the commitments we made within the carers plan.

Social Workers: Recruitment and Retention

Debate between Baroness Blackwood of North Oxford and Baroness Wheeler

Thursday 16th May 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right: that is a vital part of the programme. It is part of a wider suite of programmes that have been introduced so that we can bring individuals into social work at different points within the system. This has included the new social work degree apprenticeship scheme and, as I have said, we have 4,000 a year entering the normal degree programme. We have also introduced the fast-track training programme for high-potential graduates and the Think Ahead graduate programme for mental health social work. We are trying to attack this challenge from all angles, as well as guaranteeing that we retain those in the system through continuous professional development. This will ensure that it is a rewarding profession, as she rightly says, but also one in which people feel supported and that they have the skills to deliver for the most vulnerable in our community.

[Baroness Wheeler (Lab)]

My Lords, the Minister said earlier this week that the need to ensure that we recruit, retain and build on workforce development will be at the heart of the social care Green Paper when it arrives. Has she anything further to say about when we will actually get the Green Paper, other than that it will be very important? In view of the chronic problems of low morale, inadequate pay in the face of unmanageable caseloads and resulting problems in providing key services to vulnerable people, as we have heard about today, can she assure the House that making sure that social care work is valued is recognised as a top priority in the Green Paper?

[Baroness Blackwood of North Oxford]

The noble Baroness will know that we discussed this two days ago. I am happy to reassure her that social work and the social care workforce will be core not only to the social work Green Paper but to the workforce strategy, which will come forward imminently. She is absolutely right that we must ensure that we have the right models to retain and recruit the social care workforce, but we must also have the right funding. That is one reason why the Government have invested £9.4 billion in social work over the last few years, why we have to make sure that we integrate the long-term plan and the social care Green Paper alongside the funding settlement for local authority funding, and partly why we are working in the way we are to bring these papers forward.

Social Care: Green Paper

Debate between Baroness Blackwood of North Oxford and Baroness Wheeler

Monday 13th May 2019 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what assessment they have made of the costs and effects of the delay in publishing their green paper on social care.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Green Paper remains a priority for the Government, and we will publish it at the earliest opportunity. Despite the delay in publication, the Government are committed to improving adult social care. We recently launched our social care recruitment campaign, Every Day is Different, and continue to support the sector by distributing £12 million a year through the workforce development fund. The Government have also given councils access to up to £3.9 billion of funding for social care for 2019-20.

[Baroness Wheeler (Lab)]

My Lords, the Green Paper was first promised in 2017, when the Government said that,

“we cannot wait any longer—we need to get on with this”,—[Official Report, 6/7/17; col. 987.]

and pledged to publish by the end of that year. I remind the House that this was a year after they abandoned the Dilnot provisions on future care funding, which had cross-party support under the Care Act and were due to start in 2016. The Alzheimer’s Society has estimated that, over the past 26 months, there have been more than half a million delayed transfers of care for people affected by dementia; nearly 3 billion hours of unpaid care have been provided; and, at any one point, more than 120,000 people with dementia in England receive no help from social care or family carers. Emergency cash injections do not address the chronic underfunding of local services, change the eligibility criteria or help people plan for future care needs. When we finally get the Green Paper, can the Minister promise the House that it will address these issues and provide the major, immediate and long-term funding that is urgently needed?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for an extremely important question. I know that she will agree that decisions on future reforms must be aligned. That is precisely why the long-term plan and the upcoming social care Green Paper have been considered alongside each other. Some important measures within the long-term plan are already beginning to improve social care; for example, the enhanced health in care homes model, which will ensure stronger links between primary care networks and local care homes; the comprehensive model for personalised care, which will put the individual at the centre of services; and personal health budgets. However, the noble Baroness is also right that we have to make sure that we get funding reform right—that is why we have increased funding from £3.6 billion in 2018-19 to £3.9 billion in 2019-20. She is also right that we must ensure that we build on the carers action plan and put carers at the heart of social care. Finally, we must ensure that we recruit, retain and build on workforce development at the heart of the social care Green Paper. That is what we will do, and I look forward to the debates in this House when we bring it forward.

Food Additives, Flavourings, Enzymes and Extraction Solvents (Amendment etc.) (EU Exit) Regulations 2019

Debate between Baroness Blackwood of North Oxford and Baroness Wheeler

Tuesday 9th April 2019 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank noble Lords for their consideration of these regulations. The Government’s priority is to ensure that the high standards of food safety and consumer protection we enjoy in this country are maintained when the UK leaves the European Union. This instrument forms part of our preparations for a functioning statute book on exit.

Food additives, flavourings, enzymes and extraction solvents are important substances referred to collectively as “food improvement agents” which are used in a wide variety of everyday foods. These substances perform technological functions in or on food during its production or storage. Examples include preservatives, which are highly effective in protecting consumers from dangerous pathogens and help to provide a decent shelf life of products for consumers. Other substances are used to improve the taste, texture, and appearance of food. Common examples are artificial sweeteners, emulsifiers and flavourings added to food where they are considered necessary.

This instrument is made under the powers in the European Union (Withdrawal) Act 2018 to make the minimum necessary amendments to retained legislation that governs the use of food improvement agents and corrects deficiencies in those regulations. I wish to make clear that no policy changes are being made through this instrument, and neither is there any intention to do so at the present time. The instrument was due to be debated on Tuesday 19 March alongside four other instruments on regulated products in food. Minor drafting errors were identified which have now been rectified.

Currently, the European Commission holds a range of powers and functions under the EU legislation to enable new substances to come on to the market, to amend current conditions of use and purity criteria and to remove substances from the permitted lists. This instrument transfers these powers from the Commission to Ministers in England, Scotland, Wales and the devolved authority in Northern Ireland. It also transfers responsibility for risk assessment from the European Food Safety Authority, EFSA, to the UK “food safety authority”. This will be the Food Standards Agency in England, Wales and Northern Ireland and Food Standards Scotland in Scotland, which have a close working relationship.

Risk assessment and the oversight of food safety controls will be essential to ensure that food remains safe, whether imported or produced in the UK. The Food Standards Agency and Food Standards Scotland are responsible for protecting public health in relation to food and will continue to be independent science and evidence-based government departments. These functions will be delivered through the increased risk assessment capacity that has already been put in place. This instrument will ensure that the controls contained in 11 retained regulations governing food improvement agents continue to function effectively after exit day. All existing food improvement agents permitted for use in the UK prior to exit day will continue to be permitted immediately after exit and all conditions and requirements attached to their use will be preserved. There will be no change in how food businesses are regulated or managed.

These regulations will ensure a robust system of controls that will also underpin UK businesses’ ability to trade both domestically and internationally. This will ensure continuity and clarity for UK food businesses and those exporting their food products to the UK, while maintaining existing levels of public health protection and food safety. There are no changes to the authorisation process for new substances, except that the roles of the European Commission and EFSA will be replaced by the relevant UK entities. To support industry with these changes, the Food Standards Agency intends to publish detailed guidance on the UK authorisation processes. Scientific data requirements in support of applications will remain the same, so the same package of data can be submitted to the UK and the EU, avoiding any unnecessary additional burden.

It is also important to note that the devolved Administrations have provided their consent for these instruments. Furthermore, we have engaged positively with the devolved Administrations throughout the development of these instruments. This ongoing engagement has been warmly welcomed. A full public consultation indicated support for the proposed approach to retained EU law for food and feed safety and hygiene. These instruments therefore constitute a necessary measure to ensure the continuation of effective food safety and public health controls. I beg to move.

[Baroness Wheeler (Lab)]

I thank the Minister for introducing these important regulations dealing with food improvement agents such as preservatives, anti-oxidants, flavourings, enzymes and extraction solvents. As the Minister explained, this is the second version of the regulations, which have been re-presented to comply with requirements in drafting, elucidation and compliance with proper legislative practice identified by the Joint Committee on Statutory Instruments, which led to their hasty withdrawal and subsequent reissue. The Ministers, both today and in the Commons, described the faults in the original draft as minor, but it is important to underline for the record that the committee made some important stipulations now contained in the draft which are welcome because they assist with the clarity needed to ensure compatibility with other related regulations.

We recognise that this and the related SIs considered so far are necessary to ensure we retain the high-level principles underpinning the day-to-day functioning of the UK’s food safety legal framework. Ensuring continuity for business and public health bodies is in the vital interests of the public. However, in discussions across the range of food safety-related SIs from either the Department of Health or Defra, we have repeatedly raised our concerns about the UK’s preparedness for additional responsibilities in terms of resources and staffing levels in the Food Standards Agency, Food Standards Scotland and the related bodies that are to assume wide-ranging responsibilities from the EU after Brexit.

Let us remember that, between 2010 and 2017, the FSA saw its budget cut by 26%—nearly £30 million—leaving it resourced, in its own words,

“just to provide a basic statutory service”,

without contingency funds and with service delivery likely to be seriously compromised if any further cuts take place. Can the Minister explain how she envisages that an organisation that has been run down in this way so as to be able to carry out just its statutory obligations will, in the short or medium term after Brexit, be able to ratchet up to assume the key responsibilities currently undertaken by the European Food Safety Authority?

We have been told by the Government that both the FSA and the FSS will deliver the widened responsibility for protecting public health in relation to food through,

“an increased risk assessment capacity”,—[Official Report, Commons, Fifth Delegated Legislation Committee, 1/4/19; col. 5.]

and that additional staff are being recruited to deliver risk assessment and risk management functions from day one of Brexit. Can the Minister tell the House how many additional staff have been recruited, when they started work and what roles they are currently undertaking? What additional funds are being provided to the FSA and FSS to meet these costs, and what transitional management funding is being provided to support their taking on new and wider functions?

We are also concerned about the key issues raised by local authorities during the consultation with stakeholders on the SI, on how extra responsibilities they are taking on will be resourced—particularly if further responsibilities are identified in the course of ongoing negotiations. These so far remain unanswered by the Government. We know just how cash strapped local authorities are, so will the Minister confirm that the additional costs will be on a full cost recovery basis and that any additional financial burden that arises through ongoing negotiations will be funded, especially in the event of a no-deal Brexit?

The Explanatory Memorandum for the SI, in paragraph 2.7, expresses the Government’s confidence—which the Minister also expressed this afternoon—that,

“These changes will ensure that the retained legislation remains operable and enforceable within the UK regulatory framework without compromising existing levels of public health protection and food safety”.


Paragraph 2.9 reassures consumers that,

“existing levels of public health protection and food safety are being maintained”.

It is difficult to see how such supreme confidence can be justified in the light of the scale and extent of the changes that will take place in the food industry and related key industries. Can the Minister advise what steps have been taken on a cross-departmental basis to monitor implementation of the new structures, particularly in the transitional phase?

On the key EFSA re-evaluation programme of approved food additives, can the Minister please explain in more detail why the EU regulation is being revoked and it is not thought necessary to retain this important legislation for the UK? Why is a UK-wide re-evaluation programme not needed? While the EU regulation placing a duty on producers or users of a food additive to immediately notify the UK of any new scientific or technological information that may affect the safety assessment of a food additive is being retained, is the Minister confident that the UK will have sufficient safeguards and expertise in the FSA and FSS to ensure that food additives on the UK’s authorised list are kept under review on an ongoing basis? How will we ensure that we continue to keep up to date with and implement recommendations from international assessment bodies such as EFSA and the Joint FAO/World Health Organization Expert Committee on Food Additives?

The Explanatory Memorandum, at paragraph 12, states that the impact of the SI on business, charities or voluntary organisations is “minimal” and does not impact on the day-to-day workload of the small and micro-businesses that make up over 90% of the food industry sector. We are told that only one-off familiarisation costs resulting from the legislative changes are involved; and there is no impact assessment, because the SI has been assessed by the FSA as being below the de minimis threshold expenditure requiring an assessment to be produced. Again, the scale and extent of the proposed change makes these statements seem somewhat complacent. Can the Minister assure the House that the situation will be kept under close review so that swift action can be taken if the burden of introducing and maintaining the new arrangements leads to unsustainable costs for small businesses or voluntary organisations?

Finally, on the consultation exercise undertaken by the FSA on the EU law for food and feed and hygiene, the Minister in the Commons was quick to reassure my honourable friend Sharon Hodgson that the food industry had been fully consulted and understands the minimal impact the changes will have and “is satisfied”. Also, that of the 50 responses received,

“some 82% supported the Government’s approach”.—[Official Report, Commons, Fifth Delegated Legislation Committee, 1/4/19; col. 9.]

However, the Explanatory Memorandum, at paragraph 10.2, says that of the respondents,

“82% supported or did not agree with the proposed approach being outlined by the Food Standards Agency”.

Can the Minister clarify this? What actions are being taken to ensure that stakeholders’ concerns expressed in the consultation that changes will be clearly communicated with urgency and sufficient lead-in times are addressed?

Mental Capacity (Amendment) Bill [HL]

Debate between Baroness Blackwood of North Oxford and Baroness Wheeler

Tuesday 26th February 2019 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, the amendment on this very important matter in the name of the noble Baroness, Lady Watkins, is fully supported on these Benches. The Minister knows the strength of feeling of support in the House to ensure that the cared-for person, or their carer, relative, friend or other person advocating on their behalf, is fully informed about their rights at the start of the LPS authorisation process. The amendment, carried by a substantial majority, was very clear on this issue. That information should be provided up front to families as a matter of course—information not only about the process, but importantly, their rights to advocacy and to challenge—in an accessible format that they can understand.

The provision in Amendment 25 of a statutory duty for information to be provided “as soon as practicable” does not ensure that this essential up-front requirement for information is met. One of the excellent briefings on this matter from Mencap states:

“Families’ carers have consistently fed back to us that the lack of information up-front meant that they didn’t know what was happening, that it was a process done to them and their loved one, and that set in motion misunderstandings, mistrust and instances of an appeal which could have been avoided had information been provided and explained at the beginning”.


Mencap’s concern is that the “as soon as practicable” provision could mean a system working on the timescales of the responsible body, rather than of the individual body and the families. That is our concern, too.

Amendment 25A addresses these concerns and ensures that the loophole in the Government’s amendment is addressed by requiring a record of the decision and justification to be kept where it has not been practicable to provide that up-front information about the decision to commence authorising arrangements under subsection (1). It also provides a necessary timeframe. We have heard that the noble Baroness, Lady Watkins, is not wedded to 72 hours, but it is important to have a timeframe within which, if a copy of the authorisation record has not been provided, there must be a review of whether the lack of information provision was appropriate. The requirement would provide the necessary safeguard for the cared-for person, and the hard- pressed staff, by facilitating routine record keeping and accountability for the decisions made. The noble Baroness pointed out some very explicit examples of the type of record that needs to be kept; it would not be onerous.

We are in a strange position, which we are slowly getting used to, of having the ex-Minister reassuring the House from the Government Benches that everything he promised has been delivered—before the Minister speaks. Amendment 25A highlights a significant loophole that needs to be addressed and I hope that the Government will accept it. We accept that the Government’s intention is to provide the information needed, and as soon as possible, but the amendment is necessary to reassure that “as soon as practicable” is not as open-ended as it can so often turn out to be.

[Baroness Blackwood of North Oxford]

My Lords, I thank noble Lords for their contributions to the debate on this group. The provision of information in an appropriate and timely way goes to the heart of the Bill, in its intent to empower the cared-for person. The contributors today demonstrated how significant they have been in the process of improving the Bill.

I will respond first to my noble friend Lady Browning, and her question about clarifying what “as soon as practicable” means. This term is also used in the DoLS legislation. As we have outlined, we intend to clarify this in the code of practice with a range of examples that will make it perfectly clear exactly what it means, for practitioners and the cared-for person. We expect that this will be in the earliest stages of the process, so that the person has the information to enable them to exercise their rights, as the noble Baroness, Lady Wheeler, said,

“as a matter of course”.

This is exactly what would be expected. In order to ensure that this code of practice is workable and effective and, as my noble friend Lord O’Shaughnessy rightly put it, “has teeth”, it is being developed with strong input from stakeholders and practitioners. That is why we are confident that it will not be just a document but a usable and effective piece of statutory guidance.

We are not able to accept the amendment in the name of the noble Baroness for the reasons which she accepted, in some way, in her contribution. We have concerns about the specification of 72 hours and other aspects, but I understand her desire to ensure that information about the authorisation record is provided promptly. This is our intention as well. We have heard the will of both Houses on this and have tried to reflect that in our amendments, and I am certainly willing to consider how best to do that. We think that it is best done in the code of practice, which will be statutory and will have teeth, for the reasons that I outlined. I hope that, with these reassurances, the noble Baroness will feel bound to press her amendment. I beg to move.

Healthcare (International Arrangements) Bill

Debate between Baroness Blackwood of North Oxford and Baroness Wheeler

Committee: 2nd sitting (Hansard): House of Lords
Thursday 21st February 2019 Lords Chamber

[Baroness Wheeler]

My Lords, I listened carefully to the strong arguments put forward by the noble Lord, Lord Marks, on this issue, and I await the Minister’s response. We have every sympathy with the intention behind the amendment, and the noble Lord’s frustration that the House can either accept or reject a statutory instrument but cannot amend it, while parliamentarians can and often do take note of or reject Motions. However, Parliament is ultimately at the mercy of the Government to withdraw regulations and bring forward a revised draft, which may or may not adequately address the concerns that have been expressed. Fatal Motions are quite rightly used rarely, in exceptional circumstances.

The noble Lord, Lord Marks, says this is a probing amendment. However, I fear that, in this circumstance, it would be counterintuitive to the Bill’s primary objective of implementing reciprocal health agreements after Brexit. As my noble friend Lady Thornton said on Amendment 33 in an earlier group, time is not on our side, and I fear that the approach contained in this amendment would lead to delays in implementing reciprocal health agreements. In the event of no deal, when millions of British citizens will lose their current access to healthcare treatment overnight, any delay while Parliament debates and considers draft regulations would be catastrophic. Obviously the delay that would occur from the proposals that the noble Lord, Lord Marks, suggests would have to be taken into consideration in any future changes, and would certainly need to be discussed.

[Baroness Blackwood of North Oxford]

My Lords, I thank the noble Lord, Lord Marks, for suggesting in Amendment 32 an approach to the important issue of appropriate levels of parliamentary scrutiny, and for clarifying that this is a probing amendment. The Government clearly recognise the importance of appropriate levels of scrutiny in this Bill and the secondary legislation made under it. Obviously, the hallmark of an effective and responsible parliamentary system is the process by which we draft, consider and test legislation.

During this debate, I have listened very carefully to your Lordships and the views expressed on the affirmative resolution procedure. This is an interesting proposal by which we could consider draft legislation. While the Government support the spirit of the amendment and agree that appropriate scrutiny is important, we have questions about this approach.

It is vital that we can make regulations that allow us to respond appropriately to a variety of possible scenarios arising from not just the UK’s exit from the EU but any situation where we would need to implement regulations, where this Bill might be needed quickly and where it is required for a comprehensive international agreement. Such an approach for scrutiny would, we believe, increase the time taken to develop and lay regulations, and this may have quite a significant negative impact on our ability to bring forth timely regulations to provide healthcare arrangements to support hundreds of thousands of individuals who rely on these provisions—perhaps in a case which may be considered an emergency.

Healthcare (International Arrangements) Bill

Debate between Baroness Blackwood of North Oxford and Baroness Wheeler

Committee: 1st sitting (Hansard): House of Lords
Tuesday 19th February 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

My Lords, I thank the noble Baroness, Lady Wheeler, for moving Amendment 6 in the names of the noble Baroness, Lady Thornton, and the noble Lord, Lord Marks. I thank also my noble friend Lord Dundee and the noble Lord, Lord Foulkes, for tabling and speaking to Amendment 9. These allow me the opportunity to dwell for a moment on the importance of dispute resolution in the context of the Bill.

I am sympathetic to the spirit of these amendments and agree that it is of great importance that the Government establish robust dispute resolution in future healthcare agreements. We have every intention of being transparent and accountable as this develops. There are a number of ways in which dispute resolution might be approached in future reciprocal healthcare arrangements, but the majority would not require or benefit from regulations under the Bill. Dispute-resolution mechanisms that apply between two international parties should be set out in the agreement itself rather than in domestic regulations, since such regulations cannot bind another country’s Government. These regulations would be used to make any necessary domestic provisions for the agreed dispute-resolution mechanism.

I would, however, like to give further reassurance on the Government’s intention for future dispute-resolution mechanisms. There are different options for dispute-resolution mechanisms and it will be important to discuss these as part of future negotiations with other countries or the EU in respect of a future relationship.

To give some further context, as has been debated, the primary mechanism for resolving disputes on the withdrawal agreement is through consultation at the joint committee with the aim of reaching a mutually agreeable resolution. If parties are unable to resolve a dispute in the joint committee, either party can request the establishment of an independent arbitration panel to resolve the dispute. Prior to this, the parties can also agree to refer the dispute to independent arbitration. Future agreements for reciprocal healthcare may therefore seek to set out similar dispute mechanisms, but this is all subject to negotiation on an international rather than domestic level. This would be the case in a no-deal scenario as well as in a scenario post 2020.

In particular, noble Lords raised the point about clarity over the role of the ECJ in any future agreement with the EU. This is one point on which I believe the Government have been consistently clear, and I am happy to lay out our position. As we leave the EU, the direct jurisdiction of the European court will come to an end. However, as outlined in the political declaration, we have agreed that where a dispute raises a question of interpretation of EU law, the arbitration panel can refer this question to the CJEU for interpretation.

I reassure the Committee that, in resisting this amendment, the Government are in no way indicating that we do not place importance on dispute resolution; nor do we intend to conceal from noble Lords the approach that we may pursue. Instead, we resist this amendment as it would not be feasible or necessary to provide this level of detail regarding all possible dispute-resolution mechanisms in the regulations used to give effect to future negotiations and agreements. The correct place for this detail is in the international agreement itself, as I am sure your Lordships will agree.

The CRaG procedure will provide opportunity for scrutiny of those international agreements, which are legally binding and require ratification. We have been and will continue to be transparent about the agreements we reach. I am sure Noble Lords will agree that we abide by the rule of international law and take those commitments seriously. This means that we would be committed to upholding our end of any international agreement, including dispute resolution, and we would hold our partners accountable for doing the same.

I hope I have addressed the crux of the concerns raised and that the noble Baroness will withdraw the amendment.

[Baroness Wheeler]

I thank noble Lords for their contributions. It is hard to see how the ECJ will not have some kind of role in future health agreements. The contributions we have heard obviously underline the importance of dispute agreements being an integral part of healthcare agreements and the need for them to uphold the principles adhered to under the current provisions.

I thank the Minister for her response and her reassurances about transparency, accountability and future intentions. I hope she will reflect further on this important issue and provide fuller details as soon as possible on the dispute and appeals procedure and processes that will pertain. It is essential work that needs to be done and I hope we will be kept informed on it. I beg leave to withdraw the amendment.