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  • Sep 10, 2018:
    • Child Sexual Abuse: Safeguarding Failures - Question | Lords debates

      My Lords, is the Minister aware that the committee had evidence that one of the schools consulted its legal adviser as to whether it was legally obliged to report the abuse that it knew about. Having learned that it was not so obliged, it decided to cover it up. How much more evidence do the Government require of the need for mandatory reporting of child abuse in regulated activity? Of course, that does not include social workers, because social work is not a regulated activity. Will the Government now follow the evidence and respond with legislation?

    • Child Sexual Abuse: Safeguarding Failures - Question | Lords debates

      To ask Her Majesty's Government how they plan to respond to the report of the Independent Inquiry into Child Sexual Abuse regarding safeguarding failures at Downside and Ampleforth schools, published in August 2018.

  • Sep 6, 2018:
    • NHS: Healthcare Data - Motion to Take Note | Lords debates

      My Lords, I thank the noble Lord, Lord Freyberg, for introducing this important debate and congratulate him on his masterful tour d'horizon in his speech. I support his demand for a national strategy on this issue-we must not be left behind. I also very much enjoyed the maiden speech by the noble Lord, Lord Bethell; as I sat here, I found myself musing on whether he would follow in the temperance footsteps of his grandfather or the non-temperance footsteps of his father. I look forward to hearing a lot more from him.

      As we have heard, the NHS has the most enormous amount of valuable data that could be used for improving patient care in a large number of ways; to me, that is the most important objective. First, data can help healthcare providers to measure their performance against baseline standards and against best practice in other similar providers. It can alert us to problems with patient safety and emerging quality problems. Digging into the detail of data can often reveal where providers are failing and suggest solutions-I shall give an example of that later. Data can assist regulators and inspectors to reach their conclusions. It can inform clinical decisions, through what it reveals about efficacy and outcomes, and can influence commissioning decisions through what it reveals about cost-effectiveness and the effects of strategies on public health. It can be used to assist research and to plan and assess clinical trials, and can help agencies to plan and reconfigure services.

      The noble Lord, Lord Kakkar, mentioned the importance of the quality of data. He told us about the massive amount of it, which made me wonder how accessible that data is to researchers-if it is not easily searchable, it will be like looking for a needle in a haystack, in the same way as the doctor, mentioned by the noble Lord, Lord Bethell, looks through his pile of paper files.

      We have heard about many issues of concern. First there is patient consent and privacy, about which the noble Lord, Lord Hunt, was so eloquent. We have heard about the need to prevent exploitation and discrimination from the right reverend Prelate the Bishop of Southwark. We have heard concerns about how data is made available to commercial companies, how value can be realised and about the ownership of private data by a few large corporations. The noble Lord, Lord Mitchell, asked us to maximise that value and he is absolutely right, but there need to be enormous safeguards. I very much agree with him that the NHS, too, needs experts. If it does not, the experts in the big data companies will, as he put it, "crawl all over us".

      A transparent public dialogue is needed about how data is currently used, the opportunities for the future and how risks can be managed. It is vital to balance the benefits of sharing data, which are enormous, with concerns about security and confidentiality, but these concerns should not be a barrier to progress. Many noble Lords have mentioned the crucial need to rebuild patient trust following the care.data problems and recent massive leaks-most recently, this was mentioned by the noble Lord, Lord Macpherson.

      According to the Royal College of Physicians, patient-level data containing patient characteristics, as well as information about treatments, pathways and outcomes, are the most valuable. Indeed, such data can also reveal inequalities in access to care and the quality of care provided to different groups; it can also help to make comparisons of outcomes from different providers fairer, when we know something about the case mix they face. How fit the patient is at the point of diagnosis and how advanced the disease is at that point are important factors when comparing the outcomes achieved by different clinicians and healthcare settings. But such data should be anonymised or pseudonymised wherever possible to avoid identification of individual patients.

      One can also get a lot more out of data if information about the patient can be linked to healthcare activity and outcome information; this requires different systems to talk to one another, which is particularly important in end-of-life care. But this is where the NHS currently falls down. However, I was pleased to learn from a recent briefing by the NHS Confederation, which represents private healthcare providers, that steps are being taken to integrate their datasets with those of the NHS; this will mean patients and the NHS can get a full set of information in one record. On a point made by the noble Baroness, Lady Rock, I was told recently by Simon Stevens that the NHS is no longer the world's biggest purchaser of fax machines; he was rather indignant when I mentioned that.

      There are many examples of where data can be used successfully to improve patient services. Some studies have also been able to motivate settings to improve their track record when linked to payment incentives-a sort of payment by results. This was done as a result of the National Hip Fracture Database. A number of notable national reviews have had tremendous effects on outcomes-such as the National Review of Asthma Deaths, which shockingly found that that a quarter of deaths resulted from inadequate care-which can then be addressed. The Sentinel Stroke National Audit Programme included patient input to help improve services resulting in the establishment of the very successful hyper-acute stroke units in London and Manchester, a model now being copied across the country.

      One issue that concerns me is the amount of data available to the patient and how it could help patients to manage their own healthcare. We cannot expect patients to engage with doctors in taking steps to manage their own condition if we do not give them feedback about whether changes they make in their lifestyles result in better health. For example, I would like to know the exact readings for the good and bad types of cholesterol in my own blood tests, so that I can see whether my lifestyle changes are helping. When I asked the question, I was told, "It's fine-keep on with the medication". That is no help to me when I am trying hard to get to a position where I do not need the medication at all. I agree with the frustrations of the noble Baroness, Lady Neville-Rolfe, on this matter. Like her, I think we should be able to see our own medical records; we should be able to trust the patient with them.

      I also look forward to the day when, living in Wales, I will be able to make appointments and ask for repeat prescriptions online, as my relatives in Scotland already can and my relatives in England will be able to next year. That, however, will require a major step forward in technology, which I do not see on the horizon.

      This morning I came across a perfect example of how data can help to improve services. I hosted a round table at which we heard about research into the issues relating to local authorities missing targets for chlamydia screening. Chlamydia is an increasingly common sexually transmitted disease, which can cause major health problems including infertility. There have been several changes, and indeed reductions, in the funding for this screening. Initially the money went to local authorities, which are responsible for public health, as a dedicated grant, and then it became integrated with other funding. Finally, the funding has now dried up altogether and the National Chlamydia Screening Programme simply monitors how well targets are being met and supports local authorities. Unsurprisingly, the targets are not being met, following a year-on-year decline. In 2017, only 20% of commissioning councils achieved the Public Health England target of 2,300 annual diagnoses.

      The research that I heard about this morning was qualitative. It sought to collect data on various aspects of the difficulties that councils face with a view to proposing how things can be improved. It turns out that, although funding is a significant issue, public awareness is one of the greatest barriers that councils need help with. They would like more national resources to help them develop local marketing programmes to let people know about the dangers of chlamydia and about the screening and services available to them locally. They also need technical help with targeting the most at-risk groups. I thought it was a good example of where digging deep into the data can help to improve services. I am pleased to know that Public Health England is soon to publish a review on this and all other sexual health matters.

      So my questions for the Minister are as follows. What progress is being made on integrating patient data from all health and care settings and making the records available to patients? What measures are being taken to give patients trust and confidence in their data being properly handled? How will applications for outside use of NHS data be handled and against what criteria? Finally, is funding being passed to the Welsh Government to enable patients in Wales to benefit from the technological advances that are already available in Scotland and are soon to be available in England?

  • Jul 18, 2018:
    • Medical Equipment: EU Law | Department of Health and Social Care | Written Answers

      To ask Her Majesty's Government whether they plan to maintain equivalence with the EU Regulation on Medical Devices 2017/745 during the planned transition period from March 2019 to March 2021.

    • NHS: Warehouses | Department of Health and Social Care | Written Answers

      To ask Her Majesty's Government what assessment they have made of warehousing requirements for NHS suppliers if frictionless trade with the EU is not maintained following Brexit.

    • NHS: Warehouses | Department of Health and Social Care | Written Answers

      To ask Her Majesty's Government what assessment they have made of NHS warehousing requirements if frictionless trade with the EU is not maintained following Brexit.

    • Obesity - Question for Short Debate | Lords debates

      My Lords, I thank the noble Lord, Lord McColl, for bringing us back to this important subject, and I welcome the noble Baroness, Lady Boycott, to your Lordships' House.

      Travelling on the Tube yesterday in the middle of the afternoon, I sat opposite a gentleman who took up two seats. His stomach was protruding out of his shirt. He looked very uncomfortable, and he was eating a pasty. I thought, "Sir, this is not good for your health". It took me back to an occasion soon after I entered your Lordships' House when I sat down at the long table in the Home Room with a plate of salad. A former very personable Member of the House sat next to me, looked at both our plates and started to laugh. She said, "Oh look! The slim lady is eating salad and the fat lady is eating sausage and chips". I was too polite to say, "Well, yes, don't you think there's a connection?" Of course, the noble Lord, Lord McColl, is right. What matters most is what we eat and drink.

      Many clinicians now feel that it would help to regard obesity as a disease. We would then be less judgmental and recognise that many people suffering from it have been conditioned since childhood to respond to sugary or carbohydrate-rich foods, with those foods then becoming a need. The gentleman on the train is probably one of them. They need help and services, not judgment, and those must include mental health services. For some, one of the services needed is bariatric surgery, with a multidisciplinary team to help them return to a healthy body weight. I talked recently to an eminent paediatric bariatric surgeon. He told me that the service he provides is not widely available and yet it can save the lives of his patients and reduce the eventual costs to the NHS. Therefore, I ask the Minister what plans are in place to make this service available wherever it is needed. Of course, it is a last resort for very serious cases, and I want to emphasise that the surgeon I spoke to spends a great deal of time working with public health services to prevent people becoming obese in the first place. Prevention, I believe, is the key.

      I was interested in two items on the news this morning which chimed exactly with what I wanted to say today. First, there was new guidance from Public Health England's Scientific Advisory Committee on Nutrition about the number of calories that should be consumed by young babies. It was reported that many are consuming far too many calories and this is laying the foundation for obesity later in life. We were reminded that exclusive breast-feeding, at least for the first six months of life, lays the best foundation for health, not just because of the many antibodies and good micro-organisms passed on from mother to child but also because breast milk is perfectly balanced nutritionally and has just the right number of calories for healthy growth. Therefore, I call Public Health England in aid when I ask the Minister what is being done to encourage more mothers to breast-feed-we have a bad track record in this country-and to ensure that they can do so comfortably wherever they need to do it.

      The second news item was about the Football Association saying that many days of play are prevented because of the state of the pitches. This is because of years of underfunding of local authorities, which cannot afford the necessary upkeep. As my noble friend Lord Addington told us, what we eat may be a major part of the obesity problem but keeping active is also vital. Incidentally, it is also important for mental health. A senior tutor at an Oxbridge college told me recently that, of all the students coming forward for counselling for mental health problems, not one took part in regular sport. She found that very significant and I am sure she is right.

      However, my main concern is with young children. We have had the statistics from the Royal College of Paediatrics and Child Health, and I join its demand that there should be a 9 pm watershed ban on advertising on TV foods that are high in sugar, salt and fat. I am pleased that chapter 2 of the childhood obesity plan promises a consultation on this. I am quite sure that the evidence will show that the majority of TV watched by children is not children's programmes, which already have a ban, but family viewing between 6 pm and 9 pm. If your Lordships are looking for evidence that advertising these foods influences people's choices, they have only to look at how much the food companies spend on it. The noble Baroness, Lady Boycott, reminded us of that. They would not do that if it did not work. People are influenced by messages that tell them how delicious these foods are and how happy they will be if they eat them, so I hope the Minister will assure me that when the Government get this evidence in the consultation, they will act decisively.

  • Jul 12, 2018:
    • Sure Start - Question | Lords debates

      Following up on the previous question, is the Minister aware that yesterday, the All-Party Parliamentary Group for Children published a report showing that many local authorities are unable to afford the early intervention programmes that have just been mentioned and are so effective? The result is that a lot of children in some parts of the country are not getting the services that they would with the same level of need in another part of the country. Many children and families in that situation are going into a downward spiral and getting to the point where they need much more invasive intervention-even taking the child into care. It is cheaper and more effective to intervene early, so will the Minister have a look at the 12 recommendations of that report? They have the evidence, and the Government ought to act on it.

  • Jul 9, 2018:
    • Aortic Aneurysm | Department of Health and Social Care | Written Answers

      To ask Her Majesty's Government what assessment they have made of the availability to UK patients of fenestrated endografts, developed in the UK, manufactured in Scotland and used around the world, if the current draft NICE guidelines on Abdominal Aortic Aneurysm are implemented.

    • Aortic Aneurysm | Department of Health and Social Care | Written Answers

      To ask Her Majesty's Government whether they have conducted an impact assessment of the draft NICE Guidelines on Abdominal Aortic Aneurysm, including the impact (1) on patients over 65 years old who may be medically unsuitable for open surgical repair, and (2) of removing certain treatment options when clinical professionals have indicated that patients require such treatment.

  • Jul 5, 2018:
    • NHS: Equitable Access - Question | Lords debates

      My Lords, as a member of the Parliament choir I am a bit tempted to start singing, but I will resist. Given the remarkable success of the various vaccination programmes during the 70-year history of the NHS, will the Minister say when preventive measures for two modern-day diseases will be made equitably and nationally available? I refer to pre-exposure prophylaxis for HIV, which has already been shown by the trials to be remarkably effective, and vaccination against human papillomavirus, which should be made available for teenage boys as well as teenage girls to ensure full protection.

  • Jun 21, 2018:
    • Cannabis-based Medicines - Question | Lords debates

      My Lords, I thank the Minister for showing that he quite clearly understands the distinction between recreational and medicinal use. Is he also aware that Epidiolex, which is medicine produced by GW Pharmaceuticals for epilepsy sufferers and which will soon be approved, will not help children like Alfie Dingley who have uncontrolled epilepsy seizures? I understand that the cannabinoid CBDV is very important to such sufferers, and there is none of it in Epidiolex. Will the Minister ensure that the review takes account of the special needs of the 200,000 patients with uncontrollable seizures? Will the panel be able to hear from patients as well as studying research?

  • Jun 19, 2018:
    • Bee Population - Question for Short Debate | Lords debates

      My Lords, I congratulate the noble Baroness, Lady Bloomfield, on the debate, and I particularly enjoyed her stories about bees. I point out to her that lime pollen makes bees drunk, so they die happy, and that once a swarm is out of sight of the person whose hive it came from, if you can collect it, it is yours, and you can decide where to put it. I have benefited from that, because my gardener I found one in someone else's garden and brought it to me; they did not want it anyway. I too am a beekeeper, and I keep Welsh Black bees, not Buckfast bees. They came and squatted in an empty hive. I am very pleased with them because they are very strong.

      It has been lovely to hear stories from fellow beekeepers. The noble Lord, Lord Stevenson of Balmacara, should get a new bee suit. If he is being stung so often, it obviously has holes in it. The noble Viscount, Lord Falkland, was right about hay fever-the noble Lord, Lord Marland, mentioned it as well-but the honey must be raw and not overfiltered or heat-treated, so that you get the pollen from your local garden. It certainly works for me as well. By the way, I am very jealous of the noble Lord, Lord Marland, and his electric honey extractor. I am afraid that I have the manual kind. When it is time to harvest my honey, I have to call on the strong right arm of my husband, my noble friend Lord Thomas of Gresford. I think that he will be wondering whether I am going to raid the family coffers and buy an electric extractor. His strong right arm would certainly be grateful.

      As a beekeeper, I am well aware of the need to conserve all our important pollinators as well as our honey bees and wild bees, many species of which are endangered. The mouth parts of different insect species are adapted to reach the nectar in different-shaped flowers, so we need the whole range of insects to pollinate our crops. I am afraid that wind will not cut it because of the shape of the flowers.

      I must congratulate the noble Viscount, Lord Ridley, on his species-rich wildflower meadow and the noble Lord, Lord Robathan, on his cowslips, because they are important. I want to mention the many groups of volunteer gardeners such as my daughter and her colleagues in Altrincham in Bloom, who, with permission, have sown species-rich beds of wildflowers and other flowering plants in public places in the town. These have provided not only beauty for residents but a corridor of forage for a wide variety of bees and other pollinators. Such voluntary activity is to be encouraged and not discouraged, as happens when council workmen strim down the lot. I hope that most local authorities will encourage and co-operate with this sort of voluntary group who give so much of their time in the interests of our pollinators. It is also important that verges of major roads and motorways are left to flower and not strimmed to within an inch of their lives at the earliest opportunity. Does the Department for Transport have a policy on this?

      Gardeners can play their part. As a keen gardener myself, I have a wide variety of plants in my garden. In fact, it has often been commented that I have less of a garden and more of a plant collection, but a wide variety of plants is important because of the need for a wide variety of pollinators.

      Of course, beekeepers make a big contribution to pollination by protecting honey bees. Beekeeping is an excellent hobby, combining biology, physiology, history, horticulture and pharmacy. However, it is a big commitment and there is a great deal to learn. I have made some terrible mistakes in the past, from which I hope I have learned. It makes sense for new beekeepers to join local beekeeping associations and make use of the courses they offer and the advice so freely given. I am very grateful to my own bee mentors, Lloyd Roberts and Dell Hannaby. Does Defra provide supportive funding for these groups that are so valuable, particularly to new beekeepers?

      Bee inspectors provided by the National Bee Unit are important, too, because they check the health of bees and help prevent the spread of disease. They also give good advice, as I can testify. It is sad to see that Defra, which runs the NBU at arm's length, is not replacing bee inspectors. I heard recently from a bee inspector in Wiltshire that when he retires at the end of this year Wiltshire may not have an inspector. This is very dangerous for the health of bees in the county-we have heard all about the various diseases that are rampant. Can the Minister tell me whether this situation is happening in other areas of the country and what, if anything, is being done to replace these valuable officers?

      One of the biggest hazards for bee colonies is the use of certain pesticides. The Government's code of practice, which is due to be updated shortly-perhaps the Minister can tell us when-states that certain pesticides which may harm bees will be labelled as "harmful" or "high risk". The person responsible for a spray operation is obliged to tell local beekeepers, or the British Beekeepers Association's local spray liaison officer, 48 hours before the use of an insecticide at certain times of the year, giving beekeepers time to take the necessary precautions. The SLOs act as go-betweens, informing beekeepers when the farmer is going to spray.

      However, this process has not always been effective, so a new initiative, which has already been mentioned by two noble Lords, has been set up by responsible farmers and growers. It is called BeeConnected and aims to help reduce pollinator exposure to insecticides by alerting beekeepers electronically before spraying. As my noble friend Lady Miller mentioned, BeeConnected has been developed in conjunction with the BBKA to replace the need for SLOs and instead inform beekeepers directly. It is a simple process whereby the person responsible for the spraying registers on the website and identifies the fields using Google Maps. The system automatically informs local beekeepers when someone intends to spray a particular field. Beekeepers who have plotted the location of their hives on the system will then receive a notification ahead of a spray event. This is as an excellent initiative, and I intend to go on the website and register my hives.

      Such initiatives are important in the light of the risk to bees if we exit the EU and are no longer bound by the ban on neonics and other substances, unless the Government take similar action. Can the Minister assure us that the Government will continue to protect our pollinators if, unfortunately, we leave the EU?

      Finally, the noble Viscount, Lord Ridley, made a point about how crop-pollinating insects are thriving. If we grow more crops to feed the world's growing population, it occurs to me that we are providing more food for their pollinators, so I am not surprised that they are thriving. I wonder whether the noble Viscount agrees. I look forward to the Minister's response.

    • Drugs Licensing - Statement | Lords debates

      My Lords, I, too, welcome the Statement and thank the Minister for making it. I thank her also for her efforts in this cause and those of her noble friend Lord O'Shaughnessy, who is in his place. I welcome the fact that Professor Sally Davies will now review the mountain of evidence for the medicinal and therapeutic benefit of cannabis-based medicines. She will undoubtedly find that the fact that there are no legally recognised benefits is quite wrong and must change. By what means will Professor Davies hear evidence from the many patients who already know about the benefits? Their doctors know the benefits, too. If she does not already, I am quite sure that Professor Davies will soon know them as well.

      I also welcome the fact that the Government will reschedule cannabis when Professor Davies demonstrates those benefits. It should never have been scheduled as a drug without any medical benefits in the first place. Can the Minister estimate how long this process will take, as thousands of patients await the outcome in pain and discomfort?

      While we wait for this to be done, it is very welcome that the Government have set up an expert panel to advise Ministers on any applications to prescribe cannabis medicines. It is outrageous that the Dingley family's heroic doctors should have been put through the wringer by the inappropriate processes which the Home Office has imposed on them during the past four months.

      I cannot say how delighted I am that Alfie Dingley and Billy Caldwell will get their medicines at last. However, it should not have taken four months since the Prime Minister promised Alfie's mother, Hannah Deacon, when she visited No. 10 with me and a group of Peers and MPs, that her son would get a licence for his cannabis medicines on compassionate grounds and speedily. During that four-month period Home Office officials were trying, mistakenly, to operate a system for licensing which was not intended for such cases but was intended for normal clinical trials. It became clear very quickly that the system they were trying to use was not fit for purpose, yet they persisted. I would like to be assured that a system that is fit for purpose will be put in place. Will the Minister give me that assurance? It should not have taken a child, Billy Caldwell, being put in a life-threatening situation for the Government to take this action but I am delighted that they now have.

      During the campaign I have been convinced of the Minister's good faith in this matter but, frankly, although she is always welcome in her place, it should be a Health Minister standing there at the Dispatch Box. I am delighted to see the noble Lord, Lord O'Shaughnessy, in his place listening to this debate. Drug licensing is a health matter, not a Home Office matter and clearly the Secretary of State for Health and Social Care agrees with that, so how will the Department of Health and Social Care be involved in the new arrangements outlined in the Statement and those that will inevitably follow?

      Yesterday the Prime Minister said a system is already in place for the medicinal use of cannabis and that government policy would be driven by "what clinicians are saying". The system has failed thousands of patients, but it is good news that the Government are now trying to put that right, and I thank the Minister for that. Can she say whether expert evidence from countries such as the Netherlands, where cannabis medicines have been safely used for some time, will be heard during the review?

    • Long-term Plan for the NHS - Statement | Lords debates

      My Lords, first, the Statement mentions £1.25 billion cash to cope with specific pension pressures. Is that because so many doctors are retiring early, and therefore drawing their pensions early, because of the pressures of the job? I know three GPs who are retiring far too early because of those pressures, so will the NHS be able to spend some of that money to relieve those pressures? Secondly, the Statement mentions that the Government want to prioritise prevention and that the NHS should get better at managing demand effectively. There are two factors that limit its ability to do that: social care has been mentioned by many noble Lords but I would also mention prevention. Can the Minister assure us that, when we get the spending review, the amount of money that goes to local authorities co-operating with the NHS on the prevention of ill health will not just be enough to make up for the cuts they have suffered over recent years but enough to really go forward and transform prevention measures?

    • Long-term Plan for the NHS - Statement | Lords debates

      My Lords-

  • Jun 12, 2018:
    • NHS: Overseas Doctors - Question | Lords debates

      My Lords, is it not true that the current situation is quite deliberate? The Conservative Party manifesto last year promised to double the cost of employing someone from outside the EEA. The head of business immigration at law firm Kingsley Napley believes that the cost of employing much-needed staff from other parts of the world will be £14,174 a year more than employing EU staff. So, as EU staff leave the NHS in the face of Brexit, how will the Government's proposals help NHS budgets, even if it can get visas for the staff it desperately needs?

  • May 21, 2018:
    • Education (Student Support) (Amendment) (No. 2) Regulations 2018 - Motion to Regret | Lords debates

      I would add that the Browne recommendations had no cap at all.

    • Education (Student Support) (Amendment) (No. 2) Regulations 2018 - Motion to Regret | Lords debates

      My Lords, like the noble Lord, Lord Hunt of Kings Heath, we, too, oppose the introduction of these regulations-and for very similar reasons. It always makes sense to make policy based on evidence and on the advice of experts. This is what the Government have failed to do in relation to the funding of student nurses. The removal of the bursaries for undergraduate nurses has already considerably reduced the number of applicants, and the number of those taking up a place was 705 lower last year than the year before. Given the 40,000 nurse vacancies that the noble Lord mentioned, this is a serious matter for patient safety, as pointed out by the Care Quality Commission. I accept that these are only one year's figures, but I believe that, before upsetting the apple cart even further, the Government should postpone removing bursaries from postgraduate nurse trainees and other important groups until we have clear evidence of the effect on the number of undergraduate student nurses.

      If we want to increase the number of registered nurses quickly, which we need to do, it makes more sense to support the two-year postgraduate route, not put it at risk by removing those bursaries, too-because this is the quickest way to get more nurses. Most suppliers of the two-year courses indicate that capacity could be increased by 50% given the right financial support, yet the Government are planning to deter applicants by removing the bursary. This does not make sense. Instead, the Government are focusing on the two four-year routes into nursing, yet the apprenticeship route is not providing the expected 1,000 extra nurses per year. The most recent data tells us that there are only 30 apprentice nurses-hardly a success. Will the Government look into the barriers that are preventing NHS employers taking on apprentices? It could be the 60% cut in funding for further professional development, which has affected the number of those who would like to become training assessors and mentors for student nurses and apprentices.

      Nursing associates have a role both as assistants to registered nurses and as users of an alternative four-year route into nursing-but, again, it takes a long time and these associates, as the noble Lord, Lord Hunt, said, should not while training ever be seen as substitutes for fully qualified nurses. So why are the Government planning to deter applicants for the rapid postgraduate route, where 64% are over 25, where they are predominantly women and where they are more diverse than the general student population? In a career such as nursing it would be advantageous to attract people with a little more life experience than the average 18 year-old.

      Also, we know that older women and ethnic minority students are more debt-averse, as well as already having a student debt of up to £50,000 from their first degree. Therefore, it is vital to look at how this fast route into nursing could be supported. The RCN tells us that, if the fees were paid and a modest bursary towards living costs provided, the total would be less than the average annual premium paid by trusts over a single year for a full-time agency nurse. This is short-termism of the worst kind.

      While the Government carry out their review of post-18 education, they might benefit from looking at the measures introduced in Wales by Kirsty Williams AM, the Liberal Democrat Minister in the Welsh Government responsible for medical education. Her conversations with students revealed that the main concern and deterrent was not fees but living costs. Therefore, she has introduced the equivalent of the minimum wage for students during their course. This method of student funding should be carefully considered by the Government while carrying out their review, particularly for nursing students, who have more contact time than other students because of their clinical placement and therefore less time to get a part-time job to support themselves. Will the Government please consider this sensible idea?

      The House of Commons Select Committee on Health and Social Care stated that the nursing workforce should be expanded at scale and pace to avoid dangerous levels of vacancies. It should be based on need and demand rather than affordability. It is up to the Government to say how the money will be raised, but from these Benches we recommend some sort of hypothecated taxation or a reformed national insurance scheme which is truly progressive and demonstrates intergenerational fairness. The Liberal Democrats are also in favour of restoring the bursaries for undergraduate student nurses and we are against these new regulations, which would remove the bursary from postgraduate nursing students and other important health professional courses.

  • May 16, 2018:
    • Social Workers - Question for Short Debate | Lords debates

      My Lords, when we come to the end of this short debate and we all go home for our piece of toast because all the cafés here are closed, I hope that the noble Lord, Lord Parekh, will feel that we may not have had quantity but we certainly had quality. We have certainly had that so far from him and from the noble Lord, Lord Kennedy.

      The job of a social worker is always difficult. They have to make finely balanced judgments every day, based on a large number of factors. Every case requires them to use their professional judgment and experience and very often they are themselves judged by those who know little about it. When it comes to decisions about taking children into care, they are often damned if they do and damned if they don't-but I thank them for what they do.

      As vice-chair of the All-Party Parliamentary Group for Children, I will focus on children and family social workers, because last year our group carried out a very revealing inquiry in this area called No Good Options. We are currently part way through a piece of follow-up work. Many of the issues we revealed are applicable to all social workers.

      The big issues are heavy case loads and stress; staff turnover and stability of the workforce; and the opportunity to undertake further professional development, with pathways to progress in the profession. Staff were also concerned about the status of the profession. I hope that the new regulator, Social Work England, under the able leadership of the noble Lord, Lord Patel of Bradford, will be able to contribute positively to that status and quality with the right kind of regulation. Social workers want their professional views to be respected and to bring about the best outcomes for the children in their care. I think I can say that anyone who becomes a social worker really cares about the people they serve, and we should value the work they do for society.

      We found evidence of rising demand, rising thresholds for intervention, and increasing case complexity-at a time when resources are falling. Schools are now taking on tasks that used to be carried out by children's social workers. As a result of this, one of our recommendations was that the Department for Education and the then Department for Communities and Local Government should carry out a review of the resourcing of children's social services and provide the resources needed to enable local authorities to adhere to the LGA guidance on case loads. One problem reported to us was that local authorities cannot afford the early, low-level interventions that can prevent a case escalating into a more complex and serious matter that costs more to treat. All our witnesses were committed to this preventive work, but many found it impossible to afford because they can afford only the mandatory services.

      This upward cost and case-load spiral puts a very heavy burden on staff and supervisors. All this leads to high staff turnover, which hinders the development of stable relationships with service users. When social workers leave a stable job and go to work for an agency, they often have more work flexibility, a more manageable workload and sometimes higher pay, so you cannot really blame them. But this is not the ideal way to serve vulnerable children who suffer when their social worker keeps changing.

      Some local authorities have managed to reduce the use of locum staff, but some still have very high levels. Whereas the average was 16%, five authorities had 40% and one had 100% locum staff. In response to this, many authorities have grouped together to sign a memorandum of understanding to keep the cost of locums down and reduce churn. This has worked well and we believe that 80% of children's services now work in this way-but will the Government please look into whether there could be a national memorandum on the payment of locum staff, as the costs are crippling some hard-pressed local authorities?

      Case loads vary tremendously. A number of our witnesses recommended 12 families per social worker as the optimum case load. In Essex, where average case loads have decreased in recent years, from between 25 and 40 per social worker down to 12, the inquiry heard that staff turnover had markedly decreased and morale had improved. The LGA advises that all employers should use a workload management system that sets clear targets for safe workloads in each service and regularly assess each social worker's case load, taking into account complexity, capacity and the need for supervision. We recommended that the Department for Education should develop a strategy to reduce churn in the children's social work system. Will the Government seriously consider the need to do this?

      Cafcass is one of the country's largest employers of children and family social workers, because of their role in making assessments and advising the courts. Under the recently ended chairmanship of my noble friend Lady Tyler of Enfield, who cannot be in her place today because of other commitments, Cafcass has been turned around from what some in past years regarded as a failing organisation to one that recently received an outstanding inspection report from Ofsted. My noble friend, her chief executive and every single Cafcass staff member are to be congratulated on this achievement.

      Although, as with most organisations, some still criticise aspects of Cafcass's service, it might be instructive to look at how it made such impressive improvements. The answer, of course, is complex-and a lot of hard work. However, two paragraphs of the Ofsted report stand out in relation to our debate today. Ofsted stated:

      "Successful workforce planning and innovations in Cafcass's recruitment processes (plus additional investment secured by the chief executive) have resulted in a higher number of frontline practitioners with more capacity to sustain a high-quality service. Senior leaders are not complacent. They are committed to maintaining average caseloads for staff at manageable levels to safeguard employee well-being and productivity. In our survey of Cafcass staff, 97% agreed or strongly agreed that Cafcass, as a national organisation, continually strives to improve".

      This comment is a great credit to the management and governance of the organisation, but I did notice that very important phrase,

      "plus additional investment secured by the chief executive".

      I suspect that all employers of social workers would want to be able to say that.

      Attention at Cafcass was also paid to staff well-being, continued professional development and promotion opportunities. Ofsted stated:

      "Staff report that they are well supported, feel valued and have good access to a wide range of training and development opportunities. Many staff have benefited from in-house development schemes and have been promoted to more senior positions within the area. Staff turnover is low and caseloads are manageable across all areas of practice. Managers are readily available and guide and advise the skilled workforce effectively. The performance and learning review (PLR) process works well and includes a good balance of staff development and well-being, self-assessment, reflection and case discussion".

      This has clearly been a blueprint for success that others could follow.

      The fact that careful case planning allows the majority of Cafcass staff to consistently provide excellent, timely services for children, their families and the family courts contributes to staff morale and a high level of staff retention. I know that a big effort was also made to ensure that staff produce strong, evidence-based and succinct reports that minimise the need for additional experts, and reduce delay and the need for further appointments, which can only be helpful to service users. The voice of the child is very powerful and often quoted verbatim in reports.

      Social work is a people business and those who find ways to invest in their staff reap the rewards, as has been demonstrated. What plans do the Government have to invest in the quality and status of social work, for the sake of the workers themselves and that of their clients?