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Health Care: Guidance

Volume 805: debated on Monday 21 September 2020


Asked by

To ask Her Majesty’s Government what guidance they have issued since the end of May 2020 to hospitals, General Practitioners and other health care providers about giving appropriate treatment to different patient age groups.

My Lords, I make this point very clearly. The NHS provides a comprehensive service available to all, irrespective of gender, race, disability or age. No guidance has been issued on the provision of appropriate treatment based solely on age. The NHS has issued guidance for the restoration of non-Covid-19 health services, working on the principle that the most clinically urgent patients should be seen first, followed by those who have been waiting the longest.

I thank the Minister for his reply. He will be aware that there have been letters in the Telegraph and elsewhere, saying an advisory age of 75 is being brought in. First, is any age guidance given in any of the information sent out by his department? Secondly, will he agree to place a copy of all the circulars from the DHSC in the Library so that we can see what is going out?

My Lords, I can confirm clearly that reports of any sort of age limit of the kind referred to by my noble friend are completely wrong. On the matter of sharing circulars, there will be certain practical challenges to that, but I will inquire as to what we can possibly share, so that these decisions are as transparent as my noble friend wishes.

My Lords, the distinction between different patient groups has particularly affected care home residents through the blanket use of “do not resuscitate” orders without explanation to patients and families. Will the Minister make clear his abhorrence of this practice, and can he say how he will ensure that the recent winter guidance in relation to this for adult social care will be followed in full?

My Lords, there are no blanket DNR notices. These are completely abhorrent and against the NHS constitution. We are not supporting them at all. The noble Lord is entirely right that families should be consulted before any such measures are put in place. The social care plan published earlier this month makes that absolutely clear.

My Lords, young people have been hit hard by Covid-19, if not physically, then mentally and emotionally. They may be caring for someone who is either sick or vulnerable and therefore isolating. What is being done to ensure that young carers continue to get support during the pandemic—especially in the light of further restrictions—both for their caring duties and for their own mental health and well-being?

The noble Baroness is entirely right to focus on the plight of young carers, who play an incredibly important role in society at any time, and who are under profound pressure, particularly when isolating during this epidemic. Substantial financial support has been given to local authorities to provide their social care services with the additional funds necessary to support such cases, and we continue to work through our charity partners to ensure that young carers are supported.

My Lords, I congratulate the Government on avoiding the temptation to discriminate on the grounds of age in connection with this coronavirus illness. The original guidance suggested that a person was vulnerable just because they were over 70, and I welcome the clarification. Could my noble friend assure the House that the Government do not intend to introduce blanket age restrictions and that the individual medical conditions of each person will be taken into account, rather than just age?

My Lords, I reiterate the point I made earlier in response to my noble friend’s quite reasonable remarks on the importance of fairness when it comes to age: blanket age restrictions play no role in the NHS and are overtly against the constitution.

My Lords, I declare that I chair the National Mental Capacity Forum and am an elected member of the BMA ethics committee. All treatment decisions must be individualised based on the likelihood of benefit to the person, considering their wishes and feelings, without prejudice of age, disability or other pre-existing conditions. Will the Government continue to work with the forum to ensure this is known and understood properly across health and social care in all sectors?

The noble Baroness puts it extremely well: all treatments should be individualised and tailored to the patient’s needs and requirements. I applaud the work of the forum. We are committed to continuing that work, and it is an important part of our correspondence with trusts that these standards are upheld and advertised.

My Lords, the Minister will be aware of widespread concern that NHS measures introduced in response to Covid-19 are having serious consequences, with patients denied basic healthcare. Almost half of the 102 million GP consultations between March and July were delivered by phone or video, in line with government guidance to deliver a predominantly remote service. What steps are the Government taking to ensure that vulnerable people, especially the elderly, are not shut out from surgeries under measures introduced to stop the spread of the virus this winter? The reality is many are not online, they struggle with complex information systems and will face further difficulties if they are once again advised to isolate.

The noble Baroness is right that half of consultations have been done by telephone or on the internet. Some of those have been successful, but I agree with her that we have to keep GP surgeries open for those who either choose or need face-to-face consultations. That is why the NHS chief executive has written to CCGs and trusts urging them to be open and to have fair access to face-to-face consultations where necessary.

My Lords, I refer to my entry in the register of interests. Older people are more vulnerable to complications from the virus. Many more of them will have diabetes, and many more will feel that they need cancer treatment urgently. So why are so many older people still worried that they might be treated less favourably by the NHS due to their age? In particular, will the Minister explain how the backlog in treating cancer patients will be dealt with?

The noble Lord is entirely right that there is a large amount of concern among patients—existing patients who are on existing programmes and patients who think to go to the NHS. We are launching a “Help Us Help You” campaign at the beginning of October, which will be a substantial marketing campaign to reassure patients who might be concerned that the NHS is open and there to help them.

My Lords, during this Covid crisis, many others are suffering greatly yet feeling neglected, such as cancer patients awaiting urgent treatment. There has also been a rise in suicide across every age group. What advice is the Minister’s department giving to hospitals, GPs and other health providers in tackling these things?

My Lords, mental health concerns are a major priority at all times but particularly during Covid-19. That is why are giving substantial funds to mental health charities and supporting the work of the mental health trusts that oversee this area, and I commend their work during Covid-19.

My Lords, having been a NHS dentist for many years, I was disappointed that dentists were not allowed to keep their practices open during the lockdown period. A number of people sought my advice, which may have helped them but may not have. In past cases where there has been cause for alarm, in dentistry, like in every other part of the medical profession, they arranged a rota system. The dental profession still has these wonderful boards for local dentists to decide how and when each one would take a turn in providing the necessary services. It has gone very badly this time; I have met so many people who are desperate for a dentist and cannot get one anywhere. What can the Minister do about it?

My Lords, the challenge faced by dentists has been profound. The challenge of contagion in a dental practice is big and challenging. But I commend dentists who have gone to huge lengths to put in PPE and hygiene arrangements so that they are able to reopen. The scale of reopenings is enormous, but there is an enormous backlog, and we will be providing support for dentists to help them meet the scale of that backlog.