Government Policy on Health
Baroness Bennett of Manor Castle Excerpts(2 months, 1 week ago)
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Baroness Merron (Lab)
I thank the noble Baroness for sharing her experience of consulting widely. It is certainly entirely legitimate for government departments to do just that. However, those who do not have a formal role are not required to declare interests; it is different for those who have a formal role. Requiring them to do so would mean, for example, us sending forms in advance to Cancer Research UK before it comes in to talk to us about cancer and to assist us. Would we want that? We would not. Of course, where there is a formal role, we absolutely do that.
It is probably worth saying that a particularly high-profile invitation went from the Secretary of State to the noble Lord, Lord Darzi. He will report shortly on the true state of the National Health Service. He does not have a specific role in the department but he has been invited by the Secretary of State to assist; I believe that he will assist both your Lordships’ House and the other place.
Baroness Bennett of Manor Castle (GP)
My Lords, when the Green Party consults on health policy, among the organisations it consults are the Socialist Health Association, Keep Our NHS Public and 999 Call for the NHS—all organisations that are greatly concerned about the continuing privatisation of the NHS. Can the Minister tell me whether the Secretary of State or she herself have had meetings with any of those three organisations since coming into government?
Baroness Merron (Lab)
I cannot answer that, I am afraid. I would be very happy to look at it for the noble Baroness.
Vaginal Mesh Implants: Compensation
Baroness Bennett of Manor Castle Excerpts(2 months, 2 weeks ago)
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Baroness Bennett of Manor Castle (GP)
My Lords, I join what I am sure will be a chorus of praise for the noble Baroness, Lady Cumberlege, both for securing this debate and for her brilliant work over many years on these issues, particularly that of vaginal mesh. I started working with the noble Baroness during the passage of the Medicines and Medical Devices Act. If we think back, many of the things the noble Baroness was pushing for have since been achieved. However, today we are addressing some of the things that still desperately need to be dealt with.
One of the noble Baroness’s achievements was the appointment of a Patient Safety Commissioner. Dr Henrietta Hughes is doing a brilliant job and, as has already been referred to, brought out a report in February urging that the compensation schemes for both sodium valproate and vaginal mesh be brought in as soon as possible. I will just do a little bit of advertising for Dr Hughes. She still has a consultation open on the principles of better patient safety and there is one more day for a chance to respond to that, if anyone would like to do so. It is such important work that it deserves to be highlighted.
I want to put this in the broader context of where we are now. We seem to be hearing weekly about a cascade of official and government failures: the Grenfell Tower tragedy, the Horizon scandal, the infected blood disaster and the Hillsborough tragedy. Obviously, we have a new Government and they do not bear direct responsibility for any of those circumstances, but it presents them with an enormous challenge: the challenge to respond sensitively, appropriately and at sufficient speed to do everything possible to ameliorate the circumstances of the victims.
These cases also throw up the challenge of acknowledging that the talk about “cutting red tape” that we have been hearing for so many years is a deeply dangerous approach. We need rules, regulations and controls to keep us safe. As the noble Baroness, Lady Sugg, drew attention to, we need to keep under control what those who make profits are doing to increase them.
We also need to listen to the people who are adversely affected when things start to go wrong. The reality is that so often—we know this is particularly the case with female patients—for years and years people said, “There’s a problem here”, and officialdom said, “No, nothing to see here; it’s all fine”, sometimes even saying that it was all in their head. The Government really need to stamp on that tendency.
I understand that it is early days for the new Government, but I have noticed—this is not directed at the Minister in particular, but at the Government more generally—that when I put down Written Questions and get the Answers, I seem to get essentially the same Answers as I got a few months ago under the previous Government. I urge Ministers, both individually and collectively, to please be curious and challenging. If an Answer was given six or 12 months, or two years, ago, ask if it is still the right one, if indeed it was the right one in the first place.
I have some specific points. A number of people referred to the recent settlement in the court case against the manufacturers. One of the issues that raised was the fact that hundreds of women were unable to make a claim due to a strict 10-year time limit from the date that the product was manufactured. Are the Government planning to do something about that?
I join the noble Baroness, Lady Sugg, in paying great tribute to Sling The Mesh and other similar campaigners. Is the Minister ensuring that her door is open not only to that group but to many other campaigning groups? It would be great to hear that that is the case.
A further point is that Dr Hughes recommended at least an interim payment scheme for vaginal mesh and sodium valproate. The question everyone is asking is, when are we going to hear about that?
The Independent reports that June Dunne, a 64 year-old, has been waiting for corrective surgery since 2019. What are the waiting lists now like?
Finally, the official government figures say that there are 127,000 mesh implants. The campaigners say there may have been many more. Are the Government looking into making sure that they have the proper records of all people affected?
Vaping Products: Usage by Children
Baroness Bennett of Manor Castle Excerpts(2 months, 2 weeks ago)
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Baroness Bennett of Manor Castle (GP)
My Lords, it is a pleasure to follow the noble Baroness, Lady Walmsley, and to thank the noble Lord, Lord Storey, for securing this very important debate and reminding me that I should declare my position as a vice-president of the Local Government Association.
Seeing this on the Order Paper took me back to a moment when I really saw how much of an issue vaping is becoming. I was on a local train in the West Midlands when a young woman, maybe 18, was chatting on her phone to her friend. I remember the vehemence of the sentence that she stated then, talking about vaping: “You just need it so desperately; it’s much worse than cigarettes”. That point of addiction in the way that vaping is experienced by young people was driven home to me by that individual circumstance. This is a significant health issue.
It is worth looking at the fact that behind this is a semi-success story. The indoor smoking ban that came in in 2007, fairly strong labelling laws, education, and provision of cessation help have had a big impact. However, as the noble Lord, Lord Bethell, says, we seem to have hit a brick wall in making progress.
What has happened, as happens so often when regulating big business, is that an escape clause was levered out: vaping. It has become a new method of keeping big tobacco in business. All bar one of the giant tobacco companies have made substantial investments, as outlined by the Tobacco Tactics project of the University of Bath. I must ask the Minister a question here: are the Government concerned about the potential lobbying impacts of big tobacco on the operations of Government and Parliament? Do they intend to act on that level of influence, which is a threat to future action?
The noble Lord, Lord Winston, accurately said that there is a huge amount of uncertainty and that future research is needed. I was looking at a 2022 state-of-the-art review from the British Medical Journal, by Andrea Jonas, titled the “Impact of Vaping on Respiratory Health”. A sentence in it really struck me:
“The public health consequences of widespread vaping remain to be seen”.
We need to apply a precautionary principle, as was said by the noble Baroness, Lady Walmsley. Young people, who still have underdeveloped lungs, are taking who knows what substances into their lungs—certainly the Government do not know; no one really knows. Basic common sense says that this will certainly not be good.
It is worth looking at the figures. I am relying on the extensive briefing from the British Medical Association, which I am sure most noble Lords have received: 7.6% of 11 to 17 year-olds are vaping regularly or occasionally. That compares to 1.3% 10 years ago, so this really deserves the term “epidemic”. The YouGov survey quoted in the very useful Library briefing shows that 18% of 11 to 17 year-olds have tried vaping. That is nearly 1 million children. This is not a fringe concern.
As other noble Lords have said, many children are buying these products from shops illegally. This is very clear. It is also clear that many products are sold that do not meet health regulations. It is worth looking at the context in which this operates. I note a recent interview with the chief executive of the Chartered Trading Standards Institute, in which he pointed out that trading standards are not protected in local government budgets in the way that adult social care and children’s services are. Those two elements make up 80% of the budgets of many local councils. Trading standards are just one of the many essentials that have been squeezed and squeezed again.
This is a really useful case study in taking on the rhetoric that we hear all too often about how terrible red tape is. Protecting our children from dangerous substances and making sure that the law is enforced in shops is what some would call red tape, but I say that they need to be properly funded and supported. Among the many briefings that we have received is one from the Association of Convenience Stores stressing the cost of fully enforcing vape legislation. I was not entirely clear about where it was coming from, but it makes the point that, if we are going to do anything about this, we cannot just pass laws; we also need to fund their enforcement.
I noted in the King’s Speech in July that a tobacco and vapes Bill would be reintroduced. Can the Minister indicate whether that will include the promise of enforcement for whatever that Bill contains?
I pick up the point made by the noble Lord, Lord Bethell, about the need to future-proof that Bill. We are already seeing, in expectation of restrictions and controls coming in particularly on single-use vapes, that companies are adapting. We are seeing reusable replacements for these disposable single-use vapes already on the market, carrying the same brand name and looking very similar in product design. It is very hard to tell the difference between the single-use and the reusable. This is one of the ways in which people are attempting to intervene before the restrictions come in.
Another area that we need to look at very closely is nicotine pouches. Usage in the UK is relatively low compared to some other countries, but people in the social media world tell me that this area is exploding. We need to look at what restrictions might be placed on those products and how we stop creating an open door to be driven through.
As a Green, I feel that I must finally pick up a point made in the introduction by the noble Lord, Lord Storey, about environmental impacts, particularly of single-use vapes. We are talking about children’s health, but plastic in the environment is significant to the health of all of us, particularly children. I point to a recent study; I urge noble Lords to look it up if they have not seen it. A study of a sample of human brains found that they consisted of 0.5% plastic. Microplastics are everywhere: they are in testes, placentas, breast milk and brains.
Think about the world in which our young people live. In the UK, 1.3 million of these battery-powered devices, usually plastic, are discarded every week. Some 10 tonnes of lithium are thrown into the environment, which is sufficient to manufacture 1,200 electric car batteries a year. As with so many issues, this is a public health issue, an individual health issue and an environmental health issue. We need to look holistically at many of these issues from that one-health frame.
Coronavirus: UK Deaths
Baroness Bennett of Manor Castle Excerpts(3 months, 3 weeks ago)
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Lord Kennedy of Southwark (Lab Co-op)
My Lords, we have not heard from the Green Benches yet.
Baroness Bennett of Manor Castle (GP)
I thank noble Lords. Following on from the question from the noble Earl, Lord Clancarty, about long Covid, and of course continuing new cases are arising even from apparently initially mild infections, we also face the threat that I hope the Government are watching closely of H5N1 in terms of other respiratory diseases, and we know it is only a matter of time before another respiratory pandemic faces us. What steps are the Government taking to look at air filtration and ventilation systems to provide a better public health system that is more resistant to future diseases in schools and other public buildings and perhaps to provide ways for people to assess in premises they visit how good the ventilation and filtration is for them to be able to go into those environments?
Baroness Merron (Lab)
The noble Baroness offers some helpful suggestions as to areas that we can be looking at, but this for me all comes under the headline of resilience and certainly we are monitoring potential emergencies, including the one that the noble Baroness refers to. I can assure her also that preparedness will not just focus on respiratory means of passing on disease but will now look at all of the five routes of transmission, and I feel that will make us a much more resilient country.
Cass Review
Baroness Bennett of Manor Castle Excerpts(7 months, 1 week ago)
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Lord Markham (Con)
To take the second point first—it was also made by the noble Baroness opposite—that is absolutely right; it can be a real danger. People with English as a second language might not understand that a “person with ovaries” refers to them. It needs to be very clear. It is fundamental that the first description has to be “male” or “female”; you can then put additional parentheses after that.
The noble Baroness’s first point is exactly right. Until young people are through the age of puberty and its effects, they are not in a real position to make up their own minds. That does not mean that they should not be supported during that process, but it does mean that we should not be doing anything irreversible.
Baroness Bennett of Manor Castle (GP)
My Lords, I watched the Secretary of State’s introduction to this Statement on Monday, live from my office. She asked the other place to
“bear the sensitivities of this debate in mind”.—[Official Report, Commons, 15/4/24; col. 55.]
I am afraid that it is clear from the printed record before us, and was even clearer watching the Secretary of State speaking, that it was delivered in a triumphalist, dogmatic tone, which meant that she did not follow her own prescription.
The Statement speaks of “myths” but fails to acknowledge the agency and lived experience of children and young people. I have two questions for the Minister. Can he reassure me that we are not going to lose, in this ideological debate, the need for massively more investment in services for children and young people in the NHS? The noble Baroness, Lady Burt, referred to the huge waiting lists that are behind the report we are discussing today.
The Statement also did not mention—and I think we have to acknowledge this—that hate crime against transgender people hit a record high in figures out last October. I hope that the Minister will agree with me that children and young people seeking gender identity services should not have to live in a society where their experiences are used as a political football. They should not be treated as a weapon in the culture war. They should not have to live in a hostile society.
Lord Markham (Con)
First, I think I speak for the whole House in agreeing that no one, under any circumstances, should feel that they live in a hostile society —whatever case it is, whether it is transgender, race, sex or whatever. I totally agree with the noble Baroness there. I will absolutely clarify this in the follow-up in writing, but I know that, in this specific area, the NHS has already committed £18 million in this space. Of course, this is quite separate from the £2.3 billion that I mentioned before in the mental health space generally, which, from memory—and I will absolutely clarify this—is the provision of 350,000 extra places for young people, because we know how much the demand is out there.
Sodium Valproate and Pelvic Mesh
Baroness Bennett of Manor Castle Excerpts(8 months ago)
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Lord Markham (Con)
That is precisely what I put to Minister Caulfield this morning. She commissioned the review because her feeling was that the period from when my noble friend’s initial report came in until when Maria Caulfield was in post was too long. So it was absolutely she who commissioned it last year, and it is absolutely she who very much said that she is determined that there should be a substantive reply from us in the next few months.
Baroness Bennett of Manor Castle (GP)
My Lords, at the launch of the Patient Safety Commissioner’s report the victims of the Primodos scandal expressed great distress as they felt that they had been airbrushed out. Of course, the noble Baroness, Lady Cumberlege, recommended that they should receive redress, and they were treated the same way in the report as the sodium valproate and vaginal mesh victims. Can the Minister tell me what will be done to provide redress and ensure that there is appropriate treatment for the victims of Primodos?
Lord Markham (Con)
Again, these are difficult areas. My understanding is that we are working from the conclusions of the expert working group in 2017, and its review of all the evidence was that it could not find a causal link between Primodos and the impact it had during pregnancy. This was again reviewed by the MHRA when more information was brought up in the last year. So I am afraid that, as we stand today, the evidence is not there that suggests that causal link.
Sexual and Reproductive Healthcare
Baroness Bennett of Manor Castle Excerpts(8 months, 1 week ago)
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Baroness Bennett of Manor Castle (GP)
My Lords, I sincerely thank the noble Baroness, Lady Barker, for securing this debate. I thank her slightly less for the fact I have had to throw half of my speech out because she has covered it so comprehensively already, but it was a great introduction that set out the issue of work- force that the subject directly addresses but also the true crisis in sexual health. I echo the reflections from the noble Baroness, Lady Barker, about the importance of relationships and sex education. That is the foundation of prevention; it is clearly not being delivered to anything like the standard it should be to our young people. That means we are utterly failing them.
It is a pleasure to follow the noble Lord, Lord Hunt; he and I have had our disagreements in recent times, but I entirely agree with everything he just said. I echo his comments about public health, and that this Government have essentially abandoned public health as a way of ensuring that we have a healthy society that enables the people in it to thrive and live to their full potential. There is the failure to tackle the issue of ultra-processed foods—our broken food system—as well as issues around alcohol; I would add the failure to restrict gambling advertising and allowing the gambling industry to go totally out of control, which presents a great threat to many people.
Returning to the specific issue we are talking about, when I was reading the briefings, I came across the term “neonatal syphilis”. What I knew about neonatal syphilis before this came from reading the history of Georgian and Victorian England. If we read some of the novels of that era, we find some very vivid descriptions—they might not have known the cause, but they could describe the effect. I went and looked, and I came across the website for the Centers for Disease Control and Prevention in America setting out the reality of neonatal syphilis, which is frequently
“stillbirth, miscarriage, or neonatal death”.
If the baby survives, among the effects are
“blindness, deafness, developmental delay, or skeletal abnormalities”.
It is interesting that there is a parallel between what is happening here in the UK, with different structures, and what is happening in the US, because the US, as the CDCP says, has an acute failure in terms of neonatal syphilis—the number of babies born with neonatal syphilis in 2022 was 10 times greater than in 2012. The CDCP says that testing and treatment during pregnancy could have stopped 88% of those cases.
I reflect on those US figures because we are seeing increasingly an Americanisation of our healthcare system: a copy of the US healthcare system’s models; an import of US companies; and an import of people with professional experience, particularly managerial experience, of the US system. This is a system that the CDCP, citing the syphilis figures, says is a total failure. That is something we should really reflect on.
I should probably declare my position as a vice-president of the Local Government Association. I will pick up figures that have already been mentioned, but that have to be highlighted. Among the largest reductions in public health spend since 2015 has been spend on sexual health services—29%—yet at the same time, there has been a significant increase in demand for sexual health services: nearly 4.5 million consultations in 2022, up by a third in a decade.
Of course, we are always hearing elsewhere in your Lordships’ House about rising costs. Sexual health clinics and services are no more immune from the costs of rising energy prices and rising staff costs, et cetera, than anywhere else. The funding is falling and the demand is increasing, so of course the needs are not being met. I reflect back on the debate earlier this week on the Budget. Member after Member of your Lordships’ House got up and spoke about “broken Britain” and our broken services. The noble Baroness, Lady Vere, for the Government, said at the end: “Oh, I think you’re all being too gloomy”. Well, I am afraid that if we look at the state of our sexual health services, we see that the phrase “broken Britain” is sadly appropriate.
I acknowledge having drawn on the excellent briefings we have received, and I now turn to training. We have received demands, which seem perfectly fair and reasonable, that all sexual health medical training posts be 100% funded through the NHSE, in the same way that posts in primary care, oncology and public health are funded, and that the NHSE be accountable for ensuring that some of the recruitment gaps that the noble Lord, Lord Hunt, referred to are filled in. This is important and relates to some of the other debates we have had about the importance of expertise and of proper, full medical expertise being involved at all levels of the health service. No service should be allowed to operate without a genitourinary consultant, and meetings of organisations and commissioners must include them.
I come to two more specific asks. We have a contrast in asks from the briefings. The Terrence Higgins Trust calls for a high-level sexual health commission to address these issues, while the National AIDS Trust calls for a national sexual health strategy. I do not have a particularly strong position on which of those is the right way to approach the crisis, as all these organisations are saying, in different words, are the Government going to take serious, significant action? They may not have very long to go as a Government, but this really cannot wait until we have had an election—whenever that is.
I come back to an issue I have raised a number of times before in the House: the patchy provision of postal STI and HIV testing across England. Only during one special week, the national HIV testing week, can everyone access this testing from a single service. That makes England an outlier. Wales and Scotland already have national HIV postal testing services. In Wales, that also includes STIs, and the Scottish Government are also moving in that direction. It would surely be cost-efficient and cost-effective to make available to everyone in England a national HIV and STI testing service. It would be an extremely good way to spend government money.
I also want briefly to raise the issue of chlamydia testing. We had a full national chlamydia screening programme that included both young men and women, but that was cut back in 2021 from preventing chlamydia infection to reducing the harms of untreated chlamydia. As a result, chlamydia has come to be seen as a women’s issue. Of course, infection occurs in both sexes, but that is not being drawn to the attention young men in particular. Will the Government reverse that change and reinstate the full national chlamydia screening programme service?
The final thing I want to address is people living with HIV who are no longer engaged with services. The Government estimate that some 14,000 people have not been seen at their HIV clinic for at least a year. That is a real risk to the health of people living with HIV and a significant threat to the Government’s goal of ending new HIV cases by 2030. Of course, this issue relates to many other policy areas that the Minister cannot deal with, such as poverty and homelessness, but surely there should be within health a programme to re-engage people with HIV, who should be being cared for not only in their own interests but in the interests of the health of the nation and the whole of society.
Anaesthesia Associates and Physician Associates Order 2024
Baroness Bennett of Manor Castle Excerpts(8 months, 4 weeks ago)
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Baroness Bennett of Manor Castle
As an amendment to the above Motion, to leave out from “that” to end and to insert “this House declines to approve the draft Anaesthesia Associates and Physician Associates Order 2024 because it represents a significant constitutional change in regulation of healthcare professionals by omitting parliamentary oversight and approval for regulating anaesthesia associates and physician associates; and fails to address concerns within the medical profession about the supervision and titles of the roles.”
Baroness Bennett of Manor Castle (GP)
My Lords, I rise to move what the Minister has correctly identified as a fatal amendment that the House do not approve this order. This is on two primary grounds: the lack of democratic oversight and the concerns of the medical profession.
Before I begin, I want to make it clear that I am not opposed to the existence of physician associates or assistants, or their anaesthetist colleagues. I am not opposed to their regulation—indeed, I am keen to see them regulated—and I respect the efforts of current and future PAs and AAs who complete their studies and have the student debt to prove it.
I also want to be clear that, unless I get an indication from the House that it wishes me to do so, it is not my intention to put this amendment to the vote. My intention in tabling it was to ensure that the many hundreds of voices of concern that have reached me personally and the more than 21,000 doctors and patients who wrote to their MPs opposing this order are heard, and that the Government consider—seriously, I hope—whether they should go forward to regulate PAs and AAs in this manner, with this order.
I will first address the second part of my fatal amendment, about the views of doctors and patients. Sir Robert Peel invented the concept of policing by consent. I want to adapt that for these circumstances by saying that we must have regulation by consent. I am sure that all noble Lords engaged tonight are aware that the British Medical Association, the Doctors’ Association UK and the EveryDoctor group are opposed to this statutory instrument, for reasons on which I am sure we will hear much more from the noble Baronesses, Lady Finlay and Lady Brinton, with their regret amendments.
One of the very serious concerns is about clarity for patients and the confusion introduced by the title “associate”. On that I turn to a report from the BBC, an interview with Marion Chesterton, the mother of Emily, who tragically died after being seen twice by a PA and misdiagnosed. Marion said that her daughter
“didn’t know she hadn’t seen a doctor”.
Marion added—and this is something that I think people should focus on:
“Physician associate sounds grander than a GP”.
I pick up a point made by the Minister about PAs and AAs having been around for 20 years, an often-cited statistic. If we look back to 2014 and 2015, there were fewer than 50 PA and AA graduates. There were literally handfuls in the system. It is only when you get to 2018 that you start to see the figures leaping up to 400 graduates, and the Government’s aim is to head towards the figures that the Minister cited. So we may not have seen much confusion, but there were few people to be confused about within the system. This is a situation that is arising now, and that demands a reconsideration.
However, I will largely leave the arguments about titles, and the General Medical Council as regulator, to the regret amendments. What I want to focus on is the word “consent” and the concerns of doctors and patients in the context of the state of our medical system.
We debate as junior doctors are in the middle of their 10th strike action. We debate as one in seven British-trained doctors is working overseas. We debate after a BMA poll found last year that around 40% of junior doctors plan to leave the NHS as soon as they can find another job.
We need to make changes to the system. That is something on which the Minister and I, and I think pretty well everyone, are agreed, but we can make changes to the system only with the consent of all those involved. There is a moral argument for that, but also a very powerful practical argument. The Government need to work co-operatively and sensitively, and to listen to our medical professionals rather than ride roughshod over their serious concerns—concerns that are shared by many patients and that have filled my social media feed in recent days.
The first part of my amendment is about democracy. The order got virtually no scrutiny or consideration in the other place. We, of course, have no opportunity to amend it to tackle the issues that the noble Baronesses will focus on in their regret amendments. We have only the extraordinarily rarely used option of rejecting it. I have not had any indication from the Labour Party that it would support that, and I assume that its silence on the Order Paper means that it supports the Government’s path, but I ask the Labour Front Bench to consider whether we have to take this back to the drawing board. That is a question I put to it directly.
The Minister raised the report of our hard-working and, I fear, underappreciated Secondary Legislation Scrutiny Committee, which makes it very clear that this is not just about PAs and AAs but is meant to be the model for broad and widespread changes to medical regulation in the future. The committee’s report says that this is
“the first use of powers inserted into the parent Act by the Health and Care Act 2022 to give the GMC direct powers to make and amend standards and procedures for these associates”,
while, as it says in bold,
“removing the process from Parliamentary oversight”.
It is interesting that the Committee says:
“The Explanatory Memorandum should have been more explicit on this point and on what safeguards remain”.
In testimony, under questioning from the committee of your Lordships’ House, the department confirmed that
“changes in registration processes etc will no longer be laid before Parliament in any form, they will just be posted on the GMC’s website … however members of either House can respond to consultations if they wish”.
I am glad about that.
This has really not been made clear through the process, as the committee highlights. I think it is worth focusing on the fact that had it not been for the amendments from the noble Baronesses and me we would not even be doing this in the main Chamber. We would be in the secondary Chamber, getting, as we all well know, very little attention at all.
I particularly want to highlight, in case noble Lords did not receive it, the briefing from the Professional Standards Authority, which has responsibility for overseeing the GMC’s activities. It said, in what I think one would describe in bureaucratic terms as a carefully worded briefing, that we
“need to keep under review as the reforms are rolled out the accountability framework proposed to balance the increased autonomy for regulators with greater accountability”.
I wish to make a final point to address the fear and concerns of many patient groups and communities—which the Minister alluded to—that their communities and their families will lose ready or perhaps any access to doctors and be relegated to a second tier of NHS services, with PAs with two years of medical training versus GPs with 10. In the letter following up the very useful briefing that he arranged last week—and I think him very much for that and for the letter—the Minister makes reference, as he did in his speech, to the Government’s aim of doubling the number of medical places in England to 15,000 by 2031-32.
The Minister gave, I believe, the same figures as were reported in the Observer on Sunday. These were in a leaked letter from the Health Minister and the Minister for Skills, Apprenticeships and Higher Education to the independent regulator, the Office for Students. The figures in that letter have been interpreted as significant back-pedalling on the Government’s final aim and total. I ask the Minister whether he remains confident and can guarantee to the House that we are on target to achieve that final figure, given that we do not seem to be taking very strong steps in that direction.
The way those figures came out can only amplify the fears of many communities that those who can pay can go private, as increasing numbers of Britons feel they are forced to do. Patients at the centre of well-serviced areas where doctors can supplement their NHS pay with private work will keep access to a service like that now available, while other areas—the kinds of areas that are often talked about as being in need of levelling up—will get a second-class service.
We have to think about the context of this. Our NHS is battered by privatisation, with nearly 10% of services, including more than half of under-18 inpatient psychiatric services, now provided by for-profit providers. We have seen the disaster of PFI schemes, now set to cost £80 billion for the original £13 billion investment—the equivalent of £1,200 for everyone in the UK. We have seen this jewel in the British crown worn away by austerity—a decade in which investment in infrastructure and new technology collapsed and the pay of junior doctors and midwives in particular plummeted in real terms.
Please let us not deliver another blow. Please withdraw this order either tonight or afterwards. Take the path of consensus. Take the path of democratic oversight. Bring this forward as legislation that can be debated, amended and properly scrutinised. Please listen to the fear of communities. I ask everyone in this debate but particularly the Labour Front Bench to consider that approach and the wisdom of it. I beg to move.
The Deputy Speaker (Lord Young of Cookham) (Con)
I should inform the House that if this amendment is agreed to, I will be unable to call the amendments in the names of the noble Baronesses, Lady Finlay of Llandaff and Lady Brinton, by reason of pre-emption.
Lord Scriven (LD)
My Lords, I have listened to the debate very carefully. My professional experience as a former health service manager over many years is that we have had this debate about people taking on different roles in health and always the same arguments come. Whether it be physiotherapists taking on roles, nurses becoming nurse practitioners or pharmacists coming into this, the same argument always happens: that somehow this dilutes patient care and safety. The answer is that it does not if it is properly regulated, there is proper training and there is proper monitoring of what happens to patients.
I understand that there is some anxiety, but I have to say to the BMA, in particular, that its language in the briefings it has given has driven the bullying and ostracisation of colleagues in hospitals who are valued members of a clinical team. That is the word: “team”. It needs to be led by a senior doctor, normally the consultant, without ostracising people within that team. I gently say to the noble Baroness, Lady—I have forgotten.
Lord Scriven (LD)
The noble Baroness, Lady Bennett of Manor Castle—I remembered the Manor Castle because of Sheffield, but I could not remember the Bennett bit—that, twice during her contribution, she used the term “a second-rate service”. These people do not provide a second-rate service; they provide and augment the team service, to ensure that patient outcomes are as good as they can be.
On the whole, I support the fact that these orders are being laid, although there is one issue that I think needs to be thought through carefully: if the GMC is going to regulate, there is an issue about the way that the distinguishing of the registers is dealt with. I see that as a potential trip-up point if not thought through very carefully; I hope the Minister can give the House some assurance on that.
On the whole, I support the regulations. This is just a continuation of many years of different people in the team taking roles. With the correct regulation and the correct training and supervision, this will improve patient outcomes and service.
Baroness Bennett of Manor Castle (GP)
My Lords, I am acutely aware of the hour, but I am also aware there are a great many people—so social media tells me—watching this debate. There are a couple of things I need to say.
First, I thank everyone who has taken part in the debate, especially the noble Lords, Lord Patel and Lord Winston, for bravely telling us about the detail of their rich experience.
I will pick up on the comments made by the noble Lord, Lord Hunt, and the noble Baroness, Lady Merron. If you look back at my speech—I have handed over my notes now—I used the word “respect” talking about the PAs and AAs, and I talked about their study and student debt. I make it clear to the noble Lord, Lord Hunt, that I have not made any listing of incidents where things have gone wrong. I cited one case relating to the issue raised by the noble Lord, Lord Allan, of the difficulty patients have in understanding what the term “physician associate” actually means.
I highlight the words of the noble Lord, Lord Patel: using an SI to do a major piece of legislation is inappropriate. That is the whole reason I put down this fatal amendment. The noble Lord, Lord Hunt, and others said we cannot get the parliamentary time for it. Well, we have talked about reform a lot tonight, so maybe we ought to look at reform in Parliament as well. I will refrain from suggesting some of the Bills that we could not be doing so we could be doing this as a Bill instead.
There are a couple of points that need to be answered. The noble Baroness, Lady Bloomfield, questioned part-time GPs. If GPs are working, say, theoretically four days a week, it is more than a full-time job in terms of the stress, pressure and time involved. If we are going to keep people in the profession, we have got to allow them to contribute as much as they can. That is an issue of sustainability.
The noble Lord, Lord Scriven, referred to me talking about a second-rate service. I was talking about a possible experience a few years in the future; if there is the situation of whole regions, areas and practices—like the noble Lord, Lord Allan, said—having only PAs, effectively that would be a second-rate service. That was the future context I was talking about.
Given the time, I will make one final point. The noble Lord, Lord Bethell, said the Government are looking for the number of PAs and AAs to be 8% of the total of doctors. The question, of course, is not just about the total but about the distribution. There is the point about private hedge fund owners of GP surgeries and what they might choose to do. There is also the point which I have been driving at all the way through, having for more than a decade been visiting northern cities and towns in particular, where people really feel that they are struggling to get a decent NHS service and struggling to get the staff, and they fear that they might not get enough doctors.
Again, I thank everyone. I thank the noble Baroness, Lady Fox, for stressing how vulnerable patients are. My final point is that in making sure that patients understand they are being seen and treated by a PA or an AA, there has to be an attempt to understand that when people are ill, vulnerable and desperate, they may not absorb something just being done to them by rote. That is really important.
With that brief summing up, and in the circumstances, I beg leave to withdraw my amendment.
NHS Dentistry
Baroness Bennett of Manor Castle Excerpts(9 months ago)
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Lord Markham (Con)
The noble Baroness is quite correct. Cornwall is one of the areas where we piloted the mobile services. It is probably not the number one area, but it is fair to say that it is one of the main areas where we are putting in more resources for precisely that reason.
Baroness Bennett of Manor Castle (GP)
My Lords, I shall switch sides of the country. The campaign group Toothless in England was founded in Suffolk and is calling for contracts for NHS dentists to cover the real costs. It says that this is the only way to solve the drought of dentists in places such as Waveney Valley, where one in three people has been unable to secure an appointment over two years.
Lord Markham (Con)
These plans were welcomed by Toothless in England, which was good to see, as well as by Healthwatch. I know personally that making it economic for dentists to work in the NHS rather than in the private sector, or getting that balance right, is fundamental. The changes are a good first step towards that but more probably needs to be done.
Maternity Services
Baroness Bennett of Manor Castle Excerpts(10 months ago)
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Baroness Bennett of Manor Castle (GP)
My Lords, it is a pleasure to follow the important speech of the noble Baroness, Lady Gohir. Her words reflect what I heard last night at a meeting with Justice for Windrush Generations, where there was a reflection that minoritised communities share the experience of inequality and discrimination but the individual experience of different communities is different and needs to be acknowledged.
I thank the noble Baroness, Lady Taylor of Bolton, for securing this debate and reminding me of a meeting that I attended in Huddersfield in 2016. It had 480 people stretched across two meeting rooms with hundreds of people outside, unable to get into the room. It was the “Hands Off Huddersfield Royal Infirmary” campaign. I note in looking around today that a book recounting that campaign, Fighting from the Heart by Cormac Kelly, has just come out. It will pick up one of the themes of my speech: we have rightly been focusing on listening to individual patients but we also need to listen to communities and the demands that they make of their maternity services. The case of what has happened with Huddersfield Royal Infirmary is an example of that.
I am perhaps quite unusual in this debate in that I bring neither personal nor professional experience, so I put the topic out around the Green Party to collect people’s views and experiences. One that came back shocked me a little, and I will anonymise it because I am referring to a member of staff. This member of staff reflected on her personal experience. She was a professional woman in London, so you would have expected her to be well equipped to navigate the system, but her experience was that she did not have the NICE-recommended number of antenatal appointments and, as a result, a serious issue was missed. That reflects on an individual level what we are hearing from all the royal colleges et cetera about the inadequacy of services in all the statistics.
Coming back to the community point, a Green Party Birkenhead and Tranmere councillor, Amanda Onwuemene, who is herself a former midwife, drew my attention to the current perilous situation of the Liverpool Women’s Hospital, which is threatened with closure. The alternative accommodation and services being proposed do not match those being lost in maternity and other services, and the NHS and the women of Merseyside are being shortchanged again.
I want to look at what is happening there because it is a reflection of something we have not talked about very much: the issue of private finance initiatives, the privatisation of the NHS and how it has cut away at resources. That is reflected in what is happening in Liverpool and other places. The concern is that a particular quality of service is at risk of being lost.
That is also reflected in what is happening in London, where NHS North Central London is consulting on the potential of closing one of two maternity services in London hospitals due to fewer births. These are the Whittington and the Royal Free. If someone from outside London looks at a map, they might look at those two and think that they are not too far apart, but anyone who knows this area—and I do well from previous political campaigning—will know that the public transport provision heading east-west across London is extremely poor. People frequently have to take three buses to get from the east of what is the Whittington’s catchment area to the Royal Free, and people need local services and that is something that really must not be lost. I quote Mayani Muthuveloe from Whittington Maternity and Neonatal Voices, who told BBC London that there was a real “sense of reassurance” from giving birth in hospital near to where family and friends live, and that travelling to a facility further away would “add pressure” on patients.
We are seeing not just overall quality of service issues, but an issue of loss of local services. It is worth contrasting this with the Government’s own words in commenting this month on the women’s health strategy for England. That is focused on expanding women’s health hubs and, rightly, on maternity care,
“continuing to deliver on NHS England’s 3-year delivery plan for maternity and neonatal services”.
So the Government have plans for this, but, as we have heard from so many noble Lords, we are not seeing the outcomes that we desperately need.
I will pick up some points made by the noble Baroness, Lady Gohir, because the figures are deeply shocking. These are grouped figures, because those are what the NHS provides, but I am relying in part on the briefing from the Royal College of Obstetricians and Gynaecologists. Women from black ethnic backgrounds were three times more likely to die during or up to six weeks after pregnancy, and Asian women twice as likely. Deaths from mental health-related causes, as many noble Lords have highlighted, account for nearly 40% of the deaths occurring within the year of an end of pregnancy. I have a direct question here. Will the Government, as the royal college is calling for, commit to a time-limited target to reduce maternal inequalities to drive the innovation, improvement and, crucially, investment that is needed in these areas?
I will briefly pick up a point made by the noble Baroness, Lady Watkins, because I think it is terribly important. There is no doubt that the serious, major issues we are seeing in the outcomes of maternity services reflect more broadly the poor level of public health across our entire population. This is where I run into the Green Party problem, which is that everything is related to everything else. When you bring systems thinking in, you need to think and talk about everything. When we are talking about maternal health, we have to talk about people’s working hours and commuting time. Are people able to work from home? Do people get the breaks and the kinds of working conditions they need to have a healthy pregnancy and birth and to provide healthy care for their baby?
I was looking at a really interesting study from the University of Swansea about how, counterintuitively, during the biggest period of lockdown during the pandemic, when there were real shortages in the provision of services—probably unavoidably—in Wales, they found that rates of breastfeeding, successful breastfeeding and length of breastfeeding actually went up. This is where we need to look at that social setting. If people are able to work from home, if they are at home and if they have less commuting time and are able to spend more time with a newborn, you end up with healthier outcomes. While we have to acknowledge that breastfeeding cannot and will not work for everybody, we all know that it is crucial for the health outcomes of both mothers and babies to encourage that as much as we can.
I am sure that pretty well all noble Lords have received the perhaps predictable but important flood of briefings before this debate from Mumsnet, the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists, to which I have already referred, Baby Lifeline, Sands and the Care Quality Commission itself. They all stress the huge problems with the workforce, particularly people not being trained or having to be trained under conditions of extreme debt and, of course, the number leaving the professions, particularly midwives.
I am reminded of a trainee midwife who I spoke to just as the change was being made that midwives would be loaded down with debt through having to pay for their own training. She was, as is often the case, doing a second degree. She had done one degree, had worked, had a couple of children and decided to retrain as a midwife. She was speaking of her experience of being a trainee midwife in a birth suite where, tragically, there had been an unexpected stillbirth. It happened that all the fully qualified professionals in that room were occupied with medical things and she found herself comforting the mother who had just had an unexpected stillbirth. I find it obscene that people are now having to pay fees to be doing something like that as they are completing their training. I do not think that is acceptable.
I have some more on the debt point. These figures are from the Royal College of Midwives. Three-quarters of the student midwives in England surveyed expect to graduate with debts of more than £40,000. Just 1% expect to graduate with less than £5,000 of debt. About half—47% of all student midwives in England—have a job outside their training in order to earn money, and that job is unsurprisingly having a negative impact on their training. That cannot be acceptable. It cannot set people up for a long-term, secure, stable career in midwifery. I am referring here to the Sands briefing, which states that the lack of staff puts more pressure on the existing staff, so more people leave, and then the lack of staff puts more pressure on. It cites a midwife, who says:
“Staff are frightened to work in an understaffed under-resourced unit, for fear of mistakes or incidents occurring due to the high activity and understaffing. Fear of investigations as a consequence and fear for their mental health and wellbeing as a result”.
This is what we are doing to our midwives.
I have one financial point to make, drawing on the Mumsnet briefing. The Government paid out £2.6 billion in the past year as a result of failures in maternity and neonatal care in the NHS. This is costing us enormously, including financially. Circling back to my initial point about the importance of local facilities, women’s facilities and listening to communities, I looked up Historic England, thinking about the situation in Liverpool. The first women’s hospitals appeared in the 1840s. There were 12 by 1871. Many people may know of the site, no longer there, where Elizabeth Garrett Anderson founded the New Hospital for Women, London, on the Euston Road. We have been through several cycles. In early modern times we had female midwives who, by the standards of the time, provided good-quality care. We then saw the arrival of male midwives, which actually saw more deaths. Then in Victorian times we saw the upswelling of women’s services. We are now at risk of losing them again. This is a cycle we need to break.