GP Contract

Baroness Bottomley of Nettlestone Excerpts

Tuesday 17th March 2026 Lords Chamber

[Baroness Merron (Lab)]

When we develop digital approaches, I have to say again that the figures speak for themselves on, for example, patient satisfaction with general practice: people believe it is finally moving in the right direction. According to the Office for National Statistics, some 77% of people described contacting their GP as easy. That was in January this year, and it was up from just 60% in 2024. I think the public are giving their own view. On development of online access, we always ensure that patient safety is at its heart. I cannot give the commitment to publish that the noble Lord seeks, but I will be very happy to write to him and place a copy of the letter in the Library of the House, giving all the detail about how patient safety is assured. That is core to all our work and developments.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, it is evident all over the country that there is an epidemic of sick notes. Is there anything that the Government are doing to strengthen the arm of GPs who try to resist giving a sick note on simple request?

[Baroness Merron (Lab)]

If I have understood the noble Baroness correctly—forgive me if I have not—the GP contract does not address that directly. That is obviously a more general but important point about GPs’ practices and how they deal with matters. GPs are given advice in their updated training on how to manage those situations, and I expect them to follow it.

NHS England Update

Baroness Bottomley of Nettlestone Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Merron (Lab)]

I thank my noble friend for her reflections on what has gone before and her welcome that the opposition parties can work with us to put this into a better place now. With respect to change and productivity, and a further extension to the point raised by the noble Lord, Lord Kamall, about culture, I can say straightaway that the Government have a 2% productivity growth target in 2025-26. That is immediate. We are not waiting to make this change, because if we do not improve NHS productivity and efficiency, we will not be able to deliver the three shifts needed to future-proof the NHS and support the Government’s growth mission.

We have already invested more than £2 billion in NHS technology and digital in 2025-26, which will help with essential services and drive productivity in hospitals, such as the one that I know my noble friend serves very well. That will free up staff time, ensure that all trusts have electronic patient records, improve cybersecurity and enhance patient access through the NHS app. That is before we even make this change.

We have already achieved a lot in the past eight months, but that is why we have to continue with this reform. We have delivered the 2 million extra appointments that we promised, months ahead of schedule, we have cut waiting lists by 193,000, and, as I said earlier, we have committed to 700,000 extra urgent dental appointments, just to name some. We know about the importance of change, which the noble Lord, Lord Scriven, asked me about, and that my noble friend calls for. That is why we will always continue to take bold steps where we have to, and not shy away.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, the point is well made about duplication, bureaucracy and excessive cost. Can the Minister give us an assurance, though, that we will not move from excessive bureaucratic centralisation to political centralisation? There are few politicians who are clinicians, sophisticated managers or financiers. This is the largest employer in the world, with extraordinarily dedicated and talented individuals concerned. They will not be happy to think that they will be organised on the whim of whoever is the latest Minister.

The right reverend Prelate the Bishop of London used to be the Chief Nursing Officer—there are many people who have worked at high levels in the NHS. We need to be confident that there will be an evidence-based, rational system at some distance from party-political considerations, because the viciousness of health debates about hospital closures, boundaries and other matters knows no bounds. We do not want by-elections to become involved in non-party-political matters.

The noble Lord, Lord Waldegrave, and even the noble Lord, Lord Clarke, and I, were very happy with an NHS executive which was part of the department. However, the role of the chief executive was not the same as the role of the Secretary of State. I hope the Minister can give us some assurance.

[Baroness Merron (Lab)]

I am very pleased to give the reassurance that the noble Baroness seeks. When we reflect, the disastrous 2012 top-down reorganisation certainly did not depoliticise the NHS—it made it less efficient and less able to treat patients on time.

This is not about politicisation; this is about responsible government. I add—without embarrassing anybody—that a number of former Conservative Health Ministers have said to me, and to my colleague Ministers and the Secretary of State, how much they welcome this and how they wish that they had taken this step. That, for me, as well as the tone of the contributions from the Front Benches today, provides the reassurance the noble Baroness seeks.

Cass Review

Baroness Bottomley of Nettlestone Excerpts

Wednesday 17th April 2024 Lords Chamber

[Baroness Bottomley of Nettlestone (Con)]

My Lords, this is a deplorable situation. It is a formidably good report and I commend the Government on their firm action following its publication. I question why it took the NHS quite so long to stop the routine prescription of puberty blockers to children under 18—that seems rather slow off the mark.

However, I have a more important point. I fear that one of the great damages from all this is to one of our national and international centres of excellence. The Tavistock clinic has been in existence for over 100 years. It was started by Hugh Crichton-Miller for the treatment of soldiers with shellshock. It has been the home of John Bowlby, Lily Pincus and RD Laing. It has done incredibly important work in terms of mental distress, mental health and emotional well-being. It is a national and international centre of training, with about 2,000 students a year. If I may take up the Minister, for whom, as he knows, I have an inordinate regard, I think he said that the Tavistock clinic had closed. It has not closed; the gender reassignment clinic has closed for ever. I ask the Minister and everyone in this House to try to help reclaim the reputation and the respect that the Tavistock clinic rightly deserves.

[Lord Markham (Con)]

Yes, absolutely, and I thank my noble friend for correcting me and giving me the opportunity to correct that. Again being very honest, this shows that part of the challenge in setting up the new services is that this has become such a difficult, toxic space, and finding and recruiting staff who want to work in this area is a real challenge as well.

Sodium Valproate

Baroness Bottomley of Nettlestone Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

The noble Lord is absolutely correct. Everyone taking sodium valproate who is of childbearing age should be on a pregnancy prevention programme to make sure that those sorts of incidents do not happen. It is vital, when it is necessary for people to take it, that they really understand the risks and do everything to avoid pregnancy.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, mention has been made of the reduction in the prescription of sodium valproate but can my noble friend clarify that with a few more figures? In the report by my distinguished noble friend, which has done so much, mention was made of a redress scheme. In December the Select Committee tasked Dr Henrietta Hughes, the Patient Safety Commissioner, to bring forward proposals of what that might look like. Can he inform the House of progress there?

[Lord Markham (Con)]

I thank my noble friend. Yes, the number of cases of people of childbearing age—this is a key criterion—taking sodium valproate has reduced by 33% over the past five years. The number of pregnancies has reduced by 73% but clearly that is not zero so more work needs to be done. I was speaking to Minister Caulfield this morning about the Patient Safety Commissioner. We are expecting her report shortly and from there we hope and believe that there will be a lot more we can do on regulation.

NHS GP Surgeries: Purchase by US Companies

Baroness Bottomley of Nettlestone Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

I am not aware of any correlation between the type of ownership and the quality of the services from it. If there is one, then we can look at that, but we are focusing resources on the areas where they make most difference, and the focus is: what is the performance of that clinic? That is what we should all care about. How are the doctors there performing in terms of appointment times and everything else? I will not put a false target on who owns it and the structure of it, because that is not relevant. What is relevant is the quality.

[Baroness Bottomley of Nettlestone (Con)]

Is it not the case that the former chief executive of the NHS brought some extremely valuable experience back from America, from UnitedHealth? I remember long ago in the distant past, when the Labour Party was last in power, that Kaiser Permanente was constantly being consulted. Surely it is an arrogance to have a xenophobic approach to where we take advice and where we learn from other people’s experiences?

[Lord Markham (Con)]

I totally agree with my noble friend. I like to think that we will take advice from whoever is best placed to give it, whether they are public sector, private sector, UK or international.

Recovering Access to Primary Care

Baroness Bottomley of Nettlestone Excerpts

Tuesday 9th May 2023 Lords Chamber

[Baroness Bottomley of Nettlestone (Con)]

My Lords, I commend this plan most warmly. It has long been said that family doctors are the jewel in the NHS crown, but of course there has been a total transformation in the primary care team: it is not simply family doctors but a much more complex team, and the frustration so many of them feel is that they work to the minimum of their ability rather than the maximum. As I understand this, it will enable people to work to the maximum of their skills and use their training to extremely good effect.

The other great difficulty is that patients want to be treated like partners—they want information, they want contact—so opening up the opportunity to use pharmacies far more is going to be extraordinarily important. Will my noble friend say a little more about the contribution of the NHS app? Obviously, it will take time for people to be really comfortable with it, but it seems to me that this could be a transformational component in releasing family services and making them more available.

[Lord Markham (Con)]

I thank my noble friend for her comments and completely agree that this plan is all about making sure that we are using our most skilled practitioners in the most effective way. We want to make sure that those people who really need to see a doctor get to see one when they need to, but that patients in need of other treatments that can be delivered by a community pharmacist, a nurse or some other medic, such as a physio, are seen by the right people. Fundamental to the navigation of all that is the use of technology and the NHS app, as my noble friend mentioned.

What I see is the app really helping inform people—giving them their patient records so they can do their own research and understand and take ownership of their own health. We all know that, just as we have seen in the space of banking and other areas, giving people ownership, so they can take control of their health, is fundamental. Once they are armed with that information, they can be helped to navigate to the point of most use. That is where I see fundamental change: it is an area where we will see such change in the way we all address our NHS services and look after our own health. I truly believe that it will be one of the most fundamental changes we will ever see in this space.

Junior Doctors’ Strikes

Baroness Bottomley of Nettlestone Excerpts

Monday 17th April 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. As I mentioned, we felt we had put a fair offer on the table—something that was recommended by the trade union leaders themselves. I think we need to see the overall verdict come out across the board on all this. I note that less than a third of the membership of the RCN actually turned it down in the end, so we have to see what the overall outcome is. There is an absolute commitment on our side to continue meeting constructively with the RCN and to use all means possible to get to a solution.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, those who have awarded degrees to doctors and heard them take the Hippocratic oath that they shall do no harm can scarcely be impressed by action being taken in which the public—patients—are suffering and in which enormous pressure is put on other colleagues in the health service. I, for one, think this is a very miserable occasion, and I hope to goodness that all those in the health service involved in action will think again.

I would like my noble friend to remind us about the importance of the pay review bodies, which were fought for long and hard. If we jeopardise or undermine them, that will be a long-term legacy that not only this Government but a Government of any other persuasion may pay the price for. Can he also say a little more about junior doctors and the steps being taken to increase their remuneration and deal with their working patterns?

All will agree that the health service today is extraordinarily complex. When I was Secretary of State, we spent 5% of GDP on health. That figure is now 12%, and there is not an infinite pit. I hope that reason will prevail.

[Lord Markham (Con)]

I thank my noble friend for her questions and the wise points borne out by her own experience. The impact this is having on patients is a regret to us all. On derogations, the history has been that the unions have sat down and made sure that life is protected. It is a regret that the BMA junior doctors have not done that in this instance, and that the RCN is saying right now that it is not considering derogations in its new strike. I hope that this position will change. I do not think anyone in this Chamber would want to see life threatened in this way. I know that we are doing everything we can on our end—as I say, offering more than devolved Governments—to solve this situation. I ask for good will on all sides so that we can protect patients first.

Ockenden Report

Baroness Bottomley of Nettlestone Excerpts

Wednesday 30th March 2022 Lords Chamber

[Baroness Bottomley of Nettlestone (Con)]

My Lords, this is a deeply shocking report, and I applaud the Minister for the way in which he has responded. Above all, I of course applaud Donna Ockenden for the formidable clarity of the way in which she has taken the evidence and, without emotion but with great empathy, set out the 84 recommendations and the 15 “Immediate and Essential Actions”. Of course, some of this is about resources, and the Minister has made some statements about this and the fact that, however much we have, we will always want more, but I welcome the resources invested in this.

More important to me is the issue that the Minister touched on about multidisciplinary training. Midwifery has often been an area where there is almost tribal warfare between the midwives and the obstetricians and gynaecologists. Passing a patient on to a gynaecologist has almost been seen as an act of failure. Time and again, we see delays and this ludicrous target of a low caesarean rate. There has been a phenomenal fall in maternal and perinatal mortality over 100 years, but, at the same time, women now have babies when they are older, and babies are larger. There surely must be the interdisciplinary training that the Minister has referred to and that is so important—and the working group with the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives.

Lastly, I come to this deplorable culture where doctors bury their mistakes. It has always been the case in the medical profession that there has been a reluctance to acknowledge failures and problems, saying, “There’s been a problem. Let’s put it aside. Don’t trouble the families with the truth; it’ll upset them more”. This culture of concealment is totally destructive. There are many other professions where mistakes and errors—goodness knows, much of this happens in the heat of the moment—are used as examples from which others can learn, not with a blame culture but with a culture of learning and progress.

I very much congratulate the Government on their approach. This has been a terrible example of groupthink and lack of action, and all of us must be vigilant over whatever institutions we are working with in whatever part of the health service.

[Lord Kamall (Con)]

I thank my noble friend for her points. I will take this opportunity to elaborate a bit on multidisciplinary training in the maternity workforce. Some £26.5 million of the £95 million invested in maternity services last year will allow training aimed at how multidisciplinary teams work together. There is a new core curriculum for professionals working in maternity and neonatal services—this is being developed by the maternity transformation programme, in partnership with professional organisations, clinicians and service users, to address variations in safety training and competence assurance across England. A single core curriculum will enable the workforce to bring a consistent set of updated safety skills and continue to learn. It is important that we have collaboration and close working relationships between midwives and obstetricians because that obviously benefits the mothers and babies within their collective care. The noble Baroness has already said that this has to be mother-centred and patient-centred.

I also thank my noble friend for highlighting the fact that the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists have been clear that the professions must work together collaboratively. We expect all maternity services to act on the recommendations.

We also have to make sure that staff feel able to and confident about speaking up, as my noble friend said. The Government have taken this issue seriously. In response to a recommendation from Sir Robert Francis’s Freedom to Speak Up review, we established the independent national guardian, to help drive positive cultural change across the NHS and, in addition, to provide support to a network of local freedom speak-up guardians. We will have to see how that works, what can be done better and how we can improve it. Putting in one measure will not solve all these problems. There is no silver bullet, but one of the reasons to put this in at local level is to see where it works and where it does not, and what we can learn from that.

Women’s Health Outcomes

Baroness Bottomley of Nettlestone Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Bottomley of Nettlestone (Con) [V]]

My Lords, this is an important and timely debate and I give full congratulations to my noble friend Lady Jenkin on introducing it. I start by echoing the noble Baroness, Lady Walmsley, on the requirement for urgent action following my noble friend Lady Cumberlege’s report. It is harder being a Health Minister in the Lords because there are so many experts. I chose my noble friend Lady Cumberlege and we worked together harmoniously. It is time we had a patient safety commissioner. That is part of the recommendations, only one of which has been properly implemented. We need a register of doctors’ interests.

My real purpose in speaking is to relate my experience at the University of Hull. Only one in four medical deans is female. At Hull, Professor Una Macleod is a general practitioner who still works in east Hull. She shapes and fashions the medical school so that it is relevant to the disadvantaged and underprivileged. Many in the House will know that my first job was working for the noble Lord, Lord Field. He went to the University of Hull and, for 16 years, I have been proud to be its chancellor. It is trying to reach out to the disadvantaged and neglected, who I call the inarticulate needy, not the articulate greedy, to whom I was so used in my former constituency.

I applaud much of the research, often by nurses and the professor of nursing, because nurses listen and are where the patients are. We have talked about underrepresentation in surveys, and Professor Lesley Smith has done some magnificent work on why younger women in lower socioeconomic groups are less likely to take part in population surveys. She has fashioned a tool to reach out to underprivileged, disadvantaged, less-connected and younger women so that we can understand what they need and want.

Dr Roger Sturmey talks of one in four women suffering from a miscarriage, but of only 2% of research going into miscarriage. A nursing professor of perinatal mental health said that women’s health outcomes and that of their babies are not good enough. He has designed a new measure, a revised birth satisfaction scale.

Over the years, there has been a dramatic improvement in women’s health. When William Wilberforce lived in Hull, women lived to 44. Now, the overall life expectancy is 82.7 years for women and 78.7 years for men but, as noble Lords have said, this conceals areas of neglect and suffering. It is not the extra years only, but the quality of them. I believe that, by looking more deeply and working with professions other than the traditional medical professions and by focusing our research, we can do more to meet the unmet need that so many in this House are so knowledgeable about and have contributed so strongly on.

NHS: Staff Pay

Baroness Bottomley of Nettlestone Excerpts

Wednesday 21st March 2018 Lords Chamber

[Lord O’Shaughnessy]

I thank the noble Lord for giving me the opportunity to provide that confirmation. In the 2017 Autumn Budget we set aside in the reserves £800 million a year, which will fund the first year of the Agenda for Change pay deal, and obviously if the members of the NHS trade unions accept the agreement, that funding will be released. The Chancellor will also provide the additional funding required to fulfil his commitment through the 2018 Autumn Budget and make available £4.2 billion over three years to fund the deal. I hope that gives the clarity the noble Lord and others seek.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, the Government have every reason to be proud of providing for this very substantial pay increase. However, can my noble friend remind NHS staff that, as would be the case for any other staff, with increased pay has to come change? There are no groups of employees in any enterprise anywhere who do not have to change, restructure or change the skill mix. Appraisal and training mean doing more and achieving greater productivity. We have a heroic mission to provide care free at the point of delivery to all. This can be achieved only with a much more positive attitude towards changing the skill mix, team working, and through the many other ways of delivering cost-effective care.

[Lord O’Shaughnessy]

My noble friend is right and she speaks from great experience. I emphasise that, as the Secretary of State has said, this is a something for something deal which will deliver greater productivity in return for higher pay. That absolutely has to be the right way of doing this. I also point out that there will be an explicit focus on improving the health and well-being of NHS staff, so that they are not only happier and more likely to stay in post, but more productive as well.