Food and Drink Industry: Processed Sugar

Baroness Brinton Excerpts

Monday 14th October 2024 Lords Chamber

[Baroness Merron (Lab)]

Taking on board the noble Lord’s point, I feel that it is important that we support people to make healthier choices. The noble Lord will be aware of—and I hope will welcome—the Government’s focus on moving from ill health to prevention. We want to make sure that people live well for longer. It is not only about making informed and heathier choices but about having the means to do so. That is why I particularly want to commend the fact that we will be introducing the restrictions on junk-food advertising to children on TV and online. That will make a major contribution.

[Baroness Brinton (LD)]

My Lords, the Food Foundation review in January this year noted that 41% of multibuys were still high in salt, sugar and fat, with only 3% on fruit, veg and staples. The Minister referred to working with the supermarkets and major manufacturers. Is this issue being raised with them as well? Particularly with the cost of living crisis, it would be extremely helpful if more multibuys were for foods that were good for people, such as fruit and veg, as well as basic staples and carbohydrates.

NHS: Independent Investigation

Baroness Brinton Excerpts

Tuesday 8th October 2024 Lords Chamber

[Baroness Merron (Lab)]

I agree with my noble friend. I am pleased to inform the House that just this week I announced a number of pilot programmes, through which maternity staff will be taught and supported to better identify the signs of a baby in distress in labour, so that action can be taken more quickly, and which will help staff deal with obstetric emergencies during caesarean sections. Such actions help to avoid preventable brain injuries and are right for the baby and the mother. We also need to tackle the issue of the more than £4 billion cost of the lawsuits that have been brought over a number of years.

I have seen good examples of teamwork in Bristol and Surrey, to name just two, and there are many things that can be learned. We know what strategies work—one of which is listening to women—but the challenge is, how do we roll out what is successful, including from the pilot programmes? Following the recent report, which showed a devastating situation in maternity and neo-natal care, that is a high priority for this Government.

[Baroness Brinton (LD)]

My Lords, the excellent report of the noble Lord, Lord Darzi, refers to the stress our GPs are under and how patients are no longer flowing through the hospitals as they should. One issue is that hospitals are constantly referring patients back to their GPs when they are still on the same treatment pathway. Recently, a member of my family was at a post-op review following a pacemaker operation that had gone wrong. Her heart was still giving her problems, and she was told she had to go back to her GP to start the whole process again. Many patients in hospital clinics are being told to go back to their GP to get a scan or an MRI—which is one of the reasons why they were referred to the hospital. This is not fair on hard-pressed GPs and, above all, patients. Can this practice be stopped?

[Baroness Merron (Lab)]

I am sorry to hear of the circumstance that the noble Baroness raises. I agree with her about the pressure on GPs who, of course, are working harder than ever. We know, not just through the Darzi report but through much evidence, that discharge into the community has to take place at the right time and with the right support, and that is not the case at present. I will certainly take up the specific thing the noble Baroness asks for and look into it in far greater detail, because this is clearly a practice, as she described, that is not supporting patients or GPs but working against them.

Vaginal Mesh Implants: Compensation

Baroness Brinton Excerpts

Thursday 5th September 2024 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I thank the noble Baroness, Lady Cumberlege, for securing this debate and for her unstinting commitment to ensuring that victims of vaginal mesh, sodium valproate, Primodos and other medical problems and scandals continue to have their voices heard. Her report for the last Government, First Do No Harm, published five years ago now, was extraordinary and impossible to ignore, and those of its recommendations that have been implemented have started to change the way that support for patient victims is delivered. I hope—and I will come back to this later—that it is also starting the change in culture that we need to see inside the NHS. We all love our NHS and sometimes it can be hard to admit that some of the senior doctors within it are not the best people to support patients and ensure that patients feel they are getting the right help they need when things go wrong.

I am particularly pleased about the role of the Patient Safety Commissioner, which I remember us debating in 2020. Dr Henrietta Hughes is making a brilliant start, and I thank the noble Baroness, Lady Bennett, for the comments that she made about that. However, I repeat a question I asked when the post was first set up: is the office of the Patient Safety Commissioner getting enough resources to do the job that she so clearly has to? I have no doubt that she is a very able woman but I am concerned about the volume that her office is dealing with.

I pay tribute to the victims of not just vaginal mesh but sodium valproate and Primodos, who have continued to tell their stories. We know that repeatedly telling your story is painful too, but we need to hear them. I thank the noble Baronesses, Lady Sugg and Lady Wyld, and the noble Lord, Lord Mancroft, who told his friend’s personal story, all of whom reminded us of how dreadful the position is. While the difference between these problems and the infected blood scandal is that we are not seeing fatalities, we underestimate the long-term life changes that all these victims have faced, some of them the children of those who were fed medicines during pregnancy, not one of them at fault at all in any way.

There is one voice that we have not heard: that of the NHS whistleblowers. I shall mention one person of whom I had not been aware until there was an article about her in the British Medical Journal earlier this year. Sohier Elneil is a urogynaecological surgeon and an expert in women’s pain. She is the founder of the first NHS vaginal mesh removal centre and a tireless champion of supporting the victims and sorting out the problems. I was shocked to read that, after she started talking about this issue in 2005, she was excluded from events by doctors, then personally attacked and reported to the General Medical Council multiple times, mainly by fellow consultants—those who were the biggest implanters of mesh. She said:

“I was very upset. It felt like a war. They were saying I was removing mesh and harming patients unnecessarily”.


Professor Elneil continued with her campaign, and I have to say that her story did not stop there. She also uncovered some of the doctors being encouraged with financial incentives from the providers of vaginal mesh. It is good that both Henrietta Hughes’ report and that of the noble Baroness, Lady Cumberlege, said that things needed to become transparent. The last Government refused to allow those records to go on to the register at the GMC but they should be on that register, not kept elsewhere, because if a member of the public wants to find something out, the GMC will be the first place they go. Can the Minister say whether that will happen?

Others have already talked about the time limit. I shall make brief mention of the issue relayed by the noble Baroness, Lady Berridge, about the type of inquiry and the ability to make effective reports. In my portfolio I have covered virtually all these inquiries over the past 18 months, and I have heard every single group of victims say that another inquiry has provided the right response for them. None of the inquiries has yet been resolved—even those, such as the Post Office Horizon inquiry and the infected blood inquiry, which we think have been resolved. If the Government will not revisit the deadline, they will be dragged kicking and screaming into a higher level of inquiry as more cases are revealed. Please can the Government, preferably via the Cabinet Office, bring together the learning from all these inquiries about what goes wrong in government to make these things happen?

Palliative and End-of-life Care: Funding

Baroness Brinton Excerpts

Wednesday 4th September 2024 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness is right in her observations, and we certainly recognise that times are difficult, particularly for many voluntary and charitable organisations including hospices, for example, due to the increased cost of living. We are working alongside key partners and NHS England to proactively engage with stakeholders, including the voluntary sector and independent hospices, because we want to understand the issues they face and to seek solutions to them.

[Baroness Brinton (LD)]

My Lords, the charity Together for Short Lives has found that the NHS local funding for children’s hospices has dropped by 31% in the last three years. Worse, the previous Government’s £25 million children’s hospices grant has been given to local integrated care boards, many of which have delayed distributing it. As a result, the children’s hospice movement is in real crisis. Please will the Government urgently review the funding that government has in the past put aside for children’s hospices, to make sure that they receive it?

[Baroness Merron (Lab)]

As the noble Baroness said, in 2024-25 the £25 million in funding from NHS England was distributed, for the first time, via integrated care boards. As I understand it from the previous Government, that was in line with NHS devolution. We will carefully consider the next steps on palliative and end-of-life care funding much more widely in the coming months and will take on board the comments of the noble Baroness and other noble Lords.

Covid-19 Inquiry

Baroness Brinton Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I declare my interest as a vice president of the Local Government Association. The report by the noble and learned Baroness, Lady Hallett, UK Covid-19 Inquiry Module 1: The Resilience and Preparedness of the United Kingdom, is an effective and thorough distillation of the difficulties, and of the failures by Ministers, officials and perhaps even by wider society as well. She and the Minister remind us that we must always remember the bereaved, those who lost their lives, survivors and those on the front line who dedicated their lives, sometimes literally, to dealing with the crisis that we perhaps failed to deal well with. From these Benches, I start by remembering the hundreds of thousands who died, including some Members of your Lordships’ House, families and friends, those who survived and those whose lives changed for ever as a result. This inquiry and its reports must be the action we need to take to ensure that we do not make the same mistakes again.

My noble friend Lady Tyler reminded us of the scandal of hospitals releasing patients into care homes, bringing Covid with them. I remember the “do not resuscitate” orders placed on disabled patients’ files without their or their family’s knowledge, until that was stopped. I thank Ministers for dealing with that as soon as it appeared to be an issue. We also want to thank the many NHS front-line staff as well as the people in public health, local government, transport and food chains, who, in those earliest and darkest days in March and April 2020—often without PPE, and, for many, with enormous sacrifice—ensured that everything could be done to keep the country going. These people were selfless and are our heroes. I thank the noble Baroness, Lady Fraser, for her focus on those with cerebral palsy and other disabilities. She is right that they are still living with the consequences.

This inquiry has got the measure of those issues. Recommendations must be accepted and acted on as soon as possible. As others have said, who knows when the next pandemic will arrive? The noble and learned Baroness, Lady Hallett, is clear, from the evidence, that it will.

Politicians, civil servants and public officials got it wrong. The noble and learned Baroness, Lady Hallett, says in the report that

“the UK was ill prepared for dealing with a catastrophic emergency, let alone the coronavirus … pandemic”,

assuming that it would be like flu, as in the 2011 strategy and later: the wrong pandemic. Worse, Ministers instructed civil servants and officials to focus all their efforts on preparations for a no-deal Brexit, so pandemic exercises did not happen at the highest levels and those that did happen were ignored in Whitehall.

The report talks about the lack of leadership, appropriate challenge and oversight. I shall contrast our experience with what happened in Taiwan. I use this as an example to the noble Lord, Lord Frost, of how it is possible to have not just a learning Government but a learning society. That country learned from its previous experience of SARS and other national emergencies, and its pandemic system moved swiftly into action. The key was reminding citizens of what was expected every day and taking them with them. The spread was so low that Taiwan did not have to lock down. Every single day, there was a Minister and an official on TV not doing press conferences, but taking questions live from the public until all the questions were finished every day. Taiwan had six deaths in the first year.

I want also to raise a point on Sweden. Although I have heard the noble Lord, Lord Hannan, make many points about Sweden in the past, the one thing he never mentions is that Sweden’s culture is very like that of the Taiwanese in that the relationship between the governors and the governed is much more trustworthy than we have in this country. I am sure that is one of the main reasons that things worked.

The Taiwanese version of test, trace and isolate, including universal masking being totally accepted and digital technology helping people to isolate, was operated locally. If people were asked to isolate, they had a call every day from someone in their local council or nearby to ask what they needed from the shops or the chemist, and it was brought to their door. People knew they were supported—no civil emergency but a nation working together—and the key to their success was learning from SARS.

So I ask: have we learned from Covid? The noble Lord, Lord Bilimoria, recounted the Premier League arrangements made possible by regular testing. He is absolutely right; that is an example of where we did get it right in this country, but we needed to get it right for everyone.

I believe that the recommendations must be accepted and acted on as soon as possible; that is one of the reasons why we need a module now that reports so that work can proceed, advising government, Civil Service, the NHS and other public bodies.

I am so pleased to see the noble Baroness, Lady Thornton, in her place. She and I were the two Opposition Front-Benchers in January 2020 and, between us, we saw Covid through with the support of our colleagues. We covered over 580 pieces of legislation in Parliament, and well over 300 of those were on health. I give way to the noble Baroness.

[Baroness Thornton (Lab)]

I think that, possibly, I saw the noble Baroness and the Minister more than I saw my husband for several months.

[Baroness Brinton (LD)]

I confess that I was probably in the same position. The noble Baroness, Lady Thornton, and I were always commentating on the regulations, but it was always post-event. One issue we need to look at is emergency legislation being enacted with us being able to see it only after it has happened. I understand that that was the case at the start, but we were still seeing emergency legislation only two years on. That is unacceptable.

My noble friend Lady Tyler talked about vulnerable people at risk because of poverty. The noble Baroness, Lady Coussins, rightly made the point, as she always does, about language support being so vital. Your Lordships will not be surprised to hear me say that clinically vulnerable people have expressed concern that the modules outlined at the start of the inquiry seem to ignore their plight. The noble and learned Baroness, Lady Hallett, said that the experience of vulnerable people would be threaded through her inquiry and its reports. I want to thank her for her clear recommendations in relation to clinically vulnerable people as well as those who are vulnerable for other reasons. Six of the 10 recommendations specifically mention them. I may mention them again later.

Can the Minister assure the House that the recommendations will be implemented at pace throughout all levels of national, state and local government and public agencies? Nobody has mentioned that the inquiry reprinted the extraordinary spidergrams that constituted the departmental and structural response to the emergencies. The report also noted that many with civil emergency pandemic preparedness responsibilities had full-time roles in their departments, meaning that planning and review were easy to push into the future. Will key staff with this responsibility now have time to read, think and do the regular reviews and exercises to ensure that, as and when an emergency occurs, a smoothly run system will kick into place as it did in Taiwan and Sweden?

It was also egregious that preparing for Brexit knocked everything else out of the way in Whitehall, including postponing those regular pandemic exercises. As other noble Lords have asked, how will this new Government remove groupthink from their and officials’ behaviour? As the noble Lord, Lord Harris, pointed out, we may need a change in system thinking too.

Interestingly, groupthink has also come up in the Horizon Post Office inquiry and the Infected Blood Inquiry; I am sure it will also come up in the Grenfell Tower inquiry tomorrow. This is a massive undertaking for government. The comments from the noble Baroness, Lady Thornton, about the role of Parliament were important as well: about how important our role of scrutinising government becomes at times like this. Can the Minister tell us what success will look like to the Government about how things have really changed, because groupthink about success is also sometimes part of the problem? I am very pleased that the Government are proposing a duty of candour. I think such a duty will help change the practice of Ministers being told what civil servants think Ministers want to hear.

The report is clear that the local directors of public health were not utilised effectively. They and their teams of local government environmental health officers were often ignored and dictated to, and they were ignored in their roles in local areas. The Association of Directors of Public Health continued to do all that they could throughout. I remember a conversation with one of them about 10 days after the February half term in 2020. It was evident to him at that point that a number of families had picked up Covid in northern Italy, and it was spreading swiftly into his local schools. They could not get this taken seriously further up the line despite needing powers to be able to close down independent schools—they could close down state schools but not independent schools. As a result, independent schools and the families of those attending them had a faster spread than elsewhere.

The noble Lord, Lord Lansley talked about the 2011 plan thinking only about schools in high-impact areas. Our early experience post that February 2020 half term may have guided people to say, “If we can’t control spread in schools, we’re going to have to do something else”. There was no test, trace and isolate at that point, and spread was just not contained.

The Minister talked about flexible systems, but will they also be local? Directors of public health and their teams in local councils and local NHS are well placed to help. Please can we guarantee that they will be involved?

The noble Lord, Lord Frost, was unhappy with module reporting. I disagree with him because the major changes that have to happen, and which are recognised by many past Ministers and the new Government, are major and will and should take time to get right. We do not know when the next pandemic will happen; perhaps it is brewing already. There is not just anti- microbial resistance, as outlined by the noble Lord, Lord Lansley, but the person-to-person transmission of avian flu, now happening in parts of the US, Texas in particular. Time is not on our side.

The Minister said in the previous Statement in late July, following the publication of this report, that the previous Government had changed the way they accessed, analysed and shared data. It is essential to get that right but the last Government and UKHSA have cancelled wastewater testing for Covid, which is essential for early detection and monitoring. It continues in Scotland, which is one of the differences there, and in the USA and other countries. This makes it difficult for officials to spot early signs of increased cases and outbreaks.

The cancellation of Covid testing unless you are in hospital or in a care setting means that it is very difficult to gauge the level in the community. The ONS and ZOE data were helpful. Will the Government reconsider that background data? The noble Lord, Lord Hannan, said that Covid is endemic. It is not endemic yet. I hope we are out of a pandemic but Covid is not everywhere and safe for everybody. It is not endemic.

Knowing what is happening becomes important. We have hospitals telling clinical staff not to wear masks, even though there is Covid in their hospital. One academy school is saying this week that it is fine for symptomatic Covid children to return to school immediately, and we have schools still refusing to provide ventilation in classrooms that would allow clinically vulnerable children to return to school.

In July, the Minister said in the Statement that the Government’s first responsibility is to keep the public safe, so can the Minister assure your Lordships’ House on the urgent and outstanding issue of PPE, masks and ventilation being provided and encouraged where necessary to help reduce spread. I am not talking about everywhere, but where necessary.

I am also glad that the noble Lord, Lord Reid, referred to mpox. I am pleased that the noble Baroness, Lady Chakrabarti, raised TRIPS waivers and Gavi as well. They are really important. I know somebody who is going to the DRC next week. They will be working in the refugee camps and their doctor went to UKHSA to ask whether they could have a vaccination. They were told that the UK is not issuing any vaccines. Unfortunately, there are no vaccines in Goma in the DRC at all. This is not on. Perhaps the Minister could find out what is happening and why this Government are not taking this report seriously.

I wanted to talk about other things such as the longer-term effect of long Covid. I want to mention very briefly that the NHS has fired many of its front-line clinical staff who got severe long Covid because they could not prove they got the Covid in the hospitals. That is a disgrace and I think it will come back to bite the NHS in the future.

I want to end by referring to Pale Rider by Laura Spinney, published in 2016, on the Spanish flu. In the final chapter, on memory, she says:

“Memory is an active process. Details have to be rehearsed … But who wants to rehearse the details of a pandemic? … Instead, there was silence and a loss of memory”.


Are we sure that we will not have a loss of memory in the next three to five years? Will the recommendations from the noble and learned Baroness, Lady Hallett, make us become that new learning for government and society so that next time we can respond like Taiwan and Sweden?

Sodium Valproate and Pelvic Mesh

Baroness Brinton Excerpts

Monday 25th March 2024 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct on this. Probably the best way to do that is to come back in detail in writing, because it is vitally important.

[Baroness Brinton (LD)]

My Lords, in response to the noble Lord, Lord Hunt, the Minister said that Minister Caulfield had commissioned this report, but he misses out at least three years of work earlier. There was the report of the noble Baroness, Lady Cumberlege, and there was a long debate during the passage of the Health and Care Act when Nadine Dorries said she would look at commissioning something and then refused to do so. This is not recent history. Will the Minister please give this House a date on which the Government will come back to Parliament with a response?

[Lord Markham (Con)]

The point I was making was that Minister Caulfield absolutely agreed with the point the noble Baroness makes that the delay had been too long, and so it was she who came forward and said that she wanted to commission the Patient Safety Commissioner to report exactly in this area. So that was her being proactive on all this. In the same way, she says that she is determined to get a response back in the next few months. I cannot give a specific date yet, because it is a complicated area which involves industry, many government departments and the devolved authorities. However, as the Chancellor said, this remains a top priority area for both the Chancellor personally and the Government.

Anaesthesia Associates and Physician Associates Order 2024

Baroness Brinton Excerpts

Monday 26th February 2024 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare that I am a doctor registered with the General Medical Council, a member of the BMA and a fellow of the Royal College of General Practitioners and the Royal College of Physicians.

We have physician associates and anaesthesia associates seeing patients, examining them and advising them, who are as yet unregulated. All responsibility for their behaviour rests with the doctor who is their supervisor from whom they have delegated responsibility. The professional scope of practice for these associates can vary widely across the country. It is determined at a local level and patients have no idea about the variation.

There is a golden thread in clinical care that the most experienced person delegates down. They delegate down tasks that they know the relevant team member has the skills to undertake. A key skill in medicine, gained with extensive experience, is the integration of all the relevant information, evaluation of risk and prioritisation. Currently a problem in the whole of the NHS is that we expect staff to refer upwards and the boundaries are unclear.

A case of non-accidental injury in a child has been brought to my notice where the expert evidence was provided by a physician associate whose relevant experience is unclear at best. This blurring is misleading to non-medical professionals, including the police, judiciary and legal professionals. Supervision must be mandatory and stipulated in the GMC’s Good Medical Practice.

The junior doctors’ discontent, which we have heard about already from the noble Baroness, Lady Bennett, is boiling over. After training, medical graduates emerge with huge student debts to work a 40-hour week for just over £32,300, only to find that after a two-year postgraduate programme a physician associate typically earns between £3,000 and £11,000 more, for only 37.5 hours a week. All this has inflamed tensions—although I would say that direct verbal attacks on physician associates and anaesthesia associates, who have trained in good faith and with good intent, are not appropriate and I would not condone them.

Doctors are the only healthcare professionals who must undergo extensive, nationally stipulated postgraduate training before being appointed to a permanent senior role. Without long-term job security, these juniors rotate through departments, sometimes commuting many miles. They find that they do not belong and do not feel part of the team or valued, while patients miss out on continuity of care.

Very importantly, patients seen by a physician associate sometimes think that they have seen a doctor. The term “physician associate” gets muddled with the specialty and associate specialist doctor, who often has years of experience. Can the Minister clarify whether the term “physician associate”, which is so misleading, will become a protected title after this order passes? How can the name then be changed to revert to the more accurate “physicians’ assistant”? Currently, no medical titles are protected: “doctor” is not and grades up to and including consultant are not, which is another source of confusion. How is that going to be cleared up?

The cost-efficacy basis for these posts has been questioned in a recent paper, showing how the cost of one consultant anaesthetist supervising two operating theatres with an anaesthesia associate in each—that is, three staff—is more expensive than having two consultants doing one list each. The risk is higher if a problem arises in both theatres, especially in an anaesthetic emergency, when deterioration and brain damage can happen in minutes.

This crisis has been 20 years coming because we failed to expand medical school places or to register these new healthcare roles and define their scope of practice. What is the solution?

I fear this order will not solve all the problems. Yes, physician associates and anaesthesia associates must be regulated. It seems an outrage that people with such responsibility have been around for 20 years, unregulated, and a decade after that was recommended. The General Medical Council, in taking responsibility for regulation, must keep the register completely and clearly separate from that of medically qualified doctors. Can the Minister confirm that this clarity will be a legal requirement?

I tabled my regret amendment because it must be clearly on the record that the concerns exist, that some current regulation around the Medical Act needs updating urgently and that the GMC must be held accountable to Parliament, as has been explained by the Minister. Regulation is essential, but it is not the end of the issue; it is only the beginning.

The GMC must tackle the inappropriate way that some courses are advertised, which state that they train PAs

“to work as a safe and competent medically trained healthcare professional”

or to

“be a medically trained, generalist healthcare professional”

—which sounds awfully like a GP to me. Some courses describe working under a senior physician, but others say nothing about supervision. The anaesthesia associate courses differ slightly. They make it clear that, at present in the UK, only doctors who have specialist training in anaesthesia can administer anaesthetics and that the anaesthesia associate works as part of the anaesthetic team.

Next, the scope of practice must be clearly defined and agreed at national level, so that any employer is aware of what the associates should be doing and how the senior doctors must supervise them on site. Employers must also ensure that all patients know the qualification level of the person seeing them. Seven-day services are essential for patients.

Medical postgraduate training itself is in crisis. The royal medical colleges, the Academy of Royal Medical Colleges and the GMC must get together urgently to address postgraduate training. Perhaps it could be shortened, with post consultant-level fellowships to develop highly specialised skills and bring innovation to healthcare. Lifelong learning is essential; it is the essence of growing a good medical workforce in the long term. Medical schools, as they welcome the increased numbers, must look at how those who might wish to convert to a medical degree can be credited with their prior learning and experience, and tackle regulatory blocks in funding and timing.

Importantly, the title must be reviewed. The terms “physician assistant” and “anaesthesia assistant”, in use until 2014, clearly denoted the role as having delegated responsibilities from a supervisor. If “physician associate” and “anaesthesia associate” are to be protected terms, then we need a designation of medicine that clearly identifies a medical degree—similar to the American MD designation, for example. Patients must know who has seen them.

To summarise: patients must know the level of training of the person whom they have seen. Physician associates and anaesthesia associates must be regulated with appraisal and ongoing learning, including revalidation. The scope of practice of this new workstream must be defined to ensure that they have clear boundaries and supervision must be defined as being closely supervised on site to ensure patient safety. People must not be misled into believing that they are completely independent practitioners.

[Baroness Brinton (LD)]

My Lords, I am grateful to follow both the noble Baronesses, Lady Bennett and Lady Finlay of Llandaff, and I have been crossing out large chunks of what I was going to say, which I hope will be helpful to Members of your Lordships’ House.

As both of the other noble Lords have, I want to start by saying that this is not an attempt to discredit the many PAs and AAs who do an extremely good job. We need to understand that, and we need to understand that our health system must change and modernise. The issue is what is happening in our NHS and how the role of PAs and AAs is impacting not just on patients—I will come to the detail of that in a minute—but on the working of supervising doctors and junior doctors. All of those groups are in crisis, and this just seems to be adding further problems.

I echo the points made by, I think, the noble Baroness, Lady Bennett, about the Secondary Legislation Scrutiny Committee, which the Minister referred to in his introduction. In the committee’s report to us, it says three times that the Explanatory Memorandum assumed understanding and that it was not good enough. I ask the Minister if he will work with his officials to ensure that any more Explanatory Memorandums that come forward, not just on this issue but on others, are very clear and do not assume prior knowledge.

All of us have said that PAs and AAs—I am not going to keep saying physician associate and anaesthesia associate because it takes too much time—are not a replacement for doctors, though not one of us believes that that is the case. I am going to start with the title. The Royal College of Physicians and the Faculty of Physician Associates, which sits within the RCP, has guidance on the associate title and introduction guidance for PAs, supervisors, employers and organisations. What it says is in complete contradiction to what is happening on the ground:

“It is our view that, when a PA introduces themselves to a patient or staff member, they must make it clear at the start of the interaction that they are a physician associate, as well as explain the use of the term ‘PA’ … PAs must correct patients and staff if they refer to them as a … doctor, nurse or other professionally protected role title. This includes verbal, written and other forms of communication”.


Like other noble Lords, I have been inundated with letters from doctors and patients saying that they have been misled—not in the deliberate sense, but that PAs have not been correcting the record when someone has called them a doctor. The BMA, in its very helpful briefing, said that:

“To patients, PAs and AAs and doctors may look the same and appear to be doing a similar job”.


The problem, as the noble Baroness, Lady Finlay, said, is that the title is confusing. “Physician associate” perhaps implies that they have the same level of expertise as doctors. Unfortunately, as the noble Baroness, Lady Bennett, said, this has already led to a tragedy. Emily Chesterton died, aged 30, after two appointments with a PA who she believed was a GP, where mistakes were made.

A further difficulty, particularly in GP practices, is that GPs are beginning to worry that they are going to spend their entire time supervising PAs, as well as seeing patients with chronic diseases, and will not see ordinary people at all. Trainee GPs are worried about how they are going to be supervised. How is the Minister going to ensure that the issues of supervising and training, which are very serious, will be dealt with after the passage of this SI—because I do not think any of us are planning to call a vote today?

We have heard that, across acute trusts and GP surgeries, doctors have reported 70 instances of avoidable patient harm and near misses caused by PAs. That includes fatalities, missed diagnoses resulting in terminal diseases, missed DVTs, sepsis, heart attacks and haemorrhages. Missed cancer diagnoses in primary care has therefore emerged as a significant issue. In England, 74 acute trusts have replaced doctors with PAs on the doctors’ rota. Even if those PAs are supervised, that means that doctors who should be seeing patients are supervising more and more people. It is not a zero-sum game. One trust—I think it was Leeds, from memory—had a paper on how much more beneficial PAs were on the rota because they were much cheaper than doctors.

Doctors at 24 trusts reported witnessing PAs illegally prescribing medications, including controlled drugs. That is a particular worry because they are not permitted, under their current training and qualifications, to prescribe any drugs. That must be done by the doctor. The PA can recommend to the doctor what they think, but it should be signed off by a doctor. In addition, 42 acute trusts in England have witnessed PAs introducing themselves as doctor or failing to correct errors.

We have heard about a number of issues. I conclude by saying that, earlier on today, on the Victims and Prisoners Bill, we were talking about the duty of candour, which the NHS introduced nearly a decade ago. One issue related to this is that every regulated member of staff must report whenever they believe that something has happened that either possibly will cause damage or has caused damage. One of the good things about regulation for PAs and AAs is that they will come under the duty of candour. However, in all the cases that we have been told about where things have gone wrong, there is no evidence that there were reports to the CQC by the supervising doctors about things going wrong. Therefore, yet again I say to the Minister that my real concern is about current practice inside our extremely pressed and busy NHS, to make it safe. Just providing regulation for PAs and AAs will not in itself do that. I hope that he can help your Lordships’ House to understand.

--- Later in debate ---

Tabled by

[Baroness Brinton]

At end to insert “but regrets that the Government has failed to respond adequately to concerns over provisions in the draft Order about (1) the regulation of ‘physician associates’ and ‘anaesthesia associates’ by the General Medical Council instead of another regulator, and (2) the use of these professional titles, which risks confusion for patients over the difference between doctors and other healthcare professionals, with potential implications for patient safety.”

Amendment to the Motion not moved.

NHS App: Medical Records

Baroness Brinton Excerpts

Tuesday 19th December 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely; it is about getting that balance correct. I welcomed the support of all sides of the House when we were introducing the FDP. A lot of work was done with noble Lords on that. The fact that the federated data platform was as well received as it was in the circumstances is because of support from all Members of the House on all sides, knowing the vital role of data in improving health outcomes.

[Baroness Brinton (LD)]

My Lords, following the question from my noble friend Lord Allan about a red team, in the past not health data but personal financial data has been sold by subsidiaries or contractors of UK firms based abroad. I notice that we now have a deal with America on health data and GDPR. Is that true for other countries, such as India? Personal data, particularly medical data, would be seen as very valuable.

[Lord Markham (Con)]

The fundamental principle underlying all this is that none of the data leaves the control. The data controllers today—be it GPs, the NHS or the hospital—stay as they are, and any use of that data has to be approved outside of that. The noble Baroness is absolutely correct. We want to make sure that it is not used for any purposes that are not going to improve health outcomes, such as the ones we have talked about.

Suicide Prevention Strategy

Baroness Brinton Excerpts

Thursday 26th October 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness for her support for the suicide prevention strategy. It tries to look at the themes behind this issue, of which working to give effective support, communication and training is absolutely key—as is making sure that that is followed up on. The other thing that I want to pull out from the report is the real feeling, in terms of the seven key themes, that suicide prevention is everyone’s business and is something that we all need to be aware of and could learn more about.

[Baroness Brinton (LD)]

My Lords, the Minister has outlined how important it is to learn from the experience of people who have considered suicide. Last week, an Information Rights Tribunal asked the DWP to publish its secret report on suicide rates among vulnerable claimants; it has not yet been published despite the fact that it was written in 2019. Can the Minister explain why it still has not been published? If not—I appreciate that this falls under the DWP—can he write to me, because it is clear that we need to learn the lessons of what went wrong?

[Lord Markham (Con)]

Absolutely. I would be happy to write to the noble Baroness.

Reinforced Autoclaved Aerated Concrete: Hospitals

Baroness Brinton Excerpts

Wednesday 13th September 2023 Lords Chamber

[Lord Markham (Con)]

I hope and trust that most of us would think that it was sensible to prioritise the RAAC hospitals. That meant that we had to move some others to the right-hand side of the budget envelope, so to speak. It is not publicised very much, but we now have an agreement with the Treasury to move to five-year capital cycles, like the Department for Transport, which I think is a real positive because we need long-term planning cycles. We are busy developing a 2030-35 programme now, which those hospitals that the noble Lord mentioned will be placed in.

[Baroness Brinton (LD)]

My Lords, I want to follow on from the question from the noble Lord, Lord Hunt. My local hospital, Watford General Hospital, has been top of the rebuild list for 20 years. The town was delighted with the news on 23 May that it would be part of that group and is not part of the eight. Last week, the council was informed that there is still no confirmation of when funding will be approved by the Treasury. The town knows that it will run out of the chance to rebuild Watford General by 2030 unless that funding is confirmed very soon. Can the Minister say when it will be confirmed?

[Lord Markham (Con)]

In every hospital—and Watford was one of the first ones I visited—there is a programme on which the draw-down of the funding depends; there is already a new car park there, for instance. I can assure the noble Baroness that the plans are in place to make sure that the draw-down is in time. I have also said on all the hospitals I have visited over the summer—I have seen about 20 or so—that I have a quarterback role where I have to project manage across them all and, where there are issues, they can approach me directly. I will raise today’s question with the Treasury and make sure that Watford is well in order.