Healthcare (International Arrangements) Bill

Baroness Chisholm of Owlpen Excerpts

Report stage (Hansard): House of Lords
Tuesday 12th March 2019 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I too support the amendments in the names of the noble Baroness, Lady Thornton, and my noble friend Lord Marks. I repeat the view that he and the noble and learned Lord, Lord Judge, expressed: we should be producing only legislation resulting from the decision to leave the EU. I thank the Minister very much for meeting us and for the government amendments—particularly to those Henry VIII clauses, which have absolutely no part in modern legislation.

I agree with previous noble Lords, but any Bill dealing with healthcare agreements outside the EU is different. I would be happy to look at these issues in another Bill at another time. As has just been said, the expansion in scope of the Bill looks opportunistic and is completely inappropriate at the moment.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I cannot agree with these amendments. As we pointed out during the progression of the Bill, we live in a global world, with more people travelling internationally for all kinds of reasons. There is obviously a huge demand for healthcare systems between countries, giving the traveller peace of mind that the foreign country they are in can respond to healthcare needs.

As was also mentioned, we already have simple reciprocal agreements with non-EU countries. The domestic implications are limited, and our current powers to charge domestic overseas visitors, and the regulations under such powers, provide for domestic implementation. Importantly—

[Lord Foulkes of Cumnock]

May I interrupt the noble Baroness?

--- Later in debate ---

[Baroness Chisholm of Owlpen]

No, let me finish. The Bill will not replace or limit the prerogative power to enter into international healthcare agreements. My understanding is that agreements will still be subject to appropriate parliamentary scrutiny.

It is surely right for us to take advantage of the Bill and look at the opportunities it can offer us. We are not trying to shoehorn something dastardly into it. It could offer all kinds of things. It seems to me that planning ahead is a refreshing thing to do. Many of the arguments raised have nothing to do with protecting or giving peace of mind to travellers. As a nurse, my main priority will always be those needing care. The Bill allows them reciprocal healthcare outside the EU and just that. Should there be a Division, I hope that noble Lords will keep in mind those people who, under the Bill, will be able to travel globally with renewed peace of mind about their healthcare.

[Lord Ribeiro (Con)]

My Lords, this is an enabling Bill and no more. In a letter to the chairman of the Delegated Powers and Regulatory Reform Committee on 8 March, the Minister confirmed that these powers would be used only in the exceptional circumstances of EU exit. We will discover the outcome of that tonight.

In these circumstances, the regulations’ implementing powers would be subject to parliamentary scrutiny. The assurances and clear message from our debates in Committee—when the Minister was very clear, in answer to a question from the noble Lord, Lord Brooke of Alverthorpe, that reciprocal healthcare arrangements with the United States would present significant challenges because of the different payment systems and such an arrangement was unlikely—should surely be enough to satisfy those who believe that the Government still have a cunning plan to sell the NHS to Donald Trump and others.

As I said in Committee, I believe that the implementation of our international arrangements should be phased, giving priority to our overseas territories, as has been noted; our Commonwealth partners, of which Australia and New Zealand have already been mentioned; and our important international partners, perhaps excluding Venezuela and the Galapagos Islands from that list, as suggested by the noble and learned Lord, Lord Judge.

Anything enabling this to happen should be considered seriously, given the risks of what I believe is likely to be a no-deal Brexit. I do not support these amendments and I hope that the Minister will be able to come up with suggestions for how this can be implemented to overcome some of the concerns expressed from the other side.

Mental Health: Eating Disorders

Baroness Chisholm of Owlpen Excerpts

Monday 25th February 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is exactly right. NICE clinical guidance is clear that people should not be rejected for treatment solely on the grounds of their weight or body mass index. This is an issue that Hope Virgo in particular has campaigned on very effectively to improve awareness of treatment of eating disorders. She has discussed her campaign with NHS England and the department, and I am pleased to confirm that my ministerial colleague Jackie Doyle-Price will meet her in the coming weeks to see what more can be done.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I ask my noble friend the Minister to remember young boys and men when thinking about future policies and treatment. They are often forgotten, and I think we are seeing quite a rise in men and boys with this problem.

[Baroness Blackwood of North Oxford]

I thank my noble friend for that question and in particular for raising the issue of stigma. We have put £150 million and extended over 70 services into the community specifically so that services can be more accessible to young girls and boys and so that people can feel free to come forward and seek help where they need it.

Human Fertilisation and Embryology: Frozen Eggs Storage

Baroness Chisholm of Owlpen Excerpts

Wednesday 20th February 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is right: the 2009 regulations were not just concerned with fertility options for people who are already adults. The 55-year limit is intended for those who become infertile through serious illness or side-effects, which can happen in childhood. I understand the concerns about the 10-year limit—there was no consensus during the 2009 review—but it is being continually reviewed and will remain under review by the department.

[Baroness Chisholm of Owlpen (Con)]

Can my noble friend the Minister say what the Department of Health and Social Care is doing to publicise the fact that it is preferable for women under the age of 35 to harvest their eggs, because after that age the effect is not as good? I realise that some women do not have a choice, but some private firms take a lot of money from women as they get older without telling them of the disappointments they might face.

[Baroness Blackwood of North Oxford]

My noble friend makes an important point about the success rate of fertility treatment through the freezing of eggs, which is roughly comparable with IVF at 26%. It is important that false hopes are not raised and that women are not exploited in these very sensitive situations.

Health and Social Care (National Data Guardian) Bill

Baroness Chisholm of Owlpen Excerpts

3rd reading (Hansard): House of Lords
Wednesday 12th December 2018 Lords Chamber

Moved by

[Baroness Chisholm of Owlpen]

That the Bill do now pass.

[Baroness Chisholm of Owlpen (Con)]

My Lords, in moving that the Bill do now pass, I express my gratitude to all noble Lords for their interest in the Bill. I want particularly to thank the noble Baronesses, Lady Thornton, Lady Walmsley and Lady Kidron, and the noble Lords, Lord Patel and Lord Knight of Weymouth. Extended thanks must also go to my honourable friends in the other place, Jo Churchill, who introduced this Bill, and Peter Bone, its recent sponsor. My life was made a great deal easier during the passage of the Bill by the excellent work of the Bill team, and the continual assistance of the Minister, my noble friend Lord O’Shaughnessy, along with that of the Department of Health and Social Care. Before I sit down, I must also mention and thank the current National Data Guardian, Dame Fiona Caldicott, who has contributed so much to work in this area. I beg to move.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)]

My Lords, I join my noble friend briefly in congratulating all those involved in the passage of the Bill. I also extend my thanks to her for her sterling work in raising this issue. The Government strongly support the passage of this Bill and we hope it will achieve Royal Assent swiftly. With the permission of the House, I need to clarify an important point raised at Second Reading on demographic data. I have laid a letter on this subject before the House as a more extended account.

The role of the National Data Guardian is, first and foremost, about good practice in supporting organisations and individuals who process health and adult social care data. The Bill is drafted widely to allow the NDG to issue guidance about the processing of health and adult social care data. This should be interpreted broadly and would allow for the NDG to produce guidance on issues that impact on the processing of health and adult social care data. This would include, for example, good practice in security standards for storing health and adult social care data. This is an example of where guidance is not strictly focussed on health and social data itself, but about the processes and issues that could impact it. Almost anything that should be taken into account when processing health and adult social care data—or which broadly has the potential to impact, affect or influence that processing—would fall within the scope of that definition. With that clarification, I hope we will be able to move forward and that noble Lords will support this Bill. I once again thank my noble friend and congratulate her on her sterling effort.

Organ Donation (Deemed Consent) Bill

Baroness Chisholm of Owlpen Excerpts

2nd reading (Hansard): House of Lords
Friday 23rd November 2018 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

My Lords, I am delighted to support this Bill and thank the noble Lord, Lord Hunt, for bringing it before us today. Its importance cannot be overestimated. It is a good and—thank goodness—simple Bill, and it will save lives. As the noble Baroness, Lady Crawley, and the noble Lord, Lord Patel, mentioned, there are encouraging signs of donors coming forward, but the statistics are still depressing and distressing. As we have heard, Wales already has a presumed consent or opt-out system, and Scotland intends to follow suit. As the noble Baroness, Lady Crawley, mentioned, research has shown that 82% support organ donation, and the public consultation showed unprecedented support, yet we know that only 37% are on the organ donor register.

This simple but effective Bill has the support of doctors and health campaigners. It will not, on its own, solve the problem of getting more donors on the register, but it will enable us to move forward and launch an awareness campaign. I am sure all noble Lords remember the huge publicity around the early transplants, when the successful recipients were household names, seen on TV and interviewed in newspapers and magazines due to the rarity of the procedure. Thank goodness that is not the case today and transplants are now an everyday occurrence, but that headline news was an incentive for people to come forward as donors. The general public are, on the whole, unaware of how important it is for donors to register. Most do not register unless they are personally affected.

Therefore, to be as effective as we hope it will be, this Bill depends on the awareness campaign around it. As the noble Lord, Lord Hunt, mentioned, there needs to be a cultural change. I think I am right in saying that, at present, family refusal rates in the UK are considerably higher than in many parts of mainland Europe. There needs to be education in schools, colleges and universities; an awareness campaign on the radio and TV, in newspapers, magazines and social media; a campaign on lives saved, with examples from donors and recipients; and, perhaps most importantly, a campaign to encourage families to have the conversation. As the noble Lord, Lord Hunt, mentioned, letting the relatives know the organ donor’s decision will make it much easier for them to be supportive at a time of immeasurable grief. I still remember vividly how difficult it was, when I was nursing, to have this conversation with relatives and loved ones, who more often than not were unaware of a donor’s wishes.

This Bill does not change families’ rights. They will continue to be included and will not be overruled; it will not close families out. But the way in which the possibility of donation is presented can have a critical impact on the decision that relatives and loved ones make. Timing, language and the right healthcare professionals are all important factors, and I was pleased to see confirmation in a letter from my noble friend the Minister that there will be specialist nurses for organ donation and a key focus on training to enhance skills in supporting grieving families. It is also vital that those who opt out and relatives who do not give consent feel no shame, and that we respect their decisions.

This Bill is a no-brainer, as far as I am concerned. With the right campaign, it will become apparent that this is not a forced choice and that organ donation is still a gift, perhaps one of the greatest gifts that can be given from one human being to another. One donor can help many recipients. The donor process benefits not only recipients, but also the families of donors and recipients. Recipients’ families have the joy of having their loved ones returned to health, while donors’ families find meaning and gain peace from knowing that lives have been saved as a result of the unfortunate death of their loved ones.

Once again, I thank the noble Lord, Lord Hunt, for bringing this important Bill to our attention, and I am grateful for all the clear explanations of it from both the noble Lord and the Minister, my noble friend Lord O’Shaughnessy. I am delighted that the Government fully support it. Let us now get on with it and get the Bill through Parliament.

Health and Social Care (National Data Guardian) Bill

Baroness Chisholm of Owlpen Excerpts

2nd reading (Hansard): House of Lords
Friday 26th October 2018 Lords Chamber

Moved by

[Baroness Chisholm of Owlpen]

That the Bill be now read a second time

[Baroness Chisholm of Owlpen (Con)]

My Lords, the Bill will place the National Data Guardian on a statutory footing and will promote the provision of advice and guidance on the processing of health and social care data in England. It is an honour for me to bring the Bill before your Lordships today.

The Bill is an important step in increasing the public’s and patients’ confidence in the use and appropriate sharing of health and care data. It has gone through the necessary stages in the other place and I extend my thanks to the many people who have helped prepare the Bill, in particular to Jo Churchill for her dedication to the original Private Member’s Bill and to Peter Bone for sponsoring the Bill in the other place and ensuring that it reached this stage. It would be remiss of me to proceed without mentioning and thanking the National Data Guardian, Dame Fiona Caldicott, who has contributed so much to this area. I am grateful to the Parliamentary Under-Secretary of State for coming to listen to the debate. I appreciate the department’s help with the progress we have made so far and the cross-party support for the principle behind the Bill. Indeed, I see that Jo Churchill is also here today and we welcome her. I hope that with that cross-party support, the Bill will go through its stages here as quickly as it did in the other place.

I would like to take some time to reflect on the importance of the role of the National Data Guardian. We all know that when collected and used properly, healthcare data has the potential to be transformative for patients. Sharing data offers immense promise for improving the NHS and the social care system, as well as benefiting individuals through unlocking new treatments and medical breakthroughs. Getting information sharing right can create a better experience for people using services and make care more efficient. Too many people with serious conditions have to tell the same story to multiple people and services involved in their care. Appropriate data sharing could eliminate any unnecessary burden. As well as that, if commissioners have access to data that they need to make the decisions about the best use of their resources locally and nationally, services can be provided where they are most needed and available funds can be maximised and budgets fully optimised.

Of course, our ability to unlock the benefits of data sharing relies on the public having confidence in the health and care system’s appropriate and effective use of data. If data and information is to be used effectively to support better health and care outcomes, the public have to have trust and confidence that there are strong safeguards in place to protect it from inappropriate use. The establishment of the National Data Guardian as an authoritative and independent voice for the patient and service user on how their data and information is used is a crucial element in that. This short but important piece of legislation will promote challenge and build assurance across the health and social care system, enabling the system to access the data it needs to run safely, effectively and efficiently. A statutory National Data Guardian will enable the postholder to speak with increased authority. A statutory basis increases strength of argument, allowing for guidance to be published as standards and good practice to which relevant organisations must have regard.

Importantly, the National Data Guardian is not a regulator. The role is first and foremost to support organisations and individuals who use health and care data to do so in accordance with the relevant laws and good practice. Placing the role on a statutory footing was a manifesto commitment of the Government, and the Government’s support has been clear throughout the Bill’s progress. The Bill will be significant in maintaining public trust and confidence in the appropriate and effective use of health and care data.

I shall give a short summary of the provisions of the Bill, which consists of only six clauses and will establish the statutory role of the National Data Guardian. The Bill also makes provision for the administrative and financial operation of the National Data Guardian’s office. The Bill will give the National Data Guardian the power to publish formal guidance and provide informal advice, assistance and information relating to the processing of health and adult social care data in England. The Bill imposes a corresponding duty on public bodies within the health and adult social care sector and private organisations that contract with them to deliver health and adult social care services. They must have regard to the National Data Guardian’s formal published guidance.

The Bill requires the National Data Guardian to consult with appropriate persons before publishing the guidance and requires the National Data Guardian to produce an annual report including a set of accounts, details of advice given and guidance published in the previous financial year, and the priorities in the forthcoming year. The Bill gives the Secretary of State the power to provide for the commencement of its provisions, and requires him or her to appoint an individual to hold office as the National Data Guardian.

A money resolution to authorise money for the Bill was laid before Parliament on 21 May 2018. The expenditure of £725,000 per annum is necessary for the Office of the National Data Guardian to undertake its statutory function. The cost is based on the current £500,000 per annum provision for the existing non-statutory National Data Guardian office. The overall increase in spend of £225,000 per annum relates predominantly to additional team resources to strengthen the National Data Guardian office’s ability to prepare and disseminate statutory advice and monitor its impact and relevance, amid anticipated increased demand for independent legal advice and assurance, along with a further responsibility for communication and engagement, including delivery of formal guidance, production of an annual report and accounts, and raising the profile of the National Data Guardian’s website.

I will reflect on a few points which have been raised in discussions over the past couple of weeks. With regard to whether the statutory National Data Guardian will have access to the Information Commissioner’s Office, the National Data Guardian already has a formal understanding and close working relationship with the Information Commissioner’s Office. That is covered by a memorandum of understanding. We would expect to see this updated to reflect the statutory footing. The statutory role allows the opportunity to build on the relationships already developed with regulatory bodies, including the Information Commissioner’s Office, the CQC and NHS Improvement, and to support them in their responsibilities around ensuring that appropriate practices are being adopted by regulated organisations.

I draw your Lordships’ attention to the fact that the Act would come into force,

“on such day as the Secretary of State may by regulations appoint”.

Regulations to this effect made under Clause 5 are to be made by statutory instrument. The Bill contains no other regulation-making powers. There is no intention to amend this.

Lastly, the Bill’s provisions extend to private sector providers that contract with public bodies to deliver health and adult social care services. These must have regard to the National Data Guardian’s published guidance. Data held by privately arranged and funded health and adult social care providers is not covered by the Bill. However, private providers of healthcare will have access to NHS patient data in the vast majority of cases—for example, where patients give their consent for their records to be shared—but this alone will not bring them within the scope of the Bill. The NDG’s remit extends to all health and adult social care data but purely private bodies are not required to have regard to published guidance.

Placing the National Data Guardian on a statutory footing is important for many reasons. This is a significant time in the history of health and care and it is critical to maintain and strengthen public and patients’ support. People want to know what their data is being used for, who it is being shared with and why. A statutory National Data Guardian will be key in ensuring that citizens’ confidential information is safeguarded securely and used fairly and lawfully. I thank everyone for their help so far and I hope that we can make swift progress with the Bill. I beg to move.

--- Later in debate ---

[Baroness Chisholm of Owlpen]

My Lords, I thank noble Lords for their contributions today and support for this Bill. I must say, my life this morning has been made much easier, because my noble friend the Minister has answered all the questions raised, which I thought I was going to have to do. I feel that I have got off rather lightly, and he has done it so much better than I could have.

The NDG Bill is significant at a time when we must ensure that we maintain and strengthen public/patient support on the use of data for health and social care. As your Lordships know, it is in the greater use of technology and the integration of health and social care that the future of healthcare lies. I look forward to continuing dialogue with your Lordships as the Bill progresses. I ask the House to give the Bill a Second Reading and beg to move.

Bill read a second time and committed to a Committee of the Whole House.

Health Inequality: Autism and Learning Disabilities

Baroness Chisholm of Owlpen Excerpts

Thursday 10th May 2018 Grand Committee

[Baroness Chisholm of Owlpen (Con)]

My Lords, I thank the noble Lord, Lord Touhig, for initiating this debate. I shall speak on the importance of early diagnosis of children who are showing signs of HFA and Asperger’s syndrome. It is still hard to get a diagnosis, partly as there is no fixed set of behaviours common to all, but there are clear signs that healthcare professionals should be trained about when faced with a toddler or older child. There is also the problem of the invisibility of autism in the healthcare system, so it is vital for professionals to trust parental instincts and listen to their concerns to ensure that every individual with autism receives the correct care and support throughout their life.

It can make a difference if the condition is diagnosed early. Though frightening and bewildering, it is essential for parents and children to be able to move forward. With a diagnosis, they can understand why they are like they are. It can prevent distress as the child develops and can stop further physical illness. Many high-functioning children with autism are not diagnosed until they enter school and start struggling socially. By 24 months an autism diagnosis tends to become stable, but from 18 months onwards an intervention programme can be highly effective in improving IQ, language ability and social interaction. Research has shown that children are waiting more than three and a half years for an autism diagnosis. Parents who are involved with early diagnosis and treatment have found they are better equipped to give specific support at varying stages of the child’s development.

I welcome the fact that data collection within the NHS starts in April next year, but no decision has been made on data collection within GPs’ surgeries. A flag against a patient’s file could assist the GP and the person with autism, particularly those who have no outward physical signs. The noble Lord, Lord Touhig, mentioned the anxiety that this can cause. Decision-makers cannot plan services locally unless they know how many people need to use them. Without accurate information, autistic people can be left without the right support being available. Anonymised data from GP records would provide decision-makers with the data they need to plan effectively.

Around 70% of children on the autistic spectrum go to mainstream schools. Before a diagnosis is given, these children are often marked as disruptive. I welcome the Government’s strategy that, from September, every new teacher will have autistic training within their curriculum. What training is available for classroom assistants? Some of the most successful people in the country have an autism diagnosis, but we need to ensure that the collection of social and health data relating to autism becomes more co-ordinated and systematic; that local authorities’ and GPs’ information systems allow the collection of data from toddler-age upwards; and that provision of school nurses and health visitors who can identify those with autism is built into tendering arrangements for health service agreements with schools and colleges. If as a society we can follow through on the above, I hope that those with autism will feel that they have not been forgotten, do not have to struggle for their identity within their community and can reach their potential, and that those who care for them feel that they can get the support they require.

NHS: Cybersecurity

Baroness Chisholm of Owlpen Excerpts

Wednesday 2nd May 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is highlighting a historic problem about interoperability between different bits of the NHS in England. That is absolutely fair enough. I would highlight two things that we are doing. First, the National Data Guardian for Health and Care has defined 10 data standards that should apply to both security and interoperability between different systems, and those now apply in all key NHS contracts, including the standard NHS contract. Secondly, we have launched a programme to appoint up to five local health and care record exemplars, which will provide interactive and interoperable data for patients for their direct care—so that the issue we have at the moment of data sometimes falling between different institutions will not happen any more.

[Baroness Chisholm of Owlpen (Con)]

My Lords, obviously data security is absolutely vital, but so is the collection of data. If we are going to move forward it is so important that we collect that data for research and treatment. Can my noble friend the Minister give us some kind of indication of how we can make sure that the general public feel happy to give their data to the health service?

[Lord O'Shaughnessy]

My noble friend makes an excellent point. Not only is it critical that data is joined up for direct care—quite rightly, patients are amazed when that does not happen—it is an absolutely essential resource for research into new treatments. One thing we are doing to try to provide that reassurance to the public, which has not always been there, is introducing a new data opt-out at the end of this month to provide that reassurance for patients who do not want to be part of it. We are focused on providing that resilience and security so that they can be confident that, when the NHS holds their data, it uses it securely, safely and legally.

NHS: Cancer Treatments

Baroness Chisholm of Owlpen Excerpts

Thursday 25th January 2018 Lords Chamber

[Applause.]

[Baroness Chisholm of Owlpen (Con)]

My Lords, on a momentous day, I beg to move that we adjourn the House.

House adjourned at 6.12 pm.

NHS: Staff

Baroness Chisholm of Owlpen Excerpts

Thursday 30th November 2017 Lords Chamber

[Lord Clark of Windermere (Lab)]

My Lords, I am looking forward to this debate. I think it will be an excellent debate, with a wide array of speakers representing a great deal of experience right across the health and care service.

We all know that the NHS is one of the living institutions of our country, loved, appreciated and needed by its people. In spite of the difficulties facing it, the service it provides is second to none as the British people seek medical attention and healthcare. Year after year, surveys show that it is regarded internationally as the most efficient organisation anywhere in delivering healthcare.

I shall be a little provocative in what I am saying at this moment. I know it causes some discomfort to some Members on the Benches opposite that a state institution employing 1.3 million people can compete successfully against private medicine. When I say that, I do not include the Minister because I know he is committed to the health service, but I believe there are people in the Conservative Party who find the NHS uncomfortable. It was interesting that the Secretary of State chanced his luck when he alleged recently that the NHS was actually invented by the Conservative Party—a case utterly rebutted by my noble friend Lord Pendry on 2 November in a letter to the Guardian, so I do not need to take that further.

I trust that when we on this side speak today, the Minister will understand the strength of opinion that the Government are slowly but surely allowing the NHS to deteriorate. Several years ago, when I began to question Health Ministers on the NHS, the situation was precarious. Now it is getting almost desperate. The bottom line is that the Government are not providing sufficient funds to meet the demands of an increasing and ageing—we must take those two facts together—population, and that no clever words can hide the fact that they are breaking their manifesto policy to increase spending on the NHS in real terms year on year. If you look at the anticipated spending, you can see that that will not be the case.

I mentioned 1.3 million employees. Those employees are proud to work not for the health service but in it. The service is at its most efficient only when it works as a team. Everyone is interdependent. I feel at times that the Government do not really appreciate that fact. If there is one thing lacking in our NHS, it is that it has no central workforce planning, and that is of real concern.

At the moment, almost all employees feel the same—demoralised and undervalued. They give their all, and more and more people are treated. But the staff feel that their treatment by the Government shows that they are not regarded highly enough. They feel that they are the individuals who suffer most from the Government’s now out-of-date austerity programme. Wherever we look—whether at consultants, doctors, nurses, midwives, healthcare assistants, physiotherapists, radiotherapists, GPs, clerical staff, porters, ambulance drivers, dentists or the scores of other occupations in the health service—it is the same story. The Minister must know this because I know he talks to staff. They feel demoralised and undervalued. Yet, these are the very people who keep our NHS going. It is because of them that patients still get a good service. However, it is slowly getting worse again. We are finding, in spite of the best efforts of staff that waiting lists are growing month by month. Increasingly, deadlines for cancer treatment are being broken. In spite of the Government’s bold declarations, the future for mental health services does not look as good as it should.

Following the Budget, I noticed that initially the press lauded the Chancellor for what he appeared to be giving the NHS. However, after examination of the small print, the general public, the press and those involved increasingly realise how short-changed they were by the Chancellor. They took on board Jeremy Corbyn’s comment that the money, was “well short” of what is needed. Sir Bruce Keogh tweeted that the Budget,

“plugs some, but def not all, of NHS funding gap … Worrying that longer waits seem likely/unavoidable”.

Sir Malcolm Grant, chair of NHS England, said that the money,

“will go some way towards filling the widely accepted funding gap … we can no longer avoid the difficult debate about what it is possible to deliver for patients with the money available”.

NHS Providers stated that,

“tough choices will be needed and trade-offs will have to be made … It is difficult to see how the NHS can deliver everything in”,

the forthcoming year. I understand that just today the NHS England board is discussing what will happen—whether we will have rationing in health. This is against the background of the speech by Simon Stevens, chief executive of NHS England, who on 8 November said that an extra £4 billion was needed in 2018-19.

Yet only the Government seem to deny there is a problem. To pluck a number of key employees, we are short of 40,000 nurses. Recruitment from the European Union has all but dried up. Wages have been frozen at 1% since 2010, leading to a reduction in salary of 10.1% for nurses by this year. Unsurprisingly 70% of nurses reported feeling financially worse off, with 24% saying there were thinking of leaving their job because of money worries. The Government claim that there are 13,300 more nurses than in 2010 and 11,800 more doctors in hospitals. However, we have to question those figures. I do not dispute that they apply in hospitals but when looking at healthcare, we are talking not only about primary care in hospitals but aftercare—the care service. I have letters from care providers saying that they have had to close down some of their institutions because they simply cannot recruit nurses. There are insufficient nurses in this country.

It is no better for doctors. The BMA found a 13% decrease in applications to medical schools since 2013. Last year, there were 7,660 medical students beginning their course, compared with nearly 8,000 in 2010. GP numbers are falling. Almost one-third of GP partners are unable to fill vacancies. Only 13% of partners report that they do not need to fill vacancies, and figures show an actual decrease in the number of doctors working mainly as GPs. The result is that patients are having to wait longer and longer to get an appointment, increasing the demand on A&E departments in our hospitals, which are already under great stress. There needs to be some joined-up thinking.

Even if we go to the top of the tree and look at consultants, we find what I can only describe as a dire situation. The NHS has a shortage of consultants and would-be consultants. During the past year, 1,542 consultant posts were advertised, but only 853 certificates of completion of training issued. Not surprisingly, 45% of the advertised posts were left unfilled. There simply were not the qualified candidates. Ninety-five per cent of doctors in training report that poor morale is having a negative impact on patient safety in their hospital, with half reporting a serious or extremely serious impact.

I do not really need to continue. Perhaps I could sum up this point by citing the president of the Royal College of Physicians, Professor Jane Dacre, who neatly summed it up in her response to the Budget. She said that it,

“felt like we had been given short-term sticking plasters rather than the long-term sustainable plan our patients need”.

It is all very depressing. The Government take the view that it is really not their fault, but a lot of it is. I have to ask: why, when they came to office in 2010—with their coalition partners, but they were by far the leading partner—did they cut nurse training numbers by 22,000? It takes a long time to build up the shortfall that has been allowed. Why, at this critical moment when we do not know whether we have enough nurses or doctors—the Government say we have; I say we have not—why risk the numbers by abolishing the bursary scheme? It is a risk, and the Government know that there are fewer nurses going into training this year than in previous years. I do not have the precise figures but all the universities that I have contacted, with one exception, have found a considerable decrease. If there is no problem with nurses, why was it announced yesterday that we are to step up our recruitment of 5,500 more nurses from India?

I am being a bit critical of the Minister. I hope he will not take it personally but take this opportunity to write to me to correct the information. Last week, in a straightforward Question about agencies, I asked,

“what are the names and locations of the agencies registered to supply nurses to NHS trusts in England”?

It was a straightforward Question, but the Minister’s reply can be described only as gobbledegook. He said:

“Agency rules require that agencies are on NHS Improvement-approved frameworks and these frameworks monitor and approve agencies for supply to trusts. The approved framework operators are Crown Commercial Service, NHS Collaborative Procurement Partnership and HealthTrust Europe”—


I think HealthTrust Europe is an American company. The Answer continues:

“In addition to agencies on approved frameworks, trusts in exceptional patient safety situations can utilise the ‘break glass clause’ and work with an off-framework agency. Using an off-framework agency should be a culmination of a robust escalation process sanctioned by the trust board. Trust boards have primary responsibility for monitoring the local impact of the agency rules and ensuring patient safety”.


I spent a lot of time trying to understand it, and I have understood a bit of it. I have also found out—the latest figure I could get for any particular week—that there are 50,000 applications to use the “break glass clause”. Are those 50,000 nurses from agencies included in the Government’s figures?

[Baroness Chisholm of Owlpen (Con)]

My Lords, may I quickly say that there has been a mistake over the timing? If everybody speaks for 13 minutes, we will go two minutes over time. If possible, will your Lordships stick to 12 minutes? When the clock says 12 minutes, will noble Lords please sit down?