Health and Care Bill

Debate between Baroness Chisholm of Owlpen and Lord Hunt of Kings Heath

Lords Hansard - Part 1 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

My Lords, I am grateful to the noble Lord, Lord Hunt, particularly for his brief and, as always when he speaks, his clear understanding of the amendment. It makes it so much easier for us to know where the noble Lord is coming from.

I am grateful to all other noble Lords who spoke on this issue, and I understand the interest in the integrated care boards’ power to disclose information that is personal data. As the noble Lord, Lord Hunt, mentioned, public trust is essential in this and individuals’ data will be used lawfully and with respect, and held securely with the right safeguards in place. It will need to be proportionate, transparent and subject to individuals’ rights to access and correct information in use.

Let me further explain how we will make sure this happens. I assure noble Lords that the clause already restricts integrated care boards’ powers to disclose information by limiting these to the specific circumstances set out in the clause. Further, all use of personal data is subject to data protection legislation, including the UK general data protection regulation and the Data Protection Act 2018. This legislation provides several key protections and safeguards for the use of an individual’s data, including strict rules and key data-protection principles for the sharing of personal data.

Under the UK GDPR, health data has to be treated as a special category. This data requires additional protections due to its obvious sensitivity. For this type of data to be lawfully processed, a further condition must be met, in addition to identifying a lawful basis, as set out in the GDPR and the Data Protection Act.

This data protection legislation applies to the use of all personal data and provides robust safeguards in relation to information and disclosure. Importantly, there are additional protections on the use of health data, including the common-law duty of confidentiality, along with the role of the National Data Guardian, who advises and challenges the health and care system to help ensure that the public’s confidential information is safeguarded securely and used properly. As the noble Lord, Lord Hunt, mentioned, there are also the Caldicott principles; there are seven of these, which I am sure noble Lords are aware of, so I will not go through them all now. They provide guidance to health and care organisations on the use of confidential information. Along with this, there is also the national data opt-out.

I remind the Committee that new Section 14Z61 will apply, which provides when an ICB may disclose information obtained by it in the exercising of its functions. I emphasise that maintaining trust that healthcare data is being used properly is paramount. Individuals’ data will be used lawfully and with respect, held securely and have the right safeguards in place. None of the changes we are making will remove the duties of organisations to comply with the requirement of data protection legislation. Along with that, we are working with the Home Office to ensure that the protection and confidentiality of patient information is upheld within the Police, Crime, Sentencing and Courts Bill. Appropriate safeguards are in place and the Bill makes it clear that information can be shared only in accordance with data protection laws.

I am concerned that this amendment could cut across the different pieces of relevant legislation, preventing the ICB from effectively discharging its functions where it may be necessary to disclose information, which may include personal patient data. This would include investigating complaints, making safeguarding referrals for patients whose welfare is at risk, complying with court orders and assisting criminal investigations. It would also risk a confusing data-sharing system, with different rules applying to different organisations.

I know that my noble friend the Minister, the noble Lord, Lord Kamall, has agreed to talk about this further with the noble Lords, Lord Hunt and Lord Clement-Jones. He wants to meet civil liberties organisations, along with them, to discuss this subject further. However, I regret that the Government cannot accept this amendment. I hope that I have given the noble Lord some reassurance and that he will feel able to withdraw the amendment.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am of course grateful to the noble Baroness but I am not sure that she has entirely dealt with the concerns expressed. Because the noble Baroness, Lady Brinton, referred a lot to the GMC, I should just say that, although I am a member of its board, I am not acting here on behalf of the GMC at all.

The noble Lord, Lord Clement-Jones, and I signed the amendment and we both start from the basis of supporting digital transformation in the NHS, but we have always seen that it has to go hand in hand with the safeguards. That is why this debate is so important. We have heard powerful interventions from the noble Baronesses, Lady Brinton and Lady Harris, about why the police Bill had to be amended in relation to police access to patient information. The noble Baroness, Lady Finlay, referred to the issues for clinicians if they did not feel that the integrity of the patient confidentiality system was sufficiently safeguarded.

The Minister has basically said that we need not worry, because the NHS will only deal with information lawfully, and she went through some of the protections, including the fact that in the Bill there are conditions before the integrated care board can release the information. She referred to the data protection legislation, the GDPR, the special category given to health data about patients and the Caldicott principles. She went on to say essentially that my amendment would cause problems, because it would get in the way of legitimate information being given by the ICB, which might have an impact on patient care quality.

Human Fertilisation and Embryology (Amendment) Regulations 2018

Debate between Baroness Chisholm of Owlpen and Lord Hunt of Kings Heath

Tuesday 27th February 2018 Grand Committee

[Baroness Chisholm of Owlpen]

I cannot give a timing on that now so I will have to write. These regulations needed to be dealt with anyway and they are slightly late, partly due to a general election, so we have to put them in place now. It actually has nothing to do with Brexit. We have to put them in place now, otherwise we would have heavy fines. In a way, that slightly answers the question from my noble friend Lord Deben about why we are doing it. We are making sure that our standards are as high as those of other EU countries, so this is actually transposing existing regulations and making us consistent with the EU; we are not adding anything new.

[Lord Hunt of Kings Heath (Lab)]

The logic is that if the EU then changes regulations in this area, the UK will also change the regulations here, because of the point made by the noble Lord, Lord Deben. Or are we, having established that currently we will remain with European regulation, going to go out in Dr Fox’s brave new world and develop our own provisions?

[Baroness Chisholm of Owlpen]

No. We have to do these regulations anyway, that is the point. They should have been implemented on 29 April 2017 and, as I said, the delay was due in part to the complexity of the directives themselves—other member states have also experienced delays—and the initial timetable to make the regulations before the Summer Recess was paused because the general election was called in March 2017 and we then had a recess period. That is why we are doing the regulations now.

I think I have answered all noble Lords’ questions, so I commend the regulations.

NHS: Congenital Heart Disease

Debate between Baroness Chisholm of Owlpen and Lord Hunt of Kings Heath

Wednesday 14th December 2016 Lords Chamber

[Baroness Chisholm of Owlpen]

I do not want to go into issues relating to specific hospitals but I emphasise that no decisions have been made. Where it is decided that changes need to be made, these will be managed carefully and will be carried out in partnership with current service providers, patient groups and advocates. Decisions are likely to be made in the summer but there will be no change on the ground until at least 2018. The public consultation will give everyone a chance to put forward their views and to discuss the plans further.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Baroness says that she will not discuss individual hospitals but, in the end, Ministers are accountable. Will she confirm that the reason given by NHS England is that the Brompton does not meet its specification, which insists on same-site locations for all children’s services? Can she confirm that one of the hospitals not threatened with closure has multi-site locations, and will she also confirm that the Brompton has one of the best outcomes in the country?

[Baroness Chisholm of Owlpen]

I am not going to be drawn into discussing specific hospitals and I have given my reasons for that. However, I will say that the statement made in July by the Royal College of Surgeons and the Society for Cardiothoracic Surgery said:

“We fully support these standards. NHS England must ensure that the standards are applied for the benefit of patients, by ensuring that expertise is concentrated where it is most appropriate. The proposals put forward by NHS England today should improve patient outcomes and help address the variations in care currently provided.

It is fundamentally important that specialist surgical centres are large enough and treat patients regularly enough to develop full expertise to treat all conditions. It’s vital they are properly staffed to provide on-call rotas and teams have the time to create a supportive environment where new techniques are shared and future specialists can learn”.

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[Baroness Chisholm of Owlpen]

The noble Baroness makes a very good point. This has been fiercely debated since the publication in 2001 of the damning report into the high death rates among babies undergoing heart surgery at Bristol Royal Infirmary. The last time plans were put forward, in 2011, it led to a bitter fall-out, pitting hospitals against senior health bosses, and two years later the proposals were scrapped, with NHS bosses being told to look again. That is why we are now trying to go forward, so that we can cover both adult and children’s services.

[Lord Hunt of Kings Heath]

My Lords, may I offer some advice to the noble Baroness? It is quite clear that, in the end, the Government will not agree to the closure of the Brompton, because that has been the decision on numerous occasions since 2001. Why not just pull the consultation? It is not going anywhere, my Lords.

[Baroness Chisholm of Owlpen]

We do not yet know that it is not going anywhere. A public consultation is coming forward, and the Brompton is not the only hospital concerned; it concerns a lot of hospitals all around the country. It is fair that it should go to a public consultation. Everybody will then have a chance to put their views, and that is going to be the way forward.

NHS England: HIV Prevention

Debate between Baroness Chisholm of Owlpen and Lord Hunt of Kings Heath

Tuesday 18th October 2016 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government whether NHS England is informing patients that lifesaving drugs will be denied them if funding has to be made available for pre-exposure prophylaxis (PrEP) for HIV prevention.

[Baroness Chisholm of Owlpen (Con)]

Clinicians can apply for funding for the drugs in question where there is a clinically exceptional or clinically critical need. Each year NHS England receives many proposals for investment in specialised services. Difficult decisions then have to be made on behalf of taxpayers about how to prioritise the funding available.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the noble Baroness. She will know that evidence from clinical trials shows that PrEP can be highly effective in reducing the spread of HIV when given to those who are at most risk. Quite disgracefully, NHS England has sought to avoid funding responsibilities by saying that it is the responsibility of local authorities, at a time when there have been big cuts in the public health budgets of those councils. Even more disgracefully, government sources appear to have briefed the media that if they were forced to fund PrEP, treatments for serious conditions would have to be stopped, including treatments for children with cystic fibrosis. This was deeply unpleasant, caused great offence and may well have added to the stigma faced by many living with HIV. Will the Government assure the House that this will not happen again, and instruct NHS England to fund the drug forthwith?

[Baroness Chisholm of Owlpen]

The decision on which drugs to prioritise and how it should happen should surely be made by clinicians and NHS England, and not by politicians. As with all new drugs, PrEP needs to be properly assessed in relation to cost and effectiveness to see how it could be commissioned in the most sustainable and integrated way, and how it compares with other cost-effective approaches.

Clinical Pharmacologists

Debate between Baroness Chisholm of Owlpen and Lord Hunt of Kings Heath

Monday 12th September 2016 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

My Lords, I begin by thanking the noble Lord, Lord Hunt, for securing a debate on this important subject. He has spoken today about the vital role fulfilled by clinical pharmacologists and the contribution they make to effective treatments for the population of this country.

As the noble Lord pointed out, pharmacology lies at the heart of biomedical science, linking together chemistry, physiology and pathology. Those that take up the speciality work closely with a wide variety of other disciplines, including neuroscience, molecular and cell biology, immunology and cancer biology, to name just a few. They improve the lives of millions of people globally by providing vital answers at every stage of the discovery, testing and clinical use of new medicines.

The ability to use medicines effectively, to optimise their benefit and minimise the risk of harm to people, relies on pharmacological knowledge and understanding. We hear much about new diseases such as Ebola and Zika and their emergence and also hear much about older medicines—most notably antibiotics—no longer working as well as they did, so the contribution of pharmacology to finding better and safer medicines continues to be vital.

While it is true that there has been a decline in the number of clinical pharmacologists practising in the UK, it is important that we recognise that the fall in numbers is relatively small. Data from the British Pharmacological Society and the Royal College of Physicians show that the number of CPT consultants in the UK fell from 74 in 2002 to 72 in 2013, and that 52 of the 72 consultants were based in England, but perhaps a drop of even that amount is important.

As regards the supply of the profession, as noble Lords will be aware, from being established in 2013, it has been Health Education England’s responsibility to ensure that there is sufficient future supply of staff, including those needed in specialist fields such as this, to meet the workforce requirements of the English health system. It is the responsibility of the devolved Governments to ensure their health systems have the staff they require. Each and every year, Health Education England produces a national workforce plan for England. This is built upon the needs of local employers, providers, commissioners and other stakeholders who, as members of the local education training boards, shape their local plans.

Health Education England therefore has a responsibility for ensuring an adequate supply of trainees to provide the consultant workforce of the future, but is not responsible for setting the number of consultant posts inside the NHS. As I have just set out, this is the role of trusts, commissioners and others. HEE annually reviews the number of training places in medical specialties in response to demand expressed by the NHS. It is therefore crucial that trusts have a clear view of how they wish to utilise and promote clinical pharmacology and therapeutics positions in their hospitals.

To its credit, HEE has increased the number of training posts available. However, not all of these have been filled. Clinical pharmacology and therapeutics has suffered in terms of its fill rates against other high-profile specialties. However, as my noble friend Lady Gardner of Parkes mentioned, there needs to be more recognition of the career, more involvement with related healthcare organisations and perhaps more understanding of how fascinating and interesting this career can be, as the noble Baroness, Lady Thornton, said. In an attempt to counter this, HEE has been working to make the profession more attractive to junior doctors as they begin to specialise, including making the role more flexible to trainees, offering joint training with other specialisms and actively promoting the role at careers fairs.

The noble Lord, Lord Hunt, mentioned people not coming forward because of the uncertainty of a job. That is why some clinical pharmacologists already train towards a dual CPT, which then broadens the scope of their practice, making them more desirable to employers due to increased flexibility. I am aware that HEE has also been undertaking a review of this area and will, in due course and upon completion, share these findings with stakeholders, including the British Pharmacological Society. Leading on from that, the role has also been promoted by the chair of the British Pharmacological Society and is supported by the four UK health systems.

It may be interesting to note that the supply of clinical pharmacologists is primarily domestic, with only a very small number coming from overseas. In the three years 2012 to 2015, only one of the newly appointed consultants was trained outside the UK. Both the Royal College of Physicians and the British Pharmacological Society feel that there is a need for growth in this area and assert that current and predicted supply is insufficient to support that growth, and as such are calling for more training posts. There is, though, a lack of consensus between the Royal College of Physicians and the British Pharmacological Society about the level of future demand and the numbers required. This is perhaps an indication that it is not easy to evaluate future demand or possibly indicates a lack of understanding of these roles out in the wider health system.

Given the need to spend taxpayers’ money responsibly —and the difficulty filling the existing training posts—HEE is not able to increase the number of training positions until the demand is signalled by the NHS. At this stage, no significant increase in demand has been signalled in HEE’s annual collection of forecast demand from providers, which forms the basis for the annual training commissions for medical specialties.

In summary, I strongly encourage professional bodies with an interest in this field of medicine to actively engage locally with NHS trusts to ensure that where there is a need for additional clinical pharmacologists, they feed this in to the HEE workforce planning process. This process is the fundamental bedrock for NHS workforce planning. HEE actively engages with its stakeholders in developing its annual workforce plan, and any change in workforce planning numbers needs to be debated and resolved through this process. It is interesting that this is obviously not only a problem in the United Kingdom, because several reports have come out of the United States which show that it is having similar difficulties.

I thank the noble Lord, Lord Hunt, for giving us the opportunity to discuss this important matter.

[Lord Hunt of Kings Heath]

I am most grateful to the Minister for giving way and for the eloquence of her response. From what she said, the Government’s view is that this is solely a matter for Health Education England, and I understand that. However, does she accept that because HEE is concerned only with the accumulation of the local plans, it is not able to take any account of the national significance of this clinical speciality, and that there is a risk here because local employers do not see this as particularly important, although nationally we can see that it is vitally important? Is there a case for asking HEE to look at the national strategic importance of the professions? That would be one way of looking at this from a rather different viewpoint.

[Baroness Chisholm of Owlpen]

The noble Lord stopped me just as I was about to say that very thing. This is one of the important problems. There is not joined-up thinking—certain bodies are not aware of the importance of this—so it becomes a kind of vicious circle. I was going to say that we need joined-up thinking, and I hope that debates such as this will increase awareness and get people to think further. I will be happy to meet those bodies involved; they might well prefer to meet my noble friend Lord Prior but I will be happy to accept on his behalf.

I thank all noble Lords who have taken part in this debate.

Severe Anaphylactic Shock

Debate between Baroness Chisholm of Owlpen and Lord Hunt of Kings Heath

Thursday 26th May 2016 Lords Chamber

[Baroness Chisholm of Owlpen]

What the noble Baroness says is very true. I cannot add much to that because I agree with it.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare my presidency of the Royal Society for Public Health. The noble Baroness referred to the FSA’s review of the success of the new regulations, but is she aware that the RSPH did a mystery dining investigation a year after their introduction and found that 70% of takeaway outlets were flouting the law by not providing the required information, and that 54% did not know whether any of these 14 major allergens were in the food? Will the noble Baroness go back to the FSA and suggest that it needs to take rather greater enforcement action?

[Baroness Chisholm of Owlpen]

I thank the noble Lord for that question. He is right: there is still a lot of work to be done. The FSA is well aware of this. That is why it is providing food officers with better training to ensure that restaurants are following the rules. One of the key messages for these businesses is that they will incur much greater burdens and cost if they do not follow the regulations. They can be prosecuted and closed down. It is beneficial to them to ensure that the allergen information they provide is displayed clearly and is provided verbally.

Food Standards Agency

Debate between Baroness Chisholm of Owlpen and Lord Hunt of Kings Heath

Wednesday 10th June 2015 Lords Chamber

[Baroness Chisholm of Owlpen]

The noble Countess is indeed right. In fact, I had a few sheep and used to take them to a private abattoir. This is exactly what the discount proposals will allow for. They will allow the smaller abattoirs consistently to benefit from the highest levels of discount.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Baroness is speaking for the Department of Health because ultimately it oversees the Food Standards Agency. Can we come back to the question asked by the noble Baroness, Lady Walmsley? Ultimately, this is a question of public confidence in the food chain. Why have the Government cut, in-year, £200 million of the public health budget given to local authorities? Will that not impact on public education programmes on food and obesity? What is the Minister going to do about that?

[Baroness Chisholm of Owlpen]

I thank the noble Lord for his question—I think. I will get back to him with a full written reply.

NHS: Seven-day Working

Debate between Baroness Chisholm of Owlpen and Lord Hunt of Kings Heath

Monday 8th June 2015 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what assessment they have made of the impact of the current deficit position of NHS Trusts and NHS Foundation Trusts on the ability of the National Health Service to move to seven-day working.

[Baroness Chisholm of Owlpen (Con)]

My Lords, seven-day services will need to be implemented in an affordable way, focusing on both improving efficiency and delivering clear benefits to patients. We have increased the NHS budget by £12.7 billion over the Parliament and in some situations we have provided interim financial support—but this is dependent on trusts developing and sticking to a strong recovery plan. At the heart of all that, we are making sure that trusts continue to deliver safe and sustainable services within a balanced financial position.

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[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the noble Baroness for that response. Does she accept that you cannot achieve full seven-day working, including at the weekend, without employing more doctors, nurses and diagnostic staff? Given that NHS trusts are projected to have a £2 billion deficit this financial year, how will that be afforded? Can she confirm for me that the decision of NICE last week to pull work on guidance on nurse/patient ratios, which came out of the Mid Staffordshire situation, was the result of pressure from NHS England because of concerns about affordability?

[Baroness Chisholm of Owlpen]

My Lords, it is clear that the NHS faces significant financial challenges due to increasing demands. Seven-day services will need to be implemented in a way that is affordable and focused on both improving efficiency and delivering clear benefits to patients. The costs of the seven-day services will depend on many factors. We are working with NHS England to identify how to achieve the aim of providing seven-day services efficiently.

Medical Data Sharing

Debate between Baroness Chisholm of Owlpen and Lord Hunt of Kings Heath

Monday 1st June 2015 Lords Chamber

[Baroness Chisholm of Owlpen]

The Health and Social Care Information Centre is working closely with NHS England and the Department of Health to put a method into place for resolving these issues. People’s private identifiable health information cannot be shared unless there is a legal basis to do so. Data will be held securely and will be made available more widely only in safe de-identified formats with crucial safeguards.

[Lord Hunt of Kings Heath (Lab)]

My Lords, in welcoming the noble Baroness to her new position, I also pay tribute to the noble Earl, Lord Howe, for his stewardship of the health brief over the last five years. Not the least of his contribution has been his willingness not just to come to Oral Questions but to do most of the statutory instruments and Questions for Short Debate as well, which your Lordships have much appreciated.

On the Question—I remind the House of my presidency of GS1—does the noble Baroness agree that it would be an absolute nonsense if those patients who wished to opt out were actually denied access to screening services? That would be the impact of putting their wishes into practice. Of course there are lessons to be learnt about mistakes that have been made, but surely the Government should be vigorously in favour of, and supporting, the proper sharing of information to the benefit of patients.

[Baroness Chisholm of Owlpen]

I thank the noble Lord for his kind words. I hope that your Lordships will have patience while I learn the ways of this House. Indeed, I feel that behind me my noble friend Lord Howe, who has indeed done an incredible job over the past 18 years, is sitting on his hands at the moment, longing to rush to the Dispatch Box, push me aside and take over this brief.

To answer the noble Lord’s question, the Secretary of State intimated that we are determined to guarantee that personal data are protected, and we are enthusiastic about reacting to the benefits of sharing them. Indeed, Professor Peter Weissberg of the British Heart Foundation stated:

“Locked inside our medical records is a mine of vital information that can help medical scientists make discoveries that can improve … and save lives”.

We must keep this at the forefront of our minds.