Health and Care Bill

Baroness Cumberlege Excerpts

Lords Hansard _ Part 1 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am speaking to my Amendment 164 but I also strongly associate myself with Amendment 180 in the name of the noble Baroness, Lady Cumberlege.

In Committee, I raised concerns about a small number of individuals and families who have paid the highest personal price for the success of the Covid vaccination programme, suffering bereavement or serious injury as a direct consequence of adverse reactions to vaccination. We have the Vaccine Damage Payments Act 1979, which was intended to provide a safety net for such individuals by providing a modest ex-gratia payment to those injured or bereaved in recognition of the fact that their injuries and losses flowed directly from “doing the right thing” by having the vaccine for the benefit of society as a whole.

The scheme is 40 years old and no longer fit for purpose. The maximum payment is capped at £120,000, which is far too little to provide proper financial support for families who have maybe suffered the death of a main income earner. The current scheme also requires that all eligible applicants in the UK must meet what is called the 60% disablement criterion. This criterion is antiquated, counterproductive and unfair: many applicants could have significant injuries and may be disabled up to 59% and yet, on the basis of the current scheme, they would have no access to funds.

The current system takes far too long to provide the payment. The causal connection between certain injuries and Covid vaccination is now accepted, I believe, by clinicians and regulators. However, despite providing death certificates that identify Covid-19 as a cause of death and medical reports confirming Covid-19 as the cause of injury, the scheme still estimates that it will take more than six months to begin to process claims submitted under the scheme more than 12 months ago.

In Committee—I thank Ministers for another meeting yesterday to discuss this further—the noble Earl explained that responsibility for the operation of the scheme has transferred from the DWP to his department and the NHS Business Services Authority has taken over the operation of the scheme. This is very welcome and I am glad that it has happened. However, this is not an issue that will disappear any time soon—Covid is not an issue that is disappearing. Further vaccinations will come along and there will unfortunately be adverse effects for a very small group of people, in the interest of the greater good.

I believe that the scheme offers too little, too late, to too few and I have three asks of Ministers. First, I ask that Ministers and the NHS Business Services Authority engage with the families affected. It would be valuable if Ministers and senior executives at the NHS Business Services Authority were to meet some of the families. I know that Sarah Moore of Hausfeld will be happy to facilitate this, and I pay tribute to her. Secondly, I ask that everything that can be done is done to speed up the process of meeting claims. Thirdly, on behalf of the families and individuals, I ask the Government to consider undertaking a review of the scheme in the light of current experience and particularly look at the 60% criteria bar and the £120,000 limit which has not been updated for a number of years.

The vaccination programme has been a wonderful success both in this country and globally. It is very unfortunate that inevitably there will be a small group of people damaged in the process. I think we owe it to them to have a generous scheme. I beg to move.

[Baroness Cumberlege (Con)]

My Lords, my amendment is grouped with the amendment in the name of the noble Lord, Lord Hunt, whose persistence I admire concerning those who have suffered vaccine damage. My amendment is slightly different, but it is along the same lines in that it is about unintentional outcomes and redress for those who have suffered.

My amendment requires the Secretary of State to bring forward proposals for redress schemes to help those who have suffered avoidable harm linked to the three medical interventions that were examined in the report from the Independent Medicines and Medical Devices Safety Review, which I chaired. These are hormone pregnancy tests—the most common being Primodos—the epilepsy drug sodium valproate and pelvic mesh, which was used to treat stress urinary incontinence and pelvic organ prolapse.

I will be brief, but I make no apology for bringing this before your Lordships’ House again because the case for these schemes is so compelling. These are people who, through no fault of their own, have suffered terribly and had their lives changed for the worse and in some cases completely ruined—all because of mistakes, errors of judgment, oversights and a refusal to listen across the healthcare system. In each case—Primodos, valproate and mesh—harm could and should have been avoided. If that does not underline the moral and ethical case for providing some help, then I really do not know what does.

I believe that my noble friend the Minister and his colleagues are genuinely sympathetic to the plight of these women and their children, but I sense that they are hesitant. I urge them to overcome some of this reluctance and act now. The suffering is immense, it is continuing even today, and very sadly people are dying before they receive the help they need. I remind my noble friend that these redress schemes are not the same as compensation. We are not talking about large sums of money. We are talking only about modest funds to help with the challenges of daily life: to pay for mobility aids, a respite break, travel to hospital. This is help that they do not and cannot access at the moment from the NHS, social services or elsewhere.

In Scotland, the Government there have acted. A scheme was set up to provide help to women suffering from mesh complications. It is modest: it was given a £1 million budget and women had to apply to it to be eligible. But it was welcomed, and it has helped. That is the kind of help I have in mind. Sums of that scale are barely noticeable in the context of the hundreds of billions we spend on health and social care, yet these small sums would mean so much to so many.

Are there concerns that this might set a precedent and that before we know it dozens of other groups of people who have suffered will all want the same? I do not believe so. That has not happened in Scotland. Thalidomide did not lead to an avalanche of other groups requiring help. We have existing schemes to help others who have been harmed. If the Government really believe that compensation is the better way for these people to get help, they are mistaken. The fact is that many have tried to obtain compensation through the courts. It is time-consuming, costly, stressful, adversarial and, worst of all, it simply has not worked.

The three groups that Amendment 180 is designed to help are small in number—not millions of people, not hundreds of thousands. I do not believe that an unwelcome precedent would be set. I do not believe that these schemes would cost the earth. The cost would be modest and can be contained and managed. I believe the benefits will outweigh the cost and that we have a moral and ethical duty to help these people. They have suffered for years and in some cases for decades. Surely the measure of a decent society is how well it looks after those who have suffered harm, especially where that harm could and should have been avoided.

I have met hundreds of people who have suffered; even today I get a lot of emails, phone calls and letters. We have heard from many more people. I am clear that help is both needed and deserved. People should not be made to wait any longer. I hope that my noble friend the Minister will agree.

[The Deputy Speaker (Lord Geddes) (Con)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite the noble Baroness to speak.

Health and Care Bill

Baroness Cumberlege Excerpts

Committee stage
Friday 4th February 2022 Lords Chamber

In conclusion, the current consultation will deal only with a limited aspect of clinical negligence. It is no good thinking that there is some magic solution around the corner, so let us improve the current system but also deal sympathetically with special cases, such as those that the noble Baroness is pointing out and in relation to vaccine damages. We will probably then have a better system that is more fit for purpose, provides more value for money for the taxpayer and, above all, is fairer for patients. I beg to move.

[Baroness Cumberlege (Con)]

My Lords, I have Amendment 288 in this group. I thank the noble Lord, Lord Hunt, for the way that he has introduced this group of amendments; he is quite right that there is a lot of synergy between them.

Before I get to my subject, as it were, I will address litigation. We have been working very hard with NHS England and others to introduce the rapid resolution and redress system—RRR—for maternity services. The damage done to babies costs a huge amount of money. It is very rare, but some of the settlements are now over £10 million per baby, so this issue really needs to be addressed. The noble Lord is right that, when litigation comes in with force, it causes enormous trouble and heartache for those involved in it. We know that, when it is based on clinical negligence, the trouble is that the learning disappears or is suffocated. If we had a system that gave rapid redress and resolution, we would learn so much more from the cases that come to court.

Amendment 288 requires the Secretary of State to bring forward proposals for a redress scheme to help those who have suffered avoidable harm linked to the three medical interventions that were examined in my Independent Medicines and Medical Devices Safety Review: hormone pregnancy tests—the most common of which is Primodos—the epilepsy drug sodium valproate and pelvic mesh, which is used to treat stress urinary incontinence and pelvic organ prolapse.

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[Earl Howe (Con)]

My Lords, this has been an important and moving debate. We should recognise that, behind the technical aspects of the topic, there are stories of real harm and life-changing events for people and families.

Amendment 267 would establish an independent judge-led review into the operation of the Vaccine Damage Payments Act 1979. I appreciate the spirit behind this amendment and agree that we need to ensure the vaccine damage payment scheme works as effectively as possible. We recognise that the scope and scale of the scheme has significantly changed since 1979; it has expanded from the original eight diseases to cover 18 and the payment value has increased from the original value of £10,000 in 1979 to the current level of £120,000.

Most recently, responsibility for the operation of the scheme transferred from the Department for Work and Pensions to the Department of Health and Social Care on 1 November last year. The NHS Business Services Authority has now taken over the operation of the scheme. It is looking to improve the claimant journey on the scheme in three main ways: increasing personalised engagement; reducing response times; and making more general support available to claimants. It has also allocated additional resource to the operation of the scheme. I can tell the noble Lord, Lord Hunt, that the department will further engage with the NHS Business Services Authority to progress service improvements and, in particular, greater digitalisation.

Our focus now must be on completing the transfer of the scheme, getting support to those who are eligible as quickly as possible and improving the claimant experience. Against that background, I am not convinced that an independent review at this stage would support these goals. Indeed, it might risk delaying progress.

I shall just comment on a couple of detailed points made by the noble Lord. The first is on the disablement threshold. The 60% disablement threshold is aligned with the definition of “severe disablement”, as per the DWP’s industrial injuries disablement benefit. It is not clear that this is a significant barrier to claimants. In 2019 and 2020, just one claim out of 151 was rejected due to the 60% disability threshold not being met. Of course, there is also the option for claimants to appeal the decision.

The noble Lord also expressed concern about the length of time that it was taking to settle claims. NHS Resolution aims to get to the right answer as quickly as possible in every case but, equally, each case has to be considered on its own merits, and it is important that a proper investigation is undertaken. The department keeps NHS Resolution’s performance under regular review and is satisfied that its approach to settling claims strikes the right balance in delivering timely resolution. Recent performance on time to resolution has been influenced by the pandemic—that is not meant to be an excuse; it is just a statement of fact—and the need to relieve pressure on front-line NHS staff. To mitigate this, NHS Resolution worked with a range of industry stakeholders to introduce a specific Covid-19 clinical negligence protocol to support the management of claims during this time. This collaborative approach has been widely welcomed in the written evidence to the HSCC inquiry on NHS litigation reform.

On Covid-19 vaccines in particular, clearly, they are new, and establishing a causal relationship between the vaccines and their purported side effects is not a straightforward matter and takes time. So, while we would like to have an accelerated process, it was vital that we did not make assessments before the scientific evidence reached a settled position, to avoid payments being made in error, or those who qualify potentially missing out on payments. The NHSBSA will be writing to claimants when there is an update on their claim, and we appreciate the continued patience of claimants at this difficult time.

I turn now to Amendment 268, also tabled by the noble Lord, Lord Hunt, and supported by my noble friend Lady Hodgson of Abinger. The Government already have robust arrangements for reviewing public bodies such as NHS Resolution. Our assessment is that NHS Resolution is a well-run organisation. The National Audit Office noted in its 2017 report the efficiency gains it has achieved, including significant progress in reducing unnecessary litigation through the use of mediation and alternative dispute resolution. In 2020-21, 74% of claims handled by NHS Resolution were resolved without formal court proceedings. In fact, very few cases—0.3% of litigated claims—actually go to trial. Of the 56 cases that went to trial in 2020-21, NHS Resolution achieved a judgment in favour of the NHS in 38 cases: roughly two-thirds.

I also draw the Committee’s attention to the work under way to manage rising clinical negligence costs—a topic very appropriately raised by the noble Lord, Lord Hunt. The department is working intensively with the Ministry of Justice, other government departments and NHS Resolution, and we will publish a consultation to address this issue. An independent review would duplicate this work and, in any case, legislation would not be necessary to establish such a review.

In 2017, the NAO identified the main drivers of the cost rise as, first, compensation payments; secondly, claim volume increases; and, thirdly, legal costs. Since then, the picture has changed: payments for compensation now drive the increase and are growing at rates above inflation. We share the noble Lord’s concern that existing legislation may mean that the state pays twice for care. While from our analysis we do not think it is likely to be a significant driver of increasing costs, we remain open to evidence. Furthermore, the Government recently submitted evidence to the Health and Social Care Committee inquiry on NHS litigation reform. We welcome the inquiry and look forward to its recommendations.

Turning to Amendment 288, I thank my noble friend for her and her team’s diligence and dedication and the brave testimonies of those who contributed to the Independent Medicines and Medical Devices Safety Review. Anyone who has read that review cannot fail to be moved by the evidence submitted to my noble friend’s team. I assure your Lordships that the review has been a powerful call to action. The Government have accepted the majority of the report’s nine strategic recommendations and 50 actions for improvement.

I understand my noble friend’s point about redress, but, at the same time, I believe it is important that we focus government funds on initiatives that directly improve future safety. For this reason, the Government have already announced that redress schemes will not be established for people affected by hormone pregnancy tests, sodium valproate or pelvic mesh. However, as my noble friend knows, in order to put patient safety at the heart of the system, we have established— thanks to her recommendation—the new patient safety commissioner. The appointment of the commissioner will put the patient voice at the centre of patient safety and deliver improvements in how the system listens to and responds to concerns raised by patients.

We are also improving the safety of medicines and devices and embracing the new opportunities to reform regulatory frameworks following the UK’s departure from the European Union. The Medicines and Medical Devices Act delivers further on our commitments to patient safety, embedding reform and delivering an ambitious programme of improvements for medicines and medical devices.

I hope I have provided at least some assurance and that noble Lords will feel able not to press their amendments.

[Baroness Cumberlege (Con)]

My Lords, I very much welcome my noble friend’s response. Of course he is right: we must always look to the future safety of our services. I am really grateful to Ministers and the department for what they have done in response to our report. It is not 100% yet, but we are nearly there, and I thank them for that.

But I am not talking about the future. I am talking about the people who are suffering now as a consequence of the treatment they received, not knowing that it would do them harm. So I ask my noble friend to take this away and think further on it. As I tried to explain, we have devised in the amendment a system that is not, as we said, an open cheque. It is not huge amounts of money; it is not huge numbers of people. It is to help those who are struggling with their lives as a consequence of the harm that has been caused to them. I just ask my noble friend to take this away and think further.

[Earl Howe (Con)]

I appreciate of course my noble friend’s remarks, and I undertake to bring them to the attention of my right honourable friend the Secretary of State.

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Moved by

[Baroness Cumberlege]

283: After Clause 148, insert the following new Clause—
“GMC register: interests
In section 2 of the Medical Act 1982, after subsection (4) insert—“(5) The register shall include a list of financial and non-pecuniary interests for medical practitioners, as well as their clinical interests and their recognised and accredited specialisms.””Member’s explanatory statement
This amendment requires the General Medical Council to include the financial and non-pecuniary interests of medical practitioners on its register.

[Baroness Cumberlege (Con)]

My Lords, I am delighted that the noble Baroness, Lady Finlay, is supporting me. She is a clinician of distinction and a palliative doctor, but so much else besides. She will know as well as any of us—those of us who are not doctors—that one thing is at the heart of good, safe care: trust. As patients, we place our trust in our doctors. We trust them to use their skills and knowledge to treat us, to cure us and to keep us healthy to live our lives. We trust our doctors with our bodies, our minds and our lives. That brings great power and great responsibility. Doctors must make decisions and take actions in our interests; that is what we trust them to do. We know that trust is fragile. It is said that trust arrives on foot but leaves on horseback.

Noble Lords who were in the Chamber for the debate on Amendment 288 will know the context of the Independent Medicines and Medical Devices Safety Review, which I chaired. The people—the children—who were harmed placed their trust in their doctors and the wider healthcare system. They were let down. The lives of many have been turned upside down as a result of the harm they suffered. One woman who had been terribly harmed by a pelvic mesh implant told us:

“As patients, we allow the medical profession access to our bodies, our thoughts and our lifestyles. All manner of information to better assist them in reaching decisions about the best course of treatment for us. We, the patients deserve the same, we should be aware of clinicians’ allegiances or involvements whether they be financial or other. So we too can reach informed decisions about who is best to treat us, and how they should treat us.”


Doctors do wonderful work, often in extremely difficult circumstances. Decisions they make are not always perfect—they cannot be; we know and accept that—but must always be led by the best interests of the person who is their patient, not by external factors and commercial interests.

Amendment 283 would require the General Medical Council to expand its register of doctors to include their financial and non-pecuniary interests, as well as their particular clinical interests and their recognised unaccredited specialisms. In doing so, it would implement one of the nine major recommendations we made in our review.

The concept of declaring interests is hardly new, not least to all of us in this place. We know that it is important. It brings transparency and accountability, and the public have a right to know. Who in a position of responsibility can have a clearer, more significant impact on someone’s life and well-being than a doctor or a surgeon? Maintaining information about doctors’ clinical interests and specialisms is a vital foundation of patient safety.

I was pleased that, in their response to the recommendations of the Paterson inquiry, the Government committed in principle to creating a single repository of the whole clinical practice of consultants across England, setting out their practising privileges and other clinical consultant performance data—for example, how many times a consultant has performed a particular procedure and how recently. This information should be accessible and understandable to the public. It should be mandated for use by managers and healthcare professionals in both the NHS and the independent sector. It would be a way of measuring outcomes and ensuring safety and quality. For all these reasons, we urgently need a register.

I have been extremely encouraged that the leading journal for doctors, the British Medical Journal, is in full support. It has written extensively about it. Its editor has spoken expertly on the subject at a meeting of the First Do No Harm All-Party Parliamentary Group. The BMJ found that current reporting of interests, which is meant to be done locally and held by employers, is at best patchy. Many hospitals do not keep the information and, when they do, it is hard to find and may be out of date.

We need a central register, one that is easily accessible and complete. The General Medical Council already holds the register of qualified doctors. Adding their financial interests to the register is not difficult; it can be done via the annual appraisal. Every doctor must undertake an annual appraisal to maintain their registration. I have spoken to the GMC about this, but it seems—shall we say—lukewarm.

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I hope I have given the noble Baroness sufficient reassurance and that, at this stage, she will feel able to withdraw her amendment.

[Baroness Cumberlege (Con)]

My Lords, I thank so much the noble Lords who have supported this amendment. I always welcome the support of the noble Baroness, Lady Brinton, because she is clear, concise and very authoritative; she commented that doctors already have a duty and that we should see progress. As always, the noble Baroness, Lady Finlay, was accurate; she talked about accuracy and accessibility for patients, and said that the register really is so important because it actually safeguards doctors, a point that has been put to us by some doctors. The noble Baroness, Lady Neuberger, is a chair of one of our great hospitals in London, and I was so grateful for her contribution. She went to her medical directors and found out that they thought this was an ethical way forward and should be encouraged. I also thank her for her generous remarks about the report—I would just like to say it is not my report; it was the team’s report, and I had some really good people on the team. I thank the noble Baroness, Lady Thornton, who was right: it has to be a national register, not a local one, and it has to be accessible to patients.

In summing up, I thank the Minister very much for her comments. There is such feeling about this in the country that it would be very helpful if she could convene a meeting with me, my team and the GMC to discuss this together. I think that a little more persuasion—especially from sources such as those on the Front Bench—would make all the difference.

Amendment 283 withdrawn.

Health and Care Bill

Baroness Cumberlege Excerpts

Lords Hansard - Part 2 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the noble Lord, Lord Clement-Jones, for speaking so eloquently in support of this group of amendments. There are a number of amendments relating to data in this Committee and they fall into three categories. The first category, the group that we are debating today, is about the prioritisation of the digital transformation in the NHS. The second group looks at specific patient groups and the potential of data to improve their care outcomes. The third set is about confidentiality of data as far as patients are concerned. My view is that all three run together.

Like the noble Lord, Lord Clement-Jones, and the noble Baroness, Lady Cumberlege, I am enthusiastic about digital transformation in the NHS; indeed, I believe it is the only way we can hope to meet the challenges that healthcare faces over the next 20 or 30 years. However, there are two conditions. One is that the integrity of patients’ data is assured for individual patients. That has not always been the case in the past, and the debacle of care.data is a salutary warning of what can happen if we do not protect patient information in an appropriate way.

The second condition is resources. I was very glad that my noble friend referred to the issue of resources and to the Wade-Gery report, which is the most recent report looking at the arrangements to support digital transformation in the health service. Wade-Gery reported that

“transformation funding is … split between revenue and capital and dispersed across the organisations. Tech funding is variable, often diverted and not necessarily linked to strategy and outcomes, incentivising either monolithic programmes or small-scale initiatives.”

She commented:

“The requirement for digital transformation in other sectors has driven up the proportion of their spend on digital and technology”.


It has been well-known, for many years, that the NHS locally has not been spending sufficiently on data and data transformation. The latest estimate from NHS England is that the NHS spends less than 2% of its total expenditure on IT, while the noble Lord, Lord Darzi, and the IPPR suggest that this should be nearer 5% by 2022. I say to Ministers that, unless they can find ways to ensure the NHS starts to spend at that level, we are simply not going to achieve the kind of transformation we want.

One way to do that is to ensure that, at the ICB level, there is an official charged with driving this forward at the local level. We know, in general, in relation to boards of the health service, that the data/digital leadership often does not have a seat, in contrast to many organisations. This is why we think that needs to change. Overall, we believe this set of amendments would enable the Government and Parliament to show how important it is to prioritise the kind of digital transformation that we want to see.

[Baroness Cumberlege (Con)]

My Lords, I support these amendments but first I believe in putting right wrongs. I failed to declare my interests in last Tuesday’s debate, so I took advice from the registrar. He assured me that I do not have to give a full account of my life and times, which is a great mercy to everybody, but I do have to declare what I am currently involved in and the remunerations. I serve on the Maternity Transformation Board, which is owned by NHS England, and the maternity Stakeholder Council, which is also supported by NHS England but is much more of a free agent.

I thank the noble Lords, Lord Clement-Jones and Lord Hunt of Kings Heath; it was a very rounded, fulsome and clear introduction to these amendments. I want to pick up the issue of trust, because both noble Lords linked trust and confidentiality. That is absolutely essential. We will not get the support or trust of the public if we do not respect their confidentiality, and I will say a word about that in a minute. I support Amendments 84, 134, 140 and 160—I have added my name to them. I also support Amendments 70 and 73, and wish to comment on those.

I strongly support digital transformation. Amendments 84, 134 and 140 place a duty on integrated care boards to promote digital transformation and to produce their own five-year plans. It will need money, so Amendment 160 requires the NHS to spend at least 5% of its capital allocation to achieve it. That is right, as digital needs sustained resource—it is not simply a “nice to have”; it is absolutely essential for the future of our services. I have talked to visitors from the USA and cannot believe how antiquated they think our systems are. In many places, they are still in the dark ages, so we have to invest in digital.

I support the increased use of digital technology in healthcare largely because of my involvement in two major inquiries into NHS services in the last few years. One evening in 2014, I had a telephone call from Simon Stevens, the chief executive of NHS England, before he was knighted and welcomed into your Lordships’ House, where he has already made a very significant contribution. He invited me to chair an inquiry into maternity services for England. The noble Lord has a sense of humour: he gave me nine months in which to deliver.

I set up a panel and we delivered in time, calling our report Better Births. Our 28 recommendations were accepted by NHS England, which then set up the Maternity Transformation Board and the Stakeholder Council, on which I have declared my interests. The Stakeholder Council is interesting because it is full of a wide range of people. A lot of charities, in particular, are on that council, and add a lot to the work that we do.

Two of the 28 recommendations are particularly relevant to this Bill and these amendments. We recommended that every mother should have her own digital maternity record, which she would create with her midwife. This record would set out the plans for managing her pregnancy, the birth and aftercare, which is so necessary for the baby, the mother and, I would add, the family. The mother’s record would then be accessible, with her permission, to all those contributing to her care. In future, we could see it being part of the child health record, and possibly the lifetime health record of the mother.

Although some progress has been made on improving access to NHS health records, we are still some way from achieving this, or the ambition set out in the NHS Long Term Plan for every citizen to have their own personal health record. We need to galvanise the NHS to move quickly and capitalise on the enormous potential that digital offers. That is what these amendments are designed to do. I am sure my noble friends on the Front Bench will consider them carefully and assess the potential that they offer.

I also recently had the privilege of chairing an investigation into the safety of medicines and medical devices; our report was called First Do No Harm. Thousands of women and children suffered avoidable harm relating to the medicines and one of the medical devices which we reviewed. They continue to live with the terrible consequences today. This harm did not take place in one isolated moment; it has spanned years and even decades. Why was it not detected and stopped? Many people could have been spared the misery it has been for them and their families.

Part of the answer to that lies in the absence of data. We found that data was not collected or that, when it was, there was no attempt to link data to identify patterns of concern. Paper records, such as there were, were incomplete, dispersed, archived or destroyed. The healthcare system could not tell us how many women had taken the epilepsy drug sodium valproate and gone on to have damaged babies. It could not tell us how many women had pelvic mesh implants, or which implants were used, or where and when.

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I apologise for taking so much of the Committee’s time on this, the first of my amendments, but I thought it important to set out clearly the rationale behind them, based on practical experience on the ground over many years. I beg to move.

[Baroness Cumberlege (Con)]

My Lords, I support these amendments and I especially support the noble Lord, Lord Mawson. It was typical of him that he started our thinking about what health is; I am sure there are many answers, but I think one of them might be integration—not just integration on the biggest scale but in terms of neighbourhoods, communities and what we now call place. That is so important. Those are the building blocks of all we are trying to do in the hierarchy of the National Health Service.

I am inspired by the noble Lord. He is a man of infinite resource and sagacity, an entrepreneur and, above all, a great achiever, based on solid principles which he believes in and, like a man of the cloth, is anxious to spread to others. He does so with really good effect.

It is no accident that I entitled my first report to the Government, many years ago when I was Mrs Cumberlege, Neighbourhood Nursing: A Focus for Care, as I believe the neighbourhood—or, in today’s parlance, the place—is all-important. This is what colours how people think, behave, succeed and, sometimes, fail. The noble Lord, Lord Mawson, has shown how even the most deprived areas can be rejuvenated and thrive with strong leadership, purpose and commitment. The noble Lord’s deep unshakeable philosophy is that patients, people and the local community should be the movers and shakers and be in control.

I want to mention Bromley by Bow, because it was a really innovative and new way of thinking about things. I remember visiting it years ago, not quite when it first started but when it was beginning to really thrive. Bromley by Bow was the first health centre in the country to be owned by the patients. Founded in 1984, it began with just 12 elderly patients, a rundown church, and just £400 in the bank. Today, by applying entrepreneurial principles to challenge social and health issues, it now has more than 250 staff. It is responsible for 43,000 patients, as the noble Lord said, and four health centre sites across Poplar. It operates on 30 sites even more widely across east London. It has supported local entrepreneurs. What is really interesting is that it has built 93 small and medium-sized enterprises. This is people helping themselves and ensuring that there is employment through a charitable structure, a housing company, which is controlled by the residents and now owns 10,000 properties and 34% of the land in Poplar.

This is a remarkable achievement in a very poor part of London. It is effective because it recognises that health and wealth are profoundly connected—not in huge municipal buildings and ivory towers remote from their populations but by the people who live and work in that area. The schemes are intertwined with the population. They are neighbourhood schemes and recognised as such. They are valued by being part of the destiny of a place in which local people live and work.

I visited Bromley by Bow in the early days, as I said, and I am really disappointed by my GP practice in the village in which I live and grew up. My father, one of two GPs, knew his patients literally inside and out. He knew who was getting off with whom. As his children, the first thing we learned was confidentiality and how to respect it, because we heard all sorts of things. He managed to get a health centre built. It is called that: above the entrance to the building it says, “The Health Centre”, but today it has been renamed the medical centre. It is a service that is not about health but about transacting to patients what the doctors think they need. The practice even shuns social prescribing, which is prevalent in many areas. It is also very careful not to involve the community. The friends of the health service have become disillusioned. They were established about 20 years ago and they are fed up with what is going on. Two weeks ago, they closed that organisation.

The noble Lord, Lord Mawson, in his Amendment 41A seeks to use the new world of integrated care boards to ensure that local representation is guaranteed. We have had a lot of debate in this Committee about who should be on what board and so on, but in listening to those debates—there was a big one last Tuesday—I was very struck by people talking about the big battalions. I could see that people were trying to ensure places on the integrated care boards that were represented by the big battalions. That is understandable. They are the component parts of the NHS. There are parliamentarians who see this as the only way forward.

Alcohol Consumption

Baroness Cumberlege Excerpts

Tuesday 27th January 2015 Lords Chamber

[Baroness Jolly]

The noble Lord is right. Alcohol consumption has fallen, as has the number of alcohol-related deaths, due to the increase in taxation on alcohol by this Government and possibly previous Governments. Nevertheless, harmful effects such as liver disease, as well as social impacts linked to alcohol, such as crime and domestic violence, remain much too high.

[Baroness Cumberlege (Con)]

Does my noble friend agree that there is great merit in keeping the pubs open and that single men who are lonely and depressed are very often welcomed into pubs? Their spirits are raised—in all senses of the word—and they then are not a burden on the National Health Service.

[Baroness Jolly]

I am not quite sure. I can tell noble Lords about licensing. We are actively working with Public Health England on the practicalities of how health-related objectives for the licensing of premises selling alcohol would work at a local level.