Domestic Abuse: General Practitioner Charges

Debate between Baroness Gardner of Parkes and Lord O'Shaughnessy

Thursday 15th November 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness will appreciate that this is not a matter for the Department of Health and Social Care, but it is something that I will be happy to look into. What I do know is that the draft domestic abuse Bill is looking to establish a domestic abuse commissioner. It may be that it is through that route that support of that kind may be made available.

[Baroness Gardner of Parkes (Con)]

My Lords, do we have any special reception facilities for men or women who have been abused? When I served on the United Nations Commission on the Status of Women, we had an opportunity to consider the excellent procedures in place in Brazil, a country which has taken this matter very seriously indeed. Over the years, this issue has been raised quite often, but do the police here pay any special attention to it, and do they protect those men or women who say that they have been attacked?

[Lord O’Shaughnessy]

My noble friend is right to say that domestic abuse can affect anyone, although of course it happens predominantly to women. The police, local authorities and the third sector are there to provide support for both men and women when they are abused.

Health: Stroke

Debate between Baroness Gardner of Parkes and Lord O'Shaughnessy

Wednesday 14th November 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness is absolutely right. In 2017, NHS England announced a rollout of the mechanical thrombectomy procedure to 24 centres across England. It is expected that 10% of stroke patients will be eligible. It leads to big reductions in disability after stroke, is now approved by NICE, and will be a significant part of the long-term plan which we will publish by the end of the year.

[Baroness Gardner of Parkes (Con)]

My Lords, my husband had a stroke and it was not recognised. It was a clot. He got to the hospital rather late and his arm was definitely damaged for ever more. He died 10 years ago; the stroke did not affect his continuing to live. The hospital in Newcastle was so far ahead in clot-busting that it was three years ahead of London. I remind the House of how much effort Lady Rendell, who is no longer with us, put into Act FAST, a campaign to let people know pretty quickly what the symptoms are and not to delay so that they have more hope of being successfully treated. We have made great progress, but there is a clearly a lot more to make.

[Lord O’Shaughnessy]

I did not know that my noble friend’s husband had had a stroke; I am grateful to her for sharing that with the House. She is right that the examples of Newcastle and Northumbria have shown that hyperacute stroke units—the centralisation of services—save lives. Closing hospitals or changing services can be controversial, but in stroke we know that it makes a big difference. It is a focus of what we need to do, and we need to take courage on that. The Act FAST campaign, which my noble friend mentioned, has been incredibly successful in making sure that we get fast action when people have a stroke. More than 5,000 fewer people have been disabled by stroke since that campaign started.

Domiciliary Home Care Support

Debate between Baroness Gardner of Parkes and Lord O'Shaughnessy

Wednesday 25th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I have huge respect for the noble Lord and his expertise in this area. I take this issue very seriously, which is why I used the opportunity in answering the noble Baroness to provide the reassurance that is in law. Local authorities need to step in to provide continuity of care with notice from the CQC, which now has a new responsibility to monitor the financial sustainability of providers and to make sure that that care is provided, whether it is delivered in-house or through contracts with other providers. That reassurance did not exist before it was introduced in the 2014 Act. It ought to provide a degree of reassurance among vulnerable people, who I accept will be anxious. That responsibility is in law.

[Baroness Gardner of Parkes (Con)]

The Minister has said that this is a matter of law. There has been a court judgment that fees should be paid to carers for time spent going between clients, which can be nearly half of their day. They may have one hour to spend with many clients. Is he aware that providers of domiciliary care—run as agencies and used by most local authorities —are not honouring that legal decision that this should be paid as part of their employment?

[Lord O'Shaughnessy]

My noble friend is right to bring up that issue. They should of course be paid. If she has any specific examples to share with me, I shall be glad to investigate.

NHS: Winter 2017-18

Debate between Baroness Gardner of Parkes and Lord O'Shaughnessy

Wednesday 18th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I am not sure how much pressure I can bring on the Chief Whip for anything, but I look forward to debating the review in whatever form we can when it comes out.

[Baroness Gardner of Parkes (Con)]

My Lords, in view of the discussions about whether people from overseas should be able to use the health service, can the Minister tell us whether any statistics are kept on any impact they would have had during this crisis, or how much of our budget would have been spent on them?

[Lord O'Shaughnessy]

I do not believe that we have specific statistics on the demand from overseas visitors during winter. I say to my noble friend that overseas visitors are most welcome to use the NHS but it is important that they pay. We are reclaiming more money than ever from overseas visitors to go into funding the NHS.

HPV Vaccinations

Debate between Baroness Gardner of Parkes and Lord O'Shaughnessy

Monday 26th March 2018 Lords Chamber

[Lord O'Shaughnessy]

The committee has to take a number of considerations into account—the public health benefits, short-term and long-term, and cost effectiveness—just as NICE does when approving medicines. It has to make a judgment about whether the incremental pound spent could be better spent across the entire health system, where, of course, there are many competing demands. But it is up to it to make that decision, and that will inform its final advice.

[Baroness Gardner of Parkes (Con)]

My Lords, is the Minister aware that oral cancer is very largely due to the papilloma virus? As a dentist, and on behalf of the dental profession, I strongly support immunisation, but there will always be people who do not attend to have it, even when it is introduced. So it is also important to be aware that dentists are usually the first people to detect oral cancer. For many years I have proposed that, when people go into accident and emergency for anything, someone should take one minute to see if there was any abnormality in the mouth which could be referred on at that stage. Could this even be included in a questionnaire when people go in for treatment? It would be a way of picking up oral cancer, which has increased by 23% in the last 10 years.

[Lord O'Shaughnessy]

My noble friend is quite right to highlight the link between HPV and oral cancer. The growing evidence base is one of the things which the JCVI is taking into consideration. There is absolutely no doubt that HPV causes around 99% of cervical cancers. The link to other cancers, such as the one my noble friend mentioned, is not quite the same and is still disputed, but it is one of the issues being considered.

Prescription Drugs: Dependence

Debate between Baroness Gardner of Parkes and Lord O'Shaughnessy

Monday 19th March 2018 Lords Chamber

[Lord O'Shaughnessy]

I completely echo the noble Baroness’s praise for the charitable sector. We have some very high-quality treatment centres in this country, provided both by the state and by charities. They do a fantastic job. In the most recently published figures, local authorities’ actual spend on funding for adults for drug misuse was about £490 million a year, so a substantial amount of money is going in. Of course, we need to make sure that it is getting to the people who are addicted to prescription drugs as well as illegal drugs.

[Baroness Gardner of Parkes (Con)]

My Lords, can the Minister explain the difference between dependence and addiction, as anyone who is on life-saving drugs is dependent upon them? Where does the definition come between that and addiction?

[Lord O'Shaughnessy]

My noble friend has just given a much better and more incisive answer than I could have given. There is a distinction; the point here is that these are drugs that people have started to take because they have needed them. I should point out one area that is not included in the review; it is not looking at cancer and terminal pain, because we need to make sure that there is appropriate pain relief for people who are in the last stages of their life.

NHS: Charitable Donations

Debate between Baroness Gardner of Parkes and Lord O'Shaughnessy

Thursday 22nd February 2018 Lords Chamber

[Lord O'Shaughnessy]

I agree with the noble Lord that it is a gift. I also absolutely understand the sentiment behind what he is saying, which is a desire for people to contribute back to the NHS not just through the tax system. It is important to point out that there are more than 250 NHS charities, with an annual income of £400 million. One of the other great gifts we have in this country is people’s willingness to donate time and money not just to the NHS but to a range of health causes. So we do provide an opportunity for that and those gifts are supported by gift aid. With regard to itemising the bill, we worry about deterrence. Many users of the most expensive health services are older people. Itemising a bill could put some of them off and that would be the wrong thing to do.

[Baroness Gardner of Parkes (Con)]

My Lords, I am pleased that the Minister has acknowledged the great contribution made by charities, but is he aware that councils are also providing a lot of care for people in need, both pre hospitalisation and post hospitalisation, but that they cannot use gift aid in any way? Will the Department of Health liaise with the Treasury to see whether there is some way that special council funds could be set up, where you could make a charitable donation? Gift aid is a great attraction. Yesterday I got a letter asking me whether I would like to give something to my council. I would not give anything unless it had gift aid—so it seems that we are missing an opportunity there.

[Lord O'Shaughnessy]

My noble friend makes an important point. Gift aid is a wonderful scheme that obviously has driven huge contributions. She is quite right that public sector bodies cannot provide the gift aid opportunity, which is why in the health sector those charities attached to hospitals exist. She makes an excellent suggestion for what councils should do and I shall take it up with my colleagues in that department.

Agency Nurses

Debate between Baroness Gardner of Parkes and Lord O'Shaughnessy

Wednesday 10th January 2018 Lords Chamber

[Lord O'Shaughnessy]

I will certainly write to the noble Earl specifically on psychiatric nurses. He will, I hope, be aware of the plan to recruit many more mental health staff as we seek to radically improve outcomes and delivery in that area.

[Baroness Gardner of Parkes (Con)]

My Lords, as a former hospital chairman, I am aware that agency staff are called in only when they absolutely have to be, when there is no other alternative. I wonder whether the National Health Service has looked at offering existing nurses in hospitals the opportunity of doing some more work out of hours, as some of them would find that convenient. There is a tendency for doctors as well as nurses to look for locum and agency jobs because they are better paid.

[Lord O'Shaughnessy]

It is that last issue that we are trying to address. One factor is that there is now an hourly rate price cap on agency spend, precisely to drill down into that issue. The reason that the number of agency staff went up was in response to the Francis review and what it said about safe staffing levels in the service. The immediate response was to deal with that through agency staff. That was expensive, of course, which is why we have had to push down those costs. Nurses have to come from somewhere, and my noble friend is quite right that using existing nurses and support from nursing banks is one way of meeting demand with better value for money.

Children: Oral Health

Debate between Baroness Gardner of Parkes and Lord O'Shaughnessy

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is right to highlight this important issue. Twice as many five to nine year-olds are admitted to hospital with tooth decay as are admitted with broken arms—that is how bad the problem is. It has improved in recent years: 75% of all five year-olds have no sign of physical decay, up from 69% in 2008. Supervised tooth-brushing is part of the “Starting Well” programme, but Public Health England and local authorities are responsible for commissioning and will look at the results to see whether it can be rolled out into general dentistry practice.

[Baroness Gardner of Parkes (Con)]

My Lords, does the Minister appreciate that in Australia and the United States there is widespread community fluoridation? Fluoride has been established as one way of preventing dental decay. I went on to Google today and found an article that states:

“With 60 Years of Data and 3000 Studies, Australia Declares Fluoride ‘Completely Safe’”.


That is supported by community water fluoridation, which means that your water authority cannot only see that the right amount is put in but will take out any oversupply above the optimum rate. The noble Baroness said that she thinks that oral health is important for children from an early age; I took my treatment antenatally for my children, who have very good teeth.

[Lord O'Shaughnessy]

My noble friend is quite right that fluoridation is effective. The 2012 Act allows local areas to choose to introduce it—with local legitimacy, which is important because this issue still stirs passions. We encourage any local area considering this—I believe that Greater Manchester is one—to look at the study my noble friend mentioned in order to see its effectiveness.

Nurses: Tuition Fees

Debate between Baroness Gardner of Parkes and Lord O'Shaughnessy

Wednesday 29th November 2017 Lords Chamber

[Lord O'Shaughnessy]

I think that the figure on shortfalls that the noble Baroness has given is not right. If one looks at the UCAS data, it shows, as I said, a small drop of around 6%, but the numbers going into training are comparable to 2014-15. She is quite right about the need for additional financial support, and there is £1,000 available for childcare support for those who need it, as well as exceptional support funds of up to £3,000.

[Baroness Gardner of Parkes (Con)]

My Lords, is the Minister aware that there was a great disincentive for people to enter nursing when it was decided that it was necessary to have university-level academic education to do it? The SENs—the state enrolled nurses—were abolished. Does he think that the apprenticeship scheme, which I understand is put forward all the time as being the replacement for that, is really working well, or is there a need to bring back that middle layer of nurses who cannot get five A-levels but can nevertheless be excellent nurses?

[Lord O'Shaughnessy]

My noble friend makes an important point. It is precisely to, if you like, recreate that route into nursing that the nursing apprenticeship and nursing associate positions have been created, and the numbers are increasing.

National Health Service: Nurses

Debate between Baroness Gardner of Parkes and Lord O'Shaughnessy

Wednesday 22nd February 2017 Lords Chamber

[Lord O'Shaughnessy]

I am sorry that the noble Lord takes such a negative view of the changes we are making. There are actually 6,500 more full-time equivalent nurses and health visitors than there were in 2010. There has been a 15% increase in the number of training places and of course, through our reforms which he just mentioned, we are taking the cap off the amount of training places that can be offered.

[Baroness Gardner of Parkes (Con)]

My Lords, can the Minister tell us how the apprenticeship scheme is going, because a lot of damage was done when Tony Blair said that you had to have five A-levels to become a nurse? We hope that this apprenticeship scheme will counteract that.

[Lord O'Shaughnessy]

I am grateful to my noble friend for mentioning the nursing degree apprenticeship, which was announced at the end of last year. The first nurses should be in place from September of this year. Once established, this apprenticeship route could allow up to 1,000 additional nurses to join the NHS every year.

Hospital Beds: Availability

Debate between Baroness Gardner of Parkes and Lord O'Shaughnessy

Thursday 9th February 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord is quite right to raise the issue of mental health. I do not have the specific figure with me but I will write to him with it. We know that there has been a historic disparity between the two services. This was recognised by the Prime Minister in a very important speech she gave a few weeks ago, setting out some of the ways in which the Government are doing more on this. However, there is clearly a lot more to do.

[Baroness Gardner of Parkes (Con)]

What is the situation of people providing care at home on behalf of councils? Many carers I know are called out at 10 or 11 at night to receive someone who has just been sent home from hospital. However, they are not really trained themselves; they are trained only by the care agency. Is it not time that we provided them with proper training, particularly as so many of them have come from the Philippines and other such places and we are not sure what the future holds for them?

[Lord O'Shaughnessy]

My noble friend is quite right that there has been an increasing prevalence of domiciliary care, which involves carers caring for patients in their own homes. Making sure that those patients can get home at a good time that works for them and those who support them is clearly a critical part of dealing with this delayed discharge issue.

Health Workers: Training

Debate between Baroness Gardner of Parkes and Lord O'Shaughnessy

Wednesday 18th January 2017 Lords Chamber

[Lord O’Shaughnessy]

I do not recognise the description of “slagging off”. We know that GPs do a fantastic job and we are recruiting more of them—5,000, as the noble Lord said. More money is going into general practice as part of the five-year forward view. The Prime Minister in her statement paid tribute to the work that GPs do and said that there were obligations around extended hours and the provision of out-of-hours healthcare—and it is quite right, with the pressures we face, that every part of the healthcare system steps up to fulfil its responsibilities just as others are doing, in order to meet the pressure we are under.

[Baroness Gardner of Parkes (Con)]

My Lords, in the past I have raised the issue of the standard of training for nurses and the fact that they have to have five A-levels to get in. The answer from the Government is that they are about to introduce training that will not require five A-levels and therefore will produce many more nurses. Can the Minister tell us what is happening with that and whether there is any real progress?

[Lord O’Shaughnessy]

There are two routes into nursing. One is the university route, and because of the changes we are making, there will be the possibility for universities to recruit up to 10,000 more nurses. That is why we are removing the cap. We have also introduced an apprenticeship route, which does not involve going to university but follows the apprenticeship route practised in other fields. That will have 1,000 places in its first instance.