National Health Service: 75th Anniversary

Baroness Hodgson of Abinger Excerpts

Thursday 30th November 2023 Lords Chamber

[Baroness Hodgson of Abinger (Con)]

My Lords, I welcome the opportunity to have this debate and thank the noble Lord, Lord Hunt, for having secured it. We are so very lucky to live in a country that has a health service, and we should celebrate the NHS on its 75th anniversary. I pay great tribute to the many dedicated doctors, nurses and health professionals who have worked in the NHS over the past 75 years, many of whom really are true heroes.

However, we are having this debate at a difficult time, as we have heard, with the NHS facing unprecedented challenges and the fallout of the pandemic still significantly impacting the system. There is also, perhaps, a generational change of attitude. I do not think we have ever before had doctors and nurses going on strike. On top of that, a number of very difficult situations have come to light, with maternity scandals, as we have heard, in hospitals such as Shrewsbury and Telford, Nottingham, Mid and South Essex, Morecambe Bay and East Kent—to name some of them—revealing huge failings in safety, as well as the realisation that hundreds of avoidable deaths occur in our hospitals. No longer can we say that the UK has the best survival rates for many cancers. All this paints a picture that the NHS is somewhat in crisis. As we have heard, a recent IPSOS survey noted that public satisfaction with the running of the NHS as a whole is at its lowest level for 25 years.

Time is short in this debate and it is such a huge subject, so I thought I would concentrate my remarks on the GP system and primary care. We had the most wonderful system, but since the early 2000s this too seems to have dramatically declined, starting with the change to the GP contracts. The British Social Attitudes survey found that the proportion of patients who were satisfied with GP services, in particular, has plummeted from 68% to 38% since 2019, with people often struggling to get the care that they need. Anecdotally, we consistently hear about the crisis of patients not being able to access their doctors. Many GP practices have taken on the system of triaging patients, but if you are really feeling unwell, you do not feel like fighting with the receptionist to see a doctor—the result being that people give up and go straight to A&E, which naturally has a knock-on effect on waiting times there and on the ambulance service, which cannot discharge its patients.

It is clear that GPs too are feeling under pressure. A report published by the Health Foundation charity paints a picture of high stress and low satisfaction with workload. Just one in four UK GPs are satisfied with the time they are able to spend with their patients and appointment times are among the shortest of 11 countries surveyed. I gather that the average doctor now has to deal with 41 to 50 patients a day. When asked, GPs feel that the right number is somewhere around 30, maximum, and this situation is leading to burnout. Only one in four GPs in England is now working full time; most work three days or fewer each week. A third of GPs are considering leaving within five years, with the Royal College of GPs claiming that it is “no longer feasible” to be just a GP, despite an average salary of over £100,000 a year.

Many doctors now do not know their patients. Talking to older GPs, I learned that the job satisfaction came from knowing whole families and caring for them throughout their lives. While not knowing your doctor may not be a problem for the young and healthy, if those with small children or the elderly know their GP that makes it much easier for the GP to treat them, without having to read through all their notes each time, thus cutting their time down. I have cited in previous debates the Norwegian study published in the British Journal of General Practice, which clearly demonstrated the benefits and stated that it can be lifesaving to be treated by a doctor who knows you.

Yet in the UK, GP practices are becoming bigger and the relationship between doctors and patients less constant. While patients over 75 in the UK are given a named GP, it would appear that some doctors interpret this as just having to look at patient records. I understand that patients who wish to be seen urgently cannot always see the same GP that day, but how can a doctor deliver appropriate and responsible care to a patient without ever meeting them?

What can we do, going forward? I believe we need to redesign the whole system so that it works for doctors and health professionals, and, most importantly, for patients. Training more GPs is one easy answer. I know that there was an increase of 25% in funded medical school places in the three years up to 2020, but clearly we need more. We must cut down the number of patients who doctors are being asked to see each day. We must make it advantageous for doctors to work in a practice, rather than being a locum. Smaller practices used to work better. Most importantly, we need to encourage doctors to know their patients again; this will lead to better outcomes, as shown by the Norwegian study, and help ease pressure on the whole system.

However, we need to do more to encourage people to take responsibility for their own health. Prevention is key: good diet and exercise are vital; health checks are important and should go on until an older age. We should also include mobility checks, as people who cannot exercise will put on weight, leading to diabetes, heart problems et cetera. That would help to prevent hip and knee problems. We need to encourage practice nurses to deal with more conditions and get qualified pharmacists to be able to give a wider selection of medication without a prescription. Community nurses are such an asset, and we need to ensure that doctors work closely with them. Those dealing with patients on the phone need to be trained to be kind and caring.

Mental health takes up more and more time. Are there better ways of dealing with this, rather than endless medication? Should we encourage people with certain conditions not to go first to their GP? For example, could those with back pain go first to an osteopath or a physio or a sports therapist, who can often sort them out? Good IT can really help with the whole system.

We must make sure that primary healthcare works better for patients, as well as being a job that is once again enjoyed and valued by doctors. This is so important, as, if we can once again restore good primary healthcare, that will ease the whole health system.

General Practitioners: Recruitment and Retention

Baroness Hodgson of Abinger Excerpts

Monday 12th June 2023 Lords Chamber

[Lord Markham (Con)]

I totally agree; it is all about getting upstream of the problem. I visited an excellent surgery—Greystone House in Redhill—where they are doing exactly that. They are taking their most critical 1% of patients in respect of need and trying to get appointments in ahead of time so that they can move into preventive measures; I absolutely agree.

[Baroness Hodgson of Abinger (Con)]

My Lords, I understand that often locums are paid more than GPs in practice. How can we reverse this so that we can encourage young doctors to go into GP surgeries, become general practitioners and actually get to know their patients?

[Lord Markham (Con)]

First, I would agree—I think we all agree—that continuity of care is very important. We absolutely want a career structure that attracts and retains exactly those types of people, so that they feel it is more rewarding, both financially and as a job, to work in such a practice environment.

Primary and Community Care: Improving Patient Outcomes

Baroness Hodgson of Abinger Excerpts

Thursday 8th September 2022 Lords Chamber

[Baroness Hodgson of Abinger (Con)]

It is a great pleasure to follow the noble Baroness, Lady Meacher. Like others, I thank the noble Lord, Lord Patel, for securing this debate and introducing it with his usual thorough and considered approach. It is particularly timely, given the recent Health and Social Care Committee report’s conclusion that healthcare providers in England are facing

“the greatest workforce crisis in their history.”

We have heard this from many speakers today. A cancer specialist wrote last weekend in the Daily Telegraph that NHS general practice had reached the “point of no return” and was “irrevocably broken”, citing that, since 2013, 474 practices had closed permanently, affecting 1.5 million patients.

We hear consistently about the crisis of patients not being able to access doctors, with only 56% of patients reporting that they had had a good experience in making an appointment and 53% saying that they found it easy to get through to the practice on the phone. Most worryingly, the survey also found that 55% of people—up by over 13% over the past year—said that they had avoided making a GP appointment, with the major reason being that it was too difficult.

Many GP practices have taken on the system of triaging patients. Although I understand that this can have some benefits for doctors, it can also be very intimidating. I have had an experience of a very aggressive triaging doctor shouting at me when I was asking for a doctor to come to my very sick elderly mother. It was extremely upsetting, especially because it was followed by a refusal to attend. People who are stressed or unwell are unable to deal with being treated like that, and it creates a barrier to people receiving the care that they should.

As the noble Baroness, Lady Pitkeathley, mentioned, the result of this can be that people give up trying to see their GP and go straight to A&E instead, causing increased overcrowding there, with the knock-on effect of ambulances being unable to discharge patients and then unable to attend other urgent cases. Although we are being urged to stay away from A&E, if patients cannot access their doctor, it may be their only option to get care. There is an enormous loss of faith in GP services. A British Social Attitudes survey found that, since 2019, the proportion of patients who were satisfied with their GP services has plummeted from 68% to 38%, the lowest level on record.

It is clear that GPs are also feeling hugely under pressure. A report published by the Health Foundation charity paints a picture of high stress and low satisfaction with workload among UK GPs. Just one in four UK GPs are satisfied with the time that they are able to spend with patients—appointment times are among the shortest of the 11 countries surveyed. As we heard, only one in four GPs in England is now working full time, and most GPs work three days a week or fewer.

Although I am sure that the pandemic has exacerbated this situation, the cracks were there before. One of major things that has gone wrong is that many doctors now do not know their patients. There is enormous benefit in knowing your GP, especially for the elderly, those with small children or those with serious and ongoing health issues, and it makes it much easier for GPs to treat them. I accept that that is not always the case for younger and healthier people, who may need to see their GP very infrequently.

Last year, a Norwegian study published in the British Journal of General Practice demonstrated this. It showed that those who had the same doctor for between two and three years were about 13% less likely to need out-of-hours care, 12% less likely to be admitted to hospital and 8% less likely to die that year, rising to 30%, 28% and 25% respectively after they had had the same doctor for 15 years. Meirion Thomas, whom I referred to earlier, highlights that continuity of care is crucial in early cancer diagnosis. Survival rates in the UK lag behind almost all comparable high-income countries. Recent research has shown that 37% of patients with cancer in the UK present in A&E with acute symptoms and with advanced disease associated with a poor prognosis.

The Norwegian report stated:

“It can be lifesaving to be treated by a doctor who knows you”.


Smaller practices delivered this—yet, in the UK, the trend has been for GP practices to become bigger and pool their patients, thus eroding the relationship between doctors and patients. Although patients over 75 in the UK are given a named doctor, some doctors interpret this as just having to look at the patient’s records. Although I understand that patients who wish to be seen urgently cannot always see their GP that day, it is impossible for a doctor to be responsible and deliver appropriate care for a sick elderly patient without ever meeting them. Older GPs say their job satisfaction came from knowing patients, often whole families, and caring for them through the years. Yet so many doctors training as GPs then leave or work as locums because the pay is much better and there is less form filling.

The job has changed in other ways too. The head of the Royal College of General Practitioners recently said that family doctors were working at an intensity that was “unsustainable”, leading to many cutting their hours or taking early retirement—other speakers have referred to this. I gather that, on average, a doctor is asked to deal with 40 patients in a day, with some GPs being asked to see closer to 50. Apparently, GPs feel that the right number is probably around 30. This overload is leading to burnout and early retirement, as we have already heard. The Royal College of General Practitioners has said that 65% of GPs say patient safety is being compromised due to appointments being too short.

What can we do to improve all this? We had much better primary care 20 years ago; the damage started in 2004 with the change in the GP contract. We urgently need a system that works both for patients and doctors, but a health system needs to be patient-focused. As the noble Lord, Lord Patel, said, this is about caring for people. Training more GPs is perhaps an easy answer, but people also need to be encouraged to look after their own health so that they have fewer visits to a doctor and are healthier for longer—prevention is absolutely key. Health checks are very important. We should also include mobility checks. People who cannot exercise well can tend to put on weight, leading to diabetes and heart problems, and checks would also help the prevention of hip and knee problems.

I welcome the new women’s health strategy for England, which will tackle the gender health gap and improve the health and well-being of women and girls. We must make it advantageous for doctors to work in a practice rather than being a locum. We need to cut down on the number of patients they are asked to see daily, and make the job more enjoyable and satisfactory for them—less stress might encourage more to work full-time. We also need to encourage doctors to know their patients again; the system works best when doctors know their patients and patients have faith in their doctors. This will lead to better outcomes and help ease pressure on the whole system. If that is the case, Zoom appointments and phone calls—which can cut down on time—can be beneficial, but if a doctor does not know their patient, it is much harder to treat them satisfactorily in this way.

The NHS app is excellent for things such repeat prescriptions. Could modern technology do more to remove some of the bureaucratic functions and form filling? Practice nurses should be able to deal with more conditions, while qualified pharmacists could give a wider selection of medication without a prescription. Community nurses are a huge asset, and we need to ensure that doctors work closely with them. Mental health takes up more and more time: are there better ways of dealing with this, rather than endless medication? In addition, we should encourage people with certain conditions not to go first to their GP—for example, those with back pain should go to a physiotherapist, osteopath or sports therapist, and people should go elsewhere for sight and hearing checks.

It is urgent that primary healthcare works better for patients, as well as being a job that is once again enjoyed by doctors. Bold steps need to be taken. I absolutely support the suggestion by the noble Lord, Lord Patel, of setting up a Select Committee to look at this. If we can once again restore primary healthcare, it will greatly ease the whole health system and deliver better outcomes.

Health and Care Bill

Baroness Hodgson of Abinger Excerpts

Lords Hansard - Part 2 & Report stage
Tuesday 1st March 2022 Lords Chamber

I also join the noble Lord’s tribute to Lady Hollis, who was such a tremendous source of value in this House, including, as many of your Lordships will remember, the time when she was able to get the House to set aside the order about capital provision for poorer people.

[Baroness Hodgson of Abinger (Con)]

My Lords, I will be very brief. Having spoken on this in Committee, I simply thank my noble friend the Minister for bringing forward Amendment 16 to include palliative care services in the list of things required by ICBs to commission. We all agree that the end of life is one of those times when care is needed most, and I too congratulate the noble Baroness, Lady Finlay, on all her work on this, and all those who spoke in support in Committee.

This is an example of where the Government have truly listened and responded to concerns voiced on all sides of the House. They have made the most of the Bill’s unique opportunity to ensure that nobody with a terminal illness misses out on the care and support they need, both now and in the future.

[Baroness Walmsley (LD)]

My Lords, I congratulate the noble Baroness, Lady Finlay, without whom this amendment would not have been laid by the Government —although I pay tribute to the Government for listening to her. As she said, it could be game-changing—I say “could be” because unless the resources are made available for these services and for training enough of the health professionals needed to carry them out and make them available everywhere, it will not be game-changing. I would like a reassurance from the Minister that adequate resources will be made available so that, as appropriate, ICBs can carry out the duty that will be put on them.

I was horrified to hear the noble Baroness, Lady Meacher, mention a hospice with half its beds empty. I hope additional resources will be provided for hospices. I clearly remember somebody saying in Committee that you would not expect to have a coffee morning or a cake bake to treat a broken leg; you should not have to do the same sort of thing for services at the end of life. I hope the Minister will bear in mind the possibility that additional resources should go there.

We have heard that services are patchy across the country, and I suggest that the worst patchiness is in services for people dying at home. I know it is not easy to provide 24-hour services and advice to a family doing their best to try to care for somebody dying at home, but it must be done. I am afraid I know friends who have had a very bad experience of that. The person at the end of life had a bad experience, and the family have never forgotten it. As the noble Baroness, Lady Finlay, has often told us, it is possible for everybody to have a good death if the right services are provided to them. That means a good experience too for the family, who simply want to know that they have done the best and that that has been enough.

--- Later in debate ---

[Baroness Hollins (CB)]

My Lords, it is a pleasure to add my name to the amendment tabled by the noble Lord, Lord McColl. I am not going to say very much in support, because the background has already been explained. Without a diagnosis, people living with dementia cannot access the community support they need.

I will add one specific group who experience dementia, which is people with Down’s syndrome. Some 60% of people with Down’s syndrome will develop Alzheimer’s by the age of 60. A lot of research on Alzheimer’s has been developed from an understanding of Down’s syndrome and the changes that take place in people’s brains. The manifesto pledged to double the funding for dementia research. The amount is interesting. It was a commitment of £800 million over 10 years for dementia research. To put that figure into context, the co-chair of the APPG on dementia, Debbie Abrahams, has stated that dementia currently costs our economy £34.7 billion each year. I therefore support this amendment requiring integrated care partnerships to include a strategy to improve both the diagnosis of dementia and dementia research, which has the potential to improve the lives of so many people in the UK.

I also added my name to the amendment in the name of my noble friend Lady Finlay. I, too, began my medical career as a GP. I therefore support my noble friend Lord Crisp’s amendments. It also has some relevance to my later practice in psychiatry. Having worked as a general practitioner in south London, I began to understand the importance of social factors in the development of mental illness and in the ability of my patients to live with whatever long-term condition they might have. As a community psychiatrist I have extensive experience of practicing medicine that addresses people’s biological, psychological and social needs, and I have been a prominent advocate of the least restrictive practices. Best practice includes facilitating robust, multidisciplinary mental health care in the community where it is a feasible alternative to treatment in hospital and, when admission is needed, helping people to be discharged back into the community at the earliest point so that their recovery can continue in the community, close to family and friends. As a mother, I advocated for effective community rehabilitation for my daughter after she become quadriplegic, which was a much better option than the nursing home care that she was initially offered.

Robust integration between multiple disciplines within health and social care is essential to ensure the high-quality, coherent, consistent and readily accessible community rehabilitation that can promote physical and mental health and help people to thrive to their full potential within communities. I am very pleased to support my noble friend’s amendment. I should declare an interest as president of the Royal College of Occupational Therapists, a profession which has a particular contribution to make in community rehabilitation.

[Baroness Hodgson of Abinger (Con)]

My Lords, before I speak to my amendment I would like to put on record that I particularly support my noble friend Lord McColl’s Amendment 62, which considers the needs of those with dementia. I also support the thrust of the amendment tabled by the noble Baroness, Lady Finlay, on better rehabilitation. Perhaps the concept of convalescence, as it used to be called, would help free acute beds and thus save money. I also support the amendments tabled by the noble Lord, Lord Crisp, to ensure that integrated care boards work with primary care and, I hope, with community nursing as well.

Amendment 177 is in my name. Much of the Bill is about the architecture of the NHS, and it is important that we get it right. However, the success of the Bill will be whether it delivers for patients. As we have discussed before, healthcare needs to be patient focused. At the moment we sadly have a system where the traditional idea of a family doctor who knows their patients is too often disappearing. Why has this been allowed to happen when we know it worked so well? We need somehow to get an element of that back. I understand that today many doctors in general practice find their role far less satisfactory, with fewer people wanting to go into general practice. I am given to understand that a large element of this has to do with the fact that fewer doctors know their patients, whereas in years gone by they would know and look after the whole family and be part of the community.

With people living ever longer, looking after older people so that they can stay healthier for longer is critical, as is ensuring that they receive the care they need and have a dignified and secure old age. This amendment would introduce a new clause that lowers from 75 to 65 the age at which every patient is assigned a named GP, which would help with prevention, an issue raised by my noble friend Lord Farmer in his amendment. The amendment would also ensure that named GPs actually have to meet and have some knowledge of each patient they are responsible for, and to communicate directly with them and their family.

I will not reiterate all the facts and figures I gave in Committee. I merely remind your Lordships that studies have shown that, quite simply, being treated by a doctor who really knows you can be life-saving. Quality care by a named GP benefits patients by delivering continuity of care and therefore better healthcare, and by keeping more people out of hospital, relieving some of the burden on the NHS.

Following the debate in Committee, I have added proposed subsection (2) to enable the role of the named GP to be “delegated” to another doctor in the practice who might be chosen and preferred by the patient. But this amendment ensures that patients will have someone who actually has some knowledge of them and whom they or their relatives can turn to for help, care and advice.

I was very disappointed that, in Committee, my noble friend the Minister failed to grasp the significant difference between current regulations, guidance and what happens in practice. I have personal proof that, as things stand, some named GPs are able to choose not to know the patients they are responsible for. This amendment seeks to positively address that.

I urge the Minister to reconsider and accept these proposed changes to the Bill. I absolutely agree with the noble Lord, Lord Hunt, that primary healthcare is incredibly important. This whole area really needs an in-depth debate because it is breaking down in some places.

[Baroness Walmsley (LD)]

My Lords, I will make just a few comments. I put my name to the amendment of the noble Lord, Lord McColl, which I will not say much about because he and the noble Baroness, Lady Hollins, have said it all.

However, I will make one point about the importance of early diagnosis. As most noble Lords will know, Alzheimer’s is a complex range of diseases, and it is very important for the patient that their doctor is able to know what sort of Alzheimer’s they have so that an appropriate set of support can be prescribed. The other very important reason is that we do not yet have a disease-modifying cure. Unless more suitable patients go forward for clinical trials, the researchers will not be able to do their research, no matter how much money the Government put forward. We know that 80% of people who put themselves forward for a dementia clinical trial have to be rejected because their disease has progressed too far. So, we really need early diagnosis so that the researchers have some chance of finding the cure that we all want.

Secondly, I will say two things about primary care. The noble Baroness, Lady Hodgson, talked about patients having to see a doctor they have never seen before within their practice. Well, now—and I would like the Minister’s answer to this—not only are people ringing up and going to a doctor in the practice whom they have never seen before; in London, they are now being referred to a completely different practice, because something like five practices share patients. I understand that that is a temporary measure during the pandemic, but could the noble Lord confirm that that is the case? Could he also confirm that it is going to end once we believe the pandemic is over, which of course it is not yet?

I shall say a few words about the amendment proposed by the noble Lord, Lord Crisp. It is vital, as he rightly said, that primary care has a role in planning the commissioning of services. As the noble Lord, Lord Hunt, said, a lot of expertise has been developed, and it must not be lost. It is vital because primary care services are the gateway for a patient to everything else in the health service; it is the first port of call for a patient and, without a referral from a GP, on the whole you cannot get to anything else.

I very much support what the noble Lord, Lord Crisp, is doing and look forward to hearing what the Minister has to say about the reasons why primary care services do not appear to be treated equally with NHS trusts and foundation trusts.

Health and Care Bill

Baroness Hodgson of Abinger Excerpts

Lords Hansard - Part 1 & Committee stage
Wednesday 9th February 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I thank the noble Baroness, Lady Greengross, and others for the amendments in this group, which would help transform some of the long-standing problems in social care, as well as improve the quality of life of patients and their families, especially those who care for them. I will speak to Amendment 297D, in the name of the noble Lord, Lord Hunt, which seeks the establishment of a review into institutional abuses in care settings within six months of the passing of this Act.

Amendment 297D talks about the effects of restrictive visiting and eviction notices

“on the emotional, psychological, social and physical health of service users, and on the well-being of service users”

and their families. Obviously, “restrictions on visiting” has taken on a whole new meaning throughout the Covid-19 pandemic. I note that the Rights for Residents campaign group has secured more than 270,000 signatures on a petition for a law that ensures that

“every resident has the legally enforced right to the support of an essential visitor”.

Currently, homes are meant to support an essential caregiver for all residents—but this is advisory and some homes are still imposing blanket bans on visits. That may be because they have some Covid infections inside the home, but that is not universally true.

There is still no clear picture of how visits are going on in care settings. These could be difficult for residents with dementia, for example, if there is only a very small window for visiting—and perhaps it is just not the right time or the right day for them.

Unlock Care Homes is also doing work on this, including highlighting good practice. It is important to remember that most care homes are not just doing their best, they are doing really well with looking after their residents, despite the constraints of the pandemic, staff shortages and burnout.

Time and again, investigative journalists are uncovering practices going on in care settings that are inhuman, breach vulnerable residents’ human rights and damage patients’ mental, physical and psychological well-being. The noble Baroness, Lady Masham, referred to a long list, and that list is indeed shameful.

A series of scandals led to a CQC report into restraint, seclusion and segregation for autistic people and people with a learning disability being commissioned in 2018. It was published in October 2020. The report said:

“We found too many examples of undignified and inhumane care in hospital and care settings where people were seen not as individuals but as a condition or a collection of negative behaviours … We also found that a lack of training and support for staff meant that they are not always able to care for people in a way that meets those individuals’ specific needs. This increases the risk of people being restrained, secluded or segregated.”


However, the Government have not yet commissioned a review of the entire sector, to understand and learn from the causes and poor practices that have resulted in those institutions failing their residents. Commissioning such a review would demonstrate that the Government really want to bring a halt to these practices.

[Baroness Hodgson of Abinger (Con)]

My Lords, Amendment 297A is in my name and those of the noble Baronesses, Lady Smith and Lady Cumberlege, but I am also supportive of the other amendments in this group.

With people living ever longer, looking after older people so that they can stay healthier for longer is critical, as is ensuring that they receive the care they need and have a dignified and secure old age. Amendment 297A seeks to introduce a new clause that will not only lower, from 75 to 65, the age at which every patient is assigned a named GP but sets out to ensure that named GPs will actually have to meet and have some knowledge of each patient they are responsible for, and will communicate directly with them and the family.

We need to encourage everyone to take responsibility for their health. Having good and regular health checks is an essential part of the prevention of ill health, as well as leading to earlier identification of conditions and earlier interventions. I am sure that other noble Lords who are doctors will put me right, but I was once told that 65 is an age where things can start to go wrong. Therefore, it is important to start monitoring people’s health and being able to identify changes from this age. This will deliver better outcomes and may also enable people to stay at home and lead a fuller life for longer. The role of the GP in all this is absolutely critical.

Health and Care Bill

Baroness Hodgson of Abinger Excerpts

Lords Hansard - Part 1 & Committee stage
Monday 31st January 2022 Lords Chamber

[Baroness Hodgson of Abinger (Con)]

My Lords, I support this amendment, so ably moved by my noble friend Lord Blencathra and supported by the noble Baroness, Lady Kennedy, and the noble Lord, Lord Alton. Noble Lords have already heard the well-versed and evidenced arguments put forward and, while the amendment does not specifically refer to China, there can be no doubt that the well-documented example of the horrific treatment of the Uighur people in Xinjiang province would fall under its scope.

We have all heard today about the hundreds of millions of pounds-worth of healthcare goods that have flooded into this country since the start of the pandemic, much of it sourced from China. We would expect our Government to make every effort to disentangle our supply chains from implication in these atrocities, so was any due diligence carried out throughout our procurement process? This amendment would correct that oversight if it was not.

I do not want to repeat everything that has already been said by others, but I want to highlight the importance of the risk-assessment aspect in proposed new subsection (3). I anticipate that the Minister will highlight the work already being done by government departments to weed out companies with slave labour in their supply chains. Perhaps sometimes they are being asked to perform an impossible task, because I understand that supply chains in the Uighur region of China are almost entirely opaque. It is suggested that the area is rife with systematic forced labour, that audits there are worthless and that workers live in fear and terror of telling the truth. Indeed, as we have already heard, the US Government have just passed legislation presuming that all imports from the region are tainted unless proven otherwise.

Surely, it is our responsibility, as a signatory to the genocide convention, to do all that we can to prevent genocide when there is a serious risk of it taking place. This amendment builds on the work that we have already done in this regard. We cannot continue business as usual with China or any other state that condones or supports genocide. I ask the Government to act urgently to ensure that our supply chains are not tainted by goods made with Uyghur forced labour. I ask Members on all sides of your Lordships’ House to join us and reassert our commitment to global human rights and to provide the protection against genocide, wherever it is needed, by supporting this amendment.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I too support the amendment of the noble Lord, Lord Blencathra. As we are really talking about procurement in the NHS, I should declare my interest as president of the Health Care Supply Association.

It is entirely reasonable to use NHS procurement rules in this way. The noble Earl knows that Clause 70 is intended to give wide discretion to Ministers to bring in a new procurement regime. I see no reason why this cannot be part of that regime.

I sometimes think the NHS operates in isolation from what is happening in the world, but it cannot operate in isolation from the terrible things that the noble Lord, Lord Blencathra, and other noble Lords have spoken about. I hope the noble Earl will be sympathetic.

Health and Care Bill

Baroness Hodgson of Abinger Excerpts

Lords Hansard - Part 3 & Committee stage
Tuesday 18th January 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, whatever view we take on assisted dying, I think that there is general agreement that the noble Baroness, Lady Finlay, deserves a great deal of support in her two amendments. The predicament that we find ourselves in is that the Minister will probably reject them and say that the Government will ensure that the NHS prioritises these services in the future. The trouble is that we have been here many times before, as the noble Lord, Lord Patel, said. He mentioned 2016, but in 2015 the Economist produced its last quality of death index, as far as I can find out, which basically said that the UK had the best palliative care in the world, but it was very patchy. I am afraid that the situation has simply not moved on.

So the question is: what should we do? Clearly, it is not going to get better if you leave it to the health service. It treats hospices dreadfully, with continuous late contract signing and short-term contract signing by bodies that should be able to agree three-year rolling contracts with those institutions. The lack of priority that is given suggests to me that, unless we take legislative action, we will not see any improvement at all. That is the quandary for us in terms of collectively agreeing a way forward that makes it clear to the NHS that time is up on its neglect of palliative care. We really must take action.

[Baroness Hodgson of Abinger (Con)]

My Lords, I too have put my name to these amendments, so ably introduced by the noble Baroness, Lady Finlay of Llandaff. Because this is the first time that I have spoken at this stage of the Bill, I remind your Lordships to refer to my Second Reading speech and entry in the register of interests for my experience and links around the topic of health. The hour is late, so I shall try to be very brief.

Although Clause 16 currently lists a number of services that the ICBs are required to commission, it fails extraordinarily to include palliative care. We have already heard that current estimates suggest that, although as many as 90% of people who die have a palliative care need, only 50% currently receive that care—only half. I find it somewhat horrifying that, as the noble Baroness, Lady Finlay, told us, a Marie Curie survey found that 64% of people who died at home did not get adequate care, with pain management.

Like others who have spoken, I know from personal experience of family members how hard it was for them to get the care they needed at the end of their life. I am sure that everyone here can share examples of exceptional local hospices, especially facing the challenges of the pandemic, that currently have to fundraise to be able to do the work to fill these gaps—as the noble Baroness, Lady Finlay, told us, they sell cakes. It is quite extraordinary. I pay tribute to the outstanding work of the hospices and the wonderful palliative care doctors for the amazing support they give to those who are dying and their families.

Although I recognise the Government’s concerns about overprescribing the list of services that integrated care boards should commission, it seems anomalous for the Bill to proceed with priority given to ensuring that ICBs commission maternity and other services but have no explicit requirement to commission palliative care services. I am sure that this was not the Government’s intention, but I am concerned that the current drafting implies that health services for people at the end stage of their life are less important than health services for people at earlier stages. Surely the end of life is one of the times when care is needed most. I find it extraordinary that we are even having this discussion.

The addition of these amendments offers a unique opportunity to ensure that nobody with a terminal illness misses out on the care and support that they need, both now and in the future. I look forward to hearing the Minister’s views on these amendments, which will help us to ensure that all of us have the end-of-life experience that we would hope and wish for when our time comes.

[Lord Scriven (LD)]

My Lords, if we were having this debate about any other service in the NHS, people would be aghast. Can noble Lords imagine the response if we said that your access to dental treatment would be determined by the number of books sold; that your access to maternity services would be based on the number of jumble sales held; or that, ultimately, your access to ophthalmology would be dependent on the number of cakes and coffees sold at an afternoon party? These examples are no different from that of specialist palliative care, a service that is meant to be from cradle to grave. The unfortunate reason why the noble Baroness, Lady Finlay of Llandaff, has had to table her amendment, supported by other noble Lords, is that, for too many years, promises have been given but the services have not been delivered because the NHS does not commission parity of service across England.

I know quite a lot of people who work in the health service who are decent, hard-working and genuine, but the fact is that palliative care is seen by too many as an add-on and not central to the services they are providing. I do not blame them for that because, unfortunately, that is the behaviour that sometimes happens when the NHS does not have a mandate to provide specialist palliative care and people think that the local charity shop funds it. The noble Baroness has had to table Amendment 52 because we need to be clear about what this service is. It is not about just those last few days or weeks; it is not about just putting someone in a hospice. It is about giving psychological and medical care and support throughout a whole process to people with a life-threatening illness or who are at the end of life. This service needs to be commissioned against a clear understanding and definition of specialist palliative care.

I agree with many noble Lords: people across this country have waited far too long for access to specialist palliative care funded by the taxpayer. This does not mean that some of the charitable work would not continue, but such care should be a right and a service, funded by the taxpayer, which says that people will be looked after from cradle to grave.

Health and Care Bill

Baroness Hodgson of Abinger Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Hodgson of Abinger (Con)]

My Lords, I thank the Minister for introducing this Bill. I draw the attention of the House to my interests: I was a non-executive director of a health authority, and am chair of ISCAS, the Independent Sector Complaints Adjudication Service.

I welcome the Bill in so far as it contains changes that the NHS requested, promoting local collaboration and reducing bureaucracy. My only hesitation is how such a fundamental reorganisation will affect the NHS when it is already under such huge pressure from the pandemic.

While the Bill is mostly structural, the real test is whether it will deliver positive change for patients. I note that one of its aims is to deliver a range of targeted measures to support people at all stages of life. In the debate on 14 October, the noble Baroness, Lady Finlay, spoke movingly about hospice and social care. Can my noble friend please tell me whether the integrated care systems will have a duty to commission end-of-life and palliative care services to meet the needs of the population? I think I was told that, at present, 60% of these have to be raised from charity, which is unimaginable for other forms of healthcare. Surely, end of life is a critical and essential time when a patient needs most support.

Continuity of care is also a very important factor, especially in the care of the very young and the very old. In the debate of 14 October, I cited an article in the Times about a Norwegian study published in the British Journal of General Practice, which demonstrated the benefits of having the same GP for years. It showed that those who had the same doctor for between two and three years were about 13% less likely to need out-of-hours care, 12% less likely to be admitted to hospital and 8% less likely to die that year, rising to 30%, 28% and 25% after 15 years. It was stated:

“It can be lifesaving to be treated by a doctor who knows you.”


Yet in the UK, GP practices are becoming bigger, and the relationship between doctors and patients less constant. While patients over 75 in the UK are also given a named GP, some doctors interpret this as just having to look at patient records. While I understand that patients who wish to be seen urgently cannot always see their GP that day, how can a doctor deliver appropriate and responsible care of a patient without ever meeting them?

To deliver good healthcare and care needs good staff, and the BMA estimates that the NHS is currently facing a shortfall of 50,000 doctors. Many GP practices seem overstretched. Can we ensure that we train more GPs and change the system so that it is advantageous for them to work in GP practices rather than as locums? I know that many people now feel that they have to fight to get an appointment with a GP, or are simply unable to get one. We need to ensure that carers, both paid and unpaid, get the recognition and status that they deserve. A good carer is invaluable and we have a shortage of them too.

I hope that these changes in the Bill will ensure more focus on prevention rather than cure—reducing smoking and obesity, ensuring a better diet and other initiatives would result in a healthier nation. Health checks and screening are also important, to pick up issues such as cancer earlier, when it is easier to treat. Checks for older people are also vital to pick up issues early so that they can lead fuller lives and thus need less care—which all reduces the burden on the NHS.

Part 4 of the Bill will establish the Health Services Safety Investigations Body in statute. The impact of clinical negligence on a patient and their family can be devastating. Moreover, the costs have quadrupled in the last 15 years to £2.2 billion in 2020-21, equivalent to 1.5% of the NHS budget and eating into resources that should be available for front-line care. Surely we urgently need to find a better way to deal with these cases rather than resorting to law, which can take years to settle, putting a patient through yet more stress. I gather that nearly a quarter of the costs of clinical negligence go to legal fees.

I congratulate those who campaigned—and welcome the provisions—to make the practice of virginity testing an offence. It is a horribly demeaning process and an abuse against women. However, surely it is inextricably linked with hymenoplasty, and any commitment to ban it will be undermined if we do not ban them both together.

To conclude, in welcoming this Bill I am mindful that how we treat our elderly, infirm and ill of health is a measure of our society. We must not be found wanting.

Social Care in England

Baroness Hodgson of Abinger Excerpts

Thursday 14th October 2021 Lords Chamber

[Baroness Hodgson of Abinger (Con)]

My Lords, I thank the noble Baroness, Lady Pitkeathley, for introducing this vital debate today. With people living ever longer, looking after the elderly and infirm well is critical to the individuals, their families and our communities, ensuring that all receive the care they need and have a dignified and secure old age.

At the party conference last week, the Secretary of State urged people in need of social care to turn to families first and not always to look to the state. As has been said, that is already happening. Mothers look after disabled children, often on their own, and many people need care towards the end of their lives. In 2019, it was reported that, on average, women outlive men by about seven years. However, women often shoulder much of the care of their husbands at home, often without enough back-up and support from local services. Society simply does not recognise the contribution that many women already make in this way.

It is often reported that single people have poorer health and higher mortality rates and that, by the age of 85, over 75% of women who were married are widowed. Left on their own when their husbands die, often with no one to look after them, they then need care themselves. Too often, younger members of the family are working, based too far away to help daily, and may not be able to devote the time needed. These women needing care may then find themselves financially unable to stay in their own home, as the costs of full-time live-in care can exceed those of a care home, and they end up having to sell their home to fund their care. Surely people who want to stay in their own home should be able to.

The Secretary of State, in his speech, went on to talk about how we as citizens have to take responsibility for our health, too—all of which I agree with. Thus, having good and regular health checks is essential, leading to earlier identification of conditions and earlier interventions, which may enable people to stay at home and lead a fuller life for longer.

Of course, the role of the GP in all this is absolutely critical. Last week, there was an article in the Times about a study based on Norwegian health records, published in the British Journal of General Practice. This talked about the benefits of having the same GP for years. In Norway, all residents are assigned a named GP. The study found that, compared with a one-year patient/GP relationship, those who had the same doctor for between two and three years were about 13% less likely to need out-of-hours care, 12% less likely to be admitted to hospital and 8% less likely to die that year. After 15 years, the figures were 30%, 28% and 25%. A senior researcher at the National Centre for Emergency Primary Health Care, part of the NORCE research centre in Bergen, added:

“It can be lifesaving to be treated by a doctor who knows you. If you lose a general practitioner you’ve had for more than 15 years, your risk of needing acute admission to hospital or dying increases considerably the following year.”


Yet the model in the UK seems to be moving away from this. This appears to be detrimental not only to patients but to doctors. Most GPs I know found one of the most satisfying aspects of their job was getting to know their patients and looking after them over many years, but practices in the UK are becoming bigger, with more doctors and patients, and less of a relationship between the two.

Patients over 75 in the UK are also given a named GP, and I would like to ask the Minister exactly what their duties towards these patients should be. I hope he agrees with me that medicine should be patient-focused and not administration-focused. While I understand that patients who wish to be seen urgently cannot always see their named GP that day, should the named GP have contact with patients and their families when requested and provide continuity of care? Please can my noble friend be specific about this?

I hope the House will not mind me speaking from personal experience, because my mother suffered from lack of care from her GP at the end of her life. This was just before the pandemic took place. She had had a marvellous, caring GP for 30 years who retired. In the last six months of her life, she was transferred to a larger local practice. The named GP never came to see her or even spoke to us, even when we requested him. There was a lack of continuity of care; she saw a different doctor every time. Visit requests were refused on two occasions, even when she had fallen, hit her head, was badly bruised and her carers were asking for support; and, on another occasion, when the out-of-hours doctor said she urgently needed to be seen. The only way we got the district nurses to come, two weeks before her death, was because one of her marvellous carers actually knew them and rang them, desperate.

If my mother’s experience is the same as that of others in this situation, surely ensuring that named GPs actually attend their patients would be a good place to start, not least because, according to this Norwegian survey, it would ensure that patients stay healthier for longer and would relieve an enormous burden from the care system.

Virginity Testing

Baroness Hodgson of Abinger Excerpts

Tuesday 12th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for her question, but also for having a meeting with me to discuss some of the issues that we will debate in future weeks and months. All preparation and revision are welcome.

I give a pledge that I will push back at my department and push to have both these practices banned as quickly as possible. However, as I said, some concerns have been raised from a legal perspective, given that hymenoplasty is a cosmetic procedure. All of us would agree that this is an awful thing and that it should be banned, but I want to make sure that in doing it we are very careful. A few years ago, I was a research director for a think tank, and one issue that I always considered with any change of law was unintended consequences. We have to be clear that we do this in a proper way, and I hope that we can introduce these bans as soon as possible.

[Baroness Hodgson of Abinger (Con)]

My Lords, I join others in welcoming my noble friend to the Dispatch Box. Virginity testing is such a demeaning process and, as has already been mentioned, an abuse against women. In October 2018, the UN human rights office, UN Women and the World Health Organization issued a joint statement calling for the end of this horrid practice, saying that it was a

“medically unnecessary, and oftentimes painful, humiliating and traumatic practice”.

What is the UK doing to support the World Health Organization, UN Women and the UN human rights office to ban this across the world and to mobilise other countries to outlaw this practice domestically?

[Lord Kamall (Con)]

I thank my noble friend for her warm welcome. In answer to her specific question, the Government absolutely agree with the World Health Organization’s view that virginity testing is a violation of the victim’s human rights and is associated with immediate and long-term consequences that are detrimental to physical, psychological and social well-being—as well as, in simple terms, being demeaning.

On my noble friend’s specific question about what we are doing with the World Health Organization, I shall write to her with more details.