Healthcare (International Arrangements) Bill

Baroness Manzoor Excerpts

Committee: 1st sitting (Hansard - continued): House of Lords
Tuesday 19th February 2019 Lords Chamber

[Baroness Manzoor (Con)]

My Lords, I thank the noble Lord, Lord Patel, for moving Amendment 11 and highlighting the importance of an appropriate definition of healthcare in the Bill.

We have adapted the definition set out in the Health and Social Care Act 2012 to include the additional element of ancillary care, as the noble Lord noted. This is to reflect where current arrangements provide for ancillary costs, such as travel costs, which do not strictly fall within the definition of healthcare. This would be for use in such circumstances as in France, where residents are reimbursed with a contribution to their travel costs when attending healthcare appointments. The definition of healthcare in Clause 3 ensures that we can implement arrangements that are based on the current EU arrangements, if negotiated in future.

The noble Lord indicated that this is a probing amendment and, as a former clinician, he will understand that limiting the definition to exclude certain conditions would be inappropriate, as it is not in the UK’s jurisdiction to determine what level of access to healthcare should be provided in another country. It is up to each country to determine what is available as part of its public healthcare system, as we do here in the NHS. The government definition would enable individuals to access healthcare on those terms under reciprocal healthcare agreements. The Government are committed to ensuring access to healthcare in line with current arrangements, and that UK nationals can continue to benefit from them, as they do now.

The Government have been clear during the passage of the Bill—this alights at the heart of the noble Lord’s question—that access to social care in England would not be provided through any reciprocal healthcare agreement. However, it is worth noting that some types of treatment related to dementia care can be medical in nature and may be provided by the NHS. As the noble Lord knows, in the UK, we treat all people with any physical or mental health condition. This demonstrates the complexity of the issues that narrowing the scope of such an important definition in the Bill may afford. I hope the noble Lord, Lord Patel, will therefore agree that the definition used in the Bill is the most sensible. However, I thank him—he is a noble friend—for raising this important issue. With the assurances I have given, I hope he will feel able to withdraw his amendment.

[Lord Patel]

My Lords, I thank the Minister for her comments. I raised this issue only to make sure that whenever such agreements are made, it is borne in mind that there may be implications for other conditions not directly regarded as mental or physical health conditions; for example, an increasing number of people have dementia. On that basis, I beg leave to withdraw the amendment.

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[Baroness Manzoor (Con)]

My Lords, in Amendment 15 the noble Baronesses, Lady Wheeler, Lady Brinton and Lady Finlay, and my noble friend Lord Dundee raise an important issue on the importance of financial reporting and facilitating parliamentary scrutiny, which I can assure noble Lords that the Government are committed to ensuring. As the noble Baroness, Lady Wheeler, said, this was also the subject of Labour Front-Bench amendments in the Commons and is an issue that the Government have carefully considered. I would like to reassure the noble Baroness, Lady Wheeler, and my noble friend Lord Dundee that—as the Minister, my noble friend Lady Blackwood, set out at Second Reading—the Government are committed to openness in managing public money. I understand the desire for transparency in this area. Noble Lords can be reassured that, as indicated by the noble Baroness, Lady Wheeler, there are existing robust annual reporting processes, overseen by the Comptroller and Auditor-General, that are used today and cover reciprocal health and other departmental spending.

Expenditure by the Department of Health and Social Care relating to EU reciprocal healthcare arrangements is currently published to Parliament in the form of annual resource accounts, and this will continue. This reporting allows for scrutiny by both Houses of Parliament, as well as the Public Accounts Committee. As now, the department’s future expenditure on reciprocal healthcare will be subject to the existing government reporting requirements. However, the Government have heard the need for greater transparency in our administration and implementation of reciprocal healthcare arrangements. The Government are also committed to transparency and the prudent use of public money. This is why we have committed to going beyond the current reporting requirements.

As explained by the Minister, my noble friend Lady Blackwood, at Second Reading, the Government have committed to issuing an annual ministerial Statement on the operation of the reciprocal healthcare arrangements. The noble Baroness, Lady Wheeler, asked what this ministerial Statement would include. I am afraid that I cannot comment on that, because it is subject to any arrangements we enter into with the countries concerned. The Statement will be published as soon as is practical at the end of each financial year. It will include, but will not be limited to, reporting on the expenditure and income of reciprocal arrangements as a whole. This could include aggregated expenditure and income for the year, as well as country-by-country sums of expenditure and income. It could also provide an overview of the operation of arrangements, identifying areas of successful operation. I hope that that allays the fears that the noble Baroness, Lady Finlay, expressed. The types of reciprocal agreement entered into will determine the content of the Statement, as I said. However, I am happy to meet the noble Baroness to discuss these details further.

I hope that the noble Baroness, Lady Wheeler, and my noble friend Lord Dundee feel reassured on our commitment to ensuring that there are sufficient and appropriate checks and balances in place on reciprocal healthcare agreements and agree that it is not necessary to set out in the Bill detailed provisions on reporting. In any case, as I said, the frequency and detailed content of a financial report should and could only be determined once reciprocal healthcare agreements have been made. Currently, the UK and other EU member states are able to collect data and report both nationally as well as at EU level, as provided for in the relevant EU regulations.

The department is currently working to ensure that UK nationals can continue to access healthcare in the EU in the same way as they do now, either through an agreement at EU level or through agreements with relevant member states. In either case, we will have to agree how eligibility is evidenced, the way that and frequency with which information is exchanged and the reimbursement mechanisms that will govern these new agreements. Each of these could differ from country to country. Such agreements will have to take into account the operational possibilities and limitations of each contracting party to ensure the smooth operation of reciprocal healthcare arrangements. This should include how NHS trusts in the UK can evidence eligibility for the treatment of non-UK citizens in the most efficient and least burdensome manner. Once these administrative details are known, the Government will be able to confidently speak to the specific measures that can be reported for each country. It is therefore unnecessary to set out detailed reporting provisions in the Bill for aspects that are subject to negotiations.

It must not be forgotten, however, that regardless of the specifics of any arrangements entered into, as with all departmental expenditure, reciprocal healthcare costs are and will continue to be authorised by the Treasury supply process and included in the department’s annual estimates, as well as being included in the annual resource accounts, which, as I said, are audited by the Comptroller and Auditor-General.

The noble Baroness, Lady Finlay, raised this issue, and it was raised earlier this evening. Let me be very clear that we do not need new front-line NHS processes to charge visitors and tourists from the EU, either directly or via reciprocal healthcare arrangements. We already have processes in place for non-EU visitors. After exit day, instead of identifying EU visitors for the purposes of EHIC claims, they will be identified for the purposes of whether they are chargeable directly or covered by a reciprocal healthcare arrangement, in the same way as non-EU visitors are currently identified. They will then be charged as appropriate.

I will end by saying this. As well as the auditing that will be done by the Auditor-General, as I have mentioned, the Government have committed to lay before the House an annual ministerial Statement, which will provide an additional check and balance on the Government’s reciprocal healthcare arrangements. I hope that I have a given sufficient assurances to noble Lords, and that the noble Baroness will feel able to withdraw the amendment.

[Baroness Finlay of Llandaff]

Can the noble Baroness confirm whether she is absolutely confident that the current systems in place to pick up those coming from abroad who should not be treated on the NHS and who should be charged for their care are 100% effective? How many of those systems are not effective? I am concerned that, with a potentially increased number of people coming into the system, any system that is already not functioning well will just fall over unless more people are put in to administer it.

[Baroness Manzoor]

My Lords, no one can ever be 100% confident, but we are putting in place robust charging mechanisms. Each trust has an accountable person to look at how charging is working. We are working very closely with NHS organisations to ensure that, where charging needs to take place, it is done effectively and efficiently.

[Baroness Brinton]

I want to go back to the issue of the report. The noble Baroness read out a litany of different places where different items would be reported. Is there some benefit to having it all in one place? I do not know about other noble Lords, but I would be quite content if the annual ministerial Statement incorporated what is set out in the proposed new clause in the amendment—the information that parliamentarians think they want. But I wonder whether all parliamentarians, or anybody outside, would know all the different places to look for the odd sentence here and there in reports once a year.

[Baroness Manzoor]

I fully understand the point made by the noble Baroness, Lady Brinton. I always believe in a simplified place, but those are the accounting rules that we have for government and therefore they remain. We have gone the additional mile by saying that we will place on record a ministerial Statement at the end of each financial year and that this will include the areas I have indicated.

[Baroness Jolly (LD)]

The Minister referred to arrangements being put into NHS organisations to make this happen—but what about GP practices? If you talk to GPs, they will tell you that they are in private partnerships. Presumably the Government are talking to the Royal College. The last time I had a conversation with GPs was five or six years ago, when they were totally averse to collecting money for their services. Can the Minister clarify whether things have changed?

[Baroness Manzoor]

I can clarify that NHS trusts are funded on the basis of existing agreements and will provide additional funding for any new agreements reached within the powers of the Bill. The same thing will apply to GPs where charges need to be made for people who are not entitled to that care and do not fall within the reciprocal arrangements that we have in place. The procedure would apply as it currently applies and such people would be charged as appropriate. If they are part of the reciprocal agreements that we have, whether bilaterally or multilaterally, such charges will not be incurred.

[Baroness Wheeler]

I thank the Minister for her response. Whichever way you look at it, it is a complex system for reporting information across a wide range of different sources. The point made by the noble Baroness, Lady Brinton, about having the information in one place as part of the ministerial Statement needs to be pursued, and I hope that the Minister will do that. I noted her agreement to discussing it or exchanging correspondence about it, but important matters need to be set out in the ministerial Statement—albeit that the information is presented elsewhere—in order to reassure and inform us about how these agreements are working. With that proviso, I withdraw the amendment.

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[Baroness Manzoor]

My Lords, I am grateful to the noble Baronesses, Lady Thornton, Lady Brinton and Lady Finlay, for tabling Amendment 16 and providing the opportunity to address two important issues: the processes we have in place to recover costs from overseas visitors and how we support the NHS to deliver services to people covered by reciprocal healthcare agreements. As the noble Baroness, Lady Finlay, noted, there is complexity in the system, but this amendment proposes a new obligation upon the Secretary of State for Health to provide sufficient funding to the NHS to administer reciprocal healthcare agreements implemented using the powers in the Bill.

I reassure all noble Lords that the Government are committed to ensuring that the NHS is funded and fit for the future. Through the NHS long-term plan and the historic commitment of an extra £20.5 billion a year, we are working to make sure the NHS is fit for future patients, their families and NHS staff.

The noble Baronesses, Lady Brinton and Lady Finlay, raised two issues. They asked whether there will be 27 different agreements that require implementation. Our intention is to reach agreement with the EU so that there will be one agreement to implement. If agreements are negotiated with individual countries, it will depend on the content of the agreement being implemented, but I stress that we do not need new systems to implement them. We are not expecting costs to be much greater than at present. Every hard-working taxpayer plays a part in supporting our much-loved NHS, so it is only right that overseas visitors also make a contribution to the health service, whether that be individually, through the immigration health surcharge or through their Government reimbursing the treatment costs incurred.

The NHS has been responsible for delivering the current reciprocal healthcare arrangements for as long as they have been in operation and it has been sufficiently resourced to do so. Funding is distributed to NHS providers as part of general allocations. These support all the administrative costs associated with patient care, not just any costs associated with administering reciprocal healthcare agreements. That applies to clinical commissioning groups, which then apply funding to GPs.

We have robust administrative processes in place to recover costs from overseas visitors. These are managed by overseas visitor managers and their teams, who identify whether visitors are chargeable or are directly covered by an existing reciprocal healthcare arrangement.

Perhaps I may further reassure noble Lords that there are benefits for NHS providers who deliver services to those currently covered by EU reciprocal healthcare agreements. NHS providers receive an EHIC incentive payment of 25% of the tariff for the treatment provided to an overseas visitor covered by an EHIC. Trusts can reinvest these incentives in front-line services, meaning that we can continue to protect the most vulnerable in society and ensure that everyone receives urgent care when they need it. This is a scheme that we would certainly want to continue.

The Government have also made significant progress on charging overseas visitors and recouping funds where appropriate. However, as I indicated on the previous amendment, we want to go further—we are not quite there yet. Since 2015, we have increased identified income for the NHS with reciprocal arrangements by 40% and directly charged income has increased by 86% over the same period. Although we are satisfied that we are moving in the right direction, as I said, there is more to be done. That is why we are working with NHS Improvement to drive further improvements in the practice of cost recovery. A bespoke improvement team is working with over 50 NHS trusts to provide on-the-ground support and to share best practice.

I understand and commend the spirit behind this proposed new clause—we all want to ensure the best for our NHS—but it seems that it would replicate existing duties on the Secretary of State for Health. As the noble Baroness is aware, the Secretary of State is under an existing duty to promote a comprehensive health service, available to all who need the support that it provides. This duty encompasses ensuring that the NHS is funded for the services that it provides. Funding to provide treatment for overseas visitors is, and will continue to be, distributed to NHS providers as part of general allocations.

Further, I reassure noble Lords that any future reciprocal healthcare agreements that the UK implements through this Bill will be subject to thorough consideration and will need to take into account the existing duties on the Secretary of State to promote a comprehensive health service available to all who need the support that it provides.

I hope that my explanation has provided further reassurance to noble Lords that the Government are absolutely committed to protecting the NHS, and that the noble Baroness, Lady Brinton, will feel able to withdraw the amendment.

[Baroness Brinton]

I am grateful to the noble Baronesses, Lady Finlay and Lady Thornton, for their contributions to this brief debate, and indeed to the Minister for her response, even though I am somewhat disappointed by it. The point that all three of us were trying to make is that we are asking not for new processes but for reassurance that the costs will be reimbursed to trusts. As the Minister said, there is a general allocation, and one thing that we have discussed repeatedly since Second Reading is that there is a strong likelihood of substantially more non-EEA-type payments if there is a no-deal Brexit or if there are loads of different reciprocal arrangements that will make life very complex for hospital trusts and primary care providers.

As a brief illustration, currently when a non-EEA patient pays, half of it goes to the commissioner and half goes to the trust. The commissioner then pays half of it back to the trust and so it goes on. It is a complex arrangement. If we suddenly have 27 different arrangements just to cope with life after the EEA or with a no-deal Brexit, I can see that it will be very complex. It would be easy for NHS England—and, indeed, the Government—to miss trusts being unable to cope with the deluge of different arrangements they have to support.

At this stage, this is very much a probing amendment. I am happy to withdraw it this evening but I reserve the right to bring it back in the future. I beg leave to withdraw the amendment.

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The final element I want to speak to is that of non-NHS providers. This is rather important, because a number of non-NHS providers provide healthcare on behalf of the health system. It is not just the obvious ones that have been mentioned—I include GPs in that. It might also be private bodies carrying out NHS-funded care. A lot of diagnostic care is carried out by third parties. It might also cover providers of healthcare IT that records data. If we think of such systems as TTP, Cerner, Epic and so on that are used in hospitals, we would clearly want those bodies to be legally able to share that information. Of course, it needs to be connected with the healthcare purpose, but it is important that the Bill allows for that kind of latitude in a variety of ways, as I said. We must be absolutely clear—that is what I am seeking from my noble friend—that because of GDPR, because of the need and demand for adequacy on behalf of another country, a reciprocal partner, we would not be entering into the kind of arrangements that would bring the kinds of concerns that the public and, indeed, parliamentarians would have.

[Baroness Manzoor]

My Lords, I thank the noble Lords, Lord Patel and Lord Kakkar, even though the latter is not here, for Amendment 22, the noble Baroness, Lady Jolly, and the noble Lord, Lord Clement-Jones, for Amendment 23, the noble Baroness, Lady Thornton, for Amendment 24, and the noble Lord, Lord Patel, for Amendment 25. Each amendment allows me to speak to strict data processing protections in the Bill.

As my noble friend Lord O’Shaughnessy said, data processing is an important element of operating effective complex reciprocal healthcare arrangements, such as the current arrangements we have with the EU. I reassure noble Lords that the Government are committed to the safe, lawful processing of people’s data in healthcare. Clause 4 provides a lawful basis for the processing of data in respect of future reciprocal healthcare arrangements that are outside the EU regulations mechanism. Data processing will be permitted only for the limited purposes set out in the Bill.

Under the Bill, personal data can be processed only in accordance with UK data protection law, namely the Data Protection Act 2018 and the general data protection regulation, which will form part of UK domestic law under the EU withdrawal Act 2018 from exit day. The purpose of including data provision in the Bill is to provide a transparent basis for the processing of personal data for the purposes of funding or arranging healthcare abroad. That is it, my Lords.

On this point, I address Amendment 22, tabled by the noble Lords, Lord Patel and Lord Kakkar, which would limit the scope of personal data processed to data directly related to health. Although I appreciate the sentiment behind the amendment, it would unfortunately undermine the successful operation of reciprocal healthcare arrangements. Personal data is defined in the GDPR as data relating to a living person who can be directly or indirectly identified from that data. Examples include someone’s name, date of birth or residential address.

For example, the current European health insurance card scheme allows for UK nationals to access emergency and needs-arising care when travelling, working short-term or studying in the EU. To establish someone’s eligibility for an EHIC, we need first to establish that the person is living in the UK on a lawful basis and properly settled. Were persons authorised under the Bill unable to process data other than that strictly related to health, they would be unable to make the checks to ensure that those receiving healthcare abroad were entitled to it. Allowing authorised persons to process non-health-related personal data also ensures that we can prevent misuse arrangements and limit fraudulent activity.

The noble Lord, Lord Kakkar, and others, expressed concern at Second Reading that provisions in the Bill must not open the door to the mishandling of patient data. I believe that this is what Amendment 24, tabled by the noble Baroness, Lady Thornton, is intended to address. I absolutely agree with the sentiment. I should like to set out why we think that it would prevent the successful operation of future reciprocal healthcare arrangements. They are made possible by the close co-operation of different parties and bodies, such as the Department of Health and Social Care, commissioners of Her Majesty’s Revenue and Customs, Ministers of the devolved Administrations, healthcare providers and their opposite numbers in other EU and EEA countries. The Bill is about the provision of healthcare. It must include all possible healthcare providers who may provide NHS care in the UK in the list of those with authority to process data for the purposes of implementing arrangements under the Bill—just under this Bill.

It is also worth reflecting on the place of healthcare providers in the current EU arrangements to illustrate the vital role that they play in both the commission and delivery of healthcare abroad. Currently, under the planned treatment route, known as the S2 route, a UK resident may decide to seek planned treatment abroad. As part of the procedure, the UK resident must visit a healthcare provider in the UK to have such treatment authorised. The clinician will provide written evidence that the person has had a full clinical assessment, which must clearly state why the treatment is needed in the person’s circumstances and what the clinician considers to be a medically justifiable period within which they should be treated—again, based on their circumstances.

Under existing arrangements, this function can be served only by a medically trained healthcare provider. This paperwork is then passed to NHS England or the comparable authority in the devolved Administration—that answers a point made by the noble Baroness, Lady Finlay—for processing. Many of these persons are provided for by Clause 4(6)(b), which refers to NHS bodies. However, some NHS services in England are provided by non-NHS bodies, as was rightly pointed out by my noble friend Lord O’Shaughnessy. For example, some primary care providers, such as GPs, may not be captured by this list of NHS bodies. However, they could be involved in pre-authorisation for planned treatment and so would need to process data in that regard. Such providers not also being termed “authorised persons” may limit what reciprocal healthcare arrangements we could implement under the Bill; it could even prevent us fully implementing an agreement. Under existing arrangements governed by EU regulations, some private providers in the UK already process patient data, which is perfectly legal and proper. Of course, data protection safeguards apply to private providers too.

To further allay any other fears, I remind your Lordships that this clause contains protections to guard against any misuse of data. The persons who can process data for the purposes of the Bill are limited to “authorised persons”—quite rightly, as the noble Lord, Lord Patel, said. The list of such persons can be amended only by way of statutory instrument; the term cannot just be given automatically to anyone. The Government included a delegated power in Clause 4(6)(e) to amend this list because future arm’s-length bodies may need to process personal data to enable reciprocal healthcare arrangements to operate effectively. Amendment 25 in the name of the noble Lord, Lord Patel, would limit that ability. I appreciate that that is out of concern for the safety and security of patient data—a sentiment I share totally—but the amendment would undermine the successful operation of future reciprocal healthcare arrangements.

As the noble Lord knows, the existing reciprocal healthcare arrangements are part of a complex web of systems. They rely on the well-spirited co-operation of a number of parties and bodies, which share accurate and relevant data in a prompt fashion. That extends from patients themselves all the way up to healthcare providers and public sector administrators. In time, public bodies change: they are reformed and refashioned, and functions are transferred between them in consequence. Clause 4(6)(e) gives the Secretary of State powers to respond to such changes.

Again, I assure the Committee that the Government are committed to the safe, lawful and responsible processing of people’s data, both now and in future. In doing so, I address Amendment 23 in the names of the noble Baroness, Lady Jolly, and the noble Lord, Lord Clement-Jones, which honourably seeks to include further principles for the safe processing of data in the Bill. As the noble Baroness, Lady Jolly, and my noble friend Lord O’Shaughnessy noted, the Caldicott principles and the Government’s Data Ethics Framework are admirable standards to apply to the handling of patient data. Both of these non-legislative frameworks are in line with the Data Protection Act and the GDPR, which are enshrined in the Bill.

As has been said, data processing is an important element of operating effective complex reciprocal healthcare arrangements, like our current arrangements with the EU. Before I move on, I will answer a couple of the questions asked by the noble Baroness, Lady Thornton, about the Commons data briefing. I understand that officials met Julie Cooper MP, although I am not clear about the written briefing. However, I will pass the issue on to the Minister and bring it to his attention.

I have already covered data protection in the devolved Administrations, which would have to apply under both the GDPR and the DPA 2018. Of course, I would be happy to meet noble Lords should they wish to discuss those issues any further. My noble friend Lord O’Shaughnessy is right to say that we cannot enter into reciprocal agreements if the other country does not meet our data protection standards.

In the light of the assurances I have given and the safeguards in place to protect people’s information, I hope the noble Lord feels able to withdraw his amendment.

Obesity

Baroness Manzoor Excerpts

Wednesday 18th July 2018 Lords Chamber

[Lord McColl of Dulwich (Con)]

My Lords, I say at the outset how much I am looking forward to the maiden speech of the noble Baroness, Lady Boycott, with all her expertise. We hope to hear a lot of her expertise in the years to come.

I start by recounting the story of Labour’s deputy leader Tom Watson, which he recently broadcast in the media. He explained that he was 51, very overweight and had tried many diets. When he started looking into the problem, he realised that all the advice given by the authorities was completely wrong. His research showed that he needed to cut down radically on sugar and starchy carbohydrates, and find ways of getting fat into his diet. Fat stops one feeling so hungry during the day. He also overcame his craving for sugar. This regime resulted in him losing seven stone, or 39 kilograms.

What Mr Watson rediscovered was what had been well known during the war. In 1939, one-third of the British people were either underfed or fed on the wrong food. Food rationing cured that rapidly. For the first time, people had the right quantity and right kind of food. There was no obesity then because they ate food that satisfied them: food they had to chew, including wholemeal bread with plenty of dripping on it—there is nothing wrong with fat, except saturated fats. Also, of course, there was very little sugar and less starchy food. I should explain that when we eat fat it leaves the stomach and goes into the duodenum, releasing a hormone which specifically delays the emptying of the stomach and makes one feel full. Hence, it limits the amount we eat. After the end of rationing in the 1950s, the food industry wished to increase its sales and profits. Realising that it was not selling a great deal of food and that fat was actually a brake on how much people ate, it decided to demonise fat and encourage carbo- hydrates. A low-fat, high-carbohydrate diet is pretty tasteless because it is fat that gives it the taste. The industry had to add large quantities of sugar so that people would eat it, and so began the obesity epidemic.

Another story I would like to tell is of a Member of your Lordships’ House who was paralysed and in a wheelchair. Being overweight, he decided to take three stone of weight off. He could not exercise and so decided on a really revolutionary way of losing weight. He lost three stone simply by eating less. Politicians and that organisation, NICE, have repeatedly stated that all the calories we eat are expended on exercise. This simply is not true. Only a fraction of the calories we eat are used up on exercise. Anyone who disputes this can go to the gym and exercise on one of the machines for half an hour. If they slave away and look at the dial to see how many calories have been used up, it will be about 300 calories in half an hour. That is what one gets from a small bar of chocolate.

The press and the media have been very helpful in the last year or two in drawing attention to the real cause of obesity, which is putting too many calories into one’s mouth. Many people find it difficult to eat less, so it is probably worthwhile looking at preventable problems that make obesity more likely. A lady of 42 with an eating disorder gathered together about 45 other ladies with a similar condition to see whether they could help one another with their problem. When they went round telling their stories, they had all been sexually abused as children. That is of course an anecdote—anecdote being Greek for “unpublished”, which is arguably what most anecdotes should remain—so let us look at science.

An excellent paper published by Danese and Tan in 2014 demonstrated without doubt that the maltreatment of children is associated with a substantial elevated risk of developing obesity. There is so much domestic violence and sexual abuse of children that a greater drive on reducing these risks might also help to solve the obesity epidemic. There has also been a suggestion that as mothers increasingly work outside the home, that may lead to families increasingly relying upon ready-made junk food, which never satisfies hunger and therefore leads to people eating far too much of it and hence obesity. This may be an important contributing factor.

Some elements of the food industry have made an effort to stem the obesity epidemic. The late Professor Terence Wilkin produced some very good scientific work, which clearly showed that obesity leads to inactivity but that inactivity does not lead to obesity—so do not call children couch potatoes. When one examines the genetics of all this, it is not a question of simple inheritance. It has been shown that the children of obese parents are six to 10 times more likely to be obese but, even then, it is not inevitable that they will become so. They will become obese only if they put too many calories in their mouth. There are some medical conditions which affect appetite but none that directly lead to obesity. The tendency towards obesity looks as though it is established early on in life, long before children go to school. As Professor Wilkin stated, this questions the rhetoric around school meals, computer screens, playing fields and of course physical activity, which is fairly unstructured in early childhood.

It is important to restate that physical activity is important for mental health, the heart and the body’s general well-being and functioning. But I hope the Minister will finally put to rest the repeated statements from the Department of Health and Social Care and elsewhere, saying that obesity can be solved by increasing activity and diet. They link those two but only a fraction of the calories we eat are used up in exercise. In their advice, exercise and diet should not be coupled together. They should be separated, not put in the same sentence.

The obesity epidemic is probably costing £30 billion a year. Saving on that would be a great help to the NHS. This whole subject has been bedevilled by, first, the food industry demonising fat and promoting sugar and carbohydrates—by the way, among five to eight year-olds tooth decay is far and away the leading cause of hospital admissions, which are mainly caused by excessive sugar consumption. Secondly, there is the false statement that all the calories we eat are expended in exercise, when only a small fraction are, as I said before. Thirdly, there is blaming and insulting other people, such as calling children couch potatoes when in fact inactivity does not lead to obesity.

Fourthly, there is the nonsense of skimming milk. Skimmed milk is so tasteless that sugar has to be added to get children to drink it. There is no need to skim milk. Eight thousand children in Canada were given whole milk from birth until the age of eight; their calcium metabolism was good and they were not fat but very healthy. Whole milk can actually reduce the incidence of stroke, as in the work published quite recently by Professor Otto in Texas. Human breast milk contains 3.5% fat, as does cows’ milk. I do not think they have started skimming human breast milk yet but you never know.

A fifth part of the department’s advice was to have only two eggs a week. There is no scientific basis for this at all. You can have an egg every day if you want. The sixth thing was that GPs were told not to call patients obese because it was judgmental. There is a difference between being judgmental and making accurate diagnoses. Seventhly, psychological reasons may have a role in obesity but we do not quite understand how.

What is the answer to all this? It is an all-out campaign involving every man, woman and child, every institution, school, university and government department to try and reduce the obesity epidemic.

I believe that the Department of Health and Social Care is moving in the right direction. The idea is not to tell people what to do but to tell them the truth—not in a patronising way, as in the old days, when at 7.50 every morning, at breakfast time, you turned on the radio and the radio doctor would say, “I’m the radio doctor and I’m going to talk about your bowels”. The answer to that was to switch the thing off, saying, “We’re not having bowels for breakfast”.

There have been some very good programmes such as “The Archers”, “Horizon” and many others, which have been very professional in promoting preventive medicine. In a recent campaign against AIDS—

[Baroness Manzoor (Con)]

May I remind the noble Lord that he needs to wind up, because this is a timed debate? I am so sorry.

[Lord McColl of Dulwich]

I was just going to say that there was a successful campaign against the AIDS epidemic, run by the present Lord Speaker when he was Secretary of State for Health. Why was it so successful? Because he was honest and straightforward, and did not beat about the bush. He said, “Don’t die of AIDS. AIDS is lethal”. That is how we need to fight the obesity epidemic, which is killing millions and costing billions. The cure is free. Eat less. Put fewer calories into your mouth. We must do this: we owe it to our children.

[Baroness Manzoor]

My Lords, to assist the House, before the next speaker starts may I remind all speakers that when the clock strikes five minutes, time is up?

The NHS

Baroness Manzoor Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Darzi of Denham (Lab)]

My Lords, in opening this debate, I declare my interest. I am a practising surgeon in the NHS at St Mary’s Hospital, Paddington, and the Royal Marsden and am the chair of surgery at Imperial College. I proudly sit as a non-executive director of NHS Improvement. Over the past 10 months, I have led an independent review of the health and care system with the Institute for Public Policy Research.

As a surgeon and a former Health Minister, it is a great honour to speak in this place to mark the 70th anniversary of the National Health Service. The NHS is this country’s most treasured institution. It touches our lives at times of the most basic human need when care and compassion matter most. This is a time for reflection to celebrate the institution and give thanks to NHS staff for their service to our nation, and to look to the future.

The NHS is the expression of the moral principle that no one should be denied healthcare because of their means—the idea that the provision of healthcare should be based on need and not the ability to pay. Most people alive today cannot recall the time before the health service was created. With each passing year, the number of people who can recall the pre-NHS era recedes, but if we are to secure its future we must never forget what preceded it.

A friend recently told me the story of his family. His parent worked in the textile mills in Lancashire that have long since disappeared. In the simple kitchen there were two sugar bowls. One was for the sugar and the other for the doctor. It was where they would save a penny or two whenever they could so that, if any member of the family got sick, they could pay for a visit to a doctor. Fear of falling sick was a normal part of daily life in Britain. Illness was the surest path to poverty and destitution, not just for the individuals but for whole families. The founding of the NHS took that fear away for millions and it is a fear that those of us born since have never known and can only imagine.

The NHS was the greatest achievement of the post-war Labour Government. We owe an eternal debt of gratitude to Nye Bevan for his vision, passion and determination to establish the health service. He memorably described the NHS as taking the place of fear. It remains one of the most extraordinary achievements of any society anywhere in the world. It is on occasions such as the 70th anniversary that we must make and remake the case for comprehensive, universal healthcare, free at the point of need for all.

Never let anyone tell you that we cannot afford the NHS. The moral principle of universal access to healthcare is shared by all people everywhere. Those countries that have made it a reality have done so in different ways, but by far the most efficient, dignified and lowest cost is to create a universal service free at the point of need funded by taxation. Private insurance and social insurance systems are much more costly. Those who argue that we cannot afford the NHS are seriously wrong. It is a fundamental error of logic to say that something is unaffordable so we should make the move to something more expensive.

The NHS is funded by us all. It serves each of us and it reflects the best of us. The health service employs 1.5 million people across the four nations of the United Kingdom—that is 5% of all working people in our country. The NHS is its people, not only the doctors and nurses but clinicians of all kinds and the porters, cooks, cleaners and, yes, the vital managers and administrators too. Spending a day working as a porter in the NHS was one of the most illuminating moments of my career. Every member of Team NHS matters. Every one has a contribution to make and each is valuable. I pay tribute to the NHS employees of today who are my colleagues, and to the NHS staff of previous generations. On this day of thanksgiving, we owe them a lasting debt of gratitude.

I have worked in the NHS for longer than I have been a citizen of this country. In a time of great anxiety, I pay a special tribute to the citizens of other countries who have helped to build our NHS throughout its existence and remain the backbone of it today. From the Windrush generation to the European citizens and nationals of every race and creed, from every corner of the world today, they have made an immeasurable contribution. Let that never be forgotten.

NHS staff work at the frontiers of innovation because healthcare exists at the limits of science. This country is a scientific superpower with an extraordinary record of discovery and invention, yet in recent years we have fallen behind on investments in R&D. R&D is the engine of innovation yet R&D spending as a share of GDP has been falling while our competitors have invested more. We need a new commitment to be at the top quartile of advanced countries for R&D investment. The future prosperity of our country depends on it.

Many of the most important medical discoveries took place in this country, often through partnership between the NHS and the universities. No matter the challenges, we are constantly finding new ways to treat disease and soothe pain and suffering. That means that high-quality care is constantly a moving target: to stand still is to fall back. What energises NHS staff is relentlessly improving the quality of care they deliver to their patients. In my review of the NHS with the IPPR we found that, on a wide range of measures, the NHS has maintained and improved the quality of care it provides. Fewer people are harmed and more people are cured than ever before. There is a huge amount to celebrate and to be proud of, yet we should frankly acknowledge the difficulties the health service has faced. The past decade has been the most austere since the health service was founded. Waiting times have risen considerably and the system has been subject to needless destructive reforms. The NHS is not failing, but it is fragile.

A properly funded NHS is the foundation on which a fair, cohesive and inclusive society is built, so the new funding settlement announced by the Prime Minister, the Chancellor and the Secretary of State for Health is very welcome. My friend the noble Lord, Lord Prior, and I, together with the IPPR, recommended a 3.5% annual funding increase: the Government came close, with 3.4%. However, the settlement did not include public health, capital investment or education and training. Each of these is vital and the Government must now deliver on them too.

Securing the NHS is an eternal task. It is no more perfect than life itself. That is why new investment must be joined with reform. Together with the noble Lord, Lord Prior, and the IPPR, I set out a 10-point plan for a 21st-century NHS. At its heart is a new vision, what we call “neighbourhood NHS”, where services are organised around groups of patients with broadly similar needs, rather than groups of professionals with broadly similar skills. We argue that there should be a new option for single integrated care trusts, able to take responsibility for all the health and care needs of a population.

Warm words on mental health must be followed by bold actions. Parity of esteem should mean parity of service. Bringing care closer to people is a crucial principle for a modern NHS, yet for too long the NHS has said it would invest more in care closer to people yet continues to do the inverse of its stated strategy. Each year we say that resources will shift and each year they flow upwards towards hospitals rather than outwards towards communities. That is why we must lock in more spending on primary, community and mental health services each year in the decade ahead.

As we celebrate the past on this anniversary day, we must also look to the future. It is our duty to seize all the technological opportunities that this new era offers. There must be a tilt towards tech to create a digital-first health and care system. That will demand investment in digital infrastructure, improved data sharing and embracing full automation. Many people fear that automation will destroy jobs, but it is much more likely to reshape them by taking away mundane tasks that fill most of our time working in the NHS. This will release more time to care and give more space for clinical reasoning, for research and for innovation.

I have spent decades developing robotic surgery. The robots have yet to replace me, but they have helped me deliver higher-quality care to my patients. For all these improvements to happen, we need a radical simplification of the system. It has become impossibly complicated and is in desperate need of change. I therefore welcome the Prime Minister’s commitment to bring forward legislative change. Tinkering at the edges will not be enough: we need fundamental reform. Above all else, we need to confront the great social challenge of today, which is social care, as we heard earlier.

When the NHS was founded, life expectancy for men was 66 and for women it was just 71. Today, it is 79 and 83 respectively. Today, one-quarter of NHS beds are occupied by patients who are medically fit to go home, if there were good enough support for them. More than £3 billion a year of NHS money is wasted by delayed transfers or transitions of care. If Bevan were designing the health service today, it is unimaginable that he would have excluded social care. We must now extend that simple, noble, brilliant principle of care based on need rather than the ability to pay from the NHS and apply it to social care.

Social care reform has become the third rail of British politics: any politician touching it swiftly expires. Between now and 2030 the number of people over the age of 65 will increase by about one-third and the number of those over 85 will nearly double. At the same time, the working-age population will increase by just about 3%. If we do not act now, a heavy burden will fall on families to take care of their relatives. Since 2010, social care has been slashed. Despite rising demand, state social care has plummeted by 27%. That does not mean that less care has been provided. There has been a dramatic rise in informal care. Critics will argue that the older generation should contribute more of their wealth to pay for social care, particularly the wealth locked up in housing, but tying social care reform to the thorny issue of wealth inequality and taxation is wrong. If we make that hurdle for social care reform, there will be no progress at all. Surely, the level of personal wealth is a better basis for wealth taxation than the need for social care.

Better social care means that families spend less time on functional tasks and more time on relationships. If we want a less lonely and more dignified future for our ageing society, now is the time to act. There could be no better birthday present for the health service. It has been a privilege for me to open this debate, but it has been the greatest honour of my life serving the National Health Service for nearly 30 years. In 30 years from today I hope to see the NHS’s centenary. It is a great comfort to know, for me just as for all of us, that the NHS will be there to provide care and compassion when it matters most.

[Baroness Manzoor (Con)]

My Lords, to assist the House, I say that Back-Bench speeches are limited to four minutes so, when the clock strikes four, time is up.

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[Lord Mawson (CB)]

My Lords, I thank the noble Lord, Lord Darzi, for introducing this important debate. My colleagues and I have been at the cutting edge of the integration agenda for 35 years now. We are today generating a national and international movement and infecting the NHS culture. This year we have welcomed leaders from 23 countries across the world to see our work. Today I am taking our experience to 10 cities and towns in the north of England, through the Well North programme, which I have been asked to lead by the CEO of Public Health England. I declare my interests.

If we are to have an NHS in 70 years’ time, we suggest the following steps, based on hard-won practical experience. First, we must return to the fundamental question raised by the Peckham experiment in 1948, “What is health?”. The NHS closed this project in 1952, saying that its services would now be delivered by the NHS. It was wrong. Some 50% of our patients today do not have a biomedical problem: they have a housing, education or employment problem, or they are lonely. I am finding similar numbers in communities in the north of England. The Bromley by Bow Centre is Peckham mark II, but this time with a business plan.

Secondly, we should stop building health centres. Today we offer a vast array of services to our local community and our 40,000 patients. They stretch from conventional healthcare for local residents to opportunities to set up your own business, from support with tackling credit card debts to help with learning to read and write and help up the career ladder. We should stop building health centres, but that is not to denigrate clinical health. On the contrary, we need to position clinical health within a broad range of services to drive well-being in communities.

The list in this debate question is far too limited. We need to create a locally blended offer, where doctors sit alongside others, including patients and local residents, to provide what people need. It is healthier for doctors. Our health centres are more like a John Lewis store, where the customer is welcomed in and a host of choices are laid before them. The people who run successful department stores know that a diverse product range makes complete sense for the customer and financial sense for the business. You can capture the customer and have an opportunity to offer myriad products and services. It is the same principle in integrated holistic centres, where health is about life and living, not just disease and illness. It is about sweating our community assets. This approach would create benefits and savings across a range of Whitehall departments, not just the Department of Health.

We are working with our partners to build two new town centres in Rotherham and Stocksbridge, just outside Sheffield. The retail sector is challenged at the moment by the internet, but there is a real opportunity to rethink what a town centre is and to put the heart back into it. We will require flexibility and imagination from the NHS and other government departments.

Thirdly, over the years we have developed many innovations that have quietly gone national. The latest is the social prescribing movement which we founded in Bromley. It is now in 20% of GP practices nationally and 80% in Tower Hamlets; there is a network of 2,000 social prescribers across the country. Social prescribing should be the norm in every practice, because it focuses on what matters to patients rather than what is the matter with them. It also ensures maximum engagement with patients in managing their own health. Let us unleash healthy communities.

Finally, there is too much focus on beds and hospitals rather than on early intervention. People believe that the NHS will solve their health problems; often it will not. We are breeding a massive dependency culture through an institution that I would suggest is far from well. Let us be honest. It is not lack of resources that is the problem, but what we have chosen to focus on. I fear more of the same. What happened to the five-year plan? It is time to be more radical. Let us drop the sentimentality about the NHS and return to the fundamental question: what is health in the modern world for our children, in a society that is increasingly atomising? I agree with the noble Lord, Lord Darzi. It is time for fundamental reform, based not on sentiment, theories or ideology but on practical innovation and experience on the ground—and it cannot be led simply by the vested interests of the medical profession.

[Baroness Manzoor]

My Lords, we must keep to time, otherwise noble Lords at the end of the debate will not get their full four minutes.

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[Lord Colwyn (Con)]

My Lords, I welcome the debate of the noble Lord, Lord Darzi. I must also declare my 40 years in the NHS and that I am a fellow of the British Dental Association.

In 1948, the nation’s dental health was in a worse state than that of defeated and occupied Germany; decay and gum disease were rife and more than three-quarters of the adult population had complete dentures. The creation of the NHS meant that, for the very first time, dental care was free at the point of use and the demand was overwhelming. By late 1948, more than 80% of practising dentists had signed up to work in the NHS and, in the first nine months of its existence, NHS dentists provided over 33 million artificial teeth, performed 4.5 million extractions and put in 4.2 million fillings. By 1951, the NHS started running out of money and so charges for dentures were introduced—the first charges of any kind for NHS treatment. This controversial move caused much debate and led to the resignation of Aneurin Bevan. Charges for other types of dental treatment soon followed and, to this day, dentistry remains the only part of the NHS that is not free at the point of use.

NHS dentistry today looks very different from the way it did 70 years ago. Modern technology means that dentistry today is relatively pain free compared with the dentistry of the past. Our nation’s oral health continues to improve and most of us keep at least some of our own teeth past the age of 85. Satisfaction with NHS dentistry is at a record high. Despite an estimated 10 million adults in the UK reporting dental anxiety and 6 million experiencing dental phobia, 85% of patients rate their NHS dental experience as positive.

We cannot, however, afford to be complacent. Although oral health on average is steadily improving for the general population, there are still unacceptable variations in outcomes, depending on where you live. Almost half of five-year-old children living in places such as Pendle, Rochdale or Burnley have tooth decay, but a mere 5% are affected in Waverley or Guildford. Tooth decay remains the leading reason for hospital admissions among young children, despite being almost entirely preventable—a scandal in 21st-century Britain. Increasingly, there are also problems with access to NHS dentistry in many areas. A recent BBC investigation revealed that only 52% of dental practices were able to accept new NHS patients. Almost half of all adults in England—a total of 21 million people—have not seen an NHS dentist for over two years.

The reasons for that can be traced back to two main problems: the lack of funding and a failed dental contract. NHS dentistry has been chronically underfunded in recent years. Nominal spending on dental services per capita fell from £41 in 2013 to £36 in 2017. This drop is even greater if we take into consideration inflation and the rising cost of dental materials. At the same time, patient charges in England have increased at an unprecedented pace—a 5% rise each year for the past three years. Data shows clearly that this fee makes many people delay going to the dentist until the problem has escalated, ultimately requiring more expensive treatment.

The second reason for problems with dental access and rising inequalities in England is the way that dentistry is commissioned. The failed NHS dental contract effectively sets quotas on the number of patients a dentist is able to see on the NHS.

[Baroness Manzoor]

I am so sorry. We are running late and have to go to the next speaker.

[Lord Colwyn]

I have only one more sentence. It has led to such low morale in the workforce that 58% of dentists are looking to leave the NHS in the next five years.

Long-term Plan for the NHS

Baroness Manzoor Excerpts

Tuesday 19th June 2018 Lords Chamber

[Baroness Walmsley (LD)]

My Lords—

[Baroness Manzoor (Con)]

It is the turn of the Liberal Democrat Benches.

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[Baroness Hollins (CB)]

My Lords—

[Baroness Manzoor]

My Lords, it is the turn of the Cross Benches.

[Baroness Hollins]

My Lords, there is much concern in this House about social care. Can the Minister confirm that the now-promised social care plan will address not only the needs of older people but the needs of all vulnerable people of all ages? It is a little-known fact that the cost of meeting the needs of people with learning disabilities will soon overtake the cost of care of the growing number of older people. It is really important to address that.

--- Later in debate ---

[Baroness Ludford (LD)]

My Lords—

[Baroness Manzoor]

My Lords, we have plenty of time. It is the turn of the Lib Dem Benches.

[Baroness Ludford]

My Lords, further to the question from the noble Lord, Lord Davies, is it not true that the OBR forecast budget deficit is twice our net EU contribution? We will also be making continuing payments for participation in EU programmes and agencies, let alone the £39 billion divorce Bill. Is not the Brexit dividend claim on the No. 10 website—which is a government website, not a Tory Party website—a breach of the Government’s duty to ethics, truth and accuracy?

NHS: Deficit

Baroness Manzoor Excerpts

Wednesday 22nd November 2017 Lords Chamber

[Lord O’Shaughnessy]

As the noble Baroness pointed out, additional spending is going in. I should point out that the proportion of public spending on health has increased under this Government, so even while fiscal retrenchment has taken place, more money has been spent on health. On the idea of a cross-party convention, we talk about building a cross-party consensus on social care with the Green Paper that will come out in due course. We need to focus on action. The danger with conventions and commissions is that they just prolong the process of making decisions, whereas moving ahead with decisions on both integration in the NHS and getting consensus behind reforming social care is the way forward.

[Baroness Manzoor (Con)]

My Lords, does my noble friend agree that there is nothing to prevent NHS organisations, acute services and social care working together? There are no barriers and that can be done currently. Therefore, having a commission that will prolong things is not necessary. We must exclude any barriers that exist now.

[Lord O’Shaughnessy]

My noble friend is absolutely right: there are no barriers. Indeed, the five-year forward view, in which the NHS sets out its own future, talks about integration and moving towards accountable care systems. Some capital programmes have been announced today under what will amount to a £10 billion capital programme over five years. These are precisely to deliver the transformation which is needed by making the kind of investment to provide that level of integration.

Health: Flu

Baroness Manzoor Excerpts

Monday 30th October 2017 Lords Chamber

[Lord O'Shaughnessy]

That is unexpected and would be worrying if it is true. That is not the information on which we have based our policy. Our information is that, for most people—though not all—flu jabs are effective in mitigating the risk of flu in care settings.

[Baroness Manzoor (Con)]

My Lords, the World Health Organization recommends what strain of vaccine should be developed, nine months to a year ahead. This happened before the Australian epidemic which affected the elderly and killed many people. Will the Minister confirm that the vaccine which has been developed here in the UK is both effective and relevant and that the young and elderly people do need to access it?

[Lord O'Shaughnessy]

My noble friend is absolutely right. Back in September, Simon Stevens, the head of the NHS, warned about the impact of the flu epidemic in Australia and New Zealand. The feedback on that was that the particularly vulnerable groups were the over-80s and five to nine year-olds. We have talked about helping younger children through school-based immunisation. We also have the highest uptake in Europe of over-65s getting flu jabs. There is clearly more to do because around one-third of people still do not.

Adult Social Care in England

Baroness Manzoor Excerpts

Tuesday 10th October 2017 Lords Chamber

[Lord O'Shaughnessy]

The consultation is looking primarily at the funding situation but in doing so it will have to consider the shape of the market and making sure that the whole system is put on a sustainable basis for the future, which obviously will involve looking at some of the issues the noble Lord has highlighted.

[Baroness Manzoor (Con)]

My Lords, first, I congratulate the Government on making £2 billion available to social care. That is very welcome, but there is great variation in social care across the country which needs to be tackled, as well as the need to focus and co-ordinate services between acute and social care. Can my noble friend the Minister say exactly how NHS England will be helped to ensure that this is tackled quite urgently?

[Lord O'Shaughnessy]

The noble Baroness is quite right. In social care and the delayed transfers of care from hospitals, there is a huge amount of variation across the country. The additional money that was announced in the Budget comes with a variety of conditions, which has not been the case previously. One of these is to reduce the amount of variation in the quality of services available from local authority to local authority. For the first time, a set of reviews is taking place of local authorities—some of which will be facing challenges, others will not yet be—to make sure that that interface between the NHS and social care, which is one of the big problems where the system falls down, is looked at; that people are moving forward smoothly; that money is crossing those silos; and that the kind of service being provided is joined up and is actually providing for the needs of the people affected.

Brexit: Nursing Staff

Baroness Manzoor Excerpts

Tuesday 27th June 2017 Lords Chamber

[Lord Clark of Windermere (Lab)]

My Lords—

[Baroness Manzoor (Con)]

My Lords—

[The Lord Privy Seal (Baroness Evans of Bowes Park) (Con)]

My Lords, it is the turn of the Conservative Benches.

[Baroness Manzoor]

My Lords, it is a fallacy to continue repeatedly to suggest that EU nurses and doctors are not welcome in this country. Quite frankly, I am fed up with it. I worked in the NHS for over 25 years, and this is damaging staff morale because people are almost being targeted to feel that way. EU nurses and doctors do tremendous good work, and they are respected, welcomed and valued, as are other nurses and doctors from across the world. We have a great opportunity to celebrate this. Does the Minister agree?

[Lord O'Shaughnessy]

I completely agree with my noble friend, who speaks from experience. It is important not to peddle a myth of unwelcomeness, when it is clearly the case that nobody has said that they are unwelcome. No one in government has said that they are unwelcome; nor has the BMA, the RCN, or anyone else for that matter. They are valued as highly as any other member of the medical profession.

Health: Electronic Patient Records

Baroness Manzoor Excerpts

Thursday 27th April 2017 Lords Chamber

Asked by

[Baroness Manzoor]

To ask Her Majesty’s Government what plans they have to ensure that electronic patient records are available to healthcare professionals on a national basis, with appropriate safeguards and patient consent.

[Baroness Manzoor (Con)]

My Lords, in asking the Question standing in my name on the Order Paper, I draw the House’s attention to my entry on the register of interests.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, the Government are committed to making patient and care records digital, real-time and interoperable by 2020. Ahead of that, summary care records, which provide essential information about a patient, such as their medication, allergies and adverse reactions, are now available in many parts of the country in key areas of the NHS, such as ambulance and A&E services. Healthcare professionals can view these, with patient consent, to inform decisions about care.

[Baroness Manzoor]

I thank my noble friend for that comprehensive Answer. I am rather concerned that the National Data Guardian’s third report, which was out last year, does not fully address the issue of who those electronic patient data belong to. Do they belong to the GPs? Do they belong to NHS England? Do they belong to NHS Digital? This is particularly important because some GPs are moving towards only localised electronic patient record-sharing, which will have an adverse effect on the efficiency of the NHS. Can my noble friend the Minister assure the House and me that electronic patient data records will be kept nationally and that it is the patient’s choice over who has access to those records?

[Lord O'Shaughnessy]

My noble friend makes an important point about the use of data. There is a balance to be struck. The first point to be made about the use of data is that patients need to be part of any decision about sharing them. In 2012, the NHS Future Forum published an independent report on this issue and used the phrase,

“No decision about me without me”,


to describe the role of patients. There is of course a need to share data among clinicians, particularly when they treat a patient themselves. There can also be wider concerns: for example, in a public health pandemic or some such incident data would need to be shared more widely. But that can be done only with patients being informed and offering their consent.

Carers over 80: Support

Baroness Manzoor Excerpts

Monday 13th June 2016 Lords Chamber

[Lord Flight (Con)]

My Lords—

[Baroness Manzoor (LD)]

My Lords—

[The Lord Privy Seal (Baroness Stowell of Beeston) (Con)]

My Lords, I am so sorry to get up but we have not yet heard from the Conservative Benches. Although I recognise that there has been a series of Labour Peers it is the turn of the noble Lord, Lord Flight.

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[Lord Prior of Brampton]

Yes, we are talking about not just people who are registered carers but in particular where older people are looking after each other reciprocally, whether that is within marriage or a long-term partnership. Again, you cannot monetise something like that. It is part of a loving relationship. One of the tragedies in this is that it can sometimes change that caring relationship of husband and wife to one of a carer and a cared-for person, which can have a quite difficult psychological impact on individuals.

[Baroness Manzoor]

My Lords, do the Government have any plans to provide respite care for carers, particularly where there are significant disabilities involved with the person being cared for?

[Lord Prior of Brampton]

Respite care is hugely important. I think that the better care fund provides about £130 million a year for respite care. Giving people time out is hugely important.