Amputees: Limb Fitting
Debate between Baroness Manzoor and Baroness Jolly
Baroness Manzoor
My Lords, the data collection is not expected to be published routinely but is submitted by the provider to the relevant commissioning hub as a contractual requirement under schedule 6 of the NHS contract information reporting requirements. But I hope that my noble friend will be pleased to hear that we will be considering making available a summary of this data in due course once we have established that it has been collected and reported appropriately.
Baroness Jolly (LD)
My Lords, being fitted with a new knee can completely change a person’s life. Can the Minister tell the House what advice is given to clinical commissioning groups about commissioning knee replacements? Living in Cornwall, I would be treated sooner than if I lived on the Isle of Wight. When does the Minister expect the wait on the Isle of Wight to be the same as in Cornwall?
Baroness Manzoor
My Lords, I hope that any variation in any service is dealt with and reduced as much as possible. As the noble Baroness will be aware, NHS England commissions the prostheses centrally and has a service specification. It has a duty to reduce inequalities in access to health services and in the health outcomes achieved, as enshrined in the Health and Social Care Act 2012. Certainly the principle is to reduce inequalities.
NHS: Stroke Care
Debate between Baroness Manzoor and Baroness Jolly
Baroness Manzoor
My Lords, I agree with the noble Baroness, Lady Wheeler, that it is very important that we have the relevant NHS workforce to deliver the care needed in this very important area. Stroke is a devastating disease for patients and their families. The Stroke Association estimates that it costs the NHS around £3 billion per year, with lost productivity, disability and formal care costing the economy an additional £4 billion. To that end, we are putting in place funding of £20.5 billion each year over the next five years, with cardiovascular also being a clinical priority. This will support the national plan for stroke.
Baroness Jolly (LD)
My Lords, there is a complete postcode lottery for good stroke care, with inequities in accessing treatments such as thrombolysis and thrombectomy, as well as the subsequent appropriate rehabilitation and care. By when does the Minister expect anyone who has a stroke anywhere in England to receive the same level of treatment as in London or Manchester?
Baroness Manzoor
My Lords, the noble Baroness is absolutely right: there is variation in care. We are working very hard to tackle the variations in the system. Within its financial constraints, the NHS is committed to providing access to stroke care and prevention services and, as the noble Baroness knows, the clinical commissioning groups are responsible for commissioning these services to meet the requirements of their populations. In doing so, CCGs need to ensure that the services they provide are fit for purpose, reflect the needs of the local population, are based on available evidence and take account of national guidelines.
Healthcare (International Arrangements) Bill
Debate between Baroness Manzoor and Baroness JollyTuesday 19th February 2019
(5 years, 2 months ago)
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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.
NHS: Accident and Emergency Departments
Debate between Baroness Manzoor and Baroness Jolly
Baroness Manzoor
My Lords, of course I entirely agree with my noble friend. As I have said, there will be robust evaluation, monitoring and assessment before any targets are put in place.
Baroness Jolly (LD)
My Lords, there is no doubt that emergency departments are currently working at full tilt to care for their patients. I recently visited one that had totally reconfigured its workspace. By so doing, it had been able to operate much more efficiently, saving precious time. I believe that it had received grant funding to do this. How many emergency departments have done the same, with or without a grant?
Baroness Manzoor
My Lords, forgive me, I do not know the answer in relation to grants and will have to write to the noble Baroness, but she is right that NHS A&E admissions have been quite significant. Demand has increased. To put this into context, the NHS addressed just under 2,500 more attendances per day on average within the four-hour standard in 2017-18 compared with 2009-10, and 86.4% of patients admitted were transferred or discharged within four hours. Performance has improved since last year but we recognise that we have not hit the standard.
Health: Public Health Grant
Debate between Baroness Manzoor and Baroness Jolly
Baroness Manzoor
I think I have already answered the Question. The reduction in the grant to which the noble Baroness has referred is not a new cut, as I have already said. It was agreed in the 2015 spending review, in a difficult financial environment. Difficult decisions had to be made. Local authorities have been aware of these cuts for over a year and have been able to plan accordingly. I have already stressed the balance we have between prevention and ensuring we address that. We are going to be putting £4.5 billion into primary and community care services, in addition to the money we are already putting into current services.
Baroness Jolly (LD)
My Lords, we seem to be relying more on local government: additional preventive health campaigns; local five-year plans as part of the integrated care system; and greater social care provisions. Can the Minister please articulate exactly how the December 2018 reduction of the public health grant can have any positive impact for local authorities?
Baroness Manzoor
I understand the point that the noble Baroness is making, but I have already said that this is part of a longer plan. The grant in itself is not the only part of the NHS plan. There is much wider spending by the local authorities and joined-up thinking. The Green Paper that I have already mentioned, Prevention is Better than Cure, was published on 5 November 2018. This will support healthy life expectancy, by at least five extra years by 2035, and close the gap between the richest and the poorest. The Government are taking concerted and proper action to address these issues.
Sepsis: National Register
Debate between Baroness Manzoor and Baroness Jolly(5 years, 3 months ago)
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Baroness Manzoor
My Lords, the NHS takes this issue very seriously. NHS England and clinicians are working together very closely to make sure that we have good, clear datasets to enable us to diagnose this illness at a very early stage. Where good work is being done, we are looking at that very carefully.
Baroness Jolly (LD)
My Lords, sepsis does not respect age; it is our biggest killer, killing more people than breast, bowel and prostate cancer combined. A national register for sepsis could save thousands of lives and reduce the economic burden by £2.8 billion through improving access to healthcare and basic care for sepsis. To collect the necessary data, however, the public need to be brought alongside. What stage have the Government have reached in their conversation about a register with clinicians, patients and the third sector?
Baroness Manzoor
My Lords, there is a clear need for better data collection on sepsis, but a registry uses retrospective data collection. Through the Government’s new national action plan on AMR, we will go beyond this and develop real-time patient data collection through data linkage. We will be working on this very closely.
Health: Medicines Shortage
Debate between Baroness Manzoor and Baroness Jolly
Baroness Manzoor
My Lords, the production of medicines is complex and highly regulated, as the noble Baroness says, and materials and processes must meet rigorous safety and quality standards. Supply problems can arise for various reasons, such as manufacturing issues, problems with the raw ingredients, regulatory issues and batch failures. I assure the noble Baroness that the Government are doing everything in their power to ensure that contingency plans are in place to address exactly the kind of issue she has just raised.
Baroness Jolly (LD)
My Lords, I am pleased that there are contingency plans in place to ship prescription medicines to ensure there is no shortage. Could the Minister confirm to the House what the Government have done to guarantee transportation of generalist and over-the-counter medicines? Will they use lorries and ferries, as with prescription medicines?
Baroness Manzoor
My Lords, all planning scenarios for a no-deal exit are being considered. If it is necessary to use the kind of transportation the noble Baroness mentioned, of course we will do so. For more priority medicines, other plans are being put in place, as well as the six-week stockpiles we have agreed that community pharmacists must hold.
Health: Chief Medical Officer’s Recommendations
Debate between Baroness Manzoor and Baroness Jolly
Baroness Manzoor
My Lords, the Government have committed to review the soft drinks industry levy exemption for milk with added sugar in 2020, when we will have further information on the effectiveness of Public Health England’s voluntary reformulation programme. On baby food, product ranges that target babies and young children are now part of the Government’s reduction and reformulation programme.
Baroness Jolly (LD)
My Lords, I think we all recognise the importance of the CMO’s report and her recommendation that local government is supported to encourage healthier living through preventive health programmes. When funding given to councils for such preventive strategies is being cut by 4% under the long-term plan, how do the Government propose to honour the suggestions outlined in her report?
Baroness Manzoor
My Lords, the Government take prevention very seriously. As the noble Baroness will be aware, the 2015 spending review made £16 billion of funding available for local authorities in England over a five-year period. That is in addition to what the NHS spends on prevention, including more than £1 billion in 2016-17 on our world-leading immunisation, vaccination and screening programmes. Of course, we also need to tackle wider detriments, which is why public health has been handed over to local authorities to look at wider determinates of ill health, including pollution, poor housing and the environment.
Folic Acid
Debate between Baroness Manzoor and Baroness Jolly(5 years, 4 months ago)
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Baroness Manzoor
My noble friend highlights our problem and it is therefore important to have the impact assessment. At the moment, additives are only put into white flour, as things are removed through the milling process. Therefore, with folic acid increasingly put into breakfast cereals and a large quantity of other products, we need to look at the upper tolerance level before decisions can be made on moving forward.
Baroness Jolly (LD)
The Bread and Flour Regulations currently apply only to wheat flour, which contains gluten and is therefore unsuitable for people with coeliac disease. In the consultation, will the Government consider extending the regulations to apply to gluten-free breads, to ensure that those people have equivalent access to fortified breads?
Baroness Manzoor
That is an important point and we need to ensure that the consultation captures as wide a group of people as possible. If we move into mandatory fortification of flour, it should be done on a basis consistent with addressing all issues, including that.
National Health Service: Nurses
Debate between Baroness Manzoor and Baroness Jolly
Baroness Manzoor
My Lords, I agree with much of what the noble Lord said. There is a shortage of nurses in the NHS: 41,000 vacancies, as he rightly identified. To put that into context, our policies have enabled the NHS to put more than 13,400 more nurses on our wards since 2010. We are not complacent. We have increased nurse training places by 25% from September 2018. To reassure the noble Lord, there are more than 52,000 nurses in training. Although there are more applications than places, we know that we need to do much more work with universities. On the NHS 10-year plan, the noble Lord rightly identified that the training budget has not been set yet. We will do that by the spring. My noble friend Lady Harding is taking a quick look at the forward plan, the type of vacancies and how we can recruit more nurses into the NHS.
Baroness Jolly (LD)
My Lords, it was encouraging to see in yesterday’s plan a commitment to an extra 5,000 funded clinical placements for trainee nurses from the next academic year, 2019-20. Can the Government indicate when the funding for those places will be guaranteed? Are we certain that training places are available to absorb this welcome jump in demand?
Baroness Manzoor
There were 22,200 acceptances to study nursing and midwifery in 2018, compared with 22,575 in 2017, which we estimate will increase the final number of students on nursing and midwifery courses by a further 650. The numbers are coming through, but we recognise that we need radical campaigns to ensure that we attract more people into nursing, particularly in the community.
Health: Neural Tube Defects
Debate between Baroness Manzoor and Baroness Jolly(5 years, 8 months ago)
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Baroness Manzoor
My Lords, I fully understand the strength of feeling in the House about this important issue. The issue of the health of pregnant women and their unborn children is one that the Government take very seriously. I realise that noble Lords may have been hoping for a more definitive response from me today. All I can say is that the decision is with Ministers who are considering the issue very carefully.
Baroness Jolly (LD)
My Lords, the evidence is clear for all to see. The number of neural tube defects in Canada halved in six years when flour was fortified with folic acid. Our own Scientific Advisory Committee on Nutrition concluded in 2006, again in 2009 and last year that what others have been doing for years, adding folic acid to flour, prevents neural tube defects. What is preventing Her Majesty’s Government taking the same decision?
Baroness Manzoor
The noble Baroness is right that the Scientific Advisory Committee on Nutrition—SACN—has recommended mandatory fortification of flour with folic acid since 2006. The Committee on Toxicity—COT—is currently reviewing the maximum recommendation level and has noted that negative effects are unlikely to occur at a level below the current value. However, its work is unlikely to be completed before winter 2018. I am sorry that there is nothing I can add to that.
Human Fertilisation and Embryology Act 2008: Frozen Eggs Storage
Debate between Baroness Manzoor and Baroness Jolly
Baroness Manzoor
My Lords, of course, I recognise the tremendous, world-renowned expertise that the noble Lord, Lord Winston, has in this area. He asked a number of questions, and I cannot comment on the Written Answer on the numbers and figures that were given on the eggs that were frozen and thawed. However, I was interested to see the data published by HFEA in March on the ages of women freezing their eggs in 2016, which showed that roughly 67% were 35 or older. I recognise the argument that, as with every aspect of our body, eggs also get older, so the earlier they are frozen, it is potentially better. For those women freezing eggs for non-medical reasons, the 10-year storage limit would appear to provide a reasonable period for them to decide if they wish to go forward with fertility treatment. On the question of private clinics, the noble Lord is absolutely right. I am aware that clinics are advocating three or four cycles of treatment to freeze eggs. That can be very expensive, so it is important that women who want to go down that route regard the issue seriously because at the end of the day only 26% are successful.
Baroness Jolly (LD)
My Lords, when the scheme was first set up, will the Minister clarify whether the reason for the 10-year limit was evidence or science based, or was it based on social determinants?
Baroness Manzoor
My Lords, when the 1990 Act was reviewed, the 2005 Green Paper consulted specifically and asked views on whether the time limit should be changed, and what new limit would be appropriate. There was no consensus among the responses on what a new limit should be, with a wide range of storage periods being suggested, from 10 months to 20 years. I am not aware of any consensus now of what would be a more appropriate maximum storage limit. When the 2009 regulations were put in place, they were considering the potential storage needs of adults.
Employment Rights Act 1996 (NHS Recruitment—Protected Disclosure) Regulations
Debate between Baroness Manzoor and Baroness Jolly
Baroness Jolly (LD)
My Lords, on these Benches we too welcome the regulations. We note that they extend to just Wales and Scotland, and that they come on the back of the Francis review of 2015. I will make a few remarks and then I have a few questions.
In a sense, it is not before time, but last week I spoke to an NHS whistleblower who had given up. He has left the NHS and he is leaving the UK. He has been bullied and was passed over for employment. He had been threatened that, had he gone to an employment tribunal, it would be made sure that he lost, and therefore that he lost a lot of money on top of that. With some distance between then and now, his reflection is that in all NHS settings there are posters urging people, if they see anything that gives cause for concern, to contact their manager and that there will be no recrimination. This measure is too late for that individual.
I would like to ask the Minister some questions and I hope that her answers will clarify some of the things about which I am unclear. I said at the outset that the regulations extend to Wales and Scotland. With devolution, one might wonder why they do not extend to Northern Ireland as well. Echoing the question from the Labour Benches, to which NHS employers or category of employers do they not apply and why not? What is the reasoning behind this? What protections would be made available for a worker who supports a whistleblower? Often they can be tarred with the same brush. If two or more people are trying to raise an issue that concerns them but does not concern another body of the workforce, that can be a really uncomfortable place to be.
There has been no improvement in NHS staff’s confidence in reporting practice over the last four years, so how can we remedy that? Is the Minister confident that the regulations will change what is current practice? We know this from surveys of NHS employers. What support could the whistleblower themselves expect in new employment in the event of bullying and isolation, whether the employment is in the NHS or an arm’s-length body? The culture is in part still very much one of blame, despite the posters, so how does the Minister suggest that that should be overcome?
Baroness Manzoor
My Lords, I thank the noble Baroness, Lady Thornton, in particular for her good wishes. This is my first time at the Dispatch Box and I will endeavour to answer the many questions that have been put to me. I ask noble Lords to forgive me if I omit any; if I do, I will certainly write.
I begin with the question asked by the noble Baronesses, Lady Thornton and Lady Jolly: why is it that just the NHS is included, and which other organisations are excluded from these protections? As noble Lords know, these regulations are specifically focused on NHS employers and are not intended to cover employers in other sectors, which would be outwith the enabling powers under Section 49B of the Employment Rights Act 1996. Section 49B(7) of that Act defines “NHS public body” by reference to a list of bodies, thus the powers of the regulations are limited to those bodies only. Any amendment to that list would require primary legislation.
The noble Baroness, Lady Thornton, asked about the wording,
“because it appears to the NHS employer”.
Once again, the regulations reflect the primary legislation, which provides powers for regulations to prohibit NHS employers from discriminating because it appears that the applicant has made a protected disclosure.
The noble Baroness asked about the time limit of three months. We know that some respondents to our consultation were concerned that the three-month time limit was not long enough but, as the noble Baroness will know, it is consistent with the time limits for employment claims generally. Where discrimination involves an admission to do specified things, such as due process in job application, the time starts to run from the end of the period within which it was reasonable for the NHS employer to have acted.
On injunctive relief, in terms of making two complaints —that is, going to the employment tribunal and going to the civil courts—I think the noble Baroness was indicating that this may well be expensive. If there are dual proceedings, fees payable to the employment tribunal have recently been abolished so there will be no fees for that tribunal, and we are expecting that most cases, as I said in my opening remarks, will initially be conciliated and then go to the employment tribunal. However, we do not envisage dual proceedings except in the very limited circumstances that have been provided in the regulations. The noble Baroness asked whether we have any plans to reintroduce tribunal fees. No, there are no plans to reintroduce those fees.
On the issue of culture, the whole point from the Government’s perspective is that we need to ensure that the culture within the NHS is changed so that those people who want to highlight poor practice in the NHS, who are concerned about patient safety, have the right to speak up. It is very important that their rights are protected. Should they wish to move to a new employer, the regulations will help to safeguard them. Paramount is patient safety, and the regulations will go some way to addressing those issues.
I thank the noble Baroness, Lady Jolly, for also welcoming the regulations. I have already covered who they cover and why: it is because of the prescribed list, and we will need primary legislation if we are to amend it. However, we will keep the regulations under review and if we think that they need to be strengthened, we will look seriously at that. The whole issue is that we want the NHS to be the best employer and to protect the greatest asset that we have in the NHS: our staff.
The noble Baroness asked to which NHS categories the regulations do not apply. I think I have answered that question—yes, I am getting a nod there. The other question she asked was what protection is given to more than two people. Of course, the protection is there for someone applying for a new job, so it is relevant only to that individual. If there is another friendly person, the regulations do not cover them. Of course, in the wider aspect of work there may be some remedy under the Employment Rights Act 1996, but I cannot be sure from my basic knowledge.
What new support will we offer the person who has made the complaint, the so-called whistleblower? The whole point of the regulations and having this open, transparent, fair culture within the NHS is that it is very important for employers to have policies in place to tackle issues of concern. We are being supportive to ensure that these things do not happen.
I think I have answered most of the questions put to me. As I said, forgive me if I have missed anything: I shall write. Clearly, there are questions about how the regulations will work in practice. As I said, the Government will keep the regulations under review and consider issuing guidance.
To conclude, we want an NHS where lessons are learned to provide the safest possible care for patients. This is what it is about: actually changing the culture. The regulations will help to give a clear message that openness, transparency and fairness within the NHS should be the norm. They will also improve the trust of patients, other service users and the wider public. They will support NHS employers to be an exemplar to others in fostering a culture of openness and willingness to report problems with care.
NHS staff who are prepared to speak up are a very important asset. We want NHS staff to feel confident that when they speak up in the public interest it will not have a negative impact on their career. We want NHS employers to be exemplars in fostering a culture of openness and willingness to report problems. We want a culture in which lessons are learned to provide the safest possible care for patients.
The regulations are an important step forward in achieving those aims. I commend them to the House.
NHS: Hospital Medication
Debate between Baroness Manzoor and Baroness Jolly
Baroness Jolly
I can tell the noble Lord that NICE guidance suggests that people with Parkinson’s disease should have their medicines given at the appropriate time, not on the ward round with the trolley of regular medication. Where it is absolutely appropriate and possible, this may mean allowing self-medication.
Baroness Manzoor (LD)
My Lords, medication reconciliation is very important because it is a health and safety issue. Between 2003 and 2004, the National Patient Safety Agency declared that over 7,000 patients had been affected by an error with their medication. What are the Government doing to work closely with hospital pharmacies so that electronic records are shared between GPs and hospitals?
Baroness Jolly
NICE, the NPSA and the Royal Pharmaceutical Society have all identified the key role of pharmacists in medicines reconciliation. I am pleased to say that the majority of hospitals now have pharmacists on admission wards and doing daily ward rounds to ensure patients’ medicines are reconciled promptly. On the data point, I understand that NHS England is exploring the possibility of developing a business case for pharmacists to have access to the electronic summary care record. However, any work on this will need to be sequenced into the development timetable along with other priorities.