Government Vision on Prevention

Baroness Masham of Ilton Excerpts

Tuesday 6th November 2018 Lords Chamber

[Lord O’Shaughnessy]

We have said that we will clamp down on junk food advertising. Clearly we have cut down on the advertising of alcohol, smoking and many other things over successive Governments. This country has led the way in dealing with this sort of issue, so I am confident that we will have the necessary approach.

[Baroness Masham of Ilton (CB)]

My Lords, will the Minister assure us that some of the most important things that are not in the Statement are not downgraded? They are antibiotic resistance, vaccination and immunisation, drug misuse, the prevention of hepatitis C in prisons and sexually transmitted diseases which are becoming resistant.

[Lord O’Shaughnessy]

I can provide the noble Baroness with that reassurance. This is a vision document, not a plan. It does not go into detail in every area, but merely tries to set out an ambition for the kind of health service that we want. All the issues that the noble Baroness raises are incredibly important, and I promise her that they form a big part of the department’s agenda.

The NHS

Baroness Masham of Ilton Excerpts

Thursday 5th July 2018 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I was in this Chamber when the noble Lord, Lord Darzi, then Minister of Health, saved the life of a noble Lord who collapsed in the debate. I congratulate him on all his wonderful and inspiring work. I declare an interest, as the National Health Service saved my life when I broke my back in 1958.

I celebrate the 70 years of the NHS, but I feel that safety in medicine should be the top priority. Without good communication and leadership, the patient can be left in limbo. Last week, I spent two-and-a-half days in St Thomas’ Hospital with an infection. It brought home to me the hugeness of the NHS and the pressure that it is under. The nurses I met were all agency nurses, and I understood their reasons for that, but I never saw a sister, so answers were not forthcoming. I left wondering what Florence Nightingale would have thought. There were some charming young doctors. One of them told me she had had problems since Brexit and was thinking of leaving. This is tragic when they are so badly needed. The Government need to work very hard on providing a competent NHS workforce across the UK, with good communication between hospitals and the community.

When injuries were expected from Normandy, a specialised spinal unit for the military was set up at Stoke Mandeville Hospital. In 1948 when the National Health Service was born, civilians with spinal injuries were admitted, and having specialised treatment and rehabilitation free at the point of need made all the difference for them. Stoke Mandeville is also celebrating the 70th anniversary of the paraplegic games this year. They were founded by Sir Ludwig Guttmann, who said that sport helped to rehabilitate patients. The games became the Paralympics of today. I cannot stress enough the importance of specialised treatment centres for many rare conditions. Their specialised teams of staff and drugs can save and extend life.

Our NHS must find watertight systems to safeguard patients and protect whistleblowers who may suspect and expose dangerous procedures. Safety is of the utmost importance. The duty of candour should become part of our health and social care culture.

Gosport Independent Panel: Publication of Report

Baroness Masham of Ilton Excerpts

Wednesday 20th June 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the right reverend Prelate for his comments and for conveying those of his colleague, the right reverend Prelate the Bishop of Portsmouth. It is absolutely right that he is where he is today, ministering to that group of deeply affected people.

The facts as he set them out, and as are set out in the Statement, are truly shocking: hundreds of lives prematurely shortened because of these practices; institutional behaviour led by an individual but with others being complicit in it; cover-ups; whistleblowers being discouraged; and so on. It is hard to imagine a worse scenario. What the panel and Bishop James Jones have exposed through working so closely with families is the extent of the behaviour and the poor practice that went on.

The question now is, quite rightly, what we should do about it, and the right reverend Prelate quite rightly takes the pastoral position. There is counselling on offer and a helpline for those who think that their families may have been affected—there may be yet more people who come forward. There is also a commitment from the Secretary of State, and indeed all Ministers, to meet families to provide them with the support and information that they may need. There is an intention to meet those families at an event convened by Bishop Jones in October, and the panel secretariat is setting up specific conversations between the advisory clinicians on the board and individual families. One of the needs for counselling, sadly, will be after those conversations, when the truth about specific cases comes out—which is why it is about providing counselling not just today but on an ongoing basis. I can give the right reverend Prelate a commitment from the department that we will provide that for as long as necessary.

[Baroness Masham of Ilton (CB)]

My Lords, this tragedy has similarity to Shipman and Stafford Hospital. Does the Minister agree that there should be a far better and quick complaints procedure? This has been needed for years. Nurses should feel free and safe to bring up matters of worry concerning their seniors and colleagues, and relatives should have help to complain and be listened to.

[Lord O'Shaughnessy]

I completely agree with the noble Baroness. Clearly, improvements have been made—freedom to speak up guardians came out of the Francis review into the Mid Staffs tragedy—but I reiterate the point that I made earlier: we cannot be complacent and just assume that what exists now is up to the task, as the noble Lord, Lord Hunt, said, of guaranteeing that this will not happen again. Looking at complaints procedures, protections for whistleblowing and so on will be part of the investigations that we make.

Breast Cancer Screening

Baroness Masham of Ilton Excerpts

Thursday 3rd May 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness makes an incredibly important point. To refer back to the Statement, I think that the word used was “may” and that an upper range was given. I want to distinguish between two things. The first is the national campaigns that take place—I think there were 14 in the past eight years—to encourage women to check for their own symptoms and take up opportunities for screening programmes. Those will continue; that is part of the overall programme. In terms of writing to the women who are still alive who may have been affected, that is a separate and discrete process. It will start with a letter. It is easy for us to track down those who are registered with a GP in England and we are working with colleagues in the devolved Administrations, as noble Lords would expect, to make sure that we can write to those who have moved to those countries, and to provide resources to those countries so that they can provide screening. A helpline is also included that has been publicised.

On the point about the number of deaths that may have occurred, it is a difficult issue. On the one hand, we have received advice that that may be the case and we felt that it was wrong not to be honest and transparent about it. At the same time, there is not a clinical consensus about the benefits of breast cancer screening for women aged 70 and over—that came as something of a surprise to me—because of the non-malignancy or low malignancy of some tumours that can be spotted and the harms that can follow from treatment.

So we need to be cautious. What we have projected as a range is based on statistical modelling and not based on scrutiny of actual case note reviews. Of course, we deeply hope that the number will come down as we carry out that inquiry.

[Baroness Masham of Ilton (CB)]

My Lords, why is there the magical cut-off point of 72? In the paper the Minister just read, what are the non-threatening cancers in older people and what are the harmful tests and treatment? If they are harmful for older people, what about younger people?

[Lord O’Shaughnessy]

The noble Baroness asks an excellent question. The clinical advice that we received, which is the reason for the extension of screening from up to the age of 70 to up to the age of 73, is part of a clinical trial. There is no evidence that screening necessarily benefits women in general; of course, it will benefit some women in particular. There are breast cancers—I cannot claim to be able to describe them because that is well beyond my clinical knowledge—that women can have at that age and live with, and, indeed, they can die of something else at a later age. The treatment process, whether it is chemotherapy, radiotherapy or surgery, can be very debilitating, harmful and in some cases unnecessary, although, having found a tumour, a woman may well want to progress with that treatment. We have been driven by that age range, with 72 as the cut-off, and the wider description of this lack of clinical consensus. I assure the noble Baroness that we have been informed by a clinical advisory group throughout the process to make sure that we are as accurate and effective as possible.

[Baroness Masham of Ilton]

I am glad it is not the case that older people are not worth treating.

[Lord O'Shaughnessy]

Certainly not.

The Long-term Sustainability of the NHS and Adult Social Care

Baroness Masham of Ilton Excerpts

Thursday 26th April 2018 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank my noble friend for his persistence in securing this debate. I am sure that a great deal of time and work was put into the report.

The NHS is, without doubt, our most important insurance policy. Nobody knows when an accident or illness will strike them or their family. One minute you can be fit and well, the next minute paralysed from the neck down and unable to move. Or you may become critically ill with organ failure from sepsis if it is not diagnosed quickly and the correct treatment given.

The world seems very unstable at the moment. We need, as a top priority, sustainability in our NHS and social care. The NHS should not become a political pendulum. It faces so many problems: relentless needs and not enough GPs and hospital beds—especially intensive care beds—to care for the serious cases, which leads to the unfortunate cancellation of operations. Surely we cannot go on with ambulances piling up with patients waiting outside hospitals, and patients waiting in corridors for treatment and beds. We must do better in future.

As a member of the parliamentary group on alcohol harm, I want to mention the fact that cheap alcohol harms the health service in so many different ways. The liver units are full. Liver transplants are the last resort but they can be expensive and dangerous, given the increasing resistance to antibiotics. Far more should be done in the prevention of illness and accidents. This means, however, co-operation and collaboration between public health, NHS and social services.

Cutting public health funds is a retrograde step. Already, gonorrhoea is proving challenging because of drug resistance. There should be greater awareness of factors such as postural hypertension and autonomic impairment, which can cause “funny turns”, faints and falls. These can, in turn, cause injury from bruising and fractures, which can be debilitating and sometimes life-threatening.

I have received a letter from the chair of the Harrogate Parkinson’s UK group, who says that several older people who have been in hospital for a short time cannot be discharged to their homes because no care is available. They are, therefore, shunted off to care homes, causing great unhappiness. The letter goes on to say that this will become a much bigger issue as the elderly population grows in the coming years. Are the Government aware of this situation, and do they have any plans to deal with it? I need an answer to give them—they are waiting.

As I said earlier, Brexit is exacerbating the serious staff shortage problem, which must be solved if there is not to be a monumental catastrophe. I agree with this House of Lords report, which states:

“We are concerned by the absence of any comprehensive national long-term strategy to secure the appropriately skilled, well-trained and committed workforce that the health and care system will need over the next 10-15 years. In our view this represents the biggest internal threat to the sustainability of the NHS”.


There is concern that changes in procurement policy for wound care brought about by the Carter review could effectively restrict the availability of the most clinically appropriate wound care products. This could have serious results and add extra costs to the billions already spent by the NHS. Those with complex needs, such as leg ulcers, pressure sores and burns, could be most affected. I declare an interest in this regard, as for years I have been nursing a pressure sore in a very awkward place. As part of the NHS long-term sustainability strategy, the UK needs a national wound care strategy covering the complexity and variety of wounds, with improved diagnosis, prevention and timely treatment.

I end by saying that good health is so important to so many people. Access to rare disease medicines is paramount to those suffering from more than 6,000 rare diseases. I read last week that Brussels is cutting the UK out of the key role in approving new drugs. Nobody will benefit. We have brilliant researchers whose expertise, working with the European Medicines Agency, will be wasted. For the good of patients, everyone should be working together. Whatever happens, safety should come first.

NHS: Winter 2017-18

Baroness Masham of Ilton Excerpts

Wednesday 18th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I shall certainly look into that issue. We are reviewing insurance across primary care, as my noble friend might know, and I shall look into this specific issue.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that one of the problems is the shortage of intensive care beds, which holds up operations in hospitals so that there is a queue?

[Lord O'Shaughnessy]

The noble Baroness is quite right. That is one of the reasons we have taken some big decisions over the winter, one of which is to reduce the amount of delayed discharges. I think it has been reduced by about 1,500 beds. It was also the reason behind what was undoubtedly an unpopular decision and one that we did not want to take: to suspend and postpone some elective surgeries during January. That freed up a number of beds, which helped us to cope with the emergency admissions. Happily, it has not had to be reinstated since the end of January.

Brexit: Health and Welfare

Baroness Masham of Ilton Excerpts

Thursday 29th March 2018 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I am immensely grateful to the noble Baroness, Lady Brinton, for giving us the opportunity to discuss this vital matter.

I have just completed 60 years of being a paraplegic after a horseracing accident, when I sustained a broken back. After the first 48 hours in an accident hospital, I was fortunate to be treated at the national spinal injuries unit at Stoke Mandeville Hospital under the famous Dr Ludwig Guttmann, a German Jewish neurologist who had escaped from Nazi Germany before the war. He had been asked to establish the first spinal unit, as many patients with spinal injuries were expected after Normandy.

I also had my life saved on my honeymoon in Barbados when swimming from the notoriously dangerous Crane beach. We were unaware of the strong currents. I got washed in and out of the surf and a German woman came to my rescue, dragged me out and gave me first aid.

I saw the devastation at the end of World War II, and now, with terrorism around us in Europe, I feel it unwise not to have a united Europe, with the threat of the UK being left out in the cold. Peace with no war in Europe should be the goal of all our citizens.

Until now very little has been said about the needs of disabled people who are living in the community and need help. I declare an interest as I employ help, with my helpers coming mainly from eastern Europe. In the last year, because of Brexit, this has become very difficult. Many people feel that England does not want them, and the economic conditions in their own countries have improved. In the past, Europeans have come to the UK to learn English and have been happy to have live-in jobs, as rented accommodation is so expensive. Many of them make excellent live-in carers, and often, when they have earned enough money to build a house, they go home.

Many disabled people are young and need active young carers. If the supply cannot keep coming on a needs basis, there will be a disaster. I speak as president of the Spinal Injuries Association. There is a real fear that, if the care packages of people who need several carers due to being paralysed from the neck down are not adequate, these people may be offered a place in a care home, rather than having the chance to live at home. To most young and middle-aged people, and some elderly people, this would be the end of the road, and suicide might be their only option. That is one reason why I feel that this debate is so crucial. There is a crisis in social care. The Government need to look at this in depth and produce a carers strategy.

There is concern that the European Medicines Agency has left London for Amsterdam. In her Mansion House speech, delivered on 6 March 2018, the Prime Minister stated for the first time her ambition that the UK should continue to participate in the EMA after Brexit as an associate member, and outlined the possible advantages of such an arrangement. Membership of the European Medicines Agency would mean investment in new innovative medicines and technology continuing in the UK, and it would mean these medicines getting to patients faster, as firms prioritise larger markets when they start the lengthy process of seeking authorisation.

It would also be good for the EU because the UK regulator assesses more new medicines than any other member state and the EU would continue to access the expertise of the UK’s world-leading universities. However, I ask the Minister whether being an associate member would mean not having all the privileges and status of being a full member. As the UK is one of the leaders in this field, with many brilliant and dedicated participants, will it not be frustrating to have second-class status?

I will quote the Royal College of Physicians:

“A number of key considerations that arise from the UK’s withdrawal from the EU relate to the NHS workforce. These considerations have an immediate and direct impact on patients and the public, and place additional pressures on an already stretched workforce. We not only need many more doctors, we need nurses, care and auxiliary workers as well. If Government Departments do not come together and realise what the UK needs there will be a breakdown of society”.


The RCP president said:

“It seems astonishing to block appropriately qualified doctors from working here when the NHS is under such pressure ... As our own census shows, as well as recent BMA data, there are huge gaps in rotas. As a result, doctors are unable to deliver the standard of care they were trained to, and patients are at risk”.


Data sharing between Europe and the UK is essential for public health, medical research and ensuring patient safety. The general data protection regulation, which comes into effect in May 2018, will provide important protections for individuals while also allowing data to be shared within the EU. It is currently unclear whether data will be able to be shared when the UK leaves the EU. Sharing data for European-wide clinical trials is just one example of where data sharing enhances the ability of patients to access new treatments. With so many rare diseases, the UK exit from the EU must not impact patients’ ability to participate in high-quality research.

I feel that many people who voted to leave the EU did not really know what it all meant—but it could mean, united we stand but divided we fall.

Abortion: Misoprostol

Baroness Masham of Ilton Excerpts

Tuesday 20th March 2018 Lords Chamber

[Lord O'Shaughnessy]

The importance here is making sure that, under the auspices of the Act, women have access to safe and legal abortion, and that is what they have a right to do. An important point here is that, the earlier these abortions happen, the safer they are. The proportion of abortions under 10 weeks has risen from 68% to 81% in the last 10 years. At the moment, both courses of treatment for early medical abortion should take place in a clinical setting approved by the Secretary of State.

[Baroness Masham of Ilton (CB)]

My Lords, has any research been undertaken on the psychological feelings of people who have had abortions in their own homes?

[Lord O'Shaughnessy]

I am not aware of any research, but I shall ask the department to see if there is any. If there is, I shall write to the noble Baroness.

Antimicrobial Resistance

Baroness Masham of Ilton Excerpts

Thursday 8th March 2018 Grand Committee

[Baroness Masham of Ilton (CB)]

My Lords, I thank my noble friend Lady Greengross for securing this short debate. It may be short but it is of tremendous importance globally. AMR is widely recognised as the biggest threat we face.

Many years ago I was the first person in your Lordships’ House to have a debate on MRSA, after the late Lord Gerry Fitt’s wife died from MRSA in the Chelsea and Westminster Hospital. After that, along with a group from the Science and Technology Select Committee, I went to America to look at the problems around antimicrobials and infection. One of our recommendations was that there should be quick tests for infections so that the correct antibiotic can be prescribed. This is now happening in some places, and that is good news.

The famous physician, Sir William Osler, who is sometimes described as the father of modern medicine, said in 1892 that there are three phases to treatment: diagnosis, diagnosis and diagnosis. In modern times, diagnostics are vital to guiding clinical decision-making, determining whether a patient should be treated with antibiotics, and if so, which ones will be effective.

Sepsis is a bigger killer in the UK than bowel, breast and prostate cancer combined. With the increasing challenges of antimicrobial resistance, it is more important than ever for hospitals to diagnose accurately and rapidly so that patients with sepsis can be treated. The lack of consistency across UK hospitals in their diagnosis of sepsis has been highlighted. Research has found that 56% of hospitals are using only one set of blood cultures where sepsis is suspected rather than the recommended two sets. This leads to much less chance of the successful identification of the bacterium involved.

World Tuberculosis Day is approaching, so I thought it appropriate to remind your Lordships that TB remains the world’s deadliest infectious disease, with 10.4 million people infected and 1.7 million dying from the disease in 2016. In his review on AMR, the noble Lord, Lord O’Neill, estimated that around a third of all AMR-associated deaths are caused by drug-resistant TB. The UK itself struggles with TB and has been known as the drug-resistant capital of northern Europe. I join with the noble Baroness, Lady Suttie, in her remarks on this very important subject.

Until recently, doctors relied on the microscope to identify TB and it took months of growing cultures in laboratories to determine if the strain of TB was drug resistant. However, things have changed for the better with the production of the GeneXpert TB testing machine, which can analyse DNA. The test can identify whether someone has TB and can detect whether there is resistance to one of the main TB drugs, rifampicin. The UK Government have been central to advancing this technology by making a significant investment in it through the Ross Fund. Scientists and policymakers are working to improve this diagnostic tool and ensure that it is used as widely as possible.

The availability of a rapid diagnostic test is vital to fighting AMR and will ensure that those who need antibiotic treatment urgently receive it. It will also ensure that antibiotic drugs are not misused or prescribed inappropriately, thus driving further drug resistance. This is also important to animal health and farming. Exciting research in this field is going on around the world and certain new technologies are now able to determine antimicrobial resistance in as little as 30 minutes. We must invest to drive forward the research and development that will protect patients and the public.

Concern has been expressed about outbreaks of multiresistant hospital bacteria among newborns in hospitals, including in neonatal intensive care and special care baby units. Controlling MRSA has been improved due to hard work, but in high dependency care units where patients are more vulnerable to drug-resistant infections, the risks are great. Is anything being done to systematically collect the data, identify improvements that can be made and fund the emerging diagnostic and monitoring technologies that enable a rapid infection control response?

Another problem that needs addressing is the epidemic of Clostridium difficile-associated diarrhoea in hospital patients, largely attributable to antibiotic overuse. Good work is being done, but it is translation into practice that seems all too slow.

Finally, does the Minister agree that the European Vaccine Action Plan is of great importance? With more and more infections becoming immune to antibiotics, it is vital to prevent conditions such as gonorrhoea, which is resistant to antibiotics and needs a vaccine, as do norovirus, Clostridium difficile, HIV and many others, and a better vaccine is needed for TB. That would make the world a safer place for everyone.

Medicines and Medical Devices Safety Review

Baroness Masham of Ilton Excerpts

Thursday 22nd February 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Countess for raising that point. We have met to discuss this issue and she has been a great campaigner on medicine safety issues. That dialogue is going on. As she knows, that view concerning the safety is not currently shared by the regulators. But I want to stress that the work that my noble friend Lady Cumberlege will be leading will try to set up a process which deals equitably, objectively and compassionately with these concerns when they arise. One of the problems in the past has been, frankly, that we have not dealt with these things in the same way. It is dependent on the strength of the lobby group, the type and strength of the Government and what is on their agenda at any one time. That is not good enough. We need a consistent and compassionate approach to listening to concerns, scrutinising them properly and dealing with the consequences, which may entail no further action or could be anything up to a full public inquiry. That is what my noble friend will be dealing with and that will be a huge step forward. It will be precisely that kind of process to which any concerns about HPV or anything else should be directed.

[Baroness Masham of Ilton (CB)]

My Lords, I thank the Minister for the support he has given to the epileptic women who have taken valproate, resulting in them having children with autism. The marking and the advice were not there for them. Does the Minister realise that many people are concerned about the European Medicines Agency, which deals with safety in medicines? It was housed in London at Canary Wharf but has now gone to Amsterdam. Will we still be involved in that agency? We were leaders when it was here in London and we still have a lot to offer.

[Lord O'Shaughnessy]

The noble Baroness makes an excellent point. Specifically on valproate safety, the MHRA has taken a leading role in pushing all the time for stronger responses to the concerns. We are pleased to see that other European countries are responding. That highlights a bigger issue, which is if you look across the entire continent and the work that our agencies do—whether it is the MHRA, the GMC or others—we are seen as a leader across Europe, and indeed globally, on patient safety issues. That is one reason why it is our desire that in our future relationship with the European Union, the MHRA and other agencies continue to play that role, for the good of patients not just here but across Europe.