Failures of the 111 Helpline

Baroness McIntosh of Hudnall Excerpts

Tuesday 26th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, in a sense there are mixed messages—but there is a common-sense message here as well. We do not want to overuse antibiotics but, on the other hand, clearly where there is a serious infection, antibiotics are absolutely necessary. At one level it is a mixed message but there is a common-sense way through the two.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the noble Lord has pointed out—as those of us who have read about this case are aware—that the patient was a very young child. One thing that I find troubling about this whole history is that that fact appears not significantly to have influenced the way in which his case was handled. Is it not the case that there should be a default position in respect of very young children exhibiting symptoms where the precautionary principle should apply, whether in respect of prescribing antibiotics, referring to hospital or any other kind of presumption of the possibility of acute illness?

[Lord Prior of Brampton]

My Lords, one would expect the doctors concerned to make that presumption in the case of a very young child. But the noble Baroness makes a valid point and I am sure that NHS England will take it on board.

Down’s Syndrome: Do Not Resuscitate Orders

Baroness McIntosh of Hudnall Excerpts

Tuesday 15th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, the noble Baroness has just made a truly shocking statement. If indeed this practice was systemic and widespread, it would be a matter of huge concern and I think all of us in this House would be appalled by it. I have no evidence that this is a systemic problem, but it is absolutely the case that this group of very vulnerable people have been let down not just by doctors and clinicians but actually by all of us—the whole of society, for ever. The report produced three weeks ago called Building the Right Support recognised that we have let down this group for decades, and I hope that over the next five years we can start to make amends.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, in his original Answer the Minister referred to the Mental Capacity Act, which is widely admired as legislation that is on the whole benign. However, he will be aware that a Select Committee of your Lordships’ House met last year and produced a report that pointed out that the implementation of the Act is not always as effective as it should be, which has a lot to do with the way health professionals understand their duty under the Act in situations such as this. What progress is being made in improving the training of health professionals under the Act?

[Lord Prior of Brampton]

My Lords, the noble Baroness will be aware that the noble Baroness, Lady Finlay, has become chairman of the National Mental Capacity Forum, which was established in September. She will be looking at all these issues and reporting back in March next year. I entirely agree with the noble Baroness, Lady McIntosh, that the principles in the Act are generally accepted as being the right ones, but their application has not been as consistent as we would like.

Child Health: Play

Baroness McIntosh of Hudnall Excerpts

Monday 12th October 2015 Lords Chamber

[Baroness McIntosh of Hudnall (Lab)]

My Lords—

[Baroness Finlay of Llandaff (CB)]

My Lords—

--- Later in debate ---

[Lord Addington]

My Lords—

[Baroness McIntosh of Hudnall]

My Lords—

[Baroness Jones of Moulsecoomb]

My Lords—

Health Funding

Baroness McIntosh of Hudnall Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, the NHS is facing a challenge over the next five years to achieve productivity savings of some £22 billion. If we wish to have a sustainable, tax-funded health service in the long term, we have to make these savings. I have no doubt that over this time this will cause difficulties, but, again, it has to be seen in the context that we have a national debt of more than £1 trillion and a public sector borrowing requirement that must come down.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, does the Minister not agree that, of all the places to cut the National Health Service budget, it is incredibly short-sighted to do so in areas to do with prevention because, although there may be short-term savings to be made there, in the long term it will build up problems which will cost a great deal more in the future?

[Lord Prior of Brampton]

I repeat my earlier response that prevention is extremely important. We are looking at a relatively small reduction of £200 million out of a total public health budget of more than £5 billion.

NHS: GP Clinics

Baroness McIntosh of Hudnall Excerpts

Thursday 25th June 2015 Lords Chamber

[Lord Prior of Brampton]

I agree with the sentiments of the noble Baroness. There are indeed many GP practices that are collocating outside or very close to A&E departments. For example, I saw one at the Royal Free only last week. It is one of a number of new models of care that we should be exploring.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, may I press the Minister a little more on recruitment? In an answer to me earlier in the week, he made the same reply—that the Government were committed to recruiting more GPs—but he has not yet told us what incentives would make a newly qualified doctor wish to go into general practice, and whether those incentives are financial or otherwise. In particular, the idea that part of your commitment would be to a seven-day week is possibly not quite as alluring as he would like it to appear.

[Lord Prior of Brampton]

The right answer to the noble Baroness is twofold. First, we have to paint a picture that inspires young doctors to go into general practice. There is no doubt in my mind that the solution to the health needs of today’s population depends on a different model of general practice. We can paint that picture, and I hope that leaders of the BMA might wish to help paint it as well. Secondly, on the seven-day week issue, we are living in 2015 and people expect to be able to see GPs at the weekend. People get ill at weekends, and if we want good quality of care, we have to provide that care seven days a week. If we wish people to be treated outside hospitals, we have to provide good access seven days a week in primary care.

General Practitioners

Baroness McIntosh of Hudnall Excerpts

Monday 22nd June 2015 Lords Chamber

[Lord Prior of Brampton]

The Government are committed to seeing 5,000 new GPs. This is probably the biggest expansion of primary care that we have seen for many years. It is not just 5,000 GPs but a further 5,000 people working in primary care, including physician associates, practice nurses, physiotherapists and other allied health professionals.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, is it not the case that, although the analysis that the noble Lord has given us is very accurate, the solutions that he seems to be putting forward are not very clear? Can he say what incentives he and his colleagues will offer young medical students beginning their training to encourage them to go into general practice? It is fine to say that we will train 5,000 more doctors, but we cannot force them into general practice if they do not want to go.

[Lord Prior of Brampton]

The noble Baroness is quite right. After five years as a medical student, they then do two foundation years before making the choice whether to become a GP or to go into specialist medicine. That is a crucial time to persuade young doctors that there is a good, long-term career in general practice. Health Education England and NHS England are putting huge resources into persuading young doctors at that stage in their career that there is a good future in general practice. I say to the noble Baroness that there is no doubt at all in my mind that, if we run the clock forward five years, more care will be delivered in primary practice and in the community than in acute hospitals.

Gender-based Violence: Screening

Baroness McIntosh of Hudnall Excerpts

Monday 9th March 2015 Lords Chamber

[Earl Howe]

Most certainly. Gender-based violence is one of the issues which sexual health clinics, and indeed all parts of the NHS, are now alert to. New guidance from NICE was issued in February last year on domestic abuse and how health and social care services and the organisations with which they work can spot and respond to abuse earlier in a more joined-up and preventive way.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, does the noble Earl agree that not all domestic abuse results in physical symptoms? In his Answer, he mentioned mental health services. What is being done to deal with emotional abuse and to discover and refer people who suffer from it?

Jimmy Savile: NHS Investigations

Baroness McIntosh of Hudnall Excerpts

Thursday 26th February 2015 Lords Chamber

[Earl Howe]

My Lords, I cannot give a specific undertaking on the timescale that we envisage for the consultation or on any legislation that might ensue from it because that raises the question of whether any legislation is necessary. That is what we want to know from the consultation process. However, I can tell my noble friend that the Home Office will be leading the consultation in conjunction with all the other relevant government departments.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the noble Earl repeated a phrase in the Statement referring to Jimmy Savile as a one-off. Although that is qualified in the sentence that follows, nevertheless the reference is made. Does he consider that describing these incidents as a one-off characteristic of an unusual individual is tremendously helpful? We know that he was not a one-off because a number of other people working in NHS settings engaged in similar behaviour and have already been convicted. Many other people who were not working in NHS settings but doing other kinds of job—for example, in the rock music business—were also engaging in this kind of behaviour. Perhaps we need to take more account of the fact that, hard as it is for us to recognise, there are circumstances in which people, given the opportunity, will engage in this kind of behaviour and will continue to do so. Thinking of them as, as it were, bad apples does not help us to grapple with that reality.

[Earl Howe]

My Lords, the noble Baroness is right. It is with that thought in mind that Kate Lampard did not simply pigeonhole Savile as a one-off but has come forward with recommendations, most of which we have accepted, as to the wider lessons we should learn from this sorry saga. We know that, while the scale of Savile’s activities was probably unprecedented, there are others who have been found guilty of similar offences.

NHS: Financial Tariff for 2015-16

Baroness McIntosh of Hudnall Excerpts

Wednesday 4th February 2015 Lords Chamber

[Earl Howe]

It is the view of Monitor and NHS England that providers of specialised services should make every effort to deliver care that is both clinically appropriate and cost-effective in order to manage demand—where, after all, their clinicians have significant influence. NHS England considers the proposed rule to be warranted—this is about the 50:50 split in the tariff—because rapidly growing expenditure that exceeds population prevalence growth is unlikely to reflect efficient and effective services, which, when one thinks about it, are in patients’ best interests overall.

[Baroness McIntosh of Hudnall (Lab)]

Going back to the question asked by the noble Baroness, Lady Barker, I am sure the Minister will have seen recent reports showing that there is a serious shortage of mental health beds in the health service at the moment. Indeed, I believe that at one point in the very recent past there were no more than four or five available in the entirety of the UK—or certainly in England. Parity of esteem is a fine phrase, but is it really being played out in practice?

[Earl Howe]

My Lords, it would require a full-scale debate for me to lay out in full all the things that we are doing to promote parity of esteem in the health service. The noble Baroness is right that in certain parts of the country there has been acute pressure on bed numbers, but bed numbers have been increased in some of those areas, and NHS England is paying close attention to the need to ensure that those who need in-patient treatment receive it.

HIV

Baroness McIntosh of Hudnall Excerpts

Thursday 15th January 2015 Lords Chamber

[Earl Howe]

My Lords, I pay tribute to the work of the Halve It coalition in raising awareness about the importance of increasing HIV testing. My noble friend is right that apart from ignorance often GPs are reluctant to discuss HIV testing or are unaware of the importance of early diagnosis and possible indicator symptoms. My department was pleased to fund the Medical Foundation for AIDS and Sexual Health’s HIV testing in primary care project that provides a web-based interactive resource for GPs in primary care to help make testing easier in GP surgeries.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, does the Minister agree that one of the biggest disincentives to testing is the amount of stigma that still remains against those who are known to have HIV? Alongside encouraging people to have tests, can he say what Public Health England is doing to combat that stigma?

[Earl Howe]

The noble Baroness is absolutely right. If we were to single out three things that are important in this context, they would be prevention, testing and tackling stigma and discrimination. The NHS, local authorities, government, community and faith groups, the media and individuals themselves all have a part to play in eliminating HIV-related stigma. Our framework for sexual health improvement is clear that action needs to continue to eradicate prejudice based on sexual orientation. That depends on building an open and honest culture where everyone can make informed decisions and responsible choices about relationships.