Medicines and Medical Devices Bill

Debate between Baroness McIntosh of Hudnall and Lord O'Shaughnessy

Committee stage & Committee: 1st sitting (Hansard) & Committee: 1st sitting (Hansard): House of Lords
Monday 19th October 2020 Grand Committee

[The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab)]

I have received a request to speak after the Minister from the noble Lord, Lord O’Shaughnessy.

[Lord O’Shaughnessy (Con)]

I thank my noble friend for addressing the point about therapeutic use, but I think I am slightly more confused now than I was before. He talked about NICE, but of course, NICE does not assess every medical device and assesses from a health economics perspective, as opposed to a purely regulatory, safety and efficacy perspective. It is not something that need detain us, but perhaps he could follow up afterwards with a bit more detail.

Sexual Health Services

Debate between Baroness McIntosh of Hudnall and Lord O'Shaughnessy

Thursday 29th November 2018 Lords Chamber

[Baroness McIntosh of Hudnall (Lab)]

Following on from the question asked by the noble Baroness, Lady Barker, what is the current assessment of the undiagnosed incidence of HIV? There is usually a quantum that is reckoned to be about where we are with undiagnosed incidence. The Minister says that diagnoses have gone down and that that is a good thing, but it is not necessarily. Can he give us some information on that?

[Lord O’Shaughnessy]

Of course, I am very happy to. In this case, it is good news that diagnoses are going down because 92% of people with HIV in the UK have been diagnosed. The UN target was 90%, and we have exceeded it. That leaves 8% to reach and, clearly, we want everyone diagnosed and on treatment, with their viral loads suppressed, so that no new infections can take place.

--- Later in debate ---

[Lord O’Shaughnessy]

First, we are giving it an extremely high profile. Indeed, Governments have given it a high profile since the noble Lord the Lord Speaker raised the issue in the 1980s. All Governments since have been committed to that and this Government continue to be so. We do that through a mixture of public health campaigns and working with schoolchildren to ensure that there is no stigmatisation or bullying of any groups of young people with HIV.

[Baroness McIntosh of Hudnall]

My Lords, as there is a moment left, I ask the Minister to return to the question I asked him. Forgive me if I misunderstood his answer, but I do not think he said what the current assessment is of undiagnosed HIV in any of the populations. If he has that information, perhaps he could let me have it in writing.

[Lord O’Shaughnessy]

I thought I said that 8% are currently undiagnosed across the country. As to how that is split across different socio-demographic groups, I shall have to write to the noble Baroness with more detail.

Health: Stroke

Debate between Baroness McIntosh of Hudnall and Lord O'Shaughnessy

Wednesday 14th November 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord is quite right that patients with atrial fibrillation have a five times greater risk of stroke. Most patients are diagnosed but about 300,000 are not yet, so finding them is critical. The tests are available now not just in GPs’ surgeries but increasingly in pharmacies. I will write to him with specific details about the rollout.

[Baroness McIntosh of Hudnall (Lab)]

Of course the prevention and treatment of stroke is very important, but unfortunately some people have strokes and are incapacitated by them, sometimes physically but sometimes mentally as well. What work are the Government doing to ensure that as many people as possible register a lasting power of attorney so that, when that bad thing happens to them, a proper care plan is available?

[Lord O’Shaughnessy]

I will need to write to the noble Baroness with specific details on promoting lasting power of attorney. There has been an improvement in the availability of occupational therapy for those who suffer disabilities from stroke, but I do not know whether there is support in terms of planning ahead.

NHS: Staff

Debate between Baroness McIntosh of Hudnall and Lord O'Shaughnessy

Tuesday 13th November 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness will understand that the safety of NHS patients, and the NHS as a whole, is paramount when considering workforce. We are looking at whether additional flexibilities can be explored, but that will only be done if we can assure ourselves and others of that safety. These issues are being considered in the workforce plan.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Government have placed great emphasis on mental health recently. Could the Minister tell the House what is the current shortfall of mental health professionals—particularly psychiatrists, and particularly child psychiatrists—in the National Health Service, and how the Government intend to address that shortfall?

[Lord O'Shaughnessy]

The noble Baroness is right to highlight that issue. Only around 30% of those who should be seen for treatable mental health illnesses currently are, which means that we have an important and urgent task to expand mental health places. There simply are not enough mental health staff in any category. This affects all developed countries. A big expenditure is being made, and around 21,000 new posts are being created across all specialties.

Antimicrobial Resistance

Debate between Baroness McIntosh of Hudnall and Lord O'Shaughnessy

Thursday 25th October 2018 Lords Chamber

[Lord O’Shaughnessy]

I join the noble Baroness in congratulating farmers on fantastic action in reducing the use of antibiotics. The specific issue the noble Baroness asked about is in the competence of Defra, so I will have to speak to my colleagues in that department about their opinion on the prophylactic use of antibiotics. On food standards, we have some of the highest food standards and animal welfare standards in the world, as the noble Baroness knows, and we have no intention of lowering them in any trade deal.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister referred earlier to overprescribing. Will he tell the House what is being done to protect the future of scientific research in this area, particularly post Brexit? Although changing the behaviour of GPs and patients is important, long-term certainty will come from research which is yet to be completed.

[Lord O’Shaughnessy]

The noble Baroness is quite right. A key part of the strategy to date has been a £350 million investment in R&D specifically on AMR. On what will happen after Brexit, as she will know, our intention, as set out in the White Paper, is to be part of the successor programme to Horizon 2020, which you do not need to belong to the EU to be part of.

Child and Adolescent Mental Health Services

Debate between Baroness McIntosh of Hudnall and Lord O'Shaughnessy

Wednesday 24th October 2018 Lords Chamber

[Lord O’Shaughnessy]

As I hope the noble Lord will know, refugee children have as much right to access these services as other children. I should also point out that a new mental health assessment trial is being funded by the Department for Education specifically to design mental health assessments for looked-after children of all kinds, including refugee children.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, can the Minister say what work his department is doing with the Department for Education in making consistent the level of pastoral care available in schools, particularly for young people who have experienced mental health problems and may not be in an acute stage but need ongoing monitoring?

[Lord O’Shaughnessy]

I am pleased to tell the noble Baroness that extensive work is being done. It was summed up in the plans outlined in the Green Paper last December and revolves around two things: every school having a designated senior lead for mental health and the recruitment of mental health support teams that will sit in and around schools. It is precisely about joining up education workers and health workers in the community to provide that kind of support.

National Health Service: Mental Health Funding

Debate between Baroness McIntosh of Hudnall and Lord O'Shaughnessy

Wednesday 20th June 2018 Lords Chamber

[Lord O’Shaughnessy]

My noble friend is absolutely right to highlight this issue. Individually, our emergency workers did extraordinary deeds of bravery, for which we are all deeply grateful, during the Grenfell fire. In the aftermath of that fire, the north-west London mental health service was the lead trust in providing mental health support for not just the families and individuals who were victims of the fire but emergency service workers who had been through that very traumatic experience. I strongly encourage any emergency service workers who are experiencing trauma—of course, that can happen many months, indeed years, afterwards—to get in contact with mental health services.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, does the Minister agree that £1 spent today on child and adolescent mental health services is likely to save the NHS a considerable number of pounds in the future? What proportion of the money spent on mental health services is going to child and adolescent services? Will that proportion increase in the future?

[Lord O’Shaughnessy]

The noble Baroness makes an excellent point. The emerging science tells us that heading off mental illness in adolescence is critical to ensuring that it does not deepen and become more severe in later life, with great human as well as economic cost. At the moment, the mental health budget for children and young people does not reflect the burden that children and young people have, which is why the Prime Minister announced an extra £1.4 billion for children and young peoples’ services, as well as £300 million on top of that to support the plans set out in the child mental health Green Paper.

Health: Cancer Nurses

Debate between Baroness McIntosh of Hudnall and Lord O'Shaughnessy

Wednesday 2nd May 2018 Lords Chamber

[Lord O'Shaughnessy]

My Lords, regarding the Statement made by my right honourable friend the Secretary of State earlier today about the errors in the breast cancer screening programme, I take this opportunity to apologise wholeheartedly and unreservedly on behalf of the Government, Public Health England and the NHS for the suffering and distress that has been caused to women by this flaw in the screening service. We will have an opportunity to discuss this at greater length tomorrow, when I will repeat the Statement.

The shortage that has been described is based on an analysis of vacancy rates. The number of cancer nurse specialists has actually increased by 1,000—that is 30%—in the last three years alone. That is a huge increase. Of course we know that we need to do more, but it is worth recognising the great steps forward that we have made in cancer treatment in this country.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, can I take the Minister back to the question from the noble Baroness, Lady Hayman? In his answer, he made the rather odd observation that it was in the long-term interest of the service that we should recruit our workforce domestically, and no doubt that is at least an arguable position. However, we are not talking about the long term here: we are talking about the immediate term. In the interest of joined-up government, could he go back to his colleagues at the Home Office and ask them to look again at whether they have made the right decisions in this case?

[Lord O'Shaughnessy]

I reassure the noble Baroness that we have lots of discussions with the Home Office about the recruitment of international doctors and nurses. I reiterate the point, however, that it is our intention to increase the number of training places for doctors and nurses from this country.

Health: Online Services

Debate between Baroness McIntosh of Hudnall and Lord O'Shaughnessy

Monday 23rd April 2018 Lords Chamber

[Lord O'Shaughnessy]

On that specific point, NHS England is providing £45 million through the general practice forward view to promote online consultations. That is to ensure that they are available in general practice across the country. The noble Baroness will be aware of the GP at Hand practice, which is one practice in west London offering these services, but we are seeking to expand them, and NHS England, the CQC and others are providing regulatory support during that process.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, can the Minister explain the process? If someone chooses to access an online GP service, what happens to their registration with the GP with whom they are already registered—if they are registered? Is the process clear to each patient?

[Lord O'Shaughnessy]

That is an excellent question. It is important to distinguish between the independent sector and the NHS. The CQC report was about the independent sector, so a patient would continue to be registered with their NHS GP practice and have an augmenting consultation, if you like. With GP at Hand, as it is an NHS practice, they would switch their registration. One issue that has come up is whether people have full enough information about that switching, which is one thing that NHS England is reviewing in the independent review that it has commissioned about the success or otherwise of that service.

Children and Young People: Mental Health

Debate between Baroness McIntosh of Hudnall and Lord O'Shaughnessy

Wednesday 28th March 2018 Lords Chamber

[Lord O'Shaughnessy]

There has undoubtedly been an impact on mental health nursing. In fact, the widest definition of the mental health and learning disability workforce according to the latest workforce stats is up by around 3,000 full-time equivalent posts. But we agree that more needs to be done. That is why there is an ambition to bring in 4,400 more mental health staff to support children and young people over the next few years. It is also reassuring to know that there are 8,000 mental health nurses in training at the moment.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister will be aware that the incidence of mental health issues in children of primary school age is growing. Whatever the causes, they are almost always amplified and exacerbated by the onset of puberty and the transition to secondary schooling. What emphasis is being put on identifying and helping to meet the unmet need in primary schools, and who is undertaking that work?

[Lord O'Shaughnessy]

That is an excellent question. A terrifying statistic is that 8,000 of those under 10 years old are suffering from severe depression. The designated leaders will be in every school; that is the ambition. We are also rolling out mental health support teams to support all schools, both primary and secondary, so I can reassure the noble Baroness that primary schools are within the scope of the plans.

NHS: Charitable Donations

Debate between Baroness McIntosh of Hudnall and Lord O'Shaughnessy

Thursday 22nd February 2018 Lords Chamber

[Lord O’Shaughnessy]

That is an important point. We are not yet in a position where we have mandatory collection of all that unit pricing data. That will happen from the next financial year onwards, so we will be able to publish that data. It is important, though, to resist the urge to send out to people information itemising costs, precisely for the deterrence reasons that I mentioned.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, we can all agree that the National Health Service being free at the point of use is probably the single most valued thing about it for everybody. Personally, I would not want to see that changed or compromised in any way. However, despite the Minister’s reasonable point about putting people off, does he not think that it would help people to value the health service more if they better understood the real cost of what it takes to treat what are in some cases quite minor ailments? Further, could it not help with the pressure on GPs to overprescribe certain drugs, the use of which we would really do well to reduce?

[Lord O’Shaughnessy]

I think we are getting to a sensible position here: we want that transparency about what things cost in general, but not specific to each patient because of the concern that it might put people off. There is a lot more information available now than there ever has been about what items cost. What is critical—what we have learned—is that when people miss appointments, for example, which costs about £1 billion per year, there is a good opportunity to demonstrate what that cost is. But as regards what they incur as they go through the experience of healthcare, we worry about the deterrence.

Agency Nurses

Debate between Baroness McIntosh of Hudnall and Lord O'Shaughnessy

Wednesday 10th January 2018 Lords Chamber

[Lord O'Shaughnessy]

The number of uses of the “break glass” clause has actually fallen since April 2016, which was the peak. This shows that there has been a much more planned use of bringing in extra staff as they are needed, rather than an ad hoc response, which was what it was designed to address.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, further to the question from my noble friend Lady Pitkeathley, now that the noble Lord’s department has had “Social Care” appended to its title, does he agree that community and district nurses must be a vital part of the interface between healthcare and social care? As he has indicated that he accepts that there are fewer of them, what is being done to ensure that there are more in the future?

[Lord O'Shaughnessy]

That is an incredibly important point. We know the role that district and community nurses have, particularly in the interface between hospitals and social care. I have pointed out that more nurses will be trained. That will provide an opportunity to recruit to those areas which have not seen the increases that other areas of nursing have done, including district and community.

Young Women: Self-Harm

Debate between Baroness McIntosh of Hudnall and Lord O'Shaughnessy

Thursday 16th November 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is absolutely right to highlight the importance of schools in dealing with this. It is not just a health issue. Indeed it is not just about education either, but involves a cross-government approach. I would be very keen for her to write to me with the specific details of what she is describing—it does not sound like a positive development. Much more positively, more than 1,000 secondary schools have now had mental health first aid training for at least one teacher in the school, and the ambition is to extend that to all secondary schools. She will also know that there will very shortly be a children and young people mental health Green Paper, which I think will have quite ambitious actions for both schools and the health service to support young people with mental health problems.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, building on the Question from the noble Baroness, Lady Walmsley, does the noble Lord agree with me that bullying in schools can start very early, well before secondary school, and can give rise to very severe mental health issues among those who are bullied? Does he also agree with me that schools struggle to deal with this issue, partly because they are unclear about how to balance their duties of care to victims and to perpetrators, who often have issues of their own? Can he say in what way he is working with his colleagues in the Department for Education to make sure that primary schools have access to good resources to meet this, including programmes such as Place2Be?

Mental Health: Children’s Services

Debate between Baroness McIntosh of Hudnall and Lord O'Shaughnessy

Thursday 19th January 2017 Lords Chamber

[Lord O'Shaughnessy]

I was not aware of that fact, but it is clearly an important one and I shall write to the noble Lord with the information about what we are doing to support those children who come to this country.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister will be aware that there is an issue around identifying people in need of treatment, but there is also an issue about the sustainability of the workforce to deliver that treatment. What are the Government doing to encourage more trainee professionals, both doctors and other kinds of mental health professionals, to pursue a career in relation to mental health, which as I understand it is still fairly unpopular as a specialisation?

[Lord O'Shaughnessy]

That is an extremely good point. The people need to be there in order to deliver. There are two parts to the answer—first, that within the additional £1.4 billion going into children and adolescent mental health services over the course of this Parliament, about £130 million is for workforce development. Secondly, because of our reforms to workforce training, there are another 1,500 doctor training places. By removing the cap on nurse, midwife and allied health professional training, universities will be able to offer up to 10,000 more places a year for those positions.