HIV Diagnosis: Clinical Guidance

Debate between Baroness McIntosh of Hudnall and Lord Prior of Brampton

Thursday 1st December 2016 Lords Chamber

[Lord Prior of Brampton]

The black African community, male and female, is a group especially vulnerable to HIV, as identified in the work done by NICE. It is a part of the population where special efforts must be made to increase early testing. The work done by the Terrence Higgins Trust in the MARPs programme has also identified that community as extremely important. I think we will see greater targeting of the about 13,000 people in the population who are living with undiagnosed HIV.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister referred briefly in his opening Answer to the question of stigma. I do not know whether he will have heard some testimony from people living with AIDS on the “Today” programme this morning—probably not, as he may well have been working already. It showed that they were subjected to shocking levels of prejudice, most of which appears to come from ignorance. Can he expand a little on what the Government are doing to encourage the right kind of information, not just for people who have AIDS or might be vulnerable to getting it but to the wider population whose attitudes are, frankly, a little prehistoric in quite a lot of cases?

[Lord Prior of Brampton]

That is a very insightful question. If we look back over time it is a lot better than it was but, as the noble Baroness says, it is still far from good enough. The education programme needs to go beyond just the people who have AIDS to the wider population, to get a greater degree of understanding. Perhaps I could investigate that issue a little further and write to the noble Baroness.

NHS England: Pre-exposure Prophylaxis for People at Risk of HIV

Debate between Baroness McIntosh of Hudnall and Lord Prior of Brampton

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

I do not think that it is a fallout from the Health and Social Care Act. It is purely that the NHS specialist commissioning committee within NHS England has received clear independent legal advice, as I understand it, saying that it does not have the power to commission this product. That position may well be challenged legally, in which case it will be resolved one way or the other.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I am sure that the Minister will be aware that for those of us who are not experts in this field but know a little about it, this is an extraordinarily puzzling thing to be confronted with. It just sounds plain daft, frankly. But will he confirm that there is very little prospect of vaccination or immunisation against HIV being developed any time in the foreseeable future and that PrEP is therefore a vital tool in preventing the spread of this infection for the next generation, and probably for subsequent generations? If this legal tangle has to be untangled, can he also say how long he anticipates that will take?

[Lord Prior of Brampton]

I do not know how long a judicial review will take. I guess that it will be months rather than years, but I simply cannot answer that question as I do not know the answer to it. Again, this is a legal issue, not an efficacy issue. This is a question not of the Government saying that we do not want to fund this prophylactic, but of NHS England simply saying that it has been advised it does not have the power to do so.

Mental Health Services

Debate between Baroness McIntosh of Hudnall and Lord Prior of Brampton

Thursday 28th April 2016 Lords Chamber

[Lord Prior of Brampton]

I assure the House that, on the funding that the Government have agreed for children’s and young people’s mental health and adult mental health—in the light of the Prime Minister’s announcement in January, but particularly in the light of Paul Farmer’s report that came out six weeks ago —we are fully committed to meeting those obligations.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I do not think that the House in any way doubts the Minister’s personal commitment to additional expenditure on mental health. However, he will be aware if he has been listening to questions in this House over the past few weeks that the issue of mental health provision has come up, for example, on the Question of children caught up in separation yesterday, and in relation to asylum seekers and the prison population. One of the key resources in short supply is mental health practitioners. What are the Government doing to encourage more people coming into the health professions to regard mental health practice as a priority for their careers, not just a government priority?

[Lord Prior of Brampton]

The noble Baroness makes an interesting point. There are no short-term fixes for workforce issues. It is generally recognised that there is a shortage of people choosing psychiatry when they come through their foundation year 2 as junior doctors. We are concerned about that. There has been a significant increase in the counsellors used for delivering IAPT courses, but we are cognisant of the fact that we have to keep a very close eye on that.

Mental Health Taskforce

Debate between Baroness McIntosh of Hudnall and Lord Prior of Brampton

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, this Statement does not deal with children. The Government have promised to spend an extra £1.4 billion on children and young people over the next five years. I cannot recall the impact that it will have on the number of beds but there will certainly be more beds for children experiencing severe eating disorders. I will have to write to the noble Lord with that information if that is all right.

[Baroness McIntosh of Hudnall (Lab)]

No doubt the noble Lord will tell me if I am wrong, but I believe that attracting people who are in training, particularly as doctors, into psychiatry and other mental health-related parts of the profession is still very difficult. What work are the Government doing with the medical training institutions to encourage more people to regard psychiatry and related professions as a proper way to use their skills?

[Lord Prior of Brampton]

The noble Baroness is right: psychiatry is one of the shortage areas, along with general practice and a few other specialties. Premia will be available in the new junior doctor’s contract to encourage people to do psychiatry. That does not answer the noble Baroness’s question all that fully; this is something I should like to look into more myself. However, within the extra spending that has been announced, there will be money for, I think, 1,700 therapists who are experienced in IAPT—cognitive behavioural therapy and the like—which should also help.

Junior Doctors

Debate between Baroness McIntosh of Hudnall and Lord Prior of Brampton

Monday 8th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, we certainly do not want to go back to the days when junior doctors were working very long and unsafe hours but nor should we ignore the fact that they do not, by and large, like being treated as shift workers. The continuity of care is very important to most professional doctors. As for the actual negotiations, I have not been directly involved with them so I do not know to what extent the junior doctors have been asked to consider what my noble friend Lord Lansley has suggested. However, what he says has much merit.

[Baroness McIntosh of Hudnall (Lab)]

May I take the Minister back to an answer which I think he gave to the noble Baroness, Lady Walmsley? He referred to his hope that other medical professionals will in due course be included in seven-day working in order, as I think he put it, to support the junior doctors. Can he say whether those people who are involved in the lab work, the diagnostics and so forth will also be asked to work on contracts comparable to those which the junior doctors are currently being asked to accept?

[Lord Prior of Brampton]

My Lords, I think that they will be different for different people but we already have seven-day working in some of our hospitals. Salford Royal is a case in point where we have a lot of seven-day working. This is something which will evolve over the next three years.

NHS: Junior Doctors’ Pay

Debate between Baroness McIntosh of Hudnall and Lord Prior of Brampton

Wednesday 27th January 2016 Lords Chamber

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I think that the House will have been very interested to hear the Minister say, in terms, that seven-day working is not just about junior doctors but about a lot of other healthcare professionals who also need to be able to bring their services to bear at those times. Does he not think that it is a great pity that the dispute, as it has been conducted politically, has focused entirely on junior doctors and that this point has not been brought out? Will he do his best to make sure that it is brought out hereafter?

[Lord Prior of Brampton]

My Lords, discussions are going on with senior doctors and consultants at the same time, so I can assure the noble Baroness that it is not just with junior doctors that we are having these discussions.

Failures of the 111 Helpline

Debate between Baroness McIntosh of Hudnall and Lord Prior of Brampton

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

Debate between Baroness McIntosh of Hudnall and Lord Prior of Brampton

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.

Health Funding

Debate between Baroness McIntosh of Hudnall and Lord Prior of Brampton

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

Debate between Baroness McIntosh of Hudnall and Lord Prior of Brampton

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

Debate between Baroness McIntosh of Hudnall and Lord Prior of Brampton

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.