Primary Healthcare Facilities

Baroness McIntosh of Pickering Excerpts

Monday 17th March 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord is right to highlight regulation. Of course, there are many other aspects beyond physical infrastructure: for example, the use of technology, which also supports the subject on which we are speaking. All these matters are being considered as part of the 10-year plan and I am sure we all look forward to that reporting.

[Baroness McIntosh of Pickering (Con)]

My Lords, is the Minister aware that there is a network of community hospitals which survives? Will she therefore use some of the funds to ensure that these community hospitals remain in place, so that, after a stroke or treatment, patients will be made fit to enable them to return home?

Food and Feed (Regulated Products) (Amendment, Revocation, Consequential and Transitional Provision) Regulations 2025

Baroness McIntosh of Pickering Excerpts

Monday 10th March 2025 Grand Committee

[Baroness Coffey (Con)]

My Lords, I welcome these regulations, on several grounds. First, as the Minister mentioned, this is a deregulatory approach. There cannot be many regulations deemed to be deregulatory that have 104 pages, but 70 of those pages deal with revocations of existing legislation. That is to be welcomed.

I completely support that this will be a risk-based approach. I am conscious that consultations are ongoing on products being considered by the FSA under this approach. I am conscious that some may be concerned about removing the need for separate secondary legislation, which is a hangover from our days in the European Union, but this is perfectly routine.

I have a couple of questions for the Minister. First, I am conscious that the Food Standards Agency is a non-ministerial department, with the DHSC leading on this in government and in Parliament. Can she confirm whether DHSC Ministers will be making these decisions or whether it will be open to Defra Ministers?

Secondly, an issue that arose during the passage of what is now the precision breeding Act was concern that the devolved Administrations would be reluctant to have any GMO in products sold in their countries. The purpose of the United Kingdom Internal Market Act and the non-discrimination principle was to make sure that, where something had been given the go-ahead in England, say, it could be sold anywhere across the United Kingdom, respectful of the devolved Administrations but nevertheless giving consumers that choice. Will the UK Government fully assert the non-discrimination principle in the sale of future products? As I said, I support these regulations.

[Baroness McIntosh of Pickering (Con)]

My Lords, I support the comments made by my noble friend and concur entirely. I congratulate the Minister on bringing forward this streamlining and deregulatory process. However, I share some of the concerns put forward by the Secondary Legislation Scrutiny Committee.

My noble friend talked about GMO. I am personally very wary of GMO products: I would like to know if I were eating such a product or if such feedstuff was being fed to an animal that I may go on to eat. Can the Minister assure me that the removal of the renewals process will not lead to any information affecting the suitability of validation methods for GMOs being overlooked? Put simply, can the public and consumers rest assured that the processes that have been followed hitherto will be followed? How can the public be made aware of those processes and know that that is the case?

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their valuable and considered contributions to the debate today. I re-emphasise the main point I made in my opening comments: removing automatic renewal processes and statutory instrument requirements will not lower food safety or standards. I am grateful for the support from the noble Baroness, Lady Coffey, and for her bringing to bear her experience across relevant departments, as well as from the noble Baroness, Lady McIntosh, and the noble Lord, Lord Kamall.

I have heard a number of concerns, including from the noble Baronesses, Lady Bennett and Lady Walmsley. I understand the points made, and I hope that I can reassure them further from my opening comments. I am very happy to follow up where I have not got the ability, time or wherewithal to answer the questions.

The noble Baroness, Lady Coffey, asked about ministerial decision-making and the assertion of the non-discrimination principle. These reforms do not change what is in place to maintain the functioning of the internal market Act. Differences in approach will continue to be managed through the relevant common frameworks. I reassure not only the noble Baroness but other noble Lords that the FSA and the FSS are strongly committed to achieving a four-nation consensus, in line with our commitment to the food and feed safety and hygiene common framework. Decisions by Ministers in England—which will be from the Department of Health and Social Care, to the point brought up by the noble Baroness—as well as Scotland and Wales, will still be required for authorisations in their respective nations.

The noble Baroness, Lady McIntosh, asked about processes that will be followed with the removal of the renewals process. This SI does not change current GMO labelling requirements, which I know was another matter of concern to other noble Lords. Products that contain or consist of GMOs must be clearly labelled as defined in current legislation. Nothing will change in that regard. Following the reforms, businesses will continue to be required to notify the FSA and the FSS, if they have any new information which might affect the suitability of a validated laboratory-based method for the identification, detection and qualification of GMOs, something that the noble Baroness, Lady Bennett, was also concerned with.

To the point about the SLSC, it is suggested that the House may wish to consider the steps proposed to maintain parliamentary oversight. However, proportionate processes are in place for sufficient scrutiny of authorisation decisions, such as public consultation and the publication of safety assessments and authorisations. It is an important point that the authorisation process remains open and transparent. The SLSC recognised that this aligned with the processes used by other UK regulators.

[Baroness McIntosh of Pickering (Con)]

I do not wish to labour the point too much, but when a statutory instrument is presented to this Committee, we have the opportunity as parliamentarians to look at it. How will we be informed of the renewals if they are on a register? Do we have to ask someone to notify us? How do we know? At the moment, it is automatic; in future, it will not be.

[Baroness Merron (Lab)]

I understand the point the noble Baroness is making. I will turn to the point about the availability of information, which was also the point that the noble Baroness, Lady Walmsley, made. However, details of applications and authorisations will actually be more publicly available than they are currently. I hope that will be helpful. Of course, as we know, Ministers must provide reasoning if they disagree with FSA and FSS advice when they are making their decisions. In order for the public and anybody—including Parliament—to scrutinise regulated product applications and authorisations, all those tools and resources will be available.

The noble Baroness, Lady Walmsley, suggested a reporting mechanism. I am happy to look at that and will take into account what she said. But I say to noble Lords—and I know they know this—that statutory instruments are not the only way in which to hold matters to account, nor are they always the best way to ensure transparency and openness. We are seeking to be more transparent and ensure that we make this an easier place for industry, the public and others to work in—which most noble Lords welcomed.

National Cancer Plan

Baroness McIntosh of Pickering Excerpts

Monday 10th February 2025 Lords Chamber

[Baroness Merron (Lab)]

I am glad that my noble friend is in the health that he is. I am sure that those who have supported him will appreciate his thanks and ours.

The considerations my noble friend raises are very much part of the considerations of the national cancer plan and the 10-year plan. With respect to funding, the allocation to healthcare in the recent Budget has allowed us to take steps to arrest a continuing decline and to fix the foundations. The fact is we are spending more and we are getting less. We have to do things differently. That will mean not just looking at money but reforming care, using solutions such as technology and AI to go further still.

[Baroness McIntosh of Pickering (Con)]

My Lords, I refer to my interests in the register. I warmly welcome the national cancer plan. The Minister will be aware that there still is an unacceptable wait time of 62 days. Will she use her good offices to ensure that there is early referral from GPs and that more funding is made available—for this purpose and longer appointments with GPs—if that is needed to make the case for earlier diagnosis and referral?

[Baroness Merron (Lab)]

I say to the noble Baroness that the overall trend for cancer performance is improving but it still needs to improve further. We will take all the necessary steps. The planning guidance set stretching targets for cancer, which will see around 100,000 more people every year having cancer confirmed—or ruled out—within 28 days, and about 17,000 more people beginning treatment within two months of diagnosis. The key to all of this has to be early diagnosis and treatment and ensuring that people do not get missed out, as we have discussed earlier. The trajectory is in the right direction, but they are small steps and we need to ratchet it up.

National Insurance Contributions: Healthcare

Baroness McIntosh of Pickering Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

As the right reverend Prelate is very aware, most hospices are indeed charitable. They are independent organisations that receive some statutory funding for providing NHS services. As we discussed in a recent debate in your Lordships’ House, the amount of funding that charitable hospices receive varies by integrated care board area, and that will depend in part on population need and the breadth and range of palliative care and end-of-life care provision within the ICB footprint. With NHS funding being provided on a tariff basis, as is usual every year, there is NHS planning guidance, a local government finance settlement and consultations with independent providers. That will happen this year as it has every single year under every previous Government.

[Baroness McIntosh of Pickering (Con)]

My Lords, the Minister is aware of my interest with the Dispensing Doctors’ Association. The idea that allocations will be made in due course simply will not wash. GP practices, care homes and pharmacies will close their doors if the Government do not act urgently.

Pharmacies: Rural Areas

Baroness McIntosh of Pickering Excerpts

Tuesday 10th September 2024 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I refer to my role with the Dispensing Doctors’ Association; I am grateful to the Minister for paying tribute to it. The right reverend Prelate identified the problem of having equal funding in urban and rural areas, where the dispensing doctors she identified fulfil such a crucial role. Can she give the House a commitment that sufficient funds will be made available in the negotiation of the GP contract so that all the services that are available in urban areas will also be available in rural areas?

[Baroness Merron (Lab)]

I know that the noble Baroness understands that there are some services which cannot be provided—for example, online services do an excellent job, as do dispensing doctors, but although I regard the online option as a very creative one that I would like to see expanded further, there are some things that require in-person attention and that will not be possible. We of course take account of situations across the country, in all the discussions, and that includes rural areas.

Inflammatory Bowel Disease

Baroness McIntosh of Pickering Excerpts

Monday 20th May 2024 Lords Chamber

[Lord Markham (Con)]

I think there are two things. One is the CDC programme; the 160 centres and 7 million tests that we have rolled out are now very much helping in that space. However, it is also about making sure that the right people get the tests. On the question of awareness as well, we now have these faecal tests—a bit like bowel cancer screening—which can tell with 90% sensitivity whether you have inflammatory bowel disease or irritable bowel syndrome. With one, you absolutely need to see a specialist for endoscopy, while with the other, you do not. Telling the difference is key.

[Baroness McIntosh of Pickering (Con)]

My Lords, does my noble friend share my concern that a number of people, increasingly women, are being wrongly diagnosed with IBS when in fact they have an underlying cancer condition? How does he imagine that we can rectify this situation?

[Lord Markham (Con)]

For the benefit of the House, I would say they are often confused. Irritable bowel syndrome is suffered by about 10% of the population while inflammatory bowel disease—we are talking about Crohn’s disease and colitis—is suffered by less than 1% of the population. The key thing is trying to understand the difference between the two; as I say, we have this poo test, for want of a better word, which can do that. With people who test positive, you absolutely need to get them into that screening programme and get it right the first time, so you can pick up those problems and things such as cancer.

Integration of Primary and Community Care (Committee Report)

Baroness McIntosh of Pickering Excerpts

Thursday 9th May 2024 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I congratulate the noble Baroness, Lady Pitkeathley, and the committee on their report and on securing this debate. I also welcome my noble friend Lord Jamieson and congratulate him on his excellent contribution today.

I declare my interest as an adviser to the Dispensing Doctors’ Association, and the fact that my late father and brother were both dispensing doctors. Dispensing doctors are general practitioners who provide primary healthcare to around 9.9 million rural patients. Almost 3.5 million of those patients live remotely from a community pharmacy and, at a patient’s request, dispensing doctors are allowed to dispense the medicines they prescribe for them. Only certain patients are eligible to receive dispensing services from a dispensing doctor. In total, around 7% of all prescription items are dispensed by such doctors.

The unique benefit of a dispensing doctor service is that it provides access to medicines and general healthcare under one roof. They provide a total network of 1,107 dispensing practices, spread across England, Scotland and Wales, and are a wonderful example of integration between prescribing and dispensing services that are collocated.

Turning to the conclusions of the report and the Government’s response, I think it is important to note that in Scotland health and social care partnerships have existed for a few years, yet funding arguments continue and, despite integration, there is still inadequate funding for social care, with a lack of care placements, delays in discharge from the acute sector and difficulties admitting patients in A&E, so integration has not yet met the needs of patients in Scotland. I ask my noble friend directly: does he agree that neither GPs nor their contracts currently prevent shared facilities? There used to be physios, district nurses, health visitors and others all collocated at a surgery, but it was these very organisations that removed themselves from the premises, not GPs.

I have some points to put directly to my noble friend the Minister. Remote consultations are simply not the answer. Complex patients and multiple conditions need more face-to-face time with GPs. Social care is means-tested; healthcare is needs-led. The difference between them must be addressed before integration can proceed further. Does he not agree that coterminous health and social care areas do not necessarily work for health, where patients may be given a choice, and it could actually destabilise current general practice if that were to happen? I also ask him to consider that it is not about who owns GP practices, which is perhaps a red herring. The Government must address the rules about occupation, then ownership itself becomes irrelevant. Will my noble friend and his department be mindful of the poor history of contracting, particularly GPs contracting out for out-of-hours service?

I ask my noble friend this directly, because this is something where NHS England, particularly in parts of Suffolk, has got the wrong end of the stick: why has EPS for dispensing doctors, and indeed hospitals, not been commissioned and the infrastructure put in place? The question of who is to pay for that infrastructure remains a vexed issue. I put to my noble friend the words of Dr West, who chairs the Dispensing Doctors’ Association; they strike a chord with those of many others, such as the noble Baroness, Lady Barker, and my noble friends who talked about data sharing, as well as the noble Baroness, Lady Pitkeathley. He asks why there is not one prescribing record per patient. Currently, there are different records for GPs and each hospital where that patient may be treated.

Will my noble friend urgently address the issue of GP training? The government response says:

“We will ensure that all foundation doctors can have at least one 4-month placement in general practice by 2030 to 2031”.


I am staggered, as I am sure others are, that this is not already the case. How can it be that, among doctors who are reaching the end of their training and are looking to have a placement, there are still about 100, as of this week, who do not yet have a placement to go to? That is unacceptable when they have reached the end of what is already a very long period of study and training.

To conclude, if integration is to proceed, which I would welcome, it has to be costed and well thought through. There is no one size fits all. What may well work in an urban area such as Pimlico, which was the example that was chosen, may not work in North Yorkshire or other very rural, sparsely populated areas. It has to be acceptable for the doctors and healthcare workers as well as the patients. Again, I note that integration in Scotland has not yet brought benefits to patients. I urge my noble friend the Minister to put GPs at the centre of patient care and ensure they have access to all patient needs, to ensure better care and fewer emergency admissions to hospital and a joined-up healthcare and social care service.

Cancer: Staffing

Baroness McIntosh of Pickering Excerpts

Thursday 14th March 2024 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I remind the House of my interest with the Dispensing Doctors’ Association. Does my noble friend share my concern about the number of GPs, particularly those under 55, who are considering retirement in the next five years? How do the Government plan to fill the vacancies that will be created, to ensure that, particularly in rural areas, a fast track will exist for patients who are suffering from cancer for the earliest possible referral to hospital? I refer to the letter I wrote to our noble friend Lord Evans on this.

[Lord Markham (Con)]

I thank my noble friend and totally agree that GPs are the front line of our medical services. We are trying to do everything we can to make sure that they feel valued and are retained. The recent change to the pension law was all about addressing that very point, answering GPs’ number 1 concern in order to keep them. Their hard work has seen a 25% increase in the cancer referral rate: we treated 3 million people, up 600,000, over the last year, thanks to their work and the expansion in the diagnostic centres we have set up.

NHS App: Medical Records

Baroness McIntosh of Pickering Excerpts

Tuesday 19th December 2023 Lords Chamber

[Lord Markham (Con)]

The fundamental principle underlying all this is that none of the data leaves the control. The data controllers today—be it GPs, the NHS or the hospital—stay as they are, and any use of that data has to be approved outside of that. The noble Baroness is absolutely correct. We want to make sure that it is not used for any purposes that are not going to improve health outcomes, such as the ones we have talked about.

[Baroness McIntosh of Pickering (Con)]

My Lords, could my noble friend update the House on where we are with sharing data—in particular, the outcomes of clinical trials—with our European partners?

[Lord Markham (Con)]

Clinical trials are among the key areas that are vital to the life sciences industry. We are all aware that, post-Covid, we were falling a bit behind. I am glad to say that now we have improved, so that 80% of the time we are doing the clinical responses in time. We can still do better; that should be 100% but 80% is good. Most importantly, our data is the envy of the world. Just to give noble Lords an example, about 90% of our hospital records are digitised. In Germany, it is less than 1%.

Healthcare (International Arrangements) (EU Exit) Regulations 2023

Baroness McIntosh of Pickering Excerpts

Wednesday 5th July 2023 Grand Committee

[Baroness McIntosh of Pickering (Con)]

My Lords, I congratulate my noble friend on bringing forward what I view as very welcome regulations for us this afternoon. I have to declare an interest, as I currently have an EHIC, which I assume will expire at the end of this year, and visit a very small number of the countries on this list. Given that the list on page 5 in the Schedule seems very full, I take this opportunity for my noble friend to put my mind at rest, because originally—it was a year ago, 2022—it was pointed out that the GHIC, which my noble friend explained will replace the EHIC in the regulations, originally did not cover countries such as Norway, Iceland or Liechtenstein, but they appear on the list. Is that because the original primary legislation did not cover them, or were we just waiting for the regulations before us this afternoon? Can he confirm that the EHIC covers those three countries and that the GHIC will also cover them?

From a practical point of view, I have never yet had to make a claim. I once, rather unfortunately, contracted salmonella poisoning as a Conservative candidate at a hotel which will remain nameless in north London, which rather sorrowfully served chicken drumsticks but did not have the foresight to defrost them. Unwittingly, I was so hungry I ate the chicken drumsticks, and within 36 hours I was in a very sorry way, but not as bad as some of my older colleagues at the time, who had to be hospitalised because of salmonella poisoning. I was then fortunate enough to be injected, not in my arm but in another part of my anatomy by a French doctor and had to have a course of whatever tablets they were.

Are we under these arrangements required to pay similar costs to those in that scenario up front, keep receipts and claim them back when we are back in the UK? Is that how it works? I think most of us are covered, and I know the department and the Foreign Office encourage all of us who travel outside the UK to have the fullest possible medical insurance that we can. Is it reciprocal? Does, say, a Norwegian, a Dane, a Liechtensteiner or someone from whatever third country pay here and is then reimbursed by their medical authorities—just to be absolutely clear on the reciprocity of the situation?

I give the regulations before us this afternoon a very warm welcome.

[Lord Naseby (Con)]

As I understood it, the Schedule on page 5 covers overseas territories and dependent territories. I note that the Cayman Islands is not listed. I have not had time to check whether anywhere else is off the list, but I wondered whether my noble friend could find out and let me know. I ought to declare an interest: one member of my family is working in the Cayman Islands, and there may be others. I recently attended a conference of all the overseas territories and dependent territories, and there seemed to be rather more than appear here, but that may be me and my memory bank. I leave that question with my noble friend.