Medicines and Medical Devices Safety Review

Baroness McIntosh of Pickering Excerpts

Thursday 22nd February 2018 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I welcome the review that my noble friend has announced—I can think of no better person than my noble friend Lady Cumberlege to do it. One of the concerns of those who are campaigning and have received what they consider to be very inferior treatment is that when the mesh was originally introduced it was done, they think, without proper research, it was inserted with inadequate training, and inadequate warnings were given of the potential risks. Will my noble friend assure us that if an alternative is sought, that will not be the case but that it will be subject to rigorous testing, that there will be rigorous training of the medical professionals and that the risks will be explained to the patient?

They have also raised concerns about potential trade under any future trade agreement with the United States, where I understand a lot of the mesh comes from. They are concerned that we will not just waive any suspect mesh through but will ensure our own rigorous testing so that it meets the highest requirements of the UK.

[Lord O’Shaughnessy]

I thank my noble friend for those points; she highlights some very important issues. Medical devices are regulated differently from medicines: they have to go through a safety procedure and they are not licensed in the same way as medicines are. They come onto the market, they are used and safety assessments are made as time goes on. We are now in the position with mesh that we will have a registry, so that every time it is used we will know what the consequences are. That will also give us a comparator, as will the audit, for effectiveness against alternative procedures. As I have said, there is still a view in the medical and regulatory communities that, when used according to guidelines in the appropriate way, it can be transformative for women. However, it can also be the wrong thing and NICE has been very clear that in some cases, in some surgeries, the risks outweigh the benefits, in which case it should not be used. It is important that there is absolute conformity with those guidelines and that is part of what the registry will ensure.

On the issue of trade, under no circumstances will our trade relationships with any country in the future dilute the regulatory rigour that we apply and have always applied in this country. We have a very well regarded regulatory system in this country but we also know that we can do better and it is absolutely our intention to continue to strengthen it.

Health: Pelvic Mesh Implants

Baroness McIntosh of Pickering Excerpts

Tuesday 6th February 2018 Lords Chamber

[Lord O'Shaughnessy]

I am grateful to the noble Lord for raising this issue, because there is certainly a complication rate. I know that a lot of women are suffering as a result of complications from this procedure. As he will know, we have asked the MHRA, NICE and NHS England to have a look at the correct use of this kind of mesh. They have all concluded that they do not support a complete ban. They propose a range of restrictions on usage. Indeed, the most recent interventional procedure from NICE on prolapse said that it should be used only for research purposes and not as a front-line treatment. However, I am aware that Australia and New Zealand are implementing bans for particular usage. I have asked NICE and MHRA to investigate why they have done that and to report to me urgently so that I can see the grounds for the ban. We have different regulatory systems, but I want to know what is happening there.

[Baroness McIntosh of Pickering (Con)]

My Lords, will my noble friend explain to the House what the alternative might be if pelvic mesh implants were to be stopped? Is it not appropriate to be absolutely sure that any alternative is fool-proof and that there are no consequences?

[Lord O'Shaughnessy]

My noble friend makes an excellent point. This is one procedure, and for some women it can be positive and life-enhancing. But we also know that it carries a risk of complications. That is one reason why we wanted to carry out the audit, because it will look not only at areas and procedures where there have been problems and complications but at where it has been successful, so that we can have a proper understanding of what the complication rate is and therefore what the safety concerns are.

Nurses and Midwives: Numbers

Baroness McIntosh of Pickering Excerpts

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I think that words do have meaning, and it is important not to miss the opportunity to say how much we value those nurses who have come from the European Union as well as all staff in the NHS. One example of the value with which we hold them is the announcement in the Budget that the Chancellor will fund an Agenda for Change pay settlement for nurses.

[Baroness McIntosh of Pickering (Con)]

My Lords, I congratulate my noble friend on the increase in the number of training places, but can he give the House an assurance today on the figures for recruitment and retention of nurses in rural areas and, in particular, that their travel is fully paid for when they drive round remote parts of the country such as North Yorkshire and other isolated areas that they have to cover?

[Lord O'Shaughnessy]

Yes, absolutely—travel costs should be accounted for, as long as they are incurred in the course of an ordinary working day. I should also point out that extra travel costs are now supported as part of the student finance package for those who need to travel for study.

Greater Manchester Combined Authority (Public Health Functions) Order 2017

Baroness McIntosh of Pickering Excerpts

Tuesday 7th November 2017 Lords Chamber

[Lord Beecham (Lab)]

My Lords, I declare an interest as a member of Newcastle City Council and of its health scrutiny committee. I have served long enough to recall the original reorganisation of local government, combining public health services with social care, in the early 1970s. I congratulate the Government, the Mayor of Manchester and the combined authority on taking the issue forward in the way that the Minister described. Perhaps I should also declare a rather unfortunate interest as I myself am suffering from some oral problems—not, however, as a result of any lack of fluoridation in the north-east. In fact we have a very good record on that; it is one area in which we somewhat lead the way.

My noble friend referred in passing to funding. The public health budget is under great pressure. I hope that the Minister will be arguing the toss with the Chancellor for the forthcoming Budget and the following announcement of the local government finance settlement, which will come no doubt on Christmas Eve or thereabouts. It is crucial that this innovative approach by Manchester, but also the work done by authorities up and down the country under the present system, is adequately funded, and there is a real risk of serious problems arising unless that occurs.

In congratulating Manchester and the Government on this step, however, I ask the Minister what progress he anticipates being made on the rather more difficult area of combining health and social care provision in the way envisaged by the agreement and advocated by the Government across the whole policy field. That will be much more difficult than what is being carried through in Manchester under the terms of the order. The NHS structure is so complicated that it is difficult for local authorities to deal with it adequately now in one local authority area, let alone across a wider area. I cite as an example the difficulties that my authority and the area I represent in the city are having with the clinical commissioning group, which is a big, powerful body, one of several separate powerful bodies within the NHS, and has decided to close a surgery in an area of considerable social need, quite a distance down the hill, as it were, from other surgeries and where there is a growing population on a new housing development in the area.

This suggests that any further development of the combination of health with local services will need a review of how all the partners to that manage to co-operate. It will be very interesting to see what Manchester manages to achieve in that regard. My advice to my colleagues in Newcastle would be, frankly, while exploring options to wait and see what happens in Manchester and how it works out when that stage is reached. I appreciate that we are not at that stage yet, but it is necessary to flag up some of the potential difficulties that might have to be faced if we are to have really effective collaboration across the whole field of health and social care.

[Baroness McIntosh of Pickering (Con)]

My Lords, perhaps I may take this opportunity to question my noble friend on the fluoridation programme. I must declare an interest. I cut my legal teeth as a devil and an apprentice with Simpson & Marwick, and my devil master was the junior advocate in the fluoridation case brought by a pensioner who had dentures—she had none of her own teeth. She objected to the fluoridation programme to be carried out by Strathclyde regional council in the early 1980s. She won her case and Strathclyde regional council did not fluoridate the water supply at the time on the grounds that compelling evidence was led by the petitioner, Mrs McColl, to prove, among other things, that fluoride could be a carcinogen.

Has the Minister taken the time to consider such evidence, and can he assure the House that the level of fluoridation in the public water supply will not be such that any such fears will be raised in the fluoridation programme to be carried out by Greater Manchester council?

[Lord Turnberg (Lab)]

My Lords, perhaps I may ask the Minister about infectious diseases and express my interest as a past chairman of what was the Public Health Laboratory Service and as a Mancunian. Infectious diseases know no boundaries, and it is important with any infectious disease outbreak, which may occur anywhere in the UK, that information is spread very easily to epidemiological centres and central laboratories, so that such outbreaks can be traced and checked. Is there anything in this agreement that will ensure that there is association, collaboration and co-operation with the central laboratory services?

Alcohol: Children’s Health

Baroness McIntosh of Pickering Excerpts

Monday 3rd April 2017 Lords Chamber

[Lord O’Shaughnessy]

Given what is going to happen in the next couple of years, we might want to look at it ourselves, too.

[Baroness McIntosh of Pickering (Con)]

My Lords, is my noble friend aware that it is currently not an offence to sell alcohol to those under 18 at airports, airside, for the simple reason that the Licensing Act 2003 does not apply? Will my noble friend undertake to review this with a view to making it an offence in future and to bring the whole regime under the Licensing Act 2003 without delay?

[Lord O’Shaughnessy]

I thank my noble friend for that question; I was not aware of that issue. I understand that there is a voluntary code in place, but I shall write to her to outline in much greater detail what the situation is regarding the sale of alcohol to underage young people at airports.

Residential Care

Baroness McIntosh of Pickering Excerpts

Monday 6th February 2017 Lords Chamber

Asked by

[Baroness McIntosh of Pickering]

To ask Her Majesty’s Government what estimate they have made of the number of residential care home beds that were available in (1) 2005, and (2) 2015.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, I am informed by the Care Quality Commission that, as of 31 March 2015, there were 464,110 nursing and residential care home places in England. According to the annual reports of the Commission for Social Care Inspection, the predecessor to the CQC, the equivalent figure as of 31 March 2005 was 451,288.

[Baroness McIntosh of Pickering (Con)]

My Lords, I thank the Minister for that Answer, but will he ensure that the number of care home places remains at a sufficiently high level to enable people to be discharged from hospital when it is deemed safe to do so? If there is currently a shortage of care home beds in, for example, rural counties such as North Yorkshire, will his department work very closely with local authorities up and down the country to ensure that people can leave hospital and go to a care home when that is appropriate?

[Lord O'Shaughnessy]

I thank my noble friend for making a very important point. Clearly, the capacity in the care home sector is important for ensuring that there is a proper flow of patients out of hospitals and into a more appropriate setting. In regard to the county that she was talking about, North Yorkshire, I think the overall number of beds has been broadly flat over the period in question, but there has been an increase in domiciliary and supported accommodation, which is increasingly the way that care is being structured across the country.

Mental Health and NHS Performance Update

Baroness McIntosh of Pickering Excerpts

Monday 9th January 2017 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Lord for his question. He speaks with great knowledge and experience, particularly from his work in the Department of Health. There are two separate issues here. First, there need to be more resources, and we are providing those. Secondly, we need to make sure that those resources are applied in the right setting, so that money designed to support mental health goes there. The primary way we deliver that is through transparency: making sure that CCGs—which are, of course, independent of government and making clinical commissioning decisions based on local need—are reporting on the money they are spending and the services they are commissioning in mental health and then making sure that we work with NHS England to look at any CCGs where that is not happening. It is clearly wrong that money which is intended to support mental health does not do so, but the way to deal with that is to work with the CCGs where it is not happening and to make them report on their own performance.

[Baroness McIntosh of Pickering (Con)]

My Lords, I welcome my noble friend to his position and declare an interest as an adviser to the board of the Dispensing Doctors’ Association, having been the daughter and sister of dispensing doctors in rural practice. Are my noble friend and his department aware of a chronic shortage of psychiatrists in rural areas, which has particular implications for children waiting to be statemented and treated? Is he also aware that there may be a spike in retirements of GPs over the next five or 10 years? The Government have addressed the issue of new doctors coming through; is there a second round, bearing in mind that it currently takes seven years to train a GP?

[Lord O'Shaughnessy]

I thank my noble friend for her welcome. The global number of psychiatrists across England is increasing: I was not aware of the particular shortage in rural areas. I will certainly investigate and write to my noble friend about it. I know, from my past work in education and the example of head teachers, that the shape of the public sector workforce is now such that senior positions are weighted towards the over 55s. Although I realise that separate pension arrangements are available in the health service, now that retirement and pension ages are increasing we have a reasonable expectation that people might work longer than they did in the past. Therefore the problem described by my noble friend may not be as acute—not just in health but in other sectors as well—as she says. However, there is clearly an issue about the demography of the service and we are backing up GP recruitment with quite a big increase in extra funding for primary care over the course of this spending review period. A large part of that will go on both recruiting new staff and paying those who are in the system now.

Health: Diabetes and Obesity

Baroness McIntosh of Pickering Excerpts

Thursday 30th June 2016 Lords Chamber

[Lord Prior of Brampton]

That is a very good point, and I hope that it will be covered in the obesity strategy for young people when it comes out later in the year. A key part of our diabetes prevention strategy is to identify more and more people who are at high risk of developing type 2 diabetes and give them a personalised programme to reduce the likelihood of their getting diabetes. We hope that, by 2020, 100,000 people a year will be on that programme.

[Baroness McIntosh of Pickering (Con)]

Does my noble friend agree that we do not need to wait for the obesity strategy for doctors to recommend which diet, salads and fruits those borderline diabetes patients should be taking? Could not doctors be giving that advice now?

[Lord Prior of Brampton]

Of course they should be giving that advice, and indeed they are. There is also clear advice on the Public Health England website as to what is the right diet. Confusing messages have been given over the past couple of months. Therefore, I think it would do no harm to repeat in the obesity strategy what is the right diet.

NHS: Hospital Overcrowding

Baroness McIntosh of Pickering Excerpts

Tuesday 15th March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, there was a 10% increase in demand in January, which put the NHS under huge pressure. It is much to the credit of A&E services that we saw 111,000 more people within four hours than we did the previous January. It is also worth mentioning that, over the last five years, the number of consultants working in A&E has increased by 49%. The number of people working in emergency care as a whole has increased by 3.7%. It does not alter the fact, which I recognise, that A&E departments are under tremendous pressure—they often are in winter. We hope that that pressure reduces as spring approaches.

[Baroness McIntosh of Pickering (Con)]

My Lords, will my noble friend the Minister look very carefully at the reasons for delayed discharges, which lead to overcrowding, and to the particular role that community hospitals, such as the Lambert Hospital in Thirsk, play in rehabilitating those who have had a fall, an operation or a stroke? Will he look very carefully at the role of, and allocate sufficient resources to, community hospitals to ensure that they remain in service, playing this crucial role of step-down between the acute hospital and going home?

[Lord Prior of Brampton]

My Lords, clearly, step-down facilities, including community hospitals, have a very important role to play. The whole thrust of the five-year forward view is to treat more people outside acute hospital settings. That is the NHS’s plan, which the Government support.

Accident and Emergency Services: Staffing

Baroness McIntosh of Pickering Excerpts

Tuesday 23rd February 2016 Lords Chamber

Asked by

[Baroness McIntosh of Pickering]

To ask Her Majesty’s Government what assessment they have made of the number of shifts in hospital accident and emergency services not fully manned in each of the last three years.

[Baroness McIntosh of Pickering (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so I refer to the register of my interests.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, it is the responsibility of NHS trusts to ensure that they have the right number of staff with the right skills in the right place to deliver high-quality, safe and efficient care. There are already almost 32,000 more clinical staff working in the NHS than in May 2010, including almost 6,000 more nurses and 1,280 more doctors within the specialty of emergency medicine.

[Baroness McIntosh of Pickering]

My Lords, I thank the doctors who have been looking after my broken wrist. Does my noble friend agree that the problem is not that junior doctors are not working at weekends, but that there are simply not enough junior doctors on the books at this time, and that no other specialists such as therapists, radiologists and so forth are working over the weekend? What will the true cost of seven-day-a-week hospital opening be to the National Health Service going forward?

[Lord Prior of Brampton]

My Lords, seven-day working clearly goes far beyond junior doctors; it requires senior doctors, pharmacists, social workers, and primary care as well as acute care if we are to deliver a full seven-day service. As my noble friend knows, that is our objective over the next five years.