Carers: Back Pay Liability

Baroness McIntosh of Pickering Excerpts

Wednesday 16th May 2018 Lords Chamber

[Lord O'Shaughnessy]

I recognise the concern expressed by the noble Baroness, which the Government share. Even though the position on the change of the status on paying sleep-in payments changed in October 2016, we understand the size of civil liabilities for some providers who, of course, are, in many cases, providing for some of the most vulnerable people in society. That is why this HMRC scheme was set up. It gives providers extra time—up to 15 months—to get their house in order, understand their liabilities and pay them. That comes to an end in March 2019, which is why we are working on looking at other interventions and talking to the European Commission about the legality and state-aid rules in relation to that. I am afraid that I cannot give her any more detail at this stage, but I can tell her that it is a priority.

[Baroness McIntosh of Pickering (Con)]

My Lords, this is particularly about the retrospective nature of this award. I contacted my noble friend, who was kind enough to take up the case of the Wilf Ward Family Trust, which provides for the care needs of young people with learning disabilities and which will be affected. Is he able to contest the retrospective nature of this decision and ensure that no similar back pay will be awarded in the future? County councils are completely incapable of making up this shortfall.

[Lord O'Shaughnessy]

I thank my noble friend for raising the issue, which we are looking into. The point here is that the change in policy has come about because of decisions made by employment tribunals and a clarification of the law, and the job of government is therefore to help providers to comply with the law. That is how the scheme has come about, and why extra support is being looked into. We are working closely with providers to try to understand the scale of the liability and how it affects organisations differently—we think that up to two-thirds are affected. We will also make sure that any intervention that might follow—I stress “might”—is proportionate, fair and legal.

The Long-term Sustainability of the NHS and Adult Social Care

Baroness McIntosh of Pickering Excerpts

Thursday 26th April 2018 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, it is a pleasure to follow the noble Lord. This is a wide-ranging debate and touches on a number of major issues. We are greatly indebted to the noble Lord, Lord Patel, and his committee, and I congratulate him on securing this debate. My father and my brother were country GPs and my uncle was a surgeon. They devoted their working lives to the health service. My father was one of the first NHS GPs in 1948. In the days when home visits were the norm, he worked on duty, on call every second night and every second weekend. Whatever the weather, Dr Mac would be there to look after the patient. I yield to no one in my admiration for those who work at every level in the health service.

I would like to look at ways of enhancing the long-term sustainability of the NHS, particularly in rural areas. I work with the board of the Dispensing Doctors’ Association. Its national headquarters are in Kirkbymoorside in North Yorkshire. I recognise the great work that such doctors do dispensing in sparsely populated rural areas that are not well served by community pharmacies. Undoubtedly, providing all public services, not least healthcare, in rural areas is more challenging and more expensive, and it is not generally recognised in NHS funding.

There are further challenges, such as the lack of good access to rural broadband. It is important to acknowledge that it is very difficult for those practising in rural areas to access NHS Digital. I refer, for example, to the electronic prescription service, which is a particular challenge in rural areas. It seems bizarre that at the moment the health service seems to be putting more money into allowing patients to access wi-fi in the waiting room before a GP consultation than into beefing up the broadband available to rural GPs.

Historically, Conservatives in government have always emphasised rurality and sparsity factors in both funding and delivering healthcare. Given the vast areas that GP practices cover and the often long distances patients have to travel to general hospitals, community hospitals play a central role in delivering healthcare in rural areas. It is a matter of anger tinged with sadness that a decision was taken by the local clinical commissioning group to close the Lambert hospital temporarily, then permanently. More recently, NHS Property Services has decided to sell the site on which the hospital is situated. In terms of delivering healthcare locally, this is a retrograde step. To the local community, selling a facility that was gifted to the people of Thirsk and surrounding villages in perpetuity by the Lambert family is ethically and morally questionable. In my view, it is indefensible. It was a fantastic facility, offering step-up, step-down rehab after a fall, stroke or operation, making patients safe before they returned home. I take this opportunity to seek an assurance from the Minister that he will either intervene, block the sale of the site and permit the Lambert site to be converted into a health hub for the local community, which is what GPs in Thirsk are requesting, or ensure that the proceeds of the sale are returned and used for healthcare in Thirsk.

Primary care is currently the less-favoured arm in NHS funding compared with secondary care. This point was made by the noble Baroness, Lady Tyler. This imbalance needs to be addressed. The idea of hypothecating national insurance contributions to pay for the NHS has some merit but, as I mentioned in my earlier intervention, taking 1% out of the health service by increasing this charge is immediately to remove funding that would normally go to front-line care, so that potential gap in the finances has to be filled.

I welcome the idea of a royal commission to look at sustainable, long-term funding for the NHS, particularly if it were against a background of cross-party consensus. Such a commission would be a wonderful opportunity to review the balance of spending in favour of primary care, particularly in rural areas where costs are higher owing to rurality and the sparsity of the population, which I mentioned earlier.

I favour the model of GPs working in partnership, but we face a ticking time bomb. A number of GPs face retirement over the next five to seven years, and fewer GPs want the responsibility of being partners. It is not just that positions are difficult to fill in London, which the noble Lord, Lord Winston, referred to; they are difficult to fill in rural areas too.

My question to the Minister today is: where is the parliamentary scrutiny and accountability of NHS England and NHS Property Services? They operate independently of government and appear totally unaccountable to Parliament. I am aware of the mandate agreed between the Department of Health and Social Care and NHS England, but I question where the adequate parliamentary scrutiny is. For the sustainability of general practice and with a view to allocating more funds to delivering healthcare in rural areas, the balance between rural and urban areas should be addressed as a matter of urgency. Enabling GPs to treat patients swiftly after appointments at their surgery would prevent an increasing dependence on admissions to accident and emergency departments and prevent a troubling ailment becoming acute.

Brexit: Food Standards Agency

Baroness McIntosh of Pickering Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord O’Shaughnessy]

I can certainly reassure the noble Baroness that the Food Standards Agency is getting the resources it needs, as well as a stable funding settlement across the spending review period. The Chancellor announced £14 million more for it for 2018-19. That money will also beef up—excuse the pun—the National Food Crime Unit to make sure that it can investigate the kinds of cases that she has highlighted. As for the ongoing relationship with the EU, it is important to recognise that during the implementation period we will continue to access food information-sharing systems. We will continue to have food risk assessments carried out on our behalf by the European Food Standards Authority, and the Commission will make risk-management decisions that affect the UK. We will continue to be part of that system until the end of the implementation period. Naturally, what happens after that is a matter for negotiation.

[Baroness McIntosh of Pickering (Con)]

Will my noble friend commit to setting out the timetable for all the implementation regulatory statutory instruments that are required to enhance the powers of the Food Standards Agency, given the role that it will be required to play not just in domestic food production but in relation to all imports from 29 March next year?

Brexit: Health and Welfare

Baroness McIntosh of Pickering Excerpts

Thursday 29th March 2018 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I congratulate the noble Baroness, Lady Brinton, on securing this debate and so eloquently setting the theme. On a personal note, I am a doctor’s daughter, a doctor’s sister and a doctor’s niece. The noble Baroness mentioned that this year is the 70th anniversary of the founding of the NHS, and I am extremely proud that my father was one of the first NHS doctors, having come back from serving with the Royal Army Medical Corps in Hamburg, where he met my mother, who had come down from Copenhagen to work for the British Army at that time. Less savoury was the fact that he was referred to as a panel doctor by my uncle, who was a surgeon, but I am very proud of the service that my family has given to the NHS. As declared on the register, I also work with the board of the Dispensing Doctors’ Association, which represents GPs in rural practice.

As we speak today, what concerns me most is that we need be in no doubt as to what the impact will be on the health and welfare of those working in the NHS and those benefiting from it in this country of the proposed withdrawal from the EU of the United Kingdom. What is missing here is a sense of urgency on the part of the Government. If this debate serves no other purpose, I hope that the Minister in summing up will take back a strong message to the department that we need to tackle the issues. Let us look at the sheer volume and scale of the problem. We are told on page 19 of the report, EEA-workers in the UK labour market: Interim Update, that 4.1% of professionals working in health and 5.1% of those working in residential and social care come from the EEA. That means that just short of 10% of the total workforce of health and residential and social care comes from the EEA.

The UK is therefore heavily dependent on our EU and EEA membership for our doctors, nurses and other health professionals. Yet the Minister recently confirmed in a Written Answer that there is as yet no accreditation scheme that will apply from 29 March next year. We are rightly told that this will be on the basis of mutual recognition. How many years did it take us to achieve mutual recognition the first time? I do not believe it took so long for lawyers like myself, or for doctors like my brother, who has now retired from general practice, but for architects it took 21 years to agree, on the basis of mutual recognition, that their qualifications would be recognised. I hope that the Minister will confirm today that this will be a top priority for the Government, because we are haemorrhaging. I know that from personal experience: a Danish friend of mine and her New Zealand husband are consultants in the health service, operating at the highest level, and they are returning to Denmark to work because they simply do not know what continuity of service they will have.

We learned today from the Brexit Minister that there will no longer be free movement of people and professionals between the UK and the EU; I understand that that would be from the end of the transition period—if we have an agreement and there is a transition period. Yet we know from the briefings provided to us today that 9.3% of UK doctors working in the NHS emanate from the EU.

We are currently on course to subscribe to and apply the falsified medicines directive. This will have huge cost implications, particularly for general practice, and yet, as I speak there is no clear guidance as to what the IT provisions will be. The drug will need to be scanned when it comes in and scanned again when it goes out, and there is obviously a question mark over who will pay. I hope that the Minister will take the opportunity to explain today to what extent we will apply the falsified medicines directive.

The noble Baroness, Lady Brinton, also spoke about clinical trials, which we debated in the EU (Withdrawal) Bill Committee. It is extremely important that we have a commitment that we continue to benefit from those clinical trials. It appears that we will no longer have access to EU Horizon 2020 funds, yet the briefings we had today show that we do not just pay into the current R&D programmes but are a major beneficiary of them. Again, it would be a huge potential loss if we were no longer allowed to participate in those programmes.

On our membership of the single market and customs union, let us remember that prior to 1992 we were not in the single market. I am proud that the single market was a Conservative initiative, but we did not benefit from it until it was set up and we joined in 1992. However, we currently benefit from both, and they are vital for both the exporting and importing of our pharmaceuticals. I hope that the Minister will reassure us that those will continue even though we are due to leave the European Union.

On the exchange of blood and vital transplant organs, these are extremely perishable and cannot possibly be held at the borders, yet from the exchanges we had at Question Time, it is still not clear what the arrangements will be. The noble Baroness, Lady Brinton, mentioned the current free flow of health professionals and indeed patients across the Irish border, but we do not know what the customs arrangements will be—not just in Ireland but between the UK and our current European partners.

It is a fact that we are certainly dependent. The Royal College of Physicians is recommending that the UK must continue to welcome new doctors to work in the NHS and provide express and urgent guarantees that EU doctors currently working in the NHS will be able to permanently remain in the UK even in the event of no deal. I know for a fact that the Minister and I share a rather charming dentist who happens to be French in origin and qualified in the EU, and I am sure we would wish to continue to benefit from his services. At the moment, though, it is still not clear, until the mutual recognition accreditation schemes are set up, what the arrangements will be.

The Government are asked specifically to grow and expand the medical training initiative by increasing the number of visas available and, in addition, to seek to establish a scheme similar to that for DfID or for low-income and middle-income non-priority countries, particularly those such as Australia that have similar training programmes to the UK and where we can recruit more doctors through such training places. The RCP reports calls by the medical Royal Colleges and the BMA to keep the current cap on restricted certificates of sponsorship for the short term and exclude applications for shortage occupation roles from the allocation process. The UK is currently considered a world leader in medical research, producing around 25 of the top 100 prescription treatments. As I have mentioned, we are still a net beneficiary of research grants and very successful, so I hope the Minister will continue to give an assurance today in that regard.

I conclude by asking the Minister to give a sense of urgency to the concerns being expressed in the House in this debate. The Prime Minister has stated that she wants a Brexit that works for everyone living in the UK, so will the Minister give the House an assurance that we will continue to welcome doctors from the EU and the EEA; that health professionals currently in practice here will be allowed to remain; that we will have a certification scheme in place as a matter of urgency; that we will continue to have access to the EU research and development funds; and that we will have smooth access to vital organs, perishable medical products and clinical trials in future? I am delighted to support the noble Baroness, Lady Brinton, in this debate.

General Practitioners: Workforce

Baroness McIntosh of Pickering Excerpts

Monday 5th March 2018 Lords Chamber

Asked by

[Baroness McIntosh of Pickering]

To ask Her Majesty’s Government what assessment they have made of the number of general practitioners taking early retirement; and what steps they are taking to increase the size of the general practitioner workforce.

[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 my registered interest.

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

My Lords, in the 2016-17 pension scheme year, 721 GPs took early retirement, representing 62% of all GP retirements. However, it should be noted that many GPs who take their NHS pension then return to service. Early retirement does not necessarily mean a loss of skills and experience to the NHS. We recognise, however, the need to increase the general practice workforce, which is why the Government remain committed to delivering an additional 5,000 doctors working in general practice by 2020.

[Baroness McIntosh of Pickering]

My Lords, we appear to be in a vicious cycle of doctors retiring early and then coming back and working part-time and fewer EU doctors coming to work here. What can my noble friend do to increase the number of doctors wishing to enter GP practice as opposed to other specialties, and what will the certification procedure be for EU doctors to be recognised as doctors to practise post Brexit in this country?

[Lord O’Shaughnessy]

I thank my noble friend for her question. It is interesting to note, looking at the figures, that the total number of retirees from general practice has been falling in recent years, which is very welcome, even though in the past few years there has been an increase in the number taking early retirement. As for entering general practice, that is how we need to get more GPs. The number of training places has increased to a record 3,250, which is an 18% increase over the past three years. Finally, on certification, mutual recognition of professional qualifications is of course a matter for negotiation as part of our future relationship with the EU. However, I can tell my noble friend that the Government are committed, under whatever circumstances, to recruit 2,000 international GPs in the coming years.

Alcohol: Minimum Unit Pricing

Baroness McIntosh of Pickering Excerpts

Wednesday 28th February 2018 Lords Chamber

[Lord O'Shaughnessy]

I do not recognise the picture of obstruction about tobacco and smoking. This Government have done a huge amount, and smoking levels have never been lower. In terms of increased pricing, history tells us, if you go back hundreds of years—think about “Beer Street” and “Gin Lane”—that taxation has a really important role to play in promoting better drinking habits. That is the approach that we have taken with changes in duty for drinks that are particularly problematic, such as white cider. As I have said, we will look at how minimum unit pricing in Scotland progresses.

[Baroness McIntosh of Pickering (Con)]

Is the Minister aware that Scotland has banned or tried to reduce BOGOF—buy one get one free—at supermarkets? That is the evidence that we heard on the ad hoc committee, which I had the honour to chair, on the scrutiny of the Licensing Act 2003. Changing behaviour is a good way forward, rather than the potentially regressive tax of MUP.

[Lord O'Shaughnessy]

My noble friend speaks with great wisdom about making sure, not just with alcohol but with other health issues around food and drink, that we have a look at making those kinds of promotions not possible.

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?