Health and Social Care Bill

Baroness Morgan of Drefelin Excerpts

Tuesday 25th October 2011 Lords Chamber

[Lord Rea]

My Lords, I have spent most of my professional life working in the National Health Service. I have also worked in and observed other healthcare systems and have come to value the NHS all the more not only for its universality but for the high quality of its coverage. I admire it also for its economy of working. We spend considerably less on health per head of population than most other countries at a similar stage of economic development.

By and large, the NHS has conformed to the principles laid down in the amendment. Of course, it is far from perfect. Its bureaucracy, as the noble Baroness, Lady Williams, said, is sometimes inflexible. For example, the treatment of whistleblowers is often inappropriate. Internal criticism should be heard and acted upon and not suppressed, but this Bill is not necessary in order to correct that. The amendment is an important reminder to government at both national and local level of what the NHS stands for. Any action by government or individual staff should be taken with these principles firmly in mind.

[Baroness Morgan of Drefelin]

My Lords, there is nothing like suggesting to a House of Lords Committee that we move on to encourage one to stand up and contribute.

The noble Baroness, Lady Thornton, mentioned the debate that took place at the start of the Committee stage of the Apprenticeships, Skills, Children and Learning Bill, now an Act, in 2009. I remember sitting behind the Dispatch Box next to my then noble friend Lord Young listening to the noble Lord, Lord Hunt of Wirral, make a very convincing case for the Opposition on the need to set out a clear definition of apprenticeships and the importance of a well thought through, principled preamble. I remember listening to my noble friend take the Committee through a detailed and well argued explanation of how all those issues were carefully covered throughout the very long Bill. However, both Her Majesty's Opposition and the Liberal Democrats were united in saying that they needed to be stated clearly at the start of the Bill. They won the day and there that statement is in the apprenticeships Act.

When I saw the amendment of the noble Baroness, Lady Thornton, it made me think about all the important legislation of the past, and it led me to the Children Act 1989, which I am sure the Government are still very proud of. An important aspect of that Act is the principle of paramountcy, whereby the interests of the child are paramount in any decisions taken about their health and welfare.

Listening to debates on this Bill, I have felt genuine concern about how we resolve issues around conflict of interest. The relationship between a health professional —a doctor, nurse or physiotherapist, but principally a doctor—and their patient is based on an extremely high level of trust and is one of the cornerstones of our NHS, and I was wondering how the importance of that trust and that relationship could be incorporated in some principles. Have the Minister or the noble Baroness, Lady Thornton, thought about whether it would be appropriate to have a principle under which the needs and interests of the patient should be paramount when decisions are made about them? Obviously, there are a lot of ways of thinking about that from a legal perspective, but it is something that we need to be very concerned about. How is the conflict of interest to be carefully managed where a GP refers a patient to a service that they own and profit from? How can patients—whether as individuals or a population—be absolutely sure of the decisions being made about them, at every level throughout the system, including commissioning? It is very important that we think about the principles underpinning the health service. This is a very important debate.

[The Earl of Listowel]

My Lords, I am most grateful to the noble Baroness for this debate on the primacy of patient care. It is very important. All noble Lords may well agree that this is fundamental, so I hope they will forgive me if I raise one concern with the Minister, which has been raised by people who practise in the NHS. The constant changes to the National Health Service over many years, particularly in England, have undermined, to some degree, our efforts to deliver the best to our patients. It is something I am familiar with from speaking to child mental health professionals in the past. They have complained that constant change undermines their ability to make relationships with other professionals work effectively around the child. Also, they get to know a commissioner who then changes. It is a different area, but social workers have also raised with me the issue of local authority changes. I remember speaking to a local authority social worker on a Friday evening who was despairing at yet another structural change to social service provision within the local authority.

In its briefing to Members of your Lordships’ House on the Bill, the Nuffield Foundation also expressed concern at the constant changes to the NHS and the short horizons. One Secretary of State may make changes but then a new Government arrive and there is another upheaval. I recognise what the noble Baroness, Lady Williams, says: flexibility and changes are needed, but my sense from speaking to the professionals and expert think tanks is that there has been too much change over a continual period. This was reinforced in the briefing that the presidents of the royal colleges gave to Members of your Lordships’ House this week, in which the president of the Royal College of General Practitioners finished with a very powerful plea: “Please, give us some stability; please stop changing the NHS”. She particularly alluded to the experience in Scotland. If I remember correctly, she said that for about the same investment Scotland has better productivity. She lays this at the door of the fact that over several years there has been some stability within the health service there. I take this opportunity to ask the Minister whether, in future, he will keep in mind the need to allow important changes to bed down. Perhaps we could build a bit more of a consensus on what needs to be done, recruit and retain the best professionals on the ground and allow them to evolve the best practices. Then we will see better outcomes for our patients, with a similar input.

Health: Breast Cancer

Baroness Morgan of Drefelin Excerpts

Monday 3rd October 2011 Lords Chamber

Asked By

[Baroness Morgan of Drefelin]

To ask Her Majesty’s Government what assessment they have made of the impact Improving Outcomes: A Strategy for Cancer, issued by the Department of Health, has had on women with breast cancer.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, our cancer outcome strategy sets out our ambition to improve outcomes for all cancer patients and save an additional 5,000 lives every year by 2014-15. Specifically on breast cancer, the strategy outlined commitments on local awareness campaigns, expanding breast cancer screening, measuring the prevalence of metastatic breast cancer, and one-day stays for breast surgery. Good progress is being made in all these areas and the strategy’s first annual report will be published in the winter.

[Baroness Morgan of Drefelin]

My Lords, may I remind the House of my interest as chief executive of the research charity Breast Cancer Campaign? I thank the Minister for his response. I have two brief questions. We know that radiotherapy is a very cost-effective treatment, improving outcomes for people with cancer at 5 per cent of the NHS cancer spend. Can the Minister explain to the House what progress is being made to ensure that the additional investment set out in the outcomes strategy is actually being converted into improved outcomes rather than lost in the bottom line? Can the Minister say what steps are being taken to improve access for women to IMRT radiotherapy, which is, of course, the modern version of this treatment and which can be so beneficial for appropriate referrals?

Tobacco Advertising and Promotion (Display and Specialist Tobacconists) (England) (Amendment) Regulations 2011

Baroness Morgan of Drefelin Excerpts

Monday 11th July 2011 Lords Chamber

[Lord Judd]

My Lords, I strongly support my noble friend and applaud the fact that she has brought this Motion before the House. People have spoken with great emotion about the rights of individuals. There is no proposal before us to ban people from smoking—perhaps there should be. It concerns me that we always dance round the brutal, central point about smoking: that it is known beyond doubt to be a killer. We are condoning a delay in discouraging young people and others from indulging in a habit that kills.

It is not just the smokers themselves but their families, the grief, the cost to future production as people fall ill and the heavy cost on the health service when we already know that the health service is stretched almost beyond all reason. In the arguments of those who are against my noble friend, I find it difficult that they seem to suggest that this is a private matter for the individual. It is not: it has social implications and the cost falls upon society as a whole. It is not just a cost upon the individual who decides to smoke. What evaluations have been made of the cost of this delay? What will be the cost to the health service? How many people will die prematurely who would not otherwise have died? What will the cost be of supporting families where people have died prematurely because of indulging the habit? This is an absolutely inexcusable delay.

In the last 24 hours, we again heard the Prime Minister make great speeches about how he will not brook delay in his decision to decentralise and make sure that people share in responsibility and participate in the kind of society of which he dreams. If he will not brook delay in that circumstance, why does he do so in allowing a practice to go on of encouraging people to take up a habit that is dangerous and results in death? We must face these central facts. If we condone what the Government propose, we condone more death, suffering, cost to the general public and burdens upon the health service. How on earth can that be justified?

[Baroness Morgan of Drefelin]

My Lords, I thank my noble friend Lady Thornton for tabling this Motion of regret. Like many around this House, I am particularly concerned about the issue of tobacco control and I value this opportunity to seek assurances from the Minister on a number of key questions. For the record, I declare my interest as chief executive of the research charity Breast Cancer Campaign and also trustee of Lung Cancer Campaign Carmarthenshire. I have a particular perspective—it is not necessarily an interest—as my father was diagnosed with lung cancer when he was 40 and I was a child. My noble friend Lord Judd talked about the impact on the family. We have not got time to talk about that but I appreciate that comment.

I look forward to hearing from the Minister a full explanation of the rationale for the delay in the implementation of the tobacco advertising and promotion regulations. My noble friend Lord Judd asked what the cost will be. I would particularly like to know who will benefit from this delay. In the Government’s analysis, who are the real beneficiaries?

The House has already heard very passionate words about the campaign by the National Federation of Retail Newsagents to delay implementation, about how it was funded by British American Tobacco and that this was not made clear and transparent. I personally feel very concerned about that—if we do not address it now, where will that lead? I very much hope that the Minister can give us the assurance that the noble Baroness, Lady Thornton, is seeking that the Government are still committed to the framework convention on tobacco control, which aims to protect a range of public health policies, and this policy as an example, from vested interests.

We should not think for a moment that our understanding of the impact of smoking on our health is fully understood. We are for ever learning more about the impact of smoking on health and, as our understanding of that impact deepens, so does the case for control. We already know that smoking is the single largest preventable cause of cancer, with smoking causing 28 per cent of all deaths from cancer. Worryingly, an estimated two-thirds of smokers started smoking before they were 18 and almost two-fifths started smoking regularly before the age of 16.

Until recently the link between smoking and breast cancer, a particular interest of mine, was poorly understood, but only a few months ago new evidence emerged demonstrating a clear link between smoking and breast cancer for the first time. While previous reviews had not demonstrated an association between active smoking and breast cancer risk, a cohort study published in the BMJ on 1 March has made a very clear association between active and passive smoking and an increased risk of breast cancer in post-menopausal women, the group of women most likely to develop breast cancer. Significantly higher breast cancer risk was observed in post-menopausal women who are active smokers, with links between the intensity and the duration of smoking—what some might describe as a dose response—as well as a link with the starting age of smoking.

Compared with women who had never smoked, breast cancer risk was increased by 16 per cent among current smokers. This is yet more evidence in favour of the need to control tobacco. Among former smokers, the time since quitting smoking was significantly inversely associated with breast cancer risk. It took 20 years for a former smoker’s risk to fully reduce. On the point made by the noble Lord, Lord Judd, about whether or not this is a private matter, passive smoking was also looked at in this research very effectively. The same study suggests an association between passive smoking and breast cancer and this is a really important new piece of understanding. Among women who have never smoked, those with the most extensive exposure to passive smoking had a significantly increased risk of breast cancer compared with those who had never been exposed to passive smoking. This is a very important development in our understanding.

While there is still much more to be done to understand the precise link between smoking, both active and passive, and breast cancer, one thing that is crystal clear to me is that women will not benefit from a delay in this measure. The noble Lord, Lord Borrie, makes a very good point about the need for balance in public health policy, but it is important that we recognise that, in that balance, the desire of smokers to quit, the need to prevent young people starting and the fact that our understanding of smoking and the impact on public health continues to unfold need to be factored in.

The case for the tobacco display regulations has already been made. I do not believe that the case for delaying these regulations has been made to the satisfaction of this House and I very much welcome this debate.

Southern Cross

Baroness Morgan of Drefelin Excerpts

Thursday 16th June 2011 Lords Chamber

[Earl Howe]

My Lords, the Department of Health is being very clear with the company that we expect it to maintain service continuity and quality of care while the restructuring process is going on. As I have said, our principal concern is for the safety and well-being of the residents of the care homes that might be affected. The CQC will pay particular attention to any care homes where there is a concern that quality may be at risk or inadequate. We are continuing to talk to ADASS, the LGA and the CQC to ensure that contingency plans are in place which will allow for the continuation of care under any eventuality. If the noble Lord will forgive me, I would rather not be drawn into hypotheses as to what might happen if the restructuring does not take place. We must encourage the company to believe that that is the prime and sole option before it. If there is ever a question of a change in the arrangements for providing residential care to any resident of a Southern Cross care home, or indeed any other, the rights of those residents remain absolutely clear in law. The duties of local authorities are absolutely clear in law. I believe that all residents in Southern Cross’s homes can rest assured that local authorities are well seized of those duties and processes.

[Baroness Morgan of Drefelin]

My Lords, the Minister has reassured the House that he does not see Southern Cross as the first of many providers to go into crisis. Can he share with the House the advice that he has had to enable him to give us those assurances that Southern Cross is not just the first of a number of providers to go into crisis?

NHS: White Paper

Baroness Morgan of Drefelin Excerpts

Monday 12th July 2010 Lords Chamber

[Baroness Northover]

My Lords, perhaps I may remind the House, as invited, that this is a brief Statement. We have 20 minutes all together and we are already five minutes in. Many people want to intervene on this extremely important Statement, so if people can be brief we will be able to cover as much as possible.

[Baroness Morgan of Drefelin]

My Lords, the Minister talked about an NHS that was stifled by top-down bureaucracy. Given the impressive outcomes that we have seen with improvements in cancer treatment, I do not think that many people would recognise that story. Does the Minister accept that medicine is a fast-changing field where innovation needs to be translated into practice on the front line as quickly as possible? Does he further accept that there needs to be leadership in a complex system like this if patients are to have access to the improvements in innovation and care? How does he see that leadership working?

How will patients be represented throughout the system? For example, how will they be represented at the NHS board? How will GPs ensure that they can access fairly and without bias the views of all their patients, not just those they see regularly? How will GPs translate those patient perspectives into commissioning in line with this new strategy that the local authorities will be responsible for developing? I want to hear the Minister answer that important question in some detail.

[Earl Howe]

My Lords, the noble Baroness makes an important point about innovation. We are clear, as is the White Paper, that driving innovation through the system will remain an extremely important part of what we mean by quality. The QIPP agenda is alive and kicking. For those noble Lords who are not familiar with the acronym, QIPP stands for quality, innovation, productivity and prevention. The innovation part of that will be driven in several ways, not least by the NHS commissioning board, which will have access to sources of advice from NICE, the NHS quality board and many other sources. But we also plan to put in place incentives in the tariff, which will drive innovation and high-quality care. Our proposals for those will be forthcoming.

The noble Baroness asked about patient representation. She was absolutely right about clinical leadership, but she was also correct to say that we need to ensure that the patient’s voice is heard at every level of the health service. At the local authority level, there is no doubt that Health Watch will have a presence as the voice of local patients. We are also creating a national Health Watch, which will act as the national voice for patients, feeding directly into the Care Quality Commission so that assessments of quality can be informed by patient experience on the ground. We are not planning in any way to dilute the duty under Section 242 of the 2006 Act to involve patients in the configuration of services. It is important that local people feel that they have a say in the way that services are developed. Our proposals for this will be laid out in an engagement document that is to be published in a short while.