Primary Care: Quality and Access Improvements

Debate between Baroness Penn and Lord Patel

Thursday 21st July 2022 Lords Chamber

[Baroness Penn (Con)]

My Lords, we have 1,400 more full-time equivalent doctors working in general practice compared with March 2019. But the noble Baroness is right that we must do even more to expand the numbers. We have a record 4,000 trainees who have accepted a place on GP training this year. Another element is the wider primary care workforce, where we are on track to meet our commitment of 26,000 additional patient care staff working in primary care. The most deprived areas are being targeted for the accelerated access improvement programme, which is providing tailored support to practices in those areas to improve access.

[Lord Patel (CB)]

My Lords, in a recent inquiry by the House of Commons Health and Social Care Committee, the Minister in the Commons was asked whether he thought that general practice was in crisis. He disagreed but did agree that there were some serious challenges to be faced. Can the Minister say what the Government think that these challenges are in the short term and how they intend to address them? Furthermore, the long-term sustainability of primary care and community care will require some reforms, as suggested by two recent reports: the Policy Exchange report and the report by Claire Fuller, a practising general practitioner. I will be glad if the Minister can answer.

[Baroness Penn (Con)]

My Lords, I absolutely recognise the pressure that GP practices are under. To name just two of the factors, we have seen increased demand on the practices, which are seeing more patients than ever before, but we also have reports of people struggling to get access. There are workload pressures on those working in those practices and the need to increase staffing numbers, not just of GPs but those wider primary care staff. In terms of reform, I have not seen those specific reports, but the noble Lord will know through the Health and Social Care Act that was passed recently that the creation of integrated care boards and integrated care systems will, I hope, bring primary and secondary care closer together and enable local areas to design care that is meeting the needs of their populations better.

Deprived Areas

Debate between Baroness Penn and Lord Patel

Thursday 1st July 2021 Lords Chamber

[Baroness Penn (Con)]

My Lords, absolutely: as part of the NHS long-term plan, the Government have committed to improving mental health services and increasing the funding that goes to those services, as a proportion of overall funding, in every year of that plan.

[Lord Patel (CB) [V]]

My Lords, inequalities in healthcare have long plagued the NHS. Inequalities exist not only in years spent in ill health and shorter life expectancy but in referrals of care, leading to poor health outcomes for people from deprived communities. With waiting lists running into the millions, dealing with this effectively is a priority. To this end, does the Minister think that NHS plans for clinical validation as a way of tackling waiting lists are likely to worsen inequalities in access to treatments?

[Baroness Penn (Con)]

My Lords, clinical validation is, at its heart, about adapting to the need to manage larger and longer waiting lists and tackle those. Patients will be treated in order of clinical priority and then by length of wait to reduce the harm by waiting. But I reassure the noble Lord that his point is very well made and that, in the NHS recovery plan, there are eight actions to reduce inequalities in the restoration of services, including reporting on providing services to the poorest 20% of neighbourhoods and black and Asian patients.

Medicines and Medical Devices Bill

Debate between Baroness Penn and Lord Patel

Committee stage & Committee: 7th sitting (Hansard) & Committee: 7th sitting (Hansard): House of Lords
Thursday 19th November 2020 Grand Committee

[Lord Patel (CB) [V]]

My Lords, I sent in a request to speak after the Minister. I am grateful to her for her lengthy response, but in a way it just shows that there will be considerable areas of divergence once we exit Europe, even after we exit Europe and the agreement with the EU has expired. What the Minister said is correct—that maybe the emergency power regulations will allow us to ask questions—but those are only emergency powers, and this is longer-term.

My amendment asks for an indication, on at least a yearly basis, of where divergences are occurring. It is interesting that the Minister said that the statutory instrument is now available and will be debated in due course. Of course it is available now—although I do not know when it was made available—and we will have an opportunity to debate it. However, the MHRA was already giving guidance on the basis of that instrument before we had seen it or debated it. The Minister’s reply did not therefore satisfy the intention behind my amendment—although I will, of course, not move it today—in terms of the necessity for the Government to produce a report of where divergences are occurring and why.

[Baroness Penn (Con)]

To address the noble Lord’s question about when the statutory instrument was laid, I believe it was on 20 October. I think the statutory instrument laid on 20 October, which we shall debate, is not the Government’s approach to an answer on how we deal with the future issues of regulating medicines, medical devices and vet meds in Northern Ireland and Great Britain. What I was trying to express to the noble Lord is that we have a mechanism that means the Minister will report to Parliament every two years, both looking forward to prospective changes and back at any changes that may have been made. Of course, where new regulations are proposed there will be public consultation on those, but there will also be reports to Parliament ahead of that about the intentions, and those reports will provide a mechanism, which I think the noble Lord wants, to ensure that these issues are discussed properly in Parliament in future.

Medicines and Medical Devices Bill

Debate between Baroness Penn and Lord Patel

Committee stage & Committee: 5th sitting (Hansard) & Committee: 5th sitting (Hansard): House of Lords
Wednesday 11th November 2020 Grand Committee

[Lord Patel (CB) [V]]

My Lords, I wish to concur with some of the points made; I do not speak against anything said by the noble Baroness, Lady Finlay. We are in complete agreement and I do not counteract anything that she says anyway. Having said that, most people look at medicines as things that cure disease. Most medicines do not cure disease. Symptoms are what patients experience, and we have to treat those symptoms. As an obstetrician, I have spent most of my life treating the symptoms of pain, prescribing morphine and heroin as painkillers to mothers who are suffering from labour pains. I could not measure their pain in any way except by what they told me about it.

The problem with database evaluation is that it looks for the size of the randomised trials. I suggest that observational studies that look at the experience of patients are a good enough database to evaluate whether the substance used is effective in alleviating their suffering. That is the sort of evidence that I hope NIHR will seek to establish a proper database. I am pleased to hear the Minister say that NIHR is looking at ways of dealing with this.

[Baroness Penn (Con)]

My Lords, the only thing that I will add is that the noble Lord, Lord Field of Birkenhead, said that this was about equality. My point is that MHRA’s approach to medicinal cannabis is the approach it takes to licensing all other medicines. So whatever approach we take to evidence, or how we look at the appropriate gathering of that evidence, will be based on the approach we take to all medicines. The way in which cannabis is treated is not as a different or exceptional case, and we will want to ensure that that is the case going forwards.

Medicines and Medical Devices Bill

Debate between Baroness Penn and Lord Patel

Committee stage & Committee: 4th sitting (Hansard) & Committee: 4th sitting (Hansard): House of Lords
Wednesday 4th November 2020 Grand Committee

[Baroness Penn (Con)]

To reassure the noble Baroness, I can tell her that the Opposition’s position on the government amendments is well noted. We will take away and reconsider the use of the term “person”, but there is a view that the safeguards that the noble Baroness is talking about are built in elsewhere, in how the clause would take effect. That does not mean, however, that we would not be happy to go away and look at those exact concerns, and see whether we can provide further reassurance. I am not a lawyer drafting the Bill, but that would be about looking at the terminology as well.

[Lord Patel (CB) [V]]

My Lords, I thank the Minister most sincerely for her full and comprehensive—I might even say persuasive—response. She is right to say that it has been a week since we debated this group, and even I had forgotten some things. Certainly, the venom certainly seems to have gone out of our debate.

The Minister reminded us what our anxieties were. She is right to point out that I referred to the word “person” in the government amendment, and also to the GDPR. I am pleased to hear that, on reflection, she, too, had realised why we were concerned about the use of data that might not be protected through the GDPR. Some questions remain.

The noble Baroness, Lady Thornton, has raised some important points, and I am glad that we may debate this subject again. It would be useful to have a discussion beforehand, if possible, because the word “person” is too amorphous—unless the definition could be confined as to what kind of person is meant. In her response, the Minister mostly covered organisations that might be involved in the regulation of medicines or in recommendations regarding medicines and devices, but the proposal as drafted goes much wider than that and would go beyond that. I will not say any more about that now.

The meeting that the noble Lord, Lord Bethell, arranged with the MHRA was useful, and it would have been better if we had had some of the information earlier. The information that I gave with regard to my Amendment 27 I had acquired from the industry. Of course, we got the same information from the chief executive of the MHRA. It would have been better if we had had that earlier—but that is water under the bridge. We know that there will be new ways of keeping us informed, and that will be good. At this point, I thank the Minister sincerely for her response, and I beg leave to withdraw the amendment.

--- Later in debate ---

[Baroness Penn (Con)]

I am reminded that my noble friend Lord Lansley referred to the collective noun for former Health Ministers as a “frustration” of former Health Ministers. I can tell my noble friend that the engagement exercise will involve the pharmaceutical industry, the NHS and associated bodies and patient groups. That is the level of detail that I can give to him today. I was very pleased with being able to say “quarter 1” next year; it felt to me like a very specific timeframe for when that engagement exercise would be undertaken.

[Lord Patel (CB) [V]]

Thank you, my Lords. I apologise to the Chair for jumping in. I forget that, in the new world, I do not speak unless instructed to do so.

I thank the Minister enormously for her response. She mentioned the frustrations of the former Ministers. If she thinks that former Ministers get frustrated, think about us lesser mortals who have suffered the former Ministers when they have not listened to our arguments. Maybe that should be taken into account, too.

I thank all noble Lords who have taken part. They have spoken with passion and commitment. This has been referred to by several people, but I do so again. The noble Lord, Lord Hunt of Kings Heath, has been pursuing this passionately and eloquently for a very long time. He has made an important point: if the medicines are available and people are suffering, why do we keep arguing about health and drug budgets and how to deliver it? The principle should be how we can get those drugs to the patients who might be suffering. He is right. If a rebate is available, where did the money go? The rebate was a drug fund rebate to be reinvested, you would have thought, in people getting the medicines.

No doubt the Minister is aware that there seems to be complete consensus around this amendment. I hope that it does not need to go to Report but, if it does, Ministers will be aware that there will be complete consensus. I hope that the Minister makes rapid progress with sorting this out. In the meantime, I thank all noble Lords and the Minister most sincerely for taking part. In begging leave to withdraw the amendment, I hope that the noble Lord, Lord Lansley, will feel that we gave it enough airtime and passion.