Primary Care: Quality and Access Improvements

Debate between Baroness Penn and Lord Winston

Thursday 21st July 2022 Lords Chamber

[Baroness Penn (Con)]

My Lords, we have increased funding to general practice and primary care to address some of the pressures that they have faced. In addition to funding, we are seeking to give greater support to those practices in the most challenged areas to improve their ways of working; for example, with their telephony systems, to ensure that patients can get through to their practices and book the appointments that they need.

[Lord Winston (Lab)]

My Lords, traditionally general practice has been one of the most satisfactory things for many doctors, who have been very proud of being GPs. The current crisis is critical. Just two weeks ago, the noble Lord, Lord Patel, suggested that we might have a Select Committee to look at why there is so much dissatisfaction now among general practitioners. I am sure there would be broad consideration of that across the House if it were something that the Government were interested in trying to promote. What message can the Minister take back to the Department of Health about this?

[Baroness Penn (Con)]

The Department of Health and Social Care is cognisant of the pressures on GPs and is looking at improving the retention as well as the recruitment of GPs to increase their numbers. A number of programmes are in place looking at tailored solutions in certain areas to see why GPs are leaving the profession. We continue to work with the NHS and the profession to understand how we can help GPs and improve their working environment.

Health and Care Bill

Debate between Baroness Penn and Lord Winston

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

[Lord Winston (Lab)]

My Lords, if I may, I will introduce a slightly discordant note, seeing as my name has been mentioned. I did not intend to speak, but I do think we need to be a little cautious about all this. I congratulate deeply the noble Baroness, Lady Greengross, on her remarkable work in this area, and nobody would doubt for a moment that everybody here is speaking in very good faith and for the best of purposes.

However, as medical practitioners, we must say that the placebo effect is very powerful and can cure people or improve their health in all sorts of ways and with all kinds of activities, not only dementia. Feeling well is not a simple matter. One concern is that we might spend much more money than we expect on these activities, without coming to the gist of why and whether they work, rather than something that substitutes for them.

I remind the House of one thing. For many decades, the health service supported homeopathy. Homeopathy—like cures like—has been widely used across the world and many people have great faith in it. There is actually no evidence at all that it has any genuine medical or chemical benefit; it is probably essentially a placebo effect. I am not suggesting for a moment that we should not look at exercise, music and all the other things, but I implore the Government; if we do this on the health service, there is a duty to ensure that research is done as well, because we must have a health service that looks at evidence-based medicine. That is fundamentally important.

[Baroness Penn (Con)]

My Lords, I thank the noble Lord, Lord Howarth, for initiating this debate, and for the work he has done on this issue.

A common theme runs through the comments of noble Lords. The noble Lord, Lord Winston, at the end, talked about evidence and evaluation informing government policy. I hope that we can all agree on that. With regard to Amendment 114, as part of the Government’s plans to roll out social prescribing across the NHS in England, a large evaluation has been commissioned by NHS England and NHS Improvement, through the National Institute for Health Research, which will evaluate many of the points raised. It will seek to find out how social prescribing services operate, how well they work, who does and does not use them, whether they are of benefit to people and a good use of NHS resources, and how cost effective the interventions are. The research will benefit patients by identifying how link worker services can be developed further. It will also study how to help people access social prescribing services and use them effectively, and how to ensure that everyone has access to them, no matter where they live or who they are. Importantly, it will also evaluate the economic sustainability and capacity of social prescribing services.

Furthermore, as part of the cross-government project to prevent and tackle mental ill-health through green social prescribing, another large evaluation has been commissioned to assess models, processes, outcomes and value-for-money of green social prescribing, to inform the scale-up of green social prescribing across England. We are already embedding social prescribing in current non-statutory integrated care systems. In September 2021, NHS England and NHS Improvement published the ICS Implementation Guidance on Partnerships with the Voluntary, Community and Social Enterprise Sector, which outlines the importance of the voluntary, community and social enterprise sector as a key strategic partner in ICSs and provides guidance on how sector partnerships should be embedded in how the ICS operates. This will apply to ICBs in the future, following the successful passage of the Bill. It also describes the importance of embedding social prescribing services, which provide the bridge between health and community by connecting people to local activities and services for practical and emotional support.

Turning to Amendment 184BZ, as of December 2021, there were 1,803 additional social prescribing link full-time equivalent workers in place, and more than 826,000 referrals to social prescribing through NHS primary care. This will make us well placed to reach the target set out in the NHS Long Term Plan of 900,000 referrals by 2023-24 well ahead of time—and this is in addition to other social prescribing schemes across the NHS, local authorities and the voluntary, community and social enterprise sector. Furthermore, NHS England, the National Academy for Social Prescribing and the department worked closely with Music for Dementia to facilitate a series of webinars on creative health and on the publication of guidance for social prescribing link workers and for social workers on music prescriptions for those with dementia.

We will also set out a new dementia strategy later this year. We are working with stakeholders, including people living with dementia, and their carers, and we will be looking at how we can improve the lived experience of dementia. This will include a focus on promoting personalised and integrated approaches to health and care. For some individuals this may include the use of music and arts-based interventions.

The Government are already putting substantial resources into social prescribing. I therefore hope that the noble Lord will feel able to withdraw his amendment.

Covid-19: Children

Debate between Baroness Penn and Lord Winston

Thursday 17th June 2021 Lords Chamber

[Lord Winston (Lab)]

My Lords, I declare an interest as an adviser to Norton, the internet security company, on children’s security with software during the pandemic. My wife is involved with PaJeS, the association of Jewish schools, which has a very large number of pupils, particular in Liverpool, Manchester and London. I also work on outreach with Imperial College, where I champion visits to various schools. As I tried to tell the noble Baroness during the Queen’s Speech debate—I think she was not in the Chamber at the time—I have spoken to more than 50,000 schoolchildren over the year during my visits.

Unfortunately, I felt a mixture of sadness and almost anger when I heard the noble Lord, Lord Hannan. The schools I visit, in coastal districts and parts of Yorkshire, Derbyshire, the West Country, the north-east and the north-west of England do not have a cricket pitch and they certainly do not have a captain of cricket. What they have is something very much more valuable—they still have potential. It is not a question of ambition; it is a question of aspiration. They have ambition, but they do not have aspiration, because they do not see the aspiration possible. That has been a real problem during the pandemic.

The problems we face in schools include, first, the limitation of social interaction, which has been a really important issue. The loss of learning has led to teenagers worrying that they have fallen behind. That is particularly true, of course, before the teens, with very young children who have stopped managing to see their friends, perhaps for the first time. For some children, that has made a very big difference to their psychology. Of course, with teenagers, to come back to what my noble friend Lady Blower said, it is not a question of cricket; it is about not being able to purchase sanitary equipment for the beginning of their becoming women, when they are probably most embarrassed. There is clearly a significant increase in mental health problems during GCSE and at A-level at the moment in schools. Teachers are telling me that a great deal.

Secondly, the loss of learning has had a varied impact. It has not been at all consistent across the country, but what is a problem is how uncertainty has affected children’s aspiration. Little things such as wearing masks and washing hands before meals, and the need for teachers to organise that, has been a massive burden, which is often not recognised. The behaviour and attitude in schools is also therefore part of that and that has been reflected in the health concerns of staff and parents, and in what is happening at home and during travel.

I want to emphasise that perhaps not enough has been said about the well-being of teachers, particularly heads of schools. It is critical that something is done to recognise that this is an enormous issue. The UK has celebrated the dedication of NHS workers in an extraordinary way. We have poured money into the health service. But look at schools: they have been almost totally ignored and their leaders have been ignored. We have gone out in the streets to clap the NHS workers; we do not clap our teachers and it is something we need to think about. We need to value teachers above all. It is a very important profession. We risk the loss of staff and we know that many head teachers are beginning to give up that job.

I have a suggestion for the noble Baroness, for whom I have great respect. She has a serious concern for the difficult job she has to do and I really appreciate that. Everything I have seen of her ever since she entered this House, and now as a Minister, I find very impressive, so I hope she will understand that we need, much as the noble Lord, Lord Brooke, said, to find solutions together. First, we need to find additional funding. There is no alternative to that. It is needed to support the well-being of students and teachers and to help many schools. The greatest impact on learning would be to fund additional staff to enable smaller classes, especially in core subjects.

It has been suggested today that we should have longer school days, and perhaps even extended terms. That would be a disaster. It is not what teachers want. I have not found a single head teacher who agrees with that proposal. They do not see it as an advantage, because they think that schoolchildren are already exhausted and that is something they want to avoid. For secondary schools, a first good step by the Government would be to limit payments to the exam boards for assessments that the schools are now doing and ring-fence the money saved for additional support.

We need to think about examinations very carefully. Of course, we cannot do without A-levels in the present structure because of the need for further education and higher education. However, I do not see the value of GCSEs at the present time. Why do we need them at the moment, when schools are under massive pressure and are suddenly being asked to follow a curriculum that is constantly changing, as has already been mentioned? It is not reasonable.

Finally, I want quickly to ask some specific questions.

[Baroness Penn (Con)]

I am afraid that the noble Lord is over the time limit, which is five minutes for this debate.

[Lord Winston (Lab)]

I am about to come to my final sentence, if I may. Simply, what support is being given to improving virtual learning in schools? I have many questions about that. I have already sent the Minister my comments in a note, so I hope she can answer my questions. I will write to her again asking for the answers.

Health Protection (Coronavirus, Restrictions) (All Tiers) (England) (Amendment) Regulations 2021

Debate between Baroness Penn and Lord Winston

Monday 8th February 2021 Grand Committee

[Lord Winston (Lab) [V]]

First, perhaps I may apologise to the noble Lord, Lord Bethell. On Thursday 4 February, I asked about antiviral drugs: Synairgen’s compound SNG001, an inhaled interferon beta drug, and the controlled trial which had been published in the Lancet and which showed considerable success. I also mentioned ACTIV-2, research established by the National Institutes of Health in the US. With the limits on time to reply to the Statement, I muddled Synairgen’s seemingly effective trial with ACTIV-2, giving the impression that it was a different drug. This made it impossible for the noble Lord to answer my question effectively and I apologise for that.

As many noble Lords have repeatedly affirmed from across the House, we must work together, particularly at times of national emergency. While I speak from these Benches, it is good to celebrate the spirit of proper collaboration of which your Lordships’ House is proud. This is a time of global emergency. Of course, we want to be vaccinated as soon as possible. With vaccines still not plentiful, it is natural to be anxious about ourselves and our families, but we must recognise those elsewhere globally, and particularly in poor nations. It makes economic sense, just as it does with climate change. It may be costly, but it is morally right, and the global fight is essential, not least because of our self-interest.

We should learn from history. Yersinia pestis, the Black Death, caused at least three major pandemics: the plague of Justinian in 1541, the Black Death in 1347 and the Black Death in China in the 1850s. There were repeated, devastating waves in between for many decades. These were spread mostly by travel, by mixing of populations and by people in poverty with poor hygiene and inadequate public health. In 1665, when over 100,000 people in London—probably one-third or more of the population—died in the Great Plague, the greatest proportion were poor and disadvantaged. Lockdown then was rigidly imposed. People were even bolted in their houses, which were painted with a red cross.

The science community has repeatedly warned that we shall almost certainly need to live with Covid for a long time to come. This is likely for Covid-19 but is equally likely to be true of other deadly viruses in due course. So, in addition to global issues, we need everything we can muster: vaccines, better diagnostics, culture facilities, better public health—especially globally—and drugs which kill the virus. We also clearly need isolation, and that will reoccur from time to time. It is important that we do not breathe a huge sigh of collective relief at the blessing of new and better vaccines. There are still many important questions that we will need to consider. Randomised controlled trials must continue. One NIH trial, for example, done in the rhesus monkey, showed that they got protection with different vaccines, but these did not necessarily reduce the replication of the virus in nasal tissues, while some others did. Those are the sorts of reasons why we still do not know how problematic contact between people will be.

Whatever the effectiveness of different vaccines, apart from new mutations, there will be pockets of this virus in the population. If we are to reduce the presence of the virus in our communities, at what stage do we consider vaccinating children? If we eventually do, shall we ignore the serious anti-vaccination protests associated with measles, a far less clinically risky virus? We are relatively safe now from yersinia pestis, not because of vaccines but because of antibiotics. For example, a portable, easily distributed antiviral would be a real asset. Unfortunately, monoclonal antibodies, mentioned by the noble Lord, Lord Walney, in last Thursday’s debate, may not be quite as useful as a portable, easily distributed and administered antiviral, which could give safety, with fewer side-effects, at the early stages of infection. This might kill the virus before it starts to replicate rapidly. That would be useful during lockdown. An antiviral which gets access to the mucus membranes of the throat, pharynx, larynx and respiratory system, taken by mouth or as an aerosol, could be particularly beneficial because that is the route that the Covid virus generally takes. That would be another strategy to avoid the risk of mutations. This may be important, because we must remember how coronavirus is likely to have infected several animal species before moving into man. It is consequently more dangerous. In many parts of this crowded world, humans now perhaps live more closely to animals than at any time in our history.

Of course, we shall continue to jog the Government, but let us do so in the spirit of constructive collaboration that is important at this time of national emergency.

[Baroness Penn (Con)]

My Lords, I remind noble Lords that the time limit for Back-Bench contributions is four minutes.