Health: Pancreatic Cancer Treatment

Baroness Redfern Excerpts

Wednesday 19th December 2018 Lords Chamber

Asked by

[Baroness Redfern]

To ask Her Majesty's Government what plans they have to ensure that patients with pancreatic cancer begin treatment within 20 days of diagnosis.

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

My Lords, NHS England will soon introduce a faster diagnostic standard of 28 days for all cancer patients, including those with pancreatic cancer. Taken together with the 62-day referral-to-treatment standard, this will mean that all patients should expect to start their treatment within 34 days of diagnosis. This is a maximum, and trusts should continue to treat patients more quickly where there is a strong clinical need.

[Baroness Redfern (Con)]

My Lords, I thank the Minister for his comments, but the need for a paradigm shift on pancreatic cancer is now urgent. It is the deadliest cancer, with a dismal prognosis that has hardly changed in the last 45 years. It remains both the least survivable and the quickest killing cancer. It is hard to diagnose and, once it becomes clinically detectable, there is a rapid progression to an advanced stage. Therefore, for people facing a pancreatic cancer diagnosis, every day matters. For potentially curative and life-extending treatments such as surgery and chemotherapy, there is an optimum window of 20 days from diagnosis, when people with pancreatic cancer will have the option to be treated and the chance to live longer. It is ambitious to aim for 2024 but, for those people waiting, each day has deadly consequences. With a forecast of an extra £20 billion being injected into the NHS, does the Minister agree that it would be pleasing if some of that extra funding could be put towards improving those dismal survival rates?

[Lord O’Shaughnessy]

I agree with my noble friend and am grateful to her for raising this topic. The truth is that outcomes of pancreatic cancer are very poor, and have not improved, as she said. We are determined to change that through a number of routes. The Prime Minister has committed herself and the Government to improving early diagnosis of cancer, so that more cancers are caught earlier, which will be critical for those often caught at a late stage, such as pancreatic cancer. The faster diagnostic standard that I mentioned will help, as will a series of rapid diagnostic centres that have been rolled out around the country. I take the point that we need to do a lot more, and the NHS long-term plan gives us an opportunity to do that.

NHS: Specialist Services in Remote Areas

Baroness Redfern Excerpts

Tuesday 11th December 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord is right. Of course it is possible for us to do it in England; it is happening all over the country. Telemedicine offers fantastic opportunities, such as Skype-based GP consultations. Indeed, there is the example of Morecambe Bay’s remote clinician pilots in a variety of specialisms, such as gastroenterology and mental health care. Clearly, that is important. I point the noble Lord to the tech vision published by my relatively new Secretary of State this autumn, which points out the massive potential for digital health in reducing these kinds of inequalities.

[Baroness Redfern (Con)]

Within limits, a shifted out-patient model allows specialists to provide the same kind of consultations, investigations and procedures as in regular settings. Does the Minister not think a possible way forward would be to develop larger PCTs, as they would be more financially able and therefore have the capacity to provide that service in areas remote from the hospitals?

[Lord O'Shaughnessy]

My noble friend makes an excellent point. The number of CCGs is reducing over time, as they tend to merge. Of course, they are increasingly coming together into integrated care systems, which cover a larger geographic community. Every one of those makes sure that people have not only community care but specialist care available.

Breast Scans

Baroness Redfern Excerpts

Monday 19th November 2018 Lords Chamber

[Lord O'Shaughnessy]

Absolutely. I completely agree with the noble Baroness. Indeed, breast cancer screening saves 1,300 women’s lives every year. It is an essential part of our health system. On why women do not turn up, Professor Sir Mike Richards is reviewing all the cancer screening programmes at the moment. I will specifically put that question to him to ask him to investigate it.

[Baroness Redfern (Con)]

My Lords, we are told that pain or fear of pain is one of the main reasons why women decline screening. I ask the Minister: what initiatives have been investing to address the decline in breast screening uptake and to help ensure equality of access to screening?

[Lord O'Shaughnessy]

In addition to investigating some of the reasons through the review, a primary way in which we are encouraging women to take part in screening is through public health advertising and marketing campaigns. They have been demonstrated to have an impact. Public Health England had such a campaign on breast cancer screening this year; there will be a further campaign on cervical screening next year.

NHS: Healthcare Data

Baroness Redfern Excerpts

Thursday 6th September 2018 Lords Chamber

[Baroness Redfern (Con)]

I thank the noble Lord, Lord Freyberg, for initiating this debate. It is a pleasure to take part in a debate about how data will improve the health of the nation. It is not only crucial but has huge potential for the future of the NHS. I take this opportunity to congratulate my noble friend Lord Bethell on his maiden speech and look forward to his future contributions.

I welcome the £400 million-plus investment in new technology in hospitals, making patients safer, reducing cost and, importantly, linking people to access their health services at home. I also welcome the £75 million available to trusts to help them put in place state-of-the-art electronic systems. Those again save money but, crucially, have the potential to reduce medication errors by up to 50% compared to the previous paper systems, and to cut bureaucracy, making life better for staff, showing how electronic health records and other smart tools can support nurses both in and out of hospitals, benefiting patients who may have many health problems while ensuring that doctors are clear on their legal responsibilities.

Today, the Minister is setting out plans to make the NHS the most cutting-edge system in the world for the use of technology by investing a further £200 million to transform a group of NHS trusts into internationally recognised centres for technological and digital innovation. As he says, we are setting a gold standard for others to follow. Is that extra money? The future is to see more technology available to all, not just a select few areas of the country and not subject to a postcode lottery, thereby avoiding variations in patient outcomes and seeing all hospitals digitised as soon as possible, with healthcare becoming more integrated. In social care, for instance, the use of data is even more essential.

In developing a culture in which innovation can be rapidly adopted and rolled out across the country, we need a clear, robust strategy to take the NHS forward and not fall behind other nations—a culture that empowers to help make that change happen. As I said earlier, the UK certainly has a real opportunity to be a global leader in health data research by capturing all this potential, including artificial intelligence, the application of genomics to medicine, and the development of a range of new diagnostic tools and therapies for conditions that will enable more healthy ageing.

The evidence is out there showing how we can use technology better to create more efficiencies in passing information around and, importantly, in improving quality. The public and healthcare professionals must have confidence that access to patient data is appropriately managed so they can plan services and research new treatments. It must be clear to the public that their data matter, and that the data on research on new treatments to the NHS are stored safely. We need to bring together patients’ trust in the data in making informed choices from among other healthcare options.

Every time we go to a doctor we receive a diagnosis and, when we start a new treatment, the information goes into a database. The introduction of electronic patient records means that a patient’s journey in the health system is more accurately recorded and easily accessed, with patients receiving more effective care by having a digitised record. When we put all that together, it is a database combining millions of data points which then can be used for research purposes. Researchers are now harnessing vast amounts of information to assess what works in medicine.

There must be adherence to very strict protocols to prevent any leaks of personal information, and provision for the public to opt out, if requested. It is regrettable that some areas of the NHS have been slow to adopt information technology but we know that new technologies are changing what type of care can be provided and how it is delivered. We must support those trusts, while challenging others which are slow to engage, and help them to remove barriers. It is vital to support organisations which want to make changes in driving up productivity, bring on board new innovations, use data and welcome new technologies.

Medicine and public health are constantly evolving as new research and technology open the doors to new ways to treat or prevent diseases, so we are able to live longer—and, importantly, live well for longer.

Children: Obesity

Baroness Redfern Excerpts

Thursday 19th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I completely agree with the noble Lord. I believe that he chairs the National Citizen Service, which has been a massive initiative to encourage such habits in teenagers. I completely concur with him: the Government take a number of approaches to encourage youth social action, and that is something that we will continue to support.

[Baroness Redfern (Con)]

My Lords, does my noble friend agree that families need to be presented with clear information about the food they buy and how important clear labelling is? Does he agree that when the UK leaves the EU, that will give us a greater flexibility to determine what information should be presented on packaged food and how it should be displayed?

[Lord O'Shaughnessy]

My noble friend is absolutely right: this is one of the many opportunities which this country will enjoy after we have left the European Union. We will have the flexibility to vary food labelling to ensure that we can use the very best, and latest techniques to encourage people to eat more healthily.

NHS: Staff Pay

Baroness Redfern Excerpts

Wednesday 21st March 2018 Lords Chamber

[Lord O’Shaughnessy]

Like the noble Baroness, I think it is right to pay tribute to all the organisations involved in striking this deal. These things are never easy but it is a true partnership agreement that tries to work for everybody.

The Statement is explicit about linking pay progression with appraisals, which indeed means higher skill levels. I will write to her with the specifics of the skills and knowledge framework; I am not cognisant of that specifically, but clearly the intention is to move away from automatic progression to skill-based progression. One of the advantages of that is that it not only works for patients, but puts the onus on employers—she will see more detail of that—to make sure that there is proper professional development to help skill levels rise, so that staff can go through those gateways and progress.

[Baroness Redfern (Con)]

My Lords, in welcoming the Government’s response and the 6.5% pay rise for 1 million NHS staff, particularly in recognition of their dedication and hard work, I am pleased that the Government have recognised that the lowest full-time salaries are paid to cleaners, porters and catering staff. These groups will receive a 15% increase—£2,500—bringing their salaries up to £18,000. The fact that this is backed with new money is welcome.

[Lord O’Shaughnessy]

I thank my noble friend for making that point. It is not only about the lowest paid staff whom she has described. It is also worth dwelling on the fact that a newly qualified nurse will see a significant increase in his or her pay, which will be 12.6% higher in 2020-21. This is a package which takes account of the fact that starting salaries have been too low. We are trying to address that because it is one of the ways we can attract more people into the profession.

Prescription Drugs: Dependence

Baroness Redfern Excerpts

Monday 19th March 2018 Lords Chamber

[Lord O'Shaughnessy]

I agree with the noble Lord that it is a serious issue. A NatCen study found that there has been a doubling of the use of serious painkillers. Indeed, deaths due to opiates of all kinds have risen by about two-thirds in the past five years; of course, that is illegal as well as legally procured drugs. We agree that there is a problem. That is why the review is taking place. It is premature to say what the outcomes of that review will be, but undoubtedly we need a comprehensive approach to dealing with this problem, because it is getting worse.

[Baroness Redfern (Con)]

My Lords, I welcome this major review of prescription drug addiction. Does the Minister agree that the review must also look at the provision of alternatives to prescription drugs and the culture change needed to make that happen?

[Lord O'Shaughnessy]

My noble friend is absolutely right. It is not just about getting people off these drugs who are wrongly on them, it is about making sure that they do not go on them in the first place unless that is absolutely necessary for their treatment.

General Practitioners: Workforce

Baroness Redfern Excerpts

Monday 5th March 2018 Lords Chamber

[Lord O’Shaughnessy]

I shall have to write to the noble Baroness with the specifics on GP flexibility. However, one of the reasons that GPs take early retirement to take advantage of their pension is that it enables them to work flexibly afterwards.

[Baroness Redfern (Con)]

My Lords, regarding the workforce, having pharmacists in GP practices means that GPs can focus their skills where they are most needed: diagnosing and treating patients with more complex needs. Does the Minister agree that this not only helps GPs manage demands on their time but helps to ease their workload, while patients have the convenience of being seen by the right professional, improving quality of care and ensuring patient safety?

[Lord O’Shaughnessy]

My noble friend is absolutely right. As well as our commitment to increase the number of GPs by 5,000, we also have a commitment to increase the number of GP practice staff by 5,000, including 1,500 pharmacists, who provide exactly the kind of support she outlined.

NHS: Cancer Treatments

Baroness Redfern Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Redfern (Con)]

My Lords, I thank the noble Baroness, Lady Jowell, for initiating this debate today—it is a privilege to take part and I thank her for her passionate, moving and very brave speech. I want today to support all cancer patients who wish to have the opportunity to be involved in clinical trials, as adaptive clinical trials are a promising way to develop new treatments by offering those patients multiple opportunities to test. Life expectancy has significantly improved but unfortunately in some cancer sites early intervention is more difficult; for example, as we have heard, brain cancer and pancreatic cancer, which my late husband suffered from. Those numbers are struggling to move. As we all know, cancer touches us all.

Today’s debate, however, brings attention to how important new innovative cancer treatments can offer life-changing outcomes. The NHS is working collaboratively with the life sciences sector to improve accountability and transparency in the take-up of innovation with the support of NICE, and that has to be welcomed. The NHS enjoys the benefits of SME contributions: many of the companies in the UK life sciences sector are small and medium-sized companies, so I am pleased that financial support has been given, with the help of the new £6 million government scheme, together with £34 million over four years provided to encourage and support those innovators to develop world-leading digital solutions. A good, supportive research environment in the UK is needed to ensure that the best research can be carried out to speed up the development of pioneering treatments, accelerating access to new medicine and benefiting from working with international collaboration on clinical trials: that must continue.

Flexible pricing mechanisms, such as outcomes-based pricing, would result in quicker decisions about approvals, with pricing based on a drug’s value to the NHS. Also, more emphasis must be placed on the genomic revolution to eliminate the one-size-fits-all approach to cancer treatment. I welcome NHS England’s steps to create a genomic medicine service to close the gap and ensure equitable access to molecular diagnostic testing for all patients across England. Good data sharing is paramount.

A cancer diagnosis can be, and is, frightening, distressing and confusing. As I said, it touches us all, whether it affects a loved one, friend or colleague. A much-needed shift in emphasis towards prevention and a clinical strategy march of medical science, together with a strong media campaign, must lead to increased longevity. Finally, cancer patients throughout their treatment are focused on staying alive as long as possible, so it is important that they are free to take more risks. I thank the noble Baroness, Lady Jowell, for her brave speech: this is about giving hope for everyone, all patients; it is about improving the cancer campaign and improving outcomes.

NHS: Staff

Baroness Redfern Excerpts

Thursday 30th November 2017 Lords Chamber

[Baroness Redfern (Con)]

My Lords, I thank the House for the courtesy of allowing me to speak in the gap. I thank the noble Lord, Lord Clark, for bringing this timely debate to the House today. I refer to my interests as listed in the register and as being a member of the Select Committee on the NHS.

I welcome the statement by the Secretary of State for Health, Jeremy Hunt, that the Government recognise that it was not sustainable after seven years to carry on with the 1% rises or pay freezes. As we have heard today, we cannot expect NHS staff to go the extra mile if the money falls short; eventually, people will vote with their feet. So I am pleased to hear proposals for benefiting patients, from the announcement in the Autumn Budget of £6.3 billion of new funding for front-line NHS services and upgrades of NHS buildings and facilities to the creation of the “Homes for Nurses” scheme, giving a new right for the NHS worker to have first refusal on affordable housing, which would be generated through the sale of surplus NHS land, with an ambition that around 3,000 NHS workers would benefit. This is very much to be welcomed; our NHS staff are the backbone of the service, so it is important that we put first the people who are central to the delivery of high-quality care that is safe, effective, caring and responsive. I also acknowledge the 25% increase in placements for student nurses to increase the number of homegrown NHS staff, to reduce the reliance on expensive agency nurses, and to prepare ourselves for Brexit.

NHS staff need to feel safe and valued, with family-friendly policies, and there is a need to create a healthy morale to sustain a committed workforce. Factors that really influence staff retention include access to learning and development opportunities, a caring environment and a tough approach to violence towards staff. Retention of staff is a must, and the key to the sustainability of the NHS, while the fact remains that more has to be done to replace those who have left. I therefore welcome the launch of a new major programme to improve staff retention. It would appear—and it is regrettable—that more focus should have been on training the existing workforce, opening up the possibility of new opportunities leading to career progression. Training models in the health service have changed between 1947 and today, and will surely be radically different in 10 to 25 years’ time. We must not lose momentum on innovation and technology in order to have a continuous, dedicated and well-qualified workforce fit for the future.

Health trusts must also welcome learning from other hospitals, or look at mergers or working more closely together, sharing precious data in helping them raise their game in order that good leadership can drive continuous improvement in patient outcomes and productivity. We see staff working well in structured teams, fully engaged and supported to make changes to how they deliver that care, and able to make those changes to improve quality and productivity. It is essential that trust boards consider feedback from front-line staff. Trusts must make themselves great places to work, with job satisfaction, career progression and continual training as one. The importance of understanding what staff want cannot be understated.

Finally, I welcome, too, the Government’s endorsement of the NHS Five Year Forward View, funding it with £10 billion more a year for the health service by 2021. However, even with that funding, the health service remains under pressure, with more people than expected using the service last year. It is worthy of note that 2016-17 saw the NHS treat 2.9 million more A&E patients than in 2010. That is all thanks to our fantastic NHS.