(11 months, 3 weeks ago)
Lords ChamberMy Lords, I reinforce the points made by the noble Lord, Lord Allan, and the noble Baroness, Lady Finlay, about the importance of boards and patient safety being a key factor that they ought to take responsibility for. I will make a wider point. As health is a devolved matter and we are talking about the NHS in England, I urge the Minister to have comparisons of best practice: talk to the devolved Administrations, see what happens in Scotland, Wales and Northern Ireland, both for the way in which we can learn from each other’s experiences but also so we can arrive at common standards that can be accepted across the United Kingdom. Similarly, if any registers are being set up, these should not be confined to just England but should be UK-wide.
I thank the noble Baroness; that is a good point. We clearly need to be looking at best practice across the board. That is not limited to any one devolved authority, but means learning from each of them and, I think, somehow making sure that hopefully they can learn from the terrible events that have taken place here—so they are putting that in place as well. For me, one of the main failings that we are now putting right is the medical examiners, which I want to make sure are spread out across all the devolved authorities. Clearly it is up to them whether they take it or not, but we should absolutely be making sure that we are cross-fertilising some of those key learnings, so they go both ways.
(1 year, 2 months ago)
Lords ChamberFirst, I thank my noble friend for all the vital work that she has done in this space. She is absolutely correct. The key thing is that there are circumstances where sodium valproate is the only effective treatment for bipolar and epilepsy-type disease problems. However, we have to ensure that if people are taking it, they are going into it with their eyes completely open, so that they fully understand the risks. That is absolutely to do with the packaging. It is also about making sure that if that packaging is split up there are leaflets in every part, and that everyone signs a consent form at least once a year, fully acknowledging the risks. Thereby, if people take the treatment, they are doing so with their eyes fully open.
My Lords, last year the Scottish Government set up an advisory group on the use of valproates. To what extent does the Minister work with the devolved Administrations to make sure that there are clear guidelines on this subject across the four nations?
The regulatory authorities absolutely work closely here. It is my understanding that it is the intent of all the devolved Administrations to make sure that while there are circumstances in which this drug might be the correct treatment, as I mentioned, it is used only when everything else has been tried—and, in our case, in England—that two independent specialists will be required to prescribe it.
(2 years, 7 months ago)
Lords ChamberAs the noble Baroness says, the JCVI advised on 22 December that children aged five to 11 in a clinical risk group, or who are a household contact of someone who is immunosuppressed, should be vaccinated. GPs and hospital consultants are now urgently identifying the children eligible, and we expect rollout to have started by the end of this month, with children and parents starting to be called up for appointments by the NHS locally. The message here is that there is no need for parents to contact the NHS; the NHS will make contact with the parents or carers of those eligible. Just to further reassure parents, we will be using a paediatric Pfizer vaccine authorised by the MHRA for use in this age group.
My Lords, given that it is safest to administer the vaccinations in a school setting, and unlikely that this round of vaccinations is the last one, has the Minister given any consideration to expanding the specialist community health nurses, commonly known as school nurses? Their numbers have been decreasing over the last 10 years. They could play a role in the future administration of vaccines in school settings.
I recall well being sent to the school nurse—sometimes we have fond memories, and sometimes less fond memories, of being sent to the school nurse. The noble Baroness makes a really important point. I will make inquiries and get back to her.
(2 years, 8 months ago)
Lords ChamberThe noble Lord raises an important point about making sure that patients are released earlier from hospital into care homes, and into their own homes as well. I have answered questions previously on what is being done to make sure that it is as joined-up as possible. Some 75% of patients on the waiting list do not actually require surgical treatment but are waiting for diagnostics. The Government have invested in rolling out 100 new diagnostic centres. Some 80% of patients who require surgical treatment do not actually require an overnight stay in hospital, while 20% of people waiting for surgery are waiting for musculoskeletal or eye-related surgery. In many ways we know what the issue is—it is targeting.
My Lords, the waiting lists are clearly too long. Will the Government undertake a comparative analysis of whether the backlog pre Covid was better handled in Scotland and Wales than in England?
As the noble Baroness will recognise, health is a devolved matter. It is important that we look at international comparisons, so not just among the devolved Administrations but internationally. That is one of the things we are doing to make sure that we focus, improve and tackle the backlog.
(2 years, 9 months ago)
Lords ChamberThe noble Baroness makes an important point about us being a global hub and welcoming the whole world. For centuries the UK has been open to a number of different nationalities from across the world. Indeed, my own family came to the UK in the Windrush generation. I have always been clear that we should be a global Britain, not just focused on one small part of the world.
I want to take the opportunity to answer the question that I forgot to answer about international students. Anyone in England is eligible for the vaccine if they fall within the current eligibility criteria, and international students are encouraged to register with a GP.
On free speech, it is critical that our universities remain places where you can have free expression without fear. The essence of free speech is being able to tolerate views that you may not agree with but it is important that they are expressed. Universities should remain hubs of free speech.
My Lords, I refer to my registered interests. Given that this is not really a public health problem in its scale, but it is a bar to the recruitment of international students and their integration once they are here, may I urge the Minister—even if he cannot find a quick solution to the NHS app—to put out some information on how Covid passes can be obtained and to make sure that all universities and students have access to that information as soon as possible?
Last night I took part in a debate that involved the issue of the Covid pass, particularly with the boosters. I was frustrated because I thought I had a date I could announce. That was pulled at the last moment, but we are very close to a solution. The technical point on test and trace is that, at the moment, it is unable to validate the vaccination status of people whose vaccines are not registered on the database. We are looking at whether that can be done on trust, or whether that would open a loophole for getting around the system. I have been assured when pushing the NHS on this that it is looking at an answer.
(2 years, 9 months ago)
Lords ChamberBefore I respond, I wish to give a belated welcome to my noble friend Lady Davidson. I have worked with her often in the past, and she displays a wisdom beyond her years and a sense of humour that excels that of many on our Benches. To answer my noble friend, the Existing Liabilities Scheme for General Practice covers the historical liabilities of GPs, where the department has agreed commercial transactions with the previous indemnity providers. The scheme applies only to general practice in England and is part of the state indemnity reforms introduced in England in 2019. These 2019 reforms mean that GPs in England now benefit from more stable and affordable indemnity to cover future negligence claims. I understand that similar arrangements were introduced in Wales at the time. I am afraid that the policy on state indemnity is a devolved matter, but officials in the department are in regular contact with their counter- parts in the devolved Administrations.
My Lords, some 10 years ago the NHS Litigation Authority concluded in its maternity claims report that
“the most effective way to reduce the financial and human cost of maternity claims is to continue to improve the management of risks associated with maternity care, focusing on preventing incidents involving the management of women in labour”.
Yet, in the intervening 10 years, the number of claims has gone up from 391 in 2009 to 765 in 2019-20. Is it not about time that we put patient safety first in these considerations rather than looking at what happens to lawyers, and take some lessons from the airline industry where, if something goes wrong, we start by looking at no-fault and do not allocate blame but look at improving the system?
The noble Baroness raises an important point. However, in looking at the system overall, there is no evidence to suggest that the rise in overall costs is due to a decrease in NHS safety. Nevertheless, safety and learning from incidents are essential in their own terms. Our ambition is for the NHS to be the safest in the world and for maternity safety to be a priority, and there are various schemes in place.
(2 years, 9 months ago)
Lords ChamberI thank my noble friend for his question. The focus was on fighting Covid and making sure that people were vaccinated as quickly as possible. As noble Lords know, economics is about the allocation of scarce resources and there are always trade-offs. Sometimes there are unintended consequences of focusing on one condition rather than another. I will write to my noble friend with an answer to his specific question.
My Lords, so far, we have spoken about England. The drugs are licensed for the whole of the United Kingdom and NICE regulates what happens in England. Wales is aligned to some extent and Northern Ireland much more closely; Scotland applies a different system. Will the Minister undertake to look at whether other parts of the United Kingdom are dealing with this more efficiently? As he does so, will he also take care that NICE is not being used as a back-door way of rationing?
The noble Baroness raises an important point, especially given that health is devolved to the devolved Administrations. As much as possible, we work England-wide, but we also ensure that we co-ordinate UK-wide and that Ministers and officials regularly meet with those from the devolved Administrations.
(2 years, 10 months ago)
Lords ChamberMy Lords, the Minister made reference to the well-being strategy in his opening Answer. In the interest of joined-up government, I also urge him to take notice of another strategy, the Dimbleby review of the national food strategy. None of these problems will be resolved unless we go to their root, which is our attitude to food availability and the supply chain.
The Government will consider a number of inputs in looking at the most appropriate strategy to address type 2 diabetes and, as many noble Lords have referred to, the increase in weight of many in our population during lockdown. The Government will consider the evidence of the Dimbleby independent review throughout the development of our food strategy.
(2 years, 10 months ago)
Lords ChamberMy Lords, healthcare depends crucially on the relationship between patient and professional. A recent study of Norwegian records found that the longer the relationship between an individual GP and a patient, the more you reduce the need for out-of-hours care and the likelihood of being admitted to hospital. Face-to-face consultation is important but even more important is the case manager function of the general practitioner. Can the Government make a similar study in England in terms of individual GP and patient relationships and medical outcomes, and encourage the devolved Administrations to do similar work so we can compare data?
The relationship between the patient and the GP is important, so we have made sure that choice is at its centre. As they develop the relationship, they can decide on the most appropriate way to be consulted and to give advice.
(2 years, 10 months ago)
Lords ChamberThe noble Baroness makes a valid point; I do not think anyone in this House would disagree with what she said. Virginity testing is demeaning and hymenoplasty is not only demeaning but damaging to women’s and girls’ health and we want it to be banned as soon as possible. I give a pledge that I will push for this to be introduced as soon as possible. Whenever noble Lords are told that the Government will find parliamentary time to do something, I understand why there might be some scepticism about that, but I will push to make sure that we can introduce it as soon as possible.
My Lords, virginity testing and hymenoplasty have to be made illegal at the same time, and rather than talking about it as a cosmetic procedure, it should be seen as a form of abuse. When I read the guidance from the Royal College of Obstetricians and Gynaecologists, it is rather limp. I encourage the Minister to ensure that the medical professions recognise that they will have an integral part in reporting and preventing any of this, just as they had when we started in the early days with FGM, because it is no good creating an offence without it being enforced and actually punished.
I give the noble Baroness the assurance that I agree—I do not think anyone disagrees—that we should try to ban both these practices as soon as possible. The issue is that although I do not personally consider it a cosmetic procedure, legally it is considered as such, and that is why we have to be a little more careful about how we address the issue in legal terms, and the exact drafting of the ban. Of course, any medical professional who carries out these procedures following a ban will be breaking the law, and that is absolutely right. The other issue we then have to consider is what penalty those who break the law in this way will face.