National Health Service: Healthcare Advice

Baroness Thornton Excerpts

Tuesday 16th July 2019 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, it is exciting to contemplate the new world of communication technology and how it might help in all kinds of ways, but the noble Lord, Lord Patel, has raised some important points. The NHS-Alexa partnership has to be seen in the context of Amazon’s ambitions for our wider healthcare industry. I seek assurance. I am sure that at the moment the data is being protected, but I want to know what will happen in the future. If Amazon collects yet more data on patients raising medical concerns, what use might be made of that in the future?

I do not know how other noble Lords are getting on with their Alexa in the corner of the sitting room, but ours regularly joins in with conversations and tells us very bad jokes. My granddaughter thinks it is wonderful because she knows what noise a unicorn makes, so I am not sure, as the noble Lord said, how that plays if one is trying to have a serious discussion about a medical condition.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for that. I would be interested to know what jokes she has heard from Alexa in her family conversations. However, patients look on well-known search engines for medical advice and at the moment they may receive advice from all sorts of untested sources. NHS.uk is clinically based advice which has been approved by NHS England. The purpose of making that advice more available through the Open API, which is available through the developer system, is to ensure that that clinically based advice is more widely available and more readily searchable for patients. A reasonable point has been raised which is to ensure that the right advice reaches patients and that patients go through the right triage system, whether it is 111 or another system, but that is the intention of the programme. It will be carefully monitored and managed by NHSX, NHS England and the department.

NHS: Automation

Baroness Thornton Excerpts

Monday 15th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

Tremendous innovations are being introduced, including in robotics and AI-based automation, particularly in diagnostics, which have the potential to transform how healthcare is delivered in the NHS, but the role of automation to carry out basic administrative and repetitive functions, and of robotics in surgical operations in particular, is due to increase over the next decade. The main purpose of this automation in health is not to replace staff with machines or to reduce the role played by humans in providing care but, rather, to enable staff to spend more time delivering personalised care. But it is also to improve the productivity of health services and systems so that we can ensure that the NHS becomes more sustainable in future.

[Baroness Thornton (Lab)]

My Lords, the noble Baroness, Lady Seccombe, made a valid point about the need for human beings to be involved in the delivery of healthcare, but the use of AI and other technology is also very exciting, as is the fact that it features so largely in the long-term plan. Are the experiments in automation taking place across the country, where are they taking place, when will we see the results and who is delivering automated healthcare and AI? Is it the NHS or are private contractors being commissioned to do this work? I accept that the Minister may not be able to answer all those questions in detail, but if she cannot, I would appreciate a letter being placed in the Library.

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right: this is a very exciting area of ongoing work and a key part of the grand challenges which we put in place as part of the life sciences strategy, part of which is the AI and early diagnosis initiative, which aims to transform the prevention, early diagnosis and treatment of chronic diseases. NHSX’s work across government is to deliver that mission, creating an ecosystem of safe and effective development of AI and the regulatory infrastructure so patients and clinicians can be reassured that where it is introduced, it will be safe. There will be lots of research and development of those innovations. We are at an early stage of implementing them, but there are five centres of excellence across the country. I will be very happy to place a letter in the Library updating the House on progress with the AI mission and these exciting developments.

Childhood Obesity

Baroness Thornton Excerpts

Monday 15th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I absolutely agree with my noble friend. Obesity is a crisis that will not only create misery for those who will then experience increased risk of tooth decay and of diseases such as cancers, diabetes and other severe illnesses, but it will also create significant unsustainability within our health service, which we are able to prevent. Since we know the tools that we have to prevent it, we should all be working together to make sure we do.

[Baroness Thornton (Lab)]

My Lords, we know—and the noble Lord, Lord Bird, made this point—that it is the poorest children who are obese. This is largely because their parents buy food which is high in fat, sugar and salt, because it is cheaper than fresh food. It may or may not be from Waitrose, but the noble Lord makes an important point there. I have two questions for the Minister. First, is it true that two-thirds of the deadlines of the plans that have been put forward for the obesity strategy have been missed? Secondly, what is the Government’s strategy for dealing with summer hunger—those children who will not get proper meals during the summer break?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right to raise inequalities. This is exactly why chapter 2 of our plan is focused on childhood obesity trailblazer programmes, where we have identified areas of highest deprivation to provide specific support to local authorities in those areas. We have also recognised this issue around school holidays: around 50,000 disadvantaged children will be offered free meals and activities over the upcoming summer holidays, funded by £9.1 million from the Department for Education. That follows a successful programme last summer, which saw improvement, with football play sessions and cooking classes for more than 18,000 children across the country. However, the noble Baroness is right to recognise that this is a real challenge that we need to address.

NHS Dentistry Services

Baroness Thornton Excerpts

Thursday 11th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I am very sorry to hear of my noble friend’s experience with the Mayor of Manchester. Children’s oral health is now better than it has ever been, with more than 75% of five year-olds in England being decay-free, which we welcome. However, the number of children requiring tooth extraction remains a concern. It fell slightly between 2016 and 2017-18, which we welcome; however, we recognise that there is much more to do. That is why the NHS outcomes framework is working to ensure that we perform better, with much work being done to target improved oral health of young people, with the Starting Well core framework and Starting Well pilots in the 13 areas of greatest deprivation.

[Baroness Thornton (Lab)]

My Lords, in Portsmouth there are 20,000 patients without a dentist, due to the closure of three practices. In Cornwall, 22,000 people are on the waiting list, having to wait an average of 529 days before they get an NHS dentist. The noble Baroness is quite right that there are some serious problems to address here about access to NHS dentists. I should like to know exactly how those areas in desperate need, such as Portsmouth, will be tackled. Secondly, how many of the babies, children and young people included in those numbers currently have no dental care whatever?

[Baroness Blackwood of North Oxford]

As I said in my previous answer, children’s oral health is better than it has ever been. This is not to say that there is any complacency or acceptance of where we are. We recognise that while access has significantly improved, there are still areas where NHS England needs to do more to meet local need. NHS England is responsible for helping patients who cannot find a local dentist. Those in that situation should contact NHS England’s customer contact centre for assistance. Things that are being done to improve this include the introduction of new nationally flexible commissioning, which can help national commissioners commission a wider range of services from dental practices, and the testing of a new, reformed dental contract, which we think will make the profession more attractive for new dentists.

Restaurants: Calorie Labelling

Baroness Thornton Excerpts

Tuesday 9th July 2019 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of Diabetes UK’s Food Upfront campaign and petition; and how many businesses they estimate will be affected by the introduction of mandatory calorie labelling in restaurants.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we welcome the ongoing commitment of Diabetes UK, including the Food Upfront campaign, which, together with its encouraging support for our proposals, makes a valuable contribution to improving the nation’s diets. The impact assessment published alongside our consultation last year estimates the number of businesses that will be affected under the various policy options considered. An updated impact assessment will be published when the Government publish the outcome of the consultation later this year.

[Baroness Thornton (Lab)]

I thank the noble Baroness for that Answer. It is a shame that the consultation, which ended in December, has yet to be published. Diabetes UK tells us that three out of four people want to see calorie information on restaurant, café and takeaway menus, and that nine out of 10 say that clearer food labelling will help them make healthier food choices. Diabetes UK is worried that the Government intend to limit compulsory calorie labelling to companies with 250 employees. If that is the case—I would like to know whether it is—only 520 businesses would be included out of the 168,000 eligible, rendering this meaningless. What are the Government doing in this regard and when will we see the results of the consultation?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important question. She will know that we remain committed to delivering the actions we set out in chapter 2 of the childhood obesity plan, which included the consultation on calorie labelling in the out-of-home sector. We will publish it shortly. She will also know that our ability to introduce changes to the labelling system depends on EU legislation. We are committed to exploring whatever additional opportunities we can to have food labelling in the UK display world-leading, simple nutritional information, as well as information on origin and welfare standards. We will bring that forward as soon as possible.

NHS Pensions: Taxation

Baroness Thornton Excerpts

Tuesday 9th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important Question, which she has asked before. Retaining and maximising the contribution of our highly skilled clinical workforce is crucial to the delivery of patient care. We are preparing to provide pension flexibility that appropriately balances the benefit of new flexibilities with their affordability. We have listened, and we are discussing the issue with the Treasury. As a first proposal, the consultation will set out a potential 50:50 option, offering 50% pension accrual and halved contributions. The BMA requested this as an option earlier this year and has welcomed it as a step in the right direction. The consultation will be an opportunity to listen to a range of views and will be genuinely flexible and open; we will bring it forward as a matter of urgency. I hope that that is a reassuring answer for the noble Baroness.

[Baroness Thornton (Lab)]

The briefings that I have received from the BMA and other places say that the 50:50 solution may not prevent the problem. How many people will have to wait longer for their operations before the Minister’s colleagues, the Chief Secretary to the Treasury and the Secretary of State for Health and Social Care, concentrate on their day jobs—that is, getting together and talking about how to solve this problem instead of campaigning for whoever they are campaigning for to be the leader of her party? Surely their time could be better spent sorting this problem out.

[Baroness Blackwood of North Oxford]

The noble Baroness knows that I cannot answer for the Chief Secretary to the Treasury, although I know that this issue has been raised with the candidates as part of the leadership campaign and that they see it as a priority. As I said in my Answer to the noble Baroness, Lady Finlay, we recognise that the 50:50 flexibility option does not provide unlimited flexibility for clinicians to target their own personalised level of pension growth. Other options, such as additional pension accruals to purchase individual units alongside a pension, may be considered as part of the consultation. The message going out to the sector is that we want as much flexibility as possible to try to find the right solution to meet the complex needs of the system.

Academic Health Science Centres

Baroness Thornton Excerpts

Tuesday 2nd July 2019 Grand Committee

[Baroness Thornton (Lab)]

My Lords, I join everyone in thanking the noble Lord, Lord Butler of Brockwell, for putting forward for discussion this important subject of the future of the academic health science centres. I thank the noble Baroness, Lady Masham, for asking: what about Yorkshire? I say that as a Bradfordian.

We could probably have done with at least another hour to do justice to this subject and indeed to the distinguished speakers who have taken part, such as my noble friend Lord Darzi. We have four ex-Ministers here, and then the Minister herself. It is all right; I have been in rooms like this with virtually everyone in the room knowing more than I do about the subject being talked about.

I think we would all agree that these health centres provide essential research in medicine, clinical trials, cancer treatments, mental and physical health integration and much more. At a time of such uncertainty regarding our collaboration with Europe colleagues to conduct health science research due to Brexit, it is vital that we have clarity on the next steps for the academic health science centres in the UK. I agree with the noble Lord, Lord Prior, about the lack of ambition regarding finance, funding and our position on research. I am not sure that I quite understood whether he thought that Brexit was a good or bad thing for the future of research, and I will come back to that.

I have declared in the register of interests that I am a member of the Camden Clinical Commissioning Group, so I am at the foothills of the NHS. However, I am aware of the research done by Moorfields and UCL on, for example, laser treatment for glaucoma, which is important to our CCG. The treatment is said to have had high success rates, with the research suggesting an annual saving to the NHS of £1.5 million in direct treatment costs, potentially rising to £250 million if the treatment proves beneficial for patients with later-stage glaucoma. In Camden CCG, we are proud that our area has many major research centres—Moorfields, UCL and Great Ormond Street—and regard our job as primary care commissioners as being to make sure that we co-operate with them.

I return to Brexit. One of the health science partners, the University of Cambridge, stated:

“Both the NHS and the UK life sciences industry desperately need clarity and certainty to plan successfully for Brexit, and time has almost run out”.


That was in March, but it remains true, and the Government must consider what solid solutions can be offered. If we fall out of the European Union at the end of October, that presents an enormous challenge to the centres. It makes it more important that they exist and receive sufficient funding, I agree, but the collaborations that need to be carried out across Europe and the world seem to become more difficult. I would like the Minister’s view on that.

Lung Health

Baroness Thornton Excerpts

Monday 1st July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord is right to praise the success that we have had in smoking cessation in this country. We now have the lowest rates of smoking that we have ever had, some of which is because of the work of local authorities and PHE. He is right to identify the need to target the variation and inequalities. We are targeting this through the prevention Green Paper and we identify the need for a sustainable funding settlement through the spending review allocation.

[Baroness Thornton (Lab)]

A study of over 38,000 people with chronic obstructive pulmonary disease found that opportunities to diagnose were missed in 85% of patients in the five years before their diagnosis. My mother was probably included in that number. Will the Minister commit to introduce target case findings in general practice for people who have symptoms suggestive of COPD with follow-up care and services? How do the Government intend to eliminate the postcode lottery that exists in the quality of and access to COPD treatment?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right: COPD is the second most common lung disease in the UK. It is disturbing that around a third of people, in their first hospital admission for COPD, had not been previously diagnosed. NHS RightCare is developing a COPD pathway, which is being rolled out nationally through clinical commissioning groups, to identify the core components of an optimal service for people with COPD to ensure earlier diagnosis and better management, so that they do not experience the concerns that she has identified.

NHS Long-term Plan

Baroness Thornton Excerpts

Monday 1st July 2019 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for repeating the Statement and refer the House to my interests as listed in the register.

It is 71 years this week since the Labour Party created the NHS in 1948; it will also be a Labour Government who will turn around the NHS again, as we did from 1997. As the Minister will know, I welcome the things we agree on: alcohol care teams, perinatal mental health services, a greater focus on health inequalities and enabling gambling addiction services; all Labour ideas, of course. Even today the Minister—or rather, her right honourable friend—talked about bringing hospital catering in-house, which is another Labour idea.

The Minister has focused on three important matters in this Statement, but I have some questions about other matters that it contains. I want particularly to raise the question of support for local systems. Increasing the focus on population health in the long-term plan is of course very welcome. Can the Minister explain how STPs will become ICSs by April 2021, with all ICSs—I apologise to the House for using all these acronyms—reaching “mature” status, as described in the recently published ICS maturity matrix? Will the Minister also explain how the provider and commissioner landscape will develop, with a new integrated care provider contract due to be published this summer to provide guidance on how primary care can be integrated with secondary and community services?

The long-term plan rightly has prevention at its heart. Will the Minister set out how the Government will work with local authority partners to take forward prevention activities on obesity, smoking, alcohol, sexual health, antimicrobial resistance and air pollution, including how they will use the additional targeted funding being made available to support this series of activities?

At a time when life expectancy is stalling and infant mortality rates—the rate of children not making it to their first birthday—have risen three years in a row for the first time since World War II, vital public health services that tackle inequalities have been cut by £700 million. We all know that the NHS’s ability to plan for coming years is dependent upon a well-resourced adult social care system; of course, adult social care budgets have been cut by £7 billion. Also, we still await the social care Green paper. Will the arrival of a new Prime Minister hasten or further delay further its arrival? How can system-wide reform be delivered, as aspired to in the long-term plan, under these circumstances?

On staffing issues, we have 100,000 vacancies and are short of 40,000 nurses; at the same time, bursaries have been scrapped, CPD budgets cut and the no-deal Brexit we seem to be preparing for will exacerbate the staffing crisis. I noted and welcomed the interim NHS People Plan published by the noble Baroness, Lady Harding, but when will we see a workforce plan backed up by actual cash? It cannot be delivered unless this happens. The Government talk about IT systems but give no certainty on capital investment. Hospitals are facing £6 billion-worth of repairs, with walls crumbling, ceilings falling in, pipes bursting and outdated equipment stalling. Maintenance designated to address “serious risk” has doubled to £3 billion. Will this backlog also be tackled?

I turn briefly to mental health. We know that more than 100,000 children are denied mental health treatment each year because their problems are not judged “serious” enough. Over 500 children wait more than one year for specialist mental health treatment. When the Minister talks of a fundamental shift, does she mean that the Government will ring-fence funding? Given that just 1.6% of the public health budget is spent on mental health, will the Government insist that more is spent on mental health resilience and prevention?

Finally, I want to ask about next steps. It is my understanding from the Statement that a national implementation plan to be published by the end of the year will bring together the aggregated ICS/STP plans and national activities with performance trajectories and milestones to deliver the long-term plan commitments. However, it notes that the development of the national plan is contingent on the spending review, due to the need to account for decisions on workforce, social care, public health and capital budgets. Due to the uncertainty in the current political environment, will the spending review be delayed, and will that set back the development of the national plan beyond November?

The national plan states that the NHS needs to,

“remove the counterproductive effect that general competition rules and powers can have on the integration of NHS care”.

I say Amen to that. But are the Government now willing to admit that the Health and Social Care Act of the noble Lord, Lord Lansley, has had a devastating effect on the NHS? Will the Government bring forward primary legislation to achieve the objectives set out in the long-term plan?

[Baroness Jolly (LD)]

My Lords, I too thank the Minister for reading the Statement. I feel I should get out an orange flag—I am probably wearing the right colour—because, in the 1940s, Liberals were orange, not a yellowish colour. Beveridge, whose paper proposed the National Health Service, was indeed a Liberal and his proposal was for a service,

“free at the point of need”.

Anyway, I will get back to the Statement. I welcome the Secretary of State’s commitment to cancer and mental health services and workforce growth—who would not? But the Statement does not refer to the local five-year strategic plans to be completed by mid-November and rolled out thereafter. These will involve local consultation and incorporate performance trajectories and milestones across health and social care; they are truly the plans to implement the Secretary of State’s plan. The Statement mentions funding but is quiet about how much. I guess that is quite understandable given the position of the Government, who do not know who the new leader will be let alone his priorities.

The NHS is crying out for more capital: diagnostic and treatment equipment these days is big and very expensive; those of us who have been into English hospitals recently will notice that the buildings are looking sadder than they did 10, 15 or 20 years ago; and workforce shortages are mentioned. Will the Minister tell us when we can expect the NHS to be fully staffed and appropriately equipped? There is no mention of widespread regional variation in outcomes: by when will these be no more? Can the Minister explain how the areas for concentration will be managed? Will management be top-down or bottom-up, reflecting local needs?

Will the Minister also tell the House about any conversations regarding more funding for adult social care? I shall not say any more about the Green Paper. Public health services are critical to help people deal with obesity, stop smoking and become fit, so living longer, healthier lives. All these are critical matters for local authorities. The Statement barely mentions social care but, without an injection of staff and funding, it will fall, and with it the Secretary of State’s laudable visions for cancer treatment and mental health.

Carers: Support

Baroness Thornton Excerpts

Monday 17th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I am sorry if I have given the impression to the noble Countess that action has not been happening now. I can outline that the Government have been taking ongoing action to support carers. The Care Act 2014 introduced important new rights for carers, putting them on the same footing as those whom they care for. Through the Better Care Fund, the NHS has contributed £130 million for carers’ breaks. The Carers Action Plan, published in 2018, set out a broad, cross-government programme of work to support carers, which included 64 points which have been delivered since that time. A review will be published in July. A £5 million Carers Innovation Fund to support innovation was announced just this week and will include innovative ways to improve care for patients. This is all ongoing work which is helping carers now, but we recognise that it is not enough, because carers deserve the very best. That is why we will continue to strive to improve support for carers within the system going forward.

[Baroness Thornton (Lab)]

My Lords, according to Carers UK, 8.8 million people are carers in this country—that is up 2 million since 2011. Are the Government reviewing the funding provided in last year’s Carers Action Plan to take account of that? What discussion is the Minister’s department having with the department that funds local government? That is the nub of the problem: austerity has starved local government so that it cannot provide the right kind of care, and carers all over the country are suffering as a result.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her question. Of course, £10 billion has been provided for adult social care between 2017-18 and 2020, with an extra £240 million for adult social care to reflect winter pressures and an extra £410 million to improve social care for older people, people with disabilities and children. However, the noble Baroness is absolutely right that a sustainable long-term plan for social care is part of the discussions taking place on the spending review and as part of the Green Paper planning. The consideration of dedicated employment rights and reviewing financial support for carers is part of those discussions.