NHS: Artificial Intelligence

Baroness Thornton Excerpts

Tuesday 24th April 2018 Lords Chamber

[Lord O’Shaughnessy]

My Lords, I thank my noble friend for his question and congratulate him and the rest of the committee on the excellent report, AI in the UK: Ready, Willing and Able?, which has a substantial chapter on AI’s application in healthcare. The potential to transform every element of health and care is susceptible to artificial intelligence. A couple of areas outside the clinical setting that I would highlight are workforce planning and triaging patients between different forms of care. As for support, in addition to the items in my first Answer, I highlight the work of the Topol review, which is designed to make sure that staff are fully equipped and trained to take advantage of these technologies as they come through the system, rather than letting them sit with a few early adopters and not becoming more widespread in the NHS.

[Baroness Thornton (Lab)]

My Lords, it is quite clear that the use of big data and AI will have transformative outcomes for patients. There are at least two challenges. The first is investment, which the Minister has already mentioned. What framework of accountability and transparency is in place to deal with that level of investment? How will we know whether it is being sensibly invested? The second is safeguarding and protecting data, and I use my local hospital as an example. A partnership between Google DeepMind and the Royal Free Hospital trust resulted in a breach of the Data Protection Act and the personal data of more than 1.6 million patients was transferred to the Google subsidiary as part of the creation of Streams, an app to diagnose and detect acute kidney injury—which we would, of course, all support. This suggests inexperienced procurement and negotiation skills in the NHS and the potential for the Googles of this world to run rings round them, to all our detriment. What are the Government doing to safeguard patients and their data?

[Lord O’Shaughnessy]

The case the noble Baroness highlighted brings to the fore both the potential benefits and risks. There are tremendous benefits in having personalised healthcare, and we all want to see that delivered. At the same time, if data is not used safely and securely we lose the public’s trust. If we do not have that trust, we will not be able to get the changes that we want. The Government respect the decisions made by the Information Commissioner and National Data Guardian in their judgments about poor practice at the Royal Free. I am pleased to say that the hospital has responded well to these. We are doing a couple of things to make more systematic changes. First is implementing the proper data standards of the GDPR in one month’s time. We will also make sure that National Data Guardian’s 10 data standards are written into every NHS contract so that, when it comes to procurement, there is understanding about the kind of things they should and should not be doing to safeguard data.

Children and Young People: Obesity

Baroness Thornton Excerpts

Tuesday 17th April 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the noble Baroness, Lady Walmsley, for initiating this debate and for her patience—she has got it at last. I thank all noble Lords for their contributions, and I thank the many organisations that have sent us briefings about this important subject: the LGA, the BMA, Diabetes UK, Cancer Research UK, the Faculty of Dental Surgery, the Daily Mile and the Obesity Health Alliance. As other noble Lords have mentioned, we also received one late today from the Advertising Association, which seemed to make the argument that there is no need to have a ban on high-fat, salt and sugar advertising before the watershed at 9 pm because there is no evidence that it would have any impact. As someone who proposed a Private Member’s Bill about 10 years ago saying exactly the opposite to that, I am afraid that, like the noble Baroness, I was not in sympathy with that argument. I am sorry if I have left anyone out of the thanks for all the briefings that we have received. This amount of interest seems to be a sign that people recognise that there is a health emergency that our children and young people face.

The House of Commons Select Committee March 2017 follow-up to its 2015 report tracked the action, or inaction, of government in tackling the problem of child obesity. It commented on the Government’s child obesity plan that was published in 2016, which, like many noble Lords here, we found disappointingly modest, given the proposals of the 2015 Select Committee. It showed a lack of urgency that I am afraid is still apparent.

I am not going to repeat all the facts that many noble Lords have mentioned, but the fact that 30% of our children are overweight or obese and many will remain that way into adulthood is not good. And yet, in 2016 UNICEF estimated that 10% of children in the UK are living in severe food insecurity, which means that they do not have enough to eat. Frank Field’s Hungry Holidays report estimated that as many as 3 million children could be at risk of going hungry over the school holidays. I am sure that your Lordships will recall that at a recent teachers’ conference we heard reports of grey-faced hungry children turning up at school who cannot learn because they have not eaten.

Food poverty and obesity coexist in some of our most deprived communities. Children living in the most deprived areas are more than twice as likely to be affected by obesity as those living in the least deprived areas. Families from deprived communities have the poorest diets, as noble Lords have mentioned, high in saturated fat and low in fruit, vegetables and fibre.

Can the Minister assure the House that the Government are taking a comprehensive approach to this issue, which is also about how to support parents to make the right choices, the right decisions? It is about ensuring that children can still have access to free school lunches. It is about looking at how families can afford decent food. As the noble Lord, Lord Storey, said, it is about Sure Start centres, it is about providing support in the communities where children are most at risk. If I may add, it is also about not selling off school playgrounds.

I was struck by the briefing we received from the LGA, because since the responsibility for delivering public health transferred to councils in 2015, local government has spent more than £1 billion tackling child and adult obesity and physical inactivity. Against a backdrop of reductions to the public health budget, councils report a 50% increase in spend in the years between 2013 and 2017 on childhood obesity and a 60% increase on childhood physical inactivity in the same period.

Surely it is counterproductive to continue to cut public health budgets in this context. Public Health England’s sugar reduction programme should be extended to include salt, saturated fat and overall calories. Is the Minister prepared to ensure that compliance with these targets should be regularly monitored and backed by meaningful sanctions for companies failing to make progress?

As many noble Lords have mentioned, the Government should close existing loopholes to restrict children’s exposure to junk food marketing across all the media to which they are exposed. The rules currently apply to only 26% of children’s viewing times and still allow adverts for food and drink high in fat, sugar and salt to be shown during family viewing time—between 6 and 9 pm—when the number of children watching TV is at its highest. These rules are failing to protect our children. They deserve to be protected from exposure to adverts for food and drink that we know can influence their food preferences, choices and intake.

The noble Baroness, Lady Mone, made a great speech about what needs to be done, but the point about her analogy with seatbelt usage is that we needed legal compulsion to make people wear seatbelts because they would not do it voluntarily and the car industry was not going to install them unless the law made it comply. If we are to follow that analogy, perhaps some lessons need to be learned about compulsion.

We need a comprehensive strategy that tackles all those issues. If we fail to have that, we fail a generation of children and young people, to great personal cost to them and great public cost. The noble Baroness, Lady Jenkin, hit the nail on the head when she said that political leadership is what is required.

Brexit: Health and Welfare

Baroness Thornton Excerpts

Thursday 29th March 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I congratulate the noble Baroness, Lady Brinton, on initiating this debate and, of course, on its timing—the 70th anniversary of the NHS, and one year from Brexit. I thank all those who have taken part. They have taken a break from their Easter egg hunting to be here this morning.

I think the Minister is aware—if he was not, he certainly is now, as the noble Lord, Lord Dykes, said, from the serious and solemn nature of the debate—that, one year away from leaving the EU, we are discussing health and care issues that affect every person in the UK. They affect those from the EU who live and work here; those from the UK who work in the EU; those of us who go on holiday; those who retire to the EU; those who use medicines of any sort, including over-the-counter purchases; those, and their families, who have rare diseases—in fact, all of us. It is a long list of issues. So when the noble Lord, Lord Callanan, talked about, as he puts it, a “snapshot” of the EU law transferring in a year’s time, I can only wonder whether even the widest-lens panoramic view camera will be able to capture all the issues that will need attention if only in the health and social care arena.

As my noble friend Lady Warwick put it, uncertainty is still the problem. I spoke about uncertainty on Second Reading of the European Union (Withdrawal) Bill—thankfully, we finished the Committee stage yesterday—and every speaker in this debate has talked about uncertainty and lack of clarity. We have talked about workforce issues, reciprocity of health and social care, the licensing of medicines and clinical devices; clinical trials, research and infectious disease control, which the noble Baroness, Lady Walmsley, mentioned; food regulation, which I agree is vital in this matter; Euratom and European network references; and indeed, as my noble friend Lord Brooke said, concerns about the trade deals that are to follow Brexit and how we will move forward on those.

I shall focus on two main issues which I think bring into focus the whole challenge facing the UK in the years to come, beginning with workforce issues. A substantial proportion of UK health and safety regulations and workers’ rights originate from the EU and provide important protections for healthcare workers and their patients. As we know, the employment environment for NHS staff, including nurses and healthcare assistants, links directly to patient outcomes and patient safety. We need to ensure that nurses, midwives and doctors working in the UK from elsewhere in the EU are made to feel welcome and that their families and futures are secure, and that our NHS staff can benefit from access to medical staff from all over the EU, as we do now. These are vital workforce issues. We know that there has been a drop in the number of midwives and nurses applying to work in our NHS already. The BMA says that EU nationals—highly-skilled doctors and researchers—will choose to leave the UK because of continued uncertainty in the Brexit negotiations. In other words, 45% of EEA doctors are considering leaving the UK. This will not help with rebuilding the NHS, which we need to do now.

The working time regulations provide a framework to reduce fatigue within our nursing workforce, and put critical safeguards in place. These include compensatory rest and controls on working time, to address the health and safety effects of shift working patterns. We strongly supported their adoption in the 1990s and their subsequent updating. Fatigue, long working hours, lack of rest breaks and poorly managed shift rotas are a risk factor that again impact on the health of nursing staff and on patient safety. It is essential that the working time directive stays in place, as currently drafted.

The Royal College of Nursing and other royal colleges wrote to the Prime Minister asking for clarity on this matter in 2017. In response, the Prime Minister did not reassure them that the working time directive was a negotiating objective and priority for the UK Government, so can the Minister give that guarantee now? With one year to go until Brexit, we are calling on the Government to be louder and clearer in reassuring the tens of thousands of EU nurses, carers and doctors working across the UK, not only on their right to stay here, but how desperately the NHS and social care system needs them to stay, and how much we welcome them.

Turning to clinical trials, I thank Cancer Research UK, Genetics Alliance UK, and others for the briefs they have sent to noble Lords about this matter. As the Minister is aware, the EU clinical trials regulation—CTR—replaces the existing clinical trials directive, and will reform the governance of clinical trials across the EU. It was adopted in 2014, with the UK’s full support. However, due to a technical delay with the set-up of the portal and the database, it will come in after 2019, rather than later this year. As a result, it will not be covered by the EU (Withdrawal) Bill and automatically be converted into UK law. The noble Lord, Lord Callanan, keeps referring to “snapshots” but it will be off the edge of that snapshot.

It is important that the UK adopts and aligns with the CTR, as it will harmonise the regulation of clinical trials taking place across Europe, making it easier for cross-border research collaboration. We need action from the UK Government that an agreement will be reached to align the clinical trials regulation and remain aligned until after the end of the transition period. Let us take rare diseases as an example, which can be written across the whole of medicine development and clinical trials. Patients affected by genetic or rare conditions often have few or no effective treatments available to them. There are over 6,000 known rare diseases, yet only about 140 medicines licensed in the EU for those rare conditions.

The EU’s medicines regulator, the European Medicines Agency—EMA—has created the largest single supranational regulatory environment, covering a population of 500 million people. Why would we want to be outside that regime; why would we want to put at risk those with rare diseases, particularly children? The Minister needs to reassure the House that this will not happen. Losing the leverage that comes from being in the single market, and therefore this regime, means that the incentives of the centralised process could be the difference between UK patients being able to access a new treatment for a rare disease or not, or it could cause major delays. It looks like we might already be losing that leverage.

Can the Minister confirm that the UK has now been informed that it can no longer be the lead assessor in clinical trials and that the UK has been removed from every EU medicine committee? Can he also explain to the House the implication of this action? When the Prime Minister talks about associate membership, can the Minister explain whether that exists at present, whether it is in the negotiations and whether it means that those things that are already happening will be reversed?

European reference networks are equally important as they have the potential to revolutionise the care and treatment of patients with rare diseases. Without the UK’s involvement, those patients in the UK and, indeed, the rest of Europe will lose out. Will the Brexit negotiations include provisions for the NHS to continue to take part in ERNs so that we can ensure that families with rare diseases are not disadvantaged?

These are huge and vital matters to be solved for the whole population of the UK. If the Minister senses a whiff of panic, he would be correct. One noble Lord after another, including the two from his own Benches, has explained the consequences of not sorting this out, not resolving it and not giving clarity and assurances in these vital areas, so I hope that he will be able to do so now.

NHS: Staff Pay

Baroness Thornton Excerpts

Wednesday 21st March 2018 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for repeating the Statement. I agree with his final statements, but never has it taken so long to get to this point of a pay increase. I do not wish to sound ungracious but the pay increase is too little, too late. The cap has meant that NHS wages have fallen by 14%. Last summer, the Prime Minister told a nurse on television that a pay rise would need a “magic money tree”; I am very glad that it seems to have been found.

The NHS is now short of 100,000 staff. In part, that must be because of this Government’s neglect of the NHS workforce. Exacerbating this situation is the chronic shortage of nursing and other staff in nursing care homes, with a 16% decrease in the number of registered nurses in the care sector since 2012. Then, there is Brexit and its damage to NHS staffing. Given that the Secretary of State now has responsibility for social care as well as health, will we see a joined-up staffing strategy for NHS and care workers? Can the Minister assure the House that, to pay for the proposed increase, the Treasury has said that it will fully match any proposed rise with new money?

[Lord O’Shaughnessy]

I thank the noble Baroness for her perhaps less than fulsome welcome for what is a fantastic deal, not least for the lowest paid staff in the NHS, some of whom will see very significant pay rises. They certainly deserve them; I do not think anyone disagrees with that. We have been able to find the additional money in the NHS budget to do this precisely because of good economic stewardship, rather than relying—as others would—on trees, magic or otherwise. That stewardship has meant that we have been able to provide the money while taking our fiscal responsibilities seriously.

The noble Baroness mentioned the joined-up staffing strategy. She is absolutely right that it is very important. I hope she knows that Health Education England has included work on the social care workforce in its draft strategy. We all understand that we need increasingly to view these workforces together—not just people such as nurses, who can work in both sectors, but carers and allied health professionals and so on. Frankly, there is more work to do on the social care workforce strategy. In the health service, we are starting from a lower base in terms of having a national picture, precisely because it is generally delivered locally. However, we are providing that strategy. I would encourage all parties who want to make sure that the strategy is joined-up to contribute their ideas, because there is a genuine willingness to make sure that we can do it.

Abortion: Misoprostol

Baroness Thornton Excerpts

Tuesday 20th March 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for her question. No timeframe has been set for any decision on a policy change. She will understand that any change of policy would need to be done cautiously, in the light of the evidence and of legal developments—for example, relating to Scotland’s decision to name homes as a place. It is on that basis that we will consider any further evidence.

[Baroness Thornton (Lab)]

My Lords, if women in Norway, France and now Scotland can take this drug at home, not in a clinical setting, with careful safeguards and support in place—I have looked at what has happened in Scotland, and there is no doubt about that at all—it is important that the Government should afford the same facility to women in England. I would like the Minister to perhaps go further than he has now and say that there will be a timetable for this to happen.

[Lord O'Shaughnessy]

In terms of the experiences in other countries, of course only the countries of the UK are operating under the auspices and obligations of the 1967 Act, which any Government would have to act under. The Scottish Government have made that decision, but the noble Baroness will know that it is subject to a dispute and that a judicial review has been brought against it by the Society for the Protection of Unborn Children, which is obviously testing the legality of the Scottish Government and their powers to act. We shall look closely at developments in these legal proceedings, as well as any other evidence that arises. Unfortunately, this is why I am not in a position to give her a timetable.

Children and Young People: Mental Health Services

Baroness Thornton Excerpts

Thursday 8th March 2018 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for that response and Statement. What emerges from the Care Quality Commission’s review of children and young people’s mental health is the glaring finding, to which he has not referred, that children are suffering because of high eligibility thresholds. We know that 50% of mental health problems develop before the age of 14, and 75% develop before the age of 18. Does the Minister recognise that imposing high eligibility thresholds means that children and young people are treated only when their condition becomes very serious? Will he look into the referral criteria as a matter of urgency so that children and young people are getting proper treatment at the right time, thereby preventing a crisis that brings greater suffering for those children and their families, and greater expense for the health service?

[Lord O’Shaughnessy]

I thank the noble Baroness for those questions. On the issue of high eligibility thresholds, we are grappling with a need to expand the amount of mental health services that can be provided. Currently, about one in four children with a diagnosable mental health condition accesses NHS services. That is clearly not enough and the intention is to get that figure to one in three by 2021. Again, that is not enough but it would be progress. There is a need to move along the path, dealing first with those in the most acute trouble and then rolling out to those with less acute conditions. I agree with the noble Baroness’s point and recognise the issue. However, this cannot achieved overnight, not least because a huge number of new staff are needed to be trained in order to deliver that. We are looking at the issue of referral criteria. I should also point out to her that we have made big steps forward on waiting times and new standards for early intervention in psychosis and eating disorders. We are piloting a waiting time for access to specialist help and hope that that will start to move things along in terms of more children being seen more quickly, which is what we all want.

General Practitioners: Workforce

Baroness Thornton Excerpts

Monday 5th March 2018 Lords Chamber

[Lord O’Shaughnessy]

I thank my noble friend for her question. It is interesting to note, looking at the figures, that the total number of retirees from general practice has been falling in recent years, which is very welcome, even though in the past few years there has been an increase in the number taking early retirement. As for entering general practice, that is how we need to get more GPs. The number of training places has increased to a record 3,250, which is an 18% increase over the past three years. Finally, on certification, mutual recognition of professional qualifications is of course a matter for negotiation as part of our future relationship with the EU. However, I can tell my noble friend that the Government are committed, under whatever circumstances, to recruit 2,000 international GPs in the coming years.

[Baroness Thornton (Lab)]

My Lords, I declare an interest as a lay member of a CCG. GPs are indeed retiring before the age of 60; in fact, last year, twice as many retired as three years ago. More GPs are leaving the profession than are joining it, and soaring numbers of junior doctors are leaving the NHS after their two-year foundation training. How do the Government intend to fill the failing pipeline of junior doctors, and would the Minister care to speculate why there is a flood of departing junior doctors right now? Could it be due to junior doctors’ rock-bottom level of morale after their shabby treatment by the Secretary of State?

[Lord O’Shaughnessy]

The noble Baroness might be interested to note that in 2014, the number of GPs in specialty training was 2,671, and in 2017, it was 3,157—an increase of nearly 400. That is how we are filling the places.

NHS: Waiting Lists

Baroness Thornton Excerpts

Monday 26th February 2018 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what plans they have to reduce the waiting lists for consultant-led NHS treatment; and to what timetable they intend to carry out such plans.

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

My Lords, the joint NHS England and NHS Improvement plans for 2018-19, published on 2 February 2018, set out how £1.6 billion of funding announced in the Autumn Budget will be spent on additional elective surgery as well as ensuring that the four-hour A&E waiting times standard is met. The guidance refreshes two-year plans already in place to improve waiting times performance.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. Waiting lists at the end of November 2017 stood at 3.72 million. The head of NHS England, Simon Stevens, says that at present waiting lists will grow to 5 million by 2021, and the Minister’s Answer is inadequate in solving that problem. Does he agree with the findings of the Royal College of Physicians research that shows among other things that 45% of advertised consultants’ posts remain unfilled, 82% believe that the workforce is demoralised and 74% are worried about their ability to deliver safe patient care in the next 12 months? What are the Government’s plans to deal with this crisis in an NHS that is underfunded, underdoctored and overstretched?

[Lord O'Shaughnessy]

It is absolutely our goal and obligation to return to the referral-to-treatment standard. It is worth pointing out that the NHS has been dealing with an annual growth in demand of around 4%, which is extraordinary when looked at historically. What we have seen in the plan set out a few weeks ago are important steps to get a grip on that, including halving the number of 52-week waits, halting the growth in the waiting list and delivering more every year. Clearly that is an interim step and more needs to be done; the way to achieve that is by continuing to provide real-terms increases, which we have done and will continue to do, and by dramatically increasing the number of staff in the NHS, which again we have done. We have also increased the number of training places.

Disabled People: Social Care

Baroness Thornton Excerpts

Tuesday 20th February 2018 Lords Chamber

[Lord O'Shaughnessy]

I am very aware of this issue. Indeed, we have had the opportunity to speak about it in specific cases. Local authorities of course are obliged to provide respite care. The noble Baroness highlights an important point about care, which seems in a way to slip between the boundaries of the two. I shall write to her about the general policy work that is going on, but I know that we need to solve this because we have children who are now living longer who before might not have lived so long and who require care, as do their families. It is essential that they get the care that they deserve.

[Baroness Thornton (Lab)]

My Lords, I know that the Minister will tell me and the House again about the extra billions that the Government are putting into social care. However, when everyone else says that there is clearly a social care crisis, we have some dissonance here. The evidence of this crisis is the regression of opportunity and care for young disabled people, which is there to see in personal cases where people are not receiving the sort of support that they need. I am not convinced about the Green Paper looking at social care for older people. The noble Baroness, Lady Campbell, is right—that makes me more concerned, and I join her in that concern. Will the Minister explain how the Government will achieve their target of 1 million more disabled people being in work by 2027 if they cannot get out of bed and travel to work without help because of this combination of cuts and the stalling of a coherent support policy to make that possible?

[Lord O'Shaughnessy]

I do not want to disappoint the noble Baroness, but she is aware that more money is going in. To address the specific issue that she talks about—and I obviously can talk about it only from the point of view of the Department of Health—we want and are seeing more disabled people going into work. I would point to one big investment that the Department of Health is making, which is the disabled facilities grant. That is about making sure that disabled people can live at home and have their independence, which of course is critical to maintaining their physical health and confidence to make them, in a way, ready to go into work. I know that there are other programmes being put through job centres and the Department for Work and Pensions to make sure that they are supported, too.

NHS: Winter Crisis

Baroness Thornton Excerpts

Wednesday 7th February 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness is quite right to highlight the issue of bed occupancy; it is very high. The service managed to get it down below 85% before Christmas but inevitably it has risen since then. There is a big improvement in delayed transfers of care; we need that to continue to happen, and it was welcome that the Secretary of State for local government announced more funding for social care so that we can increase those transfers into social care and free up space in hospitals.

[Baroness Thornton (Lab)]

My Lords, following the noble Baroness’s question about bed occupancy, it is absolutely true that in 30 of the last 70 days in the winter period occupancy has been above 95%, which is dangerous. Some hospitals are at 100%. Was that part of the winter plan that the Minister assures us was timely and thorough? Will he accept that the winter plans have now been compromised in the light of pressure on beds, lack of staff and the fact that at least 23 trusts are now on black alert, which means that they are under very severe pressure?

[Lord O’Shaughnessy]

I agree with the noble Baroness that bed occupancy is higher than we want it to be and in some hospitals it is far too high. The question, of course, is what we do about that. It necessitated the difficult decision, for which the Prime Minister apologised, to cancel non-urgent elective surgery. Happily, that has not been repeated and rolled forward into February. We think and hope that the situation with flu, in particular, has stabilised and that that will start to relieve the pressure. I absolutely understand the hard work that staff are having to put in under tremendous pressure and I know that we all appreciate that.