Health: HIV

Baroness Tonge Excerpts

Monday 25th March 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question and also for his leadership on this issue while he was in the department. He knows that the Government are committed to being a world leader in domestic eradication of Hepatitis C. He will know also that a legal challenge by AbbVie delayed the start of contracts on this issue by six months. I am pleased to be able to inform the House, however, that in January the High Court found in NHS England’s favour on all grounds in this matter. We can now go forward with those innovative contracts, which are worth about £1 billion over five years. That will be rapidly put in place over the coming months, which will allow us to make progress on this matter.

[Baroness Tonge (Non-Afl)]

My Lords, although I congratulate the Government on the progress they have made in the diagnosis and treatment of HIV, does the Minister realise that women in this country have an ever-decreasing service for cervical cytology and, indeed, for having those smear tests read in laboratories, given that the number of laboratories is being decreased? Does she realise also that, because of cuts in local government funding, there are very few family planning clinics now, either for women or young girls? That means that the provision of contraception is very limited, because they have to go to their GPs.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for that probing question. The Government have mandated local authorities to commission comprehensive open access sexual services. We have continued the ring-fence around public health services in local authorities at £3 billion a year and they have maintained 3 million attendances in 2017, which is an increase since 2016. What is important is that the long-term plan has also identified sexual health services as an area for review going forward, which is one of the findings from PHE. This is therefore a cause for encouragement, and I hope that the noble Baroness will be reassured.

NHS: Dangerous Waste and Body Parts Disposal

Baroness Tonge Excerpts

Wednesday 10th October 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord is quite right. There are, of course, contractual obligations; the point is that those obligations have not been fulfilled. That is one reason why the Environment Agency is now pursuing a criminal investigation against the firm.

[Baroness Tonge (Non-Afl)]

Will the Minister give us some information? Much clinical waste is highly infectious and therefore very dangerous; it needs to be incinerated very quickly. Will he tell us exactly how it is stored and where it is stored, and will he assure us that there is absolutely no danger of very infectious agents escaping into the surroundings?

[Lord O'Shaughnessy]

The noble Baroness is quite right to highlight this issue. As I said when repeating the Statement, the items that we are talking about are stored securely and I am assured that there is no risk to public health from the stockpiling. Clearly there is a requirement to dispose of them; this is a contractual obligation of the company, which it has not fulfilled. That is why we have entered into this situation.

Abortion: Misoprostol

Baroness Tonge Excerpts

Tuesday 20th March 2018 Lords Chamber

[Lord O'Shaughnessy]

I am aware of the opinion in that judicial review. It is worth pointing out that there is still uncertainty about the legal position. This is why we will watch the developments in Scotland carefully and proceed cautiously. It would be wrong of me to prejudge either the opinions that come from the court or indeed any evidence if this scheme does get up and running in Scotland.

[Baroness Tonge (Non-Afl)]

My Lords, does the Minister agree that, up to nine weeks, it is perfectly safe for a woman to take the pills for a medical abortion? It is much better and more comfortable for her to have the consequences at home. Does he also agree that this would mean each woman would have to make half the number of appointments to get a medical abortion—a huge saving for the health service?

[Lord O'Shaughnessy]

The importance here is making sure that, under the auspices of the Act, women have access to safe and legal abortion, and that is what they have a right to do. An important point here is that, the earlier these abortions happen, the safer they are. The proportion of abortions under 10 weeks has risen from 68% to 81% in the last 10 years. At the moment, both courses of treatment for early medical abortion should take place in a clinical setting approved by the Secretary of State.

Health: Pelvic Mesh Implants

Baroness Tonge Excerpts

Tuesday 6th February 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord speaks with great experience. Obviously, a number of procedures are involved, and NICE is now looking at extra procedures to provide the guidance. It does look like it is not the right thing to do in cases of prolapse, but it can be a very successful course of treatment for other conditions. It is important to take a differentiated approach.

[Baroness Tonge (Non-Afl)]

My Lords, does the Minister share with me a sense of puzzlement that this subject was brought to the House in the first place? I find it very odd given that we have royal colleges and NICE with people to assess the efficacy of particular treatments. Many treatments, both medical and surgical, carry a risk of complications. Are they all going to be brought to the House of Lords for discussion?

[Lord O’Shaughnessy]

Our job in this House is to scrutinise the decisions that are made in our publicly funded health services. I think that it is absolutely right that we do scrutinise these issues and make sure that the care being provided in this country adheres to the highest and safest standards.

Social Care

Baroness Tonge Excerpts

Thursday 7th December 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness put it beautifully in saying that the people we are talking about, who are on the receiving end of care, need to be treated with dignity and honour. I wholeheartedly agree with her.

I will separate integrated care into older people and working-age adults, as the noble Baroness did. On older people—and on health and care in general—I encourage her again to look at the five-year forward view and the plan for integration. In the recent Budget, we funded more than £200 million of capital programmes to help move a handful of local areas to what are called accountable care systems. That is where you look at the health of a population, which is quite an important step forward towards integrated care. I agree with her that that is not necessarily the everyday experience.

On disabled working-age adults, we may talk about the ageing and growing population but I believe that they are the fastest-growing group of care users. There is of course excellent work going on at the local authority level; I had the privilege many years ago to chair a special school in Wandsworth and saw the fantastic work it did with a peripatetic autism service there. But I know that there is huge variation, which is why the parallel programme of work that I talked about is so important.

Finally, the noble Baroness talked about hard-to-reach communities, and I could not agree more on that. One of the ways of reaching them is to engage with those who give voice to those communities. I would be delighted to discuss that with her, to make sure that we are listening to every voice we can as we move ahead.

[Baroness Tonge (Non-Afl)]

My Lords, way back in the early 1980s when I was working as a community doctor, I was also chair of social services in my borough. The main topic of conversation and angst then was how to combine health and social care budgets so that patients could receive proper care. How many more decades do we have to wait for this country to get its act together and do something about it? Other countries in Europe have good social care; why cannot we?

[Lord O'Shaughnessy]

First, I think we do have good social care in this country. That was the CQC’s finding, and it is important for us to recognise that we are building from a position of strength. Secondly, I agree with the noble Baroness on her point about integration. It has taken too long and that is what we are all focused on doing. I hope that she will join in this process so that we can build a true consensus as we move ahead.

Maternal Safety Strategy

Baroness Tonge Excerpts

Tuesday 28th November 2017 Lords Chamber

[Lord O’Shaughnessy]

I am delighted to be able to respond to my noble friend, who, probably more than anyone else, has really led the charge in this area. I pay tribute to her for her work on better births, as I do to Sir Cyril Chantler, her deputy. She is right that patient safety is the golden thread that runs through all the work that the Secretary of State has led, and she is right to highlight that we have safer services. The changes that we are making, together with bringing forward the “halve it” ambition, will save 4,000 babies’ lives, which is a great prize.

With regard to my noble friend’s questions, the endorsement of the HSIB is very welcome. Some months ago I organised a briefing for noble Lords with Keith Conradi, who runs it, and I shall be very happy to organise another one. It is a very interesting organisation with an interesting methodology that has proved incredibly effective in the airline industry, where Mr Conradi comes from.

On RRR, I appreciate my noble friend’s concerns about the timing and I will certainly look into whether it is possible to bring forward its implementation. As she knows, there are some issues around governance and how it will operate that mean that we need to tread carefully, but I shall certainly take that into consideration because we want to get the scheme up and running as soon as possible.

[Baroness Tonge (Non-Afl)]

My Lords, I too declare an interest. Like the noble Baroness opposite, I am an honorary fellow of the Royal College of Obstetricians and Gynaecologists. Of course I welcome this investigation that the Government have announced, but I am a little worried that at the end of the investigation we shall hear the usual phrase “lessons will be learned”. From past experience, lessons are never learned, especially in the health service, because the main cause of the difficulty and of these babies dying is a shortage of midwives and a lack of staff. When will the Government seriously address funding in all sectors of the health service but, on this occasion, especially midwifery?

Abortion (Disability Equality) Bill [HL]

Baroness Tonge Excerpts

Report stage (Hansard): House of Lords
Friday 24th February 2017 Lords Chamber

[Lord Lester of Herne Hill (LD)]

My Lords, it is a privilege to speak after the noble Lord, Lord Winston. He and I go back together a long time to when we both created life—I as lawyer and he as expert witness—in Diane Blood’s case. As a result of that case, she was able to create two boys using her dead husband’s sperm. I listened with care to his speech. We are privileged to have him, one of the greatest experts in the country on the subject, and I agree entirely with his speech; I simply do not agree with the amendment, and I need to explain why.

I am a man; I am not, as far as I am aware, disabled at the moment; and I am not a doctor, so what is my reason for speaking on this subject, as I believe that it is very much up to the woman and parents, not to others, to decide whether to have babies? The reason I speak is because of my experience when I was counsel for the Family Planning Association in Northern Ireland, in a case that went to the Court of Appeal in Northern Ireland seeking to provide guidance to women in Northern Ireland, where, as your Lordships will know, there is no abortion Act in force, only the common law. The problem in Northern Ireland was, and is: what kind of medical service should be provided to those women in a common-law situation without the Abortion Act?

What I discovered during the course of the case and told the Court of Appeal, which was pretty disturbed by it, was that the one situation in Northern Ireland where women can get abortions without having to come to England, Scotland or Wales is on the grounds of foetal abnormality. They do so at common law, and they do so quite regularly. They do so without the benefits or burdens of the Abortion Act. My difficulty with the Bill, but my particular difficulty with the amendment, is that were it or anything like it passed, we would go back to the common law position, which is very uncertain and vague, but encourages the worst thing of all, which is backstreet abortions. The more difficult you make it to terminate pregnancies against the wishes of the woman, the more likely it is that she will be driven to other ways of aborting the foetus. That seems to me profoundly undesirable.

I understand perfectly well where the noble Lord, Lord Winston, is coming from with his amendment, but it cuts down the situation in which abortions are lawful under the Abortion Act and should remain lawful: where there is foetal abnormality but the foetus is unlikely to die when born. It should not be our function to limit the circumstances in which there can be a termination, given all the safeguards in the Bill about the medical profession and its ethics, which the noble Lord has talked about. Therefore, although I agree entirely with his speech, I cannot support his amendment.

[Baroness Tonge (Non-Afl)]

My Lords, I did not intend to speak to the amendment, but I have to stand up as a fellow medical practitioner—if a very humble one—to say that whenever the noble Lord, Lord Winston, speaks on his subject in this Chamber, he makes me feel young again. I am again a medical student listening to one of the best profs give a superb tutorial, and I thank him for that, because it was extremely useful. I add only a couple of things. I get very tired of people arguing that doctors assist women towards having an abortion—that somehow they want to get on with it, are complicit and do not allow women enough time. In my experience as a family planning doctor, and even when I was a Member of Parliament, I never came across examples of this. Women are listened to very carefully and allowed to make up their own mind. Allowing women to have the choice is essential.

A number of people say that women are terribly upset and traumatised after they have had an abortion. That is, again, a rarity. Usually, if they have had the right counselling and right termination, when they have had the abortion for whatever reason—particularly in the cases we are discussing this afternoon—there is a sense of great relief at being able to get on with their own lives. If the Bill went through we would be taking that away from a large number of women and I would deplore that.

Sustainability and Transformation Plans

Baroness Tonge Excerpts

Thursday 26th January 2017 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for making that point. The purpose of NHS England’s review of the STPs is to make sure that they account for all the priorities set out in the Five Year Forward View. Clearly, that involves end-of-life care, and NHS England will work hard to make sure that it is properly reflected.

[Baroness Tonge (Non-Afl)]

My Lords, a very interesting and good report has been published this week on pilot schemes in three London boroughs to treat the effects of female genital mutilation and prevent it occurring in future generations. We have already heard from one clinic in that pilot project that it will have to close at the end of March through lack of funding. Will Minister assure us that such projects, which are vital for many women in our communities, will continue in future?

[Lord O'Shaughnessy]

I thank the noble Baroness for raising that issue, which I was not aware of. I would be very happy to write to her on it.

HIV: Barriers to Treatment

Baroness Tonge Excerpts

Thursday 1st December 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am afraid I cannot answer that question, or at least I could answer it in only a very inadequate way. I would like to reflect on it and write to my noble friend as soon as I can.

[Baroness Tonge (Non-Afl)]

My Lords, what progress is being made in the development of a vaccine against AIDS?

[Lord Prior of Brampton]

I do not like to have two questions on the trot that I cannot answer, but I do not know the answer to the noble Baroness’s question. I shall have to research it and write to her.

NHS: Junior Doctors’ Contract

Baroness Tonge Excerpts

Wednesday 6th July 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the strong advice that we have is that the Secretary of State does have the power to introduce the new contract along with the NHS employers.

[Baroness Tonge (Ind LD)]

My Lords, the Government must realise how disillusioned junior hospital doctors are now. This has gone on for far too long. Is it not time that we had a new Secretary of State for Health, and that the present one should resign?

[Lord Prior of Brampton]

No, I do not agree with that. Where I do agree with the noble Baroness is that this has gone on for far too long. We have been in discussion on this issue for nearly four years. It has got to come to a resolution, so the Secretary of State is absolutely right to introduce this new contract.