NHS: Diabetes

Baroness Tonge Excerpts

Thursday 26th May 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness will know a lot about the diabetes prevention strategy that is being launched with the support of PHE and Diabetes UK, and about the DESMOND and DAFNE structured education programmes. The plan is to roll out the prevention strategy across the whole country by 2020, at which time we expect that at least 100,000 people will have personalised support, which will include structured education.

[Baroness Tonge (Ind LD)]

My Lords, in view of the fact that the Government are rightly worried about the obesity epidemic, will they do anything about the number of television and radio programmes that promote food, cooking, baking and gourmet meals? I find them disturbing and they make me very hungry.

[Lord Prior of Brampton]

As the noble Baroness will know, the Government will produce their childhood obesity strategy later in the summer. I am sure that advertising, particularly before the 9 pm watershed, will be addressed in that strategy.

Accident and Emergency Services: Staffing

Baroness Tonge Excerpts

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, this is a big problem, and to fully address it will take up to two years. We are addressing it in two respects: first, the number of people coming in through agencies; and, secondly, the mark-up that agencies charge, which is sometimes more than the cost of the person being supplied.

[Baroness Tonge (Ind LD)]

My Lords, will the Minister tell us when the Government are going to come clean about the health service and actually admit that we cannot carry on the way we are doing at the moment? Will he also tell us when we are going to have a national debate about how we fund the health and social care services in the future, and what services we will provide?

[Lord Prior of Brampton]

My Lords, the noble Baroness calls for a national debate but sometimes I feel that, in this House, we talk of almost nothing else. However, I understand the serious point that she makes. The fact is that the Government are committed to investing £10 billion of new money into the NHS. It is a very significant investment and is no more and no less than her own party promised at the last general election.

Health: Zika Virus

Baroness Tonge Excerpts

Thursday 4th February 2016 Lords Chamber

[Lord Prior of Brampton]

Comprehensive travel advice is on a number of different websites. The Royal College of General Practitioners and the Royal College of Obstetricians and Gynaecologists have been notified and the information has been cascaded down, so I think that there will be enough travel advice as we near the Olympics.

[Baroness Tonge (Ind LD)]

My Lords, is the Minister aware that in Brazil around 80,000 women die from unsafe abortion because of the lack of provision there? This figure will surely increase as a result of this terrible disaster. Is there any way that our Government can put pressure on the Brazilian Government to allow safe abortion in that country?

[Lord Prior of Brampton]

My Lords, that strays slightly away from the brief that I have on the subject today. May I take that on consideration? I will raise it with my honourable friend in the other House, the Minister for Public Health.

Standardised Packaging of Tobacco Products Regulations 2015

Baroness Tonge Excerpts

Monday 16th March 2015 Lords Chamber

[Lord McFall of Alcluith (Lab)]

My Lords, I want to provide a few anecdotal points in this debate today. I was prompted by the remarks made previously about criminals engaging in illicit cigarettes. Eight or nine years ago, I went on a parliamentary visit to China and saw for myself the number of sophisticated cigarette factories that the Chinese were closing down every week. In China, 25 to 30 factories were closed every week. But in the UK, the total number of Customs representatives that we had patrolling China was exactly one, and that person was based in Hong Kong. I say that if the Government want to crack down on this illegal trading, which is supposed to be producing about one in three illicit cigarettes in London, they have to tackle it very robustly at HMRC level. That is the lesson that we have to learn from this.

I was a smoker when I was young. The noble Lord, Lord Geddes, made the point that plain packaging on cigarettes did not have any effect on him. It did not have an effect on him because—I say this with due respect—that was a number of decades ago. At that time, there was a culture of smoking. All of us smoked at the time; I smoked when I was in school. In fact, we smoked Woodbines. If anyone has seen the Woodbine packaging they will know that it was not very attractive, so the more sophisticated ones went on to Benson & Hedges or Marlborough. We had a particularly nasty teacher in the school, who was a smoker. He could detect the schoolboys who were smoking. He smelled our hands, called us smoky beasts, took our five Woodbines or whatever off us, and gave us a belt at the same time—not very fair. But lots of us were engaging in smoking, because that was a good thing to do.

I was brought up very short when my late father had to enter hospital with vascular problems. I visited the Western Infirmary in Glasgow—this was about 50 years ago—and to this day, I remember the name of the consultant and I remember the brutal message that he gave me. The consultant’s name was Mr Gray—Mr Reid, sorry. Mr Reid—I wrote it down, but that is what happens when you get into the House of Lords—said to me, “Your father is suffering from severe vascular problems and he will most likely have to have his legs amputated”. Indeed, he had both his legs amputated. Mr Reid asked me whether I was a smoker, to which I said yes. He said, “Listen, my boy, you look round every bed in my ward and you will see no one other than smokers, so the lesson I have for you and your friends is that the sooner you stop smoking the better”. That stayed with me. I did stop smoking and it was the best thing that I did in my life.

I commend the noble Earl for the work that he has done and say to him that this legislation has come not a day too soon.

[Baroness Tonge (Ind LD)]

My Lords, I cannot resist putting in my oar at this stage, very briefly. I have been associated with the anti-smoking campaign for many years, in the Commons and in the Lords. I gave up smoking in 1974, I think—the noble Lord, Lord Walton, will correct me—when the report was published on the links between smoking and lung cancer. I had taken up smoking as a teenager—I say this to support all those people who say that packaging is important in attracting young people to start to smoke—and was taught to smoke by my brothers and their friends in somebody’s back garden because they did not want a sister who choked and did not know how to do it. I do not think that we used the word “cool” in those days, but they wanted me to be cool and be able to smoke. It must have been a very rich friend of my brother, because the cigarettes that he produced to teach me were those wonderful multicoloured ones with gold tips—I think that they were called cocktail cigarettes; I shall not mention the brand. I had never seen anything quite so attractive in my life and, for a while, I was seriously hooked on them until I found out how much they cost. I then investigated something called Black Russian, which were even smarter, if that was possible. I as a teenager then knew perfectly well that it was not just the packaging but the appearance of the cigarettes that was attractive. They were very smart to be able to handle because they were different colours—some noble Lords are smiling; they obviously remember them.

What is important about this measure is that it tackles the appearance of cigarettes, which should be uniform. I wholeheartedly support it. I am glad that I gave up smoking all those years ago. I hope that the majority in this House will support the regulations.

[The Earl of Erroll (CB)]

My Lords, I do not smoke. I am married to a smoker and I do not like her smoking, but that is not the point. The point about legislation is its effectiveness. What worries me about gesture legislation is that it comes about because something ought to be done about something.

As far as I know, with the current packaging situation, we have about 19% of the country smoking. Without any advertising, packaging or public involvement, we have about 21% of the country using illicit drugs. It does not seem therefore that packaging is necessarily the determining effect. If anything, the more you drive smoking underground, the more attractive it seems to become. We should be slightly careful how we tackle it. Perhaps it should be looked at as part of the overall issue of how we deal with the problem of addiction and drugs instead of trying to target a little bit of advertising, with lots of people having preconceived ideas. I am not a qualified advertising man, but I think that the purpose of packaging is to try to make somebody switch from one brand to another. I do not think that it is what makes people smoke, but I could be wrong. The statistics suggest that we should not drive it underground.

Health: Midwives

Baroness Tonge Excerpts

Tuesday 22nd July 2014 Lords Chamber

[Earl Howe]

The noble Lord makes a good point about building in a wastage rate. Since 2010, the number of midwives has increased by 5.75% and the number of births has decreased by 3.3%. This is why I indicated in my earlier answer that we were, in that sense, ahead of the curve. There is a great deal of work going on to ensure that there is no attrition or wastage during the training period, as this is a waste of the person’s skills and taxpayers’ money.

[Baroness Tonge (Ind LD)]

My Lords, what progress has been made in implementing the top 10 recommendations in the Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom, especially those relating to the 19 women who died from pre-eclampsia between 2006 and 2008, which are the latest figures we have? Can the Minister also tell us when we will get a more up-to-date report on maternal deaths?

[Earl Howe]

My Lords, I do not have information on the confidential enquiry in my brief but, according to international statistics, the NHS remains one of the safest places in the world to give birth. The latest independent CQC survey found that maternity care in England has improved, with women reporting a high level of trust and confidence in the staff caring for them. I shall gladly let my noble friend know the latest that my department has on the issues she has raised.

Abortion

Baroness Tonge Excerpts

Thursday 3rd April 2014 Grand Committee

[Baroness Tonge (Ind LD)]

My Lords, I, too, welcome the debate secured by the noble Baroness, Lady Knight. Whatever our personal position on abortion, I hope that we all want it to be carried out within the law. All providers of abortion services are tightly regulated and monitored by the Care Quality Commission, which makes unannounced inspections of all providers at least once a year. If doctors are carrying out abortion for any reason outside the law, they should be prosecuted. There is no question about that. Sometimes there may be a sound medical reason for an abortion to be carried out which, to a non-medical person, may appear to be outside the law. These cases, which are rare, should also be properly investigated. New guidelines are being drawn up by the Department of Health and they should clarify these cases, especially making it clear that abortion on grounds of sex alone is not legal.

I support the call by my noble friend Lady Barker for only one doctor to be involved. I do so because it seems to me that it would make the responsibility his or hers alone. There would be no buck-passing and it would make the law far easier to interpret, as well as making it better for the health service and for the patient.

However, attempts to criminalise doctors and prevent access to abortion services, which have recently been escalating in this country, must stop. The Abortion Act is there to prevent malpractice. Personally—I have to say this—I still think that a woman’s right to choose what she does in this situation should be sacrosanct. Whatever our personal point of view, like Queen Elizabeth I, we should not seek to look into other people’s souls or to impose our ethical stance or religion on others.

Health and Social Care Bill

Baroness Tonge Excerpts

Monday 19th March 2012 Lords Chamber

[Lord Clement-Jones]

My Lords, it is a privilege to follow the noble Lord, Lord Walton, who, as we all know, carries such respect on health matters in this House. I do not doubt the sincerity of the noble Lord, Lord Owen, in his fundamental opposition to the whole Bill. Indeed, he expressed it very clearly in his Observer article yesterday. He put the arguments very fairly on his Motion, but I have absolutely no hesitation in disagreeing with it today—and I say to him, in his capacity as a doctor, that I feel no physical or mental discomfort with a whipped vote on the matter, for the very key reason that my noble friend Lady Williams mentioned.

The risk register whose publication is being requested was written as long ago as November 2010. It will certainly not relate to the Bill being considered today, as it was drawn up many months before the pause in the Bill’s proceedings. Many changes to the Bill were made as a result of the Future Forum process, headed up by Professor Steve Field. The Bill was then changed significantly in Committee and on Report in this House, as the recent House of Commons research paper makes absolutely clear. The risks identified in the register are therefore those of the old Bill, long since superseded, or even of the White Paper which preceded it. It will have been based on worst-case scenarios—

[Baroness Tonge]

In all sincerity, if the risk register is so totally out of date and bears no relevance at all to the new amended Bill, would its publication not be a wonderful opportunity for this side of the House to show how much it has improved the Bill and dispatched all risks?

[Lord Clement-Jones]

My Lords, my next sentence was about to deal with precisely the point made by my noble friend. It can therefore be argued that publication now by the Government could, and would, wholly distort rational discussion about the Bill in its present form. The job of scrutiny carried out by your Lordships’ House is to look at every scenario and from the experience of its Members, which is considerable, suggest amendments which mitigate the problems identified. That is precisely what this House has carried out and, I would say, to good effect. However, the Motion is not suggesting that we delay the current Bill against the remote possibility that there is some risk in it which the Department of Health has identified and this House has not. It is saying that we should delay it pending the First-tier Tribunal’s reason for its decision being published.

What will passing this amendment to the Motion therefore achieve? When we know the details of the decision, the Government will still be fully entitled to appeal. They have already won with the strategic risk register, and may well take the view that they will be able to overturn Professor Angel’s decision on the transitional register. Do we want to deny them the right to appeal in the face of the very fact that with one limited exception, which the noble Baroness, Lady Royall, has mentioned, the Labour Government did not publish these risk registers when they were in government? Where would that leave us, even if the detailed reasons become available?

I was slightly taken aback by the use of the expression “rush” from the noble and learned Lord, Lord Falconer of Thoroton. I submit that a debate over revealing an up-to-date risk register might just have some merits, but not in these circumstances, where its contents are of historical interest only.

Health and Social Care Bill

Baroness Tonge Excerpts

Monday 13th February 2012 Lords Chamber

[The Earl of Erroll]

My Lords, the description by the noble Lord, Lord Hunt, of the NHS Commissioning Board and its satellites shows that you do not get economies of scale, but complexities of scale. This amendment contains a wonderful concept that bureaucrats should curb their deepest urges and I think that should be in all public sector body reorganisation Bills, but how would you enforce it? What sanctions do we have against a person who does not comply and does not curb their bureaucracy? The challenge is the same as with the previous amendment: how do we motivate people to behave in a correct and ethical way, so that patients’ and the taxpayers’ interests are looked after? I do not think that it can be done by regulation, which is very sad.

[Baroness Tonge]

My Lords, I cannot resist putting my oar in on this Bill. I do so because, many years ago, I was in middle management in the health service. I had to take part in the many reorganisations that happened. I suppose the noble Lord, Lord Fowler, must have been one of the culprits who added to my misery at work. I tried to concentrate on clinical work but people pestered me about filing cabinets, which office they should work in, who would be their line manager and what exactly would they be managing. The noble Lord, Lord Hunt, is quite right to point out that as soon as you start on any sort of reorganisation, the people themselves enlarge it. They need PAs, they need offices and so on. Suddenly, they find they have no one to do the bean counting, so they need a bean counter. The Government give the impression that this is all a delightfully simple, wonderful, altruistic idea that GPs, in consultation with their patients, will commission the care for their patients. I have been a GP as well, and I can tell the House that GPs are not going to go home instead of going to the golf club, take out their laptops and do a bit of commissioning in the evening. It will not work like that. There will have to be an office block full of commissioners—just like PCTs—to do the job for them. What is worse, I understand that private medical companies are anxious to do the commissioning for the clinical commissioning groups. That will mean that taxpayers’ money will go directly to private medical companies that will advise GPs on how to commission. I find that absolutely iniquitous and will fight it to the end.

We will see a mushrooming commissioning group with its advisers, whoever they are, in an office block. It will not stop there. The noble Lord, Lord Hunt, mentioned the number of different organisations that had been set up. The noble Lord, Lord Harris, mentioned the connections between them. It was deliciously simple for him to give us the image of tentacles reaching down from the National Commissioning Board to all parts of the health service. The noble Lord, Lord Rea, and I helped send round some information many weeks ago. There was a wonderful diagram of the interconnections between all the new bodies in the health service. It was like Spaghetti Junction. I am a midlander so I know what that junction is like. There is no way that one can navigate the maze of who provides what, and whether it is done nationally, locally, by local authorities or by clinical commissioning groups. It is overly and unnecessarily complicated. As the noble Lord, Lord Harris, said, we could have adapted the existing system to work much more efficiently, which would have been much cheaper and better. No wonder Professor McKee recently wrote an article in the BMJ asking who understood the Health and Social Care Bill, in which he explained that he did not understand it at all.

I will finish with an image that will delight noble Lords who are fed up with me. I went to the dentist this morning. Just as he got me in the reclining position, with the torture instruments looming, he said: “By the way, I know what I have to ask you: can you explain the Health and Social Care Bill?”. About 10 minutes or so later I noticed that his eyes had glazed over and he was reaching for the drill, so I shut up and gave in.

[Lord Newton of Braintree]

My Lords, I hope that the noble Lord who moved the amendment will accept my apologies. I needed to recuperate after the previous debate so I was not present for the earlier part of this debate. Therefore, it is probably unwise for me to speak. However, I have checked that I will not cross the path of my noble friend Lord Fowler in what I intend to say, so I will risk it.

The noble Lord, Lord Hunt, will also recall—if I dare advert to it—that we had a somewhat jocular conversation in a cafeteria last week. He sought my support for the amendment and I said that I thought he was joking. There is a serious point here. First, we really should not include in primary legislation things such as minimum tiers of management. Secondly—I say this with an eye on my own Front Bench as well—one of the most irritating features of the discussions for any practitioner is the naked populism of assuming that anybody who is not a doctor or clinician contributes nothing to the service. I have been chair of three health trusts, as well as Health Minister many years ago. What do we mean by “bureaucrats”? Do we mean the people who pay the nurses and doctors, and who make sure that the drugs are ordered on time and organised in neat rows? Do we mean the people whose duty is to pay small businesses in time so that they do not go bankrupt? We are all against having a system in which it takes 25 men to change a light bulb and costs about £20 when the rest of us could go out and buy one and put it in the socket. I am not talking about that kind of thing but about the fact that these resources—nurses, doctors, pharmacists and a lot of other people—are precious, and if they are not well organised by people setting up sensible systems, we will not get the best out of them. The constant knocking of management under the heading of “bureaucracy” is deeply counterproductive and I will not go along with it in the course of these debates.

I will make two further points. First, why do so many GPs’ practices have practice managers? It is because they recognise that somebody needs to manage the resource to get the best out of it. The managers perform a very valuable role. My second and even more important point, born of my experience in the three health trusts, and perhaps particularly at the Royal Brompton and Harefield, is that it is critical to involve doctors in that management. Therefore, in some ways the problem is much more complicated than has been registered. Trusts where managers sit in one silo and fire bullets or bombs at doctors sitting in another do not work. We need to engage doctors and, where they have an interest in performing a managerial role, train and involve them as managers. That is what we did at the Brompton—which was no great credit to me—and it transformed things.

This is a grossly oversimplified amendment. It does not belong in primary legislation. It rests on a crude, populist misunderstanding of what we mean by bureaucracy and management in the NHS.

Health: Smear Tests

Baroness Tonge Excerpts

Monday 13th February 2012 Lords Chamber

[Earl Howe]

The latest figure I have is that there is around 82 per cent uptake among eligible girls. However, for screening the uptake is lower. The figure I have for 2010-11 is that 78.6 per cent of eligible women had a test result in the past five years and 3.4 million women were screened. In the case of screening, it depends on whether the women themselves respond to the screening call. In the case of vaccination, it will depend on the attitude of parents and medical advisers.

[Baroness Tonge]

My Lords, will the noble Earl remind the House of what arrangements are being made for cervical cytology should the Health and Social Care Bill ever become law? Will he also reassure us that the excellent cervical smear campaign will not fall foul of the competing interests of local authorities and the clinical commissioning groups?

[Earl Howe]

My Lords, I can reassure my noble friend that the cervical cancer screening programme will be commissioned by the NHS Commissioning Board, so it will be done nationally and centrally.

Health: Children and Young People

Baroness Tonge Excerpts

Monday 6th February 2012 Lords Chamber

[Earl Howe]

My Lords, the two main outcomes frameworks relevant to this are the NHS and the public health outcomes frameworks, which we are trying to align as far as possible. They set a clear direction for the health and healthcare of children and young people, but there is more to do. As our data improve, we need to ensure that the outcomes measured are the ones that matter most to children and young people. That is why we are developing a health outcomes strategy for children. This will be the first example of an outcomes strategy as part of the health reforms model.

[Baroness Tonge]

My Lords, would the Minister remind us—in fact, more than that, would he make it absolutely clear—who will treat children whose families are not registered with a general practice?

[Earl Howe]

My Lords, as my noble friend knows, it will be the legal responsibility of clinical commissioning groups to commission care on behalf of all patients living in their geographic area, whether or not they are registered with a GP. That means that arrangements have to be made to ensure that those patients are treated when needed.